Children s Community Health Services Procurement Phase One Report (January to end of July 2014) Page 1
1. Purpose of the Paper The purpose of this paper is to set out the methodology, work undertaken and outcomes from the first six months engagement phase of the Children s Community Health Services (CHS) Procurement. This report, in addition to the external Gateway Process, provides assurance that the programme has made sufficient progress and can move successfully to the next stage. 2. Background A single integrated Community Children s Health Service for Bristol and South Gloucestershire was agreed in 2008 and a formal procurement exercise undertaken. South Gloucestershire Health Visiting was added in 2011. This service covers the majority of children s community services including Health Visiting, School Nursing, Community Paediatrics, Therapies, Child and Adolescent Mental Health Services (CAMHS) and some specialist services. Some specialist services are jointly commissioned with Bristol City Council. The contract was awarded to North Bristol NHS Trust (NBT) in partnership with Barnardo s the Children s Charity. The contract award was for five years, with the option to extend for a further two, which was recently agreed. The contract will therefore expire in March 2016. The timescale will enable the commissioners to review and redesign the community health services to ensure they support the commissioner s strategic aims to provide more care closer to home, support innovative models of delivery and commissioning. This may be done through making changes to the core services, pathways and model of delivery. Following the NHS reconfiguration in 2013 the commissioning responsibility was divided and now sits with commissioners as follows: Bristol CCG (Community Paediatrics, Therapies and CAMHS) South Gloucestershire CCG (Community Paediatrics, Therapies and CAMHS) Bristol City Council (Public Health) (School Nursing Health Visiting from 2015) South Gloucestershire Council (Public Health) (School Nursing Health visiting from 2015) NHS England (Health Visiting to 2015) In May 2014 North Somerset CCG confirmed that they wished to commission their children s community services as part of this procurement. The timescale for this procurement for a new service, to commence from the end of March 2016, enables the commissioners to engage widely and gather all required information to help scope the new service model. It allows for the commissioners to meet its legislative requirements for consultation. A full equality impact assessment will be undertaken. The main purpose of this phase was to engage with the public and a wide range of stakeholders to ascertain their views on community services and gather this feedback to help us design the future service model. Also during this time we set out the framework for this programme, gathered finance, estates and IM&T information. Version 4 30July 14 Page 2
3. Programme and Project Structure Following the appointment of a Programme Director in March 2014, to manage both the children s and adult CHS recommissioning, the first phase project plan was developed and also a project structure (Appendix 1) including individual work stream groups and a small project team was established. The project team positions were filled on a fixed term secondment basis by mid May. A part time manager was appointed to cover the children s community services recommissioning work. Both the adult CHS and children s CHS recommissioning are overseen by the CHS Programme Board which meets monthly to review progress and receive feedback from the fortnightly adult and children s CHS recommissioning project groups. 3.1 Project Plan The project plan was developed with the work stream leads and used as a working document to act as a record of the tasks completed as well as a plan for future project requirements. See Initial Project Plan at Appendix 2. The full Project Plan is available at www.bristolccg.nhs.uk 3.2 Community Health Services Procurement Programme Board The purpose of the Community Health Services Procurement Programme Board is to direct the procurement of an agreed model of adult and children s community health services for Bristol and oversee the development of the related service specifications and contract documentation. The terms of reference are at Appendix 3. The Programme Board is chaired by Bristol CCG Operations Director, Judith Brown and includes representatives from all CCGs, Councils including Public Health and CSU Procurement and Bristol Healthwatch were invited to nominate a representative to sit on this board. The minutes from the CHS programme board meetings are sent to the CCG Governing Bodies for information. 3.3 Community Health Services Procurement Project Group The Children s CHS Project Group was established to oversee the work and ensure the project remained on target, see attached Terms of Reference at Appendix 4. The purpose of the Children s Community Health Services Project Group is to oversee, coordinate and direct the work of the work stream groups in order to inform and arrive at an agreed model for children s community health services for Bristol, South Gloucestershire and North Somerset. The group also has responsibility to produce the service specification and contract documentation. 3.4 Work Stream Groups Work stream groups were established to develop various key areas that inform the services and contract. 3.4.1 Patient and Public Involvement Version 4 30July 14 Page 3
The purpose of the PPI group is to co-ordinate engagement plans and share practice and outcomes with all commissioners with the aim of ensuring the highest engagement standards across the whole procurement process. Members gather and collate information from a wide range of sources to feed into the project in order to ensure that the voices of services users shape the service specification that meets future children s community health needs for Bristol, South Gloucestershire and North Somerset. A separate report has been written on this work stream for each CCG area and these are attached at Appendix 5, Appendix 6 and Appendix 7. Survey outcome reports are available at Appendix 8 and Appendix 9. 3.4.2 Professional Engagement The main purpose of this phase was to engage with health and social care professionals to ascertain their views on community services and gather this feedback to help us design the future service model. A separate report has been written on this work stream for Bristol and is attached at Appendix 10 (See appendix 6 and appendix 7 for North Somerset and South Gloucestershire Professional Engagement). 3.4.3 Quality/Clinical Reference The role of the Quality/Clinical Reference group is to focus on researching of best models of practice and information gathering to review evidence of proven models, population health need and how this should influence the future service model. See Appendix 11 for the full report. 3.4.4 Communications The purpose of the Communications Work Stream is to ensure that there is an open, transparent two way communication system in place between patients, public, stakeholders, health and social care professionals and those directly involved in the project. A strategy was devised (Appendix 12) and from this the individual work tasks chronologically planned to deliver the strategy. 3.4.5 Estates The purpose of the Estates Work Stream Group is to complete a scoping exercise to confirm the details of the current estate portfolio owned by various NHS and public sector organisations and occupied by CCHP. This information needs to have sufficient detail to enable the CCG to develop a comprehensive strategic decision on the future of the properties within this estate. It will help to shape and inform how providers will be able to utilise existing assets or make alternative provisions to improve service delivery and to meet their service objectives. The executive summary includes portfolios outlining areas for concern and suggesting possible improvements that could be made as part of shaping a better service. Given the current financial climate the objective would be for a Version 4 30July 14 Page 4
more flexible estate provision that provides more for less and enables the best service delivery. The first report shows the condition of the portfolio is assumed to be 80% in good condition with the exception of one or two health centre s (Old School Surgery) and the North Bristol premises, mainly on the Southmead site. A functional suitability survey has not been carried out but it is assumed most premises are suitable with the exception of the North Bristol properties. The service has undergone major estate transformation with NBT investing capital to create speciality children services hubs, in each of the wards of Bristol. The next phase will be to examine further and advise on future use of the current premises, subject to service consultation outcomes, checking to ascertain if certain sites are listed as core premises and encouraged to be used by tendering providers to maintain the integrated pathway work that has been carried out on the previous 5 years. The leases would need to be assigned and a decision regarding inherent dilapidations should be discussed as part of commissioning. Certain leases present a risk to service continuity as they are currently due to expire or a break notice can be affected before the intended contract renewals. This should be discussed with the current providers and leases should be co-terminus with commissioning intentions. 3.4.6 IM&T This work stream provides an expert business intelligence and informatics input to the Children s CHS project group. It covers all child related IM&T systems that are used by the current providers in relation to the delivery of patient care that are associated with the contracts between Bristol CCG, North Somerset CCG, South Gloucestershire and NHS England. The providers in scope are - North Bristol Hospital NHS Trust in partnership with Barnardo's Weston Area health Trust (WAHT) Bristol Community Health Sirona Health Care University Hospital Bristol NHS Foundation Trust Leap Valley Surgery The work ensures that the consent from each of the individual commissioning organisation is obtained in order to undertake the necessary work. The current IM&T landscape is being documented including what information systems are used for direct patient care, and any associated information flow process maps. Once this complete the focus will be; to advise the project in relation to overall approach to IM&T and requirements for future procurement. To define and write IM&T components of service specification To advise on IM&T budget requirements for the service specification Version 4 30July 14 Page 5
4. Input to programme documentation e.g. governance, benefits, reporting in relation to IM&T Draft high level information sharing agreements Create detailed plans and resource estimates for procurement stage Identify key risks and Issues which will be added to the children s CHS procurement risk and issue logs. 3.4.7 Finance and activity The function of the group was to map current commissioner funding in scope for procurement and identify the current financial envelope for each commissioning organisation and agree what in scope for this procurement. That map is now available and is informing discussions and work plan for the next phase. The next phase will require modelling of costs for the years leading up to and for the duration of the contract and securing commissioner funding for procurement. There is a requirement to ensure that the financial model for procurement is affordable. 3.4.8 Equalities - See separate report at appendix 13 Risks / issues A Children s CHS project risk register and issues log was established and updated when new risks identified. Risks of 9 or less sit with the CHS Programme Board. Risks of 9+ will be raised to a directorate level (operations directorate) whilst those of 12 or above will be raised to Bristol CCG Governing Body and entered onto the Bristol CCG corporate risk register. 5. Lessons Learnt The programme contacted the Modernising Mental Health team and South Gloucestershire CCG to learn from their experiences of recent procurements. This proved to be very valuable. The key message from South Gloucestershire was to use the competitive dialogue procurement route. Modernising Mental Health s initial lessons were to ensure that the project starts all work streams from project commencement, including estates and IM&T. See Appendix 14 for the full lessons learnt report. 6. Next Steps The engagement phase ran from January to the end of July 2014, after which a service model will be designed that takes into account the feedback received from the PPI and engagement events, the surveys and the clinical reference group workings. The service model for adult CHS reprocurement will be taken to the Programme Board and then to the Bristol CCG Governing Board meeting on the 30 th September 2014 for ratification ahead of the formal consultation period. This model will be the subject of a 12 week public consultation running through the autumn and winter. During this period we will continue to work on the service specification Version 4 30July 14 Page 6
Appendix 1 - Community Services Procurements Programme Reporting Structure Bristol CCG Governing Body South Glos CCG Governing Body North Somerset CCG Governing Body Bristol Health & Wellbeing Board Bristol Health Scrutiny Committee Community Health Services Procurement Programme Board NHSE Bristol & South Gloucestershire LAs Bristol, South Glos and N Somerset OSCs Adult Community Health Services Procurement Group Children s Community Health Services Procurement Group IM&T Quality Finance/ Activity Engagement Estates Communications IM&T Quality Finance/ Engagement Estates Procurement Activity Clinical Reference Group - Evaluation, Needs Assessment and Shared Learning PPI GPs and other professionals Third sector organisations and other providers Clinical Reference Group - Evaluation, Needs Assessment and Shared Learning PPI GPs and other professionals Page 7 Third sector organisations and other providers
award new service award new service jan feb mar apr may jun jul aug sep oct nov dec jan feb mar apr may jun jul aug sep oct nov dec jan feb mar apr may jun jul aug sep oct nov dec Appendix 2 Initial Project Plan Adult and Children s Community Health Services Programme timeline 2014 2015 2016 children Services Adult services PRE PROCUREMENT PROCUREMENT MOBILISATION Page 8
Appendix 3 Terms of Reference Community Health Services Procurement Programme Board Version Tracking Version Date Revision description Editor Approval Status 0.1 21/10/2103 First draft for discussion at Steering Group meeting Draft 0.2 05/11/2013 Revisions made SJ Draft 0.3 14/03/14 Updated to reflect new structure and reporting 0.4 31/03/14 Revised following discussion at Programme Board meeting on 28 th March 2014 0.5 13/05/14 Accepted subject to minor revision at Programme Board meeting on 9 th May 2014 0.6 29/05/14 South Gloucestershire and North Somerset CCGs and Councils representatives added FH FH FH FH Draft Daft Final 1 Purpose Page 9
The purpose of the Community Health Services Programme Board is to direct the procurement of an agreed model of adult and children s community health services for Bristol and oversee the development of the related service specifications and contract documentation. 2 Authority Each member has pre-existing delegated responsibilities which this group will support to ensure achievement of these responsibilities and consistency across the CCG. Engagement with the three localities (Inner City and East, North and West and South) and Partnership working with the Local Authority will be paramount. The group is authorised to take recommendations to the Governing Body. 3 Reporting and sub structure The Programme Board will report to the Governing Body. See reporting structure at appendix 1. 4 Membership Membership has been identified to provide expertise in relation to identifying key functions required to complete the task. In order to ensure neutrality and independence there is no provider represented on this group. Deputies may attend on behalf of members but only where they have full authority of the members (ie they present in an acting capacity). Name and title Role Judith Brown - Chair Operations Director Fiona Hallaran Programme Director Ewan Cameron Sohail Bhatti Nicola Dunn Brian Hanratty Richard Lyle Alison Moon Niema Burns Mike Pingstone Kirsty Alexander Chair ICE Locality Public Health Chief Financial Officer Chair South Locality and clinical lead for adult community services Programme Director, Community & Partnerships Director of Transformation and Quality Equality and Diversity SWCS Procurement NW Locality and clinical lead for children s community services Version 4 30July 14 Page 10
Sarah Carr Netta Meadows Kathryn Hudson John Shaw Jeanette George?? Tara Mistry Governance Lead Bristol City Council South Gloucestershire CCG South Gloucestershire Council North Somerset CCG Lay member (Involvement) Bristol CCG It was noted that some specialist subject matter experts will be invited as and when needed e.g. Tony Jones for PPI, Jayne Kendall for communications. 5 Quorum A meeting of the Programme Board shall be quorate when there are a minimum of six members present and 1 clinical member. 6 Duties The role of the Programme Board is; 1. To provide leadership for the re-commissioning of adult and children s community services in Bristol by 2016 2. To develop a model of commissioned services that supports the delivery of the strategic objectives for improving community services for the population of Bristol 3. To develop a plan for patient and public involvement to ensure that the views of public, patients, carers and key stakeholders are gathered, understood and inform the re-commissioning of adult community health services 4. To assess the programme of work for equality impact, to ensure that the final product is aligned with community needs, promotes Equality of Opportunity, improves fair access to services and contributes to addressing current and emerging concerns in relation to Health Inequalities. 5. To manage the interface with partners 6. To agree and implement the programme plan and monitor to ensure delivery of both procurements to agreed timescales 7. To co-ordinate the planning of the procurement process for adult and children s services and contracts, to ensure best use of resources and to support effective communication. 8. To inform commissioning intentions 9. To ensure alignment between the re-commissioned services and affordability of the service model Version 4 30July 14 Page 11
10. Develop and implement effective governance of the programme 11. To understand and mitigate risks, aligned with the governance arrangements of the CCG 12. To ensure that the workforce and HR impacts of the proposed model are understood and managed 13. To use the JSNA and other data sources to inform the process 14. To ensure an impact assessment is carried out of the new model 15. To build evidence and evaluation into the commissioning cycle 16. To support the routine inclusion of standard wording around the use of evidence, and the need for evaluation, into new service specifications that are developed for commissioned services. To ensure all decisions service commissioning/decommissioning must be underpinned by robust and up to date relevant evidence. 17. To ensure that financial and statistical modelling is carried out to inform capacity planning. 7 Administrative Duties It is expected that all members will make every effort to attend this meeting, dates and details of which will be circulated well in advance. Agenda items must be sent to the Programme Director ten working days prior to the meeting date The agenda and papers will be circulated at least five working days prior to the meeting. Members will be expected to declare any interests. Action notes of meetings will be produced and circulated within five working days of the meeting. 8 Frequency of Meetings Meetings will be held monthly. 9 Review of Terms of Reference 9.1 At least once a year the group shall review its own performance and Terms of Reference to ensure it is operating at maximum effectiveness and recommend any changes it considers necessary to the chair for approval. 9.2 In the short term, during the set up phase the performance will be formally reviewed after six months. Judith Brown, Operations Director Date 28 May 2014 Version 4 30July 14 Page 12
Appendix 4 Terms of Reference Children s Community Health Services Procurement Project Group Version Tracking Version Date Revision description Editor Approval Status 0.1 8 th April 14 First draft FH Draft 0.2 23 rd April 14 Final draft FH Final draft 0.3 13May14 Signed off by Programme Board pending minor amendments FH Final Page 13
1 Purpose The purpose of the Children s Community Health Services Project Group is to oversee, coordinate and direct the work of the work stream groups in order to inform and arrive at an agreed model for children s community health services for Bristol, South Gloucestershire and North Somerset. The group also has responsibility to produce the service specification and contract documentation. 2 Authority Each member represents the work stream group that they chair and has preexisting delegated responsibilities which this group will support to ensure achievement of these responsibilities and consistency across the CCGs. 3 Reporting and sub structure The Project Group will report to the Programme Board. 4 Membership Membership has been identified to provide expertise in relation to identifying key functions required to complete the task. In order to ensure neutrality and independence there is no provider represented on this group. Deputies may attend on behalf of members but only where they have full authority of the members (ie they present in an acting capacity). Organisation Identified role Key responsibilities Contact name and details Bristol CCG Programme Director Overall management and leadership of the Programme Bristol CCG Project Manager Day to day support and management of the Children s Procurement process SWCSU Procurement Lead Lead and manage the procurement Fiona Hallaran Katie Handford Mike Pingstone Bristol CCG and Bristol City Council Lead Commissioner (CCH and CAMHS) Advice and guidance on CCH and CAMHS service requirements for Bristol Rebecca Cross Liaison with Bristol City Council commissioners for CCH and CAMHS Bristol CCG Co-ordinating commissioner, Bristol Lead Advice and guidance on CCH and CAMHS service requirements Inge Shepherd
Commissioner for Bristol Support for Business as Usual with current service provider Bristol CCG PPI and Engagement lead Co-ordination and support for the engagement of children and young people, parents and carers and other stakeholders Bristol CCG Clinical Lead Leadership and Coordination of GP and clinical input Bristol CCG Senior Officer Authorisation of key documents and decisions Bristol CCG Equality & Diversity Ensure the project meets all equality requirements Bristol City Council Bristol City Council Public Health Lead Public Health Commissioner Public Health Input into needs assessment, and advice on commissioning of PH Nursing Advice and guidance on PH Nursing South Glos CCG Lead Commissioner Advice and guidance on CCH and CAMHS service requirements for South Glos South Glos CCG Clinical Lead Leadership and Coordination of GP and clinical input South Glos CCG Senior Officer Authorisation of key documents and decisions Annabel Wilson Dr Kirsty Alexander Judith Brown Niema Burns Jo Williams Amanda Chappell Anne Colquhoun Lindsay Gee/Ali Ford Dr Kate Mansfield Kathryn Hudson South Gloucestershire Council Public Health Commissioner Advice and guidance on PH Nursing Lindsey Thomas Lesley Causon South Gloucestershire Council Mary O Reilly North Somerset CCG Lead Commissioner Advice and guidance on CCH and CAMHS Dali Sidebottom
service requirements for North Somerset North Somerset CCG North Somerset CCG Clinical Lead Senior Officer Leadership and Coordination of GP and clinical input Authorisation of key documents and decisions NHS England Lead Commissioner Advice and guidance on Health Visiting, FNP and Tier 4 CAMHS Commissioning Support Bristol CCG Finance Lead Lead and manage all elements of finance Dr Tony Ryan Liam Williams Jonathan Brook Anna Masserick Padma Ramanan South West CSU Finance support Support finance lead Vicky Munford South West CSU Communications Lead Lead and manage all elements of communication Jayne Kendall 5 Quorum A meeting of the Project Group shall be quorate when there are a minimum of six members present representing at least 3 organisations. 6 Duties The objectives and operation of the Collaborative by which all of the Parties shall abide are to act collaboratively in the commissioning and procurement of Commissioned Services so as to: provide direction and coordinate the activities of the work stream groups and plan (including needs assessment) and procure community health services to meet the needs of children and young people, and where appropriate their parents and carers ; collate the evidence from research, best practice, needs assessment, activity and engagement to inform the design of the service model and specification. To use the JSNA and other data sources to inform the process develop a model of commissioned services that supports the delivery of the strategic objectives for improving community services undertake reviews of services, manage the introduction of new services, drugs and technologies and oversee the implementation of NICE and/or other national guidance or standards relating to services; agree the range of Commissioned Services;
conduct market management and service design; provide a coordinated approach to commissioning input to clinical networks, local commissioning fora and partnerships; oversee the plan for patient and public involvement to ensure that the views of children and young people, their carers and families and key stakeholders are gathered, understood and inform the specification ensure that the project work meets all equality requirements and that an equalities impact assessment is undertaken to ensure that the final product is aligned with community needs, promotes Equality of Opportunity, improves fair access to services and contributes to addressing current and emerging concerns in relation to Health Inequalities deliver the project plan and monitor to ensure delivery to agreed timescales ensure work is completed to support the procurement process. ensure alignment between the re-commissioned services and affordability of the service model implement effective governance of the project understand and mitigate risks, aligned with the governance arrangements of the commissioners ensure that the workforce and HR impacts of the proposed model are understood and managed To ensure that financial and statistical modelling is carried out to inform capacity planning. monitor and review the effectiveness of the Collaborative; set quality standards; ensure all services meet patients rights under the NHS Constitution including Service User Booking, Patient Choice and waiting time standards. and ensure any services commissioned through the collaborative arrangements are reviewed for cost effectiveness and represent best value for money; advise on the negotiation of the Commissioning Contract; co-ordinate and plan for demand, financial and investment needs of the Parties before and during negotiations for the Commissioning Contract; co-ordinate proposals of the Parties to move provision of Commissioned Services from one or more Providers to others as part of service or pathway reconfiguration; enable the benefit of working together on achieving best value for money and optimising productivity and efficiency; establish any links and/or reporting networks with other patient care commissioning groups, as may from time to time be convenient;
appoint and liaise with the South West Commissioning Support Unit as set out in the separate agreement; 7 Administrative Duties It is expected that all members will make every effort to attend this meeting, dates and details of which will be circulated well in advance. Agenda items must be sent to the Project Manager 5 working days prior to the meeting date The agenda and papers will be circulated at least 3 working days prior to the meeting. Members will be expected to declare any interests. Action notes of meetings will be produced and circulated within 2 working days of the meeting. 8 Frequency of Meetings Meetings will be held fortnightly. 9 Review of Terms of Reference These terms of reference will be reviewed and revised at the end of the preprocurement phase ahead of the procurement stage.