NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING. 25 November 2014, 9:30-11:30

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1 Item WLCCGB NHS WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING 25 November 2014, 9:30-11:30 Boardroom in Hilldale, Wigan Road, Ormskirk, Lancashire 15 minutes to be allocated for questions from members of the public based on agenda items. Time Agenda item Action Presenter 11/14/01 09:30 Welcome John Caine 11/14/ Declaration of Interests All 11/14/ Minutes of previous meeting held on 23 September DR John Caine /14/ Matters arising - Action sheet DR John Caine Communication 11/14/ Chair s update I John Caine 11/14/ Chief Officer s Update I Mike Maguire Governance 11/14/ Register of interest report I Katie Wightman 11/14/ Board assurance framework and risk register I Katie Wightman Operational Management Section 11/14/ IM&T strategy DR Paul Kingan 11/14/ Integrated business report D Paul Kingan 11/14/ Safeguarding Policy DR Lorraine Elliot Consent items 11/14/ Minutes of sub-committees: - Quality Improvement Committee October Executive Committee 9 September - 4 November Remuneration Committee October 2014 I John Caine Other minutes: - Lancashire CCG network August, September and October Merseyside CCG network October Care Closer to Home Board September and October 2014 Other Business 11/14/ Any other business Governing Body meeting dates for I John Caine Date and Time of Next Meeting 27 January 2015, 9.30 am, Boardroom, Hilldale I Information D Discussion DR Decision Required Members of the governing body will be available after the close of the meeting for informal discussion, time permitting

2 Meeting Title: West Lancashire Clinical Commissioning Governing Body Meeting Time: am Present: Dr John Caine, Chair Mike Maguire, Chief Officer Paul Kingan, Chief Finance Officer/Deputy Chief Officer Dr Rosalind Bonsor, GP Executive Lead Dr Bapi Biswas, GP Executive Lead Dr Simon Frampton, GP Executive Lead Dr John (Jack) Kinsey, GP Executive Lead Dr Peter Gregory, GP Executive Lead Dr Adam Robinson, Secondary Care Consultant Douglas Soper, Lay Member In attendance: Karen Thompson, Public Health Specialist Cathy Ashcroft, Executive Assistant Terry Mears, Head of Commissioning Adult and Community Services, Lancashire County Council Minutes D R A F T Date: 23 September 2014 Venue: Evermoor Hub (Digmoor Community Centre), Birleywood, Skelmersdale Apologies: Claire Heneghan, Chief Nurse Greg Mitten, Lay Member Katie Wightman, Head of Corporate Affairs Jackie Moran, Head of Quality, Performance and Contracting Mike Banks, Director of Commissioning Adult Services, Health and Wellbeing Directorate Agenda Summary of Discussion Item WLCCGB/ 09/14/01 Welcome and apologies for absence John Caine opened the meeting of the West Lancashire Clinical Commissioning Group Governing Body. Introductions were made by the governing body to the four members of the public present. No questions had been received from the public in respect of the agenda. Action Apologies for absence were received from the above noted. 09/14/02 Declarations of interests The following declarations of interests pertinent to the agenda items were noted: Dr Peter Gregory confirmed his directorship of OWLs (out of hours service) All the GP Executive Leads declared an interest in item 7. 5 per head allocation. 09/14/03 Minutes of previous meeting held on 22 July 2014 The minutes of the meeting held on 22 July were agreed as an accurate and correct record. The governing body: Approved the previous minutes 09/14/04 Matters arising The action sheet was updated. West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 1 of 6

3 COMMUNICATION 09/14/05 Chair s update The report provided members with an update on both strategic and operational issues since the last meeting. John Caine highlighted key areas of interest: Breast care service at Southport and Ormskirk Hospital NHS Trust The Trust had made a public statement on 1 September, that due to a national shortage of radiologists and following 12 months of unsuccessfully recruiting to the post of breast specialist radiologist, the breast care service has been closed to new patients. Arrangements have been made for GPs to refer new patients to alternative hospitals for treatment. Aintree Hospital has been approached to provide the service on the Southport Hospital site. Public engagement will be required to identify future needs. Governing Body GP Vacancy John Caine welcomed Peter Gregory to the meeting, following his election to the post of GP on the governing body from 23 September Peter Gregory replaces Anand Bisarya, who had been thanked officially in previous meetings. Facing the Future Together update following the stakeholder meeting on 4 June, a Facing the Future Together business case is being developed. Facing the Future Together is the implementation plan for what is outlined in the CCG s five-year strategic plan. The business case was discussed at the executive committee on 9 September. Walk-in Urgent Care Services: Continuous Improvement Event - the following walk-in care services have been running parallel for many years and contracts for some areas will expire in 2015: o Ormskirk Children s Accident & Emergency Services o Skelmersdale Walk in services o o West Lancashire Walk in Centre In addition we have great links with NWAS (North West Ambulance Service). A continuous improvement event is being held on 8 October, to review the walk-in urgent care services to identify the gaps and consider how these services can be improved to meet the changing needs of the population. MacMillan GP Following interviews for a CCG MacMillan GP, Jack Kinsey has been appointed to this position. A post which has been funded by MacMillan. A Survivorship bid, to improve services for someone living with or beyond their cancer by using community assets to support them through the journey, is being developed and will be submitted to MacMillan by 30 October. Engagement with membership the common themes from the practices visits have been identified. Once an online survey has been completed by GPs, all views will be communicated back to practices with actions planned to address issues. Listening event Tarleton the second of five public listening events was held on Saturday 20 September with senior representatives from the CCG, Lancashire Care NHS Foundation Trust and Southport and Ormskirk Hospital NHS Trust in attendance. Interesting comments and good feedback had been received. Chairman s action regarding the Better Care Fund the Chairman had approved the Better Care Fund submission on 12 September 2014, which has been submitted to the Health and Wellbeing Board for final approval. The governing body: Noted the content of the report West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 2 of 6

4 09/14/06 Chief Officer s update The report provided members with an update on both strategic and operational issues since the last meeting. Mike Maguire highlighted key areas of interest: Better Care Fund (BCF) update the BCF is provided from existing money and brings together local health and social care integration schemes, which form part of the Facing the Future Together collaborative work programme. One of the aims is to reduce nonelective admissions. The performance element of the scheme changes regularly and therefore the BCF will still evolve before the end of March The BCF plan was signed by the Lancashire Health and Wellbeing Board on 19 September. CCG assurance meeting the quarter 1 assurance meeting for held on 9 September with NHS England Lancashire Area Team, had achieved a positive outcome. CCG running cost 2015/16 due to the national reduction of 10% in running costs for CCGs in and the increase in the CSU costs, the CCG had held star chambers with CSU colleagues to discuss savings to be made. It has also been agreed by the GP membership to discontinue the referral management service in the light of the new Choose and Book service going live in November, which will increase savings. Communication and engagement update the following list contains some of the communication and engagement activity from the last quarter: Examine your options; end of life; annual general meeting, Facing the Future Together and the cancer focus group. Equality Delivery System as a public sector employer, the CCG must comply with the Public Sector Equality Duty as set out in the Equality Act. Last year the six standards were measured as Developing, with three of these standards now progressing to Achieving for this year. The governing body: Noted the content of the report. OPERATIONAL MANAGEMENT SECTION 09/14/07 5 per head allocation process As all the GPs declared an interest in this item, the chair was passed to Doug Soper for this item. Following the CCG s policy for dealing with conflicts of interests, he determined that for each GP member the interests were significant, but not fundamental. The GP executive leads concerned were therefore allowed to remain present and be involved in the discussion, but unable to vote. The NHS Planning guidance this year, Everyone Counts, indicated that CCGs should make available funding to support primary care to improve the care of all patients aged 75 and over, to reduce avoidable admissions and readmissions and provide integrated care. Also, for patients to have a named GP and provide proactive care. Paul Kingan confirmed that the allocation equated to 5 per head and in most practices GPs had proposed schemes for the use of this funding in their practices. Discussions had taken place at the membership meetings to ensure the allocation of this funding was delivered through a fair process. The CCG had received and reviewed schemes from the local GP practices through an internal panel which included a neutral external observer. This report seeks approval to allocate and divide the 550,000 into 5 per head of population to practices, and proposes delegated authority be given to the accountable officer and the chief finance officer to jointly approve individual bids once the final details are West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 3 of 6

5 received and accepted. One joint bid included seven practices in Skelmersdale. The funding is recurrent and the results of pilot schemes will be reviewed prior to continuation into future years. Terry Mears stated that the learning is invaluable given the different areas and needs of the West Lancashire population and it is important to capture this learning for the future. The importance was stated of measuring what the schemes achieve in relation to improved health and value for money for patients, and the need to ensure that the additional capacity required in practices is sustainable. Possible collaborative working on some schemes could address the capacity issue. In order to allow proper analysis of the schemes the internal review panel, suggested it be a condition of approval that activity under the schemes be recorded separately. Doug Soper welcomed the external independent GP advice given to the panel and stated that this may be useful in the future when the schemes are evaluated. The governing body: Noted the process undertaken in respect of the allocation of this funding. Gave delegated authority to the accountable officer and chief finance officer to jointly approve individual funding bids within the agreed amount of 550,000. Requested they receive progress updates in due course. The chair was passed to John Caine to continue with the meeting. 09/14/08 Integrated Business Report The report provided summary information on the financial position and activity performance of the CCG to July 2014 and the financial position to August It also included quality and performance analysis for community based targets for Southport and Ormskirk Hospital NHS Trust. The report has been developed and expanded to cover additional sections including Quality, Innovation, Productivity and Prevention (QIPP) and financial indicators. Paul Kingan highlighted key financial information from the report as follows: The CCG is forecasting a surplus of million by the end of the financial year, including 1% surplus required by NHS England, although the financial risk has increased and the entire contingency reserve is assigned. This position is primarily due to the cost of continuing healthcare cases, and a combined overspend in hospital contract budgets. Cancer waits of 62 days and ambulance category A calls are both still red in status. MRSA attributable to the CCG and C. difficile are also red, with action plans now in place. Planned care this is currently over-plan, with growth in trauma and orthopaedics. Unplanned care this is under plan on cost and over on volume. The frail and elderly number of admissions have reduced, which could be a result of winter schemes and the acute visiting service. Early information suggests an increase in paediatric activity could be masking the reductions in frail and elderly emergency admissions. The data is currently being analysed to ascertain what is driving the increase. The significant increase in the community matrons contacts, compared to the previous year, is believed to be due to the counting system. Better payment practice code this target has been achieved with 95% of NHS invoices paid within 30 days of receipt. QIPP the key schemes to produce QIPP savings for include: West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 4 of 6

6 schemes relating to Care Closer to Home, prescribing, individual patient activity costs and eating disorders cost of placement. An external company, Commercial and Clinical Solutions (CCS), will be looking at 35 high cost packages and report back to the executive committee meeting on 21 October. The QIPP target is expected to be achieved with monitoring required before any further investments next year. The prescribing position is balanced at this point in the financial year. Paul Kingan reported on quality and performance and highlighted the key information from the report, which was produced by mainly July data. The performance data is reviewed to identify how this impacts on the quality issues identified by the quality improvement committee. Paul Kingan identified the key risk areas in the report as follows: 62 days cancer from referral to treatment a contributing factor to the length of time between first referral and treatment is the second referral of patients to another Trust for a specialist investigation, before returning to Southport and Ormskirk Hospital NHS Trust for first definitive treatment. Jack Kinsey who has met with Dr Paul Mansour, deputy medical director, and stated that the pathways have improved since his appointment. It was suggested that the reason for the drop in percentage rates of patients receiving first treatment within 62 days of diagnosis from 100% in April to 66.6% in May 2014, were due to a problem in diagnosis. It was agreed to work with Southport and Formby CCG around this issue through the quality improvement committee and the MacMillan doctor role. The issue around the breaches will be taken forward with the Trust and Dr Paul Monsour. North West Ambulance Service (NWAS) feedback from the recent deep dive event had suggested that first responders be utilised. This involves a team of volunteers, trained to a paramedic level, to cover the West Lancashire area. It was suggested that if the immediate care scheme was implemented, a conversation with the first point of contact could result in an ambulance standing down. The data for time taken from the initial call to arrival at the incident was requested. The following RAG ratings should be corrected for staff absence average and stroke to ensure consistency in terms of the figures. An MRSA infection has occurred at the Trust. Mixed sex accommodation further bed space is being sought in critical care. An update will be available at the next meeting. Pressure sores the significant increase in numbers of pressure sores reported in the community is primarily due to the national push to ensure that all pressure sores are recorded and not just those considered attributable to the healthcare area in which they are detected. An enquiry will be made as to why there is no detail for hospital acquired pressure sores and whether the reporting technique has changed. The small number of comments and complaints received by the CCG would suggest that GPs are not using the direct line. Although, reports could have been received by Southport and Ormskirk Hospital NHS Trust directly. This will be investigated. As part of the Southport and Ormskirk Hospital NHS Trust staffing levels data, the number of staffing incidents raised was discussed. The quality improvement committee was asked to enquire about the number and type of incidents raised to gain a better understanding. Minimum staffing levels were discussed with more detail needed. JK MM PK PK JM JM CH PK The governing body: Noted the performance to date and the actions in place to improve performance West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 5 of 6

7 CONSENT ITEMS 09/14/09 Minutes of sub-committees: The minutes from the following meetings were noted by the governing body: Minutes of sub-committees: - Audit Committee September Quality Improvement Committee August Executive Committee 15 July 2 September 2014 Other business Other minutes: - Lancashire CCG network June and July Merseyside CCG network July, August and September Strategic Partnership Board July and August Care Closer to Home Board July 2014 The following comments were added: Audit Committee procurement training is being arranged. It was proposed that the board assurance framework be presented at each governing body meeting. It would be placed at the top of the agenda if the content was of major importance and at the bottom of the agenda when the report is for noting only. This will be determined by the level of risk contained in the paper. The governing body: approved this proposal. Mersey CCG Network an increase in tariff for the maternity services in Ormskirk Hospital was discussed. The hospital where antenatal care is provided will cover the cost of the remaining maternity services, including any recharge from another Trust providing the delivery service. 09/14/10 Any other business No other business was raised. Meeting closed at am Date and time to next meeting: 25 November 2014, from am, the Boardroom, Hilldale, Ormskirk West Lancashire Clinical Commissioning Group Governing Body meeting notes from 23 September 2014 Page 6 of 6

8 Agenda item no: WLCCGB 11/14/04 West Lancashire CCG Governing Body meeting Action sheet 23 September 2014 Action Lead Date required by Action completed 09/14/08 Integrated Business Report - 62 days cancer from referral to treatment following a drop in 100% compliance in April to 66.6% in May, it was agreed to work with Southport and Formby CCG on the issue. Jack Kinsey 25 November 2014 The issue around the breaches in 62 days cancer from referral to treatment, will be taken forward with the Trust and Dr Paul Monsour. North West Ambulance Service (NWAS) - The data for time taken from the initial call to arrival at the incident was requested. The following RAG ratings should be corrected for staff absence average and stroke to ensure consistency in terms of the figures. Pressure sores - An enquiry will be made as to why there is no detail for hospital acquired pressure sores and whether the reporting technique has changed. Complaints and compliments enquiries as to whether complaints and compliments are being received directly by Southport and Ormskirk Hospital NHS Trust form GPs will be made. Mike Maguire Paul Kingan Jackie Moran Jackie Moran Jackie Moran 25 November November November November November 2014 Page 1 of 3

9 The quality improvement committee was asked to enquire about the number and type of staffing incidents raised at Southport and Ormskirk Hospital NHS Trust. Minimum staffing levels were discussed with more detail being needed. Claire Heneghan Paul Kingan 25 November November July 2014 Action Lead Date required by Action completed 07/14/10 Integrated Business Report - Claire Heneghan Claire Heneghan / Ann Butler 25 November 2014 PK confirmed Claire confirmed that the cost for agency staff is higher than that Heneghan had made of employed nurses and she will make enquiries at the Southport and Ormskirk quality committee, where the figures are scrutinised. enquiries and is looking at the data. The costs have increased and recruiting oversees. 23 September it was agreed to invite the Trust to attend an executive committee meeting to discuss the cost of agency staff. It was also noted that additional funds have been made available for recruitment, which is currently a problem in many Trusts. A comparison by Trust will be prepared for the next meeting. Claire Heneghan Claire Heneghan 25 November November 2014 Under planned care referrals, the numbers of other referrals will be included. Paul Kingan 25 November 2014 An analysis will be included in the next IBR. 27 May 2014 Action Lead Date required by Action completed 05/14/10 - Safeguarding - Approximately 20 West Lancashire CCG continuing healthcare patients are sited across the country and discussion regarding individual assessments being made of each facility was discussed. The commissioning support unit will be asked to assess 25 November 2014 Matter raised in the meeting The CSU have provided assurance that visits are being carried out on new reviews. This will be monitored and reviewed at Page 2 of 3

10 Action Lead Date required by Action completed the facilities where the patients reside in terms of cost and on 22 July 2014 the next meeting and quality with Ann Butler supporting the process. included in the IBR. 28 January 2014 Action Lead Date required by Action completed 01/14/09 - Integrated Business Report - TIA/stroke target to be assessed and treated within 24 hrs there is reduced access for assessment over weekends. Discussion ensued around the possibility of carotid artery scans being undertaken elsewhere. This will be raised at the quality tri-partite meeting along with rapid access for chest pain as NICE guidance is not being met. Jackie Moran 23 September 2014 Need confirmation that mini stroke weekend testing is taking place. Jan Ledward is carrying out a stroke review. Page 3 of 3

11 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: 25 November 2014 Agenda item no: WLCCGB 11/14/05 TITLE OF REPORT: Chair s Update BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact Yes 2. Commissioning of hospital and community services please outline impact No 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering Financial Balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact No B. Governance 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice 2. Additional resource implications (either financial or staffing resources) No No 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement Yes 6. Patient and Public Engagement Yes REPORT PREPARED BY: REPORT PRESENTED BY: Katie Wightman, Head of Corporate Affairs Dr John Caine, Chair Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

12 WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHAIR S UPDATE PURPOSE 1. This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting. ISSUES ARISING Breast care service at Southport and Ormskirk Hospital NHS Trust 2. On 1 September 2014 Southport and Ormskirk Hospital NHS Trust made a public statement that it had taken the difficult decision to close its breast care service to new patients. Trust governors and members of the public were briefed at the last meeting as to the shortage of specialist radiologists that had caused this issue to arise. 3. Since this cessation of service the CCG has been working with Southport & Formby CCG, who is the lead commissioner for Southport and Ormskirk Hospitals Trust to ensure all new breast surgery patients are seen in a timely manner by other providers. The two CCGs have approached other hospitals that currently provide this service to find an immediate solution. This solution will only be a temporary 18 months measure whilst the two CCGs jointly undertake an engagement exercise to help shape the replacement service. 4. From historic activity data we can estimate that the majority of the patients seen at Southport and Ormskirk Hospitals come from either Southport and Formby or Sefton CCGs and are likely to choose Aintree Hospitals NHS Trust as their alternative provider. Of West Lancashire CCG patients historically seen at Southport and Ormskirk Hospitals for breast surgery some would also be likely to choose Aintree Hospital particularly those from the Skelmersdale area where access to Aintree is as easy as it is for Southport. 5. As a result of understanding this data, West Lancashire CCG has been working with Southport and Formby CCG to engage Aintree Hospitals NHS Trust in the development of an interim solution for the next 18 months with the support of Southport and Ormskirk Hospital NHS Trust to provide services locally. This has now commenced and women from West Lancashire are accessing this service. 6. West Lancashire CCG is aware that some of our residents would wish to access services at Wrightington, Wigan & Leigh Hospitals Trust and so we have been working with them to ensure there is sufficient capacity in their clinics, radiology departments and in surgery to be able to deal with those women who chose to go there. We have been monitoring these numbers and the effect on waiting list and can assure the public that these women are accessing the service in a timely manner. 7. Discussions have also been on-going with Southport and Formby CCG over the last few months, regarding the longer term future shape of breast services. In order to help us ensure we meet patient needs and understand what is important to breast services patients, an engagement exercise is being planned, hopefully to be started in the new year. Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

13 8. It is expected that a procurement exercise will take place next financial year to secure the long term breast services for this area. Facing the Future Together Update 9. Since the production of the high level scoping business case in Summer 2014 and the subsequent Code of Conduct letter which was shared with the Trust in October 2014, a great deal of work has been undertaken to produce 3 follow-up documents which are outlined below: 1. Clinical Commissioning Strategy to Support the Delivery of Integrated Services 2. Commissioning Process towards Integrated Care for West Lancashire 3. Key milestones and gateways (November-June 2015) 10. These documents, which have been developed in conjunction with NHS West Lancashire s GP Membership, demonstrate how the CCG, in conjunction with its partners, will work towards achieving truly integrated care. The purpose of the first document is to outline the clinical strategy for NHS West Lancashire CCG. This strategy supports the delivery of our five year strategic plan, priorities, business objectives and ambitions and should be considered alongside the second document; The Commissioning Process towards Integrated Care for West Lancashire. This outlines the commissioning model which will support delivery of the clinical strategy and describes the process for doing so and also explains the supporting Governance framework. Finally, the third document includes a series of key milestones and gateways which we propose we will work collaboratively with the Trust on in terms of delivery. These documents have now been shared with the Trust and there is a meeting scheduled November 2014 to discuss the content of them in more detail. Ebola 11. As members are aware there is an outbreak of Ebola in Africa. Around 13,500 cases and more than 4,900 deaths have been reported globally by the World Health Organisation (31 October 2014). 12. Ebola can only be transmitted by direct contact with the blood or bodily fluids of an infected person or animal. The risk of Ebola to the general public in the UK remains very low. However it is important that GPs locally are prepared and know what to do. With this in mind we have held a number of briefings both at the CCG s clinical executive committee and at the membership council. Public Health England attended the membership council on 13 November to run an education and update session. 13. NHS England are also distributing a series of posters to inform NHS staff and patients about Ebola to all GP surgeries, A & E departments and pharmacies. AVS update 14. The CCG has been working with our well established GP out of hours service (OWLs) delivering the Acute Visiting Service pilot. This commenced on the 2 December 2013 providing an in-hours week day service (Mon Friday; caller handler service 8am pm and onsite doctor 10am pm). Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

14 15. The AVS has now been delivering the service for 50 weeks. An updated evaluation (attached) has demonstrated successful support for primary care colleagues, and supported care closer to home for our West Lancashire population. At the point of evaluation (46 weeks) 1,132 patients had been referred to the service via primary care and North West Ambulance Service (NWAS): 75% of patients have received a home visit and over 400 patients during that time were deflected from an A&E visit, in fact, 91% of NWAS referrals were deflected. Working relationships have progressed productively to expand joint working to support intermediate care provision within the service. This is enhancing learning and nursing home links. The service will continue over winter 2014/ Invitation to Tender document approval 16. On 14 October the CCG s Clinical Executive Committee received papers prepared by The North West NHS 111 Programme Board asking the Committee to approve the documents in support of the North West NHS 111 service procurement process. The next stage of the process was to invite tenders for the provision of the service. 17. The Clinical Executive Committee approved the following documents: Procurement Business Case CCG NHS 111 Options Paper Invitation to Tender (ITT) Guidance Document ITT Bidder Response Document (Questionnaire) Service Specification Listening event Ormskirk 18. The next in the series of five public listening events was held on Saturday 22 November 10am - 12pm in Ormskirk Library. Senior representatives from the CCG, Lancashire Care NHS Foundation Trust and Southport & Ormskirk Hospital NHS Trust were available for people to talk to and give their views to on local health services These sessions are aimed at enabling local people to provide feedback, both good and bad, so that services can be improved where necessary. Recommendation 20. Members are asked to note the content of the report. Dr Caine Chair November 2014 Chair s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

15 Acute Visiting Service Pilot: Our well established OWLs service has been working with West Lancashire CCG delivering the Acute Visiting Service pilot. This commenced on the 2 nd December 2013 providing an in-hours week day service (Mon Fri; caller handler service 8am pm & onsite doctor 10am pm). The service has 2 main aims: 1. Compliment primary care provision with an acute visiting service to patients where an urgent visit from a GP may not be possible or delayed, and a potential 999 call may ensue. 2. Build on previous NWAS work that suggest up to 45% of 999 calls it receives could be dealt with in primary care. During December the Ambulance team commenced using the service using NWAS Pathfinder 24 hours a day, 7 days a week. Evaluation: Where are we now? A joined up working group of OWLS colleagues, GPs, CCG, ICO Cert Team and NWAS have met regularly to proactively review and develop the service. Our aim was to support primary care during times of winter pressures; support integrated working; reduce onward travel of ambulances to A&E; provide a home visiting service to patients that GPs felt needed early input and from this remove the potential of going to A&E. Relationships have developed to produce a productive service that is continuing to support primary during 2014 and 2015 winter months. This storyboard shares some basics on what the service has supported, lessons learnt, feedback and some calculations on benefits after being in place for 46 weeks. 46 weeks into delivery So how s it gone? As we expected the uptake of use was slower in the first few weeks, but as we have established the service there is a consistency with referral patterns. Some key information and findings from the audit: 1132 referrals to the service received (in hours and out of hours). 36% from NWAS and 64% from Primary Care. Over the last 6 months as the service has been establishing primary care referrals have increased. NWAS colleagues feel there is more opportunity for referral and they are working with the team to improve communication and alerts to staff to utilise. The AVS team have visited 845 patients in their home (75% of all referrals). 686 of these patients were referred directly by primary care. Home visits are time consuming and this support provides primary care colleagues with the opportunity to see other patients. We could put a financial cost against this but in reality it more than likely supports additional patients seen in the community. If primary care did not do other visits it would have a financial saving of approximately 63,375 ( 75 per visit). We keep an eye on demand times so we can flex to support the community. There is a mid-morning peak in demand from both sources of referral, with a further mid-evening peak in ambulance calls when GP surgeries closed. Graphs below: What do we provide and what does it cost? We have built upon the robust framework in place within the OWLS service. For the 46 weeks it has cost approximately 182,655, per day to run the in-hours service. This funds a GP between 10am & 6.30pm; duty car/ driver, & call operator and administration co-ordination. The major benefit of running this with OWLs was the ability to join the work up 24 hours a day. The AVS doctor during the day takes calls from NWAS colleagues and the already established out of hours supply a continuous service.

16 How s it gone contd: As part of the audit we monitored the A&E deflections (i.e., ability to avoid unnecessary travel onto A&E) as deemed by GP and NWAS. However, we only started to record this after week 6 of the pilot starting. A total of 429 over the 40. Basically 91% of NWAS calls did not need onward referral to A&E and previously these patients would have been conveyed. The total A&E deflection equates to 429 patients remaining at home over the 40 weeks. The average cost of a general A&E attendance is 140 (based on the Kings Fund criteria used by NWAS see page 3 for admission avoidance), therefore a saving of 60,060. Importantly as a community this has supported the ICO during peak demand times. Criteria for referral were set to access the service by the CCG. GP referrals were monitored throughout the period for their appropriateness and only 5% were felt not to meet the criteria. We did an initial evaluation in June 2014 and this rate was 8% which has clearly improved. We anticipated that a large majority of referrals would be over the age of 65. The chart shares the referred age ranges from both referral sources. 82% of referrals from primary care were aged 65+, whereas, 64% were aged 65+ from NWAS. We wanted to know this so we could use the data to support our frail elderly project work across the economy. Below shares more on serving the elderly. In addition the service also took part in supporting the intermediate care provision during winter 2013/14 which also supported the ICO in managing frail elderly beds. Over summer 2014 the service has supported pilot work with nursing homes and the Beacon Primary Care practice. This work is being reported back to the Proactive Frail Elderly working group to learn and share further. What are the type of referrals and outcomes? We have grouped the referrals by symptoms and what the AVS team provided. The top 3 presenting symptoms link back with breathing problems, abdominal pain, near faint/syncope/collapse. The read codes allocated post visit show the themes to be generally unwell; abdominal pain; lower and upper respiratory tract infections; cystitis, falls, confusion & dizziness; gastroenteritis, joint and back pain. So what were the outputs of the AVS team service for patients?: 75% of patients referred received a visit and their care completed with advice, 2% required admission. So what happened 7-30 days after the service provided support?: We agreed with primary care colleagues that they feedback on what happened next after a referral (up to 30 days post visit/advice). This is continuous work in progress and the service continues. We have had feedback on what happened for 821 patients referred to the service. 42% had no further action required, 4.5% resulted in a subsequent admission, and the remainder of patients had ongoing care needs. Serving the Elderly There is a lot of integrated working to support frail elderly services through the Care Closer to Home programme. Over the 46 weeks 662 patients reviewed by the service were aged 75 and over (referral split below). 193 of these patients were deflected from onward travel to A&E. Have we avoided any admissions? This is a difficult calculation to make as really we don t know for definite! There have been various national debates on elderly non-elective admission rate avoidance. Below takes this thinking through to some very general and guesstimate thoughts on the NWAS model of calculation that is used nationally.

17 Calculation basics Based on Kings fund information (2012) on the average bed days and costs for ambulatory case sensitive patients for 2009 (this I s the type of patient NWAS and GP schemes are managing within the pathfinder for AMBER). As the calculation is over 5 years old it is thought to be conservative, however, a measurement that is recognised. Some basics: In 2009 the average cost of ambulatory case sensitive patient for an average of 2.8 day stay was Emergency dept tariffs are based on the mean value for 2014/15 of 140 per attendance (figure used in page 2) We know that an average of 31% of all NWAS conveyed patients are admitted We also know that at least half of the patients referred are over the aged of 65 and in these cases the national average LOS rises to 14 days. Let us look at our local figures as a result of the AVS/NWAS pathfinder links: We know that over the 40 weeks via the NWAS pathfinder 369 patients did not have onward travel to A&E, approximately 424 for the 46 weeks. Based on Kings fund figure of 31% saved admissions (approx ,739 per patient this equates to: 227,809 costs on av LOS of 2.8 days If we applied the figures to aged 65+ NWAS definite deflections over the 40 weeks (234 patients), and recalculate this to an average length of stay of 14 days, at a recalculated cost of 8695 per patient, the saving would equate to: 2,034,630 Question 4 asks if the doctor advised the patient to call back if the symptoms worsened since the home visit (to provide reassurance and review if needed). Results. Question 5 requires the patient to rate the overall experience of the Acute Visiting Service during the home visit. Results. Feedback from GP Practices and AVS team: We shared an online survey with staff that has run the AVS, NWAS and Primary Care who have utilised. This was an optional feedback and 31 people responded (a few however didn t complete it all). We are pleased that 53% of the feedback is from primary care colleagues using the services. It gives us a flavour of opinion and something we can rerun and build upon. We asked some questions to see how well, or not, we have been organised; communication/information; measurement, access: Patient Feedback: We posted out a simple survey to ask patients for their feedback after the contact. A quarter of all patients that have been referred to the service have provided us with feedback on 5 questions. The overall feedback is extremely positive. Results: Question 1 asks the patient to rate the initial telephone contact with the service. Results: Question 2 enquires whether during the home visit they felt the doctor listened to them and understood them. Results: Question 3 further asks the patient whether they were happy with the advice provided by the doctor. Results: Overall the feedback is positive but food for thought. We asked for some guidance on what individuals thought has worked well, not so well, improvement areas. Details overleaf.

18 Feedback grouped below: What has worked well main themes were: Early assessment takes place Detailed summary helpful Referral to the service is quick and easy Communication within the AVS and between professionals is good, quick and smooth Patients appreciate the swift response AVS GP input as strong as own GP Not worked so well main themes were: Too early to say The times the service runs Not having written feedback Grey areas for some referrals NWAS triage not always appropriate or mistrusted by some GPs Miscommunications at times The AVS team needs to be better equipped Suggested improvements the themes were: Continue the service Improve links between AVS and NWAS Share the vision/results Increase/improve the times it operates Pathfinder needs more work Future work should be developed equally between A&E and Nursing Homes Keep GPs involved in the development of the service Some additional comments made were giving support to the service and felt it had a vital role to play going forward. Lessons Learned: The programme team have reflected on the lessons over the last few months. We hope this supports colleagues in other areas to set up AVS services productively. Some tips: Focus on regular communication before and during the pilot. Get your messages right on what is available and how it can be accessed (we did flyers similar to this storyboard to support) Have regular project team meetings; we did biweekly to begin with. It keeps the team focused on developing utilisation. We used a simple spread sheet to record every referral and contact in quite a bit of detail. We set up graphs to review progress weekly so we could make early decisions on what was and isn t feasible (we have blanks on request) Lessons learnt contd: Making the pilot flexible worked for us, e.g., when we had less referrals than we anticipated we joined up with the intermediate care facilities to ensure value for money If we had our time again we would have started this much earlier in the year to get the best out of it for support winter! Summary: Below are a few bullets to summarise this evaluation update: Overall the development of this service has been received very well. The cost to run for the 46 weeks is 182,655, ( per day) to run the in-hours service, Mon - Fri. The very basic conservative savings and guesstimates, over the 46 weeks: o A&E deflection 429 ( 140 per patient) saving: 60,060 o Potential admission avoidance (based on Kings fund criteria for post ambulance admission rates): A saving range between: 227,809 & 2,034,630 There are other factors and benefits that need to be considered: o Lower referral numbers at the beginning of journey and referral patterns from primary care have increased now the service is established. o We haven t incorporated any benefits from the work to support intermediate care in its early phase, nor any potential cost savings for primary care visits o The patients that are being seen in the nursing home pilot that has commenced haven t been included, but provided in the service costs above. o Other benefits that could be costed are the savings to NWAS to avoid onward travel to A&E and any waits to hand over patients, and we also anticipate an increase in referrals as the links get better. Feedback has been really positive, but always room for improvement Important we co-design the future of the service with colleagues across primary, community and secondary care Next Steps: West Lancashire Clinical Commissioning Group has used this evaluation to support the extension of this service to continue over winter 2014/15. Many thanks to all participants in the set-up of this service and for their continued hard work to make it work effectively. Key Contacts: CCG Clinical Lead: John Caine john.caine@westlancashireccg.nhs.uk CCG Improvement Lead: Sharon Jeffrey sharon.jeffrey@westlancashireccg.nhs.uk OWLs Manager: Jayne Hetherington: jayne.heth@btinternet.com

19 Agenda item no: WLCCGB 11/14/06 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF MEETING: 25 November 2014 TITLE OF REPORT: Chief Officer s Update BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact Yes 2. Commissioning of hospital and community services please outline impact Yes 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering financial balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact No B. Governance No 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice 2. Additional resource implications (either financial or staffing resources) No 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement Yes REPORT PREPARED BY: REPORT PRESENTED BY: Katie Wightman, Head of Corporate Affairs Mike Maguire, Chief Officer Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

20 Purpose WEST LANCASHIRE CLINICAL COMMISSIONING GOVERNING BODY CHIEF OFFICER S UPDATE 1. This report provides an update on both strategic and operational issues of interest to governing body members in the months since the last meeting. Five Year Forward View 2. On 23 October NHS leaders in England published the Five Year Forward View. The Five Year Forward View sets out a vision for the future of the NHS and has been developed by the partner organisations that deliver and oversee health and care services including NHS England, Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. These partners have created a collective view of how the health service needs to change over the next five years if it is to close the widening gaps in the health of the population, quality of care and the funding of services. 3. The document states that there is now quite broad consensus on what a better future should be. The key themes are: A radical upgrade in prevention and public health in relation to obesity, smoking, alcohol and other major health risks. Giving patients far greater control of their own care including the option of shared budgets combining health and social care. Taking decisive steps to break down the barriers in how care is provided between different sectors and providers of the health care. Remove the one size fits all model of healthcare system and allow different local health communities to choose from amongst a small number of radical new care delivery options, and then given the resources and support to implement them where that makes sense. One new option will permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of-hospital care - the Multispecialty Community Provider. A further new option will be the integrated hospital and primary care provider - Primary and Acute Care Systems. Urgent and emergency care services will be redesigned to integrate between A&E departments, GP out-of-hours services, urgent care centres, NHS 111, and ambulance services. Smaller hospitals will have new options to help them remain viable, including forming partnerships with other hospitals further afield, and partnering with specialist hospitals to provide more local services. Greater investment in primary care. CCGs will be given more control over the wider NHS budget, enabling a shift in investment from acute to primary and community services. The full document can be found at Chief Inspector of Hospital Visit to Southport and Ormksirk NHS Hospital 4. England's Chief Inspector of Hospitals visited Southport and Ormskirk Hospital NHS Trust as part of a planned hospital inspection which commended on 10 November. The Chief Inspector held public engagement events so that members of the public had the opportunity to tell the inspection panel what they think of the services provided by Southport and Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

21 Ormskirk Hospital NHS Trust. The CCG along with Southport and Formby CCG has also been invited to provide views via a teleconference with the inspection team. 5. All the different views and experiences will help inspectors decide what to look at when they inspect the trust. 6. The trust is being inspected and given an overall rating under radical changes which have been introduced by the Care Quality Commission and it will be given an overall rating as a result of the inspection. 7. The new inspections are designed to provide people with a clear picture of the quality of the services in their local hospital, exposing poor or mediocre care as well as highlighting the many hospitals providing good and excellent care. 8. A full report of the inspectors findings will be published by the Care Quality Commission later in the year. The trust will be one of the first to be given one of the following ratings: Outstanding, Good, Requires improvement, Inadequate. Better Care Fund 9. Following a national review process, the Lancashire-wide Better Care Fund (BCF) submission has received the rating of 'not approved'. County Councillor Azhar Ali, chair of Lancashire Health and Wellbeing Board, said: "Colleagues across Lancashire's health and care system are fully committed to working on a county-wide basis, as well as tailoring services to meet needs in their different localities. As there are so many health and social care organisations across Lancashire the requirements of the Better Care Fund present some particular challenges in terms of merging a complex set of plans into a single proposal. 10. "The Better Care Fund will help us build upon the work undertaken to date in bringing health and social care services closer together and ensuring people get the right care and treatment in the right place at the right time, so it's important we get this right. 11. "It's disappointing that the plan has yet to be approved but all concerned will be working together to build on the positive feedback we've received about it so far, with a view to submitting a revised version for approval by the end of January." Emergency Planning Assurance 12. In July NHS England wrote to NHS organisations outlining the EPRR assurance process they will use in order to be assured that NHS England and the NHS in England are prepared to respond to an emergency, and has resilience in relation to continuing to provide safe patient care. 13. The 2014/15 EPRR Assurance Process is based on revised core standards. The national assurance process for this year now extends to Category 2 organisations of which the CCG is one. 14. Organisations have been asked to carry out a self-assessment against the NHS England Core Standards for EPRR and report their self-assessment back to NHS England by 10 December Organisations, following approval by their boards, are to state overall whether they believe they are fully, substantially, partially or non-compliant with the NHS England Core Standards for EPRR. The definitions of full, substantial, partial and non-compliance are below: Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

22 Compliance Level Full Substantial Partial Non-compliant Evaluation and Testing Conclusion The plans and work programme in place appropriately address all the core standards that the organisation is expected to achieve. The plans and work programme in place do not appropriately address one or more the core standard themes standards that the organisation is expected to achieve. The plans and work programme in place do not adequately address multiple core standard themes standards that the organisation is expected to achieve. The plans and work programme in place do not appropriately address several core standard themes standards that the organisation is expected to achieve. 16. The CCG has, in line with this requirement, undertaken a self-assessment and is suggesting Full Compliance is reported to NHS England. There is currently a work plan in place to arrange mutual aid from partners should we need to call on them to assist and a test exercise of our major incident plan. Community Safety Partnership Update 17. The CCG was represented at the Community Safety Partnership (CSP) meeting held on 12 November 2014 by the Head of Corporate Affairs at which various community safety updates were provided by the police, fire and rescue, the police and crime commissioner, West Lancashire Borough Council s Community Safety Officer, Discover Drug and Alcohol Services and the Liberty Centre. The CCG has a statutory duty to attend this meeting. Examine Your Options 18. We carried out some evaluation on last year s Examine Your Options campaign and following this as well as the positive feedback we received on the clear messages used within the promotional materials, we will be joining our Merseyside colleagues in running this campaign for a second year. 19. This decision is also supported by other patient insight we have received via our Saturday public listening events, where there is a common emerging theme around the confusion surrounding the options of health services. 20. Examine Your Options is focused on advising our community which services they should access when. It will be focused mainly on winter but will be utilised throughout the year as appropriate. CCG Constitutional Changes 21. In line with the national timelines to seek amendments to CCG constitution the CCG submitted minor proposed constitutional changes to NHE England for approval. 22. The amendments were in relation to the number of practice which constitutes the CCG which is now 22 and not 23 following a practice closer and the process for electing a GP should only a single application be received for a vacancy. Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

23 23. Approval for the changes was received from NHS England 12 November. 24. An amended version of the constitution is available on the website at Oct-2014-FINAL.pdf 25. Subject to decisions around the future of specialist commissioning and co-commissioning of primary care with NHS England future amendments to the CCG s constitution may be required. Any changes will have to be approved by the CCG s membership council. Current national consultations 26. The following are national health related consultations: Proposed Congenital Heart Disease Standards and Service specifications NHS England recently launched a 12-week consultation on the draft standards and service specifications for congenital heart disease services. The consultation runs from 15 September 2014 to 8 December These are designated as specialised services and as such are commissioned for North West residents by Cheshire, Warrington & Wirral Area Team. All the relevant documents are available on the consultation hub ( including: the consultation document, introducing the standards and specifications and setting out the key questions; the standards and specifications, combined together in a single document; an easy-read version of the consultation document; and a reference pack which pulls together useful background information which has been published during the review to date. Commissioning arrangements for stereotactic radiotherapy and radiosurgery NHS England has launched a 12-week public consultation on proposals to change the way in which stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) services are commissioned across England. The consultation will run from Monday 3 November, to midnight on Monday 26 January NHS England is consulting on a set of options for change, including a preferred option. Details of the consultation and how responses can be submitted can be found on the NHS England website at Recommendation 27. Members are asked to note the content of the report and approve the self-assessment of Full Compliance in relation to emergency preparedness. Mike Maguire Chief Officer November 2014 Chief Officer s Update West Lancashire Clinical Commissioning Group Governing Body Meeting 25 November

24 Agenda item no: WLCCGB 11/14/07 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: 25 November 2014 TITLE OF REPORT: Declaration of Members Interests - Update BRIEFING POINTS: To record the declared interests of the members of West Lancashire Clinical Commissioning Governing Body Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient No experience) please outline impact 2. Commissioning of hospital and community services please outline impact 3. Commissioning and performance management of GP Prescribing please outline impact No No 4. Delivering Financial Balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact Will provide the commissioning board and commissioning group with practical experience of implementing good governance practices Yes B. Governance please outline impact Yes 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice The report promotes good governance practices. It provides a summary of the declared interests of members. Since the register was first presented to the governing body additional posts have been recruited to. 2. Additional resource implications (either financial or staffing resources) No 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: Katie Wightman, Head of Corporate Affairs Register of Interest West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

25 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY DECLARATION OF MEMBERS INTERESTS - UPDATE BACKGROUND 1. The purpose of this report is to record the declared interests of the members of West Lancashire CCG Governing Body. 2. Since the register was presented at a previous Governing Body meeting, one additional declaration of interest has been received and one amended declaration of interest which have both been added to the record. 3. The additional declarations of interest have been included in the register and are detailed below. ACTIONS 4. The Governing Body is asked to: a. note the declared interests of its member Register of Interest West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

26 REGISTER OF INTERESTS NOVEMBER 2014 West Lancashire Clinical Commissioning Group Dr Peter Gregory GP Executive Lead a) Partner at Parkgate surgery b) Director of OWLs CIC Ltd c) Yes Parkgate surgery provides some enhanced services Dr Jack Kinsey GP Executive Lead 1) Director of Mednostic Solutions Ltd. Private organisation going to provide trading diagnostic speciality DEXA scanning. Also, other sport science and weight management. 9) Macmillan GP for West Lancashire CCG. Removed from the declaration: a) Salaries doctor at Ormskirk Hospital. Register of Interest West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

27 Form completed by the Governing Body members NHS West Lancashire Clinical Commissioning Group Declaration of interests members In accordance with the CCG s Constitution and NHS Code of Accountability I hereby declare my interests as follows (please indicate term of appointment where applicable). The interests of spouses or cohabiting partners should also be declared. a) Role and responsibilities held within member practices... b) Membership of any GP provider organisation holding or seeking to hold CCG contracts.. c) Membership of the Operating Board of such organisations.. d) ANY OTHER COMMERCIAL INTERESTS AS SET OUT IN THE CCG CONFLICTS OF INTEREST POLICY, AS FOLLOWS: 1) Directorships, including non executive directorships held in private companies or PLCs.... 2) Ownership or part ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG ) Share holdings (more than 5%) of companies in the field of health and social care.. 4) A position of authority in an organisation (eg. Charity or voluntary organisation) in the field of health and social care ) Any connection with a voluntary or other organisation contracting for NHS services... 6) Research funding/grants that may be received by an individual or any organisation in which they have an interest or role Register of Interest West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

28 . 7) Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared)... 8) Any interests in relation to the CCG s Enhanced Services Review 9) Any other interests (NO INTERESTS TO DECLARE (Please indicate in this section if there is nothing to declare ie No interests ) I confirm that the above information relates to interests which are relevant and material as defined within the Department of Health Guidance on Declaration of Interests. I understand that this information will be recorded in a formal Register of Interests, a public document which will be available for inspection upon request by the general public. NAME (BLOCK CAPITALS) SIGNATURE DATE... DESIGNATION Please complete and return to: Katie Wightman, head of corporate affairs, West Lancashire CCG Register of Interest West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

29 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF MEETING: 25 November 2014 Agenda item no: WLCCGB 11/14/08 TITLE OF REPORT: Assurance framework and risk register BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact No 2. Commissioning of hospital and community services please outline impact No 3. Commissioning and performance management of GP Prescribing please outline impact No 4. Delivering financial balance please outline impact No 5. Development of the commissioning group as a commissioning organisation please outline impact No B. Governance Yes 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice 2. Additional resource implications (either financial or staffing resources) No 3. Health Inequalities No 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: REPORT PRESENTED BY: Katie Wightman, Head of Corporate Affairs Katie Wightman, Head of Corporate Affairs Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 25 November

30 Risk Register & Governing Body Assurance Framework Introduction 1. A Board Assurance Framework (BAF) is a key part of the CCG s governance arrangements. These arrangements include a requirement for the governing body to review the documents. 2. The CCG Risk Register has been reviewed to reflect the up to date position as at 11 November Board Assurance Framework 3. The CCG s integrated risk framework requires the governing body to receive assurance on all risks. The board assurance framework (BAF) was be presented to the clinical executive committee on 4 November and the audit committee on 11 November Below is a summary of developments in the key areas. Delivery 5. The main additional risks in relation to delivery relates to Safeguarding. In particular patients in receipt of NHS funded care potentially at risk of harm as their healthcare needs may not be addressed due to gaps in commissioning the relevant services. There is also a risk in relation to a particular mental health issue raised as part of a review of individual funded patient activity and complex cases. The CCG has contacted the CSU (who arrangement suitable placements for patients on behalf of the CCG) to seek assurance that this patient s case is being dealt with appropriately. The CSU has confirmed that the case is being managed appropriately. 6. In relation to the other risk in this area Quality, Innovation, Productivity and Prevention (QIPP) schemes continue to be developed and a QIPP dashboard is being populated to monitor and report progress against identified schemes. 7. Given the current situation regarding the Safeguarding issues the overall assurance rating for delivery has increased to Red. Engagement 8. For this theme the level of risk is being managed and improvement has been seen with the advantage of a dedicated communication manager for the CCG. 9. Given the current situation the overall risk rating for engagement is amber. Contracts 10. The main issues in relation to this element are in relation to the CCG managing the financial position. A finance plan is in place for the overall allocation and discussions are taking place to arrive at a balanced running cost position for 2015/ Given the current situation the overall risk rating for contracts is amber. Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 25 November

31 Operational Systems 12. Limited assurances on nursing home issues and potential safeguarding issues not being identified remain on the risk register. The CCG s chief nurse has been reviewing the safeguarding arrangements and has found that no information is currently received from Southport and Ormksirk Hospital Trust in relation to incidents in nursing homes that their staff report. Southport & Ormskirk Hospital Trust has been asked to amend their policy to ensure staff report incident relating to nursing home patients. The CCG is still awaiting confirmation that this has been done. 13. The finalised M&T Strategy has not yet been adopted. The strategy has been discussed at the Clinical Executive Committee and positive feedback has been received from the Area Team. Funding costs are currently unknown and a full review of feedback from all partner organisations has been undertaken. The strategy will be presented to the November meeting of the governing body for formal approval. 14. Risk ID 18 Reduced prescribing capacity due to Lancashire Area Team having no process in place for authorisation has been closed. The Area Team now have adequate process in place. 15. Given the current situation the overall risk rating for operational systems is amber. Risks removed from the register 16. Risk ID 4, 9, 30 have been removed from the active risk register. Recommendations 17. The governing body is asked to note the board assurance framework and continue to support the risk management arrangements. Katie Wightman Head of Corporate Affairs November 2014 Board Assurnace Framework West Lancashire Clinical Commissioning Group Governing Body 25 November

32 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 17/11/2014 Assurance Framework 2014/ /15 Critical Outcome TEAM Delivery Failure to Deliver CCG Service Priorities MM LEAD DIRECTOR RESIDUAL RISK RATING ASSURANCE STATUS (overall) 16 RED Engagement Failure to Engage Effectively with Stakeholders Contracts Failure to effectively manage contracts to ensure high quality services Operational Systems Dr SF (Comm) Dr JK (Clinical) Dr BB PK Green Green Green Assurance Status Key: Green Complete Amber On track Red Off target NB: where there is more than 1 risk relating to a key objective the higher of the risk ratings will be shown on the summary sheet Page 1 of 5

33 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 17/11/ /15 Delivery Failure to Deliver CCG Service Priorities EXEC LEAD: MM Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective Areas where controls are not in place or are ineffective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed 32 Patients in receipt of NHS funded care potentially at risk of harm as their health and care needs may not be addressed due to: Gaps in the commissioning of 16 (4x4) the CHC service in respect of care planning and case management. Lack of capacity in CHC team resulting in routine reviews behind scheduled. CSU commissioned to manage CHC process. Monthly exception reporting care homes from CSU Quarterly reporting on CHC from CSU Monthly Exception Report Quarterly reports received from CSU Not all contracts are in place Lack of service specification Limited CSU to report on timeliness of CHC/FNC reviews with exception reporting where care needs not being addressed. Contracts to be in place for all patients under individual of care (IPA). CCG to ensure service specification in place with CSU re CHC includes commissioning/care planning and case managements and contribution to safeguarding enquiries/investigat ions as outlined in the national CHC framework 16 (4x4) RED Page 2 of 5

34 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 17/11/ /15 Engagement Failure to Engage Effectively with Stakeholders EXEC LEAD: Dr SF (Comm) Dr JK (Clinical) Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective Areas where controls are not in place or are ineffective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed None Identified Page 3 of 5

35 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 17/11/ /15 Contracts Failure to effectively manage contracts to ensure high quality services EXEC LEAD: Dr BB Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective Areas where controls are not in place or are ineffective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed None Identified Page 4 of 5

36 West Lancashire Clinical Commissioning Group Governing Body Assurance Framework 17/11/ /15 Operational Systems EXEC LEAD: PK Risk ID (Link to Risk Register) Principle Areas of Risk Initial Risk Rating (LxC) Key Controls Assurance on Controls Gaps in Control Gaps in Assurance Level of Assurance Key actions Target Date for Completion of Key Actions Lead Officer Current Risk Rating (LxC) Status These are the specific areas where failure will risk a critical outcome Processes and plans in place or actions being taken to mitigate risk in principle areas Internal or external reporting arrangements that provide assurance to the Governing Body that controls are effective Areas where controls are not in place or are ineffective Areas of insufficient evidence to assure the Governing Body that controls are being effective Must state either None Limited Significant Full Key actions being taken to mitigate the risk Colour indicates current status of principle risk area RED = off track AMBER = on track GREEN = completed None Identified Page 5 of 5

37 West Lancashire CCG Risk Register No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk 3 BAF Theme: Contracts/ Delivery JM The business intelligence information provided by the CSU is insufficient for the CCG to make informed decisions. Monitoring of key performance indicators inc resilience & recovery planning. i) KPIs are agreed and monitored for each contract. Quality Improvement Committee collecting information from various data streams ii) Direct feedback reports from secondary providers re trends iii) Informal GP sharing iv) Lead Nurse in post Data flows are established but still not yet embedded Non-specific gaps as follows : i) Lack of clarity of future role of NHSE in managing and influencing the system Establish clarity of reporting activity arrangements - quality processes now working well Feedback to CSU on the areas that we require making more robust Low/ Moderate 7 BAF Theme: Delivery 8 BAF Theme: PJ LC Failure to deliver service priorities to plan including QIPP targets Lack of engagement of providers in the quality agenda leading to a Monitoring of QIPP linked into financial reporting system CSU support for comms, finance and business intelligence Strategic Partnership Board (SPB) (6 key priorities agreed) National reporting on assurance established. Q1 -Q4 assessment completed with full assurance received Replacement engagement mechanisms being considered by Trust Cross reference QIPP programme to redesign programme Continuously refresh assumptions around QIPP programme outcomes and embed services. Joint planning for integrated care pathway group Matrix designed to monitor impact of QIPP and assist redistribution of resources. QIPP outcomes clarified and plan amended accordingly Systems improved but maintaining scrutiny pending review of final outcomes. ICPGs have continue CCG continues to Moderate Moderate Status Key: Green Complete West Lancashire CCG Risk Register Amber On track 1 Update November 2014 Red - Off target

38 Engagement lack of understanding and consistency between partners regarding outcomes of specific schemes. to replace Clinical Senate and operational groups. Individual meetings with key officer at Trust taking place. CCG attends Trust quality Committee Adoption of a programme management approach to include key partners. Robust direct comms link between S&O Hospitals Trust and GPs still to be established monitor No change to action plan at this time No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk 17 BAF Theme: Contracts/ Op Systems KW Failure of the CSU and hosted services to provide robust arrangements for meeting statutory duties relating to safeguarding. i) Hosted Services in place ii) CSU proposals Hosted Services proposals considered via Lancs CCG Chairs network no agreement yet reached CSU proposals via CCG managers meeting no agreement yet reached Multi CCG task and finish group to be established Chief Nurse is now leading in this area. Multi CCG task and finish group has been established. Chief Nurse attends. Draft Safeguarding Policy received and awaiting approval at next quality committee Low/ moderate 19 BAF Theme: Op Systems JW Failure to maintain equipment asset register by Lancashire Teaching Hospitals for equipment issued re complex packages of care i) Inform Chorley and South Ribble CCG (host CCG) and request they discuss issue at contract meeting re incident reporting and informing the CSU immediately so investigation can be undertaken Network Director contacted to discuss procedure. Issue to be raised with CSU. Ensure procedure reviewed with regard to incidents where CSU needs to be informed. CSU seeking to procure new equipment asset and maintenance system Low West Lancashire CCG Risk Register 2 Update November 2014

39 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G 22 BAF Theme: Op systems Implementation of the new IT system at S&O as it may affect the delivery of health services or the quality of those i) Monitoring of performance and quality metrics for all metrics so any changes can be identified ii) Updates on implementation going to SPB iii) Contract penalties for nonsubmission of data Monitoring of performance & quality metrics. Risk added Residual risk Moderate 23 BAF Theme: Delivery CW Children being discharged from CAMHS too early at 16 when they should remain with service until 18. Leading to risk of no services being received when child needs it safeguarding issue transition into adult service where staff are not trained to provide an age appropriate service, inappropriate placement of children on adult mental health ward i)additional expertise brought in to advise & assist ii) Reviewing adult eating disorder service specification to ensure NICE adult compliant i) Raised issue with Collaborative Arrangements Group who are considering addressing the issue. CCG awaiting response from CAG. ii) Raised with safeguarding team Awaiting response from CAG. Action plan from eating disorder service will be drafted if required Risk added on Moderate West Lancashire CCG Risk Register 3 Update November 2014

40 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G 24 BAF Theme: Engagement MM Lack of Engagement with NHS England Primary Care Teams Regular meetings between chief officer and deputy primary care lead at LAT Primary care issues raised at CCG and LAT quarterly assurance meeting Chief officer has regular 1:1s with chief executive of LAT Significant issues arising from 1:1s between chief officers and LAT to be reported to the governing body within the Chief Officers Report as from July 2014 Risk added July 2014 Residual risk Moderate 25 BAF Theme: Contracts PJ Running costs outstrip available resources Plan in place for 2014/15 which delivers running cost target Consideration being given to how to achieve 2015/16 running costs target Develop plan to achieve running cost target for 2015/16 CCG in discussions with CSU on releasing significant cost savings in 2015/16, this will involve the in-housing of certain functions where it is financially beneficial Risk added July 2014 Moderate Robust financial controls (ledger) and budget setting 26 BAF Theme: Contracts PJ Failure to Achieve Financial Balance 2014/15 Some budget holders assigned Budget allocation agreed by DoH for 2014/ Continuous monitoring of financial position. Successful implementation of QIPP schemes Risk added July Moderate West Lancashire CCG Risk Register 4 Update November 2014

41 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G Engagement made with the National C&B2 Team Residual risk 27 BAF Theme: Delivery JM Lack of a Referral Management Centre Strategy New strategy developed to move away from RMC and move to C&B2. New project structure developed with clear TOR for groups therein Implementation and rollout plan developed e-referral manager in post S&F tie in confirmed Risk added July 2014 Moderate Regular feedback to Executives at least once per month on how this project is performing 28 BAF Theme: Delivery KT Uncertainty of future of CCG affecting ability to plan long term 5 year plan finalised & submitted Strategic partnership in place Governing body development on strategic positioning held year plan submitted and feedback received. Risk reduced from (4x3) 12 to (3x3) due to potential political impact Risk added July 2014 Moderate West Lancashire CCG Risk Register 5 Update November 2014

42 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G 29 BAF Theme: Delivery PJ IPA process - financial instability, increasing costs, and assurances on quality of assessments About to begin reviews of high cost complex cases Undertaking review of internal CSU process around the information CSU sends to CCG Undertaking further training for GPs on process Report on IPA expenditure received from CSU IPA Programme Board Undertake reviews and complete training for GPs on process. CCG scrutinising the accuracy of the financial forecast produced by the CSU Risk added July 2014 Residual risk Moderate 31 BAF Theme: Op Systems CH Limited assurances on nursing home issues, - potential Safeguarding issues not identified Receive information via the CSU on all incidents reported in nursing homes. Incident dashboard being developed. Chief nurse attends RADAR meeting with local authority Regular attendance at Safeguarding Adult Board meetings. Chief nurse meets fortnightly with safeguarding team Southport & Ormskirk Trust to amend Policy to ensure staff report incident relating to Nursing Home patients. Awaiting confirmation that this has been done Risk added July 2014 Moderate 32 BAF Theme: Delivery CH Patients in receipt of NHS funded care potentially at risk of harm as their health and care needs may not be addressed due to - Gaps in the - CSU commissioned to manage CHC process. - Monthly exception reporting care homes from CSU Quarterly reporting on CHC from CSU CSU to report on timeliness of CHC/FNC reviews with exception reporting where care needs not being addressed. - Contracts to be in place for all patients under Risk added October 2014 CSU in process of clarifying role of Medium / high West Lancashire CCG Risk Register 6 Update November 2014

43 commissioning of the CHC service in respect of care planning and case management. - Lack of capacity in CHC team resulting in routine reviews behind scheduled. individual of care (IPA) CCG to ensure service specification in place with CSU re CHC includes commissioning/care planning and case managements and contribution to safeguarding enquiries/investigations as outlined in the national CHC framework CHC in relation to safeguarding enquiries No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G 33 BAF Theme: Delivery CH / JR Decisions taken on referrals into MASH not informed by relevant health information and potential therefore that harm and risks not fully recognised leading to poorer outcomes for children/families and vulnerable adults. No agreement for the ongoing funding of the Lancashire multiagency safeguarding Hub (MASH). Insufficient health contribution will impact on timeliness of information sharing and decision making and may result in poorer outcomes for children and adults at risk. - Interim funding for 2wte band 7s and 1wte admin has been made available until Options paper currently being developed which will make recommendations for future commissioning of health service contribution to MASH Options paper to safeguarding collaborative and CCG on future commissioning of health contribution to MASH - CCG/ AT/ PH agree future funding of health s contribution - Procure service Awaiting outcome of options paper Residual risk Low 34 CH / JR Statutory health Service specification Service specification with LCFT have Medium / West Lancashire CCG Risk Register 7 Update November 2014

44 BAF Theme: Delivery assessments for children looked after are not undertaken within statutory timescales and may result in the child not achieving their full potential as individual health needs not identified and addressed in a timely manner. in place with LCFT which requires them to co-ordinate the health assessment process and to quality assure assessments. S&O community paeds commissioned to undertake initial health assessments and adoption medicals for children 0-18 years Health visiting and school nursing service specifications include the requirement for services to undertake statutory review assessments. LCFT to be amended to reflect the needs of the CCG in respect of PbR Development of Lancashire wide service specification for children under auspices of multi-agency steering group re commissioning of health services for children looked after acknowledged blocks in administrative processes impacting on timeliness of assessments and action plan now in place. LCC to provide full access to their recording systems (Liquid Logic) to CLA nurses in LCFT which will improve accurate data inputting Low Contract query being issued with LCFT re uptake and timeliness of review assessments LCFT have put in place action plan to address l issues West Lancashire CCG Risk Register 8 Update November 2014

45 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G 35 BAF Theme: Delivery CH / LE Services users are potentially at risk of harm due to unlawful deprivation of liberty within hospital care home and supported living following the Cheshire West Judgement in March 2014, - Pan Lancashire action plan in place with LCC being bench marked against national plan held by NHS England - MCA/adult leads of CCGs providing training to CSU staff on DoLS CSU and S&O to be asked to provide data as to the number of patients the acid test applies to and action plan to demonstrate how compliance will be achieved - Proposal by pan Lancashire MCA implementation group to develop a CQUIN to encourage providers assessing and documenting capacity on admission to a placement - For contracts to include requirements re MCA/DOLS as standard Risk added October 2014 Residual risk Medium /High 36 BAF Theme: Delivery LC Lack of commissioning policies to drive individual patient funding decisions. Existing legacy policies being utilised Develop a new suite of policies. The CCG needs to establish clear governance arrangements for adopting polices and needs to engage in a workstream (either in conjunction with the work in Greater Preston and Chorley and South Ribble CCGs with which there is an offer of engagement, or in conjunction with county wide work being promoted by the CSU, or by designating its own officers) to develop a suite of robust and up to date policies. Risk added October 2014 Medium /High West Lancashire CCG Risk Register 9 Update November 2014

46 No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk 37 BAF Theme: Delivery PJ Provider has given formal notice to CSU (28 day standard NHS Contract) re patient on Sec 3 MHA as unable to meet patient's needs. Vulnerable patient, risk of absconding risk to self and others as well as a risk of self-harm. Provider has duty of care to patient. CSU and provider meetings taking place The CSU IPA team are responsible for placing patients on behalf of the CCG. CCG to ascertain from the CSU IPA team why there have been a delay and when will they source a more suitable placement for the patient. Risk added October 2014 Request made to the CSU IPA team in relation to this new incident. CSU have stated that they have no concerns regarding the safety of this patient but are working with the provider to resolve. Medium /High West Lancashire CCG Risk Register 10 Update November 2014

47 CLOSED RISKS Risks removed from the active register No. Lead Description Controls Score Risk Action Plan (AP) Updates Status of AP Link to BAF C L R A G Residual risk 1 BAF Theme: Operational Systems KW The Central Support Unit (CSU) do not the have the capacity /capability to ensure the CCG can fulfill statutory duties i) Regular discussion with CSU regarding the ongoing position ii) CSU seeking specialist advice to address gaps in service offer ii) CCG have contracted specialist support directly in short term Continue to manage on a week by week basis during transition Maintain contract for specialist cover in the interim Development of suite of policies. Inspections completed and reported to Audit Committee. No significant issues Regular liaison with CSU maintained. Interim specialist staff recruited by CSU for health and safety, fire and risk management. Robust CSU support now in place Development of suite of policies nearing completion Low 2 BAF Theme: Op Systems JW Impact of shortfall in recruitment to the CSU in terms of specific support posts i)good liaison with CSU regarding gaps in recruitment Continue to manage on a week by week basis When vacancies arise any short term pressures are covered Embedded team is now fully established and residual issues regarding hub functions are resolved Low 5 BAF Theme: PJ 2013/14 Financial shortfall possible due to: i) Reduction in allocation following i) Ongoing verbal assurances regarding the system wide allocation issues Regular dialogue and updates on a weekly basis Lancs wide agreement achieved regarding CCG confident of operating within budget for 2013/24 Status reduced to Low West Lancashire CCG Risk Register 11 Update November 2014

48 Contracts / Delivery redefinition of specialised services may compromise ability to meet contract costs iii) Disaggregation of budgets from CLPCT ii) Agreement with Chorley and Gtr. Preston CCGs regarding reallocation of resources allocation for 2013/14 low for this financial year 6 BAF Theme: OP Systems PJ Limit on running costs resulting in lack of flexibility to manage staff shortages in financial dept. i) Establishment is considered appropriate to meet current needs ii) Staff encouraged to work flexibly to ensure adequate cover Regular monitoring of staffing levels and capacity Examine development of matrix working to mitigate impact of staff shortages Continue watching brief Finance team fully established No current pressures status remains satisfactory Risk reduced to low For 2013/14 only Low 10a BAF Theme: Contracts / Op Systems JM Unclear system and process to ensure the CCG receives critical timely information relating to SUIs. i) Existing systems established in providers for management of SUIs. ii) Handover meetings in place Increase understanding of existing structures & systems within commissioning and providers Establish systems to ensure appropriate information flows and governance arrangements are in place Information flow arrangements agreed Chief Nurse and Quality Assurance Manager now in post Low 10a BAF Theme: Contracts/ Op Systems JM Individual Funding Request and Continuing Healthcare Requests involving WL patients (REPLACED WITH RISK 29) i) Existing systems established for management of IFRs & CHRs Ensure appropriate data is in place for IFRs and CHCs so that the CCG can appropriately monitor process and performance Information flow arrangements need to ensure adequate data regarding IFRs and CHRs. Low/ Moderate 10b BAF Theme: JM Lack of nursing input into quality, safeguarding and SUI operational systems i)development of robust quality to identify gaps ii) Regular reporting to Quality Committee of safeguarding/sui and all quality Link with Chief Nurse from neighbouring CCG to ensure links re SUIs Advertisement for additional nursing/quality posts in process Chief Nurse and Quality Assurance Manager now in post Reduce risk to low Low West Lancashire CCG Risk Register 12 Update November 2014

49 Contracts / Op Systems metrics 11 BAF Theme: Delivery/ Contracts/ Op Systems KW Ability to manage the gap in knowledge transfer during the transition process from PCT to CCG i) attendance at transition/closedown group ii) Handover meetings scheduled iii) Legacy document re. service/agency specific knowledge & contacts Maintain contacts with PCT, services and other agencies during and after transition Maintain broader overview of developments to avoid unexpected problems Issues relating to knowledge transfer have now been resolved and no new issues have been raised. Risk reduced to low Low 12 BAF Theme: KW Lack of CCG business continuity plan i) Currently linked to PCT continuity and recovery plans Develop CCG specific continuity and recovery plans in liaison with partners and stakeholders CSU Business Continuity Plan now received and both plans circulated to all relevant parties Low Op Systems 13 BAF Theme: Contracts / Delivery/ Engagem ent JW Managing the demands of the Local Area Team (LAT) regarding the performance of CCG contracted services i) Established links with LAT ii) Agreement with LAT regarding CCG Annual Plan Develop open culture with LAT regarding performance issues Ensure strong links with other CCGs is maintained Seeking to improve data around quality of GP services Continuing dialogue current relationship is very positive. Status remains satisfactory Low 14 BAF Theme: Contracts JW Possible breaks in continuity of contracted services during and post transition i) Comprehensive database of contracts in place ii) PCT support to Ongoing verification of data relating to all contracts during transition All contracts now in place and any transition issues resolved Low West Lancashire CCG Risk Register 13 Update November 2014

50 / Delivery ensure all contracts are handed over to plan 15 BAF Theme: Contracts / Delivery JW Inherited risk from PCT- Lack of governance in the Brief Therapy Support Services. i) Issues being investigated by former CL PCT CCGs CCG have fully investigated the issues. Any issues have been resolved and sound governance arrangements are in place Low 16 BAF Theme: Op Systems KW Potential impact on delivery of corporate and legal responsibilities arising from pressures on capacity. Links to No. 21 (Risk closed as relates to 2013/14) 23 CMC The Oyygen Service provided by Southport and Ormskirk Hospital Trust has a waiting list of existing patients to be reviewed i) CCG fully established with clearly defined roles ii) Matrix working principles established iii) PDP process in place iv) Informal staff and senior team meetings 1)Monthly review meetings with nurse specialist 2)Bi monthly meeting With senior team 3)Process map September 4)Review Spec in August Robust prioritization process to be developed in relation to key priorities Time management and resilience training to be developed to embed effective working practices New risk added December 2013) Prioritisation for 2014/15 needs to be progressed. 1-1 process in place. PDR process about to commence for 2014/ To continue with controls Meeting Trust to provide paper of up to date activity and risk. Moderate 20 BAF Theme: Contracts/ Delivery PJ Not achieving financial balance in 2014/15 RISK IS DUPLICATE OF 26 SO CLOSED i) Financial system to take corrective action as required Financial plan in draft Risk added Low 18 BAF Theme: MM Reduced prescribing capacity due to Lancashire Area Team (LAT) having no i) Letter sent to LAT requesting To monitor LAT s response to letter sent New Risk added Low West Lancashire CCG Risk Register 14 Update November 2014

51 Op Systems process in place to authorise practice based non-medical prescribers (NMP) to have prescription pads they establish standard operating procedures for registering new NMP with the prescription pricing division and implementin g the required checks prior to issuing prescriptions. Awaiting LAT response as at BAF Theme: OP Systems PJ Potential impact of 10% Reduction in running cost allocation from 2015/16 iv) Current position on running costs known v) Plan for 15/16 being prepared Plan for 15/16 being prepared Cost allocation plan being prepared for 2015/16 Risk removed as incorporated into Risk 25 Low/ moderate 4 BAF Theme: OP Systems/ Engageme nt KW Limited GP capacity to the CCG results in increased management costs and/or limited involvement in local meetings and groups i) Specific GP portfolios supported by CCG managers ii) Planning of GP engagements to ensure maximum benefit for CCG Planned improvements to communications pathways to improve efficiency, Ongoing development of engagement strategy will target better use of GP capacity Continue watching brief Planned improvements to communication pathways to improve efficiency. Ongoing development of engagement strategy will target better use of GP capacity Low/ Moderate 9 BAF Theme: Engageme nt MM (KW) Ongoing pressure from MPs and interested parties to provide information Websi8te & Media Coverage. Public Board Meetings & joint networking. Patient Participation Groups Patient Focus Groups My View Group Co-ordination of information flow between key stakeholder groups needs improving Additional target group contacts obtained via AGM and ongoing engagement work. Contacts continue to be gathered for the stakeholder database. Moderate West Lancashire CCG Risk Register 15 Update November 2014

52 30 BAF Theme: Op Systems PK Lack of approval/ implementation of an IM&T Strategy IM&T strategy agreed in principle by CCG. Strategy has been circulated to partner organisations. Each member practice has an agreed programme plan To review all feedback from circulation of Strategy with partner organisations prior to full implementation. Strategy being presented to governing body for formal adoption in November. Risk added July 2014 Moderate West Lancashire CCG Risk Register 16 Update November 2014

53 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: WLCCGB 11/14/09 TITLE OF REPORT: BRIEFING POINTS: West Lancashire Clinical Commissioning Group IM&T Strategy The IM&T strategy is ambitious and if successfully implemented will enable the transformation of care for patients in West Lancashire. The governing body is asked to approve the strategy. Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact Yes Improving the quality of patient services by helping to integrate patient care by using technology to integrate information flows across organisational boundaries. 2. Commissioning of hospital and community services please outline Yes impact This report links to the CCG s wider commissioning strategy and describes the IT enablers that are required to support integrated care going forward. 3. Commissioning and performance management of GP Prescribing No please outline impact 4. Delivering Financial Balance please outline impact Yes IM&T is a key enabler in delivering system wide change across the health economy which is required to deliver financial sustainability 5. Development of the commissioning group as a commissioning No organisation please outline impact B. Governance please outline impact 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk Yes number) have any legal implications promote effective governance practice.yes, Risk No.30, lack of approval of formal IM&T strategy. 2. Additional resource implications (either financial or staffing resources) The resource requirement to deliver the strategy going forward is very much part of the wider approach to health-economy system wide change and financial sustainability. The IM&T component is integral to multi-stakeholder planning. 3. Health Inequalities No IM&T Strategy West Lancashire Clinical Commissioning Group Board Meeting 25 November

54 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement Yes Clinical engagement is key to delivering the IM&T strategy. 6. Patient and Public Engagement Yes This IM&T strategy is a key enabler in delivering integrated services for patients. REPORT PREPARED BY: Chris Russ, IM&T lead, NHS West Lancashire CCG. IM&T Strategy West Lancashire Clinical Commissioning Group Board Meeting 25 November

55 Information Management and Technology Strategy 2013 to 2015 For WEST LANCASHIRE CLINICAL COMMISSIONING GROUP 1 P age

56 Document History Title Information Management and Technology Strategy Lead Chris Russ (Russ Consulting Ltd) Version FINAL 1.0 Date June 2014 Refresh Due April 2015 Client On behalf of West Lancashire Clinical Commissioning Group West Lancashire Clinical Commissioning Group 2 P age

57 Executive Summary IM&T (Information Management and Technology) is a key enabler for the delivery of our Integrated Commissioning Plan Our Integrated Commissioning Plan describes 11 clinical programmes which IM&T must underpin and enable. Delivery of these programmes will help ensure that the key points within our CCG Vision listed below are met. Providing best possible safe care Improving integration and collaboration Improved health and healthcare Better use of resources In reviewing the clinical programmes and developing this strategy we have identified six IM&T programme areas which include: 1. Consistent use of IM&T across all member GP practices in West Lancashire 2. Improved sharing of patient records to underpin transformation and Care Closer to Home 3. Improved use of technology to support patients with Long Term Conditions 4. Business Intelligence to support commissioning decisions 5. Improving Communication and Collaboration 6. Ensuring the CCG has access to the latest innovative and most cost effective IM&T services For each of the identified programme areas we have stated what needs to be delivered and the commitments we are making. The programme areas are shown within the table on page 7 to underpin the vision of the CCG. Successful implementation of this strategy is linked to a number of critical success factors: 1. Our ability to gain commitment to this strategy across the wider economy 2. That there is clear recognition that through planned investment the right project outputs can be delivered which will enable the benefits of the clinical transformation programmes to be realised 3. That the right programme governance is in place to integrate IM&T and clinical programme delivery. 4. That the right skills and capabilities in particular in the areas of Programme and Project Management are available to deliver this ambitious programme. Of significant importance is the recognition that the patient is at the centre of everything we do and the improvements that we plan to make rely so heavily on having access to the right information at the right time and in the location where care is being delivered. This strategy is about improving information flows, enabling and empowering clinicians, patients and carers alike to have the information needed to make better more informed decisions. We will do this by continuing to listen to our stakeholders, exploiting the latest technologies available and working only with those suppliers who are committed to helping us deliver our clinical priorities. 3 P age

58 Our vision for IM&T The West Lancashire CCG like all CCGs across the country faces significant challenges. With an increasing population and more people living longer, many of whom have Long term conditions the pressures that we face are significant. Added to this of course is the need to reduce cost, and improve the quality of the outcomes delivered to our patients. Achieving all of this required us to re-think how health and care services are provided. Our Integrated Commissioning Plan Programme Refresh sets out a portfolio of work containing 11 programmes designed at addressing three priority areas: 1. Right Care, Right Time, Safely Delivered 2. Preventing people from dying prematurely 3. Integrated working for better patient experience, safety, quality of life and reduced inequalities Our work will result in a significant transformation in the way services are delivered many of which we intend to deliver closer to home ensuring that those patients in hospital, belong there. Many of our patients can be treated far more cost effectively outside of a hospital environment and benefit from faster recovery and better outcomes. This programme of work and our vision for health and social care can only be achieved if our IM&T systems and services are truly aligned and we embrace innovation connecting not just the NHS, but patients too, in order that they can play an important role in the management of their conditions. Information Management and Technology (IM&T) is fundamental in helping us run the business of commissioning health care services. We need effective and reliable IM&T systems: To provide an efficient commissioning service. To improve connectivity and sharing of patient records with clinicians and with patients to deliver better outcomes and improve quality. To gather intelligence about the health needs of our patients and the wider public to help ensure that our budget for health care provision is appropriately used To understand what is working and what is not. By gathering this intelligence we can redesign pathways of care around patients needs to deliver better outcomes. Our vision for IM&T and our belief of what needs to be in place can be achieved if all partners truly collaborate to ensure through an integrated Programme Management approach we align our IM&T and transformation programme. Mike Maguire (Chief Officer) John Caine (Chair) 4 P age

59 A Clinical View As a GP working in general practice I see first-hand the issues that impact on the quality of care we provide to our patients when IM&T systems fail to work in the way we should expect. For many years now the NHS has been describing its vision for connected systems and seamless patient care, and yet still within the NHS we struggle to get to the point where we can access what we need efficiently, and at the time we need it. In a world where outside the NHS everything is connected and available to us on any device we choose I find it remarkable that within the NHS we are so far behind. Equally though I understand why this has been the case and what we must do to change the status quo. In general practice we spend too much of our time dealing with the frustrations of system performance which causes significant issues when you have back to back 5 minute telephone consultations and need fast access to the patients record to review and update. Additionally when our patients go into hospital, it can be weeks before we receive a discharge summary/letter that tells us what happened to the patient during their stay and the medications that have been prescribed. Patients frequently book appointments after their hospital episode and are amazed that we don t have any information from the hospital about them. Our strategy for delivering Care Closer to Home and for involving patients in the management of their own condition requires a connected service across all spectrums of health and social care. Achieving this requires clinical decision support systems to be in place with readily accessible pathways to help clinicians and patients navigate a complex health and social care system. Without these many of our good intentions will fall by the wayside. We are committed to supporting and maintaining safe, localised and evidence based pathways that are readily accessible to both patients and clinicians. To achieve this will require a change in culture and acknowledgement that the decisions we make should be focussed on what needs to change to improve the health and wellbeing of our patients. As we begin to transform the care we deliver through pathway re-design, we need to ensure that across the economy we have a clear understanding of the information flows needed, and how through system design we will achieve this. This will require all of our main providers to agree on what needs to be built, the priorities and the phasing of that work and for our provider of IM&T services to recognise this and represent our needs. This is fundamental to the successful delivery of our commissioning priorities. Recognising this and taking immediate action will be a big step forward, but in moving this agenda on we need to be constantly looking at innovative ways of using technology to improve health and social care. Dr Bapi Biswas GP Executive Lead and Clinical Lead for IM&T 5 P age

60 Contents Our CCG vision enabled by IM&T... 7 Our Priorities for IM&T... 8 IM&T PROGRAMME Consistent use of IM&T across member practices in West Lancashire IM&T Programme Improving the sharing of patient records to underpin transformation and Care Closer to Home. 12 Information Sharing Conceptual Model (Subject to change) IM&T Programme Improved use of technology to support patients with long term conditions IM&T Programme Business Intelligence to support commissioning decisions IM&T Programme Improving Communication and Collaboration IM&T Programme Embracing innovation and cost effective IM&T Services Implementing this strategy Appendix GP Programme Benefit Identification Appendix CMDI Clinical Digital Maturity Index for Southport and Ormskirk Hospitals NHS Foundation Trust Appendix High Level Programme Gantt chart Appendix Glossary of terms P age

61 Our CCG vision enabled by IM&T Our vision is to commission the best possible care for our local population and to empower people to be in control of their own health and healthcare services. We will do this by working with local people, our partners in West Lancashire and those partners outside of the geographical footprint to make effective use of resources. The core strands of our vision are: Best possible, safe care Improve integration and collaboration Improve health and healthcare Make better use of resources The table below maps the technology programmes described in the sections of this strategy to the core strands of the CCG Vision. It is clear from the table that each programme contributes to the delivery of the CCGs vision for integrated commissioning. Consistent use of IM&T in General Practice Improved sharing of patient records Technology underpinning Long Term Conditions Business Intelligence Improving communication and collaboration Accessing innovation and cost effective IM&T services Best possible safe care Improve integration and collaboration Improve health and healthcare Make better use of resources Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins Underpins 7 P age

62 Our Priorities for IM&T Having reviewed our commissioning priorities and plans and discussed IM&T requirements with clinical and functional leads across the West Lancashire CCG, we have developed our understanding of the IM&T requirements which need to be addressed to support the business, clinical and transformation processes within the CCG. The diagram below categorises our priorities for IM&T and has been used to determine our IM&T programme for the next 2-3 years. Embracing innovation and cost effective IM&T Services Consistent Use of IM&T across all member GP practices in West Lancashire IM&T Improved sharing of patient records to underpin transformation and Care Closer to home Improving Communication and Collaboration Business Inteligence to support commissioning decisions Improved use of technology to support patients with Long Term Conditions The following pages describe each of these priority areas, and what is required from Information Management and Technology and the commitment that we are making. Information Governance Much of what we do involves the handling of patient data. It is a legal requirement that access to and use of data is appropriate. As we deliver this strategy and more data is shared electronically we will ensure that the necessary safeguards are in place. The CCG will ensure that on all projects involving the use of sensitive data, appropriate privacy impact assessments are carried out and that all stakeholders including the LMC and patient and public groups are consulted. Furthermore we will 8 P age

63 ensure, through compliance with the National Information Governance Toolkit that we continually work towards improving controls and reducing risks associated with the handling and processing of sensitive and personal data. A balance has to be struck between meeting rigorous IG controls and the need to not delay projects that will impact significantly on the improvement and safe delivery of patient care. In taking forward this programme we will ensure that IG is never seen as an obstacle and will work pragmatically to address IG requirements. 9 P age

64 IM&T PROGRAMME 1 Consistent use of IM&T across member practices in West Lancashire Prior to the establishment of CCGs, the PCTs were responsible for the delivery of IM&T Services to General Practitioners. The CCG now holds the budget for General Practice IM&T. It has a responsibility to work with its member practices to ensure that the budget is spent wisely and in areas that will improve practice efficiency and productivity and support the technology requirements necessary to ensure that the CCG goals are met. Essentially this means: Understanding and responding to the pressures within general practice and delivering IM&T solutions that offer true efficiency savings making practices more productive in the management of their patients. Supporting the requirement to gather business and clinical intelligence from across the Health Economy from all operational systems including those in General Practice. Working to connect all provider systems to ensure important and relevant clinical data about patients is available across all care pathways at the point of need. Delivery will be complicated by the fact that the 22 practices within West Lancashire are at varying stages of maturity. We are making a commitment through our GP IM&T programme to address the levels of variation as we know that data quality, coding of patient records, clinical system and referral patterns vary between practices. We will work to ensure that all practices have access to and are consistently making use of version controlled templates in order to ensure that data collection is standardised. We will also work with practices to ensure consistent use of the referral gateway as this will enable a rapid triage of referrals and will compliment improved usage of our tier 2 services. The table overleaf sets out the IM&T projects that impact all practices, some of which are nationally mandated, others are a local requirement. The projects and initiatives have been categorised into 4 groups: Sharing Patient Data Infrastructure Business Intelligence Practice support At the time of writing this strategy, our performance is poor against nationally mandated project such as: Summary Care Records Electronic Prescription Service R2 Patient Access The CCG aims to drive forward these projects over the next 12 months ensuring that the benefits as set out in appendix 1 can be realised. Of significant importance also is the need to progress to improve across the economy electronic clinical messaging between our main provider trust, and general practice. 10 P age

65 Sharing Patient Data Infrastructure Business Intelligence Practice Support Summary Care Records Migration to EMIS Web Risk stratification Compliance with the National IG toolkit Electronic Prescription Service R2 VoIP Telephony Urgent care dashboards Achievement of data accreditation standards Patient Access to GP Records Practice connection to COIN Network Practice level benchmarking Data Quality training and support Electronic Referrals (Referral Gateway) Scanning solutions in place and embedded into business processes Access to locally agreed pathways (use of Map of Medicine) Clinical Messaging (Radiology, Pathology, Discharge Summaries) Access to patient records on the right device with the ability to prescribe and order test results on the go Electronic Ordering of tests and results reporting Patient access to book an appointment with a GP or practice nurse Access to diagnostic imaging (Where required) Clinical System Integration with provider organisations GP IM&T Programme Categorised Projects The projects above will deliver a range of benefits for a number of stakeholders including our patients. We aim to work with our IM&T provider to build a stepped approach to delivery to ensure that all practices implement the key initiative at the same time in order to maximise to opportunity to realise benefits early and to ensure that no practices are left behind. We will work across all practices equally to ensure that the benefits identified at practice level are realised through correct alignment of technology with current/newly formed business processes and that all practices will receive the necessary required level of change management support throughout the delivery of this programme. The table in appendix 1 provides for the projects a sample of the benefits that practices should gain from these projects. In addition the table shows the overall time period when we would plan to have each of these project completed by. Our commitment We are committed to delivering this programme and will ensure that we work collectively with all practices to embed the technology through carefully planned change management in order to achieve maximum benefit for the health economy as a whole. By the end of May 2014, we expect to have agreed a dossier of projects for each practice across West Lancashire aimed reducing variation of IM&T use, the delivery of which we will monitor through our Project Management toolkit. 11 P age

66 IM&T Programme 2 Improving the sharing of patient records to underpin transformation and Care Closer to Home An electronic record enables coordination of care across different points of access to care, across in- and out-of-hours services, and ideally also permits the patient to have direct access to the information 24/7. If true integration of care is to be possible, such records should include community pharmacists, community health services and social care. This would need to be achieved through the collaboration of NHS England, CCGs, commissioning support units and others Securing the future of General Practice New Models of Primary Care - July The question for us as a CCG has been, how far away are we from achieving this and what will it take to get to this state? What is clear is that if we are truly going to deliver improved care, better outcomes and a better patient experience we need to be taking big steps. The NHS has been talking about Electronic Care Records for over 10 years with a number of national initiatives such as Information for Health and the National Programme for IT being established to deliver them. Supporting patients with Long Term conditions and ensuring that throughout their care, those treating them have a full history is vital. There needs to be a cultural shift away from maintaining islands of information to one which puts the patient right at the centre and ensures that wherever he/she goes, their electronic notes follow. Where are we now? The current state is set out below: Computerisation in General Practice is good with all GPs maintaining electronic records for all of their patients and most using EMIS Web Our main provider of both hospital and community services, the Southport and Ormskirk Hospitals NHS Trust also known as the ICO (Integrated Care Organisation) does not currently score well on the CDMI (Clinical Digital Maturity Index) which is a benchmarking tool that focuses on the adoption of electronic patient records and related digital healthcare technologies at NHS acute trusts. The ICO is ranked 133rd of 160 trusts (See appendix 4) Our main provider of both hospital and Community services Southport and Ormskirk Hospitals NHS Trust is preparing for the implementation of an electronic patient record system from McKesson. The Community Services arm of the Trust presently uses the IPM patient administration system from CSC for recording activity and reporting purposes. There is no integration between this and systems in use in primary care. There already some sharing of electronic information across Primary and Community Care, work is underway to share primary care data from EMIS web with services such as A&E, 12 P age

67 Diabetes, Out of Hours (OOH) and within the hospital pharmacy, our main provider the ICO will continue to deploy to other services including palliative care. Data sharing generally between the ICO and Primary Care is a mix of paper and electronic messaging, the latter having limited progress. Other provider trusts such as Lancashire Care who are our provider of Children s services and Mental Health services having their own separate systems that are also separate. The Summary Care Records project and other national initiatives like the Electronic Prescription Service have not progressed. Impact on our plans to deliver Care Closer to Home Our strategy and our plans to deliver care closer to home requires us to connect our islands of information to ensure that information freely flows to those who need it and are authorised to access it. The diagram on page 14 provides a conceptual model of what it is we are aspiring to build. As we engage with our partners the approach we take to delivering in the information flows might be subject to change. The present state of delayed discharges summaries, paper flows, and duplication of effort has to stop if the reforms that we have planned are going to make a real difference to patient care and are going to enable us to deliver greater capacity in a system demanding more. Our Commitment The sharing of patient information with those involved in patient care is critical to transforming care and improving patient outcomes. This cannot be delivered without significant improvement to the current information flow prevalent in the NHS today. There have been many nationally reported deaths of children resulting from the failure to share information and yet GPs still do not automatically get notified if a child is added onto the child protection register. We will commit to 1. Implemention of an accessible Summary Care Record. 2. Implement capabilities to receive using electronic workflow, electronic discharge summaries and radiology/pathology results reporting into General Practice 3. Create the capability for all practices to electronically order tests 4. Implement release 2 of the Electronic Prescription Service 5. Provide the capability for Patients to access their own Primary Care Records 6. For those services who require access to PACs images we will work with the ICO to deliver this. 7. Reach agreement across the economy about the software to be used across Primary and Community Care and establish the programme management arrangements to implement ensuring alignment to our clinical transformation programmes. 8. Review and develop our systems and processes for communicating information about Children at Risk. 13 P age

68 Information Sharing Conceptual Model (Subject to change) Patients And Public Southport & Ormskirk ICO Using Will have access to Information Portal Tele-Health Tele-care Remote Consultations Community Care Service Delivered Closer to Home WILL Book GP Appointments Order Repeat Prescriptions View their Record Update parts of their record Primary Care Community Integrated Neighbourhood Teams using EMIS Community Patient/Client Record Integration Social Care & AQP Electronic Transfer Of Prescriptions from GP Access to Urgent Care Record/SCR EMIS WEB GP Access to Urgent Care Record/SCR ICO using McKesson Electronic Patient Record Sends Pathology/ Radiology Results and Discharge Summaries Electronically GP Orders Tests Electronically GPs Can access PACS Images Connected via COIN 22 GP Practices Connected to COIN Information Sharing across Primary, Community/Acute Electronic Messaging NHS OOH Integrated Record Electronic Care Plans Core Personal Profile EPACS Business Intelligence To support Commissioning and Improved care Data Warehouse OTHER Providers i.e WWL Lancs Care; GMW 14 P age

69 IM&T Programme 3 Improved use of technology to support patients with long term conditions. The vast majority of our programmes set out in the NHS West Lancashire Integrated Commissioning Plan relate to people with Long term Conditions (LTCs). With the right technology in place we know patients living with a Long Term Condition can be managed much more effectively within the community and closer to home. With the right technology in place we know we can prevent unnecessary admittance and re-admittance to hospital. We also know that by involving patients in their own care and educating them about their condition and how to manage it, better outcomes are delivered that are more cost effective allowing us to make better uses of our limited resources. This strategy has already referred to the need to share patient information across all care settings and we have described the steps we are taking to achieve this as this is clearly essential to supporting the management and self-management of patients with Long Term Conditions. However other technologies are available and emerging that will also contribute to improve outcomes and better quality of care for our patients. The diagram below shows areas of long term conditions management that will be underpinned by Information Management and Technology. End of life and palliative care Prevention/Staying Healthy Supported Management Self Management Assisted Management 15 P age

70 Prevention and Staying Healthy We will use information communications technology including social media to: Promote healthy weight and healthy eating Raise awareness of factors that can lead to long term conditions Signpost patients and the wider public to area where they can get support to reduce or stop smoking and to reduce drug and alcohol intake. We will use our Clinical and Business Intelligence to: Identify people at risk to allow early diagnosis of Long Term conditions. Self-Management For people who have to live with a long term conditions self-management is an important part of their daily lives enabling them to have a better quality of life and be more independent. Selfmanagement is about offering individuals the right information and support at the right time and empowering them to take a more active role in their health and well-being. Technology plays an important role in this and we will work to further develop our information communications technologies to: Provide information to our patients on their medication, what it does and how and when to take it. Help patients understand more about their condition, the risk factors and treatment options linked to their conditions. Provide links via the West Lancs CCG and GP web sites to an information portal containing a range of information and support available to make living with a long term condition easier. Assisted Management At some point all patients with long term conditions will require assistance, some more than others depending on the type of condition they have. Most assisted management received from within Primary Care includes practice check-ups and condition reviews which aim to help people avoid complications and slow down disease progression. Through a process of personalised care planning, which will involve patients in decisions about their treatment, will empower people with LTCs to plan their care, and have strategies in place to cope with any exacerbation of their condition. There are a number of ways in which Information Technology can underpin this process. We will ensure that: By enabling the sharing of patient records across care settings, clinicians and patients alike will be able to share, discuss and plan the stages of their care. We will exploit the opportunity to use where this is relevant assistive technologies such as Telehealth which monitors remotely patient s vital signs and Tele-care which provides sensors and aids for use in a patients home. Both of these technologies have been shown through National Demonstrator Programmes with some work already underway locally to be effective in supporting patients with LTCs to live more independently, reduce the number of admissions to emergency care and also mortality rates. As we re-design how care is delivered in each of our 16 P age

71 programme areas, we will consider the case for a wider adoption of tele-care and tele-health solutions. Supported Management Patients receiving supported management for their LTC have complex needs and are extensive users of health and social care services and also present the highest risk of hospital admission. Care provided is generally intense to prevent hospital admission by providing care in the person s home or within a community setting. Due to the number of providers involved in the case management of patients with supported management it is essential that care is co-ordinated effectively to ensure the best outcomes and quality of care is delivered. The use of Information Management and Technology is an essential component in achieving this. We will work to ensure that: We understand through data that we hold and the use of Risk Stratification tools, who the patients are that require supported management and ensure that they are all appropriately case managed. As with our approach for patients needing Assisted Management we will continue our use where appropriate of assistive technologies such as Tele-health and Tele-care. Explore the potential for using technologies to support remote consultations to avoid unnecessary travel and to increase care provision. We develop in partnership with our providers an improved state of information sharing through the development of Integrated Electronic Care Records and use of other communications technologies. End of Life and Palliative Care End of Life and Palliative Care is aimed at achieving the best quality of life for users and their families facing the problems associated with life threatening illness and to help patients live as well as possible until they die. It is essential at this stage that the patient and their carers are clear about how and where treatment should be delivered to ensure patient s wishes are respected and their dignity is maintained. We will aim to ensure as a priority that we have in place through the use of technology A complete list of all patients receiving End of Life and Palliative Care That co-ordinated care for patients receiving End of Life and Palliative Care is in place Systems are in place to store details of care being received, those involved in the care of the patient and the patient s wishes concerning their ongoing care and where this should be delivered. 17 P age

72 Our commitment Managing Patients with Long Term conditions is a complex process and one which requires a significant degree of care co-ordination. The use of Information Technology is a key enabler in supporting patients with long term conditions no matter what stage or how progressive that condition is. This is an area of significant priority for us as it is key to delivering improved outcomes for our patients. We are committed to: Using and developing our Business Intelligence Capabilities to know: The members of our community who are at highest risk of developing a Long Term Condition in order that we can work with them to reduce the risk Who our patients are with Long term conditions and are their conditions being managed appropriately The patients who would benefit from expanding our use of Assistive Technologies such as Tele-care and Tele-health. Which of our patients are receiving End of Life and Palliative Care and how effective are we at meeting patient s wishes. Reviewing our communications technologies to ensure: Patients and carers have access to the right information about their Long Term Conditions They understand their condition, treatment options and how best to manage their condition to live as normal a life as possible Developing Integrated Electronic Care Records and improving the flow of information to ensure: All Health care professionals involved in the treatment of a patient with a LTC can get access to their patient records to ensure that at every intervention, the right treatment is provided. For patients receiving End of Life and Palliative care, their records and wishes are known to all of those individuals/organisations who may be involved in their treatment. Exploiting innovation Assessing how we can use technologies such as SKYPE to deliver remote consultation in order to improve capacity and access for patients Learning from both home and oversees where mobile apps and other technologies can play an important part in areas such as self-management. 18 P age

73 IM&T Programme 4 Business Intelligence to support commissioning decisions The West Lancashire CCG relies heavily on Business Intelligence to make a range of commissioning related decisions. The CCG presently receives a Business Intelligence service from the Staffordshire and Lancashire Commissioning Support Unit (CSU). The CSU provides a range of standard reports covering: Commissioning Finance Contract Management Performance Management Quality Pathway and Service Redesign In addition to receiving standard reporting services from the CSU we also have access to the CSU Data Cube enabling us to run our own level of analysis and to develop our own performance reports and dashboards. What we need to know The diagram below sets out a cycle of high-level questions that we should need to be answering. We need to ensure that we have the right intelligence in the right format to be able to answer these and support core functions that the CCG has responsibility for. We also need to have confidence in the data and intelligence we receive, something that presently we have concerns about. How Healthy is the population? What are our future plans? What is happening in the system - Quality of Care and Outcomes? What difference have we made to the health of our population? Commissioning questions that We need Business Intelligence to support How much it it costing and are we making the best use of resources? How could we do things better through service and pathway redesign? Are the CCG provider delivering what they agreed? How do we compare with other & are we following best practice? 19 P age

74 Many of the questions in the above model help us to determine what needs to be fixed or improved, where the pressures are in the system and how effective our providers are at delivering care. The CCG has used this gathered intelligence to help shape the 11 programme areas that we are now delivering against. Our vision for BI is that we should not be more that 3 clicks away from getting access to the intelligence we need with further capability to data mine to understand why things are as they are. This capability needs to be delivered at desktop level both within the CCGs and to all practices. We have identified specific areas where we need to make improvements, areas that enable us to keep our finger on the pulse and control over what we are doing: Integrated Business Report (IBR) We presently receive and have available access to a lot of data which we use to populate our Integrated Business Report a report which is produced monthly and presented to the CCG Executive team and Board. The report covers many areas of CCG business including: Financial position including performance against QIPP Planned Care Referrals Planned Care: Acute Contract Unplanned Care: Acute Contract Lancashire Care Foundation Trust Activity Quality and Performance Complaints Serious Untoward Incidents The report is assembled from a variety of data sources and is approximately 30 pages long. The production of this report takes a large amount of time to produce and involves input from a number of people from across the CCG. The more we can automate the production of the intelligence we need at the time we need it the leaner we can become in our decision making. Commissioning and Project Management Toolkit The Commissioning and Project Management Toolkit sits at the centre of our delivery and is used to ensure minimal variation in how we develop and transform clinical services, ensuring that the best approach and standards are used consistently. The toolkit also allows us to track performance on all of our schemes and monitor the impact our work is having on reducing cost, improving efficiency of delivery, quality, and outcomes for our patients. This is a critical business intelligence tool for us and one which we need to continually develop the use of as our commissioning plans develop. 20 P age

75 Our commitment We are committed to ensuring that we have the right information at the right time to make the right decisions, this means taking stock of everything that we currently have available to us and reviewing our needs to ensure that they are being met: We aim to: Ensure that every practice across West Lancashire has the capability and is able to stratify their patients, to identify those patients that require the greatest levels of support and are high risk to ensure that they are on an appropriate care plan and being managed appropriately for their condition. Work with our CSU to ensure that the appropriate data quality and data validation checks are undertaken to build our confidence in the data we use to gather our business and clinical intelligence. Work with our member practices and our Commissioning Support Unit to ensure the right tools are in place to maintain our knowledge of the health needs of our population to: o Slow down the development of Long Term Conditions o Ensure we know who are patients are with Long Terms conditions and ensure that they are receiving the best care in line with our service transformation plans. Review our use of the integrated performance report and identify opportunities to: o Automate/Semi Automate its production o Develop a fully electronic version with capabilities to data mine. o Introduce exception reporting capabilities Develop our capabilities to more effectively monitor performance against the Alternative Quality Contract. Develop within the CCG wider capabilities and skills and tools to report on the data we have access to improve further our analytical capabilities Improve the use of the Commissioning and Project Management Toolkits across the whole economy to be able to track progress on the delivery of all of our business and service transformation schemes ensuring planned benefits are being delivered to time. Develop the capabilities of the toolkit to: o Enhance through the use of Dashboards our capability to see what is delivering and what is failing to deliver in order that programmes can be reviewed and reassessed at an early enough stage to bring back on track to deliver, or terminate if they are failing to deliver the expected outcomes. 21 P age

76 IM&T Programme 5 Improving Communication and Collaboration West Lancashire CCG works closely with a wide range of stakeholders. We need to ensure that we are able to exploit the capabilities of Information Communications Technology to ensure that messages and information we need to share can be done in an efficient way. Communicating with Patients The CCG makes good use of its internet and website capabilities for providing information to the public enabling them to interact with us in a number of ways. It is clear from the work that we do in particular around the management of patients with Long Term Conditions that communications technology is vital. The technologies that our patients use today and their expectations of service providers of which the NHS is one, have grown significantly. We need to ensure that our patients when in need of our services know what is available to them, this applies to those patients who occasionally need our support and those who are regular users, patients who in the main are older or who have Long Term Conditions, an increase of which we are seeing now in the younger generation. Given the diversity of these groups, it is essential that we have a blended approach, whilst one generation might be more comfortable communicating with the NHS in what might be described as a traditional way another and in the main younger generation will expect technology to play a central part in their interaction with the NHS, it is this area that we wish to develop to support disease prevention and self-management of Long Term Conditions. Sign posting our patients to advice on health related matters and where to get support for helping patients to play an active role in managing and controlling their condition is a priority for us and a key enabler in our strategy for the management of patients with LTCs and delivering care Closer to Home. Communicating with our partners There is a great need within the CCG to ensure that we have in place an efficient way of working with our core partners, in particular our GPs, our providers and the Commissioning Support Unit. As we begin to work collaboratively on a range of projects we need time efficient technologies deployed to make us more productive. We are aware that the CSU has been developing the use of SharePoint and Unified Communications both of which we see value in. Equally the use of SharePoint to deliver business intelligence across the CCG and to GP practices would be a significant leap forward. 22 P age

77 Our commitment Improving internal and external communications by exploiting available technologies will serve to deliver a range of benefits to patients, commissioners and our member GP practices. For our patients we will commit to: Exploiting the use of technology where there is an obvious benefit. Technology developments we are considering will include: o The use of Skype for GP consultations o The use of mobile/tablet apps for communicating with your GP i.e. Ask your GP o Apps linked to tele-health solutions for patients with long term conditions o Prescribed apps for diagnosed long term conditions that are linked to a single patient information portal o The ability to book an online appointment or request a repeat prescription either via the web or through a mobile app o Increased use of other forms of social media to keep our patients updated about health care, healthy living, disease prevention etc. Internally, we will commit to: o Improving the use of SharePoint to communicate more effectively with our GP member practices and our CSU o Ensuring that through the use and adoption of SharePoint as our document repository it support the ability to work more flexibly at any location and on any device. o Exploting the use of unified communications to support clinical and operational productivity 23 P age

78 IM&T Programme 6 Embracing innovation and cost effective IM&T Services The CCG needs to achieve significant cost savings over the coming years whilst delivering high quality care and improved outcomes for our patients. It is therefore important to us that we get best value from all of the services we procure from the Commissioning Support Unit. IM&T is no exception and is clearly seen as a key enabler in improving the efficiency of health and social care delivery in West Lancashire. Our investment in IM&T is high. We will therefore ensure that we will work openly with our Commissioning Support Unit, the Southport and Ormskirk Hospitals NHS trust and other stakeholders, to ensure that our investment is well made. We will do this by ensuring that IM&T investment is not wasted and is correctly aligned to our vision for transforming the care system in West Lancashire. Our expectation from our investment in IM&T is high. We need to capitalise on innovative technologies, learn from others and innovate. Our commitment This IM&T Strategy is challenging and sets out what we need to underpin our commissioning and service transformation programmes. This strategy goes beyond the implementation and maintenance of current IT infrastructure and introduces some real business change challenges. In order to address these we will commit to working collaboratively with our IM&T service and our health and social care providers to ensure through implementation design that we have in place the capacity and capability to deliver. 24 P age

79 Implementing this strategy This strategy is, ambitious and if successfully implemented will enable the transformation of care for patients in West Lancashire, therefore we cannot afford to fail in delivering this strategy. Delivering this strategy requires a robust Programme Management approach to ensure alignment with our clinical programmes set out in the NHS West Lancashire Integrated Commissioning Plan. We do not propose to put in place a separate governance model for taking this work forward. Instead it is our intention to review what is presently in place to support the delivery of the clinical programmes across the economy and ensure that the projects set out within this strategy are aligned to each of those individual programmes. Clearly there will be common areas of need such as integrated care records which will necessitate a need for each clinical area to review and map the information requirements in order that the right solution can be provided to meet that need. We expect that additional resources over and above what are presently offered by the CSU will be needed, in particular to support business change and to co-ordinate the delivery and alignment of the IM&T programme across the respective clinical areas. Implementing appropriate controls As with our clinical programmes we intend that the delivery of the IM&T portfolio of projects will be monitored and controlled through the Commissioning and Project Management toolkit. Our commitment To ensure that the IM&T projects and their output are embedded into the exisiting governance arrangements that underpin our wider transformation programme. 25 P age

80 Appendix 1 GP Programme Benefit Identification 26 P age

81 GP Programme Benefit Delivery It should be noted that the benefit shown in this table are some of those that can be expected to be delivered. A full set of benefits for each project will be provided to GP Practice as individual Programme Plans are constructed. Sharing Patient Data Project Benefits to the practice Expected time to deliver Summary Care Record Our patients are seen safely by those we refer to Reduced phone calls to the practice from clinical staff in all provider settings asking for medication history When working on call i.e. OOH, we will have access to patient history for those patient unknown to us If our patients are suddenly taken ill and rushed into hospital, the receiving hospital will be able to access vital information including a summary of their care record, this will help to ensure our patient are treated safely and good outcomes are delivered. April 2015 Electronic Prescription Service Reduction in practice workload from patient requesting and collecting prescriptions, by use of the repeat prescribing service Increased productivity for GPs who can sign electronically individual prescriptions or groups all at once GP has greater control as he/she can cancel a prescription up to the point they are dispensed should it be realised that a mistake has been made Where a practice operates a prescription collection service staff will no longer need to sort or post prescriptions saving both time and resources. Reduced number of queries from the dispenser. April P age

82 Sharing Patient Data (Cont.) Project Benefits to the practice Expected time to deliver Patient Access to GP Records it improves relationships between practices and patients April 2015 it helps patients feel more in control of their conditions it improves outcomes and supports patients in using health services less Enables the patient to have access to letters and test results Creates the capability for patients to order on line repeat prescriptions. it enables patients to improve the accuracy of the record reduced requests from patients for their basic health information Electronic Referrals (Referral Gateway) Greater Efficiency in the handling of referrals Greater security when transferring clinical data Appropriate use of templates will ensure the trust receives a standard set of information Integration with clinical system improving productivity, speed and reducing the potential for error. Improvements to patient safety and the quality of care. June 2014 Clinical Messaging Greater Efficiency in the handling to test results, discharge summaries and clinical letters which combined with practice workflow systems can embed the information into the patients clinical record Less paper to deal with. Faster delivery of clinical correspondence Reduced potential for data to be wrong Improvements to patient safety and the quality of care. June 2014 (To Be agreed with S&O GP side ready to accept messages) 28 P age

83 Sharing Patient Data (Cont.) Project Benefits to the practice Expected time to deliver Electronic Ordering of Tests Template driven and linked to practice system reducing June 2014 potential for error Can automate the form filling process and thus deliver productivity savings. Faster safer way of delivering test requests Using barcodes to match samples with test forms the potential for false reporting is reduced significantly Improved quality of care experienced by the patient Access to diagnostic imaging Can help to explain a diagnosis to a patient September 2014 Can help to ensure that the patient receives the most appropriate care possibly in a community delivered service rather that within a hospital trust. Can support more effective case conferences Clinical System Integration with provider Ensures patient notes follow the patient and are available December 2015 organisations at the point of care Improved safety of care Presents and joined up NHS to the patient and reduces levels of stress in patients. Faster treatment and increased productivity Improved confidentiality, less of a risk of patient notes going missing More effective communication between clinicians operating out of different care settings Migration to EMIS Web No need for practice backups Faster response to system issues as supplier are on top of issues before they hit the practice Reduces the risk of data loss from practice server theft More efficient use of resources Improved response times for branch surgeries Supports disaster recovery, practice can set up anywhere Enables GPs to access their system on the go June P age

84 Sharing Patient Data (Cont.) Project Benefits to the practice Expected time to deliver VoIP (Voice over IP) Telephony (Enabled by the Removes the use of unpopular 0845 numbers October 2015 COIN) Delivers free calls across practices and provider trusts connected on the Lancashire Network and using VoIP Supports improvements to Business Continuity and disaster recovery Will enable call recording and tracing to enable quality monitoring, dispute resolution and customer service improvement all necessary requirements as we move towards more telephone consulations and advice in particular in areas of Long Term Condition Management. Practice connection to COIN Improved infrastructure support. Some work of the Data Quality Facilitator team could be done remotely Will enable remote collection of data for Business Intelligence purposes which the practice will benefit from Allow system backups (non-clinical system) to be undertaken and stored on the CSU servers Improve collaboration between CCG and the practice, tools such as SharePoint become easier to deploy and use. Business Intelligence tools are easier to access and deploy to the practice IP telephony and wider Unified Communications tools can be made available creating greater efficiencies. Supports improvements to Business Continuity and disaster recovery. December 2014 Scanning solutions in place for workflow and receiving clinical correspondence Consolidation where possible Greater level of support to practices Helps practices reduce the burden of dealing with paper and becoming digital Practices become much more efficient and streamlined releasing productive time. June P age

85 Business Intelligence Project Benefits to the practice Expected time to deliver Access to patient records on the right device with the ability to prescribe and order test results on the go Increased practice efficiency Improved patient experience Increased patient safety June 2015 Patient Access Improved patient experience More convenient for the patient Ability to cancel appointment and reduce likelihood of DNA, frees up appointment for others. Reduced pressures on reception staff. March 2015 Patient Risk Stratification Urgent Care Dashboards (Linked to Risk Stratification) Practice Level Benchmarking Helps to understand which patient are costing the NHS the most and what the probability is of them being admitted to hospital Helps to shape the most suitable care package and to proactively manage high risk patients Help to deliver personalised care for those on Long Term Conditions Help to identify high those whose risk score is increasing. To help to understand what is happening to the practices patient during out of hours. To help proactively manage the patients and deliver a better standard of care and improved outcomes Understanding how practices compare to other practices with the same population and similar demographic Understanding if prescribing costs are too high and how a practice might intervene to reduce these. Are we making the right referrals are treatment costs to high, and is there a better pathway that is more cost effective available to us that we are not aware of. 31 P age July 2014 July 2014 July 2014

86 Practice Support Project Benefits to the practice Expected time to deliver Access and knowledge of locally agreed pathways Better patient outcomes are delivered for our patients Faster more efficient process of treatment Consistency of care delivery within the local area for all patient Patients with Long Term Conditions get the best possible treatment and live happier lives and are less demanding on the practice and wider NHS. June 2015 Compliance the National Information Governance toolkit Provides assurance that appropriate controls, policies and processes are in place for handling and sharing of patient data, in particular as we look to integrate electronic patient records to improve care. Ensures that Information Governance is not a one off exercise but that it is at the centre of all that goes on it a practice Reduces the risk of incidents but ensures that a learning process is in place to continually improve standards through the development and adoption of local policy Gives practices the opportunity to step back and question whether what they do is best practice and how they could improve IG standards further. Creates a risk management culture rich reduces the potential of things going wrong. Ongoing 32 P age

87 Practice Support Project Benefits to the practice Expected time to deliver Achievement of Data Accreditation Standards Ensures that the practice is working to standards to underpin core projects such as Ongoing with support from Data Quality Team o The Summary Care Record where a practice is required to share its data o Development of a Health Economy wide integrated care record. o Patient access to their primary care records o Risk stratification o Urgent care dashboards NOTE All of the above require the practice to have correctly coded and summarised data. Data Quality Training and support Standardised and consistent approach to clinical coding Use of consistent templates for making hospital referrals Access to best practice across the Health Economy Support to practices to ensure they are the most efficient they can be with their systems Help training and advise on creating summarised notes and coding data for projects such as the Summary Care Records Support in aligning systems and services to business processes within General Practice Ongoing with support from Data Quality Team 33 P age

88 Appendix 2 CMDI Clinical Digital Maturity Index for Southport and Ormskirk Hospitals NHS Foundation Trust 34 P age

89 Appendix 3 Programme Level Gantt chart (Reviewed and updated monthly) 35 P age

90 Appendix 4 Glossary of terms 36 P age

91 Glossary of terms A&E APP BI BYOD CCG CDMI COIN CSC CSU EMIS WEB EPR GANTT CHART GP GP2GP IBR ICO IG IM&T IT IPM IP TELEPHONY Accident and emergency Software application used on mobile devices such as tablets and Smartphones Business intelligence Bring your own device Clinical Commissioning Group Clinical Digital Maturity Index Community of interest network Computer Sciences Corporation Commissioning Support Unit Electronic Patient Record System used predominantly within General Practice Electronic patient record Pln showing when activities or project will take place General practitioner (Doctor) System and method for transferring patient records electronically between GP practices Integrated Business Report Integrated Care Organisation (Southport and Ormskirk Hospital NHS Trust) Information governance Information management and technology Information technology Name of a patient administration system Technology that allows telephone calls to be made and managed over a data network 37 P age

92 LMC LTC MoM NHS OOH PACS PAS Local Medical Committee Long term condition Map of medicine used for developing and adopting best practice clinical pathways. National Health Service Out of hours service Picture archiving and communications system (Xrays, scans etc) Patient administration system PCT QIPP SCR SKYPE SHAREPOINT TELEHEALTH TELECARE WI-FI Primary Care Trust (Now abolished organisations) A programme of Quality, Improvement, Productivity and Prevention Summary care records Publicly available on line communication tool for making telephone and video calls over the internet Microsoft product used collaboration and delivery of Business Intelligence. Technology to remotely monitor a patient s vital signs to enable them to live improved lives in the community and at home. Technology which provides sensors and aids for use in a patients home to enable them to live at home safely. Network that allows computers and other devices to exchange data without being physically connected. 38 P age

93 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERING BODY REPORT DATE OF BOARD MEETING: 25 November 2014 Agenda item no: WLCCGB 11/14/10 TITLE OF REPORT: Integrated Business Report BRIEFING POINTS: This report provides summary information on the financial and activity performance of West Lancashire Clinical Commissioning Group for September 2014 and a financial position for October Quality and performance analysis is also provided for community based targets and for the Southport and Ormskirk Hospitals. Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient Yes experience) please outline impact The report outlines quality and performance issues relevant to the CCG and describes key actions to address these. 2. Commissioning of hospital and community services please outline impact The report includes financial and activity information in relation to commissioned services and highlights areas of risk and actions. 3. Commissioning and performance management of GP Prescribing please outline impact 4. Delivering Financial Balance please outline impact Yes The report summarises the financial position of the CCG and highlights areas of financial risk. 5. Development of the commissioning group as a commissioning organisation please outline impact This report will support the CCG in developing clear and credible plans. B. Governance please outline impact 1. Does this report: Yes provide the Commissioning Board with assurance against any of the risks identified in the assurance framework have any legal implications promote effective governance practice Links to financial risks. 2. Additional resource implications No (either financial or staffing resources) 3. Health Inequalities Yes Links to health outcomes framework (all five domains) 4. Human Rights, Equality and Diversity Requirements No 5. Clinical Engagement No 6. Patient and Public Engagement No REPORT PREPARED BY: Paul Kingan, Chief finance officer Yes No Yes Integrated Business Report West Lancashire Clinical Commissioning Group Governing Body meeting 25 November 2014

94 West Lancashire Clinical Commissioning Group Integrated Business Report November P age

95 TABLE OF CONTENTS 1 Executive Summary Financial Position QIPP Planned Care: Referrals 10 5 Planned Care: Acute Contract 11 6 Unplanned Care: Acute Contract a b Prescribing Lancashire Care Foundation Trust (LCFT) Activity CPA 7 day follow up IAPT; proportion of estimated prevalence of patients that have received IAPT 9 Quality and Performance a WL CCG Performance dashboard 17 b Southport & Ormskirk hospitals NHS Trust Urgent Care Performance Dashboard 21 c Southport & Ormskirk Hospitals NHS Trust Planned Care Performance Dashboard 22 d e f Southport & Ormskirk Hospitals NHS Trust Wide Performance Dashboard Areas of Under Performance Patients Waiting by weeks g CCG Outcomes Indicator Set 28 h AQC Update 30 i Friends and Family 30 j Nurse Staffing levels 32 k Dr Foster Dashboard 33 l Safety Thermometer Complaints a West Lancashire Complaints 35 b GP Issues with Southport & Ormskirk Hospitals Trust 36 c Southport and Ormskirk Compliments and Complaint Serious and Untoward Incident reporting a New Incidents in August 37 b On going investigations 38 NB: CAVEAT TO THIS REPORT 2 P age Not all quality and performance information is available on a West Lancashire footprint. Data has been provided at this level where available and Southport and Ormskirk Hospital Trust level data is used where not.

96 1. Executive Summary This report provides summary information on the financial and activity performance of West Lancashire Clinical Commissioning Group for September 2014 a financial position for October Quality and performance analysis is also provided for community based targets and for the Southport and Ormskirk Hospitals NHS Trust. CCG position highlights OVERALL POSITION PCT delivery of financial duties CCG forecast DEMAND GP referrals Other referrals PLANNED CARE Total planned care PBR UNPLANNED CARE Total unplanned care PBR PRESCRIBING Prescribing Budget CCG key Performance indicators YTD NHS Constitution indicators RTT 18 Weeks wait (admitted) A&E 4 hours Cancer Waits 62 days Ambulance Category A Calls Footprint CCG CCG CCG CCG CCG CCG CCG Footprint CCG CCG CCG CCG Other key targets Friends and Family CCG MRSA attributable to CCG CCG C. difficile CCG Cancer 14 day urgent target breast CCG Locally set target Children s admissions CCG Key information from this report NHS West Lancashire CCG As at October 2014 the CCG is forecasting a surplus of 1.443m, including a 1% surplus ( 1.441m) as required by NHS England. Indicative performance to the end of September 2014 against the planned care element of all contracts is over plan by 670K. The performance over the same period against the planned care element of the Southport and Ormskirk contract only is over plan by 138.5k. (This figure represent actual performance and not the financial payment which is set out in the cost containment contract). Indicative performance for July against the unplanned care element of all contracts is under plan by 178.5K. Unplanned care performance for March against the Southport and Ormskirk Hospital contract is under plan by 134K. (This figure represent actual performance and not the financial payment which is set out in the cost containment contract). Provider Trust Performance issues 62 day cancer performance improved in September; however the YTD position is still red. NWAS under achievement of category A call outs for West Lancashire continued despite overall provider compliance across Lancashire. An investigation was completed May 2014 by NWAS. The CCG, in collaboration with NWAS, performance has started to show improvement. There has been an MRSA case at S&O trust. A Post Infection Review was carried out with Trust, CCG and Public Health. Actions will be reviewed at contract review meetings. C. difficile target continues to breach at S&O trust. The CCG have reviewed cases and found no lapse in care and no link has been found between cases. The Trust Action plan will be reviewed at contract meetings. Children s admissions although reducing, are still not achieving our expected 6% reduction. Although, the position has improved in Month 6. S&O trust have not met the target for TIA patients seen within 24hrs. A full review of the stroke pathway is being carried out and the CCG will be monitoring stroke performance closely. 3 P age

97 2. Financial Position The following table summarises the financial position for West Lancashire CCG at Month /15. Table 1 NHS West Lancashire CCG Financial Position as at Month /15 Full Year Annual Budget Forecast Expenditure Forecast Variance Acute services Acute NHS 74,076 75,643 1,567 Ambulance services 2,951 2,951 Sub total Acute Services 77,028 78,595 1,567 Mental Health Services Mental Health 10,957 10, Learning Difficulties (4) Sub total Mental Health Services 11,680 11, Community Health Services Community 11,190 11, Sub total Community Services 11,190 11, Continuing Care Services Individual Packages 7,959 8, Funding Nursing Care 1, (35) Sub total Continuing Care Services 8,971 9, Primary Care Services Primary Local Enhanced Services Urgent Care 2,795 2, GP IT Prescribing 18,037 17,996 (41) Sub total Primary Care Services 22,222 22, Other Budgets/Reserves Running Costs 2,649 2,649 NHS Property Services 1,429 1,154 (275) Other Corporate Costs Other Programme Services (16) Non Recurrent Schemes (561) Contingency 700 (700) Reserves 1, (1,049) Sub total Other Programme Services 8,927 6,326 (2,601) Total Commissioning services 140, ,015 (2) Planned Surplus 1,441 (1,441) Grand Total 141, ,015 (1,443) As at Month 6 the CCG has a year to date underspend of 842k, which is forecast to increase to 1.446m by the end of the financial year. This forecast position includes the delivery of a 1% surplus ( 1.441m) as required by NHS England. Key points to note are: 4 P age

98 Acute Services Month 6 activity monitoring information indicates significant and increasing levels of overperformance. The forecast overspend for this area is now projected to be in excess of 1.5m by the end of the financial year. The most material variance is with Ramsay Health Care where a forecast 611k overperformance is being driven by elective daycase activity in Orthopaedics, General Surgery and ENT. The 484k forecast overperformance at Wrightington, Wigan and Leigh NHS Trust is attributable to to both Elective and Non Elective activity mainly in the Orthopaedic and General Medicine specialties. There are also considerable forecast pressures at Aintree NHS Trust ( 408k), Liverpool Heart & Chest NHS Trust ( 279k) and Liverpool Women s NHS Trust ( 158k). Risk within the CCG s largest contract, Southport & Ormskirk NHS Trust, is largely contained within a cost certainty arrangement. Elective activity in Orthopaedics is now outside the scope of the cost containment contract though. Individual Packages The CCG is reliant on information supplied by Midlands and Lancashire Commissioning Support Unit (CSU) in formulating its financial position. The latest iteration of this has revealed predicted expenditure growth compared to 2013/14 levels of 20.9%. This growth presents a serious financial challenge to the CCG with an overspend of 839k currently being forecast. This cost pressure is the result of both significant underlying activity growth and an increase in the number of very high cost cases (over 100k pa) that the CCG funds. To address this issue the CCG has engaged the services an external company (Commercial and Clinical Solutions LLP) to undertake a value for money review of its highest cost cases and seek sustainable improvements in how such packages are commissioned in the future. This review has now been completed and the CCG are considering the recommendations. Prescribing The CCG lastest forecast from the NHS Business Services Authority, based on Prescribing trends to August, shows a potential underspend of 7k. However given the volatility of early year Prescribing forecasts and a pricing change to Category M drugs this area still presents a further financial risk to the CCG. The 41k anticipated surplus relates to Central Drugs. Property Services Following discussions with NHS Property Services it is anticipated that the CCG will benefit from a significantly reduced property recharge as a consequence of the vacation of the former PCT HQ building in Ormskirk. The annual effect is currently estimated to be 275k. Reserves This includes 550k set aside by the CCG prior to allocating 5/head of population on a Practice footprint to fund initiatives within Primary Care that will help deliver care for the over 75 population with complex needs. Slippage against this scheme, together with unallocated reserves is offsetting the budgetary pressures referred to above. The CCG is forecasting to utilise all of its Contingency to offset the above financial pressures. It is therefore unlikely that any of this 700k will be made available to invest in new initiatives. Similarly the anticipated 340k Quality Premium allocation will also be required to support the CCG s in year financial position. Any further worsening of the financial position will pose a significant risk to the CCG s ability to deliver its 1% surplus. 5 P age

99 The CCG s annual budget at Month 7 is m. This is derived as follows: Table Opening Programme Allocation 136,185 Opening Running Cost Allocation 2,676 Return of 2013/14 Surplus 1,441 Specialist Correction Alder Hey/ Liverpool Heart & Chest (235) GP IT Allocation 424 RTT Funding 154 Charge Exempt Overseas Visitors Adjustment (29) Seasonal Resilience Funding 842 Total resources (as at Month 7) 141,458 In addition to its duty on delivering a 1% surplus the CCG has other financial responsibilities: Better Payment Practice Code (BPPC) The Better Payment Practice Code requires the CCG to aim to pay valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later. The CCG s target is for 95% of invoices (both by value and volume) to be paid within this criteria. Table 3 shows the 2014/15 cumulative performance against these requirements: Table 3 NHS Target Cumulative On Target for Performance Year End to date Value 95% Volume 95% Non NHS Value 95% Volume 95% Cash Management The CCG must not utilise more cash than it has available, both on a monthly and annual basis. It has to manage its cash flow accordingly whilst ensuring there are sufficient funds available to pay suppliers and meet the BPPC targets listed above. NHS England has issued the CCG with a provisional Maximum Cash Drawdown (MCD) for 2014/15 of m. Table 4 summarises the cash expended to October: Table Maximum Cash Drawdown 2014/15 139,587 YTD Cash Drawdown 68,100 CHC Risk Pool Contribution 529 YTD Oxygen and Prescribing 10,269 Cash Available for Remainder of Year 60,689 6 P age

100 3. QIPP Each year the CCG is faced with balancing the rising demand for hospital activity with a finite amount of financial resource. Therefore the CCG seeks to negotiate the best value for money it can achieve from its contracts, whilst also seeking to achieve Quality, Innovation, Productivity and Performance (QIPP) gains. Each year the CCG sets out its QIPP target and identifies schemes that will generate the associated savings. These savings maybe either cash releasing or non cash releasing but need to have a recurrent effect if the CCG is to see a sustainable financial benefit. The CCG s 5 year financial strategy submitted to NHS England detailed how it would achieve a 1% surplus each year until 2018/19. Integral to the successful delivery of the strategy is the generation of 11.5m of QIPP savings over the period. In 2014/15 the planned QIPP savings are 1.994m and the breakdown of this into individual schemes, together with a financial risk assessment is below: Table 5 Planned Forecast Risk Saving Saving Rating Comments Schemes relating to Care Closer to Home Programme 884, ,000 Savings built into cost certainty contract with S&O Trust Prescribing 800, ,000 Limited data to assess performance at this stage Individual Patient Activity 250, ,000 CCS review of High Cost Cases is ongoing Eating Disorders 60,000 15,000 Service redesign proposed but planned savings unlikely to materialise Total 1,994,000 1,949,000 It must be stated that although the CCG has secured the 2014/15 savings relating to the Care Closer to Home Programme by negotiating these into the current contract with Southport and Ormskirk Hospitals Trust, their performance is being closely monitored in year to evidence the required changes in activity patterns. If the schemes fail to demonstrate their effectiveness this will threaten the recurrent delivery of the QIPP programme. Presented on Page 10 are some of the key performance metrics which identify the underlying activity impact of some of the schemes. Care Closer to Home Schemes 884,000: A key aim of these schemes is to reduce emergency admissions in to hospital. Due to the complexity of sub analysing data to establish savings from a bottom up approach, often the best way of understanding whether schemes are working is to look at the overall collective impact on non elective admissions. The information for the first 6 months suggests that there are significant savings against expected levels of non elective admissions, even though overall activity is over plan by 9%. This suggests that there has been a reduction in more costly and complex emergency admissions even though activity overall has risen. At Month 6 the cost of Non electives overall is static compared to last year, despite the rise in activity. 7 P age

101 Individual Schemes Care Closer to Home Unfortunately, to date we have not been able to generate data for all of the schemes which make up the 884k included in the Care Closer to Home proportion of the QIPP plan, partly due to access to data but partly due to some schemes not yet having begun. The impact graphs of the four of the main schemes in the QIPP plan are set out overleaf. These show that most of those four schemes are making savings compared to projected demand trend. These schemes are forecast to generate the following savings in this year and projected to the year end: QIPP Savings delivered to Date Savings to year end Confidence interval Adjusted savings to 000s 000s 000s CCNOT % 52 Frail Elderly % 174 Diabetes % 8 Alcohol Liaison % 9 TOTAL Budget figures for the other main scheme of Active Case Management has indicated an expected saving of 550k. The figure of 550k is indicative and may not be robust therefore if we assume a confidence level of 50% this would result in a planning figure of 275k. In addition, The Acute Visiting Service is currently being evaluated and information from the pilot suggests that net savings of c 196,000 are attributable for a full year. (This assumes recurrent scheme costs of 180,000 and recurrent savings relating to avoidable admissions/attendances of 376,000.) Adding the three figures together ( 121k + 275k + 196k), it would appear that the projected recurrent QIPP saving figure is almost being achieved (592k per annum) before the additional schemes impact are measured. The CCNOT figures are concerning, however Month 5 and 6 shows improvement and current 14/15 cost is showing a 37K saving on the same period in 2012/13 when the scheme had not been running. Work is still on going to collect metrics for the other schemes (Heart Failure, Cardiology Tier 2 etc.) these will be included when they are developed. This data will then be used to establish a QIPP dashboard where the overall effect of all of these QIPP schemes will be available for review. 8 P age

102 9 P age

103 4. Planned Care: Referrals The following section provides an overview of referrals to secondary care to August Chart A (below) shows the number of referrals for the CCG across all Lancashire providers and Southport and Ormskirk Trust. Overall there was a 6.38% increase in referrals YTD. The biggest increase is in Southport & Ormskirk Trust with 264 more referrals than last month; 208 of which are GP Referrals. Ophthalmology (56) and Physiotherapy (39) GP referrals have increased the most in the last month. Chart A: Referrals 2014/15 Compared to 2013/14 (excluding Mersey Trusts) Referrals by Source Financial Year to Date Comparison Year on Year GP HOSPITAL OTHER GP HOSPITAL OTHER No. of referrals 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, NB: The CCG has now become aware that the referrals data shown in the graph above represents only referrals made by West Lancashire GPs to trusts in Lancashire and Southport and Ormskirk Trust. Referrals to trusts in Merseyside or Greater Manchester are excluded from the graph above. The data has been requested from these providers retrospective and will be added to this graph once it has been checked for accuracy and completeness. 10 P age

104 5. Planned Care: Acute Contract All providers Performance at month 6 against the planned care element of the contract is shown below in table 2a. This shows the planned care element of the contracts is over plan by 670k. The most significant variation appears to be at Ramsay which is 281.5k over plan. The most significant variance is in Daycase POD ( 191k over plan) across a number of specialties including Trauma and Orthopaedics ( 79k over plan). There are also significant overspends at Southport and Ormskirk ( 138.5k over plan) and Wrightington, Wigan and Leigh ( 133k over plan). Table 2a: Month 5 Planned Care All Providers Point of Delivery Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Daycase 7,129 7, ,929,969 5,276, ,705 Elective 1,365 1, ,693,768 3,457, ,728 Elective Excess Bed Days , ,182 5,005 Outpatient First Attendance 15,279 16, ,242,590 2,304,094 61,503 Outpatient Follow-up Attendance 32,789 35,741 2,952 2,839,483 2,993, ,976 Outpatient Procedure 8,040 9,539 1,499 1,398,480 1,736, ,906 Outpatient Non Face-to-Face Attendance 438 1, ,728 13,339 1,611 Grand Total 65,452 71,369 5,917 15,213,194 15,883, ,978 Southport and Ormskirk Hospitals NHS Trust Performance to month 6 against the planned care element of the contract is shown below in table 2b. This shows the planned care element of the contract is over plan by 138.5k. The most significant variance appears to be in the OPPROC POD in Urology which is 142.5k over plan and Daycase POD in Trauma and Orthopaedics which is 155k over plan. There is also a significant over performance in Daycase, General Medicine which is 92k over plan, OPPROC 110: Trauma and Orthopaedics which is 82k over plan and Dermatology which is 71k over plan. Note: Southport and Ormkirk have a cost certain contract (excluding Trauma and Orthopaedics which is PBR). Table 2b: Month 5 Planned Care at Southport and Ormskirk Hospitals Point of Delivery Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Daycase 4,855 4, ,780,894 2,895, ,283 Elective ,846,000 1,591, ,211 Elective Excess Bed Days ,454 12,097-12,357 Outpatient First Attendance 10,162 10, ,547,290 1,499,888-47,402 Outpatient Follow-up Attendance 19,832 21,895 2,063 1,756,456 1,845,986 89,531 Outpatient Procedure 5,500 6,513 1, ,796 1,209, ,878 Outpatient Non Face-to-Face Attendance Grand Total 41,175 44,526 3,351 8,915,888 9,054, , P age

105 All Other Providers Performance to month 6 against the planned care element of the contract is shown below in table 2c. This shows the planned care element of the contract is over plan by 531.5k. This is largely down to the over performances already noted at Ramsay and Wrightington, Wigan and Leigh. Table 2c: Month 5 Planned Care at All other Providers* Provider Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Wrightington, Wigan & Leigh 7,564 8, ,800,268 1,933, ,808 Ramsay Operations (UK) 3,468 4,488 1,020 1,149,574 1,431, ,631 Aintree University Hospitals 3,801 3, , ,088 39,745 Lancashire Teaching Hospitals 1,500 1, , ,202-33,816 St Helens and Knowsley Hospitals 1,829 1, , ,534 26,167 Royal Liverpool and Broadgreen Hospitals 3,335 3, , ,993 8,120 Other Providers 2,779 3, ,085,864 1,162,464 76,600 Grand Total 24,277 26,843 2,566 6,297,306 6,828, ,255 *Includes points of delivery as per Tables 2a and 2b Key Risks and Actions Provider Trusts have been running theatres over summer to reduce waiting times from 18 weeks to 16 weeks. This extra activity has been funded centrally by NHS England. However, each CCG negotiated a different mechanism for recording this additional activity; therefore some additional activity will be recorded above. Additional activity by CCG is beginning to be reported by Providers, but the data warehouse held by Lancashire CSU will need to be updated before a true position can be determined. Current data shows 110K of extra activity at S&O, Aintree and St Helens and Knowsley trusts August to September. This is included in the activity but not the plan and has a separate funding arrangement. 12 P age

106 6. Unplanned Care: Acute Contract All Providers Performance for month 6 against the unplanned care element of the contract is shown below in table 3a. Overall the unplanned care element of the contract is under plan by 178.5k. This is caused by significant under performances at Southport and Ormskirk which is 134k under plan and Royal Liverpool and Broadgreen which is 129k under plan across a number of PODs. Table 3a: Month 5 Unplanned Care at All Providers Provider Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Accident and Emergency 14,677 15, ,507,077 1,584,372 77,295 Non-Elective Short Stay , ,481 24,891 Non-Elective 4,451 4, ,587,522 8,401, ,981 Non-Elective Excess Beddays 1,948 1, , ,593-91,025 Non-Elective Non-Emergency ,280,916 1,144, ,453 Non-Elective Non-Emergency Excess Beddays ,432 48,665 7,233 Non-Elective Same Day Emergency Care , , ,760 Non-Elective Threshold Adjustment ,557-14,009-8,452 Grand Total 23,075 24, ,608,148 12,429, ,733 Southport and Ormskirk Hospitals NHS Trust Performance for month 6 against the unplanned care element of the contract is shown below in table 3b. Overall the unplanned care element of the contract is under plan by 134k. This is largely due to an under performance in General Medicine which is 246k under plan, and Obstetrics which is 145k under plan. Note: Southport and Ormkirk have a cost certain contract (excluding Trauma and Orthopaedics which is PBR). Table 3b: Month 5 Unplanned Care at Southport and Ormskirk Hospitals Provider Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Accident and Emergency 11,725 12, ,211,071 1,258,121 47,050 Non-Elective Short Stay , ,254 7,425 Non-Elective 3,562 3, ,784,789 6,616, ,877 Non-Elective Excess Beddays 1,484 1, , ,626-36,593 Non-Elective Non-Emergency ,092, , ,969 Non-Elective Non-Emergency Excess Beddays ,817 26,632 12,815 Non-Elective Same Day Emergency Care , , ,253 Grand Total 18,330 19, ,025,689 9,891, , P age

107 All Other providers Performance for month 6 against the unplanned care element of the contract is shown below in table 3c. Overall the unplanned care element of the contract is under plan by 45k. The most significant variation is a general under performance at Royal Liverpool and Broadgreen Hospitals which is 129k under plan. Table 3c: Month 5 Unplanned Care at All Other Providers* Provider Activity 2014/15 Cost 2014/15 Plan Actual Variance Plan Actual Variance Wrightington, Wigan & Leigh 1,982 2, ,023,728 1,087,783 64,055 Aintree University Hospitals , ,934-11,199 Lancashire Teaching Hospitals , ,447-2,342 Royal Liverpool and Broadgreen Hospitals , , ,135 St Helen's & Knowsley Hospitals NHS Trust , ,008 50,499 Other Providers , ,867 84,284 Grand Total 4,744 4, ,582,459 2,537,624-44,835 *Includes points of delivery as per Tables 3a and 3b Key Risks and Actions Further work is on going with collaborative partners to understand the effect of the winter funded schemes (Frail elderly unit, Community Emergency Response Team, Ambulatory Emergency Care) on underlying activity trends. A review of all acute activity took place over summer This has raised 2 high impact actions, 10 urgent actions and 15 important actions that the CCG is investigating before the contract round for 2015/16. Finding will be included in this report as they are concluded. 14 P age

108 7. Prescribing In order to address the West Lancashire CCG Medicines Management duties as defined by the National Prescribing Centre s Medicines Management Competency Framework, West Lancashire CCG has set up a Medicines Management Committee (MMC). The MMC s remit encompasses all systems, policies and procedures designed to ensure the safe, secure and cost effective use of medicines. Below is a summary of prescribing costs, West Lancashire CCG is currently showing cost growth of 2.06%. This is based on Practice budgets; there is an additional CCG contingency budget, which is not shown here. Table 4. Prescribing position Aug 2014 % Growth (Forecast Outturn v 13/14 Forecast Outturn (14/15)/ List size (APU Aug14) Total Spend for Previous Year (13/14) Current YTD Spend Previous YTD Spend Growth (Forecast Outturn v CCG (14/15) (13/14) 13/14 Spend) Spend) WEST LANCASHIRE 17,049, ,202, ,952, , % Lancashire Care Foundation Trust Contract Activity The contract value for Lancashire Care Foundation Trust (LCFT) mental health services is 9.7m. A brief summary of monthly and year to date activity will be reported through the IBR each month. The LCFT contract is for a range of mental health services such as rehabilitation, community mental health teams, hospital liaison, memory assessment, CAMHS and child psychology and prison in reach. 8a CPA follow up within 7 days The proportion of eligible patients who are followed up within 7 days is one of the performance measures on which the CCG will be monitored by the Local Area Team. The Table below shows current West Lancashire performance which is better than the LCFT average. %Successful Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 YTD West Lancashire 90.0% 100.0% 100.0% 100.0% 100.0% 93.8% 96.8% 8 CCG's 94.9% 97.3% 98.2% 96.4% 98.2% 96.3% 96.9% %Successful Qtr 1 Qtr 2 Qtr 3 Qtr 4 West 96.6% 97.1% 8 CCG's 96.9% 96.9% 15 P age

109 8b IAPT; proportion of estimated prevalence of patients that have received IAPT West Lancashire IAPT figures for patients entering therapy are on above target for April to August Data for September has not been received in time for this report but will be reported next month. Prevalence Monthly Target Apr 14 May 14 Jun 14 Jul 14 Aug 14 YTD Entered Treatment YTD Variance YTD Prevalence Met (%) YTD Variance (%) Year End Trend (Target 15%) NHS WEST LANCASHIRE CCG % 0.02% 14.9% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Metric Year Activity Activity Activity Activity Activity Activity Activity Activity Activity Activity Activity Activity YTD Caseload CCT Teams Accepted Referrals 2013/ / Community Restart Teams Accepted Referrals 2013/ / CRHT Teams Referrals 2013/ / Eating Disorder Service Referrals 2013/ / MAS Teams Referrals 2013/ / Recovery Teams Accepted Referrals 2013/ / Older Adult Liaison Teams Referrals 2013/ / Contacts CMHT Dementia Contacts 2013/ / CMHT Functional Contacts 2013/ / CRHT Face to Face Contacts 18 to / / CRHT Face to Face Contacts Below / / CRHT Face to Face Contacts Over / / CRHT Telephone Contacts 18 to / / CRHT Telephone Contacts Below / / CRHT Telephone Contacts Over / / Eating Disorder Service Contacts 2013/ / MAS Referral to First Contact in 72 Hours % 2013/ NA 2014/ NA Older Adult Liaison Contacts 2013/ / Older Adult Liaison Referral to First Contact (Average Ho2013/ NA 2014/ NA Criminal Justice Liaison Contacts 2013/ / EIS EIS: New EIS Patients in Year VSMR / NA 2014/ NA EIS: Unclustered EIS Patients not seen for 8 weeks VSMR 2013/ / EIS: Caseload at Month End VSMR / NA 2014/15 34 NA Inpatient Adult Inpatient Ward Admissions 2013/ / Adult Inpatient 28 Day ReAdmissions 2013/ / Adult Inpatient 90 Day ReAdmissions 2013/ / Adult Ward Occupied Bed Days 2013/ / Adult Inpatient Length of Stay (Average Days) 2013/ NA 2014/15 NA NA NA NA NA NA Older Adult (Functional) Inpatient Ward Admissions 2013/ / Older Adult (Functional) Inpatient Length of Stay (Average2013/ NA 2014/15 NA Older Adult (Functional) Ward Occupied Bed Days 2013/ / Older Adult (Dementia) Inpatient Ward Admissions 2013/ /15 0 Older Adult (Dementia) Ward Occupied Bed Days 2013/ /15 0 Older Adult (Dementia) Length of Stay (Average Days) 2013/ NA 2014/15 NA PICU Ward Occupied Bed Days 2013/ / P age

110 9. Quality and Performance 9a West Lancashire CCG Performance Dashboard Metric Reporti ng Level Q1 Q2 Apr M ay Jun Jul Aug Sep YTD Preventing People from Dying Prematurely Cancer Waiting Times % Patients seen within two weeks for an urgent GP referral for suspected cancer % of patients seen within 2 weeks for an urgent referral for breast symptoms W Lancs CCG % of patients receiving definitive treatment within 1 month of a cancer diagnosis % of patients receiving subsequent treatment for cancer within 31 days (Surgery) % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service % of patients receiving treatment for cancer within 62 days upgrade their priority W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG RAG G G G G G G G Actual 96.75% 97.88% 97.11% 95.20% 94.44% 93.98% 95.86% Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% RAG G G G G G G G Actual 96.00% 96.88% 95.22% 98.50% 96.30% 94.44% 96.45% Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% RAG G G G G G G G Actual % % % % % 97.95% 99.28% Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% RAG G G G G G G G Actual % % % % % % % Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% RAG G G G G G G G Actual % % % % % % % Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% RAG G G G G G G G Actual % % % % % % % Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% RAG G R R R G A R Actual % 66.67% 79.31% 77.42% 89.47% 84.00% 75.11% Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% RAG G R G R G G Actual % 75.00% % 85.70% % NA 90.00% Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG G G G G G R G Actual % % % 85.70% % 75.00% 91.43% Target 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 17 P age

111 Metric Reporti ng Level Q1 Q2 Apr M ay Jun Jul Aug Sep YTD Ambulance Category A calls responded to within 19 minutes W Lancs CCG NWAS Category A Calls Response Time (Red1) Number of Category A (Red 1) calls W Lancs CCG resulting in an emergency response arriving at the scene of the incident within 8 minutes NWAS Category A (Red 2) 8 Minute Response W Time Lancs Number of Category A (Red 2) calls CCG resulting in an emergency response arriving at the scene of the incident NWAS within 8 minutes RAG A R R R A R R Actual 90.10% 87.89% 89.78% 87.20% % 89.12% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G A G G G Actual 96.20% 95.60% 95.30% 94.20% 95.30% 95.05% 95.29% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG R R R R R R R Actual 65.70% 61.90% 62.96% 42.30% 47.62% 60.87% 57.91% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% RAG G A R R A A A Actual 75.70% 73.41% 71.50% 68.50% 72.71% 71.50% 72.17% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% RAG R R R R R R R Actual 59.40% 61.75% 60.20% 53.77% 58.62% 62.00% 59.26% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% RAG G A A R A A A Actual % 74.70% 73.19% 69.20% 72.10% 73.29% 72.95% Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% Helping People to Recover from Episodes of Ill Health or Following Injury Emergency Re-admissions Emergency Re admissions within 30 days of discharge W Lancs CCG RAG G G G G Actual 10.62% 10.20% % Target 10.09% 10.90% 10.90% 10.90% 18 P age

112 Metric Reporti ng Level Q1 Q2 Apr M ay Jun Jul Aug Sep YTD Ensuring that People Have a Positive Experience of Care Referral to Treatment (RTT) & Diagnostics Referral to Treatment (Adjusted Admitted) Referral to Treatment (Non Admitted) Referral to Treatment (Incomplete) Referral to Treatment No of Incomplete Pathways Waiting >52 weeks % of patients waiting 6 weeks or more for a diagnosic test W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG W Lancs CCG RAG G G G G G G G Actual 94.97% 95.38% 93.98% 94.75% 91.84% 93.70% 94.15% Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG G G G G G G G Actual 98.05% 98.30% 98.53% 98.52% 98.25% 98.30% 98.34% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G G G G G Actual 97.64% 97.70% 97.78% 97.49% 97.23% 96.80% 97.43% Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% RAG G G G G G G G Actual Target RAG A G G G G G Actual 1.333% 0.861% 0.637% 0.629% 0.595% 0.341% N/A Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% Treating and Caring for P eople in a Safe Environment and P rotect them from Avoidable Harm HCAI Number of MRSA Bacteraemias Number of C.Difficile infections Accident & Emergency W Lancs CCG W Lancs CCG RAG G G G G G R R YTD Target RAG R R R R R R R YTD Target Hour A&E Waiting Time Target (Monthly Aggregate for Total Provider) 12 Hour Trolley waits in A&E 19 P age S & O Hospital s WWL S & O Hospital s RAG G G G G G G G Actual 96.00% 97.48% 97.59% 97.87% 97.75% 96.95% 97.26% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG A A G R G G R Actual 92.05% 92.35% 95.81% 92.20% 96.97% 98.43% 94.45% Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% RAG G G G G G G G Actual

113 Metric Reporting Level Q1 Q2 YTD Apr May Jun Jul Aug Sep Activity Activity Number of G&A non elective FFCEs in the period Total Number of G&A elective ordinary admission FFCEs in the period W Lancs CCG W Lancs CCG RAG G G G A G A A YTD 1,109 2,194 3,278 4,413 5,466 6,613 6,613 Target 1,112 2,209 3,350 4,402 5,514 6,573 6,573 RAG G G G G G G G YTD ,085 1,293 1,293 Target ,168 1,392 1, P age

114 9b Southport & Ormskirk Hospitals NHS Trust Urgent Care Performance Dashboard Subject Indicator Description Data Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Target Urgent care Accident and emergency targets Stroke EMSA HCAI HQU12: Timeliness: Time to Target initial assessment 95th Month Actual centile (arrival by ambulance) Month RAG G G G G G G G G G G G G G HQU13:Timeliness: Time to Target treatment in department Month Actual median Month RAG G G G G G G G G G G G G G HQU10: Timeliness: total time Target spent in A&E department Month Actual th centile Month RAG G G G G G G G G G G G G G Target YTD 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Timeliness: A&E 4 Hour Target YTD Actual 97.70% 97.16% 98.01% 98.03% 96.01% 96.29% 96.01% 96.17% 97.50% 97.63% 97.95% 97.23% 96.95% 95.0% YTD RAG G G G G G G G G G G G G G HQU11: Patient Impact: Left Month Actual 1.6% 1.6% 1.4% 1.3% 1.4% 1.8% 2.3% 1.5% 1.5% 1.8% 2.0% 1.9% 1.7% department without being Target YTD 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% seen rate YTD RAG G G G G G G G G G G G G G HQU09: Patient Impact: Target 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% unplanned re attendance at Month Actual 2.7% 2.6% 3.3% 3.2% 2.9% 2.7% 2.7% 2.7% 2.9% 2.8% 2.8% 2.7% 2.7% 5.0% A&E within 7 days of original Month RAG G G G G G G G G G G G G G SQU06: % stroke patients Target 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% spending 90%+ time on a Month Actual 87.5% 87.5% 82.6% 92.9% 92.5% 90.9% 69.2% 82.9% 88.5% 94.3% 84.6% 70.6% 81.8% 80% stroke unit Month RAG G R G G G G R G G G G R G SQU06: % TIA (mini stroke) Target 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% 60% patients assessed and treated Month Actual 50.0% 66.7% 40.0% 71.4% 61.5% 66.7% 75.0% 75.0% 61.5% 42.9% 83.3% 44.4% 50.0% 60.0% <> 24 hrs Month RAG A G R G G G G G G R G R R Target YTD PHQ26: Mixed Sex Month Actual Accommodation Numbers of unjustified breaches YTD Actual YTD RAG G G G G R R R R R R R R R Month Actual PHQ27: Number of MRSA Target YTD Bacteraemias YTD Actual YTD RAG G G G G G G G G G G R G R Target YTD PHQ28: Number of C. Difficile YTD Actual infections YTD RAG R R R R R R R R R R R R R P age

115 9c Southport & Ormskirk Hospitals NHS Trust Planned Care Performance Dashboard Subject Indicator Description Data Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 13 Apr 13 Jun 14 Jul 14 Aug 14 Aug 14 Target Planned care RTT 18 weeks Cancer waiting times PHQ19:RTT Admitted Target PHQ20: RTT Non Admitted Target PHQ21: RTT IncompleteTarget PHQ24: 2 weeks (urgent GP referral) PHQ24: 2 weeks (urgent referral breast symptoms) PHQ06: 1 month (definitive treatment of cancer diagnosis) PHQ06: 1 month (subsequent surgery for cancer) PHQ06: 1 month (subsequent anti cancer drug regime) PHQ03: 62 days (first definitive treatment from urgent GP referral) PHQ03: 62 days (first definitive treatment from Cancer Screening Service) Target 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Month Actual 90.8% 76.1% 74.8% 74.2% 77.2% 79.9% 92.0% 92.8% 94.7% 93.0% 91.5% 90.0% 92.2% 90.0% Month RAG G R R R R R G G G G G G G Target 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Month Actual 95.7% 95.8% 96.6% 96.1% 97.6% 97.5% 98.0% 97.9% 98.1% 98.5% 98.5% 98.3% 98.3% 95.0% Month RAG G G G G G G G G G G G G G Target 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% 92.0% Month Actual 94.2% 94.7% 94.6% 95.7% 95.7% 97.3% 97.7% 97.9% 97.9% 98.1% 97.9% 97.5% 97.7% Month RAG G G G G G G G G G G G G G Target 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% Month Actual 94.3% 95.2% 95.4% 95.6% 96.7% 95.5% 97.3% 96.6% 98.2% 96.9% 95.6% 95.5% NA Month RAG G G G G G G G G G G G G Target 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% Month Actual 89.0% 94.1% 85.7% 93.0% 96.2% 100.0% 98.4% 97.5% 97.3% 93.2% 98.0% 96.4% NA Month RAG R G R G G G G G G G G G Target 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% Month Actual 98.8% 100.0% 100.0% 100.0% 93.9% 98.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA Month RAG G G G G A G G G G G G G Target 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% Month Actual 100.0% 100.0% 100.0% 100.0% 83.3% 88.9% 100.0% 92.9% 100.0% 100.0% 100.0% 100.0% NA Month RAG G G G G R R G A G G G G Target 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% Month Actual 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA 100.0% 100.0% 100.0% 100.0% 100.0% NA Month RAG G G G G G G G G G G G G Target 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% Month Actual 93.9% 81.5% 84.1% 94.9% 87.2% 83.6% 87.1% 93.1% 83.2% 82.8% 87.5% 80.3% NA Month RAG G A A G G A G G A A G A Target 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Month Actual 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA NA 100.0% 0.0% NA NA Month RAG G G G G G G G G R 92.0% 93.0% 93.0% 96.0% 94.0% 98.0% 85.0% 90.0% 22 P age

116 9d Southport & Ormskirk Hospitals NHS Trust Trust Wide Performance Dashboard Subject Indicator Description Data Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 13 May 14 Jun 14 Jul 14 Aug 14 Aug 14 Target Trust wide Pressure sores Mortality Community acquired pressure sores grade 2 4 hospital acquired pressures sores grade 2 4 HSMR YTD Trust HSMR monthly Trust Rapid Access Chest pain seen within 2 weeks Staff sickness Absence Target N\A N\A N\A N\A N\A N\A N\A N/A N/A N/A N/A N/A N/A Month Actual N/A Target Month Actual N/A N/A N/A N/A NA NA NA NA Month RAG G G G G R Target Month Actual NA NA NA Month RAG A G A G G G G G G G Target Month Actual NA NA NA Month RAG G G R G G R G G G R Target 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% 98% Month Actual NA NA Month RAG G G G G G G G G G G G Target 3.70% 3.70% 3.70% 3.70% 3.70% 3.70% 3.70% TBA TBA TBA TBA Month Actual 3.62% 4.03% 3.77% 4.00% 4.15% 3.86% 3.89% 4.03% 4.02% % NA NA TBA Month RAG G R G G G G G G G G 23 P age

117 9e Areas of under performance A number of areas of underperformance are reported to end of February 2014; the detail below is presented by indicator for each of these areas with actions identified as required and on going, seeking to improve performance. Direction of travel of performance against indicator from previous reporting period is provided to demonstrate if performance is deteriorating where an indicator has remained at the same performance level and a details improving performance. Indicator: Mixed Sex Accommodation Breaches S&O Target: 0 Current Performance 30 YTD Direction of travel Forecast Current Issues: There were 6 breaches in July at S&O trust, but no further breaches in August or September. However, the YTD position means this target has already been exceeded for the year. Improvement Plans: S&O trust are reviewing Critical Care pathways and how each breach was managed. Pathways at Aintree have also been compared to SDGH and no differences have been found. The CCGs are continuing to work with the Trust to improve the pathways. Indicator: MRSA S&O Target: 0 Current Performance 2 YTD Direction of travel Forecast Current Issues: There have been 2 MRSA breaches at S&O trust, only one was involving a West Lancashire patient. The target for the year is zero so this target will remain red for the year. Improvement Plans: West Lancashire CCG were involved with the PIR process for their patient and the case was attributed to the Trust. Both cases have been classified as never events by the Trust. Indicator: C. difficile Target: 14 Current Performance 21 Direction of travel Forecast Current Issues: There have been 21 cases of C.Difficile at S&O trust against a trajectory of 14 (YTD). There have been no common themes found between cases. All prescribing targets are being met. This is affecting the CCG position which is also over target. Improvement Plans: West Lancashire CCG have reviewed 5 cases and agreed there were no lapses in care. There is a detailed Action plan at the Trust which will continue to be monitored. This includes the replacement of all ward pillows with a more robust type and a rolling programme of bay closures to allow deep cleaning and fogging. There are still a number of actions which are Red or Amber on the Trust Action Plan. 24 P age

118 Indicator: Ambulance category call outs CCG Target: 75% (red1) 75% (red 2) Current Performance 57.9% 59.2% Direction of travel Forecast Current Issues: Category A call outs within 8 minutes; the target of 75% achieved within 8 minutes for Red 1 and red 2 is not being met. Performance dipped in July and is beginning to show improvement. Improvement Plans: NWAS undertook a detailed investigation on 28 th May to understand the reasons for under performance; this will then inform a detailed plan and actions to improve performance in 2014/15. Key findings were: In summary although both Red 1 and Green 1 have seen decreases in volume the total volume for West Lancashire has increased by 3.8% in the last year. The red 1 volumes are very small part of activity and due to this outlying areas, these calls prove a real challenge to performance across the area. Actions and improvement options are being discussed with the CCG. Indicator: Stroke patients treated within 24hrs S&O Target: TIA 60% Current Performance 50% Direction of travel Forecast Current Issues: 5 patients were not treated within 24 hrs. Improvement Plans: A full review of the stroke pathway is being carried out by the Trust. A Dr. Foster audit is also underway. Bed managers will now prioritise certain beds, e.g. Stroke, and managers are working closer to Consultants and Specialist nurses to improve performance in this area. Indicator: Cancer 62 day target CCG Target: 85% Current Performance 75% YTD Direction of travel Forecast Current Issues: Current month performance is 80% against a 85% target, which is Amber, however YTD figures are Red due to under performance in July. September performance at Clatterbridge was 60% for West Lancashire patients. Improvement Plans: Underperformance at Clatterbridge will be raised with the Lead commissioner. 25 P age

119 9f. West Lancashire CCG patients waiting To understand how many patients were still waiting for procedures or outpatient appointments, the numbers of patients waiting for all in completed pathways for all trusts has been included in the graph below. Providers need to move to maximum waits of 16 weeks by November Looking at the graph below it is expected that the November target will be achieved. More detailed reports on RTT waiters are available via Aristotle spotlight reports. 9g CCG Outcomes Indicator Set 26 P age

120 There have been no updates to the CCG Outcomes Indicator Set this month as refreshed data is not due to be published until December The latest position is shown below for information. CCG Outcomes Indicators Indicator Description Domain 1: Preventing people from dying prematurely 1.1 i 1.1 ii 1.2 Ref Reporting period Last reported period Potential years of life lost considered amendable to healthcare (MALES) out of 211 Potential years of life lost considered amendable to healthcare (FEMALES) out of 211 Under 75 mortality rate from CVD out of 211 CCG Ranking Trend Next data due Data (improving) (improving) (declining) Sep 15 DSR (per 100,000) Sep 15 DSR (per 100,000) Sep 15 DSR (per 100,000) 1.4 Myocardial infarction, stroke and stage 5 kidney disease in people with diabetes 2011/ out of 211 New indicator Mar 15 ISR (per 100 with diabetes) Under 75 mortality rate from Respiratory Disease out of 211 Under 75 mortality rate from Liver Disease out of 211 Emergency admissions for alcohol related liver disease Apr 13 to Mar out of 211 Under 75 mortality rate from Cancer out of 211 One year survival from all cancers One year survival from breast, lung and colorectal cancers 2011 (followed up until 31/12/2012) 2011 (followed up until 31/12/2012) 69.15% 51 out of % 68 out of 211 Antenatal assessments <13 weeks Q2 2013/ % 64 out of 139 * (declining) (declining) (declining) (declining) (improving) (improving) (improving) Smoking status at time of delivery Q4 2013/ % 98 out of 211 (improving) Dec 14 Breast feeding prevalence at 6 8 weeks Q4 2013/2014 N/A N/A ** N/A Dec 14 Record of stage of cancer at diagnosis % 19 out of 210 *** New indicator Sep 15 Percentage of cancers detected at stage 1 and % 28 out of 211 New indicator Sep 15 Mortality from breast cancer in females out of 211 Domain 2: Preventing people from dying prematurely Health related quality of life for people with long term conditions Jul 13 to Mar out of 207 *** Proportion of people who are feeling supported to manage their condition Jul 13 to Mar % 78 out of 207 *** (declining) (declining) (declining) Sep 15 DSR (per 100,000) Sep 15 DSR (per 100,000) Dec 14 DSR (per 100,000) Sep 15 DSR (per 100,000) Jun 15 Jun 15 Dec 14 One year net survival (%) from all cancers (aged years). One year net survival (%) from breast, lung and colorectal cancer (aged years). Percentage of women who have seen a midwife or a maternity healthcare professional by 12 weeks and 6 days of pregnancy. The percentage of women who were smokers at the time of delivery, out of the number of maternities The percentage of infants who are breastfed at 6 8 weeks of age, out of the number of infants due a 6 8 week check. Percentage of new cases of cancer for which a valid stage is recorded at the time of diagnosis. The percentage of new cases of cancer which were diagnosed at stage 1 or 2 for the specific cancer sites, morphologies and behaviour. Sep 15 DSR (per 100,000) Sep 15 DSR (per 100,000) Sep 15 DSP People with diabetes diagnosed less than a year referred to structured education 2011 / % 67 out of 211 New indicator Mar 15 Percentage offered or attended Unplanned hospitalisation for chronic ambulatory care sensitive conditions Apr 13 to Mar out of 211 (declining) Dec 14 DSR (per 100,000) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Apr 13 to Mar out of 211 (improving) Dec 14 DSR for under 19 yrs (per 100,000) Complications associated with diabetes including emergency admissions for diabetic ketoacidosis and lower limb amputation 2011 / out of 211 New indicator Mar 15 ISR (per 100 with diabetes) Health related quality of life for carers Jul 13 to Mar out of 196 *** (declining) Health related quality of life for people with a long term mental health condition Jul 13 to Mar out of 204 *** New indicator Sep 15 DSA Sep 15 DSA Domain 3: Helping people to recover from episodes of ill health or following injury i 3.3 ii 3.3 iii 3.3 iv 3.4 Emergency admissions for acute conditions that should not usually require hospital admission (updated methodology) Apr 13 to Mar out of 211 Emergency readmissions within 30 days of discharge from hospital 2011 / out of 211 Patient reported outcome measures for elective procedures: hip replacement 2012/ out of 206 *** Patient reported outcome measures for elective procedures: knee replacement 2012/ out of 208 *** Patient reported outcome measures for elective procedures: groin hernia 2012/ out of 188 *** Patient reported outcome measures for elective procedures: varicose veins 2012/2013 Numbers are too small *** Emergency admissions for children with lower respiratory tract infections Apr 13 to Mar out of 211 Domain 4: Ensuring that people have a positive experience of care Patient experience of GP out of hours services Jul 13 to Mar % 48 out of 211 (improving) (improving) (declining) (declining) (improving) Dec 14 DSR (per 100,000) TBC ISR (per 100,000) Sep 15 Sep 15 Sep 15 Case mix adjusted health gain Case mix adjusted health gain Case mix adjusted health gain Not available N/A Sep 15 Case mix adjusted health gain (improving) (improving) Patient experience of hospital care 2013/ out of 211 New indicator TBC Responsiveness to Inpatients' personal needs 2013/ out of 211 New indicator TBC Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm Incidence of Healthcare Associated Infection (HCAI) Methicillin resistant Staphylococcus aureus (MRSA) Dec 14 DSR for under 19 yrs (per 100,000) Sep 15 Apr 13 to Jun out of 211 Dec 14 Actual count Incidence of Healthcare Associated Infection (HCAI) C. difficile Apr 13 to Jun out of 211 (declining) Dec 14 Weighted percentage of respondents reporting a good experience. Weighted average score from a selection of questions from the National Inpatient Survey measuring patient experience (score out of 100). Weighted average score from a selection of questions from the National Inpatient Survey measuring patient experience (score out of 100). Actual count (not adjusted for population) * Not all CCG's met the minimum number of maternities requirement. % calculated compares bookings for mothers having assessments at a trust to the number of maternities at the point of delivery at that trust 2 quarters later. ** The percentage of infants whose breastfeeding status was recorded falls short of data quality standard of 95% in this quarter, so no data available. *** TSome data suppressed due to small numbers. Newly available indicator Refreshed data since last report 9h Alternative Quality Contract 27 P age

121 We have received our first set of performance reports from Southport & Ormskirk Trust for Phase 1 and Phase 2 of our edischarge Indicators which are: 1.0 All discharges to be sent electronically for following Wards: SSU, EAU, FESS, T&O, Respiratory, Surgical, Cardiology, Stroke/Gen Med, Rehab, and Escalation 2.0 All discharges to be sent electronically for following Wards: SSU, EAU, FESS, T&O, Respiratory, Surgical, Cardiology, Stroke/Gen Med, Rehab, and Escalation within 24 Hrs. 3.0 All discharges to be sent electronically for following Wards: Children's ward and Paeds assessment bay 4.0 All discharges to be sent electronically for following Wards: Children's ward and Paeds assessment bay within 24Hrs. For Phase 1 Quarter 1 and Quarter 2; when looking at averages for all wards they have passed Quarter 1 and Quarter 2 target for both edischarges sent electronically and within 24Hrs; however there is a concern with the Surgical ward 15B sent within 24Hrs. performance as in Quarter 1 this was 58% and Quarter 2 has dropped to 29% Target was 70% and 80% respectively. The Trust has given this response below: This ward's unique circumstances, i.e. multiple consultants with multiple patients as well as outliers, has meant that a ward based approach hasn't had the impact on performance as it has for other wards. However, with the new EPR, we will be able to access much more granular data, and will be able to monitor performance at consultant level. We anticipate that this will facilitate improvement across all clinical areas. We are still awaiting data for the following indicators for Quarter 2: 11.0 Reduce number of hospital cancelled outpatient appointment Audit the usage of the Nutritional Assessment Screening Tool. These two indicators combined are valued at 29,625 for Quarter 2. The GP edischarge audit is well underway, we received our dataset from the trust for all our patients discharged in June 14 and we have randomly picked 100 patients split as evenly as possible across all GP Practices and sent out. We have developed a proforma to which each practice can assess the accuracy and quality of the information provided and asked to return the completed proforma so we can compile the results and create a report to summarise. This report will be available in next month s AQC update. 9j Friends and Family Test Southport and Ormskirk NHS Trust The table below provides a summary of Friends and Family Test response rates and results for Southport and Ormskirk Hospitals NHS Trust to September The England mean results have been included to put the Trust s performance into context. The response rate in A&E had shown month on month improvement since May 2014 however, this trend has now reversed with September s rate falling from 9.1% to 8.1%, which is the ninth worst response rate in the country for this element of the test. It has been difficult to draw any conclusions from the Maternity element of the Friends & Family Test from the latest data as not all response rates have been published by NHS England, so the minimum level expected may not have been met. Although the Inpatients response rate has fallen slightly, it remains above the target of 15%. 28 P age

122 The percentage of Inpatients who would recommend the service they have received to friends and family who need similar treatment or care has fallen slightly from 89.8% in August to 83.1% in September 2014, which is below the England mean of 93.7%. The result for the Birth question of the Maternity element of the test has fallen significantly from the previous month, with a figure of 78.7% be recorded for September compared to 92.9% in August This was the fourth worst result in the country for this month. Quarter 2 results for the Staff Friends & Family Test have not yet been published by NHS England, but will be included in future reports when available. Southport & Ormskirk NHS Trust Friends & Family Summary September 2014 Inpatients A&E Clinical area Response rate target Trust response rate Response rate trajectory from previous month England mean result (% would recommend) Trust result (% would recommend) Result trajectory from previous month 15% 28.7% 93.7% 83.1% 15% 8.1% 86.4% 68.6% Antenatal 15% * 24 * n/a 94.7% 100.0% Comments Response rate has fallen for the third month running but remains above target. The result has fallen from last months figure of 89.8%, and remains below the England mean of 93.7%. A fall from the previous month's response rate of 9.1%, and still significantly below the target of 15%. Response rate is ninth worst in the country in the latest month. Result has remained the same as the previous month, but unable to draw reliable conclusion as response rate not published by NHS England. Maternity Birth 15% 20.5% 95.2% 78.7% Postnatal 15% * 34 * n/a 90.9% 88.2% Postnatal community 15% * 40 * n/a 95.7% 97.5% Work (Q1 results) No target set 2.1% ** n/a 62.0% 39.0% ** n/a Result has fallen significantly on previous month (92.9%) and is the fourth worst result in the country. The England mean has remained relatively static during the last 12 months. Result has fallen compared to previous month, but unable to draw reliable conclusion as response rate not published by NHS England. Result has fallen compared to previous month, but unable to draw reliable conclusion as response rate not published by NHS England. Q2 results not published by NHS England yet. Staff Care (Q1 results) No target set 2.1% ** n/a 76.0% 48.0% ** n/a Q2 results not published by NHS England yet. * Number of eligible responses not published by NHS England in September Number of actual responses received included for information only. ** New indicator, so no historical data to compare to. Response rate or score more than 5% or 5 points below target or national mean. Response rate or score within 5% or 5 points of target or national mean. Response rate or score level with or better than target or national mean. 29 P age

123 9j Southport & Ormskirk Hospitals NHS Trust Nurse Staffing Levels CQC and NHS England have mandated that Acute Trusts provide nurse staffing information to their boards for assurance. The nurse staffing minimum indicator at Southport and Ormskirk Trust fell slightly from 98.73% in August to 97.93% in September Further analysis shows that although the level in Urgent Care was recorded as 98.46%, the temporary staff usage figure of 12.01% within Urgent Care is close to the 15% threshold. Overall temporary staffing levels at the Trust fell from 7.47% in August to 7.11% in September The number of staffing related incidents raised has increased significantly during the last quarter, as shown on the chart below however; the number of falls recorded has remained relatively static. Southport & Ormskirk NHS Trust Staffing Levels September 2014 Trust (overall) Staffing against minimum indicator Number of staffing incidents raised Number of falls 105% 100% 95% 90% 85% 80% 75% Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep Trust Expenditure on bank / agency staff Bank & agency staff usage as % of WTE Staffing against minimum indicator Number of staffing incidents raised Bed occupancy Early warning score Number of falls Pressure sores (Grade 2 4) Friends & Family Net promoter Nurse sickness Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Last 2 months (+/ ) 207, , , , , , , , , , ,251 n/a n/a 6.65% 7.61% 7.13% 7.59% 7.16% 8.67% 7.88% 7.70% 7.34% 7.88% 7.47% 7.11% 0.37% 98.19% 98.98% 96.77% 95.43% 92.05% 85.94% 88.55% 99.39% % 99.85% 98.73% 97.93% 0.80% % 82.5% 79.7% 83.0% 83.3% 82.1% 86.7% 85.6% 83.8% 82.1% 81.3% 81.8% 1.75% 99.14% 98.00% 98.95% 98.00% 98.00% 98.00% 97.74% 97.70% 96.36% 98.72% 99.74% 93.75% 1.34% % 4.89% 5.26% 5.23% 4.34% 4.25% 4.87% 4.93% 4.53% 5.07% 5.07% 4.83% Deteriorating results (on previous month) Improving results (on previous month) 30 P age

124 9k West LancashireCCG Dr Foster Mortality Dashboard The Table below shows an overview of the diagnosis groups with relative risk score. Red risk scores show that the risk is significantly higher than the England average. All relative risk takes a range of factors into account and adjusts the risk so Trusts are compared like for like. West Lancashire has no diagnosis group or procedure group shown as an outlier and therefore all mortality is within national averages. Therefore the table below is for readmissions not mortality. There is higher than expected readmissions for live birth babies, liver disease and perinatal conditions. 31 P age

125 9m Safety Thermometer On one day each month hospital trusts are required to check to see how many of their patients suffered certain types of harm whilst in their care. This measure is known as the safety thermometer. The safety thermometer looks at four harms: pressure ulcers, falls, blood clots and urine infections for those patients who have a urinary catheter in place. This helps Trusts to understand where they need to make improvements. The table below shows the percentage of patients who did not experience any of the four harms in the Trust(s). 32 P age

126 10. Complaints 10a West Lancashire: Complaints During October 2014 there were two contacts regarding NHS services in the West Lancashire area were received by the Patient Experience Team at NHS Staffordshire and Lancashire Commissioning Support Unit (CSU). One contact was a formal complaint the others were both about a concern/enquiry. The reasons for contacting the Patient Experience Team can be grouped into wider themes and monitored over time to look for any trends: Items in the Other theme relate to issues with a dental surgery, GP practice, Out of Hours service, physiotherapy, district nursing and acute trusts. The type of contacts received i.e. formal complaint or concern/enquiry can be recorded over time to look for any trends: 33 P age

127 10b GP Issues with Southport & Ormskirk Hospitals Trust There were 6 complaints/comments copied to the CCG from GP s to Southport & Ormskirk Hospitals Trust during October This now brings the year to date total to 31. The chart below shows the emerging themes of these comments and complaints. 5 GP Issues, Comments & Complaints sent to Southport & Ormskirk Trust 4 Number of comments / complaints Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Appointment availability 1 1 Communication comment Communication complaint Discharge letter/summary The most common complaints this year are around discharge letters/summaries and concerns about communication between the Trust and patients, as shown in the chart below. Themes & trends will continue to be monitored & reported against on a monthly basis, and raised with the Trust through the contract and quality monitoring process as appropriate. The Trust is now sharing reports of actions taken with the CCG via the GP operational forum. Details of the actions taken will be included in next months IBR. 10c Southport & Ormskirk Hospitals Trust Compliments and Complaints Southport and Ormskirk Trust now report their complaints quarterly. The next update will be due in December P age

128 11. Serious Untoward Incidents This section provides details of the new and on going STEIS reportable Serious Untoward Incidents (SUIs) involving West Lancashire CCG patients for the period up to end October A Serious Untoward Incident (requiring investigation) has a nationally set definition but fundamentally is defined as an incident that occurred in relation to NHS funded services and care resulting in avoidable harm or unexpected death or adverse media coverage, severe impact on service provision or loss of person identifiable data. 11a. New Incidents There were Five new SUI involving West Lancashire residents reported in October. 11b. On going investigations The table below shows the numbers of open SUIs for West Lancashire residents broken down by the reporting organisation, as at 31st October. Root cause analysis reports and action plans will be considered by the lead commissioner in conjunction with West Lancashire CCG and will be agreed as acceptable or if not, additional information will be requested. An update on progress with these cases will be presented each month as part of this report. Most of these SUI s are expected to be closed once this information is received. 35 P age

129 Provider Organisation Incident Type Date reported Total Mersey Care NHS Trust (perfromance managed by Liverpool CCG) Suicide of inpatient (not in receipt) 02/10/ Total 1 Lancashire Teaching Hospital (performance managed by Chorely and South Ribble & Greater Preston CCG) Under 18 death 22/03/ Total 1 Child Death 30/09/ Unexpected death of patient in receipt 25/08/ Serious incident by Outpatient 17/07/ Serious self inflicted injury 09/06/ Lancashire Care NHS Foundation Trust (Performance managed by Blackburn with Darwen CCG / Chorley & South Ribble in Community) Admission of an under 18 to an adult bed (mental health) 20/05/ Unexpected death 02/04/ Child Death 22/03/ Admission of an under 18 to an adult bed (mental health) 15/02/ Safeguarding a minor with LD 15/11/ TOTAL 9 Ramsay Healthcare E05 Scheme (Performance managed by NHS England) Other LAT need to agree closure 14/11/ TOTAL 1 Attempted suicide of inpatient in reciept 29/09/ Delayed Diagnosis 23/10/ Pressure Ulcer grade 3 09/10/ Southport & Ormskirk Hospitals Trust (Performance managed by ourselves via Southport and Formby CCG) Elderly patient sent home in Taxi in Early hours of morning 05/09/ Safeguarding of Patient 26/08/ Wrong site surgery Never Event 09/03/ Unexpected Maternal death following discharge 28/02/ Retained swab Never Event 30/07/ Total 8 11c. On going investigations Nursing and Care homes Data is now available to the CCG regarding incidents in care homes. There was a Grade 4 pressure sore reported in July 14 which was Steis reportable 36 P age

130 WEST LANCASHIRE CLINICAL COMMISSIONING GROUP GOVERNING BODY REPORT DATE OF BOARD MEETING: 25 November 2014 WLCCGB 11/14/11 TITLE OF REPORT: Safeguarding Policy BRIEFING POINTS: Does this report / its recommendations have implications and impact with regard to the following: A. Commissioning Board s Aims and Objectives 1. Quality (including patient safety, clinical effectiveness and patient experience) please outline impact x 2. Commissioning of hospital and community services please outline impact 3. Commissioning and performance management of GP Prescribing please outline impact 4. Delivering Financial Balance please outline impact 5. Development of the commissioning group as a commissioning organisation please outline impact B. Governance please outline impact 1. Does this report: provide the Commissioning Board with assurance against any of the risks identified in the assurance framework (identify risk number) have any legal implications promote effective governance practice. 2. Additional resource implications (either financial or staffing resources) x 3. Health Inequalities 4. Human Rights, Equality and Diversity Requirements 5. Clinical Engagement 6. Patient and Public Engagement Safeguarding Policy West Lancashire Clinical Commissioning Group Board Meeting 25 November

131 1.0 Introduction 1.1 The CCG Safeguarding Policy details the safeguarding arrangements that the CCG must put in place to fulfil its statutory duties and responsibilities for safeguarding. 1.2 A recent review of the CCGs safeguarding arrangements by Merseyside Internal Audit Agency identified a number of areas where the CCG safeguarding policy needed to be strengthened. The policy has subsequently been updated to reflect the recommendations of the review and following a period of consultation with key stakeholders. Following endorsement by the pan-lancashire CCG Collaborative and the Quality Improvement Committee the policy is now subject to Governing Body approval. 1.3 To enable the Governing Body to consider and agree the changes within the safeguarding policy (appendix 1), this paper outlines the changes made to the previous version of the policy and the consultation process undertaken. 2.0 Changes to the CCG Safeguarding Policy 2.1 A review of the CCGs safeguarding arrangements by Merseyside Internal Audit Agency (MIAA) identified the following weaknesses in the operational design of the CCGs safeguarding policies:- Governance arrangements with regard to safeguarding, i.e. reporting / monitoring arrangements at group/committee/governing body level not formally defined. Safeguarding team structures, roles and responsibilities at individual level not formally defined. Training requirements of CCG staff not outlined in sufficient detail, i.e. training expected, how it will be delivered and funded and linked to PDPs etc. 2.2 The MIAA report also recommended that consideration be given to reviewing each of the principles/requirements within the policy and to detail how these are addressed / achieved by the CCG. 2.3 The safeguarding policy has now been amended to address the issues identified in the review as detailed below:- The governance structures with regards to reporting are detailed in section 6, with a CCG safeguarding accountability flowchart at appendix 7. Roles and responsibilities of the safeguarding team have been incorporated into the policy at section 5. Guidance on safeguarding training is detailed in appendix 4. This will be supported by a safeguarding training framework which is in the process of being finalised. Safeguarding Policy West Lancashire Clinical Commissioning Group Board Meeting 25 November

132 A CCG self-assessment tool is incorporated at appendix 6 which will provide the means by which the CCG can demonstrate how the principles/requirement of the policy is achieved. 3.0 Changes to the safeguarding standards 3.1 In addition to addressing the weaknesses raised by MIAA, the safeguarding leads across pan Lancashire took the opportunity to update the safeguarding standards incorporated in the policy to ensure that they were proportionate to the services commissioned. 4.0 Consultation process 4.1 Following a period of consultation with key stakeholders, including contracting and safeguarding leads /executives across the pan Lancashire health economy, the safeguarding policy and associated standards have been considered and supported by the pan Lancashire Safeguarding Collaborative and the joint CCG Quality and Improvement Committee. 4.2 The policy has also been subject to an equality and impact assessment internally as well as by Chorley and South Ribbles CCG Patient Advisory Group. 4.3 All comments received during the consultation/equality and impact assessment have been considered and where appropriate the policy has been amended accordingly. 5.0 Conclusions and recommendations 5.1 The safeguarding policy has been updated in line with MIAA recommendations. To ensure there is a proportionate response to the monitoring of safeguarding arrangements across commissioned services a revised set of safeguarding standards has been agreed across pan Lancashire and these are incorporated into the updated policy. 5.2 The Governing Body is asked to note the key changes to the safeguarding policy and subject to approval, to ratify the safeguarding policy. Jean Rollinson Head of Safeguarding Safeguarding Policy West Lancashire Clinical Commissioning Group Board Meeting 25 November

133 NHS West Lancashire CCG Safeguarding Children and Vulnerable Adults Policy Incorporating standards for safeguarding and Mental Capacity Act for both CCGs and Commissioned Services. Document Reference: Document Title: Version: 4.0 Supersedes: 1.0 Author: Authors Designation: Consultation Group: Date Ratified: Review Date: CCG Safeguarding Children and Vulnerable Adults Policy Jean Rollinson Head of Safeguarding for NHS Chorley and South Ribble CCG; NHS Greater Preston CCG and NHS West Lancashire CCG Pan Lancashire Safeguarding Collaborative Group Page 1 of 45

134 Version Control Version Date Author Status Jean Rollinson Final Jean Rollinson Draft Jean Rollinson Draft Jean Rollinson Draft Comment / Details of Amendments Waiting for feedback from patient group Waiting for ratification by Q&I Committee before going to Governing Body for final ratification Considered and agreed by Q&I Committee Circulation List Prior to approval, this Policy was circulated to the following for consultation: Pan-Lancashire Safeguarding Collaborative Group Contracting and safeguarding leads across pan Lancashire CCGs and NHS providers. Patient Advisory Group Members of the Quality and Improvement Committee Following Approval this Policy Document will be circulated to: All CCG staff To be incorporated within contract arrangements with all commissioned services Equality Impact Assessment This document and the equality impact assessment have been reviewed by the Patient Advisory Group; the policy has been updated to reflect feedback received. Page 2 of 45

135 CONTENTS PAGE 1.0 INTRODUCTION Scope Principles Definitions ROLES AND RESPONSIBILITIES 8 General Roles and Responsibilities of the CCG 8 Chief Officer 9 CCG Board Lead with responsibility for safeguarding 9 CCG Safeguarding Team 10 CCG individual staff members 10 GP member practices GOVERNANCE ARRANGEMENTS 11 Safeguarding Assurance Committee 11 Pan Lancashire Collaborative Approach to safeguarding 11 Safeguarding Training IMPLEMENTATION 12 Method of monitoring compliance BREACHES OF POLICY 12 Contact details REFERENCE DOCUMENTS GLOSSARY CATEGORIES OF ABUSE 15 APPENDICES Appendix 1: What to do if an adult is at risk of harm 17 Appendix 2: What to do if you have concerns a child is being abused 18 Appendix 3: Information Sharing Guidance 20 Appendix 4: Safeguarding Children and Adults Training for CCG staff 22 Appendix 5: Safeguarding Standards for commissioned services 30 Appendix 6: CCG requirements re compliance with statutory and national guidance for safeguarding 39 Appendix 7: CCG safeguarding accountability flowchart 45 Page 3 of 45

136 1.0 Introduction 1.1 NHS West Lancashire Clinical Commissioning Group (CCG) as with all other NHS bodies has a statutory duty to ensure that it makes arrangements to safeguard and promote the welfare of children and young people, that reflect the needs of the children they deal with; and to protect vulnerable adults from abuse or the risk of abuse. This policy details the safeguarding arrangements which must be in place to ensure the CCG fulfils its statutory duties and responsibilities. 1.2 In discharging these statutory duties/responsibilities account must be taken of: Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework (NHS Commissioning Board 21 st March 2013) Working Together to Safeguard Children (HM Government March 2013) Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DH 2009) No Secrets (DH and Home Office 2000) Mental Capacity Act 2005: Code of Practice (Department for Constitutional Affairs 2007) Safeguarding Adults: The Role of Health Services (DH 2011) The policies and procedures of Lancashire Safeguarding Children Board (LSCB) and Lancashire Safeguarding Adults Board (LSAB). 1.3 As a commissioning organisation NHS West Lancashire CCG is required to ensure that all health providers from whom it commissions services (both public and independent sector) have comprehensive single and multi-agency policies and procedures in place to safeguard and promote the welfare of children and to protect vulnerable adults from abuse or the risk of abuse; that health providers are linked into the Local Safeguarding Children Board (LSCB) and Local Safeguarding Adult Board (LSAB) and that health workers contribute to multi-agency working. 1.4 This policy has two functions: it details the roles and responsibilities of NHS West Lancashire CCG as a commissioning organisation, and that of its employees and GP member practices. The policy also provides clear service standards against which healthcare providers, including independent providers, voluntary, community and faith sector (VCFS), will be monitored to ensure that all service users are protected from abuse and the risk of abuse. 2.0 Scope 2.1 This policy aims to ensure that no act or omission by NHS West Lancashire CCG as a commissioning organisation, or via the services it commissions, puts a service user at risk; and that robust systems are in place to safeguard and promote the welfare of children, and to protect adults at risk of harm. 2.2 Where NHS West Lancashire CCG is identified as the lead commissioner it will notify associate commissioners of a provider s non-compliance with the standards contained in this policy or of any serious untoward incident that has compromised the safety and welfare of a child/vulnerable adult resident within their population. Page 4 of 45

137 3.0 Principles 3.1 In developing this policy NHS West Lancashire CCG recognises that safeguarding children and vulnerable adults is a shared responsibility with the need for effective joint working between agencies and professionals that have different roles and expertise if those vulnerable groups in society are to be protected from harm. In order to achieve effective joint working there must be constructive relationships at all levels, promoted and supported by: A commitment of senior managers and board members to seek continuous improvement with regards to safeguarding both within the work of the CCG and within those services commissioned. Clear lines of accountability within the CCG for safeguarding. Service developments that take account of the need to safeguard all service users, and is informed, where appropriate, by the views of service users. Staff training and continuing professional development so that staff have an understanding of their roles and responsibilities in regards to safeguarding children, adults at risk, children looked after and the Mental Capacity Act. Appropriate supervision and support for staff in relation to safeguarding practice Safe working practices including recruitment and vetting procedures. Effective interagency working, including effective information sharing. The above principles reflect the expectations of the NHS safeguarding assurance and accountability framework and statutory guidance as referenced within this policy. The CCG will monitor themselves on an annual basis against a set of standards (appendix 6) reporting to the Safeguarding Assurance Sub Group of the Quality and Performance Committee on the findings including any actions required to ensure full compliance. 3.2 The CCG is committed to a human rights based approach, which ensures that employees and the community that we serve are treated with fairness, respect, equality, dignity and autonomy (FREDA) and that individuals or groups are not discriminated against on the basis of their protected characteristics. 3.3 In line with equality legislation, this policy aims to safeguard children, young people and adults who may be at risk of abuse irrespective of their protected characteristics as outlined in the Equality Act The nine protected characteristics being age; gender; race; disability; marriage / civil partnership; maternity / pregnancy; religion / belief; sexual orientation and gender reassignment 4.0 Definitions 4.1 Children: in this policy, as in the Children Act 1989 and 2004, a child is anyone who has not yet reached their 18 th birthday. Children therefore means children and young people throughout. Page 5 of 45

138 4.2 Safeguarding and promoting the welfare of children is defined in Working Together to Safeguard Children (2013) as: Protecting children from maltreatment Preventing impairment of children's health or development Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care; and Taking action to enable all children to have the best life chances. 4.3 Child protection: Part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering, or are likely to suffer, significant harm. 4.4 Young carers: Are children and young people who assume important caring responsibilities for parents or siblings, who are disabled, have physical or mental health problems, or misuse drugs or alcohol. 4.5 Looked After Children: The term looked after children and young people is generally used to mean those looked after by the state, according to relevant national legislation which differs between England, Northern Ireland, Scotland and Wales. This includes those who are subject to an interim care order, care order (The Children Act 1989 section 31, 38) or temporarily classed as looked after on a planned basis for short breaks or respite care. The term is also used to describe accommodated (The Children Act 1989, section 20) children and young people who are looked after on a voluntary basis at the request of, or by agreement with, their parents. We refer to these children as children in care. 4.6 Adult Safeguarding: The Principles for Adult Safeguarding (DH, 2011) Empowerment - Presumption of person led decisions and informed consent. Protection - Support and representation for those in greatest need. Prevention - It is better to take action before harm occurs. Proportionality Proportionate and least intrusive response appropriate to the risk presented. Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability - Accountability and transparency in delivering safeguarding 4.7 Vulnerable adult: Whilst there is no formal definition of vulnerability within health care, some people receiving health care may be at greater risk from harm than others, sometimes as a complication of their presenting condition and their individual circumstances. The risks that increase a person s vulnerability should be appropriately assessed and identified by the health care professional/vcfs/care Home provider at the first contact and continue throughout the care pathway (DH 2010). Under Section 59 Supporting Vulnerable Groups Act 2006 a person aged 18 years or over is also defined as a vulnerable adult where they are receiving any form of Page 6 of 45

139 health care and who needs to be able to trust the people caring for them, supporting them and/or providing them with services. 4.8 Adult at risk: A person aged 18 or over and who: Is eligible for or receives any adult social care service (including carers services) provided or arranged by a local authority Receives direct payments in lieu of adult social care services Funds their own care and has social care needs; otherwise has social care needs that are low, moderate, substantial or critical Falls within any other categories prescribed by the Secretary of State Is or may be in need of community care services by reason of mental or other disability, age or illness Who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation, and Is at risk of significant harm, where harm is defined as ill-treatment or the impairment of health or development or unlawful conduct which appropriates or adversely affects property, rights or interests (for example theft, fraud, embezzlement or extortion). For the purpose of this policy the term adult at risk is used interchangeably with vulnerable adult. 4.9 Prevent (Radicalisation of vulnerable people): Prevent is one of the 4 key principles of the CONTEST strategy, which aims to stop people becoming terrorists or supporting terrorism. The Prevent Strategy addresses all forms of terrorism including extreme right wing but continues to prioritise according to the threat posed to our national security. The aim of Prevent is to stop people from becoming terrorists or supporting terrorism and operates in the pre-criminal space before any criminal activity has taken place. Radicalisation refers to the process by which people come to support, and in some cases to participate in terrorism Violent Extremism as defined by the Crown Prosecution Service (CPS) as the demonstration of unacceptable behaviour by using any means or medium to express views which: foment, justify or glorify terrorist violence in furtherance of particular beliefs; seek to provoke others to terrorist acts; foment other serious criminal activity or seek to provoke others to serious criminal acts; foster hatred which might lead to inter-community violence in the UK. Categories of abuse are detailed in section 11. Page 7 of 45

140 5.0 Roles and Responsibilities for safeguarding 5.1 General Roles and Responsibilities of NHS West Lancashire CCG The ultimate accountability for safeguarding sits with the Chief Officer of the CCG. Any failure to have systems and processes in place to protect children and vulnerable adults in the commissioning process, or by providers of health care that the CCG commissions would result in failure to meet statutory and non-statutory constitutional and governance requirements. The CCG must demonstrate robust arrangements are in place to demonstrate compliance with safeguarding responsibilities. The CCG must establish and maintain good constitutional and governance arrangements with capacity and capability to deliver safeguarding duties and responsibilities, as well as effectively commission services ensuring that all service users are protected from abuse and neglect. Establish clear lines of accountability for safeguarding, reflected in governance arrangements To co-operate with the local authority in the operation of the LSCB / LSAB. Ensure that all providers with whom there are commissioning arrangements have in place comprehensive and effective policies and procedures to safeguard children and vulnerable adults in line with those of the LSCB / LSAB. Ensure that staff directly or indirectly employed by the CCG are aware of their roles and responsibilities for safeguarding and know how to act on concerns in accordance with local LSCB / LSAB policies and procedures. To participate in Domestic Homicide Reviews. Secure the expertise of a Designated Doctor and Nurse for Safeguarding Children; a Designated Doctor and Nurse and for Children Looked After (CLA); a Designated Paediatrician for Child Deaths; a Safeguarding Adult Lead and a Mental Capacity Act Lead. Ensure that plans are in place to train all staff in contact with children, adults who are parents/carers and vulnerable adults in the course of their normal duties so that they are trained and competent to be alert to the potential indicators of abuse or neglect for children and vulnerable adults, know how to act on those concerns in line with local guidance. Ensure that appropriate systems and processes are in place to fulfil specific duties of cooperation and partnership and the ability to demonstrate that the CCG meets best practice in respect of safeguarding children and adults at risk and children looked after. Ensure that safeguarding is at the forefront of service planning and a regular agenda item of the CCG Board business. Ensure that all decisions in respect of adult care placements are based on knowledge of standards of care and safeguarding concerns. Page 8 of 45

141 5.2 Chief Officer Ensures that the health contribution to safeguarding and promoting the welfare of children and vulnerable adults is discharged effectively across the whole local health economy through the organisation s commissioning arrangements. Ensures that the organisation not only commissions specific clinical services but exercises a public health responsibility in ensuring that all service users are safeguarded from abuse or the risk of abuse. Ensures that safeguarding children and vulnerable adults is identified as a key priority area in all strategic planning processes. Ensures that safeguarding children and vulnerable adults is integral to clinical governance and audit arrangements. Ensures that all providers from whom services are commissioned have comprehensive single and multi-agency policies and procedures for safeguarding which are in line with the LSCB / LSAB policies and procedures, and are easily accessible for staff at all levels. Ensures that all contracts for the delivery of health care include clear service standards for safeguarding children and vulnerable adults; these service standards are monitored thereby providing assurance that service users are effectively safeguarded. Ensures that all staff in contact with children, adults who are parents/carers and vulnerable adults in the course of their normal duties are trained and competent to be alert to the potential indicators of abuse or neglect for children and vulnerable adults, know how to act on those concerns in line with local guidance; Ensures the CCG co-operates with the local authority in the operation of the LSCB and LSAB. Ensures that all health organisations with whom the CCG has commissioning arrangements have links with their LSCB and LSAB; that there is appropriate representation at an appropriate level of seniority; and that health workers contribute to multi-agency working. Ensures that any system and processes that include decision making about an individual patient (e.g. funding panels) takes account of the requirements of the Mental Capacity Act 2005; this includes ensuring that actions and decisions are documented in a way that demonstrates compliance with the Act. 5.3 CCG Board Lead with responsibility for safeguarding Ensures that the CCG has management and accountability structures that deliver safe and effective services in accordance with statutory, national and local guidance for safeguarding and children looked after. Ensures that service plans/specifications/contracts/invitations to tender etc. include reference to the standards expected for safeguarding children and vulnerable adults. Page 9 of 45

142 Ensures that safe recruitment practices are adhered to in line with national and local guidance and that safeguarding responsibilities are reflected in all job descriptions. Ensures that staff in contact with children and or adults in the course of their normal duties are trained and competent to be alert to the potential indicators of abuse or neglect and know how to act on those concerns in line with local guidance. 5.4 CCG Safeguarding Team (Designated and Professional Leads for Safeguarding and MCA) To ensure that the CCG fulfils its statutory functions for safeguarding as detailed in statutory and national guidance, providing assurance to executive leads for safeguarding, that there is a systematic approach to safeguarding across the CCGs which includes clear standards and CCG policy for delivery across the adults and children agendas. Ensure the CCGs meet the requirements of the MCA, including Deprivation of Liberty Safeguards. Ensure that safeguarding children and adults at risk is an integral part of the CCG s clinical governance framework. Promote, influence and develop safeguarding training on a single and interagency basis - to meet the training needs of staff Provide clinical advice on the development and monitoring of the safeguarding aspects of CCG contracts. To review and evaluate the practice and learning from all health professionals as part of the serious case review processes To provide advanced expert knowledge and advice on safeguarding children and adults to a wide range of professional groups and organisations/agencies To undertake statutory designated safeguarding functions as outlined in statutory guidance (DH 2009 / HM 2013) and detailed in the Intercollegiate Documents (RCPCH 2012/14). The designated doctor and nurse functions to be incorporated into the job role/plan of those individuals designated to hold the role of designated nurse and designated doctor for safeguarding children and children looked after To provide an annual report on safeguarding which will be considered by the governing body. 5.5 Individual Staff Members including GP member practices. To be alert to the potential indicators of abuse or neglect for children and adults and know how to act on those concerns in line with local guidance. To undertake training in accordance with their roles and responsibilities as outlined by the training frameworks of the LSCB and LSAB so that they maintain their skills and are familiar with procedures aimed at safeguarding children and adults at risk. Understand the principles of confidentiality and information sharing in line with local and government guidance. Page 10 of 45

143 All staff contribute, when requested to do so, to the multi-agency meetings established to safeguard children and adults at risk. Appendices at the back of this document provide guidance as to what action needs to be taken where there are concerns that a child or an adult at risk is being abused Appendix 1: What to do if an adult is at risk of harm Appendix 2: What to do if you are worried a child is being abused 6.0 Governance Arrangements 6.1 Safeguarding Assurance Committee To ensure that safeguarding is integral to the governance arrangements of the CCG a safeguarding assurance committee is operational reporting into the Quality and Performance Committee of the CCG on a quarterly basis. The purpose of the safeguarding assurance committee is to provide assurance on the effectiveness of the safeguarding arrangements in place within commissioned services and within the CCG and will ensure that safeguarding is integral to quality and audit arrangements within the CCG. The Committee will also ensure that the CCG is kept informed of national and local initiatives for safeguarding children and adults at risk and will oversee the implementation of learning from reviews and audits that are aimed at driving improvements to safeguard children and adults at risk. The Committee will not replicate existing multi/single agency forums. In addition to the reporting arrangements above an annual safeguarding report will be submitted to the governing body with exception reporting on issues of significance e.g. serious case review reports, inspections findings. 6.2 Pan Lancashire Collaborative approach to safeguarding A collaborative partnership agreement is in place between the pan Lancashire CCGs and the Midlands and Lancashire Commissioning Safeguarding Unit with the intention of sharing best practice and learning and promoting consistency in practice, but with each CCG remaining accountable for managing their local safeguarding service. 6.3 Safeguarding training A safeguarding training framework details what training is expected of all CCG employees, including agency staff and CCG members. The framework will be made available on the CCG web site but a summary of the training requirements can be found at appendix 4. Page 11 of 45

144 7.0 Implementation 7.1 Method of Monitoring Compliance The standards expected of the CCG and all healthcare providers are detailed in the appendices. Compliance will be measured by annual audit an audit tool will be made available to all providers to facilitate the recording of information. The audit tool should be completed using the RAG definitions outlined in the Procedure for Monitoring Safeguarding Children and Vulnerable Adults via Provider Contracts. This procedure was developed in order to standardise the monitoring and escalation approach across the North West. 7.2 Note: all allegations of abuse made against a worker and any Serious Untoward Incident against a child or vulnerable adult to be notified to the Head of Safeguarding for the CCG (see section 8.3 for contact details) 7.3 The effectiveness of the policy will be monitored an annual basis. 8.0 Breaches of Policy 8.1 This policy is mandatory. Where it is not possible to comply with the policy or a decision is taken to depart from it, this must be notified to the Head of Safeguarding for the CCG so that the level of risk can be assessed and an action plan can be formulated (see section 8.3 for contact details). 8.2 Where the CCG is a lead commissioner it will notify associate commissioners of a provider s non-compliance with the standards contained in this policy, including action taken where there has been a significant breach. 8.3 Contact Details Jean Rollinson Head of Safeguarding for NHS Chorley and South Ribble CCG; NHS Greater Preston CCG and NHS West Lancashire CCG Chorley House, Centurion Way, Leyland, Lancashire, PR26 6TT Direct line: MOB: jean.rollinson@chorleysouthribbleccg.nhs.uk 9.0 Reference Documents In developing this Policy account has been taken of the following statutory and non-statutory guidance, best practice guidance and the policies and procedures of the LSCB and LSAB. Page 12 of 45

145 Statutory Guidance Department for Constitutional Affairs (2007) Mental Capacity Act 2005: Code of Practice, TSO: London Department of Health, Home Office (2000) No Secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (issued under Section7 of the Local Authority Social Services Act 1970) Department of Health et al (2009) Statutory guidance on Promoting the Health and well-being of Looked After Children, Nottingham, DCSF publications HM Government (2007) Safeguarding children who may have been trafficked, DCSF publications HM Government (2008) Safeguarding Children in whom illness is fabricated or induced, DCSF publications HM Government (2009) The Right to Choose: multi-agency statutory guidance for dealing with Forced marriage, Forced Marriage Unit: London HM Government (2013) Working Together to Safeguard Children, Nottingham, DCSF publications Ministry of Justice (2008) Deprivation of Liberty Safeguards Code of Practice to supplement Mental Capacity Act 2005, London TSO Non-statutory guidance Children s Workforce Development Council (March 2010) Early identification, assessment of needs and intervention. The Common Assessment Framework for Children and Young People: A practitioner s guide, CWCD DH (June 2012) The Functions of Clinical Commissioning Groups (updated to reflect the final Health and Social Care Act 2012) DH (March, 2011) Adult Safeguarding: The Role of Health Services DH (May, 2011) Statement of Government Policy on Adult Safeguarding DH (Nov, 2011), Building Partnerships, Staying Safe. - The Health Sector Contribution to HM Governments Prevent Strategy. Guidance for Healthcare organisations. HM Government (2006) What to do if you re worried a child is being abused, DSCF publications HM Government (2008) Information Sharing: Guidance for practitioners and managers, DCSF publications Ministry of Justice, Department of Health (2014) Mental Capacity Act: government response to the House of Lords Select Committee report NHS Commissioning Board March 2013 Safeguarding Vulnerable people in the Reformed NHS - accountability and assurance framework Royal College Paediatrics and Child Health et al (2014) Safeguarding Children and Young people: Roles and Competencies for Health Care Staff. Intercollegiate Document supported by the Department of Health. Page 13 of 45

146 Best practice guidance Department of Health (2004) Core Standard 5 of the National Service Framework for Children Young People and Maternity Services plus those elements beyond standard 5 that deal with safeguarding and promoting the welfare of children Department of Health (2009) Responding to domestic abuse: a handbook for health professionals Department of Health (2010) Clinical Governance and adult safeguarding: an integrated approach, Department of Health Department of Health (2006) Mental Capacity Act Best Practice Tool, Gateway reference: 6703 HM Government (2011) Multi-agency practice guidelines: Female Genital Mutilation HM Government (2009) Multi-agency practice guidelines: Handling cases of Forced Marriage, Forced Marriage Unit: London HM Government. (2011,July). The United Kingdom s Strategy for Countering International Terrorism, from Home Office accessed at National Institute for Health and Clinical Excellence (2009) When to suspect child maltreatment, Nice clinical guideline 89 National Institute for Healthcare Excellence (2013) NICE support for commissioning for the health and well-being of looked after children and young people. National Institute for Healthcare Excellence (2014) Domestic abuse and violence Nice PH 50 RCPCH et al (2012) Standards for Children and young People in Emergency Care Settings; Intercollegiate standards Lancashire Safeguarding Children Board Policies, Procedures and Practice Guidance Lancashire Safeguarding Adult Board Policies, Procedures and Practice Guidance Care Quality Commission - Care Quality Commission (2009) Guidance about compliance: Essential Standards of Quality and Safety Disclose and Barring Service - The primary role of the Disclosure and Barring Service (DBS) is to help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups including children Glossary CAF CCG CLA Common Assessment Framework Clinical Commissioning Group Children Looked After MCA Mental Capacity Act (2005) LSCB LSAB VCFS Local Safeguarding Children Board Local Safeguarding Adult Board Voluntary, Community and Faith Service Page 14 of 45

147 11.0 Categories of abuse 11.1 Children: For children s safeguarding, the definitions of abuse are taken from Working Together to Safeguard Children (HM Government, 2013). Abuse is defined as a form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others (e.g. via the internet). A child may be abused by an adult or adults, or another child or children. Physical abuse: A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. Emotional abuse: The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or making fun of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. Sexual abuse: Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or nonpenetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Neglect: The persistent failure to meet a child s basic physical and/or psychological needs, likely to result in the serious impairment of the child s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: provide adequate food, clothing and shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; Page 15 of 45

148 ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child s basic emotional needs Vulnerable adults (adults at risk): for adult safeguarding, the definitions are taken from No Secrets (Department of Health and the Home Office, 2000). Abuse is a violation of an individual s human and civil rights by other person or persons. Abuse may consist of single or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm, or exploitation of, the person subjected to it. Of particular relevance are the following descriptions of the forms that abuse may take: Physical abuse: including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions. Sexual abuse: including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting. Psychological abuse: including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks. Financial or material abuse: including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. Neglect and acts of omission: including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Neglect also results in bodily harm and/or mental distress. It can involve failure to intervene in behaviour that is likely to cause harm to a person or to others. Neglect can occur because of lack of knowledge by the carer. Possible indicators of neglect include malnutrition; untreated medical problems; bed sores; confusion; over-sedation. NB: Self neglect by an adult will not usually result in the instigation of the adult protection procedures unless the situation involves a significant act of omission or commission by someone else with responsibility for the care of that adult. Discriminatory abuse: including racist, sexist, that based on a person s disability, and other forms of harassment, slurs or similar treatment. Page 16 of 45

149 Appendix 1 What to do if an adult is at risk of harm Abuse discovered or suspected Is the adult at risk of immediate danger or in need of emergency medical treatment? And/or has a crime being committed? And/or is there a need to protect forensic evidence? Is anyone at risk of harm e.g. another adult or child? Yes No Consult with designated or professional lead for safeguarding for the CCG or if not available with the duty social worker in Adult Social Care Contact emergency service e.g. police ambulance or GP No Safeguarding adults issue confirmed? Yes Referral to adult social care services Document all discussions held, actions taken, decision made including who was informed and who was spoken to All information to be passed to designated professional for safeguarding on next working day Record incident on Datix Who to contact in Adult Social Care Adult Social Care Services (Mon to Fri 8am to 8pm) Tel: Emergency Duty Team (every day out of hours) Tel: Who to contact in the Police Public Protection Unit Tel: and request to speak to the PPU for the area in which the person resides In an emergency contact the police on 999 Who to contact for local NHS advice. Safeguarding Team (Mon to Fri 9am to 5pm) Tel: Designated Lead for safeguarding Adults Tel: for the Clinical Commissioning group Tel: Staff should update their knowledge by accessing regular training and be familiar with local safeguarding policies, including those of Lancashire Safeguarding Adult s Board. Page 17 of 45

150 Appendix 2 Page 18 of 45

151 Page 19 of 45

152 Appendix 3 Page 20 of 45

153 Page 21 of 45

154 Appendix 4 Safeguarding Children and Adults Training for CCG staff All Healthcare staff have a duty to safeguard and protect the welfare of children and vulnerable adults. Safeguarding children and adults training is therefore essential for all staff engaged in services for children and vulnerable adults to ensure that you retain the competences appropriate to your role and follow the relevant professional guidance. This document aims to provide guidance on the requirements and resources available to CCG staff. Reaching and maintaining safeguarding children competencies is a statutory requirement. Level 1 all CCG staff are required to undertake level 1 training (this is the minimum entry level for all staff working in healthcare settings) Level 2 - all staff who have any contact with children, young people and/or parents/carers are required to undertake level 2 training Levels 3, 4, 5 are applicable to Designated Nurses & Named Leads NB: The training requirements for the roles of Chair, CEOs, Executive Board leads and Board members will be described separately in this documentation Target Group Level and suggested content Training opportunities available Level 1 - All staff working in health care settings: CCG staff groups All non- clinical staff, administrative, domestics, Board level Executives & non executives, lay members Training must be accessed on induction or within 6 weeks of taking up the post Competencies should be reviewed annually as part of staff appraisal in conjunction with individual learning and development plans. What is abuse and neglect How to recognise abuse and neglect To be able to understand the impact a parent/carer s physical and mental health can have on the well-being of a child or young person, including the impact of domestic violence To be able to understand the risks associated with the internet and online social networking Appropriate action to take if an individual has concerns National Skills academy for Health Level 1 and 2 E Learning Children LSCB e-learning level 1 and level 2 (1 hour max) accessed via: /view.asp?siteid=3829&pageid=20832&e=e The e-learning programme can also be accessed as part of refresher training Over a three-year period staff should receive refresher training equivalent to a minimum of 2 hours. Level 2 - All staff who have any contact with children, young people and/or parents/carers CCG staff groups Documentation and information sharing National Skills academy for Health Level 1 and 2 E Learning Children Page 22 of 45

155 Target Group Level and suggested content Training opportunities available Includes: administrators for safeguarding teams, quality performance specialists, equality and diversity lead, engagement and patient experience lead, engagement assistant & customer care & patient experience officers Training should be undertaken within six months of coming into post. NB: Staff are required to have accessed level 1 training Competencies should be reviewed annually as part of staff appraisal in conjunction with individual learning and development plans. Over a three-year period staff should receive refresher training equivalent to a minimum of 3-4 hours. Training should be tailored to the roles of individuals. Professional roles and responsibilities Impact of parent/carers physical and mental health on the wellbeing of the child in order to be able to identify a child/young person at risk Using the common assessment framework Using professional and clinical knowledge and understanding of what constitutes child maltreatment and how to recognise signs of abuse and neglect To be aware of the risk of Female Genital Mutilation (FGM) and be able to refer appropriately for further care and support To be able to identify and refer a child suspected of being a victim of trafficking and/or sexual exploitation To be aware of the risk factors for radicalisation and know who to contact regarding preventative action and support Acting in accordance with statutory and non- statutory guidance and legislation LSCB e-learning level 1 and level 2 (1 hour max) accessed via: /view.asp?siteid=3829&pageid=20832&e=e ( you will need to register on ISA training to do this) Lancashire Safeguarding Children Boards LSCB policies and procedures accessed at: e_child_board/safeguarding_children_proce dures/index.asp Level 3 - All clinical staff working predominately with children and or their families who contribute to assessing, planning, intervening and evaluating the needs of a child and parenting capacity where there are safeguarding /child protection concerns. CCG staff groups Designated and professional leads to be competent at this level. To be able to identify possible signs of sexual, physical, or emotional abuse or neglect using child and family- focused approach To be able to know what constitutes child maltreatment including the effects of carer/parental behaviour on children and young people Identify, assess and meet the needs of children where there are safeguarding concerns National Skills academy for Health Level 3 E Learning Children ELearning for Healthcare.org.uk - in conjunction with the royal colleges. The impact of parenting issues such as domestic abuse, substance misuse on parenting capacity and the interagency response Recognising the importance of family history and functioning Working with family members including the lack of co-operation and superficial compliance within the context of the role Awareness of interagency policy / national guidance, implications of Lancashire Safeguarding Children Common Assessment Framework CAF /Continuum Of Need CON training d=5943&pageid=33997&e=e Information and guidance re working with children who are looked after Promoting the health and Well-being of Looked After Page 23 of 45

156 Target Group Level and suggested content Training opportunities available legislation Information sharing, confidentiality and consent; Remit and role of Local Safeguarding Children Boards Interagency frameworks for safeguarding including the Common Assessment framework (CAF); Team around the Child and the role of the Lead Professional. Additional specialist competencies Interagency working Contributing to serious case reviews/critical incidents/child death overview processes Applying lessons learnt from audit and serious case reviews to improve practice Advising others on appropriate information sharing Children (DH 2009) tandard/publicationdetail/page1/dcsf Information on domestic violence, forced marriage and honour based violence Information on working with sexually active young people accessed at om/chapters/p_sexually_active_yp.html Level 4 - Specialist roles and Named Leads CCG staff groups Designated and Named Leads NB: Those undertaking level 4 training do not need to repeat level 1, 2 or 3 training as it is anticipated that an update will be encompassed in level 4 training Competence should be reviewed annually as part of staff appraisal in conjunction with individual learning and development plan Named professionals should attend a minimum of 24 hours of education, training and learning over a three-year period. This should include non-clinical knowledge acquisition such as management, appraisal and supervision training. To be able to contribute to the development of robust internal safeguarding/child protection policy, guidelines, and protocols as a member of the safeguarding team To be able to know how to provide specialist advice to practitioners, both actively and reactively including clarification about organisational policies, legal issues and the management of child protection cases To be able to work effectively with colleagues from other organisations, providing advice as appropriate e.g. concerning safeguarding/child protection policy and legal frameworks, the health management of child protection concerns. To be able to know how to undertake and contribute to serious case reviews/case management/significant case reviews, individual management views/individual agency reviews/internal management reviews, this will include the undertaking of chronologies, the development of action plans where appropriate, and leading internal management reviews as part of this Please refer to all training opportunities available in level 3 Named professionals should participate regularly in support groups or peer support networks for specialist professionals at a local and National level, according to professional guidelines (attendance should be recorded) Named professionals should complete a management programme with a focus on leadership and change management within three years of taking up their post Named Professionals responsible for training of doctors are expected to have appropriate education Page 24 of 45

157 Target Group Level and suggested content Training opportunities available Level 5 - Specialists roles Designated professional staff groups To be able to be a trained provider of safeguarding/child protection supervision and/or support To be able to lead/oversee safeguarding quality assurance and improvement processes To be able to undertake risk assessments of organisational ability to safeguard/protect children and young people To be able to support colleagues in challenging views offered by other professionals, as appropriate To be able to support colleagues in challenging views offered by other professionals, as appropriate CCG staff groups Designated professionals NB: Training at level 5 will include the training required at levels 1-4 and will negate the need to undertake refresher training at levels 1-4 in addition to level 5. Designated professionals should attend a minimum of 24 hours of education, training and learning over a three-year period. This should include non-clinical knowledge acquisition such as management, appraisal, supervision training and the context of other professionals work To be able to know how to conduct a training needs analysis, and how to commission, plan, design, deliver, and evaluate safeguarding/child protection single and inter-agency training and teaching for staff across the health community To be able to know how to take a lead role in: Leading /overseeing safeguarding/child protection quality assurance and improvement across the health community. The implementation of national guidelines and auditing the effectiveness and quality of services across the health community against quality standards. Service development conducting the health component of serious case reviews/ case management reviews/significant case reviews drawing conclusions and developing an agreed action plan to address lessons learnt. Please refer to all training opportunities available in level 3 Designated professionals should participate regularly in support groups or peer support Networks for specialist professionals at a local, regional, and national level according to professional guidelines (and their attendance should be recorded) An executive level management programme with a focus on leadership and change Management should be completed within three years of taking up the post Strategic and professional leadership across the health community on all aspects of safeguarding/ child protection. Multi-disciplinary team reviews. Regional and national safeguarding/child protection clinical networks (where appropriate). Page 25 of 45

158 Target Group Level and suggested content Training opportunities available To be able to know how to give appropriate advice to specialist safeguarding/child protection professionals working within organisations To be able to know how to provide expert advice on increasing quality, productivity, and improving health outcomes for vulnerable children and those where there are safeguarding concerns To be able to oversee safeguarding/child protection quality assurance processes across the whole health community. To be able to know how to provide expert advice to service planners and commissioners, to ensure all services commissioned meet the statutory requirement to safeguard of children. To be able to know how to influence improvements in safeguarding/child protection services across the health community. To be able to monitor services across the health community to ensure adherence to legislation, policy and key statutory and non-statutory guidance. To be able to reconcile differences of opinion among colleagues from different organisations and agencies. To be able to proactively deal with strategic communications and the media on safeguarding/ child protection across the health community. To be able to know how to work with public health officers to undertake robust safeguarding/child protection population-based needs assessments that establish current and future health needs and service requirements across the health community. To be able to provide an evidence base for decisions around investment and disinvestment in services to improve the health of the local population and to safeguard/protect children and young people, and articulate these decisions to executive officers. Page 26 of 45

159 Target Group Level and suggested content Training opportunities available Board Level for Chief Executive Officers, Trust and Health Board Executive and non-executive directors/members, commissioning body Directors All board members must have knowledge equivalent to all staff working within the healthcare setting (level 1) as well as Board level specific competences as identified below: Demonstrates an awareness and understanding of child maltreatment Demonstrates an understanding of appropriate referral mechanisms and information sharing Demonstrates clear lines of accountability and governance within and across organisations for the commissioning and provision of services designed to safeguard and promote the welfare of children Demonstrates an awareness and understanding of effective board level leadership for the organisations safeguarding arrangements Demonstrates an awareness and understanding of arrangements to share relevant information Demonstrates an awareness and understanding of effective arrangements in place for the recruitment and appointment of staff, as well as safe whistle blowing Demonstrates an awareness and understanding of the need for appropriate safeguarding supervision and support for staff including undertaking safeguarding training Demonstrates collaborative working with lead and nominated professionals across agencies National Skills academy for Health Level 1 and 2 E Learning Children LSCB e-learning level 1 and level 2 (1 hour max) accessed via: /view.asp?siteid=3829&pageid=20832&e=e All boards should have access to safeguarding advice and expertise through designated or named leads. Page 27 of 45

160 Safeguarding Adults Training for CCG staff Target Group Level and suggested content Training opportunities available All CCG staff All CCG staff who have contact with patient services All CCG staff Introduction to safeguarding adult training What is abuse and neglect How to recognise abuse and neglect Appropriate action to take if an individual has concerns. Refresher training at a minimum every three years. The e-learning programme can also be accessed as part of refresher training Safeguarding Adults What you need to know What is abuse and neglect Understanding the terms vulnerable and adults at risk How to recognise potential or actual abusive situations An overview of the background legislation and guidance Recognition of local pathways and safeguarding structures Understanding of CQC outcome 7 expectations Understanding the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS) Awareness of the legal framework underpinning the MCA 2005 and the DoLS safeguards Roles and responsibilities in respect of this legislation Guidance on completing capacity assessments and applying the best interests check list What protection the Act offers for people providing care or treatment PREVENT Health WRAP training LEARNING OUTCOMES How to support and redirect individuals with vulnerability The Lancashire Safeguarding Adults Board (LSAB) E learning - Level 1 ts follow information for professionals then training National Skills academy for health E learning - Level 1 Pan Lancashire and Cumbria multi agency safeguarding adult procedures manual RCGP Toolkit Safeguarding Adults MCA and DOLS E Learning programme SCIE website ning/index.asp CCG Safeguarding and Mental Capacity Act standards for commissioned services appendix 4 safeguarding standards for GP member practices can be accessed on the CCG websites. Mental Capacity Act code of practice Currently this is only available as face to face training: Please contact : Page 28 of 45

161 Target Group Level and suggested content Training opportunities available How to share concerns, get advice, and make referrals Regional PREVENT Coordinator (North West) NHS England North Rm 206, Preston Business Centre, Watling St Rd, Fulwood Preston, PR2 8DY patient services Mob: Guidance- Building Partnerships, Staying Safe: guidance for healthcare organisations at ons/building-partnerships-staying-safeguidance-for-healthcare-organisations Page 29 of 45

162 Appendix 5 Audit Tool to monitor Safeguarding Arrangements for CCG Commissioned Services Organisation: Person completing the audit tool (include designation, contact details including ) Dated audit tool completed Useful links : Local Safeguarding Children Board policies/procedures Local Safeguarding Adult Board policies/ procedures Rag rating key: Green Amber Red Fully compliant (remains subject to continuous quality improvement) Partially compliant - plans in place to ensure full compliance and progress is being made within agreed timescales Non-compliant (standards not met / actions have not been completed within agreed timescales) Standard Components of standard Evidence (embed or attach evidence including audits) RAG 1. Governance / Accountability 1.1 It should be clear who has overall responsibility for the agency s contribution to safeguarding and what the lines of accountability are from each staff member up through the organisation through to the person with ultimate responsibility 1.2 The organisation is linked into the Local Safeguarding Children Board (LSCB) and Local Safeguarding Adult Board (LSAB) 1.3 The organisation regularly reviews the arrangements in place for safeguarding and MCA Board lead demonstrating specific safeguarding competence in line with National & Local Guidance Job descriptions clearly identify safeguarding responsibilities All staff know both how & who to report concerns about a child / adult at risk of harm The organisation is able to evidence how it is implementing the strategic aims of the LSCB/LSAB safeguarding strategy. The governing body should receive regular reports on their arrangements for safeguarding and MCA Page 30 of 45

163 Standard Components of standard Evidence (embed or attach evidence including audits) RAG implementation. 1.4 An adverse incident reporting system is in place which identifies circumstances and /or incidents which have compromised the safety and welfare of patients 1.5 A programme of internal audit and review is in place that enables the organisation to continuously improve the protection of all service users from abuse or the risk of abuse. All STEIS reporting in relation to patient safety and welfare are to be reported to the Designated Lead for Safeguarding Commissioners provided with a regular report (interval to be agreed between the provider and the commissioner but must be at least annually) of key themes/learning from STEIS that involve safeguarding Complaints are considered in the context of safeguarding Audits are to include; - progress on action to implement recommendations from Serious Case Reviews (SCRs); Internal management reviews; recommendations from inspections; - contribution to multi-agency safeguarding/protection meetings; early help and CLA 1.6 There is an annual safeguarding plan for safeguarding children and adults which includes quality indicators to evidence best practice in safeguarding 2. Leadership 2.1 Senior managers will need to demonstrate leadership; be informed about and take responsibility for the actions of their staff who are providing services to the children and their families Designated senior officers for safeguarding are in place and visible across the organisation Senior managers can evidence effective monitoring of service delivery Page 31 of 45

164 Standard Components of standard Evidence (embed or attach evidence including audits) RAG 2.2 There is a named lead for safeguarding children and a named lead for vulnerable adults. The focus for the named professionals is safeguarding within their own organisation. 2.3 There is a named lead for MCA the focus for named professionals is MCA implementation within their own organisation (ref MCA Best Practice Tool (DH 2006)). Safeguarding leads will have sufficient time, support and flexibility to carry out their responsibilities this should be detailed in their job plans The Commissioner is kept informed at all times of the identity of the Safeguarding Lead - MCA Leads must have in-depth, applied knowledge of MCA/DoLS, including awareness of relevant case law, and must have protected study time to ensure they keep their knowledge up to date 3. Service Development Review 3.1 In developing local services those responsible should consider how these services will take account of the need to safeguard and promote the welfare of children, children looked after and vulnerable adults (at case management and strategic level) The views of children, families and vulnerable adults are sought and acted upon when developing services and feedback provided 4. Safeguarding policies, procedures and guidance (see supporting sheet to identify those that are relevant to your organisation) 4.1 The agencies responsibilities towards children and adults at risk is clearly stated in policies and procedures that are available for all staff A statement of responsibilities is visible in policies and procedures Policies and guidance refer to the LSCB / LSAB multi-agency procedures These procedures are accessible and understood by all staff Policies and procedures are updated regularly to reflect any structural, departmental and legal changes Page 32 of 45

165 Standard Components of standard Evidence (embed or attach evidence including audits) RAG All policies and procedures must be audited and reviewed at a minimum 2 yearly to evaluate their effectiveness and to ensure they are working in practice 5. Domestic violence including Forced Marriage and Honour Based Violence, Female Genital Mutilation 5.1 The organisation takes account of national and local guidance to safeguard those children and adults experiencing domestic abuse 6. Information sharing 6.1 Effective information sharing by professionals is central to safeguarding and promoting the welfare of children and adults at risk of harm 7. Prevent 7.1 The provider includes in its policies and procedures, and complies with, the principles contained in Prevent and the Prevent Guidance and Toolkit. There is a proportionate response in relation to the delivery of WRAP for staff and volunteers. There are robust single / multi agency protocols and agreements for information sharing in line with national and local guidance Evidence that practitioners understand their responsibilities and know when to share information. - The provider must nominate a Prevent Lead and must ensure that the Commissioner is kept informed at all times of the identity of the Prevent Lead 8. Inter-agency working 8.1 Agencies and staff work together to safeguard and promote the welfare of children and vulnerable adults - Evidence of leadership to enable joint working - Evidence of practitioner s working together effectively Page 33 of 45

166 Standard Components of standard Evidence (embed or attach evidence including audits) RAG 9. Safer recruitment practices - Evidence that Early Help/Support is being used appropriately and effectively - Evidence of engagement in, and contribution to, safeguarding processes/enquiries e.g. attendance at child protection/adult safeguarding meetings, audit schedule to demonstrate commitment to multiagency work & that staff contribute to agreed assessment processes (CAF and single assessments) 9.1 Robust recruitment and vetting procedures should be put in place to prevent unsuitable people from working with children and vulnerable adults All recruitment staff are appropriately trained in safe recruitment All appropriate staff receive a DBS check in line with national/local guidance Legal requirements are understood and in place Role of LADO understood and procedures in place Staff has access to policy detailing who the named senior officer is in relation to managing allegations 10. Supervision and support 10.1 Safeguarding supervision should be effective and available to all - All staff working with children and vulnerable adults receive appropriate regular supervision (including reviews of practice) Page 34 of 45

167 Standard Components of standard Evidence (embed or attach evidence including audits) RAG 11. Staff training and continuing professional development 11.1 Staff should have an understanding of both their roles and responsibilities for safeguarding children, children looked after and adults and those of other professionals and organisations. There is a learning and development framework for safeguarding and MCA implementation which is informed by national and local guidance and includes a training needs analysis All staff have received level 1 safeguarding children at induction or within 6 weeks of taking up the post (include %) All staff have received level 1 safeguarding adults at induction or within 6 weeks of taking up the post (include %) Evidence of compliance with national guidance including percentage of workforce trained relevant to roles and responsibilities: all appropriate staff have received safeguarding children level 2 and above (include %) MCA awareness should be included in staff induction programme & mandatory training All appropriate staff have received MCA training (include %) Training to be audited to ensure its quality and effectiveness Page 35 of 45

168 Organisations will need to ensure that they have appropriate governance arrangements, policies and procedures in place to reflect the services they provide. Section 1: details the policies that need to be in place for all providers of NHS care. Section 2: details the governance arrangements, policies, procedures and guidance that should be in place within the larger providers of acute care & community health services. Section 3: details the additional procedures that need to be in place within emergency care settings. The list is not exhaustive and organisations need to always be mindful of changes to legislation and statutory/national/local guidance. Section 1: ALL PROVIDER ORGANISATIONS Y/N/Not applicable Safeguarding children policy Safeguarding adult policy Complaints and whistle blowing policies promoting staff being able to raise concerns about organisational effectiveness in respect to safeguarding Information sharing & confidentiality policy MCA/DoLS implementation policy this can be incorporated into the safeguarding policy for smaller providers. The MCA policy must be in line with the Mental Capacity Act Code of Practice 2007 Section 2: LARGE PROVIDERS OF ACUTE AND COMMUNITY HEALTH SERVICES Y/N/Not applicable The organisation is able to evidence how it is implementing the strategic aims of the LSCB/LSAB safeguarding strategies At a minimum an annual report should be presented at board level with the expectation that this will be made public, there is an expectation that there will be also regular reporting on safeguarding to governance/quality committees All NHS Trusts providing services for children must identify a named doctor and named nurse for safeguarding children; (where maternity services are provided, a named midwife for safeguarding children will be identified) The Provider must include in its policies and procedures and comply with the principles contained in Prevent Guidance and Toolkit. The Provider must include in its policies and procedures a programme to deliver WRAP and sufficiently resource that programme with accredited WRAP facilitators. Health WRAP (workshop to raise awareness of Prevent training) delivered to key frontline staff There is an operational framework/policy detailing the levels of supervision required for staff specific to their roles and responsibilities including a gap analysis. This framework meets LSCB/LSAB guidance for supervision Named Safeguarding /MCA Leads seek advice and access regular formal supervision from designated professionals for complex issues or where concerns may have to be escalated Procedures on recording and reporting concerns, suspicions and allegations of abuse Page 36 of 45

169 to children and to vulnerable adults in line with national and local guidance GUIDELINES IN LINE WITH NATIONAL, LOCAL AND NICE GUIDANCE: Sudden unexpected deaths in childhood Child Sexual Exploitation Private fostering Fabricated Induced Illness (FII) Children missing education Missing from Home Domestic violence and abuse Forced Marriage and Honour Based Violence Female Genital Mutilation Working with Children who self- harm or who have potential for suicide Historical Sexual Abuse Process for resolving disputes/differences of an opinion Sexually active children under 18 years Lancashire Continuum of Need (CAF) Practitioners working with sexually active children under 18 years E safety Clear way of identifying those children who are subject to a child protection plan and are looked after Conflict Resolution/Escalation Policies 2.1 This section is relevant to healthcare providers offering in-patient facilities to children under 18 years only Y/N/Not applicable Clear guidance as to the discharge of children for whom there are child protection concerns The CCG and the Local Authority shall be notified of any child (normally resident in CCG area) likely to be accommodated for a consecutive period of at least 3 months; or with the intention of accommodating him/her for such a period (ref s.85 & s.86 CA1989) 2.2 This section is relevant to providers of in-patient facilities and community services for adults Y/N/Not applicable Guidance on the use of restraint in line with Mental Capacity Act 2005 & DoLs Page 37 of 45

170 All inpatient mental health services have policies and procedures relating to children visiting inpatients as set out in the Guidance on the Visiting of Psychiatric Patients by Children (HS 1999/222:LAC (99)32), to NHS Trusts 2.3 This section is relevant to community providers and acute trusts where they are commissioned to undertake statutory health assessments for children looked after Y/N/Not applicable Clear protocols and procedures in relation to completion of statutory health assessments Provision of services appropriate for children looked after in accordance with statutory guidance Section 3: This section is relevant to emergency care settings Y/N/Not applicable Local procedures for making enquiries to find out whether a child is subject to a child protection plan/child looked after; this will be CP-IS once implemented All attendances for children under 18 years to A&E, ambulatory care units, walk in centres and minor injury units should be notified to the child s GP Guidance on parents/carers who may seek medical care from a number of sources in order to conceal the repeated nature of a child s injuries Guidance on the use of restraint in line with Mental Capacity Act 2005 & DoL Page 38 of 45

171 Appendix 6 CCG requirements re compliance with NHS Safeguarding Accountability & Assurance Framework & Section 11 duties under Children Act Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG 1. It should be clear who has overall responsibility for the CCGs contribution to safeguarding and what the lines of accountability are from each staff member up through the organisation through to the person with ultimate responsibility Board lead demonstrating specific safeguarding competence in line with National Guidance Job descriptions clearly identify safeguarding responsibilities All staff know both how & who to report concerns about a child / adult at risk of harm 2. Staff should have an understanding of both their roles and responsibilities for safeguarding children, children looked after and adults and those of other professionals and organisations Training framework for safeguarding /MCA informed by national /local guidance All staff have received level 1 safeguarding children/adults within 6 weeks of taking up the post (include %) Evidence of compliance with national guidance including percentage of workforce trained relevant to roles and responsibilities (include %) All appropriate staff have received Page 39 of 45

172 Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG MCA training (include %) 3. Clear line of accountability for safeguarding properly reflected in CCG governance arrangements 4. CCG responsibilities towards children and adults at risk is clearly stated in policies and procedures that are available for all staff A statement of responsibilities is visible in policies and procedures Policies /guidance refer to those of LSCB / LSAB Accessible by all staff Updated regularly to reflect structural, departmental and legal changes Audited and reviewed at a minimum 2 yearly to evaluate their effectiveness and to ensure they are working in practice 5. Statutory member of the LSCB/SAB Participates fully with LSCB /SAB including providing practical support & resources (includes in kind) Where there are a number of CCGs in LA area, attendance at Board meetings can be shared 6. To work closely with local area team, and in turn work closely with local authorities, LSCBs/LSABs, to ensure there are effective NHS safeguarding arrangements across each local health community. 7. Work in partnership with local authority to fulfil safeguarding responsibilities. 8. Effective information sharing is central to safeguarding and promoting the Page 40 of 45

173 Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG welfare of children and adults at risk of harm There are robust single / multi agency protocols and agreements for information sharing in line with national and local guidance 9. CSU supports CCGs in commissioning effective services & assuring the safety of those services. 10. Have a safeguarding adults lead and a lead for the Mental Capacity Act supported by relevant policies and training. Adult lead to have broad knowledge of healthcare for older people, people with dementia, LD and people with mental health conditions 11. Secure the expertise of designated doctors and nurses for safeguarding children; looked after children and a designated paediatrician for sudden unexpected deaths in childhood Role of designated professionals explicitly defined in JDs, with sufficient time, funding, supervision and support to enable them to fulfil responsibilities Clear accountability & performance management arrangements in place -likely that line management will sit with CCG executive lead. Where designated doctors continue to undertake clinical duties in addition to their clinical advice role there must be clarity about the two roles and the CCG will need to be able to input into the job planning, appraisal & revalidation. Where a designated professional is employed within a provider Page 41 of 45

174 Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG organisation, the CCG will need to have a service specification in place with the provider organisation that sets out the practitioners responsibilities and the support they should expect in fulfilling the designated role Where CCGs develop lead or hosting arrangements for designated professionals there needs be a formal arrangement in place to assure the effectiveness & compliance of the arrangements. CCGs and local area team to provide appropriate support /advice to designated professionals so they can access the widest possible expertise to support improving practice. 12. Designated clinical experts are embedded in the clinical decision making of the CCG, with the authority to work within local health economies to influence local thinking and practice. 13. CCG leadership arrangements for adult safeguarding to include responsibility for ensuring: CCG commissions safe services for those in vulnerable situations Effective systems for responding to abuse /neglect of adults Effective interagency working with local authorities, the police and 3 rd sector organisations 15. Contribute fully to SCRs commissioned by LSCBs/LSABs; where appropriate conducting IMRs 16. Appropriate arrangements in place to co-operate with LA in operation the Health & Well-being Board, including Page 42 of 45

175 Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG being fully engaged and working effectively to support the H&WB. 17. In developing local services the CCGs take account of the need to safeguard and promote the welfare of children, children looked after and vulnerable adults. This includes a culture of listening to children, and vulnerable adults taking account of their wishes and feelings, both in individual decisions and the development of services 18. Arrangements which set out clearly the processes for sharing information, with other professionals and with the LSCB 19. Robust recruitment and vetting procedures in place Recruitment staff trained in safe recruitment practices Appropriate staff receive DBS check in line with national/local guidance Legal requirements understood & in place Staff have access to guidance detailing how to act on concerns re the management of allegations against workers, including who to contact. 20. Safeguarding supervision and support available to all relevant staff 21. Specific responsibilities re Child Death To employ, or have arrangements in place to secure the expertise of a consultant paediatrician whose designated responsibilities are to provide advice on the commissioning of: paediatric services from paediatricians with expertise in Page 43 of 45

176 Requirement Local arrangements Identified gaps / proposed action Date by Lead RAG undertaking enquiries into unexpected deaths in childhood; from medical investigative services; and the organisation of such services Page 44 of 45

177 Appendix 7 INDIVIDUAL ACCOUNTABILITY SAFEGUARDING ACCOUNTABILITY FLOWCHART STRUCTURES/COMMITTEES Chief Officer Executive Lead for Safeguarding Governing Body LSCB SAFEGUARDING SERVICE Head of Safeguarding/Designated Nurse Adult Safeguarding/MCA Lead Specialist Safeguarding Practitioner Lead GP for Safeguarding Quality and Performance Committee Safeguarding Assurance Group LSAB Designated Doctor for Safeguarding Designated Doctor for CLA SUDC Service Page 45 of 45

178 Minutes Quality improvement committee Venue: Boardroom, Hilldale, Ormskirk Attendees: Mr G Mitten Chair Mrs C Heneghan Chief nurse Dr J Kinsey Clinical lead for clinical engagement Jackie Moran Head of quality, performance and contracting In attendance: Dr John Caine - Chair Mrs J Rollinson Head of safeguarding Miss C Ashcroft Executive assistant Date & Time: Tuesday 28 October 2014 at 1 pm 2.30 pm Apologies: Mrs A Butler Quality assurance manager Mrs L Elliott - Lead nurse for safeguarding adults and mental capacity act (in attendance) Dr R Bonsor Clinical lead Mrs J DeBacker Practice manager Agenda Summary of Discussion Item CCGQIC/ 10/14/1 Welcome and apologies for absence Greg Mitten welcomed the members of the quality improvement committee to the meeting. 10/14/2 Minutes from the previous meeting on 24 June and 26 August 2014 The notes from the previous meeting could not be approved as the meeting was not quorate. The notes will be ed to members for approval. Lead CA 10/14/3 Matters arising action sheet The action sheet was updated. 10/14/4 Integrated Business Report A brief overview of the quality and performance section of the integrated business report (IBR) for September 2014 was provided by Jackie Moran on the following key areas in the quality and performance tables: The NHS Constitution indicators showed the following: o RTT 18 weeks wait is green o o A&E 4 hour waiting is amber Cancer waits of 62 days, ambulance category A calls, MRSA attributable to CCG and C. difficile (there have been no lapses in care and much work is being done to eradicate all cases) is red. There have been no breaches in August for mixed sex accommodation. High level outcome indicators have been included in the report and show progress and decline using RAG rating. A number of greens show major improvement. Mortality rates and breast cancer are constantly reviewed as they form part of the Hospital Standardised Mortality Ratio (HSMR) Quality Improvement Committee 28 October 2014 Page 1 of 7

179 Agenda Item CCGQIC/ Summary of Discussion The Dr Foster tool is being used to show diagnosis groups in relation to the England average length of stay. The executive committee will review all the areas to choose which to focus on. Lead 10/14/5 Annual patient insight report The report provided a summary of the 73 contacts made with the Staffordshire and Lancashire Commissioning Support Unit (CSU) between March 2013 to March The contacts resulted in 23 formal complaints, 48 concerns and 2 compliments. The reasons for contact were presented by theme which demonstrated that the majority related to continuing health care (CHC), including eight complaints regarding the CHC function. These will be discussed with the Commissioning Support Unit (CSU) in addition to safeguarding concerns. JM 10/14/6 Equality and inclusion quarterly report The report provides an update on the CCG s statutory requirements in the Equality Act 2010 for the second quarter. This includes compliance with the public sector equality duties and human rights legislation. The committee will expect an action plan in the future and acknowledged the report. 10/14/7 Acute Hospital Quality Issues Rob Gillies joined the committee a. Alternative Quality Contract The list of indicators was presented and the block contract was discussed with the caveats of the level of activity to be reached to enable the instalments of funding to be released. Rob Gillies stated that the forthcoming visit by the CQC hospital inspectorate was a positive and useful process in terms of reviewing quality. In the future there will be a reinstatement of open days and road shows led by the chief executive. The visit will be utilised as an accelerant for change in terms of what we don t do that we should and to be more innovative. The Trust is looking at GPs from deprived areas to work closer with the Trust and to promote the Integrated Care Organisation (ICO) agenda. A better balance between acute and community is needed. There are changes in the Trust Board which will bring new opportunities for change with a new director of nursing and Chair. There will be a greater emphasis on risk and looking more at community via integrated care. Greg Mitten commented on the real work taking place and positive relationships which have been formed. Once the director of nursing is in post, he and Rob Gillies will arrange for a regular attendance at the quality improvement committee from January b. Southport and Ormskirk NHS standard contract quality requirements month 5 This report is compiled by Cheshire and Mersey Commissioning Support Unit on Southport and Formby CCG and West Lancashire CCG s behalf. Quality Improvement Committee 28 October 2014 Page 2 of 7

180 Agenda Item CCGQIC/ Summary of Discussion The report outlines the quality indicators associated with the Southport and Ormskirk Hospital NHS Trust contract. In response to a question about MRSA infection and if the lessons learned have been implemented, Rob Gillies confirmed that the two recent cases of MRSA infection are the first following a three year period of no occurrences. The cases have been treated as internal never events with internal meetings taking place between clinicians and executives, which has also changed culture of the organisation. There are no MRSA cases in the spinal injuries unit, which is excellent. There have been 21 cases of c. difficile, of which 9 of 10 appeals against Trust contributable cases have been won. The judgements of the Trust Development Authority (TDA) and NHS England are determined differently which will result in a negative report for the Trust. Anti-microbial prescribing is being monitored by consultants and has improved considerably. The Board will receive Trust contributable cases and Rob Gillies is aware of the specific locations of the c. difficile infection. The c. difficile and mortality action plans have been sent to the TDA. Mortality rates have plateaued, but further improvement is being pursued. The Trust has one of lowest incident reporting levels in the north west with no near miss reporting. This was recognised as an area of challenge to increase reporting of incidents and near misses. It is expected to be one of the highest performers in HSMR. A gap analysis and action plan to include standardised hospital mortality index (SHMI) data, is being developed with Dr Foster. It was suggested that feedback is provided to the reporter of incidents to encourage the culture of reporting by demonstrating the action taken. It was agreed that this feedback could be circulated on a general basis to retain the reporter s anonymity. Claire Heneghan has asked Angela Kelly to feedback on the near misses and incident reported particularly in care homes. An away day had taken place to discuss the plans to integrate community and acute, with Laurie McMahon to facilitate. The committee thanked Rob Gillies for the improvement in mixed sex accommodation breaches. This will be passed on to staff. Claire Heneghan stated that the CCG imminently intended to share their plans with the Trust to ensure that the Trust plans link with the CCG s plans for community and acute, and to share the vision. Rob Gillies feels that there is a good open working relationship with the CCGs. Further questions not put to Rob Gillies at the meeting, will be provided in writing for a response and then fedback both to this committee and the membership council. c. Open and honest care report The report is based on data from August 2014 for Southport and Ormskirk Hospitals NHS Trust as published on their website. It reports on safety, experience and improvement. Ann Butler s work continues to evaluate the data. Lead d. Friends and family report Quality Improvement Committee 28 October 2014 Page 3 of 7

181 Agenda Item CCGQIC/ Summary of Discussion An overview was given on the report. The national average response rate for A&E is 20%, with the Trust s response rate at 9.1%. Jackie Moran will include a question to Rob Gillies on the low response rate. The question for maternity services How likely are you to recommend our antenatal service to family and friends if they needed similar care or treatment? received a positive response from 8.4% of those who responded. A letter to Healthwatch Lancashire will enquire if they have progressed any work around this issue. e. E-discharging and other GP issues In September, ten complaints / comments were copied to the CCG from GPs to Trusts / Providers. The most common complaints this year are around discharge letters / summaries and concerns around communication between providers and patients. The following questions, which have been raised by the membership council, were put to Rob Gillies in terms of e-discharging: Q: Can the Trust provide a date at which it anticipates that all discharges/letters will be typed? A planned date would be preferable to a 'working towards policy' which is open-ended. A: A corner has been turned at the Trust which will be e-discharge compliant by March Alison Blundell has gone out and promoted this. Trajectories have taken an upward turn and McKesson are delighted with floor walkers being pulled back. There are two ways to proceed with e-discharge and the Trust want to send out a scribe to be compliant. Major clinical issues have been overcome and symphony has been turned off. Q: What date will letters be typed and sent out as in the contract. There is an issue with scripts that are not legible and the GP is reliant on information from the patient or must contact the consultant s secretary to ask what the correct medication is. A: A clinical radar form has been introduced to include details on complaints, concerns, compliments, steis, e-discharge, performance etc. This will be reviewed monthly and discussed at quality meetings. It is not anonymous and doctors are performance managed against the report, which is shared internally. Sign up has been received from the Board and doctors. Alison Blundell s trajectories have gone to the CCG s business analyst. JM AB Lead Q: GPs are often copied into blood test results which have been ordered by someone at the hospital. Can we have a black/white policy that clarifies that if a test is ordered by the hospital then they are acting upon this (i.e. it is not the responsibility of primary care). Confusion can often arise and/or lead to duplication of work. A specific example is labour ward ordering FBC in pregnant women - if we are copied into a result and the patient is anaemic, can we presume that the hospital Quality Improvement Committee 28 October 2014 Page 4 of 7

182 Agenda Item CCGQIC/ Summary of Discussion team are acting on this test accordingly? A: The key person to discuss this issue is Paul Mansour, as his role is to manage pathology contracting which feeds into the IT systems. The Trust want to move to electronic results and Matthew Connor will shortly be replacing Lukas Twigger as Head of IT. Q: Are there any plans for the Emergency Eye Clinic letters to be typed? If not, can there be and how soon? These letters arrive on paper smaller than A5 and are handwritten. At times, these are difficult to read and can be full of abbreviations that are not instantly recognisable. A typed letter would ensure clarity, accuracy and improve quality. A: This will be looked into. Q: A letter was received by one of our GPs from an orthopaedic consultant, which suggests that as the waiting list for the Trust is lengthy, the patient should attend Renacres to see another named consultant. A: This was felt to be unprofessional and poor conduct. Any similar letters received in the future should be forwarded to Rob Gillies directly. Q: Complaints from GPs, which are sent to the GP Response address, do not receive a response. It was suggested that if the GPs received a response to their complaint, this would create more confidence in the reporting system. A: When the data is received it is discussed and themed. Tony Ellis can provide a feedback report on the complaints and action plans are in place, which can be provided by the risk department. Q: The CCG are using Dr Foster and have picked up MI s and their length of stay. A: The Trust also use Dr Foster, which is a bag of tools, which needs to sit in the IM&T strategy. There are representatives on the Trust s core quality review group. Jackie Moran will work with Rob Gillies on the length of stay. Rob Gillies provided the following updates on current issues: The weekend rapid access heart and chest service discussions are taking place with other hospitals around a local service being provided on the Southport Hospital site. A meeting will take place with John Pugh MP on the closure of the breast cancer services. Further to the breast care mammography issue, an external report has been received and the disciplinaries are going ahead with individuals involved. As a result of the Steis meetings, A medical devices committee has been implemented to look at all services, which has introduced a raft Lead Quality Improvement Committee 28 October 2014 Page 5 of 7

183 Agenda Item CCGQIC/ Summary of Discussion of areas to be aware of where assurance must be provided. The infection prevention team are exemplary with the devises team needing to change their status. Lead 10/14/8 Serious untoward incidents (SUIs) a. Closure of specific SUIs Two SUIs have been closed since the committee last met. One regarding mental health and another about phlebotomy, both are incidents from The process for closing SUIs in Merseyside provides the CCG with sight of the report before closure, although the CCG is only notified once the closure is reached on mental health related SUIs in Lancashire Care Foundation Trust managed by Blackburn with Darwen CCG. It was agreed that if the CCG are satisfied that the process for closure of SUIs at Blackburn with Darwen CCG are robust, this will be sufficient assurance. Claire Heneghan will request Ann Butler to arrange to attend their SUI closure meeting and feedback to the committee. CH 10/14/9 Safeguarding / Individual patient activity (IPA) a. Safeguarding report The report provided an update on safeguarding development in the health economy with particular note to the following key areas: Lancashire Safeguarding Children Board Annual Report 2013/14 has been published and is available on the LSCB website. Safeguarding in care homes Aughton Grange being managed under QIP process and is currently under suspension for new admissions. Current residents care is being reviewed. Across central Lancashire as homes become subject to suspensions (4 now on suspension in central Lancashire) this will inevitably result in greater pressure on the remaining limited beds available for new admissions. From October, the CQC judgements on essential standards of care are changing which may potentially lead to homes being classed as inadequate. If CCGs have a responsibility to ensure adult placements are based on the quality and safety of care provided what impact will this have on any future placements what is the CCG commissioning strategy? CQC reviews are available on the CQC website. The issues will be raised at the executive committee. It was suggested that difference models in contracts could be introduced, to drive up quality in care homes. Communications between Lancashire County Council and the CCGs need to be established to share work that is currently taking place. A plan around the care homes is required. A paper requesting agreement from the six CCGs for collaborative funding for health presence in MASH will be presented at the Lancashire CCG Network. The Lancashire Safeguarding Children s Board annual report 2013/14 is available on the LSCB web site and will be presented at the CCG governing body meeting in November. Mersey Internal Audit Agency (MIAA) following a review of the CCGs safeguarding, significant assurance was awarded with a few actions which are being progressed. Quality Improvement Committee 28 October 2014 Page 6 of 7

184 Agenda Item CCGQIC/ Summary of Discussion The CCGs self-assessment against statutory national guidance one amber item was highlighted, which Jean Rollinson can action with assistance from Claire Heneghan and Jackie Moran. Claire Heneghan will report back. Claire Heneghan brought to the attention of the quality improvement committee, that a safeguarding peer review will take place on 20 January b. Safeguarding policy Following a review by Mersey Internal Audit Agency, the safeguarding policy has been updated and endorsed by the pan Lancashire Safeguarding Collaborative. In addition, an action plan has been developed. As the committee is not quorate, the policy will be circulated electronically with the committee s minutes for approval. A better set of standards have been agreed for the policy. Jean Rollinson will share patient group comments from Chorley and South Ribble CCG. Lead CH CA JR 10/14/10 Quality in Primary care High level indicators practice outliers Charlotte McAllister, business analyst, is collating the analysis of the three outlying practices and which will be fed back to the quality improvement committee and the Lancashire Area Team in due course. JM 10/14/11 Business matters Terms of reference As the committee is not quorate, Jackie Moran will amend the terms of reference as fit and circulate to members for comment. A six-monthly action plan will also be discussed at the next quality improvement committee. 10/14/12 Legacy policies It was suggested that the legacy clinical policies, which currently cover individual funding requests (IFR), should be updated in light of changes to NICE guidance and patients needs. The CSU will be consulted to receive a Lancashire wide view on this request. JM JM 10/14/13 Any other business No other business was received. 10/14/14 Date and time of the next meeting Formal meeting: 25 November at 1 pm, Boardroom, Hilldale, Ormskirk Quality Improvement Committee 28 October 2014 Page 7 of 7

185 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting (5mins) Discussion and Decisions Greg Mitten Adam Robinson Simon Frampton This week s actions Due Date Responsible officer RAG Finance and overview on acute contracts Dawn Moody presented a condensed version of a report commissioned to look at hospital contract overperformance. Jackie Moran, Paul Kingan and analysis team to meet and then return with plan to Exec Jackie Moran /Paul Kingan Actions are classified as either; High Impact Change, Urgent or Important. Mike to raise referral with Jonathan Parry Mike Maguire Key findings and themes were discussed. Ramsay, Wrightington, Wigan and Leigh, Trauma and Orthopaedics, Cardiology and IVF were identified as overperforming. Noted that GP referrals to Southport and Ormskirk have fallen. Jackie Moran requested referral data and will need to meet with Southport and Ormskirk to confirm data. Noted that the review found that GP referral data was not being received from Mersey providers by the CSU. CSU has been asked to ensure that this data is included in future. Discussed Choose and Book 2 and

186 potential implications at Southport and Ormskirk. Mike Maguire to raise issue in meeting with Jonathan Parry. Agreed on need to understand Southport and Formby CCG position on implementing Choose and Book 2. Report was well received and gives clarity on contracts. Noted thanks to Dawn Moody, who in turn thanked Grahame Moore for his help with data. Survivorship Jack Kinsey as Macmillan GP declared an interest. John Caine chaired the meeting for this item. The chair stated that Jack could remain in the room for the discussion but not participate in any vote. Carol to progress scoping including Jackie Moran, Nicki Watson and Paul Jones in process and then return to Exec in three weeks Carol McCabrey Carol McCabrey presented a paper on the Macmillan funding proposal for survivorship - a cancer survivor being someone who is living with or beyond their cancer. State of clinical care is not disputed however a need to improve support, both emotional and practical for survivors has been identified. Discussion then followed on the considerations and recommendations presented. Greg Mitten has a paper regarding the provision of community support and the cost involved. Carol will examine overlap between Macmillan and community

187 Better Care Fund submission models. Terry Mears suggested Carol contact Adrian Leather from Active Lancashire to consult with regarding the physical activity aspect of service. A formal evaluation by Edge Hill was suggested. Agreed to continue with further scoping work and return to Exec with detail in 3 weeks. Noted that the meeting was not quorate during this item. Karen Tordoff updated on the revised submission for the Better Care Fund and sought approval from Exec due to the timescales involved. The revised submission is due to go to Health and Well Being Board on 18 September for final approval Karen reported no major changes in narrative other than it had been updated to incorporate the Facing the Future Together work. Change identified in reduction in non-elective admissions (nationally 3.5%, locally 1.7% being proposed), however no change to plans. Performance and risk share agreements are still in discussion. Chairman s approval sought for BCF Karen Tordoff

188 Chairman s action will be sought to approve the Better Care Fund submission Facing The Future Karen Smith and Jo Didsbury from GE Healthcare Finnamore presented a scoping business case for Facing the Future Together. Four options were discussed which ranged from do nothing to delivering fully integrated care at a strategic, service and patient level. In addition to the activity implications a financial table, outlining the different options was examined and discussions followed on what was affordable and also achievable. The possibility of incremental change was also discussed. Discussion also focused on barriers to success. Questions were asked about similar schemes in other areas. The work undertaken in North West London was an example which was provided and discussed. A discussion was also had in relation to a piece of work which could be undertaken between October and March. Setting clear milestones and the importance of clinicians being involved was agreed.

189 Agreement reached to take the options to membership on 24 September for their view and to keep membership engaged with process. Take the business case to Membership on 24 September Karen Tordoff/ Claire Heneghan Governing Body agenda Katie Wightman had substantive items planned for the September Governing Body which were outlined. Eating disorders Ros Bonsor presented a paper regarding an additional funding request to Adult Eating Disorder Service. It was highlighted that the service will not take anyone who presents with a BMI below Any patient who falls below this BMI is currently assessed by CSU and is referred to the Priory, either for inpatient care (LAT funded) or for day care (CCG funded). The proposal is to bridge this gap so those patients can have their care provided by the Adult Eating Disorder Service. Discussion followed and subject to further detail this was agreed in principle. Wrap up Catherine Webster and Paul Jones will continue to work to bring back further detail to Exec. Paul Jones and Catherine Webster will meet and bring back more detail Ros Bonsor/ Catherine Webster

190 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting Discussion and Decisions Claire Heneghan Terry Mears Ros Bonsor Greg Mitten This week s actions Due Date Responsible officer RAG Declaration of Interest Notes from the 2 and 9 September None The notes from the last meetings were approved. Headline items for AOB AGM Ebola Review progress of actions vs weekly action log Noted and updated live action log which is on SharePoint Review finance and allocation update, performance and quality measures including winter pressures / Contract update Paul Kingan stated that the Integrated Business Report (IBR) was circulated with the final papers yesterday. Discussion followed around the position outlined in the IBR. It is intended that the final IBR will be circulated for the Governing Body Tuesday 23 September. The highlighted areas for further work were CDU, paediatric A & E and

191 scanning breaches. Jackie Moran and team will examine findings and provide a formal report to the Exec committee. Paul Kingan and Mike Maguire reported positive progress with the Commissioning Support Unit (CSU). Over two days Paul, Mike, the CSU and functional leads looked at where savings could be made. Key areas were identified as suitable for savings and these were discussed. The CSU will feedback by Friday 19 September. Jackie Moran to provide report in two weeks AOB AGM This will be held on 23 September at Digmoor Community Centre. Katie Wightman reminded the group that all are welcome. Ebola John Caine reported back from a Public Health England training event regarding the current situation in West Africa regarding the Ebola Virus and the potential for impact in the UK. An explanation of how the virus transmits was given and discussion followed on

192 best practice for any patients who present with symptoms and have certain risk factors. Discussion led to how the CCG should best share information with practices. A podcast was suggested. Katie Wightman suggested using this as an emergency planning test. Agreed that CCG needs to have a long term view moving forward. Examine your options - patient insight report Meg Pugh and Sharon Walkden from the CSU Engagement team presented the Examine your Options report. It was noted that the report highlights that often people use word of mouth and past experience to inform their choices and this demonstrates that further work to educate communities about routes for accessing appropriate treatment was required. Jackie Moran stated that the report reflected some issues presented in complaints. Next steps would be to consider whether to run this campaign again. Facing the Future Following the discussions at Exec on 9

193 Together September, Karen Tordoff presented an update paper which focused on the period Oct 2014 March 2015 and proposed next steps. Discussion followed on the importance of robust project management supported by the establishment of key milestones and clear gateways. It was proposed that these gateways should be via a clinically led panel and this view was supported. Consideration was also given to setting clear and significant consequences to secure positive change. A lengthy discussion ensued with regard to a proposed overarching document supported by service specifications. It was agreed that Claire Heneghan would lead on the development of service specs with support and be scoped further upon her return and then report back to Exec on 30 September. The following actions were also agreed: Further work undertaken to agree the key milestones with wider clinicians. Criteria with regards to nonachievement/achievement of gateways to be worked up. Further updates continue to be provided at Exec. Claire Heneghan to develop spec and bring back to Exec Claire Heneghan

194 Eating Disorders Any Issues arising from Membership Council meeting Agreed to try to align with Southport and Formby CCG going forward. Ros Bonsor asked that this item is deferred until next Exec. Discussion was invited on any issues arising from the Membership council meeting on 11 September One issue brought up was that of the GP and Consultant Liaison (speed dating). This was not viewed very favourably by Membership. It was noted that a change in language when promoting this idea may be helpful. The breast service issue at the Trust was also raised as. The general view was that GP s were not concerned about the necessity to refer elsewhere. However at membership there was concern about the potential impact on other trust services. This led to discussion in Exec about the difficulty in recruiting and the public perception of the current situation. Mike Maguire will meet later today with Rosie Cooper MP and expects that such issues will be a focus. Mike will also meet with Jonathan Parry to discuss Ros Bonsor

195 There was general consensus on the importance of securing good relationships to tackle issues. Agreed to liaise with Southport and Formby CCG. Summary of issues raised at practice visits Katie Wightman presented information on some of the issues raised at practice visits. Feedback themes from visits to membership Admin Team Discussion followed on some key issues such as discharge letters, slow IT systems, engagement with Trust and practices income. Agreed it would be beneficial to feedback anonymous themes to membership and seek agreement on areas to focus on. This was noted as key to furthering how practices feel part of the CCG and agreed that constant feedback would increase engagement. Wrap up

196 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting John Caine Greg Mitten Discussion and Decisions This week s actions Due Date Responsibl e officer RAG Declaration of Interest None Notes from the last meeting The notes from the last meetings were approved. Headline items for AOB Commissioning Intentions - Code of Conduct letter. Constitution. Review progress of actions vs weekly action log Noted and updated live action log which is on SharePoint Review finance and allocation update, performance and quality measures including winter pressures / Contract update Paul Kingan updated on finance. The CCG is still on target to achieve the year end surplus it is required to make, however there are significant pressures in the system. The main three being pressure on acute contracts, the delivery of the

197 pharmacy QIPP targets and the increased cost of Continuing Health Care packages. The CCG engaged a company called CCS to review these packages of care. They will review 41 cases from providers. The aim is to deliver reduced costs of these packages perhaps through economies of scale as some nursing homes have a number of our patients in them. Terry Mears suggested it would be useful to look closely at the Mental Health packages as there may be some overlap with commissioners from the council and further benefits that could be delivered by liaison with them. At the same time CCS are also reviewing the panel process and will be giving feedback on all of their work and making recommendations to the Execs in November. Winter funding - data has been requested regarding these schemes and more data is expected in November. Discussions will then take place regarding the future of these schemes. A further meeting is planned in due course to align commissioning intentions. Claire Heneghan and Terry Mears to support Simon in undertaking a Nursing Home development review Claire Heneghan / Simon Frampton / Terry Mears

198 It was noted that it appeared that little Winter money had been put into community. Ros Bonsor raised that Bootle/ Chorley had put winter scheme money into provision for GP extra sessions. Adam Robinson will bring details of their schemes and share with Exec. Adam to get copy of Bolton s scheme to increase capacity in primary care Adam Robinson GP IM&T Programme Chris Russ presented a report on the GP IM&T programme. Of the 6 priority areas within the CCG s IM&T strategy three projects within the IM&T programme require additional resources to ensure they are delivered to planned completion dates. The three projects are; Electronic Transfer of Prescriptions Patient Access Electronic Ordering and Results Reporting It was noted that the resources required do not create an additional financial pressure as in year savings from the GP IT budget were made following a CCG re-planning exercise undertaken with the CSU. Discussion followed on the Patient Access element and while it was

199 generally thought beneficial there was some concern around possible risks. It was agreed that Bapi Biswas and Chris Russ work together to develop an approach to deployment ensuring consistency across all practices. Exec agreed to support additional funding and approved to progress with this. Bapi and Chris to work on electronic/paperless approach. 1/3/15 Chris Russ/Bapi Biswas Facing the Future Update Claire Heneghan updated on the Facing the Future Together presentation that had been taken to GP Membership on 24 September. Membership had previously identified the following as essential to success; Suitable IT infrastructure. Communication - regular, consistent and clear. Planning and process of MDT meetings to be clear and simple with information sharing agreements in place. Staff, patients and carers need to understand what services/support are available in their neighbourhood and how to access them. Workforce capacity, capability and sustainability Estates, what do we have

200 available within our neighbourhoods? Discussion was invited on the next steps in the programme. Discussion centred on how to achieve integrated working, with Exec acknowledging that this is a programme of work in itself. The need for a collective response and sharing the thinking behind FtFt was agreed. The possibility of taking FtFt to Sefton membership was discussed. It was agreed that the new chair and members of the board of ICO should be invited to attend Exec and then membership thereafter. The following actions in respect of FtFt were agreed: To send out a strong code of conduct letter To establish the milestones to be achieved in the coming 9-18 months. To establish the Gateway clinical panel. The gateway process clinical panel to include Claire Heneghan, John Caine and Bapi Biswas. John Caine to invite new chair and members of board to Exec and membership John Caine

201 Healthier Together Consultation Mike Maguire invited discussion whether on a formal response to this from West Lancs CCG was required. Greater Manchester CCG s are consulting on possible service change. A brief explanation of the potential impact on West Lancs patients was provided. Discussion followed and the general agreement was that there was support around the positive aim of specialist centres but in the longer term some concern over workforce pressure. Agreed that, although the impact was considered minor a formal response was still appropriate. Mike Maguire will provide a response following a meeting tomorrow with Mersey CCG. Mike Maguire to draft a response Mike Maguire AOB Commissioning Intentions - Code of Conduct letter. Jackie Moran circulated a draft letter due to be sent to Sheila Finnegan regarding contracting changes. Comment was invited on this and the suggested amendments were agreed. Jackie Moran to amend and then send final version Jackie Moran Constitution. Doug Soper reminded Exec that the constitution requires a joint annual meeting involving members of the governing body and the GP membership council formalise the constitution.

202 Personal Health Budgets Deployment TCES Procurement/Breast Item was deferred due to time constraint. Item was deferred due to time constraint. Item was deferred due to time constraint. Eating Disorders Update Membership Council Agenda 15 October Item was deferred due to time constraint. Item was deferred due to time constraint. Wrap up

203 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting Discussion and Decisions This week s actions Due Date Responsible officer RAG Declaration of Interest All GPs and Practice Managers declared an interest in the item regarding ideas for potential slippage on 5 per head schemes Facing the Future Update A number of documents were distributed to the executive committee which aided the discussion for this item. A summary of the options and milestones that have already drafted were discussed and noted. Facing the future to be added to next week s agenda. Claire to visit, with Kim Haworth, Chorley and South Ribble and Greater Preston area to see the work that is already happening there Admin Team Claire Heneghan / Kim Haworth The suggested milestones that were raised by the membership at the last meeting were noted. The importance of agreeing the medium and short term goals was stressed. Discussion to be had with Wigan CCG regarding the cross boundary patient issues Jackie Moran A discussion was had regarding creating milestones around the development of integrated neighbourhood teams. The provision of current MDT meetings and the practicalities of these meetings was

204 discussed. The use of EMIS was discussed as a possible system that all could use to input information regarding the patients. It was highlighted that Southport and Ormskirk Hospital NHS Trust are currently rolling out the PAS system. Kim Haworth provided an overview of the work that is happening from a social care perspective. Cross boundary issues were also raised, particular in the Upholland area. A discussion took place where various ideas were shared about possible milestones; these were noted and will be developed and will be brought back to the next meeting for agreement. Eating Disorder Ros Bonsor went through a business case which provides background information and recommendations relating to the Adult Eating Disorder service provided by Lancashire Care Foundation Trust The business case request approval to extend the current service specification with Lancashire Care Foundation Trust to include outpatient treatment of people

205 with Anorexia Nervosa. A discussion was had regarding the current services and the benefits to patients if the request was approved. All voting members agreed to support the business case recurrently but will include a number of conditions. Ideas for potential slippage on 5 per head schemes Improved access to primary care Stroke Prevention All GPs and Practice Managers declared an interest in this item. It was agreed that as the interest was not fundamental the GPs and Practice Mangers could take part in the discussion and vote. A discussion was had regarding potential ideas if there was to be any slippage on the 5 per head scheme. Bapi to look further at possible AF prevention schemes Bapi Biswas Areas that were debated included schemes that would improve access to primary care and stroke prevention. It was noted that a number of practices had indicated in their returned proformas, if they had not fully spent they allocation, they would like the funding to be used at a neighbourhood level. Membership Council Agenda The membership agenda for 15 October was discussed. Amendments to be made to the agenda. Invite Rob Caudwell and Doug Callow to Admin Team John Caine

206 It was agreed that Facing the Future Together should be added to the agenda. membership meeting It was suggested that it may be useful to invite Rob Caudwell and Doug Callow to the meeting. Procurement/Breast A paper was presented to the executive committee which provided background to the recent issues with breast services at Southport and Ormskirk Hospitals, and also requested support from the Executive Committee to make recommendations to the CCG Governing Body to follow the interim procurement solution being suggested by Southport and Formby CCG and to work jointly with them to undertake the consultation and to develop the procurement strategy for the longer-term solution. Jackie to provide update to Governing Body as part of the chief officers report Jackie Moran It was highlighted that it is patients choice which hospital they which to attend. It was agreed that Jackie will provide an updates to the Governing Body. AOB Cardiology Service Bapi provided an update on cardiology services. It was agreed further discussions will take place with Southport and Formby CCG and the trust. Practice Nurse Facilitator

207 Wrap up Following the recent interview. Claire confirmed that they have appointed to the position.

208 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting Discussion and Decisions Simon Frampton This week s actions Due Date Responsible officer RAG Declaration of Interest NW NHS 111 ITT Documents - Peter Gregory Atrial Fibrillation Bapi Biswas, Ros Bonsor, Jack Kinsey and John Caine Medicine coordinators Jo Debacker Notes from 30 September & 7 October Facing the Future Together The notes from 30 September and 7 October were amended according. Following on from previous discussions at both the executive committee and membership committee, the latest version of the expected outcomes and milestones of facing the future was shared. Executive committee to Claire any further comments regarding outcomes and milestone All It was noted that the code of conduct letter for 2015/16 has been sent to Southport and Ormskirk Hospital NHS Trust, which highlights the CCG s commissioning intention. Various issues were discussed, these will be developed further and will be incorporated into the expected outcomes

209 and milestones. These included: Boundary issues Treatment room District nurses Single point of access Single assessment point These will also be discussed and worked on in collaboration with the membership council. Claire asked the executive committee to her if they had any further comments regarding the expected outcomes and milestone. It was noted that a meeting will be taking place on Thursday 16 October with Southport and Formby CCG; during this meeting our commissioning intentions will be discussed. Carers A review document and draft specification for carer services produced by Lancashire County Council was shared with the executive committee. The current contracts that Lancashire County Council hold will come to an end in March 2015, Lancashire County Council will be re-tendering these services. Currently West Lancashire CCG

210 commission a service directly with West Lancs Carers. It was agreed that the service we receive is good and no concerns have been received. Work has been done to ensure we are receiving the service that we require. All voting members agreed that West Lancashire CCG will continuing to commission carer services locally. TCES Following the concerns raised by West Lancashire CCG regarding the community equipment store. Jackie informed the executive committee that she had received reassurance that our concerns had been addresses and included in the revised contract. Diabetes Healthier Lancashire The project board are requesting approval from our CCG for Section 75 sign off. All voting members agreed that the section 75 can now be signed off. Bapi advised that he would circulate a presentation regarding diabetes to the executive committee for comment. Sam Nichol, the programme director for the Healthier Lancashire programme provided brief background summary and an overview of the progress with the programme so far. Bapi to circulate diabetes presentation Bapi Biswas

211 Sam addressed the programme stages and went through the design phase flow chart. A discussion was had and it was noted that the majority of West Lancashire Patients flow to Merseyside trusts, therefore the CCG need to look whether there is a greater importance to be more involved with a Merseyside programme. Sam informed the executive committee that the programme is constantly being developed to include the requirements from each CCG. West Lancashire CCG will be kept informed of these developments. Atrial Fibrillation Bapi, Ros, Jack and John declared an interest. The chair decided that as the interest was not fundamental; those that declared an interest could take part in the discussion but were unable to vote. Greg chaired the meeting for this item. It was noted that West Lancashire has a higher than average rate of strokes. A discussion was had regarding the GRASP tool and benefits of using this. Bapi provided feedback from a meeting that took place with Louise Ross from Lancashire CSU who had run the AF GRASP tool and produced reports of

212 those patients we are currently not optimally treated. All voting members agreed that Bapi should continue to progress with this work. It was also agreed that this should be discussed with the membership council. Dyspepsia pathway Jack provided an overview of the current dyspepsia pathway and noted that currently there is no standardisation. Jack also went through the NICE guidance requirements for this pathway. Dyspepsia pathway to be added to future membership agenda Jack Kinsey / Admin Team Examples of potential pathways were shared. A discussion was had regarding what can be done to improve the current pathway and potential changes that could improve this. It was agreed that further discussion regarding the dyspepsia pathway was required with the membership council. NW NHS 111 ITT Documents Peter, Bapi, John and Jack declared an interest. The Chair decided that Peter s interest was fundamental and was asked to leave the room. For Bapi, John and Jack it was decided that there interest was not fundamental and could take part in the discussion but were unable to vote. The chair of this meeting was passed to

213 Greg All those with an interest were asked to complete a confidentially and conflict of interest undertaking form. Katie provided an overview and went through the papers that had been circulated and noted that the papers have been presented for approval. A discussion was had regarding the possible cost implications and impact the service may have on OWLs. It was agreed that further work needs to be done on the cost implications. All voting members gave approval for the process to proceed. Minutes from Medicines Committee & Meds Co-ordinators Medicine Management Committee Nicola went through the minutes from the last medicine management committee, however it was noted that the meeting was not quorate therefore any discussion made will be ratified at their next meeting. Nicola to write to the ICO to highlight the issue of high cost dressing, appropriate use of silver dressings and excessive quantities of dressings Nicola Baxter The following issues were raised: Cost growth is 4.5% higher than the national average High number of prescriptions for dressings in the community

214 Prescription branding changes Discussion was had regarding how the issue regarding cost growth raised can be addressed. It was agreed that Nicola will write to the ICO to highlight the issue of high cost dressing, appropriate use of silver dressings and excessive quantities of dressings. The executive committee supported the use of branded generic medicines. It was noted that posters are being developed for chemists to address the high drug wastage issue, it was suggested that something similar could be done to highlight the need for prescription branding changes. Medicine Coordinators Jo Debacker declared an interest. The chair decided that as the interest was not fundamental Jo could take part in the discussion but was unable to vote. A business case was presented to the executive committee which requested the committee to Review the progress of the Medicine Coordinators scheme and review the options for allocation of medicines coordinators resource for practices.

215 The content of the report was noted and a discussion was had regarding the possible options. Wrap up All voting members agreed to option 2 however a review will take place in 12months.

216 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign ADP Roles for the meeting Discussion and Decisions Doug Soper Jackie Moran Greg Mitten Claire Heneghan This week s actions Due Date Responsible officer RAG Declaration of Interest Notes from 14 October The notes were approved as a correct record. Headline Items for AOB Information Governance Review finance and allocation update, performance and quality measures including winter pressures / contract update Paul Kingan provided an update to the executive committee on the CCGs current financial position. It was noted that there has been a push on RTT 18 weeks by NHS England. Paul provided an updated on tranche 1 and tranche 2 funding for both elective and non-elective care. A financial plan to be presented to the executive committee following receipt of operating framework The issue regarding consultant sending back referrals to be raised at the next quality improvement committee Paul Kingan Jackie Moran It was highlighted that the membership council have requested that if there is any additional winter funding available, primary care schemes should be considered.

217 An update was given on the latest IBR. The CCG has a tight financial position and the key pressures were noted, these include: Acute contracts Packages of care Prescribing The key pressures were discussed. An issue was raised regarding consultant sending back referrals to GP practices. Following the submission of the commissioning intention letter to the Lancashire CSU, possible ways forward have been discussed at the customer forum meetings. These discussions are on-going. The executive will be kept informed of the progress. A brief update was provided on next year s financial position. A paper regarding the CCGs financial plan will be presented to the executive committee following receipt of operating framework Code of Conduct Letter Joint meeting with S&FCCG The content of the code of conduct letter sent to Southport and Ormskirk Hospital NHS Trust was noted. The CCG is currently awaiting a response. The Merseyside prospectus to be added to Executive committee agenda Paul Kingan A discussion was had regarding the

218 possible options going forward. It was highlighted that the Merseyside prospectus has been published in the latest HSJ Terry provided a view from a social care perceptive regarding integrated working with social care. AOB Information Governance All were reminded to complete their mandatory information governance training. Complete mandatory information governance training All Public listening event The next public listening event will take place on Saturday 21 November at Ormksirk Library. If anyone is available to attend they were asked to let Meg know. IAPT Ros provided an updated on the IAPT Services and informed the executive committee on how well West Lancashire CCG has done to reach our targets. MASH paper for consideration by CCGs Community Triggers Commercial and Clinical Solutions (CCS) This item was deferred. This item was deferred. Gill Dolan and Andrew MacGlashan Commercial and Clinical Solutions (CCS) joined the meeting to provide an update CCS to be invited to further executive committee meeting Admin Team

219 on the review that CSS has been conducting on behalf of West Lancashire CCG regarding Individual patient activity (IPA). An update was given on the emerging general messages from the review to date. An example of two case studies was given and the results shared. A discussion was had regarding the review so far. Gill and Andrew were invited back to the executive committee to present their final report, which is due to be completed in November. Dementia Diagnostic Gap New guidance has been released regarding the dementia enhanced service from NHS England. Issues regarding waiting lists for CT scans to be raised at the next Quality and Improvement Committee Jack Kinsey A paper was presented to the executive committee which reviews the current non-recurrent investment in Community Dementia services and goes through the options for closing the Dementia Diagnostic Gap by March 2015 The possible options were discussed. Concerns were raised regarding waiting lists times for CT scans. It was noted that Beacon Primary Care

220 are holding an education event on 26 November which will be looking at Dementia. A suggestion was made regarding the possibility of filming this. Hospital Liaison A paper was presented to the executive committee on the mental health hospital liaison services which is provided at Southport and Ormksirk Hospital NHS Trust. The service has been running since June 2013 for West Lancashire patients. Mental Health Hospital Liaison pathway session to take place in December Ros Bonsor / Catherine Webster The paper highlights the activity of this service and requests funding to continue to service beyond March A discussion was had regarding the current services however it was agreed that further clarity in terms of what the money is used for was needed and the activity of the service. It was highlighted that since the pilot was funded, the service for West Lancashire patients has greatly improved. It was agreed that a pathway session will take place in December and that a decision will be made in January regarding the most appropriate way forward for this service. Wrap up

221 Part 2 West Lancashire CCG Clinical Executive Committee Action and Notes Apologies and assign roles Discussion and Decisions Ros Bonsor Adam Robinson Paul Kingan This week s actions Due Date Responsible officer RAG Declaration of Interest Notes from last meeting on 21 October 2014 The notes were approved as a correct record. Headline items for AOB Chief Inspector Public Engagement Event Review finance and allocation update, performance and quality measures and winter pressures and Contract update Item deferred BAF and risk register A discussion took place with regards to the Board Assurance Framework and the Risk Register.

222 Following this a further discussion took place around a high rated risk with regards to the delivery of Continuing Health Care Packages. It was agreed that Claire as lead, would contact Jean Rollinson at CSU and arrange a meeting to discuss this further. Claire to contact Jean Rollinson with regards to the delivery of Continuing Health Care Packages and discuss the rating for this as it has been allocated a high risk score. Claire to update Katie before Audit Committee on 11 November Claire Heneghan A further high risk was discussed regarding the lack of commissioning policies to drive individual patient funding decisions. It was agreed to invite Anthony Sudell from Public Health to discuss this issue further. It was noted that the risk register will be included on future exec agenda s to ensure that members are kept informed of any risks. Anthony Sudell from Public Health invited to exec on 18 November to discuss lack of commissioning policies to drive individual patient funding decisions that is currently on the risk register Lucinda Cawley / Admin Team If there are any risks that the members think should be on the register, could you please forward to Katie Wightman. The BAF and risk register will be presented to the audit committee on 11 November 2014 and the governing body on 25 November. It was noted that the CCG have an IM&T Strategy report, which will go to Governing Body in November for approval.

223 AOB The Chief Inspector of Hospitals is inviting members of the public to inform his inspection panel what they think and provide views about their experiences of care from the past year and say where they would like to see improvements made in the future. If members would be interested in attending these sessions the dates and venues are as follows: Wednesday 5 November pm at the Clifton Hotel, Southport Wednesday 12 November pm in the Walk in Centre, Skelmersdale Thursday 13 November pm in the Education Centre, Ormskirk It was noted that if members of the public were unable to attend there is a telephone number that could be used to share your experiences Meg will also be circulating information with regards to this event. Congenital Heart Disease NHS England has recently launched a 12-week consultation on the draft standards and service specifications for

224 congenital heart disease services. It was noted that the consultation runs from 15 September 2014 to 8 December NHS England are seeking responses to the draft standards and the specification, which have been developed in order to ensure the best outcomes for all congenital heart disease patients are achieved, as well as reducing variation and improving the patient and family experience. Following a group discussion it was agreed that Bapi would review and respond In future all other national consultations will be added to the executive committee agenda in a For Information section. Review and complete consultation response form for the new congenital heart disease review Bapi Biswas Community Triggers The community trigger is a new provision in the Anti-social Behaviour, Crime and Policing Act which became law on 20 October It was noted that the community trigger will give victims and communities the right to demand that persistent antisocial behaviour is dealt with efficiently. The Act gave CCGs a statutory responsibility to take part in the panel

225 reviewing any applications made under the Act. It is anticipated that the CCG s role will be to act as the co-ordinator of any confirmation of any health impacts stated by the victim. For example, if the victim is receiving mental health treatment or seeking support/advice from their GP as a result of any claimed anti-social behaviour, that the CCG would be required to go out to practice to formally request that patient information is sent confidentially to West Lancashire Borough Council, as evidence towards the case review. Katie confirmed that she is a member of the review panel. It is expected that the contribution from the health sector will be minimal as most of the review cases are expected to relate to housing or criminality. Facing the Future Gateways Patient scenarios were discussed with the exec committee and a number of recommendations were made by the group which will be included within the key milestones and gateway document. Following a group discussion Karen Tordoff requested that if there are any further comments with regards to the Send any further comments with regard to the Facing The Future milestones and gateways, over and above those All

226 milestones and gateways to please them to her by 6 November mentioned today to Karen Tordoff. Noted that Dr Rob Caudwell, Chairman from Southport and Formby CCG, joined the meeting at 10am. It was agreed to share the milestones and gateway document with Rob Caudwell, as Southport and Formby CCG, are also currently working to the same expectations and added that it would be useful to have a joint meeting to discuss further and possibly work together on this programme. Once the document has been finalised this will be shared on Thursday 6 November 2014 with the Trust An issue was raised with regards to hospital complaints, Jack Kinsey advised that a number of complaints have been shared with Rob Gillies and that they currently reviewing these. It was acknowledged that the CCG need to review this process and how to challenge this going forward. It was proposed that the CCG could look at practices using the Insight software, to record incidents. Explore the possibility of practices using Insight to record incidents. However would need to see which team this sits within the CSU Katie Wightman / Jackie Moran

227 Review progress of actions vs weekly action log Noted and updated live action log which is on SharePoint. Wrap up

228 Meeting Title: West Lancashire Clinical Commissioning Remuneration Committee Time: pm Present: Douglas Soper, Lay Member (Chair) Greg Mitten, Lay Member Dr Adam Robinson, Secondary Care Doctor Claire Heneghan, Chief Nurse Apologies: None Minutes D R A F T Date: 7 October 2014 Venue: Meeting Room 1, Hilldale, Ormskirk In attendance Carol Sheard, Associate Director of Workforce CSU Cathy Ashcroft, Executive Assistant Mike Maguire, Chief Officer (unless otherwise indicated) Dr John Caine, Chair (unless otherwise indicated) Agenda Summary of Discussion Item 1. Welcome, Introductions and apologies for absence Doug Soper welcomed all present to the meeting of the Remuneration Committee and introductions were made. Action Apologies were noted. 2. Minutes of the previous meeting The notes from the previous meeting held on 20 August were approved following two minor amendments. 3. Declarations of interests Mike Maguire and Dr John Caine joined the meeting and declared interests in items 5 and 6 and item 4 respectively. The level of the declaration of interest will be decided by Doug Soper, chair. 4. Employment status of clinicians in CCG roles Carol Sheard presented the paper which had been produced in response to the issue for determining the employment status of clinicians across Lancashire. The paper outlined the options to address the incongruence between employed status and posts being subject to the election process. The current role of the elected Chair as determined by the previous PCT is employed with the rights and obligations of employee status with a commitment to 6 sessions per week, reducing his clinical partnership commitments to accommodate the role. As the election process is incongruent with the employed status, should the Chair not be re-elected, the employee s contract would be terminated for a reason out of both the employer s and the chair s control. Re-deployment would be sought for the displaced Chair. Also, should the post no longer exist within in the CCG, due to organisational change rather than non-election, this could result in potential redundancy costs. The paper recommends that the Chair role is red-circled and maintains the employment status for the duration of the current individual s term of office and any subsequent re-election. It is proposed that any future process to engage a new Chair would be made on an office holder basis, which would be clarified at the start of an elected term. West Lancashire Clinical Commissioning Group Remuneration Committee 7 October 2014 Page 1 of 3

229 After the presentation of the paper, Dr John Caine left the room as his interest was deemed to be fundamental. Subsequently, the discussion and a decision took place. The Remuneration Committee will recommend to the Governing Body the following: The current Chair: will retain employment status for the duration of his term of office and any subsequent re-election The contract of employment to include a six-month notice period in line with many VSMs (Very Senior Manager) If accepted by the Governing Body, Carol Sheard will confirm terms and conditions under a VSM contract. The current elected GP Leads: posts are red-circled for the duration of their current term and remain as employees any future appointments would be made on an office holder basis if not re-elected once they hold office holder status, the GP Leads would receive a three-month resettlement payment. GP Leads who choose to stand down or not reapply will not receive this. As office holders, newly appointed Chair or Elected GP Leads: will be paid across 52 weeks per year will only be required for 44 weeks travel expenses will continue to be paid in addition to salary payments in the event that they apply for re-election but are unsuccessful, then they will be eligible for a three-month resettlement grant Carol Sheard will amend the proposed statement of appointment accordingly. The proposals will be shared with the Executive Committee and proposed to the Governing Body. Dr John Caine re-entered the room to receive the recommendations of the Remuneration Committee. 5. Performance review of the chief officer Mike Maguire left the room as his interest was deemed to be fundamental. The discussion and a decision took place in his absence. Dr John Caine confirmed that the chief officer had exceeded expectations in the first year of the CCG s operation with all statutory duties being met. The annual performance review had been circulated and the group was satisfied that the Chair continues to set and monitor the performance objectives. The group agreed that the CCG had been successful and performed well in its first year as a statutory body. Mike Maguire had provided the CCG with leadership and direction through this period. 6. Remuneration for the chief officer The chief officer s salary for 2013/14 was 110,000 per annum, made up of a basic salary of 100,000, in line with the scale of pay within a small CCG. An additional 10 percent of the basic salary was paid in recognition of the complexity factors around the post. In particular these centre around the need to bridge two health economies. A lease car entitlement under the previous PCT West Lancashire Clinical Commissioning Group Remuneration Committee 7 October 2014 Page 2 of 3

230 Director scheme equates to a benefit of 5,000 per year. Discussion took place around the absence of a National uplift for NHS staff, replaced with a non-recurrent 1 percent increase or an incremental payment. The Remuneration Committee will recommend to the Governing Body the following: The Chief Officer s: base salary is increased by a non-recurrent 1 percent along the level 1 CCG Chief Officer scale, which is in line with the headline increase received by other NHS staff this will increase the base salary to 101,000 a 10 percent recurrent complexity factor will be added giving a total salary of 111,100 the year on year increase in salary totaling 1100 will be non-recurrent for a twelve-month period from 1 April 2014 and not consolidated the current contractual entitlement to an NHS lease car is extended on the same terms, which will allow the post holder to replace the vehicle in January Mike Maguire rejoined the meeting to receive the decision. 7. Remuneration for the chief finance officer It is proposed that the chief finance officer s (CFO) salary is increased in recognition of additional duties undertaken since the departure of the deputy chief officer in May Additional responsibilities had been assumed in the areas of quality, performance and contracting. The current pay point at 85,535 represents the third increment on this banding, which occurred on 23 July The Remuneration Committee will recommend to the Governing Body the following: the CFO salary will be increased by one additional increment and backdated to the incremental date of 23 July 2014 the salary will increase to 89,640 on a consolidated basis. 8. Any other business No other business was discussed. 9. Date and time of next meeting No subsequent meeting is required at this time. West Lancashire Clinical Commissioning Group Remuneration Committee 7 October 2014 Page 3 of 3

231 Meeting held on Thursday 28 August 2014 Meeting room 231, Second Floor, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8DY Present: Dr Chris Clayton (Chair) Blackburn Dr Ann Bowman Greater Preston Dr Tony Naughton Fylde & Wyre Dr Mike Ions East Lancashire Dr Alex Gaw Lancashire North Dr Gora Bangi Chorley & South Ribble Dr John Caine West Lancashire In attendance: Mr Carl Ashworth LCSU Mr Richard Jones LAT (to 10 am) Mrs Susan Warburton LAT Mr Martin Clayton LAT Mr Jim Hayburn LAT (to 10 am) Dr Alison Rylands - Spec Comm Mrs Jan Ledward - Greater Preston/Chorley & South Ribble Mrs Debbie Nixon Blackburn Mr Peter Tinson Fylde & Wyre Mr Mike Maguire West Lancashire Mr Gary Raphael Blackpool Mr Andy Roach - Blackpool Ms Karen Sharrocks Chorley & South Ribble Mrs Jill Truby Network 1. Welcome, apologies for absence and declarations of interests Dr Chris Clayton welcomed everyone to the meeting. Apologies for absence were received from Dr Amanda Doyle, Mr David Bonson, Mrs Linda Riley, Mr Andrew Bennett, and Mrs Jane Higgs. There were no declarations of interests in relation to agenda items. 2. Feedback from working groups Dr Clayton set the scene by confirming that the notes from the July workshop event had now been received and circulated for members perusal. From this workshop working groups had been established to discuss and report back to the Network on progress on the four areas as follows. 2.1 Leadership Forum Dr Chris Clayton/Mr Richard Jones Dr Chris Clayton gave a presentation on reflections of the leadership forum to date and NHS England s role in this. Specific highlights included: What has been achieved? There was acknowledgement that a group of all stakeholders meet and commit to meeting, and it was agreed there was value in having the meeting. What Frustrations have been felt? Frustrations were around pace, ownership and the meeting themselves. Feels slow and confused around conversations and some of the work streams. What are the options for it in the future? Concept of forum had been bought into by all stakeholders. Agreed there was a need to continue. How do we shape this commissioning influence for future? How do we put leadership in around the proposed changes to NHS England? How are we going to provide leadership for it in the next transition phase? Mr Richard Jones updated the Network in relation to the future of NHS England. Consultation is currently taking place with NHS England staff which is due to be completed in October. It is anticipated that there will be a reduction of area teams to 12 on a National basis but the areas have not yet been defined. However it is expected that there will be a Lancashire office. It is thought there will be a reduction in the senior manager posts by up to 50%. Some responsibilities expected to be devolved under a framework, further work is required to understand the level at which this will be devolved. On plan to implement changes 1 April Lancs CCGs Network meeting, 28 August 2014 Page 1 of 4

232 When asked, Mr Hayburn confirmed that there would be no change in the functions provided by NHS England, they will still have statutory responsibility. In relation to the Leadership forum Dr Clayton reported that he was meeting up with forum representatives from Lancashire Care Foundation Trust, NHS England Lancashire Area Team and Lancashire County Council to discuss further. Following discussion there was a clear mandate that the Leadership forum should continue, led by the Network. 2.2 Specialised Commissioning Messrs Peter Tinson and David Bonson Mr Peter Tinson gave a presentation on specialised commissioning. He outlined what the architecture of the collaborative commissioning board would look like. He has been tasked with looking at how specialised commissioning fitted into the local system. It was understood that there was a piece of preparatory work being undertaken in the North West. Mrs Ledward informed the group that the National Commissioning Specialised Services Task and Finish group was meeting the following day where there would be more debate and Mrs Ledward agreed to feed back. 2.3 Learning Disabilities Mrs Susan Warburton and Messrs Kevin Parkinson, Carl Ashworth and Mike Banks Mr Carl Ashworth gave a presentation on suggested collaborative approach to commissioning for Learning Disabilities. Highlights included: Suggested Lancashire LD Programme - Strategic Framework for People with LD o All ages, full LD continuum exclude autism o Starts with wellness principle o Delivers universal access and personalised care o Informed by national policy, guidance and standards o Informed by case studies of national and local best practice o Informed by new models of care o o Developed through LD lead commissioners group with CSU and SCN support Stocktake of current state against strategic framework Review of current service provision Review of current commissioning arrangements for all services Highlights gap against national requirements Informed by LD SAF outputs Undertaken by LD commissioners group with CSU and SCN support, chaired by area team. Representation from all CCGs. - Commissioning Plan o Strategic framework and stocktake will highlight priorities for action across range of service provision o Commissioning plan will detail suggested actions for commissioners of each service to ensure delivery of strategic goals and priorities o Developed through LD commissioners group with CSU and SCN support o CCGs to agree which elements of commissioning plan are undertaken on a collaborative basis. - Implementation Programme o o o o Clear governance arrangements required to agree action at appropriate commissioning level local, health economy, or collaborative. This is seen as collaborative commissioning board/network. Is this Lancashire or pan-lancashire? Link of LD work stream to 3 HWBBs need exploring Implementation programme will incorporate current CCG collaborative programmes undertaken by CSU (LD SAF, LD ESS, SEND) and SCN (Task & Finish group on new models of care and workforce development) It was confirmed that Lancashire County Council would be happy to lead on this with support from CCGs. Lancs CCGs Network meeting, 28 August 2014 Page 2 of 4

233 2.4 Reconfiguration Mrs Debbie Nixon/Mr Andrew Bennett Mrs Debbie Nixon gave a presentation on reconfiguration. Highlights included: Reconfiguration in Lancashire why do we need to do it? - Driven by Case for Change which is yet to be written - Driven by a need for better outcomes - Driven by doing the right thing within sustainable resources - CCGs too small to drive big system change/providers can t do it by themselves - Reconfiguration is a by-produce of the clinical narrative e.g. vascular/dementia What could we do by when? - Could we deliver a case for change by March Emergency care, ambulatory elective care, stroke? - Agree the system specification - Options o Commissioner led Case for Change o Co-produce the Case for change with providers o Tender (difficult contractual models) o Combination of both Delivery options how could we do it? - Co-commissioning Board lead - CSU lead - Lead CCG role? - Hybrid - Current Lancashire Leadership Forum? Discussion points/key issues - Co-production with providers evidence suggests better outcomes when integration exists - The clinical case, priorities and gateways need agreeing upfront - What is truly Lancashire wide? - How do we ensure accountability once decisions are made? - Do you want to co-commission or co-produce or not? - How do we resource this? Discussion points - Leadership and talent pool are diminished, we need to rethink - Mobilisation and task group - Dedicated capacity - Clinical leadership - Hybrid CSU/CCG/Clinical/Provider - The risks of not doing it?? The risk of not doing it was considered not an option. What was considered was how to manage the process and how to involve providers. It was agreed to produce the case for change by March. 3. Draft Terms of Reference/membership for Collaborative Commissioning Board Mr Peter Tinson tabled the proposed Collaborative Commissioning Board terms of reference. The collaborative commissioning board would be a Network delivery vehicle, and membership would include all CCGs, NHSE Area Team and Specialised Commissioning, County and Unitary Councils and Strategic Clinical Network. A senior CCG officer would be responsible for each priority and the group would be supported by the CSU collaborative commissioning team. Discussion ensued and some amendments to the terms of reference were proposed. Mr Tinson agreed to make the amendments and recirculate the document for final comments. In relation to the chair and vice chair, it was agreed that Dr Clayton would seek support for these two roles. Mr Clayton, Mrs Warburton and Dr Rylands left the meeting at this point. Lancs CCGs Network meeting, 28 August 2014 Page 3 of 4

234 Routine Business Network members 4. Network Governance Mrs Karen Sharrocks had agreed to review and refresh the work previously undertaken around Network governance and had liaised with Mr Peter Tinson to ensure the appropriate links are established between the collaborative commissioning board and the network. Mrs Sharrocks presented the paper which detailed the story so far. Incorporated within this were the principles of collaboration previously presented to the Network in January A wide ranging discussion followed. Mr Maguire suggested that contribution to Lancashire collaborative schemes should be proportional to the contract financial values not per head of population wherever possible. Various opinions were expressed on what exactly was required in terms of governance. Formal governance was considered whereby all CCGs are bound by decision, or governance with options to opt out at various stages of gateways. The Network: Agreed to develop co-commissioning board Agreed the priorities for collaborative commissioning each priority pathway to outcome Agreed significant influence via Lancashire Leadership forum Agreed that the next CAG becomes co-commissioning board Dr Clayton agreed to provide a summary on Healthier Lancashire for next meeting. 5. Minutes from previous meeting held on 31 July 2014 Subject to the addition of.. for 2015/16 being inserted at end of first bullet point of item 6, the minutes of the meeting held on 31 July 2014 were agreed as an accurate record. 6. Matters arising/action sheet The Chairman sought and obtained confirmation that the actions from the previous meeting were either complete or in hand. 7. Any other business 7.1 NHSE meeting requests deferred. 7.2 Engagement re Healthier Lancashire. CSU communication and engagement team will be contacting individual CCGs to build up a picture of what engagement has already been done across Lancashire around Healthier Lancashire. All CCGs were encouraged to share this information. 7.3 General GP representative SCN Neurological Conditions Steering Group. No resources available within CCGs. 7.4 Strategic Clinical Network Learning Disability Advisory Group representative. Mrs Nixon agreed to action via local authority. 7.5 Dr Ann Bowman updated members in respect of a serious incidence. CSU to be asked to provide an update in relation to the IPA Programme Board to the next meeting of the Network. 8. Date of next meeting 25 September 2014, Meeting room 231, Floor 2, Preston Business Centre, Area Team/Specialised Commissioning in attendance. Lancs CCGs Network meeting, 28 August 2014 Page 4 of 4

235 Meeting held on Thursday 25 September 2014 Meeting room 231, Second Floor, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8DY Present: Dr Chris Clayton (Chair) Blackburn Dr Ann Bowman Greater Preston Dr Tony Naughton Fylde & Wyre Dr Amanda Doyle Blackpool In attendance: Mrs Linda Riley - LCSU Mr Carl Ashworth LCSU Ms Samantha Nicol Healthier Lancashire Programme (item 3) Mr Martin Clayton Area Team (item 6) Mrs Jan Ledward - Greater Preston/Chorley & South Ribble Mr Peter Tinson Fylde & Wyre Mr Mike Maguire West Lancashire Mr David Bonson Blackpool Mr Mark Youlton East Lancashire Mrs Jill Truby Network (minutes) 1. Welcome, apologies for absence and declarations of interests Dr Chris Clayton welcomed everyone to the meeting. Apologies for absence were received from Dr Mike Ions, Dr John Caine, Dr Gora Bangi, Dr Alex Gaw, Mrs Debbie Nixon, Mr Andrew Bennett, Ms Karen Sharrocks and Mr Andy Roach. It was noted that there was no representation from Lancashire North; therefore the meeting was not quorate. There were no declarations of interests in relation to agenda items. 2. Minutes of meeting held on 28 August 2014 Minute 2.2 Specialised Commissioning final sentence to read Mrs Ledward informed the group that the National Commissioning Specialised Services Task and Finish Group was meeting Minute 4 Network Governance Following sentence to be added after A wide ranging discussion followed. Mr Maguire suggested that contribution to Lancashire collaborative schemes should be proportional to the contract financial values not per head of population wherever possible. Various opinions were expressed.. Subject to the above amendments the minutes of the meeting held on 28 August 2014 were accepted as an accurate record. 3. Matters arising and action sheet The Chairman sought and obtained confirmation that the actions from the previous meeting were either complete or in hand. 4. Healthier Lancashire Dr Clayton welcomed Ms Samantha Nicol to the meeting. Dr Clayton reported that regular meetings were being held and it was noted that the next Leadership forum scheduled for 2 October would be in the format of workshops. Ms Nicol introduced herself and gave a presentation on Healthier Lancashire. Highlights of the presentation included: Background: Historic timeline and key milestones that have been undertaken in the last 12 months. The case for a Health and Care Strategy for Greater Lancashire was promoted by the Lancashire Leadership Forum throughout Strategic workshops took place end Followed up by a paper presented to key partners and the 3 Health & Well Being Boards. Key work streams were set up March 2014 to establish some foundations for the programme. Lancs CCGs Network meeting, 25 September 2014 Page 1 of 4

236 Substantive Programme Director, in place from September Commitment: Taken from the draft Strategic Framework due to be released on 30 October 2014 This reminded members of what they have already agreed to. Progress so far: Lancashire Leadership Forum meeting quarterly and Healthier Lancashire Executive in place Enabling projects: o Digital Health o Listening to Lancashire o Leadership Collaboration Operational Projects: o In-hospital o Out of Hospital o Neighbourhood Pilots o Third Sector Sustainability Assessment Framework (SAF) Programme Management Office in set up phase Initial key stakeholder conversations underway System management creating a programme Phases and outputs Timeline Process for services change The Healthier Lancashire Programme will be structured into five stages Mobilisation Design Implementation Delivery Procurement, contracting and delivery At the end of each phase there will be a clear commitment point before moving into the next one Illustration of the process for system wide services reconfiguration: The process for whole system reconfiguration is about ensuring recommended preferred options are based on the whole system reconfiguring, including primary care. In phase one, mobilisation, a commitment is needed from all statutory organisations involved to work together collaboratively. This leads into the need for a robust case for change a public facing document that creates the momentum for change. Prior to beginning the co-design of services in the new system it is vital that quality standards are set. They are another way of showing what needs to change and why and they enable the setting of priorities for action and are a way of engaging with a larger constituency. The co-design requires the right people to be together to design the possible service models and a particularly important part for the in-hospital group is the work on the clinical interdependencies. This process looks at many aspects. A vast array of options is necessary. The process sets out the key activities, but is based on the psychology of co-design and of the need to engage people and more importantly to not close down options before it is necessary, leading to a high level of innovation and improvements. Next steps: Governance Structure Establish Programme, Clinical and Stakeholder Boards Define purpose and develop narrative and visual identify Agree finance and resource needed Set up PMO and put processes in place Re-launch work streams Collaborative Leadership progress, incorporate cultural change element Develop programme plan Agreement to mobilise Lancs CCGs Network meeting, 25 September 2014 Page 2 of 4

237 General discussion ensued and it was agreed that Healthier Lancashire would become a standing item on future Network agendas and detailed information around resources would be on the October agenda. In response to a question from Mr Maguire, Ms Nicol confirmed that the programme included mental health for all residents regardless of age. 5. Collaborative Commissioning Board governance arrangements Mr Peter Tinson reported that the terms of reference had been shared and would be signed off at the first meeting of the Collaborative Commissioning Board (CCB). There was some discussion around future meeting dates and these would be agreed at the first meeting. 6. Primary care costs Further to a request at the July meeting of the Network, members received financial information relating to primary care costs split by CCG. Mr Martin Clayton attended from the area team and took questions from members relating to the information provided. It was noted that all CCGs would receive details of the models available, budgets and the various options of support. There would also be proposed models for conflict of interest and performance. It had been agreed to extend ability to change constitutions to end of December. Members agreed that it would be useful to have a model constitution. Mr Clayton took the opportunity to update the Network around the NHS England organisational alignment capability programme. Mr Clayton was thanked for attending and updating the Network. 6.1 Conflicts of interest Deferred to await national conflicts of interests policy. 7. Network governance update It was considered that the Network governance would continue as originally agreed based on the CCB. 8. Stroke update Mrs Ledward presented a stroke update. Introductory briefings will be prepared that will give people, particularly those who have not engaged as yet, time to catch up with the overall aims of the review, background context and progress to date. In addition to this early engagement process, there is further work to ensure continuing communication and consultation with CCG membership, other representative bodies, such as voluntary organisations, practice-based patient participation groups and locality forums and links to groups that are hard to reach. A detailed communications plan will be developed which will set out the basis for on-going communication and engagement between the programme, CCGs and key stakeholders including statutory bodies, provider organisations, public, patients and carers. CSU is looking at options, numbers, travelling time etc. A GP from Blackburn with Darwen has been appointed to the clinical senate primary/secondary work stream for Lancashire. Dr Doyle agreed to share Blackpool s work. The Network: Noted the contents of the report 9. Individual Patient Activity Programme Board update Mrs Linda Riley updated members in relation to the current status of IPA services provided by the CSU across the Lancashire CCGs footprint. The CCGs had advised the following to be taken forward which was agreed at the Customer Forum: The CCGs to take ownership of the IPA Programme Board with immediate effect To secure independent external expertise to work with us to further review areas of concern To work jointly to look at alternative options for service provision of Lancashire CCG IPA services. The CSU is keen to work with CCGs to secure the above outcomes but has so far not been able to secure CCG chair ownership to the programme Board in order to progress the above areas. Lancs CCGs Network meeting, 25 September 2014 Page 3 of 4

238 All elements of the service will continue to be updated and provided through the IPA programme Board with necessary and appropriate updates to the CFO and / or Customer Forum. A detailed action plan had been put in place following the review by KPMG. Mrs Riley reported that the next scheduled meeting of the programme board is to be cancelled and used as a workshop. Members agreed that it was not about money/numbers but interfacing with the most vulnerable patients Lancashire is responsible for. Mrs Riley confirmed that in future quality indicators would be submitted to the Network. Members also received a copy of a monthly report advising on the highlights of work stream performance within the Individual Patient Activity Function of NHS Midlands and Lancashire Commissioning Support Unit. Members noted the contents of the report. 10. CSU services Members received a copy of a letter sent by Blackpool CCG on behalf of all Lancashire CCGs in relation to commissioning intentions for the CSU services in 2015/16. Representatives from each of the Lancashire CCGs had met on 5 September to obtain a collective view of their respective commissioning intentions for CSU services from April The Network was informed that this would be the only item at the next customer forum Procurement Mr David Bonson gave an update around progress of NHS 111 service. CCGs were asked for their cooperation in delivering their CCGs approval to the procurement to enable implementation of the new contract before winter Item to be included on next CCB agenda. 12. CAMHS SRO Following the departure of the SRO for the CAMHS programme there was a need to consider the SRO function moving to another CCG. After discussion it was agreed in principle that Dr Ann Bowman would continue as clinical support and that Blackburn with Darwen would consult as to what was required. Dr Clayton to ask Mrs Nixon and Mr Hopley to action. 13. Minutes from other meetings 13.1 CAG The minutes of the Collaborative Arrangements Group meeting held on 9 September 2014 were noted for information Quality Surveillance 10/7/14 The minutes of the Quality Surveillance meeting held on 10 July 2014 were noted for information. 14. Any other business 14.1 Community Equipment Store an update from Hilary Fordham, Lancashire North to be circulated. 15. Date of next meeting 30 October 2014, Meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Area Team/Specialised Commissioning in attendance. Lancs CCGs Network meeting, 25 September 2014 Page 4 of 4

239 Meeting held on Thursday 30 October 2014 Meeting room 231, Second Floor, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8DY Present: Dr Gora Bangi (Chair) Chorley and South Ribble Dr Ann Bowman Greater Preston Dr Mike Ions East Lancashire Dr Amanda Doyle Blackpool Dr John Caine West Lancashire Dr Alex Gaw Lancashire North In attendance: Mrs Linda Riley - LCSU Miss Samantha Ruthven-Hill LCSU Mr Declan Hadley (item 4) Mr Stewart Bond (item 4) Ms Samantha Nicol Healthier Lancashire Programme (item 5) Mrs Jennifer Aldridge (item 9) Mrs Jean Rollinson (item 9) Mrs Alice Marquis-Carr (item 9) Mrs Jan Ledward - Greater Preston/Chorley and South Ribble Mr Mike Maguire West Lancashire Mr David Bonson Blackpool Mrs Debbie Nixon Blackburn with Darwen Mrs Sarah Camplin Fylde and Wyre Mrs Hilary Fordham Lancashire North Mr Mark Youlton East Lancashire Mr Gary Raphael Blackpool Ms Karen Sharrocks Chorley and South Ribble Ms Kathryn Chester Chorley and South Ribble 1. Welcome, apologies for absence and declarations of interests Dr Gora Bangi welcomed everyone to the meeting. Apologies for absence were received from Dr Chris Clayton, Dr Tony Naughton, Mr Andrew Bennett, Mr Peter Tinson, Mr Carl Ashworth, Mr Iain Crossley, Mr Iain Stoddard, Mr Roger Parr, and Mr Paul Kingan. There were no declarations of interests in relation to agenda items. 2. Minutes of meeting held on 25 September 2014 Agenda item 2 (Network Governance) CCG Network minutes from 2 September 2014 was queried by Mr Mike Maguire, with reference to the contribution to Lancashire collaborative schemes being proportional to the contract financial values and not per head of population wherever possible. It was noted that a discussion had taken place but no decision made. Subject to the above amendments, the minutes of the meeting held on 25 September 2014 were accepted as an accurate record. 3. Matters arising and action sheet The Chairman sought and obtained confirmation that the actions from the previous meeting were either complete or in hand. 4. Healthier Lancashire Dr Bangi welcomed Ms Samantha Nicol to the meeting. Ms Nicol updated members on the Healthier Lancashire Programme. Copies of the presentation had been circulated and members were asked for any comments and/or questions. Ms Nichol outlined the Healthier Lancashire process and why it is being undertaken: Healthier Lancashire is about creating an environment across Lancashire to deal with transformation issues and barriers, work collaboratively, whilst also allowing CCGs to develop independently. Lancs CCGs Network Meeting, 30 October 2014 Page 1 of 3

240 Healthier Lancashire will ensure resources are organised in a way to achieve better health outcomes. On 27/11/2014 a document will be published that will include input and information received during Healthier Lancashire discussions. The document will include the vision, values, principles, commitment, and scope of the Healthier Lancashire programme. CCGs will be able to review and provide feedback on the document The decision making process will be clearly defined within the document. Further discussions are required to confirm the leadership and decision making process for Healthier Lancashire. 5. GP IT Strategy Mr Declan Hadley and Mr Steward Bond outlined the potential areas for collaboration around digital health across the Lancashire CCGs. The proposed initiatives aim to bring together the Healthier Lancashire Digital Health Programme, the emergent CCG IT Strategies and the Informatics Work Plan of the Commissioning Support Unit. Fourteen potential areas for collaboration have been identified. CCGs were asked to prioritise the areas they wished to collaborative on. The following actions were agreed: Approach providers and other stakeholders to establish how their priorities align Develop a detailed proposal based on the emergent priorities Consolidate this revised plan into the Healthier Lancashire governance structure Link with the North West Coast AHSN to share good practice and innovation Indicate whether they wish to collaborate on a low, medium or high level Further information was requested in order to progress this collaboration, particularly capital charges and finance issues. Some of the collaboration areas will be easier to implement than others, and it was agreed to commence these areas first. It was agreed that a financial strategy was required in order to progress the GP IT Strategy. The financial strategy should include modelling, affordability, pros and cons, what we are doing now against opportunities for the future, timelines, and mapping of the next steps. It was agreed that a more comprehensive GP IT Strategy plan should be prepared and submitted to the CCG Network meeting on 18 th December. CCGs to complete template forms and return to Mr Declan Hadley by mid-november. 6. Mental Health reconfiguration Mrs Debbie Nixon verbally updated members in relation to the Mental Health Inpatient reconfiguration: This is on track to deliver by the deadline of 2017/18 and efficiency savings will be achieved. There is an encouraging trend of reduced out of area placements. Delayed discharge is currently being reviewed. The Crisis Acute Pathway is also being reviewed. The Task Finish Group have agreed to continue with funding. Mrs Nixon will produce a paper to be submitted to the Collaborative Commissioning Board. The CCGs can then present the paper to their Governing Bodies. 7. CSU contracts for 2015/16 Mrs Linda Riley verbally updated members in relation to CSO Contracts for 2015/16. The 2015/16 CSU contracts are being negotiated, and CCGs have been provided with pricing information. A table has been produced by service line advising of what is included and the prices. The Lead Provider Framework with prices will be ready for September However there are some uncertainties due to a number of CCGs indicating significant reductions in contracts with CSU. The impact needs to be understood and business cases developed to be considered by NHS E area team. 8. Differences between Lancashire and GM financial planning assumptions Discussion ensued around arrangements following the merger of the area teams in Lancashire and Greater Manchester and the possible consequences for Lancashire CCGs. It was agreed that the Collaborative Commissioning Board would take this forward at its meeting on 11 November in liaison with Healthier Lancashire. Lancs CCGs Network Meeting, 30 October 2014 Page 2 of 3

241 9. Multi-Agency Safeguarding Hub (MASH) Mrs Jennifer Aldridge, Mrs Alice Marquis-Carr and Mrs Jean Rollinson gave a verbal presentation on the future involvement of health into Lancashire s Multi-Agency Safeguarding Hub (MASH). The six CCGs across the Lancashire County Council footprint have been asked to consider and support a proposal for a continued health presence within the Lancashire MASH. The CCG Network was asked to receive the CCG responses to the recommendations within the paper and to agree to consider the proposal and the commissioning responsibilities to the Lancashire Commissioning Board. After general discussion members agreed that there was a need to understand the complexity of the arrangements and it was proposed and agreed to set up a task and finish group. Mrs Ledward agreed to lead this group and to bring back to the Collaborative Commissioning Board meeting a paper detailing current arrangements and proposed options going forward. 10. Minutes from other meetings 10.1 The draft minutes from the Collaborative Commissioning Board held on 15 October 2014 were noted. 11. Any other business 11.1 CAMHS SRO A paper was presented proposing that Blackburn with Darwen CCG becomes the CAMHS SRO. Blackburn with Darwen CCG is already the lead contractor for the LCFT Mental Health contract, overseeing all elements of the contract including CAMHS. The COO in BwD is also the SRO for major reconfiguration of Adult and Older Adult specialised inpatient services, and leads on the co-ordinating of the commissioning intentions and required service redesign, monitoring arrangements and transition. The commissioning of CAMHS services is supported by the CSU but ultimately accountable to current SRO (East Lancashire CCG). Due to the number of different arrangements currently within CCGs it was agreed that the CSU be tasked with incorporating all arrangements into a proposal for presenting to the CCB. It was noted that Dr A Bowman was the Network s clinical lead for CAMHS. It was also noted that a paper re CAMHS was being considered at the Lancashire HWB LCA letter re CHC Rates It was established the all Lancashire CCGs had received this letter and Mrs Riley on behalf of the CSU agreed to draft a response on behalf of Lancashire Primary Care Co-commissioning Dr Doyle referred to an from Mr Martin Clayton regarding preparing for co-commissioning of primary medical services. Mr Clayton had proposed that a sub-group of the CCB be set up to manage this issue going forward. Dr Bangi volunteered to Chair this group and CCGs were asked to send nominations for the group to Dr Doyle Telestroke Mrs Ledward reported that following analysis of providers she would bring back a paper recommending a decision on the outcome of the negotiation of the services following the termination of the contract by North Cumbria. She advised this was an urgent issue due to the contract ending in December. 12. Date of next meeting 27 November 2014, Meeting room 231, Floor 2, Preston Business Centre, Area Team/Specialised Commissioning in attendance. Lancs CCGs Network Meeting, 30 October 2014 Page 3 of 3

242 Meeting Held Wednesday, 1 October 2014, Daresbury Park Hotel, Warrington Present Dr S Cox S Whitehouse C Duggan A Tonge P Brickwood S Johnson S Banks F Clark Dr N Fazlani K Sheerin M McDowell I Davies K Holian T Jackson D Johnson Dr A Pryce Dr J Caine M Maguire J Owen N Evans J Hawker H Charles-Jones A Lee G James SESSION 1 CHESHIRE AND MERSEYSIDE CCG MEETING Minutes Clinical Accountable Officer, St Helens CCG (Co-Chair) Chief Executive, NHS Vale Royal CCG (Co-Chair) Director NHSE CW&WAT Chief Finance Officer, K,H and St Helens CCG Deputy AO, Head of Commissioning, St Helens CCG Chief Officer, Halton CCG Chief Operating Officer, S&F SCCG Chair, Liverpool CCG Chief Officer, Liverpool CCG CFO, S&F SS CCG Liverpool CCG Liverpool CcG CFO Liverpool CCG Chief Officer Knowsley CCG Chair, Knowsley CCG Chair, West Lancashire CCG Chief Officer, WLCCG Deputy Chief Nurse, Halton CCG Eastern Cheshire CCG Chief Officer, EC CCG Chair WC CCG Chief Officer, WC CCG CFO WC CCG Minute taker: Julie Burke APOLOGIES Dr J Hussey Medical Director NHSE L Thompson-Greatrex Acting Director of Ops and Delivery, NHSE Dr C Richards Chair Halton CCG J Wicks Interim Chief office Warrington CCG Dr A Davies Chair Warrington CCG R Cauldwell Chair S&F CCG N Leonard Chair, S&F CCG A Davies Chair, WCCG v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 1

243 L Bennett P Bowen Dr A Wilson Head of Commissioning WCCG Chair, EC CCG Chair, SC CCG No Item Action Welcome Review of Actions of meeting held 2 July All actions closed off Primary Care Commissioning SC to set up first meeting of a C&M Primary Care Co-Co-commissioning group to explore where commons standards across services could be implemented NHSE Reconfiguration overview R Barker SJC and SW welcomed R Barker to the meeting RB summarised priority areas of work for NHSE for discussion. Presentation to be circulated to members Importance of relationship with CCGs and NHSE to develop relationships Delivery pressures Robust plans for the future re: BCF and important to build and develop robust working relationships with LA colleagues. Primary care co-commissioning and specialist services Forward looking strategies Immediate priorities for Winter Stocktake/OD- needs to be done correctly Operations delivery issues as well as RTT, waiting times, dementia and other commitments. In addition to political issues especially relating to HV s and Winterbourne. Planning preparation for the deliverables. Each AT currently has around 3 colleagues analysing data for BCF assurance. CCGs should have information required for BCF plans in their own plans. Next year s plans should be 1 plan where all information is accessible. System Leadership catch all for everything. Specialist commissioning will need to change to allow delivery of plans. Proposed reconfiguration in the North, 4 ATs, not of equal size with C&M being the smallest which will link with geography of senates. Current networks and expertise will help facilitate and contribute to discussions with secondary care partners. Reorganisation will take NHSE 1 step away from CCGs which has seen reduction in 50 ATs to 27 and now to 12 outside of London. Statutory responsibility with NHSE to commission specialist services. Questions were invited PB asked for clarity on what co-commissioning means as there are no large structures in place to make it work in each area of the country as all footprints are different. JW asked for clarification on what full delegation meant for CCGs, ie, no input into co-commissioning from NHSE. RB reiterated that NHSE will still fulfil an assurance role. KS added that recent PC co-commissioning correspondence have clarified that statutory delegated authority for specialist services unlikely to change much, as too close to April 2015 to enact change. Progress had been made locally in partnership with secondary care partners. Clarification needed on governance and budgets and associated risks for specialist commissioning and primary care. SJC JB v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 2

244 No Item Action RB added that joint decision making re: specialist services means joint with NHSE and CCGs which could be through pooled budgets or NHSE. AT gave an example of where this is currently happening, reconfiguration of Trauma services. MM asked if there was any capacity planning and risk analysis for staff to enable this to happen and if it is realistic and practical for this resource to be protected. RB - directive from SS, there will be no resource from NHSE to facilitate PC co-commissioning. Responsiblity sits with CCGs, make staff available to CCGs, to produce a plan to ensure resources are not duplicated, ie a shared agency. RB formulae for allocation to CCG is population based which impacts on deprivation, little variation, resulting in distortion and changing allocations and services that could be delivered. Specialist services commissioning fast change of pace but likely to be next year before final plans. Some services will be at national level with identification of what could in co-commissioning moving from collaborative commissioning and other services moved to a wider collaborative commissioning footprint. Incentive next year relating to co-commissioning target, any savings made could be spend locally, any loss taken by NHSE. 75% of current spend in specialist service is life-style related, ie bariatric surgery. SB CCGs need to work with the AT to prepare for to ensure governance robust governance structures are in place. KS added that 1 size specialised commissioning does not fit all, some should be Merseyside Footprint and others C&M footprint to realise benefits across all pathways. In response to FC question of how colleagues could support each other to avoid reactive situations, ensuring consistency to information requests to avoid duplication, RB replied that better a single, data service would realise this. CD and FC to look at a local solution for streamlined requests. SC opened up discussions relating to recent CSU matters and if colleagues present could provide context for RB. FC S&F+SS CCG good working relationships with CSU and able to obtain information when required. Reconfiguration is causing organisational flux and FC asked is there a national plan for arms length bodies and workforce plans to ensure correct skill mix of colleagues is retained. JH + AL - expressed concerns regarding provision of support in relation to CHC for CW&W AT due to safety concerns and subsequent serious organisational and clinical risk to the NHS. Concerns had been raised with CW&WAT. C&W CCGs to outsource CHC. HCJ added this is an immediate clinical risk and problem and that CSU did understand the severity of the problem. SC quality of support provided by CSU across C&M in some service lines place corporate and reputational risks for certain CCGs. SW where staff are embedded working as part of a CCG, support provided is good. Unable to get 1 single data source which impacts on plans and an increase in transactional costs due to time spent by CCG staff to validate information. Meeting on 2 October may provide medium / long term solution but need a short term solution. CW&W AT need immediate help from NHSE re: safety concerns. AT focus should not be on business cases and SLAs. Meeting on 2 October with LG and other CCG colleagues is go obtain shared view on what CSU can retain to have a sustainable model going forward. RB responded to concerns raised. CCGs decision for future CSU model. CD/FC v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 3

245 No Item Action Have contractual levers been invoked to raise contractual issues in the appropriate way. Any changes need to be cost effective or look at a local model. AL responded that due diligence had to be followed relating to CHC issues raised earlier and this was a performance and service failure. RB 3.5% reduction next year in non elective activity. Plans need to identify what is likely to happen rather than agree to the 3.5%. TJ plans are very detailed but need to ensure that improvement in outcomes, quality and safety are at the forefront of plans Co-Commissioning specialist services Deferred to a future meeting CSU Support services across C&M Discussed above. v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 4

246 Present Dr S Cox S Whitehouse C Duggan N Allen P Brickwood S Johnson S Banks Dr C Shaw F Clark Dr N Fazlani K Sheerin M McDowell R Cauldwell N Leonard I Davies K Holian T Jackson D Johnson Dr A Pryce Dr J Caine M Maguire APOLOGIES SESSION 2 MERSEYSIDE CCG NETWORK Minutes Clinical Accountable Officer, St Helens CCG (Co-Chair) Chief Executive, NHS Vale Royal CCG (Co-Chair) Director NHSE Assistant Director, Clinical Strategy NHSE Chief Finance Officer, K,H and St Helens CCG Deputy AO, Head of Commissioning, St Helens CCG Chief Officer, Halton CCG Chair, SSCCG Chief Operating Officer, S&F SCCG Chair, Liverpool CCG Chief Officer, Liverpool CCG CFO, S&F SS CCG Chair S&F CCG Chair, S&F CCG??? Liverpool CCG??? Liverpool CcG CFO Liverpool CCG Chief Officer Knowsley CCG Chair, Knowsley CCG Chair, West Lancashire CCG Chief Officer, WLCCG Minute taker: Julie Burke Dr J Hussey L Thompson-Greatrex Dr C Richards J Wicks Dr A Davies A Davies Medical Director NHSE Acting Director of Ops and Delivery, NHSE Chair Halton CCG Interim Chief office Warrington CCG Chair Warrington CCG Chair, WCCG CHECK PART 2 Merseyside CCG Network CD updated on current reconfiguration. Reduction in management costs. 9 AT to be reduced to 4, C&M will join and be part of regional team. ADs will start in regional team so teams are more streamlined. ATs will consist of Regional Director, Finance Director, Director of Nursing, Planning Director, Development Director plus 4 area Specialist Directors. There will be no Commissioning Director Local team make-up will be Medical Director, Nursing Director, Finance Director with option to have 3 further VSMs. CD proposing for C&M Delivery Director and Director of Commissioning. Not a role for a 6 th VSM in some areas but C&M will use funding to negotiate this. Staff affected, 8cs and above - 33%. 45 day staff consultation begins , CD holding staff briefings at a local level and will discuss impact on changes where role may move from one team to another. Consultation period will include recruitment process to be concluded by December. ADs will be part of a national pool, 9 or below may be in a v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 5

247 geographical pool. Recruitment freeze is in place. C&M single team but 3 locality offices to remain, Stockton Heath, 1829 Building and Regatta Place. Specialist services team currently on a NW footprint KS asked where will this sit and for clarity on the role of NHSE in assurance and role of NHSE in commissioning. AT currently working with CCGs re: specialist commissioning. 1 area team will be responsible for Military / veterans, Offender Health will link with Manchester. In response to FC question if CCGs will be involved in the recruitment to any of these roles, ie Director of Commissioning, CD replied that CCGs will be asked to provide in-put and asked that CCGs consider current staff in recruitment to any vacant posts. JD added that 1 size of AT will not fit all geographies. ATs will look different as there is not 1 operating model. Contractual arrangement for every patient / contractor may change but the same principles will apply (NWSpC) NHSE Assurance Process NA and CD outlined proposed AT process for implementing the NHSE assurance process / role regarding significant service change. Process is not meant to be bureaucratic, will ensure there are no blocks to plans Will ensure joint response for national services Comments made NHS England (directly commissioned services) does not state involvement of CCG if NHSE initiated change this will be altered. AHSN does not commission services Concerns were expressed regarding cost effectiveness and skill mix of using outside agencies to validate, comment on BCF plans. SB asked if refresh of plans will be proposed rather than production of full new plans. Example of where assurance process would be tested, major service changes - eg relocating provision of cancer services where there is an impact on other CCGs. Responsibility for Assurance Director would sit in Medical Director. Submissions are made monthly to region and DoH of any significant changes to mitigate any political / reputational issues. Strategies would be sensed checked before business plans developed. NHSE would check where any conflicts of interest may arise to ensure impartiality. Stage 2 Could be desk-top exercise or formal decision making forum via formal letters. Best practice checks would be carried out as part of the evidence check Minutes / actions from September Merseyside CCG Network Minutes agreed as an accurate record of proceedings. Action template updated Collaborative Stroke Update JV was welcomed to the meeting. JV summarised key points and referred colleagues to the executive summary which set out clinical advice of the C&M Strategic Clinical Networks to inform the design of a future model for Hyper Acute and Acute stroke services. The clinical advice has been informed following national, local and regional engagement with Stroke Clinical Network. Current evidence from SSNAP indicates a variation of service provision across C&M contributing to inequity of access to services for parts of the population. The Stroke Clinical Network hosted a Stroke Summit on 2 July 2014 to explore how a v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 6

248 model could be developed for C&M, working with CCGs and commissioners to improve outcomes for patients. Eight standards were developed at the Stroke Summit. The CCG Network were asked to approve the next steps and recommendations on page 10 of the report. 1. Agree a safe and sustainable service model for this region from the list of options presented. 2. Set up a joint stroke commissioning group that will commit to collaborating in commissioning a stroke service by taking a regional view of stroke services and avoids organisational bias (see below) 3. Provide permission for the Stroke Network to develop an outline business case that can be shared for agreement 4. Develop a comprehensive implementation plan for the development of stroke services for the next 2-3 years. The following comments were made MM Lancashire are currently undertaking review. JV added that project support can be identified to look at options for a future model on behalf of all CCGs. KS (No2) a regional review would be too big a geographical footprint, this would need to be on a C&M footprint with local discussion. SB added that H, StH and WCCGs work across 2 two trusts and commission hyper acute and rehabilitation stroke services at a local level. SC added proposed a sub-regional group, ie MM, Liverpool, to reflect patients flows. KS requested that the information be refreshed to show where CCGs are against these standards. ACTION: Collective standards to be refreshed to identify where CCGs are against current standards at a Merseyside level meeting. CCGs agreed quality aspireations CCGs to confirm their managerial and clinical leads for this piece of work. JV to be present findings and further proposal to January 2015 Network meeting. SC asked for the wording of (No 3 above) to be amended to read.. business case that can be shared for agreement, then to sovereign organisation for ratification. Point 2 above to read by taking a evidence based regional view of Stroke services All JV JV JV NHS 111 Procurement Contract to be awarded on a 5 year contract, planned to commence on a phased basis, first phase on 1 October 2015 with transfer of one third of activity to new provider, a further third on 22 October 2015 and final third on 12 November Proposal is for C&M to be the first phase of the new contract, with Cumbria and Lancs transferred in the final phase over a 6 week period. Financial implications across the north west will be dependent on the actual tender price, estimates range from savings of 2m to a cost of 2.5m. Activity based on total number of calls answered including OoH providers across 12 month period August 2013-July Allocation of marks for bid evaluation are Service Delivery (65), Bid Price (30), Bidder Interview (5) which had been endorsed by CCG Footprint Lead CFOs. There will be a ceiling price for each of the contract equivalent to per call in each year. Bidders achieving less than 65% of marks will be dismissed. Bidders that are within 5 marks of the highest scoring bidders will be invited to interview. Assumptions on projected call volumes do not include existing OOHs calls for St Helens CCG and includes 85% of Cumbria CCG OOHs calls. There will be no national launch of NHS111. v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 7

249 Individual CCGs will be charged for actual utilisation, ie base activity levels included in the contract will be adjusted monthly and reflected in invoices/credit notes to CCGs. Procurement documentation to be published 20 October Selection of recommended bidder following conclusion of final evaluation anticipated mid February CCG Board approval of recommended bidder anticipated mid March ACTION: Formal sign-off of final procurement business case by C&M CCGs is required by 13 October 2014 in Part 2 or extra-ordinary Committee as appropriate. CCGs to ID with confirmation of approval. ID to provide update at Network meeting on 5 November Common Standards /Strategic Intentions/Commissioning Support SC presented proposed work programme for C&M CCG Network following discussion at previous meetings to identify key areas to form a programme of work. The following amendments were requested: Request that the QSG be increasingly clinically led with comparative data on providers possibly moving to a clinical Chair TJ added that Public Health colleagues are undertaking a feasibility study across Merseyside which could link into key areas of identified work. ACTION: It was agreed to use the Health Collaborative time on 8 October for CCG Network colleagues to discuss this programme of work in detail and identify top 3 areas to begin to progress Neuro Rehabilitation MMcD presented a briefing paper on the C&M Rehabilitation Network and pathway services currently commissioned by the Mersey CCGs which set out the recommended next steps for consideration. Data shown on page 4+5 of the report showed historic costs and activity. Admission criteria is being followed. Clarification to be sought to confirm if patients are choosing to stay local for services. ACTION: Independent review to be carried out to validate activity and data. Scope of framework for this review to be confirmed. Current service to be extended for a further 12 months to enable this review to be carried out Next Merseyside CCG Meeting Wednesday 5 November 2014, 1pm St Helens Chamber, Salisbury Street, off Chalon Way, St Helens WA10 1FY All All ID All MMcD v:\wl ccg\meetings\board meetings\2014\november\item 12.6 merseyside ccg network - october 2014.docx 8

250 Care Closer to Home Programme Board Minutes (RATIFIED) Wednesday, 17 th September 2014 at 9.30am in the Board Room, Corporate Management Offices, Southport District Hospital, Town Lane, Kew, Southport, PR8 6PN Attendees: Dr Rob Caudwell (RC) Dr John Caine (JC) Tracy Cook-Scowen (TCS) Alan Cummings (AC) Billie Dodd (BD) Tony Ellis (TE) Penny Fell (PF) Sheilah Finnegan (SF) Janice Horrocks (JH) Kim Haworth (KH) Niall Leonard (NL) Mike Maguire (MM) Karl McCluskey (KM) Judith Malkin (JM) Chris Russ (CR) Dave Snow (DS) Joanne Sutton (JS) Mel Wright (MW) Michelle Brocklebank(MB) Apologies: Nicky Ambrose-Miney (NAM) Keith Bennett (KB) Hannah Chellaswamy (HC) Fiona Clark (FC) Chris Cote (CC) Clare Heneghan (CH) Sharon Jeffrey (SJ) Debbie Mallett (DM) Linda Morris (LM) Joanna Stark (JS) Chair - Chair Southport & Formby CCG Chair, West Lancs CCG Deputy Clinical Director, Lancashire Care Contracts Manager, NHS England (Merseyside) Head of CCG Development, Southport & Formby CCG Marketing & Communications Manager, S&O Hospital NHS Trust Chief Operating Officer, New Directions Chief Operating Officer, S&O Hospital NHS Trust Programme Sponsor Care Closer to Home S&O Hospital NHS Trust Area Commissioning Manager, Central Lancs Commissioning Team Southport & Formby CCG Chief Officer, West Lancashire CCG Chief Strategic Planning & Outcomes Officer, S&F CCG Assistant Director of Operations, Community and Continued Care, S&O Hospital NHS Trust West Lancs CCG Clinical Director, Emergency Care, S&O Hospital NHS Trust Merseycare NHS Trust Southport & Formby CCG PA to COO, S&O Hospital NHS Trust (Minutes) Assurance Delivery Manager, NHS England Assistant Director of Operations, Urgent Care, S&O Hospital NHS Trust Deputy Director of Public Health, Sefton MBC Chief Officer, Southport & Formby CCG Lancashire County Council Chief Nurse, West Lancashire CCG Interim Senior Clinical Systems Improvement Lead, West Lancs CCG Service Development Manager, NWAS PA, S&O Hospital NHS Trust Assistant Director of Operations, Transformation, S&O Hospital NHS Trust 1

251 Cath Whalley (CW) Liz Yates (LY) Rose Gorman (RG) Michael Gray (MG) Tina Wilkins (TW) Lancashire County Council Director of Nursing &Quality, S&O Hospital NHS Trust Contract Manager, NHS England Senior Information Analyst, S&O Hospital NHS Trust Head of Service, Vulnerable People, Sefton Council No Item Action CC2HPB Welcome, introductions and apologies 14/77 Noted as above. CC2HPB Action notes of the meeting held on /78 The minutes of the last meeting were accepted as a true and accurate record. CC2HPB 14/79 Matters arising from the meeting held on and resolved actions from Action Tracker July 2014 Action Tracker: The group went through the action tracker and discussed the current position on the actions. Please see separate document for outstanding actions. The following have been completed: 14/43: Primary Care Transformation Projects: Originally concerns raised by MM at May 2014 meeting, but now not an issue. Action deleted. 14/53: Mental Health Emergency Access & Children s Unscheduled Care: TCS has met with Joanne Sutton, Merseycare. 14/53: Public Health: System Resilience Group Dr Emer Coffey attending System Operational Resilience Group. Action Resolved. 14/58: Redesign & New Ways of Working Projects: Discussions re the cardiology pathway to take place in contract meetings. Addressed for action elsewhere. 14/67: Operational Resilience Plan 2014/15: Addressed on the agenda by way of presentation on CCG strategies re IT and EMiS. Action Resolved. 14/67: Operational Resilience Plan: Plan circulated to CCtH Programme Board members. Action Resolved. 14/74: Programme Enabling Project Updates: Reporting milestones discussed and agreed with lead managers who will be reporting back on progress to the CCtH Programme Board at future specified dates, as contained in the milestones paper. 2

252 CC2HPB 14/80 CCG IT Presentation Rob Caudwell and Chris Russ presented an update of community IT; a copy of which has been attached to these minutes. IMT Strategy presentation for GP m RC/PF RC to speak separately with Penny Fell regarding compatible IT systems with partners from the social care sector. CC2HPB 14/81 CC2HPB 14/82 CC2HPB 14/83 CC2HPB 14/84 CC2HPB 14/85 There is a plan to run a workshop in October (if agreed at this board) about current and future pathways for respiratory case, with a view to making a business case by end of October. -Dave Snow left the meeting at this point. Managing Local Handover & Ambulance Turnaround Times There was no representation from NWAS at today s meeting to talk about the Excessive Handover Delays Reporting Template. SF indicated that she was not aware of any issues at present, but she has asked KB to record information onto a template which can be monitored at this meeting. Operational Resilience Plan 2014/15 BD informed the group that the feedback from NHS England was that the plan was excellent. 1 plan is still to be received and there will be an independent review on Capacity & Demand data. MM highlighted 2 areas of concern : the opportunity to redesign social care and the number of consultant vacancies. SF said that conversations have begun on this matter with other providers, however, they are experiencing the same issues. ECIST Length of Stay Action Plan An update will be given at the next meeting. A&E Performance Despite the peak in majors and patients aged 85+ attending A&E recently, A&E performance was met and no diverts took place. Primary Care Transformation Projects (a) Progress Report Most programmes have delivered, however, BD to review the ToR for the PCTG meeting. (b) Facing the Future Together BD said that there is a paper being presented at Sefton s CCG Board Meeting next week and subject to agreement, work can go forward. She will inform SF of the decision so SF can raise at S&O KB SF BD BD 3

253 CC2HPB 14/86 CC2HPB 14/87 CC2HPB 14/88 CC2HPB 14/89 CC2HPB 14/90 Trust Board. Key milestones have been drawn up for the period of engagement work, starting with locality groups with effect from September/October JM & SF left the meeting at this point. Redesign & New Ways of Working projects The report was noted by the group. Programme Enabling Project Updates (a) Pathways Some pathways that that have been redesigned are not in place due to gaps in service and issues around NICE compliance. Pathways approved by The New Ways of Working Group will be signed off at this meeting in future. JH will talk to leads and ask them for reports outlining progress and highlighting any issues regarding implementation of pathways. KMc asked for each report to be standardised. JH will ask each lead to present their report at this meeting. (b) Culture SPB are holding a workshop about this on 6 th October. Feedback will be reported back to this meeting. (c) Communications TE provided a document, describing CCtH and case studies. Tony Ellis asked for any comments to be sent to him by 24 th September. (d) Self-Care Document enclosed with agenda, provided an update. (e) Revised Report Bed Days No report was received for the meeting. Care Closer to Home Strategy JH yesterday circulated a refreshed Care Closer to Home Strategy JH asked for comments to be sent back to her within the next 2 weeks. Any other business There was no other business. Date, time and place of next meeting: Wednesday 22 nd October 2014, am, The Board Room, Corporate Management Offices, Southport DGH, Town Lane, Southport, PR8 6PN JH ALL ALL 4

254 Care Closer to Home Programme Board Minutes (UNRATIFIED) Wednesday, 22 nd October 2014 at 9.30am in the Board Room, Corporate Management Offices, Southport District Hospital, Town Lane, Kew, Southport, PR8 6PN Attendees: Fiona Clark (FC) John Caine (JC) Clare Heneghan (CH) Alan Cummings (AC) Billie Dodd (BD) Penny Fell (PF) Sheilah Finnegan (SF) Janice Horrocks (JH) Kim Haworth (KH) Niall Leonard (NL) Mike Maguire (MM) Karl McCluskey (KM) Judith Malkin (JM) Dave Snow (DS) Julie Edwards (JE) Rose Gormon (RG) Leigh Thompson (LT) Bob McGowan (BM) Niall Leonard (NL) Penny Fell (PF) Hannah Chellaswamy (HC) Linda Morris (LM) Apologies: Rob Caudwell (RC) Tony Ellis (TE) Joanne Sutton (JS) Tracy Cook-Scowen (TCS) Tom Knight (TK) Keith Bennett (KB) Joanna Stark (JS) Tina Wilkins (TW) (Chair) Chief Officer, Southport & Formby CCG Chair, West Lancs CCG Chief Nurse, West Lancashire CCG Contracts Manager, NHS England (Merseyside) Head of CCG Development, Southport & Formby CCG Chief Operating Officer, New Directions Chief Operating Officer, S&O Hospital NHS Trust Programme Sponsor Care Closer to Home S&O Hospital NHS Trust Area Commissioning Manager, Central Lancs Commissioning Team Southport & Formby CCG Chief Officer, West Lancashire CCG Chief Strategic Planning & Outcomes Officer, S&F CCG Assistant Director of Operations, Community and Continued Care, S&O Hospital NHS Trust Clinical Director, Emergency Care, S&O Hospital NHS Trust AHP & other Clinical staff Shadow Governor Contract Manager, NHS England Acting Director of Operations, NHS England, Merseyside Acting Head of Service NWAS Southport & Formby CCG Chief Operating Officer, New Directions Deputy Director of Public Health, Sefton MBC PA, S&O Hospital NHS Trust (Minutes) Chair - Chair Southport & Formby CCG Marketing & Communications Manager, S&O Hospital NHS Trust Merseycare NHS Trust Deputy Clinical Director, Lancashire Care NHS England (Merseyside) Assistant Director of Operations, Urgent Care, S&O Hospital NHS Trust Assistant Director of Operations, Transformation, S&O Hospital NHS Trust Head of Service, Vulnerable People, Sefton Council 1