28th February 2018 - Audit & Risk Committee, 7th March 2017
Health and Wellbeing Board Meetings: - Darlington, 31st January 2017 - Hartlepool, 13th March 2017 - Stockton, 29th March 2017
16:25 Questions from the Public – Members of the public may raise issues of general interest which relate to the Agenda
16:28 Post –critique of the Governing Body Meeting Date and Time of Next Meeting:
Tuesday 25th July 2017, 2pm, in the Community Safety Centre, Darlington, DL1 5LN “Representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity in which
would be prejudicial to the public interest (Section 1(2) of the Public Bodies Admissions to Meetings Act 1960)”
Contact for the meeting: Rachael White, Committee Secretary Tel: 01325 621407 or email [email protected]
A recording will be made of this meeting to assist with the preparation of the minutes. This recording will be made on an encrypted device owned by the CCG and will be held securely for a maximum of three weeks before being deleted
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Bodies Public Meeting In-Common
Tuesday 28th March 2017 at 2pm In the Hackworth Room, Community Safety Centre, Darlington
UNCONFIRMED MINUTES
Present Andrea Jones (Chair) Chair of Dton Governing Body Dr Boleslaw Posmyk Chair of HaST Governing Body John Flook Lay Member, Governance Angela Galloway Secondary Care Clinician (Darlington) Dr David Hodges Governing Body GP Member Andie Mackay Lay Member, Finance Diane Murphy Director of Nursing and Quality (Darlington) Graeme Niven Chief Finance Officer Dr Charles Stanley Secondary Care Doctor Dr Jenny Steel Governing Body GP Member (Darlington) Hilary Thompson Lay Member, Patient and Public Involvement (Hartlepool) Michelle Thompson Lay Member, Patient and Public Involvement (Darlington) Dr Nick Timlin Governing Body GP Member (Stockton) Ali Wilson Chief Officer In Attendance Andrew Carter Governance and Risk Manager Miriam Davidson Director of Public Health, Darlington Borough Council Karen Hawkins Director of Commissioning and Transformation Barbara Potter Head of Quality and Safeguarding (Hartlepool and Stockton) Lisa Tempest Director of Performance, Planning and Assurance Members of Public in Attendance Darren Bennett Lisa-Marie Dawkins Healthcare Partnership Manager AbbVie Dan Jackson Northern CCG Forum Representative Jeff Robinson NHS Commercial Director Quintiles
GB/17/1.1 Apologies for Absence 1.1.1 Apologies for absence were received from Jean Golightly, Dr Richard Harker, Dr
Saleem Hassan, Dr Alison MacNaughton-Jones and Dr Salvi Patel. GB/17/1.2 Declaration of Interest 1.2.1 No additional declarations were made at this point.
3
2
Pre-critique The Chair welcomed the members of the public to the meeting. It had been agreed that
the Chairs of each Governing Body would alternate the chairing of the meetings. Each Chair had a di fferent approach and it was acknowledged that there would be different approaches and it would be useful to compare the two.
GB/17/1.3 Unconfirmed minutes of the meeting held on Tuesday 13th December 2016 1.3.1 The minutes of the meeting were agreed as an accurate record subject to minor
amendments. GB/17/1.4 Matters Arising and Action Log 1.4.1 The Governing Body reviewed the action log and the following updates were provided: 1.4.2 GB/28/16 – Patient Story - Mr Carter advised that Mrs Leonard, NTHFT Quality Nurse
was picking up the issues raised in the story. Mr Carter added that the patient story will be passed on to the CCG Quality Team and Commissioning Team to ensure any issues were addressed. - Andrew Carter advised that despite following this up, no response had been received. This would be escalated through the Complaints Team.
1.4.3 DCCG3 – Engagement Plan Update - Discussion had taken place with Mary Bewley
and work was being undertaken to bring the engagement plans for both organisations together. Work continued to align the engagement plans.
1.4.4 DCCG4 – Planning Round 2017/19 - A further report to be brought to Governing Body
in early 2017. Ali Wilson advised that feedback was expected from NHS England in March. A report would be submitted to Committee once available. Formal feedback was still awaited.
1.4.5 GB/17/01 – Dton Patient Story - A patient had been advised that their GP was
changing practice and they could not change with them, it was queried as to what the process would be in this situation. Michelle Thompson to send the details to Karen Hawkins for follow up as Practices should only decline in times of pressure. Michelle Thompson would provide Karen Hawkins with the information at the end of the meeting.
1.4.6 GB/17/02 – HaST Financial Report - Continuing Healthcare continued to overspend
with 28% growth from the previous year. This was causing significant financial pressure and was a similar situation for other CCGs in the area. Graeme Niven to look at how the CCGs could raise the issue formally with NHS England. In Graeme Niven’s absence, Ali Wilson confirmed that this had bee n discussed with other Accountable Officers in the area and significant growth had been seen across the patch.
GB/17/1.5 Chairs Report 1.5.1 The Governing Body were provided with an update on progress and events since the
last meeting from the Chair of each organisation for their localities:
1.5.2 Hartlepool and Stockton
4
3
Dr Posmyk advised that discussion had taken place at the Local Medical Committee (LMC) as to what Clinical Commissioning Groups (CCGs) were aiming to achieve in terms of the 5 Year Forward View. The main topic discussed was regarding the level of financial support that could be provided and the difference in other areas. It was felt that the relationship between the arrangements between the LMC and the CCG needed to be invigorated and further in depth discussions on work such as this were required.
1.5.3 As part of the new joint working arrangements, work was to be undertaken to review the Governing Body appraisal process to ensure the whole team were coordinated. Members would be kept informed of the progress made.
1.5.4 Darlington
Andrea Jones advised that further Better Health Programme engagement events had taken place and t he Team were working on a more cohesive action plan to move forward. There had been a lot of discussion regarding travel implications for patients and this had been escalated. A Frailty Event and a Discharge to Assess workshop had also been held to engage specifically with clinicians.
1.5.5 Throughout recent LMC meetings there had been signification discussion regarding the Referral Management System which had been introduced in North Durham CCG. The more the topic had been discussed the more positive the approach was becoming to the benefits of such a scheme. The Governing Body NOTED the information provided.
GB/17/1.6 Chief Officers Report 1.6.1 The Governing Body reviewed the report provided by Ali Wilson which provided an
update on oper ational priorities, challenges and key national policy developments since the last Governing Body meeting.
1.6.2 HR Update – Quarter 3
The overall headcount across the two CCGs had increased from 51 at the end o f Quarter 2 to 55 at the end of Quarter 3 (full details of which were included in the report). It was asked that the Governing Body note that as part of the new arrangement it had been agreed that all new starters would be em ployed by Hartlepool and Stockton-on-Tees CCG which was why there had been such an increase in recruitment for the organisation in comparison to Darlington CCG.
1.6.3 Fortunately sickness absence levels within both organisations both long and short term were decreasing. Hartlepool and S tockton-on-Tees CCG absence levels had been consistently dropping since July 2016 and Darlington had extremely low levels of absence from April 2016 onwards.
1.6.4 Annual Report
NHS England had set out its expectations of the CCGs in terms of annual reporting that would require publications of an integrated Annual Report and Accounts no later than 31st May 2017. The Hartlepool and Stockton-on-Tees annual report from 2015/16 had been recognised as having excellent sustainability reporting as part of our annual report and it was hoped that this could continue and expand for both the CCGs reports for 2016/17.
5
4
1.6.5 Better Health Programme and Sustainability and Transformation Plan (STP) Engagement Events
During February, the Better Health Programme undertook Phase 5 of the public engagement events to engage with the public and s takeholders. The focus of this phase of events was maternity and paediatric services.
1.6.6 Darlington CCG were invited to an e vent on t he 17th February hosted by Darlington
Borough Council where elected members, local MPs and m embers of the public presented their views on the STP. The concerns expressed included; the perceived extended travel times for some residents; the need to develop services in a timely way ideally before any changes occur in the hospital; whether the ambulance could accommodate the changes. The CCG would ensure that the comments were fed into and recorded within the engagement process documentation as well as the preparation of a ‘ frequently asked questions’ document that would provide more detailed responses to the questions, that would be made available to the public.
1.6.7 Integrated Urgent Care Service - Hartlepool and Stockton-on-Tees From 1st April 2017 a new integrated urgent care service for illness and minor injuries
would be launched in Hartlepool and Stockton. Patients would be treated by a GP or urgent care practitioner based in the new integrated urgent care centres at the University Hospital of Hartlepool and the University Hospital of North Tees. In order to support the change in urgent care provision a communication plan had been initiated to ensure patients had the information they needed which included the use of social media and printed materials.
1.6.8 Fens, Hartfields and Wynyard Road Practices Following the public consultation on t he future of the Fens, Wynyard and Hartfields
practices and the decision of the Governing Body; it had been ag reed that the procurement exercise after the closure of Fens Practice should be c oncluded as quickly as possible. This would ensure minimal disruption to patient care and the CCG would fully involve those who would use the service in options development.
1.6.9 Assisted Reproduction Services
Hartlepool and S tockton-on-Tees CCG were requested to attend the Hartlepool Borough Council Audit and Governance Committee on the 8 February 2017 to discuss the future arrangements for the provision of services from the Assisted Reproduction Unit at the University Hospital of Hartlepool. The CCG presented a detailed breakdown of the procurement process and to provide further assurance that a robust evaluation process had been undertaken. The Committee recommended that the CCG undertake a new tender process for the services however it was discussed with the CCG Governing Body on the 21st February and was agreed that the CCG would not reopen the procurement process and approved the implementation of the arrangements. This would ensure the continuation of delivery of a s ignificant part of the pathway at the University Hospital of Hartlepool by current contract holders.
The Governing Body NOTED the information provided.
GB/17/1.7 Locality Reports: 1.7.1 Darlington Dr Steel reported that there was a pr essure within primary care in terms of staffing
levels. Several practices had under gone successful recruitment which would start to
6
5
improve access and continuity of care. Primary Healthcare Darlington was now providing additional appointments 7 days a week which would also aid improvement.
1.7.2 Work continued overall towards to the Darlington 2020 V ision and t he GP 5 Y ear
Forward View including the following areas: - Community Hubs continued to progress and over the next few months they would
begin to discuss their work and aim with their Patient Participation Groups. - The Healthy New Towns grant had been issued and w ould be di scussed the
following week. Communications about the next steps would be sent out as soon as possible.
- The current Care Home Project had been reviewed and work was being undertaken with Primary Care to look at how it could evolve over coming years. The Team were also working with Ventress Hall Care Homes to review how rehabilitation prospects could be t aken forward and how physiotherapy services could be provided.
1.7.3 As part of the Flu campaign in Darlington, Primary Healthcare Darlington undertook a
piece of work to raise awareness of the vaccination in patients with learning disabilities. The area had seen a huge improvement and Darlington had been ranked as one of the best in the area.
1.7.4 The Governing Body acknowledged that it was a challenging time for primary care and
stressed the need to engage efficiently with colleagues to build on working relationships.
1.7.5 Hartlepool Dr Timlin advised that recruitment was also an issue in Hartlepool and there was a lot
of pressure on nur se practitioners to fill this void. This would be di scussed at the Clinical Review Group to discuss how to move forward. In Hartlepool, extended access services would be i n place from the 1st April providing evening and w eekend appointments.
1.7.6 There had been s ome confusion in Hartlepool with some thinking that the A&E
department at the hospital was reopening. Clarification had been given where appropriate however it was felt that further communications to the public may be needed to avoid this.
The Governing Body NOTED the update. GB/17/1.8 Patient and Public Involvement Reports 1.8.1 Darlington
Michelle Thompson advised that there had bee n a s ignificant discussion at the last Community Council meeting about the Better Health Programme and i t was felt that there had been g ood attendance from the public at the recent engagement events. However at one e vent there had been c omment from a c onsultant from County Durham and Darlington Foundation Trust (CDDFT) stating that there was not enough awareness among clinical staff which had caused concern. This had been escalated to the CCG however it was asked that feedback be provided to the group to make them aware of what actions had been put in place to ensure clinical engagement.
1.8.2 Dr Steel advised that discussions had taken place with the Executive Team at CDDFT
regarding how the Better Health Programme could would with clinical staff to improve
7
6
engagement. A session was being held the following week to work through and develop the engagement plans. It had also been asked that a document be produced breaking down the difference between ‘engagement’ and ‘consultation’ as well as ‘you said, we did’ so that staff and the public could understand the process and see that their comments and concerns were being acknowledged.
1.8.3 Members of the Community Council had echoed the concerns highlighted earlier in the meeting regarding patient travel under the potential new service arrangements. They also highlighted the potential increase in activity for local services due to the housing development at Catterick. There was also a consistent feeling among the public that the A&E department was going to be closed and there was difficulties in being able to book an appointment with a GP.
1.8.4 In regards to Healthwatch Darlington, Darlington Borough Council had increased the
funding amount that would be provided which meant that further services could be secured. The annual Healthwatch report would be available in the near future which would include good news stories such as the success of the Blueprint Event that had been organised for the North of England Commissioning Support Unit (NECS) on behalf of the CCG.
Lisa-Marie Dawkins left the meeting. 1.8.5 Hartlepool and Stockton-on-Tees
Hilary Thompson advised that a Conflicts of Interest Conference was held in Leeds for Lay Members which provided a detailed overview of the latest guidance and the governance process.
1.8.6 Healthwatch Hartlepool had produced a draft report on an investigation into the patient
experience of Hartlepool Borough Council’s (HBC) Direct Care and Support Services which was instigated after the Care Quality Commission found some areas of improvement in 2016. Healthwatch recommended that its findings were noted and acted upon by relevant parties after observing that it was “a good service on the whole with some aspects that need addressing”.
1.8.7 Following on from the information providing at the previous meeting regarding
Healthwatch Hartlepool working with York University, a two-day residential course was to be held for around 30 young people aged 14 to 18 years to look at young people's priorities re Health and Social Care. The findings would be made available widely and would hopefully influence service provision. The young people selected were a representative group across the town, including some looked after children, some young inspectors, some young carers. The youth engagement team from HBC would work closely with them and Healthwatch would also look to encourage representation for their organisation.
1.8.8 Healthwatch Stockton previously undertook an Enter and V iew visit to the University
Hospital of North Tees looking at communication. A survey was carried out from September 2015 to January 2016 to gather intelligence from patient experience which included some negative feedback about various aspects. The Activity update Report to the provider with the 20 day response was due by 13th March 2017. It was anticipated a report would be published on this before the end of March 2017.
1.8.9 There were two Community Health Ambassadors coffee mornings in March, one at
Epilepsy Outlook, Hartlepool, and one at Thornaby Community Partnership following
8
7
discussion at the last Peer Group meeting in January regarding developing Ambassadors knowledge of each other’s' areas. The next Quarterly Peer Group meeting was on Thursday 27th April and there was no theme attached to this currently.
1.8.10 The Primary Care Commissioning Committee meetings continued to be challenging in terms of the decisions needing to be m ade. It had been es calated within the Committee that it was not always satisfactory for verbal updates to be provided as it was often difficult to give a fully informed decision. Colleagues were working with NHS England to resolve this.
1.8.11 It had been s tated recently in the news that the medical records of 26million patients
were involved in a major security breach with warnings that the IT system used by thousands of the GPs was not secure. Hilary asked the Governing Body what the CCGs response had been to this. Karen Hawkins advised the Governing Body that the issue had been es calated to the CCG Caldicott Guardians and Information Commissioning Officers (ICO). The advice given was that the issue outlined in the news was not in relation to the whole system but one specific module and work was being undertaken by the ICO with NHS England and NHS Digital to put a plan in place to resolve the issue. All staff were required to undertake mandatory Information Governance Training and each professional was required to gain patient consent in order to access patient information. If information was to be accessed without consent, the ‘break glass’ protocol would be enforced which would outline who had viewed the information and where from. The risk to patients was very low.
1.8.12 As Caldicott Guardian for Darlington CCG, Diane Murphy advised that a significant
amount of work had been undertaken across the localities to encourage data sharing in order to provide a better continuity of care for patients. There was a low risk to patients and the CCG and processed had been put in place to ensure consent was gained from the patient before the clinician accessed the records.
1.8.13 Patient Story
Hilary provided the Governing Body with an in-depth account of a Hartlepool patient’s journey of having Chronic Kidney Disease written by the patient themselves. The patient had been di agnosed in 1992 and had annual check-ups at University Hospital of James Cook Hospital. For 20 years the patient did not experience any symptoms and was in good health. Unfortunately in 2012 the Nephrologist advised that the patient’s creatinine levels had risen and would deteriorate over coming years. Check-ups were now required every 4 months.
1.8.14 In January 2014, the patient was admitted to University Hospital of North Tees and
University of James Cook Hospital roughly every 7weeks as symptoms became more severe. In December 2014 it was decided that a N ephrectomy would be per formed. For several months the patient recovered and felt much better however from May 2015 deteriorated and the patient was no longer able to walk for long periods of time and had to have iron infusions every 4 months due to severe anaemia. From February 2016 the patient undertook transplant training at James Cook Hospital until finally becoming active on the transplant list in August 2016.
1.8.15 After months of struggling with chronic fatigue, and struggling to eat and drink on top of
the other symptoms mentions, the Freeman Hospital had a s uitable kidney on 3 rd February 2017. The kidney was a perfect match had come from a young man who had sadly lost his life. The patient was now attending James Cook once a week and their creatinine levels had drastically reduced and was making a full recovery.
9
8
1.8.16 The patient would never forget their gift of life, a chance of a second life. In honour of their donor, they would celebrate his birthday with a cake every year. Hilary thanked the Governing Body for listening to the story and expressed the importance of the NHS and the amazing work that was undertaken by staff across the country.
1.8.17 The Governing Body thanked Hilary for sharing the individual’s story which highlighted
the importance of charitable giving and the impact that organ donation could have on another individuals life. At the meeting on the 7th February, the Governing Body had acknowledged the work undertaken by one of the Communications Team who had sadly passed away. The CCG had been s ince informed that she had been on the organ donation list and 6 of her organs had been matched to other patients giving them a new start in life. The Governing Body requested that Hilary pass on their best wishes to the patient and thank them for sharing their experience.
The Governing Body NOTED the information provided.
GB/17/3.1 DCCG Communications and Engagement Update 3.1.1 The Chair advised that this item was to be deferred due to further work needing to be
undertaken. 3.1.2 Andrew Carter advised that he attended the Communications and Engagement Group
for the CCGs and would feedback the comments from the meeting including the support from the Governing Body for further documentation for the public in regards to the Better Health Programme. Ali Wilson advised that a d raft consultation plan was being drafted and would be shared with the group as soon as possible.
Graeme Niven joined the meeting. 3.1.3 Michelle Thompson advised that since the Better Health Programme Board moved into
the Sustainability and Transformation Plan Board, her invites and the invites to Healthwatch Darlington had stopped. This was a concern as the views of Lay Members and local organisations were not being heard. Hilary Thompson also voiced these concerns. Ali Wilson advised that she would take this information back to the Board.
The Governing Body NOTED the information provided.
GB/17/2.1 Performance Report 2.1.1 The Governing Body reviewed the report which outlined the CCG’s performance in
respect of the NHS Constitutional Standards and the Quality Premium using the most up to date performance information for each indicator. The reports for both organisations had been combined into one document and exception reports had been produce for each area where the CCG/provider was not meeting the target. Lisa Tempest highlighted the following areas:
2.1.2 HaST ER01 / Dton ER02 - % of patients treated within 62 days of an urgent GP referral
for suspected cancer – Both CCGs were failing this target and action plans had been put in place both for the CCG and the providers. South Tees Hospital Foundation Trust (STHFT) had undertaken a review of their pathways and were expected to be compliant in the near future.
10
9
2.1.3 In regards to breast symptomatic and GP referrals an action plan had been put in place as there were a number of breaches due to patient choice however it was unknown as to whether these were informed decisions. Work was being undertaken to raise awareness of the process with patients to encourage them to attend their appointments as soon as possible.
2.1.4 CDDFT ER01 / NTHFT ER02 - % patients spending 4 hrs. or less in A&E minor injury
unit – Pressure had been s een across the North East and the A&E Delivery Boards were looking at additional actions that could be put in place. County Durham and Darlington Foundation Trust (CDDFT) had implemented a number of initiatives as part of the Trusts Transforming Emergency Care Plan to assist delivery and sustain performance. They undertook a ‘ perfect month’ in March in order to identify learning and review internal processes and were also looking to implement the ‘safe bundle’ which was a pat ient flow tool aimed to ease congestion in A&E. North Tees and Hartlepool Foundation Trust (NTHFT) had seen an i mprovement in performance in recent data and bot h organisations were expecting to compliant for the end of year position.
2.1.5 NEAS ER01 – 8 and 19 minute responses – The North East Ambulance Service
(NEAS) was below target for both CCGs. An action plan had been pr oduced for the next two years and s hould lead to sustained performance. NEAS had undertaken a successful recruitment exercise and would be fully staffed in April in the south of the patch.
2.1.6 Improving Access to Psychological Therapies (IAPT) – Darlington currently had t wo
providers for the service and a per formance notice had been issued to Tees, Esk and Wear Valley Foundation Trust (TEWV) in regards to performance as they oversaw the contracts. An action plan had been produced and was being reviewed. The provider for counselling services wasn’t currently contracted to deliver against standards outcomes and this was being reviewed going forward. There were also some issues with the Child and Adolescent Mental Health Services as a number of patients had not been assessed in the required time period. Since this had been escalated, performance had improved.
2.1.7 HaST Diagnostics - % of patients waiting less than 6 weeks for the 15 diagnostics tests
– NTHFT were non-complaint due to sickness absences and vacancies within the departments. Actions had been put in place and performance had improved. It was expected that the target would be achieved for the end of year position.
The Governing Body NOTED the information provided. GB/17/2.2 Quality Report 2.2.1 Darlington
Diane Murphy advised the Governing Body that unfortunately the team had not been able to combine the reports in time for the meeting however assured that work was being undertaken to do so.
2.2.2 CDDFT had now reported 10 N ever Events since April 2016. A full review of the
incidents as being undertaken with associated lessons learnt and key actions established. The action plan had been reviewed by the Quality Review Group and the Trust advised that had an external organisation reviewing the cultures within their departments. There were no specific trends identified and two cases were historic. The
11
10
Trust were also an out lier in the latest mortality data release. CDDFT had a g ood mortality review process whereby a team of consultants, pharmacists etc. meet on a weekly basis to review the cases. This data was also monitored to the Quality Review Group. There was a trend in the data and a specific pathway had been identified for review. All data was discussed at the CCGs Quality, Performance and Finance Committee and it was felt that the review being undertaken on the cultures within the organisation would provide a good insight.
2.2.3 TEWV was currently non-compliant in regards to Serious Incident reporting. This had
been discussed with the Trust and was the subject of a ‘deep dive’ discussion at the Quality Review Group in January 2017. TEWV reported that there were ongoing staffing issues that were contributing to the ability to meet the timescales.
2.2.4 The Care Quality Commission had recently undertaken an inspection of TEWV acute
wards of working age and psychiatric intensive care units and wards for older people with mental health problems. And overall rating of ‘Good’ had been given however in regards to the ‘safe’ domain; it had been as sessed as ‘requires improvement’. This was for reasons such as staff not always adhering to trust policy in documenting and monitoring the seclusion of patients and not being up to date with mandatory training. Action plans would be produced and w ould be r eviewed by the Care Quality Commission. Currently the Clinical Quality Review Groups for TEWV were separate for each CCG however it had been agreed that the Darlington, North Durham and Durham Dales, Easington and Sedgefield CCGs would come together to give a more coordinated approach.
2.2.5 Hartlepool and Stockton-on-Tees
Barbara Potter provided the Governing Body with an update on behalf of Jean Golightly, Director of Nursing for Hartlepool and Stockton-on-Tees CCG.
2.2.6 NTHFT had received the report following their independent, external Maternity
Services review however it was yet to be shared with the CCG. The findings would be shared with the Governing Body once the team were able to.
2.2.7 There was an issue regarding Health Care Acquired Infections and P rimary Care
antibiotic prescribing practice. Hartlepool and S tockton-on-Tees CCG was the 9th highest prescriber of antibacterial drugs in England in Quarter 2 however recent data had shown a dec line. Actions plans had been put in place with the practice and the Medicines Optimisation Team were working with them to review practices and to reduce the amount of prescribing if possible.
2.2.8 STHFT had reported 7 cases of MRSA within 12 months. The Trust Quality Assurance
Committee had requested a review of the Healthcare Associated Infections improvement plan. A specific action plan had been s hared with the CCG which included learning lessons, initiate a task and finish group to review invasive device management and work with Commissioners to improve compliance with screening/decolonisation.
2.2.9 Following the recent local area inspection in Hartlepool by Ofsted and the Care Quality
Commission, the formal written report had been received which highlighted a lack of information known across all agencies about the needs of the population of children and young people with Special Educational Needs and Disabilities (SEND). Work was underway to find solutions to the identification and c ollation of SEND data from
12
11
provider organisations to inform future commissioning and how relevant information could be shared across agencies in the most effective manner.
2.2.10 Barbara advised that the recently published NHS England Safeguarding Adults
booklets which outline the key aspects of The Care Act 2014 a nd roles and responsibilities. The information could also be accessed by a mobile app. The booklets were being sent out to all practice staff.
2.2.11 Ali Wilson advised that Governing Body that all providers had been asked to include
areas of service fragility in their reports so that they could be taken into consideration in the Better Health Programme work being undertaken.
The Governing Body NOTED the information provided. GB/17/2.3 Governance and Assurance Report 2.3.1 The Governing Body reviewed the report which had been c ombined for the two
organisations and pr ovided detail on s ignificant governance and as surance issues since the last meeting. The aim of the report was to provide the Governing Body with assurance of the CCGs delivery of key governance processes.
2.3.2 The Darlington and Hartlepool and Stockton-on-Tees risk registers had been fully
reviewed to ensure that all risks were up to date. A comparison had also been undertaken and a nu mber were replicated across the two with a num ber being very similar. All new and close risk were detailed in the report. The next step was to review the risk registers with the Executive to establish the CCGs ‘risk appetite’ and reassess all residual risks against the defined appetite. John Flook queried as to whether the CCGs noted inherent risks on the risk registers and the actions taken to mitigate them as other organisations were required to do so. Andrew Carter advised that currently any inherent risks were included in the Governance Statement however not on the risk register; these would be added and included as part of the overall review.
ACTION: GB/17/03 (Andrew Carter) 2.3.3 The Assurance Frameworks for both CCG’s had been reviewed and all strategic
objectives had aligned strategic risks and had been mapped to the CCG improvement and assessment framework 2016/17. The Assurance Frameworks were presented to the Audit and Risk Committee’s on 7th March 2017 and Governing Body was asked to note and approve the Governing Body Assurance Framework for 2016/17.
2.3.4 The CCG’s continue to review all policies to ensure it complies with relevant legislation.
Approval of all policies would now be m ade by the Governing Body under the new governance arrangements. A number of new and existing policies had been reviewed by the Formal Executive group who recommended that they be approved by the Governing Body. A list of which was included in the report. Each policy had not been included in the paper due to the size of the documents that would need t o be circulated. Once approved they would be made available on the CCG intranets.
2.3.5 Both Darlington CCG and Hartlepool and Stockton-on-Tees CCG were reporting that
they were compliant with all Level 2 requirements of the Information Governance Toolkit. The Governing Body were asked to formally endorse the CCG’s level of compliance and delegate to the Chief Finance Officer as Senior Information Risk Owner to sign off the submission.
13
12
The Governing Body NOTED the information provided and APPROVED the following: - Darlington and Hartlepool and Stockton-on-Tees CCG Assurance
Frameworks - The policies outlined in the report for both organisations - The CCGs certifying themselves as Level 2 for the Information Governance
Toolkit GB/17/4.1 Annual Cycle of Business 2017/18 4.1.1 The Governing Body reviewed the Annual Cycle of Business for the meeting. The
document outlined the documents to be submitted in the required timescales and should be similar to previous years. The Operation Plan process had changed however the review had been left in January with scope to change if necessary.
4.1.2 Ali Wilson asked the Governing Body what would be t heir preference in terms of
receiving information regarding the STP. An update was always included in the Chief Officers report and the minutes of the STP CCG Joint Committee would be provided. The Governing Body asked that regular updates continue to be provided in the Chief Officers report however when work started to progress towards consultation it was asked that a summary report be provided.
The Governing Body APPROVED the Annual Cycle of Business. GB/17/4.2 Committee Terms of Reference 4.2.1 The Governing Body was requested to review and approve the latest revised terms of
reference for the CCG committees. The following discussions took place: 4.2.2 Quality, Performance and Finance Committee The terms of reference were new due to the previous Darlington CCG Quality,
Performance and I nnovation Committee and H aST CCG Quality, Performance and Finance Committee joining together. The Directors expressed some concern in regards to the quorum for the meeting as currently the Chief Officer or the Chief Finance Officer were required in order to be quorate. A meeting had been held that morning in which neither could be in attendance and it was felt that this may need to be reviewed. The Governing Body APPROVED the terms of reference however asked that if quoracy became an issue that it be reviewed.
4.2.3 Audit and Risk Committees
As the CCGs were two statutory bodies, the Audit Committees for the CCGs could not be merged together. As a r esult they would meet in-Common and c ontinue to have separate terms of reference. The Governing Body APPROVED the terms of reference for both Committees.
4.2.4 Joint Committee
Hartlepool and S tockton-on-Tees CCG had approved the most terms of reference in November 2016 however Darlington had not and the first meeting was due to be held the following week. Ali Wilson advised that the membership of the Committee reflected the STP plan and t he Committee would be g iven delegated responsibility to make decisions on behal f of the CCGs. Governing Bodies would still receive updated information and be consulted on their views. The Governing Body APPROVED the terms of reference for the Joint Committee.
14
13
Karen Hawkins left the meeting. GB/17/5.1 Finance Reports 5.1.1 Darlington
The Governing Body we presented with the latest financial information for the 11months to 28th February 2017 as well as the expected outturn position for the 2016/17 financial year. Graeme Niven advised that the current position showed that the CCG would achieve a s urplus of £1,271k against the planned control surplus of £1,771k. The £500k breach had materialised within month 11 for continuing healthcare activity. There were also still significant potential financial risks to be managed, again in relation to increasing secondary care acute activity and Q uality Innovation Productivity Prevention (QIPP) in order to achieve the revised surplus. There was also risk within the Acute and Prescribing budgets which was being mitigated by assumed slippage in the Better Care Fund.
5.1.2 In regards to Continuing Healthcare, Graeme advised that significant discussion had taken place with Darlington Borough Council and t he £500k was in relation to reconciliations dating back to 2015/16. The CCG had c hallenged both Darlington Borough Council and the North of England Commissioning Support Unit (NECS) who provide the service through a Service Level Agreement as to why it had taken so long to materialise. The Continuing Healthcare Team had commissioned a new database and were undertaking a f ull review and should be able to improve forecasting going forward. A Continuing Healthcare Board meeting had also been established to review cases on a monthly basis with the CCG.
5.1.3 The Governing Body queried as to whether there was any possibility of Hartlepool and
Stockton-on-Tees CCG facing a similar issues. Graeme advised that he had requested further assurances from the Continuing Healthcare Team. It was recognised that this was a significant issue and work was well underway to try and resolve it.
5.1.4 Hartlepool and Stockton-on-Tees
The current position showed that the CCG on track to achieve its key financial targets, but only due t o the use of a s ignificant amount of available CCG reserves including significant non recurrent reserves to offset over spends, as risks had materialised. This created a scenario where all financial investments for the year had to be held/reviewed as the CCG was in a high risk position. The position reflected increasing under delivery of QIPP, particularly on NTHFT Acute.
The Governing Body NOTED the information provided. GB/17/5.2 Financial Plans 5.2.1 Hartlepool and Stockton-on-Tees
Graeme Niven provided the Governing Body with an overview of the strategic planning requirements and the allocations given to the CCG over upcoming years. Operational plans for 2017/18 – 2018/19 were to be regarded as the implementation of the STP and five year forward view and need to demonstrate aspects such as delivery of business rules and where deficit exists, reasonableness of assumptions and reconciled activity and finance.
5.2.2 The Finance Team based the outturn position on forecast outturn at month 8 less full
year impact of 2016/17 QIPP Schemes. From this it was expected that there would be
15
14
a £14.7million gap between the funding allocated to the CCG and the funding needed the necessary services for the population. This would need to be bridged via QIPP and a list of schemes was included in the report. The main challenges faced by the CCG included; balancing activity expectations and t he financial plan, contract negotiations with key providers, delivery of QIPP and continuing growth pressure in Continuing Healthcare.
5.2.3 Graeme advised that he would be attending the Clinical Review Group to discuss this
further with Primary Care later in the week. The Value Based Commissioning Policy had been r ecently reviewed and was in place and approved by the Governing Body and would not be af fected by the gap in funding. Concern was expressed at the Governing Body approving the plan without further discussion with Primary Care in regards to CASPeR and the work to be undertaken. Graeme assured that this would also be di scussed at the Clinical Review Group and had al so been discussed at Council of Members.
The Governing Body APPROVED the plan for Hartlepool and Stockton-on-Tees CCG.
Nick Timlin left the meeting. 5.2.1 Darlington
As with Hartlepool and S tockton-on-Tees CCG, the expected forecast outturn had been produced based on data available from 2016/17 and it was expected that Darlington would have a funding gap of approx. £5.8million. The same challenges were faced by the Team in managing the budget. This was a situation several CCGs were facing across the patch.
The Governing Body APPROVED the plan for Darlington CCG.
GB/17/ 6.1 Confirmed Committee Minutes:
The Governing Body noted the following minutes: DCCG Confirmed Committee Minutes: - Finance Committee, 19th December 2016 - Governance, Audit and Risk Committee, 5th December 2016 - Primary Care Commissioning Committee, 13th December 2016 - Quality, Performance and Innovation Committee, 20th December 2016 HaST CCG Confirmed Minutes: - Quality, Performance and Finance Committee, 3rd January 2017 Joint CCG Meeting Confirmed Minutes: - Audit Committee In-Common 5th December 2016 Darlington Health and Wellbeing Board Confirmed Minutes, 18th October 2016 Hartlepool Health and Wellbeing Board Confirmed Minutes, 16th January 2017 Stockton Health and Wellbeing Board Confirmed Minutes, 25th January 2017
Questions and Comments from Members of the Public No discussion took place.
16
15
Post-critique
The Chair thanked the members of the public who attended the meeting. The Governing Body acknowledged the challenging times ahead and t he work that was to be undertaken to achieve the best outcome. Miriam Davidson suggested that it would be useful to always have a Public Health representative at the meetings as it had been very useful to hear the work being undertaken by the CCG and the challenges faced.
Date and Time of Next Meeting The next in public meeting is scheduled to take place on Tuesday 25th July 2017 at
2:00pm in the Community Safety Centre, Darlington Fire Station, Darlington, DL1 5LN. Signed: ……………………………………………….. Date: ……………………………… Andrea Jones
Chair of the Governing Body
17
Action number
Date of meeting Subject Action Responsible officer
Due date Comments Date reviewed Status
GB/28/16 29/11/2016 Patient Story Mr Carter advised that Mrs Leonard, NTHFT Quality Nurse was picking up the issues raised in the story. Mr Carter added that the patient story will be passed on to the CCG Quality Team and Commissioning Team to ensure any issues are addressed.
Andrew Carter 28/03/2017 07.02.17 - Andrew Carter confirmed that the information had been passed on however no update had been received on how the issues were being addressed. Andrew to follow up to gain a response. 28.03.17 - Andrew Carter advised that despite following this up, no response had been received. This would be escalated.
Open
DCCG3 Engagement Plan Update
KH and MB to meet to discuss how the engagement plan will link with the planning round 2017/19
Karen Hawkins/ Mary Bewley
28/03/2017 07.02.17 - Discussion had taken place with Mary Bewley and work was being undertaken to bring the engagement plans for both organisations together.28.03.17 - Work contiuned to align the engagement plans for the organisations.
Open
DCCG4 Planning Round 2017/19
A further report to be brought to Governing Body in early 2017
28/03/2017 07.02.17 - Ali Wilson advised that feedback was expected from NHS England in March. A report would be submitted to Committee once available. 28.03.17 - Formal feedback was yet to be received.
Open
GB/17/01 07/02/2017 Dton Patient Story
A patient had been advised that their GP was changing practice and they could not change with them, it was queried as to what the process would be in this situation. Michelle Thompson to send the details to Karen Hawkins for follow up as Practices should only decline in times of pressure
Michelle Thompson / Karen Hawkins
28/03/2017 28.03.17 - Michelle Thompson advised that the information would be shared with Karen Hawkins at the end of the meeting.
Open
GB/17/02 07/02/2017 HaST Financial Report
Continuing Healthcare continued to overspend with 28% growth from the previous year. This was causing significant financial pressure and was a similar situation for other CCGs in the area. Graeme Niven to look at how the CCGs could raise the issue formally with NHS England.
Graeme Niven 28/03/2017 28.03.17 - Ali Wilson advised that this had been discussed with the other Accountable Officers and significant growth had been seen across the patch.
Open
GB/17/03 28/03/2017 Governance and Assurance Report
It was queried as to whether the CCGs noted inherent risks on the risk registers and the actions taken to mitigate them as other organisations were required to do so. Andrew Carter advised that currently any inherent risks were included in the Governance Statement however not on the risk register; these would be added and included as part of the overall review.
Andrew Carter 30/05/2017 Open
Darlington CCG and Hartlepool and Stockton on Tees CCG Governing Body In-Common Action Log
18
OpenClosedComplete
19
NHS Darlington Clinical Commissioning Group and
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 1.6
30th May 2017
Title Chief Officers Report
Purpose Approval ☐ Discussion ☐ Information ☒
Responsible CCG Member / Lead
Ali Wilson, Chief Officer
Author of Report Ali Wilson, Chief Officer
Recommendation(s) Governing Body to RECEIVE the report
Executive Summary
The report provides an update on operational priorities, challenges and key national policy developments since the last Governing Body meeting.
Clinical Engagement
Not Applicable
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?
Not Applicable
Has an Equality Analysis been completed?
Not Applicable
Attachments Chief Officers Report
20
Darlington CCG strategic objectives supported by this report Domain Tick
Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒
Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☒
Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans
☒
Performance Ensuring measurable improvement of the quality and safety of the services that we commission
☒
Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.
Delivery of innovative and new models of care
To demonstrate system leadership across the health and social care economy
☒
HaST CCG strategic objectives supported by this report
Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,
enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☒
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☒ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☒ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☒
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☒ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of
primary care and GPIT, whilst exploring and preparing for further opportunities
☒ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None
21
Page 1 of 6
NHS Darlington Clinical Commissioning Group and NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group
Chief Officers Report – May 2017
1.0 Governance Issues 1.1 Annual General Meeting
The CCG’s are required to hold their Annual General Meetings before 30th September 2017. This meeting is a formal requirement of the CCG as a statutory NHS body and is an opportunity for the CCG to share and reflect on its experiences of its fourth year of operation and an opportunity to meet with the public. Planning for the AGM’s for both CCG’s is currently being undertaken and dates will be released soon.
1.2 HR Update
At the end of Q4 HaST CCG had a headcount of 39 with a WTE of 23.80, an increase in headcount of six from the end of the last financial year. During the final quarter, there were two new hires processed onto the payroll for HaST CCG and three staff left the organisation. At the end of Q4 Darlington CCG had a headcount of 16 with a WTE of 10.59, an increase in headcount of two from the end of the last financial year. During the final quarter, there were no new hires processed onto the payroll for Darlington CCG and no staff left the organisation.
As at the end of the quarter Hartlepool and Stockton-on-Tees CCG
Darlington CCG
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Total Headcount 33 35 40 39 15 16 15 16
Total Full Time Equivalent (FTE) 25.35 24.25 25.75 23.80 9.87 10.47 10.59 10.59
HaST CCG’s annual sickness absence rate at the end of this financial year was 3.74%, which is above average for the region, averaging 15.8 days per FTE. However, this was mostly due to high levels of absence (a combination of long term and short term) in the earlier part of the year, peaking in July 2016, and has reduced significantly since then (between 0% and 0.16% in Q4). Darlington CCG’s annual sickness absence rate at the end of this financial year was 0.12%, which was the lowest in the region, averaging 0.57 days per FTE.
1.3 CCG 360 Stakeholder Survey
The feedback from the CCG 360 Stakeholder survey was received by the CCG’s in April 2017on 6th May. For Darlington CCG there was an overall response rate of 63% to the survey. The key points to note were:
• Good response rate from all groups • Results were broadly similar to previous years although slightly reduced
scores in some cases • Some improvement in the following areas
• Clear and visible leadership • Clear and visible clinical leadership • Improved knowledge of CCG plans and priorities, effective
communication of plans and improved opportunity to influence plans • In comparison to the national average:
• DCCG respondents have greater confidence in the quality of services commissioned and that plans will deliver improved quality within available resources
• Leadership and clinical leadership is rated more highly and that the leadership will deliver improved outcomes for patients
• Knowledge of plans and priorities is better and respondents have the opportunity to influence the plans and that these are acted on
• Engagement with the public and their influence on plans is better • Healthwatch and patient groups do not believe the CCG has engaged with
seldom heard groups • Less than half of Member practice respondents believe that they are able to
influence CCG decision making • Provider response positive • Written comments are mixed and sometimes seem to reflect both ends of the
scale. As they are not attributed it is difficult to understand how and w ith whom this needs to be addressed.
23
Page 3 of 6
For HaST CCG there was an overall response rate of 56% to the survey. The key points to note were:
• Response rate was disappointing from practices and some other stakeholders recognising that only one r espondent is identified per organisation. This means that if that person does not respond the views of that organisation is not captured.
• Results were broadly similar to previous years although some slightly poorer and some better.
• Some improvement in: • understanding the reasons for decisions • effective system leadership • ability to raise concerns re quality • knowledge of plans and priorities and that these are the right ones.
• In comparison to the national average: • Stakeholder engagement rated poorer • Working relationship a little better • Understanding reasons for decision better • Leadership possessing the necessary blend of skills and ex perience
much better as is clear and visible leadership and confidence in the leadership to deliver improved outcomes for patients
• CCG plans and pr iorities being the right ones rated higher as is effectiveness of system leadership
• Acting on t he views of patients and effectively communicating how it has acted on feedback is better
• Only one H ealthwatch responded but they did not think that the CCG had engaged with seldom heard groups a great deal
• Fewer of the practices that responded agreed that they are able to participate in and influence decision making
• Confidence in clinical leadership appears to have reduced • There is a greater level of understanding of the CCG financial and service
improvement plans than last year • High numbers of practices believe that value for money influences CCG plans
and priorities • Provider responses are good although some believe that the level of quality
monitoring is too much • Written comments are mixed and are high polarised. It appears that the
negative comments come mostly from practices and very positive comments mostly from other stakeholders Actions to address the weaker areas will be i ncluded in the revised organisational development and the communications and engagement plans.
24
Page 4 of 6
2.0 Integrated Personal Commissioning (IPC) – 100 day challenge sustainability review The Stockton-On-Tees IPC site is working with NESTA (Health Innovations Lab), a voluntary organisation which helps people and organisations bring their ideas to life to undertake a 100 day challenge, where they work very intensively with the Stockton-On-Tees site on frontline workforce development. NESTA have been commissioned through NHS England to work with only two IPC sites across the country over the next four months.
A sustainability review of the 100 day challenge took place on 25th May 2017, and further information will be provided to the Governing Body meeting on 30th May 2017.
3.0 Letter from Secretary of State to Darlington CCG
In April, Darlington CCG received a l etter from the Secretary of State for Health congratulating the CCG on being the commissioner with the strongest improvement in referral to treatment new periods per working day in the 3 months from December to February 2017, compared to the same 3 months in the previous year. The Secretary of State was keen to pass on hi s congratulations to those who work for and with the CCG.
4.0 Medical Interoperability gateway (MIG)
Across the North East, with 96% of practices signed up for the MIG (Medical Interoperability Gateway), work is now moving ahead to implement a new regional Data Sharing Agreement, which will allow acute trusts in the region to view GP patient records throughout the trust. Within Darlington CCG all 11 practices have signed up to the MiG and in HaST, only one practice has not signed up. The one GP practice that has not signed up has expressed concerns relating to Information Governance issues.
This means that patients will no longer face the anomaly where their records are available to staff treating them in A&E, but not when they move on to an inpatient or specialist ward. This latest development is expected to be complete by the end of June 2017.
5.0 NHS 111 E-Procurement
Work is now underway to procure a new NHS 111/Integrated Urgent Care Service from April 2018. All the region’s CCGs have given their authority to issue a Prior Information Notice (PIN) which was published in the first week of May.
The working group leading this procurement will brief all CCGs on a monthly basis as the work moves forward.
25
Page 5 of 6
6.0 Cyber Attack
A number of NHS organisations in the North East and North Cumbria were directly affected by the worldwide cyber-attack called WannaCry and as a result the decision was taken across the North East to completely shut down IT systems for general practice and CCG’s on Friday 12th May. Darlington CCG, Hartlepool and Stockton-on-Tees CCG and our main providers were not directly affected by the virus. However, whilst NECS, NHS England and some CCG staff worked through the weekend, p rimary care organisations across the North East did not have access to IT systems on Monday 15 May 2017 until later in the day. , By Tuesday 16th May, almost all GP’s had Network access restored and were able to access all systems, but a very small number were still not on the Network as the updates had not been applied successfully.
Valuable lessons have been learnt which will be built into business continuity and resilience plans as unfortunately it is unlikely that this is an isolated occurrence.
7.0 National Developments 7.1 NHS Workforce Race Equality Standard (WRES): 2016 data report
The NHS Workforce Race Equality Standard (WRES) was mandated in April 2015. It aims to ensure employees from black and minority ethnic (BME) backgrounds have equal access to career opportunities and receive fair treatment in the workplace. From 2015/16, the WRES became part of the NHS standard contract. The 2016 WRES report is the second publication, published on 19th April 2017. It provides a national picture of the WRES in practice and the developments in the workforce race equality agenda.
7.2 Change in CCG numbers from 1 April 2017
There are now 207 CCGs operating in England from an original 211. From 1 April 2017, Manchester CCG came into operation from the merger of Central Manchester CCG, North Manchester CCG and South Manchester CCG. Whilst CCG mergers remain few, there is growing collaboration across CCGs as they focus on delivery of their plans as a response to the Five Year Forward View.
7.3 Patient and public participation in commissioning health and care:
statutory guidance for CCGs and NHS England.
This guidance, published in April 2017, aims to support CCG staff to involve patients and the public in their work in a meaningful way to improve services. It sets out ten key actions for CCGs on how to embed involvement
7.4 Refreshed statutory guidance on involving people in health and care
Working with CCGs and a range of other stakeholders, NHS England has developed refreshed statutory guidance on involvement. The guidance, published in April 2017, highlights the benefits of involving people in their own health and care and involving communities in commissioning decisions. It reflects the new commissioning landscape and sets out the context and principles of involvement. The guidance is made up of two documents, ‘Involving people in their own health and care’ and ‘Patient and public participation in commissioning health and care’.
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 2.1
Title Performance Report May 2017
Purpose Approval ☐ Discussion ☐ Information ☒
Responsible CCG Member / Lead
Lisa Tempest, Director of Performance, Planning and Assurance
Author of Report Lisa Tempest, Director of Performance, Planning and Assurance
Recommendation(s) The Governing Body is asked to receive and consider the report.
Executive Summary
This report is to inform the Governing Body of the CCG’s performance in respect of NHS Constitutional Standards and the Quality Premium using the most up to date performance information for each indicator. NHS Constitutional Standards On a year to date basis Darlington and Hartlepool and Stockton-on-Tees CCGs are currently achieving all constitutional standards with the exception of those detailed below: Darlington and Hartlepool and Stockton-on-Tees CCGs At least 85% of patients should be treated within 62 days of an urgent GP referral for suspected cancer: Both CCGs failed to achieve the standard in February 2017, and on a Q4 and year-to-date basis. Comprehensive action plans have been developed for both CCGs to deliver sustained improvement and are included in Appendix 1 (Exception Reports HaST CCG ER01 and Darlington CCG ER01). Less than 95% pf patients should spend more than 4 hours in an A&E or minor injury unit: As at March 2017 both North Tees and Hartlepool NHS Foundation Trust (NTHFT) and County Durham and Darlington NHS Foundation Trust (CDDFT) failed to achieve the A&E standard on a year-to date basis due to significant pressures experienced across the whole of the North East region over the winter period. 28
Both Trusts did however perform well in March 2017 with NTHFT performance 96.6% and CDDFT 96.5% (YTD 94.2% and 93.2% respectively). NTHFT have continued to perform well in 2017/8 and have advised that the Integrated Urgent Care service which commenced on 1st April is having a positive impact on their A&E performance. CDDFT performance has declined since the end of their Perfect Month initiative in March however the Trust are continuing to implement their action plans to deliver sustained improvement. Ambulance category A response times (8 and 19 minutes): NEAS performance in March 2017 continued to improve for both the 8min indicator (61.4%) and 19 min indictor (90%), resulting in a YTD position of 62.5% and 89.3% against targets of 75% and 95% respectively. Performance for Darlington against the 8 min indicator was above target for each month of Q4. A comprehensive action plan is in place which is monitored through the Contract Management Board along with the Clinical Quality Review Group, details are included in Appendix 1, exception Report NEAS ER01. There remains a high differential in performance across the patch. NEAS have been asked to comment on this as it was expected that there would be improvement in the South from April 2017 and a response is awaited
Incidence of MRSA: There have been no further incidences of MRSA reported for either CCG since the last report. All breaches are discussed at monthly Clinical Quality Review Group meetings. The post infection review process has been followed for all identified cases with relevant lessons learnt identified and actions implemented as appropriate Darlington CCG Percentage of patients seen within 2 weeks of an urgent GP referral for suspected cancer: The CCG narrowly failed to achieve the standard in February 2017, achieving 92.41% performance against a target of 93%. Eighteen breaches were reported in relation to patient choice (16) capacity (1) and other (1). Tumour sites affected were lung, upper and lower GI, urology and testicular. Percentage of patients seen within 2 weeks of an urgent referral for breast symptoms: CDDFT failed the Cancer 2 week wait Breast Symptomatic indicator in Q1 & Q2 but Q3 and Q4 performance was above target however the YTD target was missed (91.3% v 93%). The improved performance is expected to continue in 2017/8. IAPT - Proportion of people who complete treatment who are moving to recovery should exceed 98% 29
The collated position for the CCGs two providers has improved in Feb-17, reporting a compliant position of 54.0% in month. This is the first time compliance has been achieved in month in 2016/17. In turn this has increased the YTD position to 46.72%. For the second month in a row Insight achieved the recovery rate in Feb-17, reporting 63.83%. This is a marked improvement in performance in comparison to previous months. TEWV reported 46.97% of people who completed treatment have moved to recovery, which is still below the target of 50% but is a marked improvement from the January position of 38.46%. The majority of breaches were due to patients either declining or ceasing treatment. The Percentage of First Episode in Psychosis who do not commence a package of care within four weeks of referral should not exceed 5%: Following non-compliance in December, Darlington CCG achieved this indicator in January and February 2017 reporting no breaches in both months. Unfortunately due to poor performance in previous months, the YTD position is still under target, but has improved. 16% of patients did not commence their package of care within four weeks on a YTD basis. The Proportion of CAMHS referrals who have waited less than 9 weeks for first appointment should exceed 90%: In the past 5 months (Oct-Feb) 100% of individuals waited less than nine weeks for their first appointment month on month. Unfortunately due to poor performance in Q1, the YTD position still remains below target. An upward trend however is noticeable and should performance remain as it is this may result in the achievement at the year end
Clinical Engagement
There is clinical representation at the Quality, Finance and Performance Committee
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?
Provides mitigation for risks associated with non-delivery of Constitutional Standards
Has an Equality Analysis been completed?
Not appliccable
Attachments Appendix 1 – Performance Report May 2017 30
Darlington CCG strategic objectives supported by this report Domain Tick
Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒
Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☐
Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans
☐
Performance Ensuring measurable improvement of the quality and safety of the services that we commission
☒
Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.
Delivery of innovative and new models of care
To demonstrate system leadership across the health and social care economy
☒
HaST CCG strategic objectives supported by this report
Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,
enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☒
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☒ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☐ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☒
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☐ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of
primary care and GPIT, whilst exploring and preparing for further opportunities
☐ Other Committees/Meetings where this report has been presented This report was presented to the Quality, Finance and Performance Committee on 28th February 2017.
Please specify
Does this need to be reported to another Committee/Meeting? Please specify
31
Performance Report
May 2017
32
2
1.5 Performance Summary Latest Reporting Data
PeriodOperational
Standard National Average Exception Report
Referral to treatment access times
% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 90.9% 93.3% 93.5% 93.1% 92.1% 92.6%Number patients waiting more than 52 weeks for treatment 0 0 1 0 0 0Diagnostic waits
% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology) Feb-17 1.00% 1.67% 0.28% 0.26% 0.12% 0.58% 0.03%A&E waits
% patients spending 4 hrs. or less in A&E or minor injury unit YTD Feb-17 95.0% 89.6% 92.9% 95.2% 94.0%
Handover between ambulance and A&E over 30 minutes 0 2606 266 74 7681
Handover between ambulance and A&E over 60 minutes 0 807 52 11 1760
Trolley waits in A&E not longer than 12 hours YTD Feb-17 0 4 0 0Ambulance response times
RED 1 response in 8 mins 79.1% 70.2%RED 2 response in 8 mins 70.0% 64.2%RED 1&2 response in 8 mins 70.7% 64.6%Cat A Response within 19 mins 95.0% 90.6% 84.1% 90.5% 89.3%
Number of crew clear delays over 30 mins 0 12833Number of crew clear delays over 60 mins 0 795Mixed Sex accommodation
Mixed Sex accommodation - number of unjustified breaches YTD Feb-17 0 0 0 2 0 0HCAI
Incidence of MRSA 0 2 2 6 7 1Incidence of C Diff CCG 17 19 109 16 43 39Cancelled Operations
All patients who have operations cancelled to be offered another binding date within 28 days YTD Feb-17 0 0 0 0Mental Health
% people followed up within 7 days of discharge from psychiatric in patient care YTD Feb-17 95.0% 96.6% 98.00%Cancer
% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 94.3% 91.8% 93.3% 93.5% 92.8% 94.4%
% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 93.6% 91.3% 96.6% 92.4% 91.8% 96.9%
% of patients treated within 31 days of a cancer diagnosis 96.0% 97.5% 98.3% 98.2% 99.6% 96.8% 99.6%% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 99.4% 98.7% 99.5% 100.0% 99.4% 99.9%% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 95.4% 98.2% 96.7% 99.0% 96.5% 97.7%% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 97.2% 96.3% 98.5% 98.1%% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 82.1% 74.1% 81.9% 85.3% 81.1% 86.0%% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.0% 92.1% 94.2% 95.2% 72.0% 88.9% 97.7%% of patients treated for cancer within 62 days of consultant decision to upgrade status N/A 88.9% 100.0% 90.9% 100.0% 90.2% 92.9%
% of patients treated for cancer within 62 days of consultant decision to upgrade status
N/A
MSA
HCAI
QER03Incidence of CDIFF up to 12th April 2017 17
% of patients receiving subsequent treatment for cancer within 31 days - surgery
94.0%
% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy
Diagnostics
% patients waiting for initial treatment on incomplete pathways within 18 weeks
Cat A 19 min
Cat A Red 1 8 min 75.0%
95.0%
Cat A Red 2 8 min 75.0%
% Patients waiting more than 6 weeks from referral for a diagnostic test
<1.00%
Ambulance Response Times
Cat A Red 1&2 8 min 75.0%
% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service
90.0% DCCG ER03
% of patients receiving subsequent treatment for cancer within 31 days - drugs
98.0%
94.0%
% of patients treated within 31 days of a cancer diagnosis
% of patients treated within 62 days of an urgent GP referral for suspected cancer
85.0% DCCG ER02
96.0%
Cancer
% of patients seen within 2 weeks of an urgent referral for breast symptoms
93.0%
% of patients seen within 2 weeks of an urgent GP referral for suspected cancer
93.0% DCCG ER01
NEAS ER01
35
Performance Issue Performance for the 62 day urgent GP referral standard has improved but HaST CCG have failed achieved the target in Feb-17 reporting 84.72%. Out of a total of 72 treatments in Feb-17, 11 patients were not treated within 62 days. Delay reasons were cited as a result of complex diagnostic pathways (6), patient choice (1), capacity issues (2), and other/unknown (2). Non-compliant specialities include Lung, Gynae, Head & Neck and Other. As a result of poor performance in January Q4 performance is non compliant and the YTD position remains below target.
Exception Report HaST CCG ER01
Actions Taken The CCG continue to monitor cancer performance robustly and have taken the actions listed below to ensure effective delivery of these standards: • Commissioners hold monthly contract review meetings with provider Trusts to address any performance issues. Actions are regularly agreed with provider Trusts and
monitored through via the contract management process. • There is monthly Task & Finish group meetings with NTHFT led by the CCG GP Clinical lead and includes a plan to address local issues with access and how to improve
patient experience. • HaST CCG continue to monitor and review breach reasons with the Trust and flag any areas or problems identified. The CCG also ensure that any matters are included in
an internal action plan. The CCG are now undertaking tumour group and treatment group thematic reviews alongside the monthly analysis of breaches • The CCG’s Cancer Action Plan has been revised for 2016/17 and a date is to be confirmed for the next update to be presented. • Both the CCG and NTHFT are undertaking work with specific tumour group teams to look at how to streamline elements of the pathway and therefore reduce waiting times
and avoid breaches. Further actions relating to this can be found in the NTHFT exception reports. This is work is undertaken each month and aligned with the Clinical Harm Reviews undertaken as part of the CQUIN process
• The Cancer Group has reviewed the RightCare pack for the CCG and produced a CCG information pack based on the data. The pack has now been reviewed by the NTHFT cancer services team in a meeting dated 10th August to identify areas for addressing spend and quality improvements. The meeting was attended by the NHSE RightCare lead who commended the data pack and the planned next steps with the clinical and operational leads from the Trust and CCG. A meeting with the BI team, the Trust leads and clinical leads was attended on the 6th October and a copy of the Rightcare report submitted to the national team.
• The Combined Cancer Locality (Durham, Darlington, Tees and Hambleton and Richmondshire) meeting was held on the 24th March that reviewed prevention activity, update regarding Alliance cancer transformation fund, updates from providers, commissioners and key stakeholders. In addition reviewed examples of good practice that have supported improvements in cancer performance rather than reviewing current performance figures.
Indicator Threshold Trend Line Mar-16 – Feb-17 Feb - 17 Quarter 4 HaST CCG
YTD Feb-17
% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0%
84.72% 81.3% 81.9%
Trend Line Apr-15 – Mar-16 Feb - 16 Quarter 4 HaST CCG
Year-end 2015/16
80.8% 79.7% 79.1%
5
Timescales for performance improvement: Performance of this standard for HaST CCG is dependant on their main provider NTHFT’s performance of the same standard, as well as performance at STHFT. NTHFT is continually working to avoid breaches and discusses all plans and courses of action with the CCG team to ensure that commissioners are aware and supportive of their plans. NTHFT and STHFT were non-compliant in the same period for this standard, although both trusts have shown a marked improvement in performance from the previous month. Actions and timescales for improvements to positively impact cancer performance can be found in the provider exception reports. Non compliance for STHFT is expected to continue throughout Q4, and may impact negatively on HaST CCG performance. Other Intelligence: The Trust is implementing monthly panels led by an Internal Executive Group that will challenge MDTs and general managers in regard to performance. These panels will address blockages or release resources as required and will review progress on a monthly basis between Sep-16 and Dec-16. The cancer pathway in each case will be a key area for review by the group.
5
36
HaST CCG Cancer breaches by Provider
6
2 Week Wait (Operational Standard 93%)
ProviderTotal
TreatedBreaches
% Treated in Time
Total Treated
Breaches%
Treated in Time
Total Treated
Breaches%
Treated in Time
Total Treated
Breaches%
Treated in Time
NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST 598 35 94.15% 588 35 94.05% 596 22 96.31% 7056 422 94.02% SOUTH TEES HOSPITALS NHS FOUNDATION TRUST 171 16 90.64% 153 10 93.46% 166 18 89.16% 2085 189 90.94%
COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST 1 0 100.00% 2 0 100.00% 1 0 100.00% 11 3 72.73%THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST 1 0 100.00% 0 0 - 1 0 100.00% 21 1 95.24%
Performance Issue Darlington CCG has not achieved the 2ww urgent GP referral target in February 2017. The CCG have narrowly failed to achieve the standard, achieving 92.41% performance. 18 breaches were reported in relation to patient choice (16) capacity (1) and other (1). Tumour sites affected were lung, upper and lower GI, urology and testicular. Darlington CCG has achieved the breast symptomatic standard for the fifth consecutive month.
Exception Report D’ton CCG ER01
7
Timescale for performance improvement Quarterly monitoring of performance against agreed actions and maintenance of action plan for locality. Performance to improve in line with the above action plan.
Other Intelligence Vacancies in Gastroenterology Service are likely to be impacting on CDDFT performance across the entire service, including outpatients.
Actions taken Lead(s) Timescale
Breast Services continues to be approached on a regional basis, with a collaborative commissioning meeting to be held on 21/4/17 to explore new models. A full options appraisal paper due June 2017, led by the Cancer Alliance
Rebecca Thomas/ Andy Copland Q4 2016/17/ Q1 2017/18
Work continues in relation to 3 GP HUBS and associated approaches re 1) direct to test, 2) deteriorating lung/late presentation, 3) colorectal
David Chapman 2017/18 with quarterly updates
NHS RightCare data profile in development as per agreement with RightCare Team David Chapman/ National RightCare Team
Q4 2016/17
Developing enhanced profile for colorectal cancer to support awareness raising and timely referral for colorectal cancer to improve attendance at 2ww appointments
David Chapman Q1-Q3 2017/18
Direct access to Lung CT in Darlington has now gone live across 3 GP Practices in Darlington. Regular monitoring and evaluation mechanism agreed to inform wider role out
David Chapman Implemented 03/04/17 with 3 month pilot
Indicator Threshold Trend Line Mar-16 – Feb-17 D’ton CCG Feb 17
% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 92.41%
38
Performance Issue Darlington CCG has failed to achieve the 62 day urgent GP standard in Feb 17 reporting 73.08% against a target of 85.0% in month. Many patients are referred in to CDDFT as main the main provider, however, some patients are shared between Tertiary and Cancer Centres.
In Feb 17 seven patients are reported to have breached the 62 day urgent GP standard. Breach reasons are cited as complex diagnosis (3), late referral to treating trust (1), other (1), medical (1) and capacity (1). Affected tumour sites are cited as lung (3), upper GI (1), lower GI (1), urology (1) and head and neck (1).
Exception Report D’ton CCG ER02
Indicator Threshold Trend Line Mar-16 – Feb-17
D’ton CCG Feb 17
% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 73.08%
8
Timescale for performance improvement
Quarterly monitoring of performance against agreed actions. The actions documented will work towards improving cancer performance of this standard throughout 2016/17 and beyond.
Other Intelligence Nothing of note
Action taken Lead(s) Timescale
CDDFT Service Development Improvement Plan (SDIP) for 17/18 now in draft with key focus on areas requiring improvement e.g. lung, breast
Rebecca Thomas/ Sarah Perkins (CDDFT)
Q1-Q4 17/18
Attendance at CDDFT cancer workshop and actions agreed to take forward through cancer ops group in CD&D- next workshop June 2017
James Carlton/ Rebecca Thomas Q4 of 2016
Direct access to Lung CT in Darlington has now gone live across 3 GP Practices in Darlington. Regular monitoring and evaluation mechanism agreed to inform wider role out- should positively impact on 62d breaches as shortened phase in planning via patients attending 2WW clinics with a CT
David Chapman/ James Carlton/ Rebecca Thomas
Implemented 03/04/17 with 3 month pilot
39
Performance Issue CDDFT achieved the 4 hour operational standard in March reporting 96.47% overall Trust position (93.75% at DMH and 92.2% at UHND, excludes urgent care activity). There were 25 breaches per day. A&E 4-hour performance in Quarter 4, and in particular in March, resulted in CDDFT achieving the agreed NHSI trajectory for the full year (trajectory - 93.05%; performance - 93.19%). This was sufficient to earn back the STF money which had been put at risk by the Q3 performance. In 2016-17, A&E attendances grew by 0.1% compared to 2015-16 (-1.4% at DMH and 1.4% at UHND). In March, attendances fell by 5.4% including falls at both sites.
Exception Report CDDFT ER01
Actions Taken CDDFT have a number of actions underway to assist compliance of the A&E Standard, these include: • CDDFT took part in a Perfect Month exercise across the Trust throughout the month of March. The perfect month was outlined as an ECIP priority
and will focus on embedding SAFER across the Trust. • A number of initiatives shown on following slide have been implemented as part of the Trusts Transforming Emergency Care Plan to assist
delivery and sustainability of the 4 hour standard. The Trusts TEC Board is currently reviewing the priorities of work and aligning where possible areas of priority as outlined from the ECIP.
• The findings and recommendations of the ECIP review have been agreed. The observations, judgements and recommendations from ECIP are built around four key priority areas:
1) Leadership 2) Assessment prior to Admission 3) Doing todays work today 4) Discharge to Assess • Changes to Urgent Care were implemented across DDES and North Durham effective as of 1st April 2017. The changes are intended to ensure
patients are seen in the Right Place, First Time.
Timescale for performance improvement CDDFT achieved performance throughout March and are working to sustain the position into the new financial year. Other Intelligence: Although published weekly A&E data had previously been available, national guidance has resulted in A&E performance data now only being reported monthly. Local arrangements have been made with CDDFT to provide daily unvalidated information.
Indicator Threshold Trend Line CDDFT Mar-17
CDDFT YTD Mar-17
% patients spending 4 hrs. or less in A&E or minor injury unit 95.0% 96.47% 93.19%
40
Exception Report CDDFT ER01
CDDFT TEC Plan (A&E Initiatives)
10
Indicator Threshold Trend Line CDDFT Mar-17
CDDFT YTD Mar-17
% patients spending 4 hrs. or less in A&E or minor injury unit 95.0% 96.47% 93.19%
Front of House Medicine/ED A&EC ED Access to Acute Medicine
Improve fast track referral process to acute medicine, following DTA in ED, reducing the need for RMO to 'accept' every patient.
ED 4 hour wait
Front of House
All clinical areas All care groups Flow Through A&E
Develop flow chart for achieving time-specific standards in ED (as per ED SAFER Bundle). CGs to develop SOPs to support, and clinical escalation plans when standards are not met.
ED 4 hour wait
Front of House
ED/UC/Acute Assessment
Units
A&EC / Surgery /
Family HealthStreaming at the Front Door
Introduce streaming for walk-in patients in ED. Develop an integrated approach particularly with UC / AEC, introduce a clinical navigator role to manage the stream and increase direct referrals to AEC / other acute specialty assessment units direct from triage.
ED 4 hour wait
Cont Care Patient Flow Corporate Nursing
Electronic Flow Management (SAFER)
Develop Nervecentre as primary source of patient flow information; train & support staff in real time data entry and develop functionality to manage referrals, patients waiting, etc. using a 'pull' system to reduce internal transfer delays.
ED 4 hr wait / Discharge before midday/ Reduce discharge delays
CSS/Enabler
ED /UC / Acute
Assessment Units
A&EC P2: Emergency Care Centre (UHND)Develop and deliver new build EC centre to facilitate delivery of improved emergency care for residents of County Durham (as per TEC clinical model).
A&EC P3: Integrated ED/UC (DMH)Business case approved to progress integration of ED/UC at DMH to facilitate the delivery of improved urgent/emergency care for residents of Darlington.
CSS/Enabler Medicine A&EC P5: Reprovide AEC/AMU (DMH) Reprovide AEC/AMU to third floor of DMH (from first
floor) as part of STEM reconfiguration of services.4 hour access/ Reduced LoS
CSS/Enabler
Business Continuity/
Performance
System Collaborative Winter Plan
Review learning from previous winter plan. Co-ordinate contributions from all care groups to ensure the Trust maintains TEC performance trajectory during periods of surge.
Develop a full capacity protocol and clear guidance for use - internally and in collaboration with regional UEC Network
4 hour access
CSS/Enabler All All Spotlight on SAFER
Deliver SAFER Spotlight (Nov/Dec) to further enhance performance following relaunch of SAFER and completion of SAFER audit.
4 hour access/ Discharge before midday/ Reduce discharge delays41
Exception Report NEAS ER01
11
Actions Taken A comprehensive action plan is in place which is monitored through the Contract Management Board along with the Clinical Quality Review Group. The action plan is broken down into three main areas/themes: Demand Actions: • Reduce the volume of Red incidents generated at the point of call
– Monitored by NEAS Operations Centre – Work to understand where Healthcare Professionals are requesting/escalating to a Red incident
• Capacity Actions: The points of focus for capacity are to: • Meet the Trust’s full establishment; anticipated that NEAS will be at full establishment in April 2017. • Utilise third party providers to cover shortfalls in the current staffing levels. • Extension of the Emergency Medical Response (EMR) pilot with the four local Fire and Rescue Services (FRS). • Increase the level of Rapid Response Vehicles (RRV) available per shift. • 2017/18 contract negotiations have led to an agreement regarding a package of additional investments:
– Additional 49 Paramedics to be appointed (FYE £3.9m) • First tranche of recruits in place October 2017 • Final tranche of recruits in place February 2018
– Investment into the Clinical Hub in 2017/18 (2018/19 subject to NHS 111 procurement) (£1.7m) – Increase resources to upskill Paramedics to treat a greater number of patients on scene (£1m)
Efficiency Actions: • Reduce/eradicate Handover delays – work continues with the FT Providers that experience delays • Reduce crew downtime to increase resource available on the roads. control staff about processes used (June 2016)
Timescale for performance improvement Through the 2017/18 negotiation round; it was made clear to Commissioners that the path to performance recovery is a long term trajectory. It is anticipated that incremental improvements will be made throughout the next 2 years with a view to seeing achievement in Quarter 4 in 2018/19. This incremental improvement will be tracked through the contract management approach in place in order to ensure that CCG’s can realise the benefits of the investments made in the organisation.
42
Exception Report NEAS ER01 continued
12
Additional performance metrics to note: In addition to the nationally reported performance metrics, a number of different measures are available to assess the quality and performance of NEAS: The above report demonstrates NEAS’ performance against the National Clinical Indicators. Historically, NEAS performs very well in comparison to other Ambulance Services. This information is scrutinised within the Clinical Quality Review Group, in which any variation is picked up by the CCG Executive Nurses. Note: Utstein is an internationally-recognised method of calculating out-of-hospital cardiac arrest survival rates and focuses on a subgroup of patients who have the best chance of a successful resuscitation. The calculation takes into account the number of patients discharged alive from hospital who had resuscitation attempted following a cardiac arrest of presumed cardiac aetiology, and who also had their arrest witnessed by a bystander and an initial cardiac rhythm of ventricular fibrillation or ventricular tachycardia.
43
Exception Report NEAS ER01 continued
13
Response to GP Urgent incidents – split by 1, 2 and 4 hour requests The above demonstrates that NEAS are not able to respond to these “less acute” incidents within the requested time frame.
44
NHS Darlington Clinical Commissioning Group and
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 2.2
30th May 2017
Title Darlington CCG Quality Report
Purpose Approval ☐ Discussion ☒ Information ☒
Responsible CCG Member / Lead
Diane Murphy, Director of Nursing and Quality
Author of Report Liz Ward, Senior Clinical Quality Manager North of England Commissioning Support Diane Murphy, Chief Nurse, NHS Darlington Clinical Commissioning Group
Recommendation(s) The Governing Body is asked to;
• receive and consider the report, • acknowledge that necessary actions are being taken forward
with the respective organisations to improve quality and experience for patients.
Executive Summary
The purpose of this report is to provide Darlington Clinical Commissioning Group (CCG) Governing Body with an update of current issues (by exception) relating to the quality of services and their impact on patient experience. Quality metrics and actions to improve the quality of care are carfeully monitored via the Joint CCG Quality, Performance and Finance Committee. Healthcare Associated Infection (HCAI)
• MRSA – There have been 2 cases assigned to Darlington CCG in 2016/17 (April data); one in June and one in October. There have been no further cases assigned to the CCG.
• C.Difficile – There have been 19 published cases (April data) assigned to the CCG in 2016/17. This is two cases above the annual trajectory of 17.
Looked After Children
• Compliance with the 20 working day timescale for initial health assessments remains a challenge for both the local authority and C DDFT and is a focus for Darlington Borough Council improvement board and the Darlington LSCB. Performance is however improving (53%) and an 45
event is planned in June across health and social care to drive further improved performance.
County Durham and Darlington NHS Foundation Trust Serious Incidents
• The Trust has had 11 Never events during 2016/17. The Trust have an extensive improvement plan in place and support from NHS Improvement (NHSI) is being provided. There has been 1 further event in April
• The Trust has made improvements to A&E assessment and treatment times during March when they implemented the ‘Perfect Month’ which supported a number of initiatives to improve performance. The trust is now undertaking work to deliver sustainability of those interventions which made a difference.
Mortality • The Trust is in receipt of a C are Quality Commission
(CQC) outlier alert for Bronchitis. All the individual cases have been reviewed by a team of consultants and a report submitted to the CQC and which will be considered at next QRG. The Trust has a mortality action plan in place which is discussed regularly and progress monitored via CQRG.
A&E Performance • Time to assess and treat patients in accident and
emergency department remains a challenge for the Trust. CDDFT have undertaken the Perfect Month during March 2017. S ince introducing the Perfect Month, performance has improved significantly.
NHS Staff Survey • The results of 2016 NHS staff survey were released in
March 2017. The Trust’s score of 3.68 for staff engagement was below (worse than) average when compared with trusts of a similar type nationally. This is deterioration from the previous year when the Trust scored 3.75. The Trust has an Organisational Development plan in place which was presented to CQRG in April. Commissioners will continue to monitor the actions to understand the impact.
South Tees Hospitals NHS Foundation Trust Healthcare Associated Infection (HCAI)
• The Trust reported five cases of Clostridium Difficile in February and five cases in March. For 2016/2017 the year to date published data indicates seven cases of MRSA have been assigned to the trust.
Patient Experience • Patient experience collected through Friends and F amily
Test responses continue to demonstrate poor response rates which are below the England average.
North East Ambulance Service Serious Incidents (SIs)
• There is continued non - compliance with the Serious Incident Management Framework in terms of timely 46
reporting and investigation. Recruitment
• Recruitment and retention continues to be a challenge. A number of activities are underway to recruit paramedics
Sickness absence • NEASFT reported at Clinical Quality Review Group
(CQRG) meeting in March 2017 that overall the Trust-wide absence rate has decreased slightly by 0.26% compared with the previous month, and is now 7.28%. However this is still above the Trust target of 5%.
Tees Esk and Wear Valley NHS Foundation Trust Serious Incidents
• The Trust continues to demonstrate non-compliance with the national Serious Incident reporting framework. The Trust are working closely with the Clinical Quality Team to improve the management of historic action plans and gain assurance in relation to these. Also the team are working to improve the reporting of interim reports provided to Commissioners.
Regulatory Inspection • A CQC inspection visit was undertaken across the trust
sites for acute wards for adults of working age and psychiatric intensive care unit which were rated ‘good’ and Wards for older people with mental health problems which were rated as ‘requiring improvement’ in February 2017. Related action plans are being monitored via the CQRG meetings.
NHS Safety Thermometer • The latest published data in March 2017 (February 2017
data) shows that TEWVFT are performing better than the national average for harm free care across all indicators with the exception of falls with harm. The falls data appears to be on an increasing trend in quarter 4.
Safeguarding Training • Current reporting of Safeguarding training by the trust is
non complaint with safeguarding training requirements. This has been discussed with the trust at CQRG and the trust has been requested to produce the data in line with contractual quality requirements which will support the analysis of improvement required. Work is underway with the Trust to ensure training requirements are met and reports provide sufficient detail to reflect the current training compliance
Clinical Engagement
The issues highlighted are discussed at CQRG.
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk
The report addresses some of the risks identified within the CCG risk register. 47
Register?
Has an Equality Analysis been completed?
N/A
Attachments Clinical Quality Update
Darlington CCG strategic objectives supported by this report Domain Tick
Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐
Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☐
Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans
☐
Performance Ensuring measurable improvement of the quality and safety of the services that we commission
☒
Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.
Delivery of innovative and new models of care
To demonstrate system leadership across the health and social care economy
☐
HaST CCG strategic objectives supported by this report
Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,
enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☐
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☐ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☐ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☐
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☐ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☐ 48
7. Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☐ Other Committees/Meetings where this report has been presented Please
specify Does this need to be reported to another Committee/Meeting? Please
specify
49
Clinical Quality Report
1. Background The purpose of this report is to provide Darlington Clinical Commissioning Group (CCG) Governing Body with an update of issues relating to the quality of services and their impact on patient experience. It also includes information relating to compliance against national and local standards. The report covers the period up t o March 2017 unless otherwise indicated. Where an up to date position is know it has been identified in the report. 2. Discussion, implications and risks The primary areas of interest, concern or risk for Darlington CCG are as follows: 2.1 Healthcare Associated Infection (HCAI) There have been 2 cases of Methicillin-resistant Staphylococcus Aureus (MRSA) assigned to Darlington CCG year to date; one in June and one in November. There have been no further cases assigned to the CCG. There have been 19 published cases of C.Difficile (C.Dif) (March data) assigned to the CCG for 2016/17 (April data). This is two cases above the annual trajectory of 17. The annual trajectories released by NHS England for MRSA and C Dif ficile remain the same for 2017/18 so the CCG will have a trajectory of up to17 cases across the year. 2.2 Looked After Children Compliance with the 20 working day timescale for initial health assessments remains a challenge for both the local authority and CDDFT and is a focus for Darlington Borough Council Children Improvement board and the Darlington LSCB. Performance is however improving (53%) and an improvement event is planned in June across health and social care to drive further improved performance. 2.3 Acute & Community Services This section provides, where known, the quality intelligence for CDDFT and South Tees Hospitals NHS Foundation Trust (STHFT) as are two main providers of care for the Darlington population. 2.3.1 County Durham and Darlington NHS Foundation Trust (CDDFT) Never Events CDDFT have reported 11 N ever Events from 1 April 2016 to 31 March 2017. Three of these are historic never events relating to previous surgery. Following the first historic ‘never event’ a ‘looks back’ exercise has been undertaken and a further 2 have emerged. At the time of writing there has also been a further incident in 17/18 Q1. There are a number of key themes emerging from the never event investigation which relates to:
• Human factors
50
2
• Busy theatre environment • Staff pressure to complete cases in timely way • Increased stress regarding site capacity and workload • Reporting and grading of incidents • Consent processes
The Trust has an i mprovement plan in place which was presented to the Care Quality Commission (CQC) for ratification and t o the Clinical Quality Review Group (CQRG) in April 2017 for an update. The Trust have been working closely with NHS Improvement (NHSI) and a member of the NHSI service improvement team has been seconded to support the Trust for 6 months commencing in April. Their remit is to support the Trust to embedded process change in relation to patient safety and process. There has been a c ultural review commissioned by the Trust and undertaken in March which is due to report in May. The findings from this will be fed into the improvement plan and shared with Commissioners. On the 7th April the Trust held an event for staff of which over 400 attended. The focus of the event was sharing with staff the never events and f indings from the subsequent investigations and also to explore with staff some of the cultural issues which have been exposed during these investigations. The governance structures relating to patient safety have been recently reviewed and restructured to include a new Clinical Quality and Safety Panel and improved processes for sharing lessons learnt from incidents. The Deputy Medical Director is leading work on t he development of National and Local Safety Standards for Invasive Procedures (NatSSIPs and LocSSIPs). This work has been underway in the Trust since 2016. Local standards are available in draft for the Surgical Care Group and are with Clinical Director and Matrons for comment. The key risk relates to clinical capacity to support development; roll out and monitoring of compliance. As a consequence of the continued incidence of never events an escalation process has been triggered. A Quality Risk profile tool has been completed and a single item Quality Surveillance Group has been recommended. A meeting with the CDDFT executive body and the CCG Chief Officer and Directors of Nursing/Quality leads has also been scheduled. Mortality The Trust is in receipt of a Care Quality Commission (CQC) outlier alert for Bronchitis. The Trust has a mortality action plan in place which is discussed regularly and progress monitored via CQRG. The trust is required to provide a response to CQC outlining key actions to improve the care of patient with Bronchitis. All the individual cases have been reviewed by a team of consultants and a report submitted to the CQC and which will also be considered at next QRG.
51
3
Health Care Associated Infections (HCAI) The final data published in April for 2106/17 shows the Trust were under trajectory with 16 published cases of C Difficile (C Diff). The Trust had five published cases of Methicillin-resistant Staphylococcus Aureus (MRSA) in 2016/17. Each case is subject to a root cause analysis (RCA) review prior to being assigned to the Trust. All RCAs are attended by the CCG Infection Prevention Control (IPC) Lead Nurses. These cases are monitored on a case by case basis by the IPC team and reported to the CCG as required. IPC Nurses attend the CQRG where challenge is provided as required. A&E Performance Time to assess and treat patients in accident and emergency department remains a challenge for the Trust. CDDFT have undertaken the Perfect Month during March 2017 and performance has improved significantly. T he Perfect Month was outlined as an Emergency Care Improvement Programme (ECIP) priority and w ill focus on embedding improved patient safety across the Trust. The aim is also to embed improvements of the Trusts Transforming Emergency Care (TEC) Programme and provides an opportunity to embed good practice. Incident Reporting via National Reporting and Learning System (NRLS) Data published in March 2017 covering the period April to September 2016 indicates that the Trust is in the middle 50% of Trusts nationally (136 trusts) for incident reporting rates per 1000 bed days. The trust is working on developing their processes for NRLS reporting to improve performance into the top percentile for reporting. The most frequently reported incidents relate to patient accidents; access/patient transfers/discharge; documentation and medications. NHS Staff Survey The results of 2016 NHS staff survey were released in March 2017. Possible scores range between 1 to 5, with 1 indicating that staffs are poorly engaged (with their work, their team and their trust) and 5 indicating that staff are highly engaged. The Trust’s score of 3.68 was below (worse than) average when compared with trusts of a similar type. This is deterioration from the previous year when the Trust scored 3.75. Questions where CDDFT scored lowest were staff recommendation of the organisation as a place to work or receive treatment; quality of appraisals; quality of non-mandatory training, learning or development; and recognition and value of staff by managers and the organisation. The Trust has an organisational development plan in place and the CCG are seeking further assurance of the impact of this plan. 2.3.2 South Tees Hospitals NHS Foundation Trust (STHFT) Serious Incidents Eight Serious Incidents were reported in February and five in March. The majority (eight in total) were pressure ulcer related. Meetings are held on alternate weeks to review pressure ulcer serious incidents with a nursing director who has specific responsibility for this area and is leading on i mplementing enhancements to this area of patient care. Monthly caseload meetings continue with the Trust and a representative from the NECS Clinical Quality Team has been invited to attend the trust’s weekly SI review panel. Healthcare Associated Infections (HCAI) For 2016/2017 the year to date published data from NECS BI Unit indicates seven cases of MRSA have been assigned to the trust. The trust reported five case of C-Difficile in
52
4
February 2017 and five in March 2017. Although it was above trajectory for those months, end of year data indicates it performed under trajectory with 43 published cases against a target of 55. The trust has an Infection, Prevention and Control action plan in place which is monitored via the Infection Prevention Action Group which is also attended by SouthTees CCG’s Head of Quality and S afeguarding. The Trust recently worked with the CCG and Local Authority to support the appointment of a Band 7 Infection Control Nurse from April 2017. It is hoped that this post holder will support improved communications and practices pan-organisations. Patient Experience The response rates for Friends and Family Test (FFT) in Inpatients and Accident and Emergency (A&E) remain below the England average. It is noted however that the A&E response rate in February 2017 is the highest in the 2016/2017 reporting year. Maternity’s response rate for February 2017 was below the England average. The trust had forecast no real improvement in FFT rates until quarter 3 2016/17 when the new data collection systems were in place. However, it is not yet clear as to how the 1000 voices campaign will support the required FFT improvements as response rates remain low for Inpatients and A&E. Progress was discussed at April’s Performance Clinic. 2.4 Mental Health Services 2.4.1 Tees, Esk and Wear Valleys NHS Foundation Trust (TEWVFT) Serious incidents Five Serious Incidents were reported in February and ni ne in March. Serious Incident management continues to remain of concern to the CCG as the Trust is non-compliant with the national reporting timescales. There is also concern in relation to the number of ongoing Serious Incidents and the quality of the root cause analysis (RCA) reports which are designed to draw out root causes and lessons learned. The trust also has a l arge backlog of ongoing action plans some of which date back a number of years in relation to historic incidents. The trust has been working to update and c lose these actions but the quality and provision of evidence is often difficult due to the historic nature of the incidents. It has been agreed with the trust to undertake work to theme the historic actions and link to improvement work undertaken by the trust to provide assurance to the CCGs so that sufficient actions have been taken to allow the historic action plans to be closed. This will continue to be monitored by the Clinical Quality Team and the Quality Review Group. The CCG is currently seeking further assurance from the trust in relation to serious incident management and g overnance processes associated with the management of these incidents. The Clinical Quality Team are meeting regularly with the trusts Patient Safety team to support improved compliance. Regulatory Inspection - Care Quality Commission (CQC) A CQC inspection visit was undertaken across the trust sites for acute wards for adults of working age and ps ychiatric intensive care unit which were rated ‘good’ and Wards for older people with mental health problems which were rated as ‘requiring improvement’ in February 2017. However, the trust retains its overall rating of ‘Good’. It has also undergone inspection of Learning Disability and Rehabilitation services by the CQC and is currently in receipt of the draft reports for comment. It is anticipated that these reports will be published imminently. Improvement plans will be monitored through the Quality Review Group.
53
5
NHS Safety Thermometer The latest published data in March 2017 (February 2017 data) shows that TEWVFT are performing better than the national average for harm free care across all indicators with the exception of falls with harm. The falls data appears to be on an increasing trend in quarter 4 The Trust has a falls reduction project in place which is being led by their Director of Nursing. Falls have been identified as a key priority by the Trust for their 2016/17 quality account. A progress update was received at the last CQRG which demonstrated that a lot of process redesign work has been undertaken on all aspects of the falls pathways including post falls care. Safeguarding Training Current reporting of Safeguarding training by the Trust is non-compliant with contractual requirements. This has been di scussed with the Trust at Clinical Quality Review Group and the Trust has been requested to produce the data in line with contractual quality requirements. This will continue to be challenged until the correct information is received. Initial reviews of the data provided demonstrate that the position is improving. The Trust has improvement plans in place for each locality. 2.5 North East Ambulance Service NHS Foundation Trust (NEASFT) and 111 Service Serious Incidents (SI’s) The trust reported one Serious Incidents in February relating to treatment delay (HaST CCG patient) and two in March 2017 relating to sub-optimal care (1 HaST and 1 DCCG patients), which is similar to previous months. There is continued non-compliance with the Serious Incident Management Framework in relation to submission of 72 hour reports and 60 day Root Cause Analysis investigation reports. The Trust reported to the QRG that all patient safety cause groups have seen a reduction in reporting. ‘Dispatch’ remains the highest cause of patient safety incidents, which has been an ong oing trend for a nu mber of months and relates to delayed ambulance response. The Trust stated that ‘Dispatch’ incidents are the highest cause group reported nationally. Delayed ambulance response remains the highest cause group across NEAS. Incident reporting continues to be discussed and challenged at the QRG. The Trust noted at the March QRG that the harm level for cases under review may be subject to change. The Trust has seen an increase in the number of ‘no harm’ and ‘near miss’ incidents, as well as an i ncrease in higher acuity harm incidents in February, specifically ‘moderate harm’ and ‘death’. This may be indicative of an improved reporting culture. As previously reported the Trust continues to implement their action plan for improvement in the overall management and reporting of incidents. The Quality team are working closely with the Contracting and Commissioning teams to monitor improvements in NEAS performance in relation to response times.
54
6
Workforce Recruitment Recruitment and retention continues to be a c hallenge. A number of activities are underway to recruit paramedics. There are currently 60 whole time equivalent student paramedics who are due to graduate from their programme prior to 31st March 2017 and an international recruitment campaign is planned. There were 35 ‘ due to qualify’ Paramedics booked in for assessment in May 2017. The team recently travelled to Warsaw in April to assess a number of potential candidates – 6wte potential recruits. A follow up visit was to take place in June to take numbers to 30 WTE. Sickness absence NEASFT reported at Clinical Quality Review Group (CQRG) meeting in March 2017 that overall the Trust-wide absence rate has decreased slightly by 0.26% compared with the previous month, and is now 7.28%. However this is still above the Trust target of 5%. The Trust has a number of initiatives in place to support employees back to work. The Trust has reported that some of the sickness issues are non-work related. Updates on workforce continue to be monitored through CQRG as a standing agenda item. 2.6 Care Homes There are currently no c are homes under executive strategy review in Darlington. One care home (St Georges) has served notice on its nursing beds. The affected patients (10) have been assessed by the CHC team and planning is underway with DBC to transition those patients to alternative accommodation. T he process for reviewing residents and relocation will take approximately 4-6 weeks and commenced 2 weeks ago. Residents in receipt of CHC funded care are currently being reviewed by the CHC team and will require subsequent relocation to an appropriate location. 2.7 Learning Disabilities Transformation The CCG continues to work towards agreed trajectories for discharge of patients within agreed timescales. Joint meetings continue with Darlington Local Authority and TEWV to progress discharge plans and packages of care in the community that may require additional support to prevent admission /loss of residence.
• Darlington CCG has 12 current inpatients • 1 Darlington patient remains in NHSE Specialised Commissioning. There is
discharge plan in place and there is no delay in discharge plan. • Out of area placements into Darlington continue to be a pressure and have resulted
in a number of disputes between Local Authorities with regard to 117 /Ordinary residence responsibilities
For those patients where discharge planning is particularly problematic the recently established Regional Hub for Transforming care has been engaged and is supporting resolution of problems to ensure as a priority a safe discharge.
3. Recommendations
The CCG Executive Team is asked to:
55
7
• receive and consider the report, • Agree that necessary actions are being taken forward with the respective
organisations to improve quality and patient experience. Authors: Liz Ward Senior Clinical Quality Manager, North of England Commissioning Support Unit (NECS). Diane Murphy, Director of Nursing and Quality, NHS Darlington CCG. Sponsor and Executive lead: Diane Murphy, Director of Nursing and Quality, NHS Darlington CCG Date: 9th May 2017
56
NHS Darlington Clinical Commissioning Group and
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 2.2
30th May 2017
Title HAST CCG Quality and Safeguarding Report Purpose
Approval ☐ Discussion ☒ Information ☐
Responsible CCG Member / Lead
Jean Golightly, Director of Nursing and Quality
Author of Report Jean Golightly, Director of Nursing and Quality Elizabeth Ward, Senior Clinical Quality Manager, North of England Commissioning Support
Recommendation(s) The Committee are asked to note the overview of quality and
safeguarding issues raised in the report and the process for assurance and monitoring. This report reflects the position in April 2017.
Executive Summary
Key Points to note: Hartlepool and Stockton-On-Tees (HaST) CCG 1. Healthcare Associated Infection (HCAI)
• C. Difficile-The CCG has exceeded its annual trajectory for the number of Clostridium Difficile cases with 2016/17 final position of 109/72.
o CCG is working collaboratively with acute providers, NHS England and NHS Improvement to explore further health care system actions that can be taken in the community around Clostridium Difficile.
• Primary Care GP practice anti-biotic prescribing has increased compared to the same period last year.
2. Safeguarding Children • The Hartlepool Serious Case Review was due for
publication in May 2017, this will now be delayed to comply with the conditions of purdah following the announcement of a general election in June 2017.
3. Safeguarding Adults/care homes • Tees Safeguarding Adults Board delivery of a Domestic
Abuse and Adult Safeguarding conference. NHS PROVIDERS North Tees Hospitals NHS Foundation Trust 4. Healthcare Associated Infection (HCAI)
• Clostridium Difficile infection rates exceeded the annual trajectory in 2016/17 finishing the year with 39/13 cases.
5. Maternity Services • The Trust summary report from the independent, external
Maternity Services review conducted in September 2016 is to be discussed at the May 2017 Clinical Quality Review Group.
6. Mortality • The Trust is no longer identified as an outlier for mortality 57
metrics. South Tees Hospitals NHS Foundation Trust 7. Healthcare Associated Infection (HCAI)
• Clostridium difficile: The Trust completed the year within trajectory with 43/55 cases
• MRSA: the Trust breached the trajectory of 0 cases, and ended the year with 7 hospital attributed bacteraemias.
8. Never Events • The Trust has reported 4 Never Events occurring during
2016-17 North East Ambulance Service 9. Serious Incidents (SIs)
• Non - compliance with Serious Incident Management Framework reporting and investigation timeframes.
10. Recruitment • Recruitment and retention continues to be a challenge. A
number of activities are underway to recruit paramedics. 11. Sickness absence
• NEASFT reported at Clinical Quality Review Group (CQRG) meeting in March 2017 that although improving, to 7.28%, this is still substantially above the Trust target of 5%.
Tees Esk and Wear Valley NHS Foundation Trust 12. Serious Incidents
• The Trust continues to demonstrate non-compliance with the national Serious Incident reporting framework.
13. Regulatory Inspection • An inspection visit was undertaken across the trust sites for
acute wards for adults of working age and psychiatric intensive care unit which were rated ‘good’ and Wards for older people with mental health problems which were rated as ‘requiring improvement’ in February 2017.
14. Safeguarding Training • Current reporting of Safeguarding training by the trust is non
complaint with contractual requirements.
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?
Health and Social Care Act 2012, ‘Quality Duty’ To ensure the GB are provided with an overview of published data and where appropriate contemporaneous data relating to the quality of services they commission from their main NHS Providers. Ensures a standard of excellence in the provision of high quality care that is safe, effective and focused on patient experience. Working across organisational boundaries and in partnership with GP Practices and NHS organisations to provide and deliver improvements in managing and learning from incidents.
Has an Equality Analysis been completed?
N/A
Attachments N/A
Governing Body strategic objectives supported by this report
Objective Tick
58
1. To be well-led and governed ensuring continuous development of the CCG, enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☒
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☐ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☐ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☐
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☐ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning of
primary care and GPIT, whilst exploring and preparing for further opportunities
☐
59
1
Governing Body Quality and Safeguarding Report Hartlepool and Stockton on Tees and Darlington Clinical Commissioning Groups
Purpose of the report The purpose of this report is to provide Hartlepool and Stockton on Tees and Darlington Clinical Commissioning Groups Governing Body with an updat e of issues relating to the quality of services and their impact on patient experience. It also includes information relating to compliance against national and local standards. The information presented is as at April 2017
Key Points to note:
Hartlepool and Stockton-On-Tees (HaST) CCG
Healthcare Associated Infection (HCAI) • C. Difficile-The CCG has exceeded its annual trajectory for the number of Clostridium Difficile
cases with 2016/17 final position of 109/72. o CCG is working collaboratively with acute providers, NHS England and N HS
Improvement to explore further health care system actions that can be taken in the community around Clostridium Difficile.
• Primary Care GP practice anti-biotic prescribing has increased compared to the same period last year.
Safeguarding Children
• The Hartlepool Serious Case Review was due for publication in May 2017, this will now be delayed to comply with the conditions of purdah following the announcement of a general election in June 2017.
Safeguarding Adults/care homes
• Tees Safeguarding Adults Board delivery of a Domestic Abuse and Adult Safeguarding conference.
NHS PROVIDERS North Tees Hospitals NHS Foundation Trust
Healthcare Associated Infection (HCAI) • Clostridium Difficile infection rates exceeded the annual trajectory in 2016/17 finishing the year
with 39/13 cases. Maternity Services
• The Trust summary report from the independent, external Maternity Services review conducted in September 2016 is to be discussed at the May 2017 Clinical Quality Review Group.
Mortality • The Trust is no longer identified as an outlier for mortality metrics.
South Tees Hospitals NHS Foundation Trust
Healthcare Associated Infection (HCAI) • Clostridium difficile: The Trust completed the year within trajectory with 43/55 cases • MRSA: the Trust breached the trajectory of 0 cases, and ended the year with 7 hospital
attributed bacteraemias. Never Events
• The Trust has reported 4 Never Events occurring during 2016-17 North East Ambulance Service
Serious Incidents (SIs) • Non - compliance with Serious Incident Management Framework reporting and i nvestigation
timeframes. Recruitment
60
2
• Recruitment and retention continues to be a challenge. A number of activities are underway to recruit paramedics.
Sickness absence • NEASFT reported at Clinical Quality Review Group (CQRG) meeting in March 2017 t hat
although improving, to 7.28%, this is still substantially above the Trust target of 5%. Tees Esk and Wear Valley NHS Foundation Trust
Serious Incidents • The Trust continues to demonstrate non-compliance with the national Serious Incident reporting
framework. Regulatory Inspection
• An inspection visit was undertaken across the trust sites for acute wards for adults of working age and psychiatric intensive care unit which were rated ‘good’ and Wards for older people with mental health problems which were rated as ‘requiring improvement’ in February 2017.
NHS Safety Thermometer • The latest published data in March 2017 ( February 2017 dat a) shows that TEWVFT are
performing better than the national average for harm free care across all indicators with the exception of falls with harm. The falls data appears to be on an increasing trend in quarter 4.
Safeguarding Training • Current reporting of Safeguarding training by the trust is non complaint with contractual
requirements.
North Tees Hospital Foundation Trust (NTHFT) Mortality The latest mortality position from North East Quality Observatory presented to NHS England Quality Surveillance Group, January 2017, indicates that the Trust is no longer an outlier for mortality metrics. However this must be viewed with caution as more contemporaneous measures (which require further validation) suggest concerns in relation to some specific disease categories. This will be further explored with the Trust via the Clinical Quality Review Group (CQRG) and other routine assurance processes. In addition to receiving mortality updates at the Clinical Quality Review Group, monitoring of Serious Incidents continues with triangulation of this information being used to inform the Commissioner Assurance Visits programme. Serious Incidents (SI’s) Following concerns raised with the Trust in relation to the reducing trend for reporting of Patient Safety Serious Incidents, the Trust saw an increase in reported SIs.
Following the reporting of 4 S I relating to safeguarding children concerns during 2016-17 Quarter 4, the Trust is implementing prompt remedial actions to ensure continued robust and s upportive clinical and management leadership of services, whilst also undertaking the appropriate Root Cause Analysis investigations. Routine collaborative and assurance meetings continue with Trust personnel at each level from the Patient Safety Team through to monthly Executive Director of Nursing meetings. This is supported and augmented by monthly performance monitoring via the NHS Standard Contract and the Local Quality Requirements.
Healthcare Associated Infection (HCAI) Methicillin-resistant Staphylococcus aureus (MRSA): Quality performance standard is zero. The final Trust position for 2016-17 was one case. Clostridium difficile: The Trust has breached its annual Clostridium Difficile Infection trajectory of and ended 2016/17 with a position of 39/13 cases. Collaborative health system work is taking place between the Trust, CCG and with NHS Improvement to understand the issues that the Trust is facing in relation to the ongoing challenged Clostridium Difficile represents. The aim is to create a combined action plan and also identify any external support required for the Trust. Performance so far in 2017-18 indicates a serious risk of failure of the annual trajectory.
Friends and Family Test (FFT) FFT published data for the period February 2017 for Accident & Emergency, In-patient and Maternity demonstrates response rates are below the England averages for each of these indicators. The Trust is also below average for the percentage recommended for the maternity question.
FFT declining rates have been discussed by the Executive Nurse with the Director of Nursing. In November 2016 the Trust recruited a manager to support the volunteer team. Their focus will be on FFT response completion to support improvement in the response rates for the Trust. There hasn’t been any immediate measurable improvement in the FFT response rates and this continues to be pursued with the Quality Leads at the Trust to understand when improvement can be expected. FFT feedback information has been observed, on the wards for staff, patients and visitors, during Commissioner Assurance Visits to the Trust Maternity Services The Trust commissioned an independent external review of their Maternity Services which commenced in September 2016, conducted by the Royal College of Obstetricians and Gynaecologists. The review was conducted following concerns identified during the 2015 C linical Quality Commission inspection and t he Local Supervisory Audit (of midwifery) the same year. The CCG were advised that this will be shared after presentation at the Trust Board meeting in March 2017 and has now received a T rust summary of this report. This will be the subject of further detailed discussion at the May Clinical Quality Review Group meeting with the Trust where further details of the outcome and associated actions will be discussed. Incident Reporting via National Reporting and Learning System (NRLS) NRLS data has recently been publ ished, covering the period 1 A pril 2016 t o 30 September 2016, of all patient safety incidents reported by Trusts. Organisations which report more incidents usually have a better and more effective safety culture. NTHFT reported 3,154 incidents (rate of 30.31 per 1,000 bed days) during this period, which places it in the lowest 25% of reporters of 136 Acute (non-specialist) organisations.
• The median reporting rate for this cluster is 40.02 incidents per 1,000 bed days. • Fifty per cent of all incidents were submitted to the NRLS more than 26 days after the incident
occurred. 50% of incidents were submitted more than 52 days after the incident occurred. • The top incident type was ‘Patient accident” accounting for 23% of all incidents reported. This is
an unusual category and the Trust is investigating the data flows underpinning this. The concern around the reduction in reporting will be addressed via the CQRG and monthly meetings with the Trust Director of Nursing. NHS Staff Survey Further analysis is needed on the results of the NHS Staff Survey and this will be reported in more detail at the next Governing Body.
62
4
Safeguarding Children Mandatory Training Compliance
Levels % Trained (actual) Safeguarding Children Level 1 100% Safeguarding Children Level 2 84% Safeguarding Children Level 3 94%
The Trust continue to perform well in relation to the compliance of safeguarding children training however there is a pe rsistent decrease in level 2 t raining in quarter 4. The Trust has compiled an action plan to address this issue which will be monitored via quality performance meetings. South Tees Hospitals NHS Foundation Trust Serious Incidents Although the reporting of SIs does not appear to indicate any concerns, as below, the nature of incidents is becoming a concern.
There have been 5 Never Events occurring in the Trust within 2016-17, and although they mostly relate to different procedures they are of a similar over arching type.
The Trust Quality Assurance Committee, Medical Directors, Director of Nursing and Director of Quality are involved in the Root Cause Analysis investigations to identify any common themes and remedial actions. These will be f urther discussed in detail at forthcoming CQRG meetings and t hrough routine assurance meetings and mechanisms. Healthcare Associated Infections (HCAI) Clostridium Difficile. The Trust successfully ended the year within trajectory and ac hieved a f inal performance of 43/55 cases. Early 2017-18 performance is beginning to indicate that this may be more of a challenge this year, however the Trust is reviewing and refreshing its HCAI action plan.
MRSA performance was more concerning with 7 Trust attributed cases of bacteraemia, against a 0 trajectory. Early themes arising from investigations indicate concerns around the handling and care of invasive devices. Delivery of enhanced training and monitoring is being incorporated into the HCAI action plan to address this.
The Trust HCAI action plan is monitored via the Infection Prevention Action Group which is also attended by the CCG’s Head of Quality and S afeguarding. The trust recently worked with the CCG and Loc al Authority to support the appointment of a Band 7 Infection Control Nurse from April 2017. It is hoped that this post holder will support improved communications and practices across the health and social care economy, to include Primary Care and the Residential Care home sector.
2017/10546 21-Apr-17 STHFT 23-Feb-17 Surgical/invasive procedure incident meeting SI criteria2017/2110 23-Jan-17 STHFT 12-Jan-17 Surgical/invasive procedure incident meeting SI criteria2016/32595 16-Dec-16 STHFT 29-Nov-16 Surgical/invasive procedure incident meeting SI criteria2016/24937 22-Sep-16 STHFT 06-Sep-16 Surgical/invasive procedure incident meeting SI criteria2016/10875 21-Apr-16 STHFT 10-Apr-16 Surgical/invasive procedure incident meeting SI criteria
63
5
The response rates for Friends and Family Test (FFT) in Inpatients and Accident and Emergency (A&E) remain below the England average. It is noted however that the A&E response rate in February 2017 is the highest in the 2016/2017 reporting year. Maternity’s response rate for February 2017 was below the England average.
The trust had forecast no real improvement in FFT rates until quarter 3 2016/ 17 when the new data collection systems were in place. However, it is not yet clear as to how the 1000 voices campaign will support the required FFT improvements as response rates remain low for Inpatients and A&E. Progression was discussed at April’s Performance Clinic.
Incident Reporting via National Reporting and Learning System (NRLS) NRLS data has recently been publ ished, covering the period 1 A pril 2016 t o 30 September 2016, of all patient safety incidents reported by Trusts. Organisations which report more incidents usually have a better and more effective safety culture. STHFT reported 4,302 incidents (rate of 28.9 per 1,000 bed days) which places it in the lowest 25% of reporters for 136 acute (non specialist) organisations.
• The median reporting rate for this cluster is 40.02 incidents per 1,000 bed days. • Half of all incidents were submitted to the NRLS more than 26 days after occurrence
o And half more than 66 days. • The top incident type was ‘implementation of care and ongoing monitoring/review’ accounting for
21.3% of all incidents reported. The concern around the reduction in reporting will be addressed via the CQRG, monthly meetings with the Trust Director of Nursing and through the Trust Quality Assurance Committee which the CCG Director of Nursing and Quality is invited to attend. NHS Staff Survey Further analysis is needed on the results of the NHS Staff Survey and this will be reported in more detail at the next Governing Body. North East Ambulance Service NHS Foundation Trust (NEASFT) Serious Incidents (SI’s) The trust reported one Serious Incidents in February relating to treatment delay (HaST CCG patient) and two in March 2017 relating to sub-optimal care (1 HaST and 1 DCCG patients), which is similar to previous months. There is continued non - compliance with the Serious Incident Management Framework in relation to submission of 72 hour reports and 60 day Root Cause Analysis investigation reports. The Trust reported to the QRG that all patient safety cause groups have seen a reduction in reporting, as per table below. ‘Dispatch’ remains the highest cause of patient safety incidents, which has been an ongoing trend for a number of months and relates to delayed ambulance response. Delayed ambulance response remains the highest cause group across NEAS. Incident reporting continues to be discussed at the QRG and the Trust stated that ‘Dispatch’ incidents are the highest cause group reported nationally. The Trust noted at the March QRG that the harm level for cases under review may be subject to change.
The Trust has seen an increase in the number of ‘no harm’ and ‘ near miss’ incidents, as well as an increase in higher acuity harm incidents in February, specifically ‘moderate harm’ and ‘death’. This may be indicative of an improved reporting culture.
As previously reported the trust continues to implement their action plan for improvement in the overall management and r eporting of incidents. The Quality team are working closely with the Contracting and Commissioning teams to monitor improvements in NEAS performance in relation to response times. Workforce Recruitment Recruitment and retention continues to be a challenge. A number of activities are underway to recruit paramedics. There are currently 60 whole time equivalent student paramedics who are due to graduate from their programme prior to 31st March 2017 and an international recruitment campaign is planned.
Safeguarding NEAS has undergone a reorganisation of their management structure and plan to recruit a Named Professional Safeguarding Children, a Named Professional Safeguarding Adults, a specialist advisor post covering children and adults, a safeguarding officer and an administrator. Additional work has been undertaken in relation to the delivery of safeguarding children training which has improved the uptake, resulted in positive feedback and has improved the system of data collection. The Trust level 3 safeguarding children training has increased from 66.93% in Q3 to 94.53% in Q4. Sickness absence NEASFT reported at Clinical Quality Review Group (CQRG) meeting in March 2017 that overall the Trust-wide absence rate has decreased slightly by 0.26% compared with the previous month, and is now 7.28%. However this is still above the Trust target of 5%. The Trust has a number of initiatives in place to support employees back to work. The Trust has reported that some of the sickness issues are non-work related.
Updates on workforce continue to be monitored through CQRG as a standing agenda item.
Tees Esk and Wear Valleys NHS Foundation Trust Serious incidents Serious Incident management continues to remain of concern to the CCG as the trust is non-compliant with the national reporting timescales. There is also concern in relation to the number of ongoing Serious Incidents and the quality of the root cause analysis (RCA) reports which are designed to draw out root causes and lessons learned. The trust also has a large backlog of ongoing action plans some of which date back a number of years in relation to historic incidents. The trust has been working to update and close these actions but the quality and pr ovision of evidence is often difficult due t o the historic nature of the incidents. It has been a greed with the trust to undertake work to theme the historic actions and link to improvement work undertaken by the trust to provide assurance to the CCGs so that sufficient actions have been taken to allow the historic action plans to be closed. This will continue to be monitored by the Clinical Quality Team and the Quality Review Group. SI reporting performance is as per the table below.
The CCG is currently seeking further assurance from the trust in relation to serious incident management and governance processes associated with the management of these incidents. Regulatory Inspection - Care Quality Commission (CQC) An inspection visit was undertaken across the trust sites for acute wards for adults of working age and psychiatric intensive care unit which were rated ‘good’ and Wards for older people with mental health problems which were rated as ‘requiring improvement’ in February 2017. However, the trust retains its overall rating of ‘Good’. It has also undergone inspection of Learning Disability and Rehabilitation services by the CQC and is currently in receipt of the draft reports for comment. It is anticipated that these reports will be published imminently. NHS Safety Thermometer
The latest published data in March 2017 (February 2017 data) shows that TEWVFT are performing better than the national average for harm free care across all indicators with the exception of falls with harm. The falls data appears to be on an increasing trend in quarter 4 The Trust has a falls reduction project in place which is being led by their Director of Nursing. Falls have been identified as a key priority by the Trust for their 2016/17 quality account. The significant work undertaken in relation to awareness, education about identifying and addressing risk, and also reporting is reflected in the increased numbers as per the table below. The Trust is to be commended for this proactive approach, whilst also addressing the learning arising from the subsequent investigations.
A progress update was received at the last CQRG which demonstrated that a lot of process redesign work has been undertaken on all aspects of the falls pathways including post falls care. Safeguarding Training Current reporting of Safeguarding training by the trust is non complaint with contractual requirements. This has been discussed with the trust at Clinical Quality Review Group and the trust has been requested to produce the data in line with contractual quality requirements. This will continue to be c hallenged as required until the correct information is received.
Hartlepool and Stockton-On-Tees (HaST) CCG HCAI and antibiotic prescribing The CCG has exceeded its annual trajectory for the number of Clostridium Difficile cases with 2016/17 final position of 109/72. The CCG is working collaboratively with our healthcare partners, including acute providers, NHS England and NHS Improvement to explore further health care system actions that can be taken in the community around Clostridium Difficile. The complete breakdown of the 109 cases is as below.
In addition to the work underway, and further actions required within the acute sector it is important for the CCG and Primary Care colleagues to identify opportunities for improvement in community care. Antibiotic resistance poses a s ignificant threat to public health, especially because antibiotics underpin routine medical practice. To help prevent the development of resistance it is important to only prescribe when they are necessary and not for self-limiting mild infections. Public Health England and local guidance on managing common infections recommends consideration should be given to a no, or back-up or delayed
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
0 0 0 0 0 0 1 1 0 1 0 0 3 3
66
8
antibiotic prescription. The latest performance data on HAST CCG prescribing during October – December 2016 indicates the following key issues: Total volume of antibiotics
• HAST CCG was the 18th highest prescriber of antibacterial drugs in England during October - December 2016.
• Overall, item growth has increased by 1.26% when compared to the same time period last year. • Compared to the RightCare peer group, HASR CCG are the 4th highest prescribers of antibiotics. • If prescribing reduced to the national average, Hartlepool & Stockton could save a pot ential
£175,134 per year. This represents a 16% reduction against total spend of antibacterial drugs. Healthcare associated infections
• Antibiotic prescribing practice and the epidemiology of C.difficile infection are changing. • Total antibiotic burden is known to be a risk factor for C.diff infection.
To support the antibiotic prescribing agenda, the practice support pharmacy teams in HaST, South Tees and Darlington will be carrying out CCG wide audits of Urinary Tract Infection prescribing in quarter 1. Results will be collated and fed back to practices, work stream meetings and Executive teams, with key points and s uggested actions to make necessary improvements. Further audits will be under taken to identify improvements. We’re also hoping to improve the antibiotic reports for 2017/18, by producing quarterly reports at prescriber detail to allow practices to benchmark prescribing internally, and review within each practice, supported by the practice based pharmacy team. The quarterly reports to CCG executive teams will continue, and we’d welcome any feedback you might have on these. Safeguarding Adults
The CCG Safeguarding Adults team continue to engage with health and s ocial care partners to progress the Domestic Abuse and Violence agenda across the Tees geography. This has included involvement with the recent Tees Safeguarding Adults Board delivery of a Domestic Abuse and Adult Safeguarding conference. With national speakers covering all areas of domestic abuse, including elder abuse, coercive control, BME specific issues, and also perpetrator programmes, the event was very well attended. Nursing home quality concerns across Hartlepool and S tockton remain a significant concern, and we continue to work with our Local Authority and CQC partners to implement remedial measures and keep patients safe.
Children Serious Case Reviews (SCR), inspections and assurance exercises • The Hartlepool SCR (vulnerable adult murdered by 2 teenage girls) was due for publication in
May 2017, this will now be del ayed to comply with the conditions of purdah following the announcement of a general election in June 2017. The embargoed report has been shared with the review team who have begun to produce an action plan based upon the recommendations from the SCR.
• A Special Educational Needs and Disabilities (SEND) inspection was carried out in Hartlepool at the beginning of October 2016 by CQC and Ofsted. The findings have now been published and a multi-agency action plan developed to address the recommendations. A SEND improvement / assurance board has been f ormed which the CCG Director of Nursing and Quality is a member.
67
9
Recommendation Governing Body members are asked to review the report and note the actions underway. Authors: Elizabeth Ward, Senior Clinical Quality Manager, North of England Commissioning Support Jean Golightly, Executive Director of Nursing and Quality, Hartlepool and Stockton-on-Tees CCG May 2017
68
NHS Darlington Clinical Commissioning Group and
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 2.3.2
30th May 2017
Title CCG Finance Report - Month March 2017
Purpose Approval ☐ Discussion ☒ Information ☒
Responsible CCG Member / Lead
Mr Graeme Niven , Chief Finance Officer
Author of Report Mr Rob Sands, Finance Manager, NECs
Recommendation(s) 1.1 . The Governing Body is requested to;
• Consider the reported financial performance • Note the financial forecast for 2016/17 as at 31 March
2017. • Note the reported financial risks and mitigating actions
being taken to ensure delivery of the CCGs statutory financial duties.
• Note the current performance and remedial actions against the CCG key performance indicators
Executive Summary
In summary the CCGs have delivered its key performance indicators. Risks have materialised in year in particular in Acute and continuing health care which have been o ffset by the use of some planned mitigations, including BCF performance.
Clinical Engagement
na
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?
Risk of not delivering our financial indicators.
Has an Equality Analysis been completed?
none 69
Attachments Finance Report
Darlington CCG strategic objectives supported by this report
Domain Tick Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐
Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☐
Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans
☐
Performance Ensuring measurable improvement of the quality and safety of the services that we commission
☐
Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.
Delivery of innovative and new models of care
To demonstrate system leadership across the health and social care economy
☐
HaST CCG strategic objectives supported by this report
Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,
enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☐
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☐ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☒ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☐
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☐ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning of
primary care and GPIT, whilst exploring and preparing for further opportunities
☐ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None 70
71
Darlington CCG Finance Report for the twelve months
ended 31st March 2017
72
£26k (Favourable)
£164,028k
£0k
98.59%
99.86%
96.75%
99.00%
Actual Outturn
Executive Summary Commissioning spend The CCG is reporting a surplus of £3,337k, this includes the planned surplus of £1,745k and the 1% which was mandated by NHS England to be held uncommitted of £1,592k. Running Costs The CCG is reporting a running cost surplus of £26k. Cash The cash drawdown is in line with the cash limit for the year. All cash targets were achieved. Quality Innovation Productivity Prevention (QIPP) Actual QIPP efficiencies of £2,733k against a plan of £4,948k.
Capital There is £10k of capital included in the plan submitted to NHS England for IT equipment, this has not been utilised in 2016/17. Better Payment Practice Code (BPPC) 95% of invoices to be paid in 30 days The CCG is exceeding the 95% target for NHS and Non NHS invoices.
Invoices Value
Non NHS
NHS 1
£2,733k
£3,337k (Favourable)
73
Overview
This report provides an update on the financial performance of NHS Darlington CCG for the twelve months to 31st March 2017. This includes performance against those primary care budgets for which delegated responsibility was awarded to the CCG from 1 April 2016. The final position shows the CCG to have achieved its key financial targets, although it should be noted that these are draft financial figures that may change during the audit process. The improvement in the reported position from month 11 is mainly due to Continuing Healthcare and Prescribing and Primary Care, both have seen a favourable movement of £554k and £437k respectively. For Continuing Healthcare, the decrease in costs is attributable to a rebate received from the NECS SLA and reduction in cost for individual packages of care following review. There has been a slight improvement in Prescribing based on the information received from the PPD and also on ETTF funding previously managed in reserves. The outturn position shows a total underspend of £3,363k after the release of £1,592k of non recurrent reserves as per NHS guidance. The CCG received a total funding allocation of £164,542k during 2016/17 of which the CCG received in month allocations of £180k for Market Rent, £20k for Resilience Funding, £2k for CYP IAPT and £1k fro GP repatriation adjustment. During 2016/17, all CCGs were mandated by NHS England to hold 1% of their total funding allocation uncommitted as a ‘risk reserve’. For Darlington CCG this equated to £1,592k. In March 2017, NHS England confirmed that all CCGs were required to increase their surplus by the value of the risk reserve. This has resulted in the increase in underspend against resource to £3,363k. Effectively this means the CCG has only been able to spend 99% of its original confirmed funding allocation for the year on commissioning healthcare for the population of Darlington.
2 74
Summary of Financial Position 31st March 2017
3
Darlington CCG Revenue Expenditure 2016-17 Budget Actual
Variance (Under)/
Overspend
Previous month
Forecast Outturn Variance Movement
£000's £000's £000's £000's £000's
Programme Services
Acute Services 75,124 76,717 1,593 1,578 15Mental Health Services 16,705 16,685 (20) 42 (62)Community Health Services 15,164 15,330 166 257 (91)Continuing Care Services 12,508 11,613 (895) (340) (554)Prescribing and Primary Care Services 19,599 20,301 702 932 (230)Other 4,605 4,736 131 (61) 192Co-Commissioning 13,713 13,527 (186) (177) (10)
Total Programme Services 157,418 158,909 1,491 2,231 (740)
RUNNING COSTS 2,295 2,269 (26) 0 (26)
RESERVES 4,829 0 (4,829) (3,710) (1,119)
CCG Net Expenditure 164,542 161,179 (3,363) (1,479) (1,885)
75
Acute Services
6
Acute services is showing an overspend of £1,593k and is largely based on month 10 activity data. County Durham and Darlington NHS FT is showing an over-spend of £2,077k, with the main areas of pressure in A&E, Critical Care, Outpatients and Direct Access. South Tees Hospitals NHS FT is showing an underspend of £157k. There has been a reduction in activity from the previous month mainly due to Electives and Outpatient reviews. Newcastle NHS FT is showing an underspend of £272k mainly due to ITU/critical care underspend partially offset by a high level of non elective activity. North Tees and Hartlepool FT is showing an overspend of £118k mainly due to elective activity. Non NHS Acute mainly comprises BMI Woodlands Hospital with an annual budget of £4,921k. The budget shows a significant increase in funding to this provider and reflects the increasing activity experienced in 2015/16. Daycases are lower than plan partially offset by a higher level of activity for electives leaving an underspend of £134k. BPAS invoices to date have been 100% higher than plan and is currently forecasting a pressure of £16k. Winter resilience is reporting an underspend mainly relating to a benefit from previous year of £39k and slippage of £170k due to delaying of schemes. Urgent Emergency Care Vanguard relates to payments to GP Practices for 111 Bookings.
Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) - the overspend of £357k relates to the Acute Liaison and Care Home Liaison services which were originally funded as part of the BCF. The position has improved slightly due to a refund in respect of 2016-17 CQUIN schemes which were not achieved. Northumberland, Tyne and Wear NHS Foundation Trust (NTW) – the forecast overspend of £90k is based on the activity report for month 10 which continues to show a pressure in Aldervale as well as in the low volume, high cost, Affective Disorder – Inpatient service. Higher activity in this service is also being seen in other CCGs where it is being reviewed to understand the pathway. Pressures are partially offset by savings from a range of services, predominantly Gainsborough Adult Acute Assessment ward. Independent / Voluntary Sector – the favourable movement in the forecast underspend is due to the write back of 2015-16 year end accruals. Local Authority Agreements – is reporting an underspend of £106k and mainly relates to s28a individual packages of care offset by a prior year benefit.
The over-spend on NHS Contracts of £225k mainly relates to County Durham and Darlington NHS FT for Urgent Care over performance of £59k, and non contracted activity of £120k relating to continence and orthotics and £39k for AQP Audiology. These are being challenged with the trust. There is also £8k included for community diabetes at Newcastle Hospitals NHS FT. The main hospice contract with St Theresa’s has been agreed as a block and is reflected in the reported budget above. The £9k overspend relates to Teesside Hospice where ad-hoc charges have been received. Other Community contracts have been agreed for all community providers and are reflected in the reported budgets above. For the month 12 position, the majority of contracts have been based on an average of year to date actuals received to month 11.
Total Community Health Services 15,164 15,330 166 257 (91)
78
Continuing Care Services
9
The £895k forecast underspend is largely due to CHC Fully Funded packages spend against budget. The Q3 package data has now been received from DBC and is going through review which will allow additional validation to take place. A favourable movement of £100k has been identified in March due to the NECS SLA rebate. Invoices received from NHS South Warwickshire CCG have been formally disputed. The change in packages in month 12 for each Benchmarking category are shown below:- CHC Fast Track - New 10, End 8 Joint Packages - New 1, End 1 Section 117 – New 3, End 4 Continuing Health Care – New 6, Decrease 1, End 3 Funded Nursing Care – New 1, End 3 PHB – Decrease 1
Budget Actuals Variance
Previous month
Forecast Outturn Variance Movement
£000 £000 £000 £000 £000National risk pool contribution - CHC restitution cases 359 359 0 0 0CHC - Management costs 205 105 (100) 0 (100)CHC Fast Track 600 393 (207) (22) (184)Continuing Care - Joint Packages 1,803 2,336 533 881 (349)Continuing Care - Section 117 1,687 1,539 (148) (18) (130)Continuing Health Care 6,364 5,628 (736) (898) 162Personal Health Budget 0 139 139 139 (0)Funded Nursing Care 726 933 207 217 (10)Children 764 181 (582) (639) 57Total Continuing Care Services 12,508 11,613 (895) (340) (554)
79
Prescribing and Primary Care Services
10
Prescribing – the final outturn position is based on the information received from the Prescription Pricing Division (PPD) and includes 10 months actual costs and 2 months accruals. Enhanced Services (minor ailments scheme) position is based 11 months actual data received. Commissioning Schemes forecast overspend of £150k relates to care home beds. Other Primary Care mainly relates to the Oxygen contract, GPIT and PCTF allocation previously managed in reserves.
Patient Transport Services is showing a £61k overspend which mainly relates to the unfunded ERS contract. Programme Projects relates to the Regional Backpain project and Salaried GPs . The variance is mainly down to Cruse Bereavement Support, GP Payments and adhoc expenditure including Carmel GP Practice. Reablement relates to the Better Care Fund which is an agreed joint funded pooled arrangement with Darlington Borough Council. NHS Property Services – the underspend reflects the actual schedule for property costs received from NHSPS.
For March 2017, the actual outturn is showing an underspend of £186k with a small favourable movement of £10k. Below is an overview of expenditure included within primary care delegated budgets: GMS (General Medical Services) - National Contract. Payments in line with the Statement of Financial Entitlement, 0.5% demographic growth included in the budget.
PMS (Personal Medical Services) - Local Contract. Payments in line with the Statement of Financial Entitlement, 0.5% demographic growth included in the budgets. Slight overspend due to increasing List Size.
QOF (Quality and Outcomes Framework) - covering the two areas of clinical and public health. Practices can choose to provide these services. Overspend YTD and forecast based on 15/16 achievement.
Enhanced services (ES) – covering additional services that practices can choose to provide. The following Enhanced Services are offered to Practices Extended Hours, Minor Surgery, Learning Disability, Extended Patient Choice, Unplanned Admissions. Underspends against Extended Hours, Unplanned Admissions & Patient Choice. Over spends against Learning Disabilities & Minor Surgery.
Premises & Other Premises - Rent, Rates & Water Rates, paid in line with GMS/PMS Premises Directions. Based on 16/17 actuals, as at Q1 Clinical Waste transferred back to NHS England . Felix House monies released . £85k removed from forecast re settled Rates Rebates.
Dispensing/Prescribing: Forecast updated based on 9 months Actuals.
Other GP Services - These include Seniority, Locums and Suspended GP's. Under spend relates to Seniority, based on Q1 - Q3 actual spend. Interpretation and Needles & Syringes transferred back to NHS England.
Pay is showing an overspend due to redundancy costs paid as a consequence of a restructure within the CCG. Non Pay (CSU) is the cost of commissioning support services from NECS and is showing an underspend of £253k due to a rebate received for the core SLA. Non Pay (Other ) includes, accommodation, audit fees and other corporate costs. The movement relates to recharges between HAST and Darlington CCGs as a result of the joint management structure.
Missed milestone unlikely to have material impact/savings within 75% of target/concern
raised
Missed milestone with a material impact/an issue/savings less than 75% of target
Data not available and or not applicable
Forecast £000s
All Schemes
2016/17 QIPP ProgrammeProject RAG Dashboard
Darlington CCG
Apr May June July Aug Sep Oct Nov Dec Jan Feb MarMonthly savings £157 £177 £170 £302 £78 £308 £483 £132 £330 £104 £292 £201Financial Recovery Plan £250 £250 £250 £250 £250 £252 £255 £258 £258 £291 £291 £291
£- £200 £400 £600
£000
s
Monthly savings Profile
85
Better Payment Practice Code (BPPC) – cumulative to 31st March 2017
Note: Credit notes, CHC and Non Contracted Activity invoices have been adjusted from the above figures. A delay in the approval of Property Services 15/16 invoices resulted in the CCG missing the Non NHS Trade by value target.
16
The BPPC (Better Payment Practice Code) requires NHS organisations to pay all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
Better Payment Practice Code - 30 Days NUMBER £000's
Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 8,034 42,200Total Non-NHS Trade Invoices Paid Within 30 Day Target 7,921 40,827Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 98.59% 96.75%
NHS Total NHS Trade Invoices Paid in the Year 1,708 104,704Total NHS Trade Invoices Paid Within 30 Day Target 1,691 104,559Percentage of NHS Trade Invoices Paid Within 30 Day Target 99.00% 99.86%
86
Hartlepool & Stockton-on-Tees CCG Finance Report for the twelve months
ended 31st March 2017
87
Executive Summary
Commissioning spend (including Reserves) The CCG final position is a surplus of £9,425k.
Running costs The CCG final position is an underspend of £941k.
Cash The closing year end cash balance of £372k is within cash efficiency targets set.
Quality Innovation Productivity Prevention (QIPP) QIPP efficiencies to be under-delivered with a final position of £4,956k at year-end against a target of £11.9m.
Better Payment Practice Code (BPPC) – 95% of invoices to be paid in 30 days Invoices Value The CCG has exceeded the 95% target for the financial year so far.
Capital Expenditure The CCG has a budget of £10k for any IT running cost need, but nothing is anticipated. LD transformation budget of £432k is not forecast to spend, TEWV withdrew.
Final
£9,425k
(Favourable)
£941k (Favourable)
£372k
£4,956k £5,025k
99.82% 100%
Non NHS
NHS
Number £000’s
Budget Final
£10k £0k
£432k £0k
HQ IT
LD
97.98% 99.13%
88
Overview This report provides an update on the final financial performance of NHS Hartlepool and Stockton-on-Tees CCG for the twelve months to 31st March 2017. The CCG’s financial position has been under continual review and the final position shows the organisation has achieved its key financial targets, but only due to the use of a significant amount of available CCG reserves including significant non recurrent reserves to offset over spends, as risks have materialised. There are overspends reported on Acute (£11.8m) and continuing healthcare (£4.1m), which are part offset by an underspend of £2m on the Better Care Fund for performance, a planned risk mitigation. It was confirmed that the CCG was not allowed to access the protected 1% non recurrent resource and that this resource remain unused by CCG’s to support ‘system-wide risk’. This balance represents £4.4m of the reported final surplus of £9.4m.
89
Summary Financial Position 31st March 2017
Budget Final Position Variance
£000s £000s £000s Acute Services 202,027 213,858 (11,831) Mental Health Services 45,035 44,016 1,019 Community Health Services 31,065 31,348 (283) Continuing Healthcare (CHC) Services 29,028 33,144 (4,116) Other Services 21,979 19,426 2,553 Prescribing 51,656 51,942 (285) Primary Care Services 45,660 42,841 2,819
Total Programme Services 426,450 436,575 (10,125)
Running Costs 6,403 5,462 941
Reserves 18,711 101 18,609
CCG NET EXPENDITURE 451,564 442,138 9,425
90
Reserves
From the £13,514k above, £9,148k of reserves have been consumed by overspends in the programme position, and £4,366k has been used to increase the surplus per NHS England direction.
Reserves Budget Final
Position Variance £000's £000's £000's Control surplus 5,060 0 5,060 Allocations - GP Training / SRG /Diagnostic Capacity / Maternity 0 0 0 Total protected reserves 5,060 0 5,060 0.5% Contingency 2,446 0 2,446 1% Non recurrent headroom 4,366 0 4,366
Planned reserves held as risk cover 3,929 0 3,929
Local Investments 2,773 0 2,773 Total reserves held as risk cover 13,514 0 13,514 Reserves total 19,386 0 19,386
91
Acute Services
Summary – Acute final position is £11.8m overspend, mainly due to over activity and non delivery of QIPP in relation to Rightcare. North Tees and Hartlepool FT – The final position reflects under delivery of non contracted QIPP and contracted QIPP. There have been significant data quality issues with activity information from this provider, which has improved in year. South Tees FT – Based on month 10 data, the final position overspend reflects under delivery of QIPP and continuing increases in Non Electives and Electives. NEAS FT – While this is a block contract, the final net position reflects the estimate of a small release of 2015/16 accruals. Private providers – Final overspend of £897k, mainly due to Nuffield (£374k), Ramsey (£277k) and BMI Woodlands (£254k). Walk in centres – activity has been profiled using 2015/16 outturn, the final position is an underspend of £85k, based on Month 11 data. Other acute services – the final overspend of £1.6m reflects the net position across a number of providers and reflects some under delivery of QIPP. The largest overspends are with Newcastle upon Tyne Hospitals (£452k) and City Hospitals Sunderland (£814k).
Annual
2016-17 Budget Final Position
Final Position Variance Under/
(Overspend) £000s £000s £000s
Acute Services North Tees & Hartlepool NHS Foundation Trust 139,743 146,304 (6,562) South Tees Hospitals NHS Foundation Trust 35,180 38,009 (2,829) North East Ambulance NHS Foundation Trust 7,935 7,950 (14) Private Providers 5,929 6,826 (897) Walk In Centres 3,187 3,102 85 Other Acute Services 10,053 11,666 (1,613) Total Acute Services 202,027 213,858 (11,831)
92
Mental Health Services
Tees, Esk & Wear Valley FT This contract is a block arrangement and therefore would normally show as breakeven, however some funding has been included for Liaison services which is not required in 16-17, though the enhancement to the liaison service did start at the beginning of 2016-17, SRG funding which was included for the full year but the service didn’t start until July 2016 and funding originally given to TEWV in 2015-16 for schemes which have not materialised therefore the funds have been returned to the CCG. Mental Health & Learning Disability Risk Share Packages The final underspend of £231k is consistent with the previous month as there were no new packages admitted in March 2017. Other Mental Health IAPT services - The final underspend is based on invoices received for April to February activity, and a March estimate.
2016-17 Budget Final Position Final Position (Overspend)
£000s £000s £000s
Mental Health Services Tees, Esk & Wear Valley NHS Foundation Trust 33,785 33,544 240
Mental Health / Learning Disability/Risk Share Packages 6,640 6,409 231
Other Mental Health 4,610 4,063 548 Total Mental Health Services 45,035 44,016 1,019
93
Community Health Services
The main Community Health Services contract is with North Tees and Hartlepool FT and is a block contract. There has been some non recurrent spend. There are now four AQP Adult Hearing contracts (Boots have de-commissioned the service). The two principal contracts are still: • North Tees and Hartlepool FT – forecast overspend £50k based on month 11 data. • Specsavers – budget was reduced by £308k in 16/17 due to a plateau of activity in the previous two years, currently showing a
forecast overspend of £107k.
Other Community Health Services contracts include South Tees Hospitals FT, which is £27k overspent. The main driver of the worst case is continued pressure in AQP audiology activity.
2016-17 Budget Final Position
Final Position Variance Under/
(Overspend) £000s £000s £000s
Community Health Services North Tees & Hartlepool NHS FoundationTrust 28,649 28,686 (37) AQP Adult Hearing 879 1,108 (229) Other Community 1,537 1,554 (18) Total Community Health Services 31,065 31,348 (283)
94
Continuing Health Care Services
2016-17 Budget Final Position
Final Position Variance Under/
(Overspend) £000s £000s £000s Continuing Care Services CHC - Fast Tracks 828 1,210 (382) CHC 10,854 15,271 (4,416) CHC - Joint Packages 6,768 6,062 706 CHC - Children 1,150 806 344 CHC - Equipment 152 157 (4) CHC - Personal Health Budgets 1,448 1,566 (117) CHC- S117 3,870 3,933 (63) FNC 3,096 3,280 (183) CHC Team NECS 523 523 0 CHC Risk Pool 337 337 0 Total Continuing Care Services 29,028 33,144 (4,116)
Continuing Healthcare (CHC) costs are based on the annual cost of individual packages of care included in the finance database at the end of the month which is the most up to date information at the time of publishing. A check against the NHS spine of recorded deaths has also been performed. Annually costs are increasing due to new packages, and increases in existing package costs following review. The main areas of increase during month 12 are: CHC – Package movements for the month resulted in a hit of £219k due to new notifications. There was also an increase in the database relating to the LA recharge, primarily Hartlepool BC resulting in a decrease of CCG adjustments and an increase in FOT of £732k. There was a benefit from a growth reduction of -£71k, an increase in equipment costs of £33k and a reduction in nof accrual of £50k The database movements in month included: Fast Tracks, Joint Funded, Children’s and FNC increased, whilst CHC and S117 decreased and PHB increased marginally by £2k. Fast Track increase is due to 45 new clients compared to 25 RIP, 8 packages increases (including 1 high cost) compared to 1 decreases, there is also 1 high cost package transferring from JF. Increases in Joint funded are mainly due to 7 new packages (including 1 high cost), 2 packages transferring from CHC (1 high cost), 1 client transferred to FT (high cost), 1 package ending, and 1 client’s recharge to the LA reduced by £18k therefore increasing the Forecast. Children's’ increase is mainly due to are 2 increases (1 high cost). FNC increase is mainly due to 6 increases (including 1 high cost case) compared to 5 decreases and there are 19 new compared to 12 RIPs. CHC decreases are mainly due to 2 high cost cases transferring to JF, There are also 14 new (2 high cost) compared to 11 RIP, and 8 increases (1 high cost) compared to 9 decreases (3 high cost). S117 decreases is marginal but movements include 25 new (2 high cost) compared to 1 RIP, 3 increases (1 high cost) compared to 7 decreases (1 high cost), 4 packages ended and 3 increases due to change in provider. There was also a £45k decrease for 2 packages which were moved to MH. The above figures include backdated packages. Discussions around S117 packages are underway and there was an expectation of £500k QIPP attached to this which is not forecast to deliver.
95
Prescribing
Prescribing figures have been prepared using month 10 data from the BSA, and the final position based on this data and other factors, as stated below, is a £285k overspend. • Factored into the prescribing budget there is an element of ‘rightcare’ QIPP delivery, and the Medicines Optimisation workstream
practice work plan projects in year savings of £1.4m to offset this, on the latest information this plan has delivered year end savings of £552k. There are many ongoing projects such as Improving systems for ordering of repeat prescriptions, Right Care and Care Home medication reviews as well as options
• New projects such as Community pharmacy managed repeat ordering services. Also shown above: Central Drugs £63k - Underspend based on Month 10 data, calculated at BSA Profiles. Oxygen £3k - Overspend based on Month 11 data.
2016-17 Budget Final Position
Final Position Variance Under/
(Overspend) £000s £000s £000s Prescribing PC Prescribing 48,725 49,076 (351) Central Drugs 1,414 1,351 63 Scriptswitch Licence 115 115 0 Home Oxygen 939 936 3 Medicine Mgt Team NECS 464 464 0 Total Prescribing 51,656 51,942 (285)
96
Primary Care Services
Included in ‘Primary Care Core - Other’ are Community Based Services and RIVIE scheme underspends , which relate to estimated benefits from 2015/16 scheme completion.
Annual
2016-17 Budget Final Position
Final Position Variance Under/
(Overspend) £000s £000s £000s Primary Care Services GMS 23,980 24,085 (105) PMS 350 350 0 Other List Based Services (APMS included) 1,246 1,315 (69) Premises Cost Reimbursement 5,690 5,294 396 Enhanced Services 1,871 1,639 233 QOF 4,033 4,033 0 Other GP Services 577 585 (8) Dispensing Prescribing Drs 318 370 (52) Reserves (Delegated Primary Care) 617 0 617 Total Delegated Commissioning 38,681 37,671 1,010 Out of Hours 2,113 2,113 0 GP IT 753 771 (18) Other 4,249 2,387 1,862 Total Primary Care Core 7,115 5,271 1,843 Total Primary Care Services 45,796 42,942 2,854
97
Other
Spend in this category relates mainly to block contracts. Better Care Fund (BCF) – the position is based on the agreed values with Hartlepool and Stockton Councils, which includes an agreed underspend in relation to performance for both. NHS Property Services (NHS PS) / Community Health Partnerships (CHP) – budgets have been set on historic void and subsidy charges and are shown as break even. In 2016/17 NHS PS moved to charging tenants market rents. The DoH earmarked a central budget to fund the impact to tenants. The impact to individual tenants was calculated and validated as accurate, and the budgets were transferred into the CCG’s resource allocation. The CCG increased contract values with the affected providers in order to transfer this funding across to tenants. The position is showing a £184k underspend, which relates to CHP confirmed charges of £13k, and the balance on planned QIPP on NHS PS properties.
The running cost allowance is the budget allocated to pay for non-clinical management and administrative support, including commissioning support services. Non pay costs include the cost of commissioning support services (CSU), clinical engagement, accommodation, audit fees and other corporate costs. A final position underspend of £941k has been reported at month 12 against Administration running costs .
Running Costs Budget Final Position
Final Position Variance Under/
(Overspend £000s £000s £000s Pay 1,246 1,164 82 Non Pay (CSU) 3,847 3,649 198 Non Pay (Other) 1,310 649 661 Running Costs Total 6,403 5,462 941
99
QIPP As at 31 March 2017 £5.025m has been delivered against the plan of £11.858m. End of year performance was slightly higher than the month 11 forecast but broadly in line with previous expectations. Pathway changes ended the year behind plan, however the savings from the MSK pathway redesign have begun to increase in the latter part of the year. Discussions have begun with the Foundation Trust with regard to the COPD pathway which failed to deliver the expected reduction in secondary care activity to ensure that the expected activity reduction is delivered in 2017-18. Excess beds days continue to move (reduction) in the right direction & it is expected that this will continue into 2017-18. The Rightcare schemes have been scoped out and now need to move to the implementation phase to deliver activity & expenditure reductions in the next financial year. Medicines Management schemes ended the year slightly below plan although ‘full year’ savings will be achieved & prescribing costs remain within budget. In summary the CCG delivered the green rated risk of £4.4m and made a contribution to the amber risk schemes of circa £0.6 m against its original QIPP plan. Looking forward to 2017-18 a QIPP workshop was held on 14th February 2017 and 3 month, 6 month and longer term actions were agreed. Plans on a page and Project initiation documents are currently being developed and the CCG now has a Programme Management Office (PMO) in place, led by the Director of Performance, Planning & Assurance to drive delivery and provide assurance to the Governing Body. The first joint Finance Recovery Group meeting with the Foundation Trust was held on the 14th March 2017. The CCG has not yet received the FT’s cost reduction plan for 17-18 to cross check alignment of plans. A concern remains that the FT is still relying on a level of income outside the affordability plan of the CCG. Areas for joint working have been identified & a meeting with the Trust is being set up to discuss.
Red 8,869£ 2,911£ 5,958-£ 3,228£ 2,911£ 3,028£ Green 90£ 90£ -£ 90£ 90£ 90£ Red 634£ 134£ 500-£ 134£ 134£ 134£ Green 1,828£ 1,553£ 275-£ 1,628£ 1,553£ 1,828£ Green 337£ 337£ -£ 337£ 337£ 337£ N/A 11,758£ 5,025£ 6,733-£ 5,417£ 5,025£ 5,417£ Scheme Total
Acute Care
MH & community
Joint Commissioning
Medicines Optimisation
Primary Care / Management costs
Project Name Project RAGForecast £000s
All Schemes
Apr May June July Aug Sep Oct Nov Dec Jan Feb MarMonthly savings £610 £33 £183 £424 £318 £414 £382 £384 £524 £652 £536 £567Financial Recovery Plan £626 £444 £705 £1,049 £1,015 £1,059 £1,073 £1,161 £1,117 £1,196 £1,157 £1,157
£-
£200
£400
£600
£800
£1,000
£1,200
£1,400
£000
s
Monthly savings Profile
101
QIPP – Analysis by scheme
QIPP Schemes 2016-17As at 31 March 2017 - Activity to March 2017
9
REF WorkstreamUnique
QIPPRef
Scheme Name16/17 Value
£Delivered Not Delivered Low risk Medium risk High risk
1 IHC Q01 MSK (1,765,733) (1,639,512) (126,221) (126,221)2 IHC Q02 Value based Commissioning Spinal procedures (354,662) 0 (354,662) (354,662)3 IHC Q03 COPD (611,000) 0 (611,000) (611,000)5 Contract Q05 A&E linked to 111 clinical hub (261,909) (132,720) (129,189) (129,189)6 PC Q06 GP variation elective care (1,282,084) 0 (1,282,084) (1,282,084)7 OHC Q07 Excess bed days (1,000,000) (448,447) (551,553) (551,553)8 Contract Q08 Audiology block (500,000) 0 (500,000) (500,000)
Total (11,757,966) (5,024,865) (6,733,101) 0 0 (6,733,101)
103
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar
£ 00
0's
QIPP Performance - April 2016 to March 2017
Plan
Plan - contracted
Actual YTD
Forecast
104
Key Financial Risks The key risks which impact on the ability to deliver the financial position in 2016/17 are shown in the table below, together with relevant controls and assurances with actions taken to mitigate the risks. Although pressures continue to be experienced, they are being effectively managed within the overall financial resource. The risk in respect of increased secondary care activity remains as a corporate risk. A sub group of the Finance and Performance Committee has been established to focus on Activity and Demand.
Risk Areas of Spend affected Management response Increased activity over Winter period
Better Payment Practice Code (BPPC) – cumulative to 31st March 2017 The BPPC (Better Payment Practice Code) requires NHS organisations to pay all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.
Note 6.1: Better Payment Practice Code 2016-17 2016-17 Number £'000
N6A N6B
Non-NHS Payables: CCG Total Non-NHS trade invoices paid in the year 15,687 109,176 Total Non-NHS trade invoices paid within target 15,370 108,224 Percentage of CCG non-NHS trade invoices paid within target 97.98% 99.13% NHS Payables: CCG Total NHS trade invoices paid in the year 2,188 284,269 Total NHS trade invoices paid within target 2,184 284,261 Percentage of CCG NHS trade invoices paid within target 99.82% 100.00%
107
NHS Darlington Clinical Commissioning Group and
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body
Public
Agenda Item: 3.3
30th May 2017
Title Committee Annual Reports
Purpose Approval ☐ Discussion ☐ Information ☒
Responsible CCG Member / Lead
Chair of the relevant committee
Author of Report Andrew Carter, Corporate Governance and Risk Manager
Recommendation(s) The Governing Body is requested to discuss and receive the
annual reports of the committees of the Governing Body: • Audit and Risk Committee • Quality, Performance and Finance Committee • Darlington CCG Remuneration Committee • HaST CCG Remuneration Committee
Executive Summary
Each of the Committees is required to produce an annual report that highlights work completed during 2016/17. The Annual Reports provide assurance to the Governing Body that the Committees have undertaken their work in line with the duties set out in their Terms of Reference. Specifically assurance is provided with regards to the performance of the CCG via the annual report and final accounts (including the annual governance statement) which is presented later in the Governing Body papers.
Clinical Engagement
Not Applicable
Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?
Darlington CCG strategic objectives supported by this report Domain Tick
Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒
Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities
☒
Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans
☒
Performance Ensuring measurable improvement of the quality and safety of the services that we commission
☒
Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.
Delivery of innovative and new models of care
To demonstrate system leadership across the health and social care economy
☒
HaST CCG strategic objectives supported by this report
Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,
enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.
☒
2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.
☒ 3. Delivery of financial balance including the 1% surplus and delivery of value
for money savings to enable the CCG to reinvest to deliver our strategic plans.
☒ 4. Identify commissioning opportunities, working in collaboration with partners,
including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.
☒
5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.
☒ 6. To demonstrate system leadership across the health and social care
economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of
primary care and GPIT, whilst exploring and preparing for further opportunities
☒ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None
110
Page 1 of 3
NHS Darlington Clinical Commissioning Group and NHS Hartlepool and Stockton-on-Tess Clinical Commissioning Group
Joint Quality, Performance and Finance (QPF) Committee
Annual Report 2016/17
Introduction
The purpose of this report is to formally report on the work of the Joint QPF Committee (which has operated from 1st January 2017 to 21st March 2017), the Quality, Performance and Innovation (QPI) Committee (which operated for Darlington CCG between 1st April 2016 – 31st December 2016) and QPF Committee (which operated for HaST CCG between 1st April 2016 and 31st December 2016)
Each of the above Committees were established in accordance with the CCGs Constitution and is accountable to the Governing Body. The principal purpose of the report is to give the GB assurance as to the work carried out by the Committees.
Joint QPF Committee The Joint QPF Committee is established under delegation from both Governing Bodies with approved terms of reference. The Committee consists of the Executive Nurses, 3 GP members of the Governing Body, the Chief Officer, the Chief Financial Officer, Director of Commissioning and Transformation, Director of Planning and Assurance and non-core members of the CCG and Commissioning Support Service and has met on one occasion formally in the period 16/17. The work programme of the Committee is guided by an annual cycle of business programme agreed annually by the committee. The programme enables the QPF to carry out its key objectives necessary to support its assurances and in a timely manner.
The principal purpose of the Committee is to exercise on behalf of the Governing Body the functions that are delegated to it for scrutinising the Quality, Performance and Finance risks and controls which affect all aspects of the CCG’s business. QPI Committee – Darlington
The QPI Committee was established under delegation from the Governing Body with approved terms of reference. The Committee consisted of the Lay Member (Patient and Public Involvement), Lay Member (Finance), GP Quality Lead, Executive Nurse, Assistant Chief Officer, Secondary care Consultant and non-core members of the CCG and Commissioning Support Service and met formally on a monthly basis.
111
Page 2 of 3
The work programme of the Committee was guided by an an nual cycle of business programme agreed annually by the committee. The programme enabled the QPI Committee to carry out its key objectives necessary to support its assurances and in a timely manner.
The principal purpose of the Committee was to exercise on beh alf of the Governing Body the functions that are delegated to it for scrutinising the Quality, Performance and Innovation risks and controls which affect all aspects of the CCG’s business. QPF Committee - HaST The QPF Committee was established under delegation from both Governing Bodies with approved terms of reference. The Committee consisted of the Executive Nurse, 2 GP members of the Governing Body, the Chief Officer, the Chief Financial Officer and non-core members of the CCG and Commissioning Support Service and m et on a bimonthly basis in the period 16/17. The work programme of the Committee was guided by an an nual cycle of business programme agreed annually by the committee. The programme enabled the QPF to carry out its key objectives necessary to support its assurances and in a timely manner.
The principal purpose of the Committee was to exercise on beh alf of the Governing Body the functions that are delegated to it for scrutinising the Quality, Performance and Finance risks and controls which affect all aspects of the CCG’s business.
Principal Review Areas – All Committees
The bulk of the Committee’s work reflected the routine consideration of bi- monthly reports which consider the following issues:
• Overall financial position of the CCG • Contractual issues • Quality including Safeguarding, Family and Friend testing (F&F), patient safety,
• Performance report including; Practice variation, Commissioning for Quality and Innovation (CQUIN), Provider issues and key targets such as 18 Weeks, Referral to Treatment (RTT) and Cancer 62 day wait
• Finance report including; performance against Quality, Innovation, Productivity and Prevention (QIPP) and Financial risks
• Workstream progress reports including updates on projects • GP Variation Report
The Committee also receives assurances from the minutes of other groups including:
• Individual Funding Requests Panel • Clinical Quality Review Groups
112
Page 3 of 3
The Committee has also considered other issues on a less routine basis including:
• Operational and Strategic Planning • CCG Finance Plans for 2016/17
Terms of Reference
The Joint QPF Committee Terms of Reference were reviewed in February 2017 and have been updated and are available on the CCGs website.
The Joint QPF Committee undertakes its role by receiving and questioning papers and presentations; discussion of key issues; seeking of assurance; making suggestions and recommendations where appropriate; and drawing significant issues to the attention of the Governing Body.
Conclusion
The Joint QPF Committees continues to provide an important role in the governance of the CCG and has a key role to play in ensuring continued good performance in Quality, Performance and Finance.
Andie MacKay Chair, Joint Quality, Performance and Finance Committee April 2017
113
Page 1 of 5
NHS Darlington Clinical Commissioning Group
and
NHS Hartlepool and Stockton-on-Tess Clinical Commissioning Group
Audit and Risk Committee- Annual Report 2016/17
Introduction
The purpose of this report is to formally report on the work of the Audit and Risk Committee (which has operated from 1st January 2017 to 21st March 2017), the Governance, Audit and Risk (GARC) Committee (which operated for Darlington CCG between 1st April 2016 – 31st December 2016) and Audit Committee (which operated for HaST CCG between 1st April 2016 and 31st December 2016)
Each of the above Committees were established in accordance with the CCGs Constitution and is accountable to the Governing Body. The principal purpose of the report is to give the GB assurance as to the work carried out by the Committees.
Joint QPF Committee Each Audit and Risk Committee is established under delegation from both Governing Bodies with approved terms of reference. The Darlington Committee consists of the Lay Member (Audit and Governance), Lay Member (Finance), the Lay Member (Patient and Public Involvement) and GP Quality Lead. The HaST Committee consists of Lay Member (Audit and Governance), the Lay Member (Patient and Public Involvement) and Non- Executive GP (Stockton-on-Tees). The Chief Finance Officer, representatives from internal and ex ternal audit and non-core members of the CCG and Commissioning Support Service also attend the Committee The Committee has met jointly on one occasion formally in the period 16/17. Prior to this each separate Committee met in-common on two occasions. The work programme of the Committee is guided by an ann ual cycle of business programme agreed annually by the committee. The programme enables the Committee to carry out its key objectives necessary to support its assurances and in a timely manner.
114
Page 2 of 5
The principal purpose of the Committee is to critically review the CCG’s financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained. In addition the committee is driven by the priorities identified by the clinical commissioning group and the associated risks.
Darlington CCG Governance, Audit and Risk Committee
The GARC Committee was established under delegation from the Governing Body with approved terms of reference. The Committee consisted of the Lay Member (Audit and Governance), Lay Member (Finance), the Lay Member (Patient and Public Involvement) and GP Quality Lead and non-core members of the CCG and Commissioning Support Service and m et formally on a quarterly basis. ). It met on t hree occasions formally during 2016/17, and has discharged its responsibilities for scrutinising the risks and controls which affect all aspects of the CCG’s business through its agreed annual work programme. The work programme of the Committee was guided by an an nual cycle of business programme agreed annually by the committee. The programme enabled the GARC Committee to carry out its key objectives necessary to support its assurances and in a timely manner.
The principal purpose of the Committee was to critically review the CCG’s financial reporting and internal control principles and ensure an appropriate relationship with both internal and external auditors is maintained. In addition the committee is driven by the priorities identified by the clinical commissioning group and the associated risks.
HaST CCG Audit Committee
The Audit Committee (AC) was established under the CCG’s constitution and has approved terms of reference that are aligned with the NHS Committee Handbook, published by the HFMA and Department of Health. The Committee consists of Lay Member (Audit and Governance), the Lay Member (Patient and Public Involvement) and Non- Executive GP (Stockton-on-Tees). It met on four occasions formally during 2016/17, and has discharged its responsibilities for scrutinising the risks and controls which affect all aspects of the CCG’s business through its agreed annual work programme.
The work programme of the AC is guided by a cycle of business agreed annually by the committee. The programme enables the AC to carry out its key objectives of ensuring that adequate assurances are provided to the organisation and that these assurances have been subject to challenge. This in turn provides the assurances required for the Annual Governance Statement.
115
Page 3 of 5
Principal Review Areas – All Committees
This annual report is divided into five sections reflecting the five key duties of the Committee as set out in its terms of reference.
1. Governance, risk management and internal control
• The Committees reviewed relevant disclosure statements, in particular the Annual Governance Statement together with the Head of Internal Audit Opinion, external audit opinion and other appropriate external independent assurances and considered that the Annual Governance Statement was consistent with the AC’s view on the CCGs system of internal control. Accordingly we supported the GB’s approval of the Annual Governance Statement for 2015/16.
• The Committees worked through the year to seek assurances for the annual reporting processes for 2016/17 including review of the timeline for production of the annual report including the annual governance statement.
• The Committees reviewed teach CCG’s Assurance Framework and believed that it was fit for purpose. The 2016/17 Frameworks are in line with Department of Health expectations and has been subject to internal audit to give additional assurance for our opinion.
• The Committees have reviewed the completeness of the risk management system. This included an oversight of the organisation’s risk management arrangements and its risk registers.
2. Internal audit: throughout the year the Committees have worked effectively with
internal audit to review and strengthen both CCG’s internal controls and in particular have:
• Reviewed and approved the internal audit operational plan and detailed
programme of work. Internal Audit are standing members of the Committee. We consider their reports, agree their programmes and consider their effectiveness.
• Internal audit delivered our fraud protection programmes. We consider their reports, agree their programmes and consider their effectiveness. In this connection there were no major incidents which required additional investigation.
• Considered the findings of internal audit and sought assurance that management had responded in an appropriate way and that any significant control weaknesses had been acted on by the CCGs.
• Received and followed up any recommendations made by Internal Audit to ensure that the CCGs strengthen internal controls.
116
Page 4 of 5
3. External audit:
• The Committee reviewed and agreed external audit’s annual plan • The Committee reviewed and commented on the reports prepared by external
audit • The Committee received the External Audit annual report and also the External
Audit letter • The Committee reviewed external audit preference and satisfied themselves in
their independence
External Audit are standing attendees of the Committee. We review their work and findings, follow up their management requests, and agree their fee. Both internal and external auditors have the opportunity to meet with the AC before each meeting without management being present.
4. Management:
• Whilst the Committee meets formally five times a year there are also regular informal meetings with the Chief Finance Officer (CFO) where appropriate.
• As a public body Value for Money is both important to the organisation and is subject to outside monitoring. We take our responsibilities seriously and are involved in scrutiny of both the external auditors report and in helping the CFO formulate his plan and budgets. The time allocated to these meetings permits a greater degree of scrutiny and understanding than is possible at a full meeting of the GB and has helped inform the reporting of progress to make this more readily accessible.
We would like to thank the CFO and his team for their openness and cooperation in sharing information with the Committee and taking the extra time to provide explanations and debate key areas with us.
5. Financial Reporting:
The Committee reviewed the annual financial statements for 2015/16 before submission to the GB and considered them to be accurate
Self-Assessment of Effectiveness We confirm that towards the end of the financial year we carried out our self-assessment. Following the outcome of the assessment there were no major concerns to be actioned but a number of areas were identified for improvement and training in the coming year.
117
Page 5 of 5
Conclusion We trust the GB will accept that this report demonstrates that the work we have carried out over the course of 2016/17 and that the Committee has complied with its terms of reference. Mr John Flook Chair Audit and Risk Committee May 2017
118
Page 1 of 2
Remuneration Committee Annual Report 2016/17
1. Introduction
The Remuneration Committee (RC) met on three occasions between April 2016 and
March 2017. This has been the fourth year of the CCG being operational and the
principal function of the RC has been involved in reviewing the CCG’s remuneration
arrangements in light of joint working with NHS Hartlepool and Stockton-on-Tees
CCG.
The RC is established in accordance with the CCGs Constitution and is accountable
to the Governing Body.
This Annual Report sets out some of the significant changes to the work and agenda
of the RC that are worth noting.
2. Cycle of Business and Key Issues
The principal purpose of the RC is to exercise on behalf of the Governing Body the
functions that are delegated to it in respect of making recommendations to the
Governing Body on determinations about pay and remuneration for employees of the
clinical commissioning group and people who provide services to the clinical
commissioning group and allowances under any pension scheme it might establish
as an al ternative to the NHS pension scheme. The Committees terms of reference
are available on the CCG’s website.
Significantly during the year, the RC have considered the following issues;
• Remuneration for the Chief Officer
• Remuneration of Directors
119
Page 2 of 2
• Lay member Remuneration
• Terms and Conditions of Clinicians
3. Some Significant Issues reflecting the work of RC
During the course of 2016/17, significant time has been invested in the remuneration
and terms of conditions for the Governing Body, to reflect the remuneration
arrangements in light of joint working with NHS Hartlepool and Stockton-on-Tees
CCG.
4. The Future
Consideration in 2017/18 will focus on the following;
• Terms and conditions of Governing Body members
• Further review of the Governing Body appraisal process
5. Self-Assessment of Effectiveness
We confirm that we have carried out our self-assessment; reviewing the terms of
reference and reporting arrangements into the Governing Body.
6. Conclusion
We trust the Governing Body will accept that this report demonstrates that the work
we have carried out is consistent with its delegated authority and terms of reference.
Michelle Thompson
Chair, Remuneration Committee
May 2017
120
Page 1 of 2
Remuneration Committee
Annual Report 2016/17
1. Introduction
The Remuneration Committee (RC) met on four occasions between April 2016 and
March 2017. This has been the fourth year of the CCG being operational and the
principal function of the RC has been involved in reviewing the CCG’s remuneration
arrangements in light of joint working with NHS Darlington CCG.
The RC is established in accordance with the CCGs Constitution and is accountable
to the Governing Body.
This Annual Report sets out some of the significant changes to the work and agenda
of the RC that are worth noting.
2. Cycle of Business and Key Issues
The principal purpose of the RC is to exercise on behalf of the Governing Body the
functions that are delegated to it in respect of making recommendations to the
Governing Body on determinations about pay and remuneration for employees of the
clinical commissioning group and people who provide services to the clinical
commissioning group and allowances under any pension scheme it might establish
as an al ternative to the NHS pension scheme. The Committees terms of reference
are available on the CCG’s website.
Significantly during the year, the RC have considered the following issues;
• Remuneration for the Chief Officer
• Remuneration of Directors
• Lay member Remuneration
• Summary of Appraisals for Governing Body members including Chair, Chief
Officer and Lay Members
• Terms and Conditions of Clinicians
121
Page 2 of 2
3. Some Significant Issues reflecting the work of RC
During the course of 2016/17, significant time has been invested in the remuneration
and terms of conditions for the Governing Body, to reflect the remuneration
arrangements in light of joint working with NHS Darlington CCG.
4. The Future
Consideration in 2017/18 will focus on the following;
• Terms and conditions of Governing Body members
• Further review of the Governing Body appraisal process
5. Self-Assessment of Effectiveness
We confirm that we have carried out our self-assessment; reviewing the terms of
reference and reporting arrangements into the Governing Body.
6. Conclusion
We trust the Governing Body will accept that this report demonstrates that the work
we have carried out is consistent with its delegated authority and terms of reference.
Hilary Thompson
Chair, Remuneration Committee
May 2017
122
PRIMARY CARE COMMISSIONING COMMITTEE
Monday 11th April 2016 14:00 – 15:30
Board Room, Dr Piper House
CONFIRMED MINUTES
Present: Andie Mackay (Chair) Lay Member, Finance
Michelle Thompson Lay Member, Patient and Public Engagement Lisa Tempest Chief Finance Officer Ali Wilson Interim Accountable Officer
Matt Brown NHS England Diane Murphy Chief Nurse In attendance: Karina Dare Senior Property Management, NHS Property Jackie Kay Assistant Chief Officer Miriam Davidson Director of Public Health, DBC Stephanie Edge Administration Assistant (minute taker)
Action
JCC/16/10 Welcome/Introductions/Apologies Apologies were received from:
• Angela Galloway Secondary Care Clinician • Richard Harker GP/Clinical Quality Lead • Liz McAllister Healthwatch Darlington • Andy Scott Councillor, DBC
JCC/16/11 Declarations of Interest All declarations of interest have now been disclosed and the necessary paperwork completed.
JCC/16/12 Minutes of the meeting held on and matters arising The minutes were approved as an accurate record.
JCC/16/13 Action Log The action log was discussed and updated accordingly.
123
2
JCC/16/14 Terms of Reference The committee reviewed the Terms of Reference for the meeting, in particular the quoracy issues. Currently, the TOR states that a GP from the Governing Body must be present for business to be transacted. AM suggested that perhaps Dr Jenny Steel or Alison Macnaughton Jones attended the committee as alternatives. Action: AW to have a discussion with Richard Harker regarding attendance and perhaps approach Alison Macnaughton Jones as an alternative. AW felt that, as the committee was now responsible for full delegation in terms of commissioning practices, it may be a conflict of interest to list GP representation as a voting member. MB said that across other CCGs GPs were listed as non-voting attendees. DM suggested a reciprocal agreement with another CCG but the committee felt that local knowledge was very helpful. The committee agreed that GP representation was a v aluable input for the group however to minimise the conflict of interest the position should drop to non-voting quoracy. Action: SE to amend the TOR accordingly. Action: SE to ensure that the LMC are also invited on a regular basis.
AW SE SE
JCC/16/15 Memorandum of Understanding The previous MOU has now expired as the committee now has level 3 responsibilities. The new MOU will be in a generic format. The deadline for the document submission is June 2016. DM referenced the ‘Core Services’ listed which NHS England will deliver within the broader context of quality. In terms of contracts and commissioning, the MOU does not cover details of this operational work. DM wanted some confirmation that this work would be undertaken by NHS England.
JCC/16/16 Primary Medical Services Contracts The committee were provided with a paper summarising the PMS review process and Darlington CCG’s approach to the review. A task group has been established to work on behalf of the practices and comprises of representatives from Darlington surgeries, GPs and a Practice Manager.
124
3
The task group have undertaken work to recalibrate all Primary Care contracts and General Medication Services funding for core services. The task group will establish how the money will be reinvested, whilst adhering to national principles. There will be a funding premium through the GMS arrangement, the funds will be kept in Darlington and redistributed to practices to be reinvested into primary care. LT highlighted that the funds will be distributed in a transparent and equitable way which does not destabilise any practices in Darlington. As part of the proposal, a c ompact has been agreed between the CCG and practices which comprises a number of services agreed by the task group. Services which will not be part of the GMS core costs have been i dentified and they will require additional funding going forward, this may be from secondary care. Paul Irving has been employed by Darlington CCG as the Primary Care Development and Commissioning Manager and will be w orking on a fixed term contract to ensure the new contracts are in place from the end of April 2016. LT gave assurance that collaborative work has been done with practices in line with local and national principles to ensure that quality is not compromised. The PMS Task Group’s detailed proposal was agreed in the ‘in-committee’ section of the meeting. Action: LT and AW to communicate to practices that the compact has now been formally agreed.
LT/AW
JCC/16/17 Monitoring Quality in Primary Care The committee were asked to consider a final draft report from NHS England and provide feedback. The report detailed a process for assurance of Primary Care and a number of quality indicators. Diane Murphy suggested that once formalised, the Primary Medical Care Assurance Framework and Implementation Process was adopted by the CCG. Wendy Stephens has provided the document as a ‘Standard Operating Procedure’. The process has been approved for implementation and has a number of key stages. Metric data will be c ollected from practices via a template, this would then be discussed at a Local
125
4
Assurance meeting and information would then be referred on to the CCG to determine next steps. A set of quality and outcome standards will then trigger alerts to the CCG, should there be any quality issues or concerns. The process is a formal contract for monitoring and escalation and will be led by NHS England. DM highlighted that the CCG should be a lerted at the initial stages and i nformation shared, so that the team can be proactive rather than reactive but also see the positive work which is being done. DM recommended that the Terms of Reference for Quality and Innovation Committee be revised and monitoring within that forum. The committee were also asked to consider the appropriate membership of the Medical Assurance Oversight group. The committee agreed that the representative should be Richard Harker and if unable to attend, a suitable deputy would have to be appointed as is essential that the CCG are represented. Action: AW to discuss this attendance with Richard and any capacity issues he may have. MT mentioned the process for gathering information and particularly the soft intelligence noted in Section 4 of the report. Healthwatch provide quarterly reports to each GP practice in Darlington and an anonymised report to the Quality & Innovation committee. MT suggested the data collected was shared, both with the CCG and t he practices themselves. Action: MB to ensure data collected is shared with practices.
AW MB
JCC/16/18 Primary Care Transformation Fund Jackie Kay advised of a l etter from NHS England sent to the Primary Care leads in February 2016 regarding the Primary Care Transformation Fund for Premises and Technology in future years. Commissioning plans will be des igned to provide health care services inclusive of local estate strategies and will specify priorities for investment in premises. CCGs have also been asked to develop local digital road maps. There has been no further guidance than the letter. The CCG have been as ked to support bids through an onl ine portal, which is not yet open. The estates strategy and road map will be an o pportunity to establish how the CCG will enable the 2020 vision. AW highlighted that we have to make preparations now and these should fit into the Sustainability and Transformation Plan. KD is working on a 3 year programme, the initial phase and cost
126
5
models. In terms of priorities and investments, the CCG cannot commit any funds. AW emphasised that fundamentally, the plans should be ab out transformation in infrastructure. The 3 year plan must be deliverable and must include shared arrangements for community based care. Khalid Azam, Jenny Steel and Andrew Stainer are working on t hese plans, Karina Dare offered to assist. Action: KD to attend meeting with KA, JS and AS.
KD
JCC/16/19 Any other business Miriam Davidson thanked the committee for her invitation to participate, members agreed MD would make a valuable contribution to the committee, particularly with the upcoming Healthy New Towns project. Public Health England Public Health England have released news updates for each area and clinicians in the North East have been advising on what influences behavioural change, in particular with urgent and emergency care vanguards. Action: MD to forward details via email to SE.
MD
Date and time next meeting Thursday 16th June 2016 from 3pm to 5pm Ground Floor Meeting Rooms 1 &2, Doctor Piper House
Confirmed Minutes of the NHS Darlington Clinical Commissioning Group Primary Care Commissioning Committee
Held on Tuesday 21st March 2016 at 1:00pm In the Board Room, Dr Piper House, DL3 6JL
Present Andie Mackay (Chair) Lay Member Finance Angela Galloway Secondary Care Clinician Graeme Niven Chief Finance Officer Michelle Thompson Lay Member Patient & Public Involvement Ali Wilson Chief Officer In Attendance Paul Irving Primary Care Development and Commissioning Manager Pauline Lax Practice Nurse LiNK Jenny Steel Executive GP - Transformation Rachael White Committee Secretary PCCC/17/01 Apologies for Absence 01.1 Apologies were received from Richard Harker, GP Quality Lead; Liz McAllister,
Healthwatch Darlington and Diane Murphy, Director of Nursing and Quality. PCCC/17/02 Declaration of Interest 02.1 No declarations were made. PCCC/17/03 Unconfirmed minutes of the meeting held on Tuesday 13th December 2016 03.1 The Committee APPROVED the minutes as an accurate record. PCCC/17/04 Action Log 04.1 The Committee reviewed the actions currently open on the action log for which no
updates had been provided. It was requested that Rachael White ask for an update for the next meeting.
In regards to the last action, the Committee sought clarification of who was the agreed
guardian for whistleblowing and for the details to be circulated to the Committee. ACTION: PCCC/17/01 (Rachael White)
PCCC/17/05 Darlington Practice Nurse Mapping Report 05.1 The Primary Care Commissioning Committee reviewed the report presented by
Pauline Lax which outlined the mapping exercise that was performed across all practices in County Durham and Darlington. The purpose of the exercise was to understand the current workforce, service delivery, qualifications, skills, clinical
128
2
supervision and the predicted future workforce within the next 3 to 10 years and the implications. The Committee was advised that the information was based on individuals rather than a whole time equivalent however that information could be provided.
ACTION: PCCC/17/02 (Pauline Lax) 05.2 The key findings from the data collected were:
• The majority of practice nursing staff were aged over 40years with almost 55% being over the age of 51years
• 50% of staff were eligible for retirement over the next 10 years with 36.5% within the next 5 years
• Nursing workforce models were practice specific • There was a br oad range of training available to support development but there
was variation in the type of training accessed and funding opportunities. • There was no agreed pay scale and salaries varied within each job role as there
was no national pay structure • Some stated that salary was not received whilst on sick leave.
05.3 As 10 out of the 11 practices were now using the workforce planning tool it was felt that
this could help manage the situation. However Jenny Steel advised that feedback had been received that the tool was not proving to be as efficient as hoped which was a concern and needed to be addressed.
ACTION: PCCC/17/03 (Paul Irving) 05.4 Pauline advised that there were a significant number of nurses in secondary care who
would like to work in a primary care / community services role however practices could sometimes struggle to recruit them if they did not have the required primary care experience. Due to training not being available to them until they were in a pr imary care role, some practices were trying to provide training earlier so that the individual had the necessary skills when starting the role. Paul Irving informed the Committee that there was also work underway to encourage more student nurses to choose primary care while in education.
05.5 The Committee agreed that there was a need for the CCG to establish what services it
wanted to commission through primary care and what support could be put in place to help practices do so. It was felt that it would be beneficial for practices to work together to establish training needs and how to boost skills in those areas. It was suggested that the information be passed onto Practice Managers and the GP Federation to raise awareness of the situation.
ACTION: PCCC/17/04 (Paul Irving) It was also agreed that this needed to be discussed with the CCG Primary Care Team.
The Committee asked that Pauline share and discuss the information with Karen Hawkins and Sue Greaves.
ACTION: PCCC/17/05 (Pauline Lax)
The Committee NOTED the information provided. PCCC/17/06 NHS England Commissioner Guidelines: Responding to Requests from Practice
to Temporarily Suspend Patient Registration 06.1 Paul Irving advised the Committee that he would present the report as there was no
representative available from NHS England.
129
3
06.2 The guidelines had been produced to support a managed approach for commissioners to respond to requests; reiterate to the process for managing formal list closures and set out the process to be adopted for informal or temporary list closures. The guidelines help to encourage practices to contact the CCG to work together to resolve any issues and agree a level of support. IT was felt that this would be very beneficial for Darlington due to 8 of the 11 practices sharing boundaries and would help the process of redirecting patients.
06.3 Jenny Steel highlighted the need for practices to be aw are of these changes in
guidance and also to be reminded of their contractual requirements. Jenny advised that she would ask Andrea Jones to discuss the guidelines with the Local Medical Committee and to also establish the process in the Durham area in order to ensure a consistent approach. This was also to be feedback to Sue Prout who was leading the work from a CCG perspective.
ACTION: PCCC/17/06 (Jenny Steel / Rachael White)
The Committee NOTED the Date of the information provided.
PCCC/17/07 Violent Patient Scheme 07.1 The Primary Care Commissioning Committee were provided with an update on the
current status of the Violent Patient Schemes operating in the area. Paul Irving advised that there were no providers in Darlington and the current service was being hosted by Durham Dales, Easington and Sedgefield CCG and was die to end on t he 31st March 2017.
07.2 In June 2016 the CCG reviewed a number of options and it was agreed to offer as a
new service to an ex isting GMS/PMS provider in the Darlington locality. However if there were no practices willing to deliver the service, it would remain with the current provider. It was agreed to offer the new service as a block contract with a sum of £10,000 per annum for 3 years however no applications were received.
07.3 Therefore, in line with the decision made in June 2016, the Violent Patient Scheme
would continue with the current provider for an extended period of 3 years. The estimated cost of the service was £10,129 per annum which was within the financial budget and the provider had ag reed to continue the service on the standard service level agreement. It was noted that the contract was yet to be signed and the Committee requested that the CCG contact NHS England to progress this.
ACTION: PCCC/17/07 (Paul Irving/Karen Hawkins) The Committee NOTED the update. PCCC/17/08 Any Other Business 08.1 Graeme Niven advised that NHS England were preparing a paper outlining the
changes to the GP GMS contract and asked that it be added to the agenda for the next meeting.
ACTION: PCCC/17/08 (Rachael White) 08.2 The Committee raised concern that there had not been a meeting since December due
to a lack of agenda items. The Chair asked that Andrew Carter be included in the meeting scheduled with Sue Greaves to discuss how the Committee would operate going forward.
130
4
ACTION: PCCC/17/09 (Rachael White) PCCC/17/09 Date and Time of Next Meeting 31.1 The next in public meeting is scheduled to take place on Tuesday 25th April 2017 at
1:00pm in Ground Floor Meeting Rooms 1&2, Dr Piper House, Darlington. Signed: ……………………………………………….. Date: ……………………………… Andie Mackay
Chair of the Primary Care Commissioning Committee meeting
131
QUALITY, PERFORMANCE AND INNOVATION COMMITTEE
Tuesday 22nd November 2016 11.00 – 13.00
Meeting Room 1&2, Dr Piper House
CONFIRMED MINUTES
Present: Richard Harker (Chair) GP Quality Lead Sarah Dodsworth Practice Nurse Representative Andie Mackay Lay Member Finance Diane Murphy Chief Nurse In attendance: Rob Milner Senior Clinical Quality Officer Sue Nuttall Designated Nurse Safeguarding Adults Andrew Rowlands Commissioning Manager – Provider
Management Jill Smith Commissioning Support Officer Rachael White Admin Assistant Kirsty Yates Designated Doctor for Looked After
Children, CDDFT
Action
QPI/16/150
Apologies for Absence Apologies for absence were received from Louise Johnson, Heather McFarlane, Dan Newsome, Tony Shaw and Michelle Thompson.
QPI/16/151 Declarations of Interest Diane Murphy declared an interest in all matters relating to County Durham and Darlington Foundation Trust (CDDFT).
QPI/16/152 Minutes of the meeting held on 27th September 2016 and matters arising The minutes of the meeting were agreed as an accurate record.
132
2
QPI/16/153 Action Log The action log was discussed and updated accordingly.
QPI/16/154 Ambulance Service Quarterly Clinical Quality Update The Quality, Performance and Innovation Committee reviewed the report which headlined the key issues experienced by the North East Ambulance Service (NEAS) and provided assurance that actions were being undertaken where appropriate. The Care Quality Commission (CQC) inspection report published earlier in the month gave NEAS an overall rating as ‘good’. The inspection team reviewed the 999 emergency operations centre; urgent and emergency care services; patient transport services; emergency planning and resilience; and NHS111. The Trust was given a rating of ‘good’ across all five domains; safe; effective; caring; responsive; and well-led. Emergency care performance continued to fall below the national standard. Of the eight trusts that were currently reporting performance against the three national standards, NEAS had the fourth highest Red 2 and Red 19 performances in August 2016. An action plan was in place and an update was to be provided at the contract meeting later that week. NEAS had reported fewer incidents in comparison to this time last year. However they were not performing as well as they had hoped. They also had more staff than this time last year however overall performance was still an issue. Staff sickness levels were still a significant concern. These issues would also be raised at the contract meeting later in the week. The Committee queried the process surrounding the prioritisation of emergency calls and how decisions were made as to where ambulances would go first. Rob Milner advised that there was a clinical hub which focused on the number of calls awaiting response and ensure that patients who have been waiting longer don’t deteriorate. The Local A&E Delivery Board were driving improvements throughout the system to help providers achieve their targets. The emergency care intensive support team (ECIST) were currently visiting County Durham and Darlington Foundation Trust (CDDFT) to review how patients were transferred through the system and ambulance handovers were improving. This improvement in the system should be helping NEAS performance improve. The Quality, Performance and Innovation Committee noted the information provided and asked that future reports provide an
133
3
example of patient feedback / patient stories. It was felt that this was necessary to ensure that patients felt they were receiving the required standard of quality service.
Jill Smith joined the meeting QPI/16/155 GP Variation in Spend
The Quality, Performance and Innovation Committee were provided with a verbal overview of the GP in Variation in Spends data and escalation process from Jill Smith. There had been a £1 decrease in spend per head since the last meeting. An escalation meeting had taken place with Denmark Street Surgery in October and there had been 3 scheduled in November with Rockliffe Court, Felix House and Clifton Court. Moorlands Surgery continued to put actions in place to reduce spending and Jill would continue to review all practices to see if there were any changes that could be put in place across Darlington. A more in-depth review of non-electives was underway and it was thought that further work needed to be undertaken to understand the coding used to see if there was any correlation to increase in spends. There had been a national increase in the tariff for live births which would be having an impact on the practice budgets. Jill was working with the team to see if obstetrics could be shown separately on the reports. The Quality, Performance and Innovation Committee noted the information provided.
QPI/16/156 Quality and Performance Report The Quality, Performance and Innovation Committee reviewed the information in the Quality and P erformance report. The report included slides showing performance against the NHS Constitutional Indicators for all main providers. All providers achieved the Referral to Treatment (RTT) incomplete 18 week pathway targets in September. All but South Tees Hospital Foundation Trust (STHFT) had also achieved the diagnostics target in August. A&E performance continued to be a concern across the patch however improvements had been made and most providers had achieved the national target in September. CDDFT had achieved indicator - % patients spending 4hrs. or less in A&E or minor injury unit – since June however they were still below the year to date threshold.
134
4
The Clinical Commissioning Group (CCG) continued to fail the following indicators:
- % patients seen with 2 weeks of an urgent GP referral for suspected cancer
- % patients seen with 2 weeks of an urgent GP referral for breast symptoms
- % of patients treated with 62 days of an urgent referral for suspected cancer
This was a concern not only for Darlington but across the country. The issue surrounding the 2 week wait targets seemed to relate to patient choice and a patient survey was to be used to establish why they were not having their appointments on time. Slide 21 of the report broke down the target types and also the different types of cancer to show performance in each area. This information was discussed with providers to highlight areas of concern to establish what actions were to be put in place to resolve. This data correlated with the information provided by Dave Chapman at the meeting in September and highlighted issues in lower GI and skin cancer. The Quality, Performance and Innovation Committee noted the contents of the report.
Kirsty Yates joined the meeting QPI/16/159 Initial Health Assessment Quality Audit
The Quality, Performance and Innovation Committee were presented with the findings of the re-audit of the Quality of Initial Health Assessments (IHAs) for Looked After Children in Darlington. The aim of the re-audit was to improve the quality of medical information documented and to ensure appropriate identification and management for the health needs of the child or young person. A total of 20 children’s cases who consecutively came into care across County Durham and Darlington in January 20916 were reviewed. 10 children were represented from each local authority and only 1 child was chosen from any sibling group. The age range for the children was from 3months to 12years old and 8/10 had a health ned (new or existing). The results of the audit were split into 3 themes, examples of these below: Local Authority themes
o Carers details missing o Missing parental demographics o GP contact information missing o Consent to share details missing
135
5
Recommendations and outcomes o Report shared with the Assistant Director of Children’s
Services o Development of Social Workers pack with the correct
forms o Quality assurance checks before the form leave the
Local Authority o Looking to develop one single consent form for parents
to be completed for all children rather than having to complete one for each child individually
Information sources themes
o Parental/family health information (incl. both parents signing consent to share form, parents attending appointments)
o GP information Recommendations and outcomes
o Appointment offered nearest to birth parents, but balance with timescales
o Combined consent form in progress to improve ‘Consent to Share’
o GP returns monitored and fed back to named GPs Medical assessment themes
o Documentation of dental registration and last date seen not provided
o Health promotion discussion for young people o Documentation of carers concerns o Emotional & behavioural development
Recommendations and outcomes o Results individualised to medical advisors o ‘Rate my health assessment’ – use with IHA’s o Date of dental appointment included on letter o More focus on documenting the child’s voice o Healthcare plans to be more child focused with SMART
outcomes targeted to the initial Looked After Children review
The Director at Darlington Borough Council has reviewed the outcome and was keen to help make the necessary changes to improve the process. The team were looking to re-audit the area again in January 2017 and disseminate the findings to new medical advisors to gain another perspective on the work that had been undertaken and the progress that had been made. Diane Murphy advised that the Local Safeguarding Boards were focused on the timeliness of IHAs and there were concerns for how delays could impact on the quality of service
136
6
experience by the children involved. A report had been produced by the Designated Nurse for Looked After Children which was to be presented that week to the Local Safeguarding Children’s Board and could be shared with the Committee in the near future. Diane assured she would reference the findings of this report at the meeting to highlight all aspects of work being undertaken. Kirsty advised that discussion had taken place with Practice Managers and in order to raise awareness in GP Practice of the importance of completing the forms in detail. Work had been undertaken to update the forms and covering letters so that when received by GPs it was clear as to what was expected. Diane advised that she would discuss this further with the Designated Nurse for Darlington to establish how the CCG could help to performance manage the forms. The Quality, Performance and Innovation Committee noted the information provided and thanked Kirsty for work undertaken and for sharing the findings.
RW
Kirsty Yates left the meeting QPI/16/157 Safeguarding Adults Bi-Annual Report
The Quality, Performance and Innovation Committee reviewed the report which provided information and assurance that the CCG was complying with its requirements to safeguarding adults. This included working with the Local Safeguarding Adults Board interagency procedures and continuing to develop safeguarding adult knowledge and awareness across its staff and member practices. A training document was to be published by NHS England in the near future and this was currently one of the gaps in the Darlington assurance document for training analysis. The guidance would clarify what was required in terms of the level of training GPs and practice staff would need to undertake. As a result of a recommendation from a Serious Case Review it had been identified that there was a need to improve the information provided to the Multi-agency Public Protection (MAPP) meetings from primary care. The Named GPs and Safeguarding team worked with colleagues from probation to develop a process to ensure information was provided to and received back. A six month pilot was launched in October and the team were collating any comments from practices on how the process could be adapted to make it as simple as possible whilst continuing to meet recommendations from the SCR and ensuring the safety of their staff as well as the public.
137
7
A pilot was also underway in Sedgefield regarding sex offender disclosures for informing primary care. Discussions were taking place to establish how this information could be flagged on the Safeguard Incident and Risk Management System (SIRMS). James Carlton was involved in this work and would be taking forward on behalf of Darlington as well. Work was still being undertaken to understand the full extent of the new Deprivation of Liberty Safeguards guidance and the definitions used. It was important that everyone reviewing the document had the same interpretation of aspects such as ‘restraint’. Sue Nuttall would follow up the need for an update for the risk register with Bev Walker. The Quality, Performance and Innovation Committee noted the contents of the report.
SN/BW
QPI/16/158 NHSE Safeguarding Children and Adults Assurance Process and Action Plan The Quality, Performance and Innovation Committee reviewed the report which provided an update on progress against the assurance process and action plan. 5 amber ratings remained in place: • The action in relation to the designated professional
resource was unlikely to be fully compliant as it would require an increase in establishment. However a new way of working was being trialled with Carole Atherton now focusing solely on the Looked After Children Designated Nurse role.
• The training needs analysis and training strategy for the CCG was awaiting final publication of the intercollegiate document for safeguarding adults before it could be completed
• The Whistleblowing policy would be amended to include a section that contained a safeguarding element
• Current recruitment policy did not cover volunteers and advice from NECS was that there were no plans to develop a separate volunteer policy. The Designated nurse was to contact HR regarding inclusion of paragraphs relating to volunteers in existing polices
Darlington was not considered an outlier in any aspects of the assurance framework and there were other areas of the country with similar difficulties. Diane Murphy advised she would discuss the implication of not having the capacity for the designated professional resource with Heather McFarlane. The Quality, Performance and Innovation Committee noted the information provided and requested again that timescales be
SN
138
8
included on the action plan.
QPI/16/160 Risk Register and Any New Risks The Quality, Performance and Innovation Committee considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Following the discussion surrounding A&E pressures, it was agreed that this risk would not be reduced as there were still concerns and we were approaching the winter period which could see performance deteriorate. Sue Nuttall confirmed she would ask Bev Walker to send an update of the actions undertaken in regards the judicial deprivation of liberty safeguards. The Committee agreed that the risk surrounding the quality of service being provided to looked after children was still to be added to the register as previously discussed. However due to the assurance of work being undertaken provided by Dr Kirsty Yates, this would be an amber risk rather than red. The Quality, Performance and Innovation Committee noted the contents of the report and agreed to the above.
QPI/16/161 Any other items No other items were raised.
Date and time next meeting The next meeting will be held on Tuesday 20th December 2016, 11-1pm in Meeting Room 1&2 at Dr Piper House, Darlington.
Present: Andie Mackay (Chair) Lay Member Finance Richard Stevens GP Orchard Court Surgery Lisa Tempest Chief Finance Officer In attendance: Lis Dunning Senior Commissioning Finance Manager Karen Hawkins Director of Commissioning and
Transformation Andrew Stainer Head of Transformation Rachael White Admin Assistant
Action
FC/16/89
Apologies for Absence Apologies for absence were received from Helen Muscroft and Jill Smith.
FC/16/90 Declarations of Interest No declarations were made.
FC/16/91 Minutes of the meeting held on 24th October 2016 and matters arising The minutes of the meeting were agreed as an accurate record.
FC/16/92 Action Log The action log was discussed and updated accordingly.
140
2
FC/16/93 Individual Packages of Care Report – October 2016 The Finance Committee reviewed the report which provided an update on financial and performance information relating to individual packages of care costs 2016/17 included within continuing healthcare for the period up to October 2016. The forecast annual spend for 2016/17 as at 31st October 2016 across the different categories of Adult Continuing Healthcare (CHC) was £9.9m against an annual budget of £11.2m therefore a potential underspend of £1.24m. The reconciliation spends for quarter 1 and 2 were still awaited from Darlington Borough Council and there were concerns that this would impact significantly. It was agreed that the process for collating information by both teams within the NHS and Local Authority was to be reviewed to understand why this was taking long that thought. The Finance Committee noted the contents of the report.
LT
FC/16/97 AOB CCG Efficiencies Lisa Tempest presented the Committee with a list of potential decommissioning and threshold options for consideration. It had been agreed that all CCGs in the north east would review the opportunities available for role out across the area. It was felt that this approach would provide more consistency for patients in terms of what services were provided in their area. The options had been split into prescribing and non-prescribing schemes with the proposed efficiencies outlined in the table for each CCG. The majority of the suggestions had been rolled out in other areas of the country so information could be sought of their success and any issues they encountered before final decisions were made. An impact assessment would be undertaken on all suggested schemes. The Committee reviewed all suggestions under the prescribing section and agreed in principle to take them forward for risk assessment etc. This covered areas such as prescribing of over the counter drugs and transferring of budgets to providers. The Committee felt that the non-prescribing list was more controversial with areas that needed more clarification before a decision could be made. The Finance Committee noted the information provided and agreed to the prescribing suggestions being taken forward.
141
3
FC/16/94 Finance Report – Month 7 Summary The Finance Committee reviewed the report which provided an update on financial performance for the seven months to 31st October 2016 as well as the expected outturn position for the 2016/17 financial year. The current position showed a total year to date underspend of £1,034k on a funding allocation of £163,670k. Acute Services were still overspending against their budget allocation with most of the costs coming from County Durham and Darlington Foundation Trust (CDDFT). The Community Health Services budget was in a similar position with the same provider however it was hoped that a review of Urgent Care Services would resolve this for 2017/18. Lisa Tempest advised that there were two mechanisms used to report the financial position to NHS England, one of with being the NON ISFE where the CCG had to quantify any risks that were currently being shown in the forecast. At the last Governing Body meeting it was agreed that the CCG was still in a position to report that it could achieve its forecast surplus with a risk of not having any reserves. However the month eight figures so far were showing a further deterioration in the position which was becoming harder to manage. It had been stated that the 1% of the budget that was to be held separate would not be accessible to help rectify the final outcome. It was felt that the Governing Body would need to consider the situation again at the next meeting as it was becoming harder to achieve the surplus set by NHS England. The Finance Committee noted the contents of the report.
FC/16/95 QIPP Update Report The Finance Committee were provided with an update in regards to the progress made by the QIPP schemes in place. Nearly half the years activity had been provided and a schedule of reporting dates had been set. The original forecast was to achieve £4,948,000 worth of savings however this was now expected to be £2,403,000. A lot of the scheme were with CDDFT and there had been some delays in starting the work which not meant that the savings would not been seen until 2017/18. Non-elective activity also continued to increase month on month without a clear explanation as to why. There were also concerns regarding prescribing as the budget was significantly overspending rather than delivering the efficiencies expected.
142
4
A meeting was to be scheduled with Richard Harrety who was not the QIPP lead for the CCGs. It was hoped that some of the issues being experienced could be resolved then as there were still issues with capacity for those implementing the schemes. It was hoped that the 2017/18 position would be more positive as some of the work started this year would produce efficiencies into the next financial year. The process for monitoring the schemes needed to be reviewed and work was to be undertaken to integrate QIPP in to the day to day business of the CCGs. The Finance Committee noted the information provided.
FC/16/96 Risk Register and Any New Risks Identified The Finance Committee considered the report which provided details of the Risk Management Policy which had been developed for the CCG and a copy of the risk register for the Committee. It was agreed that Risk 1101 CCG experiences higher than planned premises costs and Risk 1501 ability to deliver the 2016/17 financial plan were to remain red. Risk 1502 impact of local authority funding cuts on health services and costs was still a high amber. Lisa Tempest advised that the CCG had not seen a significant impact following the decommissioning of some services however it still posed a risk. A list of changes to services had been produced by Darlington Borough Council however this had not been shared with the CCG. Rachael White to source a copy of it. The Committee agreed that the risk surrounding the process of monitoring and implementing QIPP schemes was to be added to the risk register as this had impacted significantly on the success of this year. It was felt that if not rectified, 2017/18 could follow a similar path and actions needed to be put in place to avoid this. The Finance Committee noted the contents of the report and agreed to the above.
Confirmed Minutes of the NHS Hartlepool & Stockton-on-Tees Clinical Commissioning Group
Quality, Performance and Finance Committee
Held on Tuesday, 1 November 2016 In the Boardroom at Billingham Health Centre
Present Dr Nick Timlin Hartlepool Locality Lead (Chair), Dr Saleem Hassan (Chair) Stockton Locality Lead Mr Graeme Niven Chief Finance Officer Ms Ali Wilson Chief Officer Mrs Karen Hawkins Associate Director of Commissioning and Delivery In Attendance Mrs Sarah Cook-Smith Corporate Secretary (minute taker) Mrs Liz Ward Senior Clinical Quality Manager (NECS) Mrs Barbara Potter Head of Quality and Safeguarding Mrs Emma Joyeux Commissioning and Delivery Manager Mrs Tracey Hickman Head of Healthcare Procurement & Market Management Mr Derek Murphy Senior Commissioning Finance Manager (NECS) Mrs Deborah Giles Medicines Optimisation Pharmacist
QPF/71/16 Apologies for Absence 71.1 Apologies were received from Ms Jean Golightly, Executive Nurse. QPF/72/16 Declarations of Interest The Chair declared an interest for GPs in any items relating to GPs and GVIS. QPF/73/16 Pre-Critique of the Quality, Performance and Finance Committee 73.1 The Chair advised that the meeting should try stick to allotted time, it was noted that
there was low attendance and t hat the meeting had s tarted ten minutes late due t o waiting for attendees.
QPF/74/16 Draft Minutes of the QPF Committee held on 30 August 2016 The minutes of the previous meeting held on 30 August 2016 were ACCEPTED as a
true record. QPF/75/16 Matters arising and Action Log 75.1 The Committee discussed the action log and NOTED that there was no representation
from North of England Commissioning Support Provider Management who could provide updates to actions. The Committee requested Mrs Hickman feed this back and ensure that a representative is present at all future QPF and DT-QPF meetings.
ACTION: QPF/70/16 (Mrs Hickman)
145
Page 2 of 13
75.2 The Committee requested that all actions for Mrs Humphries be changed to Mrs Hirst, Senior Manager, Provider Management. It was NOTED that the actions currently under Mrs Humphries could not be updated.
ACTION: QPF/71/16 (Mrs Cook-Smith) There was no update available for the following actions:
75.3 The Committee discussed the action log and the reoccurring issue that action updates
were not being received even when prompted. The Committee agreed that as a formal escalation process actions would be forwarded to senior staff when action updates have not been received from responsible officers. Mrs Hickman requested to be copied in to all action log update requests.
75.4 Mr Niven informed the Committee that Mr Murphy had been called to another meeting
and would be joining the meeting later when he will update actions assigned. 75.5 DT-QPF/40/16 – Urgent Items - SG outlined that the issues around the Asylum seekers
service. Service was reviewed under PMS and agreed should revert back to global sum equivalent. Had meetings with Bill Williams, Janice foster, and Hannah Herron. JF had suggested that transition fund should be in addition with enhanced service. SG has challenged this with NHSE. Mr Niven advised Arrival practice has had a review, discussion followed in relation to transition funding and GMS contracts. Mrs Greaves sited the BMS guidance, and clarified current agreement with the CCG and the Arrival practice. DT AGREED NOT to double fund. AW requested this be taken out of DT and risks/costings applied to the options if the practice were to decline to carry on the Asylum seeker elements. 30/08/2016 Mr Niven advised a meeting was held to discuss this on Friday 26th August with a paper going into to PCCC. 01/11/2016 Mrs Hawkins advised that the paper is due to go to the Primary Care Commissioning Committee. Action to remain open.
75.5 DT-QPF/46/16 – Performance Update – MSK/Physio Ms Wilson asked if DT felt that an
exec to exec meeting was required with NTHFT to discuss performance. KH queried data and intelligence issues and asked what intelligence/data team input is as the team used to sit alongside and review. Discussion around data flow and validating data. DT requested that a senior performance lead attend Trust performance meetings. 30/08/2016 Mrs Hickman was not present to provide an update. 01/11/2016 Mrs Hickman advised that Mrs Hirst will be attending the Trust Performance meetings. Action closed.
- On completion of the self-assessment audit there is only one outstanding action, the ratification of the Prevent Policy. Mrs Holcroft confirmed that there is a draft policy in place but there an item that needs resolving over room hire and the Senior Governance Manager for NECS is trying to resolve this issue. The Committee discussed the risk around having an outstanding action and draft policy. The Committee requested that once the issue is resolved, the Prevent Policy is delivered to DT and then to the Governance and Risk Committee. 27/09/16 Mrs Potter advised that a Date has been requested for DT for policy to be presented.01/11/2016 Mrs Potter confirmed that this is booked onto DT and the next G&R Committee Action to be closed.
146
Page 3 of 13
75.7 There was no update available for the following actions:
QPF/76/16 Quality, Performance and Finance Monitoring Report including QIPP and
Workstream Update Report. 76.1 Quality Update
Mrs Ward gave the Committee a brief overview and updat e on Quality issues to date informing the Committee that the quality section had a new slide lay out.
76.1.1 HaST CCG
Mrs Ward advised the Committee that the CCG C-Diff year to date position is 56/72 highlighting that there is concern with the rise in community acquired C-Diff cases. Mrs Ward confirmed that there are improved communications with GP’s during Locality Lead visits and also through bulletins with work ongoing to improve the antibiotic prescribing in the community.
76.1.2 Safeguarding Adults In relation to Domestic violence the CCG are supporting the development of a Multiagency strategy and under taking a r eview of current provision with health. Mrs Ward attended the Stockton Council domestic violence meeting, highlighting that the harbor service feel very few of their clients come via GP referral and maybe GPs were not linking the associated factors such as increased alcohol consumption.
76.1.3 Safeguarding Children
Mrs Ward advised that a Local inspection in relation to children with Special Educational Needs and/or Disabilities (SEND) is took place in Hartlepool week commencing 3rd October. HAST CCG is significantly involved in this process and will take forward actions from the inspection (final report available Nov 16) Lessons learnt to be transferred across Tees. Mrs Ward added that the statutory posts of Designated doctor safeguarding children and looked after children remain vacant, the Director of nursing and quality pursuing recruitment to this role.
76.1.4 Care Homes
Mrs Ward reported that care homes are currently challenged and the Adult Safeguarding team are working with the homes as required to improve outcomes. Mrs Ward informed the Committee of a resident who had choked on a sausage while on soft diet which is being investigated.
76.1.5 NTHFT
The Committee were informed that the Trusts C-Diff is above trajectory at 22/7. The Trust had an out of hours, unannounced Commissioner Assurance Visit (CAV) undertaken, poor compliance with Infection Prevention & Control (IPC) processes was noted. Mrs Potter attends the Trusts IPC Committee and also attended the IPC summit in October. The Trust had a Maternity Services review completed in September, the review is complete and the CCG are awaiting the report. The Trust is a Mortality outlier although the position is slowly improving. CQUIN is in place for SEPSIS – Poor CQUIN achievement to date, and the Trusts Serious Incident (SI) reviews track and monitor any trends. Mrs Ward reported that in relation to the Cancer performance 104 day back stop
147
Page 4 of 13
process, the Trust have failed the Q1 CQUIN payment as no process in place for Clinical Harm Reviews. The issues have been escalated for review and monitoring.
76.1.6 STHFT Mrs Ward notified the Committee that there is continued concern about levels 1, 2 and 3 Children’s safeguarding training rates compliance for clinical staff. An information notice was issued by STCCG, and the CCG Designated nurse is monitoring compliance and is in discussions with the Trust. The CCG attends Trust Infection Prevention Action Group and post infection review meetings and there have been 4 cases of MRSA reported year to date for the Trust. There has been a CAV observation of practice in the workplace but this has not raised any particular issues. With regards to the Cancer 104 day back stop clinical harm review process, the CCG are gaining access to the Trust process and this has been ddi scussed at the Performance Clinic and a greed working group with CCG input to work through the issues. The Trust are arranging to have a task and finish group in place.
76.1.7 NEAS The Committee were advised that the Trusts Serious Incident management is improving and was discussed at the QRG with the Trust who have plan for improvement in the overall management and reporting on incidents. Mrs Ward informed the Committee that the Trusts CQC report is due out and Mrs Ward will be attending the summit on 4 th November.
76.1.8 TEWV
The Trusts Serious incident management is non-compliant with national timescales and this continues to be a key line of enquiry with the Trust. Mrs Ward reported that the Trusts Root Cause Analysis’s lack detail and substance, and the CQT continue to challenge the Trust requesting timescales and m onitoring submissions. In addition a CAV was undertaken to review Risk Assessment processes.
9:58am ~ Mr Murphy joined the meeting 76.1.9 Dr Hassan asked for an update in relation to NEAS recruitment, Mrs Hawkins advised
that the recruitment drive is expected to be complete by April 2017. Mrs Ward advised NEAS are part of national movement to try and g et agenda for change implemented throughout the service to aid with retention as staff are leaving for higher salaries in other areas. Dr Hassan suggested that the implementation of the clinical hub s hould assist the service in the future. Mrs Joyeux highlighted that the full breakdown of NEAS actions was available in the papers in slide 70. Dr Hassan added that the CQC rate for NEAS as good.
76.2 Performance Report In the absence of NECS Provider Management representation, Mrs Hickman took the
Committee through the performance report by exception: 76.2.1 HaST CCG
Mrs Hickman reported that in relation to ddiagnostics, the CCG achieved performance in August reporting an i mproved position of 0.39% on t he previous month. Following an increase in performance for Ambulance response times in Aug-16, performance of the 8 min standard has declined again for the CCG in September, reporting 67.4%. Like the 8 min indicator, performance has declined in September for the 19 min indicator, reporting 91.5%. The majority of cancer targets were achieved in August barring the 62 day urgent GP referral target. Mrs Hickman advised thtat HaST CCG started 2016/17 positively, achieving the 62 day standard in April (87.5%). Unfortunately performance declined from May-16 onwards. In the latest published month of August, performance
148
Page 5 of 13
has improved compared to the previous month, but still reports underachievement (81.9%). 13/72 treatments were not delivered within 62 da ys in August. Despite achievement in August, both the 2ww urgent GP referral standard and 31 da y subsequent surgery standard are non-compliant at the YTD position due to poor performance in previous months.
76.2.2 NTHFT
Mrs Hickman informed the Committee that the Trusts referral to treatment (RTT)Performance in August remains above target, reporting 92.6%. The Diagnostics standard has improved in August, reporting 0.18%. A&E performance has yet again improved in August reporting 96.7%. Due to poor performance in previous months, the YTD position is still under target reporting 94.4%. The Trust Ambulance handovers both targets have been breached for the year, although NTHFT are noticeably reporting the lowest figures in comparison to neighbouring trusts for the over 30 minute and 60 minute delays. There were zero 52 w eek waits, MSA breaches or 12 hour Trolley waits in August and all operations cancelled were rescheduled within 28 days. All cancer targets were achieved in August, however the 62 day urgent GP standard is still under threshold at the YTD position (83.2%) due to poor performance in previous months.
76.2.3 STHFT
Mrs Hickman summarised that the Trust RTT Performance of the 18 week incomplete standard was under target in August, reporting 90.6%. No patients have waited over 52 weeks in 2016/17. Diagnostics standard was not achieved in August, reporting a declining position of 2.19%. The Trust achieved the A&E indicator in August reporting 97.3%. The Ambulance handovers were 17 over 30 minute handovers and 0 ov er 60 minute handovers in September. The Trust had no 12 hour trolley waits, twice cancelled operations or MSA breaches were identified in August. In relation to Cancer, 6 out of 9 of the cancer targets were achieved in August. Under achievement occurred in the following standards: – 2ww breast symptomatic standard improved in August, reporting 88.9%, albeit still
under target. Referrals are lower as a result of the breast service collaboration with NTHFT (whose referrals have gone up).
– 31 day subsequent surgery standard was marginally under target, reporting 93.9% in August. The YTD position is still above threshold (94.8%).
– 62 day urgent GP referral target continues to underperform, reporting 82.8%. 22.5/131 treatments were not carried out within 62 days. Main delay reasons include to capacity issues (9.5), complex diagnostic pathways (7.5), patient choice (3), Other/unknown (1.5) and 1 late referral to the treating trust.
76.2.4 The Committee discussed the ambulance handover times, Mrs Hawkins highlighted the
information in the report showing detailed actions in relation to handovers. Mr Niven suggested that the Committee request a report in relation to NEAS to be brought to the Committee to enable the Committee to receive a more detailed and informed report.
ACTION: QPF/73/16 Mrs Hickman/Mrs Hirst 76.2.5 Mrs Hawkins raised concern with the declining performance in STHFT and asked the
Committee if the Information and detail provided within the report was enough to be assured. The Committee recognised the declining performance and felt assured with actions being taken but felt needed confidence that things would improve. Mrs Hawkins asked if the Committee was clear to challenge around actions and if actions being taken would remedy the issues. Mr Niven commented that it feels actions would deliver but may not be acted upon timely, hence the escalation process for timely action updates from responsible officers. The Committee NOTED that it is expected that a NECS Performance lead or contract manager would be deliver the performance report and advise upon actions.
149
Page 6 of 13
ACTION: QPF/70/16 (Mrs Hickman) 76.3 Finance Mr Murphy apologized for being late and explained that he had been called to another
Trust have a new financial system causing issues, there are significant issues within 3 month teething period of new system implementation. Mr Niven confirmed that this is impacting on forecasting and planning for next year and causing time delays. Ms Tribe added that NECS are looking at past 6 months to help forecast for next 6 months. Ms Tribe suggested that that this be monitored and an update provided at the next QPF meeting. 19/02/2016 Ms Tribe advised The Trust is still having significant problems with Trak – both in terms of staff experience/understanding and completeness of data extracted. The supplier is late in providing a 30-day patch to correct some of the issues, and the Trust is applying financial penalties in line with their contract. There will also be a 90-day patch to correct any further issues unresolved by the 30-day patch. Provider Management and commissioning Finance will continue to discuss with the Trust and will provide further updates to QPF. 01/03/2016 Mrs Humphries advised the 30 day patch is due out this month which should resolve some of the issues and a Discharge task and finish Group has been set up. Ms Golightly queried what the issues were, Mrs Humphries advised issue with data input and patch missing, the Trust have been chasing with provider as this is failing to deliver. Due to provider software failing to deliver in the first instance. Mr O’Brian confirmed this is an Issue with project implementation from the trust. Trak issues also picked up through safeguarding inspection, some issues are staff training. 03/05/2016 Mrs Tribe advised a review of timescales completed at meeting and discussed obtaining reasonable quality data, unfortunately Trust failed to submit data. Implications are minimal for year-end as accrued maximum cap and collar, may impact on planning going forward as judgements made. CSO trying to pull together communications for practice managers. 28/06/2016 Mr Murphy advised that there is still no end of year position agreed. Inpatient was data submitted on 24th but the data was incorrect. NECS have challenged and the Trust is due to resubmit week of 4th July 2016. Action to remain open. 18/07/2016 Mr Murphy advised that a meeting was held on the 4th July 2016. It was agreed that the FT could undertake a final submission for 2015-16 activity. This was to enable a full activity profile for the year to be secured to assist trend analysis & future planning requirements. The FT reported that they were expecting to receive their system upgrade to the 2016-17 HRG grouper w/e 15th July 2016 (this date has subsequently slipped). The trust is now making all efforts to have a full data set available for the Quarter 1 ‘freeze’ data of the 18th August 2016. 30/08/2016 Mr Murphy advised NTHFT have submitted final data on 18th August, financial settlement will be on submission, 9th September is the date set for data to be in the system. Mr Murphy advised the Trust have commented since 18th August that data is missing and have been advised that this may not be accepted. 01/11/2016 Mr Murphy advised that 2015-16 finance has been agreed and closed down with the FT. Work continues with respect to 2016-17 data submissions which are still not to the required standard. Data challenges are being issued to the Trust, on a monthly basis, who are not responding within agreed contract timeframes. This is being escalated through the contract management meetings.
76.3.2 DT-QPF/51/2016 – Post Critique - DT reviewed the slides layout and approved the new
format. GN advised hyperlinks still not added in and requested these be added for the next meeting. SH highlighted the continued use of abbreviations throughout meeting papers which can be a barrier. 30/08/2016 Mrs Humphries advised some hyperlinks are in but these are to be completed. The Committee agreed that in order for the links to work, Slide packs are to go separately when meeting papers are issued for the QPF
150
Page 7 of 13
Committee and DT-QPF meeting. Agreed action to remain open until hyperlinks are fully in place and working. 01/11/2016 Mr Murphy advised that the links are now working now we have moved to a separate document. Problem is that once you’ve clicked on one you can’t go back to the index sheet. Committee suggested the use of a back button and agreed the action will remain open until issue resolved.
76.3.3 Mr Murphy advised that where possible, month 5 data has been used to enhance the
reported position with further intelligence on activity trends. Other programme areas are based on the latest available data where possible and therefore the supporting tables may show slightly different in year and forecast positions as a result. Although North Tees and Hartlepool FT data has been received from the provider there are ongoing issues with quality and therefore the position should still be viewed with a level of caution. The current forecasted position is based on the most likely outcome of healthcare contracts driven by a multitude of factors and the delivery of planned QIPP schemes. Mr Murphy took the Committee through the three areas with exception.
76.3.4 Non Elective over-performance Mr Murphy explained that Non-electives appear to be ov er plan year to date and
showing no i ndication of stabilising ov er the coming months leading into the winter period . The lack of data following the implementation of the new PAS system at North Tees and Hartlepool FT in October 2015 has prevented detailed analyses being carried out over the last 11 months and up unt il now, a true overall financial position. Year to date activity is an es timate based on months 1 to 4 “freeze” data and month 5 “flex” which are still subject to change and final agreement across a number of providers. The split between North Tees FT and other providers is approximately 87%/13% which is consistent with the previous year. The Trust has confirmed there has been a general increase across all GP Practices.
76.3.5 Continuing Health Care (CHC) Mr Murphy reported that there is a significant increase in new care packages during the
first 6 months of 2016/17. The national FNC rate has been confirmed as £156.25. This is included in the forecast outturn, subject to further review by NHS England which may trigger a further change of rate in January 2017. Discussions are ongoing with care home providers with regards to interim payments whilst a framework for future CHC fee setting is developed. In previous years actual payment of CHC has been less than the total value of packages on the database, hence, forecast outturns includes a reduction in the total cost of packages to reflect this. The risk of this to the CCG is £902k. This may change depending on council recharge statements. Mr Murphy highlighted that work is onging wih the NECS CHC team and that the weekly CHC reports that were in place have stopped again. Mr Niven requested that Mrs Hickman escalate this and take the issues forward. The Committee requested CHC reports be provided in a timely manner.
ACTION: QPF/74/16 (Mrs Hickman) 76.3.6 Non delivery of QIPP Schemes
The Committee was informed that current forecast outturn is £4.484m against a plan of £11.758m (£6.427m contracted). Schemes which have commenced are behind plan (e.g. COPD/spinal) and the timelines of other schemes have slipped ( e.g. South Tees Audiology). Mr Murphy requested it be noted that not all schemes have begun. For some schemes, data collection and m onitoring is not fully in place combined with the data quality with North Tees & Hartlepool FT which continues to impede reporting to the relevant workstream leads. QIPP scheme delivery downgraded and working through on an individual basis. and looking to develop financial recovery plan. Mr Murphy added that work is underway on next years planning linking with programs and aligning with STP.
151
Page 8 of 13
76.3.7 The Chair asked in relation to performance monitoring in terms of visits, Mr Murphy advised streams of data are being reported and feedback is being given to practices in order to report to Drs within the surgeries to remedy issues. Mr Murphy advised that GVIS data will resume to practices. The chair requested the report resume as soon as possible. Discussion followed in relation to GVIS data to practices and what has been reported.
ACTION: QPF/75/16 (Mr Murphy) 76.4 QIPP
Mr Murphy outlined that as at 30th September 2016 £2. 367m has been delivered (forecast £4.484m) against the plan. Current performance is based on data flows available which cover respiratory, spinal procedures, MSK*, walk in centres*, excess bed days* and lucentis pathways plus a det ailed analysis of medicines optimisation schemes. Pathway changes as noted above have begun to deliver but are currently running behind plan –these have been di scussed at the In Hospital Care workstream and actions to increase scrutiny on t hese schemes have been a greed. Medicines Management schemes are forecasting to achieve their contracted target and contribute to the unallocated QIPP.
76.5 Workstream
Mrs Joyeux briefed the Committee in relation to the projects being escalated this month: • Improving cancer outcomes – 2ww performance and del ay to implementing the
treatment summary records • Weight management T3 & T4 – handover delay of T4 service from NHSE to CCG.
Mrs Joyeux advised that it is unlikely to be in place by the end of this year and is being planned in for next year.
• Maternal and infant health – lack of midwifery data being received from provider, Dta is being reviewed and the CCG had a meeting with Mrs Gretton and Mrs Joyeux is going to Primary Care workstream tomorrow.
• RightCare – data not identifying any savings work progressing. • TCES children’s health equipment – new issues regarding section 75, service
specification and finances have arisen. The project plan has been received which has raised an issue, work is underway and planned to go through DT in November
• Primary Care Anti-Coagulation – at least one practice has confirmed they do not wish to enter into the extended contract which could impact contract going forward. Mrs Hawins advised Dr Hendrie has contacted practice on several occasions and will follow this up.
• GVIS 15/16 & 16/17 – data issues; analysis completion expected end Oct report not produced due to BI issues, 1 page summaries are being provided
• RVIE 15/16 - data issues; outcome expected end October, some data has been released but BI advised data was incorrect and no payments have been made.
76.5.1 Mrs Joyeux advised that the new Improvement Assessment Framework Update is
provided in the report and covers 6 clinical domains and all information is in the public domain for the CCG in relation to indicators. Mrs Joyeux outlined the Assurance process advising that a teleconference is scheduled with NHSE to give assurance against each area. Mrs Joyeux added that rag rating is self-assessed as the average is not yet available.
The Committee NOTED the Quality, Performance and Finance Monitoring Report including QIPP and Workstream Update Report.
10:51 am ~ Mrs Holcroft joined the meeting
152
Page 9 of 13
QPF/77/16 NHS England Looked After Children Assurance 77.1 Mrs Holcroft advised that in February 2016 NHS England undertook an assurance
exercise in relation to Looked after children (LAC). The aim of this was to establish a benchmark across the region of current LAC services and pr omote compliance with revised statutory guidance of ‘Promoting the Health and Well-Being of Looked After Children’ 2015. Key issues identified 2 areas of non-compliance out of 33 standards as below:
• Gaps in absence of designated doctor for LAC, Mrs Holcroft advised that the CCG are in discussions with HR for looked after and des ignated safeguarding, timescales are March 2017
• The analysis of the strengths and difficulties questionnaire does not inform the joint health and well-being strategy
Mrs Holcroft added that there were 16 areas of partial compliance and 15 ar eas of full compliance as demonstrated in the final assurance tool returned by NHS England.
77.2 Mrs Holcroft took the Committee through the detailed action plan. In relation to number
6, Mr Niven advised this action was for Mr John Stamp, and Mrs Donna Owens. ACTION: QPF/76/16 (Mrs Holcroft)
The Committee NOTED the NHS England Looked After Children Assurance
10:58am ~ Mrs Holcroft left the meeting and Mrs Giles joined the meeting QPF/79/16 Medicines Optimisation National Prescribing indicators 79.1 Mrs Giles informed the Committee that the purpose of this paper is to provide QPF
Committee with an update on the CCG’s current prescribing performance benchmarked against other CCGs locally and nat ionally, in terms of financial balance and s pecific therapeutic areas.
79.2 Mrs Giles explained that Prescribing continues to grow in terms of costs and items and
remains a considerable pressure on CCG budgets, however the prescribing budget is currently forecast an underspend of £255, 979. Overall, prescribing spend increased by 1.33% (£261,903) from April to August 2016 w hen compared to the same period in 2015. This is higher than the national average (0.27%), however is below the average of the closest ten CCGs as defined by RightCare (1.47%).
79.3 The total number of items prescribed increased by 4.01% (102,570 items). This is
higher than the national average (3.56%) and higher than the average of the closest ten CCGs (3.56%). The top four BNF chapters in terms of cost (CNS, respiratory, endocrine and cardiovascular) account for 65% of all prescribing costs and 67% of all items prescribed.
79.4 In relation to Endocrine system drugs, Mrs Giles explained these accounted for the
greatest increase in costs April – July 2016, compared to the same period the previous year, increasing by £431,194 (7.52%). Nationally, costs in this area increased by 8.61%. C ost growth in this area is predominantly driven by drugs for diabetes (additional £245,586, 16.55%) where items have also increased. National price increases due to product shortages for corticosteroids and antithyroid drugs have also significantly impacted on the additional spend in this area (£169,538, 188.43% increase). Mrs Hawkins asked who is liaising with NHSE, Mrs Giles advised NHSE are talking with the Local Pharmacy Committee (LPC).
153
Page 10 of 13
79.4.1 The Committee discussed options available to GPs and s uggested HaSH pharmacies and NECS to do a piece of work on the drugs availability as some pharmacies have their own supplies. The Committee discussed the process of when a pharmacy advises an item is out of stock, Mrs Giles informed the Committee it is up to the individual pharmacy to contact another pharmacy to find the product for the patient. Mrs Giles confirmed that NECS pharmacists have an adv ise line for GPs to contact and/or email address to contact with queries. The Committee requested that the email address and telephone number be circulated to GB members and GPs.
ACTION: QPF/77/16 (Mrs Giles) 79.5 Mrs Giles continued through the paper, with regards to central nervous system drugs, Dr
Hassan asked in relation to pain management what are the first line and stage. Mrs Giles advised that there is a meeting scheduled next week. Dr Hassan advised that NTHFT had been contacted NTHFT and is being taken forward in relation to some drugs not being prescribed. The Chair queried the price of nefopam as different in the paper. Mrs Giles was asked to confirm.
ACTION: QPF/78/16 (Mrs Giles) 79.6 The Committee discussed spend on respiratory system drugs. Mrs Giles advised the
increase in spend in this area is predominantly driven by increases in prescribing of combined corticosteroid inhalers, and this is combined with a reduction in prescribing of single ingredient corticosteroid inhalers. Mr Niven suggested moving forward to centralized prescribing. The Committee discussed prescribing and usage of inhalers and anecdotal stories of stock piling and us age. Mrs Potter asked if stopping managed prescriptions would help. Dr Hassan advised this has been looked at and very little practices use managed prescriptions. Mrs Hawkins advised new pharmacy framework being issued may help, as the way pharmacists operate will change.
79.7 Mrs Giles commented that the spend on cardiovascular drugs increased by 0.64%
(£36,765), which is less than the national cardiovascular cost growth of 3.38%. The Committee discussed cardiovascular cost, Mrs Hawkins asked if 2 di fferent payment methods was required in terms of anticoagulation as this will be reviewed again next year. Dr Hassan suggested there would be saving for patients with low INRs.
79.18 It was highlighted to the Committee that HaST continue to prescribe above the national
average for volume of antidepressants. Mr Niven raised the subject of Improving Access to Psychological Therapies (IAPT) Programme. The Committee discussed the service and it not prescribing. Dr Hassan suggested there is not enough cognitive behavioral therapy (CVD), adding that there used to be a service called beat the blues. Dr Hassan suggested online consulting could be l ooked into rather than wait for face to face therapy.
The Committee NOTED the Medicines Optimisation National Prescribing indicators
11:31am ~ Mrs Giles left the meeting QPF/80/16 Planning Process Overview 80.1 Mrs Joyeux gave the Committee an overview of the planning process for this year
advising that the Planning guidance was issued in September and CCG are expected to have plans and contracts in place by 23rd December 2016. Mrs Joyeux confirmed that the 9 ‘ must dos’ remain in place from last year’s planning guidance along with other financial balance guidance.
154
Page 11 of 13
80.2 The Committee were briefed on t he top 5 m essages and took through the financial
considerations: 1. STP becomes basis for operational planning and contracting 2. STP represent a different way of working 3. STP financial control totals 4. Focus on ‘financial reset’ 5. Continuation of 9 must do’s from previous planning guidance
80.3 Mrs Joyeux explained the requirements for November planning submissions adding that
a detailed planning paper will be presented to the governing body.
The Committee NOTED the Planning Process Overview
QPF/81/16 Finance Sub Committee/ Financial Recovery 81.1 Mr Niven explained that the CCG has been able to manage its finances and f inancial
pressure since it was established in April 2013 and has delivered increased surpluses. Mr Niven took the Committee through the CCG recurrent and non-recurrent positions for 2013/14 to 2015/16 explaining that a financial sustainability plan was introduced in 2015/16 highlighting a number of areas where the CCG where an outlier in relation to its expenditure with other CCGs in the North East.
81.2 The Committee were informed of the key pressure areas being:
1. Acute care - non-elective activity which shows a reducing level of activity but at a higher cost suggesting a higher acuity of patients.
2. Acute care – elective activity where benchmarking has demonstrated that the CCG spend per head of population is much higher than in local CCG areas
3. 3.The CCG along with others is seeing significant pressures in continuing healthcare packages.
4. 4.The CCG is showing rising growth in prescribing above other local CCGs growth 81.3 Mr Niven advised that NHS England have assessed the CCGs financial plan which has
resulted in a 1a r ating (low risk), and the CCG has determined that it currently has a medium risk being able to deliver the plan. The financial modelling undertaken for the STP plan based on the underlying financial position indicates that the CCG will face increasing financial challenge over the coming years. Based on a ‘ do nothing’ scenario the CCG will deliver a £33.9m deficit by 2020/1. It is therefore imperative that the CCG takes immediate action to ensure long term financial sustainability.
81.4 Mr Niven provided detail of the key recovery initiatives including right care opportunities,
and background of the work planning process that was used to develop the CCG work plan for 15/16 and 16/17. Schemes identified that would result in financial improvements were identified as priority for delivery of QIPP for 16/17 and beyond. All of the schemes were risk assessed and rag rated.
81.5 The Committee were informed of the 2016/17 QIPP scheme progress and each scheme
was discussed in turn. In addition Mr Niven took the Committee through the QIPP schemes requiring further development.
81.5.1 Mr Niven requested the QIPP action plan to be updated and brought to the next
Committee meeting. ACTION: QPF/79/16 (Mr Murphy)
155
Page 12 of 13
81.5.2 Mr Niven Went through full table advising that in relation to Workstreams, any gaps in the detail will be added/updated after the next workstream meeting.
ACTION: QPF/80/16 (Mr Niven)
81.5.3 The Committee discussed the Tees Equipment Service querying of the service should go out to tender. The Committee requested that a lead is assigned to take this forward.
ACTION: QPF/81/16 (Mrs Hickman)
81.5.4 The Grey list discussed at 4th October Deliver Team meeting was debated. The Committee requested an update in relation to the status of the grey list.
ACTION: QPF/82/16 (Mrs Giles) 81.6 Mr Niven reported that a clause was included in the service delivery plan with the CCG’s
main provider to cover working in partnership to deliver financial efficiencies clarifying the principles and governance. In addition it was suggested that the transformation groups need to be strengthened to refocus on implementation.
81.7 Mr Niven carried on through the presentation taking the Committee through member
practice engagement, outcomes achieved in prior years, and the financial recovery plan report and action plan. The Committee agreed that a Finance Sub Committee is required with the suggested membership to meet monthly.
ACTION: QPF/83/16 (Mrs Cook-Smith) The Committee discussed the governance arrangements of the Finance Sub Committee
and agreed that the detail needs to reflect the appropriate reporting mechanisms. 81.8 The Committee also discussed a published list of 40 low value procedures with little or
no benefit to patients. The Chair requested that the procedures be reviewed and activity levels provided and brought back to the Committee.
ACTION: QPF/84/16 (Mr Murphy)
The Committee NOTED the Finance Sub Committee/ Financial Recovery QPF/82/16 Confirmed minutes of the Clinical Review Group 82.1 The Committee noted the minutes of the Confirmed minutes of the Clinical Review
Group held on 19 May 2016
QPF/8316 Confirmed minutes of the South Individual Funding Requests Panel Meeting 83.1 Confirmed minutes of South IFR Panel meeting held on 7 July 2016 The Committee noted the minutes of South IFR Panel meeting held on 7 July 2016. 83.2 Confirmed minutes of South IFR Panel meeting held on 4 August 2016 The Committee noted the minutes of South IFR Panel meeting held on 4 August
2016. 83.3 Confirmed minutes of South IFR Panel meeting held on 1 September 2016 The Committee noted the minutes of South IFR Panel meeting held on 1
September 2016. 83.4 Confirmed minutes of South IFR Panel meeting held on 6 October 2016 The Committee noted the minutes of South IFR Panel meeting held on 6 October
2016.
156
Page 13 of 13
QPF/84/16 Unconfirmed minutes of the Delivery Team Quality Performance and Finance meeting
84.1 The Committee noted the minutes of the Delivery Team-Quality, Performance and
Finance Committee meeting held on 27 September 2016 QPF/85/16 Any Other Business 85.1 There was no other business tabled. QPF/86/16 Post-Critique of the Quality, Performance and Finance Committee 86.1 The Chair acknowledged that the meeting had over ran. The Chair suggested there was
too much time spent on prescribing and discussion around the action log. QPF/87/16 Date, Time and Venue of Next Meeting
It was noted that the next meeting was scheduled to take place on Tuesday, 3rd
January 2017 at 9:30am-12:00pm in the Board room at CCG Offices, Billingham Health Centre.
Meeting closed 12:50pm Signed: …………………………………………………………. Date: ……………………………….... Dr Nick Timlin Chair
157
AUDIT COMMITTEE IN-COMMON
Tuesday 4th October 2016 14.30 – 16.30
Meeting Room 1&2, Dr Piper House
UNCONFIRMED MINUTES
Present: John Flook (Chair) Lay Member Governance Richard Harker GP Quality Lead Andie Mackay Lay Member Finance Hilary Thompson Lay Member Patient & Public Involvement Michelle Thompson Lay Member Patient & Public Involvement In attendance: Andrew Carter Corporate Governance & Risk Officer,
HaST CCG Liane Cotterill Senior Governance Manager, NECS Sharon Fatkin Audit Manager, Audit One Stuart Kenny Manager, Ernst & Young Graeme Niven Chief Finance Officer, HaST CCG Lisa Tempest Chief Finance Officer, Darlington CCG Rachael White Admin Assistant, Darlington CCG Nicola Wright Executive Director, Ernst & Young
Action
ACIC/16/01
Apologies for Absence Apologies for absence were received from Dr David Hodges and Ali Wilson.
ACIC/16/02 Declarations of Interest Andie Mackay declared an interest in Item ACIC/16/05 for any discussions relating to Stockton Borough Council.
ACIC/16/03 Minutes of the Audit Committee held on 25th May 2016 The minutes of the Audit Committee were agreed as an accurate record and the Committee was assured that all actions had been undertaken.
158
2
Minutes of the Governance, Audit and Risk Committee held on 26th July 2016 The minutes of the Governance, Audit and Risk Committee were agreed as an accurate record.
ACIC/16/04 DCCG Internal Audit Progress Report The Audit Committee reviewed the report which provided and update on progress against the 2015/16 and 2016/17 Darlington Clinical Commissioning Group (CCG) internal audit plan. The 2015/16 Partnership Arrangements audit had been given a ‘Limited’ assurance rating with a number of recommendations. Lisa Tempest advised the Committee that it was recognised that work needed to be undertaken with the Health and Wellbeing Board to review their terms of reference and its membership. Michelle Thompson was currently a member of the group and discussions had begun in regards to reviews and resolving any issues. In the 2016/17 plan, 1 audit had been completed, 7 were in progress and 6 were yet to begin. No issues had been identified that would impact on the annual Head of Audit Opinion. Sharon Fatkin advised that following the recently released guidance regarding conflicts of interest, the schedule may need to be reviewed and more information would be provided at the next meeting. There were a number of outstanding recommendations, several of which would be resolved following the implementation of the new joint management structure and governance arrangements. Work was being undertaken with the Continuing Healthcare Team to resolve the recommendations identified as part of the Continuing Healthcare & Funded Nursing Care. The Audit Committee noted the information provided.
Andrew Carter and Andie Mackay joined the meeting ACIC/16/05 HaST Internal Audit Progress Report
The Audit Committee reviewed the report which provided and update on progress against the 2015/16 and 2016/17 Hartlepool and Stockton-on-Tees (HaST) CCG internal audit plan. A total of 6 audit reports had been finalised since the previous meeting, 5 with ‘significant’ assurance rating for 2015/16 and 1
159
3
with ‘substantial’ assurance for 2016/17. As in the Darlington report no issues had been identified that would impact on the annual Head of Audit Opinion but there may be a proposal to change the schedule of audit in light of the recent conflicts of interest guidance. In regards to the outstanding recommendations, Graeme Niven advised that discussion had taken place with the Executive Nurse and the 3 relating to the Francis II report, would be resolved as soon as possible. Significant progress had been made in relation to the S75 recommendation for Continuing Healthcare. There was now designated support from the North of England Commissioning Support Unit (NECS) and the HaST CCG Committee Members were satisfied with the progress that had been made. The Committee were advised that the Governance and Risk Management recommendation relating to the Better Care Fund had been resolved. Governance arrangement being put in place with Local Authority Funding Panel meetings. Updates were to be made to the website in order to show best practice. Andie Mackay declared an interest in this discussion as he was employed by Stockton Borough Council and had colleagues who were involved in these discussions. The Counter Fraud self-review toolkit had been submitted and was included in the report at Appendix 6. Two fraud referrals had been made and escalated to NHS Protect; one related to drug rules in pharmacy and one to GP prescribing. The Audit Committee noted the information provided.
ACIC/16/06 Chief Finance Officers Report The Audit Committee considered the report which summarised the CCGs aged debtor and creditor position and any special payments made. Graeme Niven reported that the Chair of HaST CCG was to return his lease car and the CCG was going to have to pick up the outstanding costs. This information was not included in the report due to the submission timescales. A debt had been raised to a nursing home in Hartlepool to reclaim monies paid to them in relation to CHC fees claimed in respect of patients who had died. A County Court Judgment had been obtained against the debtor on in July 2015 in the sum of approximately £20,500 with the involvement of a High Court Enforcement Officer. The owner of the premises was not
160
4
able to repay the debt and had declared bankruptcy. As a result, it was felt that CCG should drop the pursuit of claiming back the whole of the costs and the Committee was asked to approve this choice. Procedures had now been established to check the number of patients in nursing homes and their circumstances as it was felt to be poor practice than a fraudulent act. As of 31st August 2016 the CCG aged creditor profile was:
- AP overdue 61-90 amount (£) £90,603 - AP overdue 90+ amount (£) £653,530
The majority of funding was currently being withheld for North Tees and Hartlepool Foundation Trust as there was issues regarding the quality of data being provided. As part of the contract 1% of the contract value could be withheld until the issue was resolved. The Audit Committee noted the contents of the report and gave approval for the nursing home debt to be written off. It was agreed that a Darlington CCG would produce a similar report for future meetings.
LT
ACIC/16/07 North of England Commissioning Support Unit Service Auditor Report on Internal Control The Audit Committee reviewed the report on the NECS internal controls for Provider Management (March 2016) and Healthcare Procurement (May 2016). In Section 4.2 of the report on Provider Management 14 control objectives and the report on Healthcare Procurement had 20 control objective identified. All actions were detailed in the report and the CCGs would continue to work with NECS to ensure they were all undertaken and the correct processes be adhered to. Regular updates would be provided at the monthly Chief Finance Officer meeting. Lisa Tempest and Graeme Niven were asked to review the controls and actions in more detail and highlight any areas of concern to ensure that processes would still align under the new CCG structure. The Audit Committee noted the information provided.
LT & GN
ACIC/16/08 External Audit Annual Letter from 2015/16 (HaST & Darlington) The Audit Committee reviewed and noted the HaST CCG letter which provided an overview of the external audit for 2015/16 and the audit findings identified. The letter was now to be presented the Governing Body. The Darlington Governance, Audit and Risk Committee had previously reviewed the letter
AC
161
5
and it had been presented to the Governing Body September.
ACIC/16/09 Assurance Framework 6 Questions – feedback from Governance and Risk Committee (AC/29/15) The Audit Committee reviewed the report which provided overview of a paper presented to the HaST Governance and Risk Committee regarding an update on the CCG’s assurance framework. A CCG benchmarking exercise was undertaken by internal audit across a number of CCG’s in 2015 and there were 6 questions the Governance and Risk Committee were asked to consider in developing the assurance framework for 2016/17. The report was to provide assurance that the Governance and Risk Committee had undertaken the necessary actions and the plan had met the requirements stated. Lisa Tempest advised that the Darlington Assurance Framework needed to be reviewed and it was suggested that work be undertaken with Andrew Carter to develop a framework that would cover both organisations. The Audit Committee noted the information provided.
ACIC/16/10 HaST Self-Certification for Delegated Functions: Quarter 1 2016/17 The Audit Committee were provided with the HaST self-certification template for Q1 2016/17. Whilst the 2015/16 assurance framework had now been replaced by the Improvement and Assessment Framework, national guidance was that the CCG should continue to complete the self-certification template in relation to the CCGs delegated duties in relation to OOH and Co-commissioning. There were several GP practice contracts due to expire which had been extended into the new year in order the review the services. Three practices in particular were to expire at the same time so formal consultation had been undertaken with patients to gain their views on the current services, what they felt could be improved and potential sustainable models going forward. The Audit Committee noted the report.
ACIC/16/11 NHS Protect Quality Assurance Process The Audit Committee noted the information provided.
162
6
ACIC/16/12 Any other items No other items were raised.
Date and time next meeting The next Audit Committee In-Common Meeting will be held on Monday 5th December 2016 commencing at 2.30pm in Meeting Rooms 1&2, Dr Piper House.
Confirmed Minutes of the NHS Darlington Clinical Commissioning Group, and NHS
Hartlepool & Stockton-on-Tees Clinical Commissioning Group FORMAL Quality, Performance and Finance Committee
Held on Tuesday, 28th February 2017, 10:30am
In the Boardroom at Dr Piper House
Present Ms Ali Wilson Chief Officer Mr Graeme Niven Chief Finance Officer Ms Jean Golightly Director of Nursing and Quality Dr Nick Timlin (Chair) Locality Lead – Hartlepool Dr Saleem Hassan Locality Lead - Stockton Dr Richard Harker GP Quality Lead Mrs Diane Murphy Director of Nursing and Quality Mrs Michelle Thompson Lay member (Patient and Public Involvement) Ms Lisa Tempest Director of Planning, Performance, and Assurance Mrs Karen Hawkins Director of Commissioning and Transformation Dr Jenny Steel Executive GP Transformation - Darlington In Attendance Mrs Sarah Cook-Smith Corporate Secretary (minute taker) Mrs Liz Ward Senior Clinical Quality Manager (NECS) Mrs Tracey Hickman Head of Healthcare Procurement & Market Management Mr Derek Murphy Senior Commissioning Finance Manager (NECS) Ms Trish Hirst Senior Manager – Provider Management (NECS) Mr Andrew Rowlands Commissioning Manager (NECS) Mrs Anthea Thompson Senior Finance Manager (NECS) QPF/29/17 Apologies for Absence 29.1 There were no apologies received. QPF/30/17 Declarations of Interest 30.1 The Chair declared an interest for GPs in any items relating to GPs and GVIS. QPF/31/17 Pre-Critique of the Quality, Performance and Finance Committee 31.1 The Chair welcomed everyone to the meeting and requested that people delivering items
be specific and highlight any issues reporting by exception. 31.2 The Committee were requested to direct all questions through the Chair and be
respectful of others views and opinions.
QPF/32/17 Draft Minutes of the previous meetings 32.1 The draft Minutes of the HaST CCG QPF Committee meeting held on T uesday 3rd
January 2017 were APPROVED as an accurate record.
164
Page 2 of 8
32.2 The draft Minutes of the DCCG QPI Committee meeting held on Tuesday 20th December 2017 were APPROVED as an ac curate record. A discussion followed on the use of Tapentadol.
32.3 The draft minutes of the QPF Committee meeting In-Common held on Tuesday 31st
January 2017 were APPROVED as an accurate record with the following amendments: • 22.8 - QPF/02/17 - Quality Report (NTHFT) – Ms Golightly advised that this action
relates to the sequencing of the meetings and a Q uality Risk Profile which was previously agreed to be covered across the STP footprint. Ms Golightly reported that following subsequent discussions at NHSE Quality Surveillance Group meeting, partners agreed to a revised approach which would be to undertake work to achieve a common understanding of the quality position of each of the NHS providers within the STP footprint. Agreed action to be closed.
• 23.2.2 • - ‘Mrs Murphy reported that the directors of Nursing have received a letter advising
to focus on delayed discharges in Continuing Health Care (CHC)’. • 23.4 last sentence changed to ‘Mrs Murphy informed the Committee that there were
no major issues not previously reported’.
QPF/33/17 Matters arising and Action Log 33.1 The Committee discussed the action log and it was agreed that all completed actions did
not require discussion and were to be closed. 33.2 DT-QPF/68/16 – Finance Update (CHC) - Mrs Hickman advised that an update has
been requested but not received yet. Action to remain open and Mrs Hickman to chase again.
33.3 QPF/81/16 - Finance Sub Committee/ Financial Recovery – Agreed action to be
closed. 33.4 QPF/05/17 – Performance Report (Physio) – Ms Hirst advised that this has been picked
up with the Trust and performance for core physio is poor. The Trust have fed back that commissioners were aware that there would be an impact so the Trust has been asked for the detail behind this and the resource they have in place. Dr Hassan asked for feedback on routine referrals for core physio. Action to remain open.
33.5 DCCG-03 – Safeguarding Governing Body Session – Ms Tempest advised this action is
still open. The Committee agreed to face to face training for the Governing Body as it is felt this is very important to be able to ask questions and receive feedback.
33.6 QPF/07/17 – Mr Rowlands advised Mrs Smith is following this up, no update currently
available. Action to remain open. 33.7 The following actions were closed:
• QPF/06/17 • QPF/08/17
QPF/34/17 Quality, Performance and Finance Monitoring Report including QIPP and
Workstream Update Report for HaST CCG and DCCG. 34.1 Mr Rowlands in formed the Committee of the changes in relation to combining and
streamlining the reports. Mr Rowlands advise work is still ongoing to with the reports and any feedback or suggestions are welcomed.
165
Page 3 of 8
11:14am ~ Ms Wilson joined the meeting 34.2 DCCG and HaST CCG Quality Update
Ms Golightly gave the Committee a brief overview and update on HaST CCG Quality issues to date
34.2.1 HaST CCG In relation to HCAI C. DIFF the CCG has reported above trajectory for 8 months YTD currently 86/33. The Medicines Optimisations team continue to include information on C Diff rates v weighted antibiotic prescribing in reports to the CCG. There has been improved communications with GP’s during Locality Lead visits and also through bulletins.
34.2.2 Safeguarding Children Ms Golightly reported that the SEND report was published (Dec 16) and hi ghlights significant areas of weakness in the local area’s practice. There are mmeetings being held and work streams set up to address the gaps in service. There has been two recent suicides of children aged 13 years in the Stockton area which is being addressed at the Local Improving Practice Sub-group (a sub group of the local safeguarding children board) to look at what learning can be drawn.
34.2.3 Adult Safeguarding/Care Homes There has been a Never Event reported by Gretton Court Care Home on 26th December in relation to a bed rail entrapment. The Initial Root Cause Analysis investigation report is being reviewed by the Head of Quality and Adult Safeguarding. A meeting to be held with CQC, the Care Home, Local Authority and C CG 3rd March to progress investigation. The CQC have initiated regulatory action against Cedar Court. Ms Golightly advised there are further delays in relation to the combined safeguarding report, the report has yet to be signed off with the sky methodology which is being used and a communications plan is to be out in place.
34.2.4 DCCG Mrs Murphy informed the Committee that the CCG is currently at 15/17 cases and RCA’s on al l C diff cases are carried out by the IPCT in GP practice, lessons learnt around prescribing issues are fed back to GP practices and discussed at practice meetings.
34.2.5 North Tees Hospital Foundation Trust (NTHFT)
Ms Golightly advised that Safeguarding Adults training for new staff decreased to 31% Quarter 3 from 41% in Quarter 2. Children’s Safeguarding training for new starters remains a concern with static levels of training for Level1 and Level 2. Mandatory Safeguarding children training compliance level 2 continues on the downward trajectory. Ms Golightly assured the Committee were assured that Safeguarding Children and Safeguarding Adults training was discussed at the contract review meeting in February 2017 and HAST CCG has requested a remedial action plan to address this. This LQR will be m onitored via CQRG and there are planned 1:1s with designated nurse safeguarding and the Trust named nurse.
34.2.5.1 Dr Steel asked what the consequences were for the decline in completing training as
this should be a no tolerance level. Ms Golightly explained that the CCG have asked for a breakdown of the staff profession and s ervice areas of staff which are in date with training. Discussion followed. Ms Golightly explained that this is an ongoing issue and has been raised at every point possible and monitoring continues. Mrs Ward highlighted
166
Page 4 of 8
that there are similar issues for STHFT and NTHFT and highlighted the QER03 exception report.
34.2.6 County Durham and Darlington Foundation Trust (CDDFT)
Mrs Murphy advised that the Trust is non-compliant with serious incident reporting compliance requirements .Monthly meetings with the Patient Safety team continue to support the Trust with improved reporting. The Trust has reported 2 MRSA cases in January. These are still to be assigned. Mrs Murphy highlighted the issue of a potential never event from a procedure in 2014 and an instrument being removed in 2016. The NHSI are working with the Trust in relation to this. Mrs Murphy advised she is working with CDDFT to look at an external review of their never events.
34.2.7 South Tees Hospital Foundation Trust (STHFT)
Ms Golightly advised that the Trust have launched there patient satisfaction survey and reports are being fed back. The Trust have had a never event in relation to extraction of the wrong tooth on a child. The Trust has had 1 reported case of MRSA.
34.3 Performance Report Mr Rowlands reported on the Performance report by exception 34.3.1 Diagnostics
Mr Rowlands advised that Diagnostics for HaST CCG has breached in Nov&Dec-16 previously reported due to results from an electrocardiogram staff absence.
34.3.2 A&E
The Committee was informed that CDDFT and NTHFT were below target and all 3 providers failed the targets in December. Ms Wilson advised this has been raised at the A&E delivery board meeting. Mrs Murphy asked if the breakdown of 12 hour breach trolley waits has been received, Mr Rowlands confirmed that these have been received.
34.3.3 Ambulance response times
Mr Rowlands reported that both CCGs are above national average targets but below local targets. NEAS performance is in line with national performance. Dr Steel asked what impact the fire brigade has had while working with NEAS, Ms Wilson advised a large effect but not enough to see a big difference.
34.3.4 Mixed sex accommodation breaches in CDDFT
Mrs Murphy advised this relates to 2 ITU patients who were ready to step down but the Trust were unable due to operational escalation to move them out into single sex beds so a decision was made to keep them where they were.
34.3.5 Cancer indicators
Mr Rowlands advised that in relation to 62 days this in an issue across the region and both CCGs have failed the indicator with an exception report provided for the 3 providers including action plans. With regards to 2ww , CDDFT and STHFT has impacted on the CCGs performance.
34.3.6 Mental Health (MH) & Learning Disabilities (LD)
The Committee noted that HaST CCG is achieving all the MH indicators with DCCG failing on two indicators which are being looked into. Ms Wilson requested that LD and transformation is reported on in future reports. Mrs Murphy advised the information has been requested and the quality team is looking to include this in the next quality report. Ms Wilson gave a brief in relation to LD beds across the area and discussions that have been had in relation to LD and transformation figures and targets. Ms Golightly agreed
167
Page 5 of 8
that the QPF Committee need to be s ited on t he LD and t ransformation figures but assured the Committee that the Quality team is well sited in this area already. Ms Golightly briefed the Committee on the current situation and c apacity. Ms Golightly advised that Ms Golightly and Mrs Murphy take part in monthly assurance meetings and monthly telecoms meetings and there is tremendous scrutiny in this area.
34.4 Finance Report
In summary Mr Niven highlighted that both organisations are at risk of breaching financial targets and this was discussed in the Finance Sub-Committee this morning with actions being put into place. HaST CCG are reporting £10.3m overspend, with DCCG reporting £9.3m overspend. Mr Niven advised that the risks are falling under key areas being Acute, CHC, Prescribing costs increasing for both CCGs above plan. Mr Niven added that the over performance position with NTHFT is yet to be c onfirmed but the CCG are now sited on numbers with discussions ongoing with the Local Authority in relation to the Better Care Fund.
34.4.1 The Committee were advised that NHSE asked the CCGS to confirm that they would
deliver surplus +1%, the CCGs have said neither organisation has agreed to deliver the surplus and DCCG may not deliver the full 1% surplus. There is still risk for both CCGs
34.5 QIPP
Mr Niven explained that in relation to 2017/18, plans have been submitted to NHSE for both CCGs with alterations to QIPP, for DCCG the QIPP has been increased to £1.2m.
34.5.1 Ms Wilson advised that the policy in relation to the Responsible Commissioner has been
changing and discussions are being had in relation to the ownership and passing on of high cost cases.
34.5.2 Ms Golightly briefed the Committee that in relation to Roseberry Park which closed, this
used to have a G P practice attached to this but now due t o length of inpatient stay, patients have registered with the local area. Mr Niven suggested that this package of care should include the GP registration and recharge as part of the package of care. Dr Steel highlighted that the Priory Practice in Darlington have agreed to register the patients coming into the area. Ms Wilson highlighted that this poses a huge financial risk for the DCCG.
34.5.3 Mr Niven reported that the QIPP target is challenging for both CCGs reporting that a
presentation was delivered at the Finance Sub-Committee meeting this morning covering governance arrangements, and identification of schemes, with lines of accountability etc. Mr Murphy offered to circulate the presentation to the QPF committee for assurance.
ACTION: QPF/09/17 (Mr Murphy) 34.6 Workstream
Mrs Hawkins advised a number of areas have been highlighted in the report and through exception reports which are being picked up through contracting team.
34.6.1 Ms Wilson queried the non-delivery issue of the Tees equipment service. Mr Niven
advised that there is a meeting in the diary for Mr Niven, Mrs Hawkins and Tracy Jacobs to discuss this. Ms Wilson suggested a joined up review going forward.
The Committee NOTED the Quality, Performance and Finance Monitoring Report including QIPP and Workstream Update Report for HaST CCG and DCCG.
QPF/35/17 HaST CCG GP variation
168
Page 6 of 8
The Chair gave a summary of the report provided explaining that the cumulative report is up to the end of November 2016 and outlines current performance against budget. This month we have 11 red rated practices. Most of these have been raised as an exception due to being overspent for four consecutive months and being overspent in total over the last four months. There are 11 amber practices and 14 g reen practices. Mrs Hawkins advised the reporting of the variation report will be c hanged going forward to a m ore targeted approach.
35.1 Dr Hassan advised when you look at the rag rating they are different. Mr Niven advised
that the criteria needs to be revisited and brought back to the Committee for sign off. ACTION: QPF/10/17 (Mr Niven)
The Committee NOTED the HaST CCG GP variation QPF/36/17 DCCG GP variation Mr Stainer presented the report advising that there has been a decrease in spend of £3
per head from last month (September 2016 – 12 month rolling trend data), mainly due to a decrease by Denmark Street, Clifton Court and Parkgate Surgery. Moorlands Surgery is continuing to rise in spend and the practice is currently experiencing major staffing issues along with Neasham Road Surgery which means that they are both heavily reliant on Locums at present. Mr Stainer advised that the practice is going through significant changes. Dr Steel added that the practice has lost 2 very experience GPs replaced with locums.
36.1 Mr Stainer advised that the practices have been working hard to reduce figures but there
was frustration that the targets have changed. The Committee NOTED the DCCG GP variation QPF/37/17 DCCG Research and Evidence Report Q3 Report 37.1 Mrs Murphy summerised the report highlighting that DCCG is the lowest recruiter to
research studies across Cumbria and the North East. The overall CCG average is 87.12 vs Darlington CCG at 27.52. Carmel medical practice is the highest recruiter is Darlington with 15 pat ients recruited to studies – the combined numbers for all other Darlington practices is 14 patients. Prof Fuat who is the Darlington Rep on the LCRN NENC partnership group is a GP at Carmel practice. The practice has a network funded 0.5 wte band 5 r esearch nurse. The low recruitment of Darlington patients to studies suggests that Darlington residents are not being consistently afforded opportunity to access research trials that might benefit their care and outcome.
37.2 Dr Steel advised the research nurse is funded through the research network for a day
with the CCG but there appears to be a struggle with engagement time and capacity with the practices.
37.3 Ms Wilson queried if there was a similar report for HaST CCG. Mr Niven advised that the
last report for HaST this went to the Governance and Risk Committee. Ms Wilson asked for consistency of which Committee this is reported into.
The Committee NOTED the DCCG Research and Evidence Report Q3 Report QPF/38/17 Terms of Reference 38.1 Mr Carter advised that The Committee is established in accordance with the NHS
Darlington clinical commissioning group and N HS Hartlepool and Stockton-on-Tees clinical commissioning group’s (the CCG’s) constitution, standing orders and scheme of
169
Page 7 of 8
delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the clinical commissioning group’s constitution and standing orders. Mr Carter advised that there were no major changes just an amalgamation of the two set of terms of reference.
38.2 The Committee reviewed the terms of reference and requested the following changes:
• Lay Member (Finance) - ADDITION • Lay Member (PPI DCCG) - ADDITION • Director of Quality and Nursing – ADDITION OF HaST CCG • Director of Quality and Nursing (DCCG) – TITLE CHANGE • Director of Planning, Performance and Assurance – TITLE AMENDMENT • GP (Locality) Leads (Darlington, Hartlepool, Stockton-on-Tees) – ADDITION OF
(LOCALITY) ACTION: QPF/11/17 (Mrs Cook-Smith)
The Committee APPROVED the Terms of Reference 12:53pm ~ Dr Hassan left the meeting QPF/39/17 Annual Cycle of Business (ACoB) 39.1 The Committee reviewed the ACoB and Ms Wilson requested the Research and
Evidence Report to the ACoB. ACTION: QPF/12/17 (Mrs Cook-Smith)
39.2 Mr Niven queried which Committee the draft plans should go to, Ms Wilson suggested
that draft plans should go through the Executive Team. Discussion followed. 39.3 The Committee requested a br eakdown of each Committees responsibility to be
provided in relation to the Constitution. ACTION: QPF/13/17 (Mr Carter)
The Committee APPROVED the Annual Cycle of Business
QPF/40/17 Darlington CCG Assurance Report Q2 40.1 The Committee NOTED the Darlington CCG Assurance Report Q2 QPF/41/17 HaST CCG Assurance Report Q3 41.1 The Committee NOTED the HaST CCG Assurance Report Q3 QPF/42/17 Confirmed minutes of the South Individual Funding Requests 42.1 The Committee noted the confirmed minutes of the South Individual Funding
Requests Panel Meeting held on 2nd February 2017 QPF/43/17 Any Other Business 43.1 There was no other business tabled. QPF/44/17 Post-Critique of the Quality, Performance and Finance Committee
170
Page 8 of 8
44.1 The Chair advised that it was a challenge to cover all of the information provided but was happy that the main areas covered. The Chair thanked attendees for attendance and reports.
QPF/45/17 Date, Time and Venue of Next Meeting
It was noted that the next meeting was scheduled to take place on Tuesday 28th
February 2017, 10:30am, Ground Floor 1&2, Dr Piper house, DL3 6JL Meeting closed 12:50pm Signed: …………………………………………………………. Date: ……………………………….... Dr Nick Timlin Locality Lead for Hartlepool and Chair for the Informal meeting
171
Page 1 of 9
Confirmed Minutes of the NHS Darlington Clinical Commissioning Group, and NHS
Hartlepool & Stockton-on-Tees Clinical Commissioning Group Audit and Risk Committee
Held on Tuesday 7th March 2017 at 2pm In the Board Room, Billingham Health Centre, TS23 2LA
Present Mr John Flook Lay Member (Audit) (Chair) Mrs Hilary Thompson Lay Member (Patient and Public Involvement) Mr Andie Mackay Lay Member Finance Dr David Hodges GP Member (Stockton) In Attendance Mrs Sarah Cook-Smith Committee Secretary (Note Taker) Mr Andrew Carter Corporate Governance and Risk Manager Mrs Liane Cotterill Senior Governance Manager, North of England Commissioning
Support (NECS) Mr Graeme Niven Chief Finance Officer Mrs Sharon Fatkin Audit Manager, AuditOne Mrs Nicola Wright Executive Director, Ernst & Young Mr Stuart Kenny Manager, Ernst & Young AR/01/17 Welcome, Introductions, and Apologies for Absence Apologies were received from Mrs Michelle Thompson, Lay member Patient and Public
Involvement (Vice Chair), and Dr Richard Harker, GP Quality Lead. AR/02/17 Declarations of Interest There were no interests declared. AR/03/17 Pre-Critique of the Governance and Risk Committee The Chair explained that the Committee is in place to ensure good governance for
the CCGs. The Chair asked attendees to be respectful and courteous of each other and their views. The Chair requested that all comments and questions be directed through the Chair.
AR/04/17 Draft Minutes of the Previous Audit and Risk Committee Meeting 04.1 DCCG Governance, Audit and Risk Committee held on Monday 5th December
2016 The minutes of the DCCG Governance, Audit and Risk Committee held on Monday
5th December 2016 were accepted as a true record. 04.2 Audit Committee In-Common held on Monday 5th December 2016
172
Page 2 of 9
The minutes of the Audit Committee In-Common held on Monday 5th December
2016 were accepted as a true record. 04.3 HaST CCG Governance and Risk Committee held on Monday 5th December
2016 The minutes of the HaST CCG Governance and Risk Committee held on Monday
5th December 2016 were accepted as a true record subject to section 65.4 paragraph two amended to: ‘The Chair queried why there was a different coroners procedure in Hartlepool, Mrs Potter advised that this was due to HaST CCG covering two different coroner areas’.
AR/05/17 Action Log 05.1 The Committee agreed to go through each action in turn: 05.2 AC/20/15 – Mr Niven advised that this has been actioned and will confirm this with
Ms Golightly. Agreed action to be closed. 05.3 DCCG Audit & Risk Committee – Mr Carter advised that further detail has been
added to the risk. Agreed action to be closed. 05.4 ARCIC/01/16 – Mr Niven advised a meeting has been hel d with internal audit to
clarify actions. Agreed action to be closed. 05.5 ARCIC/02/16 – Mr Carter advised that a full update has been provided. Agreed
action to be closed. 05.6 GR/12/16 – Mr Carter confirmed that the GB Development session was held on 20th
December. Agreed action to be closed. 05.7 GR/22/16 – Formal testing not yet complete due to time constraint, action to remain
open until testing complete. 05.8 GR/24/16 – Mr Carter advised that pay progression policy is still being discussed
with HR. Action to remain open until aligned with appraisal policy. 05.9 GR/26/16 – Committee acknowledged this is on today’s agenda. Agreed action to
be closed. 05.10 GR/28/16 – Mr Carter advised that the amendments were made to the policies.
Agreed action to be closed. 05.11 GR/29/16 - Mr Carter advised that the amendments were made to the policies.
Agreed action to be closed. 05.12 GR/30/16 - Mr Carter advised that the amendments were made to the policies.
Agreed action to be closed. 05.13 GR/31/16 – Mr Carter advised this was in relation to the turning off of the IG Toolkit.
A paper version is available until a ne w toolkit is available on line and staff have been contacted directly to make them aware. Agreed action to be closed.
173
Page 3 of 9
05.16 GR/32/16 – Mr Carter advised the staff were chased and questionnaires complete. Agreed action to be closed.
05.17 The Following completed actions were agreed for closure: AC/12/16 AC/13/16 AR/06/17 Internal Audit Progress Report 06.1 Mrs Fatkin advised that This progress report provides the Audit and Risk Committee
with an update on progress against the 2015/16 and 2016/17 internal audit plan at Darlington Clinical Commissioning Group (CCG) since the last meeting held on 05/12/2016. Mrs Fatkin reported that the Continuing Healthcare & Funded Nursing Care audits Draft Report has been I ssued on 29/3/16 giving limited assurance (awaiting final management response to finalise report).
06.2 The Committee were given an overview of final reports AuditOne has issued since
the audit committee meeting in December 2016 and advised that to date AuditOne have not identified any issue that may adversely affect the annual Head of Internal Audit Opinion.
06.3 Mrs Fatkin informed the Committee that Audit One are proposing to defer the audits
on better health programme and performance management into 2017/18 and to use the days from these audits to cover the additional days required for our conflicts of interest audit and t he joint governance arrangements audit (Darlington and HAST CCG), which was not originally in our internal audit plan. AuditOne have also replaced the audit of strategic planning with a pr ocess mapping exercise of continuing healthcare requested as an update on SAR was not received so internal audit was asked toto review for assurance.
06.4 Mrs Fatkin reported that A follow up audi t of Governance and R isk Management
was undertaken as part of the 2016/17 internal audit plan. This review was carried out to provide assurance that governance arrangements were operating effectively up to 31 D ecember; prior to revised joint governance arrangements being put in place between HAST and Darlington CCGs. A further review of governance and risk management will be carried out to reflect the revised governance arrangements put in place between the CCGs.
06.5 In relation to an internal safeguarding audit, the Committee were advised that this
was undertaken as part of the 2016/17 internal audit plan. The CCGs have statutory responsibilities for safeguarding. For economies of scale the three CCGs share safeguarding resources and have a Memorandum of Understanding (MoU) which sets out the working arrangement in place to ensure that the clinical commissioning groups are able to meet their statutory responsibilities. There is also a separate MoU with North East Ambulance Service. North Durham CCG is the designated host CCG for the safeguarding teams. The North Durham / DDES Director of Nursing has executive responsibility for safeguarding along with the Chief Nurse at Darlington CCG. The CCGs jointly employ a designated nurse for adult safeguarding, and there are three designated nurses for children’s safeguarding (one 0.6 FTE for each CCG). As the CCGs share the same system for safeguarding arrangements the audit has been performed jointly on the three CCGs.
The Audit and Risk Committee RECEIVED and NOTED the Internal Audit Progress Report
174
Page 4 of 9
14:25pm – Mr Mackay joined the meeting AR/07/17 Draft Strategic and Operational Internal Audit Plans for Darlington CCG and
HAST CCG 07.1 Mrs Fatkin explained that this plan sets out the methodology they have adopted to
create your strategic internal audit plan for 2017 to 2020, and provides a detailed operational plan for 2017/18 and pr ovided a s ummary. Mr Niven advised that he had met with Internal Audit to review the plan and to review and identify any efficiencies.
The Audit and Risk Committee APPROVED the Draft Strategic and Operational Internal Audit Plans for Darlington CCG and HAST CCG
AR/08/17 DCCG External Interim Audit Plan 08.1 Mrs Wright advised that this plan relates to 2016/17 and t he Interim audit was
finished last week which including lots of transactional testing. 08.2 Mrs Wright outlined the current assessment of the financial statement risks facing
the CCG, identified through the knowledge of the CCG’s operations and discussion with those charged with governance and officers. The report included risk of fraud in revenue and expenditure recognition with the approach of reviewing key accounting judgements and es timates;. In relation to the risk of management override of controls, the Committee were advised that the approach was to test the appropriateness of journal entries recorded in the general ledger and other adjustments made in the preparation of the financial statements, with a f ocus on those identified as ‘high risk’. Mrs Wright reported that risk in relation to Primary care co-commissioning was reviewed due to the CCG taking over responsibility for primary care co-commissioning. This expenditure was previously accounted for by NHS England and will now be disclosed in the CCG’s financial statements.
08.3 The Committee were informed with regards to value for money risks, Ernst & Young
(E&Y) External Auditors were required to consider whether the CCG has put in place ‘proper arrangements’ to secure economy, efficiency and effectiveness in its use of resources. For 2016/17, this was based on the overall evaluation criterion. E&Y were only required to determine whether there are any risks that they consider significant. Mrs Wright clarified that the risk assessment supports the planning of sufficient work to enable E&Y to deliver a s afe conclusion on arrangements to secure value for money and to determine the nature and extent of further work that may be required. If E&Y do not identify any significant risks there is no requirement to carry out further work.
08.4 Mrs Wright highlighted that E&Y have determined that overall materiality for the
financial statements of the CCG is £2,896,880, based on 2% of gross operating expenditure amnd E&Y will communicate uncorrected audit misstatements greater than £144,000 to the Audit & Risk Committee. Mr Niven queried that HaST CCG had asked for all materiality’s issues to be reported and asked if this should be the case for DCCG. The Committee AGREED that any unadjusted errors should be reported for DCCG and HaST CCG.
ACTION: ARCIC/01/17 (Mrs Wright)
The Audit and Risk Committee APPROVED the DCCG External Audit Plan AR/09/17 HaST CCG External Audit Plan
175
Page 5 of 9
09.1 Mrs Wright explained that the plan for HaST CCG was the same as DCCG with any
materiality’s to be r eported and asked if this is still the case for HaST CCG. The Committee AGREED that any unadjusted errors should be reported for DCCG and HaST CCG.
ACTION: ARCIC/01/17 (Mrs Wright)
The Audit and Risk Committee APPROVED the HaST CCG External Audit Plan AR/10/17 Chief Finance Officers Report 10.1 Mr Niven commented that the focus needs adapting on the Chief Finance Officers
report approach so that the report highlights any issues rather than lists of financial detail. Mr Niven confirmed that there were no issues to report.
10.2 The Chair asked if the issues with Property Services are being addressed, Mr Niven
confirmed there is a meeting on today and the issues relate mainly to void space and rent issues but there is clarity required which should clarify ongoing issues and rent issues but there is clarity required which should clarify ongoing issues. The Audit and Risk Committee NOTED the Chief Finance Officers Report
AR/11/17 DCCG Governance Assurance Report 11.1 Mrs Cotterill took the Committee through the DCCG Governance assurance report
providing the following highlights: • The Governance team continues to progress with the review of corporate
policies in partnership with Darlington CCG. 27/31 of all corporate policies are within their expiration date and four policies are past their expiration date.
• During quarter 3, 2016/17 there was one i nformation governance incident reported on S IRMS. The process for managing this incident was correctly followed and the incident was closed on 14th November 2016.
• To ensure compliance with the above the Health and Safety team have undertaken audits within the CCG area and c ontinue to have regular service line meetings to address any issues relating to H&S, Fire and Security. The CCG have 100% Compliance against all H&S Training
• As of 5 January 2017, the Equality & Diversity compliance figure for the CCG is 60% (6/10) members of staff had completed the training).
• With regards to Workforce Race Equality Standard (WRES), Mrs Cotterill advised that the eport is now ready and will be shared in the quarter 4, 2016/17 Governance Assurance Report.
• The Equality & Diversity team have drafted the updated Equality Strategy for 2016-2020. The Strategy incorporates the EDS2, the WRES and Accessible Information Standard. The Strategy is currently with the CCG for review and is due to be scheduled for approval at the end of March 2017.
• NHS England is currently assessing the impact of the Accessible Information Standard on organisations and s ervice users, to make sure that it is fit for purpose. Mrs Cotterill reported that the CCG has been asked to share the post-implementation review information before the deadline of 10th March 2017. Mr Carter advised that he is unaware of this request, Mrs Cotterill advised that she will check this with the E&D Team and come back to Mr Carter with an update.
ACTION: ARCIC/02/17 (Mrs Cotterill)
176
Page 6 of 9
• In relation to Freedom of Information (FOI) requests, The Committee were informed that between 1 October - 31 December 2016, 66 FOI requests have been received, 24 in October, 21 in November and 21 in December. All 66 requests have been responded to and completed for the quarter within the 20 working day timescale with no br eaches. The average response time to the requester was 7.9 working days
• One Subject Access Request was received by the Continuing Health Care Team for Darlington CCG, which was dealt with within 21 days.
• In November 2016, 2 members of the CCG were asked to complete the IG questionnaire for quarter 3, 2016/17. Both members of staff completed and returned the questionnaire to the IG team within the CSU.
• There were no reported Caldicott issues in quarter 3, 2016/17 • There are currently no information risks on the CCG’s Risk Register
11.2 Mrs Thompson highlighted that training compliance still seems to be low and t he
Committee requested that this is pushed with employees. Mr Carter confirmed that the training team have been contacted and a training breakdown by Staff name has been requested name in order to follow this up with individual staff.
11.3 The Chair queried if the Committee would be happy for the reports to be combined
going forward to avoid duplication. The Committee agreed to combined reports. ACTION: ARCIC/03/17 (Mrs Cotterill)
11.4 Mrs Thompson asked if there was a record of which FOIs were part of ‘round
robins’ to several organisations. Mrs Cotterill offered to look see if it was possible to obtain this information.
ACTION: ARCIC/04/17 (Mrs Cotterill)
The Audit and Risk Committee NOTED the DCCG Governance Assurance Report
AR/12/17 HaST CCG Governance Assurance Report
12.1 Mrs Cotterill summarised the HaST CCG Governance assurance report providing the following highlights: • one request to facilitate access to legal services on behalf of the CCG was
received during quarter 3, 2016/17, • 4 Corporate Policies have been s cheduled for ratification at the Formal Joint
Executive Committee in February 2017. There is one expired policy which is the Procurement Policy; the subject expert has been notified and is in the process of developing the revised policy
• During the quarter 3, 2016/17 there was one information governance incident recorded on S IRMS. The incident has been managed appropriately and w as closed on 4th January. The outcome of the incident was in relation to lack of IG awareness in North Tees and Hartlepool Foundation Trust.. Mr Carter has contacted the Trusts IG team to highlight this issue is a reoccurrence.
• The CCG is currently achieving the agreed 100% completion target for DSE assessments. The CCG has agreed to inform the H&S Team of any new starters.
• The CCG are below their targets for H&S statutory and mandatory training. The CCG is asked to encourage staff to complete their training to improve compliance.
• There have been no H &S incidents, or H*S risks reported during quarter 3, 2016/17.
177
Page 7 of 9
• As of 5 January 2017, compliance for Equality and Diversity Training was 53% (16/30 staff members). The CCG is asked to encourage staff to complete their statutory and mandatory training.
• In relation to Freedom of Information (FOI) requests, During quarter 3 2016/17, 67 requests were received, 22 in October 2016, 23 in November and 22 in December. All 67 requests have been responded to and are complete.
• 1 Subject Access Requests (SAR) was received in quarter 3, 2016/17 by the CSU Tees Continuing Health Care (CHC) Team.
• In November 2016, eight members of the CCG were asked to complete the IG Spot Check Questionnaire for quarter 3, 2016/17. All eight members completed and returned the questionnaire to the CSU IG Team and an ov erall score of 96% was achieved.
• As at 5 January 2017, 53% of CCG staff had completed their mandatory IG training (actual training for 16/17).
12.2 Mrs Thompson commented that it was appreciated that the CHAs were mentioned
in the report but commented that they were not mentioned within the engagement section. Mr Carter advised this may be relating to the CHA being supported by Catalyst and not NECS. The Audit and Risk Committee NOTED the HaST CCG Governance Assurance Report
AR/13/17 Risk Register 13.1 Mr Carter explained that the Darlington and HaST risk registers have been fully
reviewed to ensure that all risks are up to date. A comparison has been undertaken of the two risk registers and a num ber of risks have been replicated across both CCGs. Mr Carter emphasized that the risk registers are constantly evolving and moving document which will be reviewed with the executives.
13.2 The Committee were notified that 3 risks have been closed for HaST CCG with a
number of new risks identified as part of the review process across the two risk registers. The new risks below have been added to the risk registers. • Risk 1820 – Darlington CCG – Inclusion of risk regarding delivery of the sustainability and transformation plan. • Risk 1821 – Darlington CCG – Inclusion of a risk in relation to commissioning support services. • Risk 1822 – Darlington CCG - Primary Care Delegated Commissioning risk regarding reputational risk relating to now being the commissioners of primary care. • Risk 1823 – Hartlepool and Stockton-on-Tees CCG – Inclusion of risk relating to system resilience and A&E Delivery Board. • Risk 1825 - Hartlepool and Stockton-on-Tees CCG – Provision of Assisted Reproduction Services.
13.3 Mr Niven asked if a comparison has been completed in relation to the auditing
benchmarking, Mr Carter advised this has been reviewed. 13.4 The Chair commented that it appears the CCGs are moving towards a combined
risk register but the risks rating and residual risks could differ. Mr Carter agreed and highlighted that there will always be differences as the areas cover different amount of GP practices and HaST CCG covers 2 separate areas.
178
Page 8 of 9
13.5 Mrs Thompson asked in relation to risk 2551, should this still be on the register now that the score rating of 20 has gone down to 3. Mr Carter advised the last review date was 29th November with the appropriate executive and this will be reviewed in the near future.
13.6 Mr Carter advised that HaST CCG has only 1 red risk in relating to care homes and
cannot forsee ths risk reducing as is a reflection of the initial risk rating. Mr Carter explained that DCCG have a number of red risks relating to finance in comparison to HAST CCG, as HaST CCG has all of these similar risks rolled into 1 risk where as DCCG have the risks separated out so this will be discussed with Mr Niven going forward to agree the process.
The Audit and Risk Committee RECEIVED and NOTED the Risk Register Update.
AR/14/17 Governing Body Assurance Framework 14.1 Mr Carter outlined that he has tried to marry the assurance framework back to the
CCG assurance framework for 2015/16 aligning the strategic objectives with the components of the assurance and assessments identifying any gaps in control and assurances. Mr Carter added that the objectives look similar for both CCGs.
14.2 Mr Carter advised that the reports have been pulled together by hand as the SIRMS
system cannot currently pull the reports off electronically yet. 14.3 The Chair asked where there were gaps in control and assurance is there action
plans and responsible officers identified, Mr Carter advised yes and this is evident on the SIRMS system.
The Audit and Risk Committee NOTED the Governing Body Assurance Framework
AR/15/17 Terms of Reference 15.1 Mr Carter advised that the terms of reference for each of the previous Audit
Committee and Governance, Audit and Risk Committee have been reviewed to ensure they are consistent with one another. However, to comply with the legal requirements a terms of reference is required for each CCG.
15.2 Mrs Fatkin requested that section 8.1.2 in both sets of terms of reference be
changed from ‘NHS Internal Audit Standards’, to - ‘Public Sector Internal Audit Standards’,
ACTION: ARCIC/05/17 (Mr Carter) The Audit and Risk Committee APPROVED the Committee Terms of Reference
AR/16/17 Annual Cycle of Business 16.1 Mr Carter presented the Committee annual cycle of business and asked for any
comments/additions. 16.2 Mrs Fatkin requested ‘Consider mid-year report on emerging findings from Internal
Audit’ to be removed as this is considered throughout the year.
179
Page 9 of 9
16.3 Mrs Wright requested that the ‘External Audit Interim Report’ be changed to ‘External Audit Report’ as May is when the final report is provided.
ACTION: ARCIC/06/17 (Mr Carter) The Committee agreed to the requested amendments. The Audit and Risk Committee RECIEVED the Annual Cycle of Business
AR/17/17 Any other business 17.1 There were no items of any other business AR/18/17 Post-Critique of the Governance and Risk Committee Meeting 18.1 The Chair thanked everyone for their attendance and addressing questions through
the Chair. It was noted that the meeting had kept to time with enough relevant discussion.
AR/19/17 Date, Time and Venue of Next Meeting
It was noted that the next meeting was scheduled to take place on Tuesday
18th April 2017, 2pm, in the Board Room, Billingham Health Centre, TS23 2LA. Meeting closed at 3:35pm Signature: ………………………………………………………….. Date: ……………………….. Mr John Flook Chair of Audit and Risk Committee, and Lay Member (Audit)
180
-10-
ITEM NO. 4
HEALTH AND WELL BEING BOARD
31 January 2017
PRESENT – Councillor A J Scott, Darlington Borough Council (in the Chair); Councillors Copeland and C L B Hughes; Ada Burns, Chief Executive, Suzanne Joyner, Director of Children and Adults Services, and Miriam Davidson, Director of Public Health, Darlington Borough Council; Andrea Jones, Chair, Alison Wilson, Accountable Officer and Katie McLeod, Head of Commissioning and Strategy, NHS Darlington Clinical Commissioning Group; Michelle Thompson, Representative of the CCG Community Council/Chief Executive Officer, Healthwatch; Chris Mathieson, Primary Healthcare Darlington; and Tracy Freeman, Voluntary Sector Representative. (12) ALSO IN ATTENDANCE – Councillor S Richmond; Simon Hart, Independent Chair, Darlington Children’s Safeguarding Board; Mike Lavender, Chair, Child Death Overview Panel; and Andrew Allison and Keith Wanley, County Durham and Darlington Fire and Rescue Authority. (5) APOLOGIES – Rita Lawson, Chief Executive, Tees Valley Rural Community Council; Sue Jacques, Chief Executive, County Durham and Darlington NHS Foundation Trust; Karen Hawkins, Director of Commissioning and Transformation, Darlington Clinical Commissioning Group; and Patrick Scott. (4)
HWBB22. DECLARATIONS OF INTEREST – There were no declarations of interest reported at the meeting. HWBB23. REPRESENTATIONS – In respect of Minutes HWBB26, HWBB27 and HWBB30 below, representations were made by members of the public in attendance at the meeting. HWBB24. MINUTES – Submitted – The Minutes (previously circulated) of the meeting of this Health and Well Being Board held on 18 October 2016. RESOLVED – That the Minutes be approved as a correct record. REASON – They represent an accurate record of the meeting. HWBB25. SAFE AND WELL BEING VISITS UPDATE - PRESENTATION - Andrew Allison and Keith Wanley, County Durham and Darlington Fire and Rescue Authority gave a presentation to the Board on the Safe and Well Being Visits, which had commenced in February 2016. The visits were established as part of a national health and well being agenda with the Fire and Rescue Authority working in partnership with a number of key agencies, including Darlington Borough Council, Darlington Age UK, Alzheimer’s Society, Safer Homes, NECA and County Durham and Darlington NHS Foundation Trust.
181
-11-
The visits focused on six key areas, which had been identified as common factors present during accidental dwelling fire fatalities, namely:- slips, trips and falls; winter warmth/fuel poverty/flu; dementia awareness; loneliness and isolation, smoking cessation; and alcohol harm and reduction. It was reported that between 15 February 2016 and 15 January 2017 over 15,000 visits had been undertaken, 2,029 of which were in Darlington. Approximately 900 people in Darlington had agreed to answer the lifestyle questions, which had led to 415 referrals to partner agencies in Darlington. During the visit the residents were asked a number of questions with information gathered on a form. To gather lifestyle information, the residents needed to give their consent to this information being collected. References were made to the referral process; training given to the crews; evaluation of the visits; the use of alcohol score cards to gain information in respect of alcohol consumption; and a number of recommendations to improve the service. Copies of the alcohol score cards were circulated at the meeting. Discussion ensued on the sharing of information with the partner agencies; evaluation of its success; use of the data; data sharing agreements; signposting of services; and the promotion of the scheme to residents via Members’ newsletters. RESOLVED – That the thanks of the Board be extended to Andrew Allison and Keith Wanley, County Durham and Darlington Fire and Rescue Authority, for their informative presentation. REASON – To convey the thanks of the Board. HWBB26. - CHILD DEATH OVERVIEW PANEL (CDOP) - THEMATIC REVIEW - The Independent Chair of Darlington Children’s Safeguarding Board (DCSB) and the Chair of the Child Death Overview Panel (CDOP) submitted a report (previously circulated) drawing the Board’s attention to the key learning points arising from a thematic review of certain child deaths undertaken by (CDOP) (also previously circulated) and requesting the Board’s support in ensuring that those learning points are fully recognised when commissioning and providing local obstetric and paediatric services. The submitted report stated the function to overview child deaths was a statutory responsibility of Local Safeguarding Boards, who were required to set up a CDOP; in Darlington and Durham a joint Panel had been set up reporting directly to both Safeguarding Children’s Boards; and that following the death of a child, CDOP received information from agencies concerned with that child’s care in order to consider whether or not there were modifiable factors that might have contributed to that child’s death. The Panel would then consider if the death was deemed as preventable and, if so, decide on what, if any, actions could be taken to prevent such deaths in the future. It was reported that the Thematic Review into all child deaths across Darlington and Durham, modifiable factors were present, and that two significant recurring themes were identified, which were important to the future commissioning and delivery of obstetric and paediatric services, and which were of concern to the DCSB.
182
-12-
In presenting the report, the Independent Chair of DCSB stated that the reviews undertaken by the Panel were different from Serious Case Reviews; the reviews were carried out every two years; and that the DCSB were happy to support the recommendations contained within the report. The Chair of CDOP stated that of the 114 cases seen as part of the Review, 33 were noted as having modifiable factors. It was reported that there were two recurring themes from unexpected neonatal deaths at term, namely Cardiotocograph (CTG) monitoring and interpretation and the escalation policy. Both of these themes had been identified in previous CDOP Thematic Reviews. A doctor in attendance at the meeting made reference to the child mortality rate for Durham and Darlington and how it compared nationally. The Chair of CDOP responded thereon. RESOLVED - (a) That the issues contained within the Thematic Review be considered by the Durham Safeguarding Children Board and it be noted that the Independent Chairs will be collaborating to take other matters included within the report forward. (b) That it be agreed that a joint letter from the Chair of the Health and Well Being Board and the Independent Chair of the Darlington Children’s Safeguarding Board, be sent to NHS (England) and relevant NHS Commissioners and Providers within the region, drawing particular attention to the Review commissioned by County Durham and Darlington Foundation Trust, and highlighting concerns :-
(i) in relation to deaths at normal gestation where modifiable factors had been identified, other hospitals and health services in the region be requested to take note of, and respond to the findings, of the Review report; and
(ii) the need to improve escalation arrangements in cases where there may be
uncertainty in the interpretation of Cardiotocograph (CTG) data including consideration of the potential benefits of a seven day obstetric and acute paediatric service
REASONS - (a) To enable the Health and Well Being Board to have an understanding of the Boards work to date. (b) To enable the Health and Well Being Board to take proactive steps to ensure that learning from child deaths is given appropriate consideration in determining priorities in commissioning and delivery of obstetric and paediatric care and that neighbouring agencies are encouraged to strengthen collaboration in doing so. HWBB27. DEMENTIA REVIEW GROUP - FINAL REPORT - The Chair of the Dementia Review Group submitted a report (previously circulated) presenting the outcome and findings of the review Group established by the Adults and Housing Scrutiny Committee to look at the dementia pathway and the support and advice services available in Darlington. A copy of the final report from the Dementia Review Group was appended to the submitted report.
183
-13-
The submitted report outlined the background to the establishment of the Review Group to look at the dementia pathway and the support and advice services available in Darlington and it was reported that the Review Group had met on many occasions during the course of its Review and a wide number of issues had been discussed and considered. Reference was made to the wide-ranging recommendations contained within the final report and it was reported that those recommendations would be forwarded to the relevant organisations and individuals for implementation, and that the Scrutiny Committee would undertake monitoring of those recommendations after a period of six months. In presenting the report to the Board, the Chair of the Review Group stated that the recommendations contained within the final report were evidence based and challenging and further work would need to be undertaken to help improve the services for people living with dementia and their carers. A representative from the Alzheimers Society in attendance at the meeting welcomed the report and stated that it brought many strands of the help and support together and highlighted the importance of early intervention. Discussion ensued on the importance of a joint approach in respect of dementia services. RESOLVED - That the recommendations, as detailed within the final report of the Dementia Review Group, as appended to the submitted report, be noted and supported. REASON - To ensure that all partners work together to support and improve services for people living with dementia and their carers and that the dementia pathway is followed. HWBB28. HEALTHWATCH DARLINGTON – Pursuant to Minute HWBB18/Jan/18, the Chief Executive Officer, Healthwatch Darlington submitted a report (previously circulated) updating the Board on Healthwatch Darlington’s key priorities, projects and work undertaken, between October 2016 and December 2016, in championing the views of people in the Borough in order to influence and improve health and social care services. The submitted report outlined the key priorities of Healthwatch which were information gathering, informing, influencing and governance; stated that Healthwatch continued to signpost patients and provide information; Healthwatch have looked further to the established facilitated networks for a more concerted approach; and outlined the work of two its main projects, namely Youthwatch and the work with the Black, Minority and Ethnic (BME) community. Reference was also made to the implications on Healthwatch of the proposed budget cut in 2017/18 of 53 per cent. RESOLVED - That the report, and progress made to date by Healthwatch Darlington, as detailed in the submitted report, be noted. REASON - To enable the Board to consider the work of Healthwatch Darlington.
184
-14-
HWBB29. COUNTY DURHAM AND DARLINGTON URGENT CARE STRATEGY 2015/20 - JANUARY 2017 UPDATE – Pursuant to Minute HWBB29/Jan/17, the Director of Commissioning and Transformation, NHS Darlington Clinical Commissioning Group (CCG) submitted a report (previously circulated) providing the Board with an update on the progress made regarding key objectives contained with the Urgent Care Strategy 2015/20 (also previously circulated), since it was last considered and endorsed by the Board in January 2016. The submitted report stated that the key aim of the strategy was to ensure that people with urgent but non-life threatening needs have highly responsive, effective and personalised services outside of hospital as close to home as possible; the strategy provided a consistent and clear strategic framework for Darlington CCG to work within to ensure that urgent and emergency care services were clear, effective and efficient and provided the best outcomes for each individual patient; and provided an update in respect of the Urgent Care Centre, and in doing so stated that the walk in centre service had transferred, and had been delivered from Darlington Memorial Hospital, since 14 December 2016. It was reported that a banner had been displayed outside the building, providing clear signage stating that the service had moved and that a Joint Communication Plan, attached at Appendix 3 to the submitted report, had been produced, outlining the communication activity prior to the move. Particular reference was made to Clinical Streaming, which was one of the five mandated improvement initiatives contained within the A & E Improvement Plan, attached at Appendix 2 to the submitted report, in order to reduce waits and improve flow through emergency departments, by allowing staff in the main department to focus on patients with more complex conditions. It was reported that the number of pre-bookable GP appointments on a Saturday at Denmark Street Surgery had been increased from 1 January 2017. References were also made to the North East Urgent and Emergency Care Network (NEUECN), which was one of only two networks to be part of the NHS new models of urgent and emergency care programme, launched to help speed up the delivery of new services to tackle future challenges as part of the NHS Five Year Forward Plan and to the successes of the Urgent and Emergency Care (UEC) North East Vanguard. Particular reference was made at the meeting to the improvements made to the ‘111’ service’, the impact of the proposals for Cramlington Hospital; the delayed handover in care; the UEC Vanguard project; and engagement and communication on the proposals. RESOLVED - That the report, and the progress made regarding key objectives contained within the Urgent Care Strategy 2015/20, as detailed in the submitted report, be noted. REASON - To enable the Board to consider the progress made in implementing the Strategy. HWBB30. DIRECTOR OF PUBLIC HEALTH DARLINGTON ANNUAL REPORT 2016 ‘MENTAL HEALTH AND WELLBEING FOR CHILDREN AND YOUNG PEOPLE IN DARLINGTON’ - The Director of Children and Adults Services, Darlington Borough
185
-15-
Council submitted a report (previously circulated) presenting the Director of Public Health Darlington Annual Report 2016 entitled ‘Mental Health and Wellbeing for Children and Young People in Darlington’ (also previously circulated). The submitted report stated that this was the third annual report following the transfer of public health responsibilities from the NHS to local government, as part of the Health and Social Care Act 2012; outlined the theme of the first two reports; and that the theme of Mental Health and Well Being for Children and Young People, had been chosen in recognition of the fact that in order to develop resilience in adult life the foundations needed to be set in childhood. The Director of Public Health in presenting the report thanked the guest authors who had contributed to the report and stated that mental health illnesses were a leading cause of health related disabilities in children and young people and that they had adverse and long lasting effects; outlined the importance of building resilience; the risk and protective factors; the importance of investing in mental health for children and young people; local actions; and the five key recommendations contained within the report. Discussion ensued on the triggers for mental health and the importance of prevention and early intervention. RESOLVED - That the Director of Public Health Darlington Annual Report 2016 ‘Mental Health and Wellbeing for Children and Young People in Darlington’, as appended to the submitted report, be noted. REASON - The Health and Social Care Act 2012 stipulates the responsibility of the Director of Public Health to provide an annual report and for Council’s to publish that report. HWBB31. DEVELOPING A FRAMEWORK FOR THE HEALTH AND WELL BEING BOARD - PRESENTATION - The Director of Public Health, Darlington Borough Council gave an update to Members on the development of a framework for the Health and Well Being Board. It was reported that ‘One Darlington Perfectly Placed’ remained as the overarching Health and Well Being Strategy, however, the Health and Well Being Delivery Plan, which sat beneath the ‘One Darlington Perfectly Placed’ Strategy, was currently being refreshed and would be submitted to a future meeting of the Board. The Terms of Reference for the Board were also currently being reviewed and it was reported that greater focus would be given to the children and young people within future board meetings. The Terms of Reference would also be submitted to a future meeting of the Board for consideration. RESOLVED – That the update in respect of developing a framework for the Health and Well Being Board, be noted REASON – To update Board Members of work being undertaken.
186
Health and Wellbeing Board - Minutes and Decision Record – 16 January 2017 3.1
3.4 j. Hartlepool Health and Wellbeing Board Minutes and Decision Record Hartlepool Borough Council
1
The meeting commenced at 10 am in the Civic Centre, Hartlepool
Present: Councillor C Akers-Belcher, Leader of Council (In the Chair) Prescribed Members: Elected Members, Hartlepool Borough Council – Councillors Buchan, Clark and Councillor Richardson (as substitute for Councillor Thomas) Representatives of Hartlepool and Stockton-on-Tees Clinical Commissioning Group – Dr Timlin and Karen Hawkins (as substitute for Alison Wilson) Director of Public Health, Hartlepool Borough Council - Louise Wallace Director of Child and Adult Services, Hartlepool Borough Council – Sally Robinson Representatives of Healthwatch – Ruby Marshall and Margaret Wrenn Other Members: Representative of Hartlepool Voluntary and Community Sector – Tracy Woodhall Representative of Tees Esk and Wear Valley NHS Trust – Dominic Gardner Representative of Cleveland Police – Temporary Assistant Chief Constable Ciaron Irvine Representative of GP Federation, Fiona Adamson Also in attendance:- Dr Paul Edmundson-Jones, Public Health Louise Johnson, General Manager Emergency Care, North Tees and Hartlepool NHS Foundation Trust Stephen Thomas, Healthwatch Observer, Hartlepool Borough Council, Councillor Brenda Harrison L Allison, S Thomas, Healthwatch representatives Public – P Liddle, E Hughes, S Booth, C Booth, B Keane Officers: Leigh Keeble, Development Manager Joan Stevens, Scrutiny Manager Amanda Whitaker, Democratic Services Team Juliette Ward, Young Inspectors Co-ordinator
HEALTH AND WELLBEING BOARD
MINUTES AND DECISION RECORD
16 January 2017
187
Health and Wellbeing Board - Minutes and Decision Record – 16 January 2017 3.1
3.4 j. Hartlepool Health and Wellbeing Board Minutes and Decision Record Hartlepool Borough Council
2
32. Apologies for Absence
Elected Member – Councillor Thomas Representative of Clinical Commissioning Group – Alison Wilson Representative of the NHS England – Dr Butler Chief Executive, Hartlepool Borough Council – Gill Alexander Director of Regeneration and Neighbourhoods, Hartlepool Borough Council – Denise Ogden Observer – Statutory Scrutiny Representative, Hartlepool Borough Council, Councillor Tennant
33. Declarations of interest by Members Councillor C Akers-Belcher declared an interest in agenda item 4.2 as
Manager, Health Watch Hartlepool and left the meeting during consideration of that item (minute 35 refers).
34. Minutes (i) The minutes of the Board meeting held on 5 December 2016 were
confirmed. (ii) The minutes of the meeting of the Children’s Strategic Partnership held
on 27 September 2016 were received. Further to minute 33, Councillor C Akers-Belcher vacated the Chair for
consideration of the following item. Dr Timlin in the Chair
35. Healthwatch Hartlepool Dementia Diagnosis
Consultation Report (Healthwatch) The Board received a report prepared by Healthwatch Hartlepool which
provided the outcomes of the recent consultation regarding patient experience of dementia diagnosis in Hartlepool. The context and background to the report were presented by the Healthwatch Development Officer. A number of speakers who had contributed to the report were in attendance at the meeting and spoke of their dementia diagnosis experiences which supported the conclusions set out in the Healthwatch report. The report concluded that overall there was evidence that diagnosis and associated procedures had improved across the G.P practices that returned questionnaires. Awareness levels amongst all staff appeared to have improved and staff training on de mentia awareness happened routinely in most Practices. However, service development in this area was still a “work in progress” and there was still scope for further improvement. It was acknowledged that diagnosis of dementia for an individual, their family
188
Health and Wellbeing Board - Minutes and Decision Record – 16 January 2017 3.1
3.4 j. Hartlepool Health and Wellbeing Board Minutes and Decision Record Hartlepool Borough Council
3
and carers was an extremely difficult and traumatic process. There was evidence that some patients and their families felt that there was still a stigma attached to the condition and this could impair their willingness to seek help and support at an early stage. Much had been done to address some of the misconceptions and prejudice around the condition, but more was needed if the ambition of creating truly “dementia friendly communities” was to become a day to day reality. Concerns had been raised by some patients about the level of ongoing support they received once diagnosed. This had suggested that improvements could be m ade to this aspect of ongoing care and consideration given as to how understanding could be checked at diagnosis. Evidence had b een presented by those with dementia and family members and carers which showed that communication processes at all stages of diagnosis could be problematic. It was considered that every effort should be made to ensure that all parties be kept fully informed, and as far as is practicably possible had understood all aspects of diagnosis and ongoing implications. Patients who had experienced the onset of dementia at an early age more frequently reported problems and delays in reaching a diagnosis of their condition. In some instances these patients also found it hard to accept and come to terms with the diagnosis. It was accepted that the sample group had been relatively small but it had indicated that some further work was needed in order to develop the support received by this age group during diagnosis and beyond. It was noted that communication between G.P’s and the Memory Clinic in most instances appeared to be working reasonably well and the speakers at the meeting reiterated that the introduction of The Bridge Centre had been extremely helpful in providing additional information and support to patients and family members. Representatives of the Clinical Commissioning Group confirmed that the report resonated with the work undertaken in relation to the Better Care Fund and undertook to work with Healthwatch and the Council to improve communication including conveying the services available at the Bridge Centre. The new role of a Care Co-ordinator was highlighted by the representative of the GP Federation who offered also the services of the Federation to Healthwatch when conducting future surveys. Support was offered also by the representative of Tees Esk and Wear Valley Foundation Trust. The Vice Chair of the Adult Services Committee expressed his appreciation to Healthwatch representatives and to the speakers for their presentations and stressed the need to address the issues which had been highlighted. Those issues included support for carers as highlighted by a number of Board Members. The Director of Child and Adult Services responded to concerns by highlighting statutory responsibilities and with reference to inclusion of support for carers in the Better Care Fund Plan as a local performance indicator.
189
Health and Wellbeing Board - Minutes and Decision Record – 16 January 2017 3.1
3.4 j. Hartlepool Health and Wellbeing Board Minutes and Decision Record Hartlepool Borough Council
4
It was proposed that the Healthwatch report be referred to the Adult Services Committee and that a progress report be submitted to this Board in 6-12 months. Board Members responded to a suggestion from a member of the public in relation to GP databases where issues of confidentiality were highlighted together with the development of the Hartlepool Now website. The Director of Child and Adult Services requested that if the public were aware of any additional services not included on the website to inform the Department’s Development Officer.
Decision (i) The Board agreed the recommendations set out in the report that
based on the findings from the consultation events and subsequent discussions, the conclusions set out in the report are noted and acted upon by all relevant parties and that Healthwatch Hartlepool continues to monitor the ongoing development of patient experience of service delivery in this area.
(ii) That the Healthwatch report be referred to the Adult Services
Committee and that a progress report be submitted to this Board in 6-12 months
Councillor C Akers-Belcher returned to the meeting and took the Chair. 36. Urgent and Emergency Care Update - Presentation
(Clinical Commissioning Group) The Board received a presentation by Karen Hawkins, Director of
Commissioning and Transformation, Clinical Commissioning Group which provided an update on initiatives that were being implemented to manage the demands on urgent and emergency care systems and how services were being developed to improve outcomes and experience for patients. Also in attendance was Louise Johnson, General Manager Emergency Care, North Tees and Hartlepool NHS Foundation Trust who responded to questions arising from the presentation. Board Members discussed communication issues arising from the one integrated urgent care service model to be delivered by the Foundation Trust collaborating with Hartlepool and Stockton Health (HASH) and NEAS across the two sites of University Hospital North Tees and University Hospital Hartlepool. The Chair of the Board suggested that the March edition of the Council’s ‘Hartbeat’ publication would provide an ideal opportunity to convey the messages associated with the introduction of the new model to the residents of the Borough. The Emergency Care General Manager undertook to convey the opportunity to the communications work stream group and noted the request from the Chair for the provision of information to the Council’s Public Relations Team.
190
Health and Wellbeing Board - Minutes and Decision Record – 16 January 2017 3.1
3.4 j. Hartlepool Health and Wellbeing Board Minutes and Decision Record Hartlepool Borough Council
5
Decision The Chairman expressed his appreciation of the presentation and requested
that information relating to the integrated urgent care service model be forwarded to the Council’s Public Relations Team.
37. Better Care Fund:2016/17 Q2 Return (Director of Child and
Adult Services) The report provided the background to the National Conditions and
performance measures associated with the Better Care Fund. The 2016/17 quarter 2 return was attached at Appendix 1 and indicated that all national conditions were being achieved. The deadline for submission of the Q2 return (covering the period July-September 2016) had been 25th November 2016. Further detail was provided within the report on the following performance measures: • Permanent admissions to residential and nursing care homes; • Proportion of older people still at home 91 days after discharge from
hospital into reablement/rehabilitation services; • Delayed transfers of care (DToC) from hospital per 100,000 population
(days delayed); • Total non-elective admissions into hospital per 100,000; and • Estimated diagnosis rate for people with dementia. The following local performance indicators had been used to evidence impact of the Better Care fund: • Use of assistive technology; • Support for carers; • Effectiveness of reablement services; and • Overall satisfaction of people who use services with their care and
support. It was noted that work had been undertaken to review services that were currently funded by the Better Care Fund to clarify their impact. The outcome of the review would be reported to the Better Care Fund Pooled Budget Partnership Board in February 2017.
Decision The Board noted the 2016/17 Q2 return, which was submitted on behalf of the
Board using delegated authority as agreed previously.
Meeting concluded at 11.30 a.m. CHAIR
191
1
Health & Wellbeing Board A meeting of Health & Wellbeing Board was held on Wednesday, 29th March 2017 Present: Cllr Jim Beall (Chairman), Cllr Sonia Bailey, Tony Beckwith, Sarah Bowman-Abouna, Sheila Lister, Ali Wilson, Cllr Lynn Hall, Cllr Di Hewitt, Martin Gray, Dominic Gardner (Substitute for David Brown), Alan Foster and Ann Workman, Officers: Tanja Braun Also in attendance: Pat Lee (NHS England) Apologies: Cllr David Harrington, Barry Coppinger, Paul Williams, David Brown, Steve Rose, Saleem Hassan 1
Declarations of Interest Councillor Jim Beall declared a personal interest in item 7, Special Educational Needs and/or Disabilities (SEND), as he was the Chair of Governors of a school that may have Additionally Resourced Provisions located at its site.
2
Minutes of the meeting held on 22 February 2017 The minutes of the meeting held on 22 February 2017 were confirmed as a correct record.
3
Health and Wellbeing Update Members considered a report that presented the minutes of a number of meetings associated with the Health and Wellbeing structure:
- Adults Health and Wellbeing Partnership – 7 February 2017 - Children and Young People Partnership – 15 February 2017 - Children and Young People’s Health and Wellbeing Joint Commissioning
Group – 1 February 2017
An update on the 100 day challenge was provided [the challenge had recently passed its half-way point]. It was noted that a report on outcomes of the challenge would be provided to a future meeting of the Board. Members noted that the Children and Young People’s Partnership had recently discussed refreshing the Children and Young People’s Plan and changing the focus of the Partnership to be more about problem solving, using the skills of partners in a slightly different way. Reference was also made to some discussion around information sharing and the Partnership’s intention to look at this in detail, with a view to finding solutions to the problem. It was explained that the Domestic Abuse Strategy was out to consultation with a number of Partnerships and would come to the Board for endorsement in April. RESOLVED that the minutes and issues highlighted be noted.
192
2
4
Flu and Pneumococcal Immunisation across Stockton on Tees. Members considered a report, prepared by NHS England that provided the Board with data relating to the uptake of flu and pneumococcal vaccination across Stockton on Tees, including workforces operating in the Borough. Issues arising from discussion of the report could be summarised as follows: - consideration should be given to improving the immunisation rates of the wider social care workforce e.g. domiciliary care and care home staff. It was noted that NHS England and Public Health Teams would work together on this matter. - a strategic action plan was in the process of being developed via the Flu and
Adult Immunisation Board, which included public health representation. The action plan was likely to be available in May/June and would identify actions for health and social care partners, and could include some specific actions relating to Stockton priorities.
- Commissioners could look at using contract clauses/specifications to
encourage uptake of vaccinations within provider workforces.
- Members considered information relating to uptake of vaccinations, by staff, working in Foundation Trusts, within the Borough. It was noted that though improvements had been made, uptake at the Trusts was below a national target of 75%. Members heard of the considerable efforts made to increase uptake, but noted that despite the benefits to themselves and patients, some staff still resisted being vaccinated. Staff could not be compelled, through their employment contract, to have a flu vaccination. It was suggested that, locally, there should be actions to dispel the myths associated with vaccination and partners should seek to change the culture of workforces around this issue.
- Members discussed the sensitivities associated with offering incentives to take up vaccinations.
- It was noted that producing an accurate breakdown of people who received vaccinations from their GP, versus the Community Pharmacy, was not possible.
- Members noted that it was also not possible to monitor the number of carers who received a vaccination. It was noted that the Council’s Carers’ Support service would be going to tender soon and there may be some way to include something in that specification that required the provider to maximise and monitor Carer uptake.
- The Board noted that, next year, four year olds would be vaccinated at school
and two and three year olds would need to go to GPs. It was difficult to introduce any flexibility into this approach as contractual arrangements were set nationally.
RESOLVED that the report and discussion be noted/actioned as appropriate.
193
3
Early Help
The Board considered a report that set out proposals for the next phase of refinement of the early help approach. These proposals had been drawn together following the design sessions held in late 2016 with partners, focusing on the vision process and prevention. The proposals set out the basis of closer integration with the 0-19 model; enhancing the visibility of early help and an increased focus on a number of priority areas. The new proposals were based on addressing the following:
- Vision, ethos and visibility - An increased focus on secondary prevention - Pathways and systems - Our offer - Skills - Collaboration and integration
The report provided members with details of the work that was being undertaken in the areas above. Discussion:-
- It was noted that the new specification for 0 -19 services was being developed and the role of the Family Nurse Partnership would be considered as part of this.
- Work on the early help approach had included feedback from families; however, given the complex and diverse nature of the system involved, it was difficult to have a complete overview of it. Given this it was important that the correct ethos was in place and this was what was driving the early help approach.
RESOLVED that proposals described in the paper be endorsed.
6
Special Educational Needs and/or Disabilities (SEND) Local Area Inspection and Development Work The Board received a report relating to the Children and Families Act 2014 which introduced significant changes to the systems and approaches for children and young people aged 0-25 with special educational needs and/or disabilities (SEND). In 2016 an inspection framework was introduced to assess the effectiveness of local areas in fulfilling their statutory duties and in identifying and meeting the needs of children and young people with SEND. The report provided information about the inspection and associated implications and ongoing development work in Stockton-on-Tees in respect of SEND. Members were reminded that SEND was an area where the Board had agreed to look at integration. Discussion:
194
4
- Members were supportive of working in a joint way, including joint
commissioning, any opportunity of working better together in the interests of the public was considered to be positive.
- Reference was made to the Designated Medical Officer (DMO) role, which was crucial to the successful operation of the process for Education, Health and Care assessments and plans. Currently, there was no permanent DMO. It was noted that there were difficulties identifying people to take on such roles but the CCG was working hard to resolve this matter soon.
- Members discussed Additionally Resourced Provision and noted that
schools had been invited to put forward proposals. The Council was going through a process to make sure there was provision that reduced the need for travel and didn’t require children to move at key stages. It was recognised that there may need to be a little compromise to achieve this.
- The Board noted that following the Hartlepool Local Area Inspection the CCG had challenged the finding, as it was felt that it did not adequately reflect some of the good practice in place. It was also felt that the process had not been positive in terms of identifying learning.
- The Board asked for some key messages to come back to a future meeting following Stockton’s Local Area Inspection.
It was noted that, at an appropriate point, the Board would receive a further report on integrated working/joint commissioning. RESOLVED that
1. the report and discussion be noted and the development work identified, be supported..
2. the Board receive a report relating to any key messages coming from any future Local Area Inspection.
3. the Board receive a further report on integrated working/joint commission at an appropriate point
Director of Public Health – Annual Report Members were provided with the final draft of the Director of Public Health Annual Report for 2015/16. Members noted that the key focus of the report was inequalities and the work that was ongoing with partners to address inequalities through proportionate universalism. The Board was asked to provide comments on the report to the Council’s Assistant Director (Public Health)
195
5
RESOLVED that the report be noted and Members provide any feedback to the Council’s Assistant Director (Public Health)
Performance Update – March 2017 The Board considered a report that provided a performance update on key indicators from the performance monitoring framework for the Joint Health and Wellbeing Strategy delivery plan, as at March 2017. Discussion
- It was noted that the North Tees and Hartlepool Foundation Trust had signed up as a pilot site to try and get more smoking quitters. It was reiterated that smoking was still the biggest killer and therefore addressing it could have the biggest impact on individuals and families.
- ‘Smoke free areas’, around schools, parks etc. needed to be refreshed.
- Instead of just treating related illnesses, smoking needed to be looked on as an addiction, which also needed to be treated.
- Members noted the drop in the use of stop smoking services and it was suggested that there should be a discussion about what other work this team could do to help reduce prevalence. It was also suggested that all staff, coming into contact with the public could provide brief interventions around smoking.
- Reference to using e-cigarettes, as a treatment method, rather than a problem, was raised again.
RESOLVED that the report and discussion be noted/actioned as appropriate.
Adults Mental Health and Wellbeing Needs Assessment RESOLVED that this matter be deferred to a future meeting of the Board.
Sustainability and Transformation Plan Members received a brief update around the Sustainability and Transformation Plan. Members noted some of the work that would be going on during the purdah period for the Tees Valley Combined Authority Mayoral elections. This included updating manpower planning and the impact of the new junior doctors’ contract. The Board was reminded that some block social care finance had been mentioned in a recent budget. Further information was needed on this, in terms of what specifically the money was intended for.
196
6
Reference was made to a recent article in the local press, reporting claims that urgent care arrangements were the precursor to closure of A and E, at North Tees Hospital. Alan Foster, Chief Executive of the Trust, confirmed that there were no plans for this. RESOLVED that the update and discussion be noted
Members' Updates Members provided the following updates:
- The Chair circulated a letter that had come from a meeting of Tees Valley Health and Wellbeing Board’s Chairs’ Network that had been attended by the local STP Lead, and set out some shared concerns of the seven local authorities making up the STP area.
- The Chair explained that the Network had discussed the possibility of arranging a Tees Summit to look at issues across the Tees footprint. Members present expressed their support for such an event and were encouraged to provide details of any subjects they may wish to see considered, to the Chair of the Board, or the Assistant Director (Public Health)
- Members were informed of a spate of drug overdoses. There had been 66 overdoses with 6 deaths since the 27th January 2017, all related to a bad batch of heroin circulating in the community. The heroin had been cut with other substances and had some serious side effects. The substance drugs misuse service was working with the Police, Community Safety and CGL and a range of interventions had been put in place to provide additional support to those affected and at risk
RESOLVED that the updates be noted.
9
Action Tracker Members considered the Board's Action Tracker. RESOLVED that the Action Tracker be noted.
10
Forward Plan Members considered the Board's Forward Plan. RESOLVED that the Forward Plan be noted.
