CCG Narrative Template to Support Operational Planning, 2015/16. Kingston CCG Draft v5 23/4/15 Page 1 of 32

Transcription

1 CCG Narrative Template to Support Operational Planning, 2015/16 Kingston CCG Draft v5 23/4/15 Page 1 of 32

2 Context Supplementary information for commissioner planning, 2015/16 asks that a full narrative detail of commissioners' operating plans must be available locally to be shared with partners and stakeholders including NHS England. The key elements of CCG operating plans to be covered in a full narrative are set out in the following template. The template asks that you outline any recovery or action plans where performance is not in line with trajectory. When detailing these, please provide specific actions, measureable ambitions and timeframes for delivery. The template should be completed and submitted in draft by Tuesday 7 th April. The narrative will be reviewed alongside CCG activity data, financial planning data and UNIFY submissions. CCG: Kingston Clinical Commissioning Group Date: 7 th April 2015 CO signature: Kingston CCG Draft v5 23/4/15 Page 2 of 32

3 1. Delivery across the five domains and seven outcome measures Securing additional years of life for your local population Baseline measure to set a quantifiable ambition E.A.1 (annual) - Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare Are you meeting the trajectory that was submitted as part of your 2014/15 operating plan? Please provide your 2014/15 ambition and performance to date. Ambition: 1, Actual: Not released KCCG does not have access to the PCMI, and is investigating other sources of information with RBK Public Health colleagues. Using deaths in hospital as a proxy, there has been a marked reduction between and If you are not meeting the trajectory, what actions are you taking in 2015/16 to recover? Please provide specific actions, measureable ambitions and timeframes for delivery. Work is being undertaken to obtain the information within the PCMI to the measure this indicator. The Commissioning for Value packs show Kingston as having a low mortality rate compared to the comparator group. Improving the health related quality of life for people with longterm conditions, including mental health conditions E.A.2 (annual) - Health related quality of life for people with long-term conditions Ambition: 79. Actual: 81 (Draft) The latest GP Survey shows that for the five areas detailing the State of Health today, there has been a significant decrease in those people with LTCs where they have either an inability or severe problems. Draft figures suggest that KCCG is meeting this target. Reducing the amount of time people spend avoidably in hospital E.A.4 (quarterly) - Quality Premium Composite measure on emergency admissions Ambition: 1,407 Actual (FOT): 1,346 Kingston is achieving this target (YTD 3Q position is 1,034 against the YTD plan of 1,09). Kingston CCG Draft v5 23/4/15 Page 3 of 32

4 Increasing the proportion of older people living independently at home following discharge from hospital E.A.S.3 (annual) - Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services Kingston s ambition for the proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services within the BCF plan is 86.7% (52/60). This is measured on an annual basis, although the expectation (based on latest information available) is that this will be met for The rate was 82.1%. In 2014/15 the CCG and LA undertook an evaluation of the integrated health and social team providing intermediate care, rehabilitation and reablement. The recommendations related to the review of reablement criteria and exploration of a more targeted approach on those individuals who will most benefit from the services and regain full independence from the evaluation will be implemented in 2015/16 which will support improvement in the outcomes of those receiving reablement and the proportion of people living at home. The review and changes to the eligibility criteria and service model will be completed in Q1. Increasing the number of people having a positive experience of hospital care E.A.5 (annual) Proportion of people having a positive experience of hospital care Ambition: 135 Actual: Not released The CQC inpatient survey has not been released for 2014/15. However, the Inpatient survey placed Kingston CCG on the average for people having a positive experience of hospital care (source: HSCIC) N/A Kingston CCG Draft v5 23/4/15 Page 4 of 32

5 . Increasing the number of people having a positive experience of care outside hospital, in general practice and in the community E.A.7 (annual) Proportion of people having a positive experience of care outside hospital, in general practice and the community Ambition: 5.7 Actual: 5.4 The latest GP Patient Survey indicates: a decrease in the proportion of people who have had a poor experience overall of their GP Practice a marked decrease in the proportion of people having a poor experience of out of hours care N/A Making significant progress towards eliminating avoidable deaths in our hospitals E.A.8 (annual) KCCG reviews mortality summary information on several indicators held on the HSCIC CCG outcomes framework, under Domain 1: Preventing people from dying prematurely (below). 1. Preventing people from dying prematurely KCCG England Data ave year Under 75 mortality from cardiovascular disease (NHS OF 1.1) Under 75 mortality from respiratory disease (NHS OF 1.2) Under 75 mortality from liver disease (NHS OF 1.3) Under 75 mortality from cancer (NHS OF 1.4) and 5 year survival from all cancers (NHS OF 1.4 I and ii) and 5 year survival from breast, lung and colorectal cancers (NHS OF 1.4 iii and iv) Excess under 75 mortality rate in 2012/ adults with serious mental illness (NHS OF 1.5) Kingston CCG is either on the England average or better than average when the rates are compared. For the 1 and 5 year survival rates for all cancers and for breast, lung & colorectal cancers, although KCCG is on the England average some detailed work commenced in , triangulating with the Commissioning for Value pathways packs, which also demonstrated areas where improvements could be made. These are being worked through with KCCG s clinical and public health cancer leads. Kingston CCG Draft v5 23/4/15 Page 5 of 32

6 2. Improving Health: Your planned outcomes from taking the five steps recommended in the commissioning for prevention report Commentary What analysis have you undertaken of key health problems? Using a range of data from multiple sources the local Joint Health and Wellbeing Strategy has identified and focuses on 4 priority areas: o children and young people o mental health o older people and people living with long term conditions o addressing the needs of socially excluded and disadvantaged groups RBK Public Health team maintain the local Joint Strategic Needs Assessment, which informs Annual Public Health reports the 2 most recent focus on elderly care needs and mental health needs and CCG commissioning intentions and plans RBK Public Health and the CCG have jointly reviewed recent Commissioning For Value reports The CCG has undertaken more specific and detailed exploration of certain areas in preparation for commissioning and service change, particularly in aspects of services for children and young people, mental health services (children and adolescent, adult and older people), and older people / those with complex conditions The CCG continuously reviews performance / activity data from providers which helps to inform planning Based on this analysis, what are your priorities and common goals? The CCG has developed an Integrated Operating Plan for 2015/16 (aligning with RBK Public Health and Adult Social Care). It includes a number of priorities and common goals across the following health and care areas details can be provided if required: o Quality and patient safety o Voice and control for people in Kingston o Children and young people o Integrated health and care services for adults (includes older people) o Mental health Kingston CCG Draft v5 23/4/15 Page 6 of 32

7 o Primary care o Urgent and emergency care o Cancer prevention and treatment services o End of life care o Socially excluded and disadvantaged groups o Health and prevention o Integrated commissioning of health and adult social care Have you identified your high impact programmes? From within the above long list of action areas, a smaller number of priority, high impact programmes are to be progressed in 2015/16: o Better Care Fund Programme including: consolidation of Kingston at Home (integrated health and social care provision, expanded rapid response services) establishment of Kingston Coordinated Care (proactive care and support, and multi-disciplinary working for people with complex needs) o Development of an Outcomes Based Commissioning approach incorporating re-procurement of community services o Adult Mental Health Services particularly effective crisis services, enhanced primary care mental health provision and reduced dependence on secondary care services o Dementia services implement a GP-led community dementia service and dementia-friendly communities o System Resilience - including progress across the local health and social care system towards 7 day working, establishment of a walk-in centre, procurement of an integrated NHS111 and GP out of hours service o Primary Care Transformation towards NHSE(London) 17 specifications for general practice, with emphasis on access, proactive care and coordinated care; includes support for further development of Federated Working between Kingston s 26 GP practices o Kingston Health Passport further development and roll-out of shared electronic health record o Establish a Joint Commissioning Unit with RBK Adult Social Care o 2015/16 QIPP programme, which itself includes a range of service and contract change and development Kingston CCG Draft v5 23/4/15 Page 7 of 32

8 What are your plan resources? The CCG has established a Delivery Group to oversee key programmes and projects, which will include the above The above high impact programmes have established programme and project management leads Some have financial resources / envelopes assigned to them, for others that is work-in-progress linked to the CCG s financial plan, which itself is subject to change as 2015/16 contract negotiations are concluded How will you measure progress? Programmes either have or will soon have a PID which will include identified resources, milestones and performance metrics (quantitative and qualitative) Programme and project managers will be responsible for achieving the required progress and for providing progress reports The CCG Delivery Group will oversee progress and achievement, itself reporting into the CCG s Integrated Governance Committee and Governing Body Kingston CCG Draft v5 23/4/15 Page 8 of 32

9 3. Reducing health inequalities Groups of people in Kingston who may be disadvantaged or socially excluded: Refugee and asylum seekers Non-English speakers Gypsies and travellers Black and minority ethnic groups People who live in localities of deprivation Homeless people People with disabilities Which groups of people in your area have the worst outcomes and experience of care? How are you planning to close the gap? In collaboration with the local authority, Kingston CCG aims for people who are disadvantaged or socially excluded to have similar opportunities for good health and wellbeing as the wider population in Kingston. This is a key point of the Kingston Health and Wellbeing Strategy. Kingston CCG works with the Equalities and Community Engagement Team (ECET) to address the needs of disadvantaged communities: Targeted localities work on housing estates identified as areas of deprivation, including interventions to address inequalities and wider determinants of health through Participatory Needs Assessment Programmes. Mental Health Improvement Initiatives such as the Community Wellbeing Pilot, Race Inequality training, Mental health First Aid Training and ensuring the needs of disadvantaged communities are addressed by the Mental Health Improvement Strategy. Targeted Health Improvement Initiatives including delivering Health Days for Refugees, Promotion of Immunisations and Screening Campaigns, NHS Health Checks, Get the Right Treatment Campaign, Tuberculosis health promotion, Smoking cessation and physical activity promotion. Ensuring equal access to Primary Care by supporting health care providers deliver services that are accessible and user friendly for all. Community education, engagement and empowerment through Kingston Open College Network accredited Community Development and Health Training Courses, continued working with course Kingston CCG Draft v5 23/4/15 Page 9 of 32

10 graduates to support targeted community projects to improve health, and community health champions. A joint Refugee and Migrant Strategy A Learning Disability User Parliament that ensures service user representatives have direct influence on shaping and accessing services by being involved at all levels of planning and decision making. A Homelessness Forum that focuses on improving access to shelter and housing, GP and dental services, mental health support and access to advice services. Income Maximisation to strategically join up work to tackle family and generational cycles of poverty. Sustainable English Language Provision to improve health for individuals whose first language is not English. Commissioners will use invest to save principles by investing now in preventative services for disadvantaged communities with the aim to improve morbidity and reduce demand on services later. Does this include implementation of the five most cost-effective high impact interventions recommended by the NAO report on health inequalities? There are key interventions recommended in the National Audit Office Report on health inequalities which aim to provide a cost-effective way of reducing the gap in life expectancy and which may be able to close the inequalities gap if adopted on a large scale. There is a real focus on improving outcomes to address the needs of the disadvantaged groups through targeted interventions, joint working and pooled resources. Commissioners in Kingston aim to reduce the differences in life expectancy between the most and least disadvantaged communities, whilst increasing life expectancy for the general population. We also aim to engage, develop and empower disadvantaged communities effectively and systematically enough that the resulting improving health behaviours lead to identifiable change at the Kingston population level. There is a focus on strengthening the involvement of disadvantaged groups in service redesign, to reduce their exclusion and on ensuring that services motivate and support healthy behaviours and health promotion in disadvantaged groups. There is an emphasis on equal access to primary care which can improve the identification and management of hypertension, hypercholesterolaemia and smoking in socially excluded patients. Training is provided to all GP practices in the borough based on the Equal Access to Primary Care Pack, produced by the ECET. This includes details of local services for socially excluded patients to access and also the promotion of Patient Experience forms in marginalised communities. ECET provide training to front line workers and socially excluded community members on a variety of healthcare topics including tuberculosis, mental wellbeing and breast cancer screening. Kingston CCG Draft v5 23/4/15 Page 10 of 32

11 How are you planning to reduce health inequalities for Looked After Children and people with a Learning Disability and offenders? KCCG commissions dedicated services for looked after children, young offenders and children with disabilities. The aim of these services are to ensure the health needs of these vulnerable groups are identified early and responded to in a timely and appropriate manner. The objectives over 2015/16 are to ensure assessments and care plans are robust, efficient and delivered to a high standard. To achieve this there will be a review of the current activity by September 2015 and an action plan in place to ensure o 95% (10% exceptions) of children and young people are assessed within 20 working days o 100% of children and young people have an integrated care plan ( LAC Plan/ Integrated Offender Management Plan or Education, Health and Social Care Plan) o 100% of children and young people are routinely reviewed annually or sooner and this is documented and reflected within their integrated care plan The specific measurable of success by March 2016 will include: o 100% of children and young people are registered with a General practitioner o 100% of children and young people will have an up to date immunisation status according to age o 100% of children and young people will be referred appropriately to secondary / community care services. o 100% of children and young people with an ongoing health need will have access to a stable educational placement and stable accommodation o 100% of care leavers will have a health passport. What progress have you made in implementing Equality Delivery System (EDS2)? EDS2 is currently being implemented with a focus on 2 broad commissioning areas: o Community Children s Services o Acute Mental Health Services The CCG has completed the internal grading of these service areas. The external stakeholder grading took place during February 2015 The CCG will take a phased approach to the further roll out of EDS2 during 15/16 The annual objectives set for 2013/14 were carried over into 2014/15 and will be assessed during the current phase of EDS2 implementation In April 2013 the CCG approved the following equality objectives for the period : o Patient Engagement/Communications - changes across services for individual patients are discussed with them, and transitions are made smoothly to ensure KCCG strategy, campaigns and messages reach all parts of the community, including staff. o Patient Safety - the safety of patients is prioritised and assured. Kingston CCG Draft v5 23/4/15 Page 11 of 32

12 o Capturing / monitoring data - Equality and diversity data is monitored appropriately and used to improve and/or amend services and to identify and address gaps. Kingston CCG Draft v5 23/4/15 Page 12 of 32

13 4. Quality - Responding to Francis, Berwick and Winterbourne View What is your ambition for quality improvement in response to Francis, Berwick and Winterbourne View What quantifiable progress has been made in 14/15? KCCG has a Quality Strategy in place Audit taken place of the quality monitoring as recorded on KCCG s risk register What quantifiable ambitions are in place for 2015/16? What action plans are agreed to deliver this and over what timeframe? Quality Strategy Action Plan Audit of the Quality Strategy in Q3 15/16 Action Plan from auditors Supporting documents / references Important note applies throughout CQRGs report in to the CCG s Integrated Governance Committee a Committee of the Governing Body. Quality reporting is core and priority for the CCG CCG Quality Strategy What is your ambition for reducing the number of inpatients beds for people with a learning disability and improving the availability of community services for people with a learning disability? Kingston CCG has no people with learning disabilities in specialist inpatient beds (as defined in the DH Winterbourne View Concordat, Dec12) LD Self Assessment Framework (SAF) submitted Feb15 confirms local system achieving satisfactory progress and performance in all areas apart from one - A4: specific health improvement targets are generated at the time of the annual health check in primary care Kingston CCG has no people with learning disabilities in specialist inpatient beds (as defined in the DH Winterbourne View Concordat, Dec12) Specific action areas for 15/16 include: 1. Transforming care for people with learning disabilities next steps (Jan15) KCCG reviewing current service provision with main health provider to agree any necessary action 2. Care home residents review action plan for 3 long stay patients LD Self Assessment Framework (SAF) Kingston CCG Draft v5 23/4/15 Page 13 of 32

14 3. Share LD SAF learning across London LD commissioners network, esp to inform action around A4 4. Address SAF requirement A4 Quality Patient Safety How are you addressing the need to understand and measure the harm that can occur in healthcare services? For example, duty of candour, HCAI and CQC themes and action reports related to providers from 2014/15. KCCG s Quality Manager attends KHFT s weekly SI group Improved RCA report writing and assurance to CQRG, incl. Duty of Candour Monthly SI report to CQRG with analysis from acute providers; quarterly from community providers CQRG reports from all local providers, esp where CCG is lead commissioner, are standing item on CCG Integrated Governance Committee meetings Implement the new SI framework (NHS E) 2015 Discussion with community provider re added quality monitoring Improved monitoring of the smaller NHS contracts incl. primary care, GP out of hours How are you increasing the reporting of harm to patients, particularly in primary care with a focus on learning and improvement? How are you tackling sepsis and acute kidney injury? Primary care development group receives updates on best practice from NHS England and CQC reports on GPs IPC service is provided by the SE CSU PIRs are reviewed by the CSU and liaison with KCCG s Quality Manager Quality manager set up to receive primary care alerts from the NRLS As part of the Kingston Hospital contract (and other acute provider contracts), Acute providers who have chosen the enhanced tariff option will be undertaking the Kingston CCG Draft v5 23/4/15 Page 14 of 32

15 national CQUINs for tackling sepsis and acute kidney injury in line with the national CQUIN requirements. Improve the dialogue with SE CSU since new staff changes; end of Q1 How are you improving antibiotic prescribing in primary and secondary care and how? 1. Antibiotic Public Awareness Campaign Will run from 1 st October 2015 to 31 st January 2016, using the supporting documents treat yourself better, antibiotic guardian and RCGP Patient Information Leaflets 2. Primary Care Prescribing 2.1 Quality Premium Measures & Thresholds Part a) reduction in the number of antibiotics prescribed in primary care by >1% from CCGs 2013/14 value. Part b) 10% reduction in the proportion of broad spectrum antibiotics (co-amoxiclav, cephalosporins and quinolone)s as a % of the total number of selected er.co.uk/ al-and-research/targetantibiotics-toolkit/patientinformation-leaflets.aspx al-and-research/targetantibiotics-toolkit.aspx 2.1http:// k/ccg-ois/qual-prem/ Implementation via the Local Medicines Optimisation Incentive Scheme 2015/16, Local infection guidance based on the HPA guidance available on GP Team net, NICE CG 69 Prescribing of antibiotics for Kingston CCG Draft v5 23/4/15 Page 15 of 32

16 antibiotics prescribed in primary care from CCG s 2012/14 value OR below the 2013/14 median proportion for England CCGs (11.3%), whichever represents the smallest reduction for the CCG. 2.2 Activities to be undertaken: Medicines Optimisation Incentive Scheme Indicators (1 st April 2015 to 31 st March 2016) a) Reduce the number of prescription items for antibacterial drugs (BNF 5.1) per 1000 STAR PU >1% from baseline b) Reduce % co-amoxiclav, cephalosporin & quinolone items of all antibacterial items c) All clinical staff to attend/complete antibiotics education session delivered by practice pharmacist. d) Each member of the practice team to become an antibiotic guardian. e) Completion of audits of antibiotic prescribing in sore throat and urinary tract infections. Full audit cycle, including baseline, action plan and re-audit to be completed by 29/03/16 self-limiting respiratory tract infections in adults and children in primary care nce/cg69/evidence/cg69- respiratory-tract-infectionsfull-guideline3, TARGET antibiotics toolkit presentation hosted by RCGPs al-and-research/targetantibiotics-toolkit.aspx TARGET antibiotics toolkit presentation hosted by RCGPs al-and-research/targetantibiotics-toolkit.aspx m/ Quality Premium. Quality Patient Experience Kingston CCG Draft v5 23/4/15 Page 16 of 32

17 Have you set measureable ambitions to reduce poor experience of inpatient care and poor experience in general practice. How will you deliver against your ambitions? Suggestions include FFT, PPG development reference to CQC and action reports. Using the new SI framework to ensure timely reporting onto STEIS, disseminated to all commissioners and providers for inclusion in contracts, including primary care. Enhanced reporting to CQRG, expecting analysis of themes and identified organisational learning CQRG monitors action plans and how learning informs service development Friends and Family Test implemented in primary care How will you assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for patients? Suggestions include CQC reports, care homes and domiciliary care. CQC reports on care homes Local quality review group with adult social care to review quality in all local Care homes Local quality monitoring self assessment tool piloted across care homes Additional group in place to review quality of domiciliary care Reporting through to CCG s Integrated Governance Committee How will you demonstrate improvements from FFT, complaints and other feedback? CQRG receives a detailed report quarterly with themes, actions and includes data from PALS CQRGs report through to CCG s Integrated Governance Committee How will you ensure that all the NHS Constitution patient rights and commitments to patients are met? How will you ensure that the recommendations of the The CCG aims to commission sufficient capacity to meet commitments The key performance areas within the constitution related to 18 week pathways, cancer waiting times, A&E and ambulance performance are monitored through the NHS standard contract, and specific performance meetings are contractually mandated with providers to manage these measures. Variances in performance and early warnings or variances are discussed and action plans developed to improve performance. Performance around these measures and any actions to rectify them are discussed at the CCG Integrated Governance Committee and the CCG Governing Body, which meets in public. Kingston CCG Draft v5 23/4/15 Page 17 of 32

18 Caldicott Review relevant to patient experience are implemented? The CCG Caldicott Guardian and CCG lead manager are responsible The Duty to Share recommendation has been shared with commissioners to ensure providers respond accordingly and are compliant with IG toolkit Quality Compassion in practice How will you ensure that local providers are delivering against the six action areas of Compassion in Practice? How are you working with providers to ensure the roll out 6C s across all staff groups? Requirements are laid down in the CCG s Quality Strategy, reflected in contracts Local providers delivery against the 6 areas are reported and monitored through CQRGs CQRGs report to the CCG s Integrated Governance Committee, and on to the Governing Body As above and oversight of action plans Quality Staff Satisfaction What is your understanding of the factors affecting staff satisfaction in the local health economy and how staff satisfaction locally benchmarks against others? Suggestions include FFT for staff, annual staff surveys, care homes and domiciliary care. How will you ensure measureable improvements in staff experience in order to improve patient experience? Suggestions include London BME standards, linkage to patient staffing surveys. Staff satisfaction surveys are shared with CQRG Recruitment is an ongoing issue, particularly for acute providers There are retention issues across London Workforce is a workstream in the SW London Commissioning Collaborative and will help with benchmarking Reviewing the staff surveys and understanding local issues e.g. internal rotation practice, capacity and demand on services Seven Day Services Kingston CCG Draft v5 23/4/15 Page 18 of 32

19 How will you make significant progress in 2015/16 to implement at least 5 of the 10 clinical standards for seven day working, supported by a Service Delivery and Improvement Plan (SDIP) with providers? Kingston Hospital (acute): In 2015/16 the delivery of 7 day services will be supported by : o A CQUIN focussed on delivering 7 day assessment, treatment and discharge o An Implementation Plan to deliver 7 day working across the 10 clinical standards These will build on work started in 2014/15. Your Healthcare (Community): In 2014/15 a local CQUIN scheme incentivised the community provider to move towards 7 day services across a range of services. In 2015/16, based on the above, the community provider has received recurrent investment through growth and roll forward of the CQUIN to fully implement 7 day working. Delivery will be monitored through CQUIN reporting and SDIP. The CCG is working with RBK to mainstream 7 day Care Management support at KHFT to support timely assessment and discharges of those people requiring social care, building on Winter Resilience Schemes. How do you plan to meet the requirements of the Accountability and Assurance Framework for protecting vulnerable people (adults and children)? Suggestions include the Care Act Implementation, Prevent, FGM and CSE. Children Designated Nurse Safeguarding Children is an active member of the Kingston Local Safeguarding Children Board (LSCB) main board and sub groups and is working in partnership with local authorities to fulfil their safeguarding responsibilities including the Child Death Overview Panel. The Designated Nurse Safeguarding Children is the interim Lead for the PREVENT Strategy for the CCG until the role is assumed by the Adult Safeguarding Lead, providing training to key staff and coordinates the quarterly returns to NHSE. Prevent responsibilities are explicit in the National contract and providers are made aware of their responsibilities. The LSCB coordinates the multiagency Child Sexual Exploitation (CSE) and Children Missing from Home and Care Sub group working to a multiagency agreed action plan which is supported by LSCB Strategy for Safeguarding Children and Young People from Sexual Exploitation. All Health Providers have incorporated CSE into their single agency safeguarding training. A letter will be sent to all health providers to provide Kingston CCG Draft v5 23/4/15 Page 19 of 32

20 evidence of what their agencies are doing to intervene and promote awareness of CSE in their settings. Sexual Health services at Kingston Hospital use the BASHH/Brooks Spotting the Signs A national proforma for identifying risk of child sexual exploitation in sexual health services to assess and identify risk. The LSCB have a multi-agency approved Procedure for Safeguarding children and young people at risk of abuse from Female Genital Mutilation. Kingston Hospital is required to report on a monthly basis to the DOH on the following: if a patient has had FGM if there is a family history of FGM if an FGM-related procedure has been carried out on a women - (de-infibulation) Kingston CCG requires all staff at Kingston Hospital to have completed FGM awareness training by Q , and that safeguarding policies will be amended to reflect this. Health providers have incorporated FGM into their safeguarding policies and incorporate FGM into their safeguarding training.school nurses have been sent guidance: School Nurse Programme: Supporting the implementation of the new service offer: Helping school nurses to tackle child sexual exploitation from Public Health England and Department of Health. Adults Kingston CCG has ensured Kingston hospital staff and YHC community services report quarterly ASG, with focus on MCA, DoLs and Care Act 2014 implementation / compliance Kingston CCG has ensured that staff at Kingston Hospital will have completed FGM awareness training by Q , and that safeguarding policies will be amended to reflect this. What is the ambition for quality improvement in child and adult safeguarding? Suggestions include the identification of a baseline including preventing harm (minimisation of SCRs for adult and children through integration with the Local Authority and early help and domestic violence agenda) Children The Designated Nurse for Safeguarding Children is the vice Chair for the LSCB Quality Assurance sub group where all multi-agency providers including health, present audits and practice is scrutinised. The CCG has participated in multi-agency audits and S11 audits to inform the LSCB and partners of potential quality issues. The Designated Nurse Safeguarding Children is an active member of all multi- agency groups established to address need at the Kingston CCG Draft v5 23/4/15 Page 20 of 32

21 earliest opportunity e.g. task and finish group to look at cases where there has been more than one occasion where children in the family have been subject to a child protection plan to assess whether adjusted working across the multi-agency workforce can make a difference to the outcomes for the child and family. The designated nurse is a member of the MASH strategic group which monitors the functioning of the MASH and the emergence of any themes which may inform service provision. The designated nurse is an active member of the SCR sub- group and is responsible for ensuring that learning from local and national SCR s is disseminated to the health economy monitoring any action plans that my result from local SCR s. Adults Further Integration with adult social care and improvements in quality monitoring in care homes, continuing care and enhanced reporting for ASG inquiries / DoLS KCCG has appointed a lead nurse for adult safeguarding who starts in May Currently KCCG quality lead attends the ASG CCG network and has effective partnership working with adult social care in RBK ASG training is mandatory for all KCCG staff Providers are Care Act compliant How will improvement be achieved in the application of the Mental Capacity Act (House of Lords Recommendation 2014)? Please take into account Cheshire West (DOLS) and Commissioning for Compliance. Making Safeguarding Personal is an area specified within chapter 14 of the statutory guidance to the care act 2014, MSP is a shift in culture and practice in response to what we now know about what makes safeguarding more or less effective from the perspective of the person being safeguarded. It is about having conversations with people about how we might respond in safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. A comprehensive program of workshops to enshrine MSP into everyday safeguarding practice within our own and local partners to raise awareness and ultimately practice What improvements will be made through the Implementation of the Care Act from April 2015? Please take into account statutory requirements including the Statutory Duty to Corporate with the Local Authority and widening of scope of safeguarding to Work progressing on a number of fronts, with a variety of partners, including through the Better Care Fund: Statutory basis for Safeguarding Adults Kingston CCG Draft v5 23/4/15 Page 21 of 32

22 include Human Trafficking, Domestic Violence and Modern Slavery, selfneglect. Underpinned by Statutory Guidance Duty to cooperate Section 42 Enquiries Safeguarding Adults Boards Safeguarding Adults Reviews Strategic Plans Annual Reports How will you measure the requirements set out in plans in order to meet the standards in the PREVENT agenda (taking into account Tier 1-3 priority areas)? The CCG has an identified and fully trained Prevent lead who attends meetings at NHSE with leads from CCGs across London and Prevent Lead NHS England (London region) Prevent responsibilities are explicit in the National contract and providers are made aware of their responsibilities under the following sections - SC32 - Safeguarding, Mental Capacity and Prevent and Governance & Regulatory Conditions within Particulars requiring a Prevent Lead to be provided to support SC32. Prevent Quarterly returns are sent to NHS England, this is collated from submissions from the providers leads, and includes Training completion information, Numbers of referrals and inclusion of Prevent responsibilities into the organisational Policies etc Training requirements for provider health agencies has been set out within the NHS ENGLAND PREVENT TRAINING AND COMPETENCIES FRAMEWORK and Process for Nominating Staff to become WRAP Facilitators. Local authority and police Prevent and Channel leads have been identified and shared with partner agencies. Workforce What are the workforce implications from your 2015/16 operational plans and how will these be addressed? The South West London Collaborative Commissioning Plan work stream has workforce as a key enabler, which requires commissioners and providers to work collectively to review the workforce implications and work together to develop a joint workforce strategy locally and across South West London. This includes bringing acute and community providers together to explore opportunities for developing and enhancing skills and sharing the workforce through new models of care; these include community and ASC inreach into Kingston Hospital Kingston CCG Draft v5 23/4/15 Page 22 of 32

23 and joint outreach work. How are you developing a workforce that is able to work across acute and community boundaries? Please see above; work is continuing with the South West London Commisisoning Collaborative with Acute and Community to both understand the need across the workforce and to plan for sustainable change. Kingston CCG Draft v5 23/4/15 Page 23 of 32

24 5. Constitution Standards RTT, A&E, Cancer, Mental Health Plans should demonstrate the commissioning of sufficient services, based on robust demand planning, to deliver the NHS Constitution rights and pledges for patients on access to treatment as set out in Annex B of the planning guidance and how they will be maintained during busy periods. Where standards have not been met in 2014/15, details should be provided of specific steps being taken to ensure improvement this year, measureable ambitions for improvement and timelines for delivery. RTT and Diagnostics Does your provider have residual RTT backlogs - patients waiting over 18 weeks on either admitted or non-admitted pathways - who will need to be treated in 2015/16 in order to support sustainable delivery of the RTT standards? No. Kingston Hospital (of which treats 80-85% of elective RTT pathways) incomplete waiting list remains static, with demand and capacity aligned. As a result, Kingston CCG s incomplete also is static, and the incomplete RTT target of 92% of the waiting list <18 weeks being achieved since August If yes, have you agreed an additional activity profile with that provider (which is likely to be above and beyond BAU activity) to manage those backlogs? No. Demand and capacity plans and sustainability is being monitored through the Kingston Systems Resilience Group. Kingston Hospital has confirmed that they are treating people in chronological order, which can be evidenced by the minimal deterioration in performance during the period that NHSE commissioned additional activity across London. Have you agreed the timeline required for this additional activity ensuring that patients are treated as quickly as possible? Have you agreed performance trajectories based on the profile of backlogs and the timeline required to clear them? I.e. managing backlogs is likely to mean that the performance measures may not be achieved until they are managed back to a sustainable level. Have you and the provider agreed a RTT recovery plan based on the above information? No timeline has been agreed as it is felt that there is no additional capacity required to maintain RTT delivery. No performance trajectories have been agreed as it is felt that there is no additional capacity required to maintain RTT delivery. No, as RTT delivery has been consistent throughout Has your provider(s) completed detailed demand and capacity modelling at speciality level for non-admitted Kingston Hospital has undertaken demand and capacity modelling for elective and Kingston CCG Draft v5 23/4/15 Page 24 of 32

25 and admitted activity and have they shared this with you? outpatient work as part of the contract round, and also to support the SRG assurance process. No elective inpatient or daycase activity has been removed as QIPP, and there has been a planned reduction in growth for outpatient activity, which has reduced planned growth to +2.8%. In addition, the Trust and KCCG are working through the PTL ensuring consistency with the monthly returns as DQIP within Has this been used to calculate elective capacity and activity for 2015/16? Capacity around the elective and outpatient work is discussed regularly at Kingston Hospital performance meetings, although as the Trust has not signalled any capacity issues to date in achieving any of the constitutional targets (which is borne out by the performance to date) and the incomplete RTT is relatively stable, KCCG has not used the demand and capacity work for this purpose. Does the Trust have sufficient capacity to meet demand or will alternative providers need to be identified and agreed? If the Trust(s) has backlogs to clear in 2015/16 have these been profiled against BAU demand and capacity/run rates? Does the Trust(s) have sufficient capacity to deliver both BAU run rates and clear backlog or will alternative providers need to be identified to support the backlog activity and ensure that patients are treated as quickly as possible? Kingston Hospital has sufficient capacity to meet demand and to deliver the RTT targets throughout Kingston Hospital (of which treats 80-85% of elective RTT pathways) incomplete waiting list remains constant and consistent, with capacity matching demand. Kingston Hospital has sufficient capacity to meet demand and to deliver the RTT targets throughout A&E Waits By each A&E provider, provide your performance against the 4 hour standard for each quarter of 2014/15. How did this vary from your planned trajectory? Kingston Hospital position (80% of KCCG A&E attendances). The planned trajectory was to achieve the 95% for all four quarters of , as historically Kingston Hospital has achieved this target consistently. Q1: 95.45% Q2: 95.75% Kingston CCG Draft v5 23/4/15 Page 25 of 32

26 Q3: 94.70% Q4: 91.27% There has been a significant amount of work to understand the factors affecting the A&E performance at Kingston Hospital since the last week of November These are: Where 4 hour performance did not meet trajectory, have the major factors affecting performance been identified? a. There has been a case mix driven increase in emergency admissions, with a definite cohort having to stay much longer than the average, even though the average length of stay has remained reasonably constant. This has resulted in winter funded beds being insufficient to manage demand, and people having to remain in the A&E department. b. Poor patient flow with too few discharges of patients early in the day (with a peak in discharges at 17:00) and a lack of consultant ward rounds 7 days of the week. c. A historically high number of DTOCs has resulted in beds being unavailable despite patients being medically fit to return home; this is at the same level as in (both in bed days lost and numbers of DTOCs), but has compounded the issues above. There has been a range of issues agreed through the Kingston SRG, both in Hospital and Out of Hospital. What are the proposed mitigating actions to recover / maintain progress against your trajectory for 2015/16? In Hospital: a. External review of clinical model of care and operational functioning of the Emergency Department, with a redesign of the admission pathway enabling direct admission to hospital wards where required. b. Senior review all patients will have a senior clinical review before midday, and all patients will have an expected date of discharge (EDD) agreed within 24 hours of admission. c. Early discharge expansion of the Golden patient pilot, earlier start times for Packages of Care and increased utilisation of the discharge lounge all ward teams will ensure that at least 2 discharged patients will have left the ward by 10am. d. Review patients whose length of stay exceeds 5 days will be reviewed by the Kingston CCG Draft v5 23/4/15 Page 26 of 32

27 Site team in collaboration with the Service Line. Out of Hospital: a. Weekly Winter Operational Meeting chaired by KCCG with KHFT, CHS and Adult Social Care (ASC) providers to discuss performance and agree remedial actions to support systems resilience. b. Weekly over 5 Day LOS stay meeting led by Senior Medical staff and attended by CHS and ASC to discuss and plan discharges, with ASC and CHS in reaching into the hospital to facilitate discharge planning and discharges. Utilising Supporting out of hospital care during winter monies to support Social work teams to expedite packages for complex patients. c. Kingston CCG is escalating out of area delays with associate CCGs, and the Discharge to Assess model to be reviewed and expanded. The planned A&E recovery takes into account the expansion and extension of QIPP/ BCF schemes that were started within , or have been ongoing: Has your plan taken into account the impact of various schemes and investment? E.g. QIPP, NETA, BCF a. Supporting those people with complex health issues (MDT working) or those where a community rapid response service would avoid admission to hospital. b. Initiating early supported discharge and reablement to enable the freeing of bed capacity and enabling those that could remain at home to do so, and to reduce those being re-admitted into hospital. c. KCCG s community provider (Your Healthcare) has supported nursing and care homes since to manage patients through their Impact team, which has expanded in to also support some sheltered accommodation placements. Cancer waits 62 day By each provider, what is current performance against 2014/15 plan? Kingston CCG s YTD performance (Apr-Feb) against the three 62 day standards are as follows (The consultant upgrade target is at locally set 75% as per the CCG Planning round , although the achievement YTD is 90.9%). Kingston CCG Draft v5 23/4/15 Page 27 of 32

28 Where performance is not meeting trajectory, has a comprehensive action plan and recovery date been agreed with the provider? Kingston Hospital submitted an action plan to the SE CSU Transforming Cancer Services Team, which has improved performance from September 2014 compared to performance seen earlier in the year. There are still issues in transferring patients into the Royal Marsden, which is a South West London wide issue. How will you work with the provider to sustain improvement in 2015/16 to meet your trajectory? KCCG meets with Kingston Hospital on a monthly basis to discuss performance issues in detail, including all cancer targets; a significant number of the issues are related to late discharge between the Trusts transferring the patient and the Royal Marsden, who then carries on the further treatment; Further work is being undertaken cross South West London to work through the transfer issues. IAPT: By April 2016, at least 75% of adults should have had their first treatment session within six weeks of referral, with a minimum of 95% treated within 18 weeks. How are you working with providers to achieve new waiting time standards for people entering a course of treatment in adult IAPT services? Please confirm your trajectory for meeting this standard by April 2016 and the actions you are taking to deliver it. Mental Health Since the operating plan commitments were released, commissioners have been working with the IAPT service to ensure that all of the IAPT targets could be achieved sustainably, including understanding the current position. A local KPI related to the >90% of people seen within 10 days was introduced in , which the service is now achieving due to enhanced capacity within the service from October/ November For February 2015, the actual position against the targets is as follows: Kingston CCG Draft v5 23/4/15 Page 28 of 32

29 Early intervention in psychosis (EIP): By April 2016, it is expected that more than 50% of people experiencing a first episode of psychosis will receive treatment within two weeks. This will require dedicated specialist early intervention-in-psychosis services. How are you working with local secondary mental health providers to ensure this waiting time standard is met? Please confirm your trajectory for meeting this standard by April 2016 and the actions you are taking to deliver it. As per the 2015/16 NHS contract Technical Guidance we will agree a trajectory to ensure that the EIP target is met by April The CCG is currently working on this with colleagues from our secondary care provider, South West London & St.George s Mental Health NHS Trust to ensure that this is included in the signed 2015/16 contract. The CCG s expectation in signing off the SDIP is that the Trust will meet this target before the April 2016 target. There is currently an Early Intervention service in place and the most recent data available (Dec 2014) indicates that 50% of referrals were seen within 2 weeks in that month. However, this level of performance has not been consistent throughout 14/15 and we will seek to ensure that the trajectory in the SDIP ensures that it is met consistently and that performance exceeds 50% in 15/16. Development of trajectories for 15/16 is work in progress Have you agreed a Service Delivery and Improvement Plan (SDIP) as part of contracts with mental health providers? Does this plan set out how providers will prepare for and implement the new standards for EIP and IAPT during 2015/16 and achieve them on an ongoing basis from 1st April 2016? EIP has formed a part of the contract negotiation for 2015/16; delivery of EIP will be part of the contract as a Service Development and Improvement plan (SDIP) within South West London and St Georges mental health contract and progress to implement the new standards will be monitored and managed through monthly performance meetings, which will monitor progress against the set trajectory to achieve the standard by April There is a Service Delivery and Improvement Plan in place in the contract for the IAPT service in Kingston; Kingston has requested in addition that the service carry out and present a demand and capacity plan to commissioners, reflecting on enhanced staffing levels from October/ November 2014 and the move to new accommodation in December 2014/ January The IAPT service is achieving the new requirements set out in the planning process, but assurance is needed that this is sustainable with any increased demand. Kingston CCG Draft v5 23/4/15 Page 29 of 32