NHS England London Southside 4th Floor 105 Victoria Street London SW1E 6QT. 24 th July Dear Daniel, Fiona and Louise. Re: CCG Annual Assurance

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1 NHS England London Southside 4th Floor 105 Victoria Street London SW1E 6QT 24 th July 2014 Dear Daniel, Fiona and Louise Re: CCG Annual Assurance Many thanks for meeting with us on 6 th June 2014 to discuss the annual assessment of West London CCG and to review the development priorities for the coming year. This letter is a summary of the Quarterly Assurance meetings that we have held over the last year and provides a synopsis of the improvements and ambitions for future developments laid out against the assurance domains. Key area of strengths / Areas of good practice Work with Chelsea and Westminster Hospital NHS Foundation Trust and in providing strong leadership to managing the contract with the Trust on behalf of other London CCGs Leadership of work with Chelsea and Westminster Hospital NHS Foundation Trust to oversee the work of the local economy to reduce non elective admissions into the Trust by 5% in 2013/14 Your creation of practice learning sets which have been well attended by member practices and your work to create practice buddies Your focus on increasing the number of children who receive an MMR vaccination Your support of the roll out of SystmOne so all GP practices use the same IT platform Your commissioning of additional weekend GP surgeries last winter and their continuation as part of your work to improve patient access to primary care North West London CCGs - To note that West London CCG have been party to a number of pilot schemes being implemented across NWL. These include: Being successful as a Whole Systems Integration Pioneer Seven Day Working Prime Ministers Challenge Fund NHS Constitution Standards To note that the CCG has a statutory duty to report on services defined in the NHS Constitution. For 2013/14 West London CCG met the following NHS Performance Standards: 18 weeks referral to treatment (RTT) admitted performance within 18 weeks 18 weeks RTT non-admitted performance within 18 weeks 18 weeks RTT incomplete pathways performance within 18 weeks Patients waiting more than 6 weeks for a diagnostic test Total time spent in A & E < 4 hours (all activity types) 1

2 Patients who have waited over 12 hours in A&E from decision to admit to admission Cancer 2 week waits: Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer Cancer 2 week waits: Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected Cancer 31 day waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis cancer within 31-days where that treatment is surgery cancer within 31-days where that treatment is an Anti-Cancer Drug Regime cancer within 31-days where that treatment is a Radiotherapy Treatment Course cancer within 62-days of an urgent GP referral for suspected cancer cancer within 62-days of referral from an NHS Cancer Screening Service cancer within 62-days of a consultant decision to upgrade their priority status Mental health care programme approach seven day follow up: The proportion of patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days The standards which were not met include: Number of 52 week RTT pathways - admitted Number of 52 week RTT pathways - non-admitted Number of 52 week RTT pathways - incomplete pathways Mixed Sex Accommodation (MSA) breaches Mixed Sex Accommodation (MSA) breach rate The number of hospital and community acquired infections for MRSA The number of hospital and community acquired infections for clostridium difficile Number of LAS arrival to handover greater than 30mins Number of LAS arrival to handover greater than 60mins Mental Health improving access to psychological therapies (IAPT): Proportion of people with depression and/or anxiety disorders referred for and receiving psychological therapies Mental Health improving access to psychological therapies (IAPT): Proportion of people with depression and/or anxiety disorders receiving psychological therapies who are moving to recovery. NHS Statutory Duties This section covers details of discussions regarding the CCGs ability to deliver their functions as laid out in the 14Z16 or 14ZA of the NHS Act 2006 as amended by The Health and Social Care Act I can confirm the CCG has published its annual report on its website. 14T Each CCG whilst carrying out its functions must have regards to the need to reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients which affect the outcomes achieved for them. It is noted that discussion has taken place in terms of the CCGs commitment to the quality of opportunity and the promotion of the equality and diversity agenda and it can be confirmed that the CCG is actively pursuing these three policies and its commissioning decisions. The 2

3 CCG published its Equality and Diversity objectives for 2013/16 and these were discussed at an assurance meeting. These include: Supporting the physical health needs and emotional wellbeing of young carers Reducing Social Isolation for people with Learning Disabilities Improving identification of mental health patients Improve mental health and well-being for BME communities and people with learning disabilities Review access to IAPT (Improved Access to Psychological Therapies) Improve patient experience data collection and analysis and improved use of the data To improve workforce data monitoring to ensure engagement and support To improve equalities issues addressed across the CCG 14R Duty as to continuous improvement to services You have described processes whereby you monitor the quality of care commissioned on behalf of West London patients. Clinicians from the CCG chair the Clinical Quality Group at the Chelsea and Westminster Hospital NHS Foundation Trust and the Central and North West London NHS Foundation Trust (CNWL). We are aware that the CCG s chair has been very active and committed in her leadership of the mental health agenda across North West London including her chairing of the North West London Mental Health Strategic Board. The Quality and Safety Committee, a sub-committee of the Board, receives intelligence regarding safety, clinical effectiveness and patient experience. Your Board has also been briefed by the Director of Quality and Safety about the recommendations contained within the Francis Enquiry and the Berwick Review and the actions required. The Director of Quality and Safety has also described the work his team has undertaken in terms of quality monitoring especially work with local nursing homes and with CNWL following recent Care Quality Commission Visits and subsequent notices to CNWL Trust services within the CWHHE patch. The work to develop an effective monitoring/impact assessment of proposed QIPP schemes is also noted as being of a very high quality. This work has been made available to other CCGs. We have also discussed the need to continue to strive to meet the Winterbourne target, including having confidence in current data and working with the national team to ensure data is validated. It is very important that the CCG continues its focus on increasing the number of patients that have been assessed and have a proposed discharge date. We will continue to highlight this area as part of our ongoing assurance discussions. 14W Try to obtain appropriate advice in order to deliver functions Although noting that the composition of the Federation changed within the year, when Ealing CCG decided to move from the BEHH Federation to join the CWHH Collaboration, the CCG is still well served by its Senior Clinical and Management Leadership Team. The Management Team consists of experienced Directors of Quality, Finance, and Compliance who work in conjunction with the Clinical members, the Managing Director and the Accountable Officer. Your Board comprises the required range of clinicians in both primary and secondary care and we are assured therefore that you are able to access appropriate advice to allow the CCG to discharge its functions. We are aware that the Board has undergone some changes during 2013/14 including a change of Chair after Dr Sweeney stepped down and the appointment of 4 new GP Governing Body members. We also note that the managing director in post for 2013/14 has subsequently left and has been replaced by a new and substantive Managing Director. 14Z Public involvement and consultation by Clinical Group During our assurance meetings you have described the mechanisms you use to involve the local community in your work. It should be noted that West London CCG, along with the 7 3

4 other NWL CCGs, are involved in the Whole Systems Integration work which has strongly involved lay partners and is being seen as a model of good practice in terms of lay involvement. We have talked about the implementation of personal health budgets and you have noted that the preparation in the run up to April has mostly been on known complex children which has raised a number of issues in terms of Governance and Clinical Safety, however, you are assured that the mechanisms in place for involvement and discussion on personal health budgets is robust. 223H-223J Expenditure, Finance and Controls All clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended) regarding the use of resources to ensure that their capital and revenue resource use in a financial year does not exceed the amount specified by the NHS Commissioning Board West London CCG achieved all its financial duties and performance is summarised below: Expenditure not to exceed its income: In 2013/14 West London CCG recorded a surplus of 29.6m; Revenue resource use not to exceed the amount specified in directions: In 2013/14 West London CCG s net revenue expenditure totalled 314.2m, against a revenue resource limit of 343.8m; Capital resource use not to exceed the amount specified in directions: In 2013/14 West London CCG did not have a capital allocation. The 2013/14 plan was for a 20m surplus which was overachieved and the actual FCOT was a surplus of 29.6m. Health and Well-being Board There has been good progress made in working with Royal Borough of Kensington and Chelsea with regards to the development of the Health and Well-being strategy, noting the CCG has been an active member of the Health and Well-being Board. A range of issues have been discussed including the development of the Better Care Fund, Health and Wellbeing Strategy and Adult Safeguarding. The Health and Well-being Board appears to be well placed to provide strong and thoughtful leadership to improve the care and services local people receive in West London. Strategic Plan All CCGs are involved in the development of the NWL Strategic Five Year Plan. This builds on the content of Shaping a Healthier Future and develops this in a number of key areas arising from local Joint Strategic Needs Assessments as well as national priorities. The results are a solid plan which is aligned to local strategies such as improving out of hospital care. The focus for this year must now be on the delivery of these plans. Key areas of challenge: Over the year all CCGs in North West London have expressed concerns around the performance of the NWL Commissioning Support Unit (CSU), as a result a decision has been taken by all CCGs to de-commission the NWL CSU. The challenge for the first 6 months of 2014/15, will be to ensure the safe transition of services. In 2013/14 the CCG achieved QIPP of 12.1m, 91% of the planned 13.3m. The main shortfalls were in planned care and acute services metrics. West London CCG is the lead commissioner for Chelsea and Westminster Hospital NHS Foundation Trust and is well placed to continue the good collaborative work with the Trust. It is also well paced to continue its role in providing strong clinical leadership of the Central and North West London NHS Foundation Trust. 4

5 It has been noted that the move of Ealing CCG to CWHHE was particularly challenging in terms of the additional workload that it brought. Authorisation West London was authorised by the NHS Commissioning Board in March 2013 with 2 conditions placed upon it. This has required additional work by the CCG to meet and sign off these conditions. These were as follows: Systems and processes for monitoring and acting on patient feedback, and particularly in identifying quality including safety issues. Systems and processes for monitoring and acting on patient feedback, and particularly identifying early quality issues including safety. Following the submission of further evidence from the CCG, these conditions were removed in June Summary I hope this provides a helpful summary of the CCG s work and notes the progress made by the CCG during the course of its first year as a statutory body. I consider the CCG has a strong base to go forward especially given its strong financial position. I would suggest as part of our assurance process we continue to focus on the following areas; Areas of Development for Discussion; Focus on delivery of national constitution standards Focus on work to improve the quality and safety of commissioned care Delivery of CCGs QIPP and financial plans Delivery of CCGs out of hospital ambitions Delivery of CCGs engagement (public and patient) strategy building on the good work to date Continuation of work with Kensington & Chelsea Council Work as part of 8 NWL CCGs on integration, and on delivering Shaping a Healthier Future I would encourage you to publish this letter on your website and to share it with member practices and stakeholders. Yours sincerely Joanne Murfitt Acting Area Director, North West London, NHS England 5