Item Number: 6.1 GOVERNING BODY MEETING Meeting Date: 24 September 2014 Report s Sponsoring Governing Body Member: Simon Cox Report Author: Janet Probert, Director of Partnership Commissioning 1. Title of Paper: Partnership Commissioning Unit Update Report 2. Strategic Objectives supported by this paper: (check those which apply) To create a viable & sustainable organisation, whilst facilitating the development of a different, more innovative culture To commission high quality services which will improve the health & wellbeing of the people in Scarborough & Ryedale To build strong effective relationships with all stakeholders and deliver through effectively engaging with our partners To support people within the local community by enabling a system of choice & integrated care To deliver against all national & local priorities incl QIPP and work within our financial resources 3. Executive Summary: The purpose of this report is to give the Governing Body an overview of the role and responsibilities undertaken on their behalf by the Partnership Commissioning Unit (PCU) and the changes that have been made in the past twelve months to improve productivity, efficiency and clinical governance. 4. Risks relating to proposals in this paper: N/A 5. Summary of any finance / resource implications: N/A 6. Any statutory / regulatory / legal / NHS Constitution implications: N/A 7. Equality Impact Assessment: N/A 8. Any related work with stakeholders or communications plan: Ongoing as part of the PCU work programme. 9. Recommendations / Action Required To note for assurance. Page 1 Our Vision to Improve the Health & Wellbeing of our Communities
10. Assurance Paper is written to provide assurance to the Governing Body in relation to the PCU s work programme. For further information please contact: Name: Janet Probert Title: Director of Partnership Commissioning : 01904 694717 Page 2 Our Vision to Improve the Health & Wellbeing of our Communities
NHS Scarborough & Ryedale Clinical Commissioning Group Governing Body 24 September 2014 Partnership Commissioning Unit Update Report 1. Introduction and Purpose The purpose of this report is to give the Governing Body an overview of the role and responsibilities undertaken on their behalf by the Partnership Commissioning Unit (PCU) and the changes that have been made in the past twelve months to improve productivity, efficiency and clinical governance. 2. Continuing Healthcare (CHC) The CHC service has seen dramatic changes over the last 12 months. In September 2013 the service was a paper and a QA system with all the records stored for the whole of the North Yorkshire. This had led to a number of concerns over access to records in a timely way and a number of information governance issues related to the storage of these notes. An electronic system, SystmOne was implemented earlier this year and all previous records were scanned into the system. The CHC system is now paperless with everybody using an electronic system to access patient records, all assessments are now input directly onto the system and the CHC team were the first in Yorkshire and Humber to implement mobile working using SystmOne. The implementation of this system has led to significantly more confidence in the data relating to CHC and has allowed much closer monitoring of individual packages of care and the performance of the CHC team. It also means that the administration team and the nursing team can have access to the same records at the same time without needing to wait for notes to be returned to specific locations. Alongside implementation of SystmOne, the department has been restructured to allow the clinical and normal clinical staff to work more closely together in integrated teams. This has allowed the administration staff to make appointments on behalf of the clinical team, co-ordinate and prioritise work based on individual patient and service needs. A new Fast Track process has been introduced across North Yorkshire and York for patients at the end of life. Feedback to the CHC team had suggested that District Nurses were spending a considerable amount of time arranging packages for CHC patients at the end of life. A review of this service took place and as a consequence the District Nurses are now providing the CHC team with additional information
which has allowed the non-clinical staff in the CHC team to commission and implement the appropriate packages of care. The feedback from the District Nursing Teams has been really positive. Another concern raised in relation to Fast Track was the lengths of time it was taking to get approval for package from the CHC team. The turnaround time for Fast Track cases is now monitored very closely and over 80% of the packages are approved within an hour of being referred to the CHC team. Performance metrics have also been identified for implementing packages after referral and approval. This new system has been in place for just over a month now and the performance metrics were achieved 73% of the time during this period. Further work is ongoing to continue to improve this position. We are now considering commissioning options to improve continuity with existing local community services. There was concern that CHC assessments were delaying discharges from the acute hospital is across North Yorkshire and York. A review has been undertaken of how hospital discharges are prioritised and a 4 day performance target has been implemented. Any patient who has been referred for a CHC assessment who has not been seen within 4 working days will be reviewed and the reasons for the delay highlighted on a spreadsheet which is shared with the CCG Lead Nurses and both local authorities. The number of patients having an assessment within 4 days has increased dramatically, however there are still delays due to CHC nursing capacity, the family not being available to meet with us or because the local authority are unable to provide a social care practitioner. This is shared with both local authorities and action is taken on a weekly basis to address any delays. Performance is being added to the PCU matrix. There was a significant backlog in CHC assessments which has now started to be addressed by the CHC nursing teams. Performance is monitored on a weekly and monthly basis to ensure that we move to doing today's work today. Retrospective CHC assessments had not been addressed at all in September 2013 so the PCU decided to procure an external partner to undertake the preparatory work for retrospective assessment. A procurement process was followed and UK Independent Medical (UKIM) were appointed as partners, it is anticipated that the preparatory work, all the outstanding retrospective assessments (~600) will be completed within the next eighteen months, they will then progress through the normal decision making process within the Continuing Healthcare. Funding for these individuals is held by the Area Team. The contracting arrangements for CHC have improved significantly in the last 12 months. Invoices are processed in a timely and accurate manner and the amount of outstanding invoices have significantly reduced. In September 2013 the outstanding invoices were in excess of 10 million, on 2 September 2014 the outstanding invoices were 3.9 million, and many of these require joint working with both local authorities. Arrangements are now in place for these discussions to take place and they are working through outstanding invoices on a case by case basis. From September 2014 a self billing system will be introduced for funded nursing care which will give the providers a regular income with a reconciliation done every 3 months to ensure we are paying for the correct patients, this system is mutually beneficial.
Contracts are now in place for CHC providers and will be rolled out over the next few weeks, and the contracting process has been streamlined so it is requiring less input from the clinical teams. A brokerage system has been introduced which is ensuring that value for money is achieved for all new CHC cases and evaluation of brokerage will take place in December 2014. The PCU has developed a service specification for the equipment service it requires and it is intended to add this as a contract variation to the CCG contract with Harrogate District Foundation Trust, it is hoped this will be in place in the next few weeks. This will improve the management of equipment in a patient's own home as well as ensuring the governance around purchasing with appropriate training and advice is in place. Personal health budgets (PHB) have been introduced within CHC. From April 2014 patient's entitled to CHC funding in a community setting were able to request a personal health budget from October 2014 the health budget must be offered to everybody who meets this criteria. Within CHC personal health budgets are seen as a real opportunity to allow individuals and their families to develop a package of really personalised care. The PCU is working with the South Yorkshire CSU who have a great deal of experience working with 12 CCGs to deliver their personal health program. The PHB team are visiting any patients and their family who are interested in a PHB and working with to develop a plan of care that meets their clinical outcomes identified by CHC. An evaluation of this service will take place in April 2015, however informal feedback is very positive. The approach taken also has the benefit that as the patient groups are able to access PHB this service model would be able to adapt to meet their needs and provide the appropriate governance and financial framework. 3. Mental Health and Vulnerable People Individual Packages The focus of this team over the last 12 has been to ensure that all the patients who meet the criteria for the Winterbourne Concordat have been assessed and that their care is in line with the requirements to be as close to home as possible in the least intensive setting as possible. These are usually complex individuals who have a range of specific needs, they require intensive care planning with the existing provider to make any changes to their packages of care. Individual person centred care plans have been developed and where appropriate individuals are moving to the locality with appropriate support packages. The team approves and supports individuals who have significant mental health service requirements which are outside the contract with our main mental health providers. A piece of work is currently being undertaken to look at where it would be appropriate to commission services for cohorts of these patients within the existing contracts; ensuring that in doing so, it provides both high-quality care and value for money. It is anticipated this will be completed by the end 2014. The management of the individual cases within the PCU has continued with the same approach that was handed over from North Yorkshire and York PCT. To ensure that we are able to review and manage the individual packages, make
accurate funding assumptions about placements and also allow a strategic overview of the best way to provide services for these patients, we are now transferring the caseload onto the SystmOne package alongside CHC. This will allow us the same level of control and performance management that has already been rolled out within continuing care. It is anticipated that this transfer will be completed by the beginning of November 2014. Once the transfer to SystmOne is completed the focus for this team will move on to reviewing all the individuals who are currently under S117 of the Mental Health Act in partnership with both local authorities. These patients are entitled to free health and social care following admission to mental health services under parts of the Mental Health Act. It is appropriate to review these patients and ensure that where possible they are accessing mainstream health services which are funded as part of the main contracts that we are funding. Appropriate additional resources where required and discharging of these patients from S117 when they no longer meet the criteria. Many of these reviews are not up-to-date and as a consequence we may be funding services that are no longer required following individual patient assessments. This work has commenced and by December 2014 all pre-april 2012 cases will have been reviewed with a clear plan and funding agreement with the local authority for their future care. From January 2015 proactive management of all S117 cases will be implemented to ensure ongoing case management. 4. Safeguarding A designated professional for Adult Safeguarding was appointed to the Partnership Commissioning Unit in August 2014. The team is now fully established which will allow members of the team to link in with each CCG area. Over the next 6 months it is anticipated that the team will provide the clarity to all providers who hold contracts with the CCG about expectations relating to adult safeguarding. This will be part of all contract arrangements, and will be reviewed regularly to ensure that evidence is available that good practice is being demonstrated across the healthcare system. The safeguarding team are looking to improve and increase their working relationships with the safeguarding teams at both of the local authorities and continue the links with the Executive Nurses so that there is no ambiguity between issues relating to quality and safeguarding. The national profile of Mental Capacity Act and the Deprivation of Liberty guidance has significant implications for healthcare provision. The adult safeguarding team are taking a lead on behalf of the CCGs in improving both systems and understanding about the guidance and where it needs to be applied within healthcare settings. Funding has been provided by the Area Team for this year and next year to support the impending of the guidance. Within North Yorkshire and York the PCU has co-ordinated a number of training events primarily aimed at senior staff including Consultants and other clinical leaders to ensure that we are meeting statutory guidance in a consistent and appropriate way. The PREVENT agenda continues to have a high national focus and the adult safeguarding team are ensuring that this is embedded within our approach to
safeguarding with the opportunity to sign post primarily to the Police if concerns are identified. 5. Mental Health and Vulnerable People Commissioning and Contracting The mental health commissioning team have this year implemented a program of engagement initially in the Vale of York and more recently across the rest of North Yorkshire. Discover aims to develop a sustainable methodology for ensuring that the views of people and families who have needed mental health support are used to underpin the approach we take to commissioning services to meet these needs. This program has been tailored in each locality to fit with the local CCGs approach to engagement to ensure that there is a consistent approach and method used which does not cause local confusion or conflicting information. The feedback from the program today has identified very clearly about involvement in their own care plans, services in local communities and valuing the contribution of non NHS organisations to the mental health pathway. A number of partnership strategies and implementation programs are being developed with the local authority. We are currently working on an overarching mental health strategy that influences all the areas that contribute to well-being. It is anticipated that this will be completed in December 2014. A program of work looking at the key priority for dementia has been developed based on national group practice. The local approach to implementation will be based on' workshops with people who have dementia and their carers. This same group will be asked to monitor the implementation of the strategy and review its impact on people and their carers who have dementia. The key area of work has been to develop relationships with North Yorkshire Police and a new silver rated mental health meeting has been established. This meeting supports other developments such as Street triage which is currently being piloted in Scarborough and York, with a national program of wider roll out being anticipated in the next year. North Yorkshire and York now have two section 136 suites in Scarborough and York. The Northallerton Centre should be open during September 2014. Access to psychological therapies has improved significantly during 2014. In July 2014 the services were transferred to TEWV from Leeds and York Partnership Foundation Trust for the North Yorkshire patch to enable services to be integrated with the local mental health services. The national target for IAPT services is to achieve 15% in Quarter 4 i.e. January to March 2015. At this time it is anticipated that TEWV will achieve this target. Work is ongoing in each locality across both Yorkshire and York to implement a model of liaison psychiatry. A workshop held with the CCGs and local clinicians has developed a model which is now underpinned by a service specification which will be implemented in the CCG and its impact will be evaluated by the University of York. The PCU has led the contract arrangements with TEWV and has now established a quality subgroup and a finance and activity group. These groups are meeting
monthly and are providing significant assurance to the CCGs about the service provision. A meeting was held between the CCGs and TEWV in August identifying a service development strategy which uses the current resource as effectively as possible to continue to improve services over the next 3 years. 6. Childrens and Maternity Commissioning This team has seen a number of changes over the last year including the appointment of the Head of Service which has led to much strategic leadership and delivery across the whole team. The priority of the children and maternity's commissioning team has been to work with the CCG to develop the service specifications that underpin the new service provision for paediatric and maternity services at the Friarage Hospital. Involvement in this work continues through the implementation stage. Services for children s autism have traditionally not had the held the levels of capacity required particularly around assessment services. The national capacity to provide this very specialist service has been a problem within the CCG, there is a very high quality service provided by Harrogate District Foundation Trust, however it does not currently have the capacity to meet the level of the demand. Work has been undertaken to look for alternative providers and procurement routes to address this issue and plans are now being discussed with the CCG to progress this. An all age autism strategy is being developed with the local authority to provide a seamless pathway across health and social care for all individuals with autism who require support. The Department of Health strategy for children includes education health and care plans which are multi agency plans for individual children who have complex needs. The team have worked closely with both local authorities to agree how we jointly deliver these plans for some of the most vulnerable young people, including very effective engagement events with children and families which has informed our approach. Strong and trusted relationships have been developed with a number of parents groups and the team have regularly presented at conferences, meetings and schools to ensure that we get a joint understanding of how we work together across complex agendas to improve the pathway for children. Another area of focus for the team has been a comprehensive review of the CAMHS Service. North Yorkshire County Council are commissioning a new healthy child program which will impact on the school nursing service, but is aimed to provide a much more proactive approach to emotional health and well-being. It is really important that this service interface is effective with specialist health services including CAMHS. Work has been undertaken to ensure that the new specification does not duplicate services, but provides an effective pathway that children and young people can access based on their individual needs. Understanding what is part of the current contract and the current activity and delivery are important components of assessing the service requirements.
Work has also commenced with the local authority to improve transition arrangements for children with specialist needs moving into adulthood. This will provide a strategy for the next three years and will include a virtually integrated health and social care team to oversee this group of young people. 7. Corporate The delivery of the service strategies described above have been placed on ensuring that the Partnership Commissioning Unit is an effective body focusing on the key agendas for the local CCGs. To achieve this the Unit has undertaken a significant restructuring and has appointed new leadership to both the Children and Adult Safeguarding teams. We are currently recruiting to the Head of Mental Health and Case management which will ensure that the leadership and skills to provide expertise to the CCGs are in place. The governance arrangements have developed during the course of the year and include: Quarterly meetings between each CCGs senior management team and the PCU Senior Management team to ensure that we are working collaboratively on all the key agendas. The PCU Management Board which now meets bimonthly to provide assurance to each CCGs Chief Officer. A monthly performance report which is shared with the each CCG demonstrating performance against key targets. A risk register which is updated each month is shared with the CCGs at the Partnership Commissioning Unit Management Board. The Director and Deputy Director of the Partnership Commissioning Unit regularly attend key meetings with each CCG to provide expertise and assurance. Relationships have been developed with North Yorkshire County Council and the City of York Council to ensure that it is working at both strategic and implementation levels are as effective as possible. Internally within the PCU a number of steps have been taken to support the PCU staff. This has included two development days, a monthly team brief, a suggestion box which has a response board in the main reception area. Sovereign House has been redecorated and the reception area now has a receptionist. The staff room has been redecorated with new furniture which was chosen by members of staff. The Business Manager chairs a Communications Group which includes staff from all departments who look at how we can improve the way the PCU functions both internally and externally.
8. Recommendation To note for assurance.