Haringey CCG Governing Body meeting Thursday 28 November 2013 Questions from the public Question From? Response 1 Re: Commissioning Intentions item 3.1b: Diagnostics Contract. Why can t the CCG continue this contract? Is it "necessary, desirable or appropriate" to consider competitive tendering as per your Constitution? Has the CCG looked at companies with ties to the NHS? The existing diagnostics contract with InHealth has been in place for 5 years and comes to an end at the end of March 2014. In light of this, we are legally required to re-look at the contract; it cannot just be rolled forward. The current contract was commissioned across the whole of London. It is now being procured across the five CCGs in north central London, including Haringey. If you have to tender then Haringey would strongly urge the CCG not to go for Any Qualified Provider, as this could lead to privatisation. Can the CCG assure us that they will take the preferred option of an Invitation To Tender? 2 Re: Commissioning Intentions item 3.1b: Future Health Contracts. Various schemes are planned e.g. Dermatology in the community. However it is not clear whether this requires commissioning and possible tendering. In the interest of transparency and to give clearer information to the public could a link called say Health Contracts be put on the CCG website. This could give a brief description of the service proposed for change, amount, etc and who is awarded the contract. Commissioning is more than just contracting and procuring services. It s about using clinical expertise and evidence of best practice to ensure that services meet the needs of local people. Dermatology is an example of an area that we want to look at to review how the whole care pathway is working for patients. This process may or may not result in a procurement; which is the technical contracting part at the end of the review process. So it would potentially be misleading to share things like this on a website before a decision to procure was made. Any decisions to commission a service or let a new contract via a procurement process will be taken by the Governing Body and all such procurements are advertised on the NHS Supply2Health website www.supply2health.nhs.uk.
3 Re: Commissioning Intentions item 3.1b: Regarding the Direct Access Pathology proposed commissioning of a significant part of this with NCL to a Joint Venture consisting of UCLH, N Middx, Royal Free and TDL (The Doctors Laboratory.) We understand that TDL has been taken over by a private company called Sonic Healthcare. Haringey oppose any use of private healthcare. Can the CCG detail what Pathology services are commissioned for Haringey and when this future review will take place? Has the CCG considered a NHS only pathology service like Barts or the Homerton? If not why not? And given the recent concerns raised by Royal College of Pathologists can you assure the public that quality not finance is overriding decision for this proposal. 4 Chief officer s Report: Contract to Concordia. 38 Degrees Haringey are disappointed that the CCG is putting public money into a private company. We believe this damages the NHS. Can the CCG say what checks were done on this company? For example - Is it an ethical company i.e. it does not avoid tax (an action specified in your Constitution );have you specified that there be no reductions in staff; what indemnity there is in case they wish to pull out; will it be transparent on reporting complaints? How was this bid scored and what "weighting" was used? The part you are referring to in the commissioning intentions paper was misleading and we have now amended it to make it clearer in a revised version (available on the website with the meeting papers). To clarify, the CCG commissions a range of care pathways from acute trusts and pathology will be part of those packages of care. The majority of what we commission comes from the North Middlesex and the Whittington as our two main providers, but there are other providers as well. All providers will have a lab for pathology services. The CCG has no plans to change the sites from which it currently commissions pathology services. However, it is up to each provider as to how they provide services; for example, they might subcontract some of the service to another organisation. As long as the service continues to meet the quality and performance criteria and requirements set by the CCG and the CQC, this is not a problem. As with all our procurements, we have followed a proper process which is governed by strict legal rules. All bidders in a procurement process have to provide information which shows that they are financially sound. Quality also forms a big part of their submission and is judged against criteria set prior to the process. In this particular procurement, the submission criteria were 100% focused on quality because a fixed financial tariff was agreed prior to the procurement starting. 9 organisations submitted a pre-qualification questionnaire (the first stage of the procurement application process). This included 2 NHS providers; neither of which met the minimum quality requirements to proceed into the next stage.
5 Re: Commissioning Intentions item 3.1b: Haringey members are concerned about the future of Phelotomy (Blood Supply) in Haringey. At present it is operated under the NHS. Can we have the CCGs assurance that this service will be kept within the NHS in future? 6 Re: Commissioning Intentions item 3.1b: CAMHS service: You mention a "broader range of providers" Can you say who you are considering? And what specific changes are being made to increase Community treatment in Borough? 7 St Ann s Redevelopment App 3.2. On behalf of the group Haringey Needs St Ann s Hospital (HaNSAH) we welcome some of the proposals in BEH MHT s report. We are campaigning for expanded and integrated health services on the St Ann s site. We disagree with the statement of "broad public agreement " as the Community Reference were constantly frustrated in not getting basic information like whether a health assessment was made for the area testing that all health needs are covered.( I have sent the CCG a copy our Deputation to the Councils Overview and Scrutiny Committee on 7 /10/13) On Mental Health. The report shows there is an increased (and urgent) need for acute beds -which HaNSAH have been pointing out. BEH MHT and CCG are reviewing the future numbers of acute beds needed, and BEH has made capacity on the site for them. Will the We couldn t see anything in the commissioning intentions paper about phlebotomy services in Haringey. Please confirm what this question relates to so that we can provide you with a response. We think this sentence ( a broader range of providers ) in the commissioning intentions paper might have been a bit misleading. To clarify, there are no plans to have more providers in Haringey. There is, however, a need to raise awareness of the many services that are already available and how to access them. Work is being undertaken by the CCG with Barnet, Enfield and Haringey Mental Health Trust to improve access to Tier 3 CAMHS services in Haringey. The CCG is also working with the council to improve awareness of the broad range of providers already delivering Tier 2 CAMHS in Haringey. We recognise that there has been an unplanned increase in acute adult mental health admissions across London and nationally over the last 12 months and therefore the NHS locally (the CCGs and the mental health trust) are reviewing what may be required in terms of inpatient provision in the longer term. This is why the mental health trust is building in some flexibility into their outline planning application for St Ann's. We will continue to work together and keep the situation under review. We are also working closely with the Trust to think about their future structures and plans, and the emphasis will be on the development of care and support in the community and the commissioning of recovery-focused services to try and help people stay out of hospital.
CCG commit to commissioning these extra acute beds and commit to increasing the number of much needed Recovery House and Home treatment bed capacity? 8 St Ann s Redevelopment App 3.2. HaNSAH believe that a further Health Needs assessment by the Director of Public Health is needed as well as the JSNA that the CCG base their plans for health (as per H&SC Act).We believe that there is a need for an Integrated Child Development Centre bringing together health and Social Services. This is supported clinically by Whittington Health and supported by Councillor Ann Waters. We also believe that there is a need for an Urgent Care Centre to take pressure off the GPs in the area. (See our Deputation for details ) Can the CCG commit to working with the Council, the Director of Public, and HWB to fulfil their statutory role in examining future health needs and look at these options? 9 What are Haringey CCG's commissioning intentions regarding the Whittington? I have some concerns having read the following relating to emergency and urgent care: the BEH Clinical Strategy dated 25/9/13 notes that emergency, urgent and acute care will see emergency services concentrated at Barnet and NMUH hospitals with an urgent care centre at Chase farm. It also mentions plans for considerable investment in emergency series at BH and NMUH. There is no mention of the Whittington as a provider of emergency services Haringey CCG commissioning intentions paper November 2013 does not specify named Brenda Allan Please see answer to question 6 re: how we are working with the mental health trust about their future plans. Under the Health and Social Care Act 2012 local authorities and clinical commissioning groups (CCGs) are, through their health and wellbeing boards (HWBs), required to undertake a joint strategic needs assessment (JSNA) to assess the current and future social care and mental and physical health needs and assets of the local population and a joint health and wellbeing strategy (JHWS) which sets out the health priorities and how these will be met. Clinical commissioning groups and local authorities have a statutory requirement to take account of the JHWS in their commissioning plans. March 2014 will be the end of a 2 year agreement with the Whittington, so it s likely that contractual form will change and discussions are already taking place. The Whittington is an integrated care organisation that provides both hospital and community services for people in Haringey. In light of this, commissioning for values-based outcomes will be a really important part of our discussions with the Whittington. There are a number of areas which we have invested additional money in this year through the Whittington. These include 24/7 district nursing service, catheter care, RAID services, and ambulatory care. Thank you for your other comments. As a point of note, the Barnet,
providers except the new UCC at NMUH. Reference in the Haringey CCG s Finance report of 'overperformance ' in its contract with the Whittington The Whittington has said that its revised plans including not to close beds, depends on services continuing to be commissioned from them Enfield and Haringey Clinical Strategy only concerns services in and around Barnet and Chase Farm hospitals and North Middlesex Hospital which is why the Whittington is not mentioned. There continues to be an urgent care centre and A&E department at the Whittington for Haringey residents. You can find out more about the BEH Clinical Strategy here. 10 Given the national funding reductions in primary care as a proportion of the NHS budget, and cuts in local authority social care provision, what will be the impact locally on plans to shift the focus of services from hospitals to the community? Brenda Allan The CCG has not yet been given its funding allocation for the next year and is set to receive this in mid-december. NHS England, not Haringey CCG, commissions primary care services nationally, and therefore NHS England holds the budget for these services. Financial pressures are likely across all areas of the NHS. The CCG remains committed to making sure people in Haringey have access to high quality health services; services that are clinically effective, high quality, close to people s homes and provide good value for money.