GOVERNING BODY MEETING – A meeting in public

Transcription

GOVERNING BODY MEETING – A meeting in public
Tuesday 7th October 2014
Nightingale Room, OMH
2pm
AGENDA
Ref No.
GB1415/0037
GB 1415/0038
No
1.
2.
Time
2.00pm
Item
PRELIMINARY BUSINESS
(Acting Chair – Dr P Naylor)
Apologies for Absence
1.1
Chair’s Announcements
1.2
Declarations of Interest
1.3
Comments/questions from
1.4
members of the public
Patient Story
1.5
(Lorna Quigley)
Minutes and Action Points of
1.6
Last Meeting – held on 2nd
September 2014 (All)
• Matters Arising
• Action Points
ITEMS FOR APPROVAL
2.1
2.2
Procedures of Low Clinical
Priority
(Dr S Wells)
Emergency Preparedness
Response Resilience
(Paul Edwards)
Papers
DRAFT GB Minutes DRAFT Action Points
PUBLIC MEETING 02 09of WCCG -PUBLIC GB M
Cover
Govering Board
sheet_Commissioning report_Commissioning
Cover sheet EPRR
NHS England EPRR
reports Oct 14.docx Assurance Letter Septe
NHS Core Standards EPRR core standards
Requirements for CSUimprovement plan Wir
STATEMENT OF
COMPLIANCE EPRR 20
GB 1415/0039
3.
ITEMS FOR DISCUSSION
3.1
NHS Wirral CCG response to the
‘Capability and Governance
Review & Constitutional
Implications
(Paul Edwards & Jon Develing)
Review and
Wirral CCG Review Constitution cover she NHS England.pdf
High level action plan
Constitutional
in response to NHS Enimplications of the rev
GB 1415/0040
4.
ITEMS FOR INFORMATION
4.1
Quality Performance and
Finance- QPF
(Lorna Quigley/Mark Bakewell)
th
Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 7 October 2014
Cover Sheet
Integrated Performan
Slides for GB
071014.pptx
Page 1 of 3
Ref No.
No
Time
Item
4.2
Papers
Progress Report re: System
Resilience Plan
(Andrew Cooper/Sarah Quinn)
Wirral SRG Plan
Board report cover
sheet template System 201415 v3.docx
System resilience
summary paper Oct 2
4.3
4.4
Progress Report re: BCF (Better
Care Fund)
(Sarah Quinn)
Progress Report re: Continuing
Health Care (CHC)
(Iain Stewart)
Better care fund
Board report cover
sheet template BCF Osummary paper Oct 2
CHC_Provision_Cove CHC_Provision_Oct1
4_GB1.pdf
r_Sheet_GBB_071014
CHCCC Wirral action Letter to Leigh Griffin
plan Aug 2014 ver 1 0 re CHC 16 09 2014.pd
GB 1415/0041
5.
ITEMS FOR NOTING
5.1
5.2
Conflicts of Interest Policy
(Paul Edwards)
Conflicts of Interest Conflicts of Interest
Cover sheet Oct GB.doPolicy September 2014
Visions 2018 Update
(Jon Develing/Anna Rigby)
Vision 2018 Bulletin
Issue 3.pdf
5.4
5.5
Commissioning
Plan/Commissioning Intentions
(Iain Stewart)
Commissioning_Plan_ Comissioning_Plan_2
201419_ FinalDraft_C014-19_MASTER_v71
Subgroups (Ratified Minutes):
•
WGPCC of 11.06.2014
Ratified WGPCC
Executive Board Minute
•
•
Approvals Minutes of:
27.08.2014
Audit Minutes of:
28.05.2014
th
Approvals Ratified
Minutes 27th Aug 2014
audit minutes 280514
ratified.docx
Page 2 of 3
Ref No.
GB 1415/0042
No
6.
Time
Item
RISK REGISTER
Papers
Current Risk Register
7.
8.
End
To be circulated
ANY OTHER BUSINESS
7.1
DATE AND TIME OF NEXT MEETING
th
Tuesday 4 November 2014
2pm – 4pm
Nightingale Room OMH
Please forward any apologies to Allison.hayes@nhs.net
th
**Latest submission date for papers is Friday 24 October 2014**
Day
Tuesday
Tuesday
Wirral Clinical Commissioning Group – Future Meetings 2014
Date
Time
2nd December
2pm – 5pm
6th January
2pm – 5pm
th
Venue
Nightingale Room
Nightingale Room
Page 3 of 3
WIRRAL CLINICAL COMMISSIONING GROUP
GOVERNING BODY BOARD MEETING
Minutes of Meeting – Public Session
Tuesday 2nd September 2014
2pm
Nightingale Room, Old Market House
Present:
Jon Develing (JD)
Dr P Naylor (PN)
Mark Bakewell (MB)
Lorna Quigley (LQ)
Dr M Green (MG)
James Kay (JK)
Dr H McKay (HM)
Dr A Ali (AA)
Iain Stewart (IS)
Christine Campbell (CC)
Fiona Johnstone (JF)
Dr J Oates (JO)
Dr D Jones (DJ)
Andrew Cooper (AC)
Paul Edwards (PE)
Interim Accountable Officer
Acting Chair WCCG
Chief Finance Officer
Head of Quality and Performance
Consortium Chair
Lay Advisor (Audit & Governance, Deputy Chair)
GP Executive (WGPCC)
Consortium Chief Officer (WACC)
Consortium Chief Officer (WGPCC)
Director of Public Health
Consortium Chair
GP Executive (WHCC)
Consortium Chief Officer (WHCC)
Head of Corporate Affairs
In Attendance:
Allison Hayes (AJH)
Karen Prior (KP)
Richard Williams (RW)
Robin Baker
Liz Temple Murray
Ref No.
GB1415/0031
Executive Assistant
Healthwatch Wirral
LMC
Grant Thornton
Grant Thornton
Minute
Preliminary Business
1.1 Apologies for absence
Apologies were received from: Simon Wagener, Dr S Wells, Dr A Smethurst & Graham
Hodkinson.
1.2 Chairs Announcements
Chair welcomed all members to the meeting. 7 members of the public attended the meeting.
1.3 Declarations of Interest
The following GP members present declared their potential for conflict of interest in the
consideration of items 2.1 & 2.2 concerning the "Primary and Community Care investment” and
“Prescribing incentive Scheme”
Dr P Naylor (PN)
Acting Chair WCCG
Dr M Green (MG)
Consortium Chair
Dr H McKay (HM)
Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 2
nd
September 2014 Page 1 of 7
Ref No.
Minute
Dr A Ali (AA)
Dr J Oates (JO)
Dr D Jones (DJ)
Consortium Chair
GP Executive (WHCC)
In view of these declarations James Kay would take the chair for discussion of items 2.1 & 2.2 in
line with our Conflicts of Interest policy.
1.4 Comments/questions from members of the public
There were no comments or questions from members of the public.
1.5 Patient Story
LQ gave an overview of a patient’s story which highlighted potential risks associated to patients
staying in a hospital environment and how the length of stay can affect a patient’s care.
Members noted the contents of the patient story.
1.6 Minutes from previous meeting held on 5th August 2014.
The minutes of the previous meeting held on 5th August 2014 were agreed as a true and accurate
record notwithstanding grammatical/typographical errors which will be rectified. There were no
matters arising.
Action Points – please refer to separate Action Sheet
GB1415/0032
2.0 Items for approval
2.1 Primary And Community Care Investment (Over 75s Scheme &Transferring Primary
Care Schemes)
In view of the declarations of interest, and in line with the Conflict of Interests Policy, James Kay
would take the chair for this discussion:
CC and AC gave an overview of the above proposals.
The papers presents proposals to use two sets of resources currently unallocated within the CCG
financial plan:
• over 75s resource, required to be set aside for care of over 75s, under the NHS Planning
Guidance;
• resource released from discontinued Local Enhanced Services
The Governing Body approved principles for use of these resources at its meeting on the 5th
August. A paper was taken to the Approvals Committee on the 27th August to approve the
financial commitment of resources to General Practice, in line with the CCG Conflicts of Interest
Policy. Following feedback at the August Governing Body meeting, this paper includes more
detail and a full version of each General Practice scheme, for Governing Body approval.
The Governing Body were asked to support the proposals for use of these resources, taking into
account the rationale and anticipated outcomes behind each one, and the support given by the
Approvals Committee on the 27th August.
Discussions took place in relation to read codes and CC clarified this for members.
JK sought clarity around procurement processes and resources available in terms of staffing and
nd
Ref No.
Minute
work place capacity. CC explained that this is an extension of a current service and, with regards
to recruitment of nurses, assurances has been given by CWP that there are adequate numbers
of nurses to support the service. AC informed members of the task and finish groups that have
worked in collaboration with main providers in order to address this.
KP sought clarity around NHS 111 and Minor Injury services being included in the proposals. AC
gave an overview of how the schemes relate to primary care and how NHS 111 may link into this
particularly with its use of the Directory of Service.
KP also sought clarity around additional transport issues and AC explained the rational regarding
this.
The Governing Body supported the proposals and agreed to commission the schemes from
General Practice as identified and take forward next steps on commissioning the community
Dementia Liaison Nurses and the Pharmacy First scheme.
2.2 Prescribing Incentive Scheme
In view of the declarations of interest James Kay would take the chair for this discussion in line
with our Conflicts of Interest policy.
CC provided an overview of the scheme. The proposed incentive scheme attempts to address
specific areas of prescribing that are referenced within the Medicines Management QIPP plan for
the CCG. It seeks to improve quality, ensure safe prescribing, and secure a return on investment
for the CCG. It is scheduled to run from September 2014 – February 2014, and would be a
Wirral-wide scheme open to all General Practices.
The practice-based review areas will improve the practice-based systems and provide a baseline
for continued practice-based review in following years to further improve practice and systems.
The scheme has discernible links to Wirral CCG strategic objectives and priority work areas. The
proposed scheme also contains an element of GP peer to peer review and sharing of best
practice. Overall the proposed prescribing incentive scheme should provide the following
outcomes:
• Increased cost effective prescribing at GP practice level.
• Increased prescribing in line with national and local clinical guidelines.
• Improved systems and processes at GP practice level, supporting care of people in a
safe environment; protecting from avoidable harm.
• Sharing of best practice across GP peers.
The Governing Body noted that the proposal has been sent to GP practices and the feedback
received.
The Governing Body agreed the above scheme.
2.3 QIPP Plan
The QIPP plan sets out how the CCG seeks to achieve financial balance whilst improving the
quality of care across a range of transactional and transformational areas. CC gave an update of
current developments in relation to QIPP.
The Governing Body were asked to note the points and approve the QIPP Plan for Wirral CCG
for 2014/15. In line with the Vision 2018 programme, the CCG will need to shift focus towards
transformation rather than service review and redesign, and ensure that efforts are spent on
priority areas that will have an impact spanning the system, rather than just in small, isolated
areas.
nd
Ref No.
Minute
JK highlighted that appropriate governance would need to be in place across Wirral organisations
to effect the necessary change. Members suggested that an update in relation to Vision 2018 is
brought back to a future Governing Body meeting.
Members of the Governing Body approved the QIPP Plan.
2.4 Safe Guarding Adults Policy
LQ gave an overview of the Safe Guarding Adults policy and sought approval to underpin the
work of the Safeguarding Team. NHS Wirral CCG is committed to safeguarding. Safeguarding
adults incorporates measures to reduce the likelihood of abuse and neglect occurring as well as
‘adult protection’ i.e. making effective responses to protect ‘adults at risk’ where abuse and
neglect has occurred. The policy outlines the appropriate systems in place for discharging the
CCGs responsibility in respect of safeguarding.
The Governing Body approved the Safeguarding Adults Policy.
2.5 Complaints Policy
PE provided details in relation to the recent amendments made in the complaints policy. The
complaints policy is reviewed on a biannual basis as a minimum requirement.
The policy is designed to ensure staff; patients and public are informed of the current complaints
process for Wirral Clinical Commissioning Group. The existing policy was approved by the
Governing Body in September 2013.
While the principles described within the policy have not changed there has been a need to
update changes to the complaints procedure since 1st April 2013, in line with the Local Authority
Social Services and National Health Service Complaints (England) Regulations 2009.
CC suggested that an update of the complaints procedures are sent to GP practices.
GB1415/0033
GB1415/0034
The Governing Body approved the Complaints Policy.
3.0 Items for Discussion
There were no items of discussion
4.0 Items for Information
4.1 Quality Performance and Finance Report
Quality Performance
LQ gave a presentation on the activity performance for month 3 (June) and highlighted the
positive areas and the improvements in the challenges that were originally presented.
Areas included:
•
•
•
•
•
•
•
Family and friends
NWAS turnaround
Delivering the same sex accommodation
Diagnostic test
MRSA
Referral to treatment – NHS Constitution
Health Care Associated Infection
LQ highlighted the work carried out in conjunction with the Utilisation Management team and how
this has impacted on A&E performance.
nd
Ref No.
Minute
The Governing Body noted the contents of the Quality and Performance Report.
Finance Report
MB provided information of the Financial performance against budgeted allocation for 2014/15 as
at month 4 (July).
Plan is in line with the plan however limited data available for Month 4 reporting. Points to notice
are:
•
•
•
Planned Year to Date Surplus - £1.5.6m
Current Year to Date Surplus - £0.96m
£0.6m variance from plan
(£0.6m) variance from plan, adverse movement on expenditure between month 3 (June) and 4
(July)
Adverse Variances
WUTH Contract position – (£1.05m) @ M3 vs. (£17.m) @ M2
Other NHS providers – notably Royal Liverpool and Broadgreen CC (£0.35m)
Commissioned out of hospital - £0.376m (Increase in CHC/package costs)
Prescribing – circa £0.35m adverse movement
QIPP – 4/12’s of £6.9m Gap (shortfall in budgets) = £2.30m
2014/15 Key Planning Requirements
• 1% Surplus - £4.68m
• 2.5% Headroom (non-recurrent resources) - £11.4m
• Minimum 0.5% Contingency - CCG hold £3m vs £2.2m (0.5%)
• Better Payment Practice Code
• Cash Management
Forecast Outturn 2013/14
Forecast Assumptions
• Still early position in financial year, activity based contracts for month 3 (contracts) /
month 2 (prescribing)
• Adverse Movement between months increases level of risk of achievement of control total
but planned Forecast Surplus - £ 4.68m (1%) – remains on track
• Risks remain consistent with plan around main expenditure areas
• WUTH,
• Prescribing,
• Commissioned Out of Hospital Care,
• QIPP Gap
Other Issues
• Hosting Arrangements
• Discussions held with Cheshire & Merseyside Commissioning Support Unit with regards
to ceasing of arrangements relating to Isle of Man commissioner and use of CCG Ledger
• Continuing Healthcare
• Restitution /Previously Unassessed Period of Care (PUPoC)Provision claims progressing
slowly
JK sought an explanation regarding the over performance of the WUTH contract and how this
links to the delivery of the QIPP plan. MB provided assurance about the delivery of the plan.
nd
Ref No.
Minute
The Governing Body noted the financial report as at month 4 (July).
Information Governance
The purpose of the report is to update the Wirral Clinical Commissioning Group with Information
Governance performance, and to demonstrate that the correct support and programmes of work
are underway to meet the Information Governance Toolkit Requirements by 31st March 2015.
MB provided an overview of the Information Governance performance and asked the Governing
Body to:
•
•
•
•
Receive the July IG Toolkit Baseline submission scores.
note the current position and receive the 2014/15 Work Plan
commit to support compliance with the Information Governance Toolkit, in preparation of
the March 2015 submission
Approve the changes to the IG Strategy and supporting policies.
The Governing Body acknowledged the report and the work undertaken by Suzanne Crutchley
and approved the changes to the IG strategy and supporting policies.
4.2 Wirral CCG Annual Audit Letter
The Annual Audit Letter summarises the key findings arising from the work that Grant Thornton
carried out at NHS Wirral Clinical Commissioning Group (the CCG) for the year ended 31 March
2014. Robin Baker and Liz Temple Murray provided an overview of the Audit.
The audit work plan involved:
•
•
auditing the CCG's 2013/14 accounts (section two), and
assessing the CCG's arrangements for securing economy, efficiency and effectiveness in
its use of resources (section three).
The audit conclusions provided in relation to 2013/14 were follows:
•
•
•
•
Financial statements opinion – An ‘unqualified’ opinion on the CCG's financial statements
on 6 June 2014, confirming a true and fair view of the CCG's financial position as at 31
March 2014 and of net expenditure recorded for the year.
Regularity opinion - An ‘unqualified’ regularity opinion.
Value for money (VfM) – A ‘non-standard’ value for money conclusion
It should also be noted that the Annual Report was presented at the CCG’s Governing
Body on 3rd June 2014, a meeting that was held in public
The Governing Body noted the content of the Audit report and thanked Robin and Liz for their
work.
4.3 WHCC consortia Update
Each Consortium has been asked to prepare a report on a quarterly basis detailing how it has
contributed to key CCG priorities. AC gave an update and reported the activities undertaken by
Wirral Health Commissioning Consortium since their last submission. The report demonstrates to
patients, stakeholders and the public the range of innovative activities taking place at a
Consortium level, and the contribution made to the overall CCG Strategic plan and priorities
through the Consortia and their member practices.
The Governing Body noted the contents of WHCC report and gave thanks to the consortia for
their work.
nd
Ref No.
GB1415/0035
Minute
5.0 Items for Noting
5.1 Service Level Agreement (SLA) Between Wirral CCG & CSU
LQ provided an update regarding the SLA between Wirral CCG and the CSU (Commissioning
Support Unit)
The paper provided the Governing body with:
• An update regarding the progress made to date transfer of services from the
commissioning support unit (CSU) to the CCG.
• Progress to date regarding the agreement of the Service Level Agreement and Key
Performance Indicators (SLA, KPI) between the CCG and CSU.
The Governing Body were asked to support the work that the CCG are undertaking in addressing
the issues highlighted and to support the update of the CCG risk register to reflect the potential
risks identified within the paper.
The Governing Body noted the report and supported the recommendations.
5.2 Subgroups (ratified minutes for noting)
•
GB1415/0036
QPF meeting of 29.07.2014 – noted.
The Governing Body noted the reports of the above subgroups.
6.0 Risk Register
PE gave an overview of the current risk register and all items were reviewed and noted today.
7.0 Any other Business
There were no other items of business. Chair thanked members for their attendance.
The Board meeting ended at 15:40pm.
8.0 Date and Time of Next Meeting
th
The date and time of the next meeting is Tuesday 7 October 2014 at 2pm – 5pm in the Nightingale
Room, OMH please contact Allison.hayes@nhs.net with any apologies or agenda items.
Board meeting ended at: 15:40pm.
nd
Wirral Clinical Commissioning Group
Governing Body
Draft Action Points re Meeting of 2nd September 2014 (Public Session)
Duncan Room, OMH
2pm
Outstanding Actions from: 5th August 2014
Topics Discussed
Item Number/Ref
Action Points
Responsibility Action Target
date
•
•
•
•
New Actions from: 2nd September 2014
Topics Discussed
Minutes and Action
Points of the last
meeting
Minute
Action Points
Responsibility
Action Target
date
• AJH/PE to rectify grammatical errors
• AJH
• 07.10.2014
Agenda Items for next meeting / Decisions to note for next meeting / Date & time of next meeting
The date of the next meeting is Tuesday 7th October 2014 at OMH, Duncan Room.
Agenda items and apologies are to be sent to: Allison.hayes@nhs.net
Draft Action Points – Wirral Clinical Commissioning Group, Governing Body Meeting - PUBLIC SESSION – 02.09.2014
1/1
Report on Proposed Changes to Commissioning Policies
(also known as Procedures of Lower Clinical Priority – PLCP)
Agenda Item:
2.1
Reference:
GB14-15/0038
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Sue Wells
Contributors:
Clare Grainger
Governance:
Link to
Commissioning
Strategy
Link to current
strategic
objectives
1. Rigorously developed and agreed care pathways working
together with patients to secure their help, understanding,
ownership and support of the needed changes
2. Commissioned services which have a sound evidence
base
3. Provides greater equality of access to all
•
•
•
Enhance the quality of life for people with long term
conditions
Helping people to recover from episodes of ill health
or following injury
Ensuring people have a positive experience of care
Summary:
The purpose of this report is to
• To provide an overview of the process undertaken to update the
Commissioning Policies
• To present the final policy to the Governing Body for approval
• The most important changes or decisions in the consultation were
regarding: IVF, Interventional treatments for Varicose Veins, Penile
Implants and Diabetes/Continuous Glucose Monitoring, though many
others were involved.
Recommendat
ion:
To Approve
To Note
Comments
Next
Steps:
x
The Governing Body are asked to consider whether the CCG
should adopt and put into practice the updated policy but with the
recommended exceptions and amendments noted in tables 7.2 to
7.4
If the Governing Body chooses to adopt the updated policy, the
CCG has two options:
1. Put the new policy into practice as soon as possible, or
2. Phase in over a period of time to reduce the financial impact
Following this review, it was agreed that the approved policies would be shared with GPs
and providers, embedded into contracts with all local trusts and performance-managed to
monitor compliance
1/3
This section is an assessment of the impact of the proposal/item. As such, it identifies the significant
risks, issues and exceptions against the identified areas. Each area must contain sufficient (written in
full sentences) but succinct information to allow the Board to make informed decisions. It should also
make reference to the impact on the proposal/item if the Board rejects the recommended decision.
What are the implications for the following (please state if not applicable):
Financial
Available financial impact figures are detailed in section 8 and appendices 5
and 6. If the recommendations are adopted the procedures will remain under
continuous review.
Value For Money
Through applying latest clinical evidence to procedures it will enable new
treatments to be available with higher success rates and replace those offering
reduced clinical benefit. New procedures will also reduce unnecessary delays
in authorizing treatment which can happen when a treatment is subject to an
‘individual funding request’ (IFR). The revised policy would enable clinicians to
clearly identify when this is necessary. There will be no decrease in other
areas to pay for the policy changes.
Risk
There is a risk that expectancy will be set with future policy reviews.
Legal
The Commissioning Support Unit (CSU) was commissioned to take legal
advice and ensure any risks or legal implications were negligible?
Workforce
There has been substantial clinical and provider engagement and consultation
to address the potential changes and identify any impact. These are detailed
in section 3 and 4 and appendix 3 of the report. There is expected to be
negligible impact on the workforce.
Equality &
Human Rights
A full equality analysis report is detailed in appendix 4 and section 5 of the
report. The CSU have revised the policy to mitigate any potential negative
impact that was identified.
Patient and
Public
Involvement (PPI)
Patients and public have been engaged and consulted as part of the NICE
guideline development and as part of the formal engagement and consultation
that has informed the report. Full details are in section 3 of the report and
appendix 3.
Partnership
Working
The report provides evidence of partnership and collaborative working across
the Cheshire and Merseyside CCG’s to try to align the process with the
assistance of the CSU. Wirral CCG were particularly pro-active in pushing to
achieve an alignment and agreement on the proposals.
Performance
Indicators
There isn’t a performance indicator related to this overarching work. The new
draft policy does not introduce any new contracts therefore currently
commissioned services will continue to be monitored with standard procedures
already established.
Do you agree that this document can be published on the website?
(If not, please note that it may still be subject to disclosure under Freedom of Information Freedom of Information Exemptions

2/3
This section gives details not only of where the actual paper has previously been submitted and what
the outcome was but also of its development path ie. other papers that are directly related to the
current paper under discussion.
Report History/Development Path
Report Name
Reference
Procedures of
Low Clinical
Priority
Item no. 2.6
Commissioning
Policy Review
Procedures of
Low Clinical
Priority
Commissioning
Policy Review
Date
Brief Summary of Outcome
Clinical Strategy
Group (CSG)
12.11.13
Briefing and discussion
Item no. 2.5
Operational Team
Meeting
28.1.14
CSU presentation
Item no. 2.1
Extraordinary
Clinical Strategy
Group
23.1.14
Briefing and discussion highlighting
consultation
Clinical Strategy
Group
11.2.14
Highlighting consultation had started
AOB
Submitted to
Public
Engagement &
Consultation
Activity –
Commissioning
Policies Review
Item no. 55
Families and
Wellbeing Policy
and Performance
Committee
8.4.14
The Chair indicated to Members that if
they had any further comments to add
to the review, they could do so online.
RESOLVED: That
(1) the report be noted; and
(2) Ms Curtis from CSU be thanked
for her informative presentation.
PLCV
Item no. 2.3
Extraordinary
Clinical Strategy
Group
8.7.14
Members voted to agree
recommended position but escalated
to Operational team meeting for
clarification on some areas
Procedures of
Low Clinical
Priority –
contentious
issues
Item no. 4.1
Operational Team
Meeting
15.7.14
Members agreed to CSG
recommendations
Private Business
The Board may exclude the public from a meeting whenever publicity (on the item under discussion)
would be prejudicial to the public interest by reason of the confidential nature of the business to be
transacted or for other special reasons stated in the resolution. If this applied, items must be
submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to
Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication
of which may be inappropriate or damaging to an identifiable person or organisation or otherwise
contrary to the public interest or which relates to the provision of legal advice (for example clinical care
information or employment details of an identifiable individual or commercially confidential information
relating to a private sector organisation).
If a report is deemed to be for private business, please note that the tick in the box, indicating whether
it can be published on the website, must be changed to a x. If you require any additional information
please contact the Lead Officer.
3/3
GOVERNING BODY BOARD REPORT
Report Title
Lead Officer
Recommendations
Report on Proposed Changes to Commissioning Policies (also known
as Procedures of Lower Clinical Priority – PLCP)
Dr. Sue Wells
The Governing Body are therefore asked to consider whether the CCG
should adopt and put into practice the updated policy but with the
recommended exceptions and amendments noted in tables 7.2 to 7.4
If the Governing Body chooses to adopt the updated policy, the CCG has
two options:
2. phase in over a period of time to reduce the financial impact
1.
1.1
INTRODUCTION
Historically commissioning policies across Cheshire and Merseyside were developed centrally through
association and support by CISSU (CISSU project managed the production of Cheshire and Merseyside
procedures of limited clinical value); this document was due for review in 2012.
1.2
CCGs agreed that the individual funding request process (IFR) service provided by NHS Cheshire and
Merseyside Commissioning Support Unit (CSU) applied the inherited policies of CCGs, of which the
majority were out of date or requiring a review.
1.3
This position review provided a real opportunity to consider the value and economy in all CCGs agreeing
to be part of a common process to develop a comprehensive suite of commissioning policies based on
latest National Institute of Clinical Excellence (NICE) guidance and clinical best practice.
1.4
In mid-2013 the CSU were commissioned to undertake a review of the policy on behalf of the Clinical
Commissioning Groups across Cheshire and Merseyside. This review covered 12 Clinical
Commissioning Groups, 2.5 million population, 420 GP Practices and 74 individual treatment/service
lines.
1.5
The main policy draft changes were on updating the guidance based on new evidence and adding new
services/treatments/procedures that have come on stream since the old policy was adopted
1.6
Following this review, it was agreed that the approved policies would be shared with GPs and providers,
embedded into contracts with all local trusts and performance-managed to monitor compliance.
1.7
This paper is to provide the Governing Body with details of the process undertaken to arrive at the
updated policy and for the Governing Body to approve the final policy.
1.8
Please see appendix 1 and 2 for the full draft policies.
2.
2.1
REVIEW PROCESS
A seven-stage approach was developed and agreed and followed the format below:
Stage 1 Policy stimulation - practice or evidence
Stage 2 Evidence review
Stage 3 Pre Equality Impact Assessment
Stage 4 Production of a potential policy for CCG primary approval
Stage 5 Engagement- patients, carers, members of the public, referrers and providers
Stage 6 Review consultation findings, final approval by CCG and full Equality Impact Assessment
Stage 7 Policy Implementation and monitoring
1/11
2.2
A full evidence review was undertaken by CSU considering NICE guidance and the most up to date
clinical evidence base. This has been supported by Public Health who undertook independent reviews in
a number of areas.
2.3
Following this review CSU developed draft policies for consultation. A colour-coded key chart was
devised to provide and support an easier understanding of the 37 specialties (and 99
treatments/procedures) within the revised ‘draft’ policy document, to denote whether the NICE or national
guidance was recommending major, moderate or no change to the status quo :
Key
Description
Speciality / Clinical Area
Red
Important
Changes
7.1. Infertility Services
20.3 Interventional treatments for Varicose Veins
19.2 Penile (Penis) Implants
Amber
Criteria Changes
21.1 BotulinumToxin
11.3 Mental Health
14.1 Oral Surgery – extraction of wisdom teeth
16.5 Plastic and Cosmetic Surgery
17.1, 17.2 - Respiratory Services
18.2, 18.3, 18.18, 18.19 Trauma and Orthopaedics
Green
Minor word or no
changes made
1.1 Weight Management (Bariatric) Surgery
2.1 Complementary Therapies (including
Homeopathy)
3.1, 3.2, 3.4 Dermatology
5.2, 5.3, 5.4, 5.5. 5.7 Ear, Nose and Throat
8.1 Gastroenterology
9.1, 9.2 General Surgery
10.1 Gynaecology
13.1,13.2, 13.3, 13.8 Ophthalmology
16.1, 16.2, 16.3, 16.4, 16.6, 16.7, 16.8, 16.9,
16.10, 16.11, 16.12, 16.13, 16.14, 16.16, 16.17,
18.15, 18.17, 18.20, 18.21, 18.22, 18.23 - Trauma
and Orthopaedics
2/11
Dark
Blue
New - Important
Change*
4.1 Diabetes - Continuous Glucose Monitoring
Mid
Blue
New - Moderate
Change*
3.3 Dermatology
6.1 Equipment (Lycra suits)
12.1, 12.2, 12.3 Neurology
13.5 Ophthalmology
14.3 Oral Surgery
18.1, 18.4, 18.5, 18.6, 18.7, 18.8, 18.9, 18.10,
18.11, 18.12, 18.13, 18.14, 18.16, 18.22 Trauma
and Orthopaedics
19.1, 19.4, 19.5, 19.6 Urology
20.1, 20.2 Vascular Services
Light
Blue
New - Minor
Impact*
5.1, 5.6, 5.8 Ear, Nose and Throat
9.3 General Surgery
11.1,11.2, 11.4, 11.5 Mental Health
13.4, 13.6, 13.7 Ophthalmology
14.2 Oral Surgery
15.1 Paediatrics
18.23, 18.24, 18.25, 18.26 Trauma and
Orthopaedics
19.3 Urology
3. PUBLIC CONSULTATION
3.1 The National Institute of Clinical Excellence (NICE) guidelines are already determined; the premise of the
consultation exercise was to ask key stakeholders if they felt that the respective CCGs should consider
NICE guidance when forming a decision for procedures of low clinical priority. NICE guidance is not
mandatory. Cheshire and Merseyside Clinical Commissioning Groups wanted to ensure that local patients,
carers and members of the public were aware of NICE guidance and to gauge opinion in respect of the
guidance when forming policy on procedures of low clinical priority.
3.2 The need for formal consultation (90 days) was agreed for all 12 CCGs in January 2014. 10 CCGs began
the process on 6th January and 9 closed their consultation on 7th April, NHS Knowsley CCG extended their
3/11
consultation for a further 10 days until 17th April. NHS Wirral CCG and NHS Liverpool CCG started their
process later and closed on 30th April and 3rd June respectively.
3.3 This collaboration consultation across the Cheshire and Merseyside footprint resulted in 5,827 people
visiting the CSU website, 535 people completing the survey and 72 public events taking place during the
formal consultation period.
3.4 The consultation was widely publicised across Wirral during the 90-day formal consultation process;
targeting patient groups, third sector, and general public alongside NHS staff and providers. The full list of
engagement activities is listed in appendix 2 of the report. In addition to the Wirral-focussed engagement
captured in the matrix, there was regional and national engagement undertaken by the CSU on behalf of all
CCG’s; including protected groups, clinical leads, pharmacists, dentists and optometrists (via NHS
England). The CSU can provide that information separately.
3.5 Wirral CCG undertook a robust consultation which resulted in a total of 253 responses to the online survey,
the highest response rate for any CCG and nearly half of the total responses overall. There was a relatively
equal distribution of response from across all age ranges with the highest number being between the range
of 65+. In addition, 27% were between the age of 45-54, 22% between the age of 55-64, 15% ranged from
35-44 and 8% were aged 24-34. The majority of the respondents stated that they were commenting
generally and not on a specific area of the consultation. Of the 253 responses, 50% agreed with the
proposals and 50% disagreed. There were no specific trends identified in the feedback and a significant
number of responses did not pertain to the actual draft policy. A few comments pertained to a gap in the
current pathway for bariatric patients in relation to CBT, however, this did not form part of the survey
questions. Please see appendix 3 for the full consultation report.
4 CLINICAL ENGAGEMENT
4.1 Reviewing and developing commissioning policies required multi-disciplinary input and was recognised as
being a very complex process. The review would take account of 99 individual treatment lines classed as
procedures of low clinical priority. Engagement with clinicians within NHS Wirral CCG is detailed in the
engagement audit trail within the consultation report in appendix 3. Clinical engagement included:
•
•
•
•
•
•
•
Briefing paper and discussion with clinical leads in the Senior Management Team Operational
meetings (December 2013). CSU presentation (January 2014)
Reports and discussions at the Clinical Strategy Group (November 2013, January, February and
July 2014)
Draft policy, and briefing sent to all GP practice managers and GPs from the CCG Chief Clinical
officer (December 2013) with link to dedicated email address for clinical feedback
CSU presentation at Wirral GP Commissioning Consortium GP Forum (December 2013)
CSU presentations at Commissioning Consortia Clinical forums (January 2014)
Consultation sent to all GP practices (March 2014)
Alignment and development meetings (throughout)
4.2 In addition, engagement has taken place with providers of healthcare services, including:
• Provider briefing sent from CSU (December 2014)
• Details of proposed changes and the consultation process were sent to all providers (January 2014)
• CSU facilitated Provider invited briefing events (January 2014)
• Consultation sent to all provider engagement leads to distribute (April 2014)
• Details of the consultation were sent to identified Wirral Clinical leads for treatments where there
were recommended important changes e.g. varicose veins, subfertility (March 2014)
4/11
5.
5.1
EQUALITY IMPACT ASSESSMENT
A full equality impact assessment was undertaken to ensure adherence to the Equality Duty 2010. In order
to identify potential equality impacts the full NICE guidelines were reviewed, in the first instance to identify
particular procedures that effect particular protected characteristics. Once this was identified then a
specialist team with clinicians looked at the detail of the change, many changes were simply procedural or
‘better medicine’ meaning there would be ‘no clinical difference from the patient’s perspective’. However,
there were a number of changes that seemed significant enough that may have an ‘equality impact’ and of
which interested parties may need to comment. The report examined where this was the case and
ensured relevant engagement was undertaken e.g. due to the high number of proposed changes to areas
that could disadvantage the transgender community the CSU established a focus group to capture
opinions from the transgender community.
5.2
The equality analysis report is available in appendix 4. In summary the report recommends accepting the
NICE guidance and consulting with interested parties incorporating their views into decision making to
ensure that Wirral CCG are compliant with the Public Sector Equality Duty.
5.3
As a result of the equality analysis and engagement a number of changes were made to the draft policy
that is now appended.
6.
6.1
POST-CONSULTATION PROCESS
Following the conclusion of each CCG’s 90-day formal consultation process a number of activities took
place:
•
A structured approach to handling patient and public feedback was adopted in order to ensure all
views were considered. All survey data for each CCG was compiled into a report
•
All clinical feedback was considered and collated to inform the policy.
•
Provider feedback was considered and collated to inform the policy.
•
A Clinical Commissioning Group Position Meeting took place to promote discussion between CCGs,
and seek agreement to a single policy across all Cheshire & Mersey CCGs, taking into consideration
the patient, carer and public feedback, alongside feedback which has been received from clinicians
and providers.
•
The final draft policy was provided to CCGs on 2nd July 2014, and each CCG asked to formally
consider at their Governing Body whether it would like to adopt the updated policy.
7.
7.1
RECOMMENDATIONS
Wirral CCG called a meeting of the Clinical Strategy Group (CSG), with representation from QIPP (Quality
Innovation Productivity Prevention) clinical leads across Wirral to specifically review the final draft policy
alongside the consultation feedback and equality analysis report. The CSG were asked to vote on a
template provided by the CSU to capture their recommended position in relation to the final draft policy
based on clinical grounds. The CSG’s vote on Wirral’s recommended position is detailed in table 7.2 to
7.4 below.
Table 7.2 Wirral CCG position on statements that the CSU proposes to remove
No.
Title
Agreement
CSG Feedback/Comment
1. Removed statement on bariatric surgery/pathways
2.
Removed statement on Extraction of impacted
Wisdom Teeth
3. Removed statement on Orthodontics
Removed statement on Treatments for Obstructive
4. Sleep apnoea/hypopnoea syndrome in Adults
(OSAHS)
Yes
Tier 3 commissioned by CCG
Yes
Yes
Yes
5/11
Table 7.3 – Wirral CCG Position on statements that the CSU proposes to change – do we agree?
CCG Position
CCG Likely Position
No.
Title
Yes/No
1.
Continuous Glucose
Monitoring
2.
Cataracts
3.
Lycra Suits
4.
Penile implants
5.
Varicose Veins
6.
Homeopathy
7.
Psychological Distress
8.
Botox
9.
Infertility
10
Hip & Knee Surgery
NO
DISAGREE - If patient fits all criteria; Individual Funding
Request (IFR) not required
Yes
Agree with draft with Appendix 1 guide for local use. Remove
‘medically fit’ as optomertrists cannot determine this.
Yes
Yes
Agree with draft. IFR required. Further information required
from consulting with patient groups
DISAGREE. If patient meets criteria, no IFR required.
Currently provided on Wirral for those patients who meet the
criteria (very small numbers).
DISAGREE. Follow NICE Guidance. But develop a template
regarding level of symptoms. Financial Impact.
DISAGREE. Agree all other complimentary therapies. Wirral
wishes to continue commissioning Homeopathy at present.
For future review.
Agree
Yes
Agree
Yes
Follow NICE Guidance re numbers of cycles and 40-42.
Smoking to be removed as can’t police. Childlessness no
change. Surrogacy no, IFR would be required. Agreed GP
pre-conception and referral pathway. Financial impact.
And continue with local referral guidelines
NO
NO
NO
Yes
Table 7.4 Wirral CCG position on Unchanged Statements - confirming that you are happy to
continue to adopt the following unchanged statements
CSG Comment/Feedback
No.
Title
Yes/No
Surgical Laser therapy for Viral Warts (excluding
Yes
1.
Genital Warts) from secondary care providers
Yes
2.
Surgical Remodelling of External Ear Lobe
3.
Use of Sinus X-ray
Yes
4.
Rhinoplasty - Surgery to Reshape the Nose
Yes
5.
Surgery of Laser Treatment of Rhinophyma
Yes
6.
Gastro-electrical Stimulation
Surgery for Asymptomatic Gallstones
& Lithotripsy for Gallstones
Surgical Procedures – for the Treatment
of Heavy Menstrual Bleeding & Hysterectomy &
D&C (Dilatation and curettage)
Inpatient Care for treatment of Chronic Fatigue
Syndrome (CFS)
Yes
7.
8.
9.
Yes
Yes
Yes
6/11
Private Mental Health (MH) Care - Non-NHS
commissioned services including Psychotherapy,
Adult Eating Disorders, General In-patient Care,
Post-Traumatic Stress & Adolescent Mental
Health
Bobath Therapy
Trophic Electrical Stimulation for Facial/Bells
Palsy
Upper Lid Blepharoplasty - Surgery on the Upper
Eyelid
Lower Lid Blepharoplasty - Surgery on the Lower
Eyelid
Surgical Treatments for Xanthelasma Palpebrum
(fatty deposits on the eyelids)
Coloured (Irlens) Filters for treatment of
Dyslexia
Intra ocular telescope for advanced age-related
macular degeneration
Surgical removal of Chalazion or Meibomian
Cysts
Cranial Banding for Positional Plagiocephaly
Yes
20.
21.
Mastopexy - Breast Lift
Yes
22.
Surgical treatment for Pigeon Chest
Yes
23.
Surgical revision of Scars
Yes
24.
Laser Tattoo Removal
Yes
25.
Yes
27.
Apronectomy or Abdominoplasty(Tummy Tuck)
Other Skin Excisions/ Body Contouring Surgery
e.g. Buttock Lift, Thigh Lift, Arm Lift
(Brachioplasty)
Treatments to correct Hair Loss for Alopecia
28.
Hair Transplantation
Yes
29.
Treatments to correct Male Pattern Baldness
Yes
30.
Liposuction
Yes
31.
Rhytidectomy - Face or Brow Lift
Treatments for Snoring. Soft Palate Implants and
Radiofrequency Ablation of the Soft Palate,
Sodium Tetradecyl Sulfate (STS) Injection
or snoreplasty’ & Uvulopalatoplasty and
Uvulopalatopharyngoplasy
Bone Morphogenetic Proteins, Dibotermin alfa &
Eptotermin alpha
Palmar Fasciectomy /Needle Faciotomy For
Dupuytren’s Disease. Radiotherapy &
Collagenase injections
Hip Arthroscopy for Femoro–Acetabular
Impingement
Yes
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
26.
32.
33.
34.
35.
Surgical Correction of Nipple Inversion
Yes
Yes
Yes
Yes
Yes
Yes
More evidence required
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Suggest the removal of ‘age’ in criteria;
should be based on functionality
Yes
7/11
36.
37.
Surgical Removal of Bunions/ Surgery for Lesser
Toe Deformity
Treatment of Tendinopathies, Extracorporeal
Shock Wave Therapy & Autologous Blood or
Platelet Injection
Yes
Yes
NO
38.
Circumcision
39.
Yes
42.
Reversal of Male Sterilisation
ESWT (Extracorporeal Shockwave Therapy) for
Prostadynia or Pelvic Floor Syndrome
Hyperthermia Treatment for Prostadynia or
Pelvic Floor Syndrome
Surgery for Prostatism
43.
Chelation Therapy for Vascular Occlusions
Yes
40.
41.
Subjective
DISAGREE. Local need on Wirral to
prevent inappropriate surgical
techniques. Continue to commission
but requires review.
Yes
Yes
Yes
7.5 The CSG felt that there were a number of areas that required further input from the CCG – where they
disagreed with NICE guidelines or where they sought clarification around which services were currently
commissioned. The CSG recommendations were therefore taken to the Senior Managers Operational
Team Meeting on 15th July 2014 for members to consider, highlighting the areas in table 7.6 below. (Page
and item numbers refer to draft commissioning policy document)
Table 7.6
Item
no.
3.1
Continuous glucose
monitoring
11.5
cataract
5.1
Lycra suits
17.2
Penile implants
18.3
1.1
6.1
16.18
16.26
17.1
Varicose veins
Complementary therapies
fertility
Hip and Knee
Tendinopathies
circumcision
Page/104
comment
10
IFR not needed if all criteria met NB pt
comments
33/76/100 Follow NICE support use of template
22
More info needed
70
currently commissioned ?no IFR if criteria
met
72/93
Follow NICE but financial impact
7
Wirral commissions homeopathy at present
25
NICE guidelines. financial impact
61
Local guidelines
68
69
Currently commissioned for religious/cultural
to prevent unsafe surgery
7.7 The Operational Group Members were satisfied that the recommendations made by the CSG represented
the views of the CCG and that the consensus was to follow NICE guidelines with the exception of
homeopathy as a currently commissioned service.
8/11
8
FINANCIAL IMPACT
8.1 The CSG recommendations were made on clinical grounds. The financial impact and ability of the CCG to
fund any approved changes from the existing budget have been considered separately.
8.2 The CSU were limited in their ability to quantify the financial impact of all the procedures because they
apply to a low number of patients, but they were able to confirm that continuous glucose monitors are
approximately £3000 each and the NICE costing template was used to estimate costs for fertility
treatment and varicose veins as the procedures that had the most material implications. It is
important to note that these costing templates are only estimates and subject to variation.
8.3 The Varicose Veins NICE costing template, detailed in appendix 5, indicates that the local estimated
assumption of net resource impact in adopting the revised NICE guidelines is approximately £4K per
annum.
8.4 The Subfertility NICE costing template, detailed in appendix 6, indicates that the local estimated
assumption of financial impact in adopting the revised NICE guidelines is approximately £166K in year 1,
rising to £272K in year 3 before falling to a recurrent cost of £117K when the new policy has been fully
implemented. The costing template is detailed in appendix 5.
8.5 The recommendation is to proceed with funding changes based on CSG recommendations to take into
account the long time since the procedures have been reviewed. However it is on the basis that the
procedures would therefore remain under more constant review.
9
CONCLUSION
9.1 The majority of Cheshire and Merseyside CCGs have not shared their recommendations in advance and
have not yet deliberated their specific policy changes and it is therefore possible that there will be local
variation. However the recommendations in this paper should provide assurance that Wirral CCG has
applied the latest clinical evidence to commissioning plans.
9.2
The Governing Body are therefore asked to consider whether the CCG should adopt and put into practice
the updated policy but with the recommended exceptions and amendments noted in tables 7.2 to 7.4. If
the Governing Body chooses to adopt the updated policy, the CCG has two options:
2. Phase in over a period of time to reduce the financial impact
10 APPENDICES
No. Title of Appendix
1
Final Draft Policy – Cheshire & Merseyside Commissioning Policy – web-link:
https://www.wirralccg.nhs.uk/Downloads/DRAFT%20Commissioning%20Policy%20Criteria.pdf
2
Final Draft Policy – Cheshire & Merseyside Subfertility – web-link:
https://www.wirralccg.nhs.uk/Downloads/Draft%20Subfertility%20Policy.pdf
3
Wirral CCG Consultation report – web-lnk:
https://www.wirralccg.nhs.uk/Downloads/Wirral%20CPR%20Consultation%20Report.pdf
4
Equality Analysis Report – web-link:
https://www.wirralccg.nhs.uk/Downloads/Equality%20Anaylsis%20Report.pdf
5
Varicose Vein Implementation Costings
6
Subfertility Implementation Costings
9/11
APPENDIX 5 – Varicose Vein Cost Assumptions
Costing Template
Cost for selected population using
standard NICE assumptions
NHS Wirral CCG
Unit cost
£
Notes
Total population selected
Selected population who are 18 and over
Prevalence of varicose veins
Number of varicose vein interventional procedures per annum
Units
Total cost £
329,647
262,524
65,631
162
Current practice
Current practice of treatment
Number of outpatient consultant-led first attendances specialising in vascular surgery
Number of surgery interventional procedures per annum
Number of endothermal ablation interventional procedures per annum
Number of ultrasound-guided foam sclerotherapy interventional procedures per annum
Number of outpatient consultant-led follow-up attendances specialising in vascular surgery
£156
£908
£624
£315
£93
162
84
57
21
21
£25,199
£76,000
£35,613
£6,550
£1,931
£145,292
Future practice
Future practice of treatment
Number of outpatient consultant-led first attendances specialising in vascular surgery
Number of surgery interventional procedures per annum
Number of endothermal ablation interventional procedures per annum
Number of ultrasound-guided foam sclerotherapy interventional procedures per annum
Number of outpatient consultant-led follow-up attendances specialising in vascular surgery
Increase in referrals by 25%
Increase in number of outpatient consultant-led first attendances specialising in vascular surgery as
a result of increased referrals to vascular services
Increase in number of surgery interventional procedures per annum as a result of increased
referrals to vascular services
Increase in number of endothermal ablation interventional procedures per annum as a result of
increased referrals to vascular services
Increase in number of ultrasound-guided foam sclerotherapy interventional procedures per annum
as a result of increased referrals to vascular services
Increase in number of outpatient consultant-led follow-up attendances specialising in vascular
surgery as a result of increased referrals to vascular services
£156
£908
£624
£315
£93
162
8
113
41
41
£25,199
£7,336
£70,188
£12,909
£3,806
£156
40
£6,300
£908
2
£1,834
£624
28
£17,547
£315
10
£3,227
£93
10
£952
£149,298
Net resource impact
£4,005
10/11
APPENDIX 6. Sub Fertility Implementation Costings
Notes
Costs over time using standard NICE assumptions
Year 1
Incremental annual cost of access criteria for IVF
1 Rate of progression towards full implementation
Cost in each year
Year 2
Year 3
Year 4
Year 5
£600,000
40%
£142,331
80%
£284,661
100%
£355,826
100%
£355,826
100%
£355,826
33.3%
£146,138
33.3%
£193,534
33.3%
£217,232
0%
£0.00
0%
£0.00
100%
-£4,127
284,341
100%
-£4,127
474,068
100%
-£4,127
568,931
100%
-£4,127
351,699
100%
-£4,127
351,699
Non-recurrent cost of access criteria for IVF
Cost in each year
Embryo transfer strategies
Cost in each year
Total costs
£500,000
£400,000
£300,000
£200,000
£100,000
£0
Year 1
Year 2
Year 3
Year 4
Year 5
Year 1
Year 2
Year 3
Year 4
Year 5
Costs over time using local assumptions
Year 1
Incremental annual cost of access criteria for IVF
Rate of progression towards full implementation
Cost in each year
Non-recurrent cost of access criteria for IVF
Cost in each year
Embryo transfer strategies
Cost in each year
Total costs
Year 2
Year 3
Year 4
Year 5
£300,000
40%
£53,101
80%
£106,201
100%
£132,752
100%
£132,752
100%
£132,752
33.3%
£128,820
33.3%
£146,502
33.3%
£155,344
0%
£0.00
0%
£0.00
100%
-£15,731
166,189
100%
-£15,731
236,973
100%
-£15,731
272,364
100%
-£15,731
117,021
100%
-£15,731
117,021
£250,000
£200,000
£150,000
£100,000
£50,000
£0
Notes
1 It is assumed that the recommendations on access criteria for IVF will take 3 years to implement.
2 A non-recurrent cost is expected from the reduction in time spent trying to conceive spontaneously from 3 years in the 2004 guideline to 2 years in the 2012 guideline. In the year the new
recommendation is implemented the people who have been trying to conceive for 2 years and the people who have been trying to conceive for 3 years would both become eligible to receive IVF
treatment. It is assumed that centres will not have the capacity to provide IVF cycles to this increased number of people in 1 year, so the service and cost has been spread over 3 years.
3 It is assumed that the recommendations on embryo transfer strategies will be fully implemented in the first year.
11/11
Emergency Planning, Response and Resilience (EPRR) – Compliance Report
Agenda Item:
2.2
Reference:
GB14 -15/0038
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Paul Edwards, Head of Corporate Affairs
Contributors:
Laura Wentworth, Corporate Support Officer
Roger Booth, Senior Resilience Manager, Cheshire & Merseyside Commissioning
Support Unit
Governance:
Link to
Commissioning
Strategy
NHS Wirral CCG has a number of duties in relation to EPRR
and this paper aims to provide assurance to the Governing
Body of its statement of compliance against the required
areas of NHS England’s core standards for EPRR.
Link to current
strategic
objectives
5 - Ensuring people are treated and cared for in a safe
environment and protected from avoidable
harm
Summary:
The statement of compliance and action plan are completed against the required
areas of NHS England’s core standards for EPRR, of which the CCG has selfassessed as demonstrating the Full compliance level against the core standards.
Recommendat
ion:
To Approve
To Note
Comme
nts
Next
Steps:
X
Not applicable.
The Governing Body are asked to note the contents of these reports.
Governing Body Meeting 07.10.2014
1/3
Financial
In addition to the costs of the emergency planning and resilience service which
has been commissioned from the CSU, consideration may need to be given to
the contents of this report and also to the CCG’s Business Continuity Plan, in
terms of any resources required to continue to implement the plan.
Value For Money
Not applicable.
Risk
Whilst the delivery and operation of the on call facility may encounter initial
instances of lack of knowledge or experience for on call staff, this has been
addressed by additional training for key staff during 2012/13, as further
detailed within this report.
Legal
Legal issues may arise from incidents where Department of Health guidance is
not followed and may take the form of a civil action or under another statue
(e.g. Corporate Manslaughter and Corporate Homicide Act 2007) and can be
made against the CCG or individuals.
Workforce
The on call staff may be required to be away from their day job for periods of
time during the extent of any emergency, and this may impact to a degree on
the day to day work of the CCG.
Equality &
Human Rights
Equality and Diversity protected characteristics have been and will continue to
be considered throughout the process of developing actions, policies and
procedures in Wirral CCG complying with the Civil Contingencies Act 2004 and
the Department of Health Emergency Planning Response and Resilience
requirements. There is currently no impact identified which would provide
inequality.
Patient and
Public
Involvement (PPI)
Patients or public have not been involved in determining the EPRR
requirements of the CCG.
Partnership
Working
Partnership working is evidenced via the CSU attendance at Local resilience
Forum Groups in Cheshire and Merseyside which allows interactions with all
multi agency partners.
Performance
Indicators
Reports to the Governing Body will provide updates against the elements of
EPRR undertaken on behalf of Wirral CCG by CSU.

2/3
Report Name
Reference
Emergency
Planning,
Response and
Resilience
(EPRR) –
Compliance
Report
Submitted to
Date
Governing Body
7th October
2014
Private Business
Meetings) Act 1960).
The definition of “prejudicial” is where the information is of a type the publication of which may be
inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public
interest or which relates to the provision of legal advice (for example clinical care information or
employment details of an identifiable individual or commercially confidential information relating to a
private sector organisation).
it can be published on the website, must be changed to a x.
If you require any additional information please contact the Lead Officer.
3/3
Our Ref: JD/MC/EPRR Assurance
20th August 2014
Cheshire, Warrington & Wirral Area Team
Quayside
Wilderspool Park
Greenalls Avenue
Stockton Heath
Warrington
WA4 6HL
Email address: jim.deacon@nhs.net
Telephone number: 01138 251 866
TO:
EPRR Accountable Officers
Dear Colleague,
RE:
2014/15 Emergency Preparedness, Resilience and Response (EPRR) assurance
process
The Local Health Resilience Partnership (LHRP) has recently completed the 2013 / 2014
assurance process for NHS-funded members of the LHRP. Thank you for your support in
this process.
The 2014/15 EPRR Assurance Process is based on the revised core standards (previously
sent out but also attached).
To comply with the national requirements the LHRP requests that you:
1) Undertake a self-assessment against the revised core standards identifying the level
of compliance for each standard (red, amber, green);
2) Submit an action plan addressing any areas of improvement required (template
enclosed);
3) Complete the statement of compliance (enclosed) identifying the organisation’s
overall level of compliance - full, substantial, partial, non;
4) Present the above outcomes to your board or through appropriate governance
arrangements where the board has delegated their responsibility for EPRR;
5) Submit the board paper to the LHRP (by email to
14th November 2014.
by
Following receipt of your submission, we may request evidence against specific standards
but do not expect all evidence identified in your self-assessment to be submitted. The
LHRP chair and co-chair will consider submissions during the week of 17th November.
Feedback / action plan will be fed back to accountable officers during the first week in
December.
Where organisations’ board meeting dates do not fit with these timescales, the LHRP chair
will consider the paper in advance of the board meeting with confirmation from you, as the
AEO, of the date the board will consider the paper and assurance that any changes to the
overall compliance level will be communicated to us as the LHRP co-chairs.
Please feel free to contact us if you have any queries relating to this process.
Yours sincerely
Andrew Crawshaw
Director of Operations and Delivery
NHS England
Dr Rita Robertson
Warrington Borough Council
Cheshire, Warrington and Wirral Local Health Resilience Partnership Co-Chairs
NHS Core Standards Requirements for Wirral CCG – September 2014
CORE STANDARD - DUTY
Governance
1.Organisations have a director level
accountable emergency officer who is
responsible for Emergency
Preparedness, Resilience & Response
(EPRR) (including business continuity
management)
2. Organisations have an annual work
programme to mitigate against identified
risks and incorporate the lessons
identified relating to Emergency
Preparedness, Resilience & Response
(EPPR) (including details of training and
exercises and past incidents) and
improve response.
3. Organisations have an overarching
framework or policy which sets out
expectations of emergency
preparedness, resilience and response.
CLARIFYING INFORMATION
EVIDENCE OF ASSURANCE
Lessons identified from your organisation and other
partner organisations.
NHS organisations and providers of NHS funded care
treat Emergency Preparedness, Resilience &
Response (EPPR) (including business continuity) as
a systematic and continuous process and have
procedures and processes in place for updating and
maintaining plans to ensure that they reflect:
- the undertaking of risk assessments and any
changes in that risk assessment(s)
- lessons identified from exercises, emergencies
and business continuity incidents
- restructuring and changes in the organisations
- changes in key personnel
- changes in guidance and policy.
Arrangements are put in place for emergency
preparedness, resilience and response which:
• Have a change control process and version control
• Take account of changing business objectives and
processes
• Take account of any changes in the organisations
functions and/ or organisational and structural and
staff changes
• Take account of change in key suppliers and
contractual arrangements
• Take account of any updates to risk assessment(s)
• Have a review schedule
• Use consistent unambiguous terminology,
• Ensuring accountable
emergency officer's commitment
to the plans and giving a member
of the executive management
board and/or governing body
overall responsibility for the
Emergency Preparedness
Resilience and Response, and
Business Continuity
Management agendas
• Having a documented process
for capturing and taking forward
the lessons identified from
exercises and emergencies,
including who is responsible.
• Appointing an emergency
preparedness, resilience and
response (EPRR) professional(s)
who can demonstrate an
understanding of EPRR
principles.
• Appointing a business
continuity management (BCM)
professional(s) who can
demonstrate an understanding of
BCM principles.
• Being able to provide evidence
of a documented and agreed
corporate policy or framework for
building resilience across the
organisation so that EPRR and
Business continuity issues are
mainstreamed in processes,
strategies and action plans
None
Evidence Available
The Accountable Officer has
this responsibility and is
supported operationally by the
Annual work programme
developed by Cheshire and
Merseyside Commissioning
Support Unit (CMCSU) on
behalf of the CCG and taken to
Governing Body.
Organisation assurance
framework reviewed at
Governing Body.
Emergency Planning
professional accessed via
CMCSU.
Business Continuity and
Incident Response plans in
place which includes the CCG
policy and version control and
annual review arrangements (to
be reviewed Autumn 2014)
CMCSU provide advice,
support, training and annual
reports and reviews of plans/
Plans held on intranet, staff
validation exercise undertaken
4.The accountable emergency officer
will ensure that the Board and/or
Governing Body will receive as
appropriate reports, no less frequently
than annually, regarding EPRR,
including reports on exercises
undertaken by the organisation,
significant incidents, and that adequate
resources are made available to enable
the organisation to meet the
requirements of these core standard.
Duty To Assess Risk
5. Assess the risk, no less frequently
than annually, of emergencies or
business continuity incidents occurring
which affect or may affect the ability of
the organisation to deliver it's functions.
• Identify who is responsible for making sure the
policies and arrangements are updated, distributed
and regularly tested;
• Key staff must know where to find policies and plans
on the intranet or shared drive.
• Have an expectation that a lessons identified report
should be produced following exercises, emergencies
and /or business continuity incidents and share for
each exercise or incident and a corrective action plan
put in place.
• Include references to other sources of information
and supporting documentation
None
across the organisation.
• That there is an appropriate
budget and staff resources in
place to enable the organisation
to meet the requirements of
these core standards. This
budget and resource should be
proportionate to the size and
scope of the organisation.
and facilitated by CMCSU.
Requirements for debriefs
included in plans.
Monthly brief sent to CCG by
CMCSU.
Annual report to Governing
Body.
Issues from the EPRR risks
would be taken to governing
body.
CMCSU provides an annual
report on EPRR which is
reviewed at Governing Body.
Risk assessments should take into account
community risk registers and at the very least include
reasonable worst-case scenarios for:
• severe weather (including snow, heatwave,
prolonged periods of cold weather and flooding);
• staff absence (including industrial action);
• the working environment, buildings and equipment
(including denial of access);
• fuel shortages;
• surges and escalation of activity;
• IT and communications;
• utilities failure;
• response a major incident / mass casualty event
• supply chain failure; and
• associated risks in the surrounding area (e.g.
Being able to provide
documentary evidence of a
regular process for monitoring,
reviewing and updating and
approving risk assessments
• Version control
• Consulting widely with relevant
internal and external
stakeholders during risk
evaluation and analysis stages
• Assurances from suppliers
which could include, statements
of commitment to BC,
accreditation, business continuity
plans.
CCG plans updated annually
and any additional threats and
risks incorporated
Risk take into account within
the Business Continuity plan
the areas contained in clarifying
information section. Any local
risks additional to generic risks
would be identified within the
plans, there are none
CMCSU representative attends
Local Health Resilience
Partnership (LHRP) and sub
groups and Local Resilience
COMAH and iconic sites)
• Sharing appropriately once risk
assessment(s) completed
There is a process to consider if there are any internal
risks that could threaten the performance of the
organisation’s functions in an emergency as well as
external risks eg. Flooding, COMAH sites etc.
Corporate Risk Register
assessed and national risk
register considered.
Threats to CCG identified within
the Business Impact Analysis.
CMCSU representative attends
Partnership (LHRP) and sub
groups and Local Resilience
Forum (LRF) groups on behalf
of CCG.
6. There is a process to ensure that the
risk assessment(s) is in line with the
organisational, Local Health Resilience
Partnership, other relevant parties,
community (Local Resilience Forum/
Borough Resilience Forum), and
national risk registers.
7. There is a process to ensure that the
risk assessment(s) is informed by, and
consulted and shared with your
organisation and relevant partners.
Duty to maintain BC and IR plans
8. Effective arrangements are in place
to respond to the risks the organisation
is exposed to, appropriate to the role,
size and scope of the organisation, and
there is a process to ensure the likely
extent to which particular types of
emergencies will place demands on
your resources and capacity.
Have arrangements for (but not
necessarily have a separate plan for)
some or all of the issues in the next
column (organisation dependent) (NB,
this list is not exhaustive):
Forum (LRF) groups on behalf
of CCG.
Risks considered within CCG
and cascaded appropriately.
Risks affecting external
agencies cascaded via LHRP
and LRF representation.
Incidents and emergencies (Incident Response Plan
(IRP) (Major Incident Plan)
corporate and service level Business Continuity
(aligned to current nationally recognised BC
standards)
Severe Weather (heatwave, flooding, snow and cold
weather)
Pandemic Influenza
Fuel Disruption
Surge and Escalation Management (inc. links to
appropriate clinical networks e.g. Burns, Trauma and
Critical Care)
Infectious Disease Outbreak
Evacuation
Utilities, IT and Telecommunications Failure
Relevant plans:
• demonstrate appropriate and
sufficient equipment (inc.
vehicles if relevant) to deliver the
required responses
• identify locations which patients
can be transferred to if there is
an incident that requires an
evacuation;
• outline how, when required (for
mental health services), Ministry
of Justice approval will be gained
for an evacuation;
• take into account how
vulnerable adults and children
can be managed to avoid
Business Continuity (BC) and
Incident Response (IR) plans in
place which conform to NHS
Core standards and ISO 22301
for BC.
All plans mentioned within
requirements where
appropriate are contained
within the IR and BC planning.
Part of NHS England command
and control structure to respond
to Major Incidents
9. Ensure that plans are prepared in line
with current guidance and good practice
which includes:
10. Arrangements include a procedure
for determining whether an emergency
or business continuity incident has
occurred. And if an emergency or
business continuity incident has
occurred, whether this requires
changing the deployment of resources
or acquiring additional resources.
Aim of the plan, including links with plans of other
responders
• Information about the specific hazard or contingency
or site for which the plan has been prepared and
realistic assumptions
• Trigger for activation of the plan, including alert and
standby procedures
• Activation procedures
• Identification, roles and actions (including action
cards) of incident response team
• Identification, roles and actions (including action
cards) of support staff including communications
• Location of incident co-ordination centre (ICC) from
which emergency or business continuity incident will
be managed
• Generic roles of all parts of the organisation in
relation to responding to emergencies or business
continuity incidents
• Complementary generic arrangements of other
responders (including acknowledgement of multiagency working)
• Stand-down procedures, including debriefing and the
process of recovery and returning to (new) normal
processes
• Contact details of key personnel and relevant
partner agencies
• Plan maintenance procedures
(Based on Cabinet Office publication Emergency
Preparedness, Emergency Planning, Annexes 5B and
5C (2006)
Enable an identified person to determine whether an
emergency has occurred
- Specify the procedure that person should adopt in
making the decision
- Specify who should be consulted before making
the decision
- Specify who should be informed once the decision
has been made (including clinical staff)
admissions, and include
appropriate focus on providing
healthcare to displaced
populations in rest centres;
• include arrangements to coordinate and provide mental
health support to patients and
relatives, in collaboration with
Social Care if necessary, during
and after an incident as required;
• make sure the mental health
needs of patients involved in a
significant incident or emergency
are met and that they are
discharged home with suitable
support
• ensure that the needs of selfpresenters from a hazardous
materials or chemical, biological,
nuclear or radiation incident are
met.
• for each of the types of
emergency listed evidence can
be either within existing response
plans or as stand alone
arrangements, as appropriate.
Elements required from the
clarifying information box
contained within the Incident
Response and the Business
Continuity Plans
Note : -ICC contained within
corporate offices
Contained within plans
including triggers. Mutual aid
considered in plans.
11. Arrangements include how to
continue your organisation’s prioritised
activities (critical activities) in the event
of an emergency or business continuity
incident insofar as is practical.
13. Preparedness is undertaken with the
full engagement and co-operation of
interested parties and key stakeholders
(internal and external) who have a role
in the plan and securing agreement to
its content
14. Arrangements include a debrief
process so as to identify learning and
inform future arrangements
Command and Control
15. Arrangements demonstrate that
there is a resilient single point of contact
within the organisation, capable of
receiving notification at all times of an
emergency or business continuity
incident; and with an ability to respond
or escalate this notification to strategic
and/or executive level, as necessary.
16. Those on-call must meet identified
competencies and key knowledge and
skills for staff.
17. Documents identify where and how
the emergency or business continuity
incident will be managed from, ie the
Decide:
- Which activities and functions are critical
- What is an acceptable level of service in the event
of different types of emergency for all your services
- Identifying in your risk assessments in what way
emergencies and business continuity incidents
threaten the performance of your organisation’s
functions, especially critical activities
Prioritised functions within
plans as part of BIA. Further
work on BIA being undertaken
at present in respect of risk
reduction objectives and tasks.
Improvement plan submitted to
NHS England.
CCG staff involved in BIA
process, Validation exercise
and staff familiarisation
undertaken
Explain the de-briefing process (hot, local and multiagency, cold)at the end of an incident.
Debrief Process Included in
plans.
Organisation to have a 24/7 on call rota in place with
access to strategic and/or executive level personnel
Explain how the emergency oncall rota will be set up and
managed over the short and
longer term.
On call system in place.
NHS England published competencies are based
upon National Occupation Standards .
Training is delivered at the level
for which the individual is
expected to operate (ie
operational/ bronze, tactical/
silver and strategic/gold). for
example strategic/gold level
leadership is delivered via the
'Strategic Leadership in a Crisis'
course and other similar courses.
Arrangements detail operating
procedures to help manage the
ICC (for example, set-up, contact
Training undertaken by on call
staff.
This should be proportionate to the size and scope of
the organisation.
Further training required by
some staff who have been
unable to attend previous
sessions.
Command centre within plan,
decision logging included in
plan.
Incident Co-ordination Centre (ICC),
how the ICC will operate (including
information management) and the key
roles required within it, including the role
of the loggist .
18. Arrangements ensure that decisions
are recorded and meetings are minuted
during an emergency or business
continuity incident.
19. Arrangements detail the process for
completing, authorising and submitting
situation reports (SITREPs) and/or
commonly recognised information
pictures (CRIP) / common operating
picture (COP) during the emergency or
business continuity incident response.
Duty to communicate with public
22. Arrangements demonstrate warning
and informing processes for
emergencies and business continuity
incidents.
lists etc.), contact details for all
key stakeholders and flexible IT
and staff arrangements so that
they can operate more than one
control/co0ordination centre and
manage any events required.
Decision logging included in
plan
Sample sitreps and crips in
plan.
Arrangements include a process to inform and advise
the public by providing relevant timely information
about the nature of the unfolding event and about:
- Any immediate actions to be taken by responders
- Actions the public can take
- How further information can be obtained
- The end of an emergency and the return to normal
arrangements
Communications arrangements/ protocols:
- have regard to managing the media (including both
on and off site implications)
- include the process of communication with internal
staff
- consider what should be published on
intranet/internet sites
- have regard for the warning and informing
arrangements of other Category 1 and 2 responders
and other organisations.
Have emergency
communications response
arrangements in place
• Be able to demonstrate that you
have considered which target
audience you are aiming at or
addressing in publishing
materials (including staff, public
and other agencies)
• Communicating with the public
to encourage and empower the
community to help themselves in
an emergency in a way which
compliments the response of
responders
• Using lessons identified from
previous information campaigns
to inform the development of
future campaigns
• Setting up protocols with the
Communications within the
CCG via communications
support from CMCSU.
NHS England communications
would support out of hours
Input.
CCG website is updated
internally.
23. Arrangements ensure the ability to
communicate internally and externally
during communication equipment
failures
media for warning and informing
• Having an agreed media
strategy which identifies and
trains key staff in dealing with the
media including nominating
spokespeople and 'talking
heads'.
• Having a systematic process for
tracking information flows and
logging information requests and
being able to deal with multiple
requests for information as part
of normal business processes.
• Being able to demonstrate that
publication of plans and
assessments is part of a joinedup communications strategy and
part of your organisation's
warning and informing work.
Have emergency
communications response
arrangements in place
• Be able to demonstrate that you
have considered which target
audience you are aiming at or
addressing in publishing
materials (including staff, public
and other agencies)
• Communicating with the public
to encourage and empower the
community to help themselves in
an emergency in a way which
compliments the response of
responders
• Using lessons identified from
previous information campaigns
to inform the development of
future campaigns
• Setting up protocols with the
Other systems in place, mobile
telecoms, email, laptops, iPads
available.
media for warning and informing
• Having an agreed media
strategy which identifies and
trains key staff in dealing with the
media including nominating
spokespeople and 'talking
heads'.
• Having a systematic process for
tracking information flows and
logging information requests and
being able to deal with multiple
requests for information as part
of normal business processes.
publication of plans and
assessments is part of a joinedup communications strategy and
part of your organisation's
warning and informing work.
Information Sharing – Mandatory
requirements
24. Arrangements contain information
sharing protocols to ensure appropriate
communication with partners.
These must take into account and include DH (2007)
Data Protection and Sharing – Guidance for
Emergency Planners and Responders or any
guidance which supersedes this, the FOI Act 2000,
the Data Protection Act 1998 and the CCA 2004 ‘duty
to communicate with the public’, or subsequent /
additional legislation and/or guidance.
Attendance at or receipt of
minutes from relevant Local
Resilience Forum(s) / Borough
Resilience Forum(s) meetings,
that meetings take place and
membership is quorate.
• Treating the Local Resilience
Forum(s) / Borough Resilience
Forum(s) and the Local Health
Resilience Partnership as
strategic level groups
• Taking lessons learned from all
resilience activities
• Using the Local Resilience
Resilience Partnership to
consider policy initiatives
Information sharing protocol in
place with Cheshire and Wirral
providers.
• Establish mutual aid
agreements
• Identifying useful lessons from
your own practice and those
learned from collaboration with
other responders and strategic
thinking and using the Local
Resilience Forum(s) and the
Partnership to share them with
colleagues
• Having a list of contacts among
both Cat. 1 and Cat 2.
responders with in the Local
Resilience Forum(s) area
Co-operation
25. Organisations actively participate in
or are represented at the Local
Resilience Forum (LRF) (or Borough
Resilience Forum in London if
appropriate)
26. Demonstrate active engagement
and co-operation with other category 1
and 2 responders in accordance with
the CCA
27. Arrangements include how mutual
aid agreements will be requested, coordinated and maintained.
30. Arrangements demonstrate how
organisations support NHS England
locally in discharging its EPRR functions
and duties
33. Arrangements are in place to ensure
attendance at all Local Health
Resilience Partnership meetings at a
director level
None
None
NB: mutual aid agreements are wider than staff and
should include equipment, services and supplies.
None
None
Attendance at or receipt of
minutes from relevant Local
Resilience Forum(s) meetings,
that meetings take place and
memebership is quorat.
• Treating the Local Resilience
Resilience Partnership as
strategic level groups
• Taking lessons learned from all
resilience activities
• Using the Local Resilience
Resilience Partnership to
consider policy initiatives
• Establish mutual aid
agreements
• Identifying useful lessons from
CMCSU represents on LRF
and sub groups.
CMCSU attends LHRP and
sub groups and LRF and sub
groups on behalf of CCG. All
issues communicated to CCG
Via command and control and
NHS England.
Via command and control and
CCG roles agreement
document.
LHRP attended by CSU
representative responsible for
EPRR on behalf of the CCG
your own practice and those
learned from collaboration with
other responders and strategic
thinking and using the Local
Partnership to share them with
colleagues
• Having a list of contacts among
both Cat. 1 and Cat 2.
responders with in the Local
Resilience Forum(s) area
Training and Exercising
34. Arrangements include a training
plan with a training needs analysis
(TNA) and ongoing training of staff
required to deliver the response to
emergencies and business continuity
incidents
35. Arrangements include an ongoing
exercising programme that includes an
exercising needs analysis and informs
future work.
• Staff are clear about their roles in a plan
• Training is linked to the National Occupational
Standards (NOS) and is relevant and proportionate to
the organisation type.
• Training is linked to Joint Emergency Response
Interoperability Programme (JESIP) where
appropriate
• Arrangements demonstrate the provision to train an
appropriate number of staff and anyone else for whom
training would be appropriate for the purpose of
ensuring that the plan(s) is effective
• Arrangements include providing training to an
appropriate number of staff to ensure that warning
and informing arrangements are effective
• Exercises consider the need to validate plans and
capabilities
• Arrangements must identify exercises which are
relevant to local risks and meet the needs of the
organisation type and of other interested parties.
• Arrangements are in line with NHS England
requirements which include a six-monthly
communications test, annual table-top exercise and
Taking lessons from all resilience
activities and using the Local
Partnership and network
meetings to share good practice
TNA carried out in 2013. A
further TNA to be carried during
autumn 2014 to identify
additional training following the
training already carried out by
CMCSU
Training linked to NOS
people responsible for carrying
out function in the plan are aware
of their roles
• Through direct and bilateral
collaboration, requesting that
other Cat 1. and Cat 2
responders take part in your
exercises
• Refer to the NHS England
guidance and National
Occupational Standards For Civil
Joint Emergency Services
Interoperability Programme
(JESIP) familiarisation to be
sought from NWAS and Police.
Training for role as on call
ongoing.
Exercises instigated by LHRP
and LRF attended by CCG as
appropriate.
Training programme contained
36. Demonstrate organisation wide
(including on call personnel) appropriate
participation in multi-agency exercises
37. Preparedness ensures all incident
commanders (on call directors and
managers) maintain a continuous
personal development portfolio
demonstrating training and/or incident
/exercise participation.
live exercise at least once every three years.
• If possible, these exercises should involve relevant
interested parties.
• Lessons identified must be acted on as part of
continuous improvement.
• Arrangements include provision for carrying out
exercises for the purpose of ensuring warning and
informing arrangements are effective
None
None
Contingencies when identifying
training needs.
within annual report from
CMCSU.
• Developing and documenting a
training and briefing programme
for staff and key stakeholders
• Being able to demonstrate
lessons identified in exercises
and emergencies and business
continuity incidentshave been
taken forward
• Programme and schedule for
future updates of training and
exercising (with links to multiagency exercising where
appropriate)
• Communications exercise every
6 months, table top exercise
annually and live exercise at
least every three years
Attendance at multi agency
exercises where appropriate.
Attendance at exercises as
appropriate.
Public Health exercise
attended.
To be put into place. CMCSU
has records of training attended
to date.
Communications exercises
undertake regularly.
EPRR Core Standards Improvement Plan 2014/15
Trust: Wirral Clinical Commissioning Group
Core
standard
reference
Core standard description
11
Arrangements include how to
continue your organisation’s
prioritised activities (critical activities)
in the event of an emergency or
business continuity incident insofar as
is practical
16
Those on-call must meet identified
competencies and key knowledge
and skills for staff
34
37
Improvement required to achieve compliance
Assessment of the risk reduction
objectives and tasks identified in the
business Impact Analysis following
completion of the update to the plan.
Further training needs analysis (TNA)
to be circulated and further training to be
delivered
Arrangements include a training plan
Further TNA to be carried out .Joint
with a training needs analysis and onEmergency Services Interoperability
going training of staff required to
Programme (JESIP) familiarisation to
deliver the response to emergencies
be sought
and business continuity incidents
Preparedness ensures all incident
commanders (on call directors and
managers) maintain a continuous
personal development portfolio (PDP)
demonstrating training and/or incident
/exercise participation.
All on call personnel to be required to
keep details of training in a PDP
Action to deliver improvement
Deadline
Assessment and update to the risk
reduction objectives
Oct 2014
Cheshire & Merseyside Commissioning
Support Unit will circulate additional
TNA and schedule additional training
March 2015
All on call personnel to have received
appropriate training and familiarisation
March 2015 and
ongoing
PDP requirement to be circulated to on
call CCG staff
Ongoing
Page 1 of 1
STATEMENT OF COMPLIANCE EPRR 2014/15
Wirral Clinical Commissioning Group has undertaken a self-assessment against
required areas of the NHS England Core Standards for EPRR v2.0).
Following assessment, the organisation has been self-assessed as demonstrating
the Full compliance level (from the four options in the table below) against the core
standards.
Compliance Level
Evaluation and Testing Conclusion
Full
The plans and work programme in place
appropriately address all the core standards that the
organisation is expected to achieve.
Substantial
The plans and work programme in place do not
appropriately address one or more the core standard
themes, resulting in the organisation being exposed
to unnecessary risk.
Partial
adequately address multiple core standard themes;
resulting in the organisational exposure to a high
level of risk.
Non-compliant
appropriately address several core standard themes
leaving the organisation open to significant error in
response and /or an unacceptably high level of risk.
Where areas require further action, this is detailed in the attached core standards
improvement plan and will be reviewed in line with the Organisation’s EPRR
governance arrangements.
I confirm that the above level of compliance with the core standards has been or will
be confirmed to the organisation’s board / governing body.
________________________________________________________________
Signed by the organisation’s Accountable Emergency Officer
07/10/2014
Date of board / governing body meeting
____________________________
Date signed
NHS Wirral CCG response to the ‘Capability and Governance Review’
Agenda Item:
3.1
Reference:
GB 14-15/0039
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Jon Develing, Interim Accountable Officer
Contributors:
Governance:
Link to
Commissioning
Strategy
To be a high performance, high reputation
organisation with ambition.
To reduce waste and inefficiency and
duplication within the patient journey and
between partners.
Link to current
governing body
Objectives
To ensure that the CCG is a fully constituted
organisation, in order to undertake fully its
statutory requirements
NHS England’s ‘Capability and Governance Review’ in relation to NHS
Wirral CCG has made a number of key recommendations and these
have been fully accepted by the CCG. As a result, a high level action
plan has been developed in response and this is included here together
with the Review summary issued by NHS England.
Summary:
A number of the recommendations directly relate to the CCG’s
constitution and a significant degree of change is required to that
document to address the concerns highlighted by the Review.
In line with the guidance from NHS England entitled ‘Procedures for
Clinical Commissioning Group Constitution Change, Merger or
Dissolution’ (May 2013), the CCG has an opportunity to update its
constitution at two yearly submission dates and is currently aiming to
submit a revised constitution at the next submission date in November
2014.
This latter part of this report presents an overview of proposed key
changes to the constitution in response to the Review and it is envisaged
that the full revised constitution will be presented to November 2014
Governing Body.
Recommendation:
To Approve
To Note
x
Comments
Next Steps:
Revised constitution to be presented at Governing Body November 2014
WCCG Governing Body Meeting 05.11.2013
1/3
Financial
The Review indicates a need for a single approach to planning and strategy.
This should facilitate a stronger financial management and control. The CCG
Constitution describes the Quality, Performance and Finance Committee and
its role in overseeing financial performance and this will be retained as part of
the Constitutional amendment process.
Value For Money
The Review and Action Plan highlight the need to improve the effective use of
staffing resources by moving to a more cohesive, single Wirral structure. The
CCG Constitution describes the functions of the CCG, including ensuring
robust financial stewardship and efficient services and this will be retained as
part of the Constitutional amendment process.
Risk
The CCG Constitution ensures that the CCG is a fully constituted organisation,
in order to undertake fully its statutory requirements. In addressing the
concerns of the review, that Action Plan should improve organisational stability
and mitigate risk through a single planning and delivery process.
Legal
The CCG Constitution outlines how the CCG carries out its statutory duties.
The process for amendment includes consideration of the requirement for legal
advice and the CCG intends to seek legal advice before submission of
amendments to NHS England.
Workforce
The Action Plan indicates the need for a change to the CCG’s staffing
structures and this will be implemented using appropriate consultation
processes.
Equality &
Human Rights
The impact assessment required by NHS England will be completed as part of
the application process
Patient and
Public
Involvement (PPI)
The impact assessment required for constitutional change includes patient
involvement and this will be undertaken as part of the development of the
amended constitution
Partnership
Working
The CCG Constitution describes that membership of the Governing Body and
other committees. These include representation from partner organisations
such as Wirral Local Authority and Healthwatch.
Performance
Indicators
N/A

2/3
Report Name
Reference
Submitted to
Date
th
Decision deferred pending further
consultation
th
Approved
st
Noted
th
Approved
Changes to the
CCG
Constitution
GB 14-15/008
2.1
Governing Body
6 May 2014
Changes to the
CCG
Constitution
GB 13-14/045
4.5
Governing Body
5 November
2013
Changes to the
CCG
Constitution
GB 13-14/039
4.5
Governing Body
1 October
2013
Changes to the
CCG
Constitution
GB13-14/014
2.1
Governing Body
4 June 2013
Private Business
If you require any additional information please contact the Lead Director/Officer.
3/3
NHS England
Cheshire, Warrington and Wirral
Quayside
Wilderspool Business Park
Greenalls Avenue
Stockton Health
Warrington
WA4 6HL
5th September 2014
Dear colleague
RE: NHS Wirral CCG – Capability and Governance Review 2014
I am writing to you with regard to the recent review into capability and governance at Wirral
Clinical Commissioning Group which was carried out by NHS England.
In order to inform you of the findings of the review I have detailed below an over view of:






The Wirral CCG
Background to the review
Need for the review
Recommendations from the review
Next step recommendations
The Wirral CCG response
We will ensure that all stakeholders including yourself are kept fully informed and up to
date as the recommendations are taken forward however, should you have any questions
or require any further information at the current time, please contact Kirsty McBride on
kirsty.mcbride@nhs.net
Yours Sincerely
Alison Tonge
Director
About Wirral Clinical Commissioning Group (CCG)
NHS Wirral CCG serves a population of approximately 330,000 across the Wirral
Peninsula. There are both rural areas and industrialised areas within 60 square miles,
with significant variation in life expectancy.
During the first three quarters of 2013/14 the CCG was fully assured against the CCG
Assurance Framework with performance at or near required national standards, however
performance against the four hour A&E standard deteriorated markedly in the fourth
quarter of 2013/14 and has remained well below standard.
Financial performance of the CCG is in line with national expectations and it achieved
the required 1% surplus in 2013/14 and is planning to achieve this in 2014/15.
A distinctive feature of the NHS Wirral CCGs profile is that its 58 member practices form
three Consortia or Divisions within the CCG in a mosaic pattern rather than being based
on discrete populations.
NHS England has been working closely with NHS Wirral CCG for some time to assure
that the CCG discharges its functions as there were concerns particularly in relation to:
•
•
•
The leadership and development of the whole system strategy,
Delivery of A&E and Urgent Care, and
Relationships with stakeholders.
Background to the review
In May 2014 the Governing Body of the CCG requested support from NHS England
whilst a review was undertaken of the CCG. At this time both the Chair and the Chief
Clinical Officer (CCO) of the CCG agreed to voluntarily step aside from their roles whist
the review was conducted.
The purpose of this capability and governance review is to ensure that NHS Wirral CCG
can fully discharge its functions, with a core focus on:
• Governing Body capability,
• Governance, (including the structure and constitution of the CCG), and
• Senior leadership capability.
N.B. The terms of reference exclude any human resources process, which are a matter
for the CCG.
The review is based on 34 individual interviews with members of the CCG Governing
Body, the CCG Senior Leadership Team and stakeholders as well as a review of key
documents. The review team were also directly approached by a small number of
people who wished to contribute their views and were included in the review process.
The review was carried out by:


John Bewick OBE
Colin Mcllwain
NHS England
NHS England
th
The review took place over a six week period commencing 16 June 2014
Need for the review
A review into the capability and governance of the CCG was deemed necessary on the
basis of:
1. The current state of CCG progress on strategy development,
2. The need to ensure delivery of service standards today, and
3. Relationships with stakeholders.
Review findings
The CCG has fundamental organisational design characteristics which are manifesting
themselves in all three areas of concern above. These are:
•
•
•
•
•
Three CCG Consortia being mosaics of like-minded practices rather than
discrete population based commissioning areas.
The CCG Governing Body being constituted around proportionate representation
from Consortia.
No substantive CCG membership forum across the whole CCG.
The managerial resource of the CCG being significantly invested in servicing the
relatively autonomous functioning of Consortia.
The relatively complex governance arrangements for decision making which
derive from the Consortia structure.
The increasingly challenging financial environment has exposed these characteristics as
being problematic for the CCG in discharging its functions.
All CCG Governing Body members and senior staff interviewed for this review largely
recognised the problems manifesting from the CCG’s original design. There is an
encouraging consistency of views about the need to develop the CGG and free it from
its own history to better serve the population of Wirral. However, progress in addressing
these issues has not happened at the pace needed.
The review found that the CCG has been working within, and increasingly not coping
with, a set of organisational arrangements which are not fit for purpose. This has caused
increasing difficulties in operating strategically, ensuring delivery today and sustaining
relationships with stakeholders.
The review therefore found that the capability and governance issues in NHS Wirral
CCG to be primarily related to the CCG not moving at sufficient pace to pro-actively
develop itself as an organisation and get ahead of the challenges it now faces.
The review also found that the Governing Body, under the leadership of the Governing
Body Chair is largely aware of the need to develop the CCG but has not shown the
necessary capability to assure the development of the CCG to discharge its functions.
The Governing Body has expressed concern about how the organisation presently
works but has not overseen the necessary processes of development to address those
concerns.
The Governing Body itself is considered not to have had adequate development to fulfil
its role. There is no substantive development programme in place for the Governing
Body. The Chief Clinical Officer (CCO) considers that the development of the Governing
Body is primarily the lead responsibility of the Governing Body Chair.
The Chief Clinical Officer recognised the challenges of the organisation's original design,
and proposed incremental shifts away from the Consortia design to more CCG wide
arrangements, but considered that an organisational review would distract too much
from the work of today and would set the CCG back significantly. The CCO also felt
change needed to come up from the membership rather than be top down.
Taken together, the CCG Chair and CCO do not demonstrate the necessary close
working agreement about what needs to change in the CCG, by when, to develop the
CCG, nor how the necessary leadership for this work would be provided between the
two roles. The review notes that ongoing relationship between the Chair and the CCO
has impacted the ability of the organisation to make progress.
The review concludes that it is unlikely that the CCG will sustainably improve its strategic
and delivery position without undertaking a fundamental review of its constitution and
organisational structure, and its arrangements for member practice and public and
patient engagement. The main issues the CCG may wish to consider in that review are
set out below.
Recommendations from the review
1. To improve its leadership and development of the whole system strategy
a) Review the Consortia structure of the CCG to reflect the need to have whole
Wirral approaches to strategic issues and within that strong connection to
geographical communities coherent with partner commissioners.
b) Review the constitution of the CCG to reflect the need to strengthen ownership of
strategic direction across the membership of the CCG.
c) Review the senior leadership structure to better harness the CCG’s overall
management resource to strategic development.
d) Secure increased programme management capability to develop and take
forward a complex whole system strategy.
e) Strengthen the senior management presence in the Senior Leadership Team of
the CCG capable of taking an overall leadership role internally and externally on
strategic development issues.
2. To improve its delivery of A&E and urgent care
a) Review the present Consortia structure to strengthen common approaches to
meeting the urgent care needs of the whole population while retaining sensitivity
to local variation in need.
b) Develop an urgent care strategy that addresses all of the elements of the urgent
care system in social, primary, community and secondary care services.
c) Revise CCG governance arrangements to strengthen the Governing Body's
capability to corporately assure that investments in urgent care are evidence
based and consistently assessed using common criteria across the CCG.
d) Secure a programme management resource capable of developing an urgent
care strategy with commissioning partners and managing the resultant change
programmes to enable present and potential providers to engage effectively.
e) Review the working relationships with Wirral University Teaching Hospital NHS
Foundation Trust (WUTH) at senior leadership, operational and clinician to
clinician level between the CCG and the Trust to agree a framework for how the
two organisations will work together – along with the other organisations in Wirral
– to develop and implement the urgent care strategy and to reflect it in future
commissioning plans.
4. To improve relationships with stakeholders
a) Secure further external facilitation of relationship development while trust across
organisations and individuals is strengthened and to enable knowledge and skill
transfer within Wirral of leading whole system strategic developments can take
place.
b) Address the unclear governance of delegated authority, programme
management and the weak engagement of member practices in whole system
strategy through Consortia arrangements as outlined in relation to leadership and
development of the whole system strategy.
4. To improve its Governing Body capability
a) Establish an organisational development programme for the CCG Governing
Body to enable it to oversee the changes that Governing Body members have
indicated are needed to the organisation’s structure and governance.
b) Develop the capability of the Governing Body to fully discharge its ongoing
assurance role.
5. To improve governance
a) Urgently consult its membership and then submit an application to NHS England
to amend its constitution with regard to the eligibility of the Chair and the Chief
Clinical Officer roles to remove the inconsistency and contradiction within the
constitution so that both roles can then be occupied on a secure constitutional
basis.
b) Consider a fundamental review of its constitution including how it engages with
its membership in the work of the CCG and whether there should be
engagement arrangements below the level of the CCG and if so what these
should be and how they relate to populations and geographies within Wirral.
c) As part of any review of its constitution consider the composition of its Governing
Body and consult its membership on the method of identifying the Chair and GP
representatives on the governing body.
d) Undertake a development programme with its Governing Body members that
includes providing greater clarity over decision making arrangements, individual
roles and responsibilities and the collective assurance role of the Governing
Body.
e) Review its arrangements for engaging with practices as providers alongside the
review of its constitution.
6. To improve its senior leadership capability
a) Review the structure of the CCG Senior Leadership Team to reflect the proposed
review of the CCG structure and governance, with particular consideration of:
 strengthening the very senior strategic management capability of the
CCG;


securing a strategic programme management capability;
securing a corporate capability in investment appraisal and evaluation;
and
 strengthen the coordination of CCG capability through the development of
the CCGs business planning function.
b) Review the CCG leadership of organisational development capability, supported
by a revised OD plan that includes development priorities for the Governing Body
and the whole of the CCG’s staffing capacity.
c) Bring together the managerial resource in the central and three Consortia teams
to make more effective use of the CCG’s capacity.
Next step recommendations
1. The review recommends that the CCG agrees a time and task limited action plan
with the Area Team to address the recommendations of this review.
2. The Area Team should agree appropriate external support to that process in
agreement with the CCG and support the associated review of the CCG’s
constitution and organisational structure.
3. The CCG should remain as assured with support until that action plan is
discharged in full.
Wirral CCG response to the review
Wirral CCG welcomes the publication of NHS England’s capability and governance
review and accepts its recommendations.
The review makes a number of recommendations which focus on the development of a
new constitution and improving the effectiveness of the CCG as a commissioner of
health care for the people of Wirral.
The CCG has already made good progress in many of the areas covered by the
recommendations and is pleased to see that this is recognised by NHS England. A more
detailed action plan is being developed so as to consolidate this work.
In line with the recommendations the support from NHS England will continue. Therefore
Jon Develing, Regional Director of Operations and Delivery (NHS England North) will
remain as the Interim Accountable Officer so as to oversee this action plan.
The report has been shared with the Chair and Chief Clinical Officer; the CCG will
discuss this with them in due course.
Wirral CCG continues to work closely with patients, carers and the public to continuously
improve health services and reduce health inequalities across the Wirral.
ENDS
High level action plan in response to NHS England’s Governance
and Capability Review
Introduction
NHS England’s ‘Governance and Capability Review’ has now concluded (see
Appendix A) and makes a number of recommendations aimed at strengthening the
CCG and addressing the issues raised. In summary these are:
•
•
•
•
•
•
To improve its leadership and development of the whole system
strategy
To improve its delivery of A&E and urgent care
To improve relationships with stakeholders
To improve its Governing Body capability
To improve governance
To improve its senior leadership capability
High level response
The CCG has developed a high level action plan that addresses each of these
recommendations and also acknowledges that the CCG has already made
significant progress in these areas. This is shown overleaf.
Next steps
A more detailed action plan, with timescales, will be developed and the process for
amending the CCG constitution will continue in line with NHS England guidance.
Recommendation
The Governing Body is asked to note the action plan in response to the
recommendation of the ‘Capability and Governance Review’. The Governing Body
should also note the next section which deals with the specific implications for the
CCG’s constitution.
Recommendation
To improve its leadership and
development of the whole
system strategy
CCG Response
•
•
•
To improve its delivery of A&E
and urgent care
•
•
•
Progress to Date
Develop a single unified CCG demonstrated
by a new constitution and new Governing
Body composition
Strengthen senior leadership capability
and capacity resulting from the new
Governing Body composition and also an
internal staff restructure that addresses
the consortia arrangements
Interim arrangements to be maintained
whilst CCG is assured with the support of
NHS England
•
Develop whole system strategic approach
linked with the System Resilience Group
(SRG) and the new constitution.
Develop Urgent Care Strategy and
Recovery Plan.
Develop a provider engagement plan
•
•
•
•
•
•
Signed Year end position, annual
accounts, letter of compliance
with Auditors annual report and
WUTH contract
Significantly improved
relationships with Providers and
Local Authority
Engagement process begun with
members and LMC
Improved A&E performance in
the last 3/52 and an agree
recovery plan
Revised urgent care working
group now SRG
Improved relationships
Urgent Care Conference
18/09/14
To improve relationships with
stakeholders
•
•
•
To improve its Governing Body
capability
•
•
•
•
Develop a forum for clinicians to inform
strategy development
Further improve senior relationships
through the Vision 2018 process
Develop an integrated communications
strategy
•
•
•
Development of a new CCG constitution so
as to reflect the needs of patients on the
Wirral
Develop a program of development for the
new Governing Body post November
constitution approval
Roles on the Governing Body will be a
mixture of elected and appointed
Governing Body will become more
strategic so as to provide a unified vision
for Wirral
•
•
•
•
•
•
New Vision 2018 framework
System wide engagement
Integrated communications via
the Vision 2018 programme
New constitution under
development
Sought GP views on possible
options for constitution changes
Sought staff engagement of same
Researched Best practice for
model constitutions
Internal committee structure
being reviewed
Exploring governing body
development opportunities with
external partners (The CCG will
work with North West Leadership
Academy to develop a
development programme for
Governing Body)
To improve governance
•
•
•
To improve its senior
leadership capability
•
•
Consult membership on a new vision for
Wirral CCG
Develop a new CCG Constitution so as to
remove current inconsistency regarding
consortia arrangements
Develop a new Wirral wide GP
Membership Council and a Provider Forum
•
Develop a new CCG structure clinically
and operationally aligned
Become a learning organisation that is able
to respond to best practice with a
commitment to Organisational
Development
•
•
•
•
•
Sought GP views on possible
options for constitution changes.
Developing an integrated
communication and engagement
plan.
Started the impact assessment
for constitutional change
Begun consultation with staff and
member practices
Centralised consortia staff into a
single corporate function
Alignment of work plans to CCG
strategic objectives
Constitutional Implications
Of the Capability and Governance Review
Introduction
The purpose of this report is to outline the constitutional implications arising from the
Capability and Governance Review.
Summary of key issues from the review with constitutional impact
•
•
•
•
•
•
•
•
Consortia arrangements are not discrete, mosaic in nature and not population
based
Managerial resource invested in servicing relatively autonomous functioning
of consortia that has led to fragmentation
Governing Body is constituted from representation that reflects the
fragmented, mosaic consortia arrangements
Lack of cohesive strategic approach to commissioning resulting from
consortia arrangements
Current practice engagement arrangements via consortia are ‘weak’ and
hence there is a need for new approach to member engagement
Separate arrangements not in place for engaging with practices as providers
Complex and unclear governance arrangements for decision making resulting
from consortia arrangements
Need for urgent review of the composition of the Governing Body, including
the methods of identifying GP representatives and the Chair
The proposed areas of amendment:
In addressing the fundamental problems resulting from the consortia and
governance arrangements highlighted by the review, there are number of areas that
require immediate change:
•
•
•
•
Methods for determining clinical leaders
Governing Body Composition
Membership and clinical engagement methods
Governance arrangements
In addition to the evidence provided from the CCG 360 degree survey, LMC survey
of members and the review itself, the CCG has utilised a number of sources to
inform the amendments
•
•
•
•
•
•
•
Other ‘best practice’ constitutions
NHS England advice
Member practice engagement events
GP Consortia forums
Patient Forums
Local Medical Committee
CCG staff briefings and feedback
Methods of determining clinical leaders
There are advantages and disadvantages with an election and appointment process.
Election is more likely to maintain the ownership of the member practices and ensure
the leaders are responsive to their members. Appointments are more likely to ensure
the leaders have the right skills, competencies and attributes.
Whilst there are diverse views on this issue there is overwhelming support for the
development of a model that provides a balance between election and appointments
based on skills, knowledge and experience.
With that in mind, it is suggested that a model is adopted that fulfils both of those
requirements.
The Chair and Medical Director/Assistant Chair will be elected posts. Each role
will have a defined job description and person specification outlining duties,
expectations and skill-set criteria. Additionally, the Chair will be approved or
accredited through any stipulated assessment process, including any required by
NHS England within 3 months of taking office. The tenure for these posts will be four
and three years respectively so as to provide continuity.
Those who meet the defined criteria and are also a GP (partner or salaried) on the
performers’ list and working substantively in a Wirral practice, will be eligible to stand
for election.
Each practice will be balloted (as members of the CCG are practices, not
individuals), with a weighting based on list size (based on multiples of 2500
registered patients, where 1-2500 would be 1 vote, 2501-5000, would be 2 votes and
so on).
For both roles, the candidate with the largest number of votes will be elected to the
position.
The Governing Body defines a further 4 GP Clinical Lead Posts, which mirror the key
work-streams of the CCG. These also reflect the Joint Strategic Needs Assessment
and the Vision 2018 `for a healthier Wirral` programme.
•
•
•
•
Primary Care
Unplanned Care
Planned Care
Long Term Conditions
Given the future challenges and opportunities faced by Primary Care it is suggested
that the Lead Primary Care post also adopts an elected process. The CCG would
work with the Local Medical Committee in ensuring all election processes are
robustly conducted.
For the remaining posts in Unplanned Care, Planned Care and Long Term
Conditions, as these require specific skills, interest and experience these will be
selected through a process of assessment and interview against agreed job
descriptions and specifications. For each of these posts, along with the Primary
Care lead post, it is suggested that the have a three year tenure so as to ensure
equity between the elected and appointed posts.
To ensure an open and transparent process, member involvement and probity, it is
suggested that the Local Medical Committee, Lay Person and an external assessor
are part of the panel assessment process.
In addition to these posts so as to provide stronger assurances it is further proposed
that two additional positions are developed. An additional GP role, elected by the
Membership Council and an independent Registered Nurse who would be appointed
in the same way as the Secondary Care Doctor. The CCG would be supportive of
involving the Local Medical Committee in the appointment of the Registered Nurse.
Both roles add to the independent assurance challenges at Governing Body.
Board Composition (Clinical)
Governing Body composition
Other constitutions reviewed demonstrated a mix of approaches to Governing Body
membership. Wirral Practice membership feedback favoured a strong clinical
influence and hence the balance of representation is towards clinical members, with
a view that the posts identified below should all be held by GPs currently working in
Wirral practices.
This is balanced by statutory requirements to have additional clinicians on Governing
Body such as a Secondary Care Doctor and a Registered Nurse.
There are currently also two statutory Lay Members (one acting as a patient
champion and one leading on audit and governance) and it is further proposed that
an additional Lay Member is recruited to provide additional assurance. As a result
the managerial posts on the Governing Body are in a voting minority. These
managerial posts are reflective of the functions of the CCG.
Also in attendance at the Governing Body will be a representative from Healthwatch
and a representative from the Local Medical Committee, to provide further external
assurance and scrutiny.
In summary:
Clinical (where a requirement of the post)
•
•
•
•
•
•
•
•
•
•
Chair (GP)
Medical Director (GP)
Clinical Lead Planned Care (GP)
Clinical Lead Unplanned Care (GP)
Clinical Lead Long Term Conditions (GP)
Clinical Lead Primary Care (GP)
Membership Council Representative (GP)
Director of Quality and Patient Safety (Registered Nurse)
Registered Nurse
Secondary Care Doctor
Managerial (clinicians can occupy these roles, but not a requirement of the post)
•
•
•
•
Accountable Officer
Director of Commissioning
Chief Financial Officer
Director of Corporate Affairs
Lay Representation
•
•
•
Audit and Governance
Patient Champion
Additional Lay Member
In attendance
•
•
•
•
Director of Adult Social Services
Local Medical Committee
Healthwatch
Membership and clinical engagement methods
The development of a clinical senate as new approach to wider clinical engagement
•
•
•
•
•
The Clinical Senate will provide the opportunity for clinicians to establish a
multidisciplinary group in influence and driving forward service transformation.
The Clinical Senate will ensure that improved health outcomes for the
population of the Wirral are underpinned by a focus on quality and safety.
In developing a truly integrated approach to the provision of health care, the
Clinical Senate will contribute to the delivery of the CCG’s strategic and
operational plans whilst providing clinical ownership of the objectives of the
CCG.
The Clinical Senate will provide a clinical perspective on provider and primary
care performance, guiding how issues could be remedied whilst ensuring any
improvement requirement are from within a perspective of maintaining quality
and safety.
Its key duties will be to:
Inform commissioning reform in the areas of:




Major clinical strategic areas including clinical service planning and reform,
models of care and service delivery
Strategies to improve patient care by improving the integration of services
to patients across all settings of care
Identifying relevant innovations, emergent best practice and research
findings in healthcare to inform future strategies
Strategies to support the transformation of health and social care services
to reduce the growth in hospital demand
Influence clinical excellence when developing:



Strategies to implement clinical guidelines and standards
Strategies to improve the safety quality, efficiency and sustainability of
clinical services and prevention strategies
Strategies to improve the professional links between partners
organisations and professional groups
Recommend:

The Senate will discuss and make recommendations on key clinical issues
as determined by the work plan of the group or as requested by the
Governing Body
The development of a Membership Council to create a Wirral Wide practice
engagement forum
Membership Council will be a forum whereby member practices can come together
to discuss and inform key commissioning issues. The principles behind the Members
Council meeting are:
•
•
•
•
•
•
•
•
To work effectively with GPs, including sessional and locum GPs, to feed the
practice’s views into commissioning decisions.
To facilitate relationships with Governing Body members and member
practices
To give voice to member practices by ensuring members are engaged,
informed and empowered to participate.
To seek advice and views of practice members of Wirral CCG
To represent their practice’s views and act on behalf of the practice
Facilitate communication between members and the CCG Governing body
To shape the culture of Wirral CCG
Driving forward improvements in the services for patients, carers,
communities
The development of a GP Provider Forum
This forum will be where GP practices can meet to discuss issues regarding GP
practices in their roles as providers. This will be led by the GP Executive for Primary
Care and would focus on issues such as implementation of enhanced services and
other local schemes, Primary Care workforce issues, and other topical issues.
With the development of co-commissioning this forum is seen as a critical part of the
new architecture.
Local sensitivity in commissioning
It is proposed that the 4 managerial ‘Heads’ within the CCG Commissioning structure
will act as named link staff to 4 geographic MP constituencies. This will give
practices a route to engage with the CCG in presenting local issues in their local
communities. It is further suggested that practice managers, practice nurses and
patient engagement groups will also operate on this basis so as to retain local
sensitivity, share best practice and reflect variation of need.
The 4 managers will also regularly attend Neighbourhood Constituency meetings in
these geographic areas to both inform commissioning, brief local residents and build
partnerships with other agencies such as Police and Fire and Rescue.
From a planning perspective, the commissioning teams responsible for planning and
delivery will ensure these local perspectives are taken into account when developing
specifications that might require differential models that reflect and address health
inequalities.
This addresses the call from members to develop local sensitivity without the need
for bureaucracy and will need to develop and mature over time.
This will be an early consideration for the new GP Membership Council.
Governance arrangements
There are four principle roles for any govenring body be it NHS or Industry.
These are Accountability, Foresight or Vision, Strategy and Management. The table
below applies this to the new CCG consitiution so as to provide members with a
perspective of how future roles and influences will fit with the decion making process.
Overview, Shaping, Thinking (GP Council / Clinical Senate)
Envisioning
Development of Values
Development of Principles
Transparency
Testing Value for Money
Policy Making
Assurances
CCG Audit Committee
Approvals Committee
GP Membership Council
Foresight
Development of Shared Vision
Identification of Key Stakeholders
Future Scenario Planning
Identifications of Influences
Sensitivity Checking
Local Engagement with Practices
Clinical Senate
GP Membership Council
Local Medical Council
Communication
Development of business Plan
Allocate Resources
Audit Investments
Finical Controls
Value for Money
Implementation
Remuneration Committee
Provider Forum
Management
Sensitising
Making Best use of Resources
Priority Setting
Targeted Resources sensitivity
Clinical Senate
Developing New Initiatives
Redesign
Quality & Performance Committee
Provider Forum
Implementation
Strategy
Implementation (CCG Management - Operationalisation `Do`)
Adding Value (Pt Groups / Clinical Senate / LMC)
Value Protection (Assurnaces from Governing Body)
Accountability
Impact Assessment
In line with the guidance from NHS England entitled “Procedures for Clinical
Commissioning Group constitution change, merger or dissolution” (May 2013), the
CCG will also engage with key stakeholders and patients in order to comply with the
impact assessment. The CCG will also seek legal advice on the revised constitution
prior to submission.
Recommendation
These constitutional amendments are a result of careful and considerate
engagement and reflective of the urgent need for change. It is now recommended
that these are incorporated into a revised constitution for consideration by the CCG
Governing Body and submission to NHS England.
Jon Develing
Integrated Performance and Finance Report
Agenda Item:
Reference:
Report to:
Governing Body
Lead Officer:
Mark Bakewell, Lorna Quigley
Contributors:
CCG and CSU Finance and Business Intelligence teams
Governance:
Link to
Commissioning
Strategy
Sound financial control is essential to the
Clinical Commissioning Group (CCG)
strategy and is directly linked to the
delivery of the CCG Commissioning and
Operational Plan for the financial year.
Ensuring that services that the CCG
commission for the population comply
with patient’s rights under the NHS
constitution.
Link to current
governing body
Objectives
To achieve financial control total with
sound financial management.
To ensure that providers achieve strong
performance against national targets.
Meeting
Date:
October 2014
Summary:
This report updates the Governing Body on;
• Activity & Performance for Month 4
• Financial performance against budgeted allocation for
2014/15 as at Month 5 (August)
Recommendation:
To Approve
To Note

Comments
Next Steps:
Continuation of performance monitoring through the remainder of the
financial year
This section is an assessment of the impact of the proposal/item. As such, it identifies the
significant risks, issues and exceptions against the identified areas. Each area must contain
sufficient (written in full sentences) but succinct information to allow the Board to make
informed decisions. It should also make reference to the impact on the proposal/item if the
Board rejects the recommended decision.
Financial
The report sets out the financial performance within the CCG for
2014/15 financial year
Value For
Money
All expenditure plans are subject to an ongoing value for money review.
Risk
The report details the key risks and how these will be monitored in
year as part of the reporting process
Legal
Legal advice is sought on issues as and when required.
Workforce
The financial plan includes budgeted “running costs” expenditure and is
reflective of the respective workforce implications in these areas
Equality &
Human Rights
Plans will consider as appropriate the equality impact assessment for
proposals within the budgeted expenditure
Patient and
Public
Involvement
(PPI)
Budgets include funding to ensure continued involvement of patients
and public in CCG decisions.
Patient choice is a right under the constitution in relation to referral for
treatment.
Partnership
Working
The CCG works with a number of NHS Trusts and the Local Authority
on a number of its commissioning budgets.
Performance
Indicators
The plan reflects the planned achievement of statutory financial duties
and patient’s rights under the NHS constitution

(If not, please note that it may still be subject to disclosure under Freedom of
Information - Freedom of Information Exemptions
This section gives details not only of where the actual paper has previously been submitted
and what the outcome was but also of its development path ie. other papers that are directly
related to the current paper under discussion.
Report
Name
Reference
QPF Updates
Submitted to
Quality,
Performance and
Finance
Committee
Date
30th
September
Private Business
The Board may exclude the public from a meeting whenever publicity (on the item under
discussion) would be prejudicial to the public interest by reason of the confidential nature of
the business to be transacted or for other special reasons stated in the resolution. If this
applied, items must be submitted to the private business section of the Board (Section 1 (2)
Public Bodies (Admission to Meetings) Act 1960).
The definition of “prejudicial” is where the information is of a type the publication of which
may be inappropriate or damaging to an identifiable person or organisation or otherwise
contrary to the public interest or which relates to the provision of legal advice (for
example clinical care information or employment details of an identifiable individual or
commercially confidential information relating to a private sector organisation).
If a report is deemed to be for private business, please note that the tick in the box,
indicating whether it can be published on the website, must be changed to a x.
Finance & Performance Update to
Governing Body Meeting
7th October 2014
“Your partner in a healthier future for all”
NHS Wirral CCG
CCG Dashboard 2014/15
14-15 Q1
Health Outcomes Framework/Every one Counts
Safe environment and
protecting from
avoidable harm
MRSA - Incidence of HCAI YTD
Target /
Threshold
RTT non-admitted
RTT incompletes
RTT 52+ week waiters
Cancer - 2 week
Diagnostics - 6 weeks+
- 2 week wait
- Breast symptom 2 week wait
- 31 day first definitive treatment
Cancer - 31 day
- 31 day subsequent treatment - surgery
- 31 day subsequent treatment - drug
- 31 day subsequent treatment - radiotherapy
- 62 day standard
Cancer - 62 day
- 62 day screening
- 62 day upgrade
Mixed Sex
Mental Health
0
C. difficile - YTD Ceiling
RTT admitted
Diagnostics
Target /
Threshold
C. difficile - Incidence of HCAI YTD
NHS Constitution
RTT
Mixed-sex accommodation breaches
CPA follow up within 7 days
- Total elective (YTD)
- Total elective plan (YTD)
- Non-elective plan (YTD)
- Outpatients (YTD)
- Outpatients plan (YTD)
- GP referrals (YTD)
- GP referrals plan (YTD)
90%
95%
92%
0
<1%
93%
93%
96%
94%
98%
94%
85%
90%
n/a
0
95%
Target /
Threshold
Other - Activity & Efficiency
- Non-elective (YTD)
14-15 Q2
Q1
14-15 Q3
Q2
Apr
May
Jun
Jul
0
8
4
0
13
11
0
16
15
0
23
19
Apr
May
Jun
Jul
Aug
14-15 Q4
Q3
Sep
Oct
Nov
Q4
Dec
Jan
Feb
Mar
####### ####### ####### ####### ####### ####### ####### #######
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
16,900
16,900
16,900
16,900
16,900
16,900
16,900
16,900
14,863
14,863
14,863
14,863
14,863
14,863
14,863
14,863
31,471
31,471
31,471
31,471
31,471
31,471
31,471
31,471
20,387
20,387
20,387
20,387
20,387
20,387
20,387
20,387
93.2%
93.6%
93.8%
91.8%
97.4%
97.5%
97.1%
95.5%
94.9%
95.1%
94.5%
93.4%
1
1
3
1
3.7%
3.0%
0.9%
1.1%
97.4%
97.2%
95.6%
96.1%
96.0%
90.4%
95.9%
96.9%
97.5%
98.1%
98.8%
97.3%
100.0% 95.7%
92.6%
97.6%
100.0% 98.1% 100.0% 100.0%
100.0% 100.0% 96.8% 100.0%
80.9%
85.1%
91.9%
81.7%
100.0% 91.3%
86.7%
94.1%
88.0%
73.9%
78.6%
83.7%
1
1
97.5%
Apr
May
Jun
Jul
4,080
4,217
3,977
3,653
7,467
7,866
5,035
5,091
8,152
8,454
8,097
7,433
14,828
15,738
10,325
10,195
12,438
12,481
12,001
11,085
22,755
23,248
15,515
15,058
16,870
16,900
16,247
14,863
30,955
31,471
21,087
20,387
Category
Outcome
indicator
Baseline
Preferred
Outcome
Quarter 1
July 2014
Comment
Patients seen
within 4
hours of
attending
Arrowe Park
95%
Higher
88.5%
89%
As the WIC is
on site this is
a combined
target
Arrowe Park
(WIC)
95%
Higher
99.7%
99.9%
Combined
total
95%
Higher
91.1%
91.5%
Victoria
Central
Hospital walk
in Centre
95%
Higher
99.7%
99.8%
Eastham
Walk in
Centre
95%
Higher
99.7%
99.9%
NHS Constitution -4
hour A&E
Performance
Friends and Family (in patient)
Acute Trusts: Friends and Family Test scores
Aug-13
Sep-13
Oct-13
Wirral University Teaching Hospital NHS FT
Mid Cheshire Hospitals NHS FT
The Clatterbridge Cancer Centre NHS FT
East Cheshire NHS Trust
Countess of Chester Hospital NHS FT
Warrington & Halton Hospitals NHS FT
#N/A
#N/A
#N/A
#N/A
#N/A
66
71
86
87
78
76
59
68
91
77
83
77
68
77
89
77
82
82
Nov-13 Dec-13
Acute Trusts: Friends and Family Test response rates
Aug-13
Sep-13
Oct-13
Nov-13 Dec-13
Jan-14
The Clatterbridge Cancer Centre NHS FT
#N/A
#N/A
#N/A
#N/A
#N/A
20.6%
30.2%
49.1%
18.8%
44.9%
13.2%
24.7%
25.5%
51.0%
48.4%
41.0%
31.6%
21.5%
33.7%
42.7%
39.2%
36.0%
35.8%
21.4%
42.4%
56.1%
30.8%
33.8%
29.5%
21.3%
39.3%
49.4%
33.4%
38.9%
29.5%
71
74
84
78
82
75
67
75
86
77
77
71
31.3%
32.7%
38.8%
34.1%
47.1%
27.9%
Jan-14
67
68
97
73
80
78
Feb-14 Mar-14 Apr-14 May-14
Jun-14
Jul-14
73
74
93
78
80
81
73
75
90
80
73
76
Jun-14
Jul-14
23.3%
45.9%
31.8%
33.3%
34.6%
43.8%
44.6%
49.8%
60.8%
21.0%
45.9%
34.6%
33.5%
44.5%
32.8%
24.2%
25.6%
32.2%
69
76
89
79
83
81
65
73
93
82
82
79
30.1%
42.3%
53.8%
26.1%
31.8%
27.5%
70
78
95
82
82
76
21.2%
45.6%
50.5%
30.1%
32.9%
27.3%
77
75
95
74
80
74
26.6%
45.9%
47.4%
41.5%
26.4%
26.8%
Friends and Family (A&E)
Accident and Emergency: Friends and Family Test scores
#N/A
#N/A
#N/A
Acccident and Emergency:
Friends and Family Test response rates
#N/A
#N/A
#N/A
Aug-13
Sep-13
Oct-13
23
55
45
69
20
16
56
54
53
46
46
58
49
55
48
Nov-13 Dec-13
Aug-13
Sep-13
Oct-13
Nov-13 Dec-13
Jan-14
17.8%
14.7%
24.9%
21.9%
4.4%
19.9%
12.1%
24.7%
38.8%
24.9%
22.1%
17.7%
20.4%
14.9%
29.6%
25.1%
14.2%
24.1%
19.5%
21.8%
27.0%
21.4%
23.0%
12.6%
18.7%
34
59
58
57
42
49
58
56
57
35
21.2%
15.4%
21.3%
13.4%
19.9%
Jan-14
79
66
60
49
42
Jun-14
Jul-14
86
65
52
60
41
89
55
52
53
40
Jun-14
Jul-14
25.3%
18.4%
20.7%
15.9%
15.1%
19.9%
21.0%
18.7%
21.2%
20.8%
26.3%
20.4%
20.4%
21.1%
19.5%
90
59
53
48
45
90
63
46
64
39
21.6%
18.1%
21.1%
18.3%
18.5%
89
69
55
51
42
26.9%
22.8%
21.6%
19.0%
23.1%
89
68
44
57
35
28.3%
21.3%
19.2%
17.4%
18.5%
Friends and Family Ante natal
Maternity: Friends and Family Test Question 1 scores
#N/A
#N/A
#N/A
Oct-13
Nov-13 Dec-13
64
81
50
61
85
100
64
69
53
62
50
80
Jan-14
74
42
77
80
90
61
71
100
77
87
42
86
100
77
80
65
75
0
73
83
73
76
100
61
Jun-14
Jul-14
91
61
75
100
42
94
60
82
71
50
Maternity: Friends and Family Test Question 1 response rate
Oct-13
Nov-13 Dec-13
Jan-14
Jun-14
Jul-14
#N/A
#N/A
#N/A
0.0%
4.6%
10.9%
0.0%
3.2%
8.8%
11.6%
15.1%
0.0%
43.5%
26.1%
11.0%
76.9%
0.0%
13.4%
12.8%
14.8%
74.3%
1.5%
5.4%
33.7%
16.6%
30.9%
1.1%
35.7%
12.7%
16.3%
31.8%
4.0%
3.6%
6.1%
13.2%
27.9%
1.8%
14.0%
29.1%
10.4%
42.6%
1.6%
12.0%
12.7%
22.2%
31.4%
1.1%
13.4%
28.7%
15.8%
52.1%
2.3%
45.0%
Aug-14
Sep-14
Aug-14
Sep-14
Friends and Family- Birth
#N/A
#N/A
#N/A
Oct-13
84
50
100
84
60
Nov-13 Dec-13
100
64
85
84
72
90
87
75
91
79
Jan-14
89
79
80
86
78
91
93
83
83
63
82
100
96
92
80
99
68
84
79
74
81
57
92
90
65
Jun-14
Jul-14
82
89
85
94
81
79
74
81
89
73
Oct-13
Nov-13 Dec-13
Jan-14
Jun-14
Jul-14
#N/A
#N/A
#N/A
7.4%
3.5%
1.7%
17.2%
12.5%
17.8%
4.3%
19.9%
16.3%
44.9%
16.2%
12.3%
58.6%
8.8%
6.4%
24.2%
13.4%
35.3%
20.7%
18.0%
27.7%
11.6%
34.0%
28.5%
48.9%
24.3%
9.7%
21.6%
15.5%
31.4%
17.4%
18.1%
33.7%
16.9%
33.3%
25.5%
6.7%
16.5%
27.3%
37.6%
30.5%
12.9%
24.3%
16.5%
43.7%
33.5%
14.0%
54.9%
27.2%
48.9%
Aug-14
Sep-14
Aug-14
Sep-14
Friends and family –post natal ward
#N/A
#N/A
#N/A
Oct-13
79
50
84
47
Nov-13 Dec-13
93
27
66
84
69
72
70
80
88
75
Jan-14
86
67
74
59
68
97
91
88
72
74
81
76
74
86
74
94
63
100
68
67
92
62
87
82
59
Jun-14
Jul-14
73
70
79
82
74
77
55
80
76
62
Oct-13
Nov-13 Dec-13
Jan-14
Jun-14
Jul-14
#N/A
#N/A
#N/A
15.2%
3.3%
0.6%
16.4%
12.9%
13.7%
4.2%
21.1%
15.5%
47.7%
16.2%
23.6%
57.3%
8.4%
12.4%
31.2%
15.1%
43.4%
18.8%
33.5%
20.8%
24.2%
29.9%
28.0%
49.5%
23.8%
21.2%
20.1%
15.5%
34.5%
21.3%
9.4%
36.1%
24.3%
41.2%
28.2%
24.6%
12.0%
26.1%
43.3%
30.5%
20.8%
11.8%
15.8%
41.0%
28.7%
18.9%
57.7%
26.4%
51.5%
Aug-14
Sep-14
Aug-14
Sep-14
Friends and Family-Post natal community
#N/A
#N/A
#N/A
Nov-13 Dec-13
73
#N/A
#N/A
#N/A
Oct-13
-40
77
29
Oct-13
0.0%
2.1%
8.3%
0.0%
4.6%
Jan-14
88
50
63
92
74
79
88
82
73
97
46
80
100
65
88
64
77
100
77
100
56
88
100
100
100
79
80
83
78
Jun-14
Jan-14
Jun-14
6.8%
0.0%
9.5%
0.0%
33.6%
17.6%
53.9%
0.0%
21.1%
14.1%
16.0%
54.8%
0.5%
14.4%
10.9%
10.3%
52.8%
1.2%
8.5%
7.4%
18.0%
44.8%
0.6%
17.6%
9.5%
19.8%
35.8%
1.2%
6.7%
4.3%
16.4%
40.8%
3.4%
14.8%
Aug-14
Sep-14
Jul-14
Aug-14
Sep-14
96
30
87
100
67
Nov-13 Dec-13
4.1%
15.6%
15.8%
0.0%
18.2%
Jul-14
2014/15 Key Planning Requirements
• 1% Surplus - £4.68m
• 2.5% Headroom (non-recurrent resources) - £11.4m
• Minimum 0.5% Contingency
– CCG hold £3m vs £2.2m (0.5%)
• Better Payment Practice Code
• Cash Management
Year to Date (Month 5) – Financial Performance
Planned Year to Date Surplus Current Year to Date Surplus -
(£1.95m)
(£1.24m)
(£0.7m) variance from plan,
In Month over performance position has held
between Month 4 (July) and 5 (August)
* Activity based contracts for month 4 (contracts) / month 3 (prescribing)
Key Issues
•
WUTH Contract Position – (£1.7m) under @ M4 vs [(£1.05m) @ M3
(£1.7m) @ M2]
•
Other NHS Providers – Notably Royal Liverpool and Broadgreen (£0.42m)
over
•
Commissioned Out of Hospital - £0.678m (In Month increase in CHC /
Package costs)
•
Prescribing £0.16m over performance (in month improvement £0.1m)
•
QIPP Gap 5/12 - £2.6m (of £6.3m)
Forecast Outturn 2014/15
Forecast Assumptions
• Planned Forecast Surplus - £ 4.68m (1%) – remains deliverable but not
without risk an
• Risks remain consistent with plan around main expenditure areas
– WUTH (variation away from outturn as per QIPP assumptions)
– Prescribing,
– Commissioned Out of Hospital Care,
– QIPP Gap
• YTD position reflect challenges of forecast delivery
QIPP Plan 2014/15
£m
Original QIPP Planning Assumptions
(4.1)
Updates to financial planning assumptions
0.2
Vascular Activity Shift Risk (WUTH NEL Block)
(2.2)
Includes Prescribing / Contract Settlements
Specialist Commissioning Impact
- Resource Transfers
(1.0)
- Risk Management 14/15
(0.4)
Resource Utilisation (Demand Mgt / Restitution)
1.2
As at Month 5
(6.3)
Offset by
Anticipated WUTH Contract Underperformance
2.5
Contingency (Full Value £3m)
3.0
Planning Gap
(0.8)
Includes QIPP Schemes, Impact of PLCP and C2C
To be met by
Other Underperformance / Slippage / Vascular Activity
Assumes all other budgets breakeven
Self Assessment at Month 5
(August) 2014/15
Financial performance
No.
Indicator
Primary /
Supporting
Indicator
Self Assessment
Month 3 (June
2014)
Self Assessment Self Assessment
Month 4 (July
Month 5
2014)
(August 2014)
Green
Amber
Green
Green
Amber / Green
Amber / Green
Indicator - Not
yet Available
Indicator - Not
yet Available
Green
Green
Green
Amber
Green
Green
Amber / Green
Amber / Green
Indicator - Not
yet Available
Indicator - Not
yet Available
Green
Green
8 Activity trends - full year forecast
9 Running costs
10 Clear identification of risks against financial delivery and mitigations
This covers internal and external audit opinions, and an assessment of the
11
timeliness and quality of returns
Supporting
Primary
Primary
Green
Green
Green
Green
Amber / Green
Amber / Green
Indicator - Not yet
Available
Indicator - Not yet
Available
Green
Green
Supporting
TBC - Green
TBC - Green
TBC - Green
12 Balance sheet indicators including cash management and BPCC
Supporting
TBC - Amber / Green
TBC - Green
TBC - Green
13 Financial plan meets the 2014 surplus planning requirement
Supporting
Green
Green
Green
1
2
3
4
5
6
Underlying recurrent surplus
Surplus - year to date performance
Surplus - full year forecast
Management of 2% NR funds within agreed processes
QIPP ** - year to date delivery
QIPP ** - full year forecast
Primary
Primary
Primary
Supporting
Primary
Primary
7
Activity trends - year to date
Supporting
Other Performance Indicators
Cash Management
– Balance as at the end of the August £69k
Better Payment Practice Code
Other Issues
• Hosting Arrangements
– Discussions held with Cheshire & Merseyside
Commissioning Support Unit with regards to ceasing of
arrangements relating to Isle of Man commissioner and
use of CCG Ledger
• Continuing Healthcare Restitution
– New Guidance suggests future financial year top-slice to
support national shortfall on risk share basis
System Resilience Plan
September 2014
Agenda Item:
4.2
Reference:
GB14-15/0040
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Sarah Quinn, Commissioning Manager
Contributors:
Lorna Quigley, Head of Performance
Andrew Cooper, Vision 2018 Programme Manager for Unplanned Care
Angela Denny, Performance Analyst
Governance:
Link to
Commissioning
Strategy
BCF links to all 3 Vision 2018 programmes and the cross
cutting integration board
Link to current
strategic
objectives
1 Prevent people from dying prematurely
2 Enhance the quality of life for people with long term
conditions
3 Helping people to recover from episodes of ill health or
following injury
4 Ensuring people have a positive experience of care
5 Ensuring people are treated and cared for in a safe
harm
Summary:
This paper summarises the current progress in the development of the system
resilience group and the system resilience plan. Work undertaken to date has
secured £2.4 million system resilience funding from NHS England.
Recommendat
ion:
To Approve
To Note
X
Comme
nts
Next
Steps:
System resilience group will continue to meet on a monthly basis and implement the work
plan and the current version of the system resilience plan will continue to develop over the
next few months.
Governing Body WCCG 07.10.2014
1/3
Financial
£2.4 million system resilience funding has been secured from NHS England to
support system resilience plan projects between October 2014 and March
2015.
Value For Money
Each of the schemes within the plan have been assessed for VFM and will be
monitored on a monthly basis to ensure they are delivering against expected
benefits.
Risk
There is a risk that the funded schemes will not deliver the expected benefits
and ultimately the impact on 4 hour target performance required. This has
been mitigated by monthly monitoring of KPIs and payment of funding to the
providers involved in the schemes on a monthly basis.
Legal
Workforce
The majority of the system resilience projects require investment in and
recruitment of additional staff across a range of staff groups.
Equality &
Human Rights
Patient and
Public
Involvement (PPI)
Partnership
Working
The system resilience plan for Wirral has been developed in conjunction with
all members of the system resilience group including Wirral University
Teaching Hospitals NHS FT, Wirral Community NHS Trust, Cheshire and
Wirral Partnership NHS FT, Wirral Council and the North West Ambulance
Service.
Performance
Indicators
Performance indicators are in place for each scheme and will be monitored on
a fortnightly basis in the urgent care recovery plan meetings and on a monthly
basis in the system resilience group.

2/3
Report Name
Reference
System
resilience plan
Submitted to
System Resilience
Group
Date
th
16
September
2014
Approved and amendments requested
to be made prior to submission to
NHS England
Private Business
3/3
NHS Wirral CCG
Operational Resilience and Capacity Plan
2014/15
Draft agreed with:
Wirral Community NHS Trust
Cheshire and Wirral Partnership NHS FT
Wirral Council
To be agreed with:
North West Ambulance Service
Version 2
22nd September 2014
1. Introduction
1.1 NHS England, Monitor, the NHS Trust Development Agency and the Association of
Directors of Adult Social Services have recently published a joint guidance document
to support planning for operational resilience during 2014/15. This guidance covers
both urgent and planned care and measures to support the changes which will arise
through the Better Care Fund.
1.2 The guidance sets out best practice requirements across planned and urgent and
emergency care that each system should reflect in their local plan and the evolution
of Urgent Care Working Groups (UCWGs) into System Resilience Groups.
1.3 System Resilience Groups are to become the forum where capacity planning and
operational delivery across the health and social care system is co-ordinated.
1.4 This guidance also requires the Wirral health and social care economy to publish a
System Resilience Plan, signed by all members of the System Resilience Group.
1.5 The guidance makes clear that resilience needs to be delivered while maintaining
financial balance and that there can be no trade-off between finance and
performance.
1.6 The paper also refers to the work being undertaken by local systems this year setting
the ground work for the longer term changes to strategic and operational delivery that
will be brought about by outputs from the Urgent and Emergency Care Review. It
states ‘the review and its proposals will have a clear impact on the operations of
UCWGs within local systems’. Phase 2 of this review is expected to report in the
Autumn of 2014.
1.7 Wirral CCG is currently in the process of developing an urgent care strategy as part
of the Vision 2018 programme, to set out a strategy over 5 years and respond to the
findings of the national Urgent and Emergency Care Review.
2. Local reviews of the unplanned care system
2.1 Wirral CCG has recently commissioned 2 key reviews from the Greater Manchester
Commissioning Support Unit (GMCSU), the utilisation management review and a
point prevalence review.
2.2 The WUTH, along with partners from across the economy have also undertaken two
“perfect days” to work with clinical teams to understand the issues with the system
and patient pathways that are causing delays. A further “perfect day” will be held in
November to test some of the changes that have been put in place as a result of this
initiative.
2.3 The Wirral has now completed a “deep dive” with the North West Ambulance Service
(on 18th September) and lessons learned from this will feed in to the development of
plans going forward. There is already a significant focus on putting services in place
to support the ambulance service in 2015/16 Better Care Fund plans.
2.4 The recovery plan arising from these reports and the perfect day initiative is now in
place and has been signed off by all Director leads from key health and social care
economy partners. Please see Appendix 1 for completed recovery plan.
3. Wirral Urgent Care Conference
3.1 An urgent care conference was held on 18th September 2014, led by the Accountable
Officer of the CCG and the Chief Executive of WUTH. Over 100 representatives from
primary care, WUTH, WCT, CWP, DASS, patient groups were brought together to
hear about the level of challenge that that Wirral economy is facing in urgent care
now and into the future.
3.2 There were also presentations from areas of best practice in acute medicine and
primary care; and plenary sessions to discuss some of the key challenges and brain
storm solutions.
3.3 A summary of key actions from this conference include:
• Development of a voluntary sector ‘showcase’
• Focus on making cross-organisational barriers invisible
• Development of a ‘consistent offer’ to patients for unplanned care
• Development of a comprehensive Directory of Service that is user-friendly for
clinicians
• Redesign of Single Point of Access to offer senior clinician triage
• Joined up I.T across the system’
3.4 It was agreed at the end of the conference that a task and finish group would be set
up to ensure that these actions were taken forward linking in with existing groups.
3.5 The outputs from the working groups at the conference also affirmed that the current
direction of travel with the development of the Urgent Care Vision and the work plans
for the next 1-2 years, are focused in the right areas and delivery now needs to be
the priority.
4. System Resilience Group
4.1 The Wirral System Resilience Group (WSRG) is a whole system network
designed to bring together multiple stakeholders from across Wirral. It enables
all parts of the local health and social care system to co-develop strategies and
collaboratively plan safe, efficient services for patients. On an annual basis the
WSRG is responsible for recommending the approval of, updating and
monitoring the Wirral System Resilience Plan and ensuring the actions it
contains deliver the required level of performance improvement.
4.2 The proposed Terms of Reference of the have been drafted and agreed by the
first meeting of the WSRG on 16th September and feedback is being received
from partners. The group builds on those of the predecessor Urgent Care
Working Group and take into account guidance to expand the group’s remit to
cover elective care and to extend the membership of the group to include public
health and the independent and voluntary sectors.
4.3 The Draft Terms of Reference includes the following proposed membership:
Commissioners
• Chairman of the WSRG will be the Chairman of the CCG
• CCG Interim Accountable Officer
• CCG Planned and Unplanned Care Clinical Leads
• CCG Head of Performance
• Planned and Unplanned Care CCG Commissioning Leads
•
•
•
Director of Adult Social Services
Public Health representative
NHS England representative
Providers
Nominated representatives (clinical and / or managerial) from:
• Wirral University Teaching Hospital NHS FT
• Wirral Community NHS Trust
• Cheshire and Wirral Partnership NHS FT
• North West Ambulance Service
• Local Pharmaceutical Committee representative
• Independent sector
• Voluntary sector
• Healthwatch
4.4 The WSRG agreed a number of actions at the first meeting on 16th September 2014,
which are noted in the action plan section below (section 6).
5. Summary Capacity Plans and Current Performance
5.1 Monthly capacity plans and performance to date are shown in detail (month on
month) in Appendix 3 and are summarised below:
Referrals
Outpatients
Elective
A&E
Non Elective
2014/5 Plan
Q1 Plan
93886
144948
50106
113398
44443
23389
36113
12481
28272
11085
Q1
Activity
24049
35147
12438
29727
12001
Q1 Variance
Q1 2013/4
+2.8%
- 2.7%
- 0.3%
+4.9%
+ 8.3%
+2.0% (GP)
+2.6% (GP)
- 6.4% (GP)
+2.8%
+5.1% (GP)
5.2 Feedback from ECIST on the WSRG plan highlighted the need for the Wirral
economy to understand capacity and demand on an overall strategic basis across
planned and unplanned care; and also in relation to capacity across key staff groups.
The WSRG agreed on 16th September to add a review of system capacity and
demand to its work plan (see section 6).
5.3 The ECIST review also highlighted the need to understand and have systems in
place to monitor capacity and demand on a daily / weekly basis to ensure that
actions can be taken in response to rising demand at the time that it is occurring.
5.4 Daily teleconferences are now taking place across the economy, chaired by the CCG
and attended by key operational managers from WUTH, WCT, CWP and DASS. To
support this daily discussion, the CCG has developed a template which is required to
be filled in by each partner on a daily basis prior to the teleconference.
5.5 Operational actions are agreed from this meeting and followed up the same day to
ensure they have been implemented. If issues are not resolved then they are
escalated to Directors on call.
5.6 It is now confirmed that the economy is using the predictive tool provided by the
Greater Manchester Commissioning Support Unit on a daily basis to predict
admissions and discharges; and that this is playing a key part in both bed
management within the acute trust and the daily economy teleconferences.
5.7 Key recurring issues from teleconferences were reported back to the first meeting of
the WSRG and this will continue to be a standing item.
5.8 Further work is planned to:
•
Review economy wide escalation plans and trigger points and feedback to the
next meeting on 21st October 2014 (a task and finish group has been convened
to undertake this task)
•
This review will include assessment of operational actions for increasing staffing
capacity as per ECIST recommendations
•
Review and revise daily information collected on dashboard and used in daily
teleconferences to assess pressures across the system, including primary care
6. System Resilience Group Work Plan
6.1 Summary of actions agreed at the first meeting of the WSRG:
•
Review lessons learned, economy wide escalation plans and trigger points
and feedback to the next meeting on 21st October 2014 (a task and finish
group across partners has been convened to undertake this task)
•
Receive a regular report on progress with the development of the daily
teleconferences and key recurring themes and issues
•
Review and revise daily information collected on dashboard and used in daily
teleconferences to assess pressures across the system
•
Develop a strategic performance dashboard and a draft of this will be
available for review at the next meeting on 21st October 2014
•
Explore how links and regular communications can be developed with the
West Cheshire SRG and report back to the next meeting on 21st October
2014
6.2 In addition WSRG plans to review the following areas and consider on 21st October
2014 how and when those reviews will take place:
•
A review of capacity and demand across the economy for planned and unplanned
care, including specific reference to staffing capacity is required (in addition to the
operational actions that have already been put in place).
•
Assessment of current plans (urgent care recovery plan and system resilience plans)
against national priorities in response to ECIST recommendations that the current
plans do not adequately address all areas. This will include how plans will support
ambulance turnaround and patient safety.
•
In addition to the above actions undertake a review of planned care system including:
o
o
o
o
o
o
o
o
Access Policy against national rules and guidance in October
RTT policy and training plan
Sub specialty analysis of elective capacity and demand
‘Right size’ outpatient, diagnostic and admitted waiting lists, in line with
demand profile, and pathway timelines (see IMAS Capacity and demand
tools)
local application of RTT rules
RTT validation for 2013/14
Areas of good practice for referral management
Provision of choice
An initial report on the developments required to integrate planned care into the
WSRG will be given at the next meeting on 21st October 2014 but further work will be
required beyond this.
6.3 WSRG is integrating its work plan into Wirral’s Vision 2018 programme to ensure that
all programmes and projects are managed and evaluated in a consistent way, in line
with the vision and strategy that has been agreed by all partner organisations and
towards the 3 overarching priority areas of unplanned care, planned care and long
term conditions.
6.4 All projects within the system resilience plan will be monitored via the Vision 2018
Programme Management Office under the unplanned and planned care workstreams
and evaluation will be completed to assess investment and delivered outcomes for
each initiative.
6.5 While this system is fully developed the urgent care recovery plan and regular
fortnightly review meetings with all partners (chaired by the CCG) will continue to
monitor the delivery of key actions.
6.6 WSRG has reviewed Wirral’s position against all areas of best practice set out in the
operational and resilience planning guidance. In addition to these areas, the
Cheshire, Warrington and Wirral Local Area Team have also benchmarked the Wirral
economy against additional areas of best practice for urgent care. As highlighted
above in 6.2 this review will now be extended to include the detailed against national
priorities highlighted by ECIST (see Appendix 8).
7. Next steps
7.1 The WSRG will now need to:
•
Agree finalised terms of reference the next meeting on 21st October 2014
•
Undertake the tasks as set out in the outline work plan summarised in section 6,
which highlights tasks to complete for the next meeting on 21st October 2014
•
Consider the key outstanding actions following feedback from ECIST review of plans
how they will be addressed and by when
•
Continue to monitor and update the system resilience and capacity plan monthly
over the winter period up to March 2015, including receipt of monthly reports on
implementation of the urgent care recovery plan, system resilience plans and
outcomes delivered for the investment made (via the Vision 2018 PMO structure)
Appendices
Appendix 1: Agreed urgent care recovery plan for the Wirral health and social care economy,
(17th September version)
Appendix 2: Activity Plans and Current Performance
Appendix 3: Non elective system resilience plan
Appendix 4: Elective system resilience plan
Appendix 5: Lessons learned from winter 2013/14
Appendix 6: Escalation planning (currently under review)
Appendix 7: New system for daily teleconferences for WSRG
Appendix 8: Areas of best practice for elective and non elective care
Appendix 1: Wirral health and social care economy urgent care recovery plan
Final UCRP - 17th
Sep 14 V3.docx
Appendix 2: Non Elective and Elective Activity Plans and Current Performance
Referrals
Referrals
Month
2013/14 Actuals
GP
Referrals
2014/15 Plan
Other
Referrals
GP
Referrals
2909
5091
2014/15 Actuals
GP
Referrals
Other
Referrals
All
Referrals
GP
Var
Other
Var
5290
5189
2949
2760
8239
7949
186
326
123
70
1.1%
309 3.6%
396 6.7%
15514
8535
24049
456
204
660 3.0%
May
4973
4850
5338
4868
4977
5413
4692
4327
5208
4664
5079
15217
3082
2790
2836
2487
2672
2842
2574
2637
3137
2708
2859
8781
5104
4863
5329
4868
5094
5326
4630
5325
5094
4630
5095
15058
2826
2690
2947
2692
2817
2947
2560
2947
2818
2560
2818
8331
7930
7553
8276
7560
7911
8273
7190
8272
7912
7190
7913
23389
59783
33533
60449
33437
93886
August
September
October
November
December
January
February
March
Year to
Date
Full
Year
% Var
GP
All
Referrals
5394
July
Activity vs Plan %
Variance
Other
Referrals
April
June
Activity vs Plan
Variance
2815
7906
5035
2826
7861
-56
11
All
Var
-45
% Var
Other
0.4%
% Var
All
GP
Year
on
Year
Var %
Other
Year
on
Year
Var %
-6.7%
-2.9%
4.4%
2.6%
0.6%
3.9%
5.2%
6.4%
7.0%
-4.3%
-1.1%
2.4%
2.8%
2.0%
-2.8%
Elective
Electiv
e
Mont
h
April
May
June
July
August
Septe
mber
Octob
er
Nove
mber
Dece
mber
Januar
y
Febru
ary
March
Year
to
Date
Full
Year
2013/14 Actuals
2014/15 Plan
2014/15 Actuals
Elective
Ordinary
Elective
Daycase
Elective
Ordinary
Elective
Daycase
All Elective
Elective
Ordinary
Elective
Day Case
All Elective
761
721
749
777
673
691
3341
3324
3163
3576
3136
3435
749
759
716
788
723
749
3468
3478
3311
3631
3317
3469
4217
4237
4027
4419
4040
4218
618
745
726
3462
3327
3560
4080
4072
4286
811
3830
789
3628
4417
827
3597
681
3156
3837
643
3204
787
3625
4412
708
3830
753
3470
4223
734
3341
680
3157
3837
709
2231
3875
9828
753
2224
3469
10257
4222
12481
2089
10349
12438
8804
41652
8927
41179
50106
GP
Year
on
Year
Var %
Other
Year
on
Year
Var %
6.4%
-18.8%
3.3%
-3.1%
3.6%
0.1%
12.6%
-0.3%
-6.4%
5.3%
Activity vs Plan
Variance
Activity vs Plan %
Variance
El
Ord
Var
-131
El DC
Var
All Var
% Var
Ord
% Var
DC
% Var
All
-6
-137
-17.5%
-0.2%
-3.2%
-14
-151
-165
-1.8%
-4.3%
-3.9%
10
249
259
1.4%
7.5%
-135
92
-43
-6.1%
Outpatients
Out
patients
Month
April
May
June
July
August
September
October
November
December
January
February
March
Year to
Date
Full
Year
2013/14 Actuals
2014/15 Plan
2014/15 Actuals
Activity vs Plan
Variance
Activity vs Plan %
Variance
Out
patients
GP Written
Referrals
Seen
Out
patients
GP Written
Referrals
Seen
Total Out
patients
Out
patients
GP Written
Referrals
Seen
Total Out
patients
OP
Var
Seen
Var
All
Var
% Var
Seen
4053
3915
4424
11520
11276
12351
%
Var
OP
%
Var
All
7547
7606
7017
8100
7162
7943
8746
7986
7511
7938
7178
7765
7866
7872
7510
8223
7513
7865
8222
7150
8219
7862
7149
7863
23248
4351
4359
4155
4552
4158
4351
4551
3955
4546
4349
3955
4352
12865
12217
12231
11665
12775
11671
12216
12773
11105
12765
12211
11104
12215
36113
7467
7361
7927
22170
4229
4262
3957
4455
3862
4336
4879
4403
4277
4337
3950
4345
12448
-399
-298
-697
-5.1%
-6.8%
-5.7%
-511
-444
-955
-6.5%
-10.2%
-7.8%
417
269
686
5.6%
6.5%
22755
12392
35147
-493
-473
-966
-2.1%
92499
51292
93314
51634
144948
GP
Year
on
Year
Var %
Other
Year
on
Year
Var %
5.9%
-1.1%
-3.2%
13.0%
-4.2%
-8.1%
11.8%
-2.7%
2.6%
-0.4%
A&E
A&E
Activity Trajectories
A&E Attendances - All
types
115712
2013/14 Forecast Outturn
2014/15 Total
2% Reduction forecast
113398
Q1 14/15 plan
Q1 (yr/365*91days)
28272
Over
29727
118909
1455
Over
4.9%
over
over
5511
4.9%
Q1 Actual Activity 2014/15
forecast for yr (Q1 * 4)
Plan Variance Q1 2014/15
Forecast Plan Variance Q1
14/15
Plan Variance 14/15 - forecast
yr
Forecast Plan Variance 14/15
13/14 comparison
Variance 13/14 to current
3197
over
2.8%
Non Elective
Non
Elective
Month
April
May
June
July
August
September
October
November
December
January
February
March
Year to
Date
Full Year
2013/14 Actuals
2014/15 Plan
2014/15 Actuals
Non
Elective
Non
Elective
All Non
Elective
Non
Elective
3909
3940
3566
3829
3729
3561
3876
3950
4259
4070
3573
4013
3653
3780
3652
3778
3775
3652
3776
3652
3773
3773
3407
3772
11085
3977
4120
3904
11415
3653
3780
3652
3778
3775
3652
3776
3652
3773
3773
3407
3772
11085
46275
44443
44443
12001
0
Activity vs Plan
Variance
Activity vs Plan %
Variance
GP
Year
on
Year
Var %
All Non
Elective
GP
Var
All
Var
% Var
GP
% Var
All
3977
4120
3904
324
340
252
324
340
252
8.9%
9.0%
6.9%
8.9%
9.0%
6.9%
1.7%
4.6%
9.5%
12001
916
0 916
8.3%
8.3%
5.1%
Appendix 3
Wirral non elective & elective system resilience plans
See template attached below:
Wirral
op-res-cap-plan-temp
Appendix 4
North West Ambulance Service system resilience plan
See template attached below:
(Item 4-2-2) - NWAS
op-res-cap-plan-temp
Appendix 5
Lessons learned from winter 2013/14
The attached paper was received and noted by the Wirral Urgent Care Working Group on
Urgent Care Working
Group Evaluation repo
Appendix 6
Escalation Planning 2013/14 (currently under review)
The attached paper was agreed by the Urgent Care Working Group on:
Winter Planning 2013
v8.doc
Appendix 7
New system for Wirral economy daily teleconferences
The attached paper was agreed by the Urgent Care Working Group on:
Teleconferences
proposal v1.doc
Appendix 8: Review of best practice
Elective areas of best practice
Planning
•
Review and revise access policy
•
Develop and implement RTT training programme
•
Carry out annual analysis of capacity and demand
Building on existing work
•
Build upon any capacity mapping that is currently underway
Pathway redesign
•
Ensure that all specialties understand elective pathways for common referral
reason / treatment plans
•
Ensure that “patient choice” and patient rights under the NHS constitution are
communicated
•
Right size outpatient diagnostic and admitted waiting lists
Measurement
•
Review local application of RTT rules
•
Pay attention to RTT data quality
•
Put in place clear and robust performance management arrangements
•
Ensure supporting KPIs are well established
Governance
•
Provide assurance during quarter 2 2014/15 at Board level on implementation of
the above.
Non elective areas of best practice
Planning
•
Discharge planning
•
Avoiding inappropriate delays in A&E
•
Working with ambulance services
•
Unscheduled care
•
Flu planning
•
Maintaining or improving financial performance
•
Manage referrals effectively
Patient experience
•
Right care, right time, right place
•
Children’s services
•
Mental health services
Chronic conditions and home care
Caring for patients with chronic conditions
Planning for care home residents
Best practice and national
priorities reviewed by LAT
Wirral position
RAT model
In plans to be implemented
RAID model
Hear&Treat and See&Treat
Already in place
Access to primary care in
A&E
Already in place
7-day cross-system working
Facilitating and minimising
delayed discharge
Commissioning alternatives
for high-risk patients, and
appropriate data-sharing
The development of integrated teams in the community on
the Wirral includes a project to implement risk stratification,
which is currently being developed and will be rolled out by
the end of October 2014. Currently the model covers both
high and medium risk tiers. Until the development of the
tool is complete it is not possible to report the exact % of
the population this will cover, but it will be available in
October when the tool development is complete.
Preventing admissions from
residential and nursing
homes
A care homes steering group across the CCG, Council and
other partner organisations has recently been formed to
map all current projects to prevent admissions and support
care homes on Wirral. Once this mapping exercise is
complete a work plan will be agreed for key workstreams
to be implemented.
Detailed report on national priorities highlighted by ECIST review:
1. Initiatives to reduce length of stay by expediting discharge (weekend discharge rounds; enhanced
transport; home from hospital support; expedited take-out medicines (TTOs); additional juniors on
rounds; daily ward rounds 7/7 on all wards; discharge to assess schemes; trusted assessor schemes
etc).
2. 7-day working and extended hours (into the evening), not just by doctors but also relevant
supporting players (therapists, social care assessors, mental health, imaging, hospital pharmacy etc)
3. Focused initiatives to prevent admissions from residential and nursing homes (see recent British
Geriatrics Society guidance on care home medicine)
4. A focus on ambulance services: including reducing queuing at emergency departments, creating
capacity to deal with surges, improving the response to GP urgent conveyance requests and
see/hear and treat.
5. Schemes that are aimed at early senior review, including in emergency departments, acute
medical
NHS WIRRAL CCG
System Resilience Update
Background
1. NHS England, Monitor, the NHS Trust Development Agency and the Association of Directors
of Adult Social Services have published a joint guidance document to support planning for
operational resilience during 2014/15. This guidance covers both urgent and planned care
and measures to support the changes which will arise through the Better Care Fund.
2. The guidance sets out best practice requirements across planned and urgent and emergency
care that each system should reflect in their local plan and the evolution of Urgent Care
Working Groups (UCWGs) into System Resilience Groups.
3. System Resilience Groups are to become the forum where capacity planning and operational
delivery across the health and social care system is co-ordinated.
4. This guidance also requires the Wirral health and social care economy to publish a System
Resilience Plan, signed by all members of the System Resilience Group.
5. The guidance makes clear that resilience needs to be delivered while maintaining financial
balance and that there can be no trade-off between finance and performance.
Introduction
2. This paper sets out a summary of progress to date with the development of the Wirral
System Resilience Group and Operational Resilience and Capacity Plan.
Summary of progress to date
3. The first Wirral System Resilience Group (WSRG) was held on 16th September 2014,
chaired by the Wirral CCG chair, Dr Pete Naylor.
4. Draft terms of reference were discussed and will be finalised at the next meeting on 21st
October 2014.
5. The new WSRG intends to build on the work of the Urgent Care Working Group but now
also includes planned care.
6. WSRG considered the Wirral Operational Resilience and Capacity plan on 16th September
and approved it once requested amendments were made.
7. The plan includes proposals for a range of schemes to be implemented over winter
(October 2014 to March 2015) to support delivery of both the 4 hour target and the 18
week target.
8. This plan was submitted as required to NHS England on 19th September.
9. Following review by NHS England Wirral CCG were informed that system resilience
funding to the tune of £2.4 million would be released to support the delivery and
improvement in performance against the 4 hour target.
Next steps
10. The next steps include:
•
•
•
Continue to develop the system resilience group and implement the work plan
Continue to develop the operational resilience and capacity plan as this work plan
is progressed
Work with providers to implement and monitor system resilience schemes
]
Recommendations
11. The CCG Governing Body is asked to note the progress to date with the development of
the system resilience group and operational resilience and capacity plan.
Sarah Quinn
Commissioning Manager
Better Care Fund Submission
October 2014 Update
Agenda Item:
4.3
Reference:
GB14-15/0040
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Sarah Quinn, Commissioning Manager
Contributors:
Jacqui Evans, Head of Transformation, DASS
Louise Morris, Senior Accountant
Peter Tomlin, Integration Programme Manager
Sheena Hennell, Commissioning Manager
Anna Rigby, Vision 2018 Programme Manager
Damien Boden, Performance Analyst, Wirral Council
Lucy Jones, Accountant, Wirral Council
Governance:
Link to
Commissioning
Strategy
BCF links to all 3 Vision 2018 programmes and the cross
cutting integration board
Link to current
strategic
objectives
1 Prevent people from dying prematurely
2 Enhance the quality of life for people with long term
conditions
3 Helping people to recover from episodes of ill health or
following injury
4 Ensuring people have a positive experience of care
5 Ensuring people are treated and cared for in a safe
harm
Summary:
This paper summarises current progress with the development of the Better Care
Fund, provides all the latest papers submitted to NHS England for the September
submission and gives a summary of initial feedback from the national BCF
assurance team.
Recommendat
ion:
To Approve
To Note
X
Comme
nts
Next
Steps:
Formal feedback on the Wirral BCF submission is expected from NHS England by the end
of October 2014
CCG and Council commissioning teams are working on an implementation plan and with
Vision 2018 Programme leads to ensure that the programmes and projects are set up and
monitored via the new Programme Management Office.
1/3
Financial
The CCG is required to create a pooled budget with Wirral Council in 2015/16.
The BCF proposal sets out the agreed use of this money to deliver the greatest
benefit to the economy and meeting all the national requirements for BCF.
Value For Money
Each of the 25 schemes within the BCF have been or are in the process of
being assessed for value for money (depending on the level of development of
the scheme) and the current view on return on investment is summarised in the
modeling spreadsheet.
Risk
The BCF narrative submission sets out and scores a number of risks
associated with the BCF proposal.
Legal
The CCG is required to set up a section 75 agreement with Wirral Council for
the 2015/16 pooled budget. It is expected that national guidance will be given
on this.
Workforce
There are significant workforce implications within the schemes in the BCF, for
example the development of integrated care coordination teams requires staff
to work in multidisciplinary teams and be co-located. There is also a
requirement for the implementation of 7 day working which will have a
significant impact on staff.
Equality &
Human Rights
This is being completed for each BCF scheme depending on the stage of
development.
Patient and
Public
Involvement (PPI)
Patient and public involvement has been completed as part of the Vision 2018
programme.
Partnership
Working
The BCF programme of work is being completed jointly with Wirral Council.
There has also been significant provider engagement as part of the second
submission as our major providers were required to sign off the return (see
Annex 2s)
Performance
Indicators
A BCF scorecrard has been developed which monitors both nationally required
indicators and local indicators on a monthly basis.

2/3
Report Name
Reference
Submitted to
Date
BCF Update
Joint Strategic
Commissioning
Group
21st August
2014
Approved
BCF Update
Vision 2018
Programme
Managers Group
5th
September
2014
Noted
BCF Update
Joint Strategic
Commissioning
Group
16th
September
2014
Approved
BCF Update
Vision 2018
Implementation
Group
16th
September
2014
Noted
BCF
submission
Health and
Wellbeing Board
17th
September
2014
Approved
Private Business
3/3
NHS WIRRAL CCG and WIRRAL COUNCIL
Better Care Fund: October 2014 Update
Background
1. The Better Care Fund (BCF) is explicitly intended to facilitate the integration of Health and
social Care systems at a local level. The Health and Wellbeing Board has a critical role in
influencing and monitoring progress in relation to integration, it has a key role in signing off
submissions.
2. NHS Wirral Clinical Commissioning Group (CCG) and Wirral Council were required to resubmit a final ‘Better Care Fund’ plan for 2015 / 2016 to NHS England on 19 September
2014, following approval by the Wirral Health and Wellbeing Board on 17 September,
explaining how they intend to improve local services.
Introduction
3. This paper sets out a summary of the current progress with the development of the Wirral
Better Care Fund, including informal feedback on the latest submission from the national
BCF assurance team
4. Attached is the full BCF submission that was approved at the Wirral Health and Wellbeing
Board on 17th September 2014.
Summary of current progress
5. Following original submissions in April 2014, NHS England advised they would be
requesting further detailed work nationally, in response to feedback received from the
LGA, Department of Health and Acute Trusts. On 11 July 2014, Andrew Ridley made
clear his intentions regarding a ‘pay for performance’ framework.
6. Revised high level guidance was circulated on 25 July 2014, with revised full guidance
and the documents being used on 18 August 2014.
7. The new guidance specifically required the following:
•
Finance:
Plans must balance to total settlement (Minimum £28,009,000
locally).
•
National Conditions:
Details requested on the implementation of the Care Act,
including assurance funding comes from CCG allocation.
•
Non Elective
Admissions:
National expectation of a minimum 3.5% reduction target.
Nationally mandated payment by results attached.
•
Other Outcomes
&Measures:
Revision of baseline data from 2012/13 to 2013/14
These outcomes are not linked to performance payment.
•
Scheme
Specifications:
An individual annex to be submitted alongside BCF templates
demonstrating impact of each scheme.
•
Provider
Commentary:
An individual annex to be submitted to allow each local provider
to comment on deliverability of plans.
NHS Wirral CCG and Wirral Council
October 2014
8. NHS Wirral Clinical Commissioning Group (CCG) and Wirral Council (WBC) have agreed
through Vision 2018, with key providers, a level of ambition of 15% reduction in
emergency admissions over three years.
9. NHS Wirral CCG and WBC have agreed with key partners that all operational plans would
align to the level of ambition by April 2015.
10. In order to redesign services and achieve the 15% reduction in emergency admissions,
NHS Wirral CCG and WBC have recommended 25 schemes, under four themed areas:
•
Early Intervention and Prevention
•
Keeping people in their local communities
•
Step up / Step down services
•
Mental Health, including drug and alcohol services.
11. Revised guidance clarifies the performance related element, focussing on delivery of the
reduction in non-elective admissions, 5% for 2015 / 2016. Payment will be related to
delivery of the target. Potential funding will be held to mitigate the impact of non delivery
and acute pressure.
September BCF submission
12. The Wirral Health and Wellbeing Board approved the latest submission for the Wirral BCF
on 17th September 2014 which was submitted to NHS England on 19th September.
13. Informal feedback from the national BCF assurance team suggests that they consider the
Wirral submission to be strong, the narrative was coherent, they were impressed by the
scale of ambition on non-elective reduction and picked out provider engagement as being
strong compared to other areas. They also noted that they will consider using the Wirral
modelling summary template nationally for the next round of submissions.
Next steps
14. The next steps include:
•
Formal feedback on the Wirral BCF submission is expected from NHS England by the
end of October 2014
•
CCG and Council commissioning teams are working on an implementation plan and
with Vision 2018 Programme leads to ensure that the programmes and projects are set
up and monitored via the new Programme Management Office.
Recommendations
15. The CCG Governing Body is asked to note the current progress with the Wirral Better
Care Fund Proposals.
Sarah Quinn
Commissioning Manager
October 2014
Jacqui Evans
Head of Transformation, Wirral Council
October 2014
Continuing Healthcare Provision
Agenda Item:
4.4
Reference:
GB14-15/0040
Report to:
Governing Body
Meeting Date:
Lead Officer:
Iain Stewart, Chief Officer, Wirral Alliance Consortium
Contributors:
Link to
Commissioning
Strategy
Governance:
Enhance the quality of life for people with longterm conditions
Helping people to recover from episodes of ill
health or following injury
Ensuring people have a positive experience of
care
Ensuring people are treated and cared for in a
safe environment and protected from
avoidable harm
Link to current
governing body
Objectives
Summary:
Service performance issues identified with CHC service from Cheshire &
Mersey Commissioning Support Unit (CMCSU). Action plan received
from CSU. Operational management decision taken to issue notice of
service failure letter to CSU.
Recommendation:
To Approve
To Note
√
Comments Work is currently continuing on a CHC service assessment
being undertaken by Mersey Internal Audit Agency (MIAA)
which will be available for the November Governing Body
meeting
Next Steps:
CCG management team to collate outcome of MIAA assessment and prepare a
proposal for addressing the service delivery of the CHC service.
1/3
Financial
Expenditure on Continuing Healthcare (CHC) packages continues to rise year
on year due to an increase in the shift of care into the community for patients
with complex care needs. The current year forecast for 2014/15 is a c£2m
overspend against the CHC budget. A key element of the CHC Framework is
the review of care packages to ensure the current care needs are being met
and where appropriate, packages of care be reasonably adjusted. In the
absence of regular reviews the CCG is unable to achieve best value for money
against the use of its financial allocations.
Value For Money
The CCG is not as informed as it needs to be via performance reporting and
assurance on procurement processes, and as such cannot determine best
value for money against the use of its financial allocations.
Risk
Along with the financial risks (see above),the current CHC service delivery is
creating the potential for clinical and safeguarding risks, due to the backlog of
annual reviews of patients’ care packages.
Legal
The CCG has a legal duty to achieve financial balance. The failure to
commission high quality, best value services that will likely lead to budgetary
overspends, will impact on this statutory requirement.
Workforce
The CHC service is currently commissioned as an “end to end” service from
the CSU. Over the past several months, CCG staff have increasingly been
drawn into operational issues; complaints handling and performance reporting
matters. It is unrealistic to absorb the responsibilities of an end to end service
into an extremely lean CCG workforce.
Equality &
Human Rights
The CCG must be mindful of its priority to ensure people are treated and
cared for in a safe environment and protected from avoidable harm. Whilst the
current performance issues exist within the CHC service commissioned from
the CSU, the CCG must take action to assure itself that patients in receipt of
CHC packages continue to be supported appropriately with their current care
needs.
Patient and
Public
Involvement (PPI)
The increasing number of complaints received from patients and families about
aspects of the CHC service (mainly delays in decision-making) represents
involvement albeit a negative experience for those patients. The formation of a
service user forum in conjunction with the existing CHC Forum could yield
improvements in service experience.
Partnership
Working
The CCG is part of a pan-Cheshire/Wirral approach to assessing CHC service
delivery from the CSU with a view to sharing learning points and identifying
opportunities for improvement.
Performance
Indicators
Overall service delivery is not meeting agreed standards.
2/3
Report Name
Verbal update
Reference
Minutes
Submitted to
Quality
Performance &
Finance Committee
Date
th
26 August
2014
Risk identified on financial spend and
service performance matters
Private Business
3/3
NHS Wirral CCG
Continuing Healthcare provision
Background
1. When the CCG was established in April 2013 it determined that a CHC
service would be commissioned from the Commissioning Support Unit (CSU)
as part of a wider Service Level Agreement covering a full range of support
functions (e.g. Finance, Business Intelligence, Contracting etc). The service
specification agreed, encompasses all aspects of a CHC service and is
described by the CSU as an “end to end service”, meaning the CCG should
only expect to have minimal involvement in operational and managerial
aspects of the day to day delivery of the service.
2. It became clear during 2013 that increasing instances of operational and
managerial issues were being presented to the CCG to resolve. It was also
clear that processes for requesting funding authorisation for high cost
packages or increases to existing packages of care, appeared un-coordinated, reactive and rushed, resulting in pressure on the CCG to approve
high value cost proposals without a reasonable time to seek assurances that
the proposals represented value for money and that all procurement options
had been considered in determining the care package costs.
3. The CCG established a monthly CHC Forum as a means of enabling the
opportunity for the CSU provider colleagues to meet with the commissioner
and discuss operational matters, planning considerations for changes in CHC
payment rates; focus on greater explanation on processes used and
improving knowledge about joint funded care packages developed in
conjunction with Wirral Department of Adult Social Services.
4. As part of the current interim management arrangements within the CCG, the
interim Chief Operating Officer reviewed the current level of complaints
received to-date on CHC-related issues. She identified serious failings in both
the delay in responses and the overall content quality of responses, when
finally provided to complainants. To-date, two complainants have written to
the Parliamentary Health Ombudsman as a result of dissatisfaction with their
responses.
Introduction
5. This paper updates Governing Body on recent key operational decisions
taken by the management team to attempt to address current service matters
and follows on from the issue identified in the Quality, Performance & Finance
Committee on 26th August 2014 and subsequently included in the CSU
Service Level Agreement update provided to Governing Body meeting on 2nd
September 2014.
Produced by Iain Stewart, Chief Officer, Commissioning Lead for Continuing Healthcare
Current Issues identified
6. On 21st August 2014, the CCG met with senior managers from the CSU to
discuss a range of concerns regarding the current service delivery and
requested an action plan from the CSU. Key concerns were;
- Backlog of annual reviews (which increases the risk of safeguarding
matters arising due to lack of updated clinical assessment and
financial implications of care package costs)
- Performance reporting not adequate to inform the commissioner of
key aspects of the service
- Speed of response in relation to patient queries about CHC
eligibility decision-making and subsequent quality of complaint
response letter content.
In response the CSU has provided an outline action plan to address the areas
of concern raised (see Appendix 1).
7. A Due Diligence Review of the existing service has been completed on behalf
of the CCG (as part of a wider commission of work in conjunction with the
Cheshire CCGs) and highlights a general failure to deliver the service in line
with the service standards expected locally and nationally.
8. The CCG, along with the Cheshire CCGs has taken the decision to withdraw
this service from the CSU on the basis of a failure to deliver the service in line
with the agreed specification. Further concerns relate to the nature of
complaints received from members of the public and timeliness of monitoring
of care being received. A notice of service failure letter was sent to the CSU
on 16th September 2014 (Appendix 2 refers).
9. The CCG continues to hold the CSU to account for on-going delivery of the
current service.
10. The Governing Body is asked to note the operational decision taken by the
management team.
Produced by Iain Stewart, Chief Officer, Commissioning Lead for Continuing Healthcare
CHC/COMPLEX CARE FOR WIRRAL CCG – ACTION PLAN AUGUST 2014
Wirral CCG has shared concerns with CSU regarding four key elements of the
CHC/Complex Care Service. The action plan below describes briefly our understanding of
the issues and outlines the steps that will be taken to address these issues or provide further
information for discussion with the CCG.
There was also an agreement to provide a comprehensive CHC/Complex Care report for the
October 2014 CCG Board Meeting. It is proposed that this will be provided by September
22/23rd. Please confirm if this date is suitable.
Complaints:
1. Final draft responses lack an understanding of the key question/issue raised by the
complainant, do not have sufficient empathy and are too defensive. CCG would like to
enable broader range of staff to understand complaints/disputes/restitution and the
different requirements associated with each. There has in the past been a long delay in
responding to complaints.
2. It was noted the CCG have 4 (long running) CHC complaints with the Ombudsman. It is
expected that the CCG will be asked to explain why the complainants faced delays
through the process (of initial CHC delivery and in responding to the complaint raised).
Actions already taken
3
The immediate actions taken as a result of conversation between The Assistant Interim
Accountable Officer at Wirral CCG and Head of Business Solutions at CMCSU are
detailed below.
a) The CSU Head of Governance reviewed draft responses to create an analysis of
gaps in our capability
b) The CSU complaints team are using responses approved by Assistant Interim
Accountable Officer as models for future responses
c) Reinforced the meetings between complaints and CHC team so that there is a
regular focus for complaints which relate to current CHC cases
d) Checked the process for review of all CHC complaints is still in place led by the Head
of Service for CHC
e) Recognition of the need for regular review and/or training within the CSU for all those
staff handling complaints focussing how we have the discussion with the patient to
understand their expectation and desired outcome from their complaint
f) Confirmation to the complaints team as to how the CSU CHC team share the
workload for responding to complaints depending on what the nature of the complaint
and the status of the request i.e.
a. Current CHC case
b. Dispute
c. Retrospective case post 1/4/13
d. Retrospective case pre 1/4/13
4
From the observations of the above we will review the way the responses explain NHS
CHC responsibility and accountability and use of plain English; with the intent of helping
staff and CCG colleagues understand the arrangements, and differences for CHC, FNC,
Disputes and CHC legacy claims.
5
A further internal action plan for delivery by the end of September with assistance being
provided by the CSU Service Transformation team is set out below:
Actions to be taken
A. Diagnostic of complaints 1/9/13 to 31/8/14
B. Summarise numbers and trends of complaints for CHC
C. Interviews with CSU Business Solutions Locality leads to establish their
perceptions of the difficulties the CSU has with delivering excellence for
complaints that relate to CHC & write up their views
D. Interviews with 3 Heads of Client Operations ( Debbie Fairclough; Phil
Meakin; Paul Turner) to establish their perceptions of the difficulties the
CSU has with delivering excellence for complaints that relate to CHC &
write up their views
E. Interview Paul Butler and Jill Edwards who lead on inputs to all ‘legacy’
complaints and Anne Thompson Head of Governance /Debbie Invernizzi
Centre Manager to pick up on their recent learning from involvement in
delivery of complaints responses & write up their views
NOTE. CCG staff are not being interviewed as they have previously
described their views on the process and difficulties and we do not want to
impose on their time. If any further views are available they will be fed into
review.
F. Summarise ‘evidence collated’; scope the issues and write a project plan
which describes the actions that need to be undertaken – this may
include actions for several CSU teams; CCGs, and other parties
G. Produce collateral , from existing resources which explains the difference
between the different ‘routes’ that the CHC framework/DH guidance
allows for complaints – current CHC cases; Disputes, retrospective cases
after 1/4/13; retrospective cases before 1/4/13
H. Identify resources needed and oversee implementation of plan
Costs:
6
CCG believes CHC costs are escalating and that there is a high conversion rate for
CHC. There appear to be a high number of high cost cases. CCG wants to understand
reasons and whether Wirral is different from other areas. CCG would like assurance that
authorisation process is being followed in all cases.
Actions to be taken
Taking into consideration the limited accuracy of historic data, the CHC/Complex Care Team
together with Finance will:I.
J.
K.
L.
M.
Analyse patient data on Broadcare to understand high cost patients and where possible
benchmark against other CCGs locally, regionally and nationally.
Analyse Fast track referrals to establish whether they are valid palliative care cases.
(Wirral CCG has a higher number of fast track referrals than any other CCG in Cheshire
and Wirral.)
Analyse domiciliary cases to establish trends (where data permits) and impact of District
Nursess withdrawing service via case studies.
Benchmark CHC/Complex Care (incl joint funded cases) in Wirral CCG against other
CCGs locally, regionally and nationally particularly in respect of conversion rates, costs,
numbers per 10,000 weighted population and trends around activity, cost and volume.
Describe the authorisation process including delegated authorities and a process to
provide assurance to CCGs CSU is adhering to it.
CHC/FNC review backlog:
7
CCG wants to understand extent of backlog, reasons it has occurred, risks associated
with it and plan of action to address.
Actions to be taken
N. CSU will provide up to date data that details the current position regarding the backlog of
both CHC and FNC reviews and that at the point of transition from PCT to CCG.
O. Based on the CSU’s Service Proposition document shared with CCGs in March 2014
further commentary will be provided detailing reasons why the backlog has occurred,
options to address the problem together with associated risks.
Legacy Restitution:
8
CSU has provided a monthly update report detailing progress but CCG would like to
understand more detail on progress to date, financial and activity projections and
associated risks.
Actions to be taken
P. Provide data on revised projections of both the number of claims that will progress to
decision panel, the potential claims payable and the resource required to undertake the
activity.
Q. Provide information and options on the timescales for addressing the increased number
of claims expected to progress to decision panel.
R. Meet CCG Director of Finance to review the above information.
S. Agree further actions relating to legacy restitution.
Yvonne Lochhead
Head of Continuing Healthcare and Complex Care
Cheshire and Merseyside Commissioning Support Unit
25th August 2014
Our Ref: JD
16th September 2014
Leigh Griffin
Acting Managing Director
Cheshire and Merseyside CSU
NHS Wirral Clinical Commissioning Group
Old Market House
Hamilton Street
Birkenhead
Wirral
CH41 5AL
Tel: 0151 651 0011
WICCG.InTouch@nhs.net
Dear Leigh
Notice of Service Failure: Continuing Healthcare, Complex Care, Funded Nursing Care
We are writing formally to lodge our concerns regarding failure of the Continuing Healthcare, Complex
Care and Funded Nursing Care service, provided to Cheshire and Wirral CCGs, as part of the 2014/15
Service Level Agreement. For the purposes of this letter we will refer to CHC in its broadest sense,
covering CHC, Complex Care and FNC.
As you are aware we commissioned an independent Due Diligence Review of this service, a draft of
which has been shared with the CSU and yourself for review and comment. Comments have been
received from the CSU; however, evidence has not been provided that justifies a change to the
findings of this report. The report has confirmed that there is an urgent need to re-commission the
CHC service due to clinical quality, safety and governance concerns.
Whilst it is recognised that the CSU has inherited some legacy issues from PCT’s, the CSU has failed
to address these during the last 2 years, and the service has therefore continued to experience
substantial challenges that continue to impact on the operational performance of the CHC service.
This review has highlighted a number of critical failure risks and issues associated with the service
which we have summarised below:1. CHC Service Performance
The CSU is failing to deliver a comprehensive CHC service as outlined in the SLA for 2014/15.
Levels of performance in key areas do not meet the national KPI targets and due to the significant
workload pressures experienced by the service, and subsequent prioritisation of resources, means
that 3-month and 12-month reviews are de-prioritised (see table 1 overleaf) because “they
represent a financial rather than a clinical risk”. The CSU data supplied shows there are over 200
reviews (CHC and FNC) outstanding more than 12 months and some patients could be waiting up
to 24 months before a review. Not only does this pose a potential financial risk to the CCGs, but
there is also a potential clinical risk to patients. This has been raised as a particular concern by
the CHC clinical teams.
Chair: Dr Phil Jennings
Chief Clinical Officer: Dr Abhi Mantgani
2. Clinical Leadership and Direction
There is a distinct lack of clinical strategic leadership and a lack of a transformational operating
style that is essential in order to develop a continuous quality improving service. There is little
evidence of strategic direction or of a strategic development plan showing actions taken to
improve the service going forward. We would expect, given the level of clinical risk associated
with this service, that the CSU would have in place an appropriate clinical director, operating at
Board level, who could provide the clinical oversight, leadership and assurance required when
managing such a service.
3. Capability and Capacity Issues
These issues have been widely acknowledged and recognised as a critical issue. Long-term
sickness absence has and continues to be one of the major issues affecting the management
of the service and operational delivery. The service is failing to meet its statutory targets and
key performance indicators, and services are under significant pressure despite the CHC
teams carrying a high workload and working significantly long hours to maintain service
delivery.
Additional resources have been requested by the CSU to manage operational pressures in the
service; however, we have seen no supporting evidence or case for the additional resource
requests. This has been requested on behalf of CCGs and is still awaited. We would expect
such a case to provide evidence as to the increases in activity and complexity of cases and
also a plan with timescales as to how the additional resources will be used to reduce the
operational pressures and stabilise the service.
Interim Chair: Dr Pete Naylor
Interim Accountable Officer: Mr Jon Develing
We recognise the operational challenges the service has faced, particularly in relation to
complex, long-term sickness absence and are concerned about the lack of appropriate HR
support to manage these long-standing, complex issues, which are detracting clinical staff from
direct patient contact, and therefore adding to the operational issues experienced by the
service.
It has also been acknowledged that statutory and mandatory training compliance has been
adversely affected by the workload pressures on the operational teams, difficulties accessing
some of the modules and completion of some modules not being recorded on the system.
From the data provided by the CSU, 43.5% of staff still need to complete the required training
to demonstrate compliance.
4.
Governance and Assurance
We have serious concerns regarding quality assurance, in terms of delivering the service to the
required quality standard, and in accordance with the National Framework for CHC and FNC.
We are exposed to areas of clinical, safety and financial risk where reporting is weak and
where there is no credible data/ information to provide us with the appropriate assurance.
5. Financial Management and Control
Understanding the financial risks and developing the ability to effectively forecast risk has been
a critical area of concern. There has been little or no evidence that the service is organised
and delivered to support the proactive management of CHC/ FNC costs to commissioners –
which have showed signs during Q1 14/15 of spiraling out of control. Specifically, in the latter
half of 13/14 there was instances of high cost cases incurring significant spend which were
only identified towards the end of the financial year.
6. Performance Reporting
Financial, contracting and locality reports have been produced and issued, however, these
have failed to assure the CCGs about the performance of the service, are lacking the level of
data accuracy and completeness required, and have poorly supported CCG’s from a
performance / business Intelligence perspective.
We recognise the inherited legacy position and the work that the CSU has undertaken to
reconcile a significant number of datasets and to establish more robust performance reporting
via Broadcare. The draft report produced for Eastern Cheshire CCG is a significant
improvement from previous reports and is a good platform upon which to build the performance
reporting function delivered through Broadcare. The issue of credible information and data
remains a concern and priority for the CCGs.
Summary and Conclusion
The CHC service delivered by C&M CSU has been reactive rather than proactive, failing to deliver
against national KPIs. There is a distinct lack of assurance, and concerns have been raised regarding
the robustness of financial data, poor financial forecasting as well as inconsistent performance
reporting and significant data quality issues. In relation to the latter, it should be noted that the data
quality issues have, largely resulted from inherited legacy systems and processes that the CSU is
continuing to work to resolve.
Despite the significant challenges faced by the locality teams, it should be noted that the locality teams
are highly thought of by the CCGs and have managed to sustain the operational elements of the
service during testing circumstances.
Given the areas of concern identified, and the information supplied by the CSU, it is our view that
without a fundamental change to the way in which the service is currently undertaken, there will be no
significant improvement in the delivery of these services or addressing of our concerns. Only by
triggering a change in ownership, accountability and taking direct control of the service will we feel
confident that we will be able to drive service improvements aligned to our commissioning intentions,
mitigate risk, and deliver value for money services for the patients we serve.
We now request the formal transfer of the locality teams (CHC and FNC), specialist nurses and their
associated administrative support with effect from 31 January 2015. South Cheshire CCG will host the
service on behalf of Cheshire and Wirral CCGs. We also request that the CSU establishes urgent
measures to ensure the stability of the Continuing Health Care service, prior to transition to the Clinical
Commissioning Groups at the end of January 2015. We also request that the CSU provides ongoing
assurance that a stabilised state has been established, that reduces any clinical risk to patients.
As part of Phase 2 CCGs will be reviewing associated support (contracting, quality and finance) for
those of us who commission these services from the CSU.
With kind regards
Yours sincerely
Jon Develing
Wirral CCG
Agenda Item:
5.1
Reference:
GB 14-15/0041
Report to:
Governing Body
Meeting Date:
7th October 2014
Lead Officer:
Contributors:
Laura Wentworth, Corporate Support Officer
Governance:
Link to
Commissioning
Strategy
Link
to
governing
Objectives
current The conflict of interest policy is reviewed on an
body regular basis.
The policy is designed to ensure all staff work
impartially, protect against accusations of
corruption, uphold the principles of the NHS
constitution (including Nolan principles),
uphold the reputation of Wirral CCG, promote
openness and comply with the requirements of
the Bribery Act 2010.
Summary:
The existing policy was approved by the Governing Body in March 2013.
While the principles described within the policy have not changed there
is a need to update it to reflect the changes in structure and personnel
that have been implemented since its approval. The Terms of Reference
for the Approvals Committee have also been updated and are amended
within this policy.
Recommendation:
To Approve

To Note
Comments
Next Steps:
Agree amendments to the policy & the updated Terms of Reference for the
Approvals Committee.
Conflicts of Interest Policy – September 2014
th
Governing Body – 7 October 2014
1/3
Financial
Failure to disclose direct financial benefits could damage the reputation of the
CCG.
Value For Money
Not applicable.
Risk
Robust governance arrangements are essential for the CCG to operate
effectively and these include a policy on conflicts of interest. The CCG needs
to continue to make decisions in and open and transparent manner and put in
place arrangements for dealing with any conflicts of interest.
Legal
Failure to adopt clear governance policies calls in the question the validity of
the CCG decision making process which could lead to challenge including
judicial review. The policy also describes requirements necessary to satisfy the
Bribery act 2010
Workforce
This policy is available to all staff on the Intranet and folders within the shared
drive.
Equality &
Human Rights
These policies and procedures will be applied equally to all staff covered and in
accordance with the CCG’s Equality and Diversity Policy.
Patient and
Public
Involvement (PPI)
Both the policy and the accompanying register of interests are publicly
available on the CCG website and are necessary to demonstrate to the public
that the CCG is upholding its duties as a public sector organisation.
Partnership
Working
Not applicable.
Performance
Indicators
Not applicable.
th

2/3
Report Name
Reference
Submitted to
Date
Conflict of
Interest Policy
Governing Body
June 2013
Approved amendments
Conflict of
Interest Policy
Governing Body
August
2014
Updated TOR for Approvals
Committee to be reflected within the
policy
Conflict of
Interest Policy
Governing Body
October
2014
Updated policy and TOR with
Approvals Committee
Private Business
th
3/3
CONFLICTS OF INTEREST POLICY
First
issued
by/date
Jul 2012
Issue
Version
4
Purpose of Issue/Description of Change
Reviewed in line with planned review date
and amended TOR for Approvals
Committee included
Named Responsible Officer:-
Approved by
Governing Body
Policy file: General Policy
Impact
Assessment
Screening Complete -
Planned
Review
Date
July 2016
Date
Policy No.
POL012
July 2012
Full impact Assessment
Required - No
Key Performance Indicators:
1. an annual audit of declarations of interest from the Governing Body,
Consortia Board Members, Senior Managers and staff graded 8a and above;
2. an annual audit of declarations of gifts and hospitality from all staff;
3. reminder articles to staff about this policy and the importance of compliance
with it are to be issued at least twice a year;
4. an annual report of the findings of the audits described above will be
presented to the Audit Committee and the Governing Body.
Page 1 of 3
Contents
Page
1. Introduction
3
2. Purpose of the Policy
3
3. Scope
3
4. Defining a Conflict of Interest
4
5. Direct and Indirect Financial Conflicts
4
6. Non Financial or Personal Conflicts
5
7. Conflict of Loyalties
5
8. Professional Codes, Standards, Guidance and Law
5
9. Applying Guidance to the local context
8
10. Register of Interests
8
11. Declaration of Interests
9
12. Role of the Chair
9
13. Approvals Committee
9
14. Personal: Hospitality, Gifts and Sponsorship
10
Appendices
Appendix A
References
12
Appendix B
Code of Conduct Template
13
Appendix C
Declaration of Interests Proforma
15
Appendix D
Personal Benefit Declaration Proforma
18
Appendix E
Approvals Committee Terms of Reference
19
Appendix F
Impact Assessment Screening Tool
23
Appendix G
Dissemination and Training Plan
25
Page 2 of 3
1. Introduction
1.1
Good governance is critical in the design and operation of a Clinical
Commissioning Group (CCG) in order that it acts transparently, manages
conflicts of interest and has the proper checks and balances in place to
provide assurance that decisions are taken in ways that protect patients’
best interests, promote continuous improvements in quality and provide
assurance that public money is well managed.
1.2
Governance arrangements need to combine the public accountability of an
organisation responsible for improving quality and outcomes, and spending
public money wisely, with the flexibility, culture and ways of working of a
member-led organisation.
1.3
All staff have a personal responsibility to make sure that they are not
placed in a position which risks, or appears to risk, a conflict between their
private interests and their NHS duties or allegations of their official position.
2.
Purpose of the policy
2.1
This policy is intended to:
•
Ensure staff are aware of the need to act impartially in all of their work
•
Protect all staff against the possibility of accusations of corruptive
practice
•
Uphold the established principles of business conduct within the NHS
and the public sector
•
Uphold the reputation of NHS Wirral CCG and its staff in the way it
conducts its business
•
Ensure staff do not contravene the requirements of the Bribery Act 2010
•
Uphold the principles of openness
•
Uphold the Nolan Principles (the 7 principles of Public Life)
2.2
This policy will describe the types of conflict of interest that might face
professionals involved in the CCG and highlight how conflicts of interest will
be managed to mitigate against conflicts of interest.
3.
Scope
3.1
This policy applies to all employees and appointed individuals who are
working for Wirral Clinical Commissioning Group (CCG), members of Wirral
CCG, persons serving on committees and other decision-making groups
and members of Wirral CCG Governing Body and its committees.
3.2
It applies to all areas in support of the organisation’s business objectives
both clinical and corporate.
Page 3 of 3
4.
Defining a Conflict of Interest
4.1
A conflict of interest can be defined as: “a set of conditions in which
professional judgement concerning a primary interest (such as patients’
welfare or the validity of research) tends to be unduly influenced by a
secondary interest (such as financial gain)” or a situation in which “one’s
ability to exercise judgement in one role is impaired by one’s obligation in
another”. Please note that these lists are not exhaustive and members of
staff should declare an interest if they are in any doubt as to whether it
should be recorded.
4.2
Holding of a primary care contract is not deemed as requiring a declaration
unless that provider provides additional services outside of the core
contract.
4.3
Within the CCG conflicts may arise as a result of individuals having:
• A direct financial Interest
• An indirect financial interest
• Non financial or personal interests
• Conflicts of loyalty
5. Direct and Indirect Financial Conflicts
5.1
A clear conflict of interest arises when an individual involved in taking or
influencing the decisions of an organisation could receive a direct financial
benefit as a result of the decisions being taken. Examples include:
• Holding an office or shares in a private company or business, or a
charity or voluntary organisation that may do business with the NHS.
• The implementation or alteration of an existing incentive scheme that
provides financial rewards to practices such as Local Enhanced
Services or Prescribing Incentive Schemes
• Decisions which may alter the working conditions of clinicians such
as length of working hours or days of operation.
5.2
An indirect financial interest arises when a close relative of a director or
other key person benefits from a decision of the organisation. As healthcare
providers as well as commissioners, individual healthcare professionals
sitting on the Governing Body of the CCG (and their family members or
business partners) may have commercial interests in organisations that
their commissioning group is already purchasing from or that could
potentially bid/offer to provide services that the group might procure and
fund. The positions which might create real or perceived conflict due to
financial interest include:
Page 4 of 3
• partnership (for example, in a general practice which will benefit from
a proposal) or employment in a professional partnership, for
example, limited liability partnership
• directorships, including non-executive directorships held in private
companies or PLCs
• ownership or part-ownership of private companies, businesses or
consultancies likely or possibly seeking to do business with the NHS
• shareholdings in organisations likely or possibly seeking to do
business with the NHS
• any connection with a voluntary or other organisation contracting to
provide NHS services
• research funding/grants that may be received by an individual or
their department/company.
6. Non Financial or Personal Conflicts
6.1
These occur where directors or other key persons receive no financial
benefit, but are influenced by external factors such as gaining some other
intangible benefit or kudos, for example, through awarding contracts to
friends or personal business contacts.
6.2
Even if the individuals leading a CCG do not have commercial or other
direct interests in particular services or providers, they are likely to have
long-standing professional relationships with colleagues to whom they may
have allegiances as peers, and with whom they have developed particular
ways of working over a period of time. Personal conflicts could therefore
exist when decisions are being taken that would affect such relationships in
some way.
7. Conflict of Loyalties
7.1
Decision-makers may have competing loyalties between the organisation to
which they owe a primary duty and some other person or entity. For
healthcare professionals, this could include loyalties to a particular
professional body, society or special interest group, and could involve an
interest in a particular condition or treatment due to an individual’s own
experience or that of a family member.
Page 5 of 3
8. Professional Codes, Standards, Guidance and Law
8.1
The existence of and need to manage conflicts of interest is clearly not a
new issue for the NHS and the healthcare professionals working in it, and
there are various existing sets of guidance, policy and law on which the
CCG can draw. These include:
Nolan Principles
The Nolan Committee’s Seven Principles of Public Life should underpin our
approach to conflicts of interest. These are:
• Selflessness
Holders of public office should take decisions solely in terms of the
public interest. They should not do so in order to gain financial or
other material benefits for themselves, their family, or their friends.
• Integrity
Holders of public office should not place themselves under any
financial or other obligation to outside individuals or organisations
that might influence them in the performance of their official duties.
• Objectivity
In carrying out public business, including making public
appointments, awarding contracts, or recommending individuals for
rewards and benefits, holders of public office should make choices
on merit.
• Accountability
Holders of public office are accountable for their decisions and
actions to the public and must submit themselves to whatever
scrutiny is appropriate to their office.
• Openness
Holders of public office should be as open as possible about all the
decisions and actions that they take. They should give reasons for
their decisions and restrict information only when the wider public
interest clearly demands.
• Honesty
Holders of public office have a duty to declare any private interests
relating to their public duties and to take steps to resolve any
conflicts arising in a way that protects the public interest.
• Leadership
Holders of public office should promote and support these principles
by leadership and example.
Page 6 of 3
General Medical Council (GMC)
Medical practitioners also have professional guidance to adhere to which is
published by the GMC in the ‘Good Medical Practice Guidance’. With
regards to conflict of interest it states:
• You must act in your patients’ best interests when making referrals
and when providing or arranging treatment or care. You must not ask
for or accept any inducement, gift or hospitality which may affect or
be seen to affect the way you prescribe for, treat or refer patients.
You must not offer such inducements to colleagues. (para. 1.74)
• If you have financial or commercial interests in organisations
providing healthcare or in pharmaceutical or other biomedical
companies, these interests must not affect the way you prescribe for,
treat or refer patients. (para. 2.75)
• If you have a financial or commercial interest in an organisation to
which you plan to refer a patient for treatment or investigation, you
must tell the patient about your interest. When treating NHS patients
you must also tell the healthcare purchaser. (para. 3.76)
Additionally the GMC produces specific guidance for doctors working in
management roles, such as Governing Body Members, where it states:
• You must declare any interest you have that could influence or be
seen to influence your judgement in any financial or commercial
dealings you are responsible for. In particular, you must not allow
your interests to influence:
i. the treatment of patients
ii. purchases from funds for which you are responsible
iii. the terms or awarding of contracts
iv. the conduct of research
The Bribery Act 2010
The Bribery Act 2010 replaces the fragmented and complex offences at
common law, and in the Prevention of Corruption Acts 1889-1916. This
broadly defines the two sections:
•
Two general offences of bribery – 1) Offering or giving a bribe to induce
someone to behave, or to reward someone for behaving, improperly and
2) requesting or accepting a bribe either in exchange for acting
improperly, or where the request or acceptance is itself improper;
•
The new corporate offence of negligently failing by a company or limited
liability partnership to prevent bribery being given or offered by an
employee or agent on behalf of that organisation.
Page 7 of 3
Any suggestion or suspicion of corruption or fraudulent practice should be
reported to the Local Counter Fraud Specialist – as detailed in the
Countering Fraud and Corruption Policy, Strategy and Guidance Notes
Code of Conduct: Managing conflicts of interest where GP practices are
potential providers of CCG-commissioned services
The template in appendix B sets out the factors on which our CCGs will
assure ourselves, our Approvals Committee and Governing Body and be
ready to assure our local local community, Health and Wellbeing Board and
auditors – when commissioning services that may potentially be provided
by GP practices. The setting out of these factors in a consistent and
transparent way as part of the planning process, enables us to seek and
encourage scrutiny and enables our local community and Health and
Wellbeing Board to raise questions if they have concerns about the
approach being taken.
The template is based on guidance from the NHS National Commissioning
Board in October 2012 and has been adopted for use by our Approvals
Committee – see below.
9.
Applying Guidance to the local context
9.1
Members of the Governing Body, delegated sub-committees and those
holding specific roles within the CCG agree to embody the Nolan Principles
during their work on behalf of the CCG. The same members will be held
accountable for their actions and the Chair of the Governing Body will take
ultimate responsibility for this task.
10.
Register of Interests
10.1
The CCG will maintain a register of interests for members of the Governing
Body. This will be a publicly available document. The register will be
updated whenever necessary and at least annually as an agenda item of
the Governing Body.
10.2
The Audit Committee will review the register of declared conflicts of interest
on an annual basis. This register may be subject to requests under the
Freedom of Information Act 2000 and published in an annual report or other
publication. Additionally, the register may be subject to review by the Local
Counter Fraud Specialist as part of proactive detection activity and during
referred investigations. The Register of Interests is updated six monthly and
is held by the Corporate Support Officer. A copy of the most recent register
is also available on the public facing website:
https://www.wirralccg.nhs.uk/About%20Us/Whos-Who.htm
Page 8 of 3
11.
Declaration of Interests
11.1
A standing agenda item for ‘Declarations of Interest’ will feature on the
agenda of every Governing Body and Sub Committee meeting of the CCG.
Where a perceived conflict of interest exists for a meeting member they
would be expected to declare that interest again at the start of a meeting
even if the conflict has been included in the register of interests. Governing
Body members are not expected to reiterate all potential conflicts of interest
contained within the register routinely at every meeting.
11.2
Declarations of Interest should be submitted to the Head of Corporate
Affairs on the Declaration of Interests Proforma (see appendix B)
12.
Role of the Chair
12.1
Once a conflict of interest has been identified it is the responsibility of the
Chair of the meeting to determine, by committee discussion if necessary,
the extent to which the individual(s) can further contribute to the meeting.
Depending on the nature of the conflict the chair will decide whether to:
• permit contribution, as conflict considered immaterial to discussion
• exclude from any discussion on the specific item
• exclude from any vote on the specific item
• exclude from the room during any discussion or vote on the specific
item
12.2
Once a decision has been made it will be recorded for the minutes of the
meeting.
12.3
When the conflict of interest relates to the Chair, an alternate Chair without
such a conflict of interest will stand in. In the case of the Governing Body
the Lay Member with portfolio for Governance and Audit will chair that item
of discussion in the meeting.
13.
Approvals Committee
13.1
In situations where there are insufficient decision makers available after
exclusion of those with relevant interests to enable effective decision
making or management action, the matter will be conveyed to the
Approvals Committee.
13.2
The purpose and role of the Approvals Committee is to scrutinise and
approve, with or without conditions or reject commissioning decisions
where a potential conflict of interest has been identified for the GP
membership of the CCG Governing Body or Consortia Boards. This will
help the CCG to ensure and demonstrate to its stakeholders that all of its
commissioning decisions are made selflessly, fairly, transparently and with
independent scrutiny.
Page 9 of 3
13.3
The Approvals Committee reports to the Governing Body, and its terms of
reference have been established and approved by the Governing Body.
13.4
The Approvals Committee terms of reference including its membership are
described in the attached Appendix E:
14.
Personal: hospitality, gifts and sponsorship
14.1
Under the Prevention of Corruption Act 1916, any money, gift or
consideration received by an employee in public service from a person or
organisation holding or seeking to obtain a contract will be deemed by the
courts to have been received corruptly unless the employee proves to the
contrary.
Guidance from the Audit Commission and the Nolan Committee reiterated
the importance and continued applicability of the legislation to all those
involved in work for public bodies.
14.2
Some approaches may be at a personal level where an individual member,
director, or employee receives hospitality, a gift, or sponsorship from a
company or an individual. All CCG staff are required to record the receipt of
hospitality, gifts or sponsorship, seeking prior approval where required by
this policy.
14.3
All hospitality, gifts and sponsorship accepted or declined should be
declared to the Secretary to the Board/Chief Operating Officer using the
form supplied, as Appendix C.
14.4
In cases of doubt, advice must be sought from your line manager and in no
case must the value of the gift exceed £25 limit without prior approval of the
Accountable Officer.
Hospitality
14.5
Hospitality, provided it is normal and reasonable in the circumstances, may
be accepted but must always receive prior approval; retrospective
recording in the register is not acceptable.
14.6
Modest incidental hospitality (e.g. refreshments) may be accepted without
prior approval; modest incidental meals in the course of working visits may
also be accepted provided the value of the meals do not exceed the cost
that would otherwise be reimbursable by the NHS as an employer.
Casual gifts
14.7
The Register must be used for declaring all hospitality offered, but
excluding small items such as pens and calendars not exceeding £25 in
value. However, gifts should be declared if several small gifts worth a total
of over £100 are received from the same or closely related source in a 12
month period.
Page 10 of 3
14.8
It is also acceptable to receive other small value items, for example from a
patient or relative in appreciation of the treatment and care received, or
seasonal items, if it is made clear to the offerer that it is accepted on behalf
of the Consortium or Practice (and indeed is shared with colleagues), or is
to be donated to the organisation’s Charitable Fund.
14.9
Any other offers of personal gifts should be politely declined.
Cash
14.10 Under no circumstances must anyone to whom this policy applies accept
personal gifts of cash, even below the £25 threshold. It is permissible for
staff to accept cash donations to the organisations charitable funds, subject
to a receipt being issued and the cash being banked through the
organisations cash office.
Sponsorship
14.11 Commercial sponsorship for staff attendance at relevant conferences and
courses is acceptable, but only where permission is sought in advance from
your line manager. The CCG must be satisfied that acceptance will not
compromise purchasing decisions in any way.
Page 11 of 3
APPENDIX A - REFERENCES
BMA Ensuring Transparency and Probity Available at
http://www.lmc.org.uk/article.php?group_id=2182
Bribery Act 2010 Available at
http://www.legislation.gov.uk/ukpga/2010/23/pdfs/ukpga_20100023_en.pdf
GMC good practice guidance Available at http://www.gmcuk.org/guidance/good_medical_practice.asp
‘Managing conflicts of interest in clinical commissioning groups Available at
http://www.england.nhs.uk/wp-content/uploads/2013/04/ccg-conflict-int-guide.pdf
Nolan report Available at http://www.archive.officialdocuments.co.uk/document/parlment/nolan/nolan.htm
Prevention of Corruption Act 1916 Available at
http://www.legislation.gov.uk/ukpga/1916/64/pdfs/ukpga_19160064_en.pdf
Standards for members of NHS boards and governing bodies in England. 2012.
Council of Healthcare Regulatory Excellence
http://www.professionalstandards.org.uk/docs/psa-library/november-2012--standards-for-board-members.pdf?sfvrsn=0
‘Towards Establishment: creating responsive and accountable clinical
commissioning groups’ Available at http://www.england.nhs.uk/wpcontent/uploads/2012/09/towards-establishment.pdf
Page 12 of 3
APPENDIX B
NHS Wirral Clinical Commissioning Group Approvals Committee Template
Date of Approvals committee:
Insert date
Scheme title:
Consortia :
Lead Officer:
Procurement route:
Source of Resource:
Total Value:
Duration of scheme:
What authority exists at what level in the Scheme of Delegation for this
scheme?
Describe scheme:
Précis here and attach detail. How does the scheme
deliver good or improved outcomes and value for money – what are the estimated
costs and the estimated benefits? How does it reflect the CCG’s commissioning
priorities?
How have you determined a fair price for the service?
How have you involved the patients in the decision to commission this
service?
What range of partner health professionals have been involved in designing
the proposed service?
Page 13 of 3
What range of potential providers have been involved in considering the
proposals?
How does the proposal support the priorities of the CCG strategy? [When a
joint health and wellbeing strategy is in place it should also be referenced here].
What are the proposals for monitoring the quality of the service?
What systems will there be to monitor and publish data on referral patterns?
Have all conflicts and potential conflicts of interests been appropriately
declared and entered in registers which are publicly available?
Why have you chosen this procurement route?
If AQP: How will you ensure that patients are aware of the full range of qualified
providers from whom they can choose?
If Single Tender from GP Provider - What steps have been taken to demonstrate
that there are no other providers that could deliver this service?
In what ways does the proposed service go above and beyond what GP
practices should be expected to provide under the GP contract?
What assurances will there be that a GP practice is providing high-quality
services under the GP contract before it has the opportunity to provide any
new services?
Other information
□
□
□
□
Approved
Approved with conditions
Referred back to ______________________ for revision
Rejected
Page 14 of 3
APPENDIX C
REGISTER OF INTERESTS
YEAR 2014-2015
Please indicate which group/committee to which you are a member by placing a X in the box
below:Governing Body Meeting
Committee
Quality, Performance & Finance
Clinical Strategy Group/QIPP Team
Consortium
Wirral Alliance Commissioning
Wirral Health Commissioning Consortium
Wirral GP Commissioning Consortium
Audit Committee
I have read and understood the CCG Conflict of Interest Policy and hereby declare the following
interests:-
DIRECT FINANCIAL INTEREST (if you have no interests in this category, state ‘NONE’)
INDIRECT FINANCIAL INTEREST (if you have no interests in this category, state ‘NONE’)
NON-FINANCIAL OR PERSONAL INTEREST (if you have no interest in this category, state
‘NONE’)
CONFLICT OF LOYALTIES (if you have no conflict in this category, state ‘NONE’)
Signature:
…………………………………………………………………………………………………………………
Name (please print):
Date:
Page 15 of 3
Guidance Note for Completion of the declaration form
This form must be completed by all members of NHS Wirral CCG Governing Body
and updated as interests change or new interests are identified. It should also be
completed by any employees or other persons serving on NHS Wirral CCG
subcommittees or decision making groups.
Recognised interests that must be declared include:
1. directorships, including non-executive directorships held in private companies
or public limited companies (with the exception of those of dormant companies)
2. ownership or part ownership of companies, businesses or consultancies which
may seek to do business with the CCG
3. significant share holdings (more than £25,000 or 1% of the nominal share
capital) in organisations which may seek to do business with the CCG
4. membership of or a position of trust in a charity or voluntary organisation in the
field of health and social care
5. receipt of research funding / grants from the CCG
6. interests in pooled funds that are under separate management (any relevant
company included in this fund that has a potential relationship with the CCG must
be declared)
7. formal interest with a position of influence in a political party or organisation
8. current contracts held with the CCG in which the individual has a beneficial
interest
9. any other employment, business involvement or relationship or that of a spouse
or partner that conflicts, or may potentially conflict with the interests of the CCG.
Where individuals are unsure whether a situation falling outside of the above
categories may give potential for a conflict of interest they should seek advice
from the Head of Corporate Affairs or Corporate Support Officer.
Page 16 of 3
APPENDIX D
Personal Benefit Declaration
Any offers of hospitality, personal gifts (other than inexpensive items, such as
pens/calendars etc.) and sponsorship should be declared. Gifts of over £25 in
value and offers of hospitality and sponsorship should be authorised by your line
manager and for gifts, personal hospitality or sponsorship over the value of £200,
authorisation from the Accountable Officer must be sought;
Authorisation must be PRIOR to acceptance.
Name:
Job title:
Consortium:
Telephone
number
Details of the benefit
Name of organisation or individual
providing benefit
Nature and purpose of benefit
Date
Estimated value
Other information
Decision of person offered benefit
Declined
Accepted
If accepted, please have this form authorised by your line manager
Signed
Date
Authorisation by Line Manager/Accountable Officer (Limit is £200 – larger sums
must be authorised by the Chief Executive)
Yes
No
Reason for non authorisation
Name of Manager declining
Page 17 of 3
Signature
Date
Please submit this form to Head of the Corporate Affairs, NHS Wirral CCG,
for inclusion In the Hospitality, Gifts and Sponsorship Register
Page 18 of 3
APPENDIX E – APPROVALS COMMITTEE TERMS OF REFERENCE
NHS Wirral Clinical Commissioning Group Approvals Committee
Terms of Reference
1)
Introduction
An essential feature of the reforms introduced by the Health and Social Care Act
(2012) is that Clinical Commissioning Groups should be able to commission a
range of community based services to improve quality and outcome for patients.
Clinical Commissioning Groups can also make payments to GP practices for
“promoting improvements in the quality of primary medical care (e.g. reviewing
referral and prescribing)
To help them manage potential conflicts of interest associated with such
commissioning decisions, the NHS Commissioning Board has issued guidance, a
Code of Conduct and an associated decision making template. These documents
are designed to help Clinical Commissioning Groups demonstrate that they are
acting fairly and transparently and that members will always put their duty to
patients before any personal financial interest.
The Governing Body of NHS Wirral Clinical Commissioning Group (the CCG) and
the Boards of the constituent Wirral GP, Wirral Health and NHS Alliance Consortia
(the Consortia ) have a majority of GP members. It is anticipated that situations
will arise where a conflict of interest may exist for these members when
considering commissioning decisions by the CCG or Consortia. In such cases
where all or most of the GPs on a decision making body could have a material
interest in a decision, there is specific advice in the above mentioned Code of
Conduct. In essence the advice is to ensure that GPs and other practice members
who may have a potential conflict are excluded from the decision making process.
In following this advice it is therefore necessary to implement an additional
mechanism to support the Governing Body in making these commissioning
decisions.
The Governing Body has previously agreed through its Conflict of Interest Policy
that this additional mechanism should be an Approvals Committee. Pending full
authorisation of the CCG by the NHS National Commissioning Board, committee
structures and other organisational arrangements are made on an interim basis.
The tenure of the Interim Approvals Committee therefore will be until the 31st
March 2013 when a substantive Approvals Committee will be established.
The Interim Approvals Committee (the Committee) is established in accordance
with the CCG’s Constitution, Standing Orders, Scheme of Delegation and
Conflicts of Interest policy. These terms of reference set out the membership,
remit, responsibilities and reporting arrangements of the Committee and shall
have effect as if incorporated into the Constitution and Standing Orders. The
Committee has no executive powers other than those specifically delegated in
these Terms of Reference.
Page 19 of 3
2) Purpose
The purpose and role of the Committee is to scrutinise and approve with or without
conditions and/or reject commissioning decisions where a potential conflict of
interest has been identified for the GP membership of the CCG Governing Body or
Consortia Boards. This will help the CCG to ensure and demonstrate to its
stakeholders that all of its commissioning decisions are made selflessly, fairly,
transparently and with independent scrutiny.
3) Membership
•
•
•
•
•
•
•
•
•
Chair (Lay Member, Lead for Governance and Audit)
Lay Member (Patient Champion)
Lay Advisor (Audit Committee Lay Advisor)
Lay Advisor (Audit Committee Lay Advisor)
Patient Member
Head of Quality & Performance / Corporate Nurse
Chief Finance Officer
Consortia Chief Officers
- voting
- voting
- voting
- voting
- voting
- voting
- voting
- non voting
- non voting
Should it be required the Chair of the meeting will have a casting vote.
The CCG Chair and/or Chief Clinical Officer may attend to advise where
appropriate.
Any governing body member who is not a member of the Committee may attend
as a non-voting observer with the prior agreement of the Chair of the Committee.
The meetings will be chaired by the Lay Member (Governance and Audit) in the
absence of whom the meeting will be chaired by the Lay Member (Patient
Champion) or if he is unavailable by one of the other Lay Advisors or Patient
Member.
Attendance (in a non-voting capacity) will also be expected from the the Head of
Corporate Affairs who will make arrangements to ensure that the Committee is
supported administratively. Duties in this respect will include taking minutes of the
meeting and providing appropriate support to the Chairman and committee
members.
4)
Quorum
A quorum will be three voting members (including at least one of the two of the
Lay Member/ Advisors, and at least one of the Director of Public Health / Head of
Quality & Performance (Corporate Nurse). The other members would constitute
of at least two of the other members (including Consortia Chief Officers or Chief
Finance Officer)
5)
Frequency and notice of meetings
Page 20 of 3
The Committee will meet when required to consider proposals coming from the
governing body or consortia boards after the Governing Body Chair has deemed
that commissioning decisions are unable to be reached in the governing body or
consortia board due to potential conflicts of interests for members of those bodies.
Consortia Boards may refer directly to the Approvals Committee when they
identify a potential Conflict of Interest and are encouraged to do so.
The Approvals Committee are authorised by the CCG Governing Body
exceptionally to call in for review and scrutiny, commissioning decisions made by
either the Consortia Boards or Governing Body when they believe there may be a
potential for unresolved conflicts of interest in the commissioning process.
Agendas and papers will be sent out 7 days before the meeting is held. Action
points will be sent out within 48 hours of the meeting occurring. Full minutes will
be available within 2 weeks of the meeting.
To ensure there is minimum delay within the process, a monthly schedule of
meetings of the Committee will be arranged over a 12 month schedule. If no
proposals are received within 7 days of the scheduled meeting date, that meeting
will not take place.
6)
Remit and responsibilities of the Committee
The Committee will review and reach an agreement on all matters relating to the
commissioning of health services in circumstances where the Governing Body or
Consortia Board cannot do so without independent scrutiny due to potential
conflicts of interest. The Committee may approve with or without further
conditions, reject or refer back to the originating body for further development, any
proposal reviewed and not approved.
7)
Relationship with the Governing Body
The minutes of the Committee shall be formally recorded by the Committee
Secretary and submitted to the Governing Body. The Chair of the Committee shall
draw to the attention of the Governing Body any issues that require disclosure to
the full Board, or require executive action. The Committee will produce an annual
report on the decisions it has taken and submit for the Board’s consideration.
8) Policy and best practice
In order to facilitate the achievement of good governance, the Committee is
authorised to:
•
Seek any information it requires from any employee and all employees
are directed to co-operate with any request made by the Committee.
•
Use of the amended version of the NHS Commissioning Board Conflicts
of Interest Template when gathering information about commissioning
proposals to help support its decision making.
•
Obtain outside legal or other independent professional advice and/or
secure the attendance of outsiders with relevant experience and expertise if it
considers this necessary.
Page 21 of 3
•
Use core national criteria when assessing clinical decisions and ensure
that commissioning proposals support the strategic intentions of the CCG
9)
Conduct of the Group
When discharging functions delegated to it by the Governing Body the
Approvals Committee, and its individuals members must:
•
Conduct its business in accordance with Nolan’s Seven Principles of Public
Life.
•
Ensure that any relevant national guidance is adhered to.
These Terms of Reference shall be reviewed annually by the Governing Body,
with recommendations made for any amendments in line with development
requirements.
Date Agreed:
August 2014
Review Date:
August 2015
Page 22 of 3
APPENDIX F - IMPACT ASSESSMENT SCREENING TOOL
1. Initial Screening Process
1.1 Title of the policy/procedure/function/service
Conflict of Interest Policy
1.2 Directorate/Department
Governing Body
1.3 Name of the person responsible for this Equality Impact Assessment
Helen Jones
1.4 Date of Completion
July 2012
1.5 Aims and Purpose of this policy/procedure/function/service
The aim is to provide guidance to all employees regarding what constitutes a conflict of
interest in relation to their official position as an NHS employee.
1.6 Is this a new or existing policy/procedure/function/service
New
1.7 Examination of Available Evidence – Tick evidence used
Census Data for UK
_
Census Data for London
_
Census Data for Local Authority Area
_
Trust Workforce Data
_
Trust Patient Data
_
National Patients Survey
_
Trust Patients Survey
_
Complaints Summaries
_
Other Internal Research/Survey/Consultation/Audit (please list)
Other External Research/Survey/Consultation/Audit (please list)
BMA Ensuring Transparency and Probity
Bribery Act 2010
GMC good practice guidance
‘Managing conflicts of interest in clinical commissioning groups
‘Managing conflicts of interest. Technical Appendix 1.
The Nolan report
Prevention of Corruption Act 1916
Page 23 of 3
Standards for members of NHS boards and governing bodies in England. 2012.
Council of Healthcare Regulatory Excellence
‘Towards Establishment: creating responsive and accountable clinical commissioning
groups’
What is the summary of the available evidence?
It is an offence under the Prevention of Corruption Acts 1906 and 1916 for an
employee to corruptly to accept any inducement or reward for doing or refraining from
doing anything in their official capacity; or corruptly showing favour, or disfavour in the
handling of contracts.
This policy sets the CCG’s professional expectations in the work environment and
encourages transparency in dealing with external organisations or negotiating
contracts. Employees are required to declare any interests to the Governing Body
Secretary.
1.8 Does the evidence indicate that there is, or is the potential to be any significant
impact on anyone or any group in relation to the following equality strands?
No
Strand
Justified Yes/No
Ethnicity/Race
Yes/No/Insufficient
Data
No
Disability
No
N/A
Gender/Sex
No
N/A
Religion/Belief
No
N/A
Sexual Orientation
No
N/A
Age
No
N/A
Human Rights
No
N/A
N/A
If further evidence is required to complete this section, take steps to obtain to before
proceeding with the assessment. If the review of evidence indicates that there is a
significant unjustified impact, a Full Equality Impact Assessment must be carried out.
1.9 No further evidence Required. Skip to Section 5.
√
1.10 Full Equality Impact Assessment required.
Page 24 of 3
No
To ensure the residents of Wirral enjoy the best quality of life possible, being supported to make informed
choices about their own care, and being assured of the highest quality services.
Vision 2018 bulletin
Issue 3
Contents
General Update .......................................................................................................... 1
Programme & Governance Structure ......................................................................... 1
The Engagement with People Group ......................................................................... 2
Next Steps.................................................................................................................. 2
Vision 2018 in action - meet Mike: ............................................................................. 3
General Update
It may have been the holiday season but the pace has been quickening for Vision
2018!
If you haven’t already done so, have a look at the new Vision 2018 pages on the
CCG website: www.wirralccg.nhs.uk/vision2018. They are packed with background
information about the challenges facing the NHS and local government, and how
Vision 2018 aims to address them.
There are details of how we are already implementing some of the changes people
have suggested we make to improve their experience of health and social care
services, links to resources to help you lead a healthier lifestyle, and information
about how you can get involved. We’re also going to add a ‘Q&A’ section – watch
this space!
Programme & Governance Structure
Welcome to Terry Whalley, who has joined the CCG to lead Vision 2018 on
a placement from the NHS Leadership Academy (as part of the national
Fast-track Executive Development programme). His placement is being
funded by the Leadership Academy until March 2015, and is a fantastic
opportunity for us to make use of Terry’s skills and experiences from outside
the NHS as we move into the next critical phases of Vision 2018.
Terry will lead the Vision 2018 Programme Management Office and direct the efforts
of all the programmes of work within Vision 2018.
Work-streams
As described in the previous bulletin, we have established a new shape to
Vision 2018 which allows us to focus our efforts on 3 key areas; Planned Care,
1
Unplanned Care and Long Term Care. We have also a number of enabling
work-streams, for example Integration Adults, which focuses on the
development of integrated teams, services and systems to provide coordinated
care for people aged over 18.
We have done more work to ensure we have really clear strategic outcomes
defined for Vision 2018 - these are now being refined and will be shared in the
next bulletin. Each of the work-streams is now developing a detailed definition
of scope to ensure its aims and objectives are linked back to these strategic
outcomes. This will enable a clear description of how those work-streams will
enable benefits that will ultimately improve health outcomes for the people of
Wirral together with their experience of health care. At the same time,
balancing quality and value to improve the efficiency of services delivered will
be the third major consideration for each work-stream.
In addition to considering these longer term changes, each of the workstreams is now also considering the things that can be done quickly to start to
make a real difference in 2015. It is important that we balance the need to reimagine health and wellbeing in 2018 and consider how best we achieve this
future state vision with the need to make real and practical improvements to
the services we have today. It is this balance that the Vision 2018 team is now
focused on achieving. We’ll bring you more on this in next month's bulletin.
The Engagement with People Group continues to provide invaluable input
into how we engage with people about Vision 2018, ensuring we engage
with ALL Wirral communities. This group includes representatives from many
community groups and networks across Wirral. If you would like to join,
please get in touch.
Next Steps
A series of ‘patient characters’ are currently being developed. Based on real
life stories, these will illustrate how different people will benefit from the
changes Vision 2018 will bring (see Mike’s story below). They will also
enable those involved in developing patient pathways to have an
understanding of the impact that different pathway options could have on the
patient.
Vision 2018 posters and leaflets are also being produced, to help inform
Wirral residents about some of the key challenges and proposals.
Furthermore Vision 2018 will be presented at a number of events over the
coming months. These include International Older People’s Day (1 st
October) and Youth Voice Conference (16th October). More details to follow
on the website.
2
Vision 2018 in action - meet Mike:
Mike is a 61 year old widower, who lives in Tranmere. He is unemployed (following
redundancy), smokes and had COPD. He frequently goes to A & E and gets
admitted to hospital because he forgets to take his medications. He struggles to
manage household tasks, isn’t sleeping well and has recently lost weight. He also
suffers from breathlessness, constant coughing and tiredness.
Previously:



Mike would have seen his GP for support, been given medication and referred
for tests for his breathlessness, constant coughing and tiredness.
His condition may have deteriorated because his management of his health
hasn’t changed, leading to hospital admissions.
If he doesn’t start to manage his health, Mike may die earlier than necessary.
What happens to Mike under Vision 2018:




Mike sees his GP because he is struggling to cope with the loss of his wife
and is smoking more.
His GP contacts the Integrated Care Co-ordination Team , which identifies
local support to help Mike to give up smoking, and to meet with other people
who have suffered bereavement.
A care plan is developed and implemented, including:
 A pharmacist to review Mike’s medication with him, and plan how to
treat future flare ups
 A dietician to help Mike manage his medication and diet
 Assistive Technology and telehealth so his condition can be monitored
remotely
 Mental Health practitioner support to help Mike in coping with his loss
 Benefits advice in managing finances since his redundancy
Mike goes on to be a peer mentor, helping other people with similar
experiences.
If you have any questions about Vision 2018, or would like to get involved,
please contact WICCG.InTouch@nhs.net or 0151 651 0011
3
Commissioning Plan 2014-19 – Final Draft
Agenda Item:
5.4
Reference:
GB14-15/0041
Report to:
Governing Body
Meeting Date:
Lead Officer:
Iain Stewart, Chief Officer, Wirral Alliance Consortium
Contributors:
Governance:
Link to
Commissioning
Strategy
Preventing people from dying prematurely
Enhance the quality of life for people with longterm conditions
Helping people to recover from episodes of ill
health or following injury
Ensuring people have a positive experience of
care
Ensuring people are treated and cared for in a
safe environment and protected from
avoidable harm
Link to current
governing body
Objectives
Summary:
NHS Wirral CCG has developed its strategic plan for the
healthcare of the Wirral population describing how the health
needs of the population today and into the future will be met
through the commissioning (planning and buying) of high quality,
best value health services. The strategic plan covers the period
2014-2019 and sets out the fundamental changes required for how
services must be delivered in order to meet the on-going challenge
of an ageing population, living longer with long-term medical
conditions coupled with a worsening life expectancy gap
dependent upon where someone is born on Wirral, whilst planning
for reducing financial allocations over the next five years.
The CCG has also produced its 2 year Operational Plan 2014-16
which effectively commences the journey to achieving the stated
aims and objectives of the strategic plan by 2019. The Operational
Plan is constructed on key characteristics of a successful,
sustainable health care system;
- wider primary care, provided at scale
- modern model of integrated care
- access to the highest quality urgent and emergency care
- a step change in the productivity of elective care
This Commissioning Plan sets out to describe the commissioning
intentions of the CCG that will be undertaken in order to support
1/4
the priority plans between 2014-19.
The CCG will apply the following principles in its commissioning
approach;
- Cost = price
- Patients versus Spells
- Transitional relief
- Delivery
- Integration (where it makes sense to do so)
- Move from an over “medicalised” model to rewarding
innovation
- Making best use of quality payments
- Use of health economy CQUINs to drive transformation
- Consideration of savings impact – Provider Cost
Improvement Programmes versus Health System
savings
- More robust evaluation alongside contract monitoring
These principles are designed to support and achieve the
transformation of local health services which will remain
high quality and value for money, and provided in an
improved cohesive and integrated way so as to enable
innovation to meet rising healthcare demands with
increasing financial challenges.
The CCG knows what health outcomes it wishes to achieve
for Wirral patients and it knows which priority plans it wishes
to action in order to achieve those outcomes.
Recommendation:
To Approve
To Note
√
Comments Work is currently continuing on the development of an
agreed single model of Urgent Care provision for the
Wirral health economy.
Next Steps:
Further refinement to commissioning intentions to support contracting for 2015/16
and stepped progress in the description of an agreed single model of urgent care
provision for Wirral.
Commissioning Plan for 2014-19 to be approved by Governing Body at November
2014 meeting.
2/4
Financial
The continuing pressure on CCG allocations and the implementation of the
Better Care Fund (pooled budgets) requires targeted and robust
commissioning actions to secure the full range of high quality, best value local
health services to meet the increasing health needs of the Wirral population.
Value For Money
An ageing population with associated long-term co-morbidities provides the
challenge to the CCG to ensure the available financial allocations for health
services are placed into commissioned services that offer high quality
outcomes and best value investment. Innovative ways of service delivery; a
focus on the integration of service provision; and increased joint
commissioning with Social Care commissioners are approaches that the CCG
must pursue in order to continue to meet the stated health system challenges.
Risk
The Better Care Fund (pooled budgets) is a significant proportion of the CCG
financial allocation and its use for social care that derives a health benefit must
deliver both transactional and transformational outcomes that equal the historic
healthcare activity costs where the CCG has traditionally spent its allocation
across mainstream health providers. A poorly executed Better Care Fund will
represent a significant risk to the CCG and local health economy.
Legal
The CCG has a legal duty to achieve financial balance. The failure to
commission high quality, best value services that will likely lead to budgetary
overspends, will impact on this statutory requirement.
Workforce
This Commissioning Plan will necessitate a requirement to ensure the current
CCG workforce continue to be readily skilled and capable to implement the full
range of work-related activities generated by the commissioning intentions.
Equality &
Human Rights
Any change to commissioned services must be undertaken in consideration of
not impairing/worsening patients’ rights. The considerations and
recommendations in this document are designed to continue the securing of
healthcare services that meet the current health needs of the Wirral population,
based upon agreed evidenced CCG objectives and supported by data from the
Joint Strategic Needs Assessment (JSNA).
Patient and
Public
Involvement (PPI)
Further to the involvement by local patients and public in the development of
the CCG Strategic Plan, informed by the iterative Joint Strategic Needs
Assessment, this Commissioning Plan is a clinical and managerial response to
operationalize the achievement of the stated strategic objectives.
Partnership
Working
The progress of Vision 2018 and the development of key programme scopes
have informed the compilation of this Commissioning Plan and those
programme scoping summaries are included as appendices within the Plan.
Engagement with Providers through the contract monitoring process has
informed and directed the key commissioning intentions included in this Plan.
Performance
Indicators
The agreed CCG Strategic Plan outcomes along with NHS Outcomes
Framework and NHS Constitutional standards form the performance
framework for this Commissioning Plan to help achieve.
(If not, please note that it may still be subject to disclosure under Freedom of Information 3/4
Freedom of Information Exemptions
Report Name
Reference
Submitted to
Date
Private Business
4/4
2014 – 2019
Commissioning Plan
September 2014 – Final Draft v1
Page 1
Contents
1) Introduction ................................................................................................................................................................. 3
2) Commissioning Programmes................................................................................................................................... 5
2.1 Wider primary care, provided at scale .............................................................................................................. 5
2.2 Model of modern integrated care ...................................................................................................................... 7
2.3 Access to the highest quality urgent and emergency care ......................................................................... 10
2.4 Step change in the productivity of elective care ........................................................................................... 12
2.5 Better Care Fund ............................................................................................................................................... 14
2.6 Outcomes Framework Indicators .................................................................................................................... 15
2.7 NHS Constitution standards............................................................................................................................. 18
Appendices ................................................................................................................................................................ 19
Appendix 1 – NHS Outcomes Framework Indicators ......................................................................................... 19
Appendix 2 – Vision 2018 Summary Programme Documents .......................................................................... 20
Appendix 3 – Potential Years of Life lost from causes considered amenable to healthcare by Disease
group. ......................................................................................................................................................................... 23
Appendix 4 – QIPP Plan 2014 / 15 ........................................................................................................................ 25
Appendix 5 – Urgent Care Strategy ...................................................................................................................... 41
Page 2
1) Introduction
NHS Wirral CCG has developed its strategic plan for the healthcare of the Wirral population
describing how the health needs of the population today and into the future will be met through the
commissioning (planning and buying) of high quality, best value health services. The strategic plan
covers the period 2014-2019 and sets out the fundamental changes required for how services
must be delivered in order to meet the on-going challenge of an ageing population, living longer
with long-term medical conditions coupled with a worsening life expectancy gap dependent upon
where someone is born on Wirral, whilst planning for reducing financial allocations over the next
five years.
The CCG has also produced its 2 year Operational Plan 2014-16 which effectively commences the
journey to achieving the stated aims and objectives of the strategic plan by 2019. The Operational
Plan is constructed on key characteristics of a successful, sustainable health care system;
-
wider primary care, provided at scale
modern model of integrated care
access to the highest quality urgent and emergency care
a step change in the productivity of elective care
The CCG has a duty to continue to improve local services in line with agreed national outcomes as
detailed with the NHS Outcomes Framework indicators (see Appendix 1).
In 2014/15 and 2015/16 the CCG will focus upon improving its relative performance on the
following indicators:
•
•
•
Emergency admissions for alcohol-related disease
Emergency readmissions within 30 days of discharge from hospital
Emergency admissions for children with lower respiratory tract infections
The NHS Constitution affords patients in the NHS the legal expectation that certain national
standards are achieved.
As such, in 2014/15 and 2015/16 the CCG will focus on improving its performance against the
following standards:
•
•
•
RTT waiting times for non-urgent consultant-led treatment
A&E waits
Diagnostic test/waiting times
The CCG will apply the following principles in its commissioning approach;
-
Cost = price
Patients versus Spells
Transitional relief
Delivery
Integration (where it makes sense to do so)
Move from an over “medicalised” model to rewarding innovation
Page 3
-
Making best use of quality payments
Use of health economy CQUINs to drive transformation
Consideration of savings impact – Provider Cost Improvement Programmes versus
Health System savings
More robust evaluation alongside contract monitoring
These principles are designed to support and achieve the transformation of local health
services which will remain high quality and value for money, and provided in an improved
cohesive and integrated way so as to enable innovation to meet rising healthcare demands
with increasing financial challenges.
The CCG knows what health outcomes it wishes to achieve for Wirral patients and it knows
which priority plans it wishes to action in order to achieve those outcomes. This
Commissioning Plan sets out to describe the commissioning intentions of the CCG that will
be undertaken in order to support the priority plans between 2014-19.
Page 4
2) Commissioning Programmes
2.1 Wider primary care, provided at scale
WHAT
OUTCOMES
1
2
Proactive
coordination of care
for complex patients
and those with a
long term condition.
Address physical,
mental health and
social care needs
holistically.
HOW
PLANS
INTENTIONS
•
•
•
•
•
•
3
Fast and responsive
access to care to
reduce emergency
admissions.
•
•
•
New local GP contract
offer
Mapping of community
services to inform
primary care
communities
New local GP contract
offer
New Primary Care
Mental Health service
in place
Mapping of community
services to inform
primary care
communities
Improving access to
GP practice care
Primary care
communities fully
formed
Review of GP OOH
•
•
•
•
•
•
•
•
4
Promote health and
well-being and offer
rapid access to
diagnosis.
•
Training needs analysis
of primary care staff,
and up-skilling
programme
•
•
•
5
Support patients and
cares to manage
their own health and
well-being.
•
Accountable clinician
for over 75’s
•
Support practices
to maximise
uptake of the
Unplanned
Admissions DES
Primary Care
staff to be part of
the integrated
care MDT
meetings to plan
care for the most
complex
Commission
community
mental health
nurses to work
alongside primary
care clinicians as
part of integrated
teams
Define an agreed
model of Primary
Care at scale
Develop the
agreed model
into working
proposal
Implement the
agreed model
Review working
model
Renew BME
Health Link
Worker Service
Review BME
Health Link
service as part of
all 3rd sector
services
Launch of new
community
phlebotomy
service with
faster access for
those requiring
urgent
appointments
All warfarin
monitoring to
move into the
community
Investment in
general practice
for review of over
75s with caring
responsibilities,
and those who
are housebound
and / or live alone
Investment in
General Practice
to keep a register
of carers and to
undertake regular
Page 5
2014/15
WHEN
2015/16
2016/17
2017/18
*
*
*
*
*
*
*
*
*
*
*
*
*
*
•
6
Ensure consistent
high quality / safe
and effective care.
•
•
Training needs analysis
of primary care staff,
and up-skilling
programme
Primary Care outcomes
scorecard
•
•
•
•
reviews of elderly
carers
Commission
Alzheimer’s
Society Dementia
Advisor to offer
advice and
support to carers
of those with
dementia
Develop a quality
dashboard for
General Practice
Revised
specification for
GP OOH to
ensure a more
accessible and a
high quality
service
Put into place a
system for GP
Practices to
report serious
incidents and soft
intelligence on
patient
experience
Work with NHS
England to
explore cocommissioning of
primary care
contracts, with a
focus on
improved quality
and reduced
bureaucracy for
General
Practices
*
*
*
*
*
The current central tenet for the CCG in relation to commissioning primary care is focused upon
the quality of primary care. In order to achieve all of the stated strategic plan outcomes the CCG
will need to quickly move to working with NHS England in the co-commissioning of primary care in
one of the 3 categories of interest:
•
•
•
Category A – Greater involvement
Category B – Joint commissioning
Category C – Delegated authority
“Wider Primary Care, delivered at Scale” will be defined and agreed by the CCG and its
constituent member practices by March 2016 with full implementation of the agreed model by April
2017.
Page 6
2.2 Model of modern integrated care
WHAT
OUTCOMES
7
Reduce non elective
admissions and care
home placements.
HOW
PLANS
INTENTIONS
•
• Commission a
single integrated
gateway via one
telephone number
for public &
professionals to
access
• Commission a care
co-ordination model
of care with named
clinician /
professionals for
patient contacts
•
8
Reduction in length
of stay and therefore
hospital beds.
•
•
9
10
11
Increased
Community capacity
for integrated care
services.
Increased number of
people managed in
integrated service.
Increase in
coordinated care.
•
•
•
•
•
•
•
•
•
•
•
12
Ensure a consistent
high quality, safe
and effective care.
•
Integrated care coordination teams in
place
Shared care planning
place
Pooled budgets
Commissioning for
Outcomes
Redesign of children’s
pathways
Care closer to home
Single gateway
Care coordination in
the community
Electronic Shared Care
Record for all
Single assessment and
referral
place
Care closer to home
Record for all
• Alignment of ICCTs
to local authority
neighbourhoods
(akin to
parliamentary
constituencies)
• Development of
pooled budgets to
support the
commissioning
requirements of the
ICCTs
• Agree Integrated
Service
Specification
• Develop Alliance
Contracting model
of governing
specification
• Implement alliance
contract in shadow
form
• Analyse impact on
outcomes
• Implement
integrated alliance
contract
• Produce a single
consistent set of
referral, screening
assessment and
planning
documentation
• Provision of an
8am-8pm, 7 day
service, integrated
with out of hours
services
• Commission a care
co-ordination model
of care with named
clinician /
professionals for
patient contacts
• Incorporate the
voluntary,
community and faith
sector services into
the ICCTs to
promote support to
patients from
community assets.
• Appointment of
jointly funded
management roles
Page 7
2014/15
WHEN
2015/16
2016/17
*
*
*
*
*
*
*
*
*
*
*
*
*
*
2017/18
to oversee
performance and
service delivery of
each ICCT
• Establishment of an
alliance contracting
model to share risks
and manage
competing demands
of cost improvement
*
A Wirral Integrated Commissioning Plan is paramount in enabling the rapid move towards
integrated health and social care.
The advent of the Better Care Fund (BCF) offers the opportunity to pool resources and jointly
commission a range of services that deliver better value for money and productivity.
By March 2015, an agreed integrated service specification and an associated alliance contracting
model will be in place.
During 2015/16, the alliance contracting model will be applied in shadow form in order to inform
robust analyses and impact on agreed outcomes from 2016 onwards; an integrated alliance
contract for service provision will be jointly commissioned.
The CCG is committed to developing a model of integrated care through the establishment of 4
Integrated Care Co-ordinated Teams (ICCTs). The model of care can be summarised as the
following pathway:•
One number to call - A single integrated gateway that the public and professionals have
access to through one number, staffed by health clinicians and social care professionals
who through discussion with the referrer will establish if the need being referred is urgent or
can be responded to in a planned way, and whether the need is primarily a health or social
care need.
•
Telling your story once - A single set of referral, screening, assessment and care
planning documentation will be used throughout the pathway that, once consent from the
patient has been obtained, health and social care professionals have access to and can
contribute to. There will be specialist assessments required, but the core information
required for referrals will have been collected, reducing the need for separate referral
processes and repeatedly collecting the same basic information from patients.
•
One person to co-ordinate your care – A care co-ordinator model of working where the
patient has a named clinician / professional as their contact point, who works as part of an
integrated team. The care co-ordinator does not do everything, but they ensure a multiagency plan is in place and they co-ordinate the care. Once support is in place the case is
closed / the patient discharged, but it is this care co-ordinator the patient goes back to, as
they know them, if they need further support in the future (so once you are known to the
system you don’t need to start again).
•
One message – a single culture of helping people to help themselves, self-managing their
care and seeking support from community assets before statutory services will be
supported by all organisations and at each point on the pathway. The voluntary, community
and faith sector will be part of the integrated teams, promoting local, informal support as
part of the care plan to support people who require care.
Page 8
•
Local services close to home – the care will be co-ordinated through an integrated local
neighbourhood team, and health and social care services delivered by the Council, CWP,
Community Trust and WUTH will be aligned to these neighbourhoods. The neighbourhoods
are Wallasey, Birkenhead, South Wirral and West Wirral. GP surgeries will be clustered to
align to these areas, as primary care plays a pivotal role in delivering integrated care. The
local integrated teams are configured on the same footprint as the public service boards,
creating the opportunity for further alignment and partnership working with organisations
who have aligned to these neighbourhoods; the police, fire and rescue service, housing
providers, work and pensions service, job centre, the voluntary, community and faith sector,
one stop shops and anti-social behaviour teams.
•
Support when you need it – The integrated teams include the arrangers and providers of
the care as well as the clinicians / practitioners who co-ordinate the plan so the provision of
care can be prioritised immediately. The health and social care provision will be 8.00am
until 8.00pm 7 days a week, with an integrated out of hours service bringing together night
nursing and emergency duty team services, so you get the same support whether
something happens to you on a Friday night or a Wednesday lunch time.
•
Pooled Resources – The integrated teams would be responsible for the health and social
care spend in their neighbourhood and would be able to access resources, regardless of
which professional is managing the plan i.e. a nurse or therapist could commission a
package of care, so no need to re-refer / pass the person on. The team would also be
accountable for the budget and savings targets for their neighbourhood.
•
Accountable management – the model of care has jointly appointed and funded
management posts overseeing the performance, service delivery and budget for the
neighbourhood. The clinical and professional supervision required for professional bodies’
standards will continue to be provided by the employing organisations (DASS, CT, CWP,
WUTH).
• Risk Sharing – each of the providers will continue to have separate contracts, but will be
brought together through an alliance contracting model to share the risks and manage the
competing demands of cost improvement through co-ordinating the deployment of their
organisations’ resources to meet the shared objectives set out in the Integration service
specification.
Page 9
2.3 Access to the highest quality urgent and emergency care
WHAT
OUTCOMES
13
Reduced nonelective admissions
(long and short
stay).
HOW
PLANS
INTENTIONS
•
•
•
•
•
Single front door for
urgent care on the APH
site, including
streaming patients back
to primary care
Ambulance pathfinder
and community care
plans
Ensure successful
transition and
implementation of step
up / step down system
Develop a range of
admission prevention
services and pathways
•
•
•
•
•
•
•
14
Reduction in length
of stay and therefore
hospital beds.
•
•
•
15
Increased
community capacity
for urgent care
services.
•
•
16
Reduced
conveyance to
hospital by
ambulance.
•
17
Reduced emergency
readmissions.
•
Apply NonElective Marginal
rate as per PbR
Implement
Urgent Care
Action Plan
Apply zero
tolerance to
minor A&E
breaches and redirects
Agree revised
local tariff for
AAU and shadow
monitor
Apply revised
local tariff for
AAU
Incorporate
Community
Geriatrician role
into AAU
Reduce
admissions by
15% (5% pa)
Develop
wirralwide
schemes with
care home
providers to
support
admission
prevention, active
case
management and
education and
training
requirements.
Commission IMC
& transitional
beds covering 7
day response
Commission
brokerage
function
Dementia liaison
nurses in post to
support inpatient
care of those with
dementia and
facilitate timely
and appropriate
discharge
Establish agreed
model for urgent
care Wirral
Implement
agreed model
Single front door for
urgent care on the APH
site, including
streaming patients back
to primary care
Ensure successful
transition and
Care Arranging Team
•
Ensure successful
transition and
Implement a new
model of urgent care
hubs in the community,
including medical
assessment.
Ambulance pathfinder
and community care
plans
•
•
Commission a
range of NWAS
avoidance
schemes
Develop a range of
admission prevention
services and pathways
•
Commission
Wirral-wide
Admissions
Prevention
•
•
•
Page 10
2014/15
WHEN
2015/16
2016/17
2017/18
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
18
Ensure consistent
high quality, safe
and effective care.
•
•
•
Implement NHS 111
and new GP out of
hours service
Redesign discharge
pathways
pathways in urgent
care and the
community
•
service
Define local
Directory Of
Services to
support
requirements
from NHS 111
*
A single agreed model for urgent care on Wirral will be agreed by April 2015 and fully implemented
by April 2016.
At the time of writing, the Wirral health economy is appraising the following model options:




Devolve all urgent care provision to primary care
Devolve all urgent care provision with core GP practice hours to primary care
Maintain status quo
Urgent care front door and integrated community urgent care centres
Fully integrated ‘Urgent Care Village’ and integrated community urgent care centres
Each option has a series of commissioning intentions associated therefore dependent upon the
agreed chosen model, those respective commissioning intentions will be implemented.
Page 11
2.4 Step change in the productivity of elective care
WHAT
OUTCOMES
19
Reduced elective
admissions (excess
bed days)
HOW
PLANS
INTENTIONS
•
•
Outpatient strategy
•
•
•
•
•
•
•
•
•
•
•
20
Increased
community capacity
for planned care
services.
•
•
•
•
21
Increased number of
people managed in
integrated services.
•
•
•
Community Hubs
4 integrated care coordination teams in
place
Care closer to home
Sufficient staffing and
estates to deliver
greater proportion of
planned care in the
community
Transfer of planned
care into community
Community Hubs
4 integrated care coordination teams in
place and fully
operational
•
•
•
•
•
•
•
To review AQP
contracts against
current patient
needs
To determine
required market
size to meet
identified needs
and commission
appropriate AQP
services
Define an agreed
model of Primary
Care at scale
Develop the
agreed model
into working
proposal
Implement the
agreed model
Review working
model
Implement
Follow-up tariff
for in-specialty
referrals
Apply agreed Hip
& Knee referral
process
Revise
specification for
Drop-in ear care
aural climes
Re-open AQP
window for
procurement of
DADs
Procure a block
contract
arrangement for
pathology test
service
Commission an
integrated PTNS
& Botox clime for
bladder
conditions
Establish 4 fully
operational
ICCTs
Define primary
care
configuration to fit
with ICCTs
System-wide
estates plan
Establish all
relevant protocols
for referral
management
between
practices and
ICCTs
Establish 4 fully
operational
ICCTs
Define primary
care
configuration to fit
with ICCTs
Establish all
Page 12
2014/15
WHEN
2015/16
2016/17
2017/18
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
22
Protocols and
managed referrals.
•
•
•
23
Ensure consistent
high quality, safe
and effective care.
•
•
•
•
Appropriate referral
protocols across all
clinical specialties, in
primary and secondary
care
pathways for planned
care in the community
Record for all
protocols
Record for all
pathways
Commissioning for
Outcomes
•
•
•
•
•
•
•
relevant protocols
for referral
management
between
practices and
ICCTs
Rollout of
Summary Care
Record in all
practices
Consultant to
Consultant
referrals policy to
be re-launched
within WUTH
Implement
refreshed PLCP
policy and apply
non-compliance
penalties
Rollout of
Summary Care
Record in all
practices
Consultant to
Consultant
referrals policy to
be re-launched
within WUTH
Implement
refreshed PLCP
policy and apply
non-compliance
penalties
Develop COBIC
skills within key
CCG staff
*
*
*
*
*
*
*
*
The CCG will implement alternative delivery models for elective productivity so as to be more
outcome focused alongside realising 20% efficiency in elective productivity by 2018. One such
model is the Prime Provider.
The 20% efficiency in productivity is profiled over the next 4 years evenly at 5% per year.
In order for the step change in productivity to be achieved, it is vital that the whole system of Wirral
interacts and ultimately integrates around the provision of services to patients.
The CCG will commission increasingly for outcomes based results, switching its emphasis away
from costs / volume activity.
Page 13
2.5 Better Care Fund
WHAT
OUTCOMES
25
Reduction in number
of bed days due to
delayed transfers of
care per 100k
patients
HOW
PLANS
INTENTIONS
•
•
•
Step up Step down
service
Planned acute care
•
•
•
26
Reduction in
avoidable
emergency
admissions
•
•
•
•
•
•
•
Reduce the number of
people attending A&E
Admissions Prevention
service
Care Homes schemes
Urgent Care community
centres
CPN capacity
Early on-set dementia
Falls
•
•
•
•
•
*
*
Commission
brokerage
function
Community
dementia liaison
nurses
*
*
*
•
28
Reduction in
permanent
admissions to
residential and
nursing care homes
•
Care Arranging Team
•
Commission
brokerage
function
29
Patient service user
experience
•
Develop communitybased care of the
elderly service
Dementia shared care
pathways
Disabled Facilities
Grant
•
Change scope of
memory
assessment
service
Implement
outcome of joint
review of
CAMHS, ABI,
ARBD, & EOD
Pooled resources
Increase capacity
of domiciliary
care services
•
•
•
30
Percentage of care
packages
commenced within
initial contact with
agency
Care Arranging Team
•
Joint
commissioning
integrated
services
Development of
ICCTs to support
shift of outpatient
activity
Dementia Liaison
nurses within
hospital
Implement RAID
model through
review of
psychiatric liaison
service
Commission
Admissions
Prevention
Service to
support 7 day
working
Implement
agreed single
model for urgent
care
Commission
range of day
services to
support Dementia
Review current
falls services to
identify joint
commissioning
efficiencies
Review joint
mental health
posts
Increase in
proportion of people
(65 and over) still at
home 91 days after
discharge from
hospital
27
•
•
Joint careers strategy
Investment in social
care community
services
•
•
•
2014/15
Page 14
WHEN
2015/16
2016/17
*
*
*
*
*
*
*
*
*
*
*
*
*
2017/18
*
2.6 Outcomes Framework Indicators
WHAT
OUTCOMES
31
Securing additional
years of life for the
people of England
with
treatable
mental and physical
health conditions.
HOW
INTENTIONS
•
Increase cancer
screening rates
Preventing
ill-health,
ensuring more timely
diagnosis of ill-health,
and supporting wider
action
to
improve
community health and
wellbeing.
Potential years of life
lost (PYLL) from
causes considered
amenable to healthcare
Under 75 mortality rate
from cardiovascular
disease
from respiratory
disease
from cancer
Health-related quality of
life for people with longterm conditions
•
Review, update
and commission
best practice
services for :
Cardiovascular,
Respiratory,
Cancer, Stroke to
impact on PYLL
*
Improve recovery rates
for primary care mental
health
Increase diagnosis
rates for dementia
Improve clinical
outcomes for patients
with at least one longterm condition
Increase immunisation
rates for vulnerable
groups
Achieve equity of
access to physical
healthcare for those
with a learning disability
or a mental illness
Increase the uptake of
NHS Health Checks
from cardiovascular
disease
from respiratory
disease
from cancer
Health-related quality of
life for people with longterm conditions
•
Procure new
PCMH service
with minimum
recovery rate of
50% in Year 1
rising to 65% by
Year 3 and
Entering
Treatment
proportion of 15%
by Year 1 rising
to 20% by Year 3
Invest in
Dementia
services within
general practices
to achieve
diagnosis rates
60%/65%/70%/7
5%
Establish a
shared care
worker for mental
health to act as
caseworker/servi
ce navigator
Extend NHS
Health checks to
specifically
include SEMI
patients
Determine
specific metrics
for SEMI patients
accessing
prevention
services such as
smoking
cessation and
vaccinations
Commission
integrated
learning disability
pathway with
local authority
*
•
•
•
•
•
•
32
Improving
the
health
related
quality of life of the
15 million+ people
with one or more
long-term condition,
including
mental
health conditions.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Page 15
2014/15
WHEN
2015/16
2016/17
PLANS
*
*
*
*
*
2017/18
*
*
*
*
•
•
33
Reducing
the
amount of time
people
spend
avoidably
in
hospital
through
better and more
integrated care in
the
community,
outside of hospital.
•
•
•
•
•
•
•
34
35
36
Increasing
the
proportion of older
people
living
independently
at
home
following
discharge
from
hospital.
•
Increasing
the
number of people
with mental and
physical
health
conditions having a
positive experience
of hospital care.
•
Increasing
the
number of people
with mental and
physical
health
conditions having a
positive experience
of care outside
hospital, in general
practice and in the
community.
•
Emergency admissions
for alcohol-related liver
disease
Unplanned
hospitalization for
chronic ambulatory
sensitive conditions
(adults)
Unplanned
hospitalization for
Asthma, Diabetes and
Epilepsy in under 19s
for acute conditions
that should not usually
require hospital
admission
Emergency
readmissions within 30
days of discharge from
hospital
for children with lower
respiratory tract
infections
Incidence of Healthcare
Associated infection –
MRSA
C Difficile
Proportion of people
feeling supported to
manage their condition
•
•
•
•
•
Involving patients and
carers more fully in
managing their own
health and care.
•
•
•
•
Involving patients and
carers more fully in
managing their own
health and care.
Improvement in patient
experience in A&E and
acute care
High rate of patient
satisfaction with
services in community
hubs and based in their
own homes
An Improvement in
Patient Reported
Outcome Measures by
2018 for appropriate
conditions
•
•
•
•
Implement
revised
specification for
psychiatric liaison
Commission
integrated ADHD
& Personality
Disorder Service
*
*
Implement
revised AAU
specification and
local tariff
Implement
agreed single
urgent care
model
Develop
innovative
practices through
collaborative
working with the
National Centre
for Infection
Prevention
Management
(CIPM)
*
*
Establish 4 fully
operational
ICCTs
Jointly
commission
rehabilitation
services via
Better Care Fund
(BCF)
Implement
requirements of
NHS
Commitment to
Carers
Performance
manage hospital
providers to
achieve on-going
improving Family
& Friends Test
outcomes
Implement
requirements of
NHS
Commitment to
Carers
Implement
agreed single
urgent care
model
Implement Family
& Friends Test
across primary
care.
Develop a
framework for
engagement
involvement and
Page 16
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
•
•
•
•
•
•
37
Making significant
progress
towards
eliminating
avoidable deaths in
our
hospitals
caused
by
problems in care.
•
An improvement in the
experience of patients
who require planned
elective care.
Patient-reported
outcome measures for
elective procedures –
hip replacement
Patient-reported
knee replacement
Patient-reported
groin hernia
Patient experience of
GP services
GP Out of Hours
service
NHS dental services
MRSA
C Difficile
patient
experience in
conjunction with
Wirral
Healthwatch
•
Develop
innovative
practices through
collaborative
working with the
National Centre
for Infection
Prevention
Management
(CIPM)
Page 17
*
2.7 NHS Constitution standards
WHAT
OUTCOMES
HOW
PLANS
INTENTIONS
38
RTT waiting times
for non-urgent
consultant-led
treatment
•
39
Diagnostic test
waiting times
•
40
A&E waits
•
41
Cancer waits –
2weeks wait
•
42
Cancer waits – 31
days
•
43
Cancer waits – 62
days
•
44
Cancelled
operations
•
45
Mental Health –
CPA
•
46
Ambulance
handovers
•
Commissioned
services to
achieve
maximum target
of 18 weeks RRT
moving to
achieving target
of 16 weeks RRT
by 2016.
Commissioned
services to
achieve
maximum target
of 6 weeks from
referrals moving
to achieving
target of 4 weeks
by 2016
Commissioned
service to
achieve and
maintain current
target of 95%
moving to 98%
by 2016
Commissioned
services to
achieve and
maintain national
targets
Commissioned
services to
achieve and
maintain national
targets
Commissioned
services to
achieve and
maintain national
targets
Zero tolerance for
cancellations not
due to clinical
reasons
Commission of
services to
achieve and
maintain current
target 95%
moving to 98%
by 2016 and
100% by 2017
Commissioned
services to
achieve and
maintain national
targets
Page 18
2014/15
WHEN
2015/16
2016/17
2017/18
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Appendices
Appendix 1 – NHS Outcomes Framework Indicators
The chart below shows the distribution of the CCGs on each Outcomes Framework indicator in
terms of ranks. NHS Wirral CCG is shown as a red diamond. The yellow box shows the inter
quartile range and median of CCGs in the same ONS cluster as this CCG. The dotted blue line is
the England median. Each indicator has been orientated so that better outcomes are towards the
right (light blue).
Page 19
Appendix 2 – Vision 2018 Summary Programme Documents
Programme Name: Planned Care
Programme Objectives:
Objective
No
Objective Statement
1.
To enable more patients to self-care
2.
To ensure the patient sees the right professional first time
3.
To deliver planned care in a setting close to the patients home unless their care requires
specialist facilities to ensure the best outcomes
4.
To improve access to diagnostic services and treatment
5.
To improve outcomes of planned care
6.
To ensure equity of service provision
7.
To ensure the correct levels of planned care capacity are commissioned at the appropriate
level of delivery e.g. Primary, secondary or tertiary care
8.
To achieve a 20% improvement in productivity in planned care by 2018.
Programme Name: Unplanned Care
Objective
No
Overarching
Strategic
Aims
Objective Statement
•
•
•
Reduce hospital emergency activity by 15 per cent
Achieve the A&E 4 hour standard
Right care, right place, right time
1.
Ensure people know where to access advice to enable them to care for themselves
where appropriate
2.
Provision of same-day access to care when necessary (e.g. GP, Pharmacy, Dentist,
Optician, community or hospital based care as required)
3.
If advice or treatment is required, this should be provided where the patient presents
whenever possible
4.
Ensure patients have rapid access to specialist care when required
5.
Ensure care is coordinated to meet the mental, physical and social needs of the
individual
Page 20
6.
Ensure quality and patient experience is measured and monitored to continually
improve care
Programme Name: Long Term Conditions/Complex Needs Delivery programme
Objective Objective Statement
No.
[e.g. Reducing attendances, emergency admissions at Accident and Emergency
department and mortality rates within the acute hospital
1
Improve life expectancy across Wirral
2
Improve the health and social care related quality of life for people with more than 1 long
term condition
3
Empower and support people to take more responsibility for their own health needs
including understanding what the local community can offer as support.
4
Ensure that care is delivered in an environment best for individual needs, closer to home
5
Reduce attendance at A&E and reduce the number of people accessing care in long term
care settings
6
Preventing people from dying prematurely
Programme Name: Prevention, Self Care & Community Development
Objective No.
Objective Statement
[e.g. Reducing attendances, emergency admissions and mortality at Accident and
Emergency departments]
1
2
3
Community Development (Primary prevention e.g. Healthy Places)
a) Healthy, resilient, empowered and engaged communities to reduce health
inequalities improve outcomes and demand on services.
b) Greater community involvement and challenge in shaping delivering of public
services.
c) Healthy environments, utilising the assets within communities.
Prevention (Secondary prevention e.g. lifestyle services, immunisation and
vaccination programmes, screening programmes)
a) Empower and support people to take more responsibility for their own health.
Self Care (tertiary prevention)
a) Improve the quality of life and patient experience of people living with health
issues
b) Contribute to reducing inappropriate attendances and clinically inappropriate
Page 21
admissions to A & E
c) Reduce GP appointment which could be managed in a different setting
4
Workforce development
a) Remodel the role of the workforce to develop new relationships with
colleagues, patients and citizens
Programme Name: Integration – Adults
Objective Objective Statement
No.
1
2
3
4
Improving people’s care experience and health outcomes by commissioning services that
care for people at home or in their local community
Reducing by 25 per cent the length of time people with a long term condition(s) stay in
hospital by 2015
Reducing spend on long term care home placements from 3.7% to 2.1% average for the
North West (ADASS/AQUA North West Utilisation Report September 2012)
Reducing unplanned hospital admissions by 20 per cent by 2015
Programme Name: Integration – Children’s
Objective
No.
1
Objective Statement
Transformational outcome: Children are ready for school
Aim: Children will be supported to have the best possible start in life and develop healthy
lifestyle choices.
2
Transformational outcome: Young people are ready for work and adulthood
Aim: Children and Young People who need extra help to reach their potential and
achieve well will be supported.
Page 22
Appendix 3 – Potential Years of Life lost from causes considered amenable to healthcare by Disease group.
(Data from 2001-03 to 2010- 12)
Please see the attached graphical and numerical representation of Local health economy performance when addressing the disease groups considered to be
amenable to healthcare across CWW Area team. There are a number of areas where the performance to 2012 and the subsequent trend suggest an
underperformance.
The intention is to ensure the issues identified in the attachment are understood and ideally addressed in the current strategic and operational plans provided
by the respective CCGs. Clearly the timescales for the PYLL data is long term and the attached appears to be nationally the most recent data. CCG’s however
may well have more up to date information.
Potential Years of Life
lost from causes
considered amenable
to healthcare.
Eastern Cheshire
CCG
South Cheshire
CCG
Vale Royal CCG
Warrington CCG
West Cheshire
CCG
Wirral CCG
All causes.
Better than National
values. Extrapolated
trend in line with
national projection
trend in line with
national projection
trend in line with
national projection
Worse than National
trend remains worse
than national trend
trend in line with
national projection
Worse than National
trend remains worse
than national trend
Coronary heart Disease
trend in line with
national projection
trend in line with
national projection
trend in line with
national projection
Worse than National
trend remains worse
than national trend
trend in line with
national projection
Worse than National
trend remains worse
than national trend
Stroke
trend in line better
than national
trend in line better
than national
trend in line with
national projection
Worse than National
trend remains worse
than national trend
trend in line with
national projection
Worse than National
trend remains worse
than national trend
Disease area
Page 23
projection
projection
Pneumonia
trend in line with
national projection.
Delivery showing
significant swings.
trend in line with
Delivery showing
significant swings.
trend worse than
Delivery showing
significant swings
Worse than National
trend remains worse
than national trend.
Delivery showing
significant swings
trend worse than
Delivery showing
significant swings
Worse than National
Trend in line
diverting and worse
than national trend
Amenable cancers
In line with National
trend in line slightly
better than national
projection
In line with National
trend in line slightly
better than national
projection
Worse than National
trend line worse than
national trend
Trend in line with
national projection
Worse than National
trend line worse than
national trend
Worse than National
value. Extrapolated
Trend line better
than national trend
Other amenable
values, extrapolated
trend worse than
national trend
values, extrapolated
trend worse than
national trend
Trend in line with
Delivery showing
significant swings.
Trend in line with
national projection
Trend in line with
Delivery showing
significant swings.
Worse than National
value. Extrapolated
Trend in line
diverting and worse
than national trend
Page 24
Appendix 4 – QIPP Plan 2014 / 15
NHS Wirral CCG
QIPP Plan 2014/15
Page 25
What is a QIPP Plan?
During this plan we will set out what our financial challenge is for 2014/15, that is, the level of resource we need to either save, or
release by being more efficient, and by undertaking programmes of work that embrace the QIPP Principles as outlined on page 2.
We will refer to this financial challenge the QIPP Gap.
For NHS Wirral CCG in 2014/15, this is currently £6.9m which is made up of £6.5m recurrently and £0.4m non-recurrently. This was originally
£4.1m as per the CCG financial planning assumptions but has subsequently increased during the current financial year to its current value of £6.9m
(due to updates / revisions of these planning assumptions and finalisation of contract values). The original QIPP gap was driven by increases to
healthcare expenditure over the last few financial years and resulting contract agreements with healthcare providers for the 2014-15 financial year.
Pages 4 – 6 describe the current and longer term financial challenge, so that the QIPP plan for this year is not seen in isolation.
Page 7 sets out how the areas within this plan will align with other plans of the CCG – the QIPP plan is not developed in isolation.
This QIPP Plan will set out the areas in which we think as a CCG we can either avoid cost (an economic term used to describe costs that
would have been incurred should you not have taken steps to avoid them), or release efficiencies, in order to bridge our QIPP gap.
Page 9 explains how we monitor these to ensure that they will achieve the impact that we anticipate, and therefore that we are on
track to bridge our QIPP gap.
An overview of the individual schemes that make up the plan is provided on pages 12 - 14, along with the cost that we expect to
either avoid or release through these areas. Some of the pieces of work we undertake will mean that activity will shift from one
provider to another, e.g. from the hospital to services in the community.
Finally, we have identified potential risks to the delivery of the QIPP plan on page 16, and set out how we seek to mitigate these.
Page 26
Wirral CCG Financial Challenge – the next five years
Wirral health system 5 year financial challenge
projection (worst case = do nothing)
£
There is an anticipated gap between the CCG’s financial
allocation, and its anticipated expenditure. The
following graph describes the gap for Wirral over the
next five years, should no action be taken.
The high level financial forecast indicates that the
system needs to deal with the pressures using a very
different clinical and commercial model. Delivering
efficiency alone will not be sufficient to meet rising
costs and growth which are roughly equivalent to 30%
of the original baseline 14/15 budget.
The QIPP plan starts to address this gap, but greater
transformational system change will be required to
address the growing pressure.
600,000,000
c£140m
500,000,000
400,000,000
2013/14
2014/15
2015/16
Funding
Page 27
2016/17
Forecast costs
2017/18
2018/19
The QIPP Challenge – the next five years
The CCG’s QIPP requirement for the financial years 2015-16 to 2018-19 is estimated to be circa £74m based on delivery of efficiencies
through tariff, prescribing efficiencies and cash releasing savings (through transactional / transformational schemes). This is based on
the CCG delivering an efficiency requirement of 4% of its available resources which is in line with NHS England planning requirements.
The CCG will need to ensure that the contract values in each of the respective years are reflective of the required net tariff values
(including the required tariff efficiency in each of the respective years) and that through the targeting of its QIPP workstreams /
projects to deliver the cash releasing and prescribing efficiencies as appropriate.
Page 28
What is the 2014/15 QIPP Gap?
The 2014/15 QIPP gap of £6.9m has been calculated on the following basis: £6.5m recurrent & £0.4m non-recurrent (included below as part of specialised
commissioning impact)
CCG QIPP Plans 2014-15
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
Page 29
QIPP As at Month 4
Resource Utilisation
(Demand Mgt /
Restitution)
Specialist
Commissioning
Impact
Vascular Activity
Shift Risk (WUTH
NEL Block)
Updates to financial
planning
assumptions
Original QIPP
Planning
Assumptions
0.0
Vision 2018 Programme
How does this two-year QIPP Plan fit in with wider system
transformation?
Vision 2018 is the plan to re-shape health services and social
care in Wirral, whilst empowering people to take more
responsibility for looking after their own health.
It brings together health and social care partners to set out the
vision for our health and social care system over the next five
years. The work that we will do is split into three programmes
of work – planned care, unplanned care, and long term
conditions and complex needs.
The principles of QIPP must be embedded in all that we do in
order to make Vision 2018 a reality.
The QIPP Plan is not something to be seen in the system in isolation. We must focus on the areas that we know pose
the greatest challenge for us as a health economy and, by focussing time and resources in a way that is innovative,
focusses on prevention and productivity, we will make efficiencies that will contribute towards a sustainable health
and social care system.
We must be mindful that the priorities of the QIPP plan are aligned with our five year Strategic Plan, our short-term
Commissioning Plan, and our system-wide plan for Urgent Care.
Page 30
Governance in place for the development and monitoring of the Wirral CCG QIPP Plan
The Quality, Performance and Finance Committee will receive the QIPP Plan
dashboard on a monthly basis. The Operational Team will highlight any variance to
the QIPP Plan for discussion. The Governing Body will also receive the QIPP Plan on a
monthly basis, with any issues reported on an exceptional basis.
NHS Wirral CCG Governing Body
Quality, Performance and Finance Committee (monthly)
A verbal update is given on the overall progress against the
QIPP plan on a weekly basis, with any issues being reported on
an exceptional basis. If required, the Operational Team may
recommend that schemes / issues are escalated to the
Quality, Performance and Finance Committee
Operational Team meeting (weekly)
QIPP Review meeting (monthly)
QIPP
Sponsor
Commissioning
Managers
Business Intelligence
and Finance
Those staff that are involved in monitoring QIPP on a day-to-day basis meet monthly in
order to highlight and resolve any issues at an operational level, and determine what
needs to be escalated, and to what level
QIPP Workstreams
QIPP
Area
QIPP
Area
QIPP
Area
QIPP
Area
QIPP
Area
Page 31
There is a PMO process for consideration of any new areas for
potential cost avoidance or efficiency. These are judged on the basis
of alignment with strategy, and inclusion of clear, realistic outcomes.
Monitoring Progress
Progress is monitored through a QIPP Dashboard, which RAG rates each scheme, and overall plan performance, against implementation date, planned activity shifts and
financial impact – the following is an example from the 2013-14 QIPP Plan:
Longer-term QIPP Plan
Whilst this plan focusses on 2014 - 16, the CCG has embarked on ambitious programmes of transformation that will secure QIPP gains over future years.
Integration
Unplanned Care
Through its Vision 2018 programme, the CCG and its
health and social care partners are working towards
increasing integration in both commissioning of services,
and provision.
We know that we have a system where too many people go to A&E when this isn’t always the right
place for them to be treated, and that too often people are admitted to hospital because the care
offered in the community has not been accessed, or has not been the right sort of care, has not
been delivered timely enough, or where the patient and family member are not sure how best to
manage at home.
This will mean great transformation not only in the way
that services are commissioned and delivered, but also in
the way that people use services, with the following
objectives:
•
Seamless and timely response from integrated
teams and other appropriate services
•
Single gateway and streamlined pathways which
are easier for people to navigate
•
Encouraging self-care and self help
•
Health and social care having joint responsibility
for the patient pathway by pooling budgets to
reduce duplication
•
Implementation of shared electronic record to
improve communication
•
Coordinated care plans with patient led goal
setting
Page 32
We must see this as a failure of the system, and this is what we must work to address.
Our strategy for unplanned care is centred on a productive system, and one that prevents rather
than reacts. It describes treating people quickly within the community, offering rapid assessment
to those whose conditions are more complex, through to helping the hospital to ensure a smooth
journey from admission to discharge. Through this approach, we will secure efficiencies not just in
year one, but over the next generation of the NHS.
Integrated
commissioning
and provision,
and productive
and preventive
urgent care
People
empowered to
take
responsibility
for their own
health
Page 33
Sustainable
health and
social care
system
Impact Assessment of each QIPP scheme
The aim of the QIPP Programme is to find efficiencies whilst at the same time improving the quality and safety of patient care. For instance, delivering services in the
community rather than in an acute setting will be more cost-effective, but will also deliver a faster and more accessible service to patients.
Each scheme will therefore need to demonstrate an anticipated positive impact upon one or more of the following measures:
NHS Constitution
measures
These are standards
that every patient,
under the NHS
Constitution, should
expect, for instance:
- at least 90% of
admitted or nonadmitted patients
should receive
treatment within 18
weeks of referral
- at least 99% of
patients should have
received their
diagnostic test within
six weeks of referral
NHS Outcome measures – five domains, and 7
ambitions
Page 34
We will also expect each QIPP scheme to demonstrate alignment
with one of the following key Characteristics of a sustainable
NHS:

A completely new approach to ensuring that citizens are
fully included in all aspects of service design and change
and that patients are fully empowered in their own care.

Wider primary care, provided at scale.

A modern model of integrated health and social care.

Access to the highest quality urgent and emergency care.

A step-change in the productivity of elective care (more
for less).

Specialised services concentrated in centres of excellence.
Summary of QIPP Plan 2014/15
The programmes that make up the plan for QIPP savings in 2014/15 have been divided into transactional (those generated through use of enablers and contractual levers)
and transformational schemes (those with a direct impact on patient care). Through activity modelling we have estimated the anticipated financial impact of each area of
work for 2014/15. A summary of intended QIPP schemes is provided for 2015/16, where further detailed modelling is required.
QIPP Planning Gap
Recurrent
Non-Recurrent
Total
£ million
£ million
£ million
£6.5m
£0.4m
£6.9m
QIPP Delivery 2014/15
Transformational / Service Redesign QIPP
£0.13m
£0.13m
Transactional QIPP
£4.1m
£4.1m
CCG Mitigation (Contingency)
£3.0m
£3.0m
Total
£4.23m
£3.0m
£7.23m
Gap (Shortfall / Surplus)
(£2.27m)
£2.6m
£0.33m
Cost Avoidance
In addition, there is £0.7m in Prescribing Efficiency / Medicines Management that is anticipated as ‘cost avoidance’ rather than ‘cash releasing’, and therefore will further
contribute towards financial balance. A focus on prescribing therefore continues to be an imperative for the CCG.
Page 35
QIPP Plan for 2014/15 – further detail
Assumed impact of transactional schemes in 2014/15
Anticipated Financial Brief description of scheme
Impact in 2014/15
Area of Work
Vacant QIPP Lead posts
£26,900
CCG Staffing vacancies
£76,300
These are posts that have been accounted for but are
currently vacant
These resources represent slippage against various
areas within the financial plan
It is anticipated that there will be underperformance
against the WUTH contract due to referral
£2,500,000
management and a number of areas where activity is
forecast to be lower than projected within the plan.
Updated financial planning assumptions
£1,516,000
Underperformance on WUTH contract
Total
£
Page 36
4,119,200
Assumed impact of transformational /service redesign schemes in
2014/15
Anticipated Financial
Impact in 2014/15 Brief description of scheme
Area of Work
People with chest pain are risk stratified before
£14,000 referral to ensure that they are seen in the most
appropriate place
Patients previously given trial without catheter in
£50,000 hospital ward, now done in community combination of own home and hospital clinic
Patients are directly listed for hernia appointments
£20,000 where appropriate, cutting out unnecessary steps in
the patient journey
Crisis beds delivered by a more cost-effective
£30,000
provider, whilst maintaining quality of care
Working to a more cost-effective tariff for glaucoma
£13,500
follow-up within the community
Rapid Access Chest Pain Clinic
Trial Without Catheter
Direct Listing for Hernia
Crisis Beds
Community Glaucoma treatment
Total
£127,500
Taking into account both transactional and transformational impact, we therefore anticipate that with the use of contingency resources available to the
CCG that we will be able to achieve the current in – year QIPP gap, but there remains a recurrent shortfall to the CCG.
There are a number of pressures within the system that will need to be operationally managed on a monthly basis in addition to monitoring progress
against the QIPP schemes. The detail of these is brought to Governing Body on a monthly basis.
In addition, there is the following area of cost avoidance that will contribute towards achieving overall financial balance:
Anticipated Financial
Impact in 2014/15 Brief description of scheme
Area of Work
Use of more cost-effective medications and
£700,000 reduction in prescribing waste
Medicines Management / Prescribing Efficiency
Page 37
QIPP in 2015/16 and beyond
For a sustainable system, greater efficiencies will need to be gained through transformational change, rather than non-recurrent transactional impact. Moving forwards we
will need a QIPP plan that is inherently transformational, with integration of end to end services, and pathways that are truly patient-centred.
The Vision 2018 programme describes the areas for focus as follows:
Page 38
Based on this, current thinking around transformational and transactional change for 2015/16 and beyond is as follows:
Transformational
Transactional / Cost Avoidance
Reduced reliance upon care packages coupled with
enhanced commissioning of community provision for
mental health and learning disabilities
Outpatient redesign for more streamlined and integrated
patient pathways
Prime provider model for Primary Care Mental Health
Referral decision-making tools, e.g. hip and knee referral
form
Working with providers and the Local Authority to
transform pathways for older people
Urgent care transformation, as per emerging urgent care
strategy
We will need to
have a greater
focus on
transformational
change in order to
meet the growing
QIPP challenge
and to ensure
recurrent impact.
This table gives an
overview of key
areas for QIPP
impact from 2015
onwards
Integrated commissioning through the Better Care Fund
Page 39
Consultant to Consultant referrals within same patient
pathway
Compliance with Procedures of limited clinical value policy
Application of non-elective threshold / marginal rate
emergency tariff
Acute assessment unit tariff
Medicines Management / Prescribing Efficiency
Efficiency in Continuing Healthcare / care package
commissioning
Risks, Concerns and Mitigation
NHS Wirral CCG has identified a number of risks to the delivery of its QIPP Plan:
Risk
Mitigation
Unsuccessful delivery against QIPP Plan
operational management against agreed milestones
and financial plans to ensure the maintenance of
sufficient headroom between size of challenge and
savings identified
Insufficient governance and performance management process
regular performance updates to the Quality
Performance and Finance Committee, and to the
Governing Body, to track delivery and ensure ability
to take effective mitigating actions as appropriate
Lack of effective and meaningful engagement with key
stakeholders including patients and public
Failure to develop a robust recovery plan if required
Gap in transformational schemes
Page 40
These risks and
concerns will
be mitigated
through…
the development and implementation of robust
engagement strategies to include local authorities,
clinicians, patients. carers and public as part of any
QIPP programmes of work
the maintenance of effective and time bound
monitoring processes to ensure that sufficient early
warning mechanisms of any deviation from plan are
in place, such that remedial action can be taken at
the earliest possible opportunity
The Vision 2018 programme is prioritising health and
social care commissioning to ensure that the focus is
on transformational areas that will generate
recurrent efficiencies. This is governed through a
Programme Management Office function to track
delivery
Appendix 5 – Urgent Care Strategy
A Wirral-wide Urgent Care Conference was held on 18th September 2014 involving commissioners
and providers to share, gather and collate clinical opinion on the Urgent Care system for Wirral.
Agreement to a single model of the provision of urgent care services is required by April 2015 in
order to commence the required commissioning to effect the changes in the local health system
during 2015/16.
Page 41
WIRRAL GP COMMISSIONING CONSORTIUM
EXECUTIVE BOARD MEETING
Minutes of Meeting
Wednesday 11th June 2014, 6.30pm
Nightingale Room, Old Market House
Present:
Dr Akhtar Ali
Penny Angill
Christine Campbell
Dr Simon Delaney
Dr Maria Earl
Dr Andrew Lee
Dr Hannah McKay
Dr John Oates
Sam Saminaden
Eddy Shallcross
(NA)
(PA)
(CC)
(SD)
(ME)
(AL)
(HM)
(JO)
(SS)
(ES)
GP Lead
Practice Manager Member
Chief Officer
GP Lead
GP Lead
GP Lead
GP Lead
Chair
Lay Representative
Patient Council Chair
(AF)
(SR)
WGPCC Administrator
CSU Medicines Management
In attendance:
Anita Fletcher
Steve Riley
Ref No.
WGPCC/EB/
14-15/007
Minute
1.1 Apologies for absence
Apologies were received from Dr Navaid Alam and Louise Morris.
1.2 Declarations of interest
There were no declarations of interest made.
1.3 Public Comments/Questions
There were no members of the public present.
1.4 Minutes and Action Points of the last meeting
The minutes were agreed to be a true record of the meeting.
Matters Arising
Briefing Statement – Members were advised that a statement had been released by Wirral
CCG. The Chair and Accountable Officer have temporarily stepped aside whilst a review is
undertaken, led by NHS England, which is due to commence during the week of 16th June 2014.
Dr Pete Naylor is Acting Chair and Jon Develing is the Interim Accountable Officer.
JO
explained that he is aware that different members have different levels of information. If
members have any questions, JO advised that he would answer them to the best of his ability at
end of this meeting.
Action Points
th
Minutes of the WGPCC Executive Board meeting – 11 June 2014
Page 1 of 7
Ref No.
Minute
WGPCC Care Homes Scheme – Action complete – JS to share the scheme evaluation with
Patient Council members on Thursday 12th June 2014.
Minor Injury and Illness Service Evaluation 2013-14 – Action complete – CC has explored
ways to release £50k from existing financial priorities for the Consortium. This item is covered
under the WGPCC Expenditure Plan Update at this meeting.
Minor Injury and Illness Service Evaluation 2013-14 – Action complete – CC has deferred
the decision regarding future commissioning of all three of the WGPCC Minor Injury and Illness
sites to the CCG – This item is covered under the WGPCC Expenditure Plan Update at this
meeting.
Financial Budget 2013/14 – Action pending – LM to ensure activity data for all providers is
included in future monthly reports – Due to the fact that reporting does not commence until
month three or four, the full pack is not available but this information will be included going
forward.
1.5 Minutes for Noting
There were no ratified Governing Body meeting minutes available for noting.
1.6 Complaints, Compliments and Patient Feedback
Executive Board members were advised that there is nothing specific to report on relating to
services commissioned by WGPCC this month.
WGPCC/EB/
14-15/008
2.1 WGPCC Medicines Management Approach
Steve Riley attended the Executive Board meeting to introduce himself and highlight how
Medicines Management have engaged with practices and how this could be improved.
Feedback and thoughts were requested.
One member highlighted that value of the input from their Medicines Management Practice
Pharmacist. If this resource were to be lost, it would take a great deal of GP time to cover the
role. Any problems that occur in practice are resolved quickly by the Medicines Management
team.
For the budgetary position, AA suggested that there is too much emphasis placed on cost
switching medication, and would like to see more work on quality improvement. SR assured
that medication would not be switched by a practice technician on cost alone; other factors are
considered here, for example the quality of a product. CC added that the Medicines
Management Team is working to a brief set by the CCG regarding QIPP, which includes both
quality and productivity.
Members were asked to send feedback directly to Steve Riley and any issues would be looked
into; the team will be as flexible as possible in exploring any areas that a practice is interested
in.
JO suggested that supply problems with particular medication can cause problems. Members
felt it would be helpful if the team could advise practices of the length of time a product would be
unavailable and whether it is a local or national issue, as this has an impact on whether a
patient’s repeat prescription should be amended. SR agreed to look into the possibility of
resolving the timescale issues mentioned.
Members were asked to consider what they would like to see included in reporting papers that
are shared at meetings. PA suggested that the top 20 most expensive patients for each
practice would be useful to receive.
th
Page 2 of 7
Ref No.
Minute
Medicine waste was highlighted as an issue and members were advised that it is difficult to
quantify the amount of wastage that occurs. This can be done from care home information
received but is difficult to report down to practice level.
It was agreed that a draft reporting pack would be put together and brought to the next meeting
for members to comment if any different information is required.
WGPCC/EB/
14-15/009
3.1 Tier 1 Gynaecology Evaluation Report
Members were reminded that the Tier 1 Gynaecology Service was commissioned to provide a
‘one stop shop’ approach for female patients from WGPCC member practices has been
operating for eight months. The purpose of the service is for gynaecological reasons and is not
for contraceptive purposes. As the service is due for review in July 2014, it has been brought to
the Board for consideration.
Members were advised that the cost of the service for the eight month period is as follows:
•
•
•
Villa MC = £1,440
Teehey Lane = £600
Total £2,040
This includes payments for pessaries purchased for patients who subsequently decided not to
proceed with the procedure.
The cost for 38 patients to be seen in the WUTH outpatient gynaecology department would
have cost practices £5,901 in total. Therefore an approximate saving of £3,861 has been made
in the eight month period.
Villa has suggested two consultations be funded with a fee of £25 for an initial additional
consultation appointment as their experience to date had been that discussion with patients
concerning intervention and treatment in the service was required before proceeding to the
intervention. They have advised that they would only want to carry on the service on this basis.
By having the Tier 1 service, CC explained that it has avoided costs at WUTH but has not
released any costs.
If members want to see the service continue, there is an amount of slippage available but if the
service continues indefinitely, the Consortium may have to cap what is available and limited the
number of people seen.
Members were asked to consider the following:
•
•
•
Stop the service in August
Carry on and include the additional charge of £25.
Monitor the number of women going through the service and put a cap on this if the cost
approaches the budget that is available.
Members were advised that due to the QIPP review, the service may be looked at Wirral wide.
Members must decide on the future of the service at this meeting as the Executive Board does
not meet again until September.
The question was raised if details of practices that use the service could be obtained as it was
felt only a number of practices are using the service.
A proposal was made to continue funding the service until March 2015 but put a cap on activity.
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Page 3 of 7
Ref No.
Minute
The Executive Board agreed to continue the service until the end of March 2015 with the
additional consultation appointment and agreed to the funding with a cap on activity once spend
reaches the total budget available. No guarantee to be given to practices for funding beyond
March 2015.
Action: CD to collate and share details of practices that use the Tier 1 service.
Action: The Tier 1 Gynaecology service to be brought back to the Executive Board in
November 2014 or January 2015 for review.
3.2 Claim for Non-recurrent Resources
There was no conflict of interest for this item as the Member Practice involved is not
represented on the Executive Board.
Members were advised that the report asks the Board to consider a request from a Member
Practice to access non-recurrent resources that were available in 2013-14.
The practice used their non-recurrent resource allocation of £22,090 for Counselling, Health
Care Assistant and Acupuncture but failed to invoice the CCG by the deadline set, before the
end of the financial year. Therefore no money has been accrued for this. A request was made
for reimbursement due to extenuating circumstances but this request was originally turned down
by CC and JO. The practice appealed this decision and as the Chair and Chief Officer made
the original decision, the next stage is for consideration by the Board. Full details including
email correspondence is set out in the paper.
Members were advised that as the resource was not invoiced for, the money went to support the
CCG bottom line and therefore was no longer available to the Consortium. The Practice has
said it missed the communication due to extenuating circumstances. Appendices 1, 2 and 3
were highlighted. The practice is aware that the final decision would be made by the Executive
Board.
The Board was asked to consider the following:
a. There is the risk of this practice – a practice with a history of strong engagement with the
Consortium and its commissioning strategies – disengaging with the Consortium, at a
time when the CCG is working harder than ever to engage its Member Practices;
b. Three other practices did not submit an invoice in time, to a total of £56,214. The
Consortium does not have access to this level of resource, and therefore there would
need to be a particularly extenuating reason for granting reimbursement to one practice
and not to others, if we are seeking to be equitable;
c. The practice has fully implemented the schemes for which it is claiming reimbursement,
and can provide evidence of this.
Members were informed that there is strong engagement with this Member Practice.
Members were reminded that the amount was based on the financial situation at that time but
when making the decision today is must be based on the financial situation at this time.
Discussions took place and it was agreed that this must be made clear the Board is supporting
this case due to extenuating circumstances and the ability to honour this financially, but will not
be in a position to honour any future applications.
The Executive Board agreed to reimburse the Member Practice 50% of the total funding
requested.
th
Page 4 of 7
Ref No.
Minute
3.3 WGPCC Expenditure Plan Update
Members were advised that the paper set out the proposed expenditure plan for 2014/15 for
Wirral GP Commissioning Consortium’s recurrent service development budget of £695,758.
The paper shows the breakdown for each area within the budget.
Members were reminded that there had been a large discussion at the last Executive Board
meeting regarding the Minor Injury and Illness Service. This had been discussed with senior
management in the CCG for consideration. Wirral GPCC is covering the commissioning
responsibility and budget until the end of August 2014. A review is currently being undertaken
being led by the Interim Accountable Officer, with a decision to be reached by the end of August
2014.
The practice training budget has been transferred to another budget and members were
informed that the money available at practice level does not change.
With regards to the ECG service, figures on the number of patients who have used the service
are shown in figure 3.4 of the report for information, following a request raised at the previous
Executive Board meeting.
One Board Member explained that it is a valued service, with very quick reporting and
information. Comparison costs for the service would be useful for members to consider.
Members were advised that the cost for this service is £35. There is no additional cost at the
Heart Centre as this is run on a block contract. If the ECG service was stopped, this would
increase waiting times at the Heart Centre. It was agreed that the ECG service should continue.
An extra £11,000 would be available to put into the contingency fund due to the Member
Practice only receiving 50% of the non-recurrent resource.
For Primary Care Mental Health, Peninsula have agreed to a block contract for the remainder of
the year, but the additional value is still required to meet the increasing complexity of the patient
caseload.
A query was raised as to whether this could be guaranteed, whether Peninsula would ask for
more money in the future and would waiting times go up. CC advised that as it is a block
contract, there would be no further costs within 2014/15. Members were advised that this would
be monitored on a weekly basis and that the provider is currently meeting waiting times and
DNA targets. Referrals are steady and the contract is based on average numbers received.
The Board is being asked to note how the budget is broken down for the financial year 2014/15
in order for the budget to be signed off.
The Executive Board approved the breakdown of the WGPCC expenditure plan for 2014/15.
WGPCC/EB/
14-15/010
4.1 Financial Budget 2013/14
The finance update for the period 1st April 2014 to 30th April 2014 was tabled at the meeting.
Members were advised that for the year ending 31st March 2014, the accounts for the first year
of Wirral CCG have been audited and Grant Thornton have given an unqualified opinion which
concludes the financial records and statements are fairly and appropriate presented which is
good.
One challenge for the CCG is to make QIPP savings for the coming year. £5 million savings
have to be realised in order to achieve financial balance; although the idea is to look towards
£10 million savings if possible. Members were advised that CC has been given responsibility for
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Page 5 of 7
Ref No.
Minute
the QIPP plan.
There is a budget of £35 million for Continuing Healthcare and packages of care, the panel
process for which lies with the Commissioning Support Unit.
Members were advised that for some services under Peninsula Health, for example
Orthopaedics the first appointment here is more expensive that at WUTH. There is a perception
that practices think there is a less expensive tariff.
A request was made for a breakdown of which practices send patients to these services
together with tariff charges. It was agreed that tariff prices should be shared with practices.
2014/15 WGPCC Update – The total budget available to the consortium for the year is £148
million, which is based on a new “fair share” formula approach (WGPCC fair share 38.59%) of
the overall amount allocated to the Consortia of £384 million. Members were advised that this is
much less than the previous year.
The Executive Board noted the finance update for month one.
4.2 Patient Council and Engagement Update
Members were informed by ES that Healthwatch had presented at the last Patient Council
meeting and would like to attend each meeting. This was agreed on the proviso that they can
be asked to leave the meeting if it is deemed necessary, to discuss any private business.
There was a discussion and update on the Minor Injuries and Illness Service and patients are in
favour of the service.
A request had been made for Simon Wagener, the Patient Representative from the Wirral CCG
Governing Body, to attend the next Patient Council meeting.
Good feedback was received on the Primary Care Mental Health service update.
Members were advised that meetings go from strength to strength. More knowledge, good
ideas and strong good views are fed into these meetings.
ES was asked to write a letter to Simon Wagener on behalf of the patient group regarding
concerns raised at the Patient Council on how views are represented at Governing Body
meetings on the patients’ behalf, copying into the letter both AA and HM, as WGPCC
representatives at Governing Body.
Action: ES to write a letter as set out above.
4.3 Practice Managers’ Update
Phlebotomy – Executive Board members were advised that the issues highlighted at the last
Executive Board meeting still continue. A representative from the Phlebotomy service will be
attending the next Practice Managers’ Forum on 10th July 2014.
Practice Managers’ Workloads – There has been a reduction in the number of LES’s and
some of QOF has now gone in the baseline. The question was asked if this has helped with
workloads and members were advised that this is bound to help to an extent. There have been
issues with inputting figures in time for deadlines due to system problems and therefore claiming
can be difficult. Account Managers within the Local Area Team have a wider remit covering a
number of CCGs, which has reduced engagement.
th
Page 6 of 7
Ref No.
Minute
4.4 Items for Risk Register
There were no new items to be included on the risk register.
WGPCC/EB/
14-15/011
5. Any Other Business
GP Forum – Members were advised that Dr Clive Pleasance has stepped down as Chair of the
WGPCC GP Forum with the new Chair being Dr Simon Delaney. Members thanked Dr
Pleasance for all his hard work and commitment in the role of GP Forum Chair.
Action: A letter to be sent to Dr Pleasance thanking him for his services as GP Forum
Chair.
Risk Stratification – ME asked if there were any arrangements to support practices with risk
stratification. CC advised that a letter had been issued to Senior Partners and Practice
Managers a few weeks ago regarding this. The DES requirements were highlighted to
members. Members were informed that practices can use their own list of patients or can use
the list that will be provided shortly.
Action: AF to resend the risk stratification email to Practice Managers.
WGPCC/EB/
14-15/012
6. Private Business
There was no private business discussed.
7. Date and Time of Next Meeting
The date and time of the next meeting is Tuesday 16th September 2014, 6.30pm in the
Nightingale Room, Old Market House, Birkenhead.
Please send any apologies to Anita Fletcher on anitafletcher@nhs.net
The meeting finished at 8.15pm
th
Page 7 of 7
APPROVALS COMMITTEE
Minutes of Meeting
Tuesday 27th August 2014
Room 539, 5th Floor, Old Market House
James Kay (JK)
Lorna Quigley (LQ)
Present:
Lay Member (Audit & Governance), WCCG (meeting Chair)
Head of Quality & Performance
In attendance:
Chelsea Worthington (CW) Corporate Support Admin Assistant (minute taker)
Christine Campbell (CC) Chief Officer, WGPCC
Andrew Cooper (AC)
Chief Officer, WHCC
Sylvia Cheater (SC)
Audit Lay Member
Bernard Halley (BH)
Audit Lay Member
Steve Riley (SR)
Senior Prescribing Advisor
REF NO.
AC14-15/01
MINUTES
ACTIONS
1. PRELIMINARY BUSINESS
1.1 Apologies for absence:
•
•
•
Fiona Johnstone (FJ)
Simon Wagener (SW)
Mark Bakewell (MB)
Lay Member (Patient Champion), WCGG
Chief Financial Officer, WCCG
1
REF NO.
MINUTES
ACTIONS
JK introduced the new Lay Members to the group. Both Lay Members introduced themselves and their job
roles within the CCG to the Group. Each member of the group introduced themselves and their job roles to
the Lay Members also.
1.2 Declarations of interest: LQ would like to note that with regards to the over 75’s paper due to be
presented by CC in this meeting. LQ advised that she has a family member that would benefit from this
but LQ is looking at the wider population of 3,000.
JK advised that under our Conflicts of Interest Policy he has to rule on whether to a) note, b) note and not
allow the conflicted person to speak on the item or c) exclude the person from the meeting. JK ruled to a)
note.
CC advised committee that Harry Parsonage current Patient Rep has sadly passed away. Committee
noted the loss and expressed their sympathies.
JK advised that he is not sure of the process for electing a new patient rep at the current stage of the
Capacity and Governance review. He suggested that this should be left as it is until the review has been
completed.
JK informed the committee in relation to the MIAA report on the previous 12 month’s approvals activities
and their outcomes that MIAA’s report will be going to the next Audit Committee and then will come on to
Approvals Committee for information.
1.3 Minutes from Previous Meeting:
The minutes of 16th April 2014 were agreed as a true and accurate record with the exception of the
changes noted and agreed by the committee.
AC14-15/02
2. ITEMS FOR DISCUSSION
2
REF NO.
MINUTES
ACTIONS
2.1 Approvals TOR
JK presented the last approved TOR to the group with all amendments shown in red.
Revisions have already been agreed to the document.
When NHS England approve these TOR they will become the TOR the Approvals Committee will use.
As we are operating under the old TOR, JK explained that the lay members here today are here as
observers. JK’s intention in the future is to have 2 of the lay members to attend each Approvals
Committee meeting.
Action – Lay advisor title to be changed to lay member throughout the document
AC pointed out that the previous minutes need to reflect that MB should be in attendance rather than
present to the meeting as the TOR state that the CFO does not have the right to vote.
Action – CW to check with PE with regards to the CFO being a voting member or not.
BH explained that the suggested quorum for the meeting is 3 lay members. Should this not be 4?
After discussion it was agreed that the quorum should stay as 3.
Committee agreed they are happy with proposed changes to the TOR and that these can go to the next
Governing Body Meeting. As of the November GB meeting the current lay members should be able to
vote at Approvals Committee.
AC14-15/03
3. ITEMS FOR APPROVAL
3
REF NO.
MINUTES
ACTIONS
3.1 Prescribing incentive scheme
JK explained to the committee that all items for discussion use a standard pro-forma promoted by NHS
England which includes a tick box for approval. All proposals include supporting papers.
CC introduced Steve Riley to the group and Lay members introduced themselves to Steve.
CC explained this was a renewed scheme and that the main difference with this year’s scheme is that it
embodies proposals from our internal auditors (MIAA) previously completed audit report on the prescribing
scheme whereas the new scheme now reflects what MIAA have raised in the report.
CC advised that this scheme goes above and beyond the GMS and PMS contracts.
This scheme requires General Practices to undertake project work relating to the prescribing of various
drugs, with a view to ensuring consistently high quality and cost-effective prescribing. They will also be
required to undertake audits to inform future best practice.
This GP prescribing incentive scheme in 14/15 aims to:
•Encourage GP practices to review prescribing in key therapeutic areas which have been identified as
areas of high cost for the CCG or where the practices are outliers on the QIPP report.
•Improve quality of prescribing in accordance with local and national clinical guidelines.
•Improve adherence to local formulary choices and decisions.
•Improve cost effective prescribing in identified therapeutic areas.
•Improve the practice based systems involved in the handling of hospital discharge prescriptions and
outpatient letters requiring medication changes, additions or deletions. Also, identify any issues with
information supplied to GP practices.
•Improve the systems for the repeat ordering and prescribing of stoma / ileostomy products, reducing
waste and inappropriate orders via third part appliance contractors. Developing and implementing a CCG
wide approach.
•Encourage sharing of best practice and peer review amongst GPs.
4
REF NO.
MINUTES
ACTIONS
•Provide a basis for continued practice based review in following years to further improve practice and
systems.
CC confirmed that there has been money set aside for the scheme and this is within budgets already
approved.
Exploring potential sources of Conflicts of Interest
It is hard to figure out an hourly rate for the scheme as this will be using time of both admin staff and GPs,
it has been thought that it would be better to go by list size.
BH states that in section 2 of the schedule at the end of the final section it mentions about an attendance
list, and asked if there was something that can be added into that to say how we would benefit from this.
SR advised that this would be tricky. This section is itself additional as a requirement to achieve final
payment.
BH expressed surprise at paragraph 2.1 which shows GP Practices required to modify records and
discharge papers.
SR responded that is routine practice. This looks at how they do it in their practice, each practice would be
different.
SR explained that there is currently no contractual agreement on how practices should keep this
information, some may note it down and some keep only in their heads.
It’s all about looking at the best process to suit each practice.
SC asked if patients have been asked if they want this scheme and if they think it is going to help them?
CC advised that patients as a PPG or Forum have not been advised of this scheme although individual
patients will be consulted with by their GPs about their prescribing choices.
SR explained that this has not gone to any patient groups.
5
REF NO.
MINUTES
ACTIONS
JK raised the concern that patients feel more engaged when they are having a discussion rather than just
being told of what is going to happen.
JK suggested adding a recommendation that this is to go to patient groups and patient forums to have the
discussion and for them to express their thoughts
SC asked about the contract that pharmacies currently have to discuss with their patients regarding their
medicine.
Is this not duplication?
SR explained that there is currently a review to look at patients and their medicines to ask if they know
how to use it/take it/can we help you with anything etc but this is a separate NHS service and much more
limited.
Decision: The Committee approved the proposal with the recommendation that patient forums and
patient practice groups should be advised of this scheme and then encouraged to discuss it with their
members within the practice.
3.2 Improving the care of people aged 75 and over
CC introduced the improving the care of people aged 75 and over.
This scheme requires general practices to undertake a range of activities to improve the care of their
patients aged 75 and over. The aims are: to personalize a care plan for complex patients, follow-up of
patients following an early admission, review people on 10 or more medications, develop a register who
are careers, or live alone, offer a health check for vulnerable people who have not visited their practice in
more than 12 months and to review the dementia register to ensure that all appropriate patients have
been identified.
CC advised that they are asking practices to use a new information tool on local services to enhance
medical imputs. The GP practices would need to be trained to use this, meds management have been
secured to deliver this training.
6
REF NO.
MINUTES
ACTIONS
The CCG have decided to put together a pack for 75s and over to help them with any further information.
CC explained that she has worked with The Older People’s Parliament to develop and deliver these
packs.
CC explained that we have recurring money for this for years 14/15 and 15/16 within agreed budgets.
CC advised that the CCG want to develop a multi-disciplinary care plan. This is what the scheme is for as
current GP’s don’t have this in place.
JK asked if we have explored different ways that this can be done?
CC advised that this is the most cost efficient way this can be done as to procure elements individually
would be more expensive.
JK asked what happens if a GP decides that they do not want to take part in this?
CC advised that if a GP does not want to participate the neighboring GP can be commissioned to provide
these services.
BH expressed that this was a very good paper and that he thought there should be a better review date. It
says that the patients that register for the scheme should receive their pack within 3 months.
JK then asked if this could be reduced to 1 week?
CC explained that this would be something they could discuss; it just goes to the admin duties of the
practices.
BH talked about the payment for patients living alone, what is the percentage of people that are added to
the register?
CC explained that this would be hard to discuss as each GP practice has a different number of patients
already on registers.
JK advised that there needs to be something added in to the scheme that proposes a percentage increase
7
REF NO.
MINUTES
ACTIONS
and CC advised that she would look into this.
Decision: The Committee approved the proposal with the recommendations that patient forums and
patient practice groups should be advised of this scheme and then encouraged to discuss it with their
members within the practice, and the above noted review of deadline dates and percentage increases
should be reconsidered.
3.3 Transforming primary care scheme
AC presented the transforming primary care paper to the committee.
The scheme requires General Practices to undertake a range of activities to improve access to and the
provision of primary urgent care. The elements with the paper include:
• Accepting patients streamed from A&E who may require urgent appointment slots (telephone/face
to face)
• Accepting patients redirected by ambulance service and conducting home visits within 2 hours of a
referral.
• Aligning to integrated care coordination teams- attending MDT meetings for very complex cases
and regularly liasing with ICCT’s for clinical discussion of patients
• The collection of data for all GP visit requests undertaken within practice and formulating a delivery
plan to offer staggered and responsive visits for all urgent requests. From 1st April 2014, our aim
will be for practices to adopt these delivery plans to achieve staggered and responsive home visits.
The summary of costing for the Transforming Primary Care Scheme is £540,00 which includes GP
scheme, alignment to ICCT’s, GP visiting and patient streaming.
In terms of GP streaming and GP visiting schemes, patient records currently sit with GPs, we do not have
access to the records. If the ambulance team would require the records they would have to make the
clinical call to the GP themselves.
8
REF NO.
MINUTES
ACTIONS
SC asked if it would be the same for this scheme with regards to GP’s not wanting to sign up. Could
neighboring practices supply the services to patients?
AC confirmed that it would also apply to this scheme that is if GPs did not want to sign up then we would
commission another practice.
Decision: The Committee approved the proposal with the recommendations that patient forums and patient
practice groups should be advised of this scheme and then encouraged to discuss it with their members within the
practice.
AC14-15/04
5. ANY OTHER BUSINESS
No other business discussed.
AC14-15/05
The next meeting is:
Wednesday 17th September 2014
1.00 – 2.30pm
Room 539, 5th Floor, Old Market House
Agenda papers to chelsea.worthington@nhs.net no later than Tuesday 9th September 2014.
Agenda and supporting papers will be emailed to Committee members: Wednesday 10th
September 2014.
9
REF NO.
MINUTES
ACTIONS
10
Audit Committee Meeting
Wednesday 28th May 2014
10.00am – 12.30pm, Room 539, Old Market House
Present:
James Kay (JK)
Mark Bakewell (MB)
Liz Temple-Murray (LTM)
Sylvia Cheater (SC)
Tracey Fisher (TF)
Simon Wagener (SW)
Laura Wentworth (LW)
Bernard Halley (BH)
Gordon Haworth (GH)
Lin Elliott (LE)
Audit Committee Chair
Chief Financial Officer
Manager - Grant Thornton
Audit Lay Member
Audit Lay Member
Lay Member
Corporate Support Officer
Audit Lay Member
Executive Assurance- Grant Thornton
Audit Manager Mersey Internal Audit Agency
In Attendance:
Chelsea Worthington (CW)
Christine Campbell (CC)
Iain Stewart (IS)
Emma Shanks (ES)
Item No.
GA13-14/15
Administrative Assistant (minute taker)
Consortium Chief Officer
Consortium Chief Officer
Senior Reporting Accountant
Agenda Items
Action
PRELIMINARY BUSINESS
JK provided an update to Audit Committee members on the current situation
within the CCG and provided information relating to the capability and
capacity review which is currently being undertaken by NHS England. It was
confirmed that the Chair and Accountable Officer have voluntarily stepped
down from their posts for the next 4 weeks, whilst this review is undertaken.
Jonathan Develing was introduced to the meeting as the Interim Accountable
Officer and he explained his role whilst working with the CCG over the next 4
weeks to assist through the current challenges.
1.1
Apologies: Robin Baker, Andrew Cooper, Paul Edwards, Joy Hammond.
Signed – Chair
P a g e 1 of 8
Declarations of Interest:
1.2
No declarations of interest were made.
Minutes of Previous Meeting/Action points of previous meeting held on
3rd April 2014
1.3
The minutes of the previous meeting held on 3rd April 2014 were agreed as a
true and accurate record.
Actions –
32- CW to speak to LQ regarding the presentation on serious incident
reporting at Patient Forums and CW to then send an update regarding this
action via email to Audit Committee members.
53 - LW to re-send the Assurance Framework and list of acronyms to Lay
Members.
55 - MB advised that he is currently in talks with ICT regarding refreshing the
policies- MB will send update to all members regarding this in due course.
CW
LW
MB
It was noted that the actions tracker should be updated to reflect items
completed or amended.
Matters Arising:
1.4
No matters arising.
GA13-14/16
ITEMS FOR DISCUSSION
2.1
Review of CCG annual accounts
MB explained current position of annual account process at this time and that
respective CCG / audit teams are still working through final amendments in
line with member’s comments and the national guidance. MB thanked the
Finance Team and the Corporate Team for their hard work over the past few
months in completion of this report. It was noted that any amendments to the
document need to be agreed before the final version is submitted to
Governing Body on June 3rd for their approval. The final deadline for this
report to be uploaded to ‘sharepoint’ is midday on Friday 6th June.
MB advised that there are discussions in place with regards to who will sign
the annual report and the final accounts and that this should be confirmed by
the end of the day in accordance with issues regarding interim accountable
officer
MB informed group members of the issue the CCG have had regarding the
hosting arrangement with the Isle of Man and subsequent accounting
treatment.
Signed – Chair
P a g e 2 of 8
The accounting treatment has a knock on effect with the agreement of
balances exercise and has been raised with NHS England.
MB informed the committee that he had agreed to make the changes which
were in line with Manual for accounts and had been reflected in the accounts.
JK queried whether this arrangement was appropriate for the CCG and
whether this is something that we should be doing in the future?
MB clarified to the Audit Committee that the issue is purely a transactional
ledger issue that the CSU deal with directly and that the CCG does not
directly get involved in the day to day processes but clearly the year end
position has caused an additional amount of time / effort to resolve the
relevant issues
SW expressed concerns that this information will be in our accounts and that
the public may raise queries regarding this.
MB clarified that with the appropriate adjustments these will no longer appear
BH explained that someone has to do the job of hosting for Isle of Man,
providing it doesn’t cause any trouble for the CCG then his thoughts are to
carry on supporting.
SC asked if this generated any money to the CCG which MB confirmed that it
does not generate any income for the CCG.
JD explained that this is no financial risk to the CCG by delivering this and
explained that the CCG should consider charging the CSU for the support
that they are providing.
MB advised he is minded to potentially pursue with the CSU and ask them to
pursue alternative arrangements and was making contact with regards to
reviewing these options.
MB then presented the four primary statements of the 2013-14 Annual
Accounts to the Audit Committee.
MB explained the purpose of the statements and why some of the values
within the statements had been left as blank (for information / learning
purposes) and that potentially in future years they be removed if no relevant
transactions
The CCG have made further changes to the supporting notes over the past
few days following agreement with external auditors and this will be reflected
in the final version that will go to Governing Body on 3rd June.
JK queried whether the related expenditure statement for GB members
includes figures for GMS and PMS expenditure in GP members' practices.
MB explained that they are not included in the budget as they are not the
responsibility of CCG.
JK queried what should qualify for inclusion under related party transactions
and asked whether the secondary care doctor should not also be included as
his wife is a GP?
Signed – Chair
P a g e 3 of 8
MB explained the rationale behind the related party transactions note in that
transactions are included with third parties of a material nature and
predominantly where the CCG party has significant influence and control
within the organisation.
MB further responded that although AS' (secondary care doctor) wife is a GP
Partner in Wirral practice, there is an element of how far the scope of related
party transactions can be extended, given it could extend to all 58 GP
practices and that a line needs to be drawn at some point.
Although AS is a voting member of governing body, the related party
transaction would be directly with Aintree Hospitals (his employer) but there is
no direct influence over contract expenditure and that the view has been
formed that the transactions with his wife’s practices were beyond the scope
of the note.
JK queried what values were included in the figures as these financial values
didn’t seem to link back to his knowledge of CCG expenditures.
MB explained that transactions included within the note are predominantly
made of local enhanced services, prescribing schemes and consortia
developments.
MB further explained that the related party transactions are further managed
via the Approvals Committee within our organisational structure. JK asked MB
MB to check figures in previous Approvals Committee notes to check for
alignment.
SW explained that the public will possibly like to see assurance with regards
to this section and to what these values relate.
JK asked if a note could be added to explain that the amounts don’t include
GMS, PMS plus an explanation of figures and further explanation of the
relevant governance systems (via Approvals Committee) behind these areas MB
of expenditure. MB advised this would be updated to include this.
JK queried regarding what was included in other income that had been
received by the CCG. ES explained that the CCG have now received the
reimbursement for the IT expenditure incurred initially by the CSU.
MB explained with regards to note 5 of the annual accounts that the CCG
have had discussions with Grant Thornton and although the CCG has an
internal audit, the relevant figures are included under the heading Supplies
and services – general not necessarily internal audit as this specifically
relates to internal audit services provided by the external auditor. It was
advised that a short note be made to state that ‘supplies and services’
includes payments made to Mersey Internal Audit Agency.
ES to amend this accordingly.
ES
JK queried the figure quoted for the purchase of 'Non-NHS' healthcare. This
Signed – Chair
P a g e 4 of 8
seems to total 15% rather than the 3% often quoted in our GB reporting. MB
explained that alongside Non-NHS Contracts that this also includes
expenditure on Continuing Healthcare which figure alone is £32 million.
JK asked if the explanatory note could be expanded that explains this, given MB
potential public concerns.
BH raised issue with regards to the format of Note 1 re accounting policies
and asked if this could be done as a separate document and not in the middle
of the financial statements
MB advised that notes followed the reporting guidance and format for
collating this and that if we change this format it may cause difficulties with
audit and consistency.
LTM agreed and stated that the accounting policies are fundamental
principles behind the numbers included in the statements is appropriate to be
included on the 1st page, the document could possibly be narrowed down
further as most notes are just general but this was discussed earlier in MB
introduction.
MB explained that finance had tried to ensure the accounts flow and are easy
to read however that we were penalised for doing this by NHS England, as
this was not in line with the National Guidance.
JK asked for feedback to be provided to NHS England as appropriate re the
format of this section.
TF raised the issues of the page numbers through the document.
ES explained that this issue is due to technical problems with the PDF writer
and that this will be amended for the final version.
MB explained that there remained a few areas to be amended:
Note with regards to CHC Provision
Note 4.2 regarding department of health and sickness figure
Note 42- update of year end numbers
With the changes and amendments as noted above, the Audit Committee
agreed that the Annual Accounts should be presented to the Governing Body
for their approval on 3rd June.
JK, on behalf of the Audit Committee, thanked the teams at the CCG and
Grant Thornton for all of their hard work, help and support in the preparation
of these accounts.
2.2
Review the CCG’s Annual report
MB presented the Annual report to members.
MB explained to committee members that this document is still work in
progress and explained that the team have attempted to make the document
flow to make the report more readable for its audience.
Signed – Chair
P a g e 5 of 8
JK highlighted that in discussions with auditors that elements of remuneration
information should be included in the report itself rather than as an appendix.
MB agreed with this and had agreed to make this amendment.
MB
JK highlighted that there are some typo errors and grammatical errors. JK
requested for any amendments to be made to this document to be sent to LW
by the afternoon of 28th May in order to circulate to governing body.
ALL
It was noted that given the CCG current situation, arrangements are still
being confirmed in order to confirm the signature on the statements.
JK drew to the committee’s attention to the tables on page 81-83 of the
document.
His attention had been particularly drawn to the figures included under the
heading ‘Real increase in Cash Equivalent Transfer Value’ for a number of
officers.
JK queried the increased and relationship between salary and real increase.
MB explained that the information had been provided by the Pensions
Agency with some manual calculations being performed for the note locally.
MB explained that the information presented is accurate and had been
reviewed by external audit team but understood the reason for the query.
MB explained his understanding that the increase will have come from
changes to terms and conditions given roles with CCG between the
respective financial years, but there was a need to understand the relevant
explanations between each of the columns and that there is need to
understand the technical definition behind the respective headings
SC and JK again queried why the values looked the way that they did
LTM explained that she has looked at other CCG figures for this and they are
at similar amounts.
MB explained that further information could be provided as per the manual for
accounts, however there was a concern with regards to the time scale by
which we have to have these documents completed and submitted.
JK expressed his concern that given current situation of the CCG that the
public may very reasonably have an extremely sharp eye on the figures the
CCG release. The group noted the importance of ensuring that the correct
figures are published and JK asked if a narrative could be added to address
any further enquiries related to these figures.
MB
JK queried how members of staff who are not into the NHS pensions scheme
are included within the information? MB confirmed that this correctly treated
SW queried with regards to the figures in the taxable benefits column and MB
clarified that this would be regarding any expenses claimed within the
Signed – Chair
P a g e 6 of 8
previous financial year.
BH expressed that he found this report very useful however requested for a
glossary to be included within the document to explain any acronyms for the
public’s better understanding. LW agreed to include this list.
An issue was also raised with regards to page 41 as there is no mention of
the new audit lay members within in the section on audit committee. LW to
include the new members.
LW
LW
BH highlighted that the content of page 66 needs more of an explanation on
the conclusion because as it stands it reads as more of a statement than a
conclusion to the document.
With the changes and amendments as noted above, the Audit Committee
agreed that the Annual Report should be presented to the Governing Body for
their approval on the 3rd June.
JK, on behalf of the Audit Committee again thanked the teams at the CCG
and Grant Thornton for all of their hard work, help and support in compiling
and refining this report.
2.3
Receive the CCG’s draft Annual Governance Statement
The group reviewed the draft Annual Governance Statement and it was noted
that Grant Thornton will review this further and provide feedback to MB with
regards to the language and wording. Following discussion the Audit
Committee agreed that the Annual Governance Statement should go forward
to the Governing Body for their approval on the 3rd June.
2.4
Receive the external Auditor Findings (ISA260)
LTM presented the External Auditors progress report which highlights any
issues/findings from the review. LTM explained that there will be a more
detailed report of the review presented at the Governing Body on 3rd June. It
was also noted that Grant Thornton are expected to give a specific opinion on
the remuneration report.
The executive summary of the report explains the purpose and any key audit
and financial issues that Grant Thornton have found.
LTM explained that Grant Thornton are currently awaiting the service audit
opinion report from Deloitte regarding the CSU
Grant Thornton are not expecting any major concerns however LTM
highlighted that they are unable to sign this off until the CSU report had been
received.
LTM highlighted that the one issue that Grant Thornton has noted within the
audit and financial reports is that of the Isle of Man which has been stated as
a material error in the first draft of their report.
Signed – Chair
P a g e 7 of 8
MB has agreed to change the presentation of these transactions as
highlighted earlier in meeting (above).
LTM expressed her thanks for how well the finance team and corporate team
have worked together with Grant Thornton. It was noted than an update of
this report will be presented at the Governing Body meeting to be held on 3rd
June.
LTM/CW
ACTION - LTM to send CW updated report for the Governing Body
It was highlighted that the adjusted misstatement section of the document will
include MB’s comments and reasons for why this is not adjusted within the
final document.
The group noted that the Governing Body meeting to be held on Tuesday 3rd
June is the final meeting that any accounts can go to for review and final
approval.
MB explained that MIAA’s Head of Internal Audit opinion was received at the
last meeting held in April 2014 and therefore the document is for noting and
review by members.
LE agreed she is happy with this approach having discussed in detail at last
meeting
JK advised that to the above documents will be reviewed at the Governing
Body to be held on 3rd June subject to the changes discussed with Audit
Committee, Chief financial officer and Interim Accountable Officer.
GA13-14/17
ITEMS FOR INFORMATION
3.1
No further items were received or noted.
GA13-14/18
ANY OTHER BUSINESS
There was no other business.
4.1
GA13-14/19
The next meeting will be held on:
18th September 2014, 10am -12pm, Room 539, Old Market House.
Please forward apologies / agenda papers to chelsea.worthington@nhs.net
Signed – Chair
P a g e 8 of 8

GOVERNING BODY MEETING – A meeting in public

Transcription

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