Full Agenda 18.04.16 - North East Lincolnshire Council

Transcription

HEALTH AND WELL BEING BOARD
18TH APRIL, 2015
2.00p.m Grimsby Town Hall
Rob Walsh, Chief Executive
Municipal Offices, Town Hall Square, Grimsby, North East Lincolnshire, DN31 1HU.
Telephone (01472) 313131 Fax (01472) 324132 DX 13536 Grimsby 1
Our ref:
Beverly Stanton Tel: (32)6285
7th April, 2016
Dear Councillor,
Health and Well Being Board –18th April, 2016
A meeting of the Health and Well Being Board is to be held on Monday 18th April,
2016 commencing at 2.00 p.m. at Grimsby Town Hall.
Please note that there will be a private Health and Wellbeing Board Workshop that
will commence at the rise of the Health and Wellbeing Board in the Grimsby Town
Hall. The focus will be aimed around:
Children’s Mental Health – The Future in Mind Programme.
The Agenda is set out overleaf.
Yours sincerely,
Scrutiny and Committee Advisor
for Rob Walsh,
Chief Executive.
Elected Members
Councillor J. Hyldon-King (Chair)
Councillor R. James
Councillor M. Patrick
Clinical Commissioning Group
C. Kennedy
Dr. P. Melton
J. Haxby
Public Health
S. Pintus
Director of Adult Social Services J. Hewson
NHS Commissioning Board
G. Day
Healthwatch
M. Bateson
Provider - NLAG
K. Bond
Community Sector
A. Hames
Voluntary Sector
J. Rigby
Co-opted Member
P. Grant
FILMING OF PUBLIC MEETINGS
“The Council supports the principle of transparency and encourages filming,
recording and taking photographs at its meetings that are open to the public. It
also welcomes the use of social networking websites (such as Twitter and
Facebook) and micro-blogging to communicate with people about what is
happening, as it happens.
There is no requirement to notify the Council in advance, but it should be
noted that the Chairman of the meeting will have absolute discretion to
terminate or suspend any of these activities if, in their opinion, continuing to
do so would prejudice proceedings at the meeting.
The circumstances in which termination or suspension might occur could
include:
•public disturbance or suspension of the meeting
•the meeting agreeing to formally exclude the press and public from the
meeting due to the confidential nature of the business being discussed
•where it is considered that continued recording / photography / filming
/webcasting might infringe the rights of any individual
•when the Chairman considers that a defamatory statement has been made
In allowing this, the Council asks those recording proceedings not to edit the
film/recording/photographs in a way that could lead to misinterpretation of the
proceedings, or infringe the core values of the Council. This includes
refraining from editing an image or views expressed in a way that may ridicule,
or show a lack of respect towards those being photographed/filmed/recorded.
Those intending to bring large equipment, or wishing to discuss any special
requirements are advised to contact the Council's Communications Team in
advance of the meeting to seek advice and guidance. Please note that such
requests will be subject to practical considerations and the constraints of
specific meeting rooms.
The use of flash photography or additional lighting will not be allowed unless
this has been discussed in advance of the meeting and agreement reached on
how it can be done without disrupting proceedings.
At the beginning of each meeting, the Chairman will make an announcement
that the meeting may be filmed, recorded or photographed. Meeting agendas
will also carry this message.”
18TH April, 2016
GRIMSBY TOWN HALL
AT 2.00 P.M.
1.
Apologies For Absence
Page
Number
-
To receive any apologies for absence.
2.
Declarations Of Interest
-
To record any declarations of interest by any Member of the
Health and Well Being Board in respect of items on this agenda.
Members declaring interests must identify the Agenda item and
the type and detail of the interest declared.
(A) Disclosable Pecuniary Interest; or
(B) Personal Interest; or
(C) Prejudicial Interest
3.
Minutes
1
To receive the minutes from the meeting of the Health and
Wellbeing Board held on 22nd February 2016 (copy attached).
ITEMS FOR DECISION
4.
Transforming Care Plan
5
To consider a report received from the Deputy Chief Executive
of North East Lincolnshire Clinical Commissioning Group on the
Transforming Care Plan which would see a significant reduction
in Assessment and Treatment beds for people with complex
Learning Disabilities or Autism (copy attached).
5.
Better Care Fund Plan
35
To consider a report from the Deputy Chief Executive of North
East Lincolnshire Clinical Commissioning Group on how the
Better Care fund resources will be used to support local Health
and Social Care integration (copy attached).
ITEMS FOR INFORMATION ONLY
6.
NEL LSCB Annual Report 2014-2015 – Rob Mayall LSCB
To receive a report from the Chair of the North East Lincolnshire
Children’s Safeguarding Board on the Local Safeguarding
Children’s Boards Annual Report for 2014-2015 (copy
attached).
103
7.
Accountable Care Organisations
-
To receive an update on the proposed development of an
Accountable Care Organisation.
8.
Urgent Business
-
To consider any business which in the opinion of the Chairman
is urgent by reason of special circumstances which must be
stated and minuted.
The next meeting of the Health and Well Being Board is yet to be confirmed.
Rob Walsh
Chief Executive
Item 3
st
To be submitted to the Council at its meeting on 31 March, 2016
22nd February, 2016
PRESENT: Councillors Hyldon-King (in the Chair),
Councillor James and Patrick
Board Members:Michael Bateson
Anne Hames
Joanne Hewson
Dr Peter Melton
Cathy Kennedy
Stephen Pintus
Chair of Executive Board – Healthwatch
Community Sector
Director of Adult Social Services
Clinical Chief Officer, North East Lincolnshire
Deputy Chief Executive/Chief Financial Officer,
North East Lincolnshire, Clinical Commissioning
Group (CCG)
Director of Public Health
Officers in Attendance:Spencer Hunt
Beverly Stanton
Service Manager – Safer Communities
Scrutiny and Committee Advisor
Also in attendance:
Superintendent
David Hall
Humberside Police
There were also 3 members of the public present and 1 member of the
press.
HWBB.38
APOLOGIES FOR ABSENCE
Apologies for absence from this meeting were received from Helen
Kenyon – Clinical Commissioning Group.
HWBB.39
DECLARATIONS OF INTEREST
There were no declarations of interests in items on the agenda for this
meeting.
Page 1
HWBB.40
MINUTES
The minutes of the Health and Wellbeing Board meeting held on 21st
December, 2015 were approved as a correct record.
HWBB.41
DOMESTIC VIOLENCE ONE SYSTEM APPROACH
The Board considered a verbal update around the performance and the
ongoing work to tackle the prevalence of domestic abuse across the
Borough and detailing the progress and vision to develop a One System
Approach.
Mr. Hunt explained that a performance sub group had been formed to
look at key pieces of information which would gather information for
activity to be implemented. He explained the nature of the Partnership
Domestic Abuse Performance Monitoring group and the Domestic Abuse
‘One System‘ strategy. He stated that the strategy was underpinned by a
comprehensive action plan which was overseen and monitored via a
monthly ‘One System’ strategic group.
Mr. Hunt explained that there was a gap in frontline Domestic Abuse
service provision for 2016/17 period and beyond.
RESOLVED -
HWBB.42
(1)
That the progress made to date via the One System Strategic
Group be noted.
(2)
That the Domestic Abuse “One System” Strategy 2016-19 ,which
sets out the strategic approach to domestic abuse across North
East Lincolnshire, working in partnership with the Safer & Stronger
Communities Board (SSCB), Local Safeguarding Children’s Board
(LSCB) and Safeguarding Adults Board (SAB), be approved.
(3)
That the current funding gap in frontline Domestic Abuse service
provision for the 2016/17 period and beyond be noted, along with
the intention to work with the SSCB, LSCB, SAB and Office of the
Police & Crime Commissioner (OPCC) to identify longer term
funding, adopting a sustainable commissioning approach.
HEALTH AND WELLBEING EARMARKED FUNDING RESERVE
The Board received a verbal update from the Director of Public Health
informing the Health and Wellbeing Board of the work that had been
done to allocate the use of the Health and Wellbeing Ear Marked
Reserve.
Mr. Pintus explained that they had confirmed with the Big Lottery Fund
that three organisations had the opportunity to put in proposals for three
Page 2
years funding from the Big Lottery Fund. Two further organisations may
be eligible for funding from the Ear Marked Reserve and have been
asked to submit fuller proposals. Mr. Pintus stated that they would be
liaising again to call for further bids once the fund available had been
confirmed. This would determine the use of the remaining Health and
Wellbeing Ear Marked Reserve.
RESOLVED – That the update be noted.
HWBB.43
BETTER CARE FUND
The Board received a report that looked at North East Lincolnshire’s
Better Care Fund (BCF).
Ms. Hewson stated that a further report would be coming to the Health
and Wellbeing Board in April.
RESOLVED – That the update be noted.
HWBB.44
SUSTAINABLE AND TRANSFORMATION PLAN
The Board received a report on the Sustainable and Transformation
Plan.
RESOLVED – That the report be noted.
HWBB.45
TRANSFORMING CARE
It was decided that this item be withdrawn from the agenda.
There being no further business, the Chair declared the meeting closed
at 2.30 p.m.
At the rising of the Health and Wellbeing Board a workshop was held to
inform colleagues of the Account Care Organisation and Sustainable
and Transformation Plan and what they would mean for North East
Lincolnshire.
Page 3
Page 4
Item 4
DATE
13th April 2016
REPORT OF
Helen Kenyon (Leadership Team Sponsor)
SUBJECT
Transforming Care ( Learning Disabilities)
STATUS
For Information/Approval
CONTRIBUTION TO OUR AIMS
The attached 3 year plan identifies a partnership approach to meeting the Transforming Care
Agenda. This will see the improvement of a pathway for people with complex and intensive
Learning Disability or Autism through improved access to facilities closer to North East
Lincolnshire, and for some the return to North East Lincolnshire and hence closer to their
family.
EXECUTIVE SUMMARY
Following from the Winterbourne reviews, Transforming Care will see a significant reduction in
‘Assessment and Treatment’ beds for people with complex Learning Disability or Autism. The
Humber Transforming Care Partnership plan sets out how this will be accommodated on a
larger footprint and the implications for North East Lincolnshire.
RECOMMENDATIONS
To note approval of the Humber Transforming Care Partnership plan.
REASONS FOR DECISION
The recommendation to approve the plan builds on a nationally recognised and leading
Learning Disability service and pathways locally, enabling people with complex and challenging
Learning Disability or Autism who would otherwise face long term care out of area to receive
appropriate levels of support closer to home and if possible in their home town.
1.
BACKGROUND AND ISSUES
Following the Winterbourne Reviews, which highlighted a high number of people living or
being detained long-term within Specialist Hospital settings, and through the Bubb report in
November 2015 seeing little movement from that situation the Transforming Care for People
with Learning Disabilities agenda was developed. It’s signatories include Association of
Directors of Asult Social Services (ADASS), Care Quality Commission (CQC), Department of
Health, Health Education England (HEE), Local Government Association (LGA), and NHE
England. The agenda also receives active interest from Jeremy Hunt at ministerial level.
In brief Transforming Care develops the Bubb report recommendations outlining
expectations that Learning Disability services will:
• Empower People and Families
• Get the right Care in the Right Place
• Driving up quality through regulation and inspection
Page 5
• Workforce development
The key part of the National Transformation strategy is the reduction of Assessment and
Treatment beds available, necessitating more complexity of care given at more local level.
For a small authority such as North East Lincolnshire this poses significant challenges, not
least of which is the financial cost of such complex packages and the availability and
retention of the skills within the local workforce to maintain them. To meet such challenges
Partnerships working at larger footprints are indicated. Initially the Partnerships were
allocated by NHS England, though through negotiation NELCCG were able to arrange a
Transforming Care Partnership that better represents the Health and Social Care
partnerships and relationships which have proved beneficial in aligned agendas previously.
The partnership also enables closer to home access to specialised unit through easier road
links. The partnership consists of East Riding CCG and Local Authority, Hull CCG and City
Council, and North East Lincolnshire CCG as joint Health and Social Care Commissioner.
The partnership is called the Humber Transforming Care Partnership (Humber TCP) and is
led by East Riding CCG, governance arranged as per attached structure.
The attached plan is aimed at transforming services for people of all ages with a learning
disability and/or autism who display behaviour that challenges, including those with a mental
health condition, in line with Building the Right Support – a national plan to develop
community services and close inpatient facilities (NHS England, LGA, ADASS, 2015). The
plan covers 2016/17, 2017/18 and 2018/19.
The Humber Transforming Care Partnership has identified 5 key workstreams,
acknowledging that cross-pollination between these workstreams is essential. These
workstreams are:
• Communications & Engagement, Lead: Hull CCG
• Finance & Performance, Lead: NELCCG
• Pathways of Care, Lead: East Riding CCG
• Quality and Commissioning, Lead: Hull City council
• Workforce Development, Lead: Hull City Council
Representatives from local services and pathways are identified for these workstreams.
The Plan has been through the NHS England Assurance process and in addition has been
reviewed with NHS England specialist advisor. These processes have supported the plan,
and more in-depth support has not been indicated.
The Communications and Engagement plan is at Partnership and local level. The individuals
within the Transforming Care cohort are identified and are low in number in North East
Lincolnshire. Engagement and consultation will happen on individualised basis, cognisant of
the specialised needs of the individuals and including the families of those within the cohort.
The Financial plan relies on timeliness of transfer, variance of which is within the hands of
clinical improvement and for some Ministry of Justice sanctions. In addition the principle that
‘the money follows the individual’ is only achievable when cashable savings are met through
closure of Assessment and Treatment beds at national level. There is much clarity to be
given from the national level around the ‘dowry’ process, which is requested at every
opportunity.
North East Lincolnshire has commissioned a nationally recognised model of good practice
for Learning Disability services, which is heavily community based with excellent crisis
response service and Intensive Support Team – the components working together to prevent
escalation to institutional care. Of those 9 cases that are within the Transforming Care cohort
one is locally commissioned, and 8 commissioned through NHS England Specialised
Page 6
Commissioning as being linked to serious offending behaviour, violence, and/or extreme risk
to themselves. The flexibility of the local Learning Disability model has demonstrated the
ability to support complex Learning Disability with Challenging Behaviours through
Individually Commissioned packages and Positive Risk approach. The attached activity plan
illustrates a realistic trajectory for the NEL cases if underpinned by the funding attached
around the individual.
2.
RISKS AND OPPORTUNITIES
Risks:
•
•
The Transforming Care Plan is required to be supported by Health and Wellbeing
Board, not supporting it runs political risk associated with compliance with National
Transforming Care Programme
The financial risk of money not following the individual through the system may
disadvantage some individuals discharge arrangements, an element of risk is
necessary to enable smooth transfer for quality of life and dignity for the individuals
returning closer to home.
Opportunities
•
•
•
3.
The plan offers opportunity that should an individual require escalation of service in
future the pathway will include preferred option of specialist facility within 30-45
minutes’ drive – enabling a better parity for Learning Disability clients.
The plan offers opportunity to develop a risk-sharing arrangement with Hull and East
Riding Health & Social Care economies.
The plan offers potential to commission more specialist service for high complexity
individuals on a larger footprint, attracting more specialised providers.
OTHER OPTIONS CONSIDERED
The plan is in line with the national model and enables local variations as
appropriate.
4.
REPUTATION AND COMMUNICATIONS CONSIDERATIONS
The plan enables people with complex Learning Disability needs to return as close to
home as possible through a more co-ordinated pathway of care across the Humber.
5.
FINANCIAL CONSIDERATIONS
The pertinent financial considerations embodied in the report are that the Financial
plan relies on timeliness of transfer, variance of which is within the hands of clinical
improvement and for some Ministry of Justice sanctions. In addition the principle that
‘the money follows the individual’ is only achievable when cashable savings are met
through closure of Assessment and Treatment beds at national level.
6.
FINANCIAL IMPLICATIONS
Financial implications are described in the finance and Activity annex.
Page 7
7.
LEGAL IMPLICATIONS
No comment has been received from Legal Team.
8.
HUMAN RESOURCES IMPLICATIONS
Human Resource and Workforce issues will be addressed through the relevant
workstream, and will inform the specifications for any services commissioned.
9.
WARD IMPLICATIONS
The pathway covers all wards in North East Lincolnshire.
10.
BACKGROUND PAPERS
7) Plan on a page
TCP Activity and
Copy of 6)
Appendix 9
Appendix 8
finance annexes updaTransforming Care Ro HUMBER 22feb.pptx Communications Plan Transforming Care Wo
Appendix 7 Summary
Appendix 6 LD
Appendix 5 National
Appendix 4
Appendix 3 TCP
of National Service Moproperties in NYH withOutcome Measures bePopulation Projectionsinitial consultations.do
Appendix 1
Appendix 2
TCP Template
Governance StructureTransforming Care Pa HUMBER v8 24th feb
11.
CONTACT OFFICER(S)
Angie Dyson, Service Lead Disability & Mental Health [email protected]
Or
Leigh Holton, Commissioning Manager [email protected]
Care & Independence Team
NELCCG
Athena Building
Saxon Court
Grimsby
N.E. Lincolnshire
DN31 2UJ
Helen Kenyon
(Leadership Team sponsor)
Page 8
We serve…
HUMBER TRANSFORMING CARE PARTNERSHIP LD PLAN
Our vision is…
We will change services in line with the nine principles of the national model and by
March 2019 people with a learning disability and/or autism will have greater power
and control over their own care, with planned support to help them to fulfil their
potential and to live in their own communities
LD Population aged 18-64: 11,021 ; LD Population aged 65+ 3,230
LD Population with challenging behaviours : 203; Adult Population with ASC: 6,000
Population currently receiving services: 1,927; Population receiving inpatient care: 43
We are succeeding when…

KPI #1 Proportion (95%) of
crisis referrals managed

safely in a community
setting
KPI #2 ALOS for new
admissions into LD hospital
reduced by 10% from 1st
April 2016
KPI #3 Proportion (X%) of
people with LD and
Personalised Budgets

KPI #4 Raise proportion of
Adults with LD in settled
accommodation to national
benchmark

KPI #5 Proportion (X%) of
young people with LD with
a Joint Preparing for
Adulthood Transition Plan
Our transformational journey
The journey we need to take…
In 2020 we will spend
£84.9m on the following
service model
In 2015 we spent £84.9m
on the following service
model
Describe the future model
Describe the current model
People supported at home and in
communities whenever possible
CTLD provide health assessment and
crisis management,
Assertive Outreach team to manage
individuals to avoid admission
Few ISLs able to manage challenging
behaviour and complex needs
Inpatients ‘stuck’ waiting for suitable
community placements or low secure
This needs to change because…
Explain the case for change
Too many people reach crisis point
Too many still in inpatient care
People don’t always know where to get
help
Not everyone has a person centred plan
Mainstream services do not always
know how to help people with a LD or
ASC
•
•
•
•
•
•
•
•
Priority changes today
Long-term enablers
Changes to be made in the
next year
Long-term changes to
deliver plan
Establish engagement plan
Resettle last patients from Mar
14 cohort
Establish routes back for
identified forensic patients
Cap investment in inpatient
and reinvest to crisis support
Explore CCG risk-share for
high cost placements
Increase ISL capacity
Publish market statements and
develop framework tender
Develop workforce strategies
•
•
•
•
•
•
•
•
Trusting cross-organisational
relationships
Service user and carer
engagement
Personalised care planning
and budgets
Choice and Control
Building community capacity
and capability
Workforce development
Pooled or aligned budgets; risk
share arrangements
Shift in resource from inpatient
to community
Critical stakeholders…
People with a learning disability and/or autism; Carers and families, advocates
Services providers, health and social care;
Housing
Page
9 providers
Commissioners – CCGs, Councils and NHS England
Person centred care commissioned
through personalised budgets
Flexible responses wrapped around the
person, whenever or wherever needed
Risk stratification used to target the input
of specialist services
Time limited inpatient care focused on
assessment and treatment
Safe and personalised care as people
resettle into the community
This is beneficial because…
Explain the benefits of this model
People will receive care when and where
they need it rather than having to fit in
with services
People will have healthier lives and know
how to get help
More services will be available locally
instead of being provided out of area or
in inpatient settings
This should describe
what success looks like
both from a vision
perspective but also
KPIs / measurable
changes
This should describe a
summary of the needs
analysis
Key features of
the model and
the critical
requirements
for success
(long-term
enablers).
This should summarise
the current model and
where it is failing
patients.
This should be
supported by evidence,
including testimony of
service users
Plan of action
Governance /
engtPage
model10
Appendix 1
Terms of Reference
Humber Transforming Care Programme Board v2
Membership:
Member:
Deputies:
East Riding Clinical Commissioning Group
Chief Officer (SRO) - Jane Hawkard
AD Services for Vulnerable People – Neil Griffiths
Commissioning Lead (MH+LD) – Peter Choules
Programme Management Office – Donna Dudding
East Riding of Yorkshire Council
Director of Adult Social Services – Rosy Pope
Strategic Service Manager – Clare Brown
Director of Children Services – Kevin Hall
Paula South – Director of Nursing
Jackie Lown
Hull Clinical Commissioning Group
Chief Officer – Emma Latimer
Hull City Council
Service Delivery Lead - Vulnerable People – Mel Bradbury
Director of Adult Social Services (Deputy SRO) Alison Barker
North East Lincolnshire
Service delivery Lead - Angie Dyson
Deputy Chief Executive– Helen Kenyon
Director of Children Services – Joanne Hewston
Finance Lead – Lynne Popplewell
Humber NHS Foundation Trust
Care Group Clinical Director – Trish Bailey
Humberside Probation
Kate Munson
NHSE Specialised Commissioning
MH and PoC Lead – Louise Davies
NHS England
Senior Nurse – Judith Wild
Purpose:
1. To oversee the development and implementation of the Local Transforming Care Plan in line with
Building the right support, ensuring the NHSE/ADASS deadlines are met.
2. To act as a forum for partnership building, sharing good practice and ideas and identifying and
unblocking barriers to system change.
3. To agree plans when required at a system level.
4. To set and agree/acknowledge the future system vision.
5. To agree appropriate work plans required from time to time.
6. Oversight of service improvement for people with learning disabilities.
7. To provide clear capacity and leadership to ensure delivery
8. To agree an appropriate governance structure for this work
Version 3.0 (03.02.16)
Page 11
Appendix 1
Responsibilities:
1
2
3
4
Responsible for agreeing the Local Transforming Care Plan as system leaders.
Providing appropriate and adequate resources to deliver agreed system change
To receive individual organisation plans and connect in to the wider system strategy
To ensure implementation and delivery of the plan within agreed timescales
Powers/Authority to Act:
1
2
Authority to Act under individual organisational schemes of delegation.
Individual CEO’s and Clinical Leads are responsible for communicating to the group when
appropriate, internal organisational governance processes are required to be undertaken.
Accountability:
All member CEO’s and Clinical Leads are accountable to their organisations and are responsible for
ensuring that the governance processes required by their own organisations in terms of decision making
are undertaken as set out in the their organisations scheme of delegation (see attached appendix 1).
It is for leads to ensure that organisations decision-making is deliverable within the set deadline
It is the representative responsibility for each individual to obtain authority to make decisions on behalf of
their GB/CMT.
Meeting Administration:
(i)
Meeting Frequency - To meet monthly from December 2015 to December 2016, thereafter at least
six times per year
Chairing Arrangements:
(i)
Chair expected to be rotated between the CCG Chief Officers on a regular basis to be agreed by
the group, with DASS form different area as co-chair
(ii)
Action notes will be taken at each meeting.
Review date: Annually in Q1 of each financial year (Apr-June)
Version 3.0 (03.02.16)
Page 12
Appendix 2
Governance – Transforming Care Programme
Programme Management Office (PMO)
NHS England
Local Safeguarding
Adults Board
Health and Wellbeing Boards
ERY, Hull and NE Lincs.
Councils
ERY, Hull and NE
Lincs.
Clinical Commissioning Groups
ERY, Hull and NE Lincs.
Overview &
Scrutiny
Committee
Transforming Care Programme Board
HEYHT, York HT,
NLAG, Independent
Hospitals
Transforming Care Operational Group
Humber FT
Workstream 1
Pathways of Care
Workstream 2
Quality and
Commissioning
Workstream 4
Engagement
Workstream 3
Workforce
Development
Workstream 5
Finance
Page 13
VCS
Accommodation
and Care providers
Primary Care
Appendix 3
Transforming Care Partnership – initial consultations
A HOME NOT A HOSPITAL
TRANSFORMING CARE PARTNERSHIP CONSULTATIONS
COMBINED DISCUSSION FEEDBACK
1. SELF ADVOCATES ‘BETTER HEALTH’ MEETING, WHICH INCLUDED CURRENT
PATIENTS IN ASSESSMENT &TREATMENT SERVICES AT TOWNEND COURT
HULL, HELD AT TOWNEND COURT, 25th JANUARY2016
2. SELF ADVOCATES /PROVIDERS MEETING COORDINATED BY HULL AND EAST
RIDING LEARNING DISABILITY PARTNERSHIP BOARDSM HELD AT BEVERLY
LEISURE CENTRE, MONDAY 1 FEBRUARY 2016
At both events self-advocates were given a presentation about Building the right support and the
Transforming Care Programme
Presentation 1st
February SA.ppt
In small groups participants talked about what the nine principles meant to them and said what was
important to them and what we should be thinking about as we make plans. Self=advocates were
supported to write down their comments
Review of the 9 Principles of Support
1. I have a good and meaningful everyday life, what’s important to me
•
•
•
•
•
•
•
•
•
•
•
•
•
I have nice staff around me
Learning new things (Worklink)
Having choice/change (doing something different)
Social activities – different things – drama
Knowing what there is to do and how to access every day and evenings
Seeing old friends and making friends
Support from family or professionals
Job opportunities
Be able to get qualifications
Friends
Neighbours
Privacy
‘I have stopped smoking – feel better’
Page 14
Appendix 3
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cinema
Coffee morning
Café
Knitting groups
Leisure Centre
Jobs
Bowling
Pets
Adult Education
Self-Advocate voices
Professional voices
Social
Good health – mental and physical
Aware of services, activities
Work opportunities
More services near where I live
Reducing isolation
Support and funds to get out
Choice
Friendship
Day services and residential not one or the other,people;e should not have to be
withdrawn from their day service if they leave the family home and go into supported
living or residential care
Many more things to do with my day
Help with understanding my letters and appointments
Help to know how to keep safe
A safe place to live
Help to keep in touch with my family
2. My care and support is person centred, planned, proactive and co-ordinated.
•
•
•
•
•
•
•
•
•
•
•
Review meetings arranged with me and my family
I choose who I want at my meeting
People listen to me and my family
Advocates can be available to help understand
Not just from one area
Sister, families need to be included
Support from GP, nurses
Individual timetables that really happen
Choices not just what is available
Flexibility – able to change my plan when it is not working
Neighbours – good support
Page 15
Appendix 3
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Support each other
‘That it is about me’
Staff give me options
Family give me choices and help me make decisions
To have my reviews – see how things are going
If I get upset staff listen to me
Change things for me.
People assessing actually really know person/family they are assessing
Continuity too many different people
Info not shared/lost/over repeated
Crisis management Is needed for me to feel safe when I am unwell
Sometimes I need to have lots of help to m\ake me feel safe and well
Health passports and communication passports need to be understood by everyone
involved in my care
Staff huge caseloads – not able to focus on quality/person centred
Knowing what’s out there and how to access it
The new reviews CTR need to understand me and what I really need to keep me
well
Timing – not leaving people to go into crisis
We should not need to wait to access the services I need
3. I have choice and control over how my health and care needs are met
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
No or little advocacy available anymore – assumptions made by professional or
family/friends
Individual and families unaware of choice and what help we can have
Trust to make right decisions – family/friends
Lack of choice due to funding – residential provision – one or other not both why?
Lack of clarity on what’s available to help impacting on all principles
Staff awareness/people caring for me need to understand when I am becoming
unwell
Trust between provider and the individual in their care
“ I choose when I have a shower, when I go to the Doctors etc” not when help is
available
Not enough choices in East Riding/Hull/North Lincs – not knowing about choices
Restriction on finances impacts on choice
Explaining/understanding needs to be communicated in a way that I can
understand
Family and friends are helped to support me and keep in touch
Choices – On the right service I need , not just one or another service
Additional support when I need extra care
Advocacy that’s known to me
Options to help me decide
Page 16
Appendix 3
•
•
•
•
•
•
•
•
Annual health check I may need support I can be scared
Podiatry – appointments – accessibility not good
“If don’t get my own choice – makes me feel annoyed”
Talk/listen better
Listen differently
Process to ask for help when not happy is more difficult. I would like to ask for help
when I am upset. Straight away. I cannot choose to go to hospital or respite and
become poorly. I then need to have urgent care and may hurt myself– result
catastrophic
Right information is not always available to individuals or provider
Consistency – same person to help
4. My family and paid support care and support staff get the help they need to
support me to live in the community
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Staff have regular training
“I would like to know what training staff have”
The right up to date information/relevant/accessible
Support to the family to express their needs – at the right time – listen
Help families to be able to let go and transfer care responsibilities this is hard for
families
To be able to trust people to do the tright thing
Working together across agencies
Person is at the centre of the support needed
Best interest is always considered with family/carer support
Circle of support for my family and carers is really important
Support in the local community understanding the support needs of families
Workforce development – accreditation – training for staff but also some help if
needed for families
Right person – right skills to care for me , My family should help to choose
Work with providers – right providers identified with the right support available
Positive behavioural support and intervention to be readily available to help me when
I become upset
Listen to a person’s story of their life – loved ones included
Acknowledge support that is given
Responsive services to help in caring role
Good plans in place to support people who need more help
Respite/crisis response is part of the support plan
‘Good care’ – confidence in service delivery
A point of contact to discuss concerns there may be in supporting complex people
More places in the community for me and my family to go together
Page 17
Appendix 3
5. I have choice of where I live and who I live with
•
•
•
•
•
•
•
•
•
•
Important that I live in the right area near my family and friends and places I visit
I need to live in a safe area. I cannot go out on a night where I live now
I would like to live with my boyfriend
I get upset when I do not choose where to live sometime I have had to live with
people who I do not like
Provers struggle when there is a mix of individuals who are not compatible
I like to live with people who are the same age
I cannot live where I want the MOJ tell me where I can live
I want to be in Hull I know my way around on buses
In East Riding there is sometimes not many buses I cannot afford taxis
1st February: Whole group discussion response from self-advocate was that she was
shown two properties and she chose where and with whom she wanted to live. This
has made her life better.
6. I get good care and support from mainstream health services
•
•
•
•
•
•
•
•
•
•
•
My Doctor is very busy I would like longer to explain , its better when the staff go
with me
The wellbeing service in Hull is really working hard to improve access to health
checks at the doctors
The hospital is big I need help when I go there
The liaison nurse is great if she knows you are going to hospital she helps you
understand what’s happening
The chemist always helps me understand how important it is to take my tablets
The dentist is very good
Good trained staff
Good communication between families, staff, and person with an LD is really
important to help really understand
Fits (epilepsy) I always call the ambulance straight away
Advocacy used to be available to support going to the hospital
Good food at the hospital
7. I can access specialist health and social care support in the community.
•
•
•
•
•
I can ring and do ring Townend Court if I need extra help
I can see the doctors straight away
I can ask for extra help and to go into hospital ,but I need to be poorly
Lack of specialist intervention for children including diagnosis
Lack of understanding of certain conditions/disabilities by some specialists e.g.
Autism
Page 18
Appendix 3
•
•
•
not enough prevention/early intervention is available not saving money as people
run into crisis
wellbeing/mental health can be difficult to get help
access to services in urban areas seems easier intensive support can be difficult in
rural areas as home support services difficult to recruit to
8. If I need it I get support to stay out of trouble
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Early intervention by services is really needed
Things to do to keep occupied – choice – explain consequences long term effects on
people e.g. victims
Recognise/change unsafe behaviours/triggers
Peers/family/carers/trained staff to listen/advice
Good support network
Right support at the right time
Training given
Where to get the information
Trust in services/professionals
PA/Befriender/Advocacy
Alcohol and substance service
Easily accessible support
Community nurses to help
Preventative measures and support for both children and adults
awareness of abuse by opportunists – manipulation/exploitation
Police understanding/awareness of LD
Training needs – responses
Help – nice police around – trust – getting to know each other
Lose temper need help to be calmer
Triggers to a person’s behaviour – understanding relationships
Continuum team can help
Times when things not as should be
Responsive by Police – understanding – good relationships
Off drugs and alcohol – stop stealing cares
Support each other
Support in the community – right level of support
Funding
Plans
Able to have difficult discussions with Police
Resources to meet needs of the person
Can get in trouble when mentally ill people need to know not well – need alert
system
Page 19
Appendix 3
9. If I am admitted for assessment and treatment in hospital setting because my
health needs can’t be met in the community, it is high quality and I don’t stay there
longer than I need to.
•
•
•
•
•
•
•
•
•
First admission – get used to the building – area- nice bedroom
Staff understand and care for me when I am un well
The staff in the community help me to keep my day care and house to go back to
I am involved in all my meetings
I keep in touch with people that I know
The community staff take me and help me
I stay close to my friends and family
I can go to the shops
I can ask to go into the unit when not well
Vision
“The principle is good however, have to look at the individual’s assessment needs to know if
it is workable - It would improve the care and person centeredness. Would need support to
develop the services and will the funding be enough to fully support their assessed needs Who would take this on – which care provider as the area, ERYC, Hull, NE Lincs is a large
area if we are looking at only 17 beds shutting for the whole area – would it be financially
viable for a provider with the input that would be needed.
Change to –
Our vision is underpinned by the nine principles of ‘Building the Right Support’. The
Transforming Care Partnership is committed to improving care and treatment to
make sure that Children, Young People and Adults with a learning disability and/or
autism have the same opportunities as anyone else to live satisfying and valued lives
and are treated with dignity and respect.
We will change service in line with the nine principles of the national model and by
2019 people with a learning disability and/or autism will have greater power and
control over their own care, with planned support to help them to fulfil their potential
and to live in their own communities. “
Page 20
Appendix 4 – Population Projections 2014 -2030
From PANSI (Projecting Adult Needs and Service Information) and POPPI (Projecting Older People Population Information System),
Oxford Brookes University and Institute of Public Care
East Riding of Yorkshire
LD - Baseline estimates
People predicted to have a learning disability, by age
People aged 18-24 predicted to have a learning disability
Total population aged 18-64 predicted to have a learning disability
Total population aged 65+ predicted to have a learning disability
Challenging behaviour
People aged 18-24 with a learning disability, predicted to display challenging behaviour
Total population aged 18-64 with a learning disability, predicted to display challenging
behaviour
Autistic spectrum disorders - all people
People aged 18-24 predicted to have autistic spectrum disorders
Total population aged 18-64 predicted to have autistic spectrum disorders
Total population aged 65+ predicted to have autistic spectrum disorders
Page 21
2014
2015
2016
2017
2018
2020
2025
2030
656
792
982
1,201
1,063
4,694
1,671
2014
11
14
18
23
21
87
658
797
960
1,205
1,064
4,685
1,716
2015
11
14
18
23
21
87
652
804
936
1,207
1,078
4,678
1,759
2016
11
15
17
23
21
87
644
817
915
1,199
1,101
4,675
1,799
2017
11
15
17
23
22
87
632
827
901
1,181
1,126
4,668
1,836
2018
11
15
16
23
22
87
610
842
899
1,133
1,172
4,656
1,905
2020
10
15
16
22
23
87
594
834
949
997
1,229
4,603
2,083
2025
10
15
17
19
24
86
646
784
991
954
1,156
4,531
2,306
2030
11
14
18
18
23
84
2014
256
320
392
511
462
1,941
754
2015
258
322
386
511
462
1,939
770
2016
258
325
374
509
468
1,934
792
2017
256
333
366
504
478
1,936
810
2018
252
337
361
496
490
1,935
822
2020
242
348
359
474
511
1,934
856
2025
238
350
381
417
530
1,917
949
2030
261
330
405
397
499
1,892
1054
Hull
2014
2015
2016
2017
2018
2020
2025
2030
831
996
798
805
620
4,049
789
817
1,011
793
799
629
4,049
798
798
1,023
786
797
643
4,048
813
784
1,028
782
791
657
4,043
827
768
1,036
780
783
671
4,037
843
732
1,036
793
754
698
4,013
869
717
991
862
694
716
3,980
954
791
926
892
692
673
3,975
1063
behaviour
2014
14
18
15
16
12
74
2015
14
18
15
15
12
74
2016
13
18
14
15
13
74
2017
13
19
14
15
13
74
2018
13
19
14
15
13
74
2020
12
19
14
14
14
74
2025
12
18
16
13
14
73
2030
13
17
16
13
13
73
2014
313
407
335
349
274
1,677
2015
308
412
333
347
278
1,679
2016
301
420
330
345
282
1,677
2017
295
425
328
343
290
1,680
2018
289
427
326
339
296
1,676
2020
277
432
330
325
306
1,670
2025
271
414
359
300
317
1,662
2030
299
388
376
299
301
1,662
353
357
363
369
377
390
429
482
Page 22
2014
2015
2016
2017
2018
2020
2025
2030
371
503
464
536
433
2,308
365
508
454
537
438
2,303
354
515
445
536
445
2,295
346
520
438
529
457
2,290
338
520
438
518
464
2,278
324
520
443
493
480
2,261
312
493
492
428
493
2,217
341
453
508
420
455
2,176
635
648
658
671
681
702
763
837
behaviour
2014
6
9
9
10
9
43
2015
6
9
8
10
9
43
2016
6
9
8
10
9
42
2017
6
9
8
10
9
42
2018
6
9
8
10
9
42
2020
5
9
8
9
9
42
2025
5
9
9
8
10
41
2030
6
8
9
8
9
40
2014
139
199
190
227
190
945
2015
137
203
186
225
192
943
2016
132
204
184
223
196
939
2017
130
208
180
223
198
939
2018
127
210
178
219
204
938
2020
121
210
180
207
208
926
2025
118
199
198
180
215
910
2030
129
184
207
178
197
895
282
290
294
299
307
316
345
381
Page 23
Definitions
These predictions are based on prevalence rates in a report by Eric Emerson and Chris Hatton of the Institute for Health Research, Lancaster University,
entitled Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England, June 2004. The authors take the prevalence base
rates and adjust these rates to take account of ethnicity (i.e. the increased prevalence of learning disabilities in South Asian communities) and of mortality
(i.e. both increased survival rates of young people with severe and complex disabilities and reduced mortality among older adults with learning disabilities).
Therefore, figures are based on an estimate of prevalence across the national population; locally this will produce an over-estimate in communities with a
low South Asian community, and an under-estimate in communities with a high South Asian community.
The prevalence rate for people with a learning disability displaying challenging behaviour is 0.045% of the population aged 5 and over. Prediction rates have
been applied to ONS population projections of the 18-64 population in the years 2011 and 2021 and linear trends projected to give estimated numbers
predicted to have a mild, moderate or severe learning disability, to 2030. The prevalence rate is based on the study Challenging behaviours: Prevalence and
Topographies, by Lowe et al, published in the Journal of Intellectual Disability Research, Volume 51, in August 2007. In total, 4.5 people per 10,000 of the
population aged 5 and over were rated as seriously challenging (representing approximately 10% of the learning disability population). The most prevalent
general form of challenging behaviour was ‘other difficult/disruptive behaviour’, with non-compliance being the most prevalent challenging behaviour. The
prevalence rate has been applied to ONS population projections to give estimated numbers with a learning disability predicted to display challenging
behaviour, to 2030
The information about ASD is based on Autism Spectrum Disorders in adults living in households throughout England: Report from the Adult Psychiatric
Morbidity Survey 2007 was published by the Health and Social Care Information Centre in September 2009. The prevalence of ASD was found to be 1.0% of
the adult population in England, using the threshold of a score of 10 on the Autism Diagnostic Observation Schedule to indicate a positive case. The rate
among men (1.8%) was higher than that among women (0.2%), which fits with the profile found in childhood population studies. The report Prevalence of
disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP), Baird, G. et al, The
Lancet, 368 (9531), pp. 210-215, 2006. found that 55% of those with ASD have an IQ below 70%. The National Autistic Society states that 'estimates of the
proportion of people with autism spectrum disorders (ASD) who have a learning disability, (IQ less than 70) vary considerably, and it is not possible to give
an accurate figure. Some very able people with ASD may never come to the attention of services as having special needs, because they have learned
strategies to overcome any difficulties with communication and social interaction and found fulfilling employment that suits their particular talents. Other
people with ASD may be able intellectually, but have need of support from services, because the degree of impairment they have of social interaction
hampers their chances of employment and achieving independence.' The prevalence rates have been applied to ONS population projections of the 18 to 64
population to give estimated numbers predicted to have autistic spectrum disorder to 2030
Page 24
Appendix 5 National Outcome Measures: benchmarking
Public Health England Statistics (2013/14 data)
Compared with national
benchmark
Better
Lower
Indicator
England
Y+H
ERY
Similar
Worse
Similar
Higher
Hull
NEL
Population
Learning Disability QOF Prevalence
(18+)
0.5
0.5
0.5
0.5
0.6
Adults (18 to 64) with learning
disability known to local authorities
4.3
4.4
4.5
4.1
3.8
Children with Moderate learning
difficulties known to schools
15.6
15.1
14.6
19.0
24.1
Children with Severe Learning
Difficulties known to schools per
1,000 pupils
3.7
4.0
3.5
7.7
*
Children with Profound & Multiple
Learning Difficulty known to schools
per 1,000 pupils
1.3
1.3
*
*
*
Children with autism known to
schools per 1,000 pupils
9.1
8.1
5.0
7.8
9.2
44.2
45.3
50.3
30.3
50.9
Adults with learning disabilities in
settled accommodation
74.9
79.2
65.1
70.9
75.3
non-settled accommodation (%)
21.7
17.6
30.3
28.4
23.3
Adults with learning disabilities living
in accommodation whose status is
unknown to LA (%)
3.4
3.2
4.0
0.8
1.4
Health
Proportion (%) of eligible adults with
learning disability having a GP health
check
Accommodation and Social Care
Page 25
Adults with learning disabilities living
in severely unsatisfactory
accommodation (%)
0.3
0.1
0.0
0.0
0.0
employment
6.7
6.2
5.7
*
17.8
Adults with learning disabilities
receiving direct payments (%)
30.5
30.6
45.9
36.9
40.0
Rates of referral for abuse of
vulnerable person per 1,000
109.3
79.5
61.0
98.5
92.1
Comparison of LA and QOF
prevalence estimates
-0.1
-0.2
-0.1
-0.1
-0.5
Comparison of pupils with learning
difficulties and LA prevalence
estimates
80.2
79.6
*
*
*
Comparison of pupils with severe
and profound and multiple LD and LA
prevalence estimates
13.5
16.7
*
*
*
Adults using day care services
supported by the LA (per 1,000
people)
323.7
378.4
382.9
Adults receiving community services
supported by local authorities (per
1,000 people with learning
disabilities)
754.0
796.0
691.0
709.0
776.0
Children with learning disabilities
known to schools per 1,000 pupils
20.6
20.3
*
*
10.2
Coordination and local planning
Source:Public Health England, Learning Disabilities Profiles
http://fingertips.phe.org.uk/profile/learning-disabilities
Page 26
373.1
355.2
Appendix 6 Properties with a legal charge
NHS PS ID
Property Name Charged
Region
LAT
Former PCT
Agreement secured by legal charge (type/parties/date)
S256 grant agreement contained within the legal charge made between
(1) New Era Housing Association and (2) East Yorkshire Health Authority
dated 26 March 1993
(1) New Era Housing Association Limited and (2) East Yorkshire Health
Authority dated 30 November 1992
(1) The North British Housing Association Limited and (2) East Riding
Health Authority dated 30 March 1995
(1) New Era Housing Association Limited and (2) East Yorkshire Health
Authority dated 30 November 1992
(1) the Trustees for the time being of The Spice Trust and (2) East Riding
Health Authority dated 20 June 1995
Land Registry Title No
10815
1 - 4 Meadow View,
Bempton Lane, Bridlington
North
North Yorkshire &
East Riding Of Yorkshire
The Humber
10819
10 Berkeley Drive, Beverley,
North
HU17 8UE
North Yorkshire &
The Humber
10823
142 Norwood, Beverley
North
North Yorkshire &
The Humber
10834
23 Burnby Lane,
Pocklington, YO42 2QB
North
North Yorkshire &
The Humber
10860
7 Ferriby Road, Hessle,
HU13 0RG
North
North Yorkshire &
The Humber
10883
Granville Court, Esplanade,
Hornsea (1)
North
North Yorkshire &
The Humber
10884
Granville Court, Esplanade,
Hornsea (2)
North
North Yorkshire &
The Humber
10892
Land on the East Side of
High Street, Rawcliffe
North
North Yorkshire &
The Humber
10895
Millside Nursing Home,
Riverside, Driffield (1)
North
North Yorkshire &
The Humber
10896
Millside Nursing Home,
Riverside, Driffield (2)
North
North Yorkshire &
The Humber
Health Authority dated 29 March 1996 (FURTHER CHARGE)
HS244477
10824
156/158 Spring Bank,
Kingston upon Hull
North
North Yorkshire &
Hull
The Humber
(1) Housemartin Housing Association Limited and (2) Hull Health
Authority dated 18 January 1993
HS185043
10826
17 Kingfisher Rise, Sutton
on Hull, HU7 4FL
North
North Yorkshire &
Hull
The Humber
S64 Health Service and Public Health Act 1968 grant agreement
contained within the legal charge made between (1) Accent Foundation
Limited and (2) Hull Teaching Primary Care Trust dated 30 June 2011
HS243026
10833
220 Preston Road, Kingston
North
upon Hull, HU9 5HF
North Yorkshire &
Hull
The Humber
10836
27 Beverley Road, Hull, HU3
North
1XH
North Yorkshire &
Hull
The Humber
10838
29, Percy Street, Kingston
upon Hull, HU2 8HL
North
North Yorkshire &
Hull
The Humber
10854
61 Spring Bank, Kingston
upon Hull, HU3 1AG
North
North Yorkshire &
Hull
The Humber
10857
64 Westbourne Avenue,
Kingston upon Hull, HU5
3HS
North
North Yorkshire &
Hull
The Humber
10867
82 Spring Bank, Kingston
upon Hull
North
North Yorkshire &
Hull
The Humber
(1) Donald Snelgrove, The Right Reverend Kevin O'Brien and Alan Sheard HS200826
and (2) Hull Health Authority dated 5 March 1991
10880
Dove House Hospice,
Chamberlain Road, Hull,
HU8 8DH
North
North Yorkshire &
Hull
The Humber
(1) North Humberside Hospice Project Limited and (2) Hull Health
Authority dated 30 July 1990
HS358859
10889
Land and Buildings on the
North Side of Wivern Road, North
Kingston upon Hull
North Yorkshire &
Hull
The Humber
HS253523
10890
Land associated with 29
North
Percy Street, Hull, HU2 8HL
North Yorkshire &
Hull
The Humber
10891
Land at Percy Street and
Freetown Way, Kingston
upon Hull
North
North Yorkshire &
Hull
The Humber
10893
Land on the East Side of
Middlesex Road, Hull
North
North Yorkshire &
Hull
The Humber
North
North Yorkshire &
Hull
The Humber
North
North Yorkshire &
Hull
The Humber
North
North Yorkshire &
The Humber
10900
10901
10828
Rosie O'Grady's Club, 100
County Road North, Hull,
HU5 4HL
Rosie O'Grady's Club, 100
County Road North, Hull,
HU5 4HL
2 and 3 Fen Court, Toothill
Gardens, Grimsby, DN34
4ER
Health Authority dated 29 March 1996 (FURTHER CHARGE)
HS224058
HS151144
HS243462
HS29122
HS243623
HS247144
HS247144
(1) Chantry Housing Association Limited and (2) Grimsby and Scunthorpe HS244075
(1) the Trustees for the time being of The Spice Trust and (2) East Riding HS244477
S64 Health Service and Public Health Act 1968 grant agreement
contained within the legal charge made between (1) Compass- Service to
Tackle Problem Drug Use and (2) Hull Teaching Primary Care Trust dated
6 May 2011
(1) Aids Action North Humberside and (2) East Riding Health Authority
dated 11 November 1993
(1) The Council for Dependency Problems and (2) Hull Teaching Primary
Care Trust dated 20 July 2007
(1) Housemartin Housing Association Limited and (2) East Riding Health
Authority dated 20 March 1995
(1) Hull and Humberside Housing Association Limited and (2) Hull Health
Authority dated 19 January 1988
(1) The Royal Society for Mentally Handicapped Children and Adults and
(2) South Humber Health Authority dated 11 November 1997
Page 27
HS237174
HS40611
HS136249 and HS205729
HS334805
HS226157
HS136249
HS205729
HS145274
HS172858
HS172858
HS217897
Appendix 7: Summary of the National Service Model
1. People should be supported to have a good and meaningful everyday life through access to activities and services such as early years services, education,
employment, social and sports/leisure; and support to develop and maintain good
relationships.
2. Care and support should be person-centred, planned, proactive and coordinated
– with early intervention and preventative support based on sophisticated risk
stratification of the local population, person-centred care and support plans, and local
care and support navigators/keyworkers to coordinate services set out in the care and
support plan.
3. People should have choice and control over how their health and care needs are
met – with information about care and support in formats people can understand, the
expansion of personal budgets, personal health budgets and integrated personal
budgets, and strong independent advocacy.
4. People with a learning disability and/or autism should be supported to live in the
community with support from and for their families/carers as well as paid support
and care staff – with training made available for families/carers, support and respite for
families/carers, alternative short term accommodation for people to use briefly in a time
of crisis, and paid care and support staff trained and experienced in supporting people
who display behaviour that challenges.
5. People should have a choice about where and with whom they live – with a choice of
housing including small-scale supported living, and the offer of settled
accommodation.
6. People should get good care and support from mainstream NHS services, using
NICE guidelines and quality standards – with Annual Health Checks for all those over
the age of 14, Health Action Plans, Hospital Passports where appropriate, liaison
workers in universal services to help them meet the needs of patients with a learning
disability and/or autism, and schemes to ensure universal services are meeting the
needs of people with a learning disability and/or autism (such as quality checker
schemes and use of the Green Light Toolkit).
7. People with a learning disability and/or autism should be able to access specialist
health and social care support in the community – via integrated specialist multidisciplinary health and social care teams, with that support available on an intensive
24/7 basis when necessary.
8. When necessary, people should be able to get support to stay out of trouble –
with reasonable adjustments made to universal services aimed at reducing or
preventing anti-social or ‘offending’ behaviour, liaison and diversion schemes in the
criminal justice system, and a community forensic health and care function to support
people who may pose a risk to others in the community.
9. When necessary, when their health needs cannot be met in the community, they
should be able to access high-quality assessment and treatment in a hospital setting,
staying no longer than they need to, with pre-admission checks to ensure hospital care
is the right solution and discharge planning starting from the point of admission or
before.
Page 28
Appendix 8 Transforming Care Workforce Plan: Draft 1 as example
This sample template supplied by Health Education England is an outline which may guide us in our initial workstream development.
Focus
Key Elements
Objectives (how)
Establishing a
work stream
Identify and engage workforce work
stream partners
Establish co-production strategy
Agree ToR and governance arrangements
Understanding
the current
position
Understand the unpaid workforce
Understand paid workforce across all
sectors including NHS, PIV and social
care
Scope and Identify Priorities and Risk
Formulate a schedule of work
Outline high level outcome and evaluation criteria
Establish feedback loop to advisory group and
Confirm and Challenge group
Engagement with Families and Self-Advocacy Groups,
voluntary organisation
Engagement with People and their Families and SelfAdvocacy Groups; local HEE offices; Skills for Care;
and Skills for Health
Undertake and request Training needs analysis
Hold engagement, consultation, fact-finding events,
Link with local networks
Map existing assets and resources, skills, training
packages and information , venues etc.
Page 29
Who?
When?
Key
Target
Partners
Date
(indicated
completion
date)
RAG rating:
Risk of NOT
achieving
outcome
Focus
Key Elements
Objectives (how)
Understanding
the need
Establish key skills and capacity that
needs to be addressed immediately
(e.g. PBS, leadership, advocacy, personalisation, CTR
coordination)
Map the skills with model of care
Competency mapping with cohort
needs
Competency service provision
Competency mapping with cohort needs
Map future skills and impact of improved transition
and close working with education and children's
services
Meeting the
need
Engage and understand the needs of
Universal services
Define and agree key deliverables for
population,
Establish and affirm approach to coproduction
incorporate resilience, values and
compassionate care into all training
outputs
Plan development of leaders and
system leaders into programmes of
recruitment and development.
Map the workforce and skills to
providers/employers
Agree strategy for delivery to each
sector
Identify family and carer development
opportunities
Market stimulation and discussion event
Focused events
Page 30
Who?
When?
Key
Target
Partners
Date
(indicated
completion
date)
RAG rating:
Risk of NOT
achieving
outcome
Focus
Key Elements
Objectives (how)
Determine evaluation criteria and plan
a succession strategy
Develop recruitment and retention
strategy
Plan workforce transitions and
reskilling is necessary
Design training pathways and training
packages and publish resources
Plan engagement and delivery with
universal services including:
Prevent
Liaison and Diversion
Primary and secondary health
Police and Criminal Justice
Education
Working group
Economy wider strategy
Consultation and scoping exercises:
Produce delivery time table aligned to
service plan and model
Evaluate and plan sustainable
planning and development cycles
Page 31
Who?
When?
Key
Target
Partners
Date
(indicated
completion
date)
RAG rating:
Risk of NOT
achieving
outcome
Appendix 9 Transforming Care Communications Plan 2016/17: Draft 1
Target audience
Children, Young People and Adults with a Learning Disability
Children, Young People and Adults with autism
Carers and families
Providers of services for people with a Learning Disability and / or Autism
Professionals including housing providers, mental health services, primary care and acute hospitals
General Public
Key messages
Children, Young People and Adults with a learning disability and/or autism should have the same opportunities as anyone else to live satisfying and
valued lives and be treated with dignity and respect.
Children, Young People and Adults with a learning disability and/or autism should have greater power and control over their own care
People with a Learning Disability and / or Autism have hopes, dreams and abilities too
A Hospital is not a Home
Reducing the reliance on inpatient care
When individuals display behaviours that challenge, they are trying to say something and we need to be able to respond positively rather than
automatically arranging admission to a hospital (NEEDS FURTHER WORK)
Children, Young People and Adults with a learning disability and/or autism and their families should know about Personalised Care Planning and feel
supported to develop these and plan their care more creatively (NEEDS FURTHER WORK)
Children, Young People and Adults with a learning disability and/or autism should know where they can get help
Professionals should be able to recognised Personalised Care Plans including risk plans, Health Action Plans, Patient Passports and use them
effectively
Page 32
V6 -Updated 23.12.15
To be developed by Communication and Engagement Workstream
Campaign/message
Format
Area
Hull / ER/ NEL
Dignity and respect
Detail
Timescales
Cost
Lead
Tbc
Tbc
Tbc
Tbc
Campaign/message
Increased personalisation
Format
Area
Detail
Timescales
Cost
Lead
Campaign/message
Reduced reliance on inpatient
care when things are difficult
Format
Area
Detail
Timescales
Cost
Lead
Campaign/message
A Hospital is not a Home
Format
Area
Detail
Timescales
Cost
Lead
Campaign/message
Where to get help
Format
Area
Detail
Timescales
Cost
Lead
SS
Staff Key:
Action completed or part of routine work
Action in progress / not completed
Planned Press releases:
Page 33
RAG
Action overdue
To be actioned but date not due
Planned events:
Key Stakeholders and Audiences
Children, Young People and Adults with a Learning Disability
Children, Young People and Adults with autism
Carers and families
Providers of services for people with a Learning Disability and / or Autism
Professionals including housing providers, mental health services, primary care and acute hospitals
General Public
Learning Disability Partnership Boards
Clinical Commissioning Group Governing Bodies
Clinical Commissioning Group Council of Members
Council Members
Health and Wellbeing Boards
Health, Care and Wellbeing Overview and Scrutiny Committees
Healthwatch
Practice Nurses
GPs
Local partners including Fire, Police, ambulance services
Media – print, radio, TV and digital
Page 34
Item 5
DATE
18th April 2016
REPORT OF
Helen Kenyon
SUBJECT
Better Care Fund 2016-17
STATUS
Open
The Better Care Fund is a government initiative to support NHS organisations and
councils in their endeavours to create an integrated health and care system locally.
Integrated working promotes a system-wide approach to improving health and
wellbeing, which contributes to the council’s outcome framework, and will also
contribute to the creation of a sustainable health and care service in the local area.
EXECUTIVE SUMMARY
The council and CCG are required to submit their proposals as to how the Better Care
fund resources will be used to support local health and social care integration. The
detailed plan is appended to the report.
RECOMMENDATIONS
Board members are asked to approve the plan.
It is a requirement of the Better Care Fund that local plans are agreed by health and
wellbeing boards.
1.
The council and NEL CCG have adopted a system wide approach to delivering integrated
and sustainable services that produce better quality outcomes for our local population
within the available health and social care budgets. Our adult social care plan, Healthy
Lives Healthy Futures and Better Care fund plans build from the joint strategic needs
assessment (JSNA) which highlights a growing elderly and increasingly frail population.
The proportion of older adults in North East Lincolnshire is set to increase in the next five
years, placing additional demands on services. North East Lincolnshire also contains
specific pockets of deprivation which continue to present challenges for service design
and provision. In particular we are facing challenges related to health inequalities and
variations in life expectancy for men and women and between different wards in our
locality.
To support our transformative journey we have aligned the adult social care approach to
the wider vision for health and wellbeing locally, focusing on prevention, putting the
Page 35
community at the centre of service re-design, and supporting people to take greater
responsibility for their own health and wellbeing. We are using an assessment approach
which is asset based focusing on wellbeing and prevention. It is intended that the
assessment approach will produce better outcomes and value for money.
The Better Care Fund is reflective of our own aim to invest in further integration which will
help us to shift the emphasis and activity away from hospital settings. Further integration
will create efficiencies, and improve cooperation and coordination across the system,
which in turn will improve patient/service user experience.
What we were asked to do
The local area has been asked to submit a narrative plan which is attached to this report.
The plan to some extent is a continuance of the council and CCG’s integration journey
and builds on previous successful projects. It is evidence from a review of current projects
that further detailed work to develop the seven day service model and the support to care
home – both of these projects will form a substantial part of the work for the forthcoming
year.
Key actions
The following are some of the key changes to service delivery that will help to bring about
our vision for the future:
• Community nurse call integration – routine appointments, urgent responses and
end of life care all from one number
• Support for discharge from hospital – multi agency support package facilitated by
the SPA in coordination with the hospital in reach team.
• NHS 111 – improving connects with SPA
BCF plans will contribute to the on-going delivery of the aims and changes set out in the
Care Act. We are continuing to develop a comprehensive approach to wellbeing and
prevention via initiatives such as Just Checking, Single Point of Access and the
Preventative Services Market Development Board.
Areas for development
Issues that the BCF will be used to address in the local area include improving our offer of
preventative services, enhancing re-enablement and ensuring resettlement following
hospital admission or individual crisis response, reducing unplanned hospital admissions.
Disabled Facilities Grant allocation
The council will receive an enhanced allocation for disabled facilities grants totalling
£2.188m. This will enable the back log of applications to be processed and ensure that
individuals are better supported to live at home through swifter processing of new
applications. The council and CCG have recently entered into joint management
arrangements which will ensure greater co-ordination of services and functions, of which
strategic housing is a part, and is integral to supporting people to live at home and within
their communities. The joint adult services lead has been actively engaged with
supporting the better management of disabled facilities grants to ensure that swift and
Page 36
effective support is in place to facilitate discharge from hospital, or reduce an
unnecessary call on packages of care.
Finances
A summary of the new allocation for BCF is provided below:
Gross Contribution
Total Local Authority Contribution
Total Minimum CCG Contribution
Total Additional CCG Contribution
Total BCF pooled budget for 2016-17
£2,188,000
£11,157,412
£0
£13,345,412
Progress reports on the BCF plan are due for submission at 5 points in the year:
•
•
•
•
•
29 May 2015 – for the period January to March 2015
28 August 2015 – for the period April to June 2015
27 November 2015 – for the period July to September 2015
26 February 2016 – for the period October – December 2015
27 May 2016 – for the period January – March 2016
Following the submission of the plan there will be a regional and national assurance
process and the outcome of this will be reported to the health and wellbeing board.
2.
The Better Care Fund presents an opportunity to build on the work to integrate health
and care locally and will contribute the achievement of the national vision to have a
fully integrated health and care system by 2020. There are risks to the future
sustainability of health and care systems locally arising out of increased pressures on
acute services or a failure to manage demand for health services. All of the planned
activity within the BCF programme and HLHF programme aims to contribute to better
care quality, improved health outcomes and more effective use of scarce resources,
particularly for vulnerable people.
3.
No specific alternative options are considered in the context of this report, though in
developing plans, there is scope for considering a range of alternative service delivery
options; these are identified and evaluated as part of the process of creating specific
schemes
4.
There are no potentially negative reputational implications for the Council resulting
from the decision.
Page 37
5. FINANCIAL CONSIDERATIONS
Financial considerations are considered within the main body of the report. The
current section 75 agreement between the council and CCG will provide the
mechanism for pooling resources and for sharing risks. The proposal is consistent
with the Council and CCG’s joint adult social care strategy and health and
wellbeing strategy and will help to contribute to improved value for money within
the wider health and care system.
6. MONITORING COMMENTS
In the opinion of the author, this report does not contain recommended changes to
policy or resources (people, finance or physical assets). As a result no monitoring
comments have been sought from the Council's Monitoring Officer (Assistant
Director, Law), Section 151 Officer (Director of Finance) or Human Resources
Group Manager.
7. BACKGROUND PAPERS
NEL Better care fund plan submitted draft
Better care fund planning template submission
8. CONTACT OFFICER(S)
Beverley Compton 01472 326126
Helen Kenyon
(Leadership Team sponsor)
Page 38
North East Lincolnshire Better Care Fund
Vision for Local health and social care services
We have adopted a system wide approach to delivering integrated and sustainable services that produce better quality outcomes for our local population
within the available health and social care budgets. Our plans build from the joint strategic needs assessment (JSNA) which highlights a growing elderly and
increasingly frail population. The proportion of older adults in North East Lincolnshire is set to increase in the next five years, placing additional demands on
services. North East Lincolnshire also contains specific pockets of deprivation which continue to present challenges for service design and provision. In
particular we are facing challenges related to health inequalities and variations in life expectancy for men and women and between different wards in our
locality.
By ensuring that all citizens eligible for social care can access the advice, information and help they need, we aim to support people to keep well, directing
clients to preventative services wherever possible. We are working to strengthen the public health offer, by ensuring that this is focused on preventative
wellbeing, rather treatment services. To support our transformative journey we have aligned the adult social care approach to the wider vision for health
and wellbeing locally, focusing on prevention, putting the community at the centre of service re-design, and supporting people to take greater responsibility
for their own health and wellbeing.
We are using an assessment approach which is asset based focusing on wellbeing and prevention. It is intended that the assessment approach will produce
better outcomes and value for money.
The Better Care Fund is reflective of our own aim to invest in further integration which will help us to shift the emphasis and activity away from hospital
settings. Further integration will create efficiencies, and improve cooperation and coordination across the system, which in turn will improve patient/
service user experience. Together with our system partners in North Lincolnshire we have evolved a whole system model to deliver the right care, in the
right place, by the right people, as close to home as possible, releasing the capacity and innovation which exists within our community to promote healthy
living, self-care and prevention and reducing the risk of problems escalating and leading to unplanned hospital admissions.
1
Page 39
Our comprehensive whole system model
Figure 1. HLHF funnel of transformation
The HLHF programme enables the realisation of the five year forward view locally we will move our system closer to the fully integrated health and social
care by 2020. We want people to live independent, healthy lives, supporting one another and taking control of their own health. When they do need care
however, they should have access to it by;
•
•
•
Provision of services in the community, closer to the person, with reduced demand for hospital-based acute care;
Provision of specialist and tertiary acute care, of sufficient scale to ensure safe, quality services.
Access to Services 24/7 through the implementation of seven day working at a 24/7 single point of access.
Intrinsic to our vision therefore is that people should be enabled to get back to managing their own health as quickly as possible. Under the umbrella of the
Better Care Fund, we will boost re-enablement opportunities, continue to invest in intermediate tier services and develop our outcome evaluation
capability. This means that services which support people with long term conditions are just as important as those which manage urgent health issues. This
is critically important to the realisation of our vision as it embeds a whole system approach where every component, service, pathway and support element
is of equal value.
2
Page 40
Critical to this vision, and part of our BCF plan will be the ability of individuals to access professional support and advice through our integrated single point
of access (SPA). The SPA will continue to be expanded this year. To enable people to access the support they need when they need it, BCF supports delivery
of extended services throughout the week through our 7 day working initiative. This has already begun to support the shift from traditional patterns of care
within the hospital setting towards a community based model (via for example, expanded GP opening hours).
Our work on developing the community based equipment service (Assisted Living Centre) has enabled more people to access equipment and technology,
which supports them to live safely at home and to seek re-assurance and help when and where needed. This vision is a continuation of the vision submitted
within our previous BCF plan, and is also reflected in the joint (CCG and local Council) adult social care strategy at https://portal.nyhcsu.org.uk/documents/5665646/5860313/Adult+Social+Care+Strategy/461f6203-8bee-40fd-a0fc-5cd7e04028e7
A description of the aspects of the change the local area is intending to deliver using the BCF
North East Lincolnshire Council and CCG have been jointly working to deliver adult health and social care since 2007 via a section 75 agreement. In this way,
BCF runs parallel to the development of North East Lincolnshire’s existing integration journey, rather than representing a change of direction. Realising our
vision will enable patients and services users to take a more active role in their own health and care management. Evidence shows that when people are
given autonomy over their own condition, outcomes improve.
We set out within our previous BCF plan (section 2c) at page 7) how the HLHF programme will contribute to change across Northern Lincolnshire. Within a
provider and commissioner partnership, we are developing a new model of care. This work draws together the modelling for Commissioner Requested
Services, BCF and individual projects describe in detail how services will look. Outcomes from the BCF schemes are described in the project initiation
documents (PIDs) attached. All schemes designated within our previous BCF plan will continue to be supported. Evaluation demonstrates that each of the
schemes which are already operational have made, and continue to make a contribution to effecting the changes set out within our previous plan (section
2c) at page 8); such as –
•
•
•
•
Improved quality and outcomes
Improved signposting
Increased development of community wellbeing and prevention services
Improved choice and control.
Support to care homes and strands of 7 day working which are not yet fully operational will be fully rolled out to deliver the changes listed above.
Additional time has been spent on refining and revising these schemes prior to full roll out, to secure genuine confidence and ‘buy in’ from all relevant
3
Page 41
professionals to ensure successful delivery. In addition to the above – largely a continuation of our previous BCF plan – we are developing further
structures and strategies to secure and support the change set out herein including our revised policy on micro- commissioning to encourage a wellbeing
focus in all front line assessment and care planning.
Our previous plan set out the alignment of BCF plans with others such as •
•
•
•
•
•
Healthy Lives, Healthy futures programme
The health and wellbeing strategy
The CCG five year strategic plan
The council plan
The NEL joint adult social care strategy
Local strategies for implementation of change related to the Care Act
NB the above plans were attached to our previous BCF bid and are therefore not reattached, with the exception of the NEL joint adult social care strategy
which has been refreshed, and a link for which appears above. The council has continued its strategic focus on delivering a stronger economy and stronger
communities and has recently adopted an outcomes framework. This will form the basis of all partnership working in the borough and a developing “place
shaping” approach.
The diagram below sets out the intersection between some of these policies/ strategies.
4
Page 42
Further plans are being developed and refreshed such as:
•
•
•
The revision of the housing strategy (referred to above), to include an increased focus on prevention and wellbeing. A first draft has been completed
The development of a North East Lincolnshire prevention strategy, which will serve as a ‘call to action’ across all parts of the health and social care
system, and beyond, in support of the aims of BCF and more
The development of a North East Lincolnshire integrated information and advice strategy, which aims to facilitate coherent, coordinated and
effective information and advice. Whilst SPA is a key contributor to the aims of the strategy, its wider aims will include making preventative
signposting everyone’s business (i.e. will be reflective of the making every contact count philosophy). The development of this year’s annual public
5
Page 43
health report, which will focus on experiences of growing older in North East Lincolnshire, and in particular on those who are lonely and socially
isolated. North East Lincolnshire’s aging demographic has already been evidenced, but by definition, it is difficult to establish how many older people
in the area are lonely and/ or isolated. However, the impact of loneliness and isolation on health and wellbeing is well established. Via the
stakeholder engagement activities which will underpin development of the public health report, we will seek to develop and implement innovative
approaches to tackling this problem, and create a baseline against which to measure success. The support to care homes initiative (which also
supports those in the community) will contribute to this.
Respond to changes to the local public health needs and the broader demographic and socio-economic changes in the local area
The number of older people in North East Lincolnshire has been increasing and has already been a factor in strategic commissioning plans. It is anticipated
that in the period 2015-2018 there will be a 5.9 per cent increase in the number of people expected to be frail over the age of 65 and there will be a growth
in the population for whom we need to prevent or delay the need for support .(Appendix 2 of the adult social care strategy provides full details on local
demographics and levels of need). This increase is likely to place increased demand on adult social care and other services. Enhanced approaches to
managing demand are required and will be adopted. BCF schemes such as just checking, extra care housing and support to care homes (for example) will
support the over 65 demographic in particular (although not exclusively). The support to care homes scheme will help those with complex long term
conditions residing in the community, nursing or residential care through a multi-agency co-ordinated and proactive response to individual needs. This will
include regular care reviews, an urgent (same day) response for deteriorating individuals, and support following a hospital stay/ period of re-enablement in
intermediate care, to facilitate an earlier discharge than would otherwise be possible. Support will include use of new technologies and telemedicine to
ensure fast, effective clinical input.
Evidence of the input of service users and public engagement
Significant engagement and consultation with the public has taken place across Northern Lincolnshire as part of the Healthy Lives, Healthy Futures (HLHF)
transformation programme involving a range of engagement and feedback mechanisms, all of which are published on the Healthy Lives, Healthy Futures
website. Further engagement is on-going.
Comprehensive details of the engagement and consultation on our vision can be found at http://www.healthyliveshealthyfutures.nhs.uk/
The NEL joint adult social care strategy was developed through engagement and extended interviews with key professionals and through discussion and
debate at the NEL community forum. The Council’s scrutiny committee had an opportunity to shape and comment on the strategy.
6
Page 44
Community engagement took place in developing the health and wellbeing strategy. We aim to include stakeholders in all aspects of needs assessment
work and commissioning. We can point to numerous examples of where co-commissioning has been an integral part of the development of service models
e.g. extra care housing development, the assisted living centre, carer’s support services, social prescribing and Healthwatch. Our innovative work in
releasing community capacity is based on a partnership led by the communities we serve, and supported by commissioners and service managers
As part of the Care Act implementation programme, an expansive engagement and consultation schedule was developed. The aim of the schedule was to
inform the community of the coming changes, and seek dialogue on implementation possibilities. As the legislative underpinning for BCF, the Care Act
engagement and consultation scheme is of direct relevance to the implementation and development of BCF.
Also attached is the list of engagement activities undertaken by the CCG in the last year. A similar engagement plan is in development for the 2016-17
period, which will include some of the engagement events already mentioned above and others (e.g. the CCG’s refreshed commissioning intentions, and
update to its Market Position Strategy). Most BCF initiatives include their own communications and engagement plan within their PID to ensure service user
and public input. The CCG operates through use of designated work areas known as ‘triangles’ e.g. the ‘Older People, Carers and Dementia Triangle’.
These triangles comprise a commissioner, a clinician and a community member. In this way all key areas of CCG work feature public involvement. The CCG
is supported in its work via its community membership body ACCORD, which contributes to all areas of activity.
Changes to service delivery that will help to bring about this vision for the future
The single point of access (SPA) offers an ‘intelligent dispatch’ mechanism, ensuring that callers reach the right person at the right time. The operation of
SPA offers more than just an advice officer function; it includes an enhanced triage element both within and out of hours. It offers a streamlined multiagency approach to enable smooth transfer from call handling to appropriate health and social care responses. Further planned developments of the SPA
include –
•
•
•
Community nurse call Integration: those requiring both routine appointments and more urgent response from community based nurses and end of
life care services will only need to call one number (or use the web interfaces) to arrange visits or get advice - day or night
Supported discharge: those being discharged from hospital inpatients will benefit from a coordinated multi-agency support package facilitated by
SPA, in coordination with the hospital in-reach team (HIT) and others
NHS 111: improving connections between the SPA and the NHS 111 framework.
The recent appointment of the SPA manager will provide renewed focus on genuine integration and cooperation, i.e. staff will not just be co-located, but
will feel themselves to be part of, and contributing to, a shared vision. We believe this will –
7
Page 45
•
•
•
•
•
Promote wellbeing
Contribute to preventing and delaying needs
Improve the quality of care and support access
Improve patient and service user outcomes
Reflect the HLHF ‘shift to the left’ philosophy (see figure 1 above).
Relationship between the BCF plan for 2016-17 and longer term sustainability and transformation plans (STPs)
Proposed priorities in the STP year one include the continuance of established transformation programmes which have been developed through the HLHF
programme in North East Lincolnshire. The current transformation programme includes the BCF schemes which form an important part of reducing hospital
admissions, enabling people to remain as independent as possible in their own homes through access to equipment and re-ablement services, and
deployment of more appropriate and effective services via the SPA. Within years 2-5 of the STP the aim will be to deliver aggregate and sustainable financial
balance by working collaboratively with other commissioners and providers to determine the appropriate location and mix of service provision to meet the
needs of the wider STP footprint. The STP is being developed as the wider context of devolution emerges.
How BCF plans will contribute to the on-going delivery of the aims and changes set out in the Care Act 2014
Prevention is key to promoting wellbeing and avoiding or delaying a progression of needs. We are continuing to develop a comprehensive approach to
wellbeing and prevention, made up of a number of primary, secondary and tertiary prevention threads. For example, NEL promotes wellbeing and
prevention via –
•
•
The Just Checking initiative supports a fully responsive service to those who wish to remain independent at home, by enabling flexible working for
domiciliary providers. Just Checking allows domiciliary providers to react to presenting situations without having to go through a bureaucratic
process of seeking agreement to re-commission a package of care. Providers have the ability to stay, resolve and stabilise the situation drawing on
the Just Checking budget. This extra input is non-chargeable to the service user and is delivering results in terms of reduced care home placement
and respite episodes. The initiative also gives domiciliary providers the security of knowing that they will be paid for the impromptu support
delivered, thus contributing to their economic viability, and to our duty to promote a sustainable market. This responsive service both promotes
service user wellbeing, and prevents escalation of need
The SPA has successfully reduced the demand for services. Acting as a ‘front door’ to assessment functions which have been re-designed for
compliance with the Care Act, the revised approach is an asset based approach, and views the individual holistically in the context of their whole
8
Page 46
•
family; it is intended to free social workers to return to core social work values, drawing on their professional judgement, and supporting them to
avoid assessments which simply ‘tick boxes’. Data collated via SPA also enables identification of areas of unmet need (both geographically and in
terms of service provision) which could be responded to via applications to the preventative services market development board
The preventative services market development board provides funding for community based initiatives which will promote wellbeing and prevent
needs for care and support. The project has been successful in attracting additional funding into the area, and in achieving a credible social return
on investment. It has supported the creation of cost effective services with a universal offering which in turn contribute to a diverse market place,
offering users increased choice and control.
In addition to the above specific examples, the CCG and council are working together to further develop the Care Act’s vision of integration and
cooperation, via for example, specific initiatives which will –
•
•
•
Improve coordination of information and advice
Improve liaison between children and adult services
Improve liaison between public health and wider services.
Evidence base supporting the case for change
The issues that the BCF will be used to address in the local area
In NEL there is increased demand for local health and care services due to an ageing population, higher than average deprivation levels and increasing
numbers of people with long term conditions. In addition, a projected financial deficit of £104m by 2020 in health and care organisations operating in North
and North East Lincolnshire, and key skills shortages within the health and social care economy underpins the HLHF case for change
The programme is committed to improving the quality of care and outcomes for local people, balanced with the need to ensure service sustainability and
affordability for the future. The delivery of an enhanced out of hospital model which enabled health and care professionals to provide more joined up
services closer to people’s homes and communities forms the basis of the system wide model of care.
BCF will support the delivery of the HLHF vision in:
•
Enabling providers to deliver a comprehensive service from supporting prevention and self-care through community based care to specialist and
tertiary care
9
Page 47
•
•
Providers taking an integrated approach so that people have access to a seamless services
Producing higher quality care and affordable services.
Identification of the opportunity to improve quality and reduce costs, based on segmented risk stratification
The North East Lincolnshire population presents with a significant gap in life expectancy between North East Lincolnshire and those born elsewhere in
England, and there is a gap in life expectancy within the borough between the most and least deprived communities. There is a higher risk of death from
preventable causes when compared to other parts of the country, specifically deaths from heart disease are 16 percent more likely in North East
Lincolnshire when compared to the England average; Mortality from cancers are 11 per cent higher than the England average. The area is set to have a
higher than average proportion of its population aged over 65 as a result of greater life expectancy; however the population will also have a greater
population of frail elderly people, as a result of the reduced level of disability free life expectancy. This is fully documented within the JSNA and within the
HLHF case for change documents.
Older and frail elderly patients typically require more health and social care for conditions such as dementia and often present with multiple co-morbidities.
BCF will help us to:
•
•
•
Improve our preventative service offer
Enhance re-ablement and ensure resettlement following hospital admission or individual crisis episodes
Reducing unplanned hospital admissions through a range of initiatives designed to offer care and support closer to home.
How integration will be used to improve the issues identified
North East Lincolnshire Council and North East Lincolnshire CCG have historically worked together to deliver an integrated system for health and social care
since 2007 and so as authorities we are starting at a very different point from other areas.
As described earlier the aims of the Better Care Fund are reflective of our own aim to invest in further integration. Further integration will help us to shift
the emphasis and activity away from hospital settings by investing further in a tier of intermediate and community care pathways. It is also anticipated that
further integration will create efficiencies, and improve cooperation and coordination across the system, which in turn will improve patient/ service user
experience.
10
Page 48
Our vision is to deliver the right care, in the right place, by the right people, as close to home as possible, releasing the capacity and innovation which exists
within our community to promote healthy living, self-care and prevention. The HLHF programme has helped us to work across the Northern Lincolnshire
health and care system to develop new approaches and learn from new practice that is emerging.
Data that supports the case for change, including quantifying levels of unmet need, issues of service quality, and inefficiencies in service delivery
The CCG’s business intelligence underpins the case for change and commissioning intentions identifying areas where the area is an outlier in terms of
quality and service delivery as well as cost and inefficiencies. This includes the JSNA as a tool for identifying unmet need. The NEL joint adult social care
strategy referred to earlier identifies levels of need and eligibility for services; we have also develop a market position statement and commissioning
priorities that will enable us to shape the care market locally. We described in the NEL joint adult social care strategy our transformational approach which
is built upon on going service development and review, a focus on prevention, a willingness to explore alternative service delivery models which deliver
better value for money and raising income through reviewing fees and charges.
A coordinated and integrated plan of action for delivering that change
Specifics of the overarching governance and accountability structures in place locally to support integrated care
All schemes are monitored via either:
a) usual contractual processes (e.g. Just Checking which is monitored via the domiciliary care contract; invoice claims against the Just Checking budget must
be supported by an additional report with case studies for monitoring purposes. Current domiciliary contracts, of which Just Checking is a part, were retendered with community involvement in tender process)
b) its own management mechanism (e.g. the Extra Care Housing steering group, which monitors and reports on progress, and has commissioned an
independent report into its activities to date).
In addition, each scheme is managed by an individual lead. Each lead creates a high level report for the BCF lead each month; this presents an opportunity
for clarification and challenge. In the preceding year, the BCF lead provided monthly reports to the Partnership Operational Group (comprising senior
members of the CCG and Council) to provide oversight and assurance. This group has been key to developing NEL’s wider integration strategy (i.e. within
and outside of the confines of BCF). The remit and approach of the group is being reviewed to reflect new joint management arrangements between the
council and the CCG. Periodic reports to the Health and Wellbeing Board are planned. The terms of reference for the Partnership Operational Group were
11
Page 49
attached to our previous BCF plan, which sets out the former governance and accountability structures. New arrangements are to be put in place to govern
the BCF programme in the light of recent changes.
Our previous BCF plan has been subject to an internal audit, and found to offer ‘significant assurance’. The involvement of audit will continue until
completion of BCF requirements.
In addition to the above, NEL has an integrated management structure:
•
•
•
•
•
•
The DASS role is now delivered by a senior member of the CCG who leads across health and social care on behalf of the CCG and Council
The Council’s assistant director of adult services and health Improvement is a joint appointee of the CCG and Council, and line manages a number
of staff responsible for delivering BCF schemes, including the BCF lead
The director of children’s services (DCS) is supported by the CCG’s assistant director for children’s commissioning, working together via the joint
children’s partnership board
The director of public health continues to have a role in supporting both the council and CCG in developing joined up commissioning plans
The council and CCG are developing joint commissioning approaches across the full spectrum of health and social care activity as part of the
ongoing journey towards full integration
The council has three elected members on the CCG’s partnership board.
Arrangements in place to support joint working
NEL has a long history of integrated working supports a culture of joint working, supported by a section 75 for health and Social care. This has been further
enhanced recently by the creation of a number of joint roles across the council and CCG, including roles at a senior executive level. The CCG and Council
have agreed joint strategic outcomes for the area, and are developing plans to ensure delivery of these outcomes across the system.
At an operational level the providers are working together to develop and deliver integrated services for individuals. A multi-agency board has been
developed to support the delivery of the areas single point of access (SPA). The organisations involved have worked together to enable co-location of staff
to a single point to enable shared learning and development and has recently appointed an overarching manager who will assume the management of the
total team, regardless of their employer. Work is also progressing to further develop the intermediate tier, urgent & crisis care services and integrated
discharge processes All of these arrangements provide governance and accountability structures to support joint accountability.
12
Page 50
On-going discussions are taking place in the locality as part of the work of the Healthy Lives Healthy Futures programme as to the most appropriate model
for delivering integrated health and social care both within North East Lincolnshire, the wider Northern Lincolnshire footprint and the STP footprint.
Partners are working together to articulate a new accountable care system which will ensure better utilisation of resources to deliver shared health
outcomes, improved quality and sustainable services.
Key milestones associated with delivery of the plan of action
See attached action plan, created via a programme management tool called Covalent. The use of Covalent as a management and monitoring tool was
referenced in our previous BCF plan.
Risk log with evidence that it has been developed in partnership with all stakeholders and a description of how risks will be managed operationally
Each scheme has its own risk log – see attached PIDs. Risk logs are monitored via:
a) Usual contractual processes (e.g. the Assisted Living Centre (ALC), the risk log for which was developed with the involvement of the ALC Steering Group
and Board. Since its launch in 2015, the ALC – including risks - has been monitored via its service specification)
b) Its own management mechanism (e.g. the SPA Board, which is responsible for the on-going development and expansion of the SPA vision).
Where risks appear to be escalating these are challenged via contract monitoring and/ or via the scheme lead. Where appropriate, risks are highlighted by
the BCF lead via line management and/ or drawn to the attention of senior management, and the Health and Wellbeing Board. The CCG’s corporate risk
register also contains an overarching BCF risk. The risk register within the previous BCF plan has been refreshed and is attached.
The level at which strategic issues will be dealt with within structures
Strategic issues have historically been managed via the Partnership Operational Group but this will now be embedded as part of the routine management
via the joint management team arrangements.
Diagrams to explain structures for decision making and governance
13
Page 51
Approach to financial risk sharing and contingency
£363k has been set aside to cover the risk of non-delivery of non-elective delivery reduction. At this stage the figure is an estimate.
A approach to risk sharing on NEAs and DToCs in line with national conditions 7 and 8 –
NEL’s approach to risk sharing is set out within its s75 agreement. The risk sharing arrangements established between the CCG and the local providers
(NLAG, LINCS, focus, NAViGO, Care Plus Group & Core Care Links Ltd) as part of the Healthy Lives Healthy Futures Programme will be used to support the
risks associated with non-delivery of BCF targets. This includes the establishment of a sustainability fund, alongside a transformation fund to support the
changes that need to be made to make the local care system sustainable in the longer term.
Risks associated with not meeting BCF targets in 2016/17
14
Page 52
The BCF schemes are an integral part of the wider partnership arrangements that the CCG has with NELC. The schemes are part of the savings plans the CCG
has in place for adult social care and as such non delivery of targets would impact on the delivery of savings.
Risk sharing arrangements in place in the health and social care system
The existing risk sharing arrangements already in place as part of the section 75 agreement between NELC and the CCG will be used for the BCF. The risk
sharing arrangements established between the CCG and the local providers as part of the Northern Lincolnshire memorandum of understanding will be
used to support the risk associated with the non- delivery of the target.
How CCG plans have been set and how these relate to BCF risk sharing arrangements
The finance plans are based on the schemes that were in place in 2015/16 and have been agreed as part of the partnership arrangements in place between
NELC and NELCCG
How any funds that are released will be spent
The schemes are already in place as they are a continuation of what was in place in 2015/16, as such all of the funding except the £363k contingency is fully
committed.
Plans to be Jointly Agreed
The Health and Wellbeing Board will review the draft BCF plan on 18th April 2016. It is aware that the intention for this year’s plan was likely to be the
continuation of schemes under the previous plan.
Engagement with Providers
As North East Lincolnshire has been working in an integrated way since 2007, the changes for providers represented by this year’s BCF plan are perhaps less
significant than for other areas which are newer to integration. All relevant providers are aware of the continuation of schemes this year. The greatest
areas of change are within the support to care homes and SPA, and these are the areas in which providers have been most heavily involved (i.e. in
developing future plans and approach). The support to care homes implementation group is a multi-disciplinary team including GPs, nurses, social workers,
mental health professionals, practice managers and commissioners and has developed the project plan and specification. Care home providers have been
kept updated and involved throughout the scheme’s development. Similarly the SPA Board comprises clinical staff, commissioners, representatives from
15
Page 53
the community and all key providers (e.g. focus, Care Plus Group, Navigo, NLaG, Core Care Links, Yarborough and Clee Care, primary care). The Board will
continue to develop the SPA vision and plan with the newly appointed manager. This level of involvement seeks to provide a ‘doing with’ rather than a
‘doing to’ commissioning approach, which is more likely to secure the ‘buy in’ of those on which the schemes depend to deliver high quality services and
positive outcomes.
Implications for local providers have been set out clearly for HWBs
The HLHF programme brings together all local providers and commissioners, representing a forum in which collaboration is key to delivering system change.
Over the past year the partnership has been working to develop a system wide plan to reduce the financial gap and to achieve both quality improvements
and improved outcomes for service users. Health and wellbeing board chairs for both North and North East Lincolnshire are present on the programme
board and there are regular updates to each board area. BCF schemes contribute to the delivery of the HLHF programme outcomes at each locality level;
the HLHF operational group is the forum in which all providers and service leads come together to plan, manage delivery and risks associated with their
respective programmes.
Disabled Facilities Grant (DFG) allocation
The council and CCG have recently entered into a joint management arrangement which will offer both organisation greater oversight of adult services and
related, preventative services, traditionally delivered by the council. There is a commitment to the transfer of the DFG allocation. Through these revitalised
management arrangements it will be possible to ensure greater co-ordination of services and functions, of which strategic housing is a part, and is integral
to supporting people to live at home and within their communities. The joint adult services lead has been actively engaged with supporting the better
management of disabled facilities grants to ensure that swift and effective support is in place to facilitate discharge from hospital, or reduce an unnecessary
call on packages of care. Our adult services lead provides oversight of some housing funding and the assisted living centre in this way we are able to
coordinate the delivery of all activities relating to housing adaptations.
Joint agreement across commissioners and providers as to how the BCF will contribute to a longer term strategic plan
The BCF plan has been shared with partners and as described earlier is very much a part of the wider infrastructure to deliver sustainable services across
Northern Lincolnshire via the HLHF programme
An assessment of future capacity and workforce requirements across the system has been undertaken
16
Page 54
As part of the HLHF programme a comprehensive assessment of wider workforce issues has been carried out and a strategic approach is in development
which will try to address not only issues in relation to skills shortage, but a forward agenda which maximises the skill mix, ensures that cultural issues
around integration can be addressed and the workforce is orientated around supporting clients and patents to live well and independently wherever
possible. NELCCG has been affected by difficulties in recruiting GP vacancies and practice nurse posts. A number of initiatives have been invested in to
support recruitment and also to develop alternative roles to support GP capacity.
Maintain Provision of Social Care Services
Local adult social care services will continue to be supported within BCF plans in a manner consistent with 2015-16
We have reviewed the answer we gave at 7b), page 27-29 of our previous BCF bid and would re-endorse the statements therein. There have been some
high level amendments (e.g. the Priorities Framework must now be viewed in conjunction with the Care Act’s eligibility criteria) but the intentions we set
out previously remain equally relevant. All schemes which formed part of our previous BCF plan are continuing. Any changes in approach in the intervening
period have been informed by analysis of what is or is not working (in terms of delivering value for money, quality services and positive outcomes).
Irrespective of operational changes in approach, services continue to be supported in a manner consistent with 2015/16.
The council has implemented the local increase in council tax to facilitate the delivery of sustainable adult services, specifically with a view to addressing the
new minimum wage requirements. The council has also reviewed its charging policies to ensure that resources can be used deployed to those who most
need support.
Definition of support has been agreed locally and, as a minimum, maintains in real terms the level of protection as provided through the mandated
minimum element of local BCF agreements of 2015-16
The working definition remains that which was set out in our previous BCF plan:
“Protecting the most vulnerable through integration of services and pathways, effective management of demand and investment in prevention”.
Our adult social care strategy sets out the key challenges facing adult social care in the face of on-going financial restraint within local government and
details the ways in which we aim to mitigate the effects of financial reductions. We believe that our model of integration enables us to explore
opportunities to do things differently, deliver person centred care whilst at the same time delivering efficiencies. We recognise that we now need to
accelerate the pace of change and be more ambitious if we are to continue to meet the needs of the most vulnerable and remain in a financially sustainable
17
Page 55
position. In part this approach is based on involving communities and service users and defining new and imaginative responses to the needs presenting.
Where practicable we are helping communities to play a greater role in supporting people, to alleviate the pressure on traditional, statutory services.
The approach and figures set out in 2015-16 plans will be the same for the current year and is consistent with the 2012 Department of Health guidance to
NHS England on the funding transfer from the NHS to social care in 2013-14. The schemes are part of the NEL adult social care strategy. Further details are
contained within each scheme
How local demographic change will impact upon social care
An analysis of the 2011 census data has underpinned our adult social care strategy and transformation principles which will enable us to manage demand.
This indicates:
•
•
•
•
A marginal increase in the number of people over the age of 65 compared to 2001 census (31,500 compared to 31,100)
The increase in 2015 is accounted for entirely within the 65-74 age group with no increase in the over 75s
It is anticipated that there will be a slight reduction in the number of people over the age of 75 when compared with 2001 census forecasts.
The growth from 2015-2018 in the older population is still in line with previous estimates and is represented below:
 A 3.6 per cent increase in the total population over the age of 65
 A 7.1 per cent increased in the total population over the age of 85
 A 5.9 per cent increase in the total population expected to be frail over the age of 65
 A 7.0 per cent increase in the number of people with dementia
 A 9.2 per cent increased in the number of people with severe dementia
£440k has been set aside within the BCF for the implementation of the Care Act, which is the same as the previous year.
What the requirements of the Care Act mean in terms of changes to the delivery of local services
Key changes within the Care Act which are relevant to all BCF projects include –
•
Primary focus on wellbeing and prevention; numerous providers have been supported to consider how promotion of wellbeing might apply in their
context/ setting, and specifications have been updated to reflect new requirements. Refreshed strategies (e.g. the Housing Strategy) have been
reviewed to ensure that consideration of wellbeing and prevention is core to future planning
18
Page 56
•
•
•
•
A reinvigorated approach to coordination of information and advice (in development); will involve all providers and straddle delivery of all BCF
projects (as well as non-BCF projects, such as our developing Social Prescribing Initiative). The importance of information, advice and signposting
has been reflected in revised specifications. On-going work with providers will dictate further changes to ensure a genuinely coherent system
Assessment and support planning paperwork has been revised and trialled across providers with the involvement of the council’s transitions team.
The advocacy service has been re-tendered (with community involvement) and re-launched to offer a coherent and comprehensive advocacy
service.
Partnerships; the CCG and council are reviewing their existing relationship with a view to even greater cooperation and integration. The integrated
management structure referred to earlier is part of this, along with the joint initiatives mentioned (e.g. increased working between children and
adult services/ transitions’ team). The way in which these core partners interact with wider partners is also being considered, with a view to
securing greater coordination and efficiencies in delivery. This will include a refresh of the current health and social care Market Position
Statement, setting out our local vision for services.
A single officer led the Care Act implementation and the BCF programme ensuring links between the two.
As a result of longstanding partnership working, North East Lincolnshire has an early advantage in delivering on the integrated vision set out within the Care
Act having. Each BCF scheme includes elements of integrated care, which are reflective of the area’s wider integration agenda. Processes, policies and
procedures were reviewed in the lead up to implementation of the Care Act, and have continued to be in the period since implementation, as more lessons
are learned. It is the on-going review of our processes, policies and procedures which underpins our work on integration. The issues highlighted by the
impending report ‘The Care Act: one year on’ in development by the Care Act Implementation Manager/ BCF lead, will highlight opportunities for greater
partnership working and inform our further integration planning.
Specific support to improve outcomes for Carers
No specific monies have been earmarked for additional carers’ support services. We have a joint health and social care budget which is used innovatively to
provide dedicated carers’ support.
All Carers’ services were reviewed to ensure Care Act compliance and are appropriate to meet local need. Carers’ services in NEL for some time have been
led by carers, who were included in recruitment, tendering, reviewing and monitoring of all services commissioned. Carers’ services are delivered against
the required specifications. We continue to review services to identify improvements and additional ideas for innovative best practice.
Services being commissioned for carers included the:
19
Page 57
-
NEL carers’ support service (advice, information, specialist benefits advice, advocacy, support groups, befriending, counselling, holistic therapies,
social activities, training, lifelong learning fund, carer case workers and a specialist substance misuse carers support worker).
Carers support worker services
Alzheimer’s Society – Carers’ support
Carers’ Breaks –sitting and respite services, summer scheme for carers of those with learning disability during college holidays, social activities
across the year.
Carers’ emergency alert card scheme including carer discounts on production of the card at local businesses and services
All of the above services offer a robust range of services to meet local carer needs; many of these services are open to all carers as universal prevention and
wellbeing services to ensure wherever possible the impact of caring is reduced or delayed and carers are supported to maintain their caring role while
having a life of their own. Carers are offered the opportunity to evaluate services to establish whether outcomes have been met, satisfaction levels,
improvements/ gaps and also how the services have supported Carers to maintain their caring role. Carers continue to report that their outcomes are being
met by these services with high levels of satisfaction.
7-day services across H&SC to prevent unnecessary non-elective (physical and mental health) admissions
There are a number of service areas where 7 day services are already in operation, including:
•
•
•
Community nursing (adults and paediatric)
Crisis response services
Single point of access (SPA)
However, there is more work to do in refining the scope of the services available and ensuring that the available capacity meets 24/7 need. In particular,
the responsiveness of adult social care, domiciliary care and residential care to support weekend discharges needs to be considered.
There is already a GP out of hours’ service which ensures that urgent care is available 24/7. Extended hours general practice access up to 8 pm on weekdays
is available for 93% of the population and there is a local pilot covering half of the population which is testing out a model for 7 day access to general
practice. GP input into the SPA is also partially in place, but not yet 24/7. There is further work to do during 2016/17 to develop the strategy and refine the
implementation plan for full general practice 7 day access by 2020. Within 16/17 we will:
-
Agree the strategy with stakeholders, including the public
20
Page 58
-
Work with the local stakeholders and review the evidence available to understand more about requirements for planned general practice at
weekends
Learn from the local pilot of 7 day working and develop a specification for 7 day general practice, to begin implementation from 1st September 2016
Refine the requirements for GP input into the wider urgent care model, including out of hours home visits and GP support to clinical advice hub
Establish a minor ailments scheme within Pharmacies, to support access across 7 days.
The home from home service operates 24 hours a day 7 days a week to manage the acute episodes for patients with confusion and dementia, including
appropriate discharge planning. There is further work to do in-year to establish how the existing mental health services align with the community crisis
response model, and how the response can be improved for acute discharges over the weekend (non-confusion/dementia). An overarching 7 day plan,
which captures all of the elements of the service (existing and planned), will be developed during 2016/17.
Preventing unnecessary non-elective admissions (physical and mental health) 7 days a week
The CCG has a plan for the development of an out of hospital urgent care infrastructure, which will support the prevention of unnecessary non-elective
admissions. The existing elements of the single point of access (SPA) and community crisis response already operate over 7 days; further detailed planning
will take place in-year to ensure:
-
greater integration with mental health
Capacity, demand and workforce planning of the crisis response service to ensure it can meet the response targets of 1 hour, 24/7.
A clinical advice hub, specifically for health and care professionals, will provide real-time advice to support alternatives to hospital admission.
Integration with NHS 111 is already in place, and further work is planned to support 999 ‘green’ dispositions and to increase the GP support forcrisis
response for 999 on the scene responses. This is a workstream of the SPA development and is primarily designed to prevent the need to convey to
hospital.
We are is developing a more integrated, urgent care response at the ‘front door’ of the hospital, to deal more effectively with those patients that selfpresent or are conveyed to the hospital. This will include the paediatric assessment unit, medical assessment unit, end of life team, minor injuries element
of A&E, GP advice, community crisis response (including adult social care); the focus being on seeing and treating (including the ambulatory care model) and
ensuring appropriate arrangements are put in place to support individuals at home in a timely manner. Some elements still require more detailed plans and
timescales to be developed. The CCG is holding a series of events starting w/c 21st March 2016 to firm up these plans.
Supporting the timely discharge of patients, from acute physical and mental health settings, on every day of the week
21
Page 59
Driven by the System Resilience Group’s (SRG) 8 high impact initiative targets, there are clear targets for weekend discharge rates, compared to weekly
average rates (7 day discharges with weekend discharges at 80% of weekday rate). The 7 day working plan to achieve this is included within the five
priorities for transforming discharge planning:
•
A SPA accessible discharge hub is required that is a single point of access for Diana Princess of Wales (DPoW) operations and is accountable for the
organisation and timely establishment of the onward care needs of complex discharges – this will transform the current default operational ownership
and the associated processes
•
All provider approach to “Assess from Admission”
o
review & estimated date of discharge (EDD)
o
morning focused process to secure bed base for new admissions
o
weekend process to secure higher weekend discharge rates
o
relevant multi-disciplinary team working towards EDD
o
due reference to the DToC definitions and charging legislations to ensure agreed processes meet the requirements
•
Information & advice on discharge
•
Contract/service alignment such that assessment/service start is planned at EDD
•
Services to support discharge
o
Intermediate Tier service development – integrated all service step down/rehab, Discharge to assess ( bed & home supported by enhanced
home care )
o
housing, equipment, out of area, end of life
Delivery plan for the move to 7-day services including key milestones and priority actions for 2016-17
22
Page 60
The detailed plan for DToC is currently under development. Where services are already in the process of being implemented, there are delivery plans in
place which include key milestones and priority actions for 2016/17. As stated above, there is also a need to develop an overarching 7 day plan which
encompasses all of the various work streams that are have been established to develop and deliver 7 day working. This is a priority for 2016/17.
Local partners will work together to ensure that NHS providers meet the milestones for inclusion of the Clinical Standards for 7DS in 2014/15, 2015/16
and 2016/17
As outlined earlier we are working collaboratively with our partners through the HLHF programme to ensure the delivery of safe, quality and sustainable
services.
Better data sharing between H&SC based on NHS number
The health community recognises that it is important that all staff are fully empowered to support data sharing between care settings. To support this:
•
•
•
All staff are required to attend mandatory information governance training, explaining to them the fundamental principles of data sharing and
their associated responsibilities.
Through staff briefings all care or service user facing staff have a clear understanding for their responsibility in regards to the data sharing
consent model.
Electronic care systems have been configured to support and guide staff in appropriate data sharing.
The NHS Number is being used as the consistent identifier for health and care services
The wider Health Community within North East Lincolnshire recognises the importance of the use of a standard identifier across care settings. To ensure a
standard identifier is used, all local Social and Health Care systems within the locality use the NHS number as a mandatory field, providing a consistent field
utilised across all care providers.
Interoperable Application Programming Interfaces (APIs) are being perused
The wider care community is working towards implementing its agreed digital road map which outlines a joint approach to delivering a joined up care
service which aimed to be paper free at the point of care by 2020. This will require electronic systems to be appropriately implemented, where consent
allows, to facilitate real time sharing of all care records. In addition, in order to support extended hours and community based services, the health
23
Page 61
community is committed to providing shared access to records within wide ranging care settings, in order to facilitate this, a number of initiatives have
been completed or are underway:
•
The local adult social care providers, the majority of local primary care providers and the community care providers all use the SystmOne
Clinical System, allowing for an electronic shared health record.
The implementation of a summary care record (SCR) with additional information, allowing a service user the choice of sharing a view of a significantly wider
scope of information to all systems with SCR functionality. At a wider national level Interoperability between the two main primary care systems is being
developed to allow implement ‘click through’ data sharing functionality. It is expected that this functionality will become available from November. Other
providers are working directly with clinical system providers to ensure that data sharing is provided at API level. The local acute trust has a sharable view of
their electronic record available using a standard web interface. Roll out is expected to be completed by October 2016. The local acute trust is also
expecting to have interoperability with their EPR and Primary Care Systems by April 2017, although this time scale has yet to be confirmed by the suppliers.
Appropriate Information Governance controls are in place for information sharing in line with the revised Caldicott principles
To ensure that all partner organisations meet the correct governance standards, all providers have completed their IG Toolkit Level 2, which is the
recognised national standard ensuring that appropriate governance controls are in place within any organisation.
Local people have clarity about how data about them is used, who may have access and how they can exercise their legal rights
To ensure that the citizens are empowered to make an informed choice on whether they want to allow their record to be shared, a number of key
processes have taken place including:
• Writing to affected service users
• Visual advertising campaigns, e.g. use of posters & leaflets in strategic locations.
• Articles in the local media
• Direct conversation with service users at point of care or entry into the care system. For some open public access points this is scripted to ensure a
consistent and accurate message
Demonstrate how these changes will impact upon the integration of services
24
Page 62
The majority of service users requiring care within the locality are appropriately informed to be able to make decisions about how their data is shared with
care providers.
Progress made in adopting open APIs and open Standards
All Primary Care systems are obliged, through the national GPSoC framework, to use Open API’s and Standards as interoperability mechanisms, this is in
place now and agreements are being utilised to provided cross system communication. Non-GPSoC providers of local systems have also entered into wider
discussions to provide connectivity. Please also see answer above on interfaces
The Digital Road Map outlines a joint approach to delivering a joined up care service which is paper free at the point of care by 2020. This will require
electronic systems to be appropriately implemented, where consent allows, to facilitate real time sharing of all care records.
All Commissioners and major providers have signed up to the principles required to deliver the requirement outlined in the agreed Digital Roadmap.
All care providers are expected to continue renew their IG Toolkit Level 2 and are expected to have appropriate data sharing in place.
Joint approach to assessments and care planning and where funding is used for integrated packages of care, there is an accountable professional
All individuals across NEL who have significant health or social care needs have a named worker who acts as the case manager to coordinate the individual’s
health and social care needs. Dementia services as an important priority for better integrated health and social care services.
Consultation on the local dementia vision, strategy and action plan has just been completed. The final documentation is currently being progressed for
approval. The dementia steering group will lead on this Vision throughout 2016/17 to ensure all national requirements/ targets are achieved as well as
meeting local need. The action plan focuses on 7 key areas including;
•
•
•
•
•
•
•
Raising awareness & understanding
Advice, information & guidance
Timely diagnosis & effective post diagnostic support
End of life care
Carers’ support
Skilled, knowledgeable and effective workforce
Inclusion in service design, delivery & monitoring
25
Page 63
The action plan includes a review of the dementia pathway, which clearly maps health, social care and voluntary sector input throughout the dementia
journey, the processes and referral routes. The pathway includes the need to ensure that early diagnosis is a priority as well as ensure a full and wide range
of post diagnosis services are available to support those with dementia and their carers including the provision of admiral nurses, dementia advisors and
specialist mental health support services.
Joint process to assesses and plan for care are in place
At an operational level the providers are working together to develop and deliver integrated services for individuals. A multiagency board has been
developed to support the delivery of the area’s single point of access (SPA). The organisations involved have worked together to enable co-location of staff
to a single point to enable shared learning and development and has recently appointed an overarching manager who will assume the management of the
total team, regardless of their employer. The development of the new assessment tool and support plan described earlier has presented opportunities for
joint assessment and support planning. This is at an early stage.
A multi-agency discharge team has been successful in promoting better outcomes and shorter hospital stays for stroke patients expanding the work of the
hospital in-reach team, this will provide greater opportunity for joint assessments and support plans. The use of the integrated care record assists in
enabling joint assessment and support planning to be developed. A new initiative is also to commence in April 2016 to support clients in residential homes.
This will use a multi-disciplinary core team approach (including a GP) to assess and meet the on-going needs of individuals.
Overcoming barriers to joint working
Due to the nature of the section 75 agreement for health and social care close work already takes place with many aspects of decision making and as a
consequence some barriers have been removed. This has recently been further enhanced by the creation of a number of joint roles across the council and
CCG described earlier.
At an operational level the single point of access (SPA) organisations involved have worked together to enable co-location of staff to a single point to enable
shared learning and development and has recently appointed an overarching manager who will assume the management of the total team, regardless of
their employer. The use of the of integrated care record over the past three years has overcome barriers to joint working. With the consent of the
individual both health and social care records can be viewed to assist professionals in identify appropriate provision.Work is also progressing to further
develop the intermediate tier, urgent & crisis care services and integrated discharge processes. Social care staff are co-located in primary care centres in
close proximity to the district nursing staff to assist in managing long term case management. A joint funding policy is in place to provide appropriate
support to individuals who have both substantial health and social care needs and such cases are agreed at a multi -agency decision forum.
26
Page 64
The role of accountable lead professional
The accountable lead professional will co-ordinate all aspects of the individual’s health and care needs to ensure a seamless and timely response at time of
need. This person will be a health professional where the individual has health needs outweighing social care needs and a social care professional where
social needs are greater. They will be the first point of contact and be responsible for good clear communication across the individual’s support network
and to ensure the individual is central to the decision making process. A duty system is in operation for times when the key contact person is absent but
with the use of the integrated care record, information is available (subject to consent by the individual) for both health and social care professionals to
view. The SPA will be the first point of access out of hours access to integrated care record are available.
GPs will be supported in being accountable for co-ordinating patient centred care for older people and those with complex needs
GPs are key to delivery of the support to care homes & those with multiple long term conditions project, which focuses on all those residing within care
home and those with multiple long term conditions living in the community. This scheme relies on GP input into the multi-disciplinary team; Each team will
include (as a minimum) input from the patients GP, nurses, social workers, mental health specialists, Occupational and Physiotherapists and the
mobilisation of a wider network of health and social care professionals including Speech and Language Therapists, Admiral Nurses, Pharmacists and the
third sector which will wrap around the individual in accordance with scheme requirements
The MDT will ensure that all individuals are appropriately supported to ensure their health and wellbeing needs are met. This includes assessments, ongoing reviewing and effective care planning as required. It will engage in a programme of training and development to maintain the skills and competencies
of the staff involved in the delivery of the service. This will include all mandatory and statutory training, continuing professional development and any other
relevant training, including training which is condition specific e.g. dementia awareness, Carers’ awareness. The programme of training, supplemented by
contribution from the MDT and wider team’s expertise, is designed to ensure that GPs feel supported in being accountable for co-ordinating their patients’
care.
The impact of systems for people with Dementia and mental health problems
There is dedicated assessment provision for those with dementia and mental health problems. In focus Independent adult social work there are two
specialist dementia practitioners who work closely with those with dementia and their Carers and with the specialist dementia services across NEL to
ensure robust assessment, care planning and review is carried out for those with dementia and their carers. NAViGO mental health social enterprise deliver
integrated mental health and adult social care needs assessments for those with functional mental health problems. In addition we have a dedicated carers
27
Page 65
mental health assessment worker who ensures Carers’ needs and wishes form part of the service user assessment; where necessary this worker will also
undertake a dedicated Carers assessment.
Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans
All of this year’s BCF schemes are a continuation of last year’s work building on our long term strategy for integrated delivery will be;
•
•
•
Additional staff resources to deliver 7 day working projects. These have been agreed in consultation with local professionals (see for example the
first phase of extended GP working, which has been adopted by a collaborative of GPs working together)
The support to care homes scheme represents a significant change to the way in which professionals have traditionally interacted with care homes
and their residents. The scheme’s vision, model and implementation plan was developed by an implementation group which includes a range of
professionals. Presentations and regular updates on the scheme have been offered to care home providers, many of whom welcome the
opportunity to work more effectively with other external professionals
The SPA Board comprises clinical staff, commissioners, representatives from the community and all key providers (e.g. focus, Care Plus Group,
Navigo, NLaG, Core Care Links, Yarborough and Clee Care, primary care). The board will continue to develop the SPA vision and forward plan with
the newly appointed manager.
Public and patient and service user engagement in this planning, as well as plans for political buy-in
Each of the BCF schemes has some level of community/ patient/ service user involvement either in the on-going management and monitoring, or in the
inception and launch of a new scheme. The majority of the schemes include their own communications plans. The CCG’s commissioning intentions for 2016
onwards (which includes health and social care) are being launched at a public engagement event in March 2016. An engagement plan, developed in
cooperation between the CCG and the Council, will deliver activities across the coming year.
The health and wellbeing board received a report on progress for BCF in the year ending March 2016, and is poised to receive further updates at the next
board meeting. The board is aware of the outline of the coming year’s plans, and the portfolio holder has also been kept updated. In the lead up to
implementation of the Care Act 2014, elected members were engaged in a series of information and discussion sessions. The principles within the Care Act,
most notably in respect of integration and cooperation, underpin the BCF and provide its legislative foundation. Awareness of these principles formed part
of members’ briefings.
Demonstrate that the plan aligns to provider plans and the longer term vision for sustainable services
28
Page 66
As described earlier, all local commissioners have signed up via a memorandum of understanding to working as whole system to deliver better quality
sustainable services and a system plan was jointly developed in December 2015. Since then partners have been working towards an agreement to create an
accountable care system in Northern Lincolnshire, which will have a place based focus and will be capable of creating collaboration across footprints. Our
BCF plan is entirely consistent the HLHF programme in joint partnership to plan and deliver a sustainable system.
Demonstrate that mental and physical health are considered equal, and plans aim to ensure these are better integrated with one another, as well as
with other services such as social care
Within the adult social care strategy we articulate our ambition for parity of esteem in relation to physical and mental health social care services. We have
adopted the 6 principles of ‘no health with mental health’ within our health and wellbeing implementation plan. Our BCF plans show that our assess
processes are well designed to take account of the full range of clients’ needs. Through BCF we have also demonstrated that we are focussing on the
specific needs of individuals’ presentation with either mental health issues, confusion or dementia symptoms.
Clear alignment between the overarching BCF plan, CCG Operating Plans, and the provider plans
As described earlier we have worked with our commissioners and provider partners to establish a system wide plan via the HLHF programme; our STP, CCC
plans and BCF plans are all congruent with the wider vision and the system. We have developed a memorandum of understanding which facilitates the
starting date, including financial plans between commissioners and providers. In this way we can optimise resource, co-ordinate our activity and avoid cost
shunting between organisations.
Reassurance that any projected reductions in planned emergency activity are feasible
The HLHF plan schemes form the basis for emergency activity reductions and have been modelled on the basis of identifying ‘avoidable emergency
admissions’. The HLHF governance structure includes groups that have focused on this modelling and the feasibility of its phasing over coming years with
the addition that these assumptions have been further tested with the CCGs Council of Members
Confirmation that this provider is implementing their own risk management and action plans to respond to any planned change in activity
Planned changes to activity for any provider will be part of the central planning and oversight of the SRG. Variation from planned activity that occurs during
improvement implementation will be managed as a risk and risk response to progress and this will require providers own risk management and action plans
as well as the risks and risk responses that are shared, managed and overseen by the SRG.
29
Page 67
Demonstrate a shared understanding of the critical path to successful delivery
SRG oversight of capacity and demand planning is on the basis of provider collaboration across the whole system. The critical path to successful delivery is
that each part of the system is improved together with shared outcomes rather than small pieces of the system being improved in isolated areas.
Local risks and how these are being managed / shared
Local risks are demand and capacity based, particularly 7 day working and resilience and collaborative working based where joint working on effective
improvement will require improvement of service that is sustainable. The risks of these types will be shared and managed through the oversight of the
SRG.
Agreement to invest in NHS commissioned out of hospital services, which may include a wide range of services including social care
The schemes in place were agreed in 15 16 and are in line with the national conditions guidance. We can confirm that this is clearly set out in the summary
and the expenditure plan tabs of the BCF planning return template
Local risk sharing arrangements
A local risk sharing agreement ins in place as part of the section 75 agreement describe earlier. The £363k contingency funding has been reduced from 15/
16 to reflect the risk sharing arrangement under the MOU that we have in place in Northern Lincolnshire.
NHS commissioned out-of-hospital services and services that were previously paid for from funding made available as a result of achieving their nonelective ambition, continue in a manner consistent with 15-16
Not applicable as we did not achieve our planned reduction in non-elective activity in 2015 16.
The value of NHS Commissioned Out of Hospital Services in 2015-16, compared to plans for 2016-17
This is analysed in the BCF template
Impact of any changes to the level of investment in NHS Commissioned out of hospital services
No material changes as schemes have rolled forward from 15 16
30
Page 68
P4P performance in 2015-16 and how this has been used to drive the local decision on how to use this portion of the fund
The £0.5 million contingency in 2015/ 16 had to be used to fund non elective activity as we did not achieve our planned reduction in activity in 2015/16. The
schemes have remained unchanged for 16 17 as they are felt to be key building blocks in the HLHF.
Local action plan to reduce delayed transfers of care (DTOC)
DToCs have been under scrutiny for two years in terms of:•
•
•
•
•
•
•
How the CCG performs within the national DToC reporting framework
What are the onward care pathways that contribute to the most DToCs
What are the process issues contributing to DToCs
How to build on the integrated working to secure further reductions in DToCs
The guidance, best practice and requirements of The Care Act, BCF etc.
Locally driven plans for service reconfiguration to reduce DToCs.
Resilience planning
This has contributed to the development of a plan for further transforming discharge planning and onward care which forms part of the overall
commissioning intentions for the out of hospital urgent care system and resilience. This broad plan will take and build on existing provider led work streams
on DToC management over the transformation period of 2 years and focus on the five priorities for transforming discharge planning and onward Care:•
A discharge hub is required that is a single point of access for DPoW operations and is accountable for the organisation and timely establishment of
the onward care needs of complex discharges – this will transform the associated processes
•
All provider approach to “assess from admission”
o
Acute - review & estimated Date of Discharge
o
Acute – morning focused process to secure bed base for new admissions
o
All – weekend process to secure higher weekend discharge rates
31
Page 69
o
All – relevant MDT working towards EDD
o
All – due reference to the DToC definitions and charging legislations to ensure agreed processes meet the requirements
•
Information & advice on discharge implementation of SRG review ref Care Act requirements
•
Contract/service alignment such that assessment/service start is planned at EDD not after
( Dom Care, Residential Care, ASC, Therapy, Home team )
•
Services
o
Intermediate Tier service development – integrated all service step down/rehab, Discharge to Assess ( bed & home supported by Enhanced
Home Care )
o
Housing, Equipment, Out of Area, EoL fastrack
Stretching local DTOC target -agreed between the CCG, Local Authority and relevant acute and community trusts
The locally agreed target that is being specified in CCG planning is to extend the annual DToC reduction trajectory by 3.5% (Total bed days – all Health &
Social Care attributable). The plan to deliver the target will be finalised with all providers to NEL SRG.
The plan is within the context of the System Resilience Group plan for improving patient flow the target is reflected in the CCG operational plans
The SRG and commissioning intentions recognise the importance of an overall system approach to performance through collaborative working. This means
that in addition to a focus on the desired Discharge Planning and onward care services plans to support a reduction in DToCs, there are also plans to reduce
avoidable admissions through the commissioning intentions of the Out of Hospital Urgent Care response and on overall resilience which are multi-agency.
Out of hospital urgent care response plans focus on the 3 main urgent care access points (Urgent GP request to own practice, urgent walk-in (not
emergency but currently going to A&E) and access via NHS111 and the NEL SPA). The community crisis response and the way it operates across all of these
access demands is being shaped to consider 24/7 working and any agreed variations of service in the traditional out of hours period. These community crisis
response plans focus on primary care and community service providers across all disciplines (Health, ASC, MH, EoL and Therapies etc.).
The development of an urgent care centre, collocated with A&E is also planned to provide the same level of community crisis response but also change the
assessment unit approach to ensure continuity of care and opportunity for an alternative to admission to be established in a primary care/community care
32
Page 70
setting with access to diagnostics and consultant advice. In hospital management will require improvements to consultant review for those admitted and
collaboration in implementing a process for estimated date of discharge and MDT discharge processes as part of the plan to assess from admission.
Hospital review will also need to support a higher level of weekend discharges.
The DToCs reduction target is one of the key outcomes of the overall transformation plan that considers patient flow and includes the out of hospital crisis
response (admission avoidance, attendance avoidance, and conveyance avoidance), urgent care centre (reducing A&E crowding) and transforming
discharge planning and onward care. The role of the urgent GP response is built into these elements including GP out of hours.
Local risk sharing agreements with respect to DTOC
As provider collaboration develops, risk sharing arrangements will be considered by NEL SRG/CCG though accountable care models described earlier reduce
the need to do this in future.
The detailed plans are reaching a stage of maturity through publication of the commissioning intentions and as oversight of these plans and others is
managed through the SRG where discussions and agreements will continue in the coming months. The SRG has representation from all relevant providers
and will be accountable for delivery and oversight of work streams, holding each to account, monitoring the overall DToCs performance trajectories and
other measures and assurances required by each work stream.
National guidance and best practice, including the eight ‘high impact interventions’ that were agreed by ECIP
The five priorities for transforming discharge planning are fully inclusive of national guidance and imperatives:-
Care Act ( Joint working, notifications and charging )
NHSE Guidance on best practice in discharge planning ( Joint working, Discharge to Assess )
NHS “Safer, Better, Faster” guidance on implementing Urgent & Emergency Care ( Intermediate Care, EDD, MDT and review process )
NHS Commissioning Standards for Integrated Urgent Care ( Admission Avoidance )
SRG 8 High Impact Interventions/7 day services (weekend and midday discharge targets)
The guidance has been interpreted in the local context of significant collaboration and joint working already in place.
Engagement with the independent and voluntary sector providers
33
Page 71
The NEL SRG has engaged with the local alliance of voluntary/independent providers and agreed that closer working and involvement in the design of home
based services is paramount. As a result, the SRG has invited the voluntary sector alliance to be represented permanently on the SRG and partake in the
relevant aspects of system transformation. The plans will require further input from the voluntary sector to secure additional home support for patients
being discharged.
Situation Analysis
Overall Performance
For the last two years, average overall performance has
been between the median and best quartile performance
however notable degraded performance on a month by
month basis occurs at times when the local health and
care system was under extreme pressure, notably Easter
2015 and the current winter period.
34
Page 72
On a year by year basis, NEL performance has improved since
2013/14 against a national worsening quartiles picture. The
following similar graphs split out those delays attributed to
adult social Care or NHS care and show that the balance and
movement to be the NHS attributable delays to require the
main focus for our improvement plans. These have worsened
against a backdrop of national improvement whereas adult
social care attributable delays have improved against a
backdrop of national worsening. Underlying monthly analysis
shows the NHS care performance to be a result of prevailing
pressure on the whole system.
35
Page 73
Current Schemes in place to reduce delays
In addition to the on-going capacity and demand considerations of service providers and assessors involved in discharge planning, specific
initiatives/schemes established to reduce delays include integrated community assessment teams supporting hospital operational centre. Adult social care
and intermediate tier have both established in-reach teams supporting the assessment of patients for complex discharges. This team works closely with the
hospital operational and bed management team on a daily basis to optimise planning and to consider process and referral issues – including notifications.
The home from home step-down ward (dementia & confusion) has been established to enable early supported discharge for patients meeting the service
criteria. A key element is the aim to transfer the end stage of acute care to the unit allowing for hospital discharge into the “community” facility and onward
management home.
Resilience schemes agreed and adopted by NEL SRG include the use of resilience funding to support short term placements of those fit for discharge but
waiting for bed based rehabilitation services – this is particularly relevant to winter resilience where demand for the bed based rehab services can be
significantly higher than the average. Additional capacity for domiciliary care providers ensures responsiveness in starting/re-starting home care packages
for those being assessed as requiring such on discharge.
The assisted living centre supports the early and timely provision of equipment including for those whose discharge is being planned.
36
Page 74
There has been an overall reduction in the average level of delayed bed days over the last two years compared to 2013. Peaks occur where the whole
system is under pressure, especially during the winter period. The above mechanisms are thought to have contributed to reducing delays, however, the
plan considers further schemes and arrangements aimed at reducing delays. The focus of plans is to ensure the whole system has systematic
improvements but also that the NHS care pathways are improved. Any risk sharing agreements will be defined under developing provider cooperation
arrangements.
The situation analysis has considered national comparators however this is not seen as a significant driver to extend targets as a zero tolerance approach is
the necessary basis for considering all factors that contribute to delayed transfers. Taking possible measures and negative pressures of increased activity
into account the target extends the trajectory set in previous years and is aligned with the CCGs transformation targets for total bed day DToC reductions.
Accountability arrangements
These are to be agreed through the SRG
Is there read across to other local plans which will improve patient flow and support local performance?
Yes - the DToC reduction plan is one element of the overall transformation plan which considers patient flow from the point of crisis episodes, hospital
avoidance schemes and discharge planning/onward care.
Analysis of local capacity and requirements
The SRG is currently holding a series of multi-agency workshops that will produce an agreed set of demand/capacity and workforce models, based on
improved collaborative working and the reshaping of local services to deliver the required improvements.
Analysis of how capacity can best be used across health and social care to minimise DTOC and meet evolving need?
Under continuing local arrangements in NEL, health and social care is already jointly commissioned. Operational integration is in place and being developed
further at points in the system where patients access urgent care, in the response and, should admission be required, in discharge planning and care
coordination. Whilst capacity may need to be adjusted for planned demand and variation (resilience), the joint working approach supports the optimised
use of available capacity. Longer term it is desirable that further support for efficiency and sustainability is delivered by moving to one form of the
accountable care organisation model.
37
Page 75
The role of the voluntary and community sector can play in supporting patients to remain in their own home or return there more quickly following a
period in hospital
The SRG has acknowledged, based on engagement and best practice guidance, that additional voluntary and community sector support will play a vital role
in supporting patients to remain at home or return quickly following a period of acute admission. The SRG has formally invited representatives of the
voluntary sector to become permanent members of the SRG and the current series of SRG workshops considering capacity, demand and workforce will
consider current gaps in home care that prevent people from remaining at home or having early supported discharge. The role of the voluntary sector will
be central to considering how these gaps are resolved.
Scheme level spending plan
Does the narrative plan provide sufficient assurance that detailed plans are in place for each of the schemes set out in the spending plan?
Yes
Does the narrative plan include reference to how these plans are aligned with, and included in, CCG operating plans for 2016-17?
Yes
38
Page 76
Template for BCF submission 2: due on 21 March 2016
Better Care Fund 2016-17 Planning Template
Sheet: Guidance
Overview
The purpose of this template is to collect information from CCGs, local authorities, and Health and Wellbeing Boards (HWBs) in relation to Better Care Fund (BCF) plans for 2016-17. The focus of the collection is on finance
and activity information, as well as the national conditions. The template represents the minimum collection required to provide assurance that plans meet the requirements of the Better Care Fund policy framework set out
by the Department of Health and the Department of Communities and Local Government (www.gov.uk/government/publications/better-care-fund-how-it-will-work-in-2016-to-2017). This information will be used during the
regionally led assurance process in order to ensure that BCF plans being recommended for sign-off meet technical requirements of the fund.
The information collected within this template is therefore not intended to function as a 'plan' but rather as a submission of data relating to a plan. A narrative plan will also need to be provided separately to regional teams,
but there will be no centrally submitted template for 2016-17. CCGs, local authorities, and HWBs will want to consider additional finance and activity information that they may wish to include within their own BCF plans that
is not captured here.
This tab provides an overview of the information that needs to be completed in each of the other tabs of the template. This should be read in conjunction with Annex 4 of the NHS Shared Planning Guidance for 2016-17;
Better Care Fund Planning Requirements for 2016-17', which is published here: www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/
Timetable
The submission and assurance process will follow the following timetable:
• NHS Planning Guidance for 2016-17 released – 22 December 2015
• BCF Allocations published following release of CCG allocations – 09 February 2016
• Annex 4 - BCF Planning Requirements 2016-17 released - 22 February 2016
• BCF Planning Return template, released – 24 February 2016
• First BCF submission by 2pm on 02 March 2016, agreed by CCGs and local authorities, to consist of:
o BCF planning return template
All submissions will need to be sent to DCO teams and copied to the National Team ([email protected])
• First stage assurance of planning return template and initial feedback to local areas - 02 to 16 March 2016
• Second version of the BCF Planning Return template, released (with updated NEA plans) – 9th March
• Second submission following assurance and feedback by 2pm on 21 March 2016, to consist of:
o High level narrative plan
o Updated BCF planning return template
• Second stage assurance of full plans and feedback to local areas - 21 March to 13 April 2016
• BCF plans finalised and signed off by Health and Wellbeing Boards in April, and submitted 2pm on 25 April 2016
This should be read alongside the timetable on page of page 15 of Annex 4 - BCF Planning Requirements.
Introduction
Throughout the template, cells which are open for input have a yellow background and those that are pre-populated have a blue background, as below:
Data needs inputting in the cell
Pre-populated cell
To note - all cells in this template requiring a numerical input are restricted to values between 0 and 1,000,000,000.
The details of each sheet within the template are outlined below.
Checklist
This is a checklist in relation to cells that need data inputting in the each of the sheets within this file. It is sectioned out by sheet name and contains the question, cell reference (hyperlinked) for the question and two separate
checks
- the 'tick-box' column (D) is populated by the user for their own reference (not mandatory), and
- the 'checker' column (E) which updates as questions within each sheet are completed.
The checker column has been coloured so that if a value is missing from the sheet it refers to, the cell will be Red and contain the word 'No' - once completed the cell will change to Green and contain the word 'Yes'. The
'sheet completed' cell will update when all 'checker' values for the sheet are green containing the word 'Yes'.
Once the checker column contains all cells marked 'Yes' the 'Incomplete Template' cell (B6) will change to 'Complete Template'.
Please ensure that all boxes on the checklist tab are green before submission.
1. Cover
The cover sheet provides essential information on the area for which the template is being completed, contacts and sign off. The selection of your Health and Wellbeing Board (HWB) on this sheet also then ensures that the
correct data is prepopulated through the rest of the template.
On the cover sheet please enter the following information:
- The Health and Wellbeing Board;
- The name of the lead contact who has completed the report, with their email address and contact number for use in resolving any queries regarding the return;
- The name of the lead officer who has signed off the report on behalf of the CCGs and Local Authority in the HWB area.
Question completion tracks the number of questions that have been completed, when all the questions in each section of the template have been completed the cell will turn green. Only when all 6 cells are green should the
template be sent to [email protected]
2. Summary and confirmations
This sheet summarises information provided on sheets 2 to 6, and allows for confirmation of the amount of funding identified for supporting social care and any funds ring-fenced as part of risk sharing arrangement. To do
this, there are 2 cells where data can be input.
On this tab please enter the following information:
- In cell E37 ,please confirm the amount allocated for ongoing support for adult social care. This may differ from the summary of HWB expenditure on social care which has been calculated from information provided in the
'HWB Expenditure Plan' tab. If this is the case then cell F37 will turn yellow. Please use this to indicate the reason for any variance;
- In cell F47 please indicate the total value of funding held as a contingency as part of local risk share, if one is being put in place. For guidance on instances when this may be appropriate please consult the full BCF
Planning Requirements document. Cell F44 shows the HWB share of the national £1bn that is to be used as set out in national condition vii. Cell F45 shows the value of investment in NHS Commissioned Out of Hospital
Services, as calculated from the 'HWB Expenditure Plan' tab. Cell F49 will show any potential shortfall in meeting the financial requirements of the condition.
The rest of this tab will be populated from the information provided elsewhere within the template, and provides a useful printable summary of the return.
Page 77
3. HWB Funding Sources
This sheet should be used to set out all funding contributions to the Health and Wellbeing Board's Better Care Fund plan and pooled budget for 2016-17. It will be pre-populated with the minimum CCG contributions to the
Fund in 2016/17, as confirmed within the BCF Allocations spreadsheet. https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan
These cannot be changed. The sheet also requests a number of confirmations in regard to the funding that is made available through the BCF for specific purposes.
- Please use rows 16-25 to detail Local Authority funding contributions by selecting the relevant authorities and then entering the values of the contributions in column C. This should include all mandatory transfers made via
local authorities, as set out in the BCF Allocations spreadsheet, and any additional local authority contributions. There is a comment box in column E to detail how contributions are made up or to allow contributions from an
LA to split by funding source or purpose if helpful. Please note, only contributions assigned to a Local Authority will be included in the 'Total Local Authority Contribution' figure.
- Please use cell C42 to indicate whether any additional CCG contributions are being made. If 'Yes' is selected then rows 45 to 54 will turn yellow and can be used to detail all additional CCG contributions to the fund by
selecting the CCG from the drop down boxes in column B and enter the values of the contributions in column C. There is a comment box in column E to detail how contributions are made up or any other useful information
relating to the contribution. Please note, only contributions assigned to an additional CCG will be included in the 'Total Additional CCG Contribution' figure.
- Cell C57 then calculates the total funding for the Health and Wellbeing Board, with a comparison to the 2015-16 funding levels set out below.
- Please use the comment box in cell B61 to add any further narrative around your funding contributions for 2016-17, for example to set out the driver behind any change in the amount being pooled.
The final section on this sheet then sets out four specific funding requirements and requests confirmation as to the progress made in agreeing how these are being met locally - by selecting either 'Yes', 'No' or 'No - in
development' in response to each question. 'Yes' should be used when the funding requirement has been met. 'No - in development' should be used when the requirement is not currently agreed but a plan is in development
to meet this through the development of your BCF plan for 2016-17. 'No' should be used to indicate that there is currently no agreement in place for meeting this funding requirement and this is unlikely to be agreed before
the plan is finalised.
- Please use column C to respond to the question from the dropdown options;
- Please detail in the comments box in row D issues and/or actions that are being taken to meet the funding requirement, or any other relevant information.
4. HWB Expenditure plan
This sheet should be used to set out the full BCF scheme level spending plan. The table is set out to capture a range of information about how schemes are being funded and the types of services they are providing, which is
required to demonstrate how the national policy framework is being achieved. Where a scheme has multiple funding sources this can be indicated and split out, but there may still be instances when several lines need to be
completed in order to fully describe a single scheme. In this case please use the scheme name column to indicate this.
- Enter a scheme name in column B;
- Select the scheme type in column C from the dropdown menu (descriptions of each are located in cells B270 - C278); if the scheme type is not adequately described by one of the dropdown options please choose 'other'
and give further explanation in column D;
- Select the area of spending the scheme is directed at using from the dropdown menu in column E; if the area of spending is not adequately described by one of the dropdown options please choose 'other' and give further
explanation in column F;
- Select the commissioner and provider for the scheme using the dropdown menu in columns G and J, noting that if a scheme has more than one provider or commissioner, you should complete one row for each. For
example, if both the CCG and the local authority will contract with a third party to provide a joint service, there would be two lines for the scheme: one for the CCG commissioning from the third party and one for the local
authority commissioning from the third party;
- In Column K please state where the expenditure is being funded from. If this falls across multiple funding streams please enter the scheme across multiple lines;
- Complete column L to give the planned spending on the scheme in 2016/17;
- Please use column M to indicate whether this is a new or existing scheme.
- Please use column N to state the total 15-16 expenditure (if existing scheme)
This is the only detailed information on BCF schemes being collected centrally for 2016-17 but it is expected that detailed scheme level plans will continue to be developed locally.
5. HWB Metrics
This sheet should be used to set out the Health and Wellbeing Board's performance plans for each of the Better Care Fund metrics in 2016-17. This should build on planned and actual performance on these metrics in 201516. The BCF requires plans to be set for 4 nationally defined metrics and 2 locally defined metrics. The non-elective admissions metric section is pre-populated with activity data from CCG Operating Plan submissions for all
contributing CCGs, which has then been mapped to the HWB footprint to provide a default HWB level NEA activity plan for 2016-17. There is then the option to adjust this by indicating how many admissions can be avoided
through the BCF plan, which are not already built into CCG operating plan assumptions. Where it is decided to plan for an additional reduction in NEA activity through the BCF the option is also provided within the template
to set out an associated risk sharing arrangement. Once CCG have made their second operating plan activity uploads via Unify this data will be populated into a second version of this template by the national team and sent
back in time for the second BCF submission. At this point Health and Wellbeing Boards will be able to amend, confirm, and comment on non-elective admission targets again based on the new data. The full specification
and details around each of the six metrics is included in the BCF Planning Requirements document. Comments and instructions in the sheet should provide the information required to complete the sheet.
Further information on how when reductions in Non-Elective Activity and associated risk sharing arrangements should be considered is set out within the BCF Planning Requirements document.
- Please use cell E43 to confirm if you are planning on any additional quarterly reductions (Yes/No)
- If you have answered Yes in cell E43 then in cells G45, I45, K45 and M45 please enter the quarterly additional reduction figures for Q1 to Q4.
- In cell E49 please confirm whether you are putting in place a local risk sharing agreement (Yes/No)
- In cell E54 please confirm or amend the cost of a non elective admission. This is used to calculate a risk share fund, using the quarterly additional reduction figures.
- Please use cell F54 to provide a reason for any adjustments to the cost of NEA for 16/17 (if necessary)
- In cell G69 please enter your forecasted level of residential admissions for 2015-16. In cell H69 please enter your planned level of residential admissions for 2016-17. The actual rate for 14-15 and the planned rate for 1516 are provided for comparison. Please add a commentary in column I to provide any useful information in relation to how you have agreed this figure.
- Please use cells G82-83 (forecast for 15-16) and H82-83 (planned 16-17) to set out the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation
services. By entering the denominator figure in cell G83/H83 (the planned total number of older people (65 and over) discharged from hospital into reablement / rehabilitation services) and the numerator figure in cell
G82/H82 (the number from within that group still at home after 91 days) the proportion will be calculated for you in cell G81/H81. Please add a commentary in column I to provide any useful information in relation to how you
have agreed this figure.
- Please use rows 93-95 (columns K-L for Q3-Q4 15-16 forecasts and columns M-P for 16-17 plans) to set out the Delayed Transfers Of Care (delayed days) from hospital per 100,000 population (aged 18+). The
denominator figure in row 95 is pre-populated (population - aged 18+). The numerator figure in cells K94-P94 (the Delayed Transfers Of Care (delayed days) from hospital) needs entering. The rate will be calculated for you
in cells K93-O93. Please add a commentary in column H to provide any useful information in relation to how you have agreed this figure.
- Please use rows 105-107 to update information relating to your locally selected performance metric. The local performance metric set out in cell C105 has been taken from your BCF 16-17 planning submission 1 template
- these local metrics can be amended, as required.
- You may also use rows 117-119 to update information relating to your locally selected patient experience metric. The local patient experience metric set out in cell C117 has been taken from your BCF 16-17 planning
submission 1 template - these local metrics can be amended, as required.
5b. HWB Metrics Tool
There is no data required to be completed on this tab. The tab is instead designed to provide assistance in setting your 16/17 plan figures for NEA and DTOC. Baseline 14/15, plan 15/16 and actual 15/16 data has been
provided as a reference. The 16/17 plan figures are taken from those given in tab 5. HWB Metrics.
For NEAs we have also provided SUS 14/15 Baseline, SUS 15/16 Actual and SUS 15/16 FOT (Forecast Outturn) figures, mapped from the baseline data supplied to assist CCGs with the 16/17 shared planning round. This
has been provided as a reference to support the new requirement for BCF NEA targets to be set in line with the revised definition set out in the “Technical Definitions” and the “Supplementary Technical Definitions” at the
foot of the following webpage:
https://www.england.nhs.uk/ourwork/futurenhs/deliver-forward-view/
6. National Conditions
This sheet requires the Health & Wellbeing Board to confirm whether the eight national conditions detailed in the Better Care Fund Planning Guidance are on track to be met through the delivery of your plan in 2016-17. The
conditions are set out in full in the BCF Policy Framework and further guidance is provided in the BCF Planning Requirements document. Please answer as at the time of completion.
- For each national condition please use column C to indicate whether the condition is being met. The sheet sets out the eight conditions and requires the Health & Wellbeing Board to confirm either 'Yes', 'No' or 'No - in
development' for each one. 'Yes' should be used when the condition is already being fully met, or will be by 31st March 2016. 'No - in development' should be used when a condition is not currently being met but a plan is in
development to meet this through the delivery of your BCF plan in 2016-17. 'No' should be used to indicate that there is currently no plan agreed for meeting this condition by 31st March 2017.
- Please use column C to indicate when it is expected that the condition will be met / agreed if it is not being currently.
- Please detail in the comments box issues and/or actions that are being taken to meet the condition, or any other relevant information.
CCG - HWB Mapping
The final tab provides details of the CCG to HWB mapping used to calculate contributions to Health and Wellbeing Board level non-elective activity plans.
Page 78
Sheet: Checklist
This is a checklist in relation to cells that need data inputting in the each of the sheets within this file. It is sectioned out by sheet name and contains the question, cell reference (hyperlinked) for the question and
two separate checks
- the 'tick-box' column (D) is populated by the user for their own reference (not mandatory), and
- the 'checker' column (E) which updates as questions within each sheet are completed.The checker column has been coloured so that if a value is missing from the sheet it refers to, the cell will be Red and
contain the word 'No' - once completed the cell will change to Green and contain the word 'Yes'. The 'sheet completed' cell will update when all 'checker' values for the sheet are green containing the word
'Yes'.Once the checker column contains all cells marked 'Yes' the 'Incomplete Template' cell (B6) will change to 'Complete Template'.Please ensure that all boxes on the checklist tab are green before
submission.
*Complete Template*
1. Cover
Cell
Reference
C10
C13
C15
C17
C19
Health and Well Being Board
completed by:
e-mail:
contact number:
Who has signed off the report on behalf of the Health and Well Being Board:
Complete?
Checker
Yes
Yes
Yes
Yes
Yes
Sheet Completed:
Yes
Summary of BCF Expenditure : Please confirm the amount allocated for the protection of adult social care : Expenditure (£000's)
Summary of BCF Expenditure : If the figure in cell D29 differs to the figure in cell C29, please indicate please indicate the reason for the variance.
Total value of funding held as contingency as part of lcoal risk share to ensure value to the NHS
Cell
Reference
E37
F37
F47
Complete?
Checker
Yes
Yes
Yes
Sheet Completed:
Yes
Local authority Social Services: <Please Select Local Authority>
Gross Contribution: £000's
Comments (if required)
Are any additional CCG Contributions being made? If yes please detail below;
Additional CCG Contribution: <Please Select CCG>
Gross Contribution: £000's
Comments (if required)
Funding Sources Narrative
1. Is there agreement about the use of the Disabled Facilities Grant, and arrangements in place for the transfer of funds to the local housing authority?
2. Is there agreement that at least the local proportion of the £138m for the implementation of the new Care Act duties has been identified?
3. Is there agreement on the amount of funding that will be dedicated to carer-specific support from within the BCF pool?
4. Is there agreement on how funding for reablement included within the CCG contribution to the fund is being used?
1. Is there agreement about the use of the Disabled Facilities Grant, and arrangements in place for the transfer of funds to the local housing authority?
Comments
2. Is there agreement that at least the local proportion of the £138m for the implementation of the new Care Act duties has been identified? Comments
3. Is there agreement on the amount of funding that will be dedicated to carer-specific support from within the BCF pool? Comments
4. Is there agreement on how funding for reablement included within the CCG contribution to the fund is being used? Comments
Cell
Reference
B16 : B25
C16 : C25
E16 : E25
C42
B45 : B54
C45 : C54
E45 : E54
B61
C70
C71
C72
C73
Complete?
Checker
Yes
Yes
N/A
Yes
Yes
Yes
N/A
N/A
Yes
Yes
Yes
Yes
D70
Yes
D71
D72
D73
Yes
Yes
Yes
Yes
Sheet Completed:
4. HWB Expenditure Plan
Cell
Reference
B17 : B266
C17 : C266
D17 : D266
E17 : E266
F17 : F266
G17 : G266
H17 : H266
I17 : I266
J17 : J266
K17 : K266
L17 : L266
M17 : M266
N17 : N266
Scheme Name
Scheme Type (see table below for descriptions)
Please specify if 'Scheme Type' is 'other'
Area of Spend
Please specify if 'Area of Spend' is 'other'
Commissioner
if Joint % NHS
if Joint % LA
Provider
Source of Funding
2016/17 (£000's)
New or Existing Scheme
Total 15-16 Expenditure (£) (if existing scheme)
Complete?
Checker
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Sheet Completed:
Yes
5. HWB Metrics
5.1
5.1
5.1
5.1
5.1
5.1
5.1
5.1
5.2
5.2
5.2
5.3
5.3
5.3
5.3
5.3
5.4
5.4
5.4
5.4
5.4
5.4
5.4
5.5
5.5
5.5
5.5
5.5
5.5
5.5
5.5
5.6
5.6
5.6
5.6
5.6
5.6
5.6
5.6
Cell
Reference
E43
G45
I45
K45
M45
E49
E54
F54
G69
H69
I68
G82
G83
H82
H83
I81
K94
L94
M94
N94
O94
P94
Q93
C105
E105
E106
E107
F105
F106
F107
G105
C117
E117
E118
E119
F117
F118
F119
G117
- Are you planning on any additional quarterly reductions?
- HWB Quarterly Additional Reduction Figure - Q1
- Are you putting in place a local risk sharing agreement on NEA?
- Cost of NEA
- Comments (if required)
- Residential Admissions : Numerator : Forecast 15/16
- Residential Admissions : Numerator : Planned 16/17
- Reablement : Numerator : Forecast 15/16
- Reablement : Denominator : Forecast 15/16
- Reablement : Numerator : Planned 16/17
- Reablement : Denominator : Planned 16/17
- Delayed Transfers of Care : 15/16 Forecast : Q3
- Delayed Transfers of Care : 15/16 Forecast : Q4
- Delayed Transfers of Care : 16/17 Plans : Q1
- Local Performance Metric
- Local Performance Metric : Planned 15/16 : Metric Value
- Local Performance Metric : Planned 15/16 : Numerator
- Local Performance Metric : Planned 15/16 : Denominator
- Local Performance Metric : Planned 16/17 : Metric Value
- Local Performance Metric : Planned 16/17 : Numerator
- Local Performance Metric : Planned 16/17 : Denominator
- Local defined patient experience metric
- Local defined patient experience metric : Planned 15/16 : Metric Value
- Local defined patient experience metric : Planned 15/16 : Numerator
- Local defined patient experience metric : Planned 15/16 : Denominator
- Local defined patient experience metric : Planned 16/17 : Metric Value
- Local defined patient experience metric : Planned 16/17 : Numerator
- Local defined patient experience metric : Planned 16/17 : Denominator
Complete?
Checker
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
Yes
Yes
Yes
N/A
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
Sheet Completed:
1) Plans to be jointly agreed
2) Maintain provision of social care services (not spending)
3) Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective admissions to acute settings and to facilitate
transfer to alternative care settings when clinically appropriate
4) Better data sharing between health and social care, based on the NHS number
5) Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an
accountable professional
6) Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans
7) Agreement to invest in NHS commissioned out-of-hospital services
8) Agreement on a local target for Delayed Transfers of Care (DTOC) and develop a joint local action plan
1) Plans to be jointly agreed, Comments
2) Maintain provision of social care services (not spending), Comments
3) Agreement for the delivery of 7-day services across health and social care to prevent unnecessary non-elective admissions to acute settings and to facilitate
transfer to alternative care settings when clinically appropriate, Comments
4) Better data sharing between health and social care, based on the NHS number, Comments
5) Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an
accountable professional, Comments
6) Agreement on the consequential impact of the changes on the providers that are predicted to be substantially affected by the plans, Comments
7) Agreement to invest in NHS commissioned out-of-hospital services, Comments
8) Agreement on a local target for Delayed Transfers of Care (DTOC) and develop a joint local action plan, Comments
Cell
Reference
C14
C15
Complete?
Checker
Yes
Yes
C16
C17
Yes
Yes
C18
C19
C20
C21
D14
D15
Yes
Yes
Yes
Yes
Yes
Yes
D16
D17
Yes
Yes
D18
D19
D20
D21
Yes
Yes
Yes
Yes
Sheet Completed:
Yes
Page 79
Submission 2 Template Changes - Updates from Submission 1 template
Change
Summary of NHS Commissioned out of hospital services spend from MINIMUM BCF Pool' table corrected to show spend
from CCG Minimum Contribution only. Please review.
We have increased the number of rows available on the "HWB Expenditure" tab to 250 rows.
The NEA activity values have been updated following the second "16/17 Shared NHS Planning" submission. Please review the
impact and amend the additional quarterly reduction value if required.
Q3 15/16 SUS Actual data (mapped from CCG data) is now included. Q1 and Q2 have been updated.
Actual Q3 15/16 DTOC data is now included.
Tabs Impacted
4. HWB Expenditure
5. HWB Metrics
5. HWB Metrics
5. HWB Metrics
5. HWB Metrics
5. HWB Metrics
Population figures used for 14/15 changed to match the mid-2014 population estimates used in ASCOF, this impacts on DTOC
(Q1 - Q3 14/15) and Residential Admissions rates (14/15). Please review the impact and amend if required.
5. HWB Metrics
Comments fields have had text wrapped to allow for users to easily review comments fields.
5. HWB Metrics
The issue around the incorrect assigning of the number of delayed days for the 11 Health and Well-Being Boards effecting
the DTOC rates per 100,000 population has been amended. Please review the impact and amend if required.
Reablement 14/15 actual % has been amended to match published HSCIC data.
Page 80
Sheet: 1. Cover Sheet
The cover sheet provides essential information on the area for which the template is being completed, contacts and sign off. The selection of your Health and
Wellbeing Board (HWB) on this sheet also then ensures that the correct data is prepopulated through the rest of the template.
On the cover sheet please enter the following information:
- The Health and Wellbeing Board;
- The name of the lead contact who has completed the report, with their email address and contact number for use in resolving any queries regarding the return;
- The name of the lead officer who has signed off the report on behalf of the CCGs and Local Authority in the HWB area. Question completion tracks the number of
questions that have been completed, when all the questions in each section of the template have been completed the cell will turn green. Only when all 6 cells are
green should the template be sent to [email protected]
You are reminded that much of the data in this template, to which you have privileged access, is management information only and is not in the public
domain. It is not to be shared more widely than is necessary to complete the return.
Any accidental or wrongful release should be reported immediately and may lead to an inquiry. Wrongful release includes indications of the content,
including such descriptions as "favourable" or "unfavourable".
Please prevent inappropriate use by treating this information as restricted, refrain from passing information on to others and use it only for the purposes
for which it is provided.
It presents a summary of the first BCF submission and a mapped summary of the NEA activity plans received in the second iteration of the “CCG NHS
Shared Planning Process”.
Health and Well Being Board
2
Emma Overton
completed by:
3
E-Mail:
[email protected]
4
0300 3000 662
Contact Number:
5
Jane Hyldon-King
Who has signed off the report on behalf of the Health and Well Being Board:
Question Completion - when all questions have been answered and the validation boxes below have turned green you should send the template to
[email protected] saving the file as 'Name HWB' for example 'County Durham HWB'
1. Cover
5. HWB Metrics
No. of questions
answered
5
3
13
13
34
16
Page 81
Sheet: 2. Summary of Health and Well-Being Board 2016/17 Planning Template
Selected Health and Well Being Board:
Data Submission Period:
2016/17
This sheet summarises information provided on sheets 2 to 6, and allows for confirmation of the amount of funding identified for supporting social care and any funds ring-fenced as part of risk sharing arrangement. To do this, there are 2 cells where
data can be input.
- In cell E37 ,please confirm the amount allocated for ongoing support for adult social care. This may differ from the summary of HWB expenditure on social care which has been calculated from information provided in the 'HWB Expenditure Plan' tab.
If this is the case then cell F37 will turn yellow. Please use this to indicate the reason for any variance;
- In cell F47 please indicate the total value of funding held as a contingency as part of local risk share, if one is being put in place. For guidance on instances when this may be appropriate please consult the full BCF Planning Requirements
document. Cell F44 shows the HWB share of the national £1bn that is to be used as set out in national condition vii. Cell F45 shows the value of investment in NHS Commissioned Out of Hospital Services, as calculated from the 'HWB Expenditure
Plan' tab. Cell F49 will show any potential shortfall in meeting the financial requirements of the condition. The rest of this tab will be populated from the information provided elsewhere within the template, and provides a useful printable summary of
the return.
Gross Contribution
Specific funding requirements for 2016-17
1. Is there agreement about the use of the Disabled Facilities Grant, and
arrangements in place for the transfer of funds to the local housing authority?
2. Is there agreement that at least the local proportion of the £138m for the
implementation of the new Care Act duties has been identified?
3. Is there agreement on the amount of funding that will be dedicated to carerspecific support from within the BCF pool?
4. Is there agreement on how funding for reablement included within the CCG
contribution to the fund is being used?
£2,188,000
£11,157,412
£0
£13,345,412
Select a response to
the questions in
column B
No - in development
Yes
Yes
Yes
Summary of BCF Expenditure
Expenditure
Acute
Mental Health
Community Health
Continuing Care
Primary Care
Social Care
Other
£0
£227,000
£926,000
£0
£0
£3,649,600
£8,542,812
Total
12
Please confirm the amount allocated for
the protection of adult social care
Expenditure
£3,649,600
If the figure in cell E37 differs to the figure in cell C37, please indicate the reason for the variance.
£13,345,412
BCF revenue funding from CCGs ring-fenced for NHS out of hospital commissioned services/risk
share
14
Fund
Local share of ring-fenced funding
£3,170,620
Summary of NHS Commissioned out of hospital services spend from MINIMUM BCF Pool
Mental Health
13
Expenditure
£227,000
Community Health
Total value of NHS commissioned out of
hospital services spend from minimum
pool
£926,000
Continuing Care
£0
Primary Care
£0
Social Care
Other
Total
£11,081,412
Total value of funding held as
contingency as part of local risk share to
ensure value to the NHS
£1,385,600
£8,542,812
£11,081,412
£362,812
Balance (+/-)
£8,273,604
5. HWB Metrics
5.1 HWB NEA Activity Plan
Q1
Q2
Total HWB Planned Non-Elective Admissions
HWB Quarterly Additional Reduction Figure
HWB NEA Plan (after reduction)
Additional NEA reduction delivered through the BCF
3,755
0
3,755
Q3
Q4
3,756
0
3,756
3,755
0
3,755
Total
3,755
0
3,755
15,022
0
15,022
£0
5.2 Residential Admissions
Planned 16/17
Long-term support needs of older people (aged 65 and over) met by admission
to residential and nursing care homes, per 100,000 population
Annual rate
692.5
5.3 Reablement
Planned 16/17
Permanent admissions of older people (aged 65 and over) to residential and
nursing care homes, per 100,000 population
Annual %
89%
5.4 Delayed Transfers of Care
Q1 (Apr 16 - Jun 16)
Delayed Transfers of Care (delayed days) from hospital per 100,000 population
(aged 18+).
Quarterly rate
Q2 (Jul 16 - Sep 16)
655.6
655.6
5.5 Local performance metric (as described in your BCF 16/17 planning submission 1 return)
Measure Increasing the availability of community based preventative support
solutions
Numerator - The number of calls in to the first point of access service for adult
social care and urgent and non-urgent community health and social care
services (A3) that are referred on to community based preventative support
Metric Value
Planned 16/17
13.5
5.6 Local defined patient experience metric (as described in your BCF 16/17 planning submission 1 return)
Metric Value
Planned 16/17
ASCOF 4B - Proportion of people who use services who say that those services
have made them feel safe and secure
88.9
National Conditions For The Better Care Fund 2016-17
3) Agreement for the delivery of 7-day services across health and social care to
prevent unnecessary non-elective admissions to acute settings and to facilitate
transfer to alternative care settings when clinically appropriate
4) Better data sharing between health and social care, based on the NHS
number
5) Ensure a joint approach to assessments and care planning and ensure that,
where funding is used for integrated packages of care, there will be an
accountable professional
6) Agreement on the consequential impact of the changes on the providers that
are predicted to be substantially affected by the plans
8) Agreement on a local target for Delayed Transfers of Care (DTOC) and
develop a joint local action plan
Please Select (Yes,
No or No - plan in
place)
Yes
Yes
Yes
No - in development
Yes
Yes
Yes
No - in development
Page 82
Q3 (Oct 16 - Dec 16) Q4 (Jan 17 - Mar 17)
655.6
654.6
Sheet: 3. Health and Well-Being Board Funding Sources
2016/17
This sheet should be used to set out all funding contributions to the Health and Wellbeing Board's Better Care Fund plan and pooled budget for 2016-17. It will be pre-populated with the minimum CCG contributions to the Fund in 2016/17, as
confirmed within the BCF Allocations spreadsheet. https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan
0
1
2
3
4
5
6
7
8
9
These cannot be changed. The sheet also requests a number of confirmations in regard to the funding that is made available through the BCF for specific purposes.
- Please use rows 16-25 to detail Local Authority funding contributions by selecting the relevant authorities and then entering the values of the contributions in column C. This should include all mandatory transfers made via local authorities, as set out
in the BCF Allocations spreadsheet, and any additional local authority contributions. There is a comment box in column E to detail how contributions are made up or to allow contributions from an LA to split by funding source or purpose if helpful.
Please note, only contributions assigned to a Local Authority will be included in the 'Total Local Authority Contribution' figure.
- Please use cell C42 to indicate whether any additional CCG contributions are being made. If 'Yes' is selected then rows 45 to 54 will turn yellow and can be used to detail all additional CCG contributions to the fund by selecting the CCG from the drop
down boxes in column B and enter the values of the contributions in column C. There is a comment box in column E to detail how contributions are made up or any other useful information relating to the contribution. Please note, only contributions
assigned to an additional CCG will be included in the 'Total Additional CCG Contribution' figure. - Cell C57 then calculates the total funding for the Health and Wellbeing Board, with a comparison to the 2015-16 funding levels set out below. - Please
use the comment box in cell B61 to add any further narrative around your funding contributions for 2016-17, for example to set out the driver behind any change in the amount being pooled.The final section on this sheet then sets out four specific
funding requirements and requests confirmation as to the progress made in agreeing how these are being met locally - by selecting either 'Yes', 'No' or 'No - in development' in response to each question. 'Yes' should be used when the funding
requirement has been met. 'No - in development' should be used when the requirement is not currently agreed but a plan is in development to meet this through the development of your BCF plan for 2016-17. 'No' should be used to indicate that there
is currently no agreement in place for meeting this funding requirement and this is unlikely to be agreed before the plan is finalised.
18
19
20
Local Authority Contribution(s)
Gross Contribution
Comments - please use this box clarify any specific uses or sources of funding
Disability Facilities Grant
£2,188,000
<Please Select Local Authority>
£2,188,000
CCG Minimum Contribution
0 NHS North East Lincolnshire CCG
1
2
3
4
5
6
7
8
9
Gross Contribution
£11,157,412
£11,157,412
18
Are any additional CCG Contributions being made? If yes please detail below;
No
22
0
1
2
3
4
5
6
7
8
9
Additional CCG Contribution
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
<Please Select CCG>
23
Gross Contribution
24
Comments - please use this box clarify any specific uses or sources of funding
£0
£13,345,412
22
Funding Contributions Narrative
minimum CCG contribution only
The final section on this sheet then sets out four specific funding requirements and requests confirmation as to the progress made in agreeing how these are being met locally - by selecting either 'Yes', 'No' or 'No - in development' in response to each
question. 'Yes' should be used when the funding requirement has been met. 'No - in development' should be used when the requirement is not currently agreed but a plan is in development to meet this through the development of your BCF plan for
2016-17. 'No' should be used to indicate that there is currently no agreement in place for meeting this funding requirement and this is unlikely to be agreed before the plan is finalised.
Specific funding requirements for 2016-17
Select a response to
the questions in
column B
Please detail in the comments box issues and/or actions that are being taken to meet the condition, or any other relevant
information.
on going discussions with NELC to finalise spending plans
1. Is there agreement about the use of the Disabled Facilities Grant, and arrangements
in place for the transfer of funds to the local housing authority?
No - in development
23
Yes
24
Yes
25
Yes
26
2. Is there agreement that at least the local proportion of the £138m for the
implementation of the new Care Act duties has been identified?
3. Is there agreement on the amount of funding that will be dedicated to carer-specific
support from within the BCF pool?
4. Is there agreement on how funding for reablement included within the CCG
contribution to the fund is being used?
Page 83
Sheet: 4. Health and Well-Being Board Expenditure Plan
2016/17
This sheet should be used to set out the full BCF scheme level spending plan. The table is set out to capture a range of information about how schemes are being funded and the types of services they are providing, which is required to demonstrate how the national policy framework is being achieved. Where a scheme has multiple funding sources this can be indicated and split out, but there may still be instances when several lines need to be completed in order to fully describe a single scheme. In this case please use the
scheme name column to indicate this.
- Select the scheme type in column C from the dropdown menu (descriptions of each are located in cells B270 - C278); if the scheme type is not adequately described by one of the dropdown options please choose 'other' and give further explanation in column D;
- Select the area of spending the scheme is directed at using from the dropdown menu in column E; if the area of spending is not adequately described by one of the dropdown options please choose 'other' and give further explanation in column F;
- Select the commissioner and provider for the scheme using the dropdown menu in columns G and J, noting that if a scheme has more than one provider or commissioner, you should complete one row for each. For example, if both the CCG and the local authority will contract with a third party to provide a joint service, there would be two lines for the scheme: one for the CCG commissioning from the third party and one for the local authority commissioning from the third party;
- Please use column N to state the total 15-16 expenditure (if existing scheme) This is the only detailed information on BCF schemes being collected centrally for 2016-17 but it is expected that detailed scheme level plans will continue to be developed locally.
34
35
36
37
38
39
40
41
42
43
44
45
46
Expenditure
Scheme Name
0
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
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
Scheme Type (see table below for descriptions)
Intermediate tier
Single Point of Access (SPA)
Extra Care Housing
Preventative services market development
Community Equipment Services
Intermediate care services
Integrated care teams
Personalised support/ care at home
Other
Reablement services
Reablement services
Domiciliary Care - Just Checking
7 day working (including GP/Care home alignment)
Disability Facilities Grant
Reablement services
7 day working
Care Bill implementation funding
Carers (to carer & carers centre)
Dementia (memory café & dementia workers in community)
Workforce training (to support & integrated workforce)
Safeguarding (post)
Stroke (social worker)
End of Life (social work support)
Other
Support for carers
Other
7 day working projects - to commence upon achievement of the perform 7 day working
Please specify if 'Scheme Type' is 'other'
Development of 3rd sector services
sppt implementaion of care act
safeguarding
Area of Spend
Other
Other
Social Care
Social Care
Community Health
Social Care
Please specify if 'Area of Spend'
is 'other'
integrated health & social care
across all categories
Commissioner
if Joint % NHS
if Joint % LA
Provider
Source of Funding
CCG
CCG
CCG
CCG
CCG
CCG
Charity/Voluntary Sector
NHS Acute Provider
Local Authority
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
Contribution
Contribution
Contribution
Contribution
Contribution
Contribution
Community Health
Other
Other
Social Care
Community, Social Care
CCG
CCG
CCG
Local Authority
Private Sector
Local Authority
Local Authority Social Services
Social Care
Social Care
Mental Health
Other
Social Care
Social Care
Social Care
CCG
CCG
CCG
community health / adult social care CCG
Local Authority
CCG
CCG
CCG
CCG
Local Authority
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
CCG Minimum
Other
Private Sector
CCG
Page 84
Contribution
Contribution
Contribution
Contribution
Contribution
Contribution
Contribution
2016/17 Expenditure (£)
New or Existing Scheme
Total 15-16 Expenditure (£) (if
existing scheme)
£5,547,000
£929,000
£57,600
£40,000
£792,000
£496,000
Existing
Existing
Existing
Existing
Existing
Existing
£5,433,000
£919,000
£100,000
£40,000
£783,000
£491,000
£134,000
£350,000
£1,089,000
£2,188,000
Existing
Existing
Existing
Existing
£133,000 OoH
£350,000 OoH
£1,089,000 OoH
£1,148,000
£440,000
£270,000
£227,000
£265,000
£76,000
£31,000
£51,000
Existing
Existing
Existing
Existing
Existing
Existing
Existing
£362,812 New
£440,000
£267,000
£220,000
£265,000
£75,000
£30,000
£50,000
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
OoH
2016/17
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
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
129
130
131
132
133
134
135
136
137
138
Page 85
2016/17
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
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
Page 86
2016/17
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
Scheme Type
Description
Reablement services
The development of support networks to maintain the patient at home independently or through appropriate interventions delivered in the community setting. Improved independence, avoids admissions, reduces need for home care packages.
Schemes specifically designed to ensure that the patient can be supported at home instead of admission to hospital or to a care home. May promote self management/expert patient, establishment of ‘home ward’ for intensive period or to deliver support
over the longer term. Admission avoidance, re-admission avoidance.
Intermediate care services
Community based services 24x7. Step-up and step-down. Requirement for more advanced nursing care. Admissions avoidance, early discharge.
Support for carers
Improving outcomes for patients by developing multi-disciplinary health and social care teams based in the community. Co-ordinated and proactive management of individual cases. Improved independence, reduction in hospital admissions.
Improve the quality of primary and community health services delivered to care home residents. To improve the consistency and quality of healthcare outcomes for care home residents. Support Care Home workers to improve the delivery of non essential
healthcare skills. Admission avoidance, re-admission avoidance.
Supporting people so they can continue in their roles as carers and avoiding hospital admissions. Advice, advocacy, information, assessment, emotional and physical support, training, access to services to support wellbeing and improve independence.
Admission avoidance
7 day working
Seven day working across health and/or social care settings. Reablement and avoids admissions
Assistive Technologies
Supportive technologies for self management and telehealth. Admission avoidance and improves quality of care
Improving healthcare services to care homes
Page 87
Sheet: 5. Health and Well-Being Board Better Care Fund Metrics
2016/17
5. HWB Metrics
This sheet should be used to set out the Health and Wellbeing Board's performance plans for each of the Better Care Fund metrics in 2016-17. This should build on planned and actual performance on these metrics in 2015-16. The BCF requires plans to be set for 4 nationally defined metrics and 2 locally defined metrics. The non-elective admissions metric section is pre-populated with
activity data from CCG Operating Plan submissions for all contributing CCGs, which has then been mapped to the HWB footprint to provide a default HWB level NEA activity plan for 2016-17. There is then the option to adjust this by indicating how many admissions can be avoided through the BCF plan, which are not already built into CCG operating plan assumptions. Where it is
decided to plan for an additional reduction in NEA activity through the BCF the option is also provided within the template to set out an associated risk sharing arrangement. Once CCG have made their second operating plan activity uploads via Unify this data will be populated into a second version of this template by the national team and sent back in time for the second BCF
submission. At this point Health and Wellbeing Boards will be able to amend, confirm, and comment on non-elective admission targets again based on the new data. The full specification and details around each of the six metrics is included in the BCF Planning Requirements document. Comments and instructions in the sheet should provide the information required to complete the
sheet.
Further information on how when reductions in Non-Elective Activity and associated risk sharing arrangements should be considered is set out within the BCF Planning Requirements document.
5.1 HWB NEA Activity Plan
- Please use cell E43 to confirm if you are planning on any additional quarterly reductions (Yes/No)
- If you have answered Yes in cell E43 then in cells G45, I45, K45 and M45 please enter the quarterly additional reduction figures for Q1 to Q4.
- In cell E49 please confirm whether you are putting in place a local risk sharing agreement (Yes/No)
- In cell E54 please confirm or amend the cost of a non elective admission. This is used to calculate a risk share fund, using the quarterly additional reduction figures.
- Please use cell F54 to provide a reason for any adjustments to the cost of NEA for 16/17 (if necessary)
3
47
Contributing CCGs
0 NHS Lincolnshire East CCG
1 NHS North East Lincolnshire CCG
2 NHS North Lincolnshire CCG
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Totals
48
% CCG registered
population that has
resident population in
North East
Lincolnshire
0.8%
95.9%
0.1%
4
49
50
51
5
52
53
6
54
55
56
57
58
59
% North East
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Total (Q1 - Q4)
Lincolnshire resident
population that is in
CCG Total Non-Elective HWB Non-Elective
CCG registered
population
Admission Plan**
Admission Plan*
Admission Plan**
Admission Plan*
Admission Plan**
Admission Plan*
Admission Plan**
Admission Plan*
Admission Plan**
Admission Plan*
1.2%
6,388
51
6,458
51
6,458
51
6,318
50
25,622
204
98.7%
3,856
3,698
3,857
3,699
3,856
3,698
3,857
3,699
15,426
14,795
0.2%
3,871
6
3,818
6
3,791
6
3,692
6
15,172
23
100%
14,115
3,755
14,133
3,756
14,105
3,755
13,867
3,755
56,220
15,022
57
Are you planning on any additional quarterly reductions?
If yes, please complete HWB Quarterly Additional Reduction Figures
HWB Quarterly Additional Reduction Figure
HWB NEA Plan (after reduction)
HWB Quarterly Plan Reduction %
No
58
59
60
61
0
3,755
0.00%
0
3,756
0.00%
0
3,755
0.00%
0
3,755
0.00%
0
15,022
0.00%
62
Are you putting in place a local risk sharing agreement on NEA?
No
BCF revenue funding from CCGs ring-fenced for NHS out of hospital commissioned services/risk
share ***
Cost of NEA as used during 15/16 ****
£3,170,620
63
64
£2,132 Please add the reason, for any adjustments to the cost of NEA for 16/17 in the cell below.
Cost of NEA for 16/17 ****
£2,132
Additional NEA reduction delivered through the BCF
£0
HWB Plan Reduction %
0.00%
* This is taken from the latest CCG NEA plan figures included in the Unify2 planning template, aggregated to quarterly level, extracted on 7th March 2016.
** This is calculated as the % contribution of each CCG to the HWB level plan, based on the CCG-HWB mapping (see CCG - HWB Mapping tab)
*** Within the sum subject to the condition on NHS out of hospital commissioned services/risk share, for any local area putting in place a risk share for 2016/17 as part of its BCF planning, we would expect the value of the risk share to be equal to the cost of the non-elective activity that the BCF plan seeks to avoid. Source of data: https://www.england.nhs.uk/wpcontent/uploads/2016/02/bcf-allocations-1617.xlsx
**** Please use the following document and amend the cost if necessary in cell E54. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477919/2014-15_Reference_costs_publication.pdf
5.2 Residential Admissions
- In cell G69 please enter your forecasted level of residential admissions for 2015-16. In cell H69 please enter your planned level of residential admissions for 2016-17. The actual rate for 14-15 and the planned rate for 15-16 are provided for comparison. Please add a commentary in column I to provide any useful information in relation to how you have agreed
this figure.
65
Actual 14/15*****
Annual rate
Long-term support needs of older people (aged 65 and over) met by
admission to residential and nursing care homes, per 100,000 population
Numerator
Planned 15/16*****
Forecast 15/16
66
Planned 16/17
553.2
591.6
697.1
170
185
218
67
Comments
We are looking to minimise admissions wherever possible and appropriate, but need to balance this with choice and budget management. We hope that the
692.5 target given is realistic
220
Denominator
30,730
31,272
31,272
31,767
*****Actual 14/15 & Planned 15/16 collected using the following definition - 'Permanent admissions of older people (aged 65 and over) to residential and nursing care homes, per 100,000 population'. Any numerator less than 6 has been supressed in the published data and is therefore showing blank in the numerator and annual rate cells above. These cells will
also be blank if an estimate has been used in the published data.
5.3 Reablement
- Please use cells G82-83 (forecast for 15-16) and H82-83 (planned 16-17) to set out the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services. By entering the denominator figure in cell G83/H83 (the planned total number of older people (65 and over) discharged from
hospital into reablement / rehabilitation services) and the numerator figure in cell G82/H82 (the number from within that group still at home after 91 days) the proportion will be calculated for you in cell G81/H81. Please add a commentary in column I to provide any useful information in relation to how you have agreed this figure.
68
70
69
71
72
Forecast 15/16
Planned 16/17
Comments
Actual 14/15*****
Planned 15/16
Please add comments, if required
Annual %
88.7%
89.5%
91.8%
89.5%
Proportion of older people (65 and over) who were still at home 91 days
after discharge from hospital into reablement / rehabilitation services
Numerator
55
51
67
68
Page 88
£0
Denominator
60
57
73
76
*****Any numerator or denominator less than 6 has been supressed in the published data and is therefore showing blank in the cells above. These cells will also be blank if an estimate has been used in the published data.
- Please use rows 93-95 (columns K-L for Q3-Q4 15-16 forecasts and columns M-P for 16-17 plans) to set out the Delayed Transfers Of Care (delayed days) from hospital per 100,000 population (aged 18+). The denominator figure in row 95 is pre-populated (population - aged 18+). The numerator figure in cells K94-P94 (the Delayed Transfers Of Care (delayed days) from hospital) needs entering. The rate will be calculated for you in cells K93-O93. Please add a commentary in column H to provide any useful
information in relation to how you have agreed this figure.
73
15-16 plans
Q2 (Jul 15 - Sep 15)
Q3 (Oct 15 - Dec 15)
Q1 (Apr 15 - Jun 15)
Quarterly rate
Delayed Transfers of Care (delayed days) from hospital per 100,000
population (aged 18+).
Numerator
Denominator
Q4 (Jan 16 - Mar 16)
720.1
716.7
779.7
589.1
671.7
679.4
655.6
655.6
655.6
907
904
982
742
846
857
827
827
827
827
125,951
125,951
125,951
126,136
125,951
125,951
125,951
126,136
126,136
126,136
126,136
126,341
Planned 15/16
84
85
86
87
Planned 16/17
Comments
11.7
13.5
583.0
670.0
4,979.0
4,979.0
5.6 Local defined patient experience metric (as described in your BCF 16/17 planning submission 1 return)
- You may also use rows 117-119 to update information relating to your locally selected patient experience metric. The local patient experience metric set out in cell C117 has been taken from your BCF 16-17 planning submission 1 template - these local metrics can be amended, as required.
89
92
90
91
Planned 15/16
93
94
95
Planned 16/17
Comments
ASCOF 4B - Proportion of people who use services who say that those
services have made them feel safe and secure
78
Q4 (Jan 17 - Mar 17)
911
81
Metric Value
77
723.3
82
83
88
76
16-17 plans
Q2 (Jul 16 - Sep 16)
Q3 (Oct 16 - Dec 16)
915
- Please use rows 105-107 to update information relating to your locally selected performance metric. The local performance metric set out in cell C105 has been taken from your BCF 16-17 planning submission 1 template - these local metrics can be amended, as required.
Measure - Increasing the availability of community based preventative
support solutions
Metric Value
Numerator - The number of calls in to the first point of access service for
adult social care and urgent and non-urgent community health and social
Numerator
care services (A3) that are referred on to community based preventative
support solutions
Denominator - The number of calls in to the first point of access service for Denominator
75
Q1 (Apr 16 - Jun 16)
726.5
5.5 Local performance metric (as described in your BCF 16/17 planning submission 1 return)
80
74
15-16 actual (Q1, Q2 & Q3) and forecast (Q4) figures
Q2 (Jul 15 - Sep 15)
Q3 (Oct 15 - Dec 15)
Q4 (Jan 16 - Mar 16)
Q1 (Apr 15 - Jun 15)
87.9
88.9
Numerator
321.0
329.0
Denominator
365.0
370.0
Page 89
654.6
79
Comments
Sheet: 5b. Health and Well-Being Board Better Care Fund NEA and DTOC Tool
2016/17
Metrics Tool
There is no data required to be completed on this tab. The tab is instead designed to provide assistance in setting your 16/17 plan figures for NEA and DTOC. Baseline 14/15, plan 15/16 and actual 15/16 data has been provided as a
reference. The 16/17 plan figures are taken from those given in tab 5. HWB Metrics.
For NEAs we have also provided SUS 14/15 Baseline, SUS 15/16 Actual and SUS 15/16 FOT (Forecast Outturn) figures, mapped from the baseline data supplied to assist CCGs with the 16/17 shared planning round. This has been provided
as a reference to support the new requirement for BCF NEA targets to be set in line with the revised definition set out in the “Technical Definitions” and the “Supplementary Technical Definitions” at the foot of the following webpage:
5.1 HWB NEA Activity
MAR
Q1
North East Lincolnshire Data Source Used - 15/16
Q2
Q3
3,726
3,629
3,829
North East Lincolnshire 14/15 Baseline (outturn)
North East Lincolnshire 15/16 Plan
North East Lincolnshire 15/16 Actual
3,734
3,637
3,856
Q4
3,693
3,599
Total
3,723
3,630
14,876
14,495
7,685
14/15 baseline and plan data has been taken from the "Better Care Fund Revised Non-Elective targets - Q4 Playback and Final Re-Validation of Baseline and Plans Collection" returned by HWB's in July 2015. The Q1 15/16 actual performance has been taken from the "Q1
Better Care Fund data collection" returned by HWB's in August 2015. The Q2 actual performance 15/16 and the Q4 15/16 plan figure have been taken from the "Q2 Better Care Fund data collection" returned by HWB's in November 2015. Actual Q3 and Q4 data is not
available at the point of this template being released.
North East Lincolnshire SUS 14/15 Baseline (mapped from CCG data)
North East Lincolnshire SUS 15/16 Actual (mapped from CCG data)
North East Lincolnshire SUS 15/16 FOT (mapped from CCG data)
3,584
3,712
3,651
3,763
3,599
3,660
3,640
14,473
11,134
14,954
SUS 14/15 Baseline, SUS 15/16 Actual and SUS 15/16 FOT (Forecast Outturn) figures were mapped from the baseline data supplied to assist the CCGs with the 16/17 shared planning round.
Over the last year the monitoring of non-elective admission (NEA) activity has shifted away from the use of the Monthly Activity Return (MAR) towards the use of Secondary Users Service data (SUS). This has been reflected in the latest planning round where NHS England,
Monitor and TDA have worked with CCGs and providers to create a consistent methodology to enable the creation of consistent NEA plans. The SUS CCG mapped data included here has been derived using this methodology. More details on the methodology used to define
NEA can be found in the “Technical Definitions” and the “Supplementary Technical Definitions” at the foot of the following webpage:
North East Lincolnshire Mapped NEA Plan 16/17 *
North East Lincolnshire Mapped NEA Plan 16/17 (after reduction) *
*See tab 5. HWB Metrics (row 41) to show how this figure has been calculated
3,755
3,755
3,756
3,756
3,755
3,755
3,755
3,755
NEA Baseline, Plan & Actual Data
3,900
3,850
3,800
North East Lincolnshire 14/15 Baseline (outturn)
3,750
NEA
3,700
3,650
North East Lincolnshire SUS 14/15 Baseline (mapped from CCG data)
North East Lincolnshire SUS 15/16 Actual (mapped from CCG data)
3,600
North East Lincolnshire Mapped NEA Plan 16/17 *
3,550
North East Lincolnshire Mapped NEA Plan 16/17 (after reduction) *
3,500
3,450
3,400
Q1
Q2
Quarter
Q3
Q4
Page 90
15,022
15,022
Sheet: 5b. Health and Well-Being Board Better Care Fund NEA and DTOC Tool
2016/17
Metrics Tool
There is no data required to be completed on this tab. The tab is instead designed to provide assistance in setting your 16/17 plan figures for NEA and DTOC. Baseline 14/15, plan 15/16 and actual 15/16 data has been provided as a
reference. The 16/17 plan figures are taken from those given in tab 5. HWB Metrics.
For NEAs we have also provided SUS 14/15 Baseline, SUS 15/16 Actual and SUS 15/16 FOT (Forecast Outturn) figures, mapped from the baseline data supplied to assist CCGs with the 16/17 shared planning round. This has been provided
as a reference to support the new requirement for BCF NEA targets to be set in line with the revised definition set out in the “Technical Definitions” and the “Supplementary Technical Definitions” at the foot of the following webpage:
Q1
Q2
North East Lincolnshire 14/15 Baseline
568.9
726.5
779.7
Q3
Q4
698.8
723.3
589.1
689.3
720.1
671.7
866.2
716.7
Delayed Transfers Of Care numerator data for baseline and actual performance has been sourced from the monthly DTOC return found here http://www.england.nhs.uk/statistics/statistical-work-areas/delayed-transfers-of-care/. Actual Q4 data is not available at the point of
this template being released.
North East Lincolnshire 16/17 Plans
655.6
655.6
655.6
654.6
DTOC Baseline, Plan & Actual Data
1,000.0
900.0
800.0
DTOC Rate
700.0
North East Lincolnshire 14/15 Baseline
600.0
500.0
400.0
North East Lincolnshire 16/17 Plans
300.0
200.0
100.0
0.0
Q1
Q2
Quarter
Q3
Q4
Page 91
Sheet: 6. National Conditions
2016/17
This sheet requires the Health & Wellbeing Board to confirm whether the eight national conditions detailed in the Better Care Fund Planning Guidance are on track to be met through the delivery of your plan in 2016-17. The conditions are set out in full in the BCF Policy Framework and
further guidance is provided in the BCF Planning Requirements document. Please answer as at the time of completion. On this tab please enter the following information:
- For each national condition please use column C to indicate whether the condition is being met. The sheet sets out the eight conditions and requires the Health & Wellbeing Board to confirm either 'Yes', 'No' or 'No - in development' for each one. 'Yes' should be used when the condition is
already being fully met, or will be by 31st March 2016. 'No - in development' should be used when a condition is not currently being met but a plan is in development to meet this through the delivery of your BCF plan in 2016-17. 'No' should be used to indicate that there is currently no plan
agreed for meeting this condition by 31st March 2017.
- Please use column C to indicate when it is expected that the condition will be met / agreed if it is not being currently.
- Please detail in the comments box issues and/or actions that are being taken to meet the condition, or any other relevant information.
National Conditions For The Better Care Fund 2016-17
Does your BCF plan for 2016-17
set out a clear plan to meet this
condition?
Please detail in the comments box issues and/or actions that are being taken to meet the condition, or any other relevant information.
Yes
96
Yes
97
3) Agreement for the delivery of 7-day services across health and social care to prevent
unnecessary non-elective admissions to acute settings and to facilitate transfer to
alternative care settings when clinically appropriate
Yes
4) Better data sharing between health and social care, based on the NHS number
No - in development
5) Ensure a joint approach to assessments and care planning and ensure that, where
funding is used for integrated packages of care, there will be an accountable professional
Yes
98
• Where consent is in place, adult social care (ASC) and health records are currently shared between: ASC, SystmOne GP’s and Community Health users.
Further development is required for children’s services and EMIS GP’s.• There is a planned programme of work to make Child Protection information available on
the Summary Care. • We plan to use the additional information functionality of the SCR and increase access to this across wider health and social care staff. • We
are planning to share discharge information with children’s services and non-Systmone practices.
99
##
6) Agreement on the consequential impact of the changes on the providers that are
predicted to be substantially affected by the plans
Yes
##
Yes
##
A plan is in place to secure agreement
8) Agreement on a local target for Delayed Transfers of Care (DTOC) and develop a joint
local action plan
No - in development
##
Page 92
CCG to Health and Well-Being Board Mapping
HWB Code
E09000002
E09000002
E09000002
E09000002
E09000003
E09000003
E09000003
E09000003
E09000003
E09000003
E09000003
E09000003
E09000003
E08000016
E08000016
E08000016
E08000016
E08000016
E08000016
E06000022
E06000022
E06000022
E06000022
E06000022
E06000055
E06000055
E06000055
E09000004
E09000004
E09000004
E09000004
E08000025
E08000025
E08000025
E08000025
E08000025
E08000025
E08000025
E06000008
E06000008
E06000008
E06000008
E06000009
E06000009
E08000001
E08000001
E08000001
E08000001
E08000001
E06000028 & E06000029
E06000036
E06000036
E06000036
E06000036
E06000036
E08000032
E08000032
E08000032
E08000032
E08000032
E08000032
E08000032
E09000005
E09000005
E09000005
E09000005
E09000005
E09000005
E09000005
E09000005
E06000043
E06000043
E06000043
E06000023
E06000023
E09000006
E09000006
E09000006
E09000006
E09000006
E09000006
E09000006
E10000002
E10000002
E10000002
E10000002
E10000002
E10000002
E10000002
E10000002
E10000002
E10000002
LA Name
Barking and Dagenham
Barnet
Barnet
Barnet
Barnet
Barnet
Barnet
Barnet
Barnet
Barnet
Barnsley
Barnsley
Barnsley
Barnsley
Barnsley
Barnsley
Bath and North East Somerset
Bedford
Bedford
Bedford
Bexley
Bexley
Bexley
Bexley
Birmingham
Birmingham
Birmingham
Birmingham
Birmingham
Birmingham
Birmingham
Blackburn with Darwen
Blackpool
Blackpool
Bolton
Bolton
Bolton
Bolton
Bolton
Bournemouth & Poole
Bracknell Forest
Bracknell Forest
Bracknell Forest
Bracknell Forest
Bracknell Forest
Bradford
Bradford
Bradford
Bradford
Bradford
Bradford
Bradford
Brent
Brent
Brent
Brent
Brent
Brent
Brent
Brent
Brighton and Hove
Brighton and Hove
Brighton and Hove
Bristol, City of
Bristol, City of
Bromley
Bromley
Bromley
Bromley
Bromley
Bromley
Bromley
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
Buckinghamshire
CCG Code
07L
08F
08M
08N
07M
07P
07R
09A
07X
08D
08E
08H
08Y
02P
02X
03A
03L
03N
03R
11E
11H
11X
12A
99N
06F
06H
04G
07N
07Q
09J
08A
13P
04X
05C
05J
05L
05P
05Y
00Q
00T
00V
01A
00R
02M
00T
00V
00X
01G
02H
11J
10G
99M
10C
11C
11D
02N
02W
02R
02T
02V
03C
03J
07M
07P
07R
09A
07W
08C
08E
08Y
09D
09G
99K
11H
12A
07N
07Q
07V
08A
08K
08L
99J
10Y
06F
10H
06N
08G
04F
04G
10Q
10T
11C
CCG Name
NHS Barking and Dagenham CCG
NHS Havering CCG
NHS Newham CCG
NHS Redbridge CCG
NHS Barnet CCG
NHS Brent CCG
NHS Camden CCG
NHS Central London (Westminster) CCG
NHS Enfield CCG
NHS Haringey CCG
NHS Harrow CCG
NHS Islington CCG
NHS West London (K&C & QPP) CCG
NHS Barnsley CCG
NHS Doncaster CCG
NHS Greater Huddersfield CCG
NHS Rotherham CCG
NHS Sheffield CCG
NHS Wakefield CCG
NHS Bath and North East Somerset CCG
NHS Bristol CCG
NHS Somerset CCG
NHS South Gloucestershire CCG
NHS Wiltshire CCG
NHS Bedfordshire CCG
NHS Cambridgeshire and Peterborough CCG
NHS Nene CCG
NHS Bexley CCG
NHS Bromley CCG
NHS Dartford, Gravesham and Swanley CCG
NHS Greenwich CCG
NHS Birmingham Crosscity CCG
NHS Birmingham South and Central CCG
NHS Dudley CCG
NHS Redditch and Bromsgrove CCG
NHS Sandwell and West Birmingham CCG
NHS Solihull CCG
NHS Walsall CCG
NHS Blackburn with Darwen CCG
NHS Bolton CCG
NHS Bury CCG
NHS East Lancashire CCG
NHS Blackpool CCG
NHS Fylde & Wyre CCG
NHS Bolton CCG
NHS Bury CCG
NHS Chorley and South Ribble CCG
NHS Salford CCG
NHS Wigan Borough CCG
NHS Dorset CCG
NHS Bracknell and Ascot CCG
NHS North East Hampshire and Farnham CCG
NHS Surrey Heath CCG
NHS Windsor, Ascot and Maidenhead CCG
NHS Wokingham CCG
NHS Airedale, Wharfdale and Craven CCG
NHS Bradford City CCG
NHS Bradford Districts CCG
NHS Calderdale CCG
NHS Leeds North CCG
NHS Leeds West CCG
NHS North Kirklees CCG
NHS Barnet CCG
NHS Brent CCG
NHS Camden CCG
NHS Ealing CCG
NHS Hammersmith and Fulham CCG
NHS Harrow CCG
NHS Brighton and Hove CCG
NHS Coastal West Sussex CCG
NHS High Weald Lewes Havens CCG
NHS Bristol CCG
NHS Bexley CCG
NHS Bromley CCG
NHS Croydon CCG
NHS Greenwich CCG
NHS Lambeth CCG
NHS Lewisham CCG
NHS West Kent CCG
NHS Aylesbury Vale CCG
NHS Chiltern CCG
NHS Herts Valleys CCG
NHS Hillingdon CCG
NHS Milton Keynes CCG
NHS Nene CCG
NHS Oxfordshire CCG
NHS Slough CCG
Page 93
% CCG in
HWB
89.7%
6.8%
0.2%
2.1%
91.1%
2.0%
0.8%
0.1%
2.9%
2.1%
1.2%
0.1%
0.1%
94.4%
0.3%
0.2%
0.3%
0.2%
0.4%
94.0%
0.3%
0.2%
0.0%
0.1%
37.5%
0.4%
0.2%
93.6%
0.0%
1.5%
7.7%
92.0%
96.9%
0.2%
2.9%
40.1%
15.0%
0.5%
89.0%
1.2%
0.2%
0.7%
87.0%
2.6%
97.3%
1.3%
0.2%
0.6%
0.8%
45.7%
82.1%
0.6%
0.1%
1.8%
1.4%
67.4%
99.4%
97.8%
0.1%
0.6%
1.7%
0.1%
2.0%
89.6%
4.0%
1.2%
0.5%
0.2%
5.7%
4.4%
97.8%
0.1%
0.3%
94.7%
3.8%
0.2%
94.9%
1.1%
1.5%
0.0%
2.0%
0.1%
91.2%
0.6%
96.1%
1.2%
0.8%
1.2%
0.1%
0.6%
2.8%
1.3%
% HWB in
CCG
88.4%
8.3%
0.4%
2.9%
92.9%
1.8%
0.5%
0.0%
2.4%
1.6%
0.8%
0.0%
0.0%
98.2%
0.3%
0.2%
0.3%
0.4%
0.6%
98.3%
0.8%
0.5%
0.1%
0.3%
97.4%
1.9%
0.7%
89.4%
0.1%
1.6%
8.9%
57.3%
20.5%
0.0%
0.4%
18.6%
3.0%
0.1%
95.8%
2.3%
0.2%
1.6%
97.5%
2.5%
97.6%
0.9%
0.1%
0.5%
0.9%
100.0%
94.8%
1.1%
0.1%
2.2%
1.8%
18.7%
21.5%
58.4%
0.0%
0.2%
1.1%
0.0%
2.1%
87.2%
2.7%
0.6%
0.6%
0.1%
3.9%
2.8%
99.7%
0.2%
0.2%
97.9%
2.1%
0.1%
95.3%
1.3%
1.2%
0.1%
1.8%
0.2%
35.0%
0.5%
59.9%
1.4%
0.5%
0.6%
0.2%
0.8%
0.8%
0.4%
E08000002
E08000002
E08000002
E08000002
E08000002
E08000002
E08000033
E08000033
E08000033
E08000033
E10000003
E10000003
E10000003
E10000003
E10000003
E10000003
E10000003
E09000007
E09000007
E09000007
E09000007
E09000007
E09000007
E09000007
E06000056
E06000056
E06000056
E06000056
E06000056
E06000049
E06000049
E06000049
E06000049
E06000049
E06000049
E06000049
E06000049
E06000049
E06000049
E06000050
E06000050
E06000050
E06000050
E06000050
E06000050
E06000050
E09000001
E09000001
E09000001
E09000001
E09000001
E09000001
E06000052
E06000052
E06000047
E06000047
E06000047
E06000047
E06000047
E08000026
E08000026
E09000008
E09000008
E09000008
E09000008
E09000008
E09000008
E09000008
E10000006
E10000006
E06000005
E06000005
E06000005
E06000005
E06000015
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000007
E10000008
E10000008
E10000008
E10000008
E10000008
E08000017
E08000017
Bury
Bury
Bury
Bury
Bury
Bury
Calderdale
Calderdale
Calderdale
Calderdale
Cambridgeshire
Cambridgeshire
Cambridgeshire
Cambridgeshire
Cambridgeshire
Cambridgeshire
Cambridgeshire
Camden
Camden
Camden
Camden
Camden
Camden
Camden
Central Bedfordshire
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire East
Cheshire West and Chester
City of London
City of London
City of London
City of London
City of London
City of London
Cornwall & Scilly
Cornwall & Scilly
County Durham
County Durham
County Durham
County Durham
County Durham
Coventry
Coventry
Croydon
Croydon
Croydon
Croydon
Croydon
Croydon
Croydon
Cumbria
Cumbria
Darlington
Darlington
Darlington
Darlington
Derby
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Derbyshire
Devon
Devon
Devon
Devon
Devon
Doncaster
Doncaster
00T
00V
01A
01D
01M
01G
02R
02T
03A
01D
06F
06H
06K
99D
07H
07J
07K
07M
07P
07R
09A
08D
08H
08Y
10Y
06F
06K
06N
06P
01C
04J
05G
05N
01R
01W
02A
02D
02E
02F
01C
01F
01R
02D
02E
02F
12F
07R
09A
07T
08H
08Q
08V
11N
99P
00D
00K
13T
00J
00P
05A
05H
07Q
07V
09L
08K
08R
08T
08X
01H
01K
00C
00D
03D
00K
04R
02Q
05D
01C
03X
03Y
04E
04J
04L
04M
03N
04R
01W
01Y
04V
11J
11N
99P
11X
99Q
02P
02Q
NHS Bolton CCG
NHS Bury CCG
NHS Heywood, Middleton and Rochdale CCG
NHS North Manchester CCG
NHS Salford CCG
NHS Calderdale CCG
NHS East and North Hertfordshire CCG
NHS South Lincolnshire CCG
NHS West Essex CCG
NHS West Norfolk CCG
NHS West Suffolk CCG
NHS Barnet CCG
NHS Brent CCG
NHS Camden CCG
NHS Haringey CCG
NHS Islington CCG
NHS Luton CCG
NHS Eastern Cheshire CCG
NHS North Derbyshire CCG
NHS North Staffordshire CCG
NHS Shropshire CCG
NHS South Cheshire CCG
NHS Stockport CCG
NHS Trafford CCG
NHS Vale Royal CCG
NHS Warrington CCG
NHS West Cheshire CCG
NHS Halton CCG
NHS Vale Royal CCG
NHS Warrington CCG
NHS Wirral CCG
NHS Camden CCG
NHS City and Hackney CCG
NHS Islington CCG
NHS Southwark CCG
NHS Tower Hamlets CCG
NHS Kernow CCG
NHS North, East, West Devon CCG
NHS Durham Dales, Easington and Sedgefield CCG
NHS Hartlepool and Stockton-On-Tees CCG
NHS Newcastle Gateshead CCG
NHS North Durham CCG
NHS Sunderland CCG
NHS Coventry and Rugby CCG
NHS Warwickshire North CCG
NHS Bromley CCG
NHS Croydon CCG
NHS East Surrey CCG
NHS Lambeth CCG
NHS Merton CCG
NHS Sutton CCG
NHS Wandsworth CCG
NHS Cumbria CCG
NHS Lancashire North CCG
NHS Darlington CCG
NHS Hambleton, Richmondshire and Whitby CCG
NHS Southern Derbyshire CCG
NHS Bassetlaw CCG
NHS East Staffordshire CCG
NHS Erewash CCG
NHS Hardwick CCG
NHS Mansfield and Ashfield CCG
NHS Nottingham North and East CCG
NHS Nottingham West CCG
NHS Sheffield CCG
NHS Stockport CCG
NHS Tameside and Glossop CCG
NHS West Leicestershire CCG
NHS Dorset CCG
NHS Kernow CCG
NHS Somerset CCG
NHS South Devon and Torbay CCG
NHS Barnsley CCG
NHS Bassetlaw CCG
Page 94
0.8%
94.3%
0.1%
0.4%
2.0%
1.4%
0.4%
98.6%
0.4%
0.1%
1.1%
72.1%
0.9%
0.4%
0.2%
1.5%
4.0%
0.1%
1.5%
84.6%
6.0%
0.5%
3.4%
0.2%
2.1%
56.8%
0.2%
0.4%
2.4%
96.3%
0.4%
1.1%
0.1%
98.6%
1.6%
0.2%
0.7%
0.7%
2.0%
1.1%
0.2%
0.5%
99.3%
0.4%
96.8%
0.3%
0.2%
0.0%
1.9%
0.1%
0.0%
0.4%
99.7%
0.4%
97.4%
0.1%
0.7%
96.6%
1.2%
74.0%
0.3%
1.5%
95.6%
3.0%
2.7%
0.8%
0.8%
0.4%
97.4%
0.2%
98.2%
1.2%
0.0%
0.2%
50.1%
0.2%
8.1%
0.3%
92.2%
94.6%
1.9%
98.3%
0.2%
5.0%
0.5%
48.2%
0.1%
14.1%
0.5%
0.3%
0.3%
70.0%
0.4%
51.1%
0.4%
1.2%
1.2%
94.3%
0.2%
0.5%
2.0%
1.8%
0.7%
98.8%
0.4%
0.1%
0.8%
96.6%
0.7%
0.0%
0.1%
0.4%
1.4%
0.2%
2.2%
88.4%
5.1%
0.6%
3.2%
0.2%
1.5%
95.1%
0.5%
0.8%
2.0%
50.6%
0.3%
0.6%
0.0%
45.3%
1.3%
0.1%
0.2%
0.4%
1.3%
0.7%
0.0%
0.2%
29.3%
0.3%
69.4%
0.2%
6.0%
0.8%
74.1%
3.1%
0.1%
15.8%
99.4%
0.6%
53.0%
0.0%
0.7%
45.7%
0.6%
99.9%
0.1%
1.3%
93.7%
1.3%
2.6%
0.4%
0.4%
0.4%
100.0%
0.0%
96.3%
3.1%
0.1%
0.5%
100.0%
0.0%
1.4%
0.0%
11.3%
12.2%
0.5%
36.0%
0.0%
0.6%
0.4%
33.0%
0.0%
4.3%
0.2%
0.3%
0.2%
80.5%
0.3%
18.7%
0.3%
0.5%
E08000017
E08000017
E08000017
E10000009
E10000009
E10000009
E10000009
E08000027
E08000027
E08000027
E08000027
E08000027
E09000009
E09000009
E09000009
E09000009
E09000009
E09000009
E09000009
E09000009
E06000011
E06000011
E06000011
E06000011
E10000011
E10000011
E10000011
E10000011
E10000011
E10000011
E09000010
E09000010
E09000010
E09000010
E09000010
E09000010
E09000010
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E10000012
E08000037
E08000037
E08000037
E08000037
E10000013
E10000013
E10000013
E10000013
E10000013
E10000013
E10000013
E09000011
E09000011
E09000011
E09000011
E09000012
E09000012
E09000012
E09000012
E09000012
E09000012
E06000006
E06000006
E06000006
E06000006
E06000006
E09000013
E09000013
E09000013
E09000013
E09000013
E09000013
E09000013
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
E10000014
Doncaster
Doncaster
Doncaster
Dorset
Dorset
Dorset
Dorset
Dudley
Dudley
Dudley
Dudley
Dudley
Ealing
Ealing
Ealing
Ealing
Ealing
Ealing
Ealing
Ealing
East Sussex
East Sussex
East Sussex
East Sussex
East Sussex
East Sussex
Enfield
Enfield
Enfield
Enfield
Enfield
Enfield
Enfield
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Essex
Gateshead
Gateshead
Gateshead
Gateshead
Gloucestershire
Gloucestershire
Gloucestershire
Gloucestershire
Gloucestershire
Gloucestershire
Gloucestershire
Greenwich
Greenwich
Greenwich
Greenwich
Hackney
Hackney
Hackney
Hackney
Hackney
Hackney
Halton
Halton
Halton
Halton
Halton
Hammersmith and Fulham
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
02X
03L
03R
11J
11X
11A
99N
13P
05C
05L
06A
06D
07P
09A
07W
08C
08E
08G
07Y
08Y
02Y
03F
03M
03Q
09D
09F
09P
99K
09X
99J
07M
07T
06K
07X
08D
06N
08H
07L
99E
06H
99F
06K
08F
06L
06Q
06T
08N
99G
07G
08W
07H
07K
13T
00J
00L
00N
11M
05F
10Q
12A
05R
05T
99N
07N
07Q
08A
08L
07R
09A
07T
08D
08H
08V
01F
01J
99A
02E
02F
07P
07R
09A
07W
08C
07Y
08Y
10G
09G
11J
10K
09N
10M
10N
99M
10J
10R
10V
NHS Doncaster CCG
NHS Rotherham CCG
NHS Wakefield CCG
NHS Dorset CCG
NHS Somerset CCG
NHS West Hampshire CCG
NHS Wiltshire CCG
NHS Dudley CCG
NHS Wolverhampton CCG
NHS Wyre Forest CCG
NHS Brent CCG
NHS Ealing CCG
NHS Harrow CCG
NHS Hillingdon CCG
NHS Hounslow CCG
NHS East Riding of Yorkshire CCG
NHS Hull CCG
NHS Scarborough and Ryedale CCG
NHS Vale of York CCG
NHS Eastbourne, Hailsham and Seaford CCG
NHS Hastings and Rother CCG
NHS Horsham and Mid Sussex CCG
NHS West Kent CCG
NHS Barnet CCG
NHS Enfield CCG
NHS Haringey CCG
NHS Islington CCG
NHS Basildon and Brentwood CCG
NHS Castle Point and Rochford CCG
NHS Havering CCG
NHS Ipswich and East Suffolk CCG
NHS Mid Essex CCG
NHS North East Essex CCG
NHS Redbridge CCG
NHS Southend CCG
NHS Thurrock CCG
NHS Waltham Forest CCG
NHS West Essex CCG
NHS Northumberland CCG
NHS South Tyneside CCG
NHS Gloucestershire CCG
NHS Herefordshire CCG
NHS Oxfordshire CCG
NHS South Warwickshire CCG
NHS South Worcestershire CCG
NHS Wiltshire CCG
NHS Bexley CCG
NHS Bromley CCG
NHS Greenwich CCG
NHS Lewisham CCG
NHS Camden CCG
NHS Haringey CCG
NHS Islington CCG
NHS Halton CCG
NHS Knowsley CCG
NHS Liverpool CCG
NHS Warrington CCG
NHS Brent CCG
NHS Camden CCG
NHS Ealing CCG
NHS Hounslow CCG
NHS Dorset CCG
NHS Fareham and Gosport CCG
NHS Guildford and Waverley CCG
NHS Newbury and District CCG
NHS North & West Reading CCG
NHS North Hampshire CCG
NHS Portsmouth CCG
NHS South Eastern Hampshire CCG
Page 95
96.7%
1.5%
0.1%
52.7%
0.6%
2.0%
0.8%
0.2%
93.2%
4.0%
1.8%
0.6%
1.7%
0.1%
86.7%
5.7%
0.3%
0.6%
5.0%
0.6%
97.4%
9.4%
0.7%
6.4%
1.0%
100.0%
99.7%
98.1%
2.9%
0.8%
1.1%
0.1%
0.3%
95.5%
7.8%
0.1%
0.2%
0.1%
99.8%
0.1%
95.4%
1.8%
0.2%
0.2%
100.0%
98.7%
3.2%
3.4%
1.5%
0.5%
97.3%
2.3%
39.6%
0.9%
0.5%
0.3%
97.6%
0.5%
0.2%
0.3%
0.5%
1.1%
0.2%
5.2%
1.1%
88.6%
4.1%
0.8%
0.1%
90.6%
0.6%
4.1%
0.5%
98.2%
0.1%
0.3%
0.6%
0.6%
0.3%
0.0%
2.4%
0.6%
90.9%
0.5%
6.4%
0.6%
0.2%
0.5%
98.6%
2.9%
5.9%
0.9%
76.4%
99.2%
4.5%
95.4%
97.8%
1.3%
0.1%
95.9%
0.7%
2.5%
0.9%
0.5%
90.9%
6.9%
1.5%
0.2%
1.5%
0.0%
90.8%
2.9%
0.2%
0.5%
3.7%
0.4%
85.2%
8.0%
0.2%
6.6%
0.6%
34.5%
33.3%
29.7%
1.2%
0.7%
1.3%
0.1%
0.6%
90.7%
6.9%
0.2%
0.1%
0.0%
18.3%
0.0%
11.7%
0.7%
0.0%
0.0%
25.4%
22.4%
0.6%
0.4%
0.2%
0.1%
19.7%
0.4%
98.0%
1.1%
0.7%
0.2%
98.6%
0.1%
0.2%
0.1%
0.2%
0.5%
0.2%
4.3%
1.3%
89.9%
4.5%
0.7%
0.1%
94.6%
0.7%
3.4%
0.5%
96.7%
0.2%
1.1%
0.9%
1.2%
0.5%
0.1%
2.3%
1.2%
88.0%
0.8%
7.2%
0.0%
0.0%
0.3%
14.5%
0.5%
0.5%
0.0%
12.4%
15.9%
0.7%
14.6%
E10000014
E10000014
E10000014
E10000014
E10000014
E09000014
E09000014
E09000014
E09000014
E09000014
E09000014
E09000015
E09000015
E09000015
E09000015
E09000015
E09000015
E09000015
E06000001
E06000001
E09000016
E09000016
E09000016
E09000016
E09000016
E06000019
E06000019
E06000019
E06000019
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E10000015
E09000017
E09000017
E09000017
E09000017
E09000017
E09000017
E09000018
E09000018
E09000018
E09000018
E09000018
E09000018
E09000018
E06000046
E09000019
E09000019
E09000019
E09000019
E09000019
E09000020
E09000020
E09000020
E09000020
E09000020
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E10000016
E06000010
E06000010
E09000021
E09000021
E09000021
E09000021
E09000021
E09000021
E08000034
E08000034
E08000034
E08000034
E08000034
E08000034
E08000034
E08000011
E08000011
Hampshire
Hampshire
Hampshire
Hampshire
Hampshire
Haringey
Haringey
Haringey
Haringey
Haringey
Haringey
Harrow
Harrow
Harrow
Harrow
Harrow
Harrow
Harrow
Hartlepool
Hartlepool
Havering
Havering
Havering
Havering
Havering
Herefordshire, County of
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hertfordshire
Hillingdon
Hillingdon
Hillingdon
Hillingdon
Hillingdon
Hillingdon
Hounslow
Hounslow
Hounslow
Hounslow
Hounslow
Hounslow
Hounslow
Isle of Wight
Islington
Islington
Islington
Islington
Islington
Kensington and Chelsea
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kent
Kingston upon Hull, City of
Kingston upon Hull, City of
Kingston upon Thames
Kirklees
Kirklees
Kirklees
Kirklees
Kirklees
Kirklees
Kirklees
Knowsley
Knowsley
10X
10C
11A
99N
11D
07M
07R
07T
07X
08D
08H
07M
07P
07W
08E
06N
08G
08Y
00D
00K
07L
08F
08M
08N
07G
11M
05F
05N
05T
10Y
07M
06F
06H
10H
06K
07X
08E
06N
08G
06P
07H
10H
07W
08C
08E
08G
07Y
07W
08C
08G
07Y
09Y
08P
08Y
10L
07R
09A
07T
08D
08H
07P
07R
09A
08C
08Y
09C
07N
07Q
09E
09J
09L
08A
09P
99K
09W
10A
10D
10E
99J
02Y
03F
08J
08R
08P
99H
08T
08X
02P
02R
02T
03A
03C
03J
03R
01F
01J
NHS Southampton CCG
NHS Wiltshire CCG
NHS Wokingham CCG
NHS Barnet CCG
NHS Camden CCG
NHS Enfield CCG
NHS Haringey CCG
NHS Islington CCG
NHS Barnet CCG
NHS Brent CCG
NHS Ealing CCG
NHS Harrow CCG
NHS Hillingdon CCG
NHS Havering CCG
NHS Newham CCG
NHS Redbridge CCG
NHS Thurrock CCG
NHS Shropshire CCG
NHS Barnet CCG
NHS Chiltern CCG
NHS Enfield CCG
NHS Harrow CCG
NHS Hillingdon CCG
NHS Luton CCG
NHS West Essex CCG
NHS Chiltern CCG
NHS Ealing CCG
NHS Harrow CCG
NHS Hillingdon CCG
NHS Hounslow CCG
NHS Ealing CCG
NHS Hillingdon CCG
NHS Hounslow CCG
NHS North West Surrey CCG
NHS Richmond CCG
NHS Isle of Wight CCG
NHS Camden CCG
NHS Haringey CCG
NHS Islington CCG
NHS Brent CCG
NHS Camden CCG
NHS Ashford CCG
NHS Bexley CCG
NHS Bromley CCG
NHS Canterbury and Coastal CCG
NHS East Surrey CCG
NHS Greenwich CCG
NHS Hastings and Rother CCG
NHS Medway CCG
NHS South Kent Coast CCG
NHS Swale CCG
NHS Thanet CCG
NHS West Kent CCG
NHS Hull CCG
NHS Kingston CCG
NHS Merton CCG
NHS Richmond CCG
NHS Surrey Downs CCG
NHS Sutton CCG
NHS Wandsworth CCG
NHS Barnsley CCG
NHS Calderdale CCG
NHS Leeds West CCG
NHS Wakefield CCG
NHS Halton CCG
NHS Knowsley CCG
Page 96
5.5%
0.7%
97.7%
1.3%
0.6%
1.1%
0.5%
3.0%
1.3%
87.7%
2.3%
4.3%
3.7%
1.3%
90.0%
0.2%
1.7%
0.1%
0.1%
32.6%
4.0%
92.0%
0.0%
0.5%
0.1%
0.3%
98.1%
0.3%
0.8%
0.4%
0.2%
0.1%
2.1%
0.1%
96.8%
0.3%
0.5%
98.1%
2.3%
0.4%
0.7%
0.1%
5.2%
0.5%
2.2%
94.3%
1.0%
5.8%
1.0%
0.2%
88.0%
0.3%
5.3%
0.1%
100.0%
4.4%
0.4%
3.2%
1.3%
89.8%
0.0%
0.2%
4.1%
0.9%
64.1%
100.0%
1.1%
0.8%
100.0%
98.3%
0.1%
0.1%
0.3%
0.6%
6.0%
100.0%
99.9%
100.0%
98.7%
1.3%
90.6%
87.1%
1.0%
0.7%
0.9%
0.1%
0.3%
0.1%
1.0%
1.3%
99.5%
0.3%
99.0%
1.5%
1.1%
86.9%
1.1%
0.0%
39.0%
0.5%
0.0%
1.6%
0.5%
3.1%
1.4%
91.6%
1.9%
6.3%
5.0%
1.9%
84.3%
0.4%
1.9%
0.1%
0.4%
99.6%
3.3%
95.9%
0.1%
0.6%
0.1%
0.9%
97.3%
0.5%
1.3%
0.0%
0.0%
0.0%
1.6%
0.0%
46.6%
0.0%
0.1%
50.9%
0.6%
0.0%
0.2%
0.1%
6.9%
0.3%
1.8%
90.0%
0.9%
8.0%
0.6%
0.2%
87.1%
0.4%
3.6%
0.1%
100.0%
4.9%
0.4%
4.1%
1.7%
89.0%
0.1%
0.4%
5.1%
1.2%
93.2%
8.3%
0.2%
0.2%
14.1%
16.5%
0.0%
0.0%
0.0%
0.0%
1.1%
13.0%
7.1%
9.3%
30.4%
1.5%
98.5%
95.8%
1.2%
0.8%
1.5%
0.1%
0.5%
0.0%
0.8%
0.6%
54.8%
0.2%
42.4%
1.2%
0.9%
88.2%
E08000011
E08000011
E08000011
E09000022
E09000022
E09000022
E09000022
E09000022
E09000022
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E10000017
E08000035
E08000035
E08000035
E08000035
E08000035
E08000035
E08000035
E08000035
E06000016
E06000016
E06000016
E10000018
E10000018
E10000018
E10000018
E10000018
E10000018
E10000018
E10000018
E09000023
E09000023
E09000023
E09000023
E09000023
E09000023
E10000019
E10000019
E10000019
E10000019
E10000019
E10000019
E10000019
E10000019
E10000019
E08000012
E08000012
E08000012
E06000032
E06000032
E08000003
E08000003
E08000003
E08000003
E08000003
E08000003
E08000003
E08000003
E08000003
E08000003
E06000035
E06000035
E06000035
E06000035
E09000024
E09000024
E09000024
E09000024
E09000024
E09000024
E06000002
E06000002
E06000002
E06000042
E06000042
E06000042
E08000021
E08000021
E08000021
E09000025
Knowsley
Knowsley
Knowsley
Lambeth
Lambeth
Lambeth
Lambeth
Lambeth
Lambeth
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Lancashire
Leeds
Leeds
Leeds
Leeds
Leeds
Leeds
Leeds
Leeds
Leicester
Leicester
Leicester
Leicestershire
Leicestershire
Leicestershire
Leicestershire
Leicestershire
Leicestershire
Leicestershire
Leicestershire
Lewisham
Lewisham
Lewisham
Lewisham
Lewisham
Lewisham
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Lincolnshire
Liverpool
Liverpool
Liverpool
Luton
Luton
Manchester
Manchester
Manchester
Manchester
Manchester
Manchester
Manchester
Manchester
Manchester
Manchester
Medway
Medway
Medway
Medway
Merton
Merton
Merton
Merton
Merton
Merton
Middlesbrough
Middlesbrough
Middlesbrough
Milton Keynes
Milton Keynes
Milton Keynes
Newcastle upon Tyne
Newcastle upon Tyne
Newcastle upon Tyne
Newham
99A
01T
01X
09A
07V
08K
08R
08Q
08X
02N
00Q
00R
00T
00V
00X
01H
01A
02M
01E
01D
01J
01K
01T
01V
01X
02G
02H
02W
02R
02V
03G
03C
03J
03Q
03R
03W
04C
04V
03V
03W
04C
04N
04Q
04R
05H
04V
07Q
09A
08A
08K
08L
08Q
06H
03W
03T
04D
04H
03H
03K
99D
04Q
01J
99A
01T
06F
06P
00V
00W
01D
01M
00Y
01G
01N
01W
01Y
02A
09J
09W
10D
99J
07V
08J
08K
08R
08T
08X
03D
00K
00M
06F
04F
04G
13T
99C
00L
07L
NHS Liverpool CCG
NHS South Sefton CCG
NHS St Helens CCG
NHS Croydon CCG
NHS Lambeth CCG
NHS Merton CCG
NHS Southwark CCG
NHS Wandsworth CCG
NHS Blackburn with Darwen CCG
NHS Blackpool CCG
NHS Bolton CCG
NHS Bury CCG
NHS Chorley and South Ribble CCG
NHS Cumbria CCG
NHS Fylde & Wyre CCG
NHS Greater Preston CCG
NHS Knowsley CCG
NHS Lancashire North CCG
NHS Southport and Formby CCG
NHS St Helens CCG
NHS West Lancashire CCG
NHS Bradford City CCG
NHS Leeds North CCG
NHS Leeds South and East CCG
NHS Leeds West CCG
NHS Wakefield CCG
NHS East Leicestershire and Rutland CCG
NHS Leicester City CCG
NHS Corby CCG
NHS Leicester City CCG
NHS Rushcliffe CCG
NHS South West Lincolnshire CCG
NHS Bromley CCG
NHS Greenwich CCG
NHS Lambeth CCG
NHS Lewisham CCG
NHS Southwark CCG
NHS Lincolnshire East CCG
NHS Lincolnshire West CCG
NHS Newark & Sherwood CCG
NHS North East Lincolnshire CCG
NHS North Lincolnshire CCG
NHS Knowsley CCG
NHS Liverpool CCG
NHS Luton CCG
NHS Bury CCG
NHS Central Manchester CCG
NHS Oldham CCG
NHS Salford CCG
NHS South Manchester CCG
NHS Stockport CCG
NHS Trafford CCG
NHS Medway CCG
NHS Swale CCG
NHS West Kent CCG
NHS Croydon CCG
NHS Kingston CCG
NHS Lambeth CCG
NHS Merton CCG
NHS Sutton CCG
NHS Wandsworth CCG
NHS South Tees CCG
NHS Nene CCG
NHS North Tyneside CCG
Page 97
2.5%
0.2%
2.3%
0.7%
0.7%
86.8%
1.2%
1.8%
3.6%
0.2%
11.0%
13.0%
0.3%
1.4%
99.8%
1.4%
98.9%
97.4%
100.0%
0.9%
0.1%
99.8%
0.5%
3.0%
0.5%
97.1%
0.8%
0.6%
0.7%
96.4%
98.5%
97.9%
0.3%
0.6%
1.5%
2.5%
92.5%
2.6%
0.6%
85.3%
7.5%
5.4%
5.7%
0.6%
1.6%
96.2%
1.3%
0.1%
2.2%
0.2%
92.1%
3.7%
0.2%
0.2%
99.2%
98.5%
2.4%
2.7%
2.6%
90.6%
93.2%
8.5%
94.3%
3.3%
2.3%
97.2%
0.3%
93.7%
0.5%
85.1%
0.9%
2.5%
93.9%
1.5%
0.4%
4.3%
0.2%
94.0%
0.1%
0.2%
0.5%
3.5%
0.9%
87.7%
3.4%
6.5%
0.2%
0.2%
52.0%
1.5%
95.5%
0.6%
58.0%
6.0%
0.8%
0.5%
8.0%
0.1%
2.9%
0.4%
0.8%
92.7%
0.7%
1.6%
3.8%
0.0%
1.5%
1.8%
0.0%
0.2%
14.5%
0.6%
30.0%
11.9%
17.1%
0.2%
0.0%
12.8%
0.0%
0.3%
0.0%
8.8%
0.2%
0.0%
0.3%
24.3%
31.9%
42.7%
0.0%
0.2%
0.6%
2.2%
95.2%
2.6%
0.0%
40.1%
4.2%
1.0%
1.1%
0.5%
0.4%
52.7%
1.5%
0.1%
2.0%
0.3%
92.5%
3.7%
0.2%
0.0%
32.1%
30.4%
0.4%
0.6%
0.6%
19.5%
16.2%
2.8%
96.2%
1.0%
4.5%
95.5%
0.1%
36.9%
0.2%
30.3%
0.4%
1.1%
28.2%
0.8%
0.2%
1.8%
0.2%
99.5%
0.0%
0.3%
0.8%
3.0%
1.4%
81.5%
2.7%
10.5%
0.2%
0.3%
99.5%
2.5%
96.1%
1.4%
95.0%
4.2%
0.8%
0.3%
E09000025
E09000025
E09000025
E09000025
E09000025
E09000025
E10000020
E10000020
E10000020
E10000020
E10000020
E10000020
E10000020
E10000020
E10000020
E06000012
E06000012
E06000012
E06000013
E06000013
E06000013
E06000013
E06000013
E06000013
E06000024
E06000024
E06000024
E06000024
E08000022
E08000022
E08000022
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000023
E10000021
E10000021
E10000021
E10000021
E10000021
E10000021
E10000021
E10000021
E10000021
E10000021
E06000057
E06000057
E06000057
E06000057
E06000057
E06000018
E06000018
E06000018
E06000018
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E10000024
E08000004
E08000004
E08000004
E08000004
E10000025
E10000025
E10000025
E10000025
E10000025
E10000025
E10000025
E10000025
E06000031
E06000031
E06000026
E06000044
Newham
Newham
Newham
Newham
Newham
Newham
Norfolk
Norfolk
Norfolk
Norfolk
Norfolk
Norfolk
Norfolk
Norfolk
Norfolk
North Lincolnshire
North Lincolnshire
North Lincolnshire
North Lincolnshire
North Lincolnshire
North Lincolnshire
North Somerset
North Somerset
North Somerset
North Somerset
North Tyneside
North Tyneside
North Tyneside
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
North Yorkshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northamptonshire
Northumberland
Northumberland
Northumberland
Northumberland
Northumberland
Nottingham
Nottingham
Nottingham
Nottingham
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Nottinghamshire
Oldham
Oldham
Oldham
Oldham
Oxfordshire
Oxfordshire
Oxfordshire
Oxfordshire
Oxfordshire
Oxfordshire
Oxfordshire
Oxfordshire
Peterborough
Peterborough
Plymouth
Portsmouth
09A
07T
08M
08N
08V
08W
06H
06M
06L
06V
06W
99D
06Y
07J
07K
03T
03H
03K
02Q
02X
02Y
04D
03H
03K
11E
11H
11T
11X
13T
99C
00L
02N
01H
00C
02X
00D
01A
02Y
03D
03E
00K
02V
03G
03M
03Q
03R
10Y
06F
06H
03V
05A
03W
04F
04G
10Q
99D
01H
13T
00J
99C
00L
04K
04L
04M
04N
02Q
02X
03W
03X
03Y
04D
04E
04H
04K
04L
04M
04N
04Q
04R
04V
01D
01M
00Y
01Y
10Y
11M
04G
10M
10N
10Q
05R
12D
06H
99D
99P
10K
NHS Newham CCG
NHS Redbridge CCG
NHS Great Yarmouth and Waveney CCG
NHS North Norfolk CCG
NHS Norwich CCG
NHS South Norfolk CCG
NHS West Norfolk CCG
NHS Lincolnshire East CCG
NHS Bassetlaw CCG
NHS Doncaster CCG
NHS Bristol CCG
NHS North Somerset CCG
NHS Somerset CCG
NHS Cumbria CCG
NHS Darlington CCG
NHS Doncaster CCG
NHS Harrogate and Rural District CCG
NHS Leeds North CCG
NHS Scarborough and Ryedale CCG
NHS Wakefield CCG
NHS Corby CCG
NHS Nene CCG
NHS Oxfordshire CCG
NHS Cumbria CCG
NHS Nottingham City CCG
NHS Rushcliffe CCG
NHS Bassetlaw CCG
NHS Doncaster CCG
NHS Erewash CCG
NHS Hardwick CCG
NHS Mansfield and Ashfield CCG
NHS Newark & Sherwood CCG
NHS Nottingham City CCG
NHS Rushcliffe CCG
NHS Oldham CCG
NHS Nene CCG
NHS Oxfordshire CCG
NHS Swindon CCG
NHS Fareham and Gosport CCG
Page 98
0.1%
0.1%
96.9%
0.2%
0.2%
1.7%
0.7%
47.5%
0.1%
100.0%
100.0%
0.2%
98.8%
98.5%
2.6%
0.8%
95.9%
0.1%
0.2%
0.0%
0.0%
1.0%
1.4%
97.2%
1.7%
0.3%
99.1%
0.0%
1.0%
93.1%
0.7%
32.4%
1.2%
1.3%
0.2%
0.2%
0.1%
1.3%
98.7%
99.9%
0.2%
3.0%
0.5%
99.3%
32.6%
2.0%
0.1%
0.1%
1.6%
99.1%
0.3%
1.9%
3.2%
98.8%
1.2%
0.9%
0.0%
0.3%
0.2%
0.9%
98.0%
89.7%
4.7%
5.7%
4.1%
97.5%
1.7%
0.3%
7.8%
5.1%
0.4%
98.1%
97.6%
10.3%
95.0%
89.3%
90.5%
0.7%
0.6%
0.1%
1.4%
2.6%
94.7%
0.2%
6.2%
0.2%
0.1%
0.1%
2.0%
97.3%
0.7%
2.6%
22.6%
5.2%
29.3%
1.4%
0.0%
0.0%
97.9%
0.2%
0.2%
1.4%
0.7%
12.3%
0.0%
18.8%
23.7%
0.0%
25.3%
18.5%
0.7%
1.2%
98.7%
0.2%
0.1%
0.1%
0.1%
1.4%
1.4%
96.8%
1.6%
0.6%
97.7%
0.2%
2.5%
96.4%
1.1%
8.3%
1.0%
0.2%
0.1%
0.1%
0.0%
0.7%
22.9%
26.3%
0.0%
1.0%
0.2%
19.2%
18.7%
1.2%
0.0%
0.0%
1.9%
9.6%
0.2%
0.8%
1.2%
85.0%
1.1%
0.2%
0.1%
0.4%
0.2%
0.6%
98.7%
94.8%
2.1%
1.6%
1.5%
13.5%
0.6%
0.1%
0.9%
0.6%
0.1%
22.5%
15.5%
4.4%
17.3%
10.2%
13.6%
0.1%
0.4%
0.0%
1.3%
2.1%
96.3%
0.2%
1.8%
0.2%
0.1%
0.0%
0.3%
96.6%
0.3%
0.8%
96.1%
3.9%
100.0%
1.3%
E06000044
E06000044
E06000038
E06000038
E06000038
E06000038
E09000026
E09000026
E09000026
E09000026
E09000026
E09000026
E06000003
E06000003
E09000027
E09000027
E09000027
E09000027
E09000027
E09000027
E08000005
E08000005
E08000005
E08000005
E08000005
E08000018
E08000018
E08000018
E08000018
E08000018
E06000017
E06000017
E06000017
E06000017
E06000017
E08000006
E08000006
E08000006
E08000006
E08000006
E08000006
E08000006
E08000028
E08000028
E08000028
E08000028
E08000028
E08000028
E08000014
E08000014
E08000014
E08000014
E08000014
E08000019
E08000019
E08000019
E08000019
E08000019
E06000051
E06000051
E06000051
E06000051
E06000051
E06000051
E06000051
E06000051
E06000051
E06000039
E06000039
E06000039
E08000029
E08000029
E08000029
E08000029
E08000029
E08000029
E08000029
E10000027
E10000027
E10000027
E10000027
E10000027
E10000027
E06000025
E06000025
E06000025
E06000025
E06000025
E08000023
E08000023
E08000023
E06000045
E06000045
E06000033
E06000033
E09000028
Portsmouth
Portsmouth
Reading
Reading
Reading
Reading
Redbridge
Redbridge
Redbridge
Redbridge
Redbridge
Redbridge
Redcar and Cleveland
Redcar and Cleveland
Richmond upon Thames
Rochdale
Rochdale
Rochdale
Rochdale
Rochdale
Rotherham
Rotherham
Rotherham
Rotherham
Rotherham
Rutland
Rutland
Rutland
Rutland
Rutland
Salford
Salford
Salford
Salford
Salford
Salford
Salford
Sandwell
Sandwell
Sandwell
Sandwell
Sandwell
Sandwell
Sefton
Sefton
Sefton
Sefton
Sefton
Sheffield
Sheffield
Sheffield
Sheffield
Sheffield
Shropshire
Shropshire
Shropshire
Shropshire
Shropshire
Shropshire
Shropshire
Shropshire
Shropshire
Slough
Slough
Slough
Solihull
Solihull
Solihull
Solihull
Solihull
Solihull
Solihull
Somerset
Somerset
Somerset
Somerset
Somerset
Somerset
South Gloucestershire
South Tyneside
South Tyneside
South Tyneside
Southampton
Southampton
Southend-on-Sea
Southend-on-Sea
Southwark
10R
10V
10N
10Q
10W
11D
07L
08F
08M
08N
08W
07H
03D
00M
08C
07Y
08J
08P
99H
08X
00V
01A
01D
01M
00Y
02P
02Q
02X
03L
03N
06H
03V
03W
99D
04Q
00T
00V
00W
01M
01G
02A
02H
13P
04X
05C
05L
05Y
06A
01J
99A
01T
01V
02G
02P
03Y
04J
03L
03N
05F
05G
05N
01R
05Q
05T
05X
02F
06D
10H
10T
11C
13P
04X
05A
05J
05P
05R
05H
11E
11J
11T
99P
11X
99N
11E
11H
11M
12A
99N
13T
00N
00P
10X
11A
99F
99G
07R
NHS Portsmouth CCG
NHS Oxfordshire CCG
NHS South Reading CCG
NHS Wokingham CCG
NHS Havering CCG
NHS Newham CCG
NHS Redbridge CCG
NHS West Essex CCG
NHS South Tees CCG
NHS Hounslow CCG
NHS Kingston CCG
NHS Richmond CCG
NHS Wandsworth CCG
NHS Bury CCG
NHS Oldham CCG
NHS Barnsley CCG
NHS Bassetlaw CCG
NHS Doncaster CCG
NHS Rotherham CCG
NHS Sheffield CCG
NHS Corby CCG
NHS Bolton CCG
NHS Bury CCG
NHS Salford CCG
NHS Trafford CCG
NHS Dudley CCG
NHS Walsall CCG
NHS Knowsley CCG
NHS Liverpool CCG
NHS Southport and Formby CCG
NHS Barnsley CCG
NHS Hardwick CCG
NHS Rotherham CCG
NHS Sheffield CCG
NHS Shropshire CCG
NHS South East Staffs and Seisdon Peninsular CCG
NHS Telford and Wrekin CCG
NHS Wyre Forest CCG
NHS Chiltern CCG
NHS Slough CCG
NHS Solihull CCG
NHS Dorset CCG
NHS North Somerset CCG
NHS Somerset CCG
NHS Wiltshire CCG
NHS Bristol CCG
NHS Wiltshire CCG
NHS Sunderland CCG
NHS Southampton CCG
NHS Castle Point and Rochford CCG
NHS Southend CCG
NHS Camden CCG
Page 99
95.5%
0.3%
61.2%
0.2%
79.9%
3.1%
5.6%
0.9%
1.5%
92.6%
3.4%
1.8%
1.0%
47.7%
0.4%
5.0%
1.6%
92.2%
0.0%
0.3%
0.6%
0.2%
96.6%
1.8%
0.8%
3.4%
0.9%
1.1%
97.9%
0.7%
0.0%
0.3%
9.8%
2.7%
0.4%
0.2%
1.8%
0.3%
2.1%
93.9%
0.2%
0.9%
2.8%
0.2%
3.0%
54.3%
1.6%
0.3%
1.8%
2.9%
96.1%
97.0%
0.3%
0.8%
0.4%
0.7%
0.3%
98.6%
0.5%
0.4%
96.5%
0.5%
1.2%
1.0%
2.4%
0.2%
0.7%
3.2%
96.6%
0.4%
2.0%
0.3%
0.0%
0.4%
83.8%
0.4%
0.2%
3.1%
0.5%
0.9%
0.3%
98.5%
0.1%
0.6%
4.7%
0.8%
95.0%
0.0%
0.0%
99.3%
0.3%
94.5%
0.2%
4.6%
96.6%
0.5%
98.4%
0.3%
36.6%
0.6%
60.1%
2.7%
3.8%
0.8%
1.8%
88.7%
3.2%
1.7%
1.0%
99.0%
0.4%
7.1%
1.5%
90.3%
0.1%
0.6%
0.5%
0.3%
96.6%
1.6%
0.9%
3.2%
0.4%
1.3%
93.5%
1.6%
0.3%
0.6%
85.6%
12.0%
1.5%
0.3%
1.4%
0.3%
1.7%
95.1%
0.1%
1.2%
6.2%
0.2%
2.8%
89.2%
1.3%
0.3%
1.0%
5.2%
51.9%
41.9%
0.1%
0.4%
0.0%
0.3%
0.1%
99.2%
0.3%
0.3%
95.4%
0.3%
0.9%
1.0%
1.4%
0.1%
0.3%
6.7%
92.9%
0.4%
6.8%
0.3%
0.1%
0.3%
91.7%
0.5%
0.2%
1.1%
0.7%
0.3%
0.5%
97.3%
0.0%
0.4%
8.2%
1.8%
89.4%
0.1%
0.1%
99.2%
0.6%
99.6%
0.4%
4.5%
95.5%
0.4%
E09000028
E09000028
E09000028
E09000028
E09000028
E08000013
E08000013
E08000013
E08000013
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E10000028
E08000007
E08000007
E08000007
E08000007
E08000007
E06000004
E06000004
E06000004
E06000004
E06000004
E06000021
E06000021
E06000021
E10000029
E10000029
E10000029
E10000029
E10000029
E10000029
E08000024
E08000024
E08000024
E08000024
E08000024
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E10000030
E09000029
E09000029
E09000029
E09000029
E09000029
E09000029
E09000029
E06000030
E06000030
E06000030
E08000008
E08000008
E08000008
E08000008
E08000008
E06000020
E06000020
E06000034
E06000034
E06000034
E06000034
E06000027
E09000030
E09000030
Southwark
Southwark
Southwark
Southwark
Southwark
St. Helens
St. Helens
St. Helens
St. Helens
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Staffordshire
Stockport
Stockport
Stockport
Stockport
Stockport
Stockton-on-Tees
Stockton-on-Tees
Stockton-on-Tees
Stockton-on-Tees
Stockton-on-Tees
Stoke-on-Trent
Stoke-on-Trent
Stoke-on-Trent
Suffolk
Suffolk
Suffolk
Suffolk
Suffolk
Suffolk
Sunderland
Sunderland
Sunderland
Sunderland
Sunderland
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Surrey
Sutton
Sutton
Sutton
Sutton
Sutton
Sutton
Sutton
Swindon
Swindon
Swindon
Tameside
Tameside
Tameside
Tameside
Tameside
Telford and Wrekin
Telford and Wrekin
Thurrock
Thurrock
Thurrock
Thurrock
Torbay
Tower Hamlets
Tower Hamlets
09A
08K
08L
08Q
08X
01F
01J
01X
02H
13P
04Y
05C
05D
01C
04J
05G
05N
01R
05Q
04R
05V
05W
05X
05Y
05H
06A
06D
00W
01C
01N
01W
01Y
00C
00D
03D
00K
00M
05G
05V
05W
06H
06M
06L
06T
06Y
07K
00D
13T
00J
00N
00P
10G
07Q
09G
09H
07V
09L
09N
09X
07Y
08J
08R
99M
10J
09Y
08P
10V
99H
10C
08T
99J
11C
07V
08J
08K
08R
99H
08T
08X
11M
12D
99N
00W
01M
00Y
01W
01Y
05N
05X
07L
99E
08F
07G
99Q
07R
09A
NHS Lambeth CCG
NHS Lewisham CCG
NHS Southwark CCG
NHS Wandsworth CCG
NHS Halton CCG
NHS Knowsley CCG
NHS St Helens CCG
NHS Cannock Chase CCG
NHS Dudley CCG
NHS East Staffordshire CCG
NHS Shropshire CCG
NHS Stafford and Surrounds CCG
NHS Stoke on Trent CCG
NHS Walsall CCG
NHS Wyre Forest CCG
NHS Stockport CCG
NHS Darlington CCG
NHS South Tees CCG
NHS Stafford and Surrounds CCG
NHS Stoke on Trent CCG
NHS Great Yarmouth and Waveney CCG
NHS North East Essex CCG
NHS South Norfolk CCG
NHS Sunderland CCG
NHS Bromley CCG
NHS Crawley CCG
NHS Croydon CCG
NHS East Surrey CCG
NHS Hounslow CCG
NHS Kingston CCG
NHS Merton CCG
NHS Richmond CCG
NHS Sutton CCG
NHS West Kent CCG
NHS Croydon CCG
NHS Kingston CCG
NHS Lambeth CCG
NHS Merton CCG
NHS Sutton CCG
NHS Wandsworth CCG
NHS Swindon CCG
NHS Wiltshire CCG
NHS Oldham CCG
NHS Stockport CCG
NHS Shropshire CCG
NHS Basildon and Brentwood CCG
NHS Havering CCG
NHS Thurrock CCG
NHS South Devon and Torbay CCG
NHS Camden CCG
Page 100
2.0%
6.6%
1.9%
94.5%
0.0%
0.2%
2.6%
91.1%
0.6%
0.5%
99.3%
1.4%
91.9%
0.6%
0.7%
95.1%
1.1%
0.5%
96.2%
0.5%
99.5%
8.9%
1.0%
1.6%
1.2%
2.8%
0.2%
0.7%
1.6%
2.9%
95.2%
0.2%
0.4%
0.3%
0.1%
66.8%
0.3%
3.4%
0.5%
91.1%
0.1%
52.5%
99.6%
1.3%
1.2%
91.0%
0.7%
0.5%
2.3%
0.4%
98.5%
1.7%
0.4%
0.2%
6.6%
1.2%
96.6%
94.0%
1.6%
0.5%
4.4%
0.2%
23.0%
0.1%
99.5%
0.5%
0.1%
97.1%
99.0%
1.2%
0.2%
7.7%
1.0%
3.3%
0.1%
6.2%
1.4%
94.5%
0.1%
0.0%
96.3%
0.6%
0.5%
6.4%
3.6%
1.6%
85.1%
1.8%
96.7%
0.2%
0.2%
0.1%
98.4%
48.9%
1.1%
0.3%
1.3%
7.6%
1.8%
88.9%
0.1%
0.1%
2.3%
96.5%
1.1%
0.4%
14.9%
0.5%
14.5%
0.1%
0.2%
23.5%
0.4%
0.1%
23.7%
0.3%
16.6%
2.9%
0.2%
0.5%
0.2%
0.9%
0.0%
0.6%
1.1%
1.7%
96.5%
0.2%
0.2%
0.5%
0.1%
98.7%
0.5%
2.7%
0.3%
97.0%
0.2%
16.5%
52.8%
0.6%
0.4%
29.6%
0.7%
0.8%
2.0%
0.2%
96.2%
0.2%
0.1%
0.0%
0.7%
0.4%
14.1%
16.9%
0.3%
0.1%
0.7%
0.0%
4.2%
0.0%
29.6%
0.0%
0.0%
23.9%
7.6%
0.2%
0.0%
1.0%
1.9%
3.2%
0.2%
6.5%
2.0%
86.0%
0.2%
0.2%
98.4%
1.4%
0.5%
5.5%
3.8%
2.1%
88.1%
3.0%
97.0%
0.2%
0.2%
0.2%
99.3%
100.0%
0.9%
0.2%
E09000030
E09000030
E09000030
E08000009
E08000009
E08000009
E08000009
E08000009
E08000036
E08000036
E08000036
E08000036
E08000036
E08000030
E08000030
E08000030
E08000030
E08000030
E09000031
E09000031
E09000031
E09000031
Tower Hamlets
Tower Hamlets
Tower Hamlets
Trafford
Trafford
Trafford
Trafford
Trafford
Wakefield
Wakefield
Wakefield
Wakefield
Wakefield
Walsall
Walsall
Walsall
Walsall
Walsall
Waltham Forest
Waltham Forest
Waltham Forest
Waltham Forest
07T
08M
08V
00W
01G
01N
02A
02E
02P
03G
03C
03J
03R
13P
04Y
05L
05Y
06A
07T
08M
08N
08W
NHS Newham CCG
NHS Salford CCG
NHS Trafford CCG
NHS Warrington CCG
NHS Barnsley CCG
NHS Leeds West CCG
NHS Wakefield CCG
NHS Cannock Chase CCG
NHS Walsall CCG
NHS Newham CCG
NHS Redbridge CCG
Page 101
0.8%
0.2%
98.9%
4.7%
0.1%
3.2%
95.3%
0.1%
0.8%
1.0%
0.1%
0.6%
94.6%
1.8%
0.7%
1.6%
92.4%
1.3%
0.3%
1.1%
1.4%
94.3%
0.8%
0.3%
97.7%
4.3%
0.1%
2.2%
93.2%
0.1%
0.6%
0.8%
0.2%
0.3%
98.1%
4.7%
0.3%
3.1%
90.7%
1.2%
0.3%
1.5%
1.4%
96.8%
E09000032
E09000032
E09000032
E09000032
E09000032
E09000032
E09000032
E09000032
E06000007
E06000007
E06000007
E06000007
E06000007
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E10000031
E06000037
E06000037
E06000037
E06000037
E06000037
E06000037
E06000037
E10000032
E10000032
E10000032
E10000032
E10000032
E10000032
E10000032
E10000032
E10000032
E09000033
E09000033
E09000033
E09000033
E09000033
E08000010
E08000010
E08000010
E08000010
E08000010
E08000010
E06000054
E06000054
E06000054
E06000054
E06000054
E06000054
E06000054
E06000054
E06000054
E06000040
E06000040
E06000040
E06000040
E06000040
E06000040
E06000040
E06000040
E08000015
E08000015
E06000041
E06000041
E06000041
E06000041
E06000041
E08000031
E08000031
E08000031
E08000031
E08000031
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E10000034
E06000014
E06000014
Wandsworth
Wandsworth
Wandsworth
Wandsworth
Wandsworth
Wandsworth
Wandsworth
Wandsworth
Warrington
Warrington
Warrington
Warrington
Warrington
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
Warwickshire
West Berkshire
West Berkshire
West Berkshire
West Berkshire
West Berkshire
West Berkshire
West Berkshire
West Sussex
West Sussex
West Sussex
West Sussex
West Sussex
West Sussex
West Sussex
West Sussex
West Sussex
Westminster
Westminster
Westminster
Westminster
Westminster
Wigan
Wigan
Wigan
Wigan
Wigan
Wigan
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Wiltshire
Windsor and Maidenhead
Wirral
Wirral
Wokingham
Wokingham
Wokingham
Wokingham
Wokingham
Wolverhampton
Wolverhampton
Wolverhampton
Wolverhampton
Wolverhampton
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
Worcestershire
York
York
09A
08C
08J
08K
08R
08P
08X
08Y
01F
01G
01X
02E
02H
13P
05A
11M
04G
10Q
05J
05P
05Q
05R
05H
04V
10M
10N
10J
10Q
10W
99N
11D
09D
09G
09H
09L
09N
99K
09X
10V
99H
07P
07R
09A
08C
08Y
00T
01G
01X
02E
02G
02H
11E
11J
11M
10M
11X
12A
12D
11A
99N
10G
10H
09Y
10Q
10T
10C
11C
11D
02F
12F
10G
10N
10Q
10W
11D
05C
05L
05Q
05Y
06A
13P
04X
05C
11M
05F
05J
05N
05P
05R
05T
06D
03E
03Q
NHS Kingston CCG
NHS Lambeth CCG
NHS Merton CCG
NHS Richmond CCG
NHS Wandsworth CCG
NHS Halton CCG
NHS Salford CCG
NHS St Helens CCG
NHS Warrington CCG
NHS Nene CCG
NHS Oxfordshire CCG
NHS Solihull CCG
NHS Oxfordshire CCG
NHS Wiltshire CCG
NHS Wokingham CCG
NHS Crawley CCG
NHS East Surrey CCG
NHS Brent CCG
NHS Camden CCG
NHS Bolton CCG
NHS Salford CCG
NHS St Helens CCG
NHS Warrington CCG
NHS Dorset CCG
NHS Somerset CCG
NHS Swindon CCG
NHS Wiltshire CCG
NHS Chiltern CCG
NHS Oxfordshire CCG
NHS Slough CCG
NHS Wokingham CCG
NHS Wirral CCG
NHS Oxfordshire CCG
NHS Wokingham CCG
NHS Dudley CCG
NHS Walsall CCG
NHS Dudley CCG
NHS Shropshire CCG
NHS Solihull CCG
NHS Wyre Forest CCG
NHS Harrogate and Rural District CCG
0.7%
0.3%
0.1%
2.7%
3.0%
1.3%
88.8%
0.5%
0.3%
0.5%
2.2%
97.8%
0.2%
0.1%
25.6%
0.2%
0.2%
0.3%
0.8%
0.6%
0.8%
96.1%
96.8%
0.5%
93.1%
35.7%
0.7%
0.2%
9.1%
0.1%
0.1%
1.2%
99.5%
93.4%
0.3%
3.1%
1.0%
95.6%
4.2%
0.5%
1.3%
2.9%
81.6%
0.1%
23.5%
0.1%
1.1%
3.9%
0.4%
2.7%
96.7%
0.7%
0.3%
0.4%
0.9%
0.3%
0.9%
1.0%
0.1%
96.7%
12.3%
0.6%
0.2%
0.0%
0.6%
0.1%
88.9%
1.2%
0.4%
99.7%
3.2%
0.1%
0.1%
11.1%
93.5%
1.4%
0.1%
1.7%
3.9%
93.7%
0.5%
2.6%
0.8%
0.5%
1.0%
95.9%
0.3%
0.5%
2.3%
97.1%
98.5%
0.1%
60.4%
Produced by NHS England using data from National Health Applications and Infrastructure Services (NHAIS) as supplied by Health and Social Care Information Centre (HSCIC)
Page 102
0.4%
0.2%
0.0%
2.9%
1.8%
0.7%
93.6%
0.3%
0.2%
0.6%
2.0%
97.0%
0.2%
0.2%
21.4%
0.2%
0.2%
0.3%
0.2%
0.3%
0.3%
45.6%
30.9%
0.3%
66.2%
23.7%
0.9%
1.1%
7.6%
0.4%
0.1%
0.4%
57.7%
13.9%
0.0%
0.8%
0.2%
25.8%
1.0%
0.2%
2.0%
3.1%
71.1%
0.0%
23.7%
0.1%
0.8%
2.3%
0.2%
0.9%
95.6%
0.3%
0.5%
0.6%
0.2%
0.4%
0.5%
0.5%
0.1%
97.0%
10.9%
1.2%
0.5%
0.2%
0.5%
0.0%
85.5%
1.2%
0.3%
99.7%
2.7%
0.0%
0.5%
9.0%
87.9%
1.7%
0.3%
1.4%
4.0%
92.7%
0.6%
1.1%
0.4%
0.6%
0.3%
27.9%
0.1%
0.2%
1.1%
48.8%
18.8%
0.1%
99.9%
Item 6
DATE
18th April 2016
REPORT OF
Royal Mayall
SUBJECT
Local Children’s Safeguarding Board Annual
Report
STATUS
Open
Consideration of the report will inform future plans and actions of the Health and
Wellbeing Board.
EXECUTIVE SUMMARY
The Annual Report provides an overview of children’s safeguarding activity in North
East Lincolnshire. Members are particularly guided to the Executive Summary of the
Report.
RECOMMENDATIONS
That the Health and Well Being Board reflect on the Annual Report and consider:
- How the information contained might inform future JSNA activity and subsequent
plans relating to the health and well being of children and young people in North
East Lincolnshire
- the part that could be played by the Health Wellbeing Board and its partners in
helping to create a systems wide approach to children’s safeguarding in North East
Lincolnshire
For the report to be noted.
1.
It is a statutory requirement for all children’s services areas to have a Safeguarding
Children’s Board (LSCB). LSCBs are independently chaired partnership bodies and
are expected to hold partners to account in relation to their statutory safeguarding
duties. LSCBs are required to compile and publish an annual report of safeguarding
activity in their area.
This report describes continuously improving safeguarding systems and processes,
in North East Lincolnshire underpinned by strong partnership and collaboration and a
Board that is becoming increasingly effective.
Page 103
Issues faced include: operating in a climate of financial constraint, organisational
change and a recently announced national review of LSCBs
2.
Risks: None
Opportunities: HWBB have insights to inform the further improvement of the
Health and Wellbeing of children and young people in North East Lincolnshire.
3.
None.
4.
None
5.
FINANCIAL CONSIDERATIONS
None
6.
MONITORING COMMENTS
In the opinion of the author, this report does not contain recommended
changes to policy or resources (people, finance or physical assets). As a
result no monitoring comments have been sought from the Council's
Monitoring Officer (Assistant Director, Law), Section 151 Officer (Director of
Finance) or Human Resources Group Manager.
6.
WARD IMPLICATIONS
Non
7.
BACKGROUND PAPERS
LSCB Annual Report 2014 – 2015
8.
CONTACT OFFICER(S)
Rob Mayall, LSCB Independent Chair, 01522 686797,
[email protected]
Page 104
North East Lincolnshire Safeguarding Children’s
Board
Annual Report 2014/15
1
Page 105
LSCB CHAIR’S FOREWORD
I am very pleased to provide this overview of the North East Lincolnshire Children’s Safeguarding
Board (NELSCB) Annual Report 2014/15. This is my second Annual Report as Chair of the
NELSCB, having taken over a rapidly improving Board from the previous Chair in June 2014.
The year has been characterised by deep reflection combined with a focused determination on
continuous improvement and maintaining momentum within partnership activity.
The body of the report describes some of those improvements. For example, a recent system wide
commitment to an outcomes-based approach is beginning to shape safeguarding business and
giving us an ever sharper focus on safeguarding alongside an emphasis on Early Intervention. The
transformation of Children’s Centre’s into Family Hubs has emerged as a key means of delivering
this agenda and the board has shown its commitment to ‘getting the basics right’ through stronger
procedures and processes, robust quality assurance mechanisms and greater challenge from
within the system. It has also been enriched through the exploration of sub-regional approaches to
safeguarding through a recently created DCS/Chair/Police working group.
The progress we have made is notable given the current climate of the structural and financial
turbulence across the public sector, which is unlikely to diminish in the foreseeable future. This
progress therefore is testament to the energy and commitment of practitioners and partners to
make things better for Children and Young People in North East Lincolnshire.
There is much more to be done, and the body of this report describes some of that, as does the
final section, which looks forward towards progress to be made into 2016.
Rob Mayall
2
Page 106
CONTENTS
1. Executive Summary
Page: 4
2. Local Background
Page: 8
3. NEL LSCB Governance
Page: 9
4. Our 4 Priorities
Page: 12
5. Safeguarding Vulnerable Children
Page: 19
6. Partner Agency Contributions
Page: 31
7. Policies, Procedures and Guidance
Page: 43
8. Learning and Development Activity
Page: 43
9. Monitoring/QA Activity (includes Audit Activity)
Page: 44
10. Section 11 Audit of Partner Compliance
Page: 46
11. Learning from CDOP/SCRs
Page: 47
12. Engagement with Children and Young People
Page: 49
13. Communications
Page: 50
14. Conclusion/Challenges/Recommendations
Page: 51
Appendices 1-3
Page: 52 - 56
3
Page 107
1.
EXECUTIVE SUMMARY
This Annual Report 2014/15 describes the work of partners to make North East Lincolnshire a
safer place for children.
The following Executive Summary provides a brief overview of each of the main sections
highlighting, where appropriate, progress as well as areas for development.
1.1 Local Background
North East Lincolnshire has a relatively stable population, with above average levels of child
poverty, high unemployment and reducing, but still high levels of teenage pregnancy.
Progress has been made towards reducing the numbers of children formally in need of specialist
children’s services. In particular, the number of children subject to a Child Protection Plan has
reduced significantly but not as much as we would wish. The reduction in part is due to concerted
multi-agency efforts to ensure children are on the right plan for their level of need combined with
additional investment in staffing and workforce development.
1.2 Governance of Safeguarding
Governance arrangements for the Local Safeguarding Board were last reviewed in March 2015
and are now stable, with a Leadership Board, an Operational Board and a series of dedicated SubGroups. Levels of partner engagement in governance arrangements are strong, although
attendance at Leadership Board meetings fell during 2014, and this is now being addressed.
Particular attention has been given to a more coherent and consistent approach to activity across
Sub-Groups, with revised terms of reference for all groups and expectations of regular reporting
against ‘Score Cards’ which highlight levels of activity, key performance indicators, the difference
that activity has made and identified ‘next steps’.
There are good links with other partnership groups and linkages across the system are beginning
to develop, including sub-regional working, although further work is required to exploit the potential
of collaborative working across strategic agendas, partnership groups and geographical
boundaries.
1.3 Progress Against Recommendations from 2013/14
There were seven specific recommendations in the 2013/14 Annual Report. These are reported on
more fully in the body of this report, but the headline message is that good progress has been
made on all recommendations, including the stronger engagement of young people in Section 11
activity, good practice in relation to children Missing from Home and the development of a Core
Data Set and embedding the use of LSCB Performance Score Cards.
However, in one key area, early intervention, we are yet to see the expected levels of decline in the
numbers/proportions of Children In Need(CIN) or on Child Protection (CP) Plans and this remains
an issue on which to focus. Additional staff within the Safeguarding and Reviewing Service (CSRS)
has led to increased oversight of quality assurance over the last 12 months which has been one of
the factors connected with the reduction of CP cases. Staffing for social workers within the
MASH/CASS has also stabilised and this too is having a positive impact on the reduction of CIN
caseloads.
1.4 Progress Against Priorities
Neglect
Neglect referrals into Children’s Social Care represent the highest proportion of any referral type
with over 66.5% for Neglect. As such, we have made addressing concerns about neglect a priority
4
Page 108
area, with the primary aim being that families receive help much earlier to prevent escalation into
statutory services.
A Neglect Strategy was launched in November 2013. It sits alongside the Prevention and Early
Intervention Strategy. A Sub Group of the LSCB oversees the implementation of the strategy.
Activities of note include: bespoke Neglect training for over 500 participants, developing Neglect
Awareness in educational settings and embedding the use of the Neglect Assessment Tool.
The impact of this activity is being seen through the earlier identification of neglect, underpinned by
an increasing proportion of Common Assessment Framework (CAF) activity being noted as neglect
related. Again, however, we have not yet seen any noticeable reduction in the proportion of Child
Protection cases under the category of Neglect. This suggests that more needs to be done to
ensure our work addressing Neglect achieves the impact we are seeking. Amongst a suite of
activities, there will be targeted activity in areas where there are higher rates of neglect referrals.
Multi Agency Early Support
The development of the Prevention and Early Intervention Strategy in 2013 pulled existing good
practice into a coherent and inter related set of activities and included an overarching performance
framework. In 2014, an extensive re-structure enabled the creation of 0-19 family hubs, with
associated Early Help Practitioners and practice. The impact of these changes has yet to be
measured but there are already processes in place that suggest the foundations for early support
are strong; including Multi-Agency Family Hub cluster allocation meetings; work streams in place to
further develop the Family Support Pathway and a developing Communication Strategy.
North East Lincolnshire Council, supported by the Local Safeguarding Children Board submitted a
proposal for large-scale Innovation Programme relating to Prevention and Early Intervention, as
part of the Social Care Innovation Fund. Work began on the bid in the Autumn of 2014, notification
was received it had been successful in March 2015. The aim is to adopt four different practices to
create a new model for social care and the broader Children and Young People’s workforce. This
will change how organisations work together to safeguard vulnerable children, how staff work, how
we interact with service users and how we deliver the change we need. We have called this
approach the Creating Strong Communities (CSC) Model. The four constituent parts of the CSC
model are:
•
•
•
•
Family Group Conferring
Signs Of Safety
Restorative Practice
Outcome Based Accountability
This approach will result in a large-scale Workforce Development Programme, with some
additional resources to enable us to deliver the change we desire for children and families within
the Borough.
Plans for 2015/16 include the further development of the workforce in line with the Creating
Stronger Communities Model, the development of data profiles for 0-19 yr. olds and more focussed
commissioning of activity to meet identified needs.
Addressing Child Sexual Exploitation
North East Lincolnshire has a strong, integrated approach to Child Sexual Exploitation.
A range of services are provided with a keen focus on prevention through outreach activity,
curriculum packages and effective disruption tactics.
Comprehensive performance data provides evidence of positive impact in this area of activity with
both victims and perpetrators.
5
Page 109
CSE activity in 2014/15 has featured the increased use of child abduction notices and a focus on
building awareness and resilience through Sexual Relationship Education – with 600 participants in
these activities.
Priorities for 2015/16 include the implementation of Phase 2 of ‘Say Something If You See
Something’ campaign and additional training for elected embers to increase their awareness of
CSE issues.
Maintaining Continuity in Child Safeguarding Arrangements in a Changing Public
Landscape
The Education Sub Group of the Safeguarding Board has overseen the first annual audit of
safeguarding in schools, eliciting a 100% response, the second audit will report in Autumn 2015,
with expectations that safeguarding practice will have improved on the previous year .This group
has also devised and published example documentation including a model safeguarding policy
transition guidance. It has also worked jointly with the Police to raise awareness in education
establishments of the new Prevent legislation and associated statutory duties.
The Health Sub Group has undertaken audit work to help assess safeguarding standards in health
settings, resulting in reports, action plans and focussed support from the designated nurse where
required. The audit of GP practices showed a marked improvement in safeguarding awareness
and arrangements. Strong lobbying for a local Sexual Assault Referral Centre(SARC) has paid
dividends with a paediatric SARC now provided by Hull and East Yorkshire Hospital’s Trust.
1.5 Safeguarding Vulnerable Children
The underpinning organisational arrangements to support many of the most vulnerable children in
North East Lincolnshire have been maturing over the last two to three years. Processes and
procedures in the Multi Agency Safeguarding Hub are becoming increasingly sophisticated and
effective with a robust audit calendar in place and a stable staffing group that is helping to reduce
caseloads. Additionally, the implementation of Closure Panels has contributed to a safe steppingdown of cases.
Children subject to a Child Protection Plan
Strong progress has been made towards improving the efficiency and effectiveness of activities in
this area. Children’s views are being captured more consistently, there is greater challenge from
Chairpersons and this is evident in CP Conferences. Due to practical developments, parents now
leave conferences with a ‘live’ plan.
Children Experiencing Domestic Abuse and Harmful Sexual behaviour (HSB)
A ‘one system’ approach to Domestic Abuse is under development. This is a long-term piece of
work, but will ensure a systems wide approach to this issue – across partners and partner groups.
Appropriately, the profile of this issue remains high, not least because of the Council’s Safe and
Stronger Communities Scrutiny Panel making Domestic Abuse part of its work programme for
2015/16.
A HSB Operational Group has contributed to putting both a Referral Pathway and a Training
Pathway in place. An innovative HSB programme in one primary school is to be extended to other
schools in 2015/16.
Looked After Children (LAC)
Numbers of LAC have stabilised in 2014/15. An increasing proportion are in placements with
relatives. Work to engage children and hear their voice is under continuous development and the
use of Viewpoint software has increased. Nearly all Reviews are being held within timescale.
Single practice alerts (now known as Quality Assurance Notifications or QANs) have been
implemented providing more robust and consistent alerts to Social Workers and others about
6
Page 110
issues identified in cases. Resource Allocation Meetings have been successfully introduced to
ensure consistency of decision making, prevent drift, and apply resources in an equitable manner.
Missing from Home and Care
In line with a recommendation in the 2014 Annual Report, approaches to Children Who Go Missing
have become more standardised, with more consistent approaches applied across different groups
of children. There is a good understanding of the volumes and features of children going missing
and there are good multi agency arrangements in place to respond to children going missing.
Efforts have been made to improve placement stability in order to reduce the likelihood of those in
care going missing.
Allegations Against Professionals
There has been a slight reduction in allegations (45 versus 50 in 2013/14) Processes have been
continuously improved following an external audit of LADO activity in 2014. Further work is
required to capture user feedback and there is an intention to further strengthen quality assurance
processes with dip sampling of Local Authority Designated Officer (LADO) records.
Corporate Parenting
Work in this area has been re-vitalised, resulting in corporate parenting having a significantly
higher profile in the Council, the introduction of a number of processes in place which ensure that
Members are well sighted on LAC issues and practical actions to enhance quality of life for LAC
(decisions around internet access/allowances).
1.6 Partner Agencies and their Contributions to Safeguarding
North East Lincolnshire is characterised by strong relationships between and across partners.
Partner engagement in safeguarding is strong, evidenced by their engagement in the various
groups and Sub Groups of the Safeguarding Board as well as a wide range of operational activity
in relation to safeguarding. This section of the report highlights specific activity by partners
including their priorities for the forthcoming year.
Significant structural changes in the Police and Probation Services have created challenge, but
there remains a strong commitment from partners to fulfil their safeguarding duties and help make
North East Lincolnshire a safer place for young people.
A cycle of individual meetings between the Chair and statutory partners has created opportunities
for issues to be raised, challenge to be made and support provided.
1.7 Policies Procedures and Guidance
New policies have been introduced and others have been revised as part of a structured cycle. All
procedures are reviewed on a six monthly basis. The LSCB website has been re-vitalised, but
feedback tells us that it still needs to be more young person friendly and this is being addressed in
partnership with a representative group of young people.
1.8 Learning and Development Activity
Learning and development activity is strong. The volume of activity and participation has increased
on 2013/14 (going to 3300 participants from 2500 participants). Satisfaction levels are high as
indicated via the self-declared ‘impact on practice’.
New approaches to training (bite size) have been used including new training activity (E.g. safe
sleeping), the introduction of impact evaluation and this fosters an approach which is open to
change, challenge and continuous improvement.
The Learning and Improvement Framework is now in place and as it becomes embedded will drive
all learning and improvement activity.
7
Page 111
1.9 Monitoring and Quality Assurance
There is a QA Sub Group overseeing this area and in 2014/15 it has developed and implemented a
series of audits as part of a clear plan for multi-agency and themed activity. Section 11 auditing, in
particular has become far more sophisticated, and challenging with a meaningful engagement of
young people. A CSE Challenge Day was well received by partners and resulted in clear
improvement actions.
The Board’s approval of the creation of a QA Coordinator post is evidence of a commitment to this
area of activity. The full impact of this post holder has yet to be felt but is already contributing to
developing the Quality Assurance calendar and programme for 15/16 having been appointed at the
end of quarter 4, 2014/15.
1.10 Child Death Overview Panel (CDOP)
The number of child deaths has remained low. The Board receives the annual report from CDOP
which also informs the Learning and Improvement Framework and subsequent activity. During
2015 it is intended that we further explore collaboration with neighbouring CDOPs to secure more
efficient and effective working.
1.11 Engagement with Children and Young People
We identified in our previous annual report that this was an area for development.
There have been a number of notable examples of the engagement of Children and Young people,
most significantly in Section 11 processes. ‘The Voice of the Child’ is a key line of enquiry in inter
agency audit activity and the Child’s Voice is increasingly being heard in day-to-day interactions
with Children and Young People (examples are evident in case file audit outcomes and include
children involvement in CP Planning processes). A wide range of further examples are described in
the body of this annual report.
Further activity to capture the Voice Of Children And Young People in a coordinated way and
evidence how it impacts on the services we provide remains a key area for development in 2015.
2. LOCAL BACKGROUND
2.1 Population
North East Lincolnshire’s population is 159,804. There are 34,309 Children and Young People
under the age of 18 years who live in North East Lincolnshire. 50.6% are male and 49.4% are
female, this is 21.5% of the total population in the area. The proportion of the population who are
under 18 is decreasing while the proportion of those of aged 65 and over is increasing.
Over the 5 years (2009-2013) the annual number of births in NEL, has decreased by 1.7%.
Overall the population of Children and Young People aged 0 to 19 inclusive decreased by 2.0%
between 2010 and 2014. The numbers of 0 to 4’s and 5 to 9’s has risen by 2.6% and 11.7% and
the numbers of 10 to 14’s and 15 to 19’s has dropped by 9.6% and 10.8% respectively. Population
estimates for 2014 show that the largest proportion of Children and Young People were aged 0 to
4 years (27%), while the fewest children were aged 10 to 14 years (23%).
NEL’s pupils are predominantly White British (90.8%) with a small, but increasing proportion from a
Black or Minority Ethnic (BME) background (6.8%) compared with national figures of 75.4% in
primary schools and 77.1% in secondary schools. The proportion of Children and Young People
with English as an additional language is also increasing gradually with 3.9% of pupils having a
language other than English at the time of the January school census 2015.
Approximately 26.7% of the local authority’s children are living in poverty (all children), compared
to 18.6% nationally (2012). There are significant differences in some wards in the proportion of
children in poverty within our most deprived wards to our most affluent.
8
Page 112
The NEL Neglect Strategy is aligned to the Prevention and Early Intervention Strategy and as of
March 2015 17.8% of all referrals had a referral client category of Neglect, however, it is accepted
that neglect features as a secondary factor in a much higher number of cases.
The proportion of children entitled to free school meals is 19.0% (NCY1 to 11). In primary schools
this is 21.4% (the national average is 19.2%) and in secondary schools this is 16.9% (the national
average is 16.3%).
2.2 Child Protection(CP)/Child In Need(CIN) in this area
At 31st March 2015, 1941 children had been identified through assessment as being formally In
Need of a Specialist Children’s Service. This is a decrease from 2366 as at 31st March 2014.
The numbers of children subject to a Child Protection Plan fell from 407 in March 2014 to 226 in
March 2015.
2.3 Looked After Children
At 31st March 2015, 265 children were being looked after by the LA (a rate of 77 per 10,000
children).
62 (or 23%) live outside the Local Authority area. This is a combination of living with family or
friends out of Local Authority, with foster carers, placed for adoption, placement order, health
establishment or Youth Offending Institution etc. 33 live in residential children’s homes, of whom 8
(26%) live out of the authority area.
• None live in residential special schools
• 199 live with foster families, of whom 19.6% live out of the authority area
• 8 live with parents
In the year 2014-15
• There have been 36 adoptions, this is an increase from 20 children adopted in 2012/13 and 30
children adopted in 2013/14.
• 20 children became subject of special guardianship orders, this is an increase from 5 in
2012/13 and 11 in 2013/14.
• 162 children have ceased to be looked after, of whom 6.2 % subsequently returned to be
looked after.
The Local Authority operates 8 children’s homes, with 33 beds in total. All were judged to be good
or outstanding in their most recent Ofsted inspection. There has only been one external inspection
within the Annual report timescales.
•
Youth Offending Service 2011 – 3 minimum judgment (Top Score). 2014 Short Quality
Screening (SQS) 92, 92, 97 in 3 key areas (Highest score seen).
3. NORTH EAST LINCOLNSHIRE LOCAL SAFEGUARDING CHILDREN BOARD
GOVERNANCE
3.1 LSCB Structure
The LSCB structure (Please see appendix 1) consists of the LSCB Leadership Board which is
responsible for ensuring the effectiveness of local safeguarding arrangements. The LSCB
Operational Board is responsible for the delivery of the LSCB business through its scrutiny of the
work of the LSCB Sub Groups. Sub Groups are aligned to the LSCB statutory functions and
priorities. These are listed in Appendix 1.
LSCB Sub Groups all have a set of performance indicators based on the LSCB Core Data Set; all
groups provide quarterly Score Card reports to the Operational Board, which enables it to monitor
performance and Sub Group activity in response to emerging themes, patterns or declines in
9
Page 113
performance. The Operational Board reports thematic information and performance variations to
the Leadership Board.
Interagency audit tools are used to implement a themed practice audit calendar, a number of interagency audits have been undertaken including Child Sexual Exploitation, Neglect and Thresholds.
The Section 11 audit activity (partnership audits) has been revised and is now held biennially and
includes a challenge event. There is a comprehensive Learning and Improvement Framework,
aligned to LSCB priorities and learning from Serious Case Reviews.
3.2 Membership of the Leadership Board
The LSCB member representation meets the requirements of Working Together 2015. Where
agencies or interests are not represented on the Leadership Board, they are represented on the
Operational Board and Sub Groups.
3.3 Leadership Board Attendance Audit
Attendance at the Leadership Board averaged 81% in 2015, which is a slight reduction from 2014.
Non-attendance is monitored and in 2015/2016 will be rigorously addressed against the LSCB
standards.
3.4 Lay Members
The Board’s two Lay Members have been in post for 2 years; both are from a community
background and contribute fully to the work of the Board. Their tenure has been extended to
provide continuity and stability.
3.5 Joint Working with Other Partners
The NELSCB 2013/14 Annual Report was shared with the Chair of the Health and Well Being
Board and the Police and Crime Commissioner. The report was also presented to Elected
Members. There are good links between and across the LSCB and the Children and Young
Person’s Partnership Board and the Health and Wellbeing Board. These processes are currently
being strengthened and require formalising in governance arrangements. Regular strategic
meetings are held between the chairs of the LSCB, Health and Well Being Board and Safer and
Stronger Executive Group in strengthening partner relations. The Chair of the Children and Young
Person’s Partnership Board (CYPPB) sits on the LSCB Leadership Board and reports to the Board
on the progress of the CYPPB delivery of priorities. This arrangement allows for challenge by
LSCB with regard to the work of the CYPPB. The Safeguarding Statutory Partners meet on a
regular basis.
3.6 NELCB Resourcing and Budget
The NEL LSCB team comprises of:
• Strategic Manager for Safeguarding (Since June 2014)
• NEL SCB Manager
• Quality Assurance Officer
• LSCB Administrator
The annual income and expenditure of the board (financial year 2014/15 is attached at appendix
2).
3.7 NELSCB Business Plan
The NELSCB Business Plan sets out the strategic priorities for North East Lincolnshire
Safeguarding Children’s Board (NELSCB) for 2013-15 and how they will be achieved. The
Leadership Board provides the mandate for each of the Sub Groups who are key to the successful
10
Page 114
delivery of the LSCB Strategic Priorities and the LSCB Statutory Functions. (The Terms of
Reference for the LSCB Boards and Sub Groups are at appendix 3).
3.8 Progress against the recommendations from the 2013/14 LSCB Annual Report
Address neglect through Early Intervention activity and reduce the proportion of Child
Protection (CP) cases with Neglect as the main reason for referral.
The Neglect Sub Group defined key actions to support an overarching strategy that aims to shift
the balance from statutory intervention to early help and support. These have included;
•
•
•
•
•
•
•
Promoted universal professionals to be trained/ supported to name, describe, and assess
neglect.
Delivered and embedded bespoke training on neglect for 517 practitioners.
Embedding public/professional awareness of signs/symptoms of neglect in targeted areas.
Initiated a training programme within schools to ensure staffs are aware of assessment tool,
training pathway and referral process.
Building on the knowledge/skill/competency of first line managers to support their staff to
recognise neglect and intervene effectively.
Neglect referrals into NELC Multi Agency Safeguarding Hub (MASH) have been consistently
high representing 66.5% of all Child Protection Plans as of 31st March 2015. This is consistent
with the national trend. Currently there is no downward trend in the data for Child In Need (CIN)
and CP.
Key messages about the impact on children of living with neglect is beginning to change how
early help professionals respond with increased confidence to use the Neglect Tool.
Fully implement the Early Help and Neglect Strategies.
The following elements were achieved through the continued implementation of the Prevention and
Early Intervention Strategy.
•
•
•
•
•
•
•
•
•
PEI Strategy & Implementation Plan in place.
Restructure complete in place from 1st April 2015 offering multi agency prevention and early
intervention services across the 0-19 age range.
The Family Hubs work in 5 geographical clusters and bring together family support services
including Sure Start Children’s Centre’s, Health Visiting, School Nursing, Integrated Family
Support Services and some of our Youth Provision.
Early Help Coordinators replaced CAF Coordinator role.
CAF process is still in place until launch of Single Assessment & Revised Child Concern Model
etc.
Teams of Early Help Family Support Advisers allocated to each cluster.
5 Family Hub clusters identified – new weekly Family Hub cluster allocation meetings in place
(multi agency) to ensure appropriate level of support allocated.
Work streams in place to further develop the Family Support Pathway, Single Assessment and
review the processes & procedures in relation to these.
Development of Communication Strategy.
Increase evidence of the Voice of the Child in relation to contributing to service
developments and for the most vulnerable, their engagement in plans and actions which
affect their futures.
Consultation Tools for gaining the views of Children and Young People are being reviewed and
developed. All LSCB partners have begun identifying processes in place to capture the child’s
voice. The Quality Assurance Sub Group is now coordinating activity to develop a pro-forma based
on the 2015 Working Together for agencies to consider in relation to how each addresses the
issue of what children say they want from Safeguarding Services and their overall welfare.
The involvement of young people in the Section 11 Audit in January 2015 actively challenged
organisations on how service delivery was informed by children’s involvement. The recent Section
11 follow up event has evidenced real progress by organisations in this area.
11
Page 115
Standardise our approaches to Missing from Home.
Improvements have been made to performance data; this has enabled a complete set of
performance figures which has formed the baseline for future comparisons. Operational & Risk
Management Groups have been established with partner agencies. Every child who has been
missing is discussed at each Risk Meeting, irrespective of whether they have been missing from
home or from care, and appropriate actions agreed.
A Debrief Officer has been appointed, located within Young & Safe. Debriefs are conducted within
72 hours of a young person being found. If a child is identified as at risk of CSE on found reports
then a referral is made to the CSE Group if they are not already known.
Disruption tactics are employed wherever possible including Evictions and Child Abduction
Notices. YPSS/Police patrols are deployed in the area of addresses identified as being of concern.
Implement a review cycle for all Safeguarding Policies and Procedures.
The LSCB have commissioned Triex a company specialising in safeguarding procedures to
manage, review and revise the LSCB procedures. The procedures are reviewed and revisions
made arising from local or national policy changes on a six monthly basis. Where important
changes are needed to the procedures before the six monthly reviews these are made in ensuring
guidance is as current as possible and reflects local practice.
Increase our understanding of workforce learning and development needs and the impact
of activity.
A more robust safeguarding training evaluation process was implemented in 2014/15 with new
forms assessing delegates distance travelled from the beginning to end and 3-6 month follow up to
measure impact on.
The Creating Stronger Communities (innovation) Programme which is funded by the Department
for Education will embed the Signs of Safety, Restorative Practice and Outcome Based
Accountability approaches in supporting practitioners work with children and families. The LSCB
training programme will be reviewed and revised to take account of the new approaches and to
build in ongoing sustainable learning opportunities for the future.
A Learning and Improvement Framework Action Plan has been developed which will drive forward
all Learning and Improvement Activity. All Sub Group chairs contribute to the action plan by
inputting learning activity and impact. The LSCB Learning and Development Strategy has been
approved and published, it sets out how the LSCB will ensure safeguarding training/learning
activities are based on local need.
Embed the use of Score Cards and the Core Data Set as a means of individually and
collectively understanding our business and performance.
The LSCB Core Data Set is aligned to the data sets which informs each of the LSCB performance
Score Cards. There are a number of Score Cards associated with the LSCB priorities and core
functions. The Operational Board hold quarterly performance challenge boards. There has been a
particular focus on ensuring that the Difference Made is evidenced and the Voice of the Child is
evidenced within the scorecard.
Score Card leads have received Outcome Based Accountability (performance informed model for
delivering against outcomes) training. Work is continuing on improving the quality of the Score
Cards and in ensuring data is validated. The Leadership Board performance report will consist of a
number of agreed Bell Wether/Key Indicators.
4. OUR FOUR PRIORITIES
The following section provides a progress report against the four LSCB strategic priorities.
4.1 Addressing Neglect
12
Page 116
What did we say we were going to do?
•
•
The LSCB recognised that Prevention and Early Intervention in dealing with Neglect was an
area for significant development to ensure families receive targeted help much earlier to
prevent concerns escalating requiring statutory intervention.
From April 2014 to March 2015 the Neglect Sub Group defined the following key actions to
support an overarching strategy that aims to shift the balance from statutory intervention to
early help and support.
What have we done?
•
•
•
•
•
•
•
•
•
Promoted universal and early year’s professionals to be trained and supported to name,
describe and assess neglect by building competence in the workforce and ensuring they
participate in relevant training on the Professional Competency Pathway for Neglect.
Developed, piloted and embedded bespoke training on neglect for 517 professionals and
established 4 Practice Enhancement Workshops on the Voice of the Child; Using the
Assessment Tool for Neglect; Supervision and Management of Neglect; SCR’s and Neglect
and Neglect Awareness Induction training.
Begun to embed public and professional awareness about the signs and symptoms of neglect
and the impact upon Children and Young People with current targeted activity on the South
Ward where there is high prevalence.
Co-led an official launch of the ‘Living Well and Neglect Matter’s’ campaign, which included
multi-agency engagement, NELC communications; NSPCC public affairs teams in partnership.
Accessed 5 primary schools in the South area to deliver the Neglect Awareness training to
ensure that (100) staff are aware of the bespoke Assessment Tool, Training Pathway and
Referral Process.
Led on 12 public awareness raising activities from two hour inductions sessions for all council
employees to all Child-minders; Day Nursery Providers; Housing and Public Health Forums;
Refuge Collectors and Home Start reaching 260 people.
Built on the knowledge, skill and competency of first line managers across all agencies to
support their staff to recognise neglect and intervene effectively by understanding scale, type,
impact and risk.
Promoted and embedded the best practice Assessment Tool for Neglect as a means of
obtaining an objective measure of strengths and difficulties in a family where neglect is an
identified potential concern.
Collaborated with the Quality and Assurance Sub Group on an Inter-Agency Audit Plan and
outcomes in relation to neglect cases.
Evidence/Impact/Difference Made
•
•
•
•
•
Neglect referrals into NELC MASH have been consistently high for some time representing
67.7% of all Child Protection Plans as of 31st March 2015. This is consistent with the national
trend. Currently there is no downward trend in the data for Child in Need (CIN) and Child
Protection (CP).
Key messages about the impact on children of living with neglect is beginning to change how
early help professionals respond with increased confidence to use the Neglect Tool but this is a
slow process.
An uptake in the use of the Assessment Tool for Neglect within the Family Hubs demonstrating
increased confidence and competence in earlier identification and assessment.
Professional feedback:
“Using the Neglect Tool Workshop: 72% feel very confident and 27% feel confident in putting
knowledge they have learnt into practice. 91% found workshop excellent, 9% good. Quote: Be
more persistent and look beyond ‘fine’ SCR’s Level 2 Keeping the Neglected Child in Focus:
44% feel very confident and 56% feel confident about putting the knowledge learnt into
practice. 76% found course excellent, 24% good. Level 3 Keeping the Neglected Child in
13
Page 117
•
•
•
•
•
Focus: 85% strongly agreed that the training would positively impact upon their practice “Be
tenacious and not to be afraid to challenge assumptions; Neglect Awareness Training
‘Ensure I really listen to hints from children that they may need to speak to someone, ensure I
pass on concerns and don’t disregard anything the child says’.
‘I will be more honest and direct when speaking to parents’.
‘It can happen in any household’.
‘More confident in signs and symptoms of neglect and how to approach parents’.
One parents view on using the Assessment Tool for Neglect:
- It really helped me to recognise my strengths.
- I knew I could do better on a couple of things and now I am.
Next steps
•
•
•
•
•
•
Target areas which have higher rates of statutory child neglect referrals (South ward from May
15; East Marsh from September 15) by ensuring locality based Primary Health Care Providers,
PCSO’S, School Nurses, Health Visitors, Nursery Nurses, Voluntary Sector, Dentists,
Publicans and Taxi Drivers all have the same messages about what to do if they have
concerns that neglect is occurring.
Flooding each locality with the ‘Help’ message and new posters in parent led locations to
highlight early help messages.
Distribute 1,000 ‘credit cards’ with information about neglect.
Identify Professional Champions to sustain and build the momentum of this work to ensure the
strategy is not dependent upon key individuals but that a culture of tackling neglect is at the
forefront of professional thinking.
Complete the task and finish activity to develop unitary wide evaluation forms to capture the
voice of Children and Young People and families on the impact of the help received and
learning for professionals.
Write, test and deliver the practice enhancement workshop on attachment, brain development
and neglect. We are looking to form a partnership with CAMHS to deliver this.
4.2 Multi Agency Prevention and Early Intervention
•
•
•
•
•
•
Develop a Prevention and Early Intervention (PEI) Strategy and Implementation Plan.
Restructure teams across Children’s Centre’s/Children’s Health and Integrated Family Services
to develop a Family Hub Model for families with children 0-19.
Develop a Family Support Pathway across the spectrum of need.
Review and revise the Child Concern Model & Thresholds of Need document.
Develop a single assessment across the spectrum of need.
Develop the workforce – Signs of Safety approach.
What have we done?
•
•
•
•
•
•
•
PEI Strategy & Implementation Plan in place.
Restructure complete – new structure in place from 1st April 2015 – Early Help Coordinators
replaced CAF Coordinator role, however CAF process is still in place until launch of Single
Assessment & Revised Child Concern Model etc.
Full caseload audit of all open CAF’s.
Teams of Early Help Family Support Advisers allocated to each cluster.
5 Family Hub clusters identified – new weekly Family Hub Cluster Allocation Meetings in place
(multi agency) to ensure appropriate level of support allocated.
Work streams in place to further develop the Family Support Pathway, Single Assessment and
review the processes & procedures in relation to these.
Development of Communication Strategy.
14
Page 118
The PEI Strategy/Implementation Plan has been shared widely with partners and there has been
sign up by the Leadership Board.
It is difficult to evidence difference made for this area of work at this point in time as the revised
structures and Family Hub model only went live on the 1st April 15 which is the next reporting
period.
A full caseload audit of open CAF referrals prior to the restructure resulted in a number being
closed with outcomes achieved and those that remain open mainly have a lead practitioner or
agency identified.
This process has resulted in the strengthening of the QA process for new referrals to ensure that
assessment and supporting evidence is robust.
Next steps
•
•
•
•
•
•
•
•
Launch revised Family Support Pathway, Single Assessment Process & revised Thresholds
Documentation as Practitioners Handbook/Toolkit.
Further develop Allocations Meetings to meet 0-19 agenda.
Continue Communication Strategy with partner agencies to fully embed new processes –
reinforce the role of LP.
Continue to develop relationships with partner agencies in clusters & further develop data
profiles for 0-19’s.
Commission interventions/activity to meet identified need.
Further develop workforce in line with Creating Strong Communities Model – Signs of
Safety/Restorative Practice/FGC/OBA.
Review all training – Competency Framework.
Further develop IAG – Family Information Service helpline & website.
CAF data for 14/15
2238 CAF referrals opened during the year.
2179 CAF’s closed in year, with:
• 69% with outcomes achieved or closed at pending (16% increase on previous year).
• 13% stepped up to CIN (18% reduction on previous year).
End Q4 – 1838 open CAF’s
Children’s Centres
The aim in 2014/15, was for Children’s Centre’s to extend their offer, which mainly focused on
families with children aged 0-5 years, to a wider family focused age range of 0-19 years. Families
expressed an interest in being able to access services locally for their children post 5 years and the
workforce were fully involved/informed in the proposed restructure.
What have we done?
The restructure met its timeframe and moved into the Family Hub Model on 1st April 2015, offering
Multi-Agency Prevention and Early Intervention Services across the 0-19 age range. The Hubs
work in 5 geographical clusters and bring together Family Support Services including Sure Start
Children’s Centre’s, Health Visiting, School Nursing, Integrated Family Support Services and some
of our Youth Provision. All of these services work across the cluster areas, with other services,
partners and the community.
15
Page 119
During 2014/15 Children’s Centre’s completed 17 Neglect Tools, one parent explained; ‘It really
helped me to recognise my strengths…I knew I could do better on a couple of things and now I
am.’
Next Steps
We know that some families need extra help and support with issues that arise during a child or
young person’s life. Family Hubs are now able to offer the support needed to help families work
through these issues. The extra support may be provided by a range of professionals who now
meet on a weekly basis in each of the Family Hub cluster areas to discuss referrals for Prevention
and Early Intervention support. All staff employed to work out of Family Hubs will have their
learning needs mapped within supervision during 2015/16 to ensure they access training using the
Professional Capability Framework for Neglect.
4.3 Addressing Child Sexual Exploitation
Young and Safe CSE Multi-Agency approach
•
•
•
•
•
•
•
•
•
•
•
To engaging the wider community including young people.
Ensuring consistent drive and delivery on the CSE Action Plan through the CSE Ops group
Continued development and delivery of CSE training both LSCB level 2 and briefing sessions.
Development of training evaluations to show increase of knowledge and ability to deal
effectively with incidents of CSE.
To ensure that Health is represented fully at both risk and Operational groups
Ensure all health services include a recognised risk assessment tool for CSE, such as the
‘Spotting the signs’.
Development of Child Exploitation On Line Protection (C.E.O.P) and how this is delivered in
schools linking into Curriculum for Life and Safer Relationships 4 Young People (SR4YP)
Develop marketing and communications strategy alongside “Say Something if you See
Something” (SSSS) campaign to offer training, support and guidance to the leisure, licensing
and retail industries.
To develop the “Voice of the child” to ensure that services, process and policies can be
improved and developed with the thoughts and views of young people.
To develop parent support alongside Parents Against Child Exploitation (P.A.C.E) and NELC
Family Resource Services (FRS).
Developing Parenting Support Groups through Triple P Programme
What have we done?
•
•
•
•
•
•
•
•
•
•
Refreshed all current Terms of Reference (TOR’s) in relation to the CSE Ops and Multi Agency
Risk Assessment (MACE) meetings
Completed new MACE practice and guidance document.
Health now fully represented at both Risk and Operational groups
Health now use single assessment BROOK pro forma / Spotting the signs
Completed victim and suspect tactical plans for all operational officers within Humberside
Police
Compiled Appendix A in preparation of governmental focus visits, including OFSTED and
Home Office
CSE strategy completed and authorised through LSCB Leadership group, to be launched July
15th 2015
Progress reported on the current CSE action plan, currently driven by the CSE Operational
sub-group.
Refreshed the Multi Agency Child Exploitation practise, guidance and procedures
Completed third self-assessment refresh using the Bedfordshire Tool self-assessment.
16
Page 120
•
•
•
•
•
•
•
Refresh of the ‘Healthy Relationships’ educational offer to schools/academies for the academic
year starting 2015. This to be renamed Safe Relationships for young people (SR4YP) after
consultation with young people currently accessing services.
Resources for schools/academies added to the Curriculum for Life resource area.
Young and Safe CSE practitioners booked onto CEOP ambassadors course in July 2015, this
will then be cascaded out in train the trainer sessions in corporation with the current SR4YP
LSCB level 2 training updated and bespoke briefing packages developed for a variety of
audiences including health staff including GP’s
Progress reported on the audit undertaken in December 2014 and actions implemented as per
the recommendations and findings of the audit.
Continuing development of parenting work through Integrated Family Services Triple P
Programme, for both CSE and CEOP delivered by Young and Safe.
Voice of the child continued to be developed through Viewpoint & ME Assessments
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
34 Operation PRIAM patrols, 204 hours.
635 young people contacted on the streets of North East Lincolnshire from June 2014 – March
2015.
73 young people risk assessed through the MACE process to identify level of risk, required
actions and support package.
100% of all young people referred have been risk assessed through the MACE process
90% (65) female & 10% (8) males, giving a 9:1 split
78% (57) young people referred to young and safe for support through interventions specific to
CSE
12% (16) young people not referred to young and safe as deemed at not at risk of CSE and not
requiring any support from this service area, potentially referred to other areas of YPSS such
as young carers and access partnership
74 crimes have been recorded and investigations commenced
23 Child Abduction Notices issued.
38 adult perpetrators identified by Humberside Police
12 successful prosecutions 90% success rate
Over 30 years in sentences received
6 LSCB CSE level 2 training sessions delivered, with 103 attendees
Over a 90% mark of excellent provided to the training within the evaluation.
Attendees have commented on how much more confident they feel in now identifying the signs
and symptoms of CSE and where to seek assistance.
12 briefing sessions delivered to 398 attendees, including front line health practitioners,
including GP’s and NELC elected members
1 young person in secure settings due to CSE
5 Young People placed in Local Authority Care due to CSE
Next Steps
•
•
•
•
•
•
•
Develop Marketing/Comms plan through “See Something Say Something” (SSSS) campaign
delivering targeted training and messages to tourism & Licensing, this in particular developing
training for all licensed taxi drivers, Hotels and Bed and Breakfasts and retail outlets such as
Freshney Place.
Humberside police adopted trigger plan in relation to “Say Something If You See Something”
through Operation Make Safe.
Further develop young person’s campaign through National Working Group (NWG) “Say
Something”, Linked to the missing persons charity.
Strengthen links with front line Health professionals through training and referral.
Continue to develop and offer CSE briefings, Elected members, GP’s and others.
Review Operation PRIAM and its functions through proactive risk management.
To launch the strategy of both CSE and missing and SSSS on 15th July 2015.
17
Page 121
•
•
•
To continue to develop process through the action plan and audit plan.
To appoint through competitive interview process an independent missing persons officer.
To seek business admin support in relation to the MACE process.
4.4 Safeguarding In Education
Provide assurance that all North East Lincolnshire’s educational settings are meeting their
safeguarding requirements; promote consistency and a coherent approach to safeguarding; and
facilitate a tangible link to the LSCB.
Enable discussion and identification of emerging safeguarding issues; ensure there are interagency mechanisms in place to address these.
Ensure the effective dissemination of safeguarding guidance, evidence based practice and
recommendations from national and local Serious Case Reviews and that key inter-agency
safeguarding processes are effectively embedded.
What have we done?
Provided reassurance on the effectiveness of the safeguarding arrangements of all NELs’
education establishments by:
• The publication of the first annual audit for the 2013/2014 academic year with a 100%
response rate.
• Revised the 2014/2015 audit documentation which is due for publication in autumn 2015.
Raised awareness through performance reporting:
• That internal/unpublished data is unverified; not comparable nationally and local arrangements
dependent.
• Of the increasing number of electively home educated (EHE) children; the complexity of
tracking children missing from education (CME); the increase in permanent exclusions; and the
associated number of children educated in alternative provision.
Devised and published example documentation including:
• A model Safeguarding Policy.
• Casework recording guidance and transition documents.
Worked jointly with the Police to raise awareness of the new Prevent legislation and continually
raised the profile of the sub group and dissemination of its work streams.
In the 2013/2014, of the 68 (100%) submissions received, 24 (35.29%) educational establishments
self-assessed themselves at a Level 1 overall; 42 (61.77%) at Level 2; and 2 (2.94%) at Level 3.
No establishment scored itself at Level 4.
Children Missing from Education (CME) casework tracking and reporting systems are robust
despite the increase in school autonomy; the Elective Home Education (EHE) casework recording
inconsistencies that were initially identified have been addressed a business case has been
prepared to address the evidenced increasing volume of cases and associated workload.
Regular acknowledgement of the awareness raising of the group and dissemination of work
streams through primary and secondary head teacher communications and meetings.
The resurrection of the former termly Child Protection Co-ordinator Meetings with effect from July
2015.
18
Page 122
Next steps
To continue to improve the quality of data reported on and raise the EHE and CME challenges in
appropriate forums.
5. SAFEGUARDING VULNERABLE CHILDREN
5.1 Multi-Agency Safeguarding Hub and Children Assessment Safeguarding Service (CASS)
We can see a marked improvement in the quality of referrals being taken by the Principal Social
Workers (PSW) within the MASH and this was recently recognised in an external audit of the
service an external audit of the MASH in October 2014 and April of this year.
Multi Agency decision making in the MASH is improving and this is evident when referrals are
viewed at the weekly multi agency Service Challenge Meetings where the referrals to the service
from the previous week are viewed and discussed. We are now beginning to incorporate Signs of
Safety into the language of the referrals in order to underpin our practice with this approach and
that of our partner agencies.
MASH PSW’s also offer advice to professionals and families. This is an additional pressure for the
MASH PSW’s but is vital work if we are to ensure that work with children and families is
preventative and that the Early Help offer is strong. We are working with colleagues in the Early
Help/Family Hubs to ensure that families are supported at the time they most need support and
after any statutory interventions in terms of step down support.
The continued improvement within the MASH has led to an increase in quality of service to
Children and Families and has reduced caseloads due to a more thorough analysis at the point of
referral.
Attendance at the Challenge Meetings by multi agency professionals has decreased as the
appropriate people do not always attend, aside from those multi agency partners working in the
MASH. We continue to theme our Challenge Meetings. Our expectation remains that multi agency
partners invited to the Challenge Meetings will attend but where they are unable to attend weekly
due to their own agency pressures they can attend the meetings appropriate to their role.
We also undertake “road shows” to partner agencies to ensure that we can respond to any queries
or concerns and listen to proposed solutions.
Retention of Staff and Case Loads
Staffing for Social Workers has stabilised and this is having a positive impact on the reduction of
caseloads.
North East Lincolnshire has a higher proportion of CIN per 10,000 of the population than other
Local Authorities.
Closure Panels are in place in CASS to ensure that all cases are stepped down safely with senior
management oversight.
296 cases have been reviewed at closure panel and 239 of those cases were closed to CASS at
panel since January 2015. The 20% of cases that did not close required further work to be
completed prior to being able to safely step down.
Early Help (EH) professionals now form part of Closure Panels to review Thresholds and Step
Down.
19
Page 123
EH Heads of Service have contacted all schools to advise that if they have concern in respect of a
child to contact Family Hubs to discuss the child rather than escalate immediately to MASH. This is
initially to prevent the increase in referrals that happens prior to each holiday period.
The Child in Need (CIN), Child Protection (CP) and Closure Panels in CASS are ensuring that
cases are progressing in a timely manner. We aim to ensure that Children and Young People are
on the right plan at the right time with the safety and wellbeing of those children being our priority.
The panels have identified causes where delay has been a potential and decisions have been
made to progress cases. This is particularly evident in CP and LAC (S20) cases.
There has been a historical rise in the number of Looked After Children (LAC), Numbers are now
stabilising and as of March 2015 there are 268 children that are classed as LAC. A percentage of
the LAC cases are children that are placed with relatives. Increasingly we are having to issue
proceedings in order to secure these placements of children with their relatives. This is a change in
practice and as a result of the now very restricted access for families to legal aid. We are also
required to financially support these placements, although it is a very good outcome for children to
remain with their extended family and is more cost effective than long term Local Authority Care.
This area requires improvement and development in the service as to how these cases are
managed.
Audit
We have a robust Audit and observation Calendar now established in CASS. Audits are
undertaken by internal managers and an external auditor. We have recently undertaken several
multi-agency case file audits also through the LSCB Quality Audit Sub Group. The results of all
audits are shared in audit meetings on a quarterly basis with a group of Senior Officers including
the Deputy Chief Executive audits highlight strengths and areas for improvement and discussion is
held as to how we will meet the unmet need.
Within audit meetings, data is also interrogated to inform all parties of the current picture which our
data is telling us and to aid discussion in order to shape a collective response as to how we will
strengthen practice.
This Audit process is demonstrating service improvement and is now well established within the
service area.
We have also launched the Social Work Performance and Accountability Framework. This is a
proactive tool for Social Workers to monitor their performance against the expectations of them in
respect of timeliness and progression of cases. Social Workers have welcomed this tool in the
main as it follows the ethos of “High Support and High Challenge” now being adopted across the
Local Authority through Restorative Practice.
5.2 Children and Young People Subject to a Child Protection Plan
•
•
•
•
To continue to roll out Viewpoint in conjunction with partner agencies to ensure children’s views
are collated for service development.
Further developing the challenge role of the chairperson to ensure that agencies thoroughly
evidence their decision making.
Continue to review dual status children at the earliest stage i.e. those children who have a child
protection plan and have become looked after to ensure that children have one plan that
everyone works with.
Increase observed practice and promote the chairperson challenge as part of ensuring the
quality of the conference process.
What have we done?
20
Page 124
•
•
•
•
The roll out of Viewpoint continues. To date we have focused on implementation at conference
of Viewpoint that is now embedded but with the need to increase use and uptake. Conference
chairs identify who will assist a child/young person in accessing this software as well as
ensuring that all other options to support participation/attendance at conference are explored.
The challenge role of the chair person has shown improvement following briefings for IROs on
the professional challenge, on the use of Quality Assurance Notifications and from audits and
observed practice. Audits of minutes confirm that agencies thoroughly evidence their decision
making.
Children with a dual status are reviewed at the earliest opportunity to ensure children have one
plan that promotes their needs.
A bespoke tool for observed practice was developed for use with IROs during 2014/15 and a
pilot use of the tool commenced late 2014. It has now been used at a small number of
conferences and summarised for the Quarterly Performance Review.
In addition to the above we have refreshed and re-developed the performance book to ensure
that key data is captured for management oversight and service improvement and report
quarterly to the LSCB via the newly embedded Outcome Based Accountability Score Card,
(OBA).
•
•
•
•
•
•
Between 1st April 2014 to 31st March 2015 the service conducted 778 Child Protection
Conferences (on cases open as at 31st March) compared with 670 the previous year. All
children Child Protection (CP) or Looked After Child (LAC) have up to date plan to address
safety and welfare.
From a high of 407 children with a Child Protection Plan in March 2014 numbers have reduced
to 226 as at March 2015.
Case tracking is completed between CP reviews to check progress against the plan and
challenge as appropriate.
All parents now leave conference with a hard copy of a draft plan following the introduction of
multimedia TV screens allowing plans to be developed with participation from all attendees
during conference.
Distributing minutes in shorter timescales to inform Core Groups and families.
Two separate audits have been completed, as requested by the LSCB, into cases where CSE
is identified as the stated issue and where neglect is identified as the stated issue. The findings
of the audits have led to reflection on practice and changes in practice.
Next Steps
•
•
•
•
•
•
•
•
•
Further work as above to capture and monitor child participation and Voice of the child.
Further Development of the Signs of Safety process and approach to conference.
Data and performance reporting to be further streamlined to coincide with relevant boards and
interface with other service areas.
Risk paper to be produced regarding the potential impact of removal of market supplement on
vacancy and recruitment of appropriately experienced and qualified staff and ensuring NEL is
competitive with other authorities.
Introduction of a self-audit checklist for conference chairs regarding the minimum standards for
conference and the model of CP plans complementing the Signs of Safety model and use of
language to make plans explicit and outcome focused.
Follow up process for tracking and addressing outstanding issues from Quality Assurance
Notifications (QAN/SPA).
Extending use of QANs to partner agencies at conference.
Further development of Observed Practice and its use in IRO workshops and training.
Producing an action plan to be implemented for IROs in response to local Serious Case
Reviews.
21
Page 125
5.3 Children Experiencing Domestic Abuse
Working collaboratively across the Local Safeguarding Children’s Board, Safeguarding Adults
Board, Health & Well Being Board and Safer & Stronger Communities Board, develop a strategic
“One System” approach to Domestic Abuse.
What have we done?
•
•
•
•
•
During the spring and summer of 2014 a Domestic Abuse Needs Assessment and Asset
Mapping exercise was undertaken by Public Health which highlighted a number of
recommendations and was presented to the Health & Well Being Board and Safer & Stronger
Executive Board for consideration.
In November 2014 a meeting was held between the Chairs of all 4 Theme Boards mentioned
above and it was agreed to develop a jointly owned “One System” approach to Domestic
Abuse and that a steering group be established.
In December 2014 the Health & Well Being Board agreed to supply £95k funding for the
2015/16 period for the continuation of the Independent Domestic Violence Advocate, the
Independent Sexual Violence Advisor and the MARAC Coordinator. All business critical roles
that are currently not mainstreamed.
In January 2015, the Council’s Safer & Stronger Communities Scrutiny Panel met as a Crime &
Disorder Committee to discuss Domestic Abuse and were presented with the local findings
framed around the Centre for Public Scrutiny “10 Questions to ask if you are scrutinising
Domestic Violence”. The Committee agreed that Domestic Abuse would form part of the Safer
& Stronger Communities Scrutiny Panel Work Programme for 2015/16 so as they could track
progress.
Up to March 2015 the steering group has been working to develop a revised domestic Abuse
Strategy with a clear Road Map and Action Plan for delivery, taking into consideration the
recommendations contained within the Needs Assessment and any wider activity that needs to
be incorporated.
“Domestic Abuse remains a concern locally and it is accepted that the One System approach to
Domestic Abuse is a long term piece of work. Humberside Police data for the 2014/15 period
indicates that North East Lincolnshire is higher than the force average in relation to incidents and
offences (North East Lincolnshire recorded 3,885 incidents compared to a force average of 3665
and 1,111 offences compared to a force average of 999) and lower than the for force average
around arrests (North East Lincolnshire recorded an arrest rate of 37% compared to a force
average of 46%). Repeat victimization at MARAC has also increased from 33% of cases presented
in a 12 month rolling period to 43% of cases presented. However this needs to be set in the
context of more cases being heard at MARAC (475 cases from Apr14 - Mar15 set against 371
cases for the previous year) and is also attributed to victims being more confident to report due to
the support they are receiving which in turn increases the repeat victimisation rate”.
Next steps
“The Steering Group will continue to meet on a monthly basis providing regular reporting into the
Theme Boards around progress and areas that require more strategic input around resource and
commissioning. In relation to the present recorded levels of Domestic Abuse, it is acknowledged
that the current provision around IDVA support needs to be strengthened to reduce risk and
provide much needed support to victims. In addition wider opportunities around Early Intervention
needs to be maximised in order to address the longer term culture. As part of the ongoing reporting
back to the Theme Boards Chairs, information will be provided around gaps and opportunities in
relation to current provision to inform resourcing and commissioning decisions”.
22
Page 126
The MASH has a Police Designated Decision Maker who shares incidents of Domestic Abuse.
Should the child require statutory social work intervention the case will be allocated to a qualified
Social Worker. Should the family not meet the threshold for statutory intervention then a CAF will
be initiated and/or universal services can be accessed by the family.
Historically, tackling Domestic Abuse has been coordinated individually via the 4 theme boards,
(Safer & Stronger Communities Board, Health & Well Being Board, Local Safeguarding Children’s
Board, Adult Safeguarding Board). Recently there have been strategic discussions between the
four local theme board chairs to develop a new One System Approach. A One System Approach
will bring together in its entirety all elements of the agenda including, strategy and delivery models,
resource considerations and most importantly joint accountability and ownership.
A Domestic Abuse Strategic Group has been established and will report directly and regularly into
the four theme boards on progress.
5.4 Harmful Sexualised Behaviour
The mandate of the Harmful Sexualised Behaviour (HSB) Operational Group is to drive forward the
project and implementation plan for HSB.
What have we done?
•
•
•
•
•
•
•
•
Protocol/procedures are in place and are reviewed annually.
A Referral Pathway has been developed and multi-agency team meeting monthly (AIM
Information Exchange Meeting) – referrals are RAG rated (Red/Amber/Green).
Outcomes measures and a reporting structure are in place and agreed.
Police now have all cases of a sexual nature coming through Protecting Vulnerable People Unit
to support consistency of referral process.
A data dashboard complete and new data collection format agreed.
Joint Working Protocol is in place between NSPCC and Youth Offending Service to deliver
interventions as above.
Clear Intervention Pathway at all levels of concern:
Green – School Pilot – Parents workshop of internet safety and children’s access to
inappropriate people and material, school assemblies on staying safe and rules for life, based
on the PANTS campaign. Group work and 1-1 work sessions delivered by schools to children
whose behaviour is a concern. Setting personal rules.
Amber – Medium level of intervention provided via YPSS.
Red – 30 week therapeutic intervention package delivered via NSPCC.
•
•
•
The pilot of the Green Intervention Programme in schools was very successful. 100% of
parents reported they felt more confident in keeping their child safe online.
A number of assessments have identified undiagnosed learning needs which have led to
CAMHS assessments
Training Pathway in place which meets the needs of the whole service area.
Next Steps
•
•
Victims Service to be considered in conjunction with the Victim Strategy.
In order for us to be able to actively engage young people in undertaking the AIM assessment
and potentially therapeutic work to address behavior, solicitors in the area need to be trained
on the benefits of not recommending a “No Comment” interview and denying allegations if
evidence is clear that a young person will be prosecuted.
23
Page 127
•
We need to further develop the HSB programme piloted at Wybers Wood School to be rolled
out to other schools.
Data; 1st April 14 – 31st March 15
Referrals
AIM assessment
Risk assessment
Psychological assessment
Other assessment
No assessment required
Awaiting more information
40
19
10
3
3
12
4
Training:
HSB Awareness Raising training
Understanding and Responding to Sexualised Behaviour
Change for Good Programme (Amber level of intervention)
340
100
25
5.5 Looked After Children
•
•
•
•
•
To refresh and re-develop a set of performance indicators that ensure management oversight
on performance and areas for development.
To continue to roll out Viewpoint in conjunction with partner agencies in order to collate
feedback for service development.
To review the young person’s participation in the IRO Service and work with the Corporate
Parenting Board and Council for Children in Care to develop a Consultation Group of young
people specifically to advise and assist with the quality of the IRO Service.
To formalise the programme of Observed Practice within the IRO Service to drive up quality
and consistency of service delivery whilst providing a feedback tool and reflective supervision
as part of the overall quality assurance process.
To implement a monthly and quarterly audit programme for IRO cases to ensure good practice
and areas for improvement are captured and action planning for the team can be based on
thematic learning.
What have we done?
•
•
•
•
•
We have refreshed and re-developed the performance book to ensure that key data is captured
for management oversight and service improvement and report quarterly to the LSCB via the
newly embedded Outcome Based Accountability (OBA) Score Card.
The roll out of Viewpoint continues. To date we have focused on the implementation of
Viewpoint that is now embedded but with the need to increase use and uptake. IRO`s identify
who will assist a child/young person in accessing this software as well as ensuring that all other
options to support participation/attendance at reviews are explored. Further work will be
undertaken during 2015/16 on increasing children’s attendance at reviews.
The Council for Children in Care (CfCIC) meet to address issues and have developed their
contribution to the pledge. Their views are fed into the Corporate Parenting Board. A resource
has been identified to develop consultation with young people specifically in relation to this
service and this work will commence in July 2015.
Observed Practice sessions are being implemented.
The Audit Programme has been superseded by the LSCB Audit Programme. IRO`s have also
been involved in auditing cases identified in the LSCB Audit Programme and attended
practitioner sessions. The service has used thematic team meetings to reflect on cases and the
associated practice issues.
24
Page 128
•
In addition to the above the implementation of the single practice alerts (to be called quality
assurance notifications in the future) to alert social workers, their supervisors and service
managers to issues identified on cases in a more formally recorded format.
•
•
•
•
•
1049 LAC reviews are recorded as having taken place during 14/15 for 498 reviews , where
IROs visited the child on a date prior to the date of the review this is compared to 897 in the
previous year. This figure is likely to be higher but has not been recorded and therefore
cannot be evidenced. Information not being recorded was due to workload pressures. There
will never be 100% due to other factors, such as children refusing to work with the IRO.
Work is being undertaken in 2015/16 to ensure data recording is as accurate as possible.
94% of the 1049 reviews were held within timescale which means that 14 children had a late
review.
There is evidence that the use of single practice alerts has had an impact on children’s cases.
There are some good examples of children/young people participating in their reviews.
Next steps
•
•
•
•
•
•
To ensure that the Performance Work Book continues to evolve and captures the right
information and data to assist in future service planning and improvement.
To obtain feedback on the IRO Service Provision from children and professionals to inform
developments and incorporate into future service delivery.
To review what “Keeping in Touch” could look like in the context of cost, workload management
and children’s feedback.
To undertake audits of the SPA`s (to be known as Quality Assurance Notifications) to collate
thematic practice issues and use these to develop learning themes and improve practice.
IRO work to continue to be subject to an audit programme linked with the LSCB Quality
Assurance Framework.
Include baseline performance data (aligned to LSCB Score Cards were in place) and
narrative/charts explaining data.
5.6 Court Safeguarding
Care Proceedings Rise in Care Proceedings
There has been a historical rise in the number of Looked After Children (LAC), Numbers have
stabilised and as of June 2015 there are 265 children that are classed as LAC. A percentage of the
LAC cases are children that are placed with relatives. Increasingly we are having to issue
proceedings in order to secure these placements of children with their relatives. This is a change in
practice and is as a result of the now very restricted access for families to Legal Aid. We are also
required to financially support these placements, although it is a very good outcome for children to
remain with their extended family and is more cost effective than long term Local Authority Care.
This area requires improvement and development in the service as to how these cases are
managed.
Resource Allocation Meeting (RAM)
A RAM panel has been in place for over a year now within Children’s Social Care. The purpose is
as follows:
• Children and Young People should be able to live with their own family whenever this is safe to
do so. Additional support and assistance may be required for this to be possible.
• Where this is not possible, every effort will be made to provide services within the locality or as
close to home as possible.
• Whatever the primary need, in order to maximise outcomes for Children and Young People, all
aspects of their life must be considered in planning for them.
25
Page 129
•
•
•
Planning should begin by looking at the needs of the child or young person and the family’s
ability to meet those needs, with support if necessary, but must take account of finite
resources.
Plans should always have as their aim reintegration into the local community (with timescales).
All placements should represent Value for Money.
Role of the Group
•
•
•
•
•
To ensure consistency of decision making and appropriateness of admissions to care.
To prioritise the allocation of resources to maximise efficiency.
To ensure that applications for additional funding are appropriate and to ensure that
placements represent value for money.
To prevent drift and ensure that planning is robust and appropriate to meet the child’s needs.
To identify trends in the profile of the looked after population and to identify needs and gaps to
inform commissioning plans.
All members of the RAM panel are senior managers within Children’s Social Care and have
decision making powers within the Local Authority. The panel is chaired by the Assistant Director
of Children’s Services.
5.7 Missing From Home and Care
2014 Annual report recommendation: Standardise our approaches to Missing from Home and
Care.
Operational & Risk Management Groups have been established with partner agencies. All
notifications of children Missing/Absent from Home & from Care and notifications when found go
into a secure in-box and can be directly accessed by key personnel. Every child who has been
missing is discussed at each risk meeting, irrespective of whether they have been missing from
home or from care, and appropriate actions agreed.
Children Missing from Care are managed in the same way as Children Missing from Home with
information sharing and risk management being key factors.
In 2014/15 13% of individual children who went missing were Looked After Children (22
individuals) while 24% of all episodes of children going missing involved these children. (112
episodes) 2 thirds of missing episodes lasted less than 23 hours and 70% of Looked After Children
going missing are between 13 & 15 years old.
A number of these children became looked after as a result of repeated episodes of going missing
and risk taking behaviour and, in the majority of cases, missing episodes reduced.
There is regular management oversight of missing reports and the Missing in-box is checked on a
daily basis.
Close co-operation between Police, Social Care, Education and Youth Services ensure that robust
searches are conducted, Child Abduction Notices issued when appropriate and disruption tactics
employed.
Debriefs are conducted within 72 hours, the key factors identified to date being emotional
difficulties and wanting to spend time with friends.
There are close links between the Missing Risk Management Processes and CSE Management
and Looked After Children have access to the same services as all other children. There is strong
multi-agency involvement in all plans for children at risk of CSE.
We are aware of a national trend for children’s homes to be a target of CSE gangs and individuals
but this is not a pattern we have observed in NEL to date.
What have we done?
Placement stability
26
Page 130
There has been an increase in the % of children with 3 or more placements from 10% to 11.7%.
The change is not so much attributable to placement breakdown as it is to having to accommodate
children with emergency carers before settling them with carers on a longer term basis.
NELC has continued to deliver a good level of long term placement stability in spite of increased
pressure on placements and resources since 2012. Performance has dipped to 70% in 2014/15
but is still likely to above England average and in line with statistical neighbour average.
Health performance remains above 96%. There have been further improvements with initial health
assessments now being completed by the LAC Health Team.
Placement stability and enduring relationships are the only way in which children will recover from
the deficits in their early lives and become more resilient individuals.
The new health assessment process has enabled health issues to be identified at the earliest
stage and effective interventions begun. There are several case studies, particularly of young
women involved in CSE which demonstrate the positive impact of this.
The new SDQ process includes a monthly discussion with CAMHS so that issues identified can be
addressed quickly and emerging themes identified.
Stability and support in education has enabled a number of young people to attend university
and/or gain long term employment.
Regular surveys of Care Leavers & looked after children demonstrate that they value the support
they receive and, of particular importance to them are the relationships they build up with their
workers.
We are successful in maintaining contact with Care Leavers. Where young people struggle to
adapt to adulthood, this ongoing contact gives them the chance to make poor choices but still
come back for support from a group of professionals they have usually known for a number of
years. There have been several remarkable case studies to illustrate this point.
Next Steps
Continue to improve processes for recording and monitoring children who go missing and use
information from debriefs to inform individual plans and identify themes.
Ensure that there is learning from placement disruptions and that foster carers are trained and
supported.
Increase capacity in the Looked After Children Education team to reduce risks posed by children
being excluded from school.
5.8 Allegations against People Who Work with Children
•
•
•
An External Independent Audit Report from April 2014 had suggested that the forms used to
record allegations should be revised and simplified.
The LADO service is developing a tool to capture user feedback and has introduced an
observed practice quality tool.
That workshops to disseminate learning from cases will be incorporated into the LSCB Training
Calendar and Portfolio to ensure that it is available and accessible to those managers and staff
that may need to make referrals via the LADO process.
What have we done?
27
Page 131
•
•
•
•
There have been 45 allegations made to the LADO during this period. These were classified as
being based on the following concerns: 8 Emotional Harm, 4 Neglect, 24 Physical Harm and 9
Sexual Harm. Consideration was given to revising the forms used in North East Lincolnshire
but they are deemed to be helpful to the process and provide a clear record of what was
reported and what actions were taken to resolve matters.
We have yet to conduct a formal user feedback exercise but the designated officers do receive
positive comments about the usefulness of their role. An Observed Practice Tool has been
developed and observed practice sessions completed.
In addition to the above an audit tool to reflect the quality of the work undertaken by the
Designated Officers has been developed and used by the Strategic Manager for Safeguarding
to audit cases and provide feedback.
The annual report outlining themes arising out of cases and practice issues is disseminated to
the LSCB and Corporate Parenting Board. Workshops are still to be rolled out.
•
•
•
•
•
•
•
Appropriate referrals have been made to relevant governing bodies when required to ensure
future safeguarding.
83% of cases were resolved within 3 months falling slightly short of the target of 90%.
15 cases were substantiated (there is sufficient evidence to prove the allegation).
2 cases were Malicious (there is sufficient evidence to disprove the allegation and there has
been a deliberate act to deceive).
8 cases were false (there is sufficient evidence to disprove the allegation).
13 cases were unsubstantiated (there is insufficient evidence to either prove or disprove the
allegation. The term, therefore, does not imply guilt or innocence).
Several cases have emerged where, despite following safe recruitment practices, the staff
member has been dismissed due to his or her conduct with children and/or convicted of a
criminal offence. It is becoming increasingly clear that simply to follow safe recruitment
practices is not enough. All indications are that there is a need for continuous oversight of staff
practice reinforcing the need for supervision, a robust approach and response to whistle
blowing and whistle blowing policies and coupled with recognition that staff must be proactively
encouraged and enabled to report colleagues whose behaviour raises safeguarding concerns.
Next steps
•
•
•
•
•
To develop a User View Evaluation Tool to enable us to improve the service to partner
agencies.
To develop the use of technology to allow virtual meetings to take to assist in maintaining the
frequency of case reviews.
To continue to audit LADO records through ‘dip-sample’ to ensure consistency and quality
assure the process for timeliness, effectiveness and impact.
To continue to incorporate a programme of Observed Practice within the Children’s
Safeguarding and Reviewing Service to promote the advice and guidance offered to
professionals when referring LADO cases.
To develop and deliver workshops to share learning from the outcomes of cases referred into
the allegations management process.
5.9 Corporate Parenting
The Corporate Parenting Board will have access to the performance reports, stakeholders and
senior officers from services that directly impact Looked After Children (LAC). In addition, broad
aims for success of the CP provision and Elected Member responsibility are set out in the current
strategy document alongside the CP Pledge, where LAC express their wishes and feelings for the
service and the senior management team set out their promises to LAC in return. The CP Board
gives a focus to the statutory duties and responsibilities of elected Members as Corporate Parents.
28
Page 132
The Operational Group – the CP Working Group – felt the impact of re-structures and staff
turnover. We said we wanted to re-establish and refocus the new group. The Council for Children
in Care (CfCiC) had quite naturally lost membership as the members of the group had grown and
left the care system. Secondary to that is the increasing numbers of a younger cohort where the
traditional CfCiC model was no longer appropriate. We said we had to have new interest for LAC
to be a part of this group.
What have we done?
•
•
•
•
•
•
•
•
•
•
Developed and published a CP booklet aimed at raising awareness among elected members
as to their parental responsibilities. Each elected member had a copy delivered directly.
Championed through the Board an examination of the levels of pocket money to residential and
LAC which resulted in a raise of cash-in-hand (pocket money) and acknowledgement of ongoing allowances for clothing, magazines, hobbies etc.
Discussions at the Board endorsed the issue of open internet access for young people in care.
With a recognition of the risks and safeguarding considerations for this vulnerable group, all
residential units will be getting internet/Wi-Fi access, not blocked or gate-kept by Local
Authority restrictions.
Budget and resource changes are brought to and discussed at the Board.
Senior Officers also have membership of the LSCB Board and report to the CP Board. This
will be enhanced following a request to particularly share issues around CSE and Missing from
Care.
LAC complaints are a standing item and the open discussion identifies themes, ongoing issues
and queries resolution and changes that result.
Board Members receive monthly, the Reg 33 reports from each residential unit, giving
opportunity to bring themes and key points forward for discussion. Similarly, Ofsted full
inspection reports are shared, discussed and acknowledged where appropriate with letters to
the unit managers.
Financial flexibility for LAC has been a constant discussion at the Board and is partially
resolved with the introduction of unit specific credit cards, giving LAC some flexibility in
consumer options, working around the necessary rigid restrictions of council spending and
financial arrangements.
Via the Board, elected Members are encouraged to visit residential units on pre-arranged (and
sometimes unexpected) occasions.
The CfCiC continues to meet and via members of the Board gives a voice to LAC. Their input
has had a direct impact on topics referenced above. The content of the Pledge is heavily
influenced by the CfCiC.
•
•
•
•
•
The CP Booklet has high-lighted the Parental Responsibility of Councillors towards LAC.
Sharing the Reg 33 reports with Elected Members gives them a direct insight into the work of
the residential units and the interaction with Ofsted Inspectors.
The increased pocket money and access to the internet speaks to the “normality” of family life
for those children in residential care.
The CP Board has members who also sit on the LSCB, the Children’s Partnership Board,
Children’s Scrutiny and this enables information sharing, benchmarking and challenge.
CfCiC continues to meet and give a voice to Looked After Children.
Next steps
•
•
•
•
•
Awareness raising for new Councillors, offer CP training via Member Development.
Development of database of employment experience opportunities for LAC across the Local
Authority and its partners and local business.
Assess impact of CP Booklet.
Revision of CP Strategy & CP Pledge including publication.
Develop format for CP annual report, requirements of Strategy & Pledge.
29
Page 133
•
•
•
Confirmation of the incumbent to the role of CP Coordinator following organisational
restructure.
Increased membership of the CfCiC.
Members of the working group to be confirmed the outcome of structural changes
5.10 Private Fostering
A Private Fostering arrangement is essentially one that is made privately (that is to say without the
involvement of a local authority) for the care of a child under the age of 16 (under 18, if disabled)
by someone other than a parent or close relative for 28 days or more.
The number of children in private fostering arrangements of which NELC were aware from April
2014 to end March 2015 are as follows:The Private Foster Carer becomes responsible for the day to day care of the child or young person
in a way which will promote and safeguard his/her welfare. Responsibility for safeguarding and
promoting the private foster child rests with the parent or other person who has parental
responsibility.
What have we done?
The Local Authority’s duties and functions under the Children Act 1989 and regulations state that it
is NOT the responsibility of the Local Authority to approve or register private foster carers but to
assess the suitability of the placement in relation to each particular child and particular private
foster carer, their household and premises. However, it’s the duty of the Local Authority to satisfy
themselves that the welfare of children who are or will be privately fostered within their area is
being or will be satisfactorily safeguarded and promoted.
Visiting and reviewing patterns are once every 6 weeks minimum for visits and once every 6
months, minimum for private fostering review meetings.
There are performance management processes in place to monitor performance and assure
quality.
Next steps
•
•
•
•
Due to the small amount of Private Fostering cases recording on CCM is not as accurate as it
should be.
To rectify this issue all PSW’s will be trained again on CCM and the recording requirements for
Private Fostering placements.
The team have been sent a One Minute Briefing (concise brief report) and this will be followed
up in the team meeting.
Raising the awareness of Private Fostering continues from teams through the provision of
advice and the distribution of leaflets.
5.11 Asylum Seekers
We have a small number of unaccompanied asylum seekers this year. We work closely with the
Immigration Services to age assess the young people and should they be eligible we offer them
appropriate accommodation. Young people age assessed to be to 18 years or younger are opened
to the Through Care Service and do become LAC children. We always try and place these young
people in an area that meets their needs of ethnicity and diversity.
30
Page 134
6. PARTNER AGENCIES
6.1 Humberside Police
What have you done as part of the LSCB partnership that has improved safeguarding for Children
and Young People?
Humberside Police are committed to involvement in all LSCB partnership working at all levels. The
Chief Superintendent or Superintendent hold bi-monthly meetings with Board Chairs across the
Humberside Police geography, and is committed to our continued active involvement in all relevant
LSCB work In particular we are co-located in the Multi Agency Service Hub where we play an
active role in safeguarding decisions around children at risk of harm. The meetings also include
attendance by the Director or Deputy Director of Children’s Services.
Since April 2015 a commitment has been made that attendance at LSCB Board Level Meetings will
be at a rank of no less than Supt. or DCI line management to LSCB/LA area.
We have continued to be the lead agency in development of the local CSE strategies, chairing the
NEL Multi Agency Strategic Meetings, and the Multi Agency Meetings identifying and safeguarding
children at risk. We participate fully in all Multi Agency Audit Processes and Serious Case
Reviews, integrating the learning points into our strategies at the earliest opportunity. As an agency
that covers four Local Authorities (LA’s), not only do we bring the Police view on LSCB matters, we
are also able to bring best practice and learning points from other areas as we strive for the highest
standards.
In April 2015 the force moved to a new Operating Model this resulted in an increase in senior
management. There is a DCI responsible solely for NEL, giving greater resilience for partnership
working at a strategic level. While the Police service are subject to budget cuts during 2015 the
number of investigators covering the South Bank PVP (NE and N Lincs) is to be increased. All
investigators within the PVP will take the appropriate training to be accredited investigators at all
levels of sexual and physical abuse concerning children. The Police will continue to contribute fully
to all development of policies and procedures by the local LSCB, and contribute to audit
procedures. The new operating model placed PVP within the communities command, allowing for
greater sharing of information and building better working relationships. There are two bases
(Clough Road, Hull and Brigg), servicing four LA’s which currently includes 5 x DCI’s and 9 x DI’s.
The remit of the PVP is in line with the 13 strands of Public Protection as defined by the College of
Policing. This ensures our commitment to safeguarding the public is managed under one core
function within the Police. Within the PVPU there are dedicated teams dealing with Missing and
Exploited, DV, Safeguarding Adults and Children and the Management of Sexual and Dangerous
Offenders. There has been an increase in staff, which in turn has seen an increase of workloads
within the PVP and weekly meetings are in place to monitor these within the Organisation which
include regular feedback on performance.
Child Sexual Exploitation, Domestic Abuse and Serious Sexual Offences are now within our force
control strategy, placing priority and scrutiny in these significantly important areas of crime.
What have you done in your organisation to improve safeguarding for Children and Young People?
Update on activity
•
•
•
Humberside Police is settling into the new Operating Model to meet future demand in a period
of budget cuts.
Within the restructure the protection of children from harm is recognised as one of the priority
areas of business and is within the control strategy.
In April 2015 the Protecting Vulnerable People (PVP) team (including safeguarding of children)
on the South Bank of the Humber became one team and moved to Brigg.
31
Page 135
•
•
•
•
•
•
•
The benefit of this is a corporate response to child protection working to a single operating
model, incorporating best practice from across the force. It also enables a larger joint team in
order to match resources to demand.
Within this model Humberside Police remain committed to providing a Police Supervisor to
decision make alongside partner agencies within the NE Lincs MASH, and have added Police
admin support based within the MASH.
Humberside Police have also set up a Missing and Exploited Team (MET team), including a
South Bank based team specifically to deal with Missing children and CSE.
All child safeguarding issues are dealt with by a single police team who are specifically trained
for this role.
Demand within the team has risen substantially during the year. During 2014/2015 while
resources based within the PVP team covering NE Lincs rose by approximately 80%, crimes
dealt with by the team rose by approximately 140%. This is partly due to the increased remit,
but also due to an increased reporting of sexual offences locally, which reflects the national
trend and also increased awareness of perpetrators of sexual exploitation of children as we
refine our intelligence tools.
For CATS records specifically dealing with children we have seen a 19% rise in the number of
jobs for 2014/15 compared with twelve months previous. For Section 47 cases the rise is 8%.
Officers within the MET team are recognised nationally as leaders in the use of Child Abduction
Notices to disrupt offenders who target children for sexual exploitation.
Partnership Working
•
•
•
•
Humberside Police remain committed to working with our partner agencies to safeguard all
children within NE Lincs
Our attendance at LSCB meetings remains high.
We sit as panel members on all Serious Case Reviews and contribute to LSCB audit
processes.
Police are key personnel in the Multi Agency Child Exploitation (MACE) meetings collating the
intelligence to identify children at the highest risk of exploitation to make sure they have a
wraparound multi-agency approach to safeguard those children.
Next Steps/Planned Developments
•
•
•
Representation at sub committees will be on a geographic basis with a Chief Inspector
allocated to specifically work with NE Lincs LSCB and LSCB.
The increased demand placed on police resources has been recognised and there is a current
shift in resources to address this issue in an attempt to reduce this.
The MASH team will remain co located with partner agencies.
6.2 Serco (School Improvement Services)
and Young People?
Serco plays a full and active part in the governance and delivery of safeguarding in North East
Lincolnshire. Examples of activities in 2014/2015 include, the signposting of new guidance
“Inspecting Safeguarding in Early Years, Education and Skills Settings” (published June 2015) to
all settings through a variety of forums including the Early Years Settings Senco Forum. Providing
support to a number of settings when safeguarding issues have emerged. Attending the Hate
Crime Group of Safer Communities with a particular focus on racially motivated Hate Crime where
this impacts on children in schools and/or their families.
•
•
Ensure that any statutory guidance is circulated to all schools in North East Lincolnshire with
briefing notes circulated to head teachers. Principals and governing bodies
Monitor the use and maintenance of the Single Central Record in maintained schools
32
Page 136
•
•
Serco staff to receive updated training as required in relation to safeguarding procedures
School and Early Years Settings Ofsted reports analysed to identify safeguarding aspects of
the inspection, with annual report to LSCB
There has also been an analysis of the safeguarding elements of Ofsted reports, which showed no
strong messages or trends. This will be an ongoing source of intelligence to inform – safeguarding
in schools.
6.3 Children’s Services
and Young People?
Children’s Social Care (CSC) is a significant contributor to the work of the LSCB, having staff on
several Sub Groups, including that of the chairs. In particular we have contributed to the Neglect
Campaign and the Child Sexual Exploitation (CSE) partnership work within has improved
safeguarding locally. In addition to work undertaken as part of the learning from Serious Case
Reviews (SCR) was co-lead by CSC, which resulted in the multi-agency workshops which were
positively viewed by all in attendance.
CSC attend with the Operational and Leadership Board and have supported the development of
the Score Card approach, which has led to the LSCB to understand the areas issues better and
focus on next steps.
CSC is actively engaged in the Domestic Abuse work and the recent developments on this agenda
are aimed at improving our collective responses.
In terms of what we have done within our own organisation, these have been extensive for greater
detail see the earlier sections on the MASH and CASS.
CSC has increased the number of Social Workers in its front line services, in response to the
increase in safeguarding activity. Significant time and energy has been focused on ensuring all
agencies understand its referral process and the linked thresholds in respect of our services. We
have worked with colleagues to develop and enhance the Early Intervention and Prevention Offer,
so families and professionals always get a response at the level appropriate to the identified
concerns. The MASH challenge sessions have opened up the referral response process to multi
agency challenge and actions.
Service developments have continued and CSC has developed champions linked to key areas of
practise.
CSC has lead on the Signs of Safety approach to safeguarding and are a key contributor to the
Creating Stronger Community Project, which will see significant numbers of multi-agency staff
working and supported in this culture change programme will aim of improving outcomes for
Children and Young People.
Continued developments of the Early Intervention and Prevention approach based around the new
Family Hubs.
•
•
•
•
Explore greater interpretation with Adult Safeguarding.
Continue to reduce Social Work caseloads.
Focused work on Child in Need cases to reduce the very high numbers currently in the service.
To have written the revised Social Work Performance Framework.
33
Page 137
6.4 NSPCC
and Young People?
•
•
•
•
•
•
•
Services delivered by the Grimsby NSPCC Service Centre are focused upon improving the
safety and well-being of Children and Young People in NELC.
All work undertaken by the NSPCC involves strong collaboration and partnership working.
The NSPCC initiated a pilot service ‘Coping with Crying’ in NELC in May 2014. This is a short
film which is shown in Children’s Centre’s to expectant parents by trained staff. The target of
reaching 1,000 parents within 18 months is on track.
The NSPCC is a lead agency for the Harmful Sexual Behaviour Pathway and has co-written
and developed the inter-agency protocol implemented in April 2014 The NSPCC delivers the
Change For Good Treatment Programme to those Children and Young People at the highest
threshold of risk. We have co-written and developed awareness raising training material and
delivered this to over 250 professionals within NELC since October 2014.
We will continue to deliver a range of core services, including: Video Interaction Guidance for
attachment based problems; Triple P pathways 4/5 to tackle neglect; FEDUP for children and
parents who are impacted by substance use; Family Smiles for children and parents who are
impacted by parental mental health; Face to Face for Children and Young People who are
looked after or live in kinship care and Turn the Page for Children and Young People who
display harmful sexualised behaviours.
The NSPCC has contributed to writing, piloting and delivering a series of training and practice
enhancement workshops for the Professional Capability Pathway on neglect.
The NSPCC are making a five year commitment to test assessment and intervention models to
tackle neglect. The Thriving Families initiative went live in April 15 and chimes with NELC’s
PEI Strategy and the LSCB Strategy for Neglect to maximise opportunities for collaborative
work and support integrated systems and processes.
•
•
•
•
•
•
•
•
•
We ensure staff has an annual Professional Development Review that is reviewed twice a year
to ensure that staffs are appropriately trained for their role.
NSPCC practice standards require a robust level of management oversight on open cases.
Key Performance Indicators include:
Each open case supervised each calendar month. There is an expectation that reflective
supervision is well evidenced and that safeguarding and child protection is prioritised from
referral through to case closure. The child’s voice must be evidenced.
Children and Young People who are open cases to the NSPCC to be seen and spoken to a
minimum every 28 days.
There are up to date risk assessments on each open case file.
A minimum of two cases per practitioner must be audited by a team manager each month. The
Service Manager must audit 4 cases each month for compliance and quality.
We have incorporated Signs of Safety into our supervision process.
We undertake Peer Audits to promote learning.
•
•
•
•
Thriving Families implemented in April 2015 will work with families that have been identified a
experiencing neglect for Early Help to prevent escalation to statutory services.
We will work in partnership with LSCB partners to evaluate outcomes to measure the impact of
this work over the next five years.
We will implement the bespoke North Carolina Assessment Tool and use this alongside the
Graded Care Profile (version 2) to assess neglect.
We will train staff in the Safe Care Parent Training Model to work with neglecting families.
34
Page 138
6.5 North East Lincolnshire Clinical Commissioning Group
What have you done as part of the LSCB partnership to that has improved safeguarding for
children and you people?
North East Lincolnshire Clinical Commissioning Group (NELCCG) has been represented on the
Leadership Board by the Deputy Chief Executive. The Operational Board has been attended by the
Assistant Director for Service Planning and Redesign, and the Designated Nurse and Doctor. The
Designated Professionals have worked with relevant providers to ensure appropriate health
professional representation on all LSCB Sub Groups.
The Assistant Director and the Designated Nurse have co-chaired the Safeguarding in Health Sub
Group. The Sub Group has explored the identification of meaningful outcomes which will improve
arrangements across the health economy to safeguard children.
The CCG provider contracts include the requirement to incorporate LSCB priorities & local
standards into their services.
NELCCG does not directly provide any services to children. However, the NELCCG is required to
ensure they, and all their commissioned providers, operate safe systems which meet S11 statutory
duties, and safeguard children.
NELCCG identified 10 standards to be included in all contracts for services commissioned by, or
on behalf of, NELCCG. These standards reflect provider requirements arising from S11 Children
Act 2004, and Care Quality Commission Fundamental Standards – Regulation 13. Assurance has
been sought from each commissioned provider to ensure compliance with the standards.
During the year, the CCG increased its specialist professional capacity to support both the LSCB
and CCG, with the recruitment of an experienced full-time Specialist Nurse shared with North
Lincolnshire CCG.
The Designated Professionals were involved in supporting clinicians in health providers, in
particular named professionals, and practitioners in partner agencies on the appropriate
management of complex cases.
NELCCG had a duty to support the improvement in quality of primary care services. The CCG,
through their Designated & Specialist Nurses and Named GP have promoted opportunities for
practices to improve their safeguarding contribution. An audit of GP arrangements was undertaken
in the year, though the report was not finalised until after year-end.
NELCCG have developed a work plan for 2015/16 which will support delivery of the LSCB
priorities. The work plan will be dynamic and respond to emerging issues/ learning (locally and
nationally) but will include:
• Supporting & improving the quality arrangements required in independent contractor services.
• Development and roll out of safeguarding training and supervision strategies for Northern
Lincolnshire Health Economy (in collaboration with North Lincolnshire CCG).
• Embedding monitoring of safeguarding children arrangements for all provider health services,
working with other health commissioners to ensure consistency of approach and elimination of
gaps in services for vulnerable children/families.
35
Page 139
6.6 CAFCASS
Cafcass (the Children and Family Court Advisory and Support Service) is a non-departmental
public body sponsored by the Ministry of Justice. The role of Cafcass within the family courts is: to
safeguard and promote the welfare of children; provide advice to the court; make provision for
children to be represented; and provide information and support to children and their families.
Locally Cafcass is based in Hull comprising a Team of one Service Manager and 16 Family Court
Advisers (FCA) undertaking Work After First Hearing in respect of Private Law (WAFH) and Public
Law cases. All team members undertake Public and Private Law work covering the geographical
areas of North East Lincolnshire, North Lincolnshire, Hull and East Riding of Yorkshire. The Work
to First Hearing Team (WTFH) is also based in Hull comprising 0.25 Service Manager and 5
FCA’s. This is a dedicated team preparing Safeguarding Letters prior to First Directions
Appointments in respect of all private law applications to the Courts.
All staff are involved in Performance Learning Reviews and formally assessed against
safeguarding objectives on a quarterly basis. At the last point of assessment over 90% of staff
were graded as Good for safeguarding.
Effectiveness of Safeguarding Arrangements
A key focus during 2014/15 was continued improvement following our “good” Ofsted judgement in
April 2014. Cafcass has a robust programme of internal audits to assure the effectiveness of
safeguarding in both public and private law.
We provide tools for practitioners to use in self-assessment in order to benchmark the quality of
their own work.
Practitioners are supported extensively and scrutinised routinely to ensure the effectiveness of
their safeguarding practices.
Reports to court are routinely quality assured and practice observations are undertaken, as set out
in our Quality Improvement and Assurance Framework.
Further assurance is provided through yearly national audits and our Key Performance Indicators
(KPIs). A national audit of practice was undertaken in November 2014 with the objective of
providing a snapshot assessment of the standard of casework. The audit measured the progress of
work since the audit in September 2013 and the Ofsted inspection of April 2014. The conclusions
were positive, reporting the percentage of work graded as “good” at 65%. This represents a
significant improvement of 16% from the previous year’s audit.
We will undertake three thematic audits in 2015/16, focusing on further improvements required.
These will look at the extent of the improvement in the joint working between the Independent
Reviewing Officer (IRO) and the Guardian; the Guardian’s involvement and agreement to any
position statement filed in proceedings; and evidence in WAFH of the improvement in analysis of
assessment and increased use of research and tools.
We continue to respond to, and facilitate, developments within the family justice system and in
particular the move, in private law towards supporting parents, where possible, to make safe
decisions outside of court proceedings. We are currently piloting a programme announced by the
Ministry of Justice, to provide advice and to encourage out of court pathways for separating
parents, where it is safe to do so.
The supporting separating parents in dispute (SSPID) helpline was launched in November 2014.
Callers are put through to a Cafcass practitioner who can talk through the difficulties of separation,
offering support, guidance, and information.
We also ran a six month pilot of a safeguarding advisory support service for mediators, aimed at
providing support in cases featuring child protection concerns.
36
Page 140
Cafcass is also working on the Parents in Dispute Pilot, in partnership with the Tavistock Centre for
Couple Counselling. The chief aim of the project is to support separating parents involved in high
conflict disputes in the family courts.
A significant emerging issue in recent years has been Child Sexual Exploitation (CSE), We are
implementing a CSE strategy which involves consolidating systems to capture data on CSE in
cases known to us; providing mandatory training on CSE to our staff, running workshops to
increase awareness; reviewing policy guidance to staff; creating dedicated management time to
support the delivery of the strategy at a national level; and creating CSE ambassadors within each
service area.
To ensure that our staff are able to safeguard children as best as possible, Cafcass has an
extensive workforce development strategy
6.7 National Probation Service
and Young People?
Through its agency level remits described above, the National Probation Service (NPS) is fully
committed to the safeguarding and welfare of children. The NPS is organised on a Divisional basis
and the North and North East Lincolnshire Local Delivery Unit forms part of the NPS North East
Division. The North East Division has designated a lead ‘Head of LDU’ as the policy holder for
implementing safeguarding policy across the division.
•
•
•
•
•
•
•
•
•
The Head of NPS North and North East Lincolnshire has lead responsibility for Safeguarding
children; is accountable to the Deputy Director for the NPS and the National Offender
Management Service. Within North East Lincolnshire a manager at Senior Probation Officer
grade has responsibility for the operational safeguarding and the promotion of child welfare.
During the last year the following activity has been completed as a result of the NPS'
commitment to the LSCB and safeguarding children.
The North East Division provides a Business Delivery Plan for which is strategic in purpose and
cascades service delivery responsibilities to relevant leads, ensuring safeguarding is
accounted for.
Safeguarding updates are communicated locally and across Humberside via lead Senior
managers and operational lead Senior Probation Officers. As part of a National Service,
governed on a Divisional level, a briefing and bulletin system is in operation to ensure all staff
receive current safeguarding information ranging from policy, legislation implementation and
practice guidance.
Senior Managers take responsibility through direct supervision of middle managers to ensure
staff have taken appropriate measures to safeguard children as part of operational case
management. Senior Managers are also responsible for commissioning internal audits and
through the SCR or SFO processes, action plans are implemented according to findings.
Management forums which include Senior Managers, Operational managers and Business
administration managers include and focus on the contribution to safeguarding. This is
replicated for practitioner team forums which include findings from quality assurance activities
to enhance practice.
The focus has remained during the last year in respect of safeguarding being central to the
business of the Mappa SMB and at all levels of Mappa case management.
The protocol between Mappa and the LSCB has been retained to provide clear continuity of
information sharing.
The NPS currently operates the Safeguarding Children Policy written and approved by
Humberside Probation Trust (HPT) which has long had established policies and procedures.
Policies have been continually reviewed to maintain compliance with organisational change
and the implementation of legislation.
Following organisational changes implemented as part of the Transforming Rehabilitation
Reforms the NPS has sought to enhance clear and straightforward guidance to staff to be able
37
Page 141
•
•
•
to recognise and respond to child safeguarding concerns. The NPS has clear complaints and
‘whistle blowing’ policies and systems in place with clear timescales. .
NPS has clear structures and arrangements in place. In addition to line-management
arrangements, each office has an identified middle-manager (Senior Probation Officer) who
takes a Local Delivery Unit lead on safeguarding issues. Their lead role is publicised and
known by all relevant staff.
As a result of the direct operational link to the LSCB, In North East Lincolnshire, proactive and
constructive work has commenced to realise the NPS contribution to addressing Child Sexual
Exploitation (CSE). This is evident in the operation of a multi-agency approach with partners to
identify and assess targeted approached to protecting Children and Young People in North
East Lincolnshire.
The NPS has worked closely and effectively with the Humberside Lincolnshire and North
Yorkshire, Community Rehabilitation Company (HLNY CRC) to safeguard children through the
appropriately targeted sentencing recommendations for offenders, ensuring that the risk
escalation process is robust and is fit for purpose in ensuring duties of both agencies are
discharged immediately to protect children.
Central to the work of the NPS in the management, assessment and rehabilitation of offenders and
in supporting victims of crime, is the need to promote safeguarding across all areas of service
delivery. This includes;
•
•
•
•
•
•
•
•
•
•
The Pre-sentence stage to assess the risk of serious harm presented by an offender towards
Children and Young People and the recommendation of sentencing options to mitigate and
reduce such risks.
Working directly with offender in the community and in prison through the statutory supervision
framework to target their criminogenic needs and the associated risks to young people.
The NPS works on a statutory basis with victims of offences specified within Schedule 15 of the
Criminal Justice Act 2003. This allows for the child’s voice to be heard in respect of sentence
planning, risk management activities, the formation of licence conditions to manage any risks to
children (which can include no contact or supervised contact, exclusion zones, directed
residence and prohibited activities).
Cases managed through the Mappa framework facilitates the safeguarding responsibilities of
relevant authorities and provides further accountability to a collaborative approach to the
management of safeguarding practice.
Feedback is sought by victims on a regular basis and its importance is recognised through a
Service Level Agreement of the NPS which is performance managed to ensure victim feedback
which includes the active engagement of adult of child victims to inform practice.
The need to take all actions necessary to safeguard children is a priority within NPS Service
delivery. The focus and emphasis of the NPS is on managing risk to children (with a
corresponding focus on welfare in the context of risk management).
Through the NPS assessment process safeguarding is a clear requirement within each
Offender Assessment System (OASys) and practitioners have the very clear expectation that
sentence plans are constructed collaboratively with the offender and include specific objectives
targeted at safeguarding.
An Integrated Quality Assurance model operates within the NPS to quality assure NPS delivery
and safeguarding practice providing a consistent cycle of audit and development of practice to
enhance our safeguarding provision.
Staff are well versed in referral procedures to Children’s Services, the recording of risk
assessments, risk management plans completed within a multi-agency environment and
management oversight requirements for referrals. Probation Officers are skilled in identifying
the need for early help and assessment where required and work proactively and where
appropriate transparently with families to manage safeguarding issues.
The NPS promotes the fact that safeguarding is the responsibility of all members of staff and
not limited to operational employees.
38
Page 142
•
•
•
Additionally in order to successfully implement the Transforming Rehabilitation reforms YOS
youth to adult transitions have been revised to account for the NPS role for allocating which
organisation (NPS or CRC) will manage specific cases including the provision of key link
practitioners and managers in NPS and YOS.
The NPS locally has developed enhanced Public Protection Instructions which are
commissioned and endorsed via a strategic Public Protection Governance Group of managers
and practitioners. These include instruction and expectations for carrying out a range of
offender management activities focused on safeguarding.
Practitioners take direct account of the diversity needs of offenders and their families in order
that services and interventions can be appropriately targeted and achieved through a
collaborative approach with families, ensuring the voice of the child/young person is
appropriately represented.
•
As the National Probation Service moves forward, updated safeguarding training is being
implemented across the country available to all staff via an e-learning package. The NPS
continues to engage with North East Lincolnshire Child Sexual Exploitation strategies and will
continue to play a key role in working closely with LSCB partners. Additionally, quality
assurance activity is planned to continue in order to continually assess the NPS contribution to
safeguarding, the robust management of those offenders who are assessed as presenting a
risk of serious harm to Children and Young People and to strengthen our services to victims to
ensure the voice of the child remains at the centre of risk assessment, risk management and
intervention with offenders and victims.
6.8 Community Rehabilitation Company
and Young People?
Humberside Lincolnshire and North Yorkshire Community Rehabilitation Company has contributed
to the leadership and operational meetings of the LSCB and participated in the Section 11 Audit.
We responded to the few action points identified and evidenced progress at the follow up challenge
day in June 2015. Safeguarding remains a key focus for staff within HLNY CRC and is a key
element of internal practice audits which take place on a quarterly basis. In additional, our Quality
and Practice Manager, Julie Edwards, audits a random sample of safeguarding cases on a
monthly basis. An HLNY CRC Safeguarding Policy which harmonises the policies of the previous
probation Trusts has been developed. The new Policy is compliant with Working Together to
Safeguard Children 2015 and reinforces staff responsibilities in relation to safeguarding cases.
All frontline HLNY CRC staff in North East Lincolnshire have completed Level 1 Safeguarding
training; the majority have completed Level 2 and the remainder are booked on to forthcoming
training events. Routine safeguarding enquiries are undertaken for all HLNY CRC probation clients
and staff are aware of the need to consult the Multi- Agency Safeguarding Hub where offenders
are residing with or have frequent contact with children. Management oversight is a key aspect of
safeguarding work within HLNY CRC. Staff routinely discuss concerns with their line manager and
safeguarding cases are discussed on a regular basis within staff supervision. Priority is placed
upon home visits and staff are encouraged to undertake these when children will be present.
Internal audits evaluate staff contribution to core groups and case conferences.
Staff have completed e-learning in respect of Child Sexual Exploitation and further training in this
area will be an appraisal objective for 2015/2016. A representative attends monthly multi-agency
CSE meetings and we have worked closely with Humberside Police to ensure appropriate
information sharing and risk assessment processes are in place with regard to CSE suspects.
39
Page 143
The forthcoming year will be one of considerable change for HLNY CRC as our providers, Purple
Futures, begin to implement service redesign and the new operating model. Safeguarding will
remain a key priority in service delivery and we will continue to update the Leadership and
Operational LSCB meetings as changes progress. Staff have been identified to undertake the
Signs of Safety training event and this learning will then be cascaded amongst all operational staff
and relevant staff from our partnership agencies. We are also currently building links with the
Troubled Families programme to ensure a commitment to referring HLNY CRC clients for early
help and a holistic approach to supporting offenders and their families towards positive change.
6.9 Children’s Health Provision
and Young People?
•
•
•
•
•
CHP staff prioritise attendance at LSCB Sub Groups.
Work with partners to support the work of the LSCB.
Individuals have:
- Participated in working groups to support audits
- Address capturing the “Voice of the Child”
- Develop training packages
There is a CHP clinician who plays a key role in supporting the decision making processes
within MASH.
Named Nurse has supported LSCB training delivery on neglect.
•
•
•
•
•
•
•
•
•
•
•
•
The Head of Complex Health Care post has now incorporated the statutory role of Designated
Clinical Officer for Special Educational Needs and Disabilities.
Developments within CHP safeguarding team have allowed the recruitment of a further
Specialist Practitioner.
School nurses:
- Support the needs of Children and Young People within educational settings.
- Provide drop in facilities for young people to raise individual health concerns.
- Offer supportive interventions to children and their families.
- Offer support to staff when managing the needs of children in their care.
There has been a revision of the guidance for CHP staff in relation to providing court
statements for legal processes involving children and families and there has been a significant
increase in the numbers and quality of these being provided.
In the year to 31st March 2015 significant focus has been given to addressing some of the key
messages from Serious Case Reviews with staff groups in CHP.
Attachment training has been delivered by the Family Action Support Team (FAST) to the
Health Visiting teams.
Focus of interventions within FAST service delivery has been adapted to pursue “Early
Interventions”.
Training has been delivered to Health Visitors around managing “Routine Enquiry” to assist in
addressing Domestic Abuse issues.
Safeguarding Children Supervisors attended two day bespoke NSPCC training carried out in
two cohorts to develop their supervisory skills.
The Safeguarding Team sought training for practitioners in relation to court appearances.
Health Visiting Services have been delivered from Children’s Centre’s across the area.
Staff have assisted in the work to support the formation of Family Hubs.
40
Page 144
•
Communication links with health colleagues in relation to children attending A&E, with staff in
maternity services and the LAC team have progressed in 2014/15 and continue to be
developed via the safeguarding teams in both organisations.
Future plans include:
• The development of School Nursing Skills of staff in relation to Adolescent Mental Health.
• Pursuing the roll out of the Signs of Safety approach across the provision.
• Working with colleagues to deliver a child focused services.
• Safeguarding Specialist Practitioner to create direct links with CAMHS, Adult Mental Health
Services and Domestic Abuse Services.
6.10 Northern Lincolnshire and Goole NHS Foundation Trust
and Young People?
Overview of Trust in relation to Safeguarding Children.
The Trust provides a combination of services to clients within the Primary and Secondary Care
Sectors of North East Lincolnshire, North Lincolnshire and Goole. The Trust has an Executive
Lead at Board level and an overarching lead for Safeguarding (Adults and Children) across the
Trust and is compliant with its statutory duties in having in place identified named professionals for
safeguarding.
Governance arrangements are in place to oversee and quality assure our safeguarding processes
alongside the day to day advice that is available to practitioners from our team of Specialist Nurses
and Doctors.
The Trust is signed up and complies with the LSCB Safe Recruitment Protocol.
Achievements
• NLaG and specifically the safeguarding team have continued to work across a broad range of
safeguarding areas and issues such as Child Exploitation, Domestic Violence, Female Genital
Mutilation, Early Help and Early Identification/Reduction of all forms of abuse including
Emotional and Neglect.
• Child exploitation is a key area that has received much focus over the last 12 months. NLaG
have systems in place to flag both victims and perpetrators when they come into contact with
health professionals and are actively involved in the multi-agency approach to tackling CSE.
• Additional training has been undertaken to ensure that front line staff are able to identify and
assess risk when they first meet Children & Young People. NLaG is presently developing its
CSE strategy to further enhance its response and ensure a consistent approach across its 3 LA
areas.
• Domestic Abuse continues to increase across the region and within NLaG Domestic Violence
(DV) forms part of all safeguarding training as well as standalone DV training which has led to
an increased awareness amongst all staff groups. NLaG participate in MARAC and have
cascade frameworks to enable information to be shared with appropriate professionals across
the Trust.
• Early Help continues to be an area that we are developing and over the last 12 months there
has been a significant drive to increase the number of Early Help Assessments undertaken by
Midwifery whilst continuing to promote the process within the community care professionals
such as Health Visiting and School Nursing. Early Help continues to be a key aspect of early
identification of Neglect/Abuse and a major factor in helping to reduce abuse.
• NLaG provide a ‘Family Nurse Partnership’ team which aims to assist new young parents in
developing their parenting skills and lessen the impact that poor parenting has on your future
generations. This team has recently been expanded due to its success and ensure more young
parents are able to access its services.
The Safeguarding Children Training Strategy has been in place since June 2011 and has recently
been reviewed in line with National Guidance. Training figures are monitored monthly by the trusts
41
Page 145
Safeguarding Children Forum and additional training events are developed to ensure staff have the
most up to date information. All staff members of NLaG have individualised training plans in place
which are reviewed as part of the Performance Review Process. Attendance at training continues
to increase on a month by month basis.
The Trust has a Safeguarding Supervision Strategy in place and have recently widened mandatory
Safeguarding Supervision to more professionals groups than those previously included (Health
Visitors, Paediatric Nurses, Midwives and Gynaecology) and is also available to other staff
members as required.
What difference has it made to the lives of children and young people?
For Children and Young People who enter NLaG services via A&E, there is earlier identification of
risk and as such a better service is given. Communication pathways exist to ensure that Secondary
Care information is effectively shared with Primary and Community Services and therefore the
children receive prompt follow up when necessary.
Systems are in place to highlight additional service needs when children attend at the Hospital and
are on a Child Protection Plan or under the care of the Local Authority as well as systems which
identify risk in relation to Domestic Violence.
As a result of the above, children have had speedier/more effective Single and Multi-Agency
Interventions.
FNP continue to provide a service to in excess of 100 young parents and in some specific cases
the impact of this work as meant that parents make significant enough changes to make the
difference between keeping or losing a child.
Have there been any organisational/financial changes which have impacted on your ability to
safeguard children?
NLaG has been relatively stable in an organisational sense and therefore any change as not
specifically impacted on its services to Safeguarding Children. Financially NLaG is in no different
position to most other Trusts in, so far as it has a financial deficit. There has, however been no
significant impact on services delivered to Children and Young People.
The Trust undertakes regular audits covering safeguarding at both frontline service and
organisational level (examples of these are in relation to quality and appropriateness of referrals).
Audit outcomes are managed by the safeguarding children forum and reported to the Trust
Governance and Assurance Committee.
In February 2015 an external audit was commissioned from KPMG to review the safeguarding
processes within the Trust. The audit has given significant assurance that NLaG has a safe and
effect safeguarding system in place, however does make a recommendation that NLaG should
undertake a Gap Analysis to ensure that the increasing safeguarding workload is able to be
effectively managed within the current resources of whether there is a need to increase the current
capacity of the team.
Priorities for 2015/16
• Gap analysis with regards to current team resources.
• Continue to increase uptake of safeguarding training throughout all departments within the
Trust.
• Maintain an on-going audit programme to ensure safe delivery of safeguarding processes
within the Trust.
• To maintain the current commitment to working with partner agencies in order to safeguard and
promote the welfare of children across the NLaG boundaries.
42
Page 146
•
In conjunction with our commissioners continue to review the current provision for Domestic
Violence within NLaG in so far as working with our current partners in direct case management
and early detection within our client groups.
7. POLICIES PROCEDURES AND GUIDANCE
What have we done?
The NEL SCB procedures were compliant with Working Together 2013 and are in the process of
being revised in line with Working Together 2015. The LSCB commissioned Triex to manage,
review and revise the LSCB procedures. The procedures are reviewed on a six monthly basis.
Significant changes have been added in respect of national guidance. The application and
effectiveness of safeguarding procedures are measured as part of case file audits and Serious
Case Reviews which is an ongoing process. The LSCB have produced Resistant Parenting
guidance following learning from SCRs. Guidance for practitioners in respect of “Bruising to Non
Mobile Babies Policy” has been developed and will be agreed by the Board on 2015/16. Both the
Child Sexual Exploitation guidance and Harmful Sexualised Behaviour guidance have been
updated in 2014 as part of ongoing development and review. There have been 3,590 visits to the
website during 2014/15.
The LSCB built on the existing Council supported LSCB website and have developed a dedicated
LSCB Website supported and financed by the Clinical Commissioning Group. The website has
dedicated sections for children, young people, families and practitioners SCRs, procedures,
training, performance, good practice and national research.
Next Steps
Youth Action are involved in reviewing the Young Person’s section in ensuring it is young person
centred. The LSCB website will be developed on an ongoing basis and is overseen by the LSCB
Operational Board. Each of the LSCB Sub Groups feed into the Operational Board in respect of
required updates to the website.
8. LEARNING AND DEVELOPMENT ACTIVITY
What have we done?
In the training year April 2014 – March 2015, 180 safeguarding courses were run (increase of 40
from previous year) and 3315 participants were trained (increase of 878 from previous year).
These are made up of both single and interagency courses. In addition to the rolling programme of
training and continued focus on CSE, Working with Resistant Families and Neglect Awareness.
This training year saw the introduction of Safe Sleeping and Child Death Process briefings run as
bite size sessions to make attendance easier, in addition to this, new courses were introduced
relating to identifying and working with Children and Young People displaying harmful sexualised
behaviour. The Neglect training package was also further extended to provide practice
enhancement workshops around using the neglect tool, the voice of the child in assessing neglect
and for supervisors and managers.
The LSCB Board signed off the Learning and Improvement Framework and an action plan is now
finalised to drive forward all Learning and Improvement Activity, this is fed into by all Sub Group
Chairs capturing all learning activity across the Sub Groups. The LSCB Learning and Development
Strategy has been approved and is due to be published on the LSCB website the strategy sets out
how the LSCB will ensure safeguarding training/learning activities are based on local need, meet
the needs of practitioners, in being able to recognise and respond to need and risk.
43
Page 147
The new evaluation process has been implemented in 2014/15 with new forms assessing
delegates distance travelled from the beginning to end of the course in knowledge and confidence
(all courses) and 3-6 month follow up to measure impact on practice on LSCB priority
courses/events. The average distance travelled on all courses in both delegate knowledge and
confidence, is movement of three points up the scale (1-10) and over all courses the average
knowledge and confidence score at the end of the course was 8 out of 10. Feedback on the
following courses delivered over the year was;
•
•
•
•
•
Child Sexual Exploitation - 88% found the training excellent, 12% good.
Level 2 Neglect - 69% found the training excellent and 31 % good.
The Voice of the Child in Assessing Neglect: Practice Enhancement Workshop - 63% found the
workshop excellent, 33% good and 4% average.
Level 3 Neglect - 67% felt the workshop was excellent and 33% good.
Working with Resistant Families Training - 99% found the course excellent, 1 % good.
Next Steps
•
•
•
Bespoke safeguarding training is being developed for Elected Members to attend in 2015; this
is to ensure they are aware of their role and responsibilities in this area.
A further simplified multi-agency training audit is being carried out in 2015 to help inform the
content of the training programme and highlight any development issues, this will have more of
a focus on highlighting practitioners who have not accessed training, understanding why this is
and breaking down barriers to learning.
The Creating Stronger Communities (innovation) programme will embed the Signs of Safety,
Restorative Practice and Outcome Based Accountability approaches in all that
managers/supervisors and practitioners do in relation to their work with children and families. A
programme of learning is being developed using a model that identifies Coaches and Practice
Leads/Champions in each area who will support the embedding of these approaches through
disseminating the learning within their teams as well as to planned multi-agency action learning
groups. The LSCB training programme will need to be reviewed and revised to take account of
the new approaches and to build in ongoing sustainable learning opportunities for the future.
9. MONITORING /QUALITY ASSURANCE ACTIVITY
The Quality Assurance Sub-Group (QA Sub-Group) is a multi-agency group led by the Strategic
Safeguarding Manager with the core function of conducting multi-agency audits and quality
monitoring within LSCB partnerships. Its aim is to provide the LSCB with an overview of
Safeguarding Practice within North East Lincolnshire identifying and monitoring progress and
development in priority areas of provision and practice such as Child Sexual Exploitation, Neglect
and effectiveness of identification and referral processes. Through the audit and performance
monitoring process the QA Group can alert the LSCB to emerging themes, advise and assist with
the forming of action plans and where indicated promote improvements or changes to practice to
achieve better outcomes for children.
During 2014/15 the Quality Assurance Sub-group has focused on reviewing its function and
purpose and developing a schedule of audits to meet local and national drivers. The group has
reviewed its Terms of Reference and membership and undertaken a calendar of planned activity.
The QA Group has linked its activities with the LSCB key priorities for multi-agency audits to inform
an overview of safeguarding practice across NEL and promote practice improvement through
learning from audits.
44
Page 148
Working with the LSCB
The LSCB has endorsed the resourcing, recruitment and appointment to a dedicated Quality
Assurance Coordinator post to facilitate the implementation of the Audit Calendar and build in
flexibility to the audit process to meet emerging need. The QA Co-ordinator post is shared with the
Safeguarding Adult Board and recruitment took place in quarter 4 of 2014/15.
The Sub Group has worked closely with the LSCB Business Manager to build on previous audits
undertaken such as Supervision, Neglect, Education and Section 11 audits. It has produced action
plans and reports for the board following audits and held Challenge Days to enable a multi-agency
approach to analysing audit findings and share experience from a multi-agency perspective.
The group has also identified the need to improve methods and consistency across partner
agencies in how we evaluate the effectiveness of our audit programmes and develop audit tools
and processes to provide on-going multi agency audit across children’s service provision.
How much have we done?
The QA Group has held monthly meetings since July of 2014 and reported on and coordinated a
number of themed audits into CSE, Referral Thresholds and Neglect.
Its terms of reference have been revised and a robust structure put in place that specify function of
the group and its key priorities.
The group completed an in depth CSE audit and held a CSE Challenge Day that resulted in a
comprehensive action plan being overseen via the NEL lead for CSE.
The group has developed an interagency audit tool aligned to Ofsted criteria and this has been
trialled for use in audits into 2015/16. The group has also followed up the findings and outcome
from a previous Neglect Audit to inform a revised audit for 2015/16. The group also conducted a
supervision audit that again led to the need to revise the Audit Tool for Supervision to be more
applicable to all partners.
How well have we done it?
Throughout 2014/15 the group has had consistent representation from key partners and
attendance is good but has seen the impact of the restructure of policing in Humberside placing
capacity issues on consistent police representation and attendance.
The revised Terms of Reference was agreed by the group and has been endorsed by LSCB and
the Audit Process Pathway developed by the QA Co-ordinator has been implemented to ensure
timeframes for audits are adhered to.
An audit programme including Neglect and Threshold was completed during quarter 4 of 2014/15
for implementation during early May and June 2015. S11 Audit processes have been progressed
and provided assurance at board level that standards are on the whole being met by all partners.
NEL LSCB now has a robust multi-agency audit group and process in place that is shared and
owned amongst key partners. Going forward to 2015/16 the QA Group has a clear plan for themed
audits and is able to adjust its tools and methods to meet emerging needs.
The QA Group links with the Performance monitoring for all Sub-Group activity and produces an
overarching performance summary for the LSCB on a quarterly basis.
The findings from the CSE Challenge Day held January 2015 were received by the Leadership
Board and have impacted on changes to the overall CSE strategy. Multi agency analysis sessions
have been held to develop accurate overview of CSE in NEL. CSE Audit Action Plan is now in
place and managed by CSE Operational Board via the designated Sub Group. Progress will be
reported on through the QA Score Card. Progress against the CSE Strategic Action Plan reported
to April Leadership Board.
45
Page 149
Positive agency feedback was received regarding the evidence of joint working and awareness
was raised regarding the prevailing difficulties with victim engagement and key worker
relationships as a priority. All agencies are aware of CSE guidance & referral pathway and the
previous risk/screening tool was shown to be insufficient for risk, need & planning and as a result
has been revised and a more effective risk tool is being implemented to address gaps.
Audits for Thresholds and Neglect were scoped during 2014/15 and have since been implemented
in the 2015/16 audit calendar.
The S11 audit completed during 14/15 enabled a S11 Challenge Event to be held and assurances
re compliance reported to the April 2015 board.
The QA overview of the Supervision audit has been used to inform the need for and development
of a more applicable multi-agency partnership tool to evaluate supervision for 2015/16.
Areas of Challenge and Next Steps:
Partnership working - For the QA Group to effectively capture and evidence the practice from all
partners and to link with the adult audit process and partners in the adults and voluntary sector,
ensuring that all involved agencies are included within audits through the development and
maintenance of a mailing list for all agencies. Partners will be invited - following completion of
audits - to comment and advise on effectiveness, barriers and ease of use of process,
methodology and audit tools to inform development and to improve future audit effectiveness.
Child’s Voice and User Views - For the QA Group to ensure its audit programme is effective in
capturing and evidencing the impact of the child’s voice and influence and the engagement of
parents and carers in service provision.
Consultation Tools for gaining the views of Children and Young People are being reviewed and
developed. All QA partners have begun identifying processes in place to capture the child’s voice
and the QA Sub Group is coordinating activity to develop a pro-forma based on the 2015 Working
Together for agencies to consider in relation to how each addresses the issue of what children say
they want from safeguarding services and their overall welfare. To establish what parents and
carers say about services and interventions – their views will be incorporated into audits and
themed tools will be more closely aligned to the OFSTED audit format with a view to consistent
user views evaluation tools across the authority.
Future audits Themes will continue to focus on priorities and during 2015/16 include:
Thresholds
Neglect and Emotional Abuse
Decision Making at Conference
Domestic Abuse
Child Sexual Harmful Behaviour
Supervision
Unborn Planning/Interventions
Children Placed Out Of Area and Children Missing (from Home or Care)
Teenage Cusp of Care
Children involved in Youth Justice
10. AUDITS OF PARTNER AGENCIES
In 2014/15 we introduced a more sophisticated approach to Section 11 activity which included a
challenge event at which respondents to the audit engaged in dialogue with members of the
leadership Board and young people and co-produced action plans for development.
46
Page 150
The LSCB undertook a Section 11 Audit in January 2104. Organisations met the majority of
standards, where standards were recorded as not being met they were actually partially met but
further development had been identified. The quality of the audits was good on the whole, with a
small number of gaps in information such as completion dates. A number of organisations
provided more evidence to the Section 11 challenge panel that within their audit which identified
the need to provide examples within evidence given.
There were no areas of significant concern. A general area of development for all organisations
was the level to which they could evidence that service development was informed by the views of
children and families. Young people were actively involved in the Section 11 process. Questions
were developed and asked by the young people who asked “What is your organisation going to do
to improve how you listen to and involve young people in future. Organisational leads found this
element challenging and thought provoking.
A further challenge day was held 6 months after the initial challenge day in order to analyse the
progress made by organisations. Progress made by organisations included strengthening
processes such as recording, information sharing and ensuring practitioners are appropriately
trained in safeguarding. There has been particular progress in how organisations have sought to
ensure service provision is informed by the experiences of Children and Young People.
11. LEARNING FROM CHILD DEATH OVERVIEW PANEL/SERIOUS CASE REVIEWS
11.1 Child Death Overview Panel
The Child Death Overview Panel (CDOP) reviewed 7 child deaths in 2014-15, which is 1 less than
the previous year. This brings the number of child deaths since 2008 when the current CDOP
process started to 85. Of these there are 3 (from 2015) that are still under investigation and as
such the cause of death is not yet been categorised, additionally 27 deaths occurred before this
categorisation was introduced. Therefore since 2010 for these 56 children the top three categories
were:
1.
2.
3.
Perinatal/neonatal (which includes prematurity, some types of cerebral palsy, bacterial
infections and antepartum and intrapartum anoxia).
Chronic medical condition (which includes other types of cerebral palsy, liver
disease, immune deficiencies).
Chromosomal, genetic and congenital anomalies (which includes Trisomies, other
chromosomal disorders single gene defects, neurodegenerative disease, cystic fibrosis
and other congenital anomalies including cardiac).
What have we done?
Child deaths fall into two categories - expected and unexpected, the latter defined as ‘the death of
an infant or child which was not anticipated’. Since the 2008, 45 (57.7%) cases were classed as
unexpected.
Child deaths are also classed as whether there were any modifiable factors. Since 2008 13% (11)
of deaths were categorised as having modifiable factors identified. Of the deaths with modifiable
factors nearly half (4) were relating to inappropriate sleeping conditions.
These are small numbers so there is a challenge on identifying trends. However we seek to identify
any learning which is a key function of CDOPs therefore we have:
• updated our annual professional and public facing report - the public report is on the LSCB
website, the professional one contains detailed information so has restricted circulation.
47
Page 151
•
•
•
•
•
tasked all CDOP members to take back the information and learning to their organisations and
professional groups to inform and change practice where necessary.
worked with the learning and development subgroup to put on briefing sessions for
professionals working with children, young people and families to update them on the child
death process.
Worked with the lullaby trust http://www.lullabytrust.org.uk/ a national charity to offer briefings
on the safe sleeping messages. This complements the local safe sleeping guidance that was
updated recently for North and North East Lincolnshire.
worked to support a (successful) bid to NSPCC to be a pilot site for ‘Coping with Crying’
research.
identified a gap on ongoing bereavement support to parents, siblings and the wider family
which has been highlighted and discussed with commissioners.
•
•
•
•
To review the child death process practice briefings.
To continue to implement the learning from all child deaths.
To complete the CDOP Annual report from 2014/15.
To explore further collaborative working with geographical neighbours
11.2 Serious Case Review Process
What have we done?
Two SCRs have been signed off by the LSCB Leadership Board within the timescales of the
Annual Report. One at the beginning of the period and one at the end.
The first SCR was undertaken using the SCIE methodology, this was the first time it had been
used by us and we found the methodology challenging.
The second report used a hybrid methodology and colleagues reported that this was more
appreciated by those involved.
A significant amount of training has been undertaken both on a single agency and multi-agency
basis to address the issues raised in those SCRs.
The Sub Group has backed the key actions to ensure completed and followed up with further
focussed seminars (see next section for more details).
The SCR Sub Group set up a series of practice seminars for Multi-Agency professionals to ensure
as many staff as possible had the opportunity to cascade the learning from our serious case
reviews. This was to compliment the normal routes of team meetings, supervision, training and
newsletters.
The seminars also dovetailed in the Signs of Safety methodology so as to reinforce this learning
approach to all staff. The seminars focussed on the ‘Just Don’t Do Nothing’ approach, and went
through case examples and key learning from the SCRs.
Feedback from staff who attended was very positive and there was significant interest (220
attended).
The evidence of difference made remains a challenge. We have individual feedback about raised
awareness and greater confidence in responding to the issues raised.
Some elements will be picked up in future Audits and training has been developed which has also
highlighted positive feedback from attendees.
There is undoubtedly more work to be done in this area and we cannot assume that the absence of
similar cases means we have succeeded.
48
Page 152
•
•
•
SCR Seminars will be re-run later in the year to reinforce the key messages and multi-agency
learning.
The Sub Group is looking to develop a newsletter to highlight local and national learning from
serious case reviews.
Further investigation/discussion is to take place on evidencing the impact of the seminars.
12. ENGAGEMENT WITH CHILDREN AND YOUNG PEOPLE
What have we done?
The LSCB have developed a number of mechanisms in capturing the child, young person’s voice
and in demonstrating their influence.
•
•
•
•
•
•
•
•
•
•
•
•
The young advisors are actively involved in the appointment of lay members and LSCB Chair.
The “Youth Voice” are reviewing the content of the Children/ Young Persons section of the
dedicated LSCB website in ensuring it is user friendly, accessible and approximately geared
towards young people.
“Youth Action” are undertaking work with the LSCB chair around what 'safe' means to a young
person in North East Lincolnshire.
Young people’s safety is a regular agenda item on the joint meeting held quarterly between
Young Peoples voice groups and senior managers and councillors.
The Voice of the Child is a key element of the LSCB inter agency audits.
Families are actively involved in informing the learning from Significant Incident Learning
Reviews and Serious Case Reviews (SCRs).
The roll out of View Point locally provides another medium for capturing views of Children and
Young People.
The Young Reporters have reported on number issues affecting them in promoting positive
images of young people.
The LSCB Quality Assurance Sub Group are reviewing and further developing tools for gaining
the views of Children and Young People. The views of parents and carers will be incorporated
into audits.
The “Youth Voice” were involved in the LSCB Section 11 Challenge event in January 2015.
The young people involved in “Youth Action” undertook LSCB safeguarding children training in
supporting them in their work.
Models and tools for the effective communication, engagement and participation of Children
and Young People involved with or at risk of Child Sexual Exploitation are presently being
developed.
•
•
•
•
•
The views of family and young people involved in SCRs has informed practice through the
dissemination of learning through practice forums.
The young advisors actively influenced the appointment of the two LSCB lay members and the
previous and present LSCB chairs.
The voice of the child is being placed at the centre of all LSCB activity, and is the focus of the
work of the LSCB sub groups.
6 focus groups have been held with parents located in Children’s Centre’s where their views on
what neglect is has been captured and noted to be entirely attuned with professional
understanding of neglect. Feedback from parents has suggested that the posters/information
need to be displayed in more general settings (e.g. Fast Food Outlets, Supermarkets, Taxi
Offices, Sports and Social Clubs) in addition to family-focused settings (e.g. Children’s
Centre’s, libraries). We are following through these suggestions within phase two of the public
awareness campaign.
Young People are involved in recruitment processes.
49
Page 153
•
•
The Children and Young Person’s Plan has been jointly developed by Young People for Young
People.
The involvement of young people in the Section 11 Audit actively challenged organisations on
how service delivery was informed by children’s involvement.
•
•
•
To evidence and facilitate the influence of Children, Young People and Families make in
informing safeguarding practice and service development.
To capture the Child’s voice through the sub group audits and development of tools.
To ensure that all partnership activity and service provision incorporates an element of the
voice and impact of Children and Families Views.
13. COMMUNICATIONS
What have we done?
The LSCB are developing a Communication Strategy targeted at the following groups of people:
•
•
•
•
Children and Young People resident in, visiting, or accessing services/support from NELSCB
partner agencies.
Parents and carers resident in, visiting, or accessing services/support from NELSCB partner
agencies.
Professionals and volunteers in NELs children’s workforce.
The media.
Communication methods
Website - Contains all Board published information and information for Parents, Children and
Young People and those involved in supporting Young People. Provides information about all
NELSCB Multi-Agency training courses.
Newsletters - Quarterly newsletters provide up to date information about board activities; new
publications and any external information concerning the broader aspects of safeguarding children.
Newsletters seek to keep frontline professionals up to date with best practice using information
from local and national Serious Case Reviews and serious incident reviews and Thematic Case
Audits.
Publications
The Board publishes a range of guidance intended to provide additional tools for frontline workers,
most Board publications are available on the website and will be promoted in the newsletter.
Information leaflets for parents are published and available on the website. All Serious Case
Reviews are published on the Board website. This is subject to the conclusion of any court
proceedings.
Board Events
A themed annual LSCB Conference provides an opportunity to look at safeguarding issues in
depth and for staff from across the County to attend and take part.
There are established Youth Groups and Young People’s Forums which provides opportunities for
the Chair of NELSCB, Director Children Social Care and Chair of the Young and Safe Sub Group
to share and discuss information regarding young people’s agenda and ‘What Matters’. The
attendance by key strategic managers provides a meaningful link between the Board, Young
People and Partners.
50
Page 154
Minutes of Meetings
Minutes will be taken of all Board and Sub Group Meetings. Board members have a responsibility
to cascade all relevant information to staff within their agencies. Information that requires to be
more broadly disseminated will be published in the NELSCB Newsletter.
Media Releases
This may include serious safeguarding incidents which have generated press interest. Planned
media releases will be issued to raise awareness of safeguarding within the community.
The NELSCB Communication Strategy will be complete by October 2015.
14. CONCLUSION, CHALLENGES AND RECOMMENDATIONS
The range of challenges we have faced and continue to face in our commitment to continuous
improvement is significant (as would be true of most LSCBs). This report describes progress
against many of these, and also describes a wide range of areas for development, summarised in
the Executive Summary. These will ALL be addressed, but can be captured in the following two
over-arching challenges for 2015/16.
•
•
Demonstrating the impact of Early Help (particularly in relation to Neglect) on making North
East Lincolnshire a safer place for Children and Young People.
Continuing to ‘line up the system’ - linking what we do across a range of strategic partners and
where appropriate across boundaries and in so doing, secure greater effectiveness and
efficiency. This was a challenge identified in the previous Annual Report and is strategic and
long term
More specifically, and drawing from the areas for development identified in the Executive Summary
we will:
• Fully implement the Early Help and Neglect strategies.
• Reduce the numbers of children on Child Protection Plans through more effective early help
activity.
• Address neglect through Early Intervention activity supported by the four elements of the
Creating Stronger Communities Model and reduce the proportion of Child Protection cases with
Neglect as the main reason for referral.
• Give particular attention to collaborative safeguarding activity across geographical boundaries.
• Embed collaborative working with partners where there has been, or will be significant change
(Police/Probation/CRC/School Improvement).
• Embed the use of Score Cards and the Core Data Set as a means of individually and
collectively understanding our business and performance.
• Continue to address Child Sexual Exploitation through collaborative working and a focus on
prevention, perpetrators and victims.
• Embed a ‘One System’ approach to Domestic Abuse.
• Embed performance reporting and quality assurance processes.
• Further improve systems and processes to capture the Voice of the Child in order to inform the
development of better services.
• Explore the development of a CDOP across the boundaries of North East Lincolnshire and
North Lincolnshire.
There is tremendous drive and energy in North East Lincolnshire and exceptionally strong
partnerships. This, plus a clear view of what we need to do to improve and a clear and focussed
approach to addressing these challenges provide the foundations for more effective services in an
environment where Children and Young People are safe and can thrive.
51
Page 155
Appendix
1
LSCB Structure
NEL Safeguarding
Children's
Leadership Board
Operational Board
Serious
Case
Review
Keeping
Children
Safe
Group
- Missing
- CSE
- HSB
- Domestic
Abuse
Safeguarding
Education
Safeguarding
Health
Neglect
Child
Death
Overview
Panel
Quality
Assurance
&
Performace
Learning
&
Development
52
Page 156
Appendix 2
The annual income and expenditure of the board (financial year 2014/15)
CORE INCOME
Made up of contributions from
Humberside Police
CAFCASS
NEL Council
£15,000
£33,500
£550
£77,500
ADDITIONAL CONTRIBUTIONS
Additional Contributions were received as follows
Clinical Commissioning Group toward commissioning Triex procedures
Clinical commissioning group towards Serious Case reviews
Humberside Police towards Quality Assurance support role
£15,000
£10,000
£15,000
TOTAL INCOME
£162,550
Staffing
LSCB Board Manager
LSCB Administrator
Staffing Sub total
Running Costs
53
Page 157
Appendix 3
TERMS OF REFERENCE OF SUB GROUPS
The terms of reference for each of the LSCB boards and sub groups were revised during 2014
specifying reporting arrangements via Score Cards aligned to LSCB Core Data Set and LSCB
priorities.
Leadership Board - Aims
The LSCB is the key statutory mechanism for agreeing how the relevant organisations in each
local area will cooperate to safeguard and promote the welfare of children in that locality, and for
ensuring the effectiveness of what they do. The LSCB's role is to scrutinise local arrangements
and it should therefore have a separate identity and an independent voice. It should not be
subordinate to, nor subsumed within, other local structures in a way that might compromise it.
Outcomes - Evidence the effectiveness of local arrangements in safeguarding children.
Demonstrate the difference made by the LSCB to safeguarding Children and Young People
through the delivery of the LSCB business plan.
Operational Board - Aims
To scrutinise and support the work of the LSCB subgroups reporting to the Leadership Board on
progress with the business plan; the identification of key safeguarding issues emerging from the
work of the subgroups; overseeing the effectiveness of quality assurance / performance monitoring
arrangements.
Outcomes - Performance indicators / audit mechanisms evidence the impact of safeguarding
arrangements and the quality of practice. The work of the subgroups and Operational Board meets
the identified outcomes within the LSCB business.
The Terms of Reference for each of the 11 sub-groups of the LSCB have been reviewed and
revised. The key aims and objectives of each sub group are outlined below.
Child Death Overview Panel – Aims
To ensure the accurate identification of and uniform, consistent reporting of the cause and manner
of every child death. To make recommendations to individual agencies based on action required to
address any matters of concern affecting the safety and welfare of children in North East
Lincolnshire.
Outcomes - Lessons learned from CDOP activities including modifiable factors identified through
the review process are clearly communicated to all agencies and where appropriate the Public.
Systemic or structural factors affecting children’s well-being are given thorough consideration and
action identified how such deaths might be prevented in the future.
Learning and Development Sub Group - Aims
To evidence the effectiveness and impact of safeguarding children training in informing practice
and improving outcomes for children; to communicate key safeguarding messages, research,
lessons and procedural expectations to agencies, professionals, in ensuring a consistent approach
to safeguarding children and continuous learning.
Outcomes - Safeguarding training improves practice leading to improved outcomes for children.
Professional practice is underpinned by continuous learning in safeguarding children.
Neglect Sub Group - Aims
To reduce the impact and prevalence of neglect in NEL over time, raise awareness at a public and
universal level about the signs, symptoms and impact of neglect for Children and Young People
aged 0-18 years old. To ensure that neglect is identified at an early stage and that it is responded
to consistently, confidently and appropriately at the right threshold of need.
Outcomes - There is a reduction in the prevalence and impact of neglect upon Children and Young
People in North East Lincolnshire.
Quality Assurance Sub Group – Aims
54
Page 158
To ensure a culture of continuous learning and improvement across the organisations that work
together to safeguard and promote the welfare of children, identifying opportunities to draw on
what works and promote good practice.
Outcomes - There is a coherent and sustainable Quality Assurance and Performance Framework
which is aligned to and informed by the NELSCB Strategic Priorities. All agencies contribute to and
are committed to continuous learning and improvement within their respective agencies and
collectively.
Safeguarding in Education Sub Group - Aims
To provide assurance to the Leadership Board that the LA, governing bodies of maintained
schools, colleges, academies and all educational settings are meeting their requirements as laid
out in “Keeping Children Safe in Education” published in 2014.
Outcomes – Quality Assurance including audit is undertaken as agreed to assure the effectiveness
of all education establishments safeguarding arrangements. There is regular monitoring and review
of schools, academies, colleges and other educational establishments, of safeguarding policies,
practice and training
Serious Case Review Sub Group - Aims
Organisational lessons are learnt at a strategic level and changes implemented in informing
practice and to prevent future incidents of serious child abuse or death.
Outcomes - To provide assurance to the LSCB, OFSTED, SHA, HWBB that recommendations
arising from Serious Case Reviews have been actioned and learning from lessons have been
clearly communicated and disseminated to all partner agencies and frontline staff.
Safeguarding in Health Sub Group - Aims
To advise on the ‘working together’ arrangements including commissioners of health services in
North East Lincolnshire and commissioners of non-NHS services, to ensure there are effective,
robust and collaborative safeguarding arrangements across the health economy, and across
organisational and locality boundaries. These meetings will be spilt into two parts – Part A will be a
clinically led meeting to discuss safeguarding issues and service issues / gaps that cut across the
health economy, Part B will include commissioners and Strategic Leads where relevant issues
from Part A will be discussed and if appropriate taken forward as a task and finish group.
Outcomes - Establishing effective relationships between and across health commissioners and
providers to ensure that children’s safeguarding arrangements are embedded. This will promote
consistent safeguarding children practice across all health organisations and services and a
coherence of commissioning arrangements with an alignment of safeguarding standards in
contracts.
Keeping Children Safe
The four following sub-groups previously came within the Young and Safe Sub Group. All four
areas will now sit as separate sub groups and will report directly to the Operational Board.
Missing - Aims
To monitor the prevalence, and responses to children missing from home, care and education.
Outcomes - NELSCB has a system to monitor the prevalence of and the responses to children who
go missing, including gathering data from NELSCB members and other stakeholders in order to
understand trends and patterns. There are effective arrangements in place across the partnership
for reporting, referring and responding to concerns about children who are missing.
Child Sexual Exploitation - Aims
Develop a NELSCB Partnership strategy to combat Child Sexual Exploitation which takes account
of learning from serious case reviews and good practice from other local authorities.
Outcomes - To reduce the likelihood of Children and Young People being sexually exploited and
also to protect those who are involved by disrupting and bringing to account those who commit this
form of child abuse.
Harmful Sexual Behaviour - Aims
55
Page 159
To ensure that NELSCB is taking a consistent approach to the identification, assessment and
intervention to those Children and Young People who are displaying problematic and Harmful
Sexualised Behaviour. To ensure all Children and Young People who display HSB received a
timely evidenced based assessments and intervention.
Outcomes - The Strategy and Operation plan is embedded across children’s services. Children
and Young People who display HSB are assessed and appropriate services are provided which
reduces the risk to themselves and others.
Domestic Abuse - Aims
NELSCB is visible and influential through effective arrangements with other multi-agency
partnerships working to reduce the incidents and impact of children suffering or living in
households and families where domestic abuse is present. To ensure there is a co-ordinated timely
response to Children and Young People who are suffering or living in households where domestic
abuse is present.
Outcomes - There is effective recognition, response and services for Children and Young People
who are either victims of domestic abuse or living in households where domestic abuse is present.
Early identification of and intervention for children, young people and families across NEL
partnerships and agencies.
56
Page 160

Full Agenda 18.04.16 - North East Lincolnshire Council

Transcription

Similar documents

call of cthulhu

Zalinski Op Brief

Cardiovascular Disease Prevention and its impact across the system

Cancer Care Review - East Midlands Clinical Senate

Achieving vertical and horizontal integration: working with partners

health newsletter - NHS Ashford Clinical Commissioning Group

Information for Emergency Weekend Appointments Dental Access

precedo news - Precedo Healthcare

Step into Spring - Dorset HealthCare