GOVERNING BODY MEETING Wednesday 4 November 2015 at 1 … · 5. Life Expectancy Mr Dominic Harrison Presentation PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6. 6.1 6.2 Minutes of the

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CLINICAL COMMISSIONING GROUP (CCG)

GOVERNING BODY MEETING

Wednesday 4th November 2015 at 1 pm Meeting Rooms 1 and 2, Blackburn Central Library

Town Hall Street, Blackburn BB2 1AG

A G E N D A

Item No: Agenda Item Member Responsible

Report

PUBLIC PARTICIPATION 1. Chair’s Welcome

Mr Graham Burgess

2. Apologies for Absence and Confirmation of Quoracy

Mr Graham Burgess

3. Declarations of Interest relating to items on the agenda

Mr Graham Burgess

4. Questions from Members of the Public

Mr Graham Burgess

5. Life Expectancy Mr Dominic Harrison Presentation

PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6.

6.1

6.2

Minutes of the Meeting Held on 2nd September 2015 Extract from Part 2 of the Minutes of the Meeting held on 2nd September 2015 Minutes of the Annual General Meeting Held on 28th September 2015

Mr Graham Burgess Attached Attached

Attached

7. 7.1

Matters Arising Action Matrix

Mr Graham Burgess Attached

8. Clinical Chief Officer’s Report Dr Chris Clayton

Attached

9.

Chief Finance Officer’s Report

Mr Roger Parr Attached

10. Contract Performance Report


11. Quality, Performance and Effectiveness Report Dr Malcolm Ridgway Attached

12. Governing Body Assurance Framework Update


13. Annual Assurance 2014–15

Mr Iain Fletcher Attached

FOR INFORMATION 14. Communication and Engagement Update Mr Iain Fletcher Attached

15. Organisational Development Plan Update Mr Iain Fletcher Attached

16. Care Quality Commission Report – Lancashire Care NHS Foundation Trust

Dr Malcolm Ridgway/ Mrs Kim Smith

To Follow

Questions from members of the public will be received under Item 4; if submitted in advance in line with the protocol on the CCG’s website: http://www.blackburnwithdarwenccg.nhs.uk/about-us/governing-body-meetings/

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17. Quality Annual Report 2014-15

Dr Nigel Horsfield/ Dr Malcolm Ridgway

Attached

18. Any Other Business

All

19. Date and Time of Next Meeting: Wednesday 13th January 2016 in Meeting Rooms 1 and 2, Blackburn Central Library, Town Hall Street, Blackburn BB2 1AG

Mr Graham Burgess

EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960)

PART 2 (APPROXIMATELY 2.15 PM) A/15 Minutes of Part 2 of the meeting held on 2nd

September 2015 Mr Graham Burgess Attached

B/15 B/15.1

Matters Arising Action Matrix

Mr Graham Burgess Attached

C/15

Healthier Lancashire Dr Chris Clayton Attached

D/15 Reportable Events

Dr Malcolm Ridgway Attached

E/15

Complex Cases and Continuing Healthcare Mr Iain Fletcher

Attached

F/15

Lead Provider Framework Dr Chris Clayton Attached

G/15

Patient Transport Services Procurement Mrs Debbie Nixon Attached

H/15 Any Other Business

All

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Item Item 6

CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Governing Body Meeting held on

Wednesday 2nd September 2015 in Rooms 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn, BB2 1AG PRESENT: Dr Penny Morris Executive Member and Vice Chair (Chair) Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Mrs Debbie Nixon Chief Operating Officer Mr Paul Hinnigan Lay Member - Governance Dr Adam Black Executive Member Dr Tom Phillips Executive Member Mrs Anne Asher Lay Member - Nurse Representative Dr Nigel Horsfield Lay Member - Secondary Care Doctor (Retired) Dr Zaki Patel Executive Member Dr John Randall Executive Member Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council IN ATTENDANCE: Mrs Kim Smith Head of Quality (Item 11) Mrs Hannah Sellers CCG Development Officer (Minutes) Min No: 15.077 Chair’s Welcome

The Chair opened the meeting by welcoming all attendees and members of the public. She introduced herself as Vice Chair of the CCG and gave a short briefing with regard to meeting protocol and housekeeping.

15.078 Apologies for Absence and Confirmation of Quoracy Apologies for absence had been received in respect of: Dr Malcolm Ridgway, Clinical Director for Primary Care and Quality Mr Iain Fletcher, Head of Corporate Business The meeting was confirmed as quorate.

15.079 Declarations of Interest Relating to Items on the Agenda No declarations of interest were made with regards to items on the agenda; however the Chair reminded those present that if during the course of discussion, a conflict of interest became apparent, it should be declared at that point.

15.080

Questions from Members of the Public The Chair advised those present of the CCG’s protocol for questions from members of the public, highlighting the requirement for questions to be submitted by 5pm on the Monday previous to the meeting, allowing the CCG sufficient time to fully research the response. The Chair also reminded those present that questions relating to individual agenda items are not taken during the course of the meeting.

Subject to approval at the next meeting

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Q

A

I understand that the Mental Health wards in Blackburn with Darwen are nearly always full meaning that patients need to travel further or go private. Sometimes patients are not accepted to the private hospitals due to aggression or other reasons. What is the CCG doing to address this? Dr John Randall declared an interest in the subject of the question being asked, as a Medical Officer at The Priory Hospital in Preston which provides mental health inpatient beds. Mrs Debbie Nixon: Blackburn with Darwen CCG manages the inpatient beds as a network across Lancashire. Lancashire Care Foundation Trust (LCFT) will endeavour to place a patient as close to home as possible and repatriate patients as quickly as possible into their local services. We have experienced significant demand in line with the national position and have a number of patients who are outside of the Lancashire area. We are working closely with the Trust to manage this situation and have weekly teleconference meetings to ensure that patients are moved to the most appropriate place in the system. We have put a number of initiatives in to place, including Street Triage and we will be commissioning a number of clinical decision making units over the next few months to alleviate pressures in A&E and allow a therapeutic assessment period for patients to explore alternatives to admission. There was some further discussion around capacity in Mental Health wards where Mrs Nixon confirmed that trends are continuously analysed in order to further understand the requirement for mental health beds and determine future modelling.

15.081 Commissioning Intentions Presentation Mrs Debbie Nixon presented to the Governing Body around the CCG’s Commissioning Intentions for 2016/17, highlighting that the CCG are now in year 2 of the 5 year strategy and the Commissioning Intentions are consistent with the strategy. Work is currently underway to commence with the new intentions in April 2016. Mrs Nixon described the key priorities which include:

• Transforming the urgent care system • Delivering high quality scheduled care services, delivering integration through the Better

Care Fund (BCF) • Supporting 7 day access to services as appropriate • Delivering Parity of Esteem • Supporting the co-commissioning of Primary Care.

Mrs Nixon explained that all Commissioning Intentions will be aligned to the principles of Quality, Improvement, Productivity and Prevention (QIPP) and also the emerging Pennine Lancashire Case for Change. Mrs Nixon outlined the next steps, sighting engagement with clinicians, CCG members, providers and the public and the proposed issue date to providers for the Commissioning Intentions which is 30th September 2015. Questions and answers followed. The Chair thanked Mrs Nixon for the presentation. ACTION: It was agreed that Chair’s action could be taken with regards to issuing the letters to providers on 30th September following discussion at the Commissioning Business Group. Mrs Nixon agreed that detailed outcomes of the discussions would be brought to the next Governing Body Discussion and Development meeting on 7th October. RESOLVED: That the Governing Body (GB) noted the content of the presentation.

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15.082 Minutes of the Meeting held on 1st July 2015 The minutes of the meeting were accepted as a true and accurate record. RESOLVED: That the Minutes of the Meeting held on 1st July 2015 were approved as a correct record. Extract of Part 2 of the Minutes of the Meeting held on 1st July 2015 The extract of Part 2 of the minutes of the meeting was accepted as an accurate record. RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 1st July 2015 was approved as a correct record.

15.083 Matters Arising/Action Matrix The Action Matrix was reviewed. Minute 15.073 Workforce Race Equality Standards Mrs Debbie Nixon confirmed that she had agreed to be the Workforce Race Equality Standards (WRES) representative for the Executive Team of the CCG.

15.084 Clinical Chief Officer’s Report Dr Chris Clayton presented his report and highlighted key items of national and local interest. Items of note related to:

• Key appointments including the re-appointment of Sir Malcolm Grant as Chair of NHS England and Ed Smith as the joint Chair of Monitor and Chair-Designate of the Trust Development Authority (TDA).

• Changes to the NHS Constitution which aim to close the gap between physical and mental health and also increased recognition of armed forces, particularly veterans.

• Initiatives from Healthwatch England focusing on discharge processes and the effect on vulnerable patients.

• The recently published Annual Report from Blackburn with Darwen Healthwatch which outlines the key achievements over the previous year; Dr Clayton urged Governing Body members and members of the public to view the report online if they are able.

• The Alignment of Plans initiative currently being undertaken by Healthier Lancashire; the process seeks to bring together plans across Lancashire to gain a greater understanding of the commonalities and financial challenges of the Lancashire Health economy.

• The CCG assurance process and the 20 areas that the CCG will be assured against to ensure its effectiveness.

• New appointments within the CCG; Dr Pervez Muzaffar, Clinical Lead for Engagement, Dr Dinesh Mathur, Clinical Lead for Children and Young People and Caroline Edwards, End of Life Nurse Lead.

Questions and answers followed. RESOLVED: That the Governing Body (GB) noted the content of the report.

15.085 Chief Finance Officer’s Report Mr Roger Parr presented the Financial Summary, which provided details of the CCG’s overall position at the end of month 4.

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Mr Parr highlighted the year to date surplus of £728k, which is in line with the 2015/16 plan to deliver an end of year surplus of £2.1million. Mr Parr raised the current pressures being experienced in all aspects of acute care and the continued increase in referrals into the acute setting. Prescribing is reporting a year to date underspend of £44k, however this is based on only 2 months of data and more robust data will be available as the year progresses. Mr Parr confirmed that the CCG is currently operating within running costs. Mr Parr reported the risks as activity levels in secondary care; this is being monitored closely in line with QIPP delivery. Mr Parr clarified that IT capital expenditure of £148k has been allocated and this will be utilised to replenish the infrastructure within Primary Care. Questions and answers followed. ACTION: It was agreed that the report for the next GB Meeting would include a more detailed report on the remedial actions. RESOLVED: That the GB noted the content of the report and the overall position of the CCG at the end of July 2015; noting the risks and detailed appendices supporting the narrative.

15.086 Contract Performance Report Mr Roger Parr presented the Contract Performance Report, which gave the GB an update on the activity performance of the major commissioned services of the CCG as at the end of month 3. Mr Parr drew members’ attention to the key elements of the report as follows:

• There had been a slight increase in Mental Health activity which is being closely monitored (page 2).

• There had been a subtle increase in referrals to secondary care from last year (page 3 & 4).

• Acute contract performance (East Lancashire Hospital Trust (ELHT)) had experienced an increase in activity across all areas, including non-elective (page 4).

• The ELHT waiting lists for inpatients and day cases had decreased with 11 patients waiting over 36 weeks and none over 52 weeks (page 5 & 6).

• Work is ongoing with Lancashire Care Foundation Trust (LCFT) to improve the quality of the community data and it is anticipated that there will be some robust data to share with the GB over the coming months.

Questions and answers followed. RESOLVED: That the GB noted the content of the report and the detailed appendices supporting the narrative.

15.087 Quality and Performance Exception Report Mrs Kim Smith, Head of Quality presented the Quality and Performance Exception Report for month 3 on behalf of Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness. Mrs Smith reminded members that the report was an exception report and highlighted the key areas as follows:

• The notional target of 1.25% for Improving Access to Psychological Therapies (IAPT)

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was not achieved with Lancashire Care Foundation Trust (LCFT) performance at 0.99%, however it is anticipated that this is set to improve in the coming months as the system becomes more established (page 2).

• The Care Programme Approach 7 day follow up has exceeded the target of 95%, with LCFT performance at 97.5% for June 2015 (page 3).

• The Memory Assessment Service (MAS) continues to meet the 70% target, with LCFT achieving 76.79% in June 2015. The only CCG area not to achieve the target was Blackpool who achieved 60.87% (page 3).

• Safe staffing and skill mix is being closely looked at by CCG and LCFT to ensure effective working and a more detailed report on this will follow in subsequent months (page 3).

• The East Lancashire Hospital Trust (ELHT) Accident and Emergency 4 hour target must achieve a 96.08% performance level until year end in order to achieve the 95% target (page 3). Current performance on the day of the meeting is at 98%.

• The performance relating to Ambulance Handover has improved since financial implications have been introduced (page 3).

• Early indications suggest that the Stroke 4 Hour Target has not been achieved and a request for assurance has been submitted to ELHT. A recovery plan has not yet been received and the request has been escalated (page 3).

• All Red emergency targets were met in June 2015, which is a significant improvement on last year; performance is being continuously monitored (page 4).

• The CCG NHS Constitution report highlighted only two red areas, Cancer and 4 hour Accident and Emergency Waits, which have both been affected by only one patient (page 5).

Questions and answers followed. RESOLVED: That the GB noted the content of the report.

15.088 Governing Body Assurance Framework Mr Roger Parr presented the report, highlighting the highest rated strategic risk as GP Workforce Capacity. Mr Parr asked members to review the request in item 4.2 of the report, which proposes that the strategic risk around the responsibility for co-commissioning Primary Care is reduced, following the establishment of the Primary Care Co-commissioning Committee. Questions and answers followed. RESOLVED: That the GB noted the content of the report and approved the reduction in risk relating the commissioning of Primary Care.

15.089 Financial Control Environment Assessment Mr Roger Parr presented the Blackburn with Darwen CCG’s Financial Control Environment Assessment for information purposes and assured members that the report had been reviewed in detail by the CCG’s Audit Committee. Mr Parr explained that the report provides assurance for the GB and NHS England around the management and assessment of financial governance. The report has also been reviewed by the internal auditors. RESOLVED: That the GB noted the content of the report.

15.090 Lead Provider Framework – Proposal for Lancashire Clinical Commissioning Groups This item was deferred to October’s GB Discussion and Development Meeting as there had

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been significant changes at a Lancashire level since the paper was submitted to the GB.

15.091 Clinical Commissioning Group Chair Dr Chris Clayton advised members that the process surrounding the appointment of a new Chair is ongoing and being carried out in line with the CCG’s Constitution. Dr Clayton reported that the process thus far had been successful and rewarding in relation to the field of applicants. Dr Clayton advised that the recruitment of the Chair would be further discussed during Part 2 of the meeting, with the aim of the CCG being in a position to make an announcement regarding the recruitment process shortly.

15.092 Care.data Mr Roger Parr provided a verbal update regarding the ongoing Care.data process. Mr Parr confirmed that practices are currently close to completing their readiness templates. Mr Parr explained that the purpose of the pathfinder process is to find and address issues that are raised across the pathfinder CCGs. Mr Parr reported that the stakeholder letters had not yet been sent and are due to be sent during Autumn; however engagement with stakeholders is ongoing. Mr Parr assured members that all work would be carried out in conjunction with the other pathfinder CCGs. RESOLVED: That the GB noted the content of the update.

15.093 Any Other Business Annual Audit Letter from Grant Thornton Mr Paul Hinnigan confirmed that the letter has been reviewed by the Audit Committee and is consistent with all previous reports to the GB. RESOLVED: That the GB noted the content of the Annual Audit Letter as the final formal letter of the financial year.

15.094 Date and Time of Next Meeting The next meeting will be held on 4th November at 1pm in Meeting Rooms 1 & 2 Blackburn Central Library, Town Hall St, Blackburn, BB2 1AG. The Chair thanked everyone for their attendance and input and the meeting closed.

EXCLUSION OF THE PRESS AND PUBLIC – ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section1(2)Public Bodies(Admission to Meetings)Act 1960).

Signed ………………………………………………. Chair ……………………………………………… Date

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Item 6.1


Extract from the Minutes of Part 2 of the Governing Body Meeting held on

Wednesday 2nd September 2015 at 3.15pm in the Rooms 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn, BB2 1AG

PRESENT: Dr Penny Morris Executive Member and Vice Chair (Chair) Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Mrs Debbie Nixon Chief Operating Officer Mr Paul Hinnigan Lay Member - Governance Dr Adam Black Executive Member Dr Tom Phillips Executive Member Mrs Anne Asher Lay Member - Nurse Representative Dr Nigel Horsfield Lay Member - Secondary Care Doctor (Retired) Dr Zaki Patel Executive Member Dr John Randall Executive Member Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council IN ATTENDANCE: Mrs Kim Smith Head of Quality Mrs Hannah Sellers CCG Development Officer (Minutes)

A/15 Minutes of Part 2 of the Meeting held on Wednesday 1st July 2015 The Minutes of Part 2 of the Meeting held on 1st July 2015 were considered and accepted as an accurate record. RESOLVED: That the Minutes of Part 2 of the Meeting held on 1st July 2015 were approved as an accurate record.

B/15 B/15.1

Matters Arising/ Action Matrix Mr Roger Parr confirmed that there are no firm dates for the launch of Care.data at present and assured the GB that Blackburn with Darwen will ensure that any actions taken by Blackburn with Darwen are aligned with the other pathfinder CCGs. No further items were noted.

C/15 Reportable Events Mrs Kim Smith presented the Reportable Events paper on behalf of Dr Malcolm Ridgway. Mrs Smith reviewed each of the incidents contained in the report: Mrs Smith also provided a brief on a number of safeguarding issues: Questions and answers followed. RESOLVED: That the Governing Body (GB) noted the content of the reports.

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D/15 Transforming Care – Fast Tracks Mrs Debbie Nixon briefly explained the reasons for the Fast Track Programme which related to Transforming Care for people with learning disabilities. ACTION: Mrs Nixon will present a patient centred report around the Transforming Care Programme to the Governing Body Discussion and Development Meeting on Wednesday 7th October 2015. RESOLVED: That the GB noted the content of the report.

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Item 6.2


Minutes of the Governing Body Annual General Meeting

Monday 28th September at 2 pm Meetings Room 1 and 2, Blackburn Central Library,

Town Hall Street, Blackburn BB2 1AG

PRESENT: Dr Penny Morris Executive Member and Vice Chair (Chair) Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Mrs Debbie Nixon Chief Operating Officer Mr Paul Hinnigan Lay Member - Governance Dr Nigel Horsfield Lay Member - Secondary Care Doctor (Retired) Dr John Randall Executive Member Mr Dominic Harrison Director of Public Health, Blackburn with Darwen Borough Council

IN ATTENDANCE:

Mr Iain Fletcher Head of Corporate Business Mrs Helen Sanderson-Walker Locality Communication and Engagement Lead Mr Anthony Ashfaq Administration Assistant Mrs Pauline Milligan Corporate Support Officer (minutes) Min No: 15.095 Chair’s Welcome

The Chair welcomed everyone to the Clinical Commissioning Group’s (CCG’s) second Annual General Meeting (AGM). She gave a short briefing with regard to the content of the agenda, meeting protocol and housekeeping. The Chair informed attendees that parts of the meeting were being filmed and requested that any attendee who objected to being filmed should contact the Communication and Engagement Lead. She said that, if any members of the public wanted to use their mobile devices to ‘tweet’ about the meeting, they could so but requested the mobiles were set to ‘silent’ mode to avoid disturbing others. The Chair continued that, at the close of the meeting, Governing Body (GB) members would be available for a short period for informal discussions with attendees. There would be an opportunity to ask questions following the presentations by the Clinical Chief Officer and Chief Financial Officer but there would also be a dedicated opportunity following their reviews. The Chair introduced herself as the Interim Chair of the CCG and provided a brief biography.

15.096 Apologies for Absence and Confirmation of Quoracy Apologies for absence were received from: Dr Adam Black Executive Member

Subject to approval at the next meeting

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Dr Tom Phillips Executive Member Dr Zaki Patel Executive Member Dr Malcolm Ridgway Clinical Director for Primary Care and Quality Mrs Anne Asher Lay Member - Nurse Representative The meeting was confirmed as quorate.

15.097 Declarations of Interest Relating to Items on the Agenda No declarations of interest were made with regards to items on the agenda; however the Chair reminded those present that if during the course of discussion, a conflict of interest became apparent, it should be declared at that point.

15.098 Minutes of the Annual General Meeting Held on 18th September 2014 The minutes of the Annual General Meeting held on 18th September were reviewed and approved. RESOLVED: That the minutes of the Annual General Meeting held on 18th September 2014 were approved as an accurate record.

15.059

Review of the Year 2014/15 The Chair provided a brief summary of the work of the CCG; its challenges, roles and responsibilities. The Chair reminded the attendees of the CCG’s membership, which consisted of 27 member practices all of whom were part of the CCG’s Clinical Senate. The Senate met on a quarterly basis and was involved in the CCG’s decision making process. The CCG’s GP Practices were grouped into 4 localities; namely Blackburn North, East West and Darwen. The groupings involved individual practices coming together to work more closely with integrated care for the benefit of its citizens. The Chair outlined some of the challenges faced within the Blackburn with Darwen (BwD) Borough:

• 10% of the working-age population claiming incapacity benefits (May 2014); • Housing dominated by older terraced stock, much of it in poor condition; • Official estimates of child poverty suggesting that 22.5% of the Borough’s children

were living in low-income families in 2012; • A significantly higher than average proportion of underweight children; • 22.5% of the population having a smoking prevalence; • Alcohol being a major contributor to ill-health in the area; • An ageing population with a substantial proportion having two or three long term

conditions. The Chair referred to the CCG’s partnership with its stakeholders:

• The CCG had strengthened its partnerships with BwD Borough Council whilst creating more joined-up working across health and social care;

• The Better Care Fund (BCF) had provided a platform to build on the CCG’s partnership work;

• The GP and CCG member led locality groups had begun to provide a truly integrated service;

• As lead commissioner for Mental Health Services (provided by Lancashire Care NHS Foundation Trust (LCFT)) the CCG had improved outcomes for patients in 2014/15;

• The CCG had strengthened its partnerships with voluntary and community organisations as well as the Third Sector; particularly Healthwatch and had enhanced its relationship with local people;

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• The CCG had worked in collaboration across Pennine Lancashire and Healthier Lancashire to achieve plans for clinical transformation.

The Chair informed the meeting how the CCG had continued to listen to patients, carers and the public by:

• Using their views to monitor the quality of health care services; • Their views influencing how the CCG improved the services it planned and

commissioned; • The Health and Well-being Board organising its work into three areas: Start Well,

Live Well and Age Well and that those principles were being woven into the work of the CCG;

• Demonstrating a determination to play a full part in making ‘wellness’ a feature of the lives of its citizens.

The Chair highlighted the CCG’s statutory responsibilities and how it worked, via its Assurance Framework, to ensure that:

• Local people received good quality care; • Patients’ rights under the NHS Constitution were promoted; • Health outcomes for local people were improved; • The CCG commissioned services within its financial allocation; • Any conditions of authorisation were addressed and removed (where relevant); • The CCG maintained its assurance status of “assured” throughout the entire

reporting period. Questions and answers followed. Dr Chris Clayton responded to a question about the number of separate but similar local NHS organisations which seemed to overlap; therefore potentially creating waste. He stated that the question picked up on a common theme that had been widely reported, particularly around the time of the NHS reforms. He added that, in terms of NHS architecture and infrastructure, the CCG minimised any inefficiencies which arose. It also operated on different levels as well as BwD, i.e. across Pennine Lancashire and Lancashire. He stated that it was when those areas were considered that there were several different organisations. He concluded by remarking that what was interesting going forward was that the NHS and the care sector itself were trying to bring services back together, where it made sense for patients and the public. The CCG had to work with the local system in place and make the best use of it; which it did in BwD. Dr Clayton introduced himself further with a short biography and continued the review of 2014/15. He thanked the Chair for stepping into the Interim Chair’s role and announced that, as had previously been reported, Mr Graham Burgess had been appointed as the CCG’s new Chair and would take up the role on the 1st October 2015. Dr Clayton reminded attendees of the CCG’s 5 Year Strategic Plan and that, whilst the main focus of the CCG’s work was within the BwD Borough, some of its work related to the Pennine Lancashire and Lancashire footprints. Dr Clayton provided detail on the key action areas for the CCG throughout the previous year which were:

1. Delivering high quality Primary Care at scale and improving access; 2. Self-care and early intervention; 3. Enhanced Integrated Primary Care Services; 4. Access to re-ablement and intermediate care; 5. Improved hospital discharge and length of stay; 6. Community based ambulatory care for specific conditions; 7. Access to high quality Urgent Care;

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8. Scheduled Care; 9. Quality.

Dr Clayton expanded on comments he made at the previous year’s AGM, where he had outlined the CCG’s ‘authorisation’ process and referred to the rigorous assurance process by which NHS England continued to check on the CCG’s progression. He was pleased to report that during 2014/15 the CCG remained as fully ‘assured’. Dr Clayton provided evidence of the CCG’s assurance and highlighted its plans to bring together health and social care via its BCF submission, which had been supported by partner organisations and had received full assurance from NHS England. Dr Clayton referred to the process to review the CCG’s Constitution and the changes which had taken place. In July 2014 these had particularly been around the roles of members and member practices; the CCG’s updated mission statement and amendments to its Scheme of Reservation and Delegation. In January 2015, the amendments included the CCG’s Primary Care Co-commissioning Committee (PCCC); an updated joint commissioning arrangements section to reflect delegated authority from NHS England; strengthened arrangements for managing conflicts of interest and an amended process for appointing members to the GB (from nomination to by appointment). Dr Clayton moved on to performance monitoring and the CCG’s major role in monitoring key performance indicators for health and action with providers of services to make improvements where targets had not been met. In 2014/15 the highest priority areas the CCG monitored were:

• Operational standards for treating people in Accident and Emergency (A&E); • Response times for ambulances to emergencies; • Waiting times for cancer diagnosis and treatment; • Waiting times for planned treatment, such as orthopaedic surgery.

Dr Clayton picked out some of the CCG’s key achievements which included:

• 95% of mental health patients being treated within 18 weeks; • In BwD GP clusters now focused around 4 localities; • Integrated Care and the BCF successes:

o Delivery of integrated locality teams providing wrap around care to meet people’s health and social care needs in their own communities;

o Supporting people with multiple and complex health and care needs to stay in their own homes through Intensive Home Support;

• Key priorities identified to reduce the reliance on A&E Departments, improve outcomes and patient experience.

Dr Clayton concluded by highlighting some of the results of the CCG’s 360o stakeholder review which formed part of NHS England’s assurance process and provided a summary of the results of its overall engagement and relationship status. The CCG had improved its standing on all of the points indicated during 2014/15. Questions and answers followed. Dr Clayton responded to a question regarding the provision of school health services and if there were any plans to make funding available to tackle the particular problem of head lice in children. Dr Clayton referred to a common theme in terms of identifying what was the NHS’s role and responsibility and what was society’s and the individual citizen’s role and responsibility. He stated that over the years, as people lived longer with potentially more than one long term condition, the demand on resources increased and funding had to be spent in the most appropriate way. Many years ago more funding may have been spent on problems such as head lice but, unfortunately, this was not the case in today’s

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terms. There was also the question of how this type of problem was managed by the wider society; and education support, particularly, was an important part of the solution. Mr Dominic Harrison added that, in terms of Public Health (PH) in schools there were the School Nurses and Health Visitors and these, in effect, formed the PH Nursing Service. From 1st October 2015, each Local Authority (LA) would be responsible for the commissioning of Health Visiting Services; along with the School Nurses and that would provide an opportunity to restructure some of the school and early years related health care nursing interventions for PH. The services were being reviewed by PH, along with the Director of Children’s Services and the CCG. Mr Harrison added that, in terms of head lice specifically, at any one time 2% of the population were infected and the problem moved around the population. Preventative steps could be taken but, unfortunately, there was very little that could be done to stop occasional influxes. Advice could be provided by the School Nurses and preventative steps could be taken by parents, with assistance from high street Pharmacies but it was very difficult to totally eradicate the problem. Dr Clayton responded to a series of questions about the Prime Minister’s Challenge Fund (PMCF). These related to the lack of public knowledge about the PMCF; that the project had been implemented in a rush; that the project was two months behind schedule; that the training had been inadequate and that Doctors were not available to cover the appointments. Dr Clayton provided background to the PMCF bid for the benefit of attendees. The CCG was amongst the second wave application for the PMCF. The PMCF was unusual in a sense that it was funding that providers had bid for, in this case the GP Practices. The funding came from the Department of Health, via NHS England, but had to be governed in the way in which it was spent. The CCG’s role was to ensure that the funding was utilised in the way that was set out in the bid. Dr Clayton explained that, when funding was awarded in this way, the process from bidding to receipt of the funding could take place very quickly and this, by way of the nature of the process, could mean it was ‘rushed’. Plans, ideas and concepts had to be quickly turned into reality and this had proved a real challenge as the funding had to be spent effectively and within the timeframe provided. The PMCF was provided for one year; therefore services had to be implemented quickly and had only just ‘gone live’. Some challenges had arisen from the launch. Workforce, in general, was a problem but was a challenge for the NHS as a whole and not specifically related to the PMCF. Mr Roger Parr continued that only two weeks had been completed in terms of activity. Data had been received for the first week. The utilisation of the operating spokes was 89% after week one. Mr Parr reminded those present that the PMCF was about improving access to Primary Care. He explained that the delay in the programme plan had been because the CCG wanted to ensure that there was an adequate Information Technology (IT) Service in place. It was important that patients had access to the safest treatment and this meant GPs having access to patients’ full records. The safest IT solution had to be sourced and had meant a lead in time of 8 weeks. The CCG held a fortnightly Steering Group meeting with all the stakeholders involved and Mr Parr agreed to feedback the points raised. ACTION: Mr Parr to feedback comments about the implementation of the PMCF to the Steering Group. Mr Parr concluded that he had been surprised by the level of utilisation of the service in the first week and expected that it would improve access to Primary Care and have a positive effect in terms of easing some of the pressures within the Urgent Care system. The CCG would undertake full monitoring and evaluation of the PMCF and an update

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would be provided to the next PCCC. Mr Parr responded to further questions about the data and the availability of weekend service by explaining the process by which a patient requested and gained access to an urgent GP appointment and that funding was only available for one spoke to be open at the weekend. He continued to explain that experience from the first wave had indicated that there would be a better uptake of appointments on Saturdays rather than Sundays. The plans would be launched and evaluated to ensure resources provided maximum utilisation. ACTION: Mr Parr agreed to raise the issues with Mr Martin Wall, Interim Project Manager and request that Mr Wall be available if appropriate to respond to the questioner concerned. The Chair thanked Dr Clayton for his presentation and introduced Mr Parr, Chief Finance Officer, who had just been responding to questions.

15.060

Financial Review Mr Parr introduced himself as the CCG’s Chief Finance Officer and provided an overview of the financial reports for 2014/15. Mr Parr confirmed that the accounts had been produced on time and to a high standard. Mr Parr thanked the CCG’s Internal Auditors, Mersey Internal Audit Agency and External Auditors, Grant Thornton for auditing the accounts. Mr Parr also thanked the CCG’s Finance Team, which was supported by colleagues from the Midlands and Lancashire Commissioning Support Unit for their work to prepare the accounts for auditing. The CCG achieved each of its key financial duties in 2014/15, as it:

• Remained within its revenue allocation; • Remained within its running cost allocation; • Paid suppliers and providers in line with the Better Payment Practice Code.

Mr Parr provided a high level analysis of the CCG’s income and expenditure and highlighted the CCG’s running costs which amounted to 1.7% of its total funding; meaning that the CCG had to be a lean organisation in terms of corporate costs. He highlighted some of the CCG’s investments and developments during 2014/15 and drew members’ attention to the roll out of the Integrated Localities and Mental Health Services which formed part of the CCG’s main focus during the year. The CCG’s spend of its £207m funding equated to £1,215 per head of the GP registered population and Mr Parr highlighted the areas where the money was spent; the majority of which was on acute care (59%). He provided some of the data related to hospital activity (all providers) which indicated a figure of 21,249 scheduled admissions; along with 19,595 emergency admissions and 59,751 A&E attendances. Mr Parr looked to the future in terms of the CCG’s allocation and stated that in 2015/16 the CCG had received an allocation increase of 3.6% but remained 1.68% outside its target allocation. Investments in 2015/16 related to:

• BCF • Intensive Home Support • Annual Resilience • Mental Health • Primary Care Co-commissioning • PMCF

A full copy of the CCG’s Annual Accounts and Financial Statements 2014/15 is available in the CCG’s Annual Report on its website via the following link:

Page 7 of 8

http://www.blackburnwithdarwenccg.nhs.uk/about-us/publications/ The Review of the Year 2014/15 presentation is available on the CCG’s website via the following link: http://www.blackburnwithdarwenccg.nhs.uk/about-us/governing-body-meetings/ The Chair thanked Mr Parr for his presentation and requested specific questions on the Financial Review first and then general questions which would be taken as part of the next item.

15.061

Questions and Answers Mrs Debbie Nixon responded to a series of questions related to its investment in and work to improve the quality of Mental Health Services across Lancashire; via the development of the specialist Mental Health Teams, the reconfiguration of in-patient services and redesign of the crisis and unscheduled care pathways. There was also the redesign of the Community Teams for older adults and adults. This meant that the Crisis Teams would be better aligned to the Urgent Care system and would have a consistent model of hospital and psychiatric liaison. There were also the street triage service, clinical decision making units and medical assessment facilities for mental health which provided additional capacity into the system. The CCG was driving forward the services required on a consistent level across Lancashire to manage demand but also to support the CCGs in some of their local developments. In addition, the majority of CCGs had invested parity of esteem funding in mental health but had chosen to support some of their local priorities as well. The aforementioned work all formed part of the CCG’s role as lead commissioner. Dr Clayton responded to a question about the diversity of the CCG’s GB by stating that the CCG was a bigger organisation than those colleagues sat around the meeting table and that was reflected within its partnerships as well. The CCG encouraged development within communities and progression in terms of academic achievement and education so that communities and the organisations that serve those communities were represented. However, there was still more work to do. Mr Harrison added that the CCG served a community that was 30% non-white and needed to aim, as it did in so many areas of service provision, to get to a point to where the systems and public services that serve the communities reflected the ethnic and other diversities within those communities. He acknowledged that the Council and the CCG took this very seriously but there was still a long way to go. Dr Clayton responded to a question about the barriers faced by people coming into the UK who did not speak English properly and their difficulties in understanding when attending hospitals or other health services. Dr Clayton reported that in BwD there were funded translation services in place. However, within General Practice in particular, there was limited consultation time due to the number of patients that needed to be seen and a translation solution would need to optimise a patient’s GP consultation time. He added that the issue was regularly discussed by the Council and the CCG. Mr Harrison remarked that there were different kinds of needs related to translation; e.g. there may be patients with learning difficulties or those with hearing problems. Some work was being done to explore ways in which technology could be used more effectively. Over the last 18 months the use of iPads to give more immediate access to different kinds of translation had been explored with the hospital and it was hoped that increased technological enablement would solve some, if not all, of the problems. Mr Harrison concluded that translation services had improved over the years, whereas in

Page 8 of 8

the past there had been some reliance on patients’ family members. There was still a long way to go and the problem was likely be exacerbated in future by a much more global population visiting health services. However, the health partners would continue to work to ensure improvements took place.

15.062 Any Other Business No further business was discussed.

15.063 Closing Remarks The Chair drew the meeting to a close and advised those attending that GB members would be available for questions or informal discussions following the meeting. The Chair referred to Dr Clayton’s presentation which highlighted key areas for the CCG for 2014/15 but also provided an idea of some of the challenges in 2015/16 and beyond. The Chair hoped that the CCG’s stakeholder review highlighted the CCG’s commitment to partnership working to improve the care of the citizens of BwD. On behalf of the CCG, the Chair thanked colleagues for their hard work and contribution to its successes in 2014/15. She added that the CCG’s GB members provided strong leadership and direction and the member practices contributed to the CCG in many different ways. The Chair thanked all of the partners who work with the CCG and its staff and support staff; without whom none of its successes would happen. The Chair closed the meeting by thanking all those who had attended for their contributions, questions and challenges to the CCG’s AGM.

Signed ……………………………………………….Chair …………………………………… Date

Item 7.1 GOVERNING BODY (GB) MEETING - ACTION MATRIX PART 1

Action Origin

GB Ref Action Owner Due Date Status

15.053 Contract Performance Report Following an enquiry from Mr Paul Hinnigan about the level of detail related to medical specialities within the section highlighting elective over performance (page 5), Mr Roger Parr agreed to look into the possibility of highlighting one particular speciality (depending on performance) in each report.

RP

SEPT

IN PROGRESS

WORK TO AMALGAMATE THE CONTRACT AND QUALITY REPORTS

ONGOING

15.059 ANNUAL GENERAL MEETING

Prime Minister’s Challenge Fund Mr Roger Parr to feedback comments from members of the public about the implementation of the PMCF to the Steering Group.

RP

NOVEMBER

COMPLETED

15.059 ANNUAL GENERAL MEETING

Prime Minister’s Challenge Fund Mr Roger Parr agreed to raise the issues with Mr Martin Wall, Interim Project Manager and request that Mr Wall be available if appropriate to respond to the questioner concerned.

RP

NOVEMBER

COMPLETED

15.081

Commissioning Intentions Presentation It was agreed that Chair’s action could be taken with regards to issuing the letters to providers on 30th September following discussion at the Commissioning Business Group. Mrs Debbie Nixon agreed that detailed outcomes of the discussions would be brought to the next Governing Body Discussion and Development meeting on 7th October.

DN

OCTOBER

DEVELOPMENT AND

DISCUSSION MEETING

COMPLETED

15.085

Chief Finance Officer’s Report It was agreed that the report for the next GB Meeting would include a more detailed report on the remedial actions.

RP

OCTOBER

DEVELOPMENT AND

DISCUSSION MEETING

COMPLETED

Report of the Clinical Chief Officer – 4th November 2015 Page 1 of 10

GOVERNOVERNING BODY MEETING


TITLE OF PAPER CLINICAL CHIEF OFFICER’S REPORT

Date of Meeting 4th November 2015 Agenda Item 8

CCG Corporate Objectives

To extend the life of our citizens and their quality of life adding life to years as well as years to life. X

To ensure there will be no gaps, no duplication – with integrated services and partnership working; includingbetter relationships with voluntary, community and faith sector organisations

X

To engage and encourage patients and the public to participate in everything we do and the importance of self-care and family wellbeing. √

To improve services and tackle inequality, evidence best practice to inform decisions and root out poorpractice.

X

To offer effective service interventions which will provide a better experience for patients with privacy anddignity.

X

CCG High Impact Changes

Delivering high quality Primary Care at scale and improving access X

Self-Care and Early Intervention X

Enhanced and Integrated Primary Care and Better Care Fund X

Access to Re-ablement and Intermediate Care X

Improved hospital discharge and reduced length of stay X

Community based ambulatory care for specific conditions X

Access to high quality Urgent and Emergency Care X

Scheduled Care X

Quality X

Clinical Lead: Chris Clayton

Senior Lead Manager Iain Fletcher

Finance Manager Roger Parr

Equality Impact and Risk Assessment completed: The report is for the information of members only.

Patient and Public Engagement completed: The report is for the information of members only.

Financial Implications The report is for the information of members only.

Risk Identified The report is for the information of members only.

Report authorised by Senior Manager: Chris Clayton

Decision Recommendations The Governing Body is requested to receive this report and to note the items as detailed.


Y



4TH NOVEMBER 2015

CLINICAL CHIEF OFFICER’S REPORT

1) Introduction

This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer’s (CCO) efforts have been directed since the last meeting.

2) Department of Health

2.1 Appointments

The Department of Health has announced that Mr Jim Mackey, Chief Executive of Northumbria Healthcare NHS Foundation Trust, has been appointed as the Chief Executive of NHS Improvement. NHS Improvement was created earlier this year to be the health sector regulator and to support urgent improvements at the frontline and the long-term sustainability of the healthcare system. Mr Mackey will start to bring together expert teams to deliver all of NHS Improvement’s responsibilities. He will be in post full time from 1 November 2015.

3) NHS England

3.1 Appointments

NHS England Chief Executive, Mr Simon Stevens, has announced the appointment of three frontline NHS leaders to strengthen NHS England’s work on primary care, drive improved cancer services, and lead the commissioning of specialised hospital services. Announcing the appointments, Mr Stevens said that the exceptionally high calibre new appointments will strengthen NHS England’s national leadership and its connection with frontline delivery, helping turbo-charge implementation of the Five Year Forward View. Dr Arvind Madan becomes NHS England’s Director of Primary Care to provide clinical leadership for the transformation of primary care provision. Dr Madan is a practising General Practitioner based at the Hurley Group, a large multi-site general practice and urgent care provider. In his new role he will also serve as a deputy National Medical Director to Sir Bruce Keogh, National Medical Director. Dr Madan has a strong track record of using new technology and redesigned ways of working across care boundaries to improve outcomes and deliver better value for money. Ms Cally Palmer has been appointed to NHS England as NHS National Cancer Director. She will lead the implementation of the NHS Cancer Taskforce’s 5 year strategy for cancer care improvement, as well as new cancer Vanguards using outcomes-based commissioning to


redesign care and the patient experience. Ms Palmer is Chief Executive of The Royal Marsden Hospital NHS Foundation Trust, and will retain this role while seconded to NHS England. Dr Jonathan Fielden is appointed NHS England’s new Director of Specialised Commissioning. He will lead the national specialised commissioning function within NHS England and lead the development of the national strategy for specialised services. He will also serve as a deputy National Medical Director to Sir Bruce Keogh. Dr Fielden is currently Medical Director of University College London Hospitals NHS Foundation Trust, a Consultant Intensive Care Medicine and member of a CCG GB. All three posts were advertised externally and subject to open competition.

3.2 Annual General Meeting

NHS England held its Annual General Meeting (AGM) on 21 October 2015. The AGM fell on the first anniversary of the launch of the Five Year Forward View. The meeting provided its stakeholders and the public with the opportunity to scrutinise its work towards delivering this and discussing its future direction. It also demonstrated how it is transforming the NHS and working in partnership to improve the NHS.

3.3 Winter Campaign

A major drive to help people stay well this winter has been launched by Public Health England (PHE) and NHS England.

The campaign begins with a national flu vaccination programme for children, which this year seeks to help over 3 million 2-6 year olds, as the programme is extended to children in school years 1 and 2.

For the first time, all of the youngest primary school children will be eligible to receive the free nasal spray vaccine, making this the largest school-based vaccination programme in England involving children in 17,000 schools.

As in previous years, the adult flu vaccine will also be offered for free to those in groups at particular risk of infection and complications from flu. The groups being offered the adult flu vaccine are:

• Pregnant women; • Those aged 65 or over; • Those aged under 65 with long-term conditions; • Carers.

As well as protecting against flu, the NHS ‘Stay Well This Winter’ campaign will urge people over 65 or those with long-term health conditions, such as diabetes, stroke, heart disease or respiratory illness, to prepare for winter with advice on how to ward off common illnesses.

The NHS ‘Stay Well This Winter’ campaign urges the public to:

• Make sure you get your flu jab if eligible; • Keep yourself warm – heat your home to least 18oC (65oF) if you can; • If you start to feel unwell, even if it’s just a cough or a cold, then get help from your

Pharmacist quickly before it gets more serious; • Make sure you get your prescription medicines before Pharmacies close on Christmas

Eve; • Always take your prescribed medicines as directed; • Look out for other people who may need a bit of extra help over winter.


All frontline NHS staff will once again be offered a free flu jab this season in order to protect themselves and patients from infection. Last year only 54% of staff were vaccinated. NHS leaders are encouraging them to take up this offer as part of their duty to protect patients and keep them safe.

The NHS has strengthened planning for winter this year with work starting earlier than ever before. Funding was provided to local health systems via CCGs in April and, for the first time, included in their baseline allocation to ensure local urgent and emergency care and planned services are sustainable year round.

To improve services for the public over the longer term, the NHS is also forging on with implementing the urgent care review, redesigning the urgent care system to reduce the rise in emergency admissions that have put pressures on hospitals and ensuring the public can get the right care, in the right place, every day of the week.

Eight areas across the country are trailblazing new approaches to improve the coordination of urgent and emergency care services and work is underway to bring NHS 111 and GP Out of Hours Services closer together to provide patients with a “new front door” to urgent health care services.

The new service will offer patients improved access to a new 24/7 urgent clinical assessment, advice and treatment service – bringing together NHS 111, GP Out of Hours and clinical advice.

PHE has also published a Cold Weather Plan which further aims to help people stay well this winter.

‘Stay Well This Winter’ will be run in partnership with PHE, the Trust Development Authority, Monitor and the Department of Health. It runs across a range of media including TV, radio, digital, press and poster sites.

Further information via: www.nhs.uk/staywell

3.4 Mental Health Services Passport for Children and Young People

Young people, their parents and carers have worked with NHS England to develop and launch a template of a passport-style brief which summarises children and young people’s use of Mental Health Services. This will help them tell their story when moving between different services and avoid having to repeat their history and preferences to different people. The Mental Health Services Passport includes clinical information as well as key personal preferences, and should be created by the service user with the support of their practitioner. It can be used across care settings, either on paper or on mobile phones.

The Future in Mind Report published in March 2015, about improving children and young people’s mental health, said “you should only have to tell your story once, to someone who is dedicated to helping you, and you shouldn’t have to repeat it to lots of different people” and the tool has been developed in line with this. Since the report was published NHS England and partners have been working to address the issues it raised.

For more information and a video guide, also created by young people, on how to use the passport, can be viewed via: http://www.england.nhs.uk/mentalhealth/2015/10/15/passport-brief-yp-mh/


4) PHE

PHE has produced a business plan for its North West centre, setting out the key objectives and milestones for 2015 – 2016 and outlining some of the past successes of the North West centres in 2014 – 2015. The business plan has been produced following the merge and transition this year of the previous Cheshire and Merseyside, Cumbria and Lancashire and Greater Manchester PHE centres to PHE North West. This plan flows from the work the previous PHE centres developed with local partners. It will be refined with partners, to enable PHE to develop common priorities to meet local need. The main focus of the work is to support the delivery of four core functions to best meet local priorities alongside continued delivery of the PHE seven national priorities. The Health and Social Care Act of 2012 has already established specific legal duties on health inequalities; PHE North West will demonstrate that they are meeting these legal duties through underlying actions and activities that will contribute towards a reduction in health inequalities in the North West of England.

The plan can be accessed via: https://www.gov.uk/government/publications/phe-north-west-business-plan-2015-to-2016

5) Health and Social Care Information Centre (HSCIC)

Two new duties came into force on the 1st October 2015, as part of the Health and Social Care (Safety and Quality) Act 2015. The Information Governance Alliance (IGA) has worked with Information Governance specialists who support health and social care organisations across England to prepare them for the introduction of the guidance. The Act has two sections that are relevant from an Information Governance perspective:

• A requirement for health and adult social care organisations to use a consistent identifier (the NHS Number) for sharing data for direct care of a patient;

• A legal duty requiring health and adult social care bodies to share information with each other

for the direct care of a patient.

For a person's direct care, the default position should now be to share unless there is a reason not to. The Act aims to address the 'culture of anxiety' with regards to data sharing that was identified by the 2013 Caldicott Report.

The IGA has supporting the Department of Health to raise awareness of these new duties and to address potential concerns and has produced a package of guidance material to help organisations to comply with the new duties: Further information via: http://systems.hscic.gov.uk/infogov/iga/resources/infosharing

6) NHS Confederation

The Confederation has announced that Mr Stephen Dorrell has been appointed as its new Chair.

Mr Dorrell has been a parliamentarian for over 30 years and, as the former Secretary of State for Health and the first elected chair of the Health Select Committee, brings a wealth of experience and insight to the role.

As Chair of the Board of Trustees he will work alongside the Chief Executive, the senior team and members of staff across the NHS Confederation to ensure the Confederation remains as the credible


and trusted voice of the NHS, effectively representing its members drawn from across the full breadth of health and care and giving direct support for NHS leaders.

7) Healthier Lancashire Further to previous reports, the Lancashire Transformation Executive Group held an extraordinary meeting on 24th September where it signed off a draft version of the Alignment of Plans (AoP) Report that was issued on 1st October to the Lancashire Leaders Forum (LLF) members along with supporting collateral. The AoP Report is incorporated into a document “Healthier Lancashire Forward View: From understanding the challenges to creating the solutions” that was also distributed to leaders across the Lancashire health care system on the 1st October. Included within this document is a specific ask for commitment to move to the next phase of work together as Healthier Lancashire. The expectation is that Boards and GBs will use this information to help them consider the AoP Report and the “Healthier Lancashire Forward View: From understanding the challenges to creating the solutions” within their organisations in relation to working collaboratively on further activities required to bring about the necessary change during October and then share the outcomes of these discussions at the Executive Leadership Summit on 19th November, after which a formal report is expected to be published. The Lancashire Transformation Executive Group requested that organisations discuss the AoP Report and the “Healthier Lancashire Forward View: From understanding the challenges to creating the solutions” at their development sessions during October Blackburn with Darwen (BwD) CCG considered the documents at its development meeting on 7th October and will take part in the outcomes discussions at the Leadership Summit.

8) BwD CCG

8.1 Appointments

I am delighted to confirm that, following a rigorous appointment process, Mr Graham Burgess was appointed to the role of Chair of the CCG and has been in post since 1st October 2015.

Graham has held a number of senior positions in Local Government, becoming one of the best known Chief Executives. In 2011, he was voted fourth out of the fifty most influential Local Government figures in health and social integration, by trade magazine Local Government Chronicle. He started his career as a social worker with Liverpool City Council in 1974. He joined BwD Borough Council in 1998, before rising to position of Chief Executive in 2006. This then became a combined role with BwD Primary Care Trust in 2010. At this time, he was only one of five Chief Executives in the country to hold the dual role of Council and Primary Care Trust Chief Executive, leading a unique integration of Local Authority and health commissioning services.

After leaving the area three years ago to join Wirral Council, he is delighted to be returning to the Borough and continuing to build on the strong and effective working relationships that have been developed. He has kept a close eye on local news over the years as the town is very close to his heart. He is looking forward to the future challenges the CCG faces as it continues to move further forward integrating health and social care. He is confident that his experience and knowledge will ensure that our patients continue to receive high quality healthcare services.


I was pleased to welcome Graham to the CCG. He has brought with him a wealth of experience, not only Local Government and health and social care, but of the local area. He is an experienced Chair who has faced many challenges and transformational changes and I’m positive that he will provide the CCG with strong and strategic leadership.

I was also pleased to announce the successful recruitment of two new Clinical Leads; Dr Dinesh Mathur, who has recently taken up the post of Clinical Lead for Children and Young People and Dr Pervez Muzaffar who has taken on the position of Clinical Lead for Engagement. These were new posts within the CCG structure, which recognise the requirement to strengthen clinical leadership in these areas; the new Clinical Leads will work closely with the CCG GB to ensure effective leadership and service delivery across BwD.

8.2 Care.data

The CCG is a pathfinder for the care.data programme and has been supporting practices in getting ready for its implementation.

• Each practice has undergone training and information sessions with the CCG engagement

lead supported by NHS England/and or HSCIC. • GP Practices have had the opportunity to be involved with the development of the patient and

public facing materials which will be used in the public communications campaign, and also in the development of the GP Practice toolkit which will support local implementation.

• The information collated from the GP Practices has been used to influence the programme. • Each practice has undergone a readiness assessment and completed a supporting checklist

which has been designed to ensure that local processes are in place to support implementation.

• The practices have also been asked to supply the name of their Caldicott Guardian who will be included as the local signatory on the personalised letters which will be sent to each patient (aged 15¾ and over) registered to participating practices. This requirement has been helpful in generating discussion on the responsibility of practices for the management of data collected by each practices.

• Engagement and training has been undertaken with Healthwatch Blackburn to ensure they are ready to support the public communications.

• Engagement has commenced with the Patient Participation Groups (PPGs) and the engagement lead is to attend a series of PPG meetings over the coming months.

• A training and information session was held with the ‘Patient Voices’ Group and a stakeholder event was held with the assistance of the voluntary sector’s ‘Regional Voices’.

On 2nd September the Health Secretary announced a number of measures to assure the security of confidential medical information. This will include a review of standards of data security for patients’ confidential data across the NHS to be carried out by the Care Quality Commission (CQC). The National Data Guardian for health and care, Dame Fiona Caldicott, will contribute to this review by developing clear guidelines for the protection of personal data against which every NHS and care organisation will be held to account. She will provide advice on the wording for a new model of consents and opt-outs, which will be used by the care.data programme to deliver the work that is so vital for the future of the NHS. The review will be completed by January 2016 and from April next year, the new guidelines will be assured through CQC inspections and NHS England commissioning processes. As a pathfinder for the care.data programme BwD CCG, and the other three pathfinders, will be pleased to help the National Data Guardian as requested. Work with the pathfinders continues as planned and will form part of the review.


8.3 Integrated Web

The CCG has funded the development of an integrated web-based solution, which includes a new website, intranet and GP Practice websites. Dr Hereward Brown is the lead GP for this project, and he is supported by the Communication and Engagement Team. Dr Brown’s GP practice website has operated as the pilot site for this work. This has now concluded and the practice website is updated and operational. Work has proceeded apace with integrating every GP Practice website in the area and linking these together to form the communication network.

8.4 Lancashire Care NHS Foundation Trust

8.4.1 Annual Review

The Trust has published its Annual Review 2014-15, which provides an overview of how the Trust performed during the last year, along with progress against its priorities and an outline of its future direction. The Trust continues to work with its partners to further develop care outside of hospital. The full Annual Report and Accounts 2014-15 have also been published. The documents are available via: http://www.lancashirecare.nhs.uk/communications/Publications/Annual-Plan-Report-Accounts.php

8.4.2 The Harbour

The Trust has announced that the official opening of The Harbour will take place on 30th October 2015. The Harbour is a new 154 bedded mental health hospital situated just off junction 4 of the M55 at Blackpool. The hospital was designed with extensive input from service users and clinicians and is based on good practice guidance and 'safety by design' to ensure that it can provide high quality care. The ethos of the unit is to provide therapeutic care which is empowering, person centred and needs led, and focuses on promoting recovery and independence.

8.5 East Lancashire Hospitals NHS Trust

The Trust has published its Annual Review 2014–15, which provides a summary of its performance and activities over the last financial year; and “Compassionate Care – a series of first hand patient stories”, which are a representation of recent patient experiences. The full Annual Report and Quality Account 2014-15 have also been published.

The Trust is planning a Stakeholder Engagement Event in November where it will inform its stakeholders of the outcome of the latest CQC inspection. The publications are available via: http://www.elht.nhs.uk/corporate-publications.htm

9) Good News and Events

9.1 Big Health and Social Care Day Event

The CCG along with the BwD Borough Council (BC) held a Big Health and Social Care event for people with learning disabilities (LD) on the 18th September at Audley Sports and Leisure Centre.


Following past experience of the low attendance to the annual event it was decided to hold a ‘fun’ session rather than workshops to ensure more people with LD attended. The Communication and Engagement Team worked closely with the Motivate Team and attended sessions and asked people with LD what sort of event they would like to attend. Activities were booked including arts and crafts, dancing and penalty shoot outs and sponsors were sought for prizes for a questionnaire draw. Stalls were invited which would be relevant for people with LD. Approximately 40 people with LD attended, along with their carers and families. Short welcoming speeches were given at the beginning of the event but the main attraction was the launch of the new ‘About Me’ LD cards which were developed following a request from a lady with LD at last year’s event. The ‘About Me’ cards are to offer discreet information on a day to day basis, so that others can understand the needs of the person with LD. The Communication and Engagement Team will continue to promote the cards to local organisations and ensure distribution to people with LD. The report will be shared with the CCG and BwD BC.

9.2 Paediatric Asthma Survey

The Communication and Engagement Team was asked to work in collaboration with local radio station Rock FM to gather feedback with regards to children and parents’ experiences of living with, or living with a child, who had asthma. It was agreed that the process would target one area of BwD, i.e. Shadsworth, and work would be undertaken within four schools in this area. The schools which took part were:

• Shadsworth Infant School; • Shadsworth Junior School; • Our Lady and St John Catholic High School; • Blackburn Central High School.

Presentations took place during morning assemblies to inform and raise awareness amongst pupils and teachers about the causes, affects and treatment of asthma. Pupils who had asthma then took part in workshops run by Rock FM, exploring what it was like to live with asthma and to develop short radio promotions highlighting the causes, avoidance and treatment of asthma. During these sessions children were asked to complete a questionnaire. Parents were invited to these sessions but even with the support from the schools, unfortunately, only a limited number of parents took up the opportunity. As part of the sessions in each school both children with asthma and their parents were asked to complete a survey, which explored how they felt about and coped with living with asthma. 55 children completed the survey, using touch-screen, hand-held survey units. Only 9 parents completed the survey, which, although disappointing, still provided some useful insight. The report was presented to the CCG’s commissioner for Children’s Services.

10) Meetings

Members may be interested to note the following meetings and events which have taken place during the course of the last two months:

19th August East Lancashire Hospital Trust Accident and Emergency Department Performance

19th August Celebration Event for the CCG Chair 26th August Joint Integrated Commissioning Executive Group 27th August Lancashire CCG Network 2nd September CCG Governing Body 2nd September Pennine Lancashire Professional Reference Group 3rd September Pennine Lancashire System Resilience Group 9th September CCG Commissioning Business Group


9th September Pennine Lancashire Chief Executives Steering Group 10th September Local Medical Committee 10th September Healthier Lancashire Workshop: Joint Health and Social Care

Economies “Create the Options” 16th September Lancashire and South Cumbria Urgent and Emergency Care Network 17th September Integrated Strategic Needs Assessment Group 18th September Pennine Lancashire Transformation Programme Board 23rd September Chief Executive Officer Forum – Autumn Event 24th September Lancashire CCG Network 28th September Joint Integrated Commissioning Executive Group 28th September CCG Annual General Meeting 29th September BwD Health and Well-being Board 1st October Pennine Lancashire System Resilience Group 7th October CCG Governing Body, Development and Discussion Meeting 7th October Pennine Lancashire Professional Reference Group 8th October Pennine Lancashire Community Safety Steering Board 8th October Local Medical Committee 13th October CCG Clinical Senate 14th October CCG Commissioning Business Group 15th October Prescribed Specialist Services Advisory Group 16th October Collaborative Summit for Commissioning Leaders across the North 21st October Lancashire and South Cumbria Urgent and Emergency Care Network 22nd October Lancashire Care NHS Foundation Trust, CQC Quality Summit

11) Recommendation

The Governing Body is requested to receive this report and to note the items as detailed.

Dr. Chris Clayton Clinical Chief Officer 23rd October 2015

Governing Body Meeting Page 1 of 2

GOVERNING BODGOVERNING BODY MEETING

Y


Chief Finance Officer’s Report



To extend the life of our citizens and their quality of life adding life to years as well as years to life. y


y

To engage and encourage patients and the public to participate in everything we do and the importance ofself-care and family wellbeing.

y

To improve services and tackle inequality, evidence best practice to inform decisions and root out poor practice.

y


y


Delivering high quality Primary Care at scale and improving access y

Self-Care and Early Intervention y

Enhanced and Integrated Primary Care and Better Care Fund y

Access to Re-ablement and Intermediate Care y

Improved hospital discharge and reduced length of stay y

Community based ambulatory care for specific conditions y

Access to high quality Urgent and Emergency Care y

Scheduled Care y

Quality y

Clinical Lead: N/A

Senior Lead Manager Mr Roger Parr

Finance Manager Mrs Linda Ring

Equality Impact and Risk Assessment completed: Not required

Patient and Public Engagement completed: Not required

Financial Implications Not required

Risk Identified Yes

Report authorised by Senior Manager: Mr Roger Parr

Decision Recommendations It is recommended that the CCG Governing Body note the contents of this financial summary and the overall position of the CCG at the end of September 2015, noting the risks and detailed appendices supporting this narrative.

Governing Body Meeting Page 2 of 2

Executive Financial Summary Month 6 – Period Ending 30th September 2015

Year to Date Full year

forecast

Budget Actual Variance Budget Actual Variance £000 £000 £000 £000 £000 £000

Funds Available 119,462 119,462 0 239,918 239,918 0

Commissioning 88,207 89,321 (1,114) 174,998 177,197 (2,199)Primary Care 25,530 25,694 (164) 52,232 52,559 (327)Corporate 3,548 3,527 21 7,133 7,083 50Reserves 1,085 0 1085 3,371 895 2,476Balance 1,092 920 (172) 2,184 2,184 0

Summary Financial Position ‐ The CCG is reporting a year to date surplus of £920k which behind the 2015/16 plan. The current revenue position is forecast to deliver the year end surplus of £2,184k. The CCG is putting in place mitigating actions to recover the ytd slippage against plan.

Commissioned Services

• Healthcare Commissioning from providers is reporting a YTD overspend of £1,114k with a year‐end forecast overspend of £2,199k mainly on inpatient day case, outpatients and non‐electives.

• Primary Care Services are reporting a YTD overspend of £164k and forecast overspend of £327k. Prescribing is reporting a YTD overspend of £161k with a forecast overspend of £320k. Prescribing is based on actual expenditure to July with estimated costs for August and September. Primary Care Co‐Commissioning, delegated from NHS England, is reporting a small YTD underspend of £6k and a forecast breakeven position is reported.

• Corporate Services are reporting a YTD underspend of 21k and a forecast underspend of £50k. The CCG is forecasting to operate within its running cost allocation at month 6.

RISKS • Acute activity levels continue to be a key factor in 2015‐16. Schemes

are in place to reduce elective and non‐elective activity with our main provider.

• Continuing health care and complex packages continues to be a key risk. The CCG continues to work with MLCSU to closely monitor this area of expenditure.

• Prescribing expenditure is volatile and is monitored closely by the Medicines Management Team. QIPP

• 46% of the QIPP target has been achieved at month 6. This is behind the plan to meet a full year target of £5m. The CCG is in the process of formulating a recovery plan to close this gap. Capital

• The CCG is anticipating IT capital expenditure of £148k. It is anticipated that this allocation will be fully utilised.

Recommendation ‐ It is recommended that the CCG Governing Body note the contents of this financial summary and the overall position of the CCG at the end of September 2015, noting the risks and detailed appendices supporting this narrative.

NHS Blackburn with Darwen CCG APPENDIX A

Summary Governing Body Report ‐ September 2015

Budget to Date£000

Expenditure to Date £000

Variance to Date£000

Annual Budget £000

Annual Forecast£000

Annual Forecast Variance£000

Revenue Resource Limit

Confirmed (119,462) (119,462) 0 (239,918) (239,918) 0

Anticipated 0 0 0 0 0 0

Total Revenue Resource Limit (119,462) (119,462) 0 (239,918) (239,918) 0

Expenditure

Commissioning (Page 2) 113,737 115,015 (1,278) 227,230 229,756 (2,526)

Corporate (Page 4) 1,797 1,798 (1) 3,578 3,578 0

Reserves (Page 4) 1,085 0 1,085 3,371 895 2,476

Healthcare Sub Total 116,619 116,813 (194) 234,179 234,229 (50)

Running Costs (Page 4) 1,751 1,729 22 3,555 3,505 50

Total Expenditure 118,370 118,542 ‐172 237,734 237,734 (0)

Surplus/(Deficit) 1,092 920 ‐172 2,184 2,184 0

Better Payment Practice Code YTD Value (%) YTD Volume (%) FOT Value (%) FOT Volume (%) Target (%)

NHS 99.7 99.2 98.0 98.0 95.0

Non NHS 98.7 98.4 98.0 98.0 95.0

NHS Blackburn with Darwen CCG

Healthcare Commissioning Report ‐ September 2015

Budget to Date £000



Annual Budget £000


Acute Services

NHS contracts (includes Ambulance Services) 56,636 57,078 (442) 113,272 114,151

Non NHS Providers 3,025 3,202 (177) 6,051 6,404

NHS Contract Exclusions / Cost per Case 721 786 (65) 1,030 1,100

Non Contract Activity 368 682 (314) 736 1,364

Other 0 0 0 0 0

Sub Total Acute Contracts 60,750 61,748 (998) 121,089 123,019

Mental Health Services

NHS contracts 7,775 7,775 0 15,551 15,551

Non NHS Providers 356 361 (5) 632 632

NHS Contract Exclusions / Cost per Case 53 46 7 107 107

Non Contract Activity 17 16 1 33 33

Other (110) (110) 0 (221) (221)

Sub Total Mental Health Services 8,091 8,088 3 16,102 16,102

Community Health Services

NHS contracts 7,678 7,678 0 15,203 15,203

Non NHS Providers 718 961 (243) 1,172 1,643

NHS Contract Exclusions / Cost per Case 77 73 4 153 158

Non Contract Activity 0 0 0 0 0

Hospices 522 529 (7) 1,045 1,045

Other 136 119 17 343 323

Sub Total Community Services 9,131 9,360 (229) 17,916 18,372

Total Healthcare Contracts 77,972 79,196 (1,224) 155,107 157,493

Continuing Care Services

Continuing Care 4,615 4,573 42 8,210 8,109

Free Nursing Care 304 288 16 608 608

Sub Total Continuing Care Services 4,919 4,861 58 8,818 8,717

Primary Care Services

Prescribing 13,755 13,916 (161) 27,511 27,831

Enhanced Services 311 319 (8) 580 587

Primary Care Co‐Commissioning 9,675 9,669 6 20,199 20,199

Out of Hours 971 971 0 1,942 1,942

Commissioning 368 362 6 1,101 1,101

Other 450 457 (7) 899 899

Sub‐total Primary Care services 25,530 25,694 (164) 52,232 52,559

Other Programme Services

Other Non Acute 2,810 2,847 (37) 6,060 6,153

Complex Cases & Individual Funding Requests2,506 2,417 89 5,013 4,834

Sub Total Other Programme Services 5,316 5,264 52 11,073 10,987

Surplus/(Deficit) 113,737 115,015 (1,278) 227,230 229,756

APPENDIX B


(879)

(353)

(70)

(628)

0

(1,930)

0

0

0

0

0

0

0

(471)

(5)

0

0

20

(456)

(2,386)

101

0

101

(320)

(7)

0

0

0

0

(327)

(93)

179

86

(2,526)

NHS Blackburn with Darwen CCG APPENDIX C

Main Healthcare Contracts ‐ September 2015

Budget to Date£000



Annual Budget £000



Acute Contracts

Main Provider

East Lancashire Hospitals NHS Trust 48,523 49,224 (701) 97,045 98,444 (1,399)

Other Lancashire Providers

Lancashire Teaching Hospitals NHS FT 2,537 2,347 190 5,075 4,694 381

Blackpool Fylde & Wyre Hospitals NHS FT 264 218 46 527 436 91

University Hospitals Morecambe Bay NHS FT 64 54 10 128 107 21

North West Ambulance Service NHS Trust (Block) 3,453 3,453 0 6,906 6,906 0

Sub Total Other Lancashire Providers 6,318 6,072 246 12,636 12,143 493

Greater Manchester Providers

University Hospital South Manchester NHS FT 247 261 (14) 495 523 (28)

Salford Royal NHS FT 140 148 (8) 279 296 (17)

Royal Bolton Hospitals NHS FT 186 148 38 373 296 77

Wrightington, Wigan & Leigh NHS FT 318 300 18 636 600 36

Central Manchester University Hospital NHS FT 702 793 (91) 1,403 1,587 (184)

Pennine Acute NHS Trust 70 58 12 140 117 23

Sub Total Greater Manchester Providers 1,663 1,708 (45) 3,326 3,419 (93)

Merseyside Providers

Royal Liverpool & Broadgreen NHS Trust 132 74 58 265 147 118

Sub Total Merseyside Providers 132 74 58 265 147 118

Independent Sector Contracts

BMI Healthcare (Beardwood, Beaumont, Gisburne) 2,460 2,521 (61) 4,920 5,043 (123)

Ramsay 215 320 (105) 431 640 (209)

Sub Total 2,675 2,841 (166) 5,351 5,683 (332)

Total Acute Contracts 59,311 59,919 (608) 118,623 119,836 (1,213)

Mental Health Contracts

Lancashire Care NHS FT (Block) 7,475 7,475 (0) 14,949 14,949 0

Calderstones Partnership NHS FT (Block) 284 284 0 567 567 0

Greater Manchester West NHS FT 16 16 0 32 32 0

Total Mental Health Contracts 7,775 7,775 (0) 15,548 15,548 0

Community Health Contracts

Lancashire Care NHS FT (Block) 7,678 7,678 0 15,203 15,203 0

Total Community Health Contracts 7,678 7,678 0 15,203 15,203 0

Surplus/(Deficit) 74,764 75,372 (608) 149,374 150,587 (1,213)

NHS Blackburn with Darwen CCG APPENDIX D

Non Healthcare Commissioning Report ‐ September 2015

Budget to Date£000



Annual Budget £000



Other Corporate Costs (Non‐Running Costs)

CSU re‐charge 260 260 0 519 519 0

NHS Property Services re‐charge 1,129 1,129 0 2,258 2,258 0

Other 408 409 (1) 801 801 0

Sub Total Corporate Costs 1,797 1,798 (1) 3,578 3,578 0

Plan requirements & reserves

Reserves 1,085 0 1,085 3,371 895 2,476

Sub Total Reserves 1,085 0 1,085 3,371 895 2,476

Running Costs

CCG Pay 740 742 (2) 1,469 1,469 0

CSU re‐charge 673 673 0 1,347 1,347 0

NHS Property Services re‐charge 84 84 0 169 169 0

Other 254 230 24 570 520 50

Running Costs Reserve 0 0 0 0 0 0

Sub Total Running Costs 1,751 1,729 22 3,555 3,505 50

Surplus/(Deficit) 4,633 3,527 1,106 10,504 7,978 2,526

NHS Blackburn with Darwen CCG APPENDIX E

Statement of Financial Position ‐ September 2015

Statement of Financial PositionSeptember

£000

Non Current AssetsProperty, Plant, Equipment 0

Total Non Current Assets 0

Current AssetsTrade and Other Receivables 2,404Financial Assets 0Current Assets 0Cash and Bank 415

Total Current Assets 2,819

Total Assets 2,819

Current LiabilitiesTrade and Other Payables (9,703)Other Liabilities 0Provisions 0Borrowings 0

Total Current Liabilities (9,703)

Total Assets less Current Liabilities (6,884)

Non Current LiabilitiesTrade and Other Payables 0Provisions 0Borrowings 0Other Liabilities (132)

Total Non Current Liabilities (132)

Total Assets Employed (7,016)

Financed ByGeneral Fund (7,016)Revaluation Reserve 0Donated Asset Reserve 0Government Grant Reserve 0Other Reserves 0

Total Equity (7,016)

1 | P a g e

Title of Paper: Contract and Performance Report

Date of Meeting 4TH NOVEMBER 2015 Agenda Item 10


To extend the life of our citizens and their quality of life adding life to years as well as years to life. Y


Y

To engage and encourage patients and the public to participate in everything we do and the importance of self-care and family wellbeing.

N/A

To improve services and tackle inequality, evidence best practice to inform decisions and root out poorpractice.

Y


Y


Delivering high quality Primary Care at scale and improving access N/A

Self-Care and Early Intervention Y

Enhanced and Integrated Primary Care and Better Care Fund Y

Access to Re-ablement and Intermediate Care N/A

Improved hospital discharge and reduced length of stay Y

Community based ambulatory care for specific conditions Y

Access to high quality Urgent and Emergency Care Y

Scheduled Care Y

Quality Y

Clinical Lead: N/A

Senior Lead Manager Mr Roger Parr

Finance Manager Mr Roger Parr



Financial Implications Nil

Risk Identified N/A

Report authorised by Senior Manager:

Decision Recommendations The Governing Body is requested to note the contents of the report and the supporting appendices.


2

D

2 | P a g e

1. Intro 1.1

2. Lanc 2.1

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3 | P a g e

For BwD CCG alone, bed days are +15.6% higher than last year, admissions are +13.4% higher than last year and the average length of stay has increased from 38.8 days in 2014-15, to 39.5 days in 2015-16.

2.3 BwD CCG has a monthly target of 246 patients entering psychological treatment to meet

the 15% prevalence target. The table below demonstrates the number of patients entered into Psychological Therapies with LCFT and the Lancashire Women’s Centre (LWC) for BwD CCG. In month 5, 266 patients entered into treatment against a target of 246 (+20, +8.1). In 2014/15, NHS England’s assessment of performance in this target was measured solely using data for quarter 4. For 2015/16, the target is required to be met each quarter. LCFT alone (without the additional activity undertaken by LWC) has achieved the target in quarter 1 (April to June), and in July. However, without the additional activity from LWC, LCFT has not met the target in August.

LCFT Only LCFT + LWC IAPT Performance 15‐16 Q1 Jul‐15 Aug‐15 Q1 Jul‐15 Aug‐15

Treatment Target 738 246 246 738 246 246 Entered Treatment 751 250 200 870 307 266

Variance 13 4 ‐46 132 61 20 % Variance 1.8% 1.6% ‐18.7% 17.9% 24.8% 8.1%

2.4 Year to date referrals for Psychological Therapies to LCFT, have been slightly below the

level required to achieve target, 1,560 year to date referrals, versus 1,600 required (-40, -2.6%). However, factoring in referrals to LWC results in the number of referrals being above the required level, i.e. 1,975 referrals, versus 1,600 required, (+375, +19%). LCFT’s estimate of the required referral rate assumes a 25% attrition rate. Performance monitoring has recently indicated that the ‘Did Not Attend’ rate at LCFT is reducing. The implementation of LCFT’s new IT system (IAPTus), has led to a new text reminder facility to patients being initiated (which may further reduce DNAs). This would suggest that the estimate of the required number of referrals may need to be revised in the near future.

3. Referrals to Secondary care

3.1 Referrals for treatment to the CCG’s main provider East Lancashire Hospitals NHS Trust

(ELHT) are monitored monthly to ensure performance variances are investigated. From the table below it can be seen that month 5 reflects an increase in activity compared to the same period last year. The referral activity measured on an average per working day shows an increase in total referrals from the previous year (+3.2%). This compares to the month 4 reported increase of +1.3% on the same period last year. This indicates high referral levels in August, with GP referrals at 2,303 (a +14.4% increase on August last year, and ‘Other’ referrals at 1,387 (a +9.0% increase on August last year).

Referral Type

Number of Referrals Referrals per Working Day2015‐16 2014‐15 Variance % 2015‐16

(104 days) 2014‐15 (104 days)

Variance %

GP 1 12292 11613 5.8% 118.2 111.7 5.8%Other 2 3591 3728 ‐3.7% 34.5 35.8 ‐3.7%Excluded 3 3551 3493 1.7% 34.1 33.6 1.7%Total 19434 18834 3.2% 186.9 181.1 3.2%

4 | P a g e

3.2 When comparing referrals per working day to the same period last year, G.P. referrals are up in the following specialties by >10%:

Referrals per Working Day Change Versus Previous Year

Pain Management group 1.2 per working day +0.5 (64.0%)

General Medicine group 12.9 per working day +2.2 (20.9%)

Paediatrics 4.6 per working day +0.8 (22.3%)

4. Acute Contract Performance – East Lancashire Hospitals NHS Trust 4.1 The contract monitoring performance summary is detailed in Appendix 2. The main

points of delivery are summarised below with the positive figures indicating variance over plan.

Point of delivery Financial Variance Activity Variance £k % % A and E (inc Minor Injuries Unit) +£31K +1.3% +17 +0.1%

Elective (Inpatient Elective and Day Cases) +£173K +2.9% +568 +9.8%

Non Elective inc. ‘Non Elective Non‐Emergency’[1] +£763K +6.4% +210 +2.5%

Outpatients (inc procedures) +£157K +3.1% +1,661 +3.3%[1] Includes financial adjustments for the Non‐Elective Threshold / Marginal rates / Ambulatory Care

4.2 Elective admissions are reporting an overtrade of +£173k (+2.9%). At specialty level, the greatest overtrade is reported under the Medical Specialties group +£145k (+14%). Also over trading are Trauma and Orthopaedics +£78k (+6%) and Urology +£30k (+9%). The only specialty showing a substantial under trade is Cardiology -£97k (-20%).

4.3 Elective plans in Pain Management and Trauma and Orthopaedics have been set below

last year’s outturn (-2%) and (-16%) respectively, as it was believed that the Muscular-Skeletal case for change would reduce the numbers into the service. To date, this has proved achievable in Pain Management (-9 spells, -6%), but not in Trauma and Orthopaedics (+104 spells, +19%). However, a shift is expected over the next few months.

4.4 The non-elective (including non-elective non-emergency) activity, shows performance is

above cumulative plan by +210 spells or +£763k. The pressure is due to increased activity in longer stay patients with more complex needs, particularly in Medical Specialties.

4.5 Medical Specialty Emergency admissions are substantially above plan in respect of:

• COPD related HRGs o +£160K (+53.1%) [+93 spells, +62.4%]

• Pneumonia related HRGs o +£106K (+25.2%) [+37 spells, +21.9%]

• Unspecified Acute Lower Respiratory Infection o +£60K (+63.3%) [+44 spells, +64.1%]

• Heart Failure or Shock o +£40K (+22.8%) [+25 spells, +31.7%]

• Admission for Unexplained Symptoms

5

5 | P a g e

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9.2 Appendix 5 outlines the current reporting schedule on activity and performance. This indicates that the majority of service lines are reporting lower than planned levels of activity.

9.3 LCFT has advised that the underperformance in the Adult Learning Disability Service,

Community Stroke Service, Diabetes Specialist Nursing Service, Podiatry and Tissue Viability Service is due to significant capacity issues at the Trust. Long term sickness and significant vacancies in quarter 1 have affected activity levels. However, most vacancies have now been recruited to and an improvement in quarter 2 data is expected. This will be carefully monitored going forward.

9.4 The BwD CCG services where no activity was being recorded has now been rectified by

the Trust. However, this highlights significant underperformance in Community IV Therapy, Ear Care and Ulcer & Vascular. Further exceptions will be raised with the Trust and an update will be provided in a future edition of the report.

10. Other Community Services

10.1 General Practitioners with Special Interests (GPwSI) work on a block contract basis.

Appendix 6 details activity and performance against plan demonstrating variances against activity plan by provider. Commissioners continue to work closely with the GPwSI providers to monitor performance.

10.2 The new Integrated Eye Service launched on 5th October 2015 and is a single provider

who leads multiple providers and following a service redesign project which has created a new integrated eye care pathway and service. The prime provider is East Lancashire Hospitals NHS Trust (ELHT) and delivered by the Integrated Eye Team which includes, Local Optical Committee, Pennine Lancashire Eye Care Limited (local Optometrists) and GP with Special Interest (GPwSI), based in the community.

10.3 The Integrated Skin Service Redesign Project was established in March 2015 and has

developed a plan for a multi-provider model with a prime provider. The project includes Patients and representatives from Primary Care who contribute and attend monthly implementation meetings. The aim of the service redesign is to develop an innovative and integrated skin service across primary, community and secondary care services across the Pennine Lancashire footprint. This project has been identified in the Commissioning Intentions for 2016/17. A paper will be presented to the Blackburn with Darwen Executive in October to agree a Clinical Lead for this project.

11. General Practice Out of Hours Service

11.1 The Out of Hours service is a block contract with activity profiles based on a 2 year average of activity. The table below shows activity for Blackburn with Darwen.

8 | P a g e

GP Out of Hours Service (ELMS) – August 2015

11.2 The total activity is performing above plan when compared to the same period last year with the main increases in the Dr Advice service. The detailed monthly performance is contained in graphical form in Appendix 7.

12. Recommendation

12.1 The Governing Body is requested to note the contents of the report and the supporting

appendices. Mr Roger Parr Chief Finance Officer 28th October 2015

2015/16 2014/15 Status 2015/16 2014/15 StatusAttendances 4,572 4,724 ‐152 ‐3.2% G 11,180 11,580 ‐400 ‐3.5% GDr Advice 1,994 1,295 699 54.0% R 4,876 3,205 1,671 52.1% RHome Visits 1,116 1,089 27 2.5% A 2,729 2,597 132 5.1% RTotal 7,682 7,108 574 8.1% R 18,786 17,382 1,404 8.1% R

Data Source: Monitoring report provided by East Lancashire Medical Services (ELMS)

Year to date ‐ Activity Full Year Forecast ‐ ActivityVariance Variance

9 | P a g e

Appendix 1

BwD CCG GP Referrals to ELHT by Specialty – August 2015 (Year to Date)

Specialty

Number of Referrals Referrals per Working Day GP

Referrals 2015‐16

GP Referrals 2014‐15

Variance Quantity

Variance %

2015‐16 (104 days)

2014‐15 (104 days)

Variance %

General Surgery group 4 1960 1942 18 0.9% 18.85 18.67 0.9%

E.N.T. 1020 1171 ‐151 ‐12.9% 9.8 11.3 ‐12.9%

T & O 964 978 ‐14 ‐1.4% 9.3 9.4 ‐1.4%

Other Specialty group 5 524 427 97 22.7% 5.0 4.1 22.7%

Gynaecology 1324 1243 81 6.5% 12.7 12.0 6.5%

Cardiology 636 581 55 9.5% 6.1 5.6 9.5%

Dermatology 879 825 54 6.5% 8.5 7.9 6.5%

Rheumatology 268 273 ‐5 ‐1.8% 2.6 2.6 ‐1.8%

Paediatrics 478 391 87 22.3% 4.6 3.8 22.3%

Obstetrics 855 795 60 7.5% 8.2 7.6 7.5%

Urology 607 588 19 3.2% 5.8 5.7 3.2%

Pain Management group 6

123 75 48 64.0% 1.18 0.7 64.0%

General Medicine group 7 1340 1108 232 20.9% 12.9 10.7 20.9%

Ophthalmology 1314 1216 98 8.1% 12.6 11.7 8.1%

Grand Total 12292 11613 679 5.8% 118.2 111.7 5.8%

Data Source Ref: Referrals to Consultant-Led clinics in ELHT Referrals dataset Definitions:

GP Referrals into Consultant-led clinic from a GP Other Referrals into Consultant-led clinic from non-GP medical professional (e.g.

Consultant, Nurse Specialist) Excluded Referrals into Consultant-led clinic from other sources (e.g. Self-Referral, A&E

department, Midwifery)

SpecialtyGroupings:

General Surgery Group4

General Surgery, Breast Assessment, Vascular Surgery

Other Specialty group 5

Cardiothoracic Surgery, Paediatric Respiratory, Community Paediatrics, Endocrinology, Clinical Haematology, Clinical Genetics, Rehabilitation, Palliative Medicine, Medical Oncology, Child & Adolescent Psychotherapy, Radiotherapy

Pain Management group 6

Pain Management and Anaesthetics

General Medicine Group7

General Medicine, Gastroenterology, Diabetic, Thoracic and Elderly Medicine

10 | P a g e

Appendix 2

East Lancashire Hospitals Trust for BwD CCG: Contract Monitoring August 2015 (Year to Date)

Point of Delivery (POD) Activity Plan

Activity Actual

Activity Varian‐ce Cost Plan Cost Actual Cost Variance

Activity Varian‐ce

%

Cost Varian‐ce

%

A&E Accident & Emergency 23,587 23,567 ‐20 £2,397,693 £2,427,034 £29,340 ‐0.1% 1.2%

A&E ‐ Minor Injuries Unit 879 916 37 £50,825 £52,963 £2,138 4.2% 4.2%

A&E Total 24,466 24,483 17 £2,448,518 £2,479,997 £31,479 0.1% 1.3%

Pathology Total 540,276 555,837 15,561 £1,167,117 £1,177,937 £10,821 2.9% 0.9%

Block Contract Total £5,762,791 £5,762,791

CQUIN Total £946,521 £946,521

Critical Care Total 1,076 1,042 ‐34 £257,624 £268,908 £11,284 ‐3.2% 4.4%

Radio‐logy

Direct Access 9,234 9,308 74 £362,166 £383,704 £21,539 0.8% 5.9%

Outpatients 10,087 10,030 ‐57 £728,847 £757,745 £28,898 ‐0.6% 4.0%

Radiology Total 19,321 19,338 17 £1,091,013 £1,141,450 £50,437 0.1% 4.6%

Elective In Patient Daycase 4,599 5,111 512 £3,329,491 £3,606,909 £277,418 11.1% 8.3%

In Patient Elective 1,198 1,254 56 £2,603,569 £2,499,500 ‐£104,069 4.6% ‐4.0%

Elective Total 5,797 6,365 568 £5,933,060 £6,106,409 £173,349 9.8% 2.9%

Excess Bed Days

Elective Excess Bed Days 332 246 ‐86 £74,233 £54,070 ‐£20,163 ‐25.9% ‐27.2%

Non‐Elective Non‐Emergency Excess Bed Days

224 388 164 £70,596 £97,364 £26,768 73.6% 37.9%

Non‐Elective Excess Bed Days 3,392 2,921 ‐471 £715,762 £619,292 ‐£96,470 ‐13.9% ‐13.5%

Excess Bed Days Total 3,948 3,555 ‐393 £860,591 £770,726 ‐£89,865 ‐10.0% ‐10.4%

Rehabilitation Total 1,822 2,330 508 £547,582 £691,981 £144,398 27.9% 26.4%

Non Elective

Non‐Elective 5,964 6,224 260 £9,203,385 £10,028,368 £824,983 4.4% 9.0% Non‐Elective Same Day Emergency Care

554 529 ‐25 £434,879 £422,380 ‐£12,498 ‐4.5% ‐2.9%

Non‐Elective Short Stay 716 758 43 £484,739 £517,387 £32,649 6.0% 6.7%

NEL Threshold Adjustment 0 0 0 £0 £0 £0

Non Elective Total 7,233 7,511 278 £10,123,003 £10,968,136 £845,133 3.8% 8.3% Non Elective Non‐Emergency Total

1,189 1,121 ‐68 £1,848,280 £1,766,497 ‐£81,783 ‐5.7% ‐4.4%

Out‐patient

Outpatient First Attendances 13,789 14,169 380 £1,888,269 £1,912,619 £24,349 2.8% 1.3%

Outpatient Follow‐up Attendances

27,601 28,213 612 £2,000,163 £2,059,400 £59,236 2.2% 3.0%

Outpatient Procedures 8,761 9,430 669 £1,185,294 £1,258,464 £73,169 7.6% 6.2%

Outpatient Total 50,151 51,812 1,661 £5,073,727 £5,230,482 £156,755 3.3% 3.1%

Total £36,059,826 £37,311,834 £1,252,007 3.5%

Other Total £4,384,425 £4,541,095 £156,671 3.6%

Grand Total £40,444,251 £41,852,929 £1,408,678 3.5%

Data Source: Month 5 Data, based upon version 2 of the CSU Contract Monitoring Pivot updated 7th October 2015

11 |

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Appendix 4

Inpatient and Daycase Waiting List Source : ELHT Performance Report

Current Month ‐ August 2015 Previous Month ‐ July 2015

Specialty 0‐<6 Weeks

6‐<13 Weeks

13‐<20 Weeks

20 + Weeks

Grand Total

0‐<6 Weeks

6‐<13 Weeks

13‐<20 Weeks

20 + Weeks

Grand Total

Variance %age +/‐

General Surgery 604 186 47 13 850 622 199 34 10 865 ‐15 ‐1.7% Urology 196 165 35 6 402 251 83 15 0 349 53 15.2% Breast Care 31 20 2 0 53 50 10 6 1 67 ‐14 ‐20.9% Orthopaedics 450 234 64 12 760 513 224 39 11 787 ‐27 ‐3.4% ENT 177 121 44 27 369 207 140 48 18 413 ‐44 ‐10.7% Ophthalmology 373 207 59 21 660 421 214 65 12 712 ‐52 ‐7.3% Oral Surgery / Maxillo Facial 292 76 22 2 392 273 83 8 2 366 26 7.1% Medical Oncology 0 0 0 0 0 0 0 0 0 0 0 N/A Clinical Oncology 3 0 0 0 3 0 0 0 0 0 3 N/A Surgical Division 2126 1009 273 81 3489 2337 953 215 54 3559 ‐70 ‐2.0% General Medicine 583 6 2 1 592 634 4 1 1 640 ‐48 ‐7.5% Rehabilitation 0 0 0 0 0 0 0 0 0 0 0 N/A Cardiology 133 53 5 0 191 144 27 5 0 176 15 8.5% Dermatology 0 0 0 0 0 0 0 0 0 0 0 N/A Thoracic Medicine 21 0 0 0 21 17 0 0 0 17 4 23.5% Nephrology 2 0 0 0 2 0 2 0 0 2 0 0.0% Medical Division 739 59 7 1 806 795 33 6 1 835 ‐29 ‐3.5% Gynaecology 182 66 10 1 259 216 55 8 1 280 ‐21 ‐7.5% Genito Urinary Medicine 0 0 0 0 0 0 0 0 0 0 0 N/A Family Care Division 182 66 10 1 259 216 55 8 1 280 ‐21 ‐7.5% Interventional Radiology 0 0 0 0 0 0 0 0 0 0 0 N/A Pain Management 13 66 16 1 96 60 54 14 0 128 ‐32 ‐25.0% Rheumatology 42 45 3 0 90 63 27 1 0 91 ‐1 ‐1.1% Haematology 2 0 0 0 2 2 1 0 0 3 ‐1 ‐33.3% Diagnostic & Clinical Support 57 111 19 1 188 125 82 15 0 222 ‐34 ‐15.3% Total 3104 1245 309 84 4742 3473 1123 244 56 4896 ‐154 ‐3.1%

13 | P a g e

Appendix 5 LCFT: Service Line Activity against Plan – August 2015

Service Line

Year to date ‐ Activity Full Year ‐ Activity Year‐on‐Year Comparison Plan Actual Variance Status^ Plan Forecast 15/16 14/15 Variance

Adult Learning Disabilities 878 719 ‐159 ‐18.1% 2,096 1,720 719 867 ‐148 ‐17.0% Community IV Service BwD 764 16 ‐748 ‐97.9% 1,825 38 16 201 ‐185 ‐92.0% Children's Learning Disabilities 399 406 7 1.8% 952 971 406 437 ‐31 ‐7.0% Chronic Fatigue Syndrome 21 104 83 388.2% 51 249 104 41 63 153.0% Community Matrons 5377 6,375 998 18.6% 12,837 15,250 6,375 5316 1,059 19.9% Community Neurological Service 0 81 81 N/A 0 194 81 16 65 420.7% Community Respiratory Service 0 64 64 N/A 0 153 64 0 64 N/A Community Stroke Service 2543 1,811 ‐732 ‐28.8% 6,071 4,332 1,811 2487 ‐676 ‐27.2% Dermatology 2195 2,369 174 7.9% 5,241 5,667 2,369 2291 78 3.4% Diabetes Specialist Nursing Service 2448 1,671 ‐777 ‐31.7% 5,843 3,997 1,671 2296 ‐625 ‐27.2%

District Nursing 43727 37,873 ‐5,854 ‐13.4% 104,387 90,598 37,873 41569 ‐3,696 ‐8.9% District Nursing (Out of Hours) 2946 3,924 978 33.2% 7,032 9,387 3,924 3851 73 1.9% Ear Care 2120 278 ‐1,842 ‐86.9% 5,061 665 278 2109 ‐1,831 ‐86.8% Heart Failure Service 0 0 0 N/A 0 0 0 0 0 N/A Healthy Legs 464 438 ‐26 ‐5.6% 1,108 1,048 438 462 ‐24 ‐5.1% Intermediate Care Services 3904 5,023 1,119 28.7% 9,319 12,016 5,023 4241 782 18.4% Minor Injury 626 736 110 17.6% 1,494 1,761 736 539 197 36.6% Oxygen Service* 1617 1,366 ‐251 ‐15.5% 3,861 3,268 1,366 1609 ‐243 ‐15.1% Podiatry 10695 8,770 ‐1,925 ‐18.0% 25,531 20,979 8,770 10399 ‐1,629 ‐15.7% Pulmonary Rehabilitation 2932 3,020 88 3.0% 6,999 7,224 3,020 2881 139 4.8% Rapid Assessment Team 7499 7,678 179 2.4% 17,902 18,367 7,678 8814 ‐1,136 ‐12.9% Tissue Viability Service 463 359 ‐104 ‐22.4% 1,104 859 359 449 ‐90 ‐20.1% Treatment Rooms 25359 29,327 3,968 15.6% 60,539 70,155 29,327 26323 3,004 11.4% Ulcer & Vascular 2288 624 ‐1,664 ‐72.7% 5,461 1,493 624 1946 ‐1,322 ‐67.9% Grand Total 119,264 113,032 -6,232 -5.2% à 284,714 339,096 113,032 119,142 -6,110 -5.1%

Reporting Tolerances

Under plan >‐5% to <+5%

Over Plan >+5%

Close to plan >‐5% to <+5%

Data Source: LCFT Community Schedule 6 Monitoring Contacts (both Face‐to‐Face (F2F) and Non‐F2F, First and Follow‐Ups, including Group contacts)

LDS = Learning Disability Service C&EL CITT = Central & East Lancs Community Intravenous Therapy Team TR = Treatment Room CPC = Cost per Case ^ Trend direction vs previous month. = within 5%

Page 1

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Governing Body Meeting Page 1

Title of Paper: Quality, Performance and Effectiveness Report





Y


Y

To improve services and tackle inequality, evidence best practice to inform decisions and root out poor practice. Y


Y


Delivering high quality Primary Care at scale and improving access Y



Access to Re-ablement and Intermediate Care Y




Scheduled Care Y

Quality Y

Clinical Lead: Malcolm Ridgway, Clinical Director for Quality and Effectiveness

Senior Lead Manager Kim Smith, Head of Quality

Finance Manager N/A



Financial Implications N/A

Risk Identified N/A

Report authorised by Senior Manager: Malcolm Ridgway, Clinical Director for Quality and Effectiveness

Decision Recommendations This report provides the Clinical Commissioning Group (CCG) Governing Body with an update on the Quality, Performance and Effectiveness information of the main commissioned services as at August 2015, Month 5.




4TH NOVEMBER 2015

QUALITY, PERFORMANCE AND EFFECTIVENESS REPORT

1.0 Introduction The following report contains information on CCG performance as well as provider quality performance against contractual obligations throughout the month of August 2015. The report focuses on exceptions and the progress of associated recovery plans collated from a range of sources including but not limited to: provider board reports; Midlands and Lancashire Commissioning Support Unit (MLCSU) Business Intelligence; provider quality submissions; and Clinical Commissioning Group (CCG) staff exception reports. Information from external bodies such as the Health & Social Care Information Centre (HSCIC), NHS England and Advancing Quality (AQ) is also included, and where appropriate, additional data focusing on other CCG patients is provided to give a broader perspective of services where Blackburn with Darwen (BwD) CCG is the Lead Commissioner. 2.0 Lancashire Care Foundation Trust – Mental Health Services 2.1 Improving Access to Psychological Therapies The notional 1.25% Improving Access to Psychological Therapies (IAPT) Prevalence target was not met at Trust level in August 2015, with performance at 1.15%. Performance for BwD was 1.02% in August 2015, with year to date (YTD) Prevalence now under trajectory, to meet the end of year 15% target at 6.10%. The notional 1.25% target for IAPT Prevalence was achieved for three CCG areas in August 2015: Chorley & South Ribble, Fylde & Wyre, and Lancashire North. Two additional CCG areas, West Lancashire and Fylde & Wyre, are currently under trajectory on a YTD position; however, performance in Fylde & Wyre shows improvement, meeting the notional 1.25% prevalence target in July and August 2015. Lancashire Care Foundation Trust (LCFT) are reporting that the month of August is historically a month were performance decreases as result of reduced patient availability and staff leave. The 50% Recovery target was once again not met for any CCG area in August 2015, with Trust performance of 35.5% and a performance for BwD of 32.2%. Recovery rates show continued fluctuations across teams, however, this may be due to data issues associated with the ongoing IAPTus data cleaning exercise. The Trust are confident performance will improve when the IAPTus system becomes more established and is fully utilised by clinicians; therefore, the Trust are confident they will meet the Recovery target by Q3. Positive feedback about the system has already been articulated by clinical staff, particularly around the reduction in time to input records and the wealth of real time information available to clinicians. The Trust also has plans in place to address Recovery rates, for example LCFT are looking at good practice within the service to see if this can be applied across Lancashire wide. The Trust are also developing a new report on reliable improvement, which measures the degree of improvement made by patients. For patients who fall short of Recovery, this alternative measurement is particularly valuable to recognise the progress made during treatment. The process to develop this report is however, taking longer than initially anticipated. As has previously been reported, following the publication of “Improving Access to Mental Health Services by 2020” (NHS England and the Department of Health, 2014), a set of new mental health access and waiting time standards have been introduced across the NHS in England for 2015/16. The standard relating to waiting times is for 75% of people referred to IAPT services to be treated within 6 weeks of referral, and 95% to be treated within 18 weeks of referral. LCFT are not currently able to report definitive completed waiting time data until IAPTus has been fully established, however this data is expected to be available retrospectively. In the interim LCFT provide IAPT waiting list numbers


by present length of wait. As at the end of August 2015, 72.0% of patients were waiting less than 6 weeks and 94.9% waiting less than 18 weeks. Although not a representation of actual waiting times for IAPT services, the data indicates a continued improvement from the previous figures reported in June 2015, which indicated 27.2% of patients waiting less than 6 weeks and 72.3% waiting less than 18 weeks. Some of this apparent improvement may be due to the IAPTus data cleansing exercise, however the LCFT have reported that the Trust is also working on a number of strategies to improve waiting times, including online and telephone therapy alongside active management of backlogs. The Trust aims to meet the 6 week target by the end of September 2015. The BwD, Fylde & Wyre, Preston and Burnley areas have the longest waits in Lancashire and these are receiving focused attention. CCGs in all areas, with the exception of Lancs North, have been successful with applications for waiting list improvement funding and the Trust are working with those CCGs to develop waiting list initiatives. 2.2 Care Programme Approach 7 day follow-up The target for 95% of patients under the care of adult mental illness specialties to be followed up within seven days of discharge from psychiatric in-patient care (Care Programme Approach (CPA)), was met for 5 of the 8 Lancashire CCGs in August 2015, with Trust performance at 95.2%. All BwD patients in August 2015 were followed up within 7 days, with a YTD position of 100%. The failure in the Chorley & South Ribble and Lancashire North CCG areas relates to two patients in each area, with the failure in West Lancashire CCG area relating to a single patient. Exception reports have been shared with those CCGs concerned. 2.3 Memory Assessment Service Following the phasing out of unfunded capacity over baseline (additional hours and weekend clinics) from Q2, LCFT are now reporting against a 6 week waiting time target, in common with national standards for IAPT services, rather than the 4 week target reported in April to June 2015. Across the Trust, 93% of patients were seen within 6 weeks by the MAS, with the 70% target being met for all CCG areas. BwD performance was 91%. 3.0 Lancashire Care Foundation Trust – Community Services No issues have been reported with regards to the provider’s Month 5 Quality submission. The MLCSU co-located Quality team continue to attend regular contract review meetings together with CCG colleagues. Members of the co-located teams in both CCGs continue to work together to explore ways of address common issues in a systemic way across the entire provider. Currently, the teams are working with the Trust to improve workforce reporting. There has been some limited improvement in data flows to support achievement of contractual requirements and our expectation is that these improved data flows will also facilitate more detailed quality reporting in future editions of this report. 4.0 East Lancashire Hospitals Trust 4.1 Accident and Emergency 4 Hour Performance against the 4 hour Accident and Emergency (A&E) target in August 2015 was 93.32% against the 95% target. As previously reported a Quality Review was held on the 19th August 2015 with East Lancashire Hospitals Trust (ELHT) around A&E performance to discuss key issues of medical staffing, capacity, escalation and flow. ELHT provided a number of detailed reports at the meeting which highlighted the events and action taken leading up to and during the 8th, 9th and 10th August 2015 where performance had declined. It was identified that the root cause was a lack of medical staff within the department, as well as a new rotation of junior doctors, the holiday period and flow into the Medical Assessment Unit and wards. A number of actions were agreed with ELHT and a series of system wide actions have been captured within the 30 to 90 day System Resilience Plan and are being monitored through the System Resilience Group. Improvements in performance were noted in the first half of September 2015, with performance averaging over 96%. Concerns were raised around the sustainability of improved performance as additional staff and management had been brought in to provide additional focus. In the second half of September 2015, performance deteriorated with the month end position falling below the 95% target.


4.2 Cancelled Operations (28 day rule) There was 1 cancellation on the day of surgery where a patient was not offered another binding appointment within 28 days, in August 2015. YTD there have been 5 breaches of the 28 day rule in 2015/16 against a zero tolerance. 4.3 Ambulance Handover There has been a reduction in the number of breaches over 30 minutes in August 2015, compared to the previous month; however breaches over 60 minutes have increased. Financial penalties are being applied in 2015/16 and the financial risk to the Trust in August 2015 is £83,200, which includes a penalty for 133 missed handover stamps. Work continues across the Health Economy to improve ambulance handover performance led by the Systems Resilience Group. 4.4 Stroke Performance against the 4 hour stroke target as reported in the Sentinel Stroke National Audit Programme (SSNAP) data shows Trust performance at 48% against a revised local target of 65%. At the Quality Review Meeting on the 6th October 2015 ELHT advised that they have concerns regarding their data quality and data completeness and are undertaking a data cleansing exercise. ELHT are currently carrying out a gap analysis against the service specification and have produced an action plan to address some of the issues identified in SSNAP. Additional resource is being identified to support the processing of data. 5.0 North West Ambulance Service All Red emergency call targets were met at both BwD CCG and Trust level in August 2015, with all YTD performance targets also currently being met. It should be noted that the CCG’s Quality Premium is linked to performance across the entire North West Ambulance Service (NWAS) operational footprint for Red 1 calls on a YTD position, which is meeting the 75% target with a performance of 77.90%. Due to underperformance against national ambulance targets throughout 2014/15, NWAS were instructed by the Trust Development Authority (TDA) to meet the Red emergency call targets for Q1 2015/16, which was achieved. To achieve this however, NWAS had been conducting daily teleconferences with sector managers put on shifts and other operational managers on vehicles as paramedics. Paramedic admin days were also cancelled with all available staff either on the road, or if no vehicles were available, in hospitals acting as liaison and checking crews. Concerns had therefore been raised regarding the sustainability of this improved emergency call response time performance; however, significant further investment into NWAS has now been agreed by the North West CCGs and an additional 400 staff and 60 extra ambulance/response vehicles is planned to ensure that this performance is maintained. 6.0 Primary Care Following the CCG taking on Co-commissioning of primary care in April of 2105, the CCG’s Quality Performance and Effectiveness Committee (QPEC) now monitors the quality of services provided by General Practices. The CCG has always had the responsibility to assist NHS England regarding this but still does not have a direct role in the individual performance of practitioners. Performance and Quality information has started to be forwarded to the CCG from NHS England and, together with other sources of intelligence, will be used in 2015/16 to inform QPEC and the Governing Body as to how practices are performing, as well as to determine the priorities for practice quality and development visits. The first practice quality and development visit has been undertaken and a quality improvement plan submitted by the practice. This will be monitored with updates required on a 6 monthly basis. 7.0 NHS Constitution A full breakdown of August 2015 NHS Constitution performance has been provided on the following pages 5 to 7, including exception information.

G Governing Boody Meeting Page

5


*Due to some initial data issues experienced following the move to monthly A&E reporting by NHS England in 2015/16, the Aristotle YTD position may not match local reporting (the issue was resolved from the August 2015 data onwards)

Level Period TargetAugust

2015 Position

Year to Date

Position

CCG Aug 2015-2016 0 0 0

CCG Q1 2015/16 95.00% 100.00% 100.00%

CCG Aug 2015-2016 0 0 0

ELHT Aug 2015-2016 0 0 0

ELHT Aug 2015-2016 9,093 46,096

ELHT Aug 2015-2016 16,056 82,496

Metric

NHS Constitution support measures

Mixed Sex Accommodation Breaches

1067: Mixed sex accommodation breaches - All Providers

Mental health

138: Proportion of patients on (CPA) discharged from inpatient care w ho are follow ed up w ithin 7 days

Referral To Treatment waiting times for non-urgent consultant-led treatment

1839: Referral to Treatment RTT - No of Incomplete Pathw ays Waiting >52 w eeks

A&E waits

1928: 12 Hour Trolley w aits in A&E

Activity Measures

1927: A&E Attendances: All Types

A&E

1926: A&E Attendances: Type 1


7.1 A&E waits Performance was 93.32% for ELHT in August 2015 against the 95% A&E 4 Hour target, with YTD performance at 93.70% (source: Aristotle) (please see section 4.1 on page 3 for more information). 7.2 Cancer - 31 days (Surgery) Although the standard for 94% of patients to receive ‘subsequent treatment for cancer within 31 days (surgery)’ was met for BwD patients in August 2015, at 100%, YTD performance remains under trajectory at 92.31%. 7.3 Cancer – 62 days (Standard) The standard for 85% of patients to receive ‘first definitive treatment for cancer within 62 days’ was not met for BwD patients in August 2015, with performance at 84%, YTD performance however, remains above target at 87.31%. August 2015 performance relates to 4 breaches, 2 at ELHT and 2 at Lancashire Teaching Hospitals Foundation Trust. 7.4 Activity Measures Activity measures have been provided as a high level overview only. Activity performance is covered in detail by the Contracting and Business Intelligence Report, which is available from Amanda Atkin, Contract Management Locality Lead.

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8.4 Quality and Financial Gateways The CCG is required to demonstrate effective use of public resources while undertaking its business. Failure to do so will result in no Quality Premium payment being made. NHS England reserve the right to not make any Quality Premium payment where they assess that:

a) In the view of NHS England, during 2015/16 the CCG has not operated in a manner that is consistent with the obligations and principles set out in Managing Public Money (2013)

b) The CCG ends the 2015/16 financial year with an adverse variance against the planned surplus, breakeven or deficit financial position, or requires unplanned financial support to avoid being in this position

c) The CCG receives a qualified audit report in respect of 2015/16 Malcolm Ridgway Clinical Director for Quality and Effectiveness 27th October 2015

Level Period Target

Blackburn With

Darwen CCG

Blackpool CCG

Chorley & South

Ribble CCG

East Lancashire

CCG

Fylde & Wyre CCG

Greater Preston CCG

Lancashire North CCG

Provider Aug 15‐16 95% 93.317% 96.855% 95.082% 91.139% 95.978% 95.082% 95.978%

CCG Aug 15‐16 93.00% 95.556% 92.50% 98.438% 94.702% 93.182% 95.588% 88.06%

CCG Aug 15‐16 93.00% 96.108% 96.982% 95.484% 95.876% 95.652% 95.113% 86.313%

CCG Aug 15‐16 94.00% 100.00% 100.00% 96.429% 95.918% 97.222% 96.552% 94.737%

CCG Aug 15‐16 94.00% 100.00% 94.118% 93.75% 100.00% 90.476% 100.00% 94.118%

CCG Aug 15‐16 96.00% 98.507% 97.938% 96.629% 98.425% 98.81% 96.875% 100.00%

CCG Aug 15‐16 98.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

CCG Aug 15‐16 85.00% 84.00% 83.051% 84.615% 88.158% 83.333% 73.81% 96.154%

CCG Aug 15‐16 90.00% 92.308% 80.00% 100.00% 80.00% 75.00% 75.00% 100.00%

CCG Aug 15‐16 100.00% 93.333% 81.818% 94.444% 95.00% 95.652% 96.296%

CCG Aug 15‐16 95.00% 95.149% 94.70% 93.122% 92.591% 88.603% 93.545% 91.448%

Provider Aug 15‐16 95.00% 95.109% 95.109% 95.109% 95.109% 95.109% 95.109% 95.109%

CCG Aug 15‐16 75.00% 80.851% 84.211% 65.909% 61.94% 62.00% 86.364% 77.778%

Provider Aug 15‐16 75.00% 77.652% 77.652% 77.652% 77.652% 77.652% 77.652% 77.652%

CCG Aug 15‐16 75.00% 76.977% 83.42% 72.472% 70.011% 54.32% 73.779% 64.083%

Provider Aug 15‐16 75.00% 75.42% 75.42% 75.42% 75.42% 75.42% 75.42% 75.42%

CCG Aug 15‐16 1.00% 0.175% 0.582% 0.778% 0.416% 0.927% 0.512% 1.045%

CCG Aug 15‐16 90.00% 92.524% 93.227% 91.429% 93.488% 92.421% 90.481% 84.792%

CCG Aug 15‐16 95.00% 97.525% 95.402% 96.661% 96.996% 96.212% 96.57% 96.828%

CCG Aug 15‐16 92.00% 97.179% 95.64% 95.699% 96.945% 95.331% 95.331% 94.204%

Summary - NHS Constitution 2015-16

MetricWest

Lancashire CCG

NHS Constitution measures

A&E waits

431: 4‐Hour A&E Waiting Time Target (Monthly Aggregate for Total Provider) 94.807%

Cancer waits – 2 week wait

17: % of patients seen within 2 weeks for an urgent referral for breast symptoms (MONTHLY) 96.774%

191: % Patients seen within two weeks for an urgent GP referral for suspected cancer (MONTHLY) 94.186%

Cancer waits – 31 days

25: % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) (MONTHLY) 100.00%

26: % of patients receiving subsequent treatment for cancer within 31 days (Surgery) (MONTHLY) 88.889%

535: % of patients receiving definitive treatment within 1 month of a cancer diagnosis (MONTHLY) 96.667%

1170: % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) (MONTHLY) 100.00%

Cancer waits – 62 days

539: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHLY) 85.185%

540: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (MONTHLY) 80.00%

541: % of patients receiving treatment for cancer within 62 days upgrade their priority (MONTHLY) 100.00%

Category A ambulance calls

546: Category A calls responded to within 19 minutes 87.261%

95.109%

1887: Category A Calls Response Time (Red1) 56.25%

77.652%

1889: Category A (Red 2) 8 Minute Response Time 56.036%

75.42%

Diagnostic test waiting times

1828: % of patients waiting 6 weeks or more for a diagnosic test 0.567%

Referral To Treatment waiting times for non‐urgent consultant‐led treatment

61: Referral to Treatment RTT (Adjusted Admitted) 93.981%

62: Referral to Treatment RTT (Non‐Admitted) 95.846%

1291: Referral to Treatment RTT (Incomplete) 95.605%

http://bi.xfyldecoast.nhs.uk/_vti_bin/ReportServer/http://bi.xfyldecoast.nhs.uk/All_Reports/Latest Position Report.rdl

Summary - NHS Constitution 2015-16

Level Period Target

Blackburn With

Darwen CCG

Blackpool CCG

Chorley & South

Ribble CCG

East Lancashire

CCG

Fylde & Wyre CCG

Greater Preston CCG

Lancashire North CCG

Provider Aug 15‐16 0 0 0 0 0 0 0 0

CCG Q1 15‐16 95.00% 100.00% 100.00% 95.652% 95.455% 95.833% 100.00% 85.714%

CCG Aug 15‐16 0 0 0 0 0 0 0 0

CCG Aug 15‐16 0 0 0 0 1 0 0 1

Provider Aug 15‐16 9,093 7,467 16,534 34,501 25,574 16,534 25,574

Provider Aug 15‐16 16,056 16,916 19,827 45,603 36,576 19,827 39,110

NHS Constitution support measures

A&E waits

1928: 12 Hour Trolley waits in A&E 0

Mental Health

138: Proportion of patients on (CPA) discharged from inpatient care who are followed up within 7 days 94.444%

Mixed Sex Accommodation Breaches

1927: A&E Attendances: All Types 27,267

MetricWest

Lancashire CCG

Activity Measures

A&E

1926: A&E Attendances: Type 1 23,974

1067: Mixed sex accommodation breaches ‐ All Providers 0

Referral To Treatment waiting times for non‐urgent consultant‐led treatment

1839: Referral to Treatment RTT ‐ No of Incomplete Pathways Waiting >52 weeks 0

http://bi.xfyldecoast.nhs.uk/_vti_bin/ReportServer/http://bi.xfyldecoast.nhs.uk/All_Reports/Latest Position Report.rdl


GOVERNING BODGOVERNING BODY MEETING


Title of Paper: Governing Body Assurance Framework Quarterly Update





Y


Y


Y


Y









Scheduled Care Y

Quality Y

Clinical Lead: Dr Chris Clayton

Senior Lead Manager Mrs Claire Moir

Finance Manager N/A



Financial Implications Nil

Risk Identified Outlined within Appendix 1

Report authorised by Senior Manager: Mr Roger Parr

Decision Recommendations The Governing Body is requested to:

i. Note the contents of the report ii. Approve the amendment to Risk ID CO4.3 in para 3.3


Y

NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP (CCG)


WEDNESDAY 4th NOVEMBER 2015

GOVERNING BODY ASSURANCE FRAMEWORK

1. Introduction

1.1 The purpose of this report is to present NHS Blackburn with Darwen (BwD) Clinical Commissioning Group’s (CCG) Governing Body Assurance Framework (GBAF) for review and approval.

2. Background

2.1 The CCG is required to have in place a system of internal control that supports the achievement of the organisation’s strategic aims and objectives. The GBAF is a key document which links the corporate objectives to risks, controls and assurances and is the main tool that the Governing Body uses to discharge its overall responsibility for internal control.

2.2 The GBAF is designed to ensure the requirements of the annual reporting arrangements i.e. the Annual Governance Statement (AGS) are met and that principal risks to the CCG achieving its objectives are managed appropriately.

3. Strategic Risks to Corporate Objectives

3.1 There are currently 9 strategic risks contained within the GBAF:

• CO1.1 ‐ There is a risk that ineffective commissioning decisions will prevent the CCG from achieving its corporate objectives, improving health and reducing inequalities.

• CO2.1 - System-wide capacity issues may emerge that prevent the delivery of the CCG's plans and priorities.

• CO2.2 - Conflicting priorities between partners including East Lancashire CCG, the Local Authority and our providers may result in health and social care commissioning responsibilities not being aligned.

• CO3.1 - There is a risk that insufficient engagement with patients and the public on CCG priorities and service developments may lead to decisions that do not fully meet their needs and could result in a challenge to the CCG.

• CO4.1 - Inability to secure active participation from member practices for delivering the CCG's plans around primary care at scale.

• CO4.2 - Responsibility for co-commissioning primary care must be carried out within the CCG's existing financial resources - failure to manage this effectively may impact on the delivery of existing CCG plans and priorities.

• CO4.3 - Current GP workforce capacity may impact plans for future primary care delivery.


• CO4.4 - Failure to effectively manage conflicts of interests relating to the co-

commissioning of primary medical care services.

• CO.5.1 – The risk that providers deliver poor quality care and do not meet quality standards and outcomes.

3.2 The highest rated strategic risk previously reported is:

• CO4.3 GP Workforce Capacity (20) – current workforce capacity may impact plans for future primary care delivery.

It was reported to the Governing Body in September 2015, that the Quality, Performance and Effectiveness Committee (QPEC) had agreed that this risk would be reviewed to identify whether the control mechanisms were adequate/effective. This identified there are wider workforce capacity issues across the health economy, which may impact on the delivery of services.

3.3 It is therefore proposed that the risk description is amended:

CO4.3 Clinical Workforce Capacity (20) – Current clinical workforce capacity is challenged across the system:

• GP capacity may impact plans for future primary care delivery

• Nursing and therapy provision is experiencing a shortfall in key service areas

• Additional clinical workforce capacity is required to support the care sector

3.4 At a CCG level, the actions required to mitigate this risk will be to support the establishment of innovative models of care which attract interest in clinical roles within BwD and, collaboration with local colleges and universities, to generate work placements that provide the necessary job opportunities for the local population. In addition, it will require collaboration across providers to share workforce pressures and identify collective solutions.

The current controls and actions to mitigate this risk are outlined in Appendix 1.

4. On-going Review of Strategic Risks

4.1 All risks continue to be assessed and risk rated based on the CCG’s risk management strategy scoring matrix (Appendix 2). A senior member of the organisation is identified as the lead for each risk, with responsibility for monitoring and updating the status of the risk in collaboration with the Governance, Assurance and Delivery Manager, and where gaps in controls exist, ensuring action plans are in place to mitigate those gaps.

5. Future Update and Maintenance of the GBAF

5.1 The GBAF risks will continue to form part of the CCG’s full Corporate Risk Register which is presented monthly to the QPEC. The GBAF will continue to be presented to the Governing Body for review on a quarterly basis.


6. Recommendations

6.1 The Governing Body is requested to:

i. Note the contents of the report ii. Approve the amendment to Risk ID CO4.3 in para 3.3

Claire Moir Governance, Assurance and Delivery Manager 23rd October 2015

NHS Blackburn with DarwenClinical Commissioning GroupGoverning Body Assurance Framework2015/16

PAGE 9

Pauline.Milligan

Typewritten Text

Appendix 1

Governing Body Assurance Framework 2015/16 : NHS Blackburn with Darwen CCG MENU

CO1.1

Initial Current TargetLikelihood Possible Possible UnlikelySeverity Major Major MajorLevel 12 12 8Date Apr‐15 Oct‐15 Apr‐16

Action Assigned to Due Date Completed

Debbie Nixon Review monthly

Debbie Nixon 09 November 2015 PAGE 1

Innovation / Quality / Outcomes

Financial / VFMCompliance / Regulatory

Reputation

Engagement events are planned for Q3 and Q4 including event on 9 Nov 2015 to review draft Prioritisation Policy and process with patient representatives and key stakeholders. Implementation of policy will then be tested against a commissioning workstream

Corporate Objective

Risk

Controls Assurance

Gaps in Controls Gaps in Assurance

ACTION PLAN

Action Description Progress to Date

Implement process for reviewing the effectiveness of CCG's commissioning decisions

Debbie Nixon

An assurance framework/commissioning plan tracker has been produced and continues to be developed linked to QIPP/Cases for Change 2015/16

Risk Owner

• The CCG has produced an operational plan 2015/16 (underpinning the 5 year strategic plan which outlines strategic objectives and priorities for 2014/19)

• Plans developed in conjunction with Health and Wellbeing Board and the Integrated Strategic Needs Assessment (ISNA). Health and Wellbeing Strategy also informs CCGs plans and local health issues and significant barriers to improving health and reducing inequalities

• CCG Governing Body receives assurance and progress updates on implementation of the plan• Commissioning Business Group and Primary Care Commissioning Committee established with

responsibility for developing, approving and monitoring plans and business cases linked to delivery of overarching 5 year plan

• The CCG has full delegated authority from NHS England to co‐commission primary care which enables the CCG to provide a strong focus on local clinical leadership and enable optimal decision making on

CCG Governing Body receives papers and minutes from Commissioning Business GroupMonthly Contracting and Finance reportMonthly Quality, Performance and Effectiveness report5 Year Plan is aligned to Integrated Strategic Needs Assessment and Health and Wellbeing StrategyExternal assurance will be provided through NHS England Assurance Framework for CCGs process. The CCG's baseline assurance status for 2015/16 is "assured as good"CCG's Annual Plan has been assured by NHS England

• Fragmentation of the commissioning system may slow down decision making• The frequency and timeliness of performance monitoring data varies according to the measure

e.g. Potential Years of Life Lost (PYLL) figures are produced annually

Currently limited information on community services, primary care or specialist commissioning plans or performance monitoring information

There is a risk that ineffective commissioning decisions will prevent the CCG from achieving its corporate objectives, improving health and reducing inequalities

Corporate Objective 1: To extend the life of our citizens and their quality of life by adding life to years as well as years to life


CO2.1

Initial Current TargetLikelihood Possible Possible UnlikelySeverity Major Major MajorLevel 12 12 8Date Apr‐15 Aug‐15 Apr‐16


Roger Parr CompletePAGE 2

Corporate Objective

Controls Assurance


Risk Owner Roger ParrFinancial / VFM

Compliance / RegulatoryInnovation / Quality / Outcomes

Reputation

Risk

ACTION PLAN


CCG to contribute towards the fuding of Pennine Lancashire PMO function PMO function now in place

• Pennine Lancashire Clinical Transformation Board established for a number of years, provides leadership around Pennine Lancashire transformational plans

• Programme Management Office function (which CCG contributes to) is now in place to oversee delivery of Pennine Lancashire transformational plans

• Lancashire CCG Network established supported by Collaborative Arrangements Group (CAG)• Lancashire Leadership Forum established by NHS England to support the Healthier Lancashire Programme

(delivery of care in and outside of hospital). Strategic alignment of plans is expected to be published by mid‐November 2015

• NHS Accelerate Programme developed to explore innovative models of care • Pennine Lancashire Urgent Care Group established with system wide representation• Utilisation of Prime Ministers Challenge Fund (PMCF) to support improved access and patient experience

Minutes of Pennine Lancashire Clinical Transformation BoardExternal assurance provided through the NHS England "continous assurance" processStrong relationships and leadership across the health and social care economySystem Resilience Group operational and has an assured plan in place

• The frequency and timeliness of performance data varies according to the measure e.g. reducing emergency admissions through urgent care data is produced quarterly, but the comparison of performance is made year on year

• PMCF plans facing challenging timescales for delivery

Health economy‐wide plans still in developmentPriorities for joint Pennine Lancashire commissioning plans still in development

System-wide capacity issues may emerge that prevent the delivery of the CCG's plans and priorities

Corporate Objective 2: To ensure there will be no gaps, no duplication - with integrated services and partnership working; including better relationships with voluntary, community and faith sector organisations


CO2.3

Initial Current TargetLikelihood Likely Likely UnlikelySeverity Major Major MajorLevel 16 12 8Date Apr‐15 Oct‐15 Apr‐16


Claire Jackson Reviewed quarterly PAGE 9

Ops Group 09‐Nov‐15

PAGE 3


ACTION PLAN


Develop and approve Prioritisation Policy for review by CBG

Engagement event planned 9 Nov 2015 (postponed from 1 Oct 15) to review draft Prioritisation Policy and process with patient representatives and key stakeholders. Implementation of policy will then be tested against a commissioning workstream

Monitor delivery of BCF through PMO function ensuring CCG and LA risk registers are aligned CBG receive qtly update report on progress with BCF Plans

Corporate Objective

Risk

Controls Assurance

Risk Owner Debbie Nixon/Dr Chris ClaytonFinancial / VFM


Reputation

• Joint delivery of CCG's 5 year plan including the Better Care Fund plans is overseen by Programme Management Office function

• BCF plan submission sets out approach to integration of health and social care across the borough• Integrated Commissioning Group with Local Authority • Integrated Care (BCF) Programme Reporting structure in place• Programme Management Office Governance Structure in place• Proposal for more collaborative approach with East Lancs CCG to review current commissioned

services and potential joint working across Pennine Lancashire• Prioritisation policy in development which will be adopted across both EL and BwD CCGs

Better Care Fund Plan fully assuredHealth and Wellbeing Board minutesMinutes of Senior Responsible Officers GroupMinutes of Joint Commissioning Recommendations GroupCBG Better Care Fund Quarterly Update Report

• Project timescales for implementation across organisations may differ• The frequency and timeliness of performance data varies according to the measure

Priorities for joint Pennine Lancashire commissioning plans still in development

Conflicting priorities between partners including East Lancashire CCG, the Local Authority and our providers may result in health and social care commissioning responsibilities not being aligned

Corporate Objective 2: To ensure there will be no gaps, no duplication - with integrated services and partnership working; including better relationships with voluntary,


CO3.1



Iain FletcherReview at the end of each quarter

PAGE 4


ACTION PLAN

Action Description Progress to DateContinue to utlilise customer forum meetings to provide feedback on satisfaction with continuty of service

Permanent communications officer now in post

Corporate Objective

Risk

Controls Assurance

Risk Owner Iain FletcherFinancial / VFM


Reputation

• CCG has developed and agreed its Communications and Engagement Strategy for 2015/16• Plans for co‐commissioning primary care will be phased with engagement planned public, patients,

and Health and Wellbeing Board to assess needs and decide on priorities• All CCG cases for change, business plans and service specifications are subject to Equality Impact

Assessments including engagement with relevant service users • Patient Participation Group network well established and CCG actively engages with the network in the

development of its plans to seek patients' views on improvements for local health services• Good engagement with member practices with regular practice newsletters produced and Clinical Chief

Officer/Chair hold 1:1 practice visits • Engagement has been undertaken around the CCG's co‐commissioning intentions with the 4 locality

groups • 360 degree survey identifies stakeholder views on breadth and depth of engagement with CCG

• Communications and engagement strategy for 2015/16 developed• Updates to Governing Body on progress with engagement meetings/events• External assurance via NHS England ongoing assurance meetings• Results of 360 degree stakeholder survey• CCG has programme of systematic engagement with Healthwatch

Annual engagement plans and activities to be published on website

There is a risk that insufficient engagement with patients and the public on CCG priorities and service developments may lead to decisions that do not fully meet their needs and could result in a challenge the the CCG

Corporate Objective 3: To engage and encourage patients and the public to participate in everything we do and the importance of self-care and


CO4.1



Julie Kenyon/Peter Sellars 01‐Apr‐15 01/04/2015

Julie Kenyon/Peter Sellars Review quarterlyPAGE 5


ACTION PLAN

Action Description Progress to DateImplementation group to be formed to support the development of the CCG's plans for co‐commissioning of primary care services

Completed and the Primary Care Co‐Commissioning Committee met on 6th May 2015

Design group formed to support implementation of primary care strategy and co‐commissioning role Design group to meet monthly and report to PCCC/CBG

Corporate Objective

Risk

Controls Assurance

Risk Owner Debbie Nixon/Dr Malcolm RidgwayFinancial / VFM


Reputation

• CCG has developed its plans for primary care through collaboration with all constituent member practices within Blackburn with Darwen

• Local agreement has been reached through the CCG's clinical senate, the Local Authority and community trust to co‐locate and integrate service around four localities (Darwen and Blackburn East, West and North)

• Plans for a federation model for General Practice in BwD has been established; a successful bid has been made by the federation to NHSE (Prime Minister's Challenge Fund)

• The CCG has full delegated authority to co‐commission primary medical care with NHS England

• Minutes of clinical senate meetings• Minutes of Primary Care Co‐Commissioning Committee• External assurance will be via NHS England and assurance process for co‐

commissioning primary medical care services including CCG's self certification on operation of delegated commissioning arrangements

• Results of 360 stakeholder survey presented to Governing Body• CCG Governing Body to receive monthly updates on progress with co‐commissioning

• GP Federation still developing and is working with practices to consider new ways of working

Inability to secure active participation from member practices for delivering the CCG's plans around primary care at scale

Corporate Objective 4: To improve services and tackle inequality, evidence best practice to inform decisions and root out poor practice


CO4.2



Roger Parr

Review quarterly

PAGE 6

Compliance / Regulatory

Corporate Objective

Risk

Risk Owner Roger ParrFinancial / VFM

Innovation / Quality / OutcomesReputation

Controls Assurance


ACTION PLAN

Action Description Progress to DatePrimary Care Design Group implemented to support delivery of primary care strategy/co‐commissioning responsibilities

Group to include finance manager and will receive finance reports

• Programme management approach to commissioning of out of hospital care including delegated primary care functions, will ensure advantage is taken of the synergies within existing CCG projects and enable functions to be discharged

• The CCG will work with NHS England to agree a joint robust process that will achieve a high quality, transparent process standards within strong governance arrangements

• CCG has invested in a primary care function within current core management running costs which has focused on supporting practices in key quality improvement areas

• MOU between CCG and NHS England agreed and signed • Financial allocation agreed

• Application successful and CCG now has full delegated authority to co‐commission primary medical care service

• Updates from Primary Care Co‐Commissioning Committee to be provided to Governing Body and NHS England

• Major service change will require high quality estate and supportive infrastructures including IT and data sharing. CCG will review current arrangements with local partners and NHS Property Services

• Increasing pressures on NHS resources will intensify from 2015/16 • Limited availability of quality and performance data for General Practices from NHS England

Responsibility for co-commissioning primary care must be carried out within the CCG's existing financial resources - failure to manage this effectively may impact on the delivery of existing CCG plans and priorities



CO4.3

Initial Current TargetLikelihood Likely Likely PossibleSeverity Major Major MajorLevel 16 20 12Date Apr‐15 Oct‐15 Apr‐16


Peter Sellars Review quarterly

Claire Moir Review monthlyPAGE 7


ACTION PLAN

Action Description Progress to DateWorkforce development group established to review recruitment opportunitiesQPEC agreed "deep dive" to test assurances and controls on this risk Reviewed and agreed to broaden the risk definition to clinical

workforce capacity to reflect wider system issues

Engaging with Health Education NW to view opportunities to encourage GP placements in BwD

Corporate Objective

Risk

Controls Assurance

Risk Owner Malcolm RidgwayFinancial / VFM


Reputation

• Workforce Development Group established to review opportunities for recruitment and retention (short/medium term) with Health Education North West

• Prime Ministers Challenge Fund will support changes in access to primary care and help re‐model local health economy

• CCG now has full delegated authority to co‐commission primary care which enhances the CCGs remit to influence local GP workforce development in conjunction with NHS England

• CCG will support General Practice in workforce review, skill mix, and development in particular Health Education England's recent survey around practices current workforce (medical and non medical)

• New roles in primary care will be encouraged to create a sustainable workforce across primary care as a whole including increasing Advanced Nurse Practitioners and Health Care Assistants to allow GPs to become Expert Generalists and focus on more complex work. Integrated localities will support this

• Governing Body has reviewed the Primary Care Strategy which is now finalised• 5 year strategic plan approved by Governing Body and aligned to the the vision for high quality

primary care in BwD• CCG has engaged with Health Education North West to review opportunities to encourage GP

placements in BwD• Engaging with Health Education North West to review opportunities to encourage GP placements

in BwD• Currently reviewing ways of employing GPs differently and scoping how future GP portfolios are

developed • Database in development to map out GP provision, skill base and service delivery across BwD

• Increasing financial pressures on NHS resources from 2015/16 • Increasing workforce pressures including existing recruitment and retention problems • Workforce implications of CCG's plans still be be fully mapped out

(Revised) Current clinical workforce capacity is challenged across the system



CO4.4

Initial Current TargetLikelihood Possible Possible UnlikelySeverity Major Major MajorLevel 12 12 8Date Jul‐14 Oct‐15 Apr‐15

Action Assigned to Due Date CompletedClaire Moir Review quarterly

Claire Moir Complete

PAGE 8


ACTION PLAN

Action Description Progress to DateEnsure ongoing review and update of CCG's Constitution and Conflict of Interest policy to ensure co‐commissioning of primary care function is delivered effectively

Amendments to CCG constitution were approved by the CCG's Clinical Senate on 13th October 2015 and will be submitted to NHS England for approval

Provide refresher training on managing conflicts of interests for CCG committee chairs, locality GP chairs and meeting facilitators

Corporate Objective

Risk

Controls Assurance

Risk Owner Dr Chris Clayton Financial / VFM


Reputation

• CCG's constitution document provides governance framework for decision making including delegated decision making and managing conflicts of interest

• Conflict of Interest Training provided for staff by Mersey Internal Audit Agency• The CCG's Conflict of Interest Policy has been reviewed and updated following guidance from NHS

England• The CCG's constitution and existing conflicts of interest arrangement now include the remit for co‐

commissioning primary care services and have been reviewed and revised accordingly and in line with national guidelines. This includes the establishment of a Primary Care Co‐commissioning Committee to manage conflicts of interest which may arise around primary medical care services .

• The CCG has developed a Register of Procurement/Commissioning Decisions (once finalised will be published as per the CCG's policy for managing conflicts of interest)

• CCG's Constitution and Register of interests published on website• External assurance via NHS England meetings ,• Mersey Internal Audit review of the Conflict of Interest policy and its implementation within the

CCG• All CCG Committee minutes have been reviewed to ensure they comply with the CCG's policy for

managing conflicts of interest

• Existing Terms of Reference for CCG Committees continue to be reviewed to ensure roles and responsibilities for primary medical care services commissioning are clear (e.g. quality monitoring)

Failure to effectively manage conflicts of interests within co-commissioning of primary care services with NHS England



CO5.1

Initial Current TargetLikelihood Possible Possible UnlikelySeverity Major Major MajorLevel 12 12 8Date Jul‐14 Oct‐15 Apr‐15

Action Assigned to Due Date CompletedKim Smith Jul‐15

Kim Smith review monthlyPAGE 9


ACTION PLAN

Action Description Progress to DateUpdate Quality Strategy for approval by QPEC CompletedQuality and performance lead from CCG now attends Contract Quality and Performance meetings

Corporate Objective

Risk

Controls Assurance

Risk Owner Dr Malcolm RidgwayFinancial / VFM


Reputation

• Quality, Performance and Effectiveness Committee well established and meets monthly• Internal quality structures functioning well as confirmed through internal audit reports (high

assurance on performance reporting)• Monitoring assurance received through contractual route that provider cost improvement plans will

not negatively impact on quality and safety of services• Lancashire Quality Surveillance Group established and Provider Quality Accounts reviewed by QPEC• Patient experience monitored using inpatient surveys • Quality and performance lead attends monthly Community Contract Quality and Performance

meetings• Monthly scrutiny meetings to review Quality, Performance and Effectiveness Report

• QPEC minutes• Integrated Quality, Performance and Effectiveness Reports and exception reports (including

findings of CQC inspection visits)• Minutes from Contract and Performance meetings• NHS England assurance meetings (monthly) ‐ quality issues discussed• Mersey Internal Audit Review of the CCG's performance management arrangements received

"high assurance"

• Availability of quality data relating to community services is limited • Awaiting quality and performance data from NHS England to enable monitoring of general practice

There is a risk that providers deliver poor quality care and do not meet quality standards and outcomes

Corporate Objective 5: To offer effective service interventions which will provide a better experience for patients with privacy and dignity


Appendix 2 Impact Assessment Risk Grading/Severity Score

Descriptor 1 2 3 4 5

Insignificant Minor Moderate Major Catastrophic Objectives / Projects

Insignificant cost increase / schedule slippage. Barely noticeable reduction in scope or quality

<5% over budget / schedule slippage. Minor reduction in scope or quality

5-10% over budget / schedule slippage. Reduction in scope or quality

10-25% over budget / schedule slippage. Does not meet secondary objectives

>25% over budget / schedule slippage. Does not meet primary objectives

Injury Minor injury not requiring first aid

Minor injury or illness. First aid treatment needed

RIDDOR / Agency reportable

Major injuries or long term incapacity / disability (loss of limb)

Death or major permanent incapacity

Client/Patient Experience

Unsatisfactory client/patient experience not directly related to patient care

Unsatisfactory client/patient experience – readily resolvable

Mismanagement of client/patient care

Serious mismanagement of client/patient care

Totally unsatisfactory client/patient outcome or experience

Complaint Locally resolved complaint

Justified complaint peripheral to clinical care

Below excess claim. Justified complaint involving lack of appropriate care

Claim above excess level. Multiple justified complaints

Multiple claims or single major claim

Service / Business Interruption

Loss / interruption up to 1 hour

Loss / interruption up to 8 hours

Loss / interruption up to 1 day

Loss / interruption up to 1 week

Permanent loss of service or facility

Staffing and Competence

Short term low staffing level temporarily (<1 day) reduces service quality

On-going low staffing level reduces service quality

Late delivery of key objective / service due to lack of staff. Minor error due to poor training. On-going unsafe staffing level

Uncertain delivery of key objective / service due to lack of staff. Serious error due to poor training

Non-delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training

Financial Loss <0.1% of budget

Loss 0.1 to 0.24% of budget



Loss >1% of budget

Potential cost

Or up to £10K Or between £10,000 - £25,000

Or between £0.25m - £0.5m

Or between £0.5m - £1m

Or over £1m

Inspection / Audit

Minor recommendations. Minor non-compliance with standards

Recommendations made. Non-compliance with standards

Reduced rating. Challenging recommendations. Non-compliance with core standards

Enforcement action. Low rating. Critical report. Major non-compliance with core standards

Prosecution. Zero rating. Severely critical report

Adverse Publicity / Reputation

Contained within the organisation. Rumours

Local media – short term. Minor effect on staff morale

Local media – long term. Significant effect on staff morale

National media up to 3 days

National media >3 days. MP concerns (Questions in the House)


Likelihood score

1 2 3 4 5 Descriptor Rare Unlikely Possible Likely Almost Certain Frequency Not expected to

occur for years Expected to occur at least annually

Expected to occur at least monthly

Expected to occur at least weekly

Expected to occur at least daily

Probability <1% 1-5% 6-20% 21-50% >50% Will only occur in exceptional circumstances

Unlikely to occur Reasonable chance of occurring

Likely to occur More likely to occur than not

Risk Grading Matrix

Likelihood Consequence

1 2 3 4 5 1 1 Low 2 Low 3 Low 4 Moderate 5 Moderate 2 2 Low 4 Moderate 6 Moderate 8 Significant 10 Significant 3 3 Low 6 Moderate 9 Significant 12 Significant 15 High 4 4 Moderate 8 Significant 12 Significant 16 High 20 High 5 5 Moderate 10 Significant 15 High 20 High 25 High


ERNING BODGOVERNING BODY MEETING

Y


CCG ANNUAL ASSURANCE 2014/15 AND UPDATE ON QUARTER 1 2015/16



To extend the life of our citizens and their quality of life adding life to years as well as years to life. N


Y


Y


N


Y


Delivering high quality Primary Care at scale and improving access N

Self-Care and Early Intervention N




Community based ambulatory care for specific conditions N

Access to high quality Urgent and Emergency Care N

Scheduled Care Y

Quality Y


Senior Lead Manager Mr Iain Fletcher

Finance Manager Mr Roger Parr

Equality Impact and Risk Assessment completed: NHS England’s assurance framework EIA completed by them.

Patient and Public Engagement completed: Internal to the NHS but shared at meetings in public.

Financial Implications No Financial implications identified.

Risk Identified Delivery of Accident and Emergency (A&E) 4 hour standard, Cancer 62 day target and Improving Access to Psychological Therapies (IAPT) recovery target.


Decision Recommendations The Governing Body is requested to note the content of the paper and the positive response received from NHS England on the CCG’s assurance.




4TH NOVEMBER 2015

CCG ANNUAL ASSURANCE 2014/15 AND QUARTER 1 UPDATE 2015/16

1. Introduction 1.1 This report provides the Governing Body with a summary of the Assurance process held

over the last year (2014/15) with NHS England. This was the final review using the original six domains of authorisation. The Assurance process going forward is based on the Assurance Framework with its five components: well led organisation, delegated functions, performance and outcomes, financial management and planning.

2. Key Areas from an NHS England perspective for 2014/15 regarding the CCG

2.1 NHS England acknowledged the overall progress the CCG had made to date with the ongoing establishment of the organisation getting to grips with the local agenda and challenges. Areas they noted where evidence of strong delivery was demonstrated included:

• Continuous quality monitoring of commissioned services; • Close collaboration with the providers to improve the quality of services delivered; • The challenges regarding Accident and Emergency (A&E) delivery requiring significant

cross health economy working; • Active participation in the Quality Surveillance Group; • Demonstration of strong clinical input; • One of four organisations to work as a care.data pathfinder; • Joint working examples within the Better Care Fund and integrated discharge planning

schemes; • Exemplar Care Quality Commission (CQC) report with regard to Out of Hours provider; • Evidence of CCG leadership in working collaboratively with East Lancashire Hospitals

NHS Trust.

2.2 NHS England did, however, identify that the CCG has had particular challenges across the following areas:

• Delivery of the A&E 4 hour standard; • Cancer 62 day standard; • Improving Access to Psychological Therapies (IAPT) recovery.

2.3 Overall NHS England congratulated the CCG on the progress it has made and the capability

and capacity that it has worked hard to build and develop over the previous year.


3. Overall CCG Assurance Summary

4. Quarter 1 Assurance Update 2015/16


5. Recommendation 5.1 The Governing Body is requested to note the content of the paper and the positive response

received from NHS England on the CCG’s assurance.

Mr Iain Fletcher Head of Corporate Business 28th October 2015



Communications and Engagement Quarterly Report – July to September 2015



To extend the life of our citizens and their quality of life adding life to years as well as years to life.






Delivering high quality Primary Care at scale and improving access

Self-Care and Early Intervention

Enhanced and Integrated Primary Care and Better Care Fund

Access to Re-ablement and Intermediate Care

Improved hospital discharge and reduced length of stay

Community based ambulatory care for specific conditions

Access to high quality Urgent and Emergency Care

Scheduled Care

Quality

Clinical Lead: Chris Clayton

Senior Lead Manager Iain Fletcher

Finance Manager Roger Parr

Equality Impact and Risk Assessment completed: An EIA was completed on the Communications and Engagement Strategy in 2014

Patient and Public Engagement completed: Full engagement

Financial Implications This is within budget

Risk Identified Identified risk of minimal members of the public engaging

Report authorised by Senior Manager: David Rogers

Decision Recommendations The Governing Body is requested to:

i. Note the contents of the report. ii. Feedback any comments or suggestions in relation to communications and engagement activity and comment

on future plans. iii. Receive a further report at its meeting in February.




4TH NOVEMBER 2015

COMMUNICATION AND ENGAGEMENT QUARTERLY REPORT: JULY TO SEPTEMBER 2015

1 Introduction

1.1 This report provides a summary of activity on communication and engagement by Blackburn with Darwen CCG. Blackburn with Darwen CCG (BwD CCG) is supported in its communications and engagement activity by the Midlands and Lancashire Commissioning Support Unit (MLCSU).

1.2 The communication and engagement team have developed a communications and engagement strategy in line with the Operational Plan for 2015/16 and the Five Year Report. This was brought to the Governing Body in June 2015 and was approved. Action plans to support the delivery of the strategy are now being developed.

1.3 This document covers the wide range of activity the communications and engagement team have supported during the last three months. These include: Engagement activity, including staff engagement and events Proactive and reactive media relations Design and marketing activity Digital, website and social media activity Campaigns and strategies

1.4 The report also recommends further work in key areas and outlines the approach to be taken moving forward.

2 Overall assessment 2.1 The CCG has boosted its positive reputation with the local media. There has been a

marked increase in proactive stories with all but one story being reportedly positively or neutrally. Most notably were the achievements of pathfinder status for the Care.data programme and the winter campaign.

2.2 The CCG embarked on a collaborative piece of work with the Blackburn with Darwen

Local Authority and East Lancashire CCG to develop four marketing videos to highlight the following areas of the Think campaign:

Pain management Cold and flu Children General Think Messages

3. Media interest and management 3.1 The coverage for the CCG due to its involvement with Care.data has increased over the

last quarter, with press enquiries from the nationals, regionals and trade press. The



team has worked with their partners at NHS England and Health and Social Care Information Centre (HSCIC) to coordinate messages and mitigate negative publicity. A joined-up approach was used to disseminate messages to key stakeholders and partners to support the messages coming from the central team and allay any fears that the national media were creating around the Care.data process.

3.2 Twenty three of the 26 stories covered in the print media have been positive and with

only one negative story (regarding Improving Access to Psychological Therapies (IAPT) waiting times) and two neutral stories. The media coverage this quarter should be celebrated.

3.3 Details are provided in Table 1, below. Table 1: Media Activity

Media activity/coverage July – September 2015

Examples

Media enquiries received

1

Emergency admissions for lung related diseases

Proactive media releases issued

10

Appointment of new GP (Dr Singh) at the Stepping Stone practice Success at the Learning Disability Big Health and Social Care Day New Chair appointed

Media articles (CCG-specific) Print

13

Care.data Integrated MSK, dermatology, ophthalmology Big Health Day Good Neighbour Awards

Positive

10

Success at the Big Health and Social Care Day Integrated care survey being carried out CCG supported Good Neighbour Awards Blackburn best place to work highlighted by new GP partner at Stepping Stones practice AGM Graham Burgess returns to the area as new Chair of CCG

4. Integrated Care Communications 4.1 Integrated Care is about ensuring that individuals get the right care, in the right place, at

the right time. The teams are made up of different health and social care professionals such as GPs, Social Workers and District Nurses. They work closely as a team to improve health and wellbeing and it is a complicated change programme.

4.2 As the Communication Leads for the project board, we have supported the roll out of the

communications tool kit. This toolkit was developed primarily to help the CCG and Local Authority leads manage the promotion of Integrated Care in their areas. The key



managers were responsible for utilising the tool kit and embedding the programme. A number of case studies to support the tool kit were developed. The toolkit consists of:

Briefing Messaging matrix FAQ’s Case study proforma Press release Newsletter Climate testing Video Ongoing case studies Communications strategy

4.3 The primary emphasis of the toolkit is on the messaging matrix. This has been devised

and tested by the communication leads to ensure that the project vision is clear to all stakeholders and buy in can be sought for this change programme, at all levels. A high level overview of the toolkit was shared with the Joint Commissioning and Recommendations Group to use at officer level.

4.4 An action plan is now being put together to promote the communication and

engagement activity going forward. 5. Lead CCG for Mental Health Commissioning - additional communication and

engagement support 5.1 The CCG continues to support communications and engagement around the dementia

proposals, including input and advice regarding stakeholder management, including Overview and Scrutiny Committee support. This will continue and expand to cover the development of community-based dementia services. There is a significant opportunity to feature the CCG’s role in improving dementia services in Lancashire in national and local media – an opportunity which is being pursued.

5.2 Support has been given to the planning of the Mental Health Crisis Care Concordat to be

held next quarter. 6. Care.data Pathfinder Programme 6.1 The CCG is a pathfinder for the Care.data programme and has been supporting

practices in getting ready for its implementation. 6.2 Each practice has undergone training and information sessions with the CCG

engagement lead supported by NHS England/and or HSCIC. GP practices have had the opportunity to be involved with the development of the patient and public facing materials which will be used in the public communications campaign, and also in the development of the GP practice toolkit which will support local implementation.

6.3 The information collated from the GP practices has been used to influence the

programme. Each practice has undergone a readiness assessment and completed a supporting checklist which has been designed to ensure that local processes are in place to support implementation.



6.4 The practices have also been asked to supply the name of their Caldicott Guardian who will be included as the local signatory on the personalised letters which will be sent to each patient (aged 15¾ and over) registered to participating practices. This requirement has been helpful in generating discussion on the responsibility of practices for the management of data collected by each practice.

6.5 Engagement and training has been undertaken with Healthwatch Blackburn to ensure

they are ready to support the public communications. 6.6 Engagement has commenced with the Patient Participation Groups (PPGs) and the

engagement lead is to attend a series of PPG meetings over the coming months. A training and information session was held with the ‘Patient Voices’ Group and a stakeholder event was held with the assistance of the voluntary sector’s ‘Regional Voices’ team.

6.7 Work with the pathfinders continues as planned and will form part of the review by Dame

Fiona Caldicott. 7. GP web solutions website, intranet and GP practice website 7.1 The CCG has funded the development of an integrated web-based solution which

includes a new website, intranet and GP practice websites. Dr Hereward Brown is the lead GP for this project, and he is supported by the communication and engagement team. A pilot GP practice website has operated as the pilot site for this work. This has now concluded and the practice website is updated and operational. Work has proceeded apace with integrating every GP practice website in the area, and linking these together to form the communication network.

7.2 The following practices have now been integrated into the GP web solutions system:

Limefield Surgery, Cornerstone Health Care, Umar Medical Centre, Pringle Street Surgery and Springfenisco Healthlink.

8. Design and Marketing 8.1 The CCG has produced a number of documents, marketing and digital materials. These

include statutory documents and local developments to promote the CCG, including:

Annual report Staff engagement presentation and questionnaires Practice newsletter

8.2 These are available on the website at www.blackburnwithdarwenccg.nhs.uk

9. Web and Social Media 9.1 The table below provides the website and social media statistics for the third quarter of

2014/15. Details are provided below in table 2.



Table 2: Web and Social Media

Website Category Numbers Visitors 4,253

Unique/new visitors

3,173

Page views 12,006 Average pages viewed per visit

2.82

Top 5 pages 1 – Meet The Team

2 – GP Surgeries 3 – Contact Us 4 – News and Events 5 – About Us

Social media/Twitter Categories Numbers Examples Followers

2465

Tweets 86 Dry January Think Flu AGM Big Health and Social Care Day ATT Event

Reach 301,600

Link Clicks 395 Retweets

155

Smoking Cessation Alcohol Awareness Stop The Supply

Mentions

76

Mental Health

Favourites

25



10. Campaigns and Marketing 10.1 ‘Think’ Campaign

Both CCGs across Pennine Lancashire agreed to continue to promote the ongoing ‘Think’ Campaign that aims to educate the public to go to the right place for the right treatment. The ‘Think’ Campaign has two messages, the first is to ensure that people are aware of which services to use and when such as the NHS 111 service and local pharmacies. The second message revolves around self-care and how to manage the ten most common minor ailments without having to see your GP or attend the Urgent Care Centre.

10.2 The newsletter has been updated and formatted to direct people to services available

to them for minor ailments or injuries. As previous experience shows the forehead thermometers were well received when the campaign was originally promoted and are to be used again, along with a wallet sized concertina card, the newsletter, individual minor illness leaflets, posters, radio messages, press releases and face to face engagement.

10.3 The ‘Think’ campaign is a long term campaign which, with the assistance of the

MLCSU engagement team, the CCG will continue to promote throughout the winter months.

10.4 Nationally, NHS England has advised local System Resilience Groups (SRGs) that the

focus of any campaigns this winter should be to promote the national campaign “Stay well” and to amplify the “Stay well” messages locally. We are working on a revised campaign plan to ensure that this requirement is achieved.

11. Engagement, Insight and Market Research Paediatric Asthma Survey 11.1 The engagement team was asked to work in collaboration with local radio station Rock

FM to gather feedback with regards to children and parents experiences of living with or living with a child who has asthma. It was agreed that the process would target one area of Blackburn with Darwen, Shadsworth, and work would be undertaken within four schools in this area. The schools that took part were:

Shadsworth Infant School Shadsworth Junior School Our Lady and St John Catholic High School Blackburn Central High School

11.2 Presentations took place during morning assemblies to inform and raise awareness

amongst pupils and teachers about the causes, affects and treatment of asthma. Pupils who had asthma then took part in workshops run by Rock FM, exploring what it was like to live with asthma and to develop short radio promotions highlighting the causes, avoidance and treatment of asthma. During these sessions children were asked to complete a questionnaire which explored how they felt about and coped with living with asthma. Parents were invited to these sessions but even with the support from the schools only a limited number of parents took up this opportunity, although all the parents who attended did complete the questionnaire.



11.3 Fifty five children completed the survey, using touch-screen, hand-held survey units. Only nine parents completed the survey, which, although disappointing, still provided some useful insight. The report was presented to the CCG Commissioner for children’s services.

12. Big Health and Social Care Day Event 12.1 The CCG along with the local council held a Big Health and Social Care event for

people with learning disabilities (LD) on the 18 September at Audley Sports and Leisure Centre. Following past experience of the low attendance to the annual event it was decided to hold a ‘fun’ session rather than workshops to ensure more people attended with LD. The engagement team worked closely with the motivate team and attended sessions and asked the people with LD what sort of event they would like to attend. Activities were booked including arts and crafts, dancing and penalty shoot outs and sponsors were sought for prizes for a questionnaire draw. Stalls were invited who would be relevant for people with LD. Approximately forty people with LD attended with their carers and families. Short welcoming speeches were given at the beginning of the event but the main attraction was the launch of the new ‘About Me’ LD cards which were developed following a request from a lady with LD at last year’s event. The About Me cards are to offer discreet information on a day to day basis so that others can understand the needs of the person with LD. The communications and engagement team will continue to promote the cards to local organisations and ensure distribution to people with LD. The report will be shared with the CCG and Local Council.

13. CCG Events 13.1 The engagement team has supported the CCG with a number of events including the

Assessment and Treatment Team event, Pendleview visit and the Long Term Conditions Local Improvement Scheme event.

14. Scheduled Care Redesign 14.1 BwD CCG has been working closely with East Lancashire CCG and East Lancashire

Hospitals NHS Trust to re-procure the Musculoskeletal Service (MSK) (including the Pennine Lancashire Integrated Musculoskeletal Service), Ophthalmology Services and Dermatology as more integrated services. This has required a significant amount of communications and engagement work.

14.2 To date, there has been a number of comprehensive information packs sent out both

in printed copy and electronically to all GP practices and Optometrists where appropriate. Now that the MSK and Integrated Eye Service pathways have gone live, we are beginning a programme of proactive PR to promote the amount of work that has gone into it. For this we are using social media and the local press.

14.3 Each work-stream has now received its own unique branding which follows a consistent them of ‘connected care’. Each of these brands underwent vigorous engagement with key clinicians and stakeholders. Once the branding was filtered down, it was then shown to patients of that particular service. The feedback from them steered final sign off.



15. Conclusion 15.1 The CCG has increased its PR activity significantly. Media management has become a

key strategic priority with the CCG working with partners to ensure coordinated messaging. It’s hoped that this will be developed further in the coming months. The majority of engagement activity has concentrated on the Care.data pathfinder. The winter campaign is being rolled out and resource is in place to support. A coordinated response to the campaign will be shared next quarter.

15.2 The CCG is delighted that so many practices are supporting the Care.data programme

to ensure we get this right for the British public.

The Governing Body is requested to:

i. Note the contents of the report. ii. Feedback any comments or suggestions in relation to communications and

engagement activity and comment on future plans. iii. Receive a further report at its meeting in February.

Mr David Rogers Accredited Practitioner, MCIPR Service Partner Communication and Engagement MLCSU 28th October 2015

Page 1 of 3

GOVERNINODGOVERNING BODY MEETING

Y


ORGANISATIONAL DEVELOPMENT PLAN UPDATE



To extend the life of our citizens and their quality of life adding life to years as well as years to life. N


N


N


N


N


Delivering high quality Primary Care at scale and improving access N

Self-Care and Early Intervention N

Enhanced and Integrated Primary Care and Better Care Fund N

Access to Re-ablement and Intermediate Care N

Improved hospital discharge and reduced length of stay N

Community based ambulatory care for specific conditions N

Access to high quality Urgent and Emergency Care N

Scheduled Care N

Quality Y


Senior Lead Manager Mr Iain Fletcher

Finance Manager Mrs Linda Ring

Equality Impact and Risk Assessment completed: The EIA was complete upon the inception of the plan in 2013/14

Patient and Public Engagement completed: Staff have been engaged through development sessions where the OD plan and update have been presented.

Financial Implications These are contained within the Commissioning Support Unit contract

Risk Identified Wider development resources as the CCG undertakes additional roles such as Co-commissioning of primary care and specialised commissioning in the future.


Decision Recommendations The Governing Body is requested to note the content of the report and the development highlights to date.

Page 2 of 3



4TH NOVEMBER 2015

ORGANISATIONAL DEVELOPMENT PLAN UPDATE

1. Introduction

1.1 The purpose of this report is to update the Governing Body on the progress made to deliver the organisational development (OD) plan. The document will continually evolve during 2015 – 2016 with the emerging new directions of the organisation and the new roles undertaken. The CCG prides itself on organisational development and the development of its staff.

2. Background

2.1 The OD plan describes how we wish to harness the rich talents within our workforce, clinical community, patients, service users and partners to realise our vision. It addresses the significant development required to deliver the transformational change outlined in our Five-Year Strategic Plan. In short, the overall aim of the OD plan is to enable us to become a top-performing CCG able to transform health and healthcare across Blackburn with Darwen.

2.2 The OD plan vision set out clear ambition for the future of the workforce: to guide and inspire

the whole organisation, to deliver continuous improvement in high quality and compassionate commissioned services to all in our community.

3. The OD Plan Development Highlights

3.1 Significant progress has been made in the deliver our co-commissioning responsibilities,

with assurance acknowledged by NHS England regarding good governance arrangements though the committee structures. We have been chosen as a partner to NHS Employers to share experience of the delivery of equality and diversity for patient and workforce.

3.2 Feedback from the CCG’s 3600 survey from the CCG membership and other stakeholders is that they have confidence in the CCG’s leadership and are supportive of our plans.

3.3 Feedback from NHS England that the CCG is well run, with robust leadership, governance

arrangements in place and received a rating of assured in 5 of the 6 domains assessed.

3.4 Good clinical engagement is achieved through a range of activities demonstrated through the full attendance at Senate meetings of the membership to well attended monthly locality meetings. In addition, analysis has shown that the weekly e-bulletin Practice News is consistently well received.

3.5 The further development of the CCG’s programme of appraisal and personal development

plans includes robust monitoring linking objectives and individual plans to all commissioning projects, corporate objectives and supports staff to better manage their workloads.

3.6 Completion of a review of the Terms of Reference of the Governing Body and Sub- Committees, as well as the CCG’s Constitution. The Senate gave approval for the changes to be made to the Constitution at its meeting on 13 October 2015, and these will now be submitted to NHS England for formal approval.

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3.7 Clear plans which continue to deliver the quality, innovation, productivity and prevention (QIPP) challenge within financial resources, in line with national requirements (including excellent outcomes) linked with local Joint Health and Well-being Strategies and the CCG Commissioning Intentions for 2016/17.

3.8 The CCG continues to work with the integrated locality structures supporting the Chairs and

Vice Chairs in their own development need. Additional support is being negotiated via Primary Care Commissioning (PCC) in the development of the wider primary care system.

4. The Evolving Plan

4.1 The OD plan will continue to evolve as the organisation develops to deliver:

• An inspirational vision for the future with a focus on quality; • Executive coaching for senior staff, Executive GPs and Clinical Leads; • Clearly aligned goals and objectives at every level and feedback on performance; • Good people management and employee engagement; • Contiguous learning and quality improvement; • Team working, cooperation and integration across services and organisations; • Engagement, participation and involvement; • Autonomy and accountability; • Staff surveys to be undertaken; • To become a learning organisation; • Maximise the use of Advancing Quality Alliance (AQuA) and the NHS Leadership

Academy as leadership developers.

5. Conclusion 5.1 The definition underpinning our approach to OD is: “The practice of planned intervention to

bring about significant improvements in organisational effectiveness”. In order to deliver the level of transformation reflected in our vision, 5 year plan and goals we will need to develop leaders, our wider workforce including member practices and an organisational culture that supports high performance. Our structure, systems and management practices will also need to be aligned to deliver results. The plan takes into account this range of inter-related factors and identifies goals that will enable us to improve CCG performance in order to meet the needs of our population.

6. Recommendation

6.1 The Governing Body is requested to note the content of the report and the development highlights to date.

Mr Iain Fletcher Head of Corporate Business 28th October 2015


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Title of Paper: Quality Annual Report





Y


Y

To improve services and tackle inequality, evidence best practice to inform decisions and root out poor practice. Y


Y









Scheduled Care Y

Quality Y

Clinical Lead: Malcolm Ridgway, Clinical Director for Quality and Effectiveness

Senior Lead Manager Kim Smith, Head of Quality

Finance Manager N/A

Equality Impact and Risk Assessment completed: N/A

Patient and Public Engagement completed: N/A

Financial Implications N/A

Risk Identified N/A

Report authorised by Senior Manager: Malcolm Ridgway, Clinical Director for Quality and Effectiveness

Decision Recommendations This report provides the Clinical Commissioning Group (CCG) Governing Body with the Quality Annual Report.


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4TH NOVEMBER 2015

QUALITY ANNUAL REPORT 2014/15

1.0 Introduction

The annual report will provide assurance and a summary of the progress against the aims and objectives set out within the Quality Strategy for Blackburn with Darwen CCG (BwD CCG) The Quality Strategy sets out how BwD CCG intends to achieve continuous improvement in all commissioned services, reflecting national and local priorities. It reinforces the CCG’s commitment to the development and implmentation of quality improvement with and between care settings. The strategy provides a quality framework that will underpin the services commissioned by BwD CCG in collaboration with key stakeholders to ensure that the local population receive quality assured and timely care in the appropriate setting. The health and well-being of all patients within the local health economy is the key driver underpinning the strategy. The strategy sits below and supports BwD CCG’s 5 Year Strategic Plan, with the overarching vision identified as: “To deliver effective, efficient, high quality, safe, integrated care. This will improve the health and well-being of the population of Blackburn with Darwen and help people live better for longer, reducing health inequalities and improving outcomes in the borough”. The aim for BwD CCG is to secure better outcomes for patients as defined by the NHS Outcomes Framework and uphold the pledges in the NHS Constitution.

1.1 What is Quality?

Quality means different things to different people. As an overarching principle, we believe quality to be the minimisation and eradication of harm and a continuous improvement in clinical effectiveness, patient experience and patient safety of health and social care services for the local population. This broadly includes:

The safety of the care and treatment provided.

The cost effectiveness of care and parity of esteem.

The experience of care including accessibility, acceptability and appropriateness. Lord Darzi’s report ‘High Quality Care for All’ (DH 2009) defined quality as “Care which is clinically effective, personal and safe”. The three key elements of quality are Safety, Effectiveness and Experience, as detailed in Figure 1 below. These elements have been used to organise the quality agenda into a coherent plan aligned to the CCG’s overarching 5 Year Strategic Plan


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Figure 1 Elements Descriptor Safety Safe systems to protect patients

Preventing avoidable harm and risks to individual safety Effectiveness Care is delivered according to the best evidence as to what is clinically effective in

providing an individual’s health outcomes. Experience Patients, users and carers central to everything we do

Giving the individual as positive an experience of receiving care as possible, including being treated according to what the individual wants or needs, and with compassion, dignity and respect.

The overarching aim of the strategy is: “To provide assurance to the CCG Governing Body that commissioned services are of high quality in terms of Safety, Effectiveness and Experience” The specific objectives are that the CCG will:

Ensure that services being commissioned are safe, personal, effective and continuously improving.

Ensure that the appropriate quality mechanisms are in place so that standards of patient care are described and effectively demonstrated.

Ensure that quality outcomes are monitored and triangulated, with appropriate action taken if the quality of a commissioned service is found to be compromised.

Identify local quality priority areas, aligned with Quality, Innovation, Productivity and Prevention (QIPP), and continue to provide examples of delivering Quality and Productivity.

Embed a governance structure to monitor Quality and Safety, including the analysis of personalised care, effectiveness and safety.

Use patient, carer and other stakeholder feedback, along with complaints and concerns raised with the CCG, to strengthen their ability to detect early warning signs of deterioration in quality, as well as evidence of excellence that should be adopted and shared.

Work with HealthWatch and other partners to understand the experience of service users and help local people to shape and understand the need for different service’, to encourage them in turn to use these services.

Commission services sensitive to local needs by seeking feedback from each member practice’s population. This will be a two way process with decision making being accountable, inclusive and effective.

Reflect strategic and operational planning in the CCG’s contracts with Providers. The delivery of which will be monitored rigorously by the CCG, and will include seeking assurance of the quality of care Providers deliver. The CCG recognises that mature relationships with Providers both drives and sustains improvement.

Look beyond their direct commissioning responsibilities to recognise where quality depends on commissioning services on a larger geographical footprint.


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A process has also been put in place to ensure that the implementation of the Quality Strategy is monitored, this includes:

An annual report will be presented to Quality, Performance and Effectiveness Committee (QPEC) to demonstrate that the overarching aim and objectives of the strategy have been met.

An audit of the terms of reference of QPEC which take place annually to ensure the committee has complied with its delegated duties.

An annual review of the strategy to ensure it remains fit for purpose.

1.2 Quality Structure

A Quality Assurance Governance Structure has been established to oversee the systems and process to ensure that there is a clear focus on quality within the CCG, the committee and groups which form this structure are described below.

1.3 The Governing Body

The CCG Governing Body will receive regular reports, information and assurance on quality of care within our primary, community and secondary care setting.

1.3.1 Quality, Performance and Effectiveness Committee (QPEC)

QPEC is responsible for providing an appropriate level of assurance to the CCG on all matters relating to the implementation of this strategy.

The Committee will report to the Governing Body on a regular basis providing assurance of process, whilst highlighting risks to service quality using exception reports.

The Committee will consider the learning from national reports and enquiries in order to provide recommendations to the Governing Body on remedial actions required to embed this learning in the local health economy.

Members will also ensure that there are systematic arrangements for sharing intelligence with other commissioners and partners e.g. local authorities, in place to provide “early warning” mechanisms.

The Terms of Reference for the Committee can be found at Appendix 1

1.3.2 Quality and Performance Meetings

Quality and Performance Meetings are in place for larger providers as part of the contract management process to monitor, challenge and improve practice.

Bespoke performance management procedures are in place with all other providers, commensurate with the scope and scale of the contract.

These procedures monitor the performance and quality of all commissioned services focusing on suboptimal areas of performance. Each provider meeting adheres to an agreed terms of reference.


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A collegiate approach to performance improvement is adopted, with all parties working together to ensure appropriate remedial action plans are developed, enacted and monitored within agreed timescales.

1.3.3. Serious Incident Review Panel In its capacity as lead commissioner, Blackburn with Darwen CCG (BwD CCG) has established a multi-agency panel comprising BwD CCG Quality Leads, LCFT, Midlands and Lancashire CSU, NHS England and associate CCGs to ensure that there is a robust system in place to review all serious incidents and monitor the implementation of lessons learnt across the Trust in order to improve patient safety.

1.3.4. Pennine Lancashire Quality Improvement Forum The CCG is a member of this forum to ensure that it learns from others and engages in collaborative working across the heath economy.

2.0 Implementing the Quality Assurance Governance Framework 2.1 Quality, Performance and Effectiveness Committee (QPEC)

In its role as a subcommittee of the Governing Body, QPEC has been able to demonstrate how has it has discharged its delegated responsibilities for providing assurance to the CCG Governing Body on all matters relating to quality improvement in the following ways.

The terms of reference has been reviewed and refreshed to ensure that they remain fit for purpose.

Throughout the past 12 months, the committee has received both quantitative and qualitative data on all aspects of quality both for the CCG as an entity and for those services it commissions from providers. The prime medium for dissemination of the monthly Quality, Performance and Effectiveness Report prepared by the co-located MLCSU Quality & Performance team.

The committee also uses a wealth of additional information and data to make judgements

and assist in decision making and/or recommendations. This may include quality and performance information from local and national systems, soft intelligence gained through a variety of sources and reports from other system-wide stakeholders.

A work plan for QPEC was also developed to ensure that key workstreams are addressed

. All actions have been completed bar implementation of the HCAI strategy. This was due to lack of resources across the health economy. This action will be rolled over into 2015/16 with a clear plan to address this outstanding issue. Appendix 2

2.2 Reporting Domains

The quality assurance framework work is set out within the 3 domains below; with evidence presented under each domain. The aim to provide confidence that internal controls are in place and are operating effectively and those objectives are being achieved. It also identifies any risks to service quality and provides exception reports when things are not going to plan

2.3 Safety

2.3.1 Serious Incident process


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The CCG has introduced a Serious Incident Review panel in the past 12 months. The overarching purpose of the panel is to systematically review and monitor serious incidents reported by LCFT, to ensure that there are measures in place for safeguarding of people, property, NHS resources and reputation. This includes the responsibility to learn from these incidents in order to minimise the risk of re-occurrence. It will also inform future decisions on commissioning of services. The group meets on a monthly basis and has reviewed and closed a total of 125 incidents during 2014/15. The panel will only agree to close incidents where there is clear evidence of implementation of lessons learnt. Several themes such as record keeping, physical health monitoring and risk assessment have been identified by the panel. An action plan is in place to address this, which is being monitored at monthly Quality and Performance meetings with LCFT.

2.3.2 Health Care Acquired Infections (HCAI)

The CCG has undertaken a system wide review of internal CCG HCAI arrangements over the past 12 months. Plans are in place to increase the resources available to support this agenda. A post infection review panel has been set up which includes members from provider organisations as well as the local authority. The panel’s remit is to review all HCAI incidents to identify any lapse in care and ensure that any lessons are learnt and change of practice takes place. There is clear evidence of partnership working at the meeting. However the CCG’s 2014/15 position is above the threshold of 25 cases, at 51. The majority of cases were deemed to be unavoidable. The significant increase in reportable clostridium difficile cases, compare to the 24 reported in 2013/14, has been acknowledged by the CCG. However, it is also recognised that the investigation process has improved leading to more cases being identified. It is also important to note that very few of the 51 cases have been identified as avoidable (i.e. a lapse in care) and all other cases are generally related to co morbidity of patients who often present with complex needs. Of the few cases which were deemed avoidable, 3 are related to less than effective prescribing and 2 are due to individual patient’s life style choices. It is also worth noting that across the health economy there has been a rise in clostridium difficile infections generally, and again the trends from these are also linked to co-morbidity of patients. The CCG will continue to monitor and challenge this via the post infection review panel, with the overarching aim of a reduction in incidents. 2.3.3 Safeguarding

As with all other NHS bodies, the CCG has a statutory duty to ensure that it makes arrangements to safeguard and promote the welfare of children and young people and to protect vulnerable adults from abuse, or the risk of abuse. In recognition of this, the CCG has established constitutional and governance arrangements to ensure it has the capacity and capability to deliver its statutory duties. The CCG has implemented a Safeguarding and Vulnerable Adults Policy, which reflects the CCG’s obligation to ensure that all health, third sector and social care providers from whom it commissions services (both public and independent sector), have comprehensive single and multi-agency policies and procedures in place to safeguard and promote the welfare of children and to protect vulnerable adults from abuse or the risk of abuse. The CCG also has direct links into the Local Safeguarding Children and Safeguarding Adult Boards and has a designated nurse lead for safeguarding embedded within its own internal


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structure. The Safeguarding lead is a member of QPEC and provides assurance to the committee in relation to all safeguarding arrangements. A Safeguarding Annual Report is also produced. The second annual safeguarding report BwD CCG of is due to be received by the CCG Governing Body in October 2015. The report provides information about national changes and influences; includes local developments and activity over the period 1st April 2014 to 31st March 2015; and outlines how the CCGs statutory requirements are being assured, and how challenges relating to safeguarding are being managed. The key priorities identified for 2015-2016 are:

Take account of national guidance on the commissioning of the statutory health assessments for looked after children placed out of area, review the CCGs compliance against guidance, identifying any gaps and taking the necessary action to ensure full compliance.

To continue to develop the Prevent agenda both within the CCG and with respect to commissioned services.

Develop an internal system for the monitoring of CCG commissioned services

safeguarding self-assessment submissions and overview of action plan delivery.

To review the commissioning and the delivery of the CCG Safeguarding adult / Mental Capacity Act leadership function in view of recent statutory guidance

To review the commissioning and the delivery of the lead GP for safeguarding function in view of recent statutory guidance

To develop further the safeguarding assurance process for care homes with nursing and to develop an assurance process for primary care as the CCG takes on the co-commissioning responsibilities for General Practice

The safeguarding annual report has provided an insight into local issues, developments and initiatives pertaining to safeguarding that have taken place during the last twelve months. In doing so, it aims to provide a level of assurance that the organisation is fulfilling its statutory duties and responsibilities for safeguarding children and adults at risk of harm. The agenda continues to evolve and its workload continues to escalate in line with national direction, new legislation, emerging scandals and findings from critical incidents and serious case reviews. The underpinning message however remains the same in that safeguarding is everyone’s business irrespective of role or position. It is a commissioning, provider and community responsibility to safeguard and protect the most vulnerable adults and children in our society. The child and vulnerable adult must remain at the centre of our focus, and motivate all of our actions.

2.4 Effectiveness

2.4.1 Practice Nurses Forum

The Practice Nurse Forum was re-launched in December 2013 inviting Health Care Professionals to undertake learning and development. GP Practices have supported their nurse’s development and attendance has grown from strength to strength.


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The forum agenda has been developed and co-ordinated through the Primary Care development and Educational Steering Group Initially the forums were held every month and delivered over a two hour period, allowing for lunch and networking followed by topics identified by Practice Nurses. Due to feedback from the evaluation sheets from April 2015 the sessions were extended to three and half hours and delivered every other month. It was felt that this would enhance the quality by allowing both reflective practice and the sharing of good practice to be built into the agenda The CCG has recognised the importance of having Nurses to drive and influence the nursing agenda, and have asked for expressions of interest to become a Nurse Champion/Leader. Their development will be supported with a leadership training course.

2.4.2 Quality, Performance and Effectiveness Report

The MLCSU co-located Quality & Performance team produce an integrated business report on a monthly basis, included with this is the Quality, Performance and Effectiveness Report (QPER). This report contains information on CCG performance as well as provider quality performance against contractual obligations throughout the month. The report focuses on exceptions and the progress of associated recovery plans collated from a range of sources including but not limited to provider board reports; MLCSU Business Intelligence; provider quality submissions and CCG staff exception reports. Information from external bodies such as the Health & Social Care Information Centre (HSCIC), NHS England and Advancing Quality (AQ) is also included, and where appropriate, additional data focusing on other CCG patients is provided to give a broader perspective of services where BwD CCG is the lead commissioner. The report is presented to QPEC on a monthly basis to allow oversight, scrutiny and challenge as part of the assurance framework. An executive summary is then presented to Governing Body to provide overarching assurance.

2.4.3 Quality and Commissioning for Quality and Innovation (CQUIN) Measures 2014/15

BwD CCG is the lead commissioner for LCFT. The CCG identified 8 specific Commissioning for Quality and Innovation (CQUIN) goals for 2014/15, of the 8 the Trust have been met 6 in full, 1 was partially met and the remaining indicator was not met. These are reported on as part of the QPER report as well as CQUIN for which the CCG is an associate commissioner.

2.4.4 Quality Premium

The ‘quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. These are tracked as part of the QPER, although national reporting timescales mean that there is often a significant time lag in data becoming available. However, the CCG has worked extremely hard with partners to ensure that any areas of non-achievement had robust actions plans in place, with monthly monitoring taking place to maximise achievement.

2.4.5 Quality Schedules

Quality Schedules are in place for all providers detailing national and local reporting requirements as agreed during contract negotiations, together with required reporting frequencies for each individual indicator. All schedules were reviewed in year to ensure their fitness for purpose. A standard schedule was developed for small providers to ensure a level of consistency, with appropriate deviation to match the service in question.


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The provider’s submission in support of the quality schedule is a key information source for monitoring the provider’s performance and any exceptions are discussed during quality & performance meetings, with remedial action plans being requested where appropriate.

2.5 External Audit

During 2014/15 four external audits were carried out by Mersey Internal Audit Agency (MIAA). The results of which are presented in the table below. Audit Rating Risks Final Report

Received Mental Health Commissioning

High Assurance 1 Low Yes

Performance Management

High Assurance 2 Low Yes

Safeguarding Significant Assurance

3 Medium 1 Low

Yes

Serious Untoward Incidents

Significant Assurance

6 Medium 1 Low

Yes

Levels of Assurance are defined by the auditors are shown below: Level of Assurance Description

High Our work found some low impact control weaknesses which, if addressed would improve overall control. However, these weaknesses do not affect key controls and are unlikely to impair the achievement of the objectives of the system. Therefore we can conclude that the key controls have been adequately designed and are operating effectively to deliver the objectives of the system, function or process.

Significant There are some weaknesses in the design and/or operation of controls which could impair the achievement of the objectives of the system, function or process. However, either their impact would be minimal or they would be unlikely to occur.

Limited There are weaknesses in the design and / or operation of controls which could have a significant impact on the achievement of the key system, function or process objectives but should not have a significant impact on the achievement of organisational objectives.

No There are weaknesses in the design and/or operation of controls which [in aggregate] have a significant impact on the achievement of key system, function or process objectives and may put at risk the achievement of organisational objectives.

Levels of Risk are defined by MIAA below Level of Assurance Description

Critical Control weakness that could have a significant impact upon, not only the system, function or process objectives but also the achievement of the organisation’s objectives in relation to:

• the efficient and effective use of resources


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• the safeguarding of assets • the preparation of reliable financial and operational information • Compliance with laws and regulations.

High Control weakness that has or is likely to have a significant impact upon the achievement of key system, function or process objectives. This weakness, whilst high impact for the system, function or process does not have a significant impact on the achievement of the overall organisation objectives.

Medium Control weakness that: • has a low impact on the achievement of the key system, function or

process objectives; • has exposed the system, function or process to a key risk, however

the likelihood of this risk occurring is low. Low Control weakness that does not impact upon the achievement of key system,

function or process objectives; however implementation of the recommendation would improve overall control.

2.6 Experience 2.6.1. Quality Visits

BwD CCG led teams have carried out a total of 6 unannounced quality visits as part of the contractual arrangements with LCFT in their role as lead commissioner. The overarching aim of these visits is to enable team members to observe first-hand the services commissioned, and seek the views of service users and staff. The quality visits are intended to be a supportive process, whilst enabling further assurance to be provided to Governing Body and associate CCGs. Any areas of immediate concern are raised with the service provider as soon as they are identified. If the visiting team identified any unprofessional practice or immediate risk to service users, visitors or staff, the service provider is asked to rectify the situation immediately. After the visit, a formal report is prepared and shared with the provider. Following review, a remedial action plan is them prepared, addressing the issues identified. This is monitored through QPEC. Overall the outcome from quality visits over the past 12 months has been positive, with evidence that staff are focused on patients’ needs and are providing effective care. It was also noted that the provider is monitoring the clinical effectiveness and impact of changes in practice, implemented as a result of clinical audit. However there is some evidence that implementation is inconsistent across the organisation in both depth and breadth. This is being addressed through the quality and performance meetings with the provider.

2.6.2 Compassion In Practice

The CCG has been monitoring providers against the implementation of NHS England’s 6Cs Compassion in Practice requirements through a standing agenda item at the provider’s quality and performance meeting. A presentation has been disseminated to all CCG staff on the implementation and values of the 6Cs to increase the awareness of the importance of this agenda. Reporting on this is include in quarterly returns from the provider on how they are further developing quality improvement processes for the benefit of patients.


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2.6.3 Patient and Staff Experience

As part of ongoing contract monitoring processes, the CCG receives information on “Safe Staffing”, staff survey results, staff FFT, sickness and absence rates, percentage of agency/bank staff and these are measured against regional and national indicators to benchmark performance. In addition, the CCG will continue during 2015/16 to undertake a programme of provider quality visits where discussions with staff, individuals, and/or groups will be held to get direct frontline feedback. The findings of these visits will be shared with providers via a report, which is also discussed at provider Quality and Performance meetings. All providers are expected to have mechanisms in place to monitor staff satisfaction such as staff surveys and staff temperature checks, and these will continue during 2015/16. In addition a programme of staff development opportunities should be in place, which may include some or all of, staff engagement forums, away days, attendance at training events and conferences, as well as regular 1:1s and appraisals. The key focus of all of these events is to ensure continuing improved outcomes for patients.

2.6.4 Friends and Family Test (FFT)

During 2014/15 contract year, implementation of FFT was a CQUIN measure, and funded accordingly. It will continue to be monitored through the quality schedule, although no specific additional funding will be provided. Providers are required to provide reporting on FFT feedback from staff and patients which is then monitored and challenged at Quality and Performance meetings. Providers are also required to provide summary reports on all patient feedback including patient experience surveys, complaints, compliments, PALS interactions, and the outcomes of Ombudsmen cases by service provision. Action plans to tackle issues identified are requested, and completion of these monitored at Quality and Performance meetings. The CCG has ensured that all providers have been able to demonstrate that changes in practice have occurred to enhance patient safety.

2.6.5 Response to Francis, Berwick, and Winterbourne View

The implementation and monitoring of all national reviews (including Francis, Berwick, and Winterbourne View) are identified in the CCG’s Quality Strategy. All NHS providers are required to report progress against implementation of those standards applicable to their service provision. The CCG has monitored progress with this through contractual Quality and Performance meetings. All providers are expected to demonstrate lessons learned, as well as changes to practice. LCFT’s progress against the key findings to these national reviews is a standing agenda item at the provider’s monthly Quality and Performance meeting. During 2014/15 Transforming care was largely focused on discharging people from long term hospital placements into community placements, this has continued into 2015/16 with a target of 50% discharge being applied nationally.

3.0 Outcomes and Assurance

The CCG has been able to demonstrate that is has been able to implement the overarching aims of the Quality Strategy via the QPEC. There are robust governance processes is place which include hard intelligence from the QPER, the Quality and Performance meetings with providers, the Serious Incident Review Panel as well as soft intelligence from such areas as quality visit. This has been validated from external audits carried out by MIAA. Throughout the year, QPEC has


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been able to provide assurance to the Governing Body that it has systems in place to ensure that the local population receive quality assured and timely care in the appropriate setting.

4.0 Areas of Development and Forward Plan

BwD CCG will continue to focus on the development and improvement of the quality of all commissioned services, with an increased focus on those services provided within primary care settings. This will underpin the CCG’s vision “to deliver effective, efficient, high quality, safe, integrated care. This will improve the health and wellbeing of the population of Blackburn with Darwen and help people live better for longer, reducing health inequalities and improving outcomes in the borough”. The objectives for BwD CCG are to secure better outcomes for patients as defined by the 5 domains of the NHS Outcomes Framework and uphold the pledges in the NHS Constitution. A work plan will be developed to ensure that key work steams are addressed and that assurance can be provide to Governing Body. Kim Smith Head of Quality 16th October 2015

Documents

GOVERNING BODY MEETING Wednesday 4 November 2015 at 1 … · 5. Life Expectancy Mr Dominic Harrison Presentation PART 1 BUSINESS (APPROXIMATELY 1.30 PM) 6. 6.1 6.2 Minutes of the