CCG Narrative Template to Support Operational Planning, 2015/16 Page 1 of 59
Context Supplementary information for commissioner planning, 2015/16 asks that a full narrative detail of commissioners' operating plans must be available locally to be shared with partners and stakeholders including NHS England. The key elements of CCG operating plans to be covered in a full narrative are set out in the following template. The template asks that you outline any recovery or action plans where performance is not in line with trajectory. When detailing these, please provide specific actions, measureable ambitions and timeframes for delivery. The template should be completed and submitted in draft by Tuesday 7 th April. The narrative will be reviewed alongside CCG activity data, financial planning data and UNIFY submissions. CCG: West London CCG Date: 14 May 2015 CO signature: Clare Parker Page 2 of 59
1. Delivery across the five domains and seven outcome measures Baseline measure to set a quantifiabl e ambition Are you meeting the trajectory that was submitted as part of your 2014/15 operating plan? Please provide your 2014/15 ambition and performance to date. If you are not meeting the trajectory, what actions are you taking in 2015/16 to recover? Please provide specific actions, measureable ambitions and timeframes for delivery. Securing additional years of life for your local population E.A.1 (annual) - Potential Years of Life Lost (PYLL) from causes considere d amenable to healthcare 2012: 1823 2013: 1552 2014 data not available, but 15% improvement between the above years, so CCG expects to deliver 2014/15 plan. A joint plan is in place across the CCGs, NHS England and local authorities to reduce PYLL over the next 5 years. This plan includes the following key areas: Tri-borough CCGs Public Health Project Manager working with relevant area leads within the CCG, local authority colleagues and NHS England to complete a mapping exercise that focuses on interventions currently commissioned to support the reduction of PYLL for the top three causes of mortality. A benchmarking report / performance dashboard has been completed that identifies GP practices that are outliers in Page 3 of 59
performance across a number of public health areas (including immunisations, seasonal flu and screening). Plans being developed for the new extended access service for GP practices to include the requirement to provide flu, pneumococcal immunisations and childhood immunisations. A new community cardiology and respiratory service is being launched (effective from April 2015 for Central and West London CCGs). Childhood immunisations work programme: o Following on from the MMR1 local priority project from 13-14, the CCGs are now continuing to work on improving children s immunisations uptake across all vaccination areas for children aged 0 to 5 years. This includes regular updates to localities and practices plus snapshot performance pages on each CCG extranet are planned. o There is a particular focus on Page 4 of 59
improving uptake for MMR1 and MMR 2. Cervical Screening: o Collaborative work in improving cervical screening uptake across the 3 CCGs in conjunction with NHS E and LA colleagues via quarterly joint CCG public health meetings. o Snapshot performance data to relevant forums (practice nurse and practice managers). Seasonal Flu: o Weekly tracking of seasonal flu immunisations and reports to CCG representatives with special focus on children s flu uptake during campaign period. Improving the health related quality of life for people with longterm conditions, including mental health conditions E.A.2 (annual) - Health related quality of life for people with longterm 2012: 73.6 2013: 73 2014 data not available, but performance has worsened by 1% between the above years. Actions are described in the column on the right. Significant redesign programmes are underway within West London CCG to improve health related quality of life, reduce emergency admissions and support older people to live independently at home following discharge. The CCG s key transformational pathway change is its Whole Systems model of care Page 5 of 59
conditions for older people. This will be the mobilisation of an integrated way of working, focused on two hub sites, where teams are co-located and care is driven and co-ordinated by primary care. Reducing the amount of time people spend avoidably in hospital Increasing the proportion of older people living E.A.4 (quarterly) - Quality Premium Composite measure on emergenc y admission s E.A.S.3 (annual) - Proportion 2012: 1855 2013: 1773 2014 data not available, but 4% improvement between the above years, so CCG expects to deliver 2014/15 plan Note: as CCGs are not required to submit data against this measure, please include details of the ambition set in your Part of this new pathway will be the Community Independence Service, which will support patients when they are in crisis and need rapid access to a multi-disciplinary team, including nursing and therapies. The service will also provide rehabilitation and reablement to help people regain their independence. The Community Independence Service will be embedded in the Whole Systems model and will support primary care to manage its most complex and vulnerable patients. Whole Systems Integrated Care West London CCG is launching its Whole Systems model of care for older adults (aged over 65) in 2015/16. The model looks to transform patient care, with regular care planning, review appointments, a model of self-care including social prescribing, and the development of two care hubs (north and south) as a focus Page 6 of 59
independently at home following discharge from hospital of older people (65 and over) who were still at home 91 days after discharge from hospital into reablemen t/rehabilita tion services Better Care Fund plan and any improvements against baseline. RBKC Baselin e (2013/1 4) Plann ed 14/15 Planne d 15/16 Annual % 98.1 86.3 87.5 Numerat 680 599 607 or Denomin 695 694 694 ator Annual change in proportio n -11.8 1.2 Annual change in % WCC Baselin e (2013/1 4) -12% 1.3% Plann ed 14/15 Planne d 15/16 Annual % 92.4 87.5 88.2 Numerat 325 310 312 or Denomin 355 354 354 ator Annual -4.9 0.7 for local community-based provision and supported by a new integrated governance system. The main operational components of the model are as follows: The target population (patients who are over 65 years of age) is divided into 4 tiers, based on their needs (including mental health and social care needs, in addition to their clinical needs). The care delivered to a patient is based on the tier that the patient has been allocated to. Key building blocks of the 'Model of Care' for each patient are: o Supporting each patient with a proactive care plan (which is codesigned with inputs from patients, provides tools for self-care, provides for mental health/social care needs) with the aim of keeping people healthier for longer o Actively case managing patients with greatest need; to be undertaken by senior nurses who can conduct holistic health/social care needs assessment and are responsible for keeping track of care planning, keeping track of changes to the conditions of their patients, and Page 7 of 59
change in proportio n Annual change in % -5.3% 0.8% o o o following-up on referrals for these patients Enhancing GP-support for patients with greatest need; patients can be seen in longer appointments with their GPs (at the Whole Systems hub and practices) to allow for extra time to address the complex needs of this patient cohort Integrating care by bringing together GPs, older adult specialists, services such as imaging/diagnostics, allied health services/voluntary sector services to work closely with each other Providing urgent care and out of hours care through external services. The key objective for this wider system change is to deliver better organised care which is focused around the patient and where they reside/their home, avoiding preventable emergency stays in hospital and/or long-term dependency on institutional care. Community Independence Service The Tri-borough CCGs and local authorities Page 8 of 59
are commissioning a single, integrated Community Independence Service (CIS) in 2015/16. The Community Independence Service will provide a range of functions, including rapid response services to prevent people going into hospital, in reach services to support people with discharge from hospital, and rehabilitation and reablement, which enable people to regain their independence and remain in their own homes. The single integrated CIS specification that has been developed for 2015/16 will ensure that there are consistent standards and services available across the Tri-borough. The specification proposes an integrated, multidisciplinary model of care that includes: A Single Point of Referral A rapid response multidisciplinary team (MDT) providing community care within 2 hours and for up to 5 days Non-bedded community rehabilitation, treating noncomplex conditions in a community setting Integrated reablement with access to short term community beds for between 6 and 12 weeks Page 9 of 59
7 day support to help people leave hospital. This improved, integrated and standardised service aims to address an anticipated increase in demand for intermediate care services. It will create demand for care and support services in the community, especially home care and, for people with acute and complex needs. The integrated CIS will improve the person s and practitioner s experience of communitybased care and drive improved quality and savings by treating people outside of the acute hospital setting. Increasing the number of people having a positive experience of hospital care Increasing the number of people having a positive E.A.5 (annual) Proportion of people having a positive experienc e of hospital care E.A.7 (annual) Proportion 2012: 126.4 2013: 121.2 2014 data not available, but 4% improvement between the above years, so CCG expects to deliver 2014/15 plan. 2012: 7 2013: 5.5 The CCG is committed to working in partnership with patients, carers, the wider public and local partners to ensure that the services that are commissioned are responsive to the needs of the population. More specifically, the CCGs are committed to ensuring both the continuous improvement in patient experience and the overall quality of care that is provided locally. The CCG s Patient and Carer Experience Strategy was co-designed with patients, carers and stakeholders. It has identified key areas of priorities that the CCG has Page 10 of 59
experience of care outside hospital, in general practice and in the community of people having a positive experienc e of care outside hospital, in general practice and the communit y 2014 data not available, but 21% improvement between the above years, so CCG expects to deliver 2014/15 plan committed to resourcing and these are reflected in core quality schedule for 14/15. These include: Ensuring that providers produce quarterly patient experience reports which: o Incorporate qualitative as well as quantitative data o Compare feedback from weekday and weekend services o Capture feedback that reflects the diversity of their patient and carer population. o Include actions and evidence of improvements to address gaps in satisfaction and experience Working in collaboration with health and social care organisations through the Whole Systems Integration and Transforming Primary Care Programmes to embed patient and carer experience at every stage of development and implementation. More specifically to: o Ensure that patients are actively involved in shared decision making and supported by clear information that it appropriate to the patient and carer needs o Improve staff learning and experience Page 11 of 59
o To undertake a Community Independence Service insight project in order to capture patients, service users and carers insight to enable us to have a baseline on which we can evaluate impact in the future. Making significant progress towards eliminating avoidable deaths in our hospitals E.A.8 (annual) Note: Indicator in development, this should be available for measuring a national ambition in Autumn 2015 and local ambitions in 2016/17.For the purpose of your 2015/16 operating plan, please outline any local measures currently in use and any improvements against baseline Promoting patient and lay voice at a strategic level and in collaboration with CWHHE and North West London CCGs by ensuring that the following committees have lay and patient representation: o Clinical Quality Groups o CCGs Quality, Patient Safety and Risk Committees o NWL Quality Working Group o CWHHE Quality, Patient Safety and Risk Committee which is also chaired by a Lay Member. The CCGs have been monitoring the Summary Hospital-level Mortality Indicator (SHMI), all providers are either as expected or below expected for the SHMI scores at present and throughout the year. One Trust has displayed a significant downward trend across a two year period. We are seeking further clarity as to the change that led to this positive trend. We await the full guidance later this year. Page 12 of 59
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2. Improving Health: Your planned outcomes from taking the five steps recommended in the commissioning for prevention report Commentary The CCG s Contracting Intentions for 2015/16 have been developed following analysis of the CCG s key health problems and priorities. There are several sources of information to inform these plans, including the JSNA, the Health and Wellbeing Strategies for both Westminster and Kensington and Chelsea, and NHS England s Commissioning for Value packs, which serve as a benchmarking tool to compare pathways across similar CCGs. We also work closely with public colleagues who have supported us to identify priority areas of work relating to specific health needs in our population. What analysis have you undertaken of key health problems? Over the year we will seek to build further our business intelligence capability to provide a more comprehensive vision of past and current performance by providers at local level that will help us inform QIPP and commissioning planning for 2016/17. This is underpinned by a major business intelligence project (WHYSE) to implement an easier front-end to access data. Some of the key areas identified as priorities or opportunities through the JSNA and Commissioning for Value packs include: Mental health, including IAPT access, recovery and dementia Respiratory and cardiovascular disease Diabetes Paediatrics (including A&E attendances in under 5s) Delayed transfers of care Older adults inpatient spend (linked to LTCs) Sight loss Provision of self management for patients with long-term conditions Page 14 of 59
Improving primary care (including management of long-term conditions). The CCG has work programmes in place in these key areas, as outlined below. The CWHHE Collaborative has identified 6 strategic objectives, which are as follows: Based on this analysis, what are your priorities and common goals? Objective 1: Enabling patients to take more control of their health and wellbeing Objective 2: Securing high quality services that improve patients experience and outcomes for patients and addressing health inequalities Objective 3: Developing the mechanisms by which we can deliver high quality commissioning such as co-production with patients and co-commissioning primary care with NHS England Objective 4: Working with partner organisations to deliver improved integration of services Objective 5: Delivering strategic change programmes in the areas of primary care transformation, mental health, whole systems integrated care, and hospital reconfiguration Objective 6: Delivering our statutory and organisational duties In addition, the CCG has its own annual priorities, which fall into 6 work programmes, as outlined below. Finally, the CCG is working closely with its local authority partners in the delivery of the objectives in the Health and Wellbeing Strategies for both Westminster and Kensington and Chelsea. These objectives are as follows: Page 15 of 59
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The CCG s 6 priority out of hospital programmes, which are aligned to the key health problems and opportunities outlined above, are: Have you identified your high impact programmes? Programme Description Outcomes Whole Systems Integrated Care Mobilise WS model of care for older people Deliver seamless, integrated care and support to older people according to 4 tiers of need. This includes extended care planning appointments and access to a range of health and social care professionals, including case managers Non-elective admissions reductions linked to Community Independence Service and Whole Systems Excess bed day reductions 50% increase in number of patients seen by Primary Care Navigators Page 17 of 59
Self management support for patients with long-term conditions Primary Care Transformation Developing a new offer for Primary Care enabled through Co- Commissioning Launch of Out of Hospital Services, including services for management of diabetes, mental illness, care planning and multi-disciplinary team working and extended access Roll out of Prime Minister s Challenge Fund initiatives to support primary care access Mental Health Shifting Settings of Care IAPT access and recovery IAPT waiting times Dementia diagnosis Urgent care pathway delivery Whole Systems for long-term mental health needs Page 18 of 59 Increase in number of appointments available per 1000 patients in practices Improvement in network level performance in Out of Hospital KPIs (ie diabetes control) Increase in number of MDTs held in practices IAPT access (15%), recovery (50%) and waiting time measures (95% in 18 weeks and 75% in 6 weeks) 67% dementia diagnosis rate Unplanned Care Transforming Non-elective
unplanned care and embedding real pathway change Reducing DTOCs Extending ambulatory care pathways to prevent avoidable admissions Intermediate care beds Better Care Fund, including Community Independence Service and neuro rehab beds Paediatric children s hubs to be embedded Planned Care Transforming planned care and embedding real pathway change Launching and embedding new community pathways in cardiology, respiratory, dermatology and ophthalmology admissions reductions linked to Community Independence Service and Whole Systems Excess bed day reductions Increase in number of patients accessing ambulatory care pathways Reduction in NEL, A&E and outpatient attendances for paediatrics Planned care outpatient attendance reductions (ie 50% shift of cardiology and respiratory activity into community; 30% shift of ophthalmology activity) Hubs Development of integrated, multi professional care hubs Hubs to be operational in north and south to support Whole Systems and delivery of planned care services close to home Increase in services available in hubs in support of Whole Systems and service redesign Page 19 of 59
The CCG is currently reviewing the organisational structure and workforce required to deliver the above transformational programmes. What are your plan resources? All business cases and QIPP PIDs have clearly identified resources required for 2015/16. In some cases, this includes providing non-recurrent funding to support transformation. In other cases, redesign plans are supported through shifting activity from acute into community settings, therefore making more cost effective use of resources. The CCG is investing significantly in Whole Systems, the Community Independence Service and primary care in order to make real transformational change in the coming year. The table above, outlining the CCG s out of hospital priorities, provides some details of key measures. There are numerous other KPIs and measures in place across all programmes and QIPP initiatives. How will you measure progress? Progress on delivering the key projects within the programmes listed above is monitored via the CCG s QIPP and Operating Plan monitoring process. Programme and project managers are required to complete monthly updates on their actions and key risks. These are discussed at the CCG s QIPP and Operating Plan Delivery Group and at the Finance and Performance Committee on a monthly basis. Through the Senior Management Team (SMT) the project managers have a clear line of escalation for any risks and / or issues that cannot be mitigated or resolved locally. Page 20 of 59
3. Reducing health inequalities West London CCG s population is characterised by a large proportion of young working age residents, high levels of migration in and out the borough, and ethnic and cultural diversity. Although residents have high life expectancy, particularly in the south, there are significant pockets of poor health in the more deprived areas and therefore large inequalities. The CCG has published its Equality Objectives for 2013-16, which identify key areas of focus in reducing health inequalities. These are as follows: Priority Key actions Outcomes Which groups of people in your area have the worst outcomes and experience of care? How are you planning to close the gap? Supporting the physical health needs and emotional wellbeing of young carers Commission a young carers home based family support service to work with families to address: o Issues that can impact on the health of family members, e.g. poor diet, non-attendance at medical appointments o Poor attendance at school, lack of toys, books, etc. o Unrecognised or poorly managed mental health or substance misuse issues o Safeguarding concerns o Reach 20-25 families per year o Improve physical health outcomes (wider determinants) by appropriate use of health services o Improved mental health outcomes through the referral into preventative programmes - IAPT/young carer support services o Reduced levels of isolation for young carers o Improved identification of adults with complex health needs who have a young carer and are not currently Page 21 of 59
Reducing Social Isolation for people with Learning Disabilities o Improve the understanding of primary healthcare professionals in relation to the needs of people with Learning Disabilities and Autism o Work with practices to support reasonable adjustments and enhance the experience of GP practices for people with Learning Disabilities and Autism being supported via NHS/Social Services o Improve relationship between young carers and GPs via identification and referral o Improved engagement with education services through improved joint working between NHS and Education Services o Improved rate of health checks from 54% to 80% across member practices o Increased number of health action plans for people with learning disabilities o Reduced emergency interventions (Epilepsy) o Baseline of number of people identified on GP register o 10% increase in identification of people on spectrum across member practices o Autism awareness policy in 30% of practices o Improved impact on quality and safeguarding (Winter Bourne View) o Practices demonstrate and increased multidisciplinary approach to supporting Page 22 of 59
their patients with Learning Disabilities and Autism Improving identification of mental health patients Improve mental health and well-being for BME communities and people with learning disabilities. Review access to IAPT (Improved Access to Psychological Therapies) Improve the identification of patients, including older people, to reduce isolation and address their needs. To improve the access for people with learning disabilities and mental health issues from BME groups for primary care mental health services. To improve equitable access to all groups, in particular older people, long term conditions, carers and BME communities. Increase the number of older people recorded who access primary care mental health services to address their needs and reduce social isolation. Increase the number of BME communities and people with learning disabilities recorded who access primary care mental health services. Increase the number of people from BME communities, older people, carers and those with long term conditions who access IAPT. The CCG also has a number of other initiatives in place to reduce health inequalities and promote appropriate and fair access to healthcare for all population groups. These include: Health roadshows, which are being held in May and June 2015 to promote a range of messages in local communities, including how to access urgent care and mental health services Patient and Public Engagement grants, which have been awarded to third sector organisations to deliver a range of programmes locally, with particular focus on those groups who do not access healthcare in proportion to their needs Primary Care Navigators, who support older patients to navigate and access health care Page 23 of 59
services, thus improving their experience, reducing DNAs and improving outcomes. The NAO report references 5 key risk factors, which are: Tobacco High blood pressure Alcohol Cholesterol Being overweight In addition, there are 3 cost-effective high impact interventions recommended in the report: Does this include implementation of the five most cost-effective high impact interventions recommended by the NAO report on health inequalities? Increasing the number of smoking quitters through smoking cessation services; Improving control of blood pressure through prescribing anti-hypertensives to patients at risk of or already diagnosed with cardiovascular disease; and Reducing cholesterol levels through prescribing statins to patients at risk of or already diagnosed with cardiovascular disease. The CCG and local authority partners have a range of initiatives in place to reduce risk factors in these areas. These include: Smoking Cessation Stopping smoking is one of 5 top priorities for public health in the Tri-borough. A stop smoking quits and prevention service has been commissioned. The service runs three national and three local prevention campaigns each year, and works in schools and with young people to prevent the uptake of smoking. In addition, the service works with GPs, pharmacies, community groups, hospitals and mental health trusts to promote and develop the stop smoking agenda, with targets for 4 week quitters. The targets are focused on areas of deprivation and amongst communities where smoking rates are highest. Page 24 of 59
Work is also commissioned to support smoke free homes and cars; smoke free hospital grounds; and work with maternity services to reduce smoking amongst pregnant women. The Smokefree Alliance brings together all agencies involved in tobacco control across the three boroughs, reviews KPIs on underage sales, illicit tobacco, counterfeit tobacco, compliance with the health act, and numbers of quitters, and reviews progress across all the Smokefree agenda. Out of Hospital Service for Ambulatory Blood Pressure Monitoring Central London, West London, Hammersmith & Fulham, Hounslow and Ealing CCGs are currently working to deliver an ambitious Out of Hospital programme intended to ensure that patients are at the centre of care, with the registered GP providing, managing and coordinating the care received. A key part of each OOH strategy is the intent in each CCG to support the continued development of high quality primary care at both a practice level and network of practices level. As part of this work, the CCGs are commissioning an Ambulatory Blood Pressure Monitoring service from practices. This service is aimed at adults who need a diagnosis of primary hypertension particularly for patients with suspected white-coat hypertension, and also in patients with apparent drug resistance, hypotensive symptoms with antihypertensive medications, episodic hypertension, and autonomic dysfunction to provide reliable, convenient and accurate blood pressure readings. The service will enable further assessment enabling a more accurate assessment of blood pressure for those patients where this is clinically indicated. Practices will be expected to implement best practice prescribing guidelines as part of the model. Alcohol 2015-16 will be a year of transformation for substance misuse services in the Tri-borough due to the re-procurement of core drug and core alcohol services. The new services, due to go live in April Page 25 of 59
2016, will have a greater focus on outreach and will be equipped to respond to a broader range of substances to reflect local need. Success will be measured by improved access and delivering better outcomes. During the year there will be a number of alcohol initiatives under development, with the intention of engaging residents who drink problematically but are treatment naive. Particular attention will be given to improving access to community alcohol detoxification within primary care and developing joint initiatives to help identification and engagement via the local hospitals. By strengthening pathways, residents will be supported in community based treatment services and this in turn will reduce the burden that alcohol-related hospital admissions have on the NHS. Supporting patients with cardiovascular disease West London and Central London CCGs have recently procured a new community cardiology and respiratory service, which will support treatment and management of patients in community settings, close to home. The community cardiology service will provide a co-ordinated, integrated approach to cardiovascular prevention and management, to be delivered in easily accessible community locations across West and Central London CCG catchment areas. The service will provide a one stop service that can incorporate diagnostic testing and treatment during a single visit (where appropriate) and shift the activity, as far as clinically appropriate, from secondary to community care. The service will also provide education and support to GPs to enable them to manage their patients with cardiac conditions in-house and improve overall health outcomes through earlier diagnosis and treatment of common cardiology conditions. The service will be expected to implement best practice prescribing guidelines as part of the model. Page 26 of 59
Obesity Childhood obesity is one of the top five public health priorities in the Tri-borough. Data is collected on obesity for children through the National Child Measurement Programme. High rates of overweight and obese children have led to the recommissioning of children s weight management services, public health dietetics services, and the commissioning of two place obesity pilots, in Queen s Park, Paddington and in Golborne, in the Royal Borough of Kensington and Chelsea. These interventions will bring all groups to work together to reduce childhood obesity. For adults, the NHS health check evaluation reveals that amongst adults between 40-74, who are otherwise healthy, the rates of overweight adults was 31% and obese adults 18%; and physically inactive adults was 17%. Following a health check referrals are made to services including health trainers, Weight Watchers vouchers, community dieticians, and physical activity programmes. In addition diabetes champions, community champions and physical activity champions all raise awareness in the community and signpost people to prevention programmes and services. Learning Disability How are you planning to reduce health inequalities for Looked After Children and people with a Learning Disability and offenders? The CCG recognises that people with a learning disability can often find it difficult to access services in a way that meets their individual needs. Work will be undertaken during the year with people with learning disabilities, their carers and other partners across the statutory and third sector to improve access to equitable healthcare. This will include primary and secondary health care, as well as keeping people safe and reducing the inequalities that people with learning disabilities face that impact on their access to effective health care. The three CCGs (HF CCG, WL CCG and CL CCG) all have action plans from the LD Self- Assessment Framework to improve health outcomes and reduce health inequalities for people with Learning Disabilities. This includes: Page 27 of 59
Improving access to mainstream health care Improve (or maintain where performance is high) the rates of health checks and health action plans for people with learning disabilities including specific health outcomes Identify gaps in current provision of offender health services to people with Learning Disabilities Specific work areas include: West London CCG is working with its Tri-borough and local authority counterparts to reduce reliance on inpatient care for patients with learning disabilities, through the Care and Treatment Review (CTR) programme. CTR action plans are overseen by the Learning Disability commissioner across the three CCGs, and will inform future reporting to each CCG in order to provide assurance and oversight. The three CCGs are engaged with the three local authorities in improving the services available to support people with Learning Disabilities to achieve wellness and to avoid inpatient services where appropriate. This will be achieved through task and finish groups, which include children s commissioners, to ensure that the CCGs work with children and young people through transition to improve health outcomes and reduce the need for mental health inpatient services. One task and finish group has been held and identified opportunities for early intervention services based in the community, based on an existing model in one of the local boroughs. An additional area of focus will be upskilling staff in mainstream services, including community mental health services, in providing high quality reasonably adjusted services to people with Learning Disabilities. The CCGs have already made a proposal to produce all new information in language accessible to people with Learning Disabilities. All three CCGs have a focus on improving the rates of health checks and improved partnerships between the CCGs, primary care practitioners and the Community Learning Disability Teams, to better coordinate improved attendance at health check appointments. A pilot project has been working well and the CCGs are looking to roll this out more widely to target all GPs across the three CCGs. All three of the CCGs have attained at least an amber rating for health checks in their recent Page 28 of 59
Learning Disabilities Self Assessment, which was submitted in January. This is seen as a key element in promoting and maintaining positive health outcomes and reducing unnecessary and inappropriate inpatient admissions to acute and mental health placements. Procuring a service to reduce the health inequalities faced by families where there is a young carer providing support. Improving mainstream mental health services for people with Learning Disabilities through the Green Light Toolkit work stream. Looked After Children The CCGs are working with the Local Authority and Safeguarding Children Board via the Safeguarding Team to: Ensure that health assessments are completed in a timely way and are embedded into the individual child s care plan Use care plans to inform the development of a clear profile of children looked after by the local borough including age, gender, culture, specific health needs Identify specific areas of vulnerability for LAC such as child sexual exploitation Consider location of placements and identify gaps in provision whether locally or out of borough Agree priorities for 2016/17 commissioning intentions for LAC to address gaps Ensure that LAC is kept visible at LSCBs and that both borough and system wide views are taken. CCG staff work closely with local authority officers who support looked after children. Recent work has included Rethink enabling care leavers to co-produce training for social workers; revision of the looked after children s nurses service specification to improve quality measures; and sustained input to the new Education, Health and Care Plan process, including joint panels for complex placements. The CCG has also embarked upon work with local parent s group, Parents Active, to strengthen GP training on disability, improve local medicine management arrangements for families and to improve patient representation on performance and planning groups. Page 29 of 59
Offenders In each of our youth offending teams, there is a CAMHS practitioner embedded in the service. The CCG also spot purchases community assessments and treatments from the specialist CAHMS community service. West London CCG has published progress against equality objectives for 2013 in accordance with EDS2 Requirements. The Equalities Objectives have been identified in consultation with patients, service users and 3 rd sector organisations. The priority areas include: What progress have you made in implementing Equality Delivery System (EDS2)? Improving the quality of data collection in relation to patient experience by providers by ensuring that all data reports for 15/16 include: o 80% of data relevant to equalities groups within the local area. o Relevant to reasons for access and non-access. o Actions taken to improve equalities outcomes. Health and wellbeing for young carers Health and wellbeing for adults with autism Reducing social isolation for adults with learning disabilities Reducing social isolation for older adults Improved access to bilingual counselling Improved access to mental health services, including Improved Access to Psychological Therapies (IAPT) for: o Older adults o Young people (18 25) o People with a long term condition o Carers o BME communities Page 30 of 59
4. Quality - Responding to Francis, Berwick and Winterbourne View What quantifiable progress has been made in 14/15? What quantifiable ambitions are in place for 2015/16? What action plans are agreed to deliver this and over what timeframe? Supporting documents / references What is your ambition for quality improvement in response to Francis, Berwick and Winterbourne View Winterbourne View project across 8 CCGs Develop commissioning framework across the 5 CCGs for Winterbourne View to improve access to local community services with specialist support. CQG ToR.pdf Mental Health - LD.docx What is your ambition for reducing the number of inpatients beds for people with a learning disability and improving the availability of community services for people with a learning disability? Work has been achieved to reduce the number of people placed in inpatient beds. This is reported to NHS England on a fortnightly basis. The CCG has cooperated with NHS England in carrying out Care and Treatment Reviews on those where there are difficulties in finding appropriate placements. There are discharge plans in place for any patient who remains in an inappropriate ATU placement. By the end of Q2 a business case will be developed by each of the CCGs to consider. This will provide options for the commissioning of local services to reduce the need to use out of area assessment and treatment placements. It will also improve the local crisis and respite responses and potentially specialist community services, including WinterB reducing the number of inpatients b WinterB reducing the number of inpatients b Page 31 of 59
those to support some clients with a forensic history. Quality Patient Safety How are you addressing the need to understand and measure the harm that can occur in healthcare services? For example, duty of candour, HCAI and CQC themes and action reports related to providers from 2014/15. Using information from the reporting and investigation of serious incidents, the Quality and Safety Team works with colleagues across the five CCGs to improve the quality and safety of NHS commissioned services across The North West London Collaborative of Clinical Commissioning Groups. The sole purpose of reporting serious patient safety incidents is to generate and share learning to prevent harm to patients recurring. The Key Performance Indicators for providers for the Reporting and Investigating of Serious Incidents are In addition to safety assurance activity, the Collaborative Patient Safety Strategy (2015-16) will outline plans for a health system-wide improvement programme aimed at reducing harm from Pressure Ulcers. Pressure Ulcers continue to reflect a high human and financial cost and the success of provider trust approaches to reduce Pressure Ulcers is often an indicator of quality and safety in the organisation. The programme will use the Breakthrough Series Collaborative approach pioneered by the Institute for Healthcare Improvement and used with great success in the QIPP Safe Care Programme in 2011-12. CQG ToR.pdf To report on the Strategic Executive Page 32 of 59
Information System (STEIS) within 48 hours, the details of healthcare incidents meeting the nationally agreed definition of a Serious Incident To investigate using robust and reliable investigation techniques and submit a report to commissioners within 45 working days To develop an action plan designed to prevent recurrence and submit with the investigation report To be open and transparent with patient and their families about the incident, its investigation and outcomes To demonstrate an open patient safety culture through high reporting numbers, and by learning lessons from investigations and not Page 33 of 59
repeating the same mistakes. These KPIs are subject to amendment in the new National Framework for Reporting and investigating Serious Incidents which is due to be published in March 2015. This revised Framework will provide the basis for the Collaborative Patient Safety Strategy. The Patient Safety Team quality assures investigation reports received from providers, returning reports which fail to meet quality standards. A monthly report to Quality, Patient Safety and Risk Committees details provider performance over a six month period. This report will identify themes and trends from investigations. The Assistant Directors work together to identify remedies and to agree approaches with providers to improve quality and patient Page 34 of 59
safety. Data from a number of sources is used to create a broad picture of the organisational patient safety culture. In addition to STEIS, data form the National Reporting and Learning Service and the NHS Safety Thermometer help to understand the approach a provider has to safety, to data and to the use of data for improvement. How are you increasing the reporting of harm to patients, particularly in primary care with a focus on learning and improvement? How are you tackling sepsis and acute kidney injury? GPs are encouraged to report their concerns and CCGs have systems in place to gather intelligence on primary care services. The CCGs supported and funded the Practice Nurse Development Programme for primary care nurses in CWHHE. The Sepsis alert (Sept 14) was sent to all Trust Infection Prevention and Control teams and discussion has taken place The quality team will work closely with NHS England to develop systems and processes to further support the development of a reporting and learning culture in primary care. In 15/16 the CCGs and HENWL have supported the creation of fixed term posts to support the further development of practice nurses. A quality indicator on Sepsis has been included in Trust Quality Schedules for 2015/16 (acute, community and mental health), which Trusts will be required to report on Page 35 of 59
with them regarding its implementation: http://www.england.nhs.uk/wpcontent/uploads/2014/09/psasepsis.pdf A Sepsis Workshop was jointly coordinated with NHSE and the UK Sepsis Trust in Feb 2015, attended by 40 senior clinicians from across the health economy, to discuss and share approaches. All cases of MRSA sepsis are reviewed (whether Trust or CCG attributed) for any lessons to be learnt and action plans are monitored. All RCAs from SIs linked to sepsis are reviewed by the Quality Team. quarterly to CQGs. Work will take place to encourage Trusts to adopt the NHS urinary catheter passport, to improve communication on catheter management between all care providers and avoid associated sepsis. The need for this has been identified through MRSA Post Infection Reviews in 2014/15 identifying catheters as a risk for sepsis. The Sepsis CQUIN is being implemented in trusts who have accepted the 14/15 tariff arrangements and the plan is that it will locally negotiated for those trust who have not accepted this. Acute kidney information is being included in the templates for discharge from hospital. Primary Care Primary Care How are you improving antibiotic prescribing in primary and secondary care and how? Each CCG has had initiatives in 2014/15 which focus on improving antibiotic prescribing. Each CCG has agreed initiatives which will continue to focus on antibiotic prescribing in 2015/16. Trust IPC guidance.docx All CCGs monitor antibiotic In each CCG there will be 2 indicators Page 36 of 59
prescribing and identify GP practices which our outliers when compared with others. Ealing and West London CCGs have been working with their local acute trusts to produce local antimicrobial prescribing guidelines. All the CCGs in CWHHE have antibiotic prescribing indicators within their Prescribing Incentive Scheme which focus on both quantity of antibiotics prescribed and choice (reflecting national guidelines). CCG Medicines Management Pharmacists are members of the multi-disciplinary Infection Clinical Network. CCG pharmacists have taken the opportunity to present to GP networks on good antimicrobial stewardship and promote resources such as the TARGET tool-kit. within GP Prescribing Incentive Schemes which focus on: Overall volume of antibiotic prescribing measured as quantity of antibiotics prescribed per 1000 antibiotic STAR PU Appropriate choice of antibiotic measured as, for example, number of oral cephalosporin quinolone and co-amoxiclav items as a percentage of all antibiotic items or percentage of preferred antibiotics prescribed Exact targets for improvement will be set when EPACT data for 2014/15 is released. Each CCG has plans to discuss whether additional actions are required to address the antibiotic elements of the Quality Premium. Regular meetings between primary care and secondary care pharmacists to discuss cross-sector antimicrobial issues are being planned from quarter 1 2015/16. Page 37 of 59
Secondary care This issue is discussed with IPC teams/antimicrobial prescribing leads at quarterly meetings and is a standing item on the quarterly Infection Clinical Network agenda. Results of Trust antimicrobial prescribing audits have been reviewed during 2014/15 and scrutiny applied to the development and implementation of action plans. Secondary care A quality indicator on antimicrobial prescribing is included in acute Trust Quality Schedules for 2015/16. Trusts will participate in the data validation exercise linked to the CCG Quality Premium in 2015/16 (one large acute Trust participated in the pilot exercise). CCGs await further information on the detail of this, and in due course the prescribing indicators anticipated for 2016/17. The CCG Antimicrobial Lead Pharmacist will attend the Imperial Antimicrobial Review Group to provide oversight for commissioners on the effective management of this function. Quality Patient Experience Have you set measureable ambitions to reduce poor experience of inpatient care and poor experience in general practice. How will you deliver against your ambitions? The CCG is committed to working in partnership with patients, carers, the wider public and local partners to ensure that the services that are commissioned are responsive to the needs of the population. More specifically, the CCGs are committed to ensuring both the continuous improvement Page 38 of 59
Suggestions include FFT, PPG development reference to CQC and action reports. in patient experience and the overall quality of care that is provided locally. The CCG s Patient and Carer Experience Strategy was co-designed with patients, carers and stakeholders. It has identified key areas of priorities that the CCG has committed to resourcing and these are reflected in core quality schedule for 14/15. These include: Ensuring that providers produce quarterly patient experience reports which: o Incorporate qualitative as well as quantitative data o Compare feedback from weekday and weekend services o Capture feedback that reflects the diversity of their patient and carer population. o Include actions and evidence of improvements to address gaps in satisfaction and experience Working in collaboration with health and social care organisations through the Whole Systems Integration and Transforming Primary Care Programmes to embed patient and carer experience at every stage of development and implementation. More specifically to: o Ensure that patients are actively involved in shared decision making and supported by clear information that it appropriate to the patient and carer needs o Improve staff learning and experience o To undertake a Community Independence Service insight project in order to capture patients, service users and carers insight to enable us to have a baseline on which we can evaluate impact in the future. Promoting patient and lay voice at a strategic level and in collaboration with CWHHE and North West London CCGs by ensuring that the following committees have lay and patient representation: o Clinical Quality Groups o CCGs Quality, Patient Safety and Risk Committees o NWL Quality Working Group o CWHHE Quality, Patient Safety and Risk Committee which is also chaired by a Lay Page 39 of 59
How will you assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for patients? Suggestions include CQC reports, care homes and domiciliary care. Member. The CCGs Quality, Patient safety and Safeguarding team work closely together and have established links with local Healthwatch organisations and now have a structured formalised process for reporting of Dignity Champions visits to provider organisations. These reports are received and then shared with the Clinical Quality Groups where actions are followed through. There is a provider concerns meeting at which the CCG, safeguarding and local authority partners come together to discuss care homes causing concern or to take a joint approach to addressing issues that arise. Safeguarding Information Sharing panels have been established in each borough to which the CQC are also invited participants. How will you demonstrate improvements from FFT, complaints and other feedback? How will you ensure that all the NHS Constitution patient rights and commitments to patients are met? How will you ensure that the recommendations of the Caldicott Review relevant to patient experience are implemented? The CCGs will work closely with the provider organisations who are required to produce quarterly reports, addressing patient experience through information from FFT, complaints and the link with incident reporting. The CCGs will ensure that the principles of the NHS Constitution enable patients rights to be met through working closely with lay partners as equals at committees, in procurements, and in our review and assurance of the services commissioned by the CCGs. During 2014/15 the CCGs have been working with a diverse range of stakeholders to further the principles outlined in the Caldicott 2 review. A governance framework has been established across the health economy to facilitate the sharing of patient records for direct patient care. A memorandum of understanding (MOU) for the sharing of records for direct patient care has been developed that cites best practice and legal frameworks that apply across the NHS. This MOU has been cited as good practice in the Independent Information Governance Oversight Panel s report to the Secretary of State for Health in 2014. All provider Trusts in North West London, all other healthcare providers and almost all primary care providers have signed up to the memorandum of understanding. Patient and staff information materials have been produced and circulated initially across all GP practices. Also during 2014/15 GP practices have enabled the functionality to provide online access for patients to their GP held Page 40 of 59