NHS Kernow FOI Disclosure Log January NHS Kernow - Disclosure log Freedom of Information requests January 2016

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1 NHS Kernow - Disclosure log Freedom of Information requests January 2016

2 Contents Children s health... 4 FOI CAMHS... 4 FOI Local transformation plan... 5 Clinical management... 6 FOI Helicobacter pylori testing... 6 Contracts... 7 FOI GP services... 7 FOI Out of hours service... 7 FOI Community disability equipment... 7 FOI Community eye health services... 8 FOI Out of hours service... 9 FOI Sleep positioning systems... 9 FOI50590 Community Health Services Finance & budgets FOI Financial penalties to health trusts Long term conditions FOI Diabetes services Mental health FOI In-patient beds / out-of-county services FOI PTSD Organisation FOI Better Care Fund FOI Information Governance Prescribing & pharmacies FOI Cow's Milk Protein Allergy Appendix: FOI Out of hours service Appendix: FOI Local transformation plan The information supplied to you continues to be protected by the Copyright, Designs and Patents Act ou are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other re-use, for example commercial publication, would require the permission of the copyright holder. Most documents supplied by NHS Kernow Clinical Commissioning Group will have been produced by local officials and will be our copyright. Information you receive which is not subject to our copyright continues to be protected by the copyright of the 2

3 person, or organisation, from which the information originated. ou must ensure that you gain their permission before reproducing any third party information. 3

4 Children s health FOI CAMHS Date received: 27/01/ The name of your CCG A. NHS Kernow Clinical Commissioning Group 2. What was the average number of days waiting time between referral to CAMHS and first appointment in each of the last three calendar years and for each tier of CAMHS care? A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership Foundation Trust (cpntr.freedomofinformation@nhs.net), who may hold the information you have requested. 3. What was the single longest number of days waiting time between referral to CAMHS and first appointment in each of the last three calender years and for each tier of CAMHS care? A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership Foundation Trust (cpntr.freedomofinformation@nhs.net), who may hold the information you have requested. 4. What information do you hold or have access to showing, or having the potential to show, the following: a) patient incidents in the time between referral to CAMHS and first appointment? A. NHS Kernow does not hold the information you have requested. Incidents are managed by providers internally on their own systems. Please redirect your request to Cornwall Partnership Foundation Trust (cpntr.freedomofinformation@nhs.net), who may hold the information you have requested. b) serious case investigations in the time between referral to CAMHS and first appointment? A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership Foundation Trust (cpntr.freedomofinformation@nhs.net), who may hold the information you have requested. c) patient suicides in the time between referral to CAMHS and first appointment? 4

5 A. None. However, Cornwall Partnership Foundation Trust may hold more information on patient suicides. Please redirect your request to Cornwall Partnership Foundation Trust 5. How many a) patient incidents A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership Foundation Trust who may hold the information you have requested. b) serious case investigations A. None. However, Cornwall Partnership Foundation Trust may hold more information on serious case investigations. Please redirect your request to Cornwall Partnership Foundation Trust c) patient suicides have there been between the date of first referral to CAMHS and the date of first appointment in the last three calender years? A. None. However, Cornwall Partnership Foundation Trust may hold more information on patient suicides. Please redirect your request to Cornwall Partnership Foundation Trust 6. Please provide me with a copy of the CAMHS referrals dataset, including (but not limited to) the following fields of information (where available): the date of the referral; the date of the first appointment; the tier and type of CAMHS care the referral was for; whether or not the patient attended the first appointment; the reasons for non-attendance; the severity of the case; any other non-exempt field of information. Please provide this as a linked dataset in a machine-readable format, as you are required to under the dataset provisions of the Act. A. NHS Kernow does not hold the information you have requested. Please redirect your request to Cornwall Partnership Foundation Trust (cpntr.freedomofinformation@nhs.net), who may hold the information you have requested. FOI Local transformation plan Date received: 29/01/ A copy of your final Child and oung People's Mental Health and Wellbeing Local Transformation Plan (or if you have already published this online please could you let me have the link) 5

6 A. The Child and oung People s Mental Health and Wellbeing local transformation plan is available on our website. 2. A copy of your CCG's template high level summary of the plan as requested by NHS England in Annex 1 of the guidance published in August 2015 A. NHS Kernow s high level summary of the plan is attached. 3. A copy of your CCG's self-assessment checklist as requested by NHS England in Annex 2 of the guidance published in August 2015 A. NHS Kernow s self-assessment checklist is attached. Please note the final version has been submitted to NHS England for approval. 4. A copy of your CCG's tracking template as set out by NHS England in Annex 3 of the guidance published in August A. NHS Kernow s tracking template is attached. NHS Kernow recognises that this document is not user friendly due to the document being locked as a template by NHS England. To obtain this document in a more acceptable format, please contact NHS England (england.contactus@nhs.net). Clinical management FOI Helicobacter pylori testing Date received: 21/01/2016 Please provide the following: 1. Helicobacter pylori testing Adults and Adolescents a) A list of the tests recommended/allowed to be used for the diagnosis of a Helicobacter pylori infection within your CCG. b) If Helicobacter test INFAI is not on the recommended/allowed list, please provide a reason. 2. Helicobacter pylori testing Children a) A list of the tests recommended/allowed to be used for the diagnosis of a Helicobacter pylori infection in children within your CCG. b) If Helicobacter test INFAI is not on the recommended/allowed list, please provide a reason. 3. Changing a recommendation a) If a product/procedure is not on the recommended/allowed list, please can you advise regarding the process to be followed to have a product/procedure accepted on to the recommended/allowed list. Please can you advise of any associated contact details/information required for the process. A. NHS Kernow does not hold the information you have requested. Please redirect your enquiry to Royal Cornwall Hospital Trust: foi.rcht@cornwall.nhs.uk. 6

7 Contracts FOI GP services Date received: 05/01/ I would like to request information on whether the NHS Kernow CCG is considering implementing video appointments for the delivery of GP services to local patients. 2. If video appointments are under consideration, what are the timescales for implementing this measure. A. There are currently no active plans to implement video appointments with patients at a CCG level. We are always investigating methods to improve patient care and interaction and this may be something we look at with a wider view in the future. There may be individual GP practices that are investing in this form of service. NHS England, which commissions GP services, may have the information you have requested. Please contact england.contactus@nhs.net. FOI Out of hours service Date received: 06/01/ The GP out-of-hours contract was let by NHS Kernow to Cornwall Health, a registered company. Why is payment being made to Devon Doctors a different registered company? A. The GP out-of-hours contract is signed by Devon Doctors Ltd and they are subcontracting to Cornwall Health Ltd. FOI Community disability equipment Date received: 11/01/ Under the FOI Act, for the period 1 April 2014 to 31 March 2015, applying only to disabled and terminally ill children, would you please provide the amount of money spent by your organisation on the provision of community disability equipment* in your area. * The term community equipment includes such items as wheelchairs, buggies, specialist beds, standing frames, hoists and specialist seating. We do not include structural adaptations, consumables such as nasal gastric tubing and incontinence supplies, IT equipment or surgical aids. A. NHS Kernow spent 533,579 between 1 April 2014 and 31 March 2015 on community disability equipment for children, which includes wheelchairs and buggies, specialist beds, standing frames, hoists and specialist seating and other equipment. 7

8 FOI Community eye health services Date received: 14/01/ Confirmation that the following services are in place: cataract post-op cataract referral glaucoma repeat readings OHT monitoring A. es, the above services are in place. 2. Service activity data presented as the number of patients to have accessed each service in the year 1st April st March a) cataract post-op A. NHS Kernow does not hold the information you have requested as cataract postop services did not commence until December b) cataract referral A. 166 patients. c) glaucoma repeat readings A. 617 patients. d) OHT monitoring A. 629 patients. 3. The number of optical practices contracted to provide each service: a) cataract post-op A. The contract for this with service is with Primary EyeCare Company (Cornwall & Isles of Scilly) Limited, which has sub-contracts with 33 optometrist practices in Cornwall. A. 18. A. 28. A. 13. b) cataract referral c) glaucoma repeat readings d) OHT monitoring 8

9 4. The CCG's financial expenditure on each service in the year 1st April st March 2015 a) cataract post-op A. NHS Kernow does not hold the information you have requested as cataract postop services did not commence until December b) cataract referral A. 2,358. c) glaucoma repeat readings A. 11,335 d) OHT monitoring A. 30,554 FOI Out of hours service Date received: 21/01/ Details for the past three years on how your out of hours providers have performed against their national quality requirements for NQR 9, 10 and 12, by month please. A. Out of hours activity for NQR 9, 10 & 12 can be found in the attached spreadsheet. FOI Sleep positioning systems Date received: 22/01/ The total amount in pounds sterling spent upon Sleep positioning systems for the financial year The number of requests for funding of Sleep positioning systems during the financial year The list of diagnoses where funding for Sleep positioning systems has been requested during the financial year The number of times funding for Sleep positioning systems has been requested for the diagnosis of scoliosis in the financial year A. NHS Kernow does not hold the information you have requested. Please redirect your request to the following organisations, who may hold the information you have requested: Cornwall Partnership Foundation Trust: cpn-tr.freedomofinformation@nhs.net Peninsula Community Health: PCH.InformationGovernance@nhs.net Royal Cornwall Hospital: rch-tr.foi@nhs.net 9

10 FOI50590 Community Health Services Date received: 25/01/ Under the Freedom of Information Act, we wish to know the full cost of legal services and advice incurred to date as a result of the 2015 NHS Kernow Adult Community Health Services Procurement exercise. A. NHS Kernow has incurred costs of 8,710.20, inclusive of VAT, for legal services and advice for the adult community health services procurement. 2. Please also provide an estimate of anticipated costs to completion. A. NHS Kernow does not hold the information you have requested. We are unable to provide an estimate of anticipated costs for legal advice as the procurement has not yet concluded. Finance & budgets FOI Financial penalties to health trusts Date received: 14/01/ Have you or will you be fining or issuing any financial penalties to health trusts for uncoded episodes of patient care in 2015? A. No. 2. Please could I have a breakdown by trust of the figure for the penalty/fines and the number of patients who were uncoded for 2015? A. N/A - no penalty/fines being imposed. 3. What will happen to those fines/penalties? A. N/A - no penalty/fines being imposed. Long term conditions FOI Diabetes services Date received: 07/01/2016 For each GP practice within the CCG, please state: 1. Does the practice run a diabetes clinic? 2. Does the practice run a clinic for Type 1 diabetes patients? 3. Does the practice have a GP with special interest in diabetes (GPwSI)? 4. Are there any diabetes specialist nurses (DSN) available onsite e.g for clinics? 10

11 5. If no DSN is available, do any of the nurses hold a diabetes accreditation, e.g. Warwick certificate or MSc? 6. Is there a registered diabetes dietician available onsite e.g. for clinics? 7. Does the practice run a diabetes and/or long-term condition psychology service? 8. Does the practice run a podiatry or foot clinic? A. NHS Kernow does not have the information you have requested as it does not commission GP services. NHS England, which commissions GP services, may have the information you have requested. Please contact england.contactus@nhs.net. 9. Does the practice offer structured education for Type 2 diabetes patients? If yes, what is it called e.g. X-Pert, Desmond? A. NHS Kernow does not have the information you have requested as there is no commissioned Type 2 diabetes structured education. NHS England, which commissions GP services, may have the information you have requested. Please contact england.contactus@nhs.net. 10. Does the practice offer structured education for Type 1 diabetes patients? If yes, what is it called? E.g. DAFNE A. Structured education for Type 1 patients is commissioned by NHS Kernow and offered via the diabetic nurse specialist service, not via the practice, and it is a locally developed course. 11. Is retinopathy screening provided onsite at the practice? 12. Does the practice accept Out of Area patients? 13. Does the practice offer patients remote consultations e.g. through Skype? A. NHS Kernow does not have the information you have requested as it does not commission GP services. NHS England, which commissions GP services, may have the information you have requested. Please contact england.contactus@nhs.net. For each community diabetes service within the CCG, please state: 1. Is it a consultant-led service? A. No, it is a community diabetes service that works closely with colleagues in primary and secondary care, as well as medicines management. 2. Is it funded under a block contract with the CCG? A. es. 3. Does the service cater for Type 1 diabetes patients? A. es. 11

12 4. Are there any diabetes specialist nurses (DSN) available onsite? A. As a community service, the DSN s are available in the community and also as in-patient nurses within an acute hospital. 5. If no DSN is available, do any of the nurses hold a diabetes accreditation, e.g. Warwick certificate or MSc? A. Some practice nurses do hold this and are expected to when the practice claims for an enhanced service payment for insulin initiation, which is available locally. 6. Is there a registered diabetes dietician available onsite? A. The community service does not have a specific site. The service has access to dieticians and a dietetic diabetes lead. 7. Does the service run a diabetes and/or long-term condition psychology service? A. No. 8. Does the service run a podiatry or foot clinic? A. The podiatry service run podiatry clinics in the community, foot checks will occur in practices as part of the annual checks for people with diabetes. 9. Does the service offer structured education for Type 2 diabetes patients? If yes, what is it called? E.g. X-Pert, Desmond A. No. 10. Does the service offer structured education for Type 1 diabetes patients? If yes, what is it called e.g. DAFNE? A. es it is a locally developed course. 11. Does the service offer retinopathy screening onsite? A. Retinal screening is provided by Public Health England and is offered across many community sites. Please redirect your enquiry to FOI@phe.gov.uk. 12. Does the service offer patients remote consultations e.g. through Skype? A. No. Virtual reviews are being offered as part of the North Kerrier locality diabetes integrated pilot, providing care closer to home and through closer working and information sharing between primary and secondary care. 13. Is the service available through GP referral? A. es. 12

13 14. Is the service available through self-referral? A. No. 15. Does the service accept Out of Area patients? A. No, patients are required to be registered with a GP in Cornwall or the Isles of Scilly. Mental health FOI In-patient beds / out-of-county services Date received: 27/01/2016 Please answer these questions for both adult and child & adolescent mental health (CAMHS) patients and provide data for the financial years and A. NHS Kernow does not hold the information you have requested for child and adolescent mental health (CAMHS) patients. Please redirect your question to NHS England s FOI team at england.contactus@nhs.net. 1. How many acute mental health patients (i.e. those that require an in-patient bed) did you send to facilities run by other trusts? A. Adults: a) 2013/14: Less than five b) 2014/15: Seven. 2. Where no NHS beds were available (in or out of area), how many acute mental health patients did you send to private providers? A. Adults: a) 2013/14: 57 b) 2014/15: What is the furthest distance you have sent an acute mental health patient - please provide specific locations and postcodes. A. Adults: Bradford, BD12 8LR. 4. How much money was spent on sending acute mental health patients to facilities run by other trusts (incl any transport costs, payments to other health providers - NHS and private) 13

14 A. Adults (for NHS patients only): NHS Kernow does not hold the information in a format you have requested. The spend on sending acute mental health patients to facilities run by other trusts are included as part of overall individual packages of care and we are therefore unable to separate out the cost of these services. 5. How much money was spent on sending acute mental health patients to private providers; please provide figures for all costs - in and out of the trust s postcode area. A. Adults: a) 2013/14: 876,088 b) 2014/15: 652,874. FOI PTSD Date received: 21/01/ Please indicate the staffing in your service and how many of each professional discipline work in provision dedicated to the care and treatment of adult onset PTSD: e.g. 1psychiatrist, 3 psychiatric nurses, and if part-time in decimal form, e.g. 1.3 according to contract. 2. What models of psychological intervention are provided for adult onset PTSD? 3. Please indicate what kinds of social support is provided within your service. 4. Please describe any outreach work carried out to extend specialist traumatic stress provision to adult populations who are underrepresented in accessing mental health services but are recognised as exposed to considerable psychological trauma (e.g. homeless persons) below. 5. Please indicate the following for the 12 month period leading up to the date on which this form was received: The total number of adult referrals made for PTSD intervention The total number of referrals accepted for treatment Number of referrals that completed only 1 treatment sessions. Number of referrals that completed 2-4 treatment sessions. Number of referrals that completed 5-8 or more treatment sessions. Number of referrals that completed 8 or more treatment sessions. 6. Please indicate numbers with regards to referrals accepted for treatment. Ethnicity Age Gender 7. Please indicate the methods of referral to access specialist PTSD provision: 8. Please indicate the length of time after a traumatic event that your service becomes actively involved in providin2 therapeutic support: 14

15 A. NHS Kernow does not hold the information you have requested. Please note, NHS Kernow commissions, not provides services. Cornwall Partnership Foundation Trust may hold this information, please redirect your questions to Organisation FOI Better Care Fund Date received: 18/01/2016 Under the Better Care Fund policy framework, local areas were asked to set targets against five key metrics and I would like to request the following information: 1. The CCG's locally-proposed metric 2. The targets set by the CCG (or HWB in which the CCG participates) for each metric - please state precise statistical targets where applicable 3. Please state the "starting position" for each metric - i.e. please give statistics on how that metric was performing at the start of the measuring period (e.g. if the Delayed Transfers of Care target is to reduce DTOCs from their 2014/15 level, please state the DTOCs figure for 2014/15) 4. Please state whether the CCG or the local authority (please state which) is responsible for measuring progress for each target 5. Please state what statistical progress to date has been made towards each target, and whether each target is currently forecast to be achieved by the end of 2015/16 A. Listed below are the five national metrics for the financial year 2015/16. The performance is set against the data from the previous financial year 2014/15. Actual data is available between four to five weeks after the end of the quarter, therefore data is unavailable for some of the metrics at this time. 1. Non elective admissions into hospital (all ages) for the Cornish resident population This is the total non-elective (emergency) admissions in to hospital (general & acute), all-age, per 100,000 population. A national target of a 3.5 per cent reduction against the 2014/15 baseline was set. The CCG measures and monitors progress and the forecast is the target will not be met. Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline 2,397 2,289 2,520 2,346 Target 2,295 2,190 2,412 2,448 Actual 2,364 2,386 2,501 Data unavailable Variance

16 2. Admissions to residential and care homes This is the annual rate of council supported permanent admissions of older people (aged 65 and over) to residential and nursing care. An admission is a new admission, so does not include people transferring from one home to another or from residential to nursing. It does include people moving from temporary to permanent care. A target of a reduction of 12 places against the 2014/15 baseline was set. The council measures and monitors progress and the forecast is the target will be met. However, the results for Q3 actual figures are provisional and are likely to change (increase) as data filters through from Care Homes. Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline Target Actual Data unavailable Variance Effectiveness of reablement Increased productivity of the team achieving an additional 700 people receiving services resulting in 60 per cent of them realising a 10 per cent reduction in package. The council measures and monitors progress and the forecast is that the target will not be met and is measured over a number of elements to arrive at an estimate of what capacity has been generated to deal with additional packages of care based on average package costs. a) Reduce the number of care packages held over 6 weeks by the Short Term Enablement Planning Service (STEPS) team Assumption that there is an average saving per package of 840 Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline Target Actual Data unavailable Variance The ability of the STEPS team to release care packages is impacted by the pressures in the system and the capacity of providers to pick up care packages. Consequently, no cost saving has been generated that could be used to enable additional packages of care to be delivered. There has been an increase in packages held over 6 weeks rather than a decrease. 16

17 b) Increase the number of contact hours spent by STEPS team workers with clients Assumption that there is an average saving per package of 420 Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline 19,804 18,647 21,423 20,940 Target 21,209 19,737 22,599 22,083 Actual 21,209 17,686 17,450 Data unavailable Variance 0-2,051-5,149 The STEPS team holding packages of care past six weeks has a direct impact on contact hours available to new clients. Consequently, no cost saving has been generated that could be used to enable additional packages of care to be delivered. There has been a reduction in contact hours rather than an increase. 4. Delayed transfers of care Delayed days per 100,000 population (aged 18+ and attributable to social care) per month. A delayed transfer of care occurs when a patient is ready for transfer from a hospital bed, but is still occupying such a bed. A patient is ready for transfer when (a) a clinical decision has been made that the patient is ready for transfer; (b) a multi-disciplinary team decision has been made that the patient is ready for transfer; and (c) the patient is safe to discharge/transfer. A target of a 25 per cent reduction against the 2014/15 baseline was set. The CCG measures and monitors progress and the forecast is that the target will not be met. Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline Target Actual data unavailable data unavailable Variance ASCOF Measure 1A Social Care related Quality of Life (Patient / service user experience) Data is reported annually so the 2015/16 actual figures will be reported in April 2016 following receipt of questionnaires. We therefore exempt the release under Section 22 of the Freedom of Information Act, information intended for future publication. 17

18 A target of 0.9 per cent improvement in 2015/16 against the 2014/15 baseline figure of 20 per cent was set. The council measures and monitors progress and the forecast is that the target will be met. 6. Penwith pilot mental health wellbeing patient score compared to the general population - locally proposed metric The Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) is a seven item scale of mental well-being covering subjective well-being and psychological functioning, in which all items are worded positively and address aspects of positive mental health. It is being used to measure the wellbeing of a group of people within Penwith, Cornwall and the figure compared to the general population. A target of 20 per cent compared to a general population of 8 per cent was set. The CCG measures and monitors progress and the forecast is that the target will not be met. Q1 Apr - Jun Q2 Jul - Sep Q3 Oct - Dec Q4 Jan - Mar Baseline 8% 8% 8% 8% Target 20% 20% 20% 20% Actual 16.59% Data unavailable Data unavailable Data unavailable Variance -3.4% FOI Information Governance Date received: 14/01/ How many Information Governance staff are employed by the CCG? A. NHS Kernow employs one Information Governance Manager however, Information Governance is a part of the responsibilities of all employees of NHS Kernow and the contribution each employee makes to Information Governance is variable dependent on their primary role. 2. What are the roles of the staff in your Information Governance office, a brief description of each role, and the Agenda for Change band allocated to each role? A. The role of the Information Governance Manager is to provide specialist advice and guidance on information governance and data protection issues to colleagues internally as well as to external health and social care and partner organisations. The role will also work collaboratively for a common outcome with primary care to ensure their progress matches the commissioners view. The role provides strategic leadership in Information Governance and Data Protection and will be the subject matter expert source for advice, guidance and policy 18

19 development. The role is also responsible and accountable for the completion and evidence submitted to the NHS annual IG Toolkit. 3. What is the annual cost for Information Governance office at your organisation including staff salaries? A. We are unable to provide a breakdown of costs specifically related to Information Governance as there are a range of staff that contribute to the organisations compliance with information governance requirements and the level of their contribution is not assessed. We therefore do not hold information relating to that contribution in a form that allow us to analyse the proportion of time all other staff contribute to information governance. The salary grading for an Information Governance Manager is Band 8A for, which is subject to the NHS Agenda for Change pay scale. This pay banding is 39,632 to 47,559, which excludes employer on-costs. We exempt the publication of the exact salary under section 40 of the Freedom of Information Act, Personal Data. Prescribing & pharmacies FOI Cow's Milk Protein Allergy Date received: 11/01/2016 We would like to request the following information regarding the prescribing of specialised infant formula for cow s milk protein allergy (CMPA) within Kernow CCG 1. Does your organisation use any guidelines when prescribing specialised infant formula for cow s milk protein allergy (CMPA)? If yes, please provide a link to, or a copy of the guidelines referenced by your organisation. A. NHS Kernow s guidelines for prescribing specialised infant formula for cow s milk protein allergy are available on the Eclipse formulary website. We therefore exempt this information under section 21 of the Freedom of Information Act, information accessible by other means. 19

20 Appendix: FOI Out of hours service

21 92.4% 630/ % 2617/ % 715/ % 2428/ % 775/ % 3101/ % 805/ % 3270/3369 TC % 117/127 Visit % 292/333 TC % 1038/1047 Visit % 608/641 TC % 114/118 Visit % 297/343 TC % 967/ % 601/648 TC % 114/125 Visit % 332/388 TC % 1327/1349 Visit % 692/749 TC % 86/93 Visit % 291/348 TC % 905/921 Visit % 539/622 TC % 132/141 Visit % 312/359 TC % 1171/1201 Visit % 618/717 TC % 149/156 Visit % 279/324 TC % 1288/1309 Visit % 579/627 FOI Out of Hours Activity NQR 9, 10 & 12 NQR 9A Providers must have a robust system for identifying all immediate life threatening conditions and once 100% identified those call must be passed to the ambulance service within 3 minutes. NQR 9B Start definitive clinical assessment for urgent calls 95% within 20 minutes if the call being answered by a person. NQR 9B (New): Start definitive clinical assessment for urgent calls within 20 minutes of the call being answered by a person. Clinical Floor Walker Intervention. NQR 9C Start definitive clinical assessment for all other calls 95% within 60 minutes of the call being answered by a person. NQR 10 Face to Face Clinical Assessment - Applies to providers N/A of who offer walk in services only. NQR 12A Face to Face Consultations - Emergency (Within 1 hr) 95% ear 1 ear 2 ear 3 Target Level Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 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 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov % 44/ % 456/484 28>3 mins 93.72% 403/430 27>3 mins 94.30% 529/561 32>3mins 95.31% 366/384 18>3mins 94.74% 234/247 13>3mins 89.81% 370/412 41>3mins 93.24% 386/414 28>3mins 88.11% 326/370 44>3mins 90.45% 303/335 32>3mins 93.73% 389/415 26>3mins 92.14% 340/369 29>3mins 95% % 5973/ % 13/ % 5080/ % 10/ % 5123/ % 23/ % 6740/ % 15/18 89% 4971/ % 11/ % 9867/ % 17/ % 7018/ % 9/ % 7652/ % 12/ % 8980/ % 11/ % 6774/ % 9/ % 7338/ % 5/6 99.9% 8064/ % 8/ % 500/542 42>3mins 99.9% 9561/ % 12/ % 473/513 40>3mins 99.8% 8633/ % 5/ % 336/357 21>3mins 99.8% 6799/ % 8/9 93.0% 332/357 25>3mins 99.8% 6645/ % 9/ % 373/406 33>3mins 99.7% 8053/ % 2/ % 395/417 21>3mins 99.9% 8942/ % 8/ % 277/297 20>3mins 99.8% 5745/ % 5/7 93.9% 323/344 21>3mins 99.8% 5710/ % 4/ % 249/265 16>3mins 99.8% 6214/ % 3/5 90.7% 195/215 20>3mins 99.8% 4299/ % 8/ % 104/112 8>3mins 99.8% 2840/ % 5/ % 29/32 3>3mins 100% 496/ % 3/4 88.9% 16/18 2>3mins 50% 1/2 87.1% 27/31 4>3mins 100% 4/4 76.9% 20/26 6>3mins 50% 2/4 100% 22/22 0>3mins 66.7% 2/ % 17/19 2>3mins 100% 3/ % 16/22 6>3mins 85.7% 7/8 93.7% 489/ % 3388/ % 524/735 86% 3741/ % 691/ % 4579/ % 550/ % 3489/ % 723/ % 3964/ % 810/ % 4106/4512 No Data No Data No Data No Data No Data No Data NQR 12B Face to Face Consultations - Urgent (Within 2 hours) 95% 93.7% 1278/ % 1142/ % 1050/ % 1291/ % 1038/ % 1339/ % 1053/ % 963/ % 1135/ % 905/ % 1002/ % 1090/ % 1156/ % 1195/ % 924/ % 956/ % 1092/ % 1233/ % 998/ % 917/ % 1109/ % 829/ % 951/ % 704/731 93% 861/ % 747/813 NQR 12C Face to Face Consultations - Routine (Within 6 hours) 95% 96.8% 4214/ % 3071/ % 3193/ % 3046/ % 3075/ % 4294/ % 2883/ % 3186/ % 3866/ % 2784/ % 3041/ % 3465/ % 4027/ % 3612/ % 3216/ % 3224/ % 4102/ % 4688/ % 2972/ % 3044/ % 3702/ % 2755/ % 3129/ % 2502/ % 3735/ % 3124/3226

22 Appendix: FOI Local transformation plan

23 Annex 1: Local Transformation Plans for Children and oung People s Mental Health Developing your local offer to secure improvements in children and young people s mental health outcomes and release the additional funding: high level summary Q1. Who is leading the development of this Plan? (Please identify the lead accountable commissioning body for children and young people s mental health at local level. We envisage in most cases this will be the CCG working in close collaboration with Local Authorities and other partners. Please list wider partnerships in place, including with the voluntary sector and include the name and contact details of a single senior person best able to field queries about the application.) NHS Kernow is leading on the submission of the plan, and is the main commissioner of CAMH services in terms of funding levels. Cornwall Council and Council of the Isles of Scilly, including Public Health, are partner commissioners. Partners include; Headstart Kernow; Cornwall Partnership Foundation NHS Trust; Royal Cornwall Hospitals NHS Trust; oung People Cornwall; Zenzone (Kooth); Addaction; Penhaligons Friends; Parent Carer Councils, outh Justice Board; Head Teachers, the leads for Cornwall Association of Secondary Heads and Primary Heads, GPs, CAMHs Clinical Lead for the CCG; Together for Families; Gweres Kernow The police are partners on the S136 Board and the lead commissioner in the CCG is also a member of the board. The membership of the Board is being reviewed to ensure appropriate partner involvement and accountability/governance. Jude Bowler; Programme Lead; Maternity and Children Services, NHS Kernow judebowler@nhs.net Telephone: Q2. What are you trying to do? (Please outline your main objectives, and the principal changes you are planning to make to secure and sustain improvements in children and young people s mental health outcomes. What will the local offer look like for children and young people in your community and for your staff?). Please tell us in no more than 300 words The overarching vision set by children and young people is that The emotional wellbeing and mental health of all children and young people is improved because they can easily access the right support when they need it. This will ultimately mean that whole communities understand and are skilled in nhs kernow annex

24 dealing with mental health issues so that they can help prevent, identify early and help when needed. The main objectives are to: Build on some excellent work already in place Offer extensive training and skills development across a range of professionals and others Ensure the voice of children and young people and their families and carers are heard and acted upon Have excellent and easy accessible information sources; Build on an integrated early help for mental health model (Bloom) involving schools; independent sector providers; public sector providers; GPs to ensure services are tailored to meet local need. Provide services in a way that meet the needs of children and young people and their families/carers Have a strong prevention element around peri natal and infant mental health so that attachment issues are identified earlier Offer parents support on a consistent basis through delivering evidenced based parenting programmes Have services that target the more vulnerable and hardly reached groups Have a crisis service in place with robust pathways that prevent the need for in-patient care Have a seamless offer across agencies and sectors; including into adult hood and that data sharing is enabled Ensure all providers and commissioners work together to be able to measure the impact of services and progress; use this to plan and agree how resources will be best used to meet unmet need Q3. Where have you got to? (Please summarise the main concrete steps or achievements you have already made towards developing your local offer in line with the national ambition set out in Future in Mind e.g. progress made since publication in March 2015.) Please tell us in no more than 300 words The Draft CAMHs Strategy has been updated to reflect FiM; priorities have been signed off by the Children s Trust Board and Transformation Plan has been developed that is also the implementation plan for the Strategy. Wide stakeholder engagement has been undertaken with more planned [Appendix One] and this engagement has been used to consult on & refine the emerging outcomes & key deliverables; and the prioritisation. Self harm guidance for school has been developed which is being rolled-out, training is in development. A PHSE audit has been undertaken with a mapping of existing training provision. The integrated working early help model for mental health is being piloted in the Penwith area and plans are being developed to use this as a model to roll out to nhs kernow annex

25 other areas. Early Help Hub has been launched which is a single referral point for CAMHs. Work on co-producing the single point of access with young people is taking place. Infant mental health pathway has been developed including video interactive guidance. Headstart Kernow has been aligned with FiM and is part of the transformation. The digital offer is being developed alongside Headstart to ensure linkages with the young person developed website (Mind our Way) and SAVV (health schools website). Additional capacity management and clinical resources are being secured to implement and manage the transformation programme. The review of the Eating Disorder pathway is underway, led by a GP with the CAMHs provider and acute paediatricians. A DES is being explored and there is shared learning from the Exeter team. The psychiatric liaison in RCHT has been analysed and a business cases developed. Q4. Where do you think you could get to by April 2016? (Please describe the changes, realistically, that could be achieved by then.) Please tell us in no more than 300 words A training needs assessment will be completed by schools and a service specification produced to secure a service to deliver training to improve skills and knowledge to schools in the first instance then rolled out to GPs and wider community. A procurement will begin before April Self harm training to schools will be in place; GP training will be in place ( linked to this will be the offer to fund non recurrently back fill). There will be worked up business cases for a crisis service and additional staffing in place. There will be directed enhanced service in place for GPs to support the Eating disorder pathway. The new model of ED will be agreed and additional staff will be appointed to deliver this. There will be a business case in place to deliver the whole pathway for infant mental health. There will be a waiting list initiative to get to a level playing field. Work will start on developing a common data set will be established across commissioners train with solutions around data sharing being prioritised and be part of the wider interoperability framework. There will be an assessment of the peri natal mental health pathway and a plan in place to ensure this meets FiM as well as NICE guidance. Invest in clinical leadership and project management time to develop the programme nhs kernow annex

26 Extend the pilot of the Bloom project from Penwith to other Living Well areas and invest in additional independent capacity Explore the Tavistock Thrive model and embedding within Cornwall and Isles of Scilly Q5. What do you want from a structured programme of transformation support? Please tell us in no more than 300 words Sharing good practice especially around New models; training and skills courses; other workforce development; the plans; templates; service specifications; IT solutions; Data sets; Data sharing protocols. Critical friend network for re drafts of strategies Creating stronger links to HEE Plans and trackers should be submitted to your local DCOs with a copy to England.mentalhealthperformance@nhs.net within the agreed timescales The quarterly updates should be submitted in Q3 and Q4. Deadline dates will be confirmed shortly and are likely to be shortly after quarter end. These dates will, where possible, be aligned with other submission deadlines (eg, for the system resilience trackers, or CCG assurance process). DCOs will be asked to submit the trackers to england.camhs-data@nhs.net for analysis and to compile a master list nhs kernow annex

27 Annex 2: Self assessment checklist for the assurance process Please complete the self-assurance checklist designed to make sure that Local Transformation Plans for Children and oung People s Mental Health and Wellbeing are aligned with the national ambition and key high level principles set out in Future in Mind and summarised in this guidance Theme /N Evidence by reference to relevant paragraph(s) in Local Transformation Plans Engagement and partnership Please confirm that your plans are based on developing clear coordinated whole system pathways and that they: 1. have been designed with, and are built around the needs of, CP and their families 2. provide evidence of effective joint working both within and across all sectors including NHS, Public Health, LA, local Healthwatch, social care, outh Justice, education and the voluntary sector The local CAMHs Transformation plan is the implementation plan for the (Draft) CAMHs Strategy which is currently being updated and going through governance. A needs assessment was undertaken in that was developed with extensive engagement. There is on-going engagement through the Shadow CAMHs Board; IAPT and Head start, and targeted events on how to transform CAMHs. The Draft CAMHs Stakeholder Engagement Report is attached at Appendix One (not for sharing as still to be signed off). There is a mature partnership board in place that has representatives from the majority of these agencies in place, and this will form the Transformation Board for CAMHs. A new independent chair will be appointed and the terms of reference will be updated. Healthwatch has been approached to be part of this and they are part of the Crisis Concordat work. There has also been a specific stakeholder event to enable the input into the plan and this is set out in the Draft CAMHs Stakeholder Engagement Report (Appendix One) not for sharing as this has yet to be signed off. 3. include evidence that plans have been developed collaboratively with NHS E Specialist and Health and Justice Commissioning teams, 4. promote collaborative commissioning approaches within and between sectors There has been discussions with the lead commissioner in NHSE regarding Tier 4 and they will be invited to the focus group on developing the crisis pathway. The lead for the Justice commissioning team is on the Partnership Board, and representatives from probation have been involved in the engagement. A mapping of services commissioned by schools is in train to establish what is being commissioned. The Deal for Cornwall will move all sectors to adopting new ways of commissioning and providing. Currently the Partnership Board brings together these sectors and a Children s Integrated Commissioning Board representing four commissioners will engender the collaborative 1

28 Theme /N Evidence by reference to relevant paragraph(s) in Local Transformation Plans Are you part of an existing CP IAPT collaborative? Transparency Please confirm that your Local Transformation Plan includes: 1. the mental health needs of children and young people within your local population 2. the level of investment by all local partners commissioning children and young people s mental health services 3. the plans and declaration will be published on the websites for the CCG, Local Authority and any other local partners Level of ambition Please confirm that your plans are: 1. based on delivering evidence based practice 2. focused on demonstrating improved outcomes Equality and Health Inequalities Please confirm that your plans make explicit how you are promoting commissioning needed to elicit transformation. The Draft CAMHs Strategy is built on a needs assessment which was undertaken in There are plans to review and refresh the needs assessment on an on-going basis. A draft benchmarking report is available at Appendix Two and this will be updated and refined on a regular basis as part of the overall programme management. The plan will be published on the NHS Kernow website, with a web link connecting from the Cornwall Council & Council of the Isles of Scilly websites; as well as young people website and Savvy. This will be improved over the next year to ensure that the plan is as accessible and transparent as possible. es there will be implementation of specific NICE guidance (para 9); including around Conduct disorder; anxiety and personality disorder (Annex One ). Parenting programmes will be evidenced based (Annex One: 1.09) as well as interventions around peri natal (Annex One: 1.0) and infant mental health (Annex One: 2.0). The quality standards for Eating disorders (Annex One: 2.14) will form the basis of the new service specification. The new model of the early help for mental health (Annex One: 1.10) will have evaluation built in to ensure that where there is no evidence base, it can evidence that the model is delivering the desired outcomes. es see all of Annex One. A full EIA has been draft and is at Appendix Three.

29 Theme /N Evidence by reference to relevant paragraph(s) in Local Transformation Plans equality and addressing health inequalities Governance Please confirm that you have arrangements in place to hold multi-agency boards for delivery There is a mature partnership board in place that has representatives from a wide range of stakeholder. Risks from this will be highlighted to the Cornwall Children s Trust Board and Isles of Scilly Children Committee; as well as through the CCGs internal risk assurance process. Please confirm that you have set up local implementation / delivery groups to monitor progress against your plans, including risks Measuring Outcomes (progress) Please confirm that you have published and included your baselines as required by this guidance and the trackers in the assurance process Please confirm that your plans include measurable, ambitious KPIs and are linked to the trackers Finance Please confirm that: 1. your plans have been costed An operational group has been set up as well as several task and finish groups. The programme will have a risk register compiled of risks from each project. See governance structure in the LTP. This has been populated however more refinement is needed and this will be done through the working groups. Some areas of work have more developed KPIs than others. High level costed plans have been developed and are being refined. 2. that they are aligned to the funding allocation that you will receive es they will cover the allocation for eating disorder and CAMHs 3. take into account the existing different and previous funding streams including the MH resilience funding (Parity of Esteem) es see Appendix Two Draft Benchmark report.