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Sandwell and West Birmingham Clinical Commissioning Group
Governing Body Meeting
Date: Wednesday 24th April 2013
Time: 12.30-14.45
nd
Venue: Boardroom, 2 Floor Front, Kingston House,
High Street, West Bromwich B70 9LD
Room: Boardroom
AGENDA
Non-Confidential
Item
Subject
INTRODUCTION
1.
Welcome and Introductions
2.
Apologies for Absence:
Dr N Pall
3.
Declarations of Interest
Lead
Time
Verbal
Verbal
Dr N Harding
Dr N Harding
12.30
12.35
Verbal
Dr N Harding
12.40
To request members to disclose any interest they have, direct or indirect, in any items to be
considered during the course of the meeting and to note that those members declaring an interest
would not be allowed to take part in the consideration or discussion or vote on any questions relating
to that item.
Minutes of Previous Meeting held on 27th March Enc. 1
2013
5.
Action Register
Enc 2
Verbal
Chairman’s Report
6.
Verbal
Questions from the Public
7.
Enc 3
Chief Officers Report
8.
9. Governance
9.1
Corporate Objectives
Enc 4 & 4a
9.2
Declarations of Interest Report
Enc 5
9.3
Engagement Scheme
Enc 6
10. Performance
Enc 7
10.1 Finance Report
Enc 8
10.2 Performance Report
Enc 9
10.3 Quality and Safety Committee Report
Enc 10
10.4 Strategic Commissioning and Redesign
Verbal
10.5 Partnerships Committee Report
Verbal
10.6 Audit Committee Report
10.7 Organisational Development Committee (No
10.8 meeting held since last governing body)
11. Minutes for Information (All minutes available on CCG Website)
11.1 Finance and Performance Committee Minutes
Enc 11
Enc 12
11.2 Quality and Safety Committee Minutes
Enc 13
11.3 Strategic Commissioning & Redesign Minutes
No Meeting
11.4 Partnership Committee Minutes
No Meeting
11.5 Audit Committee Report Minutes
11.6 Organisational Development Committee Minutes No Meeting
Enc 14
11.7 Sandwell Health Alliance LCG
Enc 15
11.8 Black Country LCG
Enc 16
11.9 ICOF LCG
4.
Dr N Harding
12.45
Dr N Harding
Dr N Harding
Dr N Harding
A Williams
12.50
12.55
13.05
13.10
A Hodgson
A Hodgson
J Dicken
13.15
13.35
13.40
J Green
J Green
Dr Mukherjee
Dr G Solomon
Dr Andreou
J Jasper
Dr Harding
13.50
14.00
14.10
14.20
14.30
14.35
All
14.40
11.10 HealthWorks LCG
11.11 Pioneers for Health LCG
12. ANY OTHER BUSINESS
Enc 17
Enc 18
13. DATE AND TIME OF NEXT MEETING
Wednesday 29th May 2013
Boardroom, 2nd Floor Front, Kingston House
CLOSE OF MEETING
14.45
Resolution adopted from the Public Bodies (Admission to Meetings) Act 1960:
That those representatives of the press and other members of the public be excluded from the
remainder of the meeting having regard to the confidential nature of the business to be transacted,
publicity on which would be prejudicial to the public interest.
Guidance on Declarations of Interest
Definition of Interests
A Governing Body/Committee member has a personal interest if the issue being discussed at a
meeting affects the well being or finances of the member, the member’s family or a close associate
more than most other people who live in the area affected by the issue.
Personal interest are also things related to an interest the member must register such as outside
bodies to which the member has been appointed by the PCT or membership of certain public bodies.
A personal interest is also a prejudicial interest if it affects the finances of the member, the
member’s family or a close associate and which a reasonable member of the public with knowledge
of the facts would believe it likely to harm or impair the member’s ability to judge the public
interest.
Declaring interest
If a member has an interest, they must normally declare it at the start of the meeting or as soon as
they realise they have the interest.
If a member has a personal and a prejudicial interest, they must not debate or vote on the matter
and must leave the room.
Enc No. 2
SWBCCG Board Meeting Action Register
Wednesday 24th April 2013
Action
281112
By Whom
Hodgson
191212
1
Feb 2013
Meeting needs to be rearranged
with Sandwell
8.1 Sandwell and West Birmingham CCG
Constitution
Develop communication to support the Lynda
publication of the Draft Constitution to seek
Scott/Alison
comments.
191212
Comment / Response
Date
Completed
7.6 Commissioning Redesign Committee
Report
To meet with members of the Local Andy Williams
Authority to discuss the changes to the
Locally Enhanced Services.
281112
Deadline /
update
7. Chairman’s Report
To invite Toby Lewis, Chief Executive of Nick Harding
Sandwell and West Birmingham Hospitals to
visit the CCG.
CCG Research Presentation
To further consider the gender issue and Andy Williams
models and strategies that can be adopted
to encourage females to take positions on
Governing Bodies.
December
2012
May 2013
The Constitution was ratified at
the 3rdApril 2013 meeting of
the Governing Body and is on
the website.
Has been invited to attend in
May
Ongoing
February
2013
3rd April
2013
May 2013
Action
191212
191212
27213
27213
By Whom
Chief Officers Report
To set up a debriefing process to review the Nick Harding
winter pressures and urgent care
Risk Sharing Agreement
To further explore the options for entering James Green
into a Risk Sharing Agreement
Organisational Development Report
To develop a glossary of terms used.
Central Care Records
To review the extent of possible miscoding.
Deadline /
update
March
2013
January
2013
Alison Hodgson
Comment / Response
This is currently happening
regionally and a process will
happen locally.
This has not happened due to
the risk regarding CCG funding
Completed
On going
Dr N Harding
To provide the detail of what information Dr N Harding
will be recorded as part of the Central Care
Record.
27213
27313
2
Any Other Business
To explore the issue of Dudley Consultants Claire Parker
providing letters to GP in Sandwell regarding
their patients.
Finance Report
The proposed budget was accepted but due James Green
to significant risks the governing body wish
to be kept informed of progress.
Ongoing
April 2013
Date
Completed
Action
27313
3
By Whom
Any Other Business
To ensure chairs of Governing Body Alison Hodgson
Committees are aware that the minutes are
in the public domain and therefore should
provide clear and concise. Also noted a
number of items are deferred due to lack of
attendance and chairs of committees to
make sure a deputy attends or a report is
provided.
Deadline /
update
April 2013
Comment / Response
Date
Completed
24th April 2013
Enc 3
Report Topic:
Accountable Officer’s FAQ
Report From:
Andy Williams - Accountable Officer
Date:
24th April 2013
Provide an overview to the Board around the following key areas:
Aim of Report
•
•
•
Finance
Activity
Quality
RECOMMENDATIONS For Information
IMPLICATIONS:
Financial
N/A
Patient & Public
Involvement
N/A
Healthcare
Commissioning
N/A
Equality Impact
Assessment/Diversity
Impact
N/A
Engagement (Clinical
or Non Clinical)
N/A
Legal
N/A
Vision and Values
N/A
Workforce
N/A
Other
N/A
Theme
Finance
Activity
Quality
Area
QIPP
Comment
SWB CCG is currently forecast to be £3m under a target of £16.9m by the end of the
financial year, although potential savings against innovation funds have not yet been
incorporated into this shortfall.
Control total
Surplus of £6.5m by year end. Achievement of required surplus of £6.976 in line with the
agreed Strategic Health Authority control total.
CCG Activity Numbers @ Point of Delivery
YTD Plan
YTD Actual
February 2013
Non Elective
63,099
67888
GP Referrals
118,349
129428
(Using HoB data as proxy for Other Referrals
80,933
85,885
West Birmingham)
First OP (GP referrals)
94,824
96,377
First OP (All)
173,720
177,742
Electives
71,582
66,629
Missed
Performance A&E:
Year to date performance at HEFT and SWBH is below the required 95% standard. The CCG
Indicators
as lead commissioner has issued an improvement trajectory and performance notices to
SWBH NHST.
18 Weeks Referral to Treatment:
Local providers have missed the November 90% admitted target in the following Specialties
: SWBH (T&O, Plastics) and WHT (T&O)
CCG Diagnostic Waits:
CCG wide – 62 patients waited longer than the 6 weeks equating to 0.78% of patients,
below the 1% threshold.
At SWBH – 59 patients waited longer than 6 weeks, equating to 0.89% of patients, again
below the 1% threshold.
Urgent Care Escalation
Escalation levels across all urgent care sites remain high on a consistent basis across the
Birmingham and Black Country health economy.
SHA Ambitions
Eliminate Avoidable Pressure Ulcers:
CQUIN measures in place to assess and pre-determine avoidable pressure ulcers and
accountability meetings have been established with the Chief Nurse where Matrons and
Ward Managers are called to account for every grade 3/4 hospital acquired avoidable sore.
RAG
Amber
Green
Red
Red
Red
Red
Red
Green
Red
Red
Red
Red
Green
Improve Quality and Safety in Primary Care:
The CCG is currently in the process of adopting the West Midlands Primary Care Quality
Template
Create a Revolution in Patient and Customer Experience:
SWBH are currently achieving a Net Promoter score of 67% against a baseline of 65%. The
CQUIN for 2012/13 is to improve by 10%.
Make Every Contact Count:
CQUIN measure are in Place with providers to ensure that trained staff provide brief advice
in particular to all those on the district nurse caseload, those who drink at harmful levels
accessing acute care and new mothers seen by health visitors.
Strengthening Partnerships Between the NHS and the Local Authority:
Health and Well Being Board established, reviewing joint Commissioning arrangements and
memorandum of understanding with public health signed.
Never Events
No Never Events were reported in December
CQC Concerns
No CQC Concerns
SWBH
UHB
HEFT
BWH
BCHC
BSMH
WMAS
Key to NHS Provider Abbreviations
Sandwell and West Birmingham Hospitals
DGH
Dudley Group Foundation Trust
University Hospitals Birmingham
RWHT
Royal Wolverhampton Hospital
Heart of England Foundation Trust
WHT
Walsall Hospital Trust
Birmingham Women’s Hospital
ROH
Royal Orthopaedic Hospital
Birmingham Community Healthcare
BCH
Birmingham Children’s Hospital
Birmingham and Solihull Mental Health Trust
BCPFT
Black Country Partnership Foundation Trust
West Midlands Ambulance Service
Amber
Green
Amber
Green
Green
Green
Enclosure No: 5
GOVERNING BODY
Report Topic:
Declarations of Interest Register 2013/14
Report From:
Alison Hodgson, Head of Quality, Risk and Safety
Date:
24th April 2013
Aim of Report
The Governing Body members are asked to approve the
Declarations of Interests Register for all Sandwell and West
Birmingham Clinical Commissioning Group Members. This
is a requirement for Sandwell and West Birmingham
Clinical Commissioning Group members under Standing
Orders set out in the Constitution.
Discussion Points
RECOMMENDATIONS
For Information
Members of Sandwell and West Birmingham Clinical
Commissioning Group are asked to:
1.
Approve the Sandwell and West Birmingham Clinical
Commissioning Group Declarations of Interest Register.
IMPLICATIONS
Financial
Patient & Public
Involvement
Equality Impact
Impact
Healthcare
Commissioning
Engagement (Clinical or
Non Clinical)
Legal
Vision and Values
Workforce
None
None
Not Applicable
All
Director Checked [Initials]
Date Received by Committee Secretary
1
10/4/13
SWBCCG Governing Body Register of Interests – February 2013
NAME
MEMBERS
Nick Harding
ORGANISATION
•
INTEREST
•
Partner and property share owner.
•
•
•
•
•
partner and director of subsidiary companies
Trustee
GP trainer, GP examiner
Appointed doctor
Appointed doctor
•
•
Handsworth Wood medical centre. Partner and
property share owner.
Vitality Partnership
Vineyard Churches UK & I.
Royal college of GP
Home Office – Birmingham Crematorium
Health & Safety Executive for Asbestos, Ionising
Radiation, and Lead medicals
Maritime Coastguard Agency
Faculty of Medical Leadership & Management
•
•
Appointed doctor
Member
Niti Pall
•
•
•
•
•
•
•
•
Smethwick Medical Centre
PHD CIS
PHIPL – India
IDF
DPF
Euradia
NED
NHS Alliance
•
•
•
•
•
•
•
•
Partner
Director/Chair
Director/Chair
Board Member
Chair
Board Member
Expert CIC
Executive Board Member
Basil Andreou
•
•
•
QOF
Sandwell local medical committee
sponsored by drug companies
•
•
•
Lead Minor Surgery Provider
Secretary
Teacher at Educational Events
•
•
•
•
•
SWBCCG BOARD REGISTER OF INTERESTS: UPDATED FEBRUARY 2012
NAME
Priyand Hallan
ORGANISATION
• GP Solutions UK
•
Wife Nurse Practitioner
•
•
Principal-Newtown and Aston Pride Health
Centres
Director ICOF LLP and GGP.Com Ltd
SWBH
•
•
Founder member of both companies
Wife is Clinical Nurse Specialist
Inderjit Marok
•
•
•
•
Rotton Park MC
Summerfield Group practice
GPP.com
ICOG LLP
•
•
•
•
GP principal
Partner
Director
Director
Vijay Bathla
•
•
•
•
•
•
Principal GP senior Partner
Member and Executive member
Chairman
•
PMS practice
Birmingham LMC
Birmingham British International Doctors
Association
Pioneers for Health LCG
•
Chairman
Sirjit Bath
•
WRM Ltd
•
Director
George Solomon
•
•
Black Country Family Practice
Tipton Care Organisation
•
•
Director
Co-Chair
Sam Mukherjee
•
INTEREST
• Spouse holds directorship
NAME
Ian Walton
Ranjit Sondhi
ORGANISATION
• Ryland View Nursing Home
• Spires Health Care
• Tipton Care Organisation
• Primhe
• British Society of Clinical and Academic
Hypnosis
• Lilly pharmaceuticals
• ASD Metals
• Horseley Heath Surgery and Tandon Medical
Centre
•
INTEREST
• Partner
• Associate
• Chair
• Chair
• Course Organiser
• Paid speaker
• Medical Adviser
• Partner and Owner of Share in the Property
CCG Board. Not associated with any member
practice. Lead lay member on patient and public
engagement at Board level
Trustee – PMA Trust
Trustee – Nishkam Health Care Trust
Chairman of Advice Birmingham – a partnership
of voluntary organisations
•
Vice Chairman
•
•
•
Trustee
Trustee
Chairman
•
Women’s Hospital Birmingham
•
•
•
Judicial Appointments Commission
Criminal Cases Review Commission
Baring Foundation
•
•
•
•
Wife (Anita Bhalla) is non-executive Director
Commissioner
Commissioner
Trustee
•
•
•
NAME
Felix Burden
Andy Wakeman
ORGANISATION
INTEREST
• Burdens of Disease
• Director
• Committee of Diabetes UK
• Member/healthcare professional
• Langton Medical Group, Lichfield
• Spouse is GP Principal
• Public Health/ Deputy DPH, BSOL Cluster.
• Consultant
• Employment to move to Birmingham City
Council w.e.f 1st April 2013
• Member
• British Medical Association,
• Board member
• Royal College of GPs and Faculty of Public
Health
• Member
• Council of Faculty of Sports & Exercise Medicine
Julie Jasper
•
•
•
•
•
Weetlands Associate
Black Country Cluster Board
Thorns Community College
Stourbridge College Corporation
Dudley CCG
•
•
•
•
•
Managing Director
Non-Executive Director
Chair
Governor
Member
Margot Warner
•
•
•
•
•
Nursing and Midwifery Council
Warner Healthcare
Birmingham and Solihull NHS Cluster
Royal College of Nurses
GMB Union
•
•
•
•
•
Member
Director and Owner
Senior Nurse
Member
Member
Richard Nugent
•
Principal Healthcare Estates consultancy service
(HECS) Architects
Sandwell college
Warley Woods Community Trust
•
•
•
•
•
Trustee
Director
NAME
ORGANISATION
Janette Rawlinson
• Just Real Solutions – independent consultancy
• Cerebral Palsy Midlands
• SCVO
• Institute of Directors
INTEREST
• Owner/principal consultant
• Clients of Just Real Solutions
• Clients of Just Real Solutions
• Member
Andy Williams
•
My partner works as a senior manager in the
Commissioning Support Unit that the CCG
contracts with.
•
James Green
•
None Registered
•
None Registered
Claire Parker
•
Birmingham Crisis Centre- Women’s refuge for
Domestic Violence with direct links to
Safeguarding
•
Trustee and Vice Chair
Sharon Liggins
•
None Registered
•
None Registered
Alison Hodgson
•
None Registered
•
None Registered
24th April 2013
Enc 6
Report Topic:
Report From:
Sandwell and West Birmingham CCG Quality and Engagement
Scheme 2013/14
Dr Pri Hallan, GP Director
Mohammed Khalil, Senior Commissioning Manager
Jon Dicken, Chief Officer (Operations)
Date:
24 April 2013
Aim of Report
To update the Governing Body on the Quality and Engagement
Scheme for 2013/14
1 The Governing Body are recommended to note the contents of
the report.
2 Agree delegated authority for the Remuneration Committee to
RECOMMENDATIONS sign off the Quality and Engagement Scheme for 2013/14
3 Agree to the implementation of the Quality and Engagement
Scheme subject to Remuneration Committee sign off
IMPLICATIONS:
Financial
A total of £1.1 million has been set aside for this scheme.
Patient & Public
Involvement
Details of the scheme will be shared through Patient Participation
Groups.
Healthcare
Commissioning
Improved engagement of practices will strengthen the CCG’s
decision making and commissioning.
Equality Impact
Impact
or Non Clinical)
An initial Equality Impact Assessment has indicated that the scheme will
not adversely affect care to any particular protected group. Care will be
delivered where appropriate to patients within the primary and
community care setting rather than the acute setting. A full Equality
Impact Assessment will be undertaken at the end of the scheme to assess
areas for any impact or discrimination.
The scheme development has involved clinicians and managers
through the Strategic Commissioning and Redesign Committee and
through working groups set up to develop the scheme. Tier 3 has
been developed by the Medicines Management Team. GP Directors
have been engaged through the Directors meeting.
Legal
The proposed scsheme wil:
Vision and Values
•
•
Engage practices with CCG and Locality Commissioning
Group objectives
Improve primary care quality and capacity
•
Workforce
Other
Improve quality and cost effectiveness of prescribing
SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING
GROUP
Report to the Governing Body
Subject:
Date:
Author:
Sandwell and West Birmingham CCG Quality and Engagement
Scheme 2013/14
24 April 2013
Introduction
Sandwell and West Birmingham CCG is a large and progressive Clinical Commissioning Group with
commissioning responsibility for some 530 000 patients spanning two Local Authorities, in addition
the CCG has taken on lead commissioner responsibilities for a number of key developments across
Birmingham, Solihull and the Black Country and indeed West Midlands wide.
The views and involvement of the CCG member practices in the day to day business of the
organisation are crucial to its decision making and success going forward. The CCG also has a very
strong focus upon quality and service improvement. The CCG has therefore proposed the
development and implementation of a quality and engagement scheme for 2013/14.
The sum of £1.50 per registered patient has been set aside for 2013/14 to incentivise practices to
engage with and support the implementation of key CCG objectives. In addition a further £300, 000
is available for incentives relating to prescribing.
The proposed scheme has been developed to reflect the aims and objectives of the CCG and to
engage member practices with CCG activity; focus upon primary care development and quality; and
improve prescribing.
Progress Update
The development of the proposed scheme has been clinically led by Dr Pri Hallan and reported
through the Commissioning Business Planning Group (a sub group of the Strategic Commissioning
and Redesign Committee), the Strategic Commissioning and Redesign Committee and the Directors
Group.
The proposed scheme was presented to the CCG Remuneration Committee on 21 March 2013 and
members asked for further work to be undertaken to clarify a number of points of detail to ensure
that the appropriate governance processes have been followed prior to implementation.
The required work has been completed and the proposed scheme is due to return to the
Remuneration Committee before the end of April. The next step subject to agreement by
Remuneration Committee is the implementation of the scheme.
Conclusion
The involvement of CCG member practices is crucial to the success of the organisation in terms of
the achievement of its aims and objectives. The timely implementation of the proposed scheme is
clearly very important in this regard and it is therefore proposed that delegated authority should be
given to the Remuneration Committee to sign off the scheme once members are satisfied with the
rationale and governance. This will enable immediate implementation without further delay once
approval has been given.
Recommendations
The Governing Body are recommended to
1 Note the contents of the report.
2 Agree delegated authority for the Remuneration Committee to sign off the Quality and
Engagement Scheme for 2013/14.
3 Agree to the implementation of the Quality and Engagement Scheme subject to Remuneration
Committee sign off.
Contact
Enc 7
Sandwell and West Birmingham CCG
Finance and Performance Committee
Finance and Activity Report
Report Topic:
Finance and Activity Report as at 31st March 2013
Report From:
James Green – Chief Finance Officer
Date:
22nd April 2013
Purpose of the
Report
To provide information to the committee on the financial performance
of the CCG for the 2012/13 financial year.
•
•
•
•
Key Issues
Summary
End of year surplus position of £7.5m
Prescribing budgets contributing £5.4m to end of year surplus
QIPP reported as achieving £800,000 less than £16.97m Target
NHS Trust activity over spend by nearly £3.5m
Members of the Committee are asked to:
Recommendations
1.
2.
Discuss the content of the report
Note the contents of the report and associated risks
Enc 7
1. Executive Summary
Performance for Sandwell and West Birmingham CCG a surplus position of £7.5m which is
line with the forecast agreed with the Strategic Health Authority.
Key Finance Performance
Delegated Statutory Duties
Financial Balance
Total QIPP Target
Plan (£m)
Surplus
£6.98
£16.97
Year to Date (£m)
Surplus
£7.09
£16.17
G
A
Acute activity posted a deficit position of £3.449m based on validated activity and final
agreements with trusts. Information has been validated for April to January for most trusts
and it remains a risk that further activity is a cost pressure to SWB CCG in the 2013/14
financial year.
Prescribing performance remains strong with a final surplus of £5.4m at the year end. This
is in line with previous forecasts.
Community spend was £1.166m lower than planned due a successful scheme to control the
costs of complex packages of care in BSOL.
Table 1: Sandwell & West Birmingham CCG Summary Financial Position – Month 12
Annual
Budget
£000's
Spend
£000's
Surplus/
(Deficit)
£000's
Acute
Prescribing
Community
Mental Health and Learning Disabilities
Contingency & Other (inc Running Costs)
Planned Surplus
352,683
84,885
118,015
75,272
23,342
6,976
356,131
79,509
116,849
75,340
25,935
(112)
(3,449)
5,376
1,166
(68)
(2,593)
7,088
Total SWB CCG
661,173
653,652
7,520
Enc 7
2. Acute Contract Performance
NHS Trust performance information has been validated for April to January of the 2012/13
financial year, with indicative data for February and financial estimates made for March.
Figure 1 below sets out the forecast outturn position for the major acute contracts for the
CCG.
£3,500
£3,000
£2,500
£2,000
£1,500
£1,000
£500
-£1,000
WMH
SWBH
RWH
UHB
ROH
HEFT
DGH
BWH
-£500
BCH
£-
Thousands
M12
M11
M10
M9
M8
M7
M6
M5
M4
M3
M2
Acute activity posted a deficit position of nearly £3.5m based on known activity; including
some final agreements with trusts. Information has been validated for April to January for
most trusts.
Final settlements have been reached with Sandwell & West Birmingham NHST as well as a
number of trusts where the CCG is an associate commissioner. These agreements are full
and final and no further charges are expected from those providers.
There is however a risk that expenditure is charged once activity is finalised from Dudley
Group of Hospitals amongst others. Any activity charged over and above accrued amounts
will be charged to SWB CCG and will represent a cost pressure in 2013/14 budgets.
Enc 7
3. Prescribing
Prescribing performance data has been received from
the PPA for February 2013, which shows a surplus
position of £5.4m.
Precribing
£000’s
Previous month’s performance was in line with the PPA
forecast and the end of year position remains on track.
86,000
However, any costs over and above this forecast will be
incurred by the CCG.
82,000
84,000
80,000
78,000
76,000
Plan
Spend
4. Quality Innovation Productivity and Prevention (QIPP)
The CCG has a QIPP target of
£16.97m for the 2012/13 financial
year.
Final performance is still being
finalised but indications are that the
target will be missed by £800k.
The majority schemes have been
built into contractual arrangements
with SWBH.
QIPP - Forecast to Target
Forecast
Target
£000’s
15,500
16,000
16,500
17,000
Sandwell PCTs latest report shows a forecast over performance of £107k by the end of the
year. HoB PCT is forecasting a short fall of £924k which will be offset by non-recurrent
measures such as the release of PCT held contingencies.
Enc 7
The chart below sets out performance against the main QIPP categories.
QIPP
£000’s
10,000
8,000
6,000
4,000
2,000
Other
PCT Running Costs
Primary Care Prescribing
Forecast
Continuing Healthcare
Target
Community
Acute
0
5. Transition Year 2012/13
During 2012/13 the statutory duty for financial balance remains with Sandwell PCT and
Heart of Birmingham PCT (HoB). As such the financial position of the separate Sandwell
and HoB practices will be reported to the respective PCT Cluster boards.
As shown in table 3 below SWB CCG summary financial position is split showing that
Sandwell practices are forecasting a £9.1m surplus and HoB practices forecasting a deficit
position of £1.6m.
Table: SWB CCG Financial Summary by PCT Cluster
Annual
Budget
£000's
Spend
£000's
Surplus/ (Deficit)
£000's
Black Country PCT Cluster
Birmingham & Solihull PCT Cluster
410,918
250,254
401,780
251,872
9,138
(1,618)
Total SWB CCG
661,173
653,652
7,520
Enc 7
6. Statement of Financial Position
at 31 March 2013 – Sandwell PCT
31 March
2013
31 March
2012
£000
£000
Non-current assets:
Property, plant and equipment
Intangible assets
investment property
Other financial assets
Trade and other receivables
Total non-current assets
£000s
0
31,851
0
0
31,851
£000s
0
31,527
102
0
31,629
Current assets:
Inventories
Trade and other receivables
Other financial assets
Other current assets
Cash and cash equivalents
Total current assets
32,596
0
0
9,203
0
41,799
32,104
0
0
8,163
0
40,267
0
0
41,799
73,650
40,267
71,896
42,981
0
(41,561)
0
(3,287)
(1,867)
40,982
0
(42,680)
0
(4,373)
(6,071)
Non-current assets plus/less net current assets/liabilities
71,783
65,825
Non-current liabilities
Trade and other payables
Other Liabilities
Provisions
Borrowings
Other financial liabilities
Total non-current liabilities
(2,355)
0
0
0
(2,018)
(4,373)
(6,549)
0
0
0
(1,008)
(7,557)
Total Assets Employed:
67,410
58,267
0
0
(23,362)
(23,362)
0
0
(27,393)
(27,393)
Non-current assets held for sale
Total current assets
Total assets
Current liabilities
Trade and other payables
Other liabilities
Provisions
Borrowings
Other financial liabilities
Total current liabilities
Financed by taxpayers' equity:
General fund
Revaluation reserve
Other reserves
Total taxpayers' equity:
Enc 7
7. Capital Resource Limit
Sandwell PCT has a statutory duty to keep within the Capital Resource Limit (CRL) set by the
Strategic Health Authority. Sandwell PCT reported a surplus of £309k in the 2012/13 final
accounts.
Capital Resource Limit
Charge to Capital Resource Limit
(Deficit)/Surplus Against CRL
2012-13
£000
2011-12
£000
5,112
4,803
309
10,017
10,008
9
8. Conclusion
Sandwell and West Birmingham CCG have a financial surplus of £7.5m the end of the
financial year 2012/13 on an overall budget of £655m. This surplus was is required to
deliver the CCG’s delegated element of the Sandwell PCT target surplus.
9. Recommendations
Members of the F&P Committee are asked to:
1. Discuss the contents of the report;
2. Approve the contents of the report;
Contact Officers
James Green – Chief Finance Officer – JMGreen@nhs.net
Paul Sheldon – Deputy Chief Finance Officer – paul.sheldon@sandwellandwestbhamccg.nhs.uk
Enc 8
Sandwell and West Birmingham CCG Board
Key Indicators Performance Report
Report Topic:
Key Indicators Performance Report – as at January 2013
Report From:
James Green – Chief Finance Officer
Date:
24th April 2013
Aim of Report
To provide information to the Board on the performance of the
CCG against key indicators for the 2012/13 financial year.
Discussion Points
•
•
•
•
RECOMMENDATIONS
A&E and Urgent Care
18 Weeks Referral to Treatment
Diagnostic Waits
Mixed Sex Accommodation
Members of the Committee are asked to:
1.
2.
Discuss the content of the report
Approve the contents of the report
Enc 8
1.
Introduction
This report presents the most to up to date position for Sandwell and West Birmingham CCG (SWB
CCG) against key performance indicators. The overall performance of the CCG is good against both
the key requirements of the Operating Framework and against the quality requirements contained
within the acute contract. There are a few areas of concern which are indicated below with more
detail about why the performance is below the required standard and options for rectification.
2.
A&E and Urgent Care
Figure one below shows the outturn position of the all Birmingham and the Black Country providers
(including walk in centres) against the Operating Framework indicator for 4 hour waits against the
standard of 95% seen within that timeframe. Trusts are measured on their performance on a
monthly basis as part of the contract review process although no financial penalty is attributable
until the end of the financial year when the outturn position is agreed (2% of the actual outturn
value for the service line).
A&E All Types
Birmingham
Birmingham Children's Hospital NHS Foundation Trust
Heart of England NHS Foundation Trust
South Birmingham GP Walk In Centre
University Hospital Birmingham NHS Foundation Trust
Summerfield Urgent Care Centre
Birmingham Walk In Centre
Assura Vertis Urgent Care Centres (Birmingham)
Greet General Practice & Urgent Care Centre
Birmingham Community Healthcare NHS Trust
Solihull Walk In Centre
Black Country
Sandwell & West Birmingham Hospitals NHS Trust
The Dudley Group Of Hospitals NHS Foundation Trust
The Royal Wolverhampton Hospitals NHS Trust
Walsall Healthcare NHS Trust
Dudley Borough Walk in Centre
Badger Walsall OOH
Walsall Walk In Centre
Q1 Performance
(Outturn)
Q2 Performance
(Outturn)
Q3 Performance
(Outturn)
Q4 Performance
(Outturn)
Year to Date
97.51%
94.39%
100.00%
96.34%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
97.86%
93.16%
100.00%
95.55%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
96.23%
91.47%
100.00%
93.12%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
97.92%
85.37%
100.00%
93.77%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
97.34%
91.20%
100.00%
94.69%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
95.03%
97.40%
97.37%
96.15%
100.00%
100.00%
100.00%
93.54%
95.85%
96.46%
95.52%
100.00%
100.00%
100.00%
91.18%
95.06%
95.20%
94.62%
100.00%
100.00%
100.00%
89.79%
92.98%
94.01%
94.00%
100.00%
100.00%
100.00%
92.43%
95.36%
95.75%
95.02%
100.00%
100.00%
100.00%
Figure 1 - A&E Performance at 31/03/2013
The table confirms that SWBH and HEFT failed to achieve the minimum standard required at the
cumulative year end stage. University Hospitals Birmingham also failed to get over the line after two
poor quarters of performance, reaffirming the problems that have been experienced in urgent care
across the whole system. In the Black Country region the remaining three acute providers missed the
target in Q4 but all had created sufficient headroom in the previous months to cover this.
Enc 8
3.
18 Weeks Referral to Treatment
Using January 2013 as the most up to date comparable data Figure 3 below shows the all specialties
view of the 90% standard for admitted patients for the local acute providers and the CCG as
commissioner (using the two constituent PCTs as a proxy). This shows that as previously reported
T&O is an issue across the Birmingham and Black Country geography.
Specialty
Cardiology
Cardiothoracic Surgery
Dermatology
ENT
Gastroenterology
General Medicine
General Surgery
Geriatric Medicine
Gynaecology
Neurology
Neurosurgery
Ophthalmology
Oral Surgery
Other
Plastic Surgery
Rheumatology
Thoracic Medicine
Trauma & Orthopaedics
Urology
Total
Sandw ell
PCT
HoB PCT
SWBH
DGOH
HEFT
UHB
Walsall
93.10%
86.00%
91.72%
94.29%
94.29%
93.50%
100.00%
100.00%
100.00%
NA
NA
NA
100.00%
NA
96.23%
92.31%
95.11%
100.00%
97.62%
91.03%
NA
96.20%
95.65%
97.98%
97.44%
92.05%
95.35%
90.91%
100.00%
100.00%
100.00%
98.11%
100.00%
100.00%
NA
95.65%
100.00%
96.34%
100.00%
100.00%
95.00%
100.00%
92.29%
96.30%
95.34%
95.09%
91.56%
90.37%
92.23%
0.00%
0.00%
100.00%
NA
NA
100.00%
100.00%
95.68%
88.00%
95.22%
96.15%
93.72%
NA
93.17%
100.00%
100.00%
100.00%
NA
NA
100.00%
NA
77.78%
72.73%
NA
NA
NA
92.41%
NA
93.78%
91.57%
92.13%
99.29%
91.30%
91.06%
91.03%
96.39%
92.77%
95.22%
94.00%
100.00%
95.45%
97.56%
96.95%
96.21%
97.06%
96.95%
95.72%
94.49%
100.00%
85.06%
90.91%
86.67%
95.24%
NA
92.86%
NA
100.00%
100.00%
100.00%
100.00%
NA
NA
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
100.00%
NA
85.61%
84.67%
79.45%
97.52%
87.79%
96.67%
84.36%
97.21%
94.03%
96.68%
89.83%
92.34%
91.46%
96.81%
94.05%
92.73%
93.97%
96.75%
92.43%
93.45%
91.67%
Figure 2 - Admitted 18 Weeks Performance (Jan 13)
4.
Diagnostic Waiting Times
The issue around diagnostic waits at SWBH has been resolved in February. The trust still has
problems with those patients waiting for diagnostic test in the ‘oscopy’ category but the overall
picture has improved so that 99% of patients waiting for the 15 diagnostic tests monitored have
their test completed within 6 weeks.
The table overleaf (figure 3) shows the performance of SWBH against this measure for the 11
months to February 2013.
Enc 8
Diagnostics - Of all the waits
for named test, what % are
over 6 weeks
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
JANUARY
FEBRUARY
AUDIOLOGY_ASSESSMENTS
1.4%
0.2%
1.1%
0.0%
0.2%
0.5%
3.4%
0.0%
0.2%
0.4%
1.2%
BARIUM_ENEMA
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
COLONOSCOPY
7.1%
4.4%
3.6%
0.3%
7.6%
9.0%
11.7%
15.6%
14.1%
11.3%
6.0%
CT
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
CYSTOSCOPY
5.6%
2.0%
4.1%
3.0%
3.8%
12.1%
5.4%
5.5%
7.9%
4.5%
4.6%
DEXA_SCAN
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
ECHOCARDIOGRAPHY
1.3%
0.6%
0.2%
0.2%
0.0%
0.8%
0.3%
0.3%
0.5%
0.5%
4.2%
ELECTROPHYSIOLOGY
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
7.6%
FLEXI_SIGMOIDOSCOPY
15.3%
6.8%
0.0%
0.0%
8.3%
5.8%
16.5%
21.3%
25.2%
22.0%
GASTROSCOPY
4.6%
2.4%
4.2%
2.8%
8.8%
5.2%
2.8%
6.7%
7.5%
10.3%
3.0%
MRI
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.2%
0.0%
0.0%
0.0%
0.1%
NON_OBSTETRIC_ULTRASOUND
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
PERIPHERAL_NEUROPHYS
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
SLEEP_STUDIES
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
URODYNAMICS
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
TOTAL
1.3%
0.6%
0.6%
0.3%
1.0%
1.5%
2.0%
1.7%
1.9%
2.0%
0.9%
Figure 3 - SWBH 6 Week Diagnostic Waits
5.
Mixed Sex Accommodation Breaches
There were two breaches of mixed sex accommodation for Sandwell patients at Royal
Wolverhampton Hospital. The CCG has contacted the lead commissioner to ascertain the
reasons for the breaches, where they occurred and what measures have been put in place
to ensure there are no more. The CCG will also demand that the fine be levied as per the
national requirements in the contract clauses.
6.
Recommendations
Members of the F&P Committee are asked to:
1. Discuss the contents of the report;
2. Approve the contents of the report;
Contacts
James Green, Chief Finance Officer, james.green@sandwell-pct.nhs.uk
Martin Stevens, Head of Business and Contract Performance, martin.stevens@nhs.net
24th April 2013
Enc 9
Report Topic:
Quality and Safety Report
Report From:
Sam Mukherjee
Date:
24th April 2013
Aim of Report
RECOMMENDATIONS
To update the Governing Body on the work of the Quality and
Safety Subcommittee and ratify any policies agreed by the
committee.
• Individual Funding Requests
• Ethical Framework for Priority Setting and Resource
Allocation
• Patients Leaving Non-Commercially Funded Trials
• Patients Leaving Industry Sponsored Trials
• Patients Leaving a CCG Funded Trial
• Implementation and funding of guidance produced by the
National Institute for Health and Care Excellence
• Patients Changing Responsible Commissioner
• In-Year Service Developments and the Clinical
Commissioning Group’s approach to treatments not yet
assessed and prioritised
• Experimental and Unproven Treatments
• On-going access to treatment following a ‘trial of treatment’
which has not been sanctioned by the Clinical
Commissioning Group for a treatment which is not routinely
funded or has not been formally assessed and prioritised
• SWBCCG Pol09 SALARY VARIATION
The Governing Body is asked to NOTE the contents of this report
and ratify decisions undertaken by the Q&S.
IMPLICATIONS:
Financial
None
Patient & Public
Involvement
PPI involvement in Quality and Safety committee, patient
experience is an important part of monitoring and commissioning
the best quality services.
Healthcare
Commissioning
None
Equality Impact
Impact
None
or Non Clinical)
None
Legal
None
Vision and Values
Healthcare without Boundaries- to ensure the CCG population has
equity of service and an expectation that the service they receive is
safe and of the highest quality.
Workforce
None
Other
SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING
GROUP
Report to the Governing Body
Subject: Quality and Safety Subcommittee
Date:
24th April 2013
Author:
Claire Parker
Remit of Subcommittee
The purpose of the Committee is to;
•
•
•
•
•
provide the Governing Body with assurance that it is improving Quality and Effectiveness
for patients by:
Monitoring and reacting to Patient Experiences
Ensuring services commissioned are safe and effective
Ensuring Quality is embedded into everything the CCG delivers
Update the Governing Body on any Safeguarding Issues
Progress last Month
The last meeting of the group was 9th April 2013
There were no Never Events reported for March 2013.
For March 2013 there were:
•
14 incidents opened on STEIS of which:
o 10 were reported by SWBH
o 3 were reported by the Black Country Partnership
o 1 by CCG (transferred to B&SMHT)
•
23 incidents were closed on STEIS during March 2013
o 2 closed by BCPFT
o 19 closed by SWBHT
o 1 closed by CCG (transferred to B&SMHT)
•
As at 16.4.13 there are 32 incidents open on STEIS for longer than 45 days :
o 7 open for SWBHT
o 23 open for BCPFT
o 2 for the CCG
Safeguarding Children
Sandwell has had an OFSTED inspection under the interim framework- the report was published on
9th April. Sandwell has been deemed inadequate in all areas inspected. The final report is a separate
agenda item for the Governing Body. The Designated Nurse will present a paper under the
confidential items of the Governing Body.
Datix Incident Reporting System: Up and ready to use as of 1st April 2013. Sandwell GP’s have been
notified by link email but not all GP’s aware. System available for West Birmingham GP’s and quality
team will be supporting the practices to implement the system.
Quality report (as presented to April Q&S committee attached as appendix A)
Outbreaks: Norovirus and diarrhoea and vomiting continue to remain an issue at SWBHT which has
lead to a continuation in a number of ward closures and continues to impact on the urgent care
system. A number of other outbreaks have been reported from the trust including Salmonella
infantis and iGAS (invasive Group A Streptococcus) - the trust is investigating infection control
practices and this is being monitored closely through the clinical quality review process.
Mortality: National Bowel Cancer Audit- SWBHT is showing as a mortality outlier nationally. The
clinical director, Neil Cruickshank has been invited to the clinical quality review meeting in April to
discuss the findings of the audit and to advise on actions taken.
Francis Report: A draft version of the main commissioning recommendations from the Francis
report was presented to the Q&S committee with the responses of the CCG. The committee were
asked to review the responses and make any comments. The responses will then be formatted into
an action plan against which detailed actions, staff and dates will be aligned to show progress
against the plan. The Q&S committee will manage and update the plan. The initial action plan will be
presented to the Governing Body.
BCPFT:
There are no issues to report against BCPFT as the April children’s services meeting was cancelled by
Dudley CCG. SWB CCG do not commission children’s services from BCPFT.
A meeting with Wolverhampton CCG was arranged to have one joint clinical quality review process
for BCPFT, this was agreed and will commence in June 2013.
Risk Register
The risk register will remain as a regular item on the Q&S committee. Risks around safeguarding and
infection prevention were identified.
Emergency Department
There are no significant updates relating to quality and safety in the emergency department;
however performance continues to be an issue. The Emergency department assurance group for
April was cancelled due to system pressures and therefore a chance to discuss the action plan did
not take place.
Medicines Optimisation and Individual Funding Requests
A number of IFR policies were presented for ratification at the April meeting for Governing Body
ratification:
• Individual Funding Requests
• Ethical Framework for Priority Setting and Resource Allocation
• Patients Leaving Non-Commercially Funded Trials
•
•
•
•
•
•
•
Patients Leaving Industry Sponsored Trials
Patients Leaving a CCG Funded Trial
Implementation and funding of guidance produced by the National Institute for Health and
Care Excellence
Patients Changing Responsible Commissioner
In-Year Service Developments and the Clinical Commissioning Group’s approach to
treatments not yet assessed and prioritised
Experimental and Unproven Treatments
On-going access to treatment following a ‘trial of treatment’ which has not been sanctioned
by the Clinical Commissioning Group for a treatment which is not routinely funded or has
not been formally assessed and prioritised
Policies for ratification by the Governing Body:
•
SWBCCG Pol09 SALARY VARIATION
Work Plan for Next Month
• Monitor Infection Prevention Strategies through clinical quality review process
• Recruitment of staff to Quality Teams
• Safeguarding team review to support child protection in Birmingham and Sandwell
Issues for escalation to Governing Body
Note no Never Events
OFSTED for Sandwell Safeguarding board is inadequate
Note the Serious Incidents reported and the closure of incidents.
Infection prevention issues at SWBHT
QUALITY REPORT
April 2013
1
OVERVIEW
1.1
Introduction
1.2
Key Points
1.3
Provider summary
2
PATIENT SAFETY
2.1
Serious Incidents
2.2
HCAI
2.3
Medicines management
2.4
Safeguarding
3
CLINICAL EFFECTIVENESS
3.1
NICE Quality standards
3.2
Appreciative Enquiry
3.3
Mortality
4
PATIENT EXPERIENCE
4.1
Net Promoter
4.2
Complaints/PALS
4.3
a) Complaints data
b) PALS data
c) PHSO cases
Net promoter
Page No.
1.1
Introduction
This report is intended to inform the committee on areas of clinical quality on which the CCG are
currently focussed. This provides the opportunity to scrutinise, challenge and to inform further lines of
enquiry or actions which can then be monitored through a recorded process.
1.2
Key Points
SWBH update
Many of the Trust’s medical wards are giving rise for concern especially with regard to staffing
arrangements – we are taking additional steps to try to resolve this issue and have this month seen
signs of improvement with a reduction in sickness absence on many wards, improved vacancy rate and
positive signs with key quality metrics. L4 is alerting in several areas and is therefore receiving targeted
assistance.
BCPFT update – intended future joint CQRM with Wolverhampton CCG
1.3
Provider summary
SWBH
Quality Report
• Safety Thermometer results in February improved to 96%. This is the first month that the Trust
has achieved the 95% harm free target. The largest reduction in harm events is within pressure
damage. No patients experienced more than one harm event.
• Falls in January decreased from the November and December position. The biggest reduction in
falls events occurred at Sandwell.
• Infection rates – there have been further problems with Norovirus in February with a different and
more virulent strain affecting the community and hospital. C diff rates increased, especially at
Sandwell although both C diff and MRSA remain within trajectory for the year.
• Pressure Damage – There were 14 avoidable hospital acquired pressure sores reported in
December. Of these there were no grade 4 sores and a total of 3 grade 3 sores. This represents a
continuing improving picture over the year.
• Nutritional assessments on admission are back to an acceptable level but repeat assessments still
need improvement.
• Bank/agency (nursing) increased in February to just under 7000 shifts. This is related to additional
staffing requirements for ‘specialling patients’ in the EDs and to cope with lack of flexibility around
outbreak wards.
• Staffing ratios – the vacancy position and sickness absence position improved in February as a
result of recruitment, closing of some beds and robust absence management. There has also been
some improvement in quality measures with less wards showing concerning trends. Actual
staffing levels are being maintained but often with high bank/agency use and poor skill mix.
Outbreaks
Targets 2012/13:
C difficile – 57 cases (post 48 hours, using SHA testing methodology)
(National Priority
MRSA – 2 cases (post 48 hours)
Local contract) MRSA Screening – 85% eligible patients
Blood culture contaminants – 3% or less
E Coli and MSSA – Continue to record and TTR device related
infections
National cleanliness standards – 95%
MRSA
There were no post-48 hour MRSA bacteraemia for Febuary. The total number of MRSA bacteraemias
against the Trust target to date is 1.
Mortality
As part of the Trust’s annual contract agreement with the commissioners the Trust has agreed a CQUIN
scheme with an end year target to review 80% of hospital deaths within 42 working days.
During the most recent month for which complete data is available (December) the Trust reviewed 66%
of deaths compared with a target trajectory for the month of 74.0%. The Trust has failed to meet the
trajectory for December. Operational pressures within the trust have had effects on many parts of the
organisation and carrying out mortality reviews has not escaped.
In addition, the Trust has developed and implemented a revised Mortality Review System which will
spread the burden of carrying out reviews more equitably across the medical specialities. This is
planned to result in more deaths being reviewed as required.
CQC Mortality Alerts received in 2012/13
Perinatal Mortality
The Trust received notification from the CQC on 18th December 2012 of being an outlier for perinatal
mortality. An investigation report has been submitted to the Commission on 7th January. A response
from the CQC was received on 18th February indicating that they did not wish to undertake any further
enquiries at this time.
Elective Caesarean Section rates
The Trust received notification from the Care Quality Commission on the 18th February 2013 of
being an outlier for elective caesarean section rates. The Commission indicated that following
the consideration of maternity indicators, their analysis had indicated significantly high rates of
elective caesarean section at the Trust and it required further information from the in order to
consider the matter further. A review of relevant cases in underway and the findings will be
reported to the Commission.
Complaints
Some complaints continue to accrue “active” days as they have not yet been concluded and closed.
This is for varying reasons and include:
•
•
•
•
6 cases where the complainant has requested a meeting
1 case where the complainant is considering their next steps
1 case where the complainant wishes to wait for the outcome of an inquest prior to receiving a
response
Pressure ulcers Grade 4
None Reported
BCPFT
The March meeting mainly concentrated on Learning Disability Services.
Serious Incidents
There were 6 new STEIS’ reported since the last report.
There are currently 16 ongoing Serious Untoward Incidents (excluding the new STEIS’)
11 for Adult Mental Health
3
for Children, Young Persons and Families
2
for Learning Disabilities
Serious Untoward Incidents Ongoing within Timeframe
6 x Adult Mental Health which 1 includes a Police Investigation
1 x Children, Young Persons and Families which is subject to a Serious Case Review
Serious Untoward Incidents in Internal Process - Ongoing Outside NPSA Timeframe
Learning Disability
1 x Returned to February Care Governance with amendments as requested in January however still not
approved, Divisional Manager meeting with author.
1 x RCA sent to Serious Incident Scrutiny Group for approval.
Adult Mental Health
1 x RCA completed awaiting Divisional Managers approval.
1 x RCA completed awaiting Care Governance approval.
1 x RCA sent to Serious Incident Scrutiny Group for approval.
Alerts
•
There were 8 new Medical Device Alerts received during January 2013
•
4 Medical Device Alerts was reviewed and closed with no action required
•
1 Medical Device Alerts was cascaded with sufficient feedback received to close alert
•
There was 1 overdue alert which has now been closed
External Visits and Reviews
A number of visits and reviews have taken place and the reports were shared at the CQRM
CQC – Health Lane
The CQC has undertaken a review at Health lane Hospital. This review is part of a targeted inspection
programme to services that care for people with learning disabilities to assess how well they
experience effective, safe and appropriate care treatment and support that meets their needs and
protects their rights; and whether they are protected from abuse.
CQC findings
Outcome 4: People should get safe and appropriate care that meets their needs and supports their
rights
Patients’ needs are assessed and staff have most of the information they need to know how to meet
individual needs. However, they need more information to be able to meet individual health needs.
Patients do not always have information available to help them understand what their plan is about or
how they are involved. For some patients activities are limited, which impacts on their well being and
choice.
Overall, we found that improvements are needed for this essential standard.
Outcome 7: People should be protected from abuse and staff should respect their human rights
Systems are in place to ensure patients are protected from abuse, or the risk of abuse. However,
patients do not have the information they need to know how to report abuse and to whom, so they
may not be able to do this. Patients’ human rights are respected but their privacy and dignity is not
always considered.
Overall, we found that Sitwell Ward was meeting this essential standard but, to maintain this, we have
suggested that some improvements are made.
Assurance
It was confirmed that the CQC have deemed they are complaint across the division in all areas except
for a minor concern relating to staff training regarding values and activity which will be followed up.
Quality Review Audit Visit
Gerry Simon Clinic
This visit to Gerry Simon Clinic was undertaken on 12th June 2012 by Helen Pettengell. The purpose
of the visit was to undertake a quality audit to provide an independent view of the services
provided focusing on Outcomes 1, 2, 4, 5, 7, 8, 10, 13, 14 and 21 in order to make a judgement
regarding compliance with the outcomes of the Essential Standards of Quality and Safety. The
report from the quality audit would enable an action plan to be developed to address any areas of
concern.
The visit was not unannounced as the patients had been made aware of the visit. At the time of
the visit to the ward there were 14 patients receiving care, treatment and support. Seven (50%) of
patients and a number of staff were spoken with during the visit. All staff were found to be open
and welcoming. During the visit, systems and records relating to the care and welfare of the
patients were examined, including the care plans and associated records.
Key concerns identified through the visit are as follows:
There were no areas which were viewed as critical and require immediate action on this unit.
Daisy Bank
This visit to Daisy Bank was undertaken on 14th August 2012 by Helen Pettengall. The purpose of the
visit was to undertake a quality audit to provide independent view of the services provided focusing on
a number of the outcomes of the Essential Standards of Quality and Safety.
General concerns for consideration: Care plans must be developed for all areas of identified need and
must provide staff with adequate information to meet the person’s needs in a person centred way that
upholds the service users wishes, preferences and choice.
Newton House
This visit to Newton House at Hallam Street was undertaken on 30th August 2012 by Helen Pettengell.
The purpose of the visit was to undertake a quality audit to provide an independent view of the
services provided focusing on a number of the Outcomes in order to make a judgement regarding
compliance with the outcomes of the Essential Standards of Quality and Safety.
As identified on the other Trust visits, to ensure the safety of patients from any ligature risks, the works
plan must be agreed and timescales for completion of the work must be set. It is important that the
works plan is monitored to ensure that there is no slippage and that the works plan is completed in a
timely manner. Robust risk assessments must be made available on the unit to identify and manage the
risks while awaiting the completion of the works plan. Staff must be aware of these risk assessments.
•
To ensure patients are not put at risk, allergies must be clearly identified and recorded where
relevant.
•
The recording of capacity and consent must be consistent with other documentation within the
file(s).
•
Consideration should be given to the current filing system and introducing
Walsall Learning Disability Services
This visit to the Walsall Learning Disability Service was undertaken on the 15th November 2012 by
Helen Pettengell. The purpose of the visit was to undertake a quality audit to provide an independent
view of the services provided in order to make a judgement regarding compliance with the outcomes of
the Essential Standards of Quality and Safety.
This was a positive visit with one area of identified minor non-compliance and a few recommendations
for practice development/improvement to ensure continued compliance with the essential standards
of quality and safety.
Complaints and Compliments
48 complaints were received between October to December. This shows a 41% increase in comparison
to the same period last year, when 34 complaints were received. The overall total of complaints
received since April is 127 and there is a 10% increase in comparison to the equivalent period for last
year (April to December 2011) when 115 complaints were received.
We have seen a 60% increase in compliments, with 61 received (October to December 2012) with
compared with the same period last year, when 38 were received (October to December 2011). The
overall total of compliments for April to December 2012 is 183 which shows a 63% increase when
compared with the same period last year, when 112 were received (April to December 2011).
Workforce
Trust Wide
•
Sickness absence for the month of November stood at 5.03%. This has been an increase
since last reported on in November, however is a reduction on the previous month.
•
The turnover figure for the Trust continues to be well within the acceptable target range of
12.9%.
•
With effect from this month mandatory training is reported in two separate figures:
o Percentage of staff attending the new Annual Mandatory Training Day.
o Percentage of staff compliant with Specialist Mandatory Training.
•
The percentages of staff who have attended the new mandatory training day is 18.3%, this
is since its launch at the end of October 2012. The Trust target being 95% by the end of
October 2013. Feedback received by staff attending this new training day has been very
positive.
•
The percentage of staff compliant with Specialist Mandatory Training is 54.8%, with the
Trust target being 95%. This figure is a combined compliance figure of a range of
mandatory training topics. It is proposed to implement the same automatic booking
approach to this training as applied to the mandatory day.
•
Appraisal rate for the Trust as a whole continues to increase and now stands at 80.7%. This
is a significant achievement for the Trust and is thanks to the hard work of all involved.
•
Agency, which includes both medical locums and non-medical agency costs has further
reduced. 35.6% of the spend is on medical locums totalling £61,559 for the month of
December.
Corporate Directorates and Operational Divisions
•
•
•
•
Sickness absence within Learning Disabilities continues to be above the Trust target figure
of 4.5% and currently stands at 7.78%. Work is currently on-going within the Division to
address this.
Children’ Division currently has the highest attendance at the new annual mandatory
training day with 35.57% of their staff attending since the launch. The percentage of staff
compliant in specialist mandatory training in all divisions is below the target of 95%.
Children’s currently stands at below 20%.
The appraisal compliance target of 80% was achieved in December by Mental Health,
Learning Disabilities and Corporate Services. Children’s compliance percentage for
December is 68%.
Mental Health have the highest usage of bank and agency (42.4% of agency spend is on
medical locums totalling £61,559). Mental Health still has a substantial number of
vacancies within the Division.
2.0 Patient safety
2.1
Serious Incidents
Incidents
Reporting of incidents continues to rise year on year which evidences an improving safety culture. This
has been helped by the introduction of the electronic reporting system. Management of incidents
within an agreed timeframe is important to understand trends and themes and allow for actions to be
taken at the appropriate time. Incidents remain in a “holding” file until they are managed and closed.
This may cause delays in addressing issues if not corrected. A targeted plan is in place to assist
managers with managing their unmanaged incidents.
Type of Incident
1600
1400
1200
Non clinical
Number
1000
Patient Safety
800
Un assigned
600
TOTAL
400
200
0
Apr12
May12
Jun- Jul-12 Aug12
12
Sep12
Oct12
Nov12
Dec12
Jan13
Feb13
Month
2.2
HCAI
C.Difficile
60
50
40
30
20
10
0
Apr-12
May-12
Jun-12
Jul-12
Sandwell
Aug-12
City
Sep-12
Oct-12
Threshold (cumulative)
Nov-12
Dec-12
Jan-13
Feb-13
M
Trust Total (cumulative)
Blood Contaminant
Percentage Possibly Contaminated
5.0%
4.0%
3.0%
2.0%
Consultant Data City
1.0%
Consultant Data Sand
0.0%
05/2012
06/2012
07/2012
08/2012
09/2012
10/2012
11/2012
12/2012
01/2013
02/201
Outbreak and Other Infection Control Activity
•
There were more outbreaks of diarrhoea and/or vomiting across both sites in February, mostly
due to confirmed norovirus. This is thought to be due to a more virulent strain of the virus, and
is causing an unprecedented number of incidents both within the community and in many
•
•
2.3
trusts in the region.
The number of confirmed cases of Influenza A continues to rise, with many patients requiring
Critical Care. The majority of cases are due to H3N2, not H1N1 (swine flu),
A patient was admitted with a respiratory illness which was later confirmed to be due to novel
coronavirus. He had travelled from Pakistan to the UK via Saudi Arabia. Another two family
members who had not been abroad were subsequently found to be positive for novel
coronavirus, confirming the ability of the virus to be transmitted from person to person. It is
imperative that staff follow HPA guidelines on patients returning from abroad with signs of a
respiratory illness to ensure that they are not at risk of having contracted novel coronavirus.
Medicines Management
Warfarin CQUIN.
An audit of patients admitted taking warfarin with an INR above 5 whose dosage had been adjusted or
reviewed prior to the next dose, was carried out over a 1 week period in December. Compliance of
100% was achieved.
Drug Storage Audits
Ward drug storage audits were carried out in January and the early results are summarised below.
General Drugs:
Compliance of between 90-100% was evident against 93%
November 2012
of standards, compared to 70% in
Compliance of 70% or higher was evident against 100% of
November
standards which is the same as in
Controlled Drugs:
Compliance of between 90-100% was demonstrated against 80% of standards, compared to 75% in
November 2012.
Compliance of 70% or higher was demonstrated against 90% of standards, compared to 85% in
November.
2.4
Safeguarding
Reported separately
2.5 National Patient Safety Agency (NPSA) alerts
Overdue alerts:
 NPSA 2011/PSA001 – Safer spinal (intrathecal) epidural and regional devices. This alert will continue
to remain as “ongoing” on the Central Alert System until all of the components we require to safely
convert to the new neuraxial devices are available.
New alerts: No new alerts have been received.
Medical Devices Agency (MDA) alerts
Overdue alerts:
 MDA 096 – Resuable laryngoscope handles All Models, All Manufacturers. Process have been put in
place to address this alert but a final solution for ongoing compliance is being discussed currently.
 MDA 075(r) – Medical devices and medicinal products containing chlorhexidine. Awaiting
confirmation from 2 areas that they are compliant.
3.0 Clinical effectiveness
3.1
NICE Quality standards
Nothing to report
3.2
Appreciative enquiry
Nothing to report
3.3
Mortality
See above
4.0 Patient Experience
Patient & Staff Safety: Listening into Action
•
•
A guide on good examples of feedback is being developed to send to assist managers via staff
communication.
A snapshot audit shows that incident and risk issues are being discussed at 70% of staff
meetings. There is some concern that some staff say that they do not have team meetings
and this will further be addressed through a hot topics questionnaire.
Friends and Family Test Survey (Net Promoter)
Summary Results Dashboard – January 2013
The Trust continues to achieve above the NPS target of 65
Note: All Trusts have different targets and baselines. Common feature is
showing a 10 -point improvement over the year.
While the Trust continued to improve its NPS, the survey response rate dropped
further.
Net Promoter position
Resources have now been identified to expand the Patient Experience Team which will enable a more
robust and co-ordinated approach to improvements in patient experience and bringing patient
experience to the Trust Board.
Hospital Site Details
Total responses in each category for A&E
Department
Site code
*The Site
code is
automatically Hospital Site
name
populated
when a Site
name is
selected
1 - Extremely Likely
2 - Likely
3 - Neither likely or unlikely
4 - Unlikely
5 - Extremely unlikely
6 - Don't Know
City Hospital RXK02
Sandwell
General
Hospital RXK01
55
11
10
8
0
1
5747
85
1.5
38
5
6
4
0
0
3866
53
1.4
Birmingham
Midland Eye
Centre (Bmec) RXK03
101
8
7
9
1
0
1834
126
6.9
Total
194
24
23
21
1
1
11447
264
2.3
Total
Total
Number number of
Resp
responses
of
rate fo
for each
people
A&
A&E
eligible
depar
departme
to
nt
respond
Friends & Family Test results for A&E
Patient Related Outcome Measures (PROMs)
Complaints / PALS
4.2
Complaints Data
Complaints:
The following table sets out the complaints data for February 2013 with reference to
previous months where relevant.
MONTH
First
Complaint type:
Complaint type:
RECEIVED
SENT
Link*2
TOTAL
contact*
Oct 2012
62
First
Link*2
TOTAL
19
116
contact*
12
74
97
Nov 2012
68
11
79
113
15
128
Dec 2012
39
5
44
76
17
93
Jan 2013
60
14
74
47
7
54
Feb 2013
70
6
76
56
10
66
*First Contact complaint: where the Trust’s substantive (i.e. initial) response has not yet been made.
2
* Link complaint: the complainant has received the substantive response to their complaint but has returned as th
remain dissatisfied/or require additional clarification.
Breach cases
Some complaints continue to accrue “active” days as they have not yet been concluded and closed.
These are generally out of the control of the Trust and as at the time of this report these include:
Correction position as at 1 February 2013 was20 cases in breach. The breakdown is as follows:
3 cases where the complaint is progressing to a meeting
2 cases where the complainant is considering next steps
10 cases where the response is at the final stages of the complaints process
5 cases at early stage of the complaints process
PALS Issues
•
•
•
Contacts and general enquiries: In February 2013 PALS recorded 196 PALS enquiry contacts and
174 general enquiry contacts. In comparison, to January 2013, where we received 196 PALS
enquiry contacts and 203 general enquiry contacts. The general informal enquiries are not
captured on the PALS database but relate to enquiries taken at the PALS reception desk.
Chart A provides a breakdown of the themes identified via PALS contacts in February 2013. The
main categories reported during the month of February 2013 were issues relating to:
Clinical Treatment PALS received 36 enquiries this month in comparison to 29 issues reported
during January 2013. These relate to queries compromising the categories of clinical care, low
•
•
staffing levels, and medicines. In addition, issues relating to a delay in the following: investigations,
results, surgery treatment and x-ray/scan.
During February 2013 there was reduction in the number of appointment queries where 26 were
reported this month, in comparison to 34 enquiries during January 2013. Appointment related
enquiries relate to appointments cancelled, delay, notification and time.
There has also been a reduction in the number of formal complaint issues which comprise the
categories of handling, advice, process, referral and response time from 31 enquiries received this
month in comparison to 44 enquiries reported during January 2013.
24th April 2013
Enc 10
Report Topic:
Strategic Commissioning & Redesign Subcommittee Report
Report From:
Dr George Solomon
Date:
22nd April 2013
Aim of Report
To update the Governing Body on the work of the Strategic
Commissioning & Redesign Subcommittee
RECOMMENDATIONS
The Governing Body is asked to NOTE the contents of this report and
ratify decisions undertaken by the SCR.
IMPLICATIONS:
Financial
None
Patient & Public
Involvement
None
Healthcare
Commissioning
None
Equality Impact
Impact
None
Engagement (Clinical or
Non Clinical)
None
Legal
None
Vision and Values
None
Workforce
None
Other
SANDWELL AND WEST BIRMINGHAM CLINICAL COMMISSIONING GROUP
Report to the Board
Subject: Strategic Commissioning & Redesign Subcommittee
Date:
22nd April 2013
Author:
Lisa Maxfield
Remit of Subcommittee
The purpose of the Committee is to;
•
•
•
provide the Governing Body with assurance that it is meeting the obligations of an effective
commissioning organisation
ensure effective and efficient delivery of the CCG’s strategic commissioning plan
ensure all commissioning intentions; strategically determined or locality derived, are aligned
to the strategic commissioning plan
Progress last Month
The last meeting of the group was in March 2013
The SCR committee received a 6 month evaluation of Sandwell MBC’s Rapid Intervention Team for
End of Life. The evaluation was focussed on efficiency - facilitating dying at home and avoiding
hospital admission. Cost effectiveness – compared with the costs of alternative services including,
hospitals, hospices and Sandwell End of Life Bungalow beds. Qualitative – feedback from carers and
professionals who refer to the service. The evaluation was favourably received and the SCR agreed
to continue to fund the service from NHS/LA transfer monies if they are available.
The SCR agreed to commission the Diabetes Service Specification subject to changes to KPIs.
Evaluation of the Black Country LCG Cardiology pilot was presented. SCR agreed that a Cardiology
Steering Group be formed to devise and agree a Community Cardiology Specification for the CCG. It
was also agreed to extend the Black Country Cardiology pilot for a further three months to enable
the steering group to agree future provision options.
An evaluation of the AF service was presented to the SCR, this has proved to be very successful.
There are significant savings attributable to this service not only monetary but from a prevention
and quality of life perspective. The committee agreed to run the same scheme during the winter of
2013/14.
An update was given to the SCR regarding the community DVT pathway and progress so far. SCR
agreed that oral anticoagulation should be incorporated into the pathway and it was agreed that the
Community DVT Pathway Service Specification be presented at the next meeting.
The SCR agreed to a GP Incentive Scheme which is to Simplify Tier 1, incorporate investment of time
and effort by practices in engaging with CCG/LCG:
• Practice representation, each practice nominates a clinical lead and deputy (deputy can be
the practice manager) to undertake specific roles to support the delivery CCG and LCG
priorities.
• Practice attendance at LCG meetings (regular locality meetings and 2 PLTs organised by the
locality and CCG events (PLTs and membership events)
• Practice regularly reviewing activity and financial information supplied by the CCG
• Practice utilising of the designated CCG demand management and risk stratification tools
when they become available
• Payment 75p per registered patient
The SCR received a business case proposal from Vitality Partnership, the SCR agreed with the overall
concept but was unable to make a decision on the day and agreed it would write to Vitality
Partnership.
The SCR agreed in principle to a paper in relation to innovation schemes.
The SCR were given an update on the Bungalow Beds that are being procured and agreed to receive
an updated position in 2 weeks at the next CBPG.
Workplan for Next Month
1. JSNA
2. QIPP Commissioning Intentions
3. NHS 111
4. Termination of pregnancy
5. Diabetes local Incentive Scheme
6. Dermatology Business Case
7. DVT Service Specification
8.
Issues for escalation to Board
No issues were identified for escalation.
Enc 11
FINANCE and PERFORMANCE MEETING
Minutes of the meeting held on 25th March 2013
In Meeting Room 2, 4R, Kingston House
Attendees:
Name
Job Title
Ian Sykes
Julie Jasper
James Green
Martin Stevens
Dr Klair
Black Country Commissioning LCG
Lay Member – Chair of Audit Committee
Chief Finance Officer – SWB CCG
Head of Business and Contract Performance – SWB CCG
Louise Piper
Business Support
Apologies:
Vijay Bathla
Paul Sheldon
Chair of SWB CCG Finance and Performance Committee
Deputy Chief Finance Officer – SWB CCG
Item
1.
Subject
Welcome and Apologies
Ian Sykes chaired in place of Vijay Bathla and welcomed everyone to the
meeting.
2.
All received apologies were noted as above.
Minutes
Were presented in draft for approval – these were approved as a true record of
the previous meeting
Pass to AH for Board
3.
Chairs report
It was noted that this is the last meeting of the shadow CCG before it is officially
recognised as the CCG
4.
1
Finance report
Action
Enc 11
Item
Subject
James Green gave an update from the last 11 months of the financial year
This year will end in financial balance , with the £7.4m surplus from PCT
transferred to CCG which will account for the mandated surplus required for
2013/14
A discussion was undertaken surrounding Innovation funding and how/if it will
be allocated in the new financial year. It was agreed that there needed to be
standardisation of process for innovation schemes if they are happening in 201314. It was further decided that innovation schemes need to be genuinely
innovative, and that evaluation needed to be undertaken in the 2012/13 projects
for potential rollouts.
5.
Performance report
Group reviewed the performance report.
It was agreed that a business performance group is to be convened, with a
membership of Martin Stevens, Paul Sheldon and Olivia Amartey as the core
members then clinicians/officers to be brought in as and when required. The
group will report into Finance & Performance Committee. The purpose of this
group will be to monitor performance of the CCG, and as an operational group to
enhance and drive performance, that Finance &Performance Committee can
challenge if required.
A&E underperformance was discussed with reference to the Stroke Service,
which should divert pressure from City Hospital, this is to be monitored to
ensure it is delivering. The increase of the Plastic Surgery service was discussed;
in particular there is a specialist in breast reconstruction that has long waiting list
as there are of people choosing to see this consultant.
6.
The Committee approved the report.
Finance report – Proposed budget 2013/14
JG tabled the report which was then reviewed and discussed.
The report is based on January draft financial strategy. The scopes of
responsibilities were detailed. Available resources reviewed and compared with
PCT.
Costs and expenditures were reviewed and discussed.
The QIPP challenge was outlined, The risks highlighted and reviewed. At present
2
Action
Enc 11
Item
Subject
Action
a £15m gap has been identified relating to Specialised Services allocation
dedications, we are currently working across CCGs to identify areas as this is an
issue across West Midlands. Work is being undertaken to review and identify
reductions.
No acute contract has been signed as yet, which impacts across CCGs. There is a
commitment to resolve but solution not identified as yet. LAT have been made
aware of issue and know that contracts unlikely to be signed by Thursday. There
is at present a £5m exposure, identified as too high risk to sign off contracts.
The possibility of risk sharing across the Midlands was discussed, but was
deemed not a possible solution at present. Risks are highlighted at beginning of
year – JG to add appendix with further detail analysing risk.
The committee approves the report on principle to be passed to Governing Body
for further approval.
7.
Any Other Business
The was no further business to discuss
8.
Date and Time of Next Meeting
A set pattern is to be established for 2013/14
Next meeting will be provisionally on Monday 22nd April at 1pm to 3pm Kingston
House.
The group will be canvassed for dates at the May meeting to be provisionally
held on the 20th.
3
Enc 12
QUALITY AND SAFETY MEETING
Minutes of the meeting held on Monday 11th March 2013
In Meeting Room 4R, Kingston House
Present:
Richard Nugent (RN) –Independent Committee Member - CCG
Claire Parker (CP) – Chief Officer, Quality - CCG
Andy Wakeman (AW) – Public Health Lead, Governing Body
Alison Hodgson (AH) – Corporate Assurance Manager
Liz Walker (LW) – Head of Medicines Optimisation
Dr Ayaz Ahmed (AA) – GP Lead – Sandwell Health Alliance
Dr Liz England (LE) – GP, Healthworks
Noorin Akhtar (NA) – Patient Representative HOBAG Birmingham Link
Jonathan Holt (JA) – Clinical Excellence Facilitator
Dot Gospel (DG) – Links Management Group/Sandwell Patients Representative
In Attendance:
Dr Bob Ryder – Diabetes Consultant – Sandwell & West Birmingham NHS Hospital Trust
Dr Pia Gupta – Research Fellow – Sandwell & West Birmingham NHS Hospital Trust
J Taylor – Temp. Business Support Officer (notes)
Apologies:
Dr Sam Mukherjee
Dr Gwyn Harris
Dr Pri Hallan
Jane Salter-Scott
Eileen Welch
Lornay Webley
Margot Warner
Martin Stevens
Emma Bodycote
Item
Subject
Action
1. Apologies
As noted above.
2. Declarations of Interest
None recorded.
3. Minutes of Last Meeting
Minutes of the previous two meetings (08.01.13 and 12.02.13) were confirmed
as an accurate record of discussions.
4. Action Register:
Updates were recorded as follows:
1
Enc 12
Item
Subject
Action
GP Record Keeping Audit
CP reported that the latest GP Record Keeping Audit was to be an AOB agenda
item at next Health Forum meeting in order to discuss how to take forward.
Safeguarding
CP reported that the bi-monthly report was due for the April meeting.
Serious Incident Report
CP reported that Helen Jones had now left the organisation and that Jonathan
Holt would assume temporary responsibility for SI reporting. Updated SUI report
had been compiled and was circulated at the meeting (see agenda item below).
Emergency Department Update
See agenda item below.
111 Update
To be removed from report.
Risk Register
See agenda item below.
Items taken out of sequence on agenda:
5. Presentation – Research Study
A slide presentation was made by Dr Bob Ryder and Dr Pia Gupta from SWBHT
regarding research into a potential new NHS treatment (Endobarrier) which, it
was reported, may be beneficial for people who are overweight / have poorly
controlled diabetes. Dr Ryder explained that the Endobarrier treatment had
been the subject of a multi centre study, tested in a number of different
countries and had achieved European CE mark. Research support costs had
been achieved via grant and the treatment had been approved by National
Institute for Health Research (approved NHS study). Because the study had been
undertaken in the NHS, it required NHS treatment costs for which financial
support was now being sought from the CCG.
Dr Ryder reported that the treatment had been used privately in the UK and it
was hoped to now test it in an NHS environment. The treatment was associated
with 20% weight loss and 2% reduction in HbAlc and it was highlighted that some
patients may be able to come off medications or require less. It was unknown
what happens after the initial treatment year however and further research was
required therefore to ascertain what happens with combined treatments and to
find out how Endobarrier works with regard to devising new treatments.
The multi-centre trial had involved Glasgow RI, City Hospital Birmingham (Dr
Ryder Chief Investigator) and Kings College Hospital London. It was hoped to
2
Enc 12
Item
Subject
Action
recruit 72 patients – 24 in each centre. Trying to target patients who currently
have access to best therapies available currently apart from surgery. (Inclusion
criteria – HbAIc > 7.5%, BMI > 35). Exclusion criteria related mostly to issues of
safety (anti-coag/bleeding etc).
Treatment arms would involve three different patient groups:
a. Patients who would continue on drug treatment but on higher dose –
within licence (not in wide use in UK)
b. Patients who would have device inserted but would discontinue drug
c. Patients who would have device inserted but would continue on drug
It was proposed that comparisons would be made within b. and c. patient
groups.
Discussion took place re cost comparisons: National tariff £7k for bariatric
surgery (severe complications exist here however, also non-reversible
treatment). Endobarrier device cost approx £3.2k (£1600 each for putting in
and taking out, reversible treatment).
It was highlighted that it was also important to ensure safety assessments were
carried out properly (abdominal x-ray and full blood count in subsequent follow
up visits). Manufacturers were also recommending that all patients that had
device, proton pump inhibitor be fitted for a year.
Therapy for first patient group would be stepped up with 1.8mg dose – extra
costs associated for these patients extra costs for those eight patients would be
approx. £7600.
Overall costs for 24 patients equate to £64k. Figure does not include cost
savings associated with patient group b. Significant cost saving over £7k.
It was commented that drop-out rates would be measured.
Patient primary outcome would be based on the differences in the three patient
groups, taking drop-out rates into account; end point calculated at year after
device removal.
Queries were raised with regard to offering the patient control group
Endobarrier treatment and whether the treatment involved any complications or
side effects. It was advised that UK-wide coverage in NHS was being attempted
and that the whole treatment protocol had been assessed in depth and involved
much patient and public involvement and generated much patient interest.
Side-effects included temporary nausea/abdominal pain (patients would have
been warned about this). 500 patients had been trialled in Netherlands,
resulting in two patients experiencing complications for bleeding for which
device needed to be removed. Two out of 100 had experienced pancreatitis but
3
Enc 12
Item
Subject
were fine after having the device removed.
The query was raised with regard to differences between Endobarrier and gastric
balloon. It was advised that the gastric balloon was inserted into the stomach
but not the intestine to give patients the feeling of increased fullness but that
the treatment had not performed well in clinical trials and was deemed to be
ineffective. The Endobarrier was designed with the aim of mimicking bariatric
surgery, by-passing the intestine (not touching the stomach) and producing
changes in gut hormones.
It was proposed that two gastroenterologists would be trained re Endobarrier
treatment (one of which would always be around) and patients would be
provided with contact telephone numbers if the devices were required to be
removed quickly.
Discussion took place with regard to exit costs and whether these related to drug
(Liraglutide) costs only. Dr Ryan advised that if a patient had lost three stone on
a 1.8mg dose, then a reduced dose of 1.2mg should be trialled to see if that
patient could maintain their weight on that reduced dose. If they were unable to
do this however, a special on-line request could then be raised for that particular
patient. A question was raised about the 1.8mg dose in the control group – the
response was to give the group something good for being part of the trial.
The query was raised as to why the trials did not include the use of Exenetide.
Dr Ryan advised that an ongoing nationwide audit on Liraglutide was underway
in real clinical practice from which data was being collected. The patients going
into the Endobarrier trial would be from the audit as six months of data would
be available to demonstrate that those patients had plateau’d, providing
baseline therefore before fitting the Endobarrier.
With regard to queries relating to patient selection, it was advised that patients
would come from within the nationwide audit who still had the criteria of being
poorly controlled/BMI in excess of 35. It would be up to clinicians who have
such patients who meet criteria to put them forward. Patients would also be
referred from diabetic and obesity clinics.
The query was raised as to whether CCG clinicians would have an opportunity to
nominate patients to go into the trial. It was advised that those patients would
have to have been in the nationwide audit for six months.
Discussion took place with regard to funding being requested (£64k) and
commencement of CCG governance process. Dr Ryan advised that as the
Endobarrier treatment had been the subject of an NHHR study, the treatment
had to be undertaken within an NHS endoscopy suite.
CP explained that currently such funding sat within the Public Health section of
the PCT but it was not clear where research funding would sit from 1st April. CP
4
Action
Enc 12
Item
Subject
Action
suggested because of this situation there was the need to take the request to
the Strategic Commissioning & Redesign Group to identify research funding
streams/CCG priorities.
ACTION: Funding request to be agenda item at next SCRG meeting. CP to
feedback information from that meeting to Dr Ryan/discuss next steps that
need to be taken from a commissioner perspective.
CP
6. Quality Report
SWBH:
Outbreaks: AH reported that a report had recently been submitted to the S&WB
meeting following recent CQRM visits which had included an update on
outbreaks following ward closures; debriefing session bulleted learning
highlights were contained within the report.
Mortality: AH referred to Roger Stedman report on mortality highlighting the
significant differences reported in mortality rates between Sandwell and City
Hospitals. It was reported that Sandwell & West Birmingham Trust had a lower
mortality rate than any of the top 15 chosen for special review following the
Francis Report. Sandwell General Hospital on its own however had a higher rate
and fell within the top ten in the country for mortality. This situation is
concerning and as a result more in-depth information and reporting has been
requested. CP commented that she would be would be looking to replicate
national “deep dive” situation at Dudley Group within Sandwell also. She added
that Roger Stedman was scheduled to meet with Dudley Group, reporting from
which would be picked up via the CQRM process. AH reported that mortality
reviews are continuing.
Francis Report: AH reported that a summary of 290 recommendations had been
provided to the Trust for initial response and that in order to progress/take
forward, the CCG Governing body and SWBH Trust Board would benefit from
taking a joint approach. Event to be organised.
Dementia: AH advised that Rachel Overfield had provided an update on how the
organisation was looking to improve dementia patient experience and work
being undertaken with the multi-agency/multi-professional steering group. Key
areas for progression included staff training and improvements to the
environment, End of Life care, activities and information. CP provided
information on Black Country Partnership Lighthouse Project and Sandwell &
West Birmingham project around improving ward environments for patients
with dementia. She added that both Trusts had been shortlisted for a grant and
had now to go through the next process for approval.
5
Enc 12
Item
Subject
BCPFT:
Learning and Development:
AH reported that following the mandatory training review across Black Country
Partnership, the process had been revamped to enable core mandatory training
to be undertaken in one day.
Lots of good reviews had been reported,
attendance had increased with people booking in to training in advance;
managers supporting fully.
NICE Guidance and Quality Standards
AH advised that a really good report had been received around infection
prevention and control. (Data contained within report for information). She
added that complaints were still be monitored and no breaches had been
reported. AH/CP provided an overview of the revised/improved complaints
procedure following advent of Francis Report. AH advised that consideration
was being given to looking at devolving complaints down to clinical areas but
highlighted the need to ensure priorities remain however in responding to
complaints.
AH provided clarification on National Patient Safety Alerts advising that national
alerts were received in relation to services/medical devices/medication etc
which are then disseminated to providers of services who then have to respond
to say that they have taken the appropriate response against that alert.
Enables trend analysis nationally re all sorts of clinical incidents.
Discussion took place with regard to the format of the quality report; CP
commented that work would continue to develop the report in order to
streamline/make it more user-friendly.
SUI Report
JH provided an overview of the SUI report highlighting incidents around ward
closures and around grade 3 pressure ulcers reported by SWBHT. Also picked up
were issues around delays in relation to the notification process. (Report
received was up to date as of 07.03.13).
CP commented on the need to get closure on SIs within 45 days. She added that
much work had been undertaken to ensure as many as possible were closed
prior to Helen Jones’ departure. CP added that a number of grade 3 pressure
ulcer SIs had been closed down and that most of the other SIs related to the
second outbreaks of Norovirus and ward closures. SIs were also being looked at
by the Infection Prevention Team and being picked up on delayed reporting/
through CQRM. CP advised that issue with Black Country would be raised at the
next Mental Health meeting.
CP reported that it would be possible to make comparisons re SIs on the new
6
Action
Enc 12
Item
Subject
Action
st
Datix system from 1 April. She added that once Helen’s replacement was in
post, it would be possible to report more robustly. ACTION: J Holt to provide JH
report re month on month changes.
CP provided an overview of the STEIS national web-based SI reporting system.
7.
Policy Ratification
No policies were presented for ratification at this meeting.
CP suggested that it would be beneficial for patient representatives to visit the
virtual patient group in order to be able to comment on policies from a patient
perspective. It was reported that once ratified, policies are updated to CCG
website.
8.
Exception Reports
CP reported that a skeleton action plan had been started in response to Francis
report. CP will begin to look at this in themes initially around Complaints/
Concerns/Datix system reporting as this formed major part of action plan.
ACTION: Draft Action Plan – ongoing agenda item.
8.1
Emergency Department
CP reported ongoing issues relating to performance at the Emergency
Departments at both sites. She added that quality and safety had improved
hugely and as a result planned to present incident reporting relating to ED as
there had been no serious incidents since summer last year. CP expressed
concerns however in that low level incident reporting was also coming down.
This was not the case however as green and yellow reporting was increasing.
(Good reporting culture). Red incident report was going down. CP commented
that this demonstrated even though going through reporting issues, situation is
reported as safe.
CP reported that both ED’s had been put into special measures by the Trust
purely relating to Q&S issues picked up last summer. She added that at the
recent Assurance Group meeting however it had been agreed that both EDs
would come out of special measures but that performance reporting would
continue.
Discussion took place with regard to recruitment plans for the hospital.
Approval for funding was received in January at SWBH Trust Board for extra
middle grade doctors and nursing staff and an additional Registrar for ED.
CP reported that the action plan received appeared to be “very corporate” and
did not reflect what was happening at the “coal face”. CP had a meeting
scheduled with the new ED project manager to go through the action plan to
7
Enc 12
Item
Subject
look at actions relevant only to ED.
General discussion took place re Acute Trust/intermediate care beds/message
going out to public about not turning up at A&E. In relation to a query raised by
DG regarding doctors going into hospital A&E Departments, CP reported that
GPs had been in place at Sandwell Hospital for the previous three months and
for just 2-3 weeks at City Hospital and that the situation was currently under
review. DG raised concerns about the non-education of people in relation to
patient queues. Further discussion ensued with regard to Walk-in centres; CP
advised that this situation was also currently under review and that evaluation
was awaited.
8.2
Screening Programmes
ACTION: Remove from agenda – screening programmes no longer CCG
responsibility. Programmes commissioned by NCB.
In view of above, RN suggested that it would be beneficial for a summary to be
produced in relation to the new areas of responsibility relating to screening.
9.
Infection Prevention
No updated report available.
CP reported a further number of ward closures around Norovirus. Sandwell and
City hospitals had been badly hit; some of that being a reflection of the number
of agency nurses in use, pulling people in who have worked on both infected and
non-infected wards and moving around when they shouldn’t. This has been
recognised as an issue. Auditing still meets required standard.
CP also reported a further outbreak of VRE - particularly prevalent amongst
community groups. CP trying to bottom out with Sandwell Public Health.
10.
Datix
AH provided update re Datix advising that the system was currently being “built”
to CCG specification. The incidents reporting side of this was almost complete,
forms/policy links would be available. CCG will be contacting practices with
regard to organising installation and training. Practice reports will be available
(utilising live dashboard). Next steps will be complaints and risk management. It
was suggested that a live demonstration could be made at the next Q&S
Committee meeting.
CP highlighted that it would also be possible to report on concerns as well as
complaints, balanced with compliments. She added that a customer care team
would be in place to enable reporting of informal complaints/concerns and that
it would be possible to analyse emerging trends and issues/action accordingly.
8
Action
Enc 12
Item
11.
Subject
Action
Issues were raised with regard to concern reporting protocols especially in
relation to individuals when they are not aware of the concerns being raised.
ACTION: Emerging information/information governance situation to be CP/
AH
reviewed.
Equality & Diversity
Quarterly report due for May meeting.
12.
Risk Register
AH reported that the risk register had been issued several times and that it had
been raised as a risk that the report was not being completed. She added that
the Finance Team had risks to be included, together with the Strategic
Commissioning Redesign team. The report was therefore starting to get
populated and the Audit Committee had asked for the Q&S committee to look at
the risks and give assurances that they are being appropriately recorded and
appropriate controls and actions are in place. AH reported that all meeting
Chairs had been requested to include risk register as an agenda item at all
meetings.
AH asked if there were any risks that had been missed and needed to be
included from a Q&S perspective. RN suggested that clarification about
responsibility within new structure should be included as a risk.
AW reported differences in the PLCV commissioning policies in existence.
ACTION: Risk Register to remain as standard agenda item.
13.
Clinical Audit Proposal
CP enquired if any further consideration had been made around Diane Lynch
proposal around delivering a programme of clinical audit for the CCG. She added
that it was not clear where audit sits from a CCG point of view currently but that
there was some value in having a programme with regard to bigger pieces of
audit work to improve quality - situation requires clarification. CP enquired if
Clinical Audit should remain as an agenda item for the C&S Committee or
transfer to Primary Care Quality Committee.
CP suggested chosing four audits per year across CCG and linking with Francis
Report action plan and Datix trend information also.
ACTION: Clinical Audit Proposal to remain as agenda item.
14.
Quality Structure Update
CP reported that recruitment was underway currently for six posts within
9
Enc 12
Item
15.
Subject
Quality.
Community Nursing Specification – Update
Item deferred to next meeting.
16.
Primary Care Quality Dashboard
Item removed from agenda.
17.
Any Other Business
Medicines Optimisation Team Strategic and Operational Framework April 2013March 2014.
Liz Walker provided an overview of the above report which detailed the
operating framework to be utilised by the Medicines Optimisation Team in
relation to the key aims and vision for the team over the forthcoming year. The
document would be used to focus the team in order to reduce HARMS
associated with medicines use, improve patient experience and reduce health
inequalities in relation to medicine taking. The team would also support
prescribers by advising on safe and best practice, forming part of the wider QIPP
agenda by achieving cost effective medicines management.
18.
Date of Next Meeting
Tuesday, 9th April 2013 – Boardroom, 2F – Kingston House
PLEASE NOTE THAT ALL FUTURE QUALITY AND SAFETY COMMITTEE MEETINGS
WILL COMMENCE AT 13:00-15:00.
10
Action
Enc 13
SCR Meeting : 28th February 2013
Attendance:
George Solomon
Olivia Amartey
Paul Sheldon
Richard Nugent
Basil Andreou
Arun Saini
Mark Foullerton
Pri Hallam
Ian Walton
Paul Russell
Carla Evans
Sirjit Bath
Mohammad Khalil
Angela Poulton
Apologies:
Lisa Maxfield
Jon Dicken
Manir Aslam
Jayne Salter-Scott
Simon Butler
Claire Parker
Dr Chawla
Declarations of Interest: GP incentive scheme and Diabetes incentive scheme
(all GPS)
Previous Minutes:
Add Pri Hallam in Attendance
Various spelling errors noted
Actions
JSNA
Paper - JSNA
Item
Decision
Action
JSNA
Andy Wakeman to
JSNA and Health & Wellbeing
produce a paper on
Strategy paper to be produced
JSNA and for Health &
Wellbeing Strategy for
clarity
Owner
Andy
Wakeman
Enc 13
111
Item 7:
Tier 3 weight
Management
service
Risks need to be highlighted in
reports in future for the Risk
Register
Basil
Andreou
GP from Partnerships
Committee to be
identified to join the
Sandwell Children and
Families Obesity Group
as representative
Contract
Evaluation
All
Questions to be clarified for end of
April
Paul
Stevens
9.2
Integrated
Paper not presented
commissioning
of sexual health
2013
9.3 Diabetes
Group note the report,
further detail to be
presented in March.
Ratification to be
sought at Board
Carla Evans
Enc 13
9.4 Maternity
Spec and KPI
Decision to work with
the Wirral to develop a
similar model for SWB
CCG
Carla Evans
AQP specification for
community Midwifery to
be undertaken
Local KPIs to be
included in contract for
12-13
Noted the update to the
two workstreams
9.5 Bungalow
Beds
9.6 Community
Nursing –
Service
specification
Deferred decision
George Solomon & Paul Sheldon to
work up the options in order to get
consensus by email
George
Solomon
Paul Sheldon
V3 to go to consultation Group to review the document and
provide feedback to Angela Poulton
Angela Poulton to forward the
document to Mark Foulerton
Reminder from George Solomon that
this is confidential and not to be
shared outside this group
Incentive
Scheme
Move to two tier model
– paper to be written for
discussion at next
Directors Group
Support for 50p in tier 1
Mohammad
Khalli
£1 for tier two
AOB – Paul Sheldon – Murray Hall reduction in income Charity is now
untenable until an action plan is created. They can continue in a reduced
capacity once they have transitioned – proposal to fund the transition period
through PCT money – currently provide valuable community service. Group
agrees in principle, but service delivery needs to be agreed.
Enc 13
Enc 13
Enc 14
SANDWELL HEALTH ALLIANCE L.C.C. BOARD MEETING
Minutes of the Meeting held on Tuesday 26th February 2013,
1.00-4.00pm @ Oakwood Surgery, Izons Road, West Bromwich
Attendees:
Dr B Andreou (BA)
Dr P Hallan (PH)
Dr A Ahmed (AA)
Dr S Chawla (SC)
Dr P Klair (PK)
Dr D Manivasagam (DM)
Deska Howe (DH)
Laura Mainwaring (LM)
Angela Poulton (AP)
Hannah Peach (HP)
Chair
Vice-Chair
Quality & Safety GP Lead
Strategic Commissioning & Redesign GP Lead
Finance & Performance GP Lead
Partnerships GP Lead
Patient Representative
Finance Management Lead, SWB CCG
Senior Commissioning Manager, SWB CCG
Prescribing Lead
In Attendance:
Andy Williams
Accountable Officer, SWB CCG
Apologies:
None
Item
1.0
Subject
1.1
BA welcomed Andy Williams.
1.2
No apologies were given.
2.0
2.1
All GPs in relation to Dr First and the Respiratory Pilot.
3.0
Minutes of Previous Meeting
The Minutes were declared a true and accurate account of the previous meeting.
3.1
Matters Arising
None.
1
Enc 14
3.2
Progress Against Actions
From meeting 23/10/12
3.2.1
6.8 LM to provide Lymphodema performance information before the next Board meeting.
3.2.2
12.3.1 AP has contacted PK about taking on the SHA Demand Management locality lead role. PK
to find out more in relation to what is involved and assess whether the role can be fulfilled given
his finance & performance lead commitments.
20/11/12
3.2.3
3.2.4
3.3.7 AA reported that he had intended to raise the issue of X-ray reporting at Sandwell Hospital
under AOB at the last Quality & Safety Committee but the Francis Report led to the need to take
this to the next meeting - action carried forward.
.
5.2 PK confirmed that the locality referral report for 2012/13 had been sent out by Laura
Mainwaring.
22/01/13
2
3.2.5
4.2.4 PH confirmed that he had been appointed as Clinical Lead for Community Nursing. Version
3 of the revised service specification should be completed by tomorrow for presentation to SCR to
enable patient engagement to commence. An options appraisal paper has been requested by
Directors to be taken to March Governing Body to confirm the preferred procurement route. GP
engagement is required but the approach to this is still being developed as given the commitment
to put the service out to tender there is the need to manage the conflicts of interest (as GPs could
potentially provide) with the need to enable wider GP input into the redesign work and
specification. There remains the concern that the specification has been developed to date
without nursing input which needs to be addressed. PH stated that it had been agreed to limit
distribution of the latest draft of the specification to Directors and in strictest confidence – action
closed.
3.2.6
5.2.6 PK/LM confirmed that the outpatient referral data had been re-sent as some practices had
difficulty using the pivot tables – action closed. 7.3 Action carried forward. MD to send patient
details where he had been asked to prescribe by the acute Trust to HP.
3.2.7
7.4 Steering Group agenda item to advise members that instances where pharmaceutical
companies were contacting GPs directly need to be reported to Medicines Management.
3.2.8
8.9 Item was discussed at the Planning & Delivery meeting on 19th February and is on this
meeting’s agenda.
Enc 14
3.2.9
11.1.4 EC sent AP a report just before the meeting so there has been no time to review this. It was
agreed that this will be carried over to the following meeting.
3.2.10
11.1.5 Respiratory pilot later on the agenda for this meeting.
3
4.0
Chair/Vice Chairs Report
4.1
PH reported CSU and future ICT provision had been discussed at Directors meetings during
February. The CSU are providing ICT support to the CCG and Graham Westgate is the lead.
4.2
The Francis Report had been discussed at Directors given the 290 recommendations it contained.
Key headlines include GPs having a bigger monitoring role on providers, the establishment of
minimum standards of care and the need for changes in the both the culture of care and quality
of provision.
4.3
PH reported that locally 111 had been red rated, resulting in the soft launch being delayed until
the 12th March.
4.4
At Directors there has been a demonstration of the Map of Medicine referral management tool. It
integrates with current systems, will integrate with EMIS in October and will include all local
pathways. It will also help GPs with their validation. PH explained that the way it works is that
each time a problem is entered on to the system it automatically finds the appropriate patient
pathway. The tool will audit and record all information that has been viewed. Discussions are
underway regarding practices potentially being incentivised to use it
4.5
Discussions at Directors also focussed upon the problems in the urgent care system. Andy W
stated that the challenges in A&E were due to a combination of factors including problems with
bed flow, in part relating to Local Authority issues, the ward closures owing to Norovirus at
Sandwell and City sites, and leadership within the Trust.
4.6
BA reported that the CCG Constitution has been to both LMCs twice.
4.7
It was reported that a paper on the management support organisational structure had been
presented and discussed at Directors. The restructure was required due to the CCG taking on
more responsibilities than originally planned e.g. WMAS commissioning lead, safeguarding,
continuing healthcare, and had resulted in the creation of some new posts and the re-banding of
some existing posts.
4.8
AW stated that in terms of change to internal management structure, the CCG has taken on a
number of additional roles: the regional Lead Commissioner for Urgent Care, West Midlands
Ambulance Service, 111, and Stroke. In addition there has been a change to the amount of work
received from CSU and that this CCG is going to deliver itself. It is the combination of these two
things, as well as disaggregating shared commissioning arrangements with the Council regarding
Mental Health and Learning Disabilities that required a major change to the structure of the
Enc 14
organisation. This has meant relocation from Floor 2F to 4R in Kingston House, and an increase in
the number of directly employed people from 44 to 92. Overall this has resulted in a considerable
saving against the management costs budget (£1m), with a total of £2m saved as a consequence
of not relying on other organisations. The Directors considered the proposals and agreed them.
In response to a question, Andy W clarified that for the regional posts commission on behalf of the
West Midlands and the CCG pays a proportion of the cost, with the other CCGs we work with
contributing to the total cost. However, this CCG has to take on the respective increased
responsibility and accountability.
4
4.9
PH stated that he raised some concerns at the Directors Meeting regarding the re-banding, but
having gone through the reasons for the changes and the need to ‘match and slot’ staff to jobs he
was now reassured.
4.10
Andy W confirmed that QOF/GP appraisals (as part of primary care contracting) is the
responsibility of the NCB. CCG can play a role in supporting but the resource to support has gone
to the NCB. The CCG and NCB are both operating with much smaller staff numbers.
5.0
Finance and Performance Report
5.1
PK reported that A&E is not meeting its 4 hour target despite investment for winter pressures.
Discussions were underway regarding the way the service is managed and the option to use fines.
5.2
The 18 week waits for plastics and Trauma & Orthopaedics is not being met and this needs
tackling. Fines can be applied amounting to 2% of the contract value and it is the decision of
Directors whether to enforce this. There was a discussion about reinvestment with a plan of how
this will be delivered in the future.
5.3
The savings on Medicines Management were originally thought to go back to the Treasury but at
least 60% goes back to CCGs. The Strategic Health Authority has asked for between £6-10m in
reserve to act as a buffer.
5.4
Practice budgets are a concern of GPs and the right to challenge the approach to budget setting
was being sought. The Finance and Performance Committee are seeking to clarify LCG budgets
for 2013/14. There are two formulas that can be used, one is historical budgets (what they always
had) or fair share (based on population and disease prevalence). The general agreement was that
there will be winners and losers whether either formula is used and it is therefore being proposed
that a hybrid solution is used so that everyone feels that they are getting a reasonable budget for
their practice. Once the budget by practice is established the plan is to create a league table
showing budget management performance (similar to referrals). The reason for this is for the CCG
to identify outliers in addition to those practices that are spending wisely.
5.5
PH raised a question relating to the proposed hybrid formula for budget setting. He explained that
it was his understanding that there had been a commitment to move practice budgets to be
established based upon fair shares. If this is the case, there is the question regarding whether
hybrid formula would change every year to account for this. PK replied that for the last 3-4 years
Enc 14
there has been a move towards fair shares and then it went back to being set on a historical basis.
The proposed formula takes account of both historical and fair shares. LM stated that the budget
needs to be managed as with fair shares some localities do not spend and some will overspend but
the approach to it needs to be sorted to ensure that it is fair. PH responded stating his concern
that SHA currently under spend but if the budgeting formula is changed and the locality then
reports overspending, it could appear that the SHA is performing badly.
5.6
PK explained that it was suggested that the formula is taken to the LCGs to ask their view but the
fear is that there will be five different views. Each LCG will go for the one that it will benefit from,
so there will need to be approach needs to take account of the different patterns of referral. The
formula used needs to address this and ensure fair allocations to practices. BA stated that we are
acting as CCG and not individual practices when sharing the risk.
5.7
PK reported that in relation to Outpatient referrals, practices had been sent their information and
that the aim was to increase awareness of the different pattern of referrals across the locality.
Practices will conduct a “deep-dive” exercise and PK will discuss performance with them to see
where improvements can be made.
ACTION: PK to bring back a report in relation to outpatient referrals performance 12/13 to a
future Board meeting.
5.8
In relation to contract negotiations, LM reported that the Finance allocation is £606m and
distributed a document setting out our responsibilities. There is a QUIP challenge £15m and until
contract negotiations are concluded the CCG does not know the extent to which this will be
achieved.
5.9
LM reported on the new MICS system which contains finance and activity information, and allows
comparisons to be made between practices. LM advised that it will now be rolled out to all
localities and it will be up to each locality to decide how they want to be trained on this. Options
include organising sessions that GPs can choose to attend or 1:1 training. All finance information
will now be accessible via MICS. AP stated the Margaret Holden (Dr Patel & partners) has already
been trained on this. It was agreed that DM would be trained to use the system and with a GP and
Practice Manager trained the decision could be taken back to the Steering Group.
ACTION: MD to organise training on MICS. The decision regarding how to roll out training on
MICS in the locality to be taken to a future Steering Group meeting (AP).
5
5.10
LM stated that there is currently an under spend of £1.9m.
5.11
In relation to 12/13 innovation funding, AP stated that she has not received all of the Funding
Agreements for approved schemes and corresponding invoices with supporting data. Invoices are
not authorised in the absence of a signed funding agreement.
5.12
BA asked about the engagement monies. LM replied that this was originally set at £1.50 (2 x 75p)
per patient per practice and there was a proposed increase to £3.00. The incentive scheme did not
Enc 14
go ahead and the second 75 pence will not be paid as no targets were set. BA stated that
Practices had been led to believe that they would receive £1.50. AW stated there are no plans to
pay any more out and there is no incentive scheme this year. Initially the second 75 pence was in
the management costs allowance, but when the investment monies were considered, the decision
was taken to defer the incentive scheme. The second 75 pence was transferred to the Innovation
Fund.
Action: AW to liaise with JG and send a communication to LCGs.
6.0
6.1
Quality & Safety Report
A Quality and Safety meeting was held on the second Tuesday of the month and majority of the
meeting was taken up discussing the Francis Report. It contains 290 recommendations. The key
points were:
• The appalling and unnecessary suffering of patients
• Corporate finance put before patient care
• Basic standards of care not observed, including lack of fluids, patients being left
unwashed and unfed, filthy conditions, medication not issued, patients being
discharged without regard to welfare and focus on Foundation Trust status. The
system failed at every level to take action in regard to complaints and Local Medical
Committee did not know till too late.
• SHA did not put patient safety and wellbeing at forefront. The commissioner didn’t
test healthcare adequately etc.
The Francis Report Recommendations included:
• Clearly understood and fundamental standards which should be defined by what patients
and the public expect and what healthcare professionals believe can be delivered.
• Openness, transparency and candour throughout the system. A duty of candour and
statute should be imposed on all NHS staff. The deliberate obstruction of this duty should
be a criminal offence.
• Improved support of compassionate caring. No member of staff should have hands on
care without being properly trained and registered.
• There should be a new registration status for nurses.
• There should be strong patient centred leadership
• The public should be entitled to see leaders held to account.
• There should be a common code of ethics and conduct.
• Patients should have access to useful accurate and relevant information and leaders
should be able to demonstrate compliance.
• False representation should be a criminal offense
AA stated that CP would be reporting how the recommendations are to be implemented at a
future Quality & Safety meeting.
6.2
6
A group of members carried out a quality spot check at Sandwell on wards Newton 5 and Lyndon
4. They were happy with what they found.
Enc 14
6.3
AA informed the Committee that for quarter 3 there were 53 complaints, 30% received by PALS,
30% by phone and 18% by letter. 9% were by email, via an MP and in person. A breakdown of
complaints by service provider showed that 62% was concerning GPs, 9% was concerning Out of
Hours Service and 9% concerning SWBH. Approximately two thirds were against GP practices and
this was comparable with the previous quarter. 20% were against dentists/pharmacists.
6.4
There was a presentation regarding proposed support to help with audits in GP practices at a cost
of £93K. AA and Claire Parker were in favour but HoB GPs were not as they undertake audits
themselves. It was argued that the investment would enhance the quality of audits.
ACTION: AA to report back whether the proposal was approved at the next Board meeting.
7
6.5
DH stated that there are many lessons to learn on how we commission acute and other care.
There are issues of performance that come to the LCG. We need to highlight concerns and actions,
and decide how use Jayne Salter Scott’s team to capture real patient experience. The CQC are
capturing patient experience when using NHS secondary and primary care services but what this
tells us is often different to the perspective of patients. There is the opportunity to look at way
services delivered, how engage and raise standards.
7.0
Strategic Commissioning & Redesign Report
7.1
PH provided an update of the content of the previous Business Planning meeting of SCR. A
number of business cases were presented for information and debate:
7.2
BNP testing for Heart Failure: Dr Berg presented a business case for this test that prevents
referrals. The business case has been deferred as pathology services are subject to open
procurement. PK stated that Sandwell used to provide the service but it was decommissioned
previously. BA stated there was always a dispute between Cardiologists and Biochemists about
the reliability and it was expensive. He asked if there was any consultation with Cardiologists in
developing the business case.
7.3
Gynaecology: The community gynaecology service has returned to a hybrid service and the uptake
was better. The only problem was that some of the Choose and Book Service was going straight to
the Trust and not to community service so Choose and Book has been suspended for Gynaecology.
7.4
Faecal Incontinence Nurse: Dr Cruickshank, Gastroenterologist presented the case for a pilot
scheme for a faecal incontinence nurse. PH stated that 2-10% of the population suffer with it and
it tends to result in a referral. It was decided to accept the business case as it would save money
and would be better for patients
7.5
PH reported that there was quite a big discussion regarding Estates. SPCT had 6 legacy schemes
and three are now a priority as GPs are in buildings where the lease is about to expire. The
decision was to take three schemes forward and other three will be looked at by another group
set up by George. A seventh scheme in Great Barr was not listed.
Enc 14
ACTION: PH is to confirm which three legacy estate schemes in primary care are being taken
forward at the next Committee meeting.
7.6
PH reported that SCR had considered the IBS evaluation and decided to cease this service. The
decision was also taken to decommission the Rowley Regis Hospital bath service. An engagement
event with the day hospital is underway.
7.7
The work on the end of life bungalows work still underway and will be taken to the next SCR
meeting. These are for terminally ill patients who can no longer to be looked after at home. There
is a consultant on call and nursing cover. There is an issue around the bungalows having only 50%
occupancy which makes them expensive.
7.8
In relation to the provision of religious circumcisions, BA stated that there a policy meeting in
relation to procedures of limited clinical value last Friday, and religious circumcision was one of
them. As there is a discrepancy in service provision in Sandwell and Birmingham it was decided
that there should be a joint review joint review. There was no Birmingham representative
present. The next meeting is March 16th. The Group is looking at all procedures and impact
assessment will have to be done.
7.9
Other SCR decisions included an extra £3K has been agreed for the Handsworth Medical Centre
and funding to support the overspend of £49K by Crossroads and an additional £20K to support
the service until yearend.
7.10
There is a plan to deliver IV diuretic therapy in the patients’ home. This has already been given to
some of the Sandwell patients but the plan is for it to be commissioned across the entire CCG.
7.11
Mental Health proposals by SCR were presented and although felt to be very good owing to
limited time to use the Innovation Fund (ending March) were not supported other than the
training element.
7.12
DH stated that there is an issue around the approval process of Innovation Fund business cases
and the need for the lessons learnt to be used to plan future processes to use development funds.
8.0
Partnerships
8.1
8
DM stated that there had been no further meetings since the last Steering Group Meeting but
there was a meeting regarding Diversity and Equality. One area that was discussed was in regards
to genital mutilation. Saba has sent an email to all the practices. It was suggested that this issue be
given a twenty minute slot in one of the Steering Group Meetings to discuss as a potential PLT
item.
9.0
Your Partnership for Health Outpatient Proposal
9.1
This came from Business Planning and then through SCR. It was presented by Simon Mitchell and it
Enc 14
was a proposal to move some activity from Secondary Care services to Community for two
Practices, one in Black Country and one in Healthworks. SCR supported the scheme. It was going
through as a PCT legacy. LM asked if the service should be tendered as anyone can deliver the
service. AW explained that the organisation does not need to tender to test concepts. It was
agreed the facts needed to be understood.
ACTION: PH to take YPH Outpatient Proposal back to SCR to emphasise Board concerns
regarding process for the scheme going forward.
10.0
Respiratory Pilot
10.1
AP stated that it was agreed at the last Steering Group that the Board wanted to discuss the next
steps in response to the mid-term evaluation report presented by Elaine Cook. The report
indicates that Elaine spent six months at two sessions per week assessing what the level of
education and qualifications are supporting COPD and asthma in the practice according to a selfdeveloped scoring mechanism. Training provision has started but only relatively recently. Issues
raised in the report were:
•
•
•
9
Engagement/access issues with some practices – one practice has declined to participate
Insufficient time to deliver the project, largely owing to no administrative support
There will still be some training that would need to be delivered within the LCG that will
fall beyond the end of the pilot.
10.2
AP stated that she met with Dr Haque and Elaine on 6th February and they discussed the need to
share the scoring tool developed and to agree the minimum level of competence the pilot is
aiming to achieve across the LCG. Once the minimum level is agreed between Dr Haque and
Elaine, an assessment is required of the training needed across the LCG compared to the forward
schedule to the end of July. If there remains a gap, the Board will need to decide whether the
training delivered for the duration of the project needs to aim for a lower minimum standard or
how the remaining training might be delivered.
10.3
Discussion followed regarding concerns that a business case was put forward with an associated
level of funding to deliver a level of education in Primary Care and that now there is the potential
for a further business case to be submitted to enable the outstanding training to be delivered. DH
raised the issue of the significant time that had been taken to assess the practices and identify
training needs versus time actually delivering the training required. He stated that it is a lesson
learnt in terms of ensuring that members submit a realistic budget when future opportunities
arise to use development funding and the need for the LCG to pay for agreed outcomes and not
activities.
10.4
PK stated that he was concerned about the approach taken as in his practice’s experience the
score had been attributed via a phone call as far as he was aware. PH asked how the shortfall in
money had occurred. AP replied that Elaine had stated at the Steering Group that a major reason
why she felt there was insufficient resource to deliver the pilot was owing to her having no
administrative resource. It was agreed that for the next meeting the Board will require details of
how much money has been spent so far, the scoring mechanism, details of the minimum level all
Enc 14
Practices should be achieving, an assessment of how large the gap in training will be.
ACTION: AP to circulate the Respiratory Pilot status information prior to the next meeting.
11.0
Dr First Evaluation Report
11.1
The evaluation report is currently in draft form but the cost-benefit analysis has some outstanding
work to be undertaken. AP reported that GPs like it, were able to implement it quickly and have
sustained delivery. A current issue is that the detail behind how the £2K pump prime budget was
used, as per the agreement, is not currently available. 29 practices participated.
11.2
The patient survey feedback required updating as two more Practices have submitted surveys.
There is generally positive support although there are issues around patients not knowing about
the service until the point where they actually use it. AP reported that the analysis of the survey
results showed that 13% of respondents stated that if they had not been able to speak to the
doctor or see the doctor through the Dr First scheme they would have gone to A & E. This
indicates that the pilot may have contributed to reducing the size of the increase in demand for
A&E being experienced.
11.3
AP reported that there was a discussion regarding its helpfulness from a Primary Care point of
view as a patient can be assessed over the telephone and anecdotally people are saying tht it can
be quicker.
ACTIONS: AP to work with LM to complete the cost/benefit analysis and finalise the report In Liz
Green’s absence. AP to send letter to practices requiring them to provide information on how
they spent the £2K allocation or the money will have to be returned.
12.0
LCG Protected Learning Time
12.1
AP requested that this item be deferred to the next meeting as Claire Parker was advising the
Senior Commissioning Managers of the decisions taken regarding locality PLTs at a meeting
scheduled on 11th March.
ACTION: AP to ensure LCG PLT an agenda item for next Committee meeting.
13.0
LCG Engagement
13.1
AP advised the group that they should have received a list of meeting dates and asked if they were
still happy to go ahead with the scheduled meetings during 2013/14. The dates were agreed and
will be circulated to members.
13.2
AP reported that the meeting room at Oakwood costs in the region of £30.00 per meeting plus
hospitality costs and asked the group if they wished to continue to use this venue. It was
suggested that the room may now be too small for the Steering Group Meeting. AP said that if the
venue of the Steering Group was changed it was likely to cost more. The consensus of the group
was that Oakwood was fine for most meetings, but to look at changing the venue for the Steering
Group Meeting. BA offered a meeting room in Oldbury Health Centre for Steering Group meetings
10
Enc 14
at no charge.
ACTION: AP to obtain costing of alternative venues for Steering Group meetings and bring back
to the next meeting.
13.3
14.0
AP reported that Elaine Cook had sent an email to BA asking if Practice Nurses should be more
involved in meetings. It was suggested that they are invited to join the Practice Managers Group
or the Steering Group. AP asked the Committee’s view regarding having a nurse representative
attend these meetings. It was felt that there may be difficulty in practices releasing nurses to
attend meetings.
ACTION: AP to feed back the decision to Elaine Cook.
CAMHS
14.1
BA reported his concerns regarding questions asked on the CAMHS referral form that he feels are
not ones that can easily be answered by a GP, and arguably need to be answered by the service
when the patient is seen e.g.“What does the parent expect from this referral?”. BA has spoken to
Dr Rao, the Associate Medical Director – CAMHS, and raised the issues. BA suggested that Dr Rao
be invited to a future Steering Group Meeting which was agreed.
14.2
PK agreed with BA and reported that he was asked if he could clarify what teachers think and if
there had been involvement from other agencies. Dr Rao told BA that there had been a cut in
funding so there is no proper screening of the referrals and they are trying to cope with a lot of
work with less money. AW stated that CAMHS has a tariff deflator in terms of an internal CIP, but
there has been no disinvestment in Mental Health Services. AP suggested that maybe Dr Rao is
missing the point and that the problem lay with the questions and the responses expected – the
question being asked is whether they are questions the GP should be asked. AP described her
knowledge of a CAMHS service in an adjacent health economy in which the questions causing
concern were part of the initial referral appointment discussion/assessment.
14.3
BA stated that CAMHS also require the form to be signed by the parent stating that they agree
that information can be shared with other agencies before the referral can take place. BA has
spoken to Lisa Hill who agrees that the form needs reviewing.
ACTION: AP to invite Dr Rao to a future Steering Group Meeting.
15.0
15.1
Any Other Business
AP reported that Dr Hirani has agreed to be the SHA Cardiology Lead. There is no MSK lead and
this is now urgently needed as the risk is that changes to services are made with no input from the
locality.
15.2
AP stated that there have been 8 volunteers to attend the two SWBH Community Nursing LiA
events from SHA.
15.3
DH stated that he attends the Patient and Partnerships Advisory Group meeting and asked if this
11
Enc 14
could be added to the agenda as a standard item. They have looked at the Terms of Reference
and are looking at the Remuneration Policy. A piece of work has been done by Jonathon Bostick
developing an Information Portal which will be part of the CCG website. There will be another
PPAG meeting tomorrow and Jon Dicken will be there to talk about the CCG’s strategic aims and
the workplan.
15.4
SC raised a quality issue regarding one of her pregnant patients. She was diagnosed with having
an ectopic pregnancy and the tube was removed prior to her being referred to the fertility service.
The patient then had a scan in Poland and was still sixteen weeks pregnant. SC was advised to
submit an incident form so that Claire Parker will pick this issue up.
ACTION: SC to complete an incident patient for expectant patient.
15.5
BA has sent an incident form regarding an injection given by a District Nurse. It was unknown who
had prescribed the injection, but the patient’s name was on the box. The chemist, Boots, was
contacted and they said that the wrong name had been put on the box.
15.6
HP reported that Medicines Management has under spent. The practices will be asked to work
with Medicines Management to understand current practice and provide assurance that patients
are benefitting from the range of interventions available.
16.0
ACTION: HP to meet with AP to discuss under spending SHA practices in relation to Medicines
Management
Tuesday 26th March 2013 1.00 – 4.00pm Oakwood Health Centre
ACTIONS
WHO
BY WHEN
Meeting 23/10/12
6.8 LM to provide Lymphodema performance information before the next Board LM
meeting.
26/03/13
12.3.1 AP has contacted PK about taking on the SHA Demand Management locality PK
lead role. PK to find out more in relation to what is involved and assess whether the
role can be fulfilled given his finance & performance lead commitments.
26/03/13
Meeting 20/11/12
3.3.7 AA reported that he had intended to raise the issue of X-ray reporting at AA
Sandwell Hospital under AOB at the last Quality & Safety Committee but the Francis
Report led to the need to take this to the next meeting - action carried forward.
.
12
26/03/13
Enc 14
5.2 PK confirmed that the locality referral report for 2012/13 had been sent out by
Laura Mainwaring.
PK
26/03/13
7.4 Steering Group agenda item to advise members that instances where
pharmaceutical companies were contacting GPs directly need to be reported to
Medicines Management.
AP
09/04/13
11.1.4 EC sent AP a report just before the meeting so there has been no time to
review this. It was agreed that this will be carried over to the following meeting.
AP
26/03/13
PK
26/03/13
5.9
MD to organise training on MICS. The decision regarding how to roll out
training on MICS in the locality to be taken to a future Steering Group meeting (AP).
MD
26/03/13
5.12
AW
26/03/13
7.5
PH is to confirm which three legacy estate schemes in primary care are
being taken forward at the next Committee meeting.
PH
26/03/13
9.1
PH to take YPH Outpatient Proposal back to SCR to emphasise Board
concerns regarding process for the scheme going forward.
PH
26/03/13
10.4 AP to circulate the Respiratory Pilot status information prior to the next AP
meeting.
26/03/13
AP to ensure LCG PLT an agenda item for next Committee meeting.
AP
26/03/13
13.2 AP to obtain costing of alternative venues for Steering Group meetings and
bring back to the next meeting.
AP
26/03/13
13.3
14.3
AP
AP
26/03/13
09/04/13
15.6 HP to meet with AP to discuss under spending SHA practices in relation to AP
Medicines Management
26/03/13
Meeting 22/01/13
Meeting 26/2/13
5.7
PK to bring back a report in relation to outpatient referrals performance
12/13 to a future Board meeting.
12.1
13
AW to liaise with JG and send a communication to LCGs.
AP to feed back the decision to Elaine Cook.
AP to invite Dr Rao to a future Steering Group Meeting.
Enc 15
Minutes of the Black Country LCG Members Committee held:
Thursday 21 February 2013, 13.00 - 15.00pm
Tipton Sports Academy
Present:
Dr G Solomon (GS)
Dr I Walton (IW)
Dr A Saini (AS)
Tanya Cooper (TC)
Dr S Sharma (SS)
Dr C Leadbeater (CL)
Dr D Gahle (DG)
Dr Aggarwal
Kiran Lali (KL)
Pam Jones (PJ)
Naurin Akhtar (NA)
Dr A Indwar (AI)
Doug Round (DR)
Dr D Hamilton (DH)
Linda Lamb (LL)
Dr P Desai (PD)
Pam Bradbury (PB)
Horseley Heath
Tividale Family Practice
Swanpool Medical Centre, Sharma & Sharma
Swanpool Medical Centre, Leadbeater & Bhimji
Warley Medical Centre
Rowley Regis Hospital
Finance Manager, SWBCCG
Patient Lay Representative
The Victoria Surgery
19 Walford Street
Lay Member
Regis Medical Centre
Tipton Community Organisation
Whiteheath Clinic
Regional Director, NHS111
Apologies
Dr T Crossley (TC)
Carla Evans (CE)
Ray Sullivan (RS)
Dr Ian Sykes (IS)
Malling Health
SWB CCG, Senior Commissioning Manager
Glebefields Health Centre
Oakham Surgery
1.0
1.1
GS welcomed all to the meeting.
2.0
Declarations of any Interest on Agenda Items for Discussion
2.1
No declarations of interest were recorded.
3.0
Minutes and Actions from the Previous Meeting
3.1
The minutes dated Thursday 20 December 2012 were declared an accurate record
of discussions.
1
Enc 15
Action Register
3.1.1 – invite to Jyoti – as Carla is away this will need to be confirmed with her on
her return.
5.1.7 – codes and password – some members are still to action
5.2.4 – Partnership team – quarterly meeting – GS confirmed that this has been
actioned
6.1.5 – Referral patterns across 2011/2012/2013 - KL confirmed that an e-mail
and attachment had now been sent to all practices
4.0
Chairman’s Communications
4.1
GS informed members of the following:
Authorisation – the CCG has now received its authorisation, from April 2013 it will
become a statutory body. Due to an increase in the number of Officers, the staff
team at Kingston House have recently moved to 4th floor rear.
Clinical Leads – in order to appoint to a number of clinical lead roles, the first set
of interviews have taken place 21/02/13 (today).
Contract negotiations – these are on-going for the main contracts
Mental Health (reviewing agreements with Local Authority) – currently on-going
Innovation schemes – the schemes are now to be evaluated to decide which
schemes to take forward
5.0
ITEMS FOR INFORMATION/DISCUSSION
5.1
NHS111
GS introduced Pam Bradbury, NHS111 Regional Director, going on to say that NHS
Direct were successful in their winning bid to run the new service which will be
launched in the West Midlands on 19th March 2013, commencing with a ‘soft
launch’ before being rolled out with a national programme of media coverage.
5.1.1
This introduction was followed with a presentation from PB who gave members
an overview of the new service, stating that:
5.1.2
The following core principles of the new service have been identified as:
1. Completion of a clinical assessment on the first call
2. Ability to refer callers to other providers – without re-triage
3. Transfer clinical assessment data to other providers and book
appointments where appropriate and agreed
4. Ability to dispatch an ambulance without delay
5. Provision of health information or reassurance about what to do next
2
Enc 15
5.1.3
PB explained that 111 is not a service to replace 999 and will not change GP
practice. NHS111 will operate through the use of non clinical call handlers who
will work through a series of scenarios and options before closing the call. PB
advised that, in case of Out of Hours cover, surgery telephone messages will need
to change to reflect the new contact details. PB referred to the Directory of
Services (DoS) which will need to be populated by practices.
5.1.4
PB welcomed questions from members, who asked a lot of pertinent questions.
Below are examples of a two such questions.
Q 1: one member asked how the organisation differs from NHS Direct in terms of
size and number of staff.
A: PB advised previously 33 call centres with 4000 staff, which has now been
reduced in number to six call centres, with the local operations being run from a
call centre in Dudley. PB pointed out that NHS Direct did not secure the whole
contract but won 33% of the business.
Q 2: Dr Desai asked who maintains the DoS
A: PB advised that a lady by the name of Louise is the DoS manager for the region
and that it for practices to work with her to ensure that the directory is populated.
5.1.5
PB mentioned that all information delivered at this meeting would also be sent
out to all practices for their perusal. And in response to another question she
advised that referrals to GP’s surgery following a patients contact with NHS111 is
showing from early analysis to be around 1 per 1000 patient population.
5.2
5.2.1
Ophthalmology Clinics at Rowley Regis Hospital
SA discussed the provision of an eye care service, whose aim is to provide a one
stop service. This has already been operating for the last 18 months. The clinic is
consultant lead with experienced specialist nurses or associated specialist doctors.
The service is listed on Choose and Book, but a referral can be send via letter or in
the case of an emergency by phone. Following referral patients attend for surgery
with one follow-up appointment thereafter. The clinics run Tuesday to Friday.
Emergencies can be booked in within a fortnight.
5.2.2
A member asked, ‘what are the advantages to the patient over services run by the
acute sector’. SA said that waiting times are lower (In general patients are seen
within 2-4 weeks), plus it is a one stop service held in the community. A member
asked why is a similar service not provided at Sandwell. SA confirmed that there
is, but as part of RCRH, services are also being moved out into the community.
6.0
6.1
6.1.1
LCG OPERATIONAL BUSINESS
Finance and Performance update
KL provided a summary of the finance report at the end of month 9 (December),
3
Enc 15
informing members that a year to date deficit of £2.6m has been recorded. CCG
has a surplus of £1.6m, and is forecast to under spend by £6.5m largely due to PCT
control target. Referring to page 3, KL explained the position that the CCG hopes
to be in by the end of the year. For Dudley group an under spend of £683,000 has
been forecasted, although £175,000 has been allocated to Black Country mainly
due to reporting on Maternity Services. With regards to the forecast outturn
position, no agreement has been reached for the end of the year. Walsall - status
is consistent with the figures reported as of last month. Birmingham Women’s – a
decision has been made to raise internal cap on births from 7,200 to 8,000 which
has brought about a slight overspend. Prescribing – for the CCG as a whole a
surplus of £2.4m year to date has been reported. Innovation funds – a budget of
£530, 000 was set aside, of which £189,000 has been utilised which leaves an
under spend of £341,000. The bottom line is that the CCG are due to over spent
mainly at Sandwell and West Birmingham.
6.2
6.2.1
Quality and Safety update
The issues with regards to the Francis report were raised where a member posed
the question ‘how does each LCG take responsibility for monitoring the quality of
secondary care’. And, ‘how do practices report in concerns that have been raised
by patients’. ‘Is there a process?’ GS responded by saying that there is a process
which is being developed at the moment. He also went on to say that one of the
recommendations of the Francis report is that the CCG report and monitor
patients concerns, acting on issues raised.
6.2.2
One GP suggested that patients complete a satisfaction survey on discharge from
hospital, responses of which can then be feedback to the local CCG responsible for
the contract. GS said that this is one idea, although recognised that not all
patients would complete a survey. GS said there will be an opportunity to discuss
further as more guidance is provided.
6.3
6.4
6.4.1
Strategic Commissioning and redesign update
As discussed earlier
Partnership Committee update
SM provided members with the following update, saying that Sharon Liggins had
completed a scoping exercise to clarify the financial resources of the CCG and to
look at partnership working with the Local Authority. SM noted that historically
the PCT has supported pooled budgets and additionally has given out grants to
support community agendas. Some of which will cease in the new financial year.
Adult Social Care have to reduce their expenditure by £20bn over the next two
years, which will have an overall impact on health care budgets. In addition, there
4
Enc 15
will be a cap on benefits, the impact of which may be seen in Primary Care as GP’s
are often the first port of call when families are in crisis. The Drug and Alcohol
service is likely to be redesigned when its current contract comes to an end.
6.5
6.5.1
Attendance and Future Configuration of LCG Meetings (ENC 1)
GS explained that the paper was in two parts, the first part being attendance at
meetings, two practices have not attended to date, whilst other practices have
varying levels of attendance from 40 – 100%. GS reminded members that there is
a payment made to practices to ensure they are all represented and engage with
LCG. GS was keen to understand the barriers which are preventing fuller
participation from all member practices, i.e. meeting times, day, duration and so
on. To explore this further GS opened up discussion.
6.5.2
Members discussed alternating meetings. It was agreed that Thursdays would be
the best day in the week. One member said that it might be worth contacting
the worst offending practices, particularly where there has been very low or no
attendance. That way you can get at the root of the issue as it affects them.
6.5.3
The second part of the paper discussed bi-monthly meetings. GS advised that
there has been a suggestion that members meet on a bi-monthly basis, alternating
the Members group and Board meeting. So every two month’s there would be a
larger members meeting with a meeting in between where actions can be picked
up and taken forward.
6.5.4
Decision: after much discussion it was agreed that the Members and Board and
meetings should be held on a bi-monthly basis, alternating each month taking
place on a Thursday as this is the day that works best for practice members.
6.6
6.6.1
LCG Commissioning Intentions
GS asked members to think about areas for consideration. Early suggestions,
were:
1. IV – Antibiotics
2. DVT pathway
3. Minor injuries
6.6.2
Members discussed the merits of the above ideas. GS stated that item 1 & 2 may
well be picked up by the CCG in any case and that due to the low uptake and cost
of setting up and running a minor injuries service it may not prove feasible to take
forward.
5
Enc 15
6.6.3
GS asked members to give this matter some greater consideration, e-mailing
himself or Carla with further suggestions which come to mind.
7.0
Close
8.0
8.1
18 April 2013, 13:00 – 15:00PM, Tipton Sports Academy
6
Enc 15
Action Register
Item
No
Action
By
Complete/Resolved
7
14th April 2013
Enc No 16
ICOF Board Meeting Minutes
Minutes of the ICOF LCG Board Meeting held on Thursday 21 March 2013,
12.30-3pm, at Aston Pride Health Centre
Present:
Dr S Mukherjee
Dr I Marok
Linda Baldwin
Bi, Sobia
Mohammed Khalil
Dr S Sarwar
Chris Vaughan
Mango Hoto
ICOF LCG Chair
ICOF LCG Vice-Chair
Business Support Officer
Finance Manager
Senior Commissioning Manager
ICOF Board Member
ICOF Board Member, Patient Representative
ICOF Board Member, Patient Representative
In attendance:
Phil Lydon
Patient and Public Involvement Commissioning Manager
Apologies:
Mary Mungovan
Dr R Muralidhar
Dr M Aslam
Dr M Sinha
ICOF Board Member, Practice Nurse
ICOF Board Member
ICOF Board Member
ICOF Board Member
Item
1.
Subject
INTRODUCTION
Welcome, Introductions and apologies
Dr Mukherjee welcomed everyone to the meeting. Apologies as noted above.
2.
All doctors declared an interest
3.
3.1
Minutes of Previous Meeting/Action Register
Declared as a true record of discussion of the meeting held on 21 March 2013.
3.1.1
Members progressively worked through the action register, all items of which are to be picked up on
day’s agenda
4.
4.1
Chairman’s report
Dr Mukherjee provided the following updates:
NHS111 – it is expected that there may be pressure in the system due to the roll out of the service on
19 April and the Easter holiday period.
Bed capacity – is at saturation point in a number of hospitals, managers are working hard to resolve
and come up with a solution. SWBH is increasing capacity front end. GP’s are to look at pre and post
Easter access and make sure there is plenty of available access. It was agreed that people with known
long care conditions should be seen before the Easter period to ensure that they are safe and well and
that their needs are being attended to.
Repeat Prescriptions – notification is to be given to patients to remind them that as practices and most
pharmacies will be closed over the Easter holiday that they should collect repeat prescriptions
beforehand.
1
Item
Subject
Delayed Transfer of Care – the LCG are to ask for a list from SWBH which will be given to practices to
inform them of patients that may need help.
Communications – leaflets will be distributed ahead of the Easter break to inform members of the
public what to do in the case of sickness or an emergency
5.
5.1
ITEMS FOR INFORMATION
TB Training – 28 March 2013
It was agreed that an e-mail should be sent to members to remind them of the date. It was confirmed
that all other arrangements were in hand. A number of sponsors will be supporting the event.
6.
6.1
6.1.1
ITEMS FOR DECISION
RAC Evaluation
MK advised members that ICOF have now received a 3 month extension from the Strategic
Commissioning Review Planning meeting, which will allow ICOF time to work up a revised model. MK
asked who would lead on this piece of work and what input will be required from the board and
practices. Also looking ahead, ICOF need to look at options to see how the service can continue beyond
the 3 month time period. To enable these discussions to take place, MK suggested setting up a
progress group. MK also mentioned the work that the CCG is conducting to improve Demand
Management; they are currently looking to introduce Map of Medicine across all LCG’s.
6.1.2
Dr Mukherjee thoughts were that ICOF can’t release RAC until a suitable replacement is found, or until
RAC has been developed into an effective model (whichever of the two is taken forward). Dr Marok
expressed concerns that GP’s are now engaging with RAC having built it up over the last two years and
are now starting to see reductions in referrals; if the CCG changes over to another system GP’s may not
share the same enthusiasm for its introduction. MK advised that would need to look at the costs and
the risks; software may also need to be reviewed to make the process more automated. Dr Marok
suggested using both systems in parallel to see how one compares to the other.
6.1.3
Action: LB to set up a meeting to discuss the future of RAC – looking to a date mid April and setting
aside two hours for discussion. Dr Mukherjee, Dr Marok (if available), MK, MP and Osman Majothi
to attend. May also consider inviting Matthew Maguire. 4 meetings to be held in total.
6.2
ICOF Board – Nurse and Practice Manager representative
Deferred to the next meeting
7.
7.1
ITEMS FOR DISCUSSION
Pharmacy Review Project Plan
7.1.1
Dal Sidhu provided an update on the project:
Phase 1 – all simple switches have now been completed, generating savings to date of £162,000
Phase 2 – A further £176,000 of potential savings were highlighted at this stage, but are dependent on
further work in practice.
Care Home Pilot (Phase 3) – the pharmacist has commenced visits to 5 care homes and plans to carry
out a medicine reviews for all identified patients. It was hoped that it would be possible for Care
Homes’ staff to receive medicines management training, but this is now looking unlikely given the
limited time available. Staff have expressed an interest in receiving the training should it become
available.
7.1.2
2
DS informed members that by the time the project comes to a close potential savings in the region of
£385,000 should have been achievable or the LCG will be on target to achieve such sums. However,
Item
Subject
despite such promising news, to date only 3.5% of these savings have actually been realised. This could
be due to a number of reasons; it could take 6/9 months before the effects of the medicine
management work can be fully seen in terms of savings. The Prescribing Advisor for ICOF (Sajjad Raja)
should be able to follow through on any identified savings made over the last few months to ensure
that they come to fruition. Dr Mukherjee also suggested that in parallel to the work of the CCG, ICOF
could do some work of their own.
7.1.3
In addition, DS mentioned some further savings that have been picked up over recent days, which
could bring in a further £79, 000 worth of savings, this related to calcium medications. Dr Mukherjee
suggested that DS and Sajjad arrange a handover where all of the above identified savings can be made
known and passed on.
7.1.4
CV enquired about recent news coverage around the effectiveness of prescribing antibiotics over a long
period. DS advised that this has been a known issue for some time, and GP’s are reminded of this.
7.1.5
As this was DS’s last meeting Dr Mukherjee thanked Dal and his team for all their hard work. Dal also
expressed thanks to ICOF for giving him the opportunity to work with the Board and practices.
7.2
7.2.1
Finance Report
Sobia reported on month 10 (January 2013), saying that year to date figures show that ICOF have
generated a deficit of £221k which is expected to rise to £497k by year end. Expenditure on most areas
of reporting have remained consistent (Table 1 provides an overall picture). The performance of the
CCG as a whole is showing a year to date under spend position of £5.9m, which is set to rise by a
further £3m come the end of the financial year. A financial surplus of £8.7m is predicted by the end of
the financial year on an overall budget of £655m. With agreement from the SHA Sandwell PCT has
increased its forecast to £9.966m.
7.2.2
Hospital expenditure
SWBH – An agreement has been reached over the financial outturn with Performance at Sandwell and
West Birmingham NHS Trust, agreed at £3.3m.
UHB – the trust has reported 6% over performance. At present SWB CCG are reporting £2.184m, or
10%, above planned levels.
7.2.3
QIPP
SB referred to Table 3 to demonstrate QIPP performance for this reporting period. SWBCCG is
currently forecast to be £817k under target by the end of the financial year.
7.2.4
Financial risk
The main risks have been recorded as follows:
•
•
•
Acute over performance - £537k
Decommissioning Targets under achieved - £333k
Restructuring - £1.9m
Bringing a total of £2.8m set against risk
7.3
7.3.1
Innovation Funds
ICOF have utilised £201k of their allocated budget of £510k. MK and SB advised that provision has
been made for all payments which will be paid out in the coming weeks. Dr Mukherjee advised that no
innovation monies have been set aside in the next financial year 2013/14.
7.3.2
Members discussed the spending and allocations of the other LCG’s. Some CCG member organisations
have spent a greater part of their allocated funding. Healthworks for example have spent all but £29k
3
Item
Subject
of their allocated budget of £630k.
7.3.3
Dr Marok reminded SB that she was to provide practice level reporting. SB said that she has had
difficulty in obtaining this information, but would try again.
7.3.4
Innovation Projects 2012/13 update:
MK brought members up to date, as follows:
Immunology – are now running 6 clinics, patients uptake has increased which has allowed the model to
be tested. An evaluation will be completed. Patient flow through the RAC has also been very good.
Ophthalmology – Slow start. Pioneers for Health have started to use the RAC more frequently after a
delayed start. Computer literacy could have been a problem.
BP Monitors – the majority of practices have now ordered the equipment. 2 practices have decided
not to take advantage of the funding. LB is currently chasing practices for copy invoices and is also
waiting on some Service Level Agreements.
Demand & Access – some practices have now had their training, whilst others have booked for future
dates. Because of year end returns members have been asked to submit invoices for reimbursement
ahead of the training. Again, LB is chasing all invoices to ensure payments are processed before
finances close for the year.
Reducing Emergency Admissions – as well as the return of Service Level Agreements to mark
participation, we are still waiting on the monthly returns for most practices. Month 1 (January) and
Month 2 (February) should now be in hand for all practices, with Month 3 (March) being expected early
April. LB to continue to chase for this information.
7.3.5
Members agreed that there had been some communication and system capability problems, as well as
some less than timely responses to requests, which would need to be considered when similar work is
entered into in the future. Dr Mukherjee recognised the pressures and thanked everyone for their
efforts.
7.4
7.4.1
Patient Summit
Members discussed the timing of the Summit and the topics of discussion. It was thought that a very
early meeting might not leave enough time for preparation, and for those patients who are engaging,
too late a date might prove difficult. Members agreed that April would be too soon; therefore 9 May
2013 was settled on, to take place over a lunchtime. MH suggested a Saturday, but members advised
that this would not work for everyone. Based on past experience of running such events PL provided
some guidance on what might work well, not so well. PL requested a patient list from Patient Network.
MH to supply PL with a list. CV has already forwarded another list. Dr Mukherjee suggested PL asked
practices for their PPG list.
7.4.2
Members were asked to hold the following date in their diaries:
Date: Thursday 9 May 2013
Time: 13:30 – 16:00PM approx
Venue: TBC
7.4.3
In the meantime, PL will work with patients and practices to decide on a programme and inform them
of the date, and arrangements for the day. Another inroad would be for PL to go along to PPG
meetings. Members suggested potential venues which PL will look into.
7.5
7.5.1
LCG PLT Events
MK advised members that there would be two CCG wide PLT events. In addition, each LCG would hold
two PLT events of their own. MK said that an indicative budget of £5000 to include Out of Hours cover
had been set for each LCG event. From there, MK tried to gauge people’s ideas on when to hold, topics
of discussions, who will lead on the events, so on and so forth.
4
Item
7.5.2
Subject
After discussion, members decided on the following dates:
•
•
Tuesday 11 June 2013, 12:30 – 16:30PM, Venue TBC
Tuesday 10 September 2013, 12:30 – 16:30PM, Venue TBC
7.5.3
It was agreed that a meeting needs to be held outside of the Board to discuss the agenda, building up
to the events as they occur. Both PLT events will be open to GP’s, PM’s, PN’s and HCA. As Dr Matthew
Nye has facilitated discussions for similar events in the past, members agreed he should be asked if he
would be happy to do so again. MK pointed out that no additional payment would be made to
clinicians for providing support. CV asked as a Patient representative, if an agenda item could be
included to identify the relationship between general practice and Public Health, especially given that
the CCG no longer has the remit for public health which has now moved over to Local Authority.
7.5.4
In relation to the above, CV asked if each LCG has its own Medical Director. Dr Mukherjee confirmed
that there is no Medical Director at either LCG or CCG level, but Dr Steve Cartwright fulfils the role for
the Local Area Teams.
8.
Any Other Business
None discussed
9.
DATE AND TIME OF NEXT MEETING
Tuesday 16 April 2013, 12.30pm
Aston Pride Health Centre
CLOSE OF MEETING
5
Enc 17
Enc 17
Healthworks Locality Commissioning Group
Committee (Board) Meeting
Tuesday 12th March 2013
Meeting Minutes
Attendees:
Dr Nick Harding (NH)
Dr Niti Pall (NP)
Keith Eden (KE)
Dr Simon Butler (SB)
Dr Gwyn Harris (GH)
Dr Liz England (LE)
Dr Mark Foulerton (MF)
Diane Charles (DC)
John Cash (JC)
Chair
Vice Chair
Finance and Performance Lead
Redesign Lead
Prescribing
Quality and Safety Lead
Partnerships Lead
In Attendance:
Sally Sandel (SS)
Jayne Salter-Scott (JSS)
Paul Southon
Jonathon Woodstock (JW)
Senior Commissioning Manager
Senior Commissioning Manager (Engagement)
Public Health Development Manager, Sandwell MBC
People Matters Network
Apologies:
None
Agenda
Item
Discussion
Action
1.
Introduction
1.1
Welcome and Introductions
NH welcomed everyone to the meeting.
1.2
Absence and Apologies
Noted as above.
1.3
It was agreed that declarations would be made as appropriate at the
relevant agenda item.
1.4
Minutes of Previous Meeting
It was agreed that the minutes were a true and accurate record of
the meeting
1.5
Matters Arising/Actions
There were no matters arising
1
Enc 17
2.
Feedback from CCG Board / Communities
2.1
AO’s Governing Body Report
NH reported that City and Sandwell were not routinely hitting the
95% four hour target for Urgent Care. There was a Cross
Birmingham Urgent Care Summit yesterday where it was reported
that while Urgent Care was busy throughout the whole of the UK,
Birmingham is at the nadir of this. As a consequence most of the
Urgent Care Systems will have to remain open through Easter at
least.
SB reported that Healthworks have committed a large amount of
money to Urgent Care projects – Vitality through City Hospital and
Carters Green through Sandwell Hospital and there has been
engagement with both City and Sandwell A & E Departments to
attract people away from A & E. They are Innovation Fund projects
and despite three attempts to go live, no patients were seen and the
scheme has therefore now been withdrawn.
LE raised the question as to whether the problem lay with City or
Sandwell. SB replied that Sandwell has a GP service in A & E and is
refusing to send patients to their own GP and from the 1st March the
CCG gave City a large amount of money to enable the creation of a
solution and they brought in the same GPs so both hospitals now
have the same service.
JSS advised the group that the engagement team have been doing a
piece of work, which involved visiting the A & E departments to find
out why people are there. The early results of this are:
•
•
•
50% of patients could have been treated elsewhere.
Many patients did not know that there are walk-in centres and
other ways of accessing services.
A considerable number reported that they had been referred
by their GP.
She suggested that it would be useful to bring the completed report
to the next meeting for discussion.
LE stated that there has been a similar project looking at the reasons
that people call an ambulance and the results were fairly similar.
NH reported that there is to be a Transformation Team and their first
project will be to redesign the Urgent Care system.
2.2
CCG Governing Body Minutes
There were no matters arising from these minutes.
2.3
Commissioning and Redesign Committee
MF reported that the soft launch of the NHS 111 service will be on
19th March and the full launch will be two or three weeks later.
At the meeting there was an update of the SWBCC Contracts
Evaluation that is being carried out by Atkins and MF reported that
2
JSS
Enc 17
there is to be a presentation on the results of all the evaluations at
the end of March. SB stated that the date had been set as the 11th
April.
MF reported that there was an update in regards to the diabetes
redesign plans which involve greater support for practices to care for
diabetic patients including training for staff, joint consultation clinics,
and a local incentive scheme for diabetes which is still ongoing. JC
raised the question as to whether any of the group had any contact
with local diabetes groups. NP stated that she does.
MF reported that there was an agreement that the Maternity Services
specification is to be added to the SML Birmingham Hospitals
contract including the local Key Performance Indicators. Looking
ahead the group were looking at changing the provider via an AQP.
They are looking at One-to-One which is being run in the Wirral.
He ended by stating that the final decision is still to be made in
regard to the bungalows as there was not enough financial
information.
2.4
Finance and Performance Committee
This will be KE‘s last meeting and NH, DC and JC all thanked him for
all his hard work.
KE stated that the Finance and Performance Committee has not met
since the last Healthworks Committee Meeting and they are still
waiting for the league tables that they had agreed to distribute to the
practices. He stated that the work will really start when his successor
is appointed.
2.5
Quality and Safety Committee
LE reported that there had been a long presentation in regards to a
diabetes study comparing the benefits of different treatments. The
committee were asked for £64K which raised the question of the
budgets for research. LE stated that committee was unsure of these
and is trying to gather some more information.
She stated that the group had discussed the Francis Report. It is
going to be thematically analysed and the first theme was to look at
how complaints and significant events are triangulated and the Datix
System which will be implemented on the Birmingham side. LE
stated that her understanding is that Sandwell GPs already use Datix
and it allows them to record any significant events and any
information around clinical events which is then sent to the Quality
and Safety Committee for correlation. It has been specifically
designed to allow anyone in the practice to report into it. It is going to
be rolled out towards the end of May.
LE updated the group that the Emergency Departments were visited
on Friday and that the consensus of opinion was that the quality and
safety is improving there.
She raised the question as to whether the CCG should be funding
audits. She stated that there had been a presentation on audits and
3
Enc 17
there was the idea that if an external provider was going to carry out
strategic audits then the tender would have to be put out to AQP.
2.6
Partnerships Committee
MF advised the group that he had received a report from the Quality
and Diversity sub-committee which agreed on a single equality
priority for the next year. The priority is to improve the uptake and
quality of Primary Care Services among new migrant communities.
He reported that there was a long discussion on the Joint
Commissioning Team Report on Learning Disability Services
commissioned by Birmingham City Council which include Continuing
Healthcare Services and out of area management for the
Birmingham Community Healthcare Learning Disability Speciality
Services.
MF ended by stating that there was an update of the Partnership
arrangements with Birmingham City Council and CCGs.
2.7
Feedback From Patient Representatives
JC stated that the patient representatives were a part of the team
carrying out the surveys in A & E. They used the Smartkit a handheld
tablet, which worked quite well. DC stated that she was concerned
regarding some of the questions. There were five requesting details
in regards to ethnicity and none of the patients surveyed were asked
how long they had been waiting. JSS replied that the questions
followed on from an academic piece of research commissioned from
one of the Birmingham Universities and all the questions had been
tested. She stated that she will liaise with DC to have a more detailed
conversation.
JC raised the issue of drug budgets and asked if it was true that
some patients ‘hoard’ drugs. GH replied that it does happen but that
the matter is in hand, particularly looking at repeat requests from
patients and pharmacists. The Medicines Management Team are
actively engaging with Practices to discuss the problem so that when
the Practices are more aware they can get the member of staff
responsible for repeat prescriptions to look at how frequently
medicines are being ordered and have awareness of how often
certain medicines need to be ordered. He stated that the Practices
who are engaging with the Medicines Management Team have
already made savings in the cost of medicines. With regards to
patients who are prescribed medicines but do not take them that is a
more difficult problem.
Leading on from this SB raised the question of dressings. There have
been conversations for years regarding centralised dressings stores.
SB enquired as to whether this has progressed at all. GH replied that
at the moment a restricted dressings formulary is being considered.
The team is also considering a return to pre-printed dressings
prescriptions. Dudley PCT has already implemented this with some
success. NP reported that nursing homes are currently being
reviewed with regard to the number of dressings they use.
4
Enc 17
NH advised the group that he gave a talk at Link-Sandwell.
NP reported that Healthwatch are currently recruiting. They are
looking for candidates with HR and Finance experience.
3.
Items for Decision/Agreement
3.1
Vitality Partnership Outpatient Plan
It was agreed to begin with Innovations Funding update.
SS reported that Kally Judge is now in post. She is trying to ascertain
progress against the milestones that have been put in place within
the funding agreements. KJ has met with a few project leads or
project sponsors but has not met with everyone yet. Finance have
confirmed the funding situation in that all money must be spent by
31st March. The evaluation approach has now been agreed and an
email should be going out within the next couple of days to confirm. It
will include the evaluation template. This template need not
necessarily be used but it includes the things that would be expected
to be in an evaluation.
NP thanked SS for all her hard work on this project.
SB stated that Vitality Partnership Outpatient Plan was put together
following a discussion with George Solomon (the SCR lead)
regarding concerns raised about what to do with the existing
Innovation Funds Project.
HealthWorks are working slightly differently to other areas and new
services have been created delivering a change in care pathways
locally. In particular those going through are urology, ENT,
physiotherapy, immunology, PVD and dementia. These are due to
cease on 31st March and SB questioned this, as change was being
delivered and the process was still to be evaluated. All of the different
schemes are a change of care process but there is no CCG
leadership or strategy in some of these areas and they are the
starting point for bigger pieces of work.
He asked what can be done and as there is no leadership or
strategy….perhaps if effect could be evidenced over an extended
period of time some of the processes could be taken on. He asked if
provider lead leadership is to be allowed into the organisation. NP
stated that KE, MF, JC, DC, and herself would vote on this. She
further stated that the decision made at this meeting will have an
effect on all the other Innovation Fund projects. She urged the group
to seriously consider the effect of stopping these services as it is
saving money and it is providing a quality service. A precedent has
been set in the Black Country Commissioning Group by which this
has been accepted as the norm going forward. SS stated that this
has been raised at SCR and asked if SB had received any feedback.
SB replied that it was approved at SCR for delivering service in the
Rowley area and then went back to SCR recently to propose
extending the service to Carters Green. However there was a
question regarding funding. But the principal was approved and the
money was approved for Rowley. SS stated that this is because they
have decommissioned series at SWBH
5
Enc 17
NP asked for comment from the group and the consensus was that
services are good; evaluation is necessary, and that on the whole,
these schemes needed to continue. NP, KE, MF, JC and DC were all
in agreement.
4.
Items for Discussion/Information
4.1
Impact of Welfare Reforms
PS gave a presentation regarding the impact of welfare reforms.
The areas that will be affected are :
• Housing benefit
• Council Tax Benefit
• Social Fund/Crisis loans
• Incapacity benefit – ESA
• DLA – Personal Independence Payments
• Child Benefits and child maintenance earnings thresholds
• Working Tax Credits thresholds
A benefits cap and a Universal Credit System will also be introduced.
As part of the presentation there were some scenarios showing how
the changes will affect the income of a variety of families and the
possible impacts this will have in regards to health.
4.2
Prescribing Update
GH reported that he had presented some data at the Member’s
Event. He extended his thanks to NP for all her help.
He reported that there was one key marker the committee looked at
which was cost effective and evidence-based prescribing of
cholesterol lowering drugs. This LCG has shown the greatest
improvement in savings.
It was agreed that there would be a more detailed report at the next
meeting.
4.3
Patient Participation
NP introduced JW from People Matters which is the company
invested in to take some of the on-line patient participation material.
He gave a presentation showing a draft version of the Patient
Summit website which is ready to go live.
4.4
Patient Summit
There was a discussion regarding the agenda for the Patient Summit.
NP had some concerns regarding the current agenda and asked for
volunteers to draft an alternative. It was agreed that the dates will
also need to be amended.
It was also agreed that the Committee should drive this and truly
sign-up to it. This was agreed.
NH Left the meeting.
4.5
QP Support - Moving Forward
SB reported that GP Practices should be submitting their QP on 31st
6
GH
Enc 17
March 2013. The last data that came out of BSOL was in July. There
is a very quick piece of work being done in the CCG but the data to
support the submission will not be collected fast enough. He reported
that NH and the chair of BSOL are talking regarding the submission
of QP without any data.
5.
Any Other Business
5.1
Elections – Finance and Performance Lead
SS reported that the elections timetable will be going out this week
and that Celine Ryder had agreed to co-ordinate this.
5.2
Clinical Leads
LE asked if anyone in the group knew who the clinical leads will be.
SS replied that there will be an announcing once they have all been
appointed. There are a couple of appointments still to be made.
5.2
PLTs
SS reported that LCGs have the opportunity for two local PLTs
funded through the CCG. NP suggested that the group contact SS
with suggestions of who should be on the PLTs and the clinical
training that is needed.
5.3
SCR
SB reported that SCR has agreed that LES’s will be run for another
six months during the evaluation process. BSOLs are disappearing
and the Practices will need a document advising them of the six
month extension. SB is to draft a document for NH to sign.
6.
6.1
The next meeting will be on 16th April 2013 at 12.30 pm
7
All
SB

pdf, 1.15 MB - Sandwell and West Birmingham CCG

Transcription

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