1

East of EnglandSpecialised Commissioning Group

2010

AnnualReview

Working togetherto develop specialised

services in the east of England

2

Looking back over the last 12-15 months we can see that it has been a time of great change and challenge for the SCG. We developed and launched our five-year strategy, taken part in a rigorous world class commissioning assessment and sought to deliver cost effective service change and improvement.

Changes to Chief Operating Officer and Chair

2010 was also a time of great change. In May, our Chief Operating Officer Trevor Myers leftthe SCG to pursue new opportunities and challenges after making a vital contribution to the establishment of the SCG in 2007. As a result of this change we appointed new Joint Chief Operating Officers, Ruth Derrett and Neil Wilson, working on an interim basis to steer the SCG through the forthcoming period of NHS transformation, initiated by the publication of the NHS White Paper Equity and Excellence: Liberating the NHS.

Changes have also taken place at Chair level. In December 2009 Andrew Pike, Chief Executive of NHS South East Essex replaced Julie Garbutt, Chief Executive of NHS Norfolk,to consolidate the host-Primary Care Trust (PCT) and chairmanship arrangements of the SCG. However, in June 2010 further changes were required when Andrew became the single Chief Executive for both South East and South West Essex PCTs.

It was my pleasure to become the new Chair of the SCG in June 2010, and I am grateful for the opportunity to build on the excellent foundations laid by both Andrew and Julie.

The future - responding to NHS Reform

During our year of challenge and change, we have maintained our focus on patients and wemust continue to do this in the even more

demanding times that now lie ahead.We know we can only meet the growing demand for NHS care, if we get better qualityoutcomes and greater efficiency from our existing services and by continuing to look at new ways of working. At the same time we must also work with our partner organisations to implement the significant changes outlined in the NHS White Paper.

These are challenging but also exciting times. We are involved in the work which is shapingthe future of specialised commissioning and we are exploring new ways of working with GP clusters and consortia groups to ensure all parts of the new system knit together.

That is why throughout this review you will see not only examples of our work over the last 15 months but also references to planning for the future. And I am convinced that by building on our commitment to ongoing engagement and involvement, we can continue working towards having world class specialised services in the east of England.

I give my thanks to all our partners, stakeholders and staff who have been incredibly supportive and who continue to work so hard to deliver the best possible specialised services for all our patients.

Dr Paul WatsonChief Executive of NHS Suffolk & SCG Chair

Introduction

3

Patient engagement: the key to our success

4

When Lord Carter set out his vision for Specialised Service Commissioning he said that one of our key roles was to champion the needs of patients with rare conditions.

At the SCG we are committed to the engagement and involvement of service users and carers at all levels of our planning and service development. Our five-year strategy, which was launched in April 2010, set out our vision for ensuring a high quality patient experience. Instead of just limiting ourselves to specialised treatment, we are determined that we must look across the entire patient journey - from initial GP consultation to specialised service intervention and all the way back again - if we are to succeed in bringing meaningful improvements to services.

You will also see how it has been a year of great change and challenge both within the SCG and across the wider NHS. Our staff have worked tirelessly to rise to these challenges, working to realise our vision, meet quality, efficiency and improvement targets and more recently to respond to a major change in national policy and direction for the NHS.

The changing NHS landscape and the need to ensure every penny of public money counts, demand that we maintain our keen focus on Carter’s ambition for ensuring the needs of patients with rarer conditions are properly recognised, understood and planned for. Throughout this review of our year, you will see numerous examples of the commitment and innovation shown by staff to foster an attitude of continuous involvement and engagement in all that we do.

For up to date information about our work and our plans, please visit our website atwww.eoescg.nhs.uk

Chris Hudson, Patient Representative

Chris Hudson sits on the SCG Board and the Clinical Advisory and Quality Committee, as well as contributing to other service areas.

My role is not only to listen; I have to ensure

that anything that affects the patient is central

to the discussions, as it is not just about the figures.

5

Commissioning is the process of planning and buying healthcare. The role of the SCG is to commission specialised health services for the people in the east of England. Often described as high cost/low volume services, they are services for rare medical conditions with very low numbers and are usually needed by only small numbers of patients. In order to provide fair access to specialised care, and consistent high quality and value for money we commission these services over a large population base.

Specialised services are defined by the Specialised Services National Definitions Set (see appendix A) and are not provided by every hospital. They tend to be found in hospitals based in large towns and cities or in stand-alone single speciality hospitals helping to:

•Achievethebestoutcomesandmaintain clinical competence • Sustainthetrainingofspecialiststaff • Ensurecost-effectivenessinprovision •Makethebestuseofscarceresources (including staff expertise, high tech equipment, donor organs)

SCG BoardThe SCG board consists of the chief executives from all 13 PCTs in the region who meet bi-monthly to consider and approve matters of finance, strategy, planning and operational issues. All papers and minutes of the board meetings can be found on the SCG website at www.eoescg.nhs.uk

The commissioning cycle focuses around patients and public. The key components consist of understanding patient needs, planning and specifying services, procuring those services, and monitoring and managing the delivery of those services. By seeking public and patient views through public consultation and engagement, we can assess their needs whilst reviewing

current service provision. This enables the SCG to highlight priorities and implement improvements in services.

Where we fit in - Connecting the whole pathway

The traditional view of specialised services

Our view of specialised services

What we do and what are specialised services?

Specialised care

Secondary Care

Primary Care

Com

munication Collaboration

Education Information

Tech

nolo

gy

PatientPrim

ary C

are Secondary Care

Specialised Care

Patient experience is dependent on quality outcomes at every stage - this

means we cannot work in isolation and must do more to share information and agree common expectations

6

World Class Commissioning (WCC) was a three year project designed to help all commissioning organisations improve their ability to plan and buy the very best health services for their populations.

Following a successful pilot in the North West Specialised Commissioning Group, a bespoke WCC process for specialised commissioning was launched in 2009.

With the agreement of the East of England SCG Board, we embarked on our WCC process in June 2009, using the opportunity to take part and measure ourselves against the standards as a tool to strengthen the way we work.

Although the WCC process has now ended we will continue to use the learning we gained from taking part as we develop our 2011/12 operational plan and programme of work.

Our VisionOur vision sets out where we want to get to – we want world class specialised care for those who need it in east of England.

Our MissionOur mission illustrates why we are here and summarises the purpose of the East of England SCG.

“To continuously improve outcomes for patients in the east of England by driving quality and enabling fair access to specialised care based on sound, efficient investment decisions”

Our AimsOur aims explain what we need to do in order to achieve our vision and deliver our mission. • Togetthebestoutcomesforpatients today and in the future through evidence based planning and commissioning of innovative quality services.

• Toimprovethepatientexperienceat every stage of care by facilitating open communication between patients, health care professionals and other commissioners. • Tocommissionclinicallyandcosteffective specialised services ensuring fair and equal access to all who require specialised care in the east of England.

Our five year strategy The SCG has produced a five-year strategy outlining how we will deliver our vision, aims and objectives. To download the full SCG five year strategy visit our website at www.eoescg.nhs.uk.

Moving towards world class specialised services

East of England Specialised Commissioning Group Five Year Strategy

7

In July 2010 the Secretary of State for Health published the NHS White Paper Equity and Excellence: Liberating the NHS, which sets out a new vision for healthcare in England.

The new policy direction set out five key transformational requirements:

• StrategicHealthAuthorities(SHAs)tobe abolished from 2012. • PCTstobeabolishedfrom2013. •Communityserviceandacute hospital commissioning will move to GP commissioning consortia. • Publichealthmatterswillmovetolocal authorities. •CommissioningofGPs,maternity,dental, ophthalmic and specialised services to become part of a soon to be formed, NHS Commissioning Board.

The timetable for change is rapid – the consultation on the White Paper closed in October 2010 with a view to transforming the plans and responses received into a legislative framework for parliamentary approval in the autumn of 2010. Once approved, shadow organisations will emerge soon after to begin full implementation.

Specialised services and the NHS Commissioning Board

After the publication of the White Paper it was confirmed that specialised commissioning will rest with the new NHS Commissioning Board. However, how it will operate and organise itself is still unclear. The timetable as it currently stands is that the Board will

be established in shadow form as a special health authority in 2011 with the following 12 months being used to develop a future business model, organisational structure and staffing. It will be converted by the forthcoming Health Bill into a statutory body, with its own powers and duties, to go live in April 2012.

The current SHA will support the board during its preparatory year, and will have a critical role during the transition in managing finance and performance. It will be for the NHS Commissioning Board to decide how it wishes to manage specialised services into the future.

What we will do - our role and purpose over the next 12 months

Our absolute priority during this period of transition is on maintaining our focus and core purpose; through all these changes our role in commissioning high quality specialised care must continue.

Our priority will remain the delivery of affordable high quality care, promoting innovation, demanding efficiency, and ensuring engagement and involvement of our patients and stakeholders.

We will continue to support national work that is ongoing to develop the future structure of specialised commissioning. We have worked with our colleagues across the country and with the National Specialised Commissioning Group to give a co-ordinated response to the changes taking place, offering ideas and advice on how best to develop specialised commissioning in ways that will protect and promote the needs of our patients.

For the very latest on the changes taking place in the NHS, please visit our website atwww.eoescg.nhs.uk

What the future holds - the White Paper and the SCG

8

Achievements in acute specialised commissioning

9

Renal

The SCG identified a need for more renal dialysis capacity across the region in 2008 and developed a strategy to address the shortfall in the areas of greatest need. The strategy recommended development of new services across the region with four key aims:

• Improveequalityofaccesstoservices based on population need.

• Improvetheexperienceofpatientsby expanding patient choice where clinically appropriate.

• Improvethebalanceofgeographical access to services, including shorter travel times for patients, so that the majority are no longer than 30 minutes away from a unit.

• Ensurethathaemodialysisunitsarethe right size and therefore provide cost effective services.

In order to hear the view of patients, their families, carers and staff working in this area of healthcare, the SCG carried out a public consultation to find out what people thought of the plans. The consultation ran for 12 weeks between December 14, 2009 and March 8, 2010 with 13 publicised events across the east of England region.

All the views received in response to the consultation were taken into account and have helped to inform the service developments for current and future patients. This information ensured that the Renal Project Board could make appropriate decisions on the approval of the location of new units and the expansion of home therapies.

10

Neuromuscular review

A service review into provision of care for patients living with a neuromuscular disorder has been undertaken in response to a number of studies highlighting the healthcare needs of patients living with these conditions, in particular;

•AccesstoSpecialistNeuromuscularCare: The Walton Report, published by the All Party Parliamentary Group for Muscular Dystrophy in July 2009.

Neuromuscular disorders cover a wide range of conditions which can strike any time from infancy through to adulthood. There are more than 60 different types of muscular dystrophy and related neuromuscular disorders.

The SCG has been working closely with the charity the Muscular Dystrophy Campaign in the development of a neuromuscular project board.

The aims of the review are:

•Discoverwhatneuromuscularservicesare available to people in the east of England and their capacity. •Developingasetofcarepathwaysthatlink specialised care with local services. •Developmentandstrengtheningoflocal services. •Understandingtheneedsofpatientsand their carers.

A workshop was held for patients and carers from across the region with various speakers including those living with a neuromuscular condition. The workshop was immensely successful with the views gathered helping to shape work on improving access to both specialist and local services.

11

Review of Specialised Neuro-Rehabilitation Services (SNRS)

Specialised inpatient units provide services to help people, who suddenly become disabled as the result of neurological incident, to make the best possible recovery. Timely, good quality rehabilitation offers these people the chance to achieve goals for independent living.

The National Service Framework for long term conditions (March 2005) states that early rehabilitation reduces the risk of patients developing preventable complications and reduces length of stay in hospital and lowers readmission rates.

During 2009-10 current treatment for people requiring specialist rehabilitation services were reviewed to ensure a seamless patient journey through the various services available to them.

The key aims were to:

• Prepareadetailedmapofspecialised neuro-rehabilitation services available to patients from the east of England. • Prepareanoutlineofthecurrent commissioning arrangements.

• Identifygapsinprovisionfortheeastof England.

•Undertakeamarket/capacityanalysisof available hospitals.

• Producepathwaymapsforalllevelsof SNRS including the integration with NHS and local authority services.

• ProduceaservicespecificationforSNRS making use of existing specifications.

•WorkwithHeadwayrepresentativesand other patient and carer groups across the east of England to set out the needs of patients and carers.

Primary angioplasty service Working closely with the cardiac and stroke networks, acute hospitals, the SHA, the ambulance service and PCTs, the SCG were able to commission a primary angioplasty service during 2009-10 for the east of England. This service ensures that ST elevation myocardial infarction (STEMI) patients are diagnosed, transported by blue light ambulance and treated at a heart attack centre within 165 minutes of calling an ambulance (the national target is 75% within 150 minutes). The majority of patients are discharged home within 2-3 days of admission with the cause of their heart attack successfully treated and a clear rehabilitation plan in place.

The service was launched between April and September 2009, with four heart attack centres located at Papworth Hospital, Norfolk and Norwich Hospital, Essex Cardiothoracic Centre and the Royal Brompton and Harefield, operating 24/7 throughout the year. Watford Hospital and Lister Hospital both provide a 9-5 service as part of the Royal Brompton Harefield heart attack centre, ensuring 100% population coverage across the east of England. In response to concerns raised by residents via public consultation a slightly different model was in operation across east Suffolk as a pilot study.

A review was conducted of the pilot study which concluded that east Suffolk patients should receive specialist PPCI treatment at one of the four dedicated heart attack centres in the region. A patient experience survey was conducted during the study which collected feedback from east Suffolk patients. The majority of patients rated their care as excellent or good. The external endorsement of the proposals mean services, which were run on a pilot basis to allow the review to take place can now be formalised by the SCG.

12

Pancreatic cancer surgery One year after approval at the SCG Board in September 2009, the implementation of a ‘single centre’ for pancreatic cancer surgeryatCambridgeUniversityHospitalNHSFoundation Trust (Addenbrooke’s) has been completed.

The project, which included a full public consultation, ensures that all patients in Suffolk, Norfolk, Cambridgeshire, mid and north Bedfordshire and north east Essex now have service that meets national standards (Improving Outcome Guidance - IOG).

Patients now have access to a specialist team offering the best possible care and the opportunity to participate in trials for new treatments. The feedback received during the consultation was incorporated into the design of the new service and the patient representative has remained actively involved in the monitoring and review of the service.

The new single specialist multidisciplinary team now take on the responsibility for all pancreatic cancer cases. The surgical team at the centre will have four to six hepato-pancreato-biliary (HPB) surgeons, taking referrals from Bedfordshire, Cambridgeshire, Suffolk, Norfolk and North East Essex PCTs.

This service change will affect approximately 300 people a year with pancreatic cancer from a population of around 3.2 million living in the relevant areas. The majority (at least 80%) of patients that will benefit from the changes the SCG has introduced will not see a change in where they go for their care. Those that will now have to travel further for surgery or access trials may be entitled to additional support.

Paul Morris, Patient Representative

Paul Morris is a member of the project steering group to implement the IOG in the east of England. He lives outside the region and provides an independent perspective.

I am proud of the way the pancreatic cancer project

steering group have kept, at the forefront of their minds, the needs of patients and the desire tosee improving outcomes.

13

Achievements in mental health specialised commissioning

14

Improving patient outcomes in specialised mental health services

In 2009 the SCG continued to take on responsibility for services defined within the specialised services national definition set, with the portfolio now consisting: •Highsecureservices •Mediumsecureservices • Lowsecureservices • Eatingdisorders • Perinatalmentalhealth •Genderdysphoria •Mentalhealthservicesfordeafpeople • Personalitydisorders

Secure services

The SCG undertook a formal process of designation with all east of England medium secure providers. The national framework for service designation helps patients by promoting equity of access to highly specialised centres of excellence. All medium secure services have achieved the necessary requirements to become a designated service.

Gate keeping ‘Gate keeping’ policies are continually being introduced to support all services commissioned within specialised areas of mental health. These policies ensure patients are placed in services suitable to their individual needs.

Clinical NetworksPerinatal mental health

In 2009/10 the SCG developed a perinatal mental health designation framework for use when commissioners are assessing if each hospital or provider of services is giving the most appropriate care. The project group for this service area continue to work on all other aspects of its work plan which include a regional understanding of the maternal pathway to ensure local systems are in place to promote and enable mothers to be more involved in service design, delivery and evaluation. Network members have been actively involved in the development of the inpatient service specification and the perinatal psychiatric care pathway.

Deaf mental health

A regional project group for this area was established during 2009/10. They agreed immediately that they needed to find out from the deaf community what they require from mental health services. The participants agreed that a service user led consultation exercise would need to take place to ensure that any future service development reflected the needs of the patient group. The group continue to work on other aspects of its work plan which include care pathway modelling, service user engagement and supporting the national service designation programme.

Eating disorders

The group has continued to be active during 2009/10 and has developed an Eating Disorder Services ‘Guiding Principles and Care Pathway’ leaflet which has been written to support GPs, community mental health teams, community eating disorder services and specialist inpatient eating disorder services in the monitoring, referral and admission of patients diagnosed with an eating disorder. Clinical outcome measurement tools are currently in development.

15

Personality disorders

Following a public consultation in 2009 that covered the east of England, London, south east coast and south central specialised commissioning group areas, a joint NHS committee agreed on how Tier 4 personality disorder services should be organised after taking into account all of the responses to the consultation. This means that there will now be one residential unit with four regional outreach teams in each of the four regions. This work is now being taken forward and being led by a team at the east of England.

Improving the patient experience & innovationPatient forums

Commissioners and case managers now attend patient forums to hear first hand from service users what can be improved or what works well. This means that the SCG can work with service providers to make sure that the services meet patients’ needs:

As a result, this particular provider moved the public telephone to a private location.

Patient involvement in contract monitoring

Patients now attend some contract monitoring meetings where the SCG meets with service providers to assess how they are meeting the required standards. There are plans to develop this further in 2010-11.

Involvement in regional networks

Patients are encouraged to take part in clinical reference groups and are particularly active in the Personality Disorder Reference Group.

Partnership working to improve quality and innovation

Commissioners and providers have continued to work in partnership to develop innovative ways of providing services. This includes the development of an ‘acute phase 2’ eating disorder service whereby patients progress ‘down’ to this level of treatment prior to being discharged from inpatient care.

This new phase of treatment is believed to increase patient involvement in their care plan and improve the patient experience by allowing them to take responsibility for themselves, whilst still receiving an appropriate level of care required prior to any discharge.

Quote from a patient at Care Principles:

I thought everything was OK about what was said about Beech House. The questions they asked me

about the shop were very good and what I thought of the staff and I said it was all OK. I enjoyed the meeting and the company and would like to go again.

Anon, 2009:

We don’t have any privacy when phoning mum because the phone is in

a public area on the ward.

16

Achievements in the Perinatal Network

17

Improving specialist care for newborn babies in the east of England

Following a public consultation in 2009, the SCG Board supported the proposals for hospitals in Essex to form part of formal ‘networks’ and to be given the opportunity to work towards British Association of Perinatal Medicine (BAPM) standards. These are national clinical standards that all neonatal units have to meet.

Developing BAPM standards for ‘Local NeonatalUnits’meansthatallneonatalunitsin Essex would have the staff and facilities to provide all levels of care, including some short-term intensive care. Babies requiring longer term intensive care would be more safely cared for in a highly specialised unit within their formal ‘networks’.

The East of England Perinatal Networks has been working with the five Essex hospitals in Basildon, Chelmsford, Colchester, Harlow and Southend to help them achieve the BAPM standards. For babies that will now be transferred to London for intensive care, good relationships have been formed with the relevant hospitals.

The lead nursing and medical staff from Essex sit on a ‘Clinical Implementation Group’ which is also chaired by a paediatrician from ColchesterUniversityHospitalNHSFoundationTrust. This group monitors progress along with the overarching project group to ensure that quality and safety are at the heart of the service.

All units in Essex which did not already meet BAPM standards at the time of public consultation intend to meet them by March 2011.

Norfolk, Suffolk and Cambridgeshire Neonatal Review

Similar to the consultation that took place in Essex, which assessed what level each neonatal unit can safely and effectively operate at, the same process is now being undertaken in Norfolk, Suffolk and Cambridgeshire.

A review of each unit was completed by a parent representative, PCT commissioners and medical staff. The recommendations they made will form the proposals for public and clinical engagement, expected to happen in early 2011.

The Department of Health has also produced standards for neonatal care that recommends that units should be renamed according to the types of patients they mainly treat and their staffing levels. The new names will be;

• SpecialCareBabyUnit

• LocalNeonatalUnit

•NeonatalIntensiveCareUnit

18

As with the Essex public consultation, the proposed changes will only affect a very small number of babies who need the most specialist intensive care, which can only be provided at neonatal units with the experience and staff to be able to treat them safely.

The project group that oversees this work includes a parent representative and clinical members of staff from within neonatology.

24 hour specialist transport for sick babies launched

In October 2009, the Acute Neonatal Transport Service (ANTS) moved from a 12 hour to a 24 hour service.

The ANTS ambulances, which are specially adapted from normal emergency ambulances, contain all of the equipment needed to transfer sick and small babies from one unit to another. It is manned by a team of specialist doctors, nurses and drivers and allows staff at units to continue to care for babies who may not be as ill.

The move to a 24 hour service has been very reassuring for parents of sick and small babies at what is an incredibly stressful time.There is a separate nurse-led team who transfer babies back to units closer to home as they get better, ensuring that families can be closer to home as soon as possible.

For more information about this project visit the Perinatal Network pages at: www.eoescg.nhs.uk

Cheryl France, Parent Representative:

Input from families has been at the heart of the work for the

Perinatal Networks and parent views are actively sought and listened to.

19

Finance and assurance

20

Financial Plans

We have always known that year on year increases in national funding would slow down as we reached levels of health spending that are equivalent to other European health systems. However, the global economic downturn means added pressure for public services.

The NHS received a two year financial arrangement for 2009/10 and 2010/11 with allocation increases in east of England PCTs ranging from 10.6% to a maximum of 12.3%. These are the final years of growth, prior to much lower increases from 2010/11 onwards, when we expect a prolonged period of low or no growth in years three to five of our strategic plan. We can expect even further increases in efficiency savings targets and our plans will be increasingly dependant on achieving savings targets of at least two% per annum. At the same time our regional population is growing and there will be many more older people with demands on health services. Expectations continue to rise, there will be new drugs and treatments to fund but we remain firmly committed to improving health and health services for people living in the east of England.

Financial responsibilities

The financial year 2009/10 was the third year of the SCG, which saw a significant shift in the budget managed on behalf of the 13 PCTs. The budget increased from £482m in 2008/09 to £683m in 2009/10. The increase was primarily due to re-configuration of commissioned services across the 13 PCTs and where possible aligning the commissioning arrangements across the portfolio in line with the national requirement of the Carter Review.Through the hosting arrangement with South East Essex PCT (SEE PCT), the SCG utilises the shared services and resources of the host in compliance with regulatory returns and requirements. The PCTs entrust their element of the commissioning budget to the SCG,

which jointly commissions specialist services from a range of providers across the east of England and nationally.

Value for money

We competitively tender to drive down prices for region wide activity delivered in and outside of the region, eg. mental health services. The SCG has reviewed a local pricing structure in order to achieve comparable prices, for like for like services, where national payment by result prices are not applicable. This work will continue into 2010/11 and 2011/12. In addition, during 2010/11 we are required to deliver quality, innovation, productivity and prevention plans (QIPP) of £18 million to help meet our statutory financial responsibilty. These savings plans will become common in successive years, with the expectation that during the next five year period from 2010/11 we will deliver a cumulative total of £120 million savings.

Economies of scale in contracting on behalf of 13 PCTs enable a more robust discussion with providers to negotiate cheaper prices for similar services across some mental health service provision through competitive tendering. This will continue as the portfolio volume activity changes and the SCG begins to align PCT services and specialist activity across the region. Benchmarking with the other nine regional specialised commissioning groups is being developed too.

In terms of commissioning services and activity,

the SCG demonstrates its commitment to driving efficiency and value for money through its contracting processes.

21

The salaries and wages costs of the SCG in 2009/10 were less than 0.5% of the overall care budget. Economies of scale are further achieved through the management of a relatively small number of contracts managed on behalf of the PCTs, who would otherwise be required to manage replicated contracts across their respective area.

Audit arrangements

Internal and external audit arrangements are closely aligned with our host PCT (SEE PCT audit committee), who in conjunction with the SCG negotiate and agree the audit plan for the year, for both internal and external audits. The joint external auditors for the SCG and SEE are PKF Accountants and Business Advisers. They focus particularly on the internal audit activity based on the audit plan agreed at the Audit Committee of SEE PCT, at which SCG is in attendance.The expenditure for 2009/10 is audited

and reported gross as part of the SEE PCT final accounts. The SEE PCT Annual Report includes the full ‘Statement on Internal Control 2009/10. The SEE PCT Accounts were approved by the auditors and the audit opinion is in their annual report, which you can find on page 72 and the audit fees are on page 61 of the SEE PCT Annual Report.

Better payment practice code

The Non NHS Trade Creditor Payment Policy complies with both the Confederation of British Industry Prompt Payment Code and Government Account Rules. The target is 95% of both the value and number of non-NHS trade creditors to be paid within 30 days of receipt of goods or a valid invoice, whichever is later unless other payment terms have been agreed.

Better payment practice rate

Ref: month 12 outturn report June 2010 SCG Board.

Cumulative 2009/10

NHS

Number

Non NHS

Number

Value

Total number of bills

2745

£677.5m

2870

£54.5m

Bills paid within 30 days

2287

£658.1m

2632

£51.4m

5 of bills within 30 days

83%

97%

92%

94%

22

Specialised Budgets 2010-2011

Financial Plans for 2009/10 and 2010/2011

The financial plans for 2009/10 and 2010/11 are defined here in terms of the indicative allocation against the Carter Definitions. These figures outline the split across the specialised services for the east of England.

* Other services include all those listed on the next page.

Renal 10%

Mental health 13%

Cardiac 19%

Other 38%

Children’s services 20%

23

Specialised Services for 2009/10 2010/11 (£million) (£million)

1 Cancer 12.3 13.2

2 Blood and marrow transplantation 9.3 9.6

3 Haemophilia and other related bleeding disorders 22.4 21.4

4 Women’s health (inc fertility) 21.7 21.7

5 Complex physical disabilities 3.3 3.4

6 Spinal services 10.0 11.4

7 Complex rehabilitation 0.3 0.3

8 Neurosciences services 19.5 18.7

9 Burn care services 1.0 8.7

10 Cystic fibrosis 3.5 3.7

11 Renal 73.8 68.4

12 Home parenteral nutrition 0.8 0.8

(intravenous feeding of patients at home)

13 Cardiology and cardiac surgery 176.1 129

14 HIV/AIDS treatment and care services 21.2 2.5

15 Cleft lip and palate services 1.7 1.6

16 Clinical immunology services 0.9 1.0

17 Allergy 0.3 0.2

18 Infectious diseases 0.2 0.5

19 Hepatology, hepatobiliary and pancreatic surgery 5.2 4.5

20 Medical genetic services 10.3 5.4

21 Learning disability 14.5 17.2

22 Mental health services 92.9 87.1

23 Specialised services for children 127.5 130.0

24 Dermatology services 0.9 1.3

25 Pathology services 0.2 0

26 Rheumatology services 0.1 0.5

27 Endocrinology services 0.5 0.2

28 Hyperbaric oxygen (treatment in high pressure chamber) 0.7 0

29 Respiratory services 10.4 9.9

30 Vascular services 0.7 1.9

31 Pain management services 1.5 3.9

32 Ear surgery 7.2 0.8

33 Colorectal services 6.0 6.4

34 Orthopaedic services 14.0 9.1

35 Morbid obesity services 4.2 4.4

36 Additional services 0.8 1.4

37 Other specialised services & non-specialised services 7.3 68.9

Total 683.1 668.6

24

Environmental standards

A Carbon Footprint Working Group has been established and sets out the SCG’s Sustainability Development Management Plan (adapted from our host SEE PCT). Regular updates on progress are submitted to the SCG Board and the NHS South East Essex Good Corporate Citizenship Group.

Freedom of information

Provision of information under the Freedom of Information (FOI) Act information is a legal requirement. The SCG have policies and guidance in place to deal effectively and efficiently with any requests. The SCG is committed to maintaining transparency and openness and making a wide range of information available to the public. Our website provides comprehensive information including minutes of meeting and board papers which are available to download at www.eoescg.nhs.uk. We have had nine requests under the Freedom of Information Act 2000.

Complaints

Complaints from patients and service users are a valuable source of feedback. They help us understand the area’s we perform well in, but most importantly area’s we could improve on.

On 1 April 2009, new complaints regulations were introduced for the NHS and social care. In 2009, the SCG responded to 19 complaints satisfactorily.

Serious incidents requiring investigation

When things go wrong, we have robust systems to ensure that we learn quickly from these incidents. This process involves working closely with the providers to investigate and identify a root cause for any serious incidents with action plans formed where necessary to achieve improvements. In 2009 there were 54 serious incidents that were reviewed by our commissioners and case managers.

Ensuring all lessons are captured appropriately and action plans are formed to safeguard our patients. We hold quarterly review meetings with the SHA to monitor progress and identify action plans where necessary.

In 2010/11, we will continue to improve

our reporting processes with providers and the SHA

25

Consultation and engagement

It is the role of the Communications Team at the SCG to raise awareness of our work, create an understanding of the services we are responsible for and facilitate open discussions with all groups who need specialised services.

This helps us to get people involved in the work that we do – from clinicians and GPs to patients and carers.

In 2009/10 the Communications Team have: •Organisedandcarriedoutapublic consultation on ‘Developing Renal Dialysis Services for People in the East of England’, organising 13 consultation events and receiving nearly 300 responses from NHS professionals, patients, carers and staff.

•Analysedtheresultsoftheconsultation and informed the SCG Board about what respondents thought about the proposals and what they wanted from their service.

• Improvedinternalcommunicationstostaff by introducing a staff survey, SCG induction days and the SCG staff forum, to help improve staff welfare and training. • ProducedaCommunicationsand Engagement Strategy for the SCG which detailed how we will work closely with NHS partners, charities, voluntary organisations and local authorities.

• Implementingthisstrategyand forging stronger links with all stakeholders to achieve a whole system approach to patient care in specialised services.

• Providedsupporttocomissionerswhen involving patients and others interested in or affected by specialised illnesses more in their work.

The re-design and introduction of our new website in early 2011 will help us to build on this work, in a timely and easily accessible way.

26

Tell us what you think and get involved

Contact details:Website: www.eoescg.nhs.uk

Email: communications@eoescg.nhs.uk

Address: East of England Specialised Commissioning Group Endeavour House Coopers End Road Stansted Essex CM24 1SJ

Telephone: 01279 666388 or 01279 666969

If you would like copies of this annual review, copies in any other language, large print or another format, please contact us using the details above.

Would you like to support the SCG in its

engagement work? Why not get involved in our public consultation or engagement events. For further information please contact the Communications Team.

27

Specialised services national definitions set (third edition) 2010 • Specialisedcancerservices(adult) • Specialisedservicesforbloodandmarrowtransplantation(allages) • Specialisedservicesforhaemophiliaandotherrelatedbleedingdisorders(allages) • Specialisedservicesforwomen’shealth(adult) •Assessmentandprovisionofequipmentforpeoplewithcomplexphysicaldisability(allages) • Specialisedspinalservices(allages) • Specialisedrehabilitationservicesforbraininjuryandcomplexdisability(adult) • Specialisedneurosciencesservices(adult) • Specialisedburncareservices(allages) •Cysticfibrosisservices(allages) • Specialisedrenalservices(adult) • Specialisedintestinalfailureandhomeparenteralnutritionservices(adult) • Specialisedcardiologyandcardiacsurgeryservices(adult) •Cleftlipandpalateservices(allages) • Specialisedimmunologyservices(allages) • Specialisedallergyservices(allages) • Specialisedservicesforinfectiousdiseases(allages) • Specialisedservicesforliver,biliaryandpancreaticmedicineandsurgery(adult) •Medicalgeneticservices(allages) • Specialisedmentalhealthservices(allages) • Specialisedservicesforchildren • Specialiseddermatologyservices(allages) • Specialisedrheumatologyservices(allages) • Specialisedendocrinologyservices(adult) • Specialisedrespiratoryservices(adult) • Specialisedvascularservices(adult) • Specialisedpainmanagementservices(adult) • Specialisedearservices(allages) • Specialisedcolorectalservices(adult) • Specialisedorthopaedicservices(adult) • Specialisedmorbidobesityservices(allages) • Specialisedservicesformetabolicdisorders(allages) • Specialisedophthalmologyservices(adult) • Specialisedhaemoglobinopathyservices(allages)

Four definitions have been removed from the specialised services national definitions set. They were HIV/Aids treatment and care, specialised learning disability services, specialised pathology and hyperbaric oxygen treatment services.

Appendix A