Chief Officer s Report July-August 2015 Purpose This paper provides a summary of the key areas of business as led by the chief officer for this and the other four clinical commissioning groups (CCGs) in the collaborative. It includes a brief summary of the main matters. The CWHHE collaborative comprises NHS Central London, West London, Hammersmith and Fulham, Hounslow, and Ealing CCGs. It has been written as a standard report across all five CCGs. The report covers the following areas: Continuing Care Team - Ealing CCG Safeguarding children Safeguarding adults Strengthening infection prevention and control Paediatrics Quality deep dive Parliamentary and political update Seven day services NHS England away day sets out plans for the future Breaking the Cycle West London CCG: developing joined up services for older people Stroke service improvements at Charing Cross Hospital get green light CWHHE CCGs win funding to improve mental health for young people 1
Victoria Medical Centre in Westminster rated outstanding by CQC Hammersmith and Fulham CCG seeks public feedback on new services Ealing commissions Integrated Intermediate Care Service Ealing CCG drive to promote local Patient Participation Groups Patient online services available in Hounslow Policy review to be launched into obesity Central London GPs invited to stand in open elections to CCG governing body Declarations of Interest and Gifts and Hospitality Continuing Care Team - Ealing CCG In July, the Ealing Executive Committee agreed to transfer the Ealing CCG NHS Continuing Care Team to CWHHE Quality, Nursing and Patient Safety (a dotted line will remain to the Managing Director for budgetary and wider commissioning responsibilities). This change strengthens the clinical leadership to the team with regard to its provider responsibilities. The team will remain based at Perivale House and an integral part of Ealing CCG. Safeguarding Children A review of the Designated Doctors and Named GPs for Safeguarding Children has been undertaken. New contracts have been drafted and are being considered. We envisage that these will be implemented before the end of the calendar year. These new contracts will strengthen the contractual arrangements in place with local Trusts in relation to the Designated Doctors. In addition, it establishes the role of the Named GPs within the CCGs having transferred from NHS England. Safeguarding Adults The Safeguarding Adult and Mental Capacity Act Lead role has been reviewed in consultation with the current post-holders. From 1 September the role will widen to incorporate a clinical quality lead element in relation to Care Providers. This also means that there will be increased CCG capacity through the funding of an additional role to be part of Hounslow CCG, increasing the number of roles across the five CCGs from two to three. 2
Strengthening Infection Prevention and Control The CCGs Lead Nurse for Infection Prevention continues to meet quarterly with infection prevention teams in CWHHE provider organisations. The teams have all been advised of the requirement to produce a quarterly report on compliance with Quality Schedule indicators for infection control, for review at their CQG, and are being supported to meet this goal. Post Infection Reviews (PIRs) for both MRSA and Clostridium difficile, as well as Root Cause Analyses (RCAs) for outbreaks and infection-related Serious Incidents, produced by Trusts are reviewed by the Lead Nurse for Infection Prevention to ensure that Trusts have robust infection prevention systems in place and capture lessons learned. Additional attention has been paid to Imperial College Healthcare NHS Trust with a focus on Clostridium Difficile infections and also a current issue of Carbapenemresistant Enterobacteriaceae (CRE) - an antibiotic-resistant bacteria. As a result the CCGs Lead Nurse for Infection Prevention and the Hammersmith and Fulham CCG Assistant Director for Quality carried out a clinical visit to renal and vascular wards at Imperial to review the infection control measures in place with Trust clinical leads. Paediatrics Chelsea and Westminster NHS Foundation Trust The CCG team were present at the Chelsea and Westminster Paediatric Clinical Governance Review in July. This reviewed systems and processes in place within paediatric services. A particular highlight was a resolution of a Serious Incident that was initially raised in spring 2014, where, following trials over the previous six months, new equipment has now been delivered to support assessment of young babies. Quality Deep Dive The CCGs Quality Team are currently preparing for a deep dive into quality as part of the NHS England assurance process. The shared team across the five CCGs is leading the work locally and is at the evidence gathering stage. The purpose of the exercise is to identify successes and areas to focus on over the next year. Parliamentary and political update At his summer budget on 8 July, George Osborne said the government s priority was the NHS, and committed to fully funding the Simon Stevens plan. He said: Mr 3
Deputy Speaker, public spending should reflect public priorities and we have to make choices. Our priority is the National Health Service. We will fund fully the plan the NHS has itself produced for its future the Stevens Plan. That plan requires very challenging efficiency savings across the health service which must be found. But it also requires additional government funding. Our balanced approach means I can today confirm the NHS will receive in addition to the 2 billion we ve already provided this year a further 8 billion. That s 10 billion more a year in real terms by 2020. It s proof that you can only have a strong 7-day NHS if you have a strong economy. Seven day services Jeremy Hunt continues to drive forward his plans for seven day services and has called upon doctors to let go of the clause in their contracts allowing them to opt out of non-emergency weekend work. The Department of Health had said it is making an investment of 175m in primary care. A DH spokesperson said: GPs help to keep people well and out of hospital that saves money in the long term. NHS England away day sets out plans for the future NHS England London region held an away day in July at the Oval where they reflected on the year past, the challenges ahead and possible ways forwards. The most interesting parts to the presentation followed each other with Anita Charlesworth from The Health Foundation laying bare the financial challenge the NHS is facing and Professor Tim Briggs talking about clinically led innovation driving improved quality of care and efficiency by ensuring we: even out variations in practice; use standard techniques and equipment to drive up purchasing power; and only allow providers to provide a service if they have enough patients to make it efficient. Professor Briggs work on orthopaedic care showed that Trusts and even consultants within Trusts were using different makes of equipment e.g. replacement hips and that in some cases were only carrying out one or two procedures a year. There is real enthusiasm across Trusts and CCGs to see how we can implement these findings in NWL, so improving quality and reducing costs at the same time. If the work in orthopaedics is successful we will look to roll out the same approach to other surgical specialties. We are also using the wider principles of reducing variation and increasing standardisation to drive our 16/17 planning process. 4
Breaking the Cycle Breaking the Cycle III is planned for 13 and 14 October. The Organisational Development Committee continues to oversee this programme and is actively canvassing ideas for this next wave of action as well as reviewing the feedback staff have given on work so far. West London CCG: developing joined up services for older people Patients over 65 in Kensington and Chelsea and Queens Park Paddington will soon be able to benefit from improved, joined up services, thanks to the imminent implementation of Whole Systems Integrated Care (WSIC). The WSIC programme has seen the health, social care and voluntary sector services working together to develop new models of care for all people aged over 65. This new way of providing care includes: Inviting people to speak to their GP about developing a care plan. This identifies ways of helping people to maintain or improve their health and social care situation Inviting people to access a range of activities, such as exercise classes, nutritional guidance, social groups and more. Ensuring people have enough time with their GP and other health and social care professionals, who will work together to provide care that is centred around a person s needs Stroke service improvements at Charing Cross Hospital get green light Imperial College Healthcare NHS Trust has approval to move forward this autumn with its proposal to bring all stroke services together at Charing Cross Hospital in Hammersmith, creating a 34-bed stroke unit, an expanded gym, as well as a 20-bed hyper-acute stroke unit (HASU) on the same floor. The Trust will be offering seven day senior clinical review and therapy services to all stroke patients, while keeping the total number of stroke inpatient beds and staff the same. Outpatient follow-up care will continue to be provided at St Mary s Hospital as well as at Charing Cross Hospital. This is a short term move to improve the quality of care for stroke patients, as there are significant differences in length of stay and outcomes between the two sites as a result of the more extensive services and 7 day working 5
at Charing Cross. In the medium term, both the HASU and the St Mary s stroke beds will move back to St Mary s in line with Shaping a Healthier Future. CWHHE CCGs win funding to improve mental health for young people NHS England has announced that 30m will be distributed to CCGs as the first stage of a programme to improve mental health and wellbeing for children and young people, with a particular focus on eating disorders. Money will be invested in innovative and intelligent ways of supporting young people with eating disorders and their families as early as possible. The funding will be recurrent for five years, as was announced in last year s autumn statement. This cash boost is in addition to the 1.25bn pledged in the March 2015 budget for CAMHS which is also over the next five years. Victoria Medical Centre in Westminster rated outstanding by CQC The Victoria Medical Centre one of the oldest practices in Westminster - was rated outstanding in the Care Quality Commission s (CQC) latest round of reports. The Victoria Medical Centre offers General Practice (GP) services, and specialises in diagnostic and screening procedure, family planning services, surgical procedures, treatment of disease, and disorder or injury. Hammersmith and Fulham CCG seeks public feedback on new services Hammersmith and Fulham CCG is currently looking to buy and plan a new: cardiorespiratory community service (heart and lung conditions); musculoskeletal community service (the treatment of muscles, joints, bones and nerves injuries); and neuro-rehabilitation service (specialist treatment for brain, spinal and nerve injuries). Ealing commissions Integrated Intermediate Care Service The contract for the new Ealing Integrated Intermediate Care Services (EIICS) was jointly commissioned by Ealing CCG and London Borough of Ealing and awarded to a consortium led by the West London Mental Health NHS Trust (WLMHT). Other consortium partners include Central and North West London NHS Foundation Trust 6
(CNWL), Ealing Social Services, London Central and West Unscheduled Care Collaborative (LCW) and Chelsea and Westminster Hospital NHS Foundation Trust. The service expects to receive over 5,000 patient referrals a year from GPs and care teams in the community and from the hospitals local to Ealing. Once in the service, every patient is allocated their own key worker and access to support 24 hours a day. The service will actively promote independent living for local people and work to improve the self-care skills of patients, their carers and families, as well as providing access to a variety of physical and mental health care specialists in a timely way. WLMHT will work with current ICE service provider LNWHT to mobilise the new service to launch on 1 October 2015 and ensure a safe and effective handover of care. Until the new service begins, the existing ICE service will continue to receive referrals and care for people in the usual way. Ealing CCG drive to promote local Patient Participation Groups Ealing CCG had a special push last month to encourage local residents to get involved in their Patient Participation Group (PPG). Ealing Clinical Commissioning Group in partnership with Healthwatch Ealing have set up seven Network PPGs across the borough, to bring together representatives from the practice based PPGs. Zereen Rahman-Jennings, patient and public engagement and equalities manager at Ealing CCG, said: We strongly encourage people from all ages and backgrounds to get involved it ll be a chance to meet other patients and carers, learn about local health initiatives, hear about examples of achievements and an opportunity to make a difference. Patient online services available in Hounslow Patients in Hounslow can now view and change their GP appointments online. Patients can use the internet to view their medical records, request repeat prescriptions from a home computer or mobile device, have their prescriptions delivered to their pharmacy, and, depending on their practice, access their test results. Hounslow residents can download the SystmOnline app from Apple, Google, or the SystmOnline website. Policy review to be launched into obesity The government has announced a policy review that will look at linking together people who access unemployment benefit with receiving support to lose weight or 7
manage an addiction. The consultation paper, first published in February, originally referred only to obesity, but has now been extended to consider people with addictions too. Professor Dame Carol Black has been asked to look into how best to support benefit claimants with potentially treatable conditions, such as obesity or addictions to drugs and alcohol, back into work. Obesity is estimated to cost the NHS 5 billion per year by the DH, based on the figure that nearly one out of every four adults, and around 15 per cent of all children, are obese. Some evidence shows a correlation between obesity and wider mental health problems. An editorial on the matter in the British Medical Journal pointed out that the only treatment consistently successful for obesity is bariatric surgery, a major surgical procedure. Requiring people to undergo a major surgical procedure as a condition of receiving benefits seems far from ethical, it said. The British Psychological Society has also commented that the proposal could violate medical ethics. Central London GPs invited to stand in open elections to CCG governing body Central London CCG is to hold elections to its governing body and has invited local GPs to stand for election as GP member leads. GP member leads provide clinical expertise to the governing body and form an important part of the CCG s strong clinical and corporate leadership, actively supporting practice engagement and involvement. The CCG intends to run an inclusive election for seven GP member lead roles to be contested by a range of candidates competing to fill vacant GP member lead positions. Governing body elections will be held on 30 September 2015. The new governing body will meet as soon as possible after the election, when it will elect the Chair and Vice-Chairs of the CCG. Declarations of Interest and Gifts and Hospitality The CCGs have responded to a call, by Dame Barbara Hakin, to review our systems and processes for managing and monitoring declarations of interests and gifts & hospitality. This comes in the wake of allegations that a number of individuals in the NHS may have acted inappropriately in dealings with pharmaceutical companies. We have concluded that the CCGs have in place appropriate systems and processes to ensure that conflicts of interest or potential conflicts of interest are declared and mitigated. Each CCG has a Conflicts of Interest Policy, which has been approved by the Governing Body. The policy includes guidance and processes for recognising and declaring potential and actual conflicts of interest, as well as declaring gifts and hospitality. 8
All colleagues are reminded of the importance of notifying the CCG Head of Governance, immediately, of a potential or actual change in circumstances. Clare Parker Chief Officer CWHHE CCGs 25 August 2015 9