WOLVERHAMPTON CCG Governing Body Meeting 9 th September 2014 ` Agenda item:12 TITLE OF REPORT: REPORT PRESENTED BY: Title of Report: Purpose of Report: Commissioning Committee Summary Kamran Ahmed Update from the Commissioning Committee reporting period 31 st July 2014 and 31s t August 2014. To provide an update of the Commissioning Committee to the Governing Body of Wolverhampton Clinical Commissioning Group (CCG). Author(s): Owner: Filepath: Key Points: Recommendation to the Board. Action Required: Clinical view: View of patients, carers or the public and the extent of their involvement. Resource Implications and Kamran Ahmed Kamran Ahmed W:\Commissioning\Sharon\Comissioning Committee\CCM\Meeting 2014\August 2014 For Information and Assurance Key points highlighted in the report. The Governing Body of Wolverhampton CCG considers the contents of this report. Decision Assurance The meeting is attended by CCG board members and DDG leads providing clinical and managerial input. Meeting open to the Public and attended by appointed Lay representatives. Contained within the report and detailed in formal WCCG Governing Body Meeting Page 1 of 10
Financial consequences: Relevance to Board Assurance Framework (BAF): minutes. Select which Domain(s) the report is relevant to: Domain 1: A clinical and multi-professional focus, with quality central to the organisation. Domain2: Good engagement with patients and the public, listening to what they say and truly reflectingtheir wishes. Domain 3: A clear and credible plan over the medium-term to deliver great outcomes within budget, which has been determined in partnership locally, and reflects the priorities of the health and wellbeing board. Domain 4: Proper constitutional and governance arrangements, and the capacity and capability to deliver all their duties and responsibilities. Domain 5: Collaborative arrangements with other CCG s, local authorities and NHS England, appropriate commissioning support and good partnership relationships with their providers Domain 6: Great leaders who individually and collectively can make a real difference. Risk / Legal implications: Implications on Quality and Safety: Equality Impact Assessment: Implications on Information Governance Relevance to National / Local Policy: OUTLINED IN REPORT OUTLINED IN REPORT N/A N/A WCCG Board Assurance Framework 1. PURPOSE OF THE REPORT To provide an update from the Commissioning Committee to the Governing Body of Wolverhampton City Clinical Commissioning Group (CCG). WCCG Governing Body Meeting Page 2 of 10
Overview of Committee Discussions 2.1 Wolverhampton City Council Medium Term Financial Strategy (MTFS) Savings Proposal Update. At its meeting in January 2014 CC received a report on the WCC MTFS savings proposals. This outlined Government grant reductions meaning that the Council had to find 98M of savings by 2018/2019 on top of the 100M it has already made over the past 5 years. The MTFS was updated in June 2014 The Local Authority Cabinet approved a range of further savings proposals. These amount to 16.9M and are in addition to 63.8M of savings already agreed over the MTFS period. These combined savings reduce the Councils forecast medium term deficit from 123M to 42.3M. WCC is on target for savings in 2014/15 with 2015/16 identified as a more difficult timeframe. Key points - 5M savings target Looked after Children - 7M savings target Promoting Independence Older & Younger Adults Mental Health. [30% has been taken out of the total contract from this allocation] Actions - WCC will share implementation Plan in a private meeting with CC following cabinet agreement in September. This will assist in outlining schemes that will directly impact on healthcare. - WCC will aim to share risk templates for WCC schemes in private meeting with CC. 2.2 NHS 111 Procurement NHS 111 is the telephone answering service for OOH in the West Midlands with the exception of Shropshire. Following the failure of NHS Direct, the original NHS 111 procured provider across the West Midlands, CCGs were required to secure step-in arrangements for provision of this mandated service. Step-in providers were secured and contracts run from November 2013 to April 2015, provision to extend for a further 6 months, subject to prior notification, to September 2015. Following a commissioner event in May 2014 a paper was drafted for CCG AOs highlighting key factors requiring CCG decision. This paper was discussed on 23rd May 2014 by AOs or their deputies. There were three primary outcomes:- - Sandwell & West Birmingham CCG to continue as the lead collaborative commissioner for the NHS 111 service across the West Midlands. Thus the requirement is the mobilisation of a robust project team for NHS 111 re-procurement and to continue to lead the step in service and its decommissioning. WCCG Governing Body Meeting Page 3 of 10
- Sandwell & West Birmingham CCG to develop an options appraisal of the key decisions to be taken and the options available to the CCG s. - Make recommendation for a preferred approach for the re-procurement of NHS 111 services across the WM CCGs. The current service providers are: - Staffordshire Doctors On-Call (SDUC) for the 6 Staffordshire CCGs - West Midlands Ambulance Service (WMAS) for the remaining 16 WM CCGs. This service will legally; need to be procured to avoid competition challenge due to the process used to secure the step-in providers. It is anticipated that a single procurement exercise will cost c. 300-500k. CCGs need to consider the levels of additional costs to individual CCGs by having multiple procurement processes, e.g. If there are 5 procurement exercises the costs to the CCGs will be 5 * 300-500k. Essentially, the more procurement processes the greater the cost to each individual CCGs. The options outlined in section 4 have been identified by CCGs as potential procurement approaches. The options are: Option 1: Option 2: Option 3: A single procurement exercise across 22 West Midlands CCGs excluding Worcestershire CCGs A West Midlands single exercise procurement excluding Worcestershire CCGs A multiple procurement exercises across the West Midlands CCGs There has been a notable improvement in quality with the current service with Sandwell and West Birmingham CCG managing the current contract well. Action The CC recommends Option 1 - A single procurement exercise across 22 West Midlands CCGs excluding Worcestershire CCGs to Governing Body. - provides for a cost effective procurement approach across the West Midlands, limiting risks associated to transfer of service provision to identified preferred providers. - supports information and knowledge transfer across West Midlands CCGs. - supports the delivery of local sensitivities and commissioning ambitions delivered through locally developed service specifications. 2.3 Adult Placement Panel An overview was presented of the new service. The Adult Placement Panel, which includes a GP with an understanding of Mental Health, commenced in November 2013. - There are currently 21 individuals requiring care from specialist placements - There were 17 historical cases agreed prior to CCG inception in April 2013 that were in receipt of care WCCG Governing Body Meeting Page 4 of 10
- Between April 2013 and June 2014 8 individuals have been discharged from specialist placements - From November 2013 and June 2014 a total of 11 cases have been considered by the panel ( at present 2 are still awaiting placement to commence) - 1 individual was placed via a Court Order for a period of 28 days - There are 5 individuals awaiting assessment and consideration who are currently in secure care - 1 individual is incurring costs of 5,000 a week and negotiations continue with NHS England to share the costs of this patient. Only one facility nationally would accept this individual as an inpatient. - The CCG should be aware that due to the cost pressures currently being experienced in all areas of NHS, this is likely to increase referrals from NHS England as Specialised Commissioners are under considerable pressure - The number of individuals requiring assessment and consideration for specialist placements is increasing year on year. - This is likely to continue to rise, given the fact that Wolverhampton has a significant number of individuals currently detained within High, Medium and Secure Settings; the majority of who will move through the system until they require rehabilitation placements funded by the CCG. - The limited number of specialist placements within the NHS requires the CCG to commission out of city care within private hospitals in order to meet individuals needs 2.4 AOB - July 2014 a) Headstart Wolverhampton have been successful in receiving 0.5M from the Big Lottery Fund. A Launch Event has been held and Wolverhampton will look to future funding for this scheme. b) Assisted Conception Queries were raised by the Governing Body regarding the new regional Assisted Conception policy and possible challenge around i) number of cycles offered and ii) requests made by transgender couples. The CC received assurance on both these issues from the Wolverhampton Commissioning Manager Lead. 2.5 Adult Mental Health Strategy Including Implementation and Financial Plan An update of the Mental Health Strategy Refresh Including CAMHS and Pond Lane / Learning Disabilities (LD) service was presented. The Implementation plan was presented and An Agreement has been reached for the new service to fit within current financial QIPP savings. The Core Group will meet monthly and will continue to identify new opportunities for QIPP. A New LD pathway will be visible from April 2016 and changes in the delivery of the service will be visible from June 2015. The Mental Health refresh will be aligned with Better Care Fund. Actions: Gantt chart mapped on Implementation plan. WCCG Governing Body Meeting Page 5 of 10
A full presentation will be given to Governing Body at the September Board Meeting. 2.6 Certiluzimab (Cimzia) for alternative indications other than Rheumatoid Arthritis (RA) Business Case. A business case received from RWT and presented by the Medicines Management Commissioning Lead. Cimzia is currently NICE approved for RA but also licensed to be used for i) Ankylosing Spondylitis and ii) Psoriatic Arthopathy. This would be an additional treatment option for these two conditions. Cimzia has shown to have a better response rate for these two conditions compared to placebo. The manufacture has agreed to provide the first 12 weeks of treatment free of charge to the NHS. Therefore cost at Year 1 = 6792 and Year 2+ = 9295. The treatment is delivered by the subcutaneous route and delivered to patients by Homecare Service. The business case will result in a cost saving for the CCG and has been identified as a QIPP scheme. Action Recommend Approval of Business Case to Governing Body. 2.7 End of Life Strategy EOLC helps all those with advanced, progressive, incurable illness to live as well as possible until they die. It enables the supportive and palliative care needs of both patient and family to be identified and met throughout the last phase of life and into bereavement. It includes management of pain and other symptoms and provision of psychological, social, spiritual and practical support. A local EOLC Strategy based on the national EOLC Strategy ran from 2009-2013. Since 2012 a commitment was made for the national End of Life Care strategy to be refreshed however this has not taken place. To this end a local EOLC Strategy for Adults in Wolverhampton has been drafted with input from the CCG, local acute, community and hospice services. The Draft EOL strategy was presented. The draft strategy proposes 12 projects aimed at driving improvements in EOLC. Projects:- Health Economy Wide Developments 1. Rapid Discharge Home to die pathway 2. Do Not Attempt CPR 3. Advance Care Planning template and Facilitators 4. New guidance for the management of the dying patient 5. Electronic Palliative Care Co-ordination System (EPaCCS) 6. Transition Pathway for young people with life limiting conditions Development Specifically Impacting on End of Life Care in Hospital WCCG Governing Body Meeting Page 6 of 10
7. Gold Standard Framework in Hospital Development Specifically Impacting on End of Life Care in Residential Care 8. Development of Clinical Guidelines on the management of patients at the end of life in Nursing /Residential Homes. 9. Care Homes Education in EOL Other projects that will impact on the provision of EOL in Wolverhampton 10. Review of Community Services Provision 11. Homes in Reach Team (HIT) 12. Enhanced Services for patients at high risk of unplanned admissions An overview of these projects was presented. Action - Identify the lack of resource for Primary Care GSF is a risk to the implementation of EOL Strategy - The EOL strategy will be closely linked to the CCG Strategy and Better Care Fund - The EOL project team to demonstrate value of projects proposed and funding - Education via TEAM W workshops for GP s / Care homes to be organised to increase ownership of strategy and suggested projects. 2.8 Home in Reach Team Business Case Pilot undertaken to develop a dedicated team to support residents of nursing homes when they deteriorate and to provide support to staff. - A&E attendances, acute admissions and deaths in hospital all reduced during the pilot for the homes included. - A small number of nursing homes were identified from A&E attendance data for the pilot. - The pilot showed a reduction in A&E attendance, Acute Admissions and Deaths in Hospital between the pilot periods (January May 2014) relative to the previous year despite the Urgent Care Pressures seen this year. - An initial business case received in July 2014 was felt to be deficient and was returned to RWT. A further business case has been received at CC in August 2014 that addresses the key issues and an outline of a future for this service. -Three options identified; i) Do nothing ii) Option 2 - implement a 5 day service for all 20 NURSING homes in Wolverhampton iii) Option 3 - implement a 7day service for all 20 NURSING homes in Wolverhampton Option 2 shows savings of 128k but requires an increase in funding to meet the seven day framework. This saving does not take into account the cost of the geriatrician which is paid by the CCG from a separate budget. Option 3 shows savings of 157k the saving is not exponential due to the increased clinical cost for consultant cover over 7 days. WCCG Governing Body Meeting Page 7 of 10
Actions - Recommend the approval of Option 3 7 Day service - to the Governing Body. - Approval subject to sharing costing, Approval from finance & agreement on service specifications for this service. - Undertake a review of funding for 2015/16. 2.9 Contracting & Procurement Update Month 3 Report (June) Contract Status A number of contracts where Wolverhampton is not the host commissioner remained unsigned and we continue to chase Lead Commissioners. Those of sufficient value including Nuffield Hospital (2.6M) and University Hospital Birmingham NHS FT (2.1M). RWT Fines RTT General Surgery RTT Trauma & Orthopaedics Diagnostic waiting > 6 weeks A&E ambulance handover E-discharge YTD variance is 1,719,000 Over performance. The majority of the over performance is in Non-elective care spells. (1,2M) and first and follow up outpatient attendance. BCPT A Remedial Action Plan has been received to achieve IAPT waiting times. Procurement See Register - Appendix 1 160 days procurement time allocated for 2014/15 44 Days procurement time remains 3. CURRENT SITUATION Contained within section 2 of the report 4. KEY RISKS AND IMPLICATIONS Contained within section 2 of the report WCCG Governing Body Meeting Page 8 of 10
5. RECOMMENDATIONS Receive and discuss this report. Note the action being taken. Name Dr Kamran Ahmed Job Title Governing Body Lead - Commissioning & Contracting Date: September 2014 ATTACHED: Appendix 1 Procurement Schedule GLOSSARY: NIL WCCG Governing Body Meeting Page 9 of 10
Appendix 1 - The table below outlines the current procurement register for 2014/15:- Service Area: Project Lead: : Procurement Type: Non-Emergency Patient Transport (NEPTS) Assisted Conception Services Termination of Pregnancy Services (TOPS) Community Dermatology Service Primary Eye Care and Assessment Service (PEARS) Urgent Care Service Clare Barratt Clare Barratt Clare Barratt Sharon Sidhu Sharon Sidhu Dee Harris Modernisation and Medicines Optimisation Modernisation and Medicines Optimisation Modernisation and Medicines Optimisation Modernisation and Medicines Optimisation Modernisation and Medicines Optimisation Primary Care Procurement Start Date: Procurement Days: Expected Contract date: Closed September 2013 1 October 2014 *DELAYED* Start Governing Body Approval: April 2014 Closed September 2013 0 August 2014 May 2014 Open May 2014 10 November 2014 September 2014 Closed February 2014 20 April 2015 September 2014 AQP April 2014 15 August 2014 * Delayed to September 14 TBC TBC (Autumn 2014) 40 TBC TBC July 2014 Step Down / CHC Framework Dorothy McIntosh / Angela Parkes Integrated Programme Board Framework October 2014 30 (TBC) April 2015 February 2015 WCCG Governing Body Meeting Page 10 of 10