A G E N D A - Tameside€¦ · Dr. Jamie Douglas GP Member (PC Quality and HT) Dr. Alan Dow GP Chair . Dr. Tina Greenhough (GP Clinical Vice Chair, Mental Health and Partnerships)

CCG GOVERNING BODY PUBLIC MEETING

TO BE HELD ON WEDNESDAY NOVEMBER 6TH AT 1p.m. 2013

BOARD ROOM, NEW CENTURY HOUSE, DENTON

A G E N D A

1. Welcome and Apologies to the Public Meeting

2. Initial Declarations of Interest

3. Consideration of Any Other Business

4. Chair’s Introduction

CCG Authorisation Update

5. Minutes of the Meeting Held on October 2nd 2013 pg3

Accuracy, Actions and Matters Arising:-

i. 111 Update pg20

Committee Reports and Minutes of Meetings

6. Public and Patient Engagement Reports

- Including draft Minutes of PPIC Committee

held on 9th October 2013 Celia Poole pg24

- Patient and Public Engagement Framework Training Celia Poole/pg30

for all Governing Body members Amir Hannan

7. Quality Reports

- Including draft Minutes of the Quality Committee Celia Poole

Held on October 30th 2013 – to follow

KEOGH - verbal update Nikki Leach

Safeguarding Update Nikki Leach pg34

HCAI Accountability/Responsibility Update Nikki Leach/ pg39

Anna Moloney

8. Planning Implementation and Quality Reports

- Including Draft Minutes of PIQ Committee Graham Curtis pg47

Held on October 16th 2013

- Integration Update Clare Watson pg57

- Transformation Report Clare Watson pg62

- Winter Plan Clare Watson pg67

9. Performance Reports

- Corporate Performance Reports Elaine Richardson pg134

- Finance and QIPP Report Kathy Roe pg184

10. Integrated Governance, Audit and Risk Reports

- Including draft minutes of the IGAR Committee Graham Curtis pg208

Held on October 2nd 2013

11. Locality Leads Meeting Reports

- Including draft minutes of the meeting held on Richard Bircher pg218

October 29th 2013

12. Association of GM CCGs Governing Group Committee Reports

- Including Minutes of the Association Meeting held on 1st October 2013 pg223

- Healthier Together – Verbal update

13. Tameside and Derbyshire Health and Well Being Reports:

- Verbal updates from DHWBB meeting on 25th July Alan Dow

and the Integrated Workshop of 13th September

- Verbal update from THWBB September 19th 2013 Tina Greenhough

14. Any Other Business

15. Date and Time of Next Meeting – December 4th 2013 at 1PM

Dr. Tina Greenhough in Chair

1

Minutes of the Governing Body Meeting Held on October 2nd 2013.

Dr. R. Bircher GP Member (Urgent Care)

Graham Curtis Deputy Chair/Lay Member

Dr. Jamie Douglas GP Member (PC Quality and HT)

Dr. Alan Dow GP Chair

Dr. Tina Greenhough (GP Clinical Vice Chair, Mental Health

and Partnerships)

Dr. Amir Hannan GP Member (Long Term Conditions, IMT)

Dr. Ram Jha GP Member (Planned Care/Cancer)

Nikki Leach Director of Nursing and Quality

Celia Poole Lay Member

Yvonne Pritchard Lay Advisor

Kathy Roe Chief Finance Officer

Clare Symons Nurse Member (Caldicott Guardian)

Clare Watson Director of Transformation

Dr. G. Wilkinson GP Member (Planned Care)

In attendance: Dr. A. Hershon, Dr. Gideon Smith, Elaine Richardson

1. Welcomes

Paul Connellan (Chair, Tameside FT), Sarah Dodgson (British Red Cross),

Carlo Carosi (Grunenthal), Lesley Surman (Patient Participation Group

Glossopdale)

Apologies

Steve Allinson, Angela Hardman, Dr. J. S. Bamrah

2. Declarations of Interest

It was agreed that the ‘Register of Interests’ would be made available

at each Governing Body Meeting. Members would be asked at each

meeting to declare their declarations of interest at the outset and as

arising to all items on the Governing Body agenda.

3

2

Declarations of Interest Reported at the GB Meeting:-

Dr. Tina Greenhough - (special interest in 111) Dr. Ram Jha – 1 Session

at Go to Doc.

Declarations of Interest Reported at the PIQ meeting

Dr. Alan Dow, Dr. Tina Greenhough, Dr. Guy Wilkinson, Dr. Ram Jha, Dr.

Jamie Douglas (as outlined in the declarations of interest in the PIQ

Minutes Held on September 18th).

Clare Symons, declared an interest in her capacity as Mental Health

and Learning Disability Commissioning Manager when presenting her

papers at PIQ.

3. Consideration of Any Other Business

None were declared.

4. Chair’s Introduction

Steve Allinson – Chief Operating Officer

The Governing Body was concerned to learn that Steve Allinson had

been involved in a cycle accident, and would be unavailable for work

for, at least 4 weeks. Kathy Roe had taken up the role of Acting COO.

The Governing Body offered their best wishes to Steve Allinson, for a

speedy recovery.

A discussion took place on capacity to cover the critical work in

addition to deputising at strategic meetings. Kathy Roe reassured the

Governing Body that early plans had been put in place and this was a

standing item at each weekly CCG Management Team meeting, to

prioritise work and ensure there is appropriate cover.

Graham Curtis raised a concern about how the CiC was operating

and he was less assured because of Steve’s absence, as Deputy

Member on that Group.

Target Lead

Alan Dow stated that the CCG’s Target Lead position had been filled

by Dr Tim Dowling.

4

3

Tameside Foundation Trust – Board Meeting Representation

Alan Dow stated that he had attended a recent Trust Board meeting

and had found it useful and informative.

It was proposed that Governing Body Members would attend, on a

rotational basis, arranged by Julie Bell.

Alan Dow reported from the Board meeting that one of the decisions

welcomed from the Secretary of State was the official announcement

of the ‘twinning’ of Tameside FT with South Manchester.

Less good news was that Tameside FT was 44 clinicians down in terms

of their full complement, and due to those core vacancies, locums

were creating high costs for the Trust.

Paul Connellan stated that a new batch of nurses had commenced

employment, which was now alleviating the situation somewhat.

There was a potential for the removal of Paediatric Orthopaedic

Surgery. The Governing Body were dismayed as this was agreed to be

a useful, local, service. Paul Connellan confirmed that this was only a

potential proposal at the moment.

Lorenzo

Lorenzo was due to ‘go live’ at TFT on October 7th.

‘Tameside Listens’ Smartphone App

It was noted that this was the first reported in the NHS, with positive

feedback from NHS England.

Paul Connellan stated that this created a very fast response system,

which captured questions, and then answered within minutes.

Finance Team – Awarded Level 2 Accreditation in the ‘Towards

Excellence Scheme’.

The Governing Body was pleased to note that the finance team were

successful in achieving level 2 accreditation in the Towards Excellence

scheme, one role of the North West Finance Skills Development

organisation. Towards Excellence accreditation is a key part of the

finance performance management process and organisations are

being assessed on a three year rolling programme. The aim is that the

finance function of each organisation strives for continued excellence

as part of its development.

5

4

The feedback in the confirmation letter stated that “This is an excellent

achievement demonstrating sustained performance and a culture that

is both innovative and consistently supportive of the development of

the finance capability within your organisation.”

The Governing Body congratulated the Finance Team.

CCG OD Plan

Kathy Roe stated that Staff would shortly be receiving the draft OD

Plan and the CCG Management Team is currently considering how to

‘launch’ the OD Plan more widely.

Alan Dow felt that the Plan read well; was practical, workable and

focussed.

e.learning – Mandatory Training

It was noted that there was a deadline of 31st October for Information

Governance Training, and 31st December for the other modules.

An email would be sent out offering support via Karen Stott, for those

members who would find the timelines challenging.

HFMA Training

Amir Hannan asked about this particular training. It was noted that the

training was not mandatory however, it was deemed useful,

particularly given the current financial situation.

Governing Body Development Sessions – 2014

It was agreed to hold half day sessions (Wednesdays), for the

forthcoming year. Julie Bell would issue the dates.

A & E Monies

It was noted that the joint bid had been successful with £2.475M (£1.5M

of which is Tameside FTs direct share). Work was now underway to

address the non-recurrent spend on winter preparations, such as

clinical/medical workforce; urgent care; MAU type pathways work.

Guy Wilkinson asked if there could be a quick purchase of Telehealth

Units. Clare Watson stated that this purchase would be evaluated

against other proposals at PIQ for a final decision.

6

5

5. Minutes of the Meeting Held on September 4th 2013

The Minutes were agreed as an accurate record of the meeting with

one amendment – Kathy Roe’s title was incorrect on the attendance

list, and would be replaced with Chief Finance Officer.

Matters Arising

Healthcare Acquired Infections

Nikki Leach and Angela Hardman were meeting to clarify respective

roles and responsibilities in the new environment (ie. what services the

CCG does not now have responsibility for).

Action: Nikki Leach and Angela Hardman

Locality Meetings

Richard Bircher would collect attendance numbers.

Action: Richard Bircher

Ashton Locality Meetings

Ram Jha would ensure he secures a deputy if he cannot attend the

Ashton Locality Meetings.

Action: Ram Jha

Memorandum of Understanding

It was noted that 6 practices had not signed up to the MOU. Alan Dow

understood the reason why 1 practice had reservations. It was agreed

that a follow up conversation with the Practices would be undertaken

to clarify their issues/concerns, and to outline the positive benefits to

general practices from the support of the CCG.

111 Update

Kathy Roe updated on the current position, stating that the Contract

for the Stability Partner (NWAS) was due to be signed in mid

September, however, due to National delays in the system this had

been deferred to October 10th.

7

6

There would be further NHS England Gateways to go through, to test

reassurance for readiness in terms of robust call handling/triaging.

Contingences were also in place for a Plan B, if required.

The Governing Body noted that NWAS was more expensive, due to set

up costs, however, there was a great deal of scrutiny on the costs and

the CCGs would be working with NWAS to create efficiency going

forwards. However, the CCG had sufficient funds in its current forecast

to cover the costs for the next 12 months.

Guy Wilkinson asked what scope the CCG had in terms of input to the

specification of the clinical model. It was noted that this was a GM

model, and was the model which best served everyone.

Alan Dow stated that potentially this area was in a better position as

GM had been able to re-articulate what the national guidelines

meant, and the specification is different from other areas.

6. Public and Patient Engagement Reports

- Draft Minutes of the PPIC Committee – September 18th 2013

Celia Poole updated on the key issues raised at the meeting:-

Training for Commissioners

It had been proposed that the training around Patient and Public

Engagement Framework would be delivered to the Governing Body as

the next phase in delivering the training to a wider audience. This

suggestion would be formally agreed at November Governing Body

meeting.

Action: Celia Poole – proposition for GB training to be presented to

GB Board in November

PPG/DES

An update was given on the progress of a PPG Network that had

started in Glossop. This cluster group would hold public facing

meetings, to discuss how the CCG and Public Health can support this

agenda.

CQUINS

This item was deferred to the meeting in October

8

7

Young Inspectors Programme

Governing Body noted that this was a national programme, setting out

a standardised approach to services being reviewed by young

people. It was noted that Celia Poole had requested a copy of the

final reports from Justin Wiggin, Participation & Partnerships Manager,

Communities, Children’s Adults and Mental Health, TMBC.

Proposals for Evaluation and Patient Involvement in the Integrated

Response and Intervention Service

There had been a brief update on the IRIS project report. Members

considered the evaluation metrics and service user survey in order to

measure/monitor the effectiveness of, and outcomes of, the pilot.

PPIC were requested to offer guidance around any patient and public

participation which the IRIS project team should undertake in order to

ensure optimum input into the future service model.

Concerns and Complaints Report

This item was still pending, awaiting an agreed format for reporting.

Celia Poole would discuss this further with Nikki Leach.

The Governing Body received the minutes.

7. Quality Reports

- Minutes of the Quality Committee held on August 21st

The Governing Body received the minutes held on August 21st (noting

the verbal update given on key issues at September Governing Body

meeting).

- Draft Minutes of the Quality Committee Meeting Held on 25th

September

Celia Poole updated on the key issues as follows:-

Suboptimal Discharges from TFT

Mark Simon had been asked to join the meeting to provide an update

on Suboptimal Discharges discussed at the previous meeting,

concerning discharges from TFT to Grange View. One of the main

issues had been around communication and agreement had been

reached on a process that will be used to manage discharges

appropriately.

9

8

Quality Improvement GP Lead

Joanna Bircher presented an update of the quality improvement work,

which included –professional concern email portal; Links with TFT and

Primary Care Quality Improvement work.

Announced and Unannounced Visits to Providers

Clare Watson updated on the plans for announced and unannounced

visits, in terms of what the intentions and outcomes would be.

Nursing Strategy

It was noted that Nikki Leach was developing a Nursing Strategy which

would be presented to the next Quality Committee.

Incidents Occurring with Service Providers

At this juncture Graham Curtis stated that Mark Simon was setting up

an officer group (to include Terms of Reference), to look at incidents

occurring within service providers, looking at root cause analysis reports

and action plans, making recommendations to IGAR. Its remit has

been widened from the previous PCT group (SUI Monitoring Group).

The Group will also look at quality issues (arising from these incidents

and the implementation of the action plans) and it will also therefore

report into Quality Committee.

The Governing Body agreed that the Quality Committee would be the

appropriate meeting to receive updates on Tameside FT Improvement

Board.

The Governing Body received the draft minutes of Quality Committee

held on 25th September.

Keogh Verbal Update

Nikki Leach updated on the recent meeting, which main focus was

around governance and structure to support the Action Plan and work

streams. Tameside FT had established a Programme Management

Office to support this work. Nikki Leach would be meeting with the

Programme Director shortly.

10

9

Safeguarding Update

Nikki Leach stated that the CCG was expecting the outcome of the

Authorisation outturn in Mid October.

Nikki Leach updated the Governing Body on Safeguarding

Governance arrangements; CCG Safeguarding Policy; A Safeguarding

Commissioning Strategy; the Whole Health Economy Safeguarding

Children forum and Safeguarding Adults Forum.

Nikki Leach particularly outlined a safeguarding concern about a

gentleman (with multiple pressure sores) who had been cared for by a

number of health systems, and that a safeguarding investigation was

currently taking place with the whole health economy led by Gill

Gibson. An update would be provided at the next Governing Body

meeting.

Ram Jha asked what the process was for reporting potential ‘at risk’

issues in homes. It was noted that this was through the CCGs

Continuing Health Team ([email protected]).

Graham Curtis and Amir Hannan asked for assurance on the CCG’s

reporting process on ‘sores’.

Nikki Leach reassured the Governing Body that there were mechanisms

in place to capture concerns and ‘common themes’. There was also a

‘safety thermometer’, a snap shot of prevalence, captured daily for

different health settings and going forwards the CCG was working

across Health and Social Care to support good practice. Work was

also taking place across GM, which the CCG would align to.

Amir Hannan asked if Adult Safeguarding training could be delivered

at one of the GB Development Sessions in 2014. This was agreed.

Action: Nikki Leach to provide an update of the safeguarding

concern to the next Governing Body meeting

8. Planning Implementation and Quality Reports

- Draft Minutes of the PIQ Meeting Held on 18th September 2013

Graham Curtis updated Governing Body on the following key issues

from the meeting:-

11

mailto:[email protected]

10

Ivan Bennett – Greater Manchester Primary Care Strategy

Ivan Bennett explained that he was the Primary Care Champion for

Healthier Together, and his role was to ensure all CCGs within GM are

up to speed on progress on the current HT agenda.

Local Issues

The meeting received positive feedback from GPs regarding IRIS.

Concern had been received in relation to the Ambulatory Care

Pathways, where GPs had attempted to use the service however,

Tameside FT staff seemed unsure of arrangements. It was noted that

the pathway would be reviewed.

Choose and Book

It was noted that discussions had been progressed with Tameside FT,

however, in light of the feedback received from the locality meetings,

progress was on hold at present.

Guy Wilkinson felt there was a lack of clarity in the minutes.

Ram Jha stated that his locality (Ashton) was against the proposals,

unless they are compensated for staff time.

Paul Connellan further stated that the Trust had demonstrated a

willingness to resolve certain issues, to ensure there are no unintended

consequences to patients.

In conclusion Alan Dow stated that the process required further

scrutiny/debate and, as a suggestion, those ‘pro’ to the process, may

be encouraged to liaise with the Trust and GPs to try and “build the

case”.

Enhanced Services

It was noted that discussions around strategic financial planning for the

next 3-5 years would be part of the October PIQ agenda.

IM & T Group

The Terms of Reference were agreed.

12

11

Carers CVAT

After careful consideration, PIQ did not approve the proposals set out

in the paper and agreed that more clarity was needed around the

proposals and costing to be brought back to future meetings.

Alan Dow made a general observation about the non voting rights at

PIQ for those members who declare specific interests.

After a lengthy discussion it was agreed that those members ought not

to be excluded from conversations (recorded for transparency) to

ensure a balanced view and to understand any clinical risks associated

with proposals, but would not be part of the decision making.

On another general matter of governance, Graham Curtis reminded

the Governing Body that, in receiving Committee Reports, the

Governing Body was agreeing all recommendations as the sub

committees did not have delegated authority.

The Governing Body received the draft PIQ Minutes held on 18th

September 2013.

Outcome of Diabetes Procurement

Andy Hershon outlined the background to the procurement. The

Governing Body agreed to discuss this issue further at Part B of the

Governing Body meeting.

9. Performance Reports

- Corporate Performance Report

Elaine Richardson took the Governing Body through the following key

Performance areas. The Governing Body noted the action plans being

put into place for continuous improvement:-

C.Diff; MRSA; MSSA; RTT; Over 52 weeks; Diagnostic Performance;

Waiting Times; NWAS; Dementia.

A & E was discussed at length noting improvement at quarter 2 at

Tameside FT, which was a testament to the hard work of Tameside FT,

CCG and CSU working constructively together to improve this position.

It was further noted that Clare Watson had written to Tameside FT,

recognising this improved position.

Governing Body noted data missing from Lifestyle Choice and Mental

Health Provider.

13

12

In terms of Mental Health, Tina Greenhough stated that some mental

health targets were set very differently from others, in terms of

quantifying quality rather than quantity, and, as Lead for mental

health, Tina felt relatively confident about the reporting process for

mental health.

Guy Wilkinson also stated that some milestones were missing. Elaine

Richardson stated that dates were in the diary to review these with

lead GPs. There was also much more sophisticated information behind

the performance indicators.

After a lengthy debate on the Provider Performance Reports, it was

agreed to ask CSU to provide a 1 page summary report for the

Governing Body.

The Governing Body received the Corporate Performance Report.

Planned Care and Cancer Deep Dive

Guy Wilkinson and Ram Jha provided an overview of the work to date,

outlining that the overall performance is being maintained at or above

targets, however, there was still data outstanding around outcomes

and cancer survival, which were not reflected in the performance

assessment.

The Governing Body received the following updates:-

Increasing Direct Access/Straight to Test; New Services Implemented;

Increasing Effective Use of Services and Continued Service

Development.

Guy Wilkinson further stated that Map of Medicine had sent a report,

which gave some information to try to link performance to clinical

behaviour, he would forward this information to Governing Body

Members.

The Governing Body received the encouraging update on this

particular Deep Dive.

- Finance and QIPP Committee Meeting Held on September 4th 2013

Yvonne Pritchard took Governing Body members though the key issues

and decisions made at the meeting.

The Governing Body received the minutes.

14

13

- Finance and QIPP Report

Kathy Roe stated that the CCG was still on target to meet its overall

required surplus of £3,059K, with budgets set to deliver against the plan.

Kathy stated that she had met with Tameside FT the previous day to

jointly agree an accurate forecast for the Contract. There was still

clarity required on how Keogh costs are to be covered going forwards.

The latest Tameside FT activity information received outlined an

overspend on emergency admissions, day cases, electives and close

scrutiny would be maintained on these areas.

Graham Curtis reiterated that it was important for GPs to become even

more involved in the finance agenda of the whole health economy,

given the local challenging agenda.

In terms of QIPP, the CCG was slightly ahead of trajectory, and a piece

of work would be undertaken with Tameside FT to look at QIPP

schemes.

Clare Watson stated that the QIPP schemes were being reviewed and

developed further in terms of which are now relevant, as part of the

Healthier Together Return.

As a general comment Celia Poole asked why the finance reports

were presented at IGAR, and, the Governing Body. Kathy Roe

explained that this was to ensure a robust governance route, in view of

the Finance Committee meeting bi-monthly.

The Governing Body received the Finance and QIPP Report.

10. Integrated Governance, Audit and Risk Report

- Including verbal update on key issues of the meeting on October

2nd 2013

Graham Curtis updated on the key issues raised:-

MOU

There was concern that 6 practices had not signed the MOU

(previously discussed earlier in the Governing Body meeting).

Legacy Issues

15

14

Legacy Issues would continue until the end of this financial year, and

there was a level of assurance by CSU for support to the CCG.

CSU Scores

Discussion took place on the performance of CSU support.

Risks in Primary Care

Mark Simon would liaise with the Area Team about a process for

monitoring risks in Primary Care.

There was a question around whether each general practice should

have a Risk Register. This would require further discussion

Portal for Professional Concerns

This discussion would expand further to discuss ways to develop an

education process for GPs.

Information Governance

There had been a complex presentation on this subject, and it had

been outlined that the CCG was not currently meeting IG standards.

Measures were being put in place to rectify this.

MIG Risk Assurance

Richard Bircher presented an overview, however, IGAR was not

convinced that this was a CCG issue, and advice may have to be

sought from the LMC.

The Governing Body received the verbal update from the IGAR

committee.

11. Locality Leads Meeting Report

- Including draft Minutes of the Locality Leads Meeting Held on

September 24th 2013

Richard Bircher took the Governing Body through the key issues

discussed at the meeting, particularly the presentation of CCG

Financial Model and 5 year Plan, which had made an impact on the

members of the group, in terms of more awareness of the financial

challenges facing the whole health economy.

16

15

Richard Bircher also updated on Feedback from Localities, the main

theme being QP; direct access to event recorders and echo’s. It was

noted that Dr. Jones would be requested to provide an update at the

next meeting.

The Governing Body received the draft Locality Leads Minutes.

12. Association of GM CCGs Governing Group Committee Reports

- Including Minutes of the Meeting Held on September 5th 2013

Kathy Roe updated on key issues arising from the meeting:-

Healthier Together

Kathy stated that there was going to be HT regular updates to CCGs,

host Trusts and Local Authorities, as there was some disquiet in the

system around the HT agenda and pace, in view of the different

nuances across GM.

It was further noted that HT was going out to consultation in January

and therefore views would need to be aired quickly.

A general concern from the Governing Body was that more assurance

ought to be sought from HT team in terms of more recognition from the

HT team to the Southern Sector proposals.

At this juncture Paul Connellan stated that the above may have been

an accurate reflection weeks ago, however, he felt there had been a

definite ‘sea change’ now in the right direction. The Governing Body

was reassured to hear this update.

At this point in the meeting Alan Dow asked for comments from the

Governing Body about setting a ‘finish’ time for GB meetings. He

would discuss this further with senior management team.

13. Health and Wellbeing Board Reports

Alan Dow stated that the CCG had been requested not to circulate

the draft minutes of the HWBB’s Tameside, and, Derbyshire, until

ratified, which, in some cases may cause a three month delay in

reaching the CCG Governing Body meeting.

17

16

The Governing Body therefore agreed that representatives from the

CCG would offer verbal updates at the Governing Body, to ensure it is

receiving timely reports on key issues.

14. Integration Update

Clare Watson updated on the work associated with the integration

agenda, outlining the issues discussed at the Joint Integration Board to

Board meeting which took place on October 1st.

Tina Greenhough and Graham Curtis, who were present, raised issues

around some outcomes. They reiterated that the process should not

escape the CCGs influence and engagement had to penetrate all

levels of both organisations.

The Governing Body members also requested to be more informed on

all aspects of the integration agenda, prior to the Board to Board

meeting on October 23rd.

Clare Watson stated that her office would be arranging two ‘briefing

sessions’ which would also include the financial elements of the

integration proposals.

It was agreed that Tameside FT would need to be engaged in the

CCG/LA discussions going forwards and would be encouraged to

participate in all discussions.

It was also agreed that written reports would be presented to the

Governing Body meetings.

Action: Clare Watson to arrange briefings and ensure written

reports to the Governing Body


There was no other business to discuss.

16. Date and Time of Next Meeting – November 6th 2013 at 12.30

18

17

19

GOVERNING BODY MEETING

Title of Subject:

North West 111 Service

Date of paper:

15th October 2013

Prepared By:

Kathy Roe

History of paper:

Following the North West 111 Interim Programme

Board on 10th October NHS Blackpool are confirming

that the North West NHS 111 Service is due to transfer

to NWAS on 29th October 2013.

Executive Summary:

The letter attached outlines information on the

Transfer Approval; Finance and Contract with

NWAS; Planning for increased levels of activity

over the winter period and information on the

Communications Plan which will be shared with

CCGs prior to transfer on 29th October.

Recommendations required

of the Governing Body

(for Discussion and

Decision)

To note the content of the letter and to receive

further updates as 111 enters the final

preparations prior to the service transfer on 29th

October and that further updates will be

provided regarding performance and impact

following service transfer.

20

QIPP principles addressed

by proposal:

ALL

Direct questions to:

Kathy Roe

21

Blackpool Stadium Seasider’s Way

Blackpool FY1 6JX

Tel 01253 653578 Fax 01253 651268 E-mail [email protected]

15 October 2013 Dear Colleague Briefing for CCG Chairs and Chief Officers

Introduction Following the North West NHS 111 Interim Programme Board on 10 October we can confirm to colleagues that the North West NHS 111 Service is due to transfer to NWAS on 29 October 2013. Transfer Approval To support the agreement on go live a number of key elements of assurance were required. These are summarised below:-

Detailed service delivery plan

Detica external scrutiny reports

Clinical governance assurance submission – commissioners were required to provide written assurance to NHS England regarding current and future clinical governance systems and processes

Technical readiness assurance – NWAS was required to provide details of their IM&T infrastructure which has been assessed by NHS England as appropriate to meet the requirements of the NHS 111 service

Directory of services standard operating procedures – to confirm processes are in place to enable the service to continue to operate in the event of directory of services failure.

Both the national and regional teams were assured that we have processes in place to allow safe transfer of the contract. NWAS formally agreed to the transfer of the NW NHS 111 Service to their management at their Board meeting on 8 October 2013. Finance and Contract with NWAS The financial cost of the transfer has been agreed between Commissioners and NWAS to enable the contacts to be signed. The Interim Programme Board agreed for Dr Amanda Doyle as Chair to sign the contract on behalf of the Board prior to obtaining authorised signatures from all 33 North West CCGs. All CCGs are asked to ensure that the requisite signatures are obtained prior to the transfer date. Following national direction, the contract period for NWAS, initially proposed as 12 months, will now continue until 31 March 2015.

22

mailto:amanda.doyle@

CCGs have in principle agreed to implement a footprint based risk share to manage the costs of the North West NHS 111 service in 2013/14. Final costs are currently being agreed by Chief Finance Officers. It should be noted the risk share is based on the estimated total costs of the existing and transitioned NHS 111 services, Out of Hours services where they are providing contingency support, and current 08454647 activity. Please note the implications for out of hours contracts, where call taking is included. NHS Direct 08454647 Service The 08454647 number will be turned off in Cheshire and Merseyside on 29 October 2013. If a member of the public dials 08454647 they will be advised to redial 111 which will be a free call. Winter Planning Planning for the transfer of the 111 Service from NHS Direct to NWAS has included consideration of increased levels of activity over the ‘winter’ period based on experience of previous years. Whilst the North West NHS 111 Service is not going to a full public launch during its transition to NWAS, there is a recognition that CCGs will need to include NHS 111 within their local details of urgent care services available to the public. We have shared a statement regarding winter planning and the NHS 111 Service with urgent care leads, through NHS England area team leads to assist with Winter Planning. Communication A communications plan will be shared with CCGs prior to transfer on 29 October 2013. For absolute clarity there are no plans to undertake a hard launch and associated publicity for the transfer. CCGs are asked to ensure that this message is adhered to within any of their local communication plans. The communication plan will ensure that CCGs are sighted on a core statement regarding the NHS 111 service transfer and switch off of the 08454647 number. The plan will include frequently asked questions that may arise in the media and how they should be escalated locally within the agreed governance arrangements. We will of course keep colleagues informed as we enter the final preparations prior to service transfer on 29 October 2013, and will provide updates regarding performance and impact following service transfer. Yours sincerely

Amanda Doyle Chair - North West Interim Programme Board

Chief Clinical Officer, NHS Blackpool CCG

23


PUBLIC AND PATIENT IMPACT COMMITTEE

Title of Subject:

Public and Patient Involvement Committee

Date of paper:

9th October 2013

Prepared By:

Celia Poole

History of paper:

Public and Patient Impact Committee held a meeting

on 9th October 2013 and will meet regularly,

promoting and providing assurances to the Governing

Board that the CCG is providing strategic leadership

for the development of Public and Patient

Engagement.

Executive Summary: The Public and Patient Impact Committee is

responsible for providing assurances that the needs

and aspirations of patients, carers, local community

groups and the general public have helped shape

and influence service delivery.



(for Discussion and

Decision)

To discuss and note the key issues discussed and

agreed at the meeting on 9th October 2013.


by proposal:

To receive the report


Celia Poole

24

1

Public and patient Impact Committee (PPIC)

Wednesday 9th October 2013 9.30am-11.30pm

Boardroom, NCH Denton

Present:-

Celia Poole (CP)

Nikki Leach (NL)

GB Lay Member, CCG (Chair)

Director of Nursing and Quality, CCG

Dr Amir Hannan (AH) Governing Body GP Member, CCG

Alison Lewin (AL)

Dr Richard Bircher (RB)

Tracy Wood (TW)

Peter Denton (PD)

Jo Baines (JB)

In attendance:-

Deputy Director of Transformation, CCG

Governing Body GP Member, CCG (part)

Community Healthcare, SFT

Healthwatch Manager, Healthwatch Tameside

Chief Officer, Volunteer Centre Glossop

Adam Shepphard (AS) Head of Communications, GM CSU

Brenda Hawkins (BH)

Julia Allen (JA)

Gideon Smith (GS)

Complaints Manager, CCG

Equality and Diversity Consultant, GM CSU

Consultant in Public Health Medicine, TMBC

Karen Stott (KS)

Clare Bromley (CB)

Corporate Administration Team, CCG (Observer)

PA, Corporate Office (note taker)

1. Chairs Welcome, Introductions and Apologies

CP welcomed Gideon Smith to members. This is Gideon’s first attendance at this meeting as a

Public Health representative. CP further welcomed Karen Stott to members. Karen was

attending as an observer.

Apologies were received from:-

Amy King Community Involvement Worker, Healthwatch Derbyshire

Yvonne Pritchard GB Lay Advisor, CCG

James Gray Scrutiny Support and Coordination Officer, TMBC

Graham Spencer Improvement and Scrutiny Officer, Derbyshire County Council

Tracy Turley Patient Experience Manager, CCG

Clare Symons Governing Body Nurse

Reagan Blythe Pennine Care

Anna Hynes Co-ordinator for the Health and Social Care Network, CVATs

Beverley Tabernacle

John Goodenough

Deputy Director of Nursing and Patient Experience, TFT

Director of Nursing, TFT

2. Declarations of interest

AS noted a declaration of interest for item 10. T&G CCG Corporate Identity Proposal (update).

AS clarified that he would present this proposal on behalf of GM CSU.

PD declared an interest under item 6. ‘PPE Framework training’. PD would provide an update

to members in terms of feedback of the training.

25

2

3. Patient Story

Members noted that as Clare Symons has offered her apologies to today’s meeting the update

on the Carers Forum as a patient story would be deferred to the next meeting in November.

BH therefore presented a patient story extracted from the complaints received within the CCG.

A replacement hoist had been provided to a patient who had limited mobility following a

stroke; however, the hoist was not one that his carers had been trained to use. Following

contact from the patient, explaining the problem, we liaised with the Community Service and

Social Care who arranged for an alternative to be provided.

4. Minutes of the previous meeting: 18TH September 2013

The notes of the previous meeting were agreed as an accurate record subject to a few minor

amendments as follows:

Item 5. Matters arising

Keogh Review Case Study

AS made presentation to members of the ‘full’ (remove the word internal) communication work

currently being carried out.

5. Matters arising

Concerns and Complaints reports (format)

Members agreed that there is a need to get some internal processes in order before

establishing a standing item on the agenda with regard to complaints and concerns. NL will

check whether complaints reports do come into CSU (TPM).

Action: NL

NL confirmed discussion with TFT and using the format of that report as a template to receive a

report on a monthly basis.

It was then noted that Steve Allinson had previously mentioned this to look at streamlining all

data received by the CCG and suggestion was made to this being part of the IM&T Strategy

and question was raised as to who would develop this. NL and Amir Hannan to discuss this

further and feedback any thoughts at the next meeting in November.

Action: AH/NL

Members agreed that mechanisms are needed to feed in clear lines of reporting.

JA confirmed that E&D leads at GM CSU for all CCGs had reviewed where information is fed in

and reported that NHS England is to have an official launch of EDS2 (Equality Delivery System 2).

JA agreed to provide a short report in relation to this at the next meeting in November.

Action: JA

PD noted that we must ensure that we are able to coordinate information of patient

experience data with Healthwatch and PPIC and confirmed that discussion on this is still taking

place between PD with NL and Gill Gibson.

AL proposed a possible opportunity to measure clinical challenge areas with Long Term

Conditions as an example and a report to be presented to Governing Body. Members agreed

with this suggestion and AL and AL agreed to take that suggestion forward.

Action: AL/AH

26

3

6. PPE framework training (update)

PD noted that the report within the papers presented to members is self-explanatory which

reflects on the training given and how it was received.

Those that received the training had all found a way to fit the training tool/model into their

workloads.

PD noted areas of how the tool can be developed and useful ways to make links with patient

engagement:

- Clarity on signing off work

- Checklist

- Guidance on what is a S242

- Steps taken using the framework before any engagement work is carried out

- Evaluate any planning

- During planning stage plan feedback to people/public you engage with.

PD had discussed the paper with Tracy Turley and JA specifically around equality training. JA

had made proposals as to additional training and this had been agreed at CMT.

It was noted that there is a concern of consultation fatigue with engagement to the same

people/patients addressing some of the same issues and concerns. AH proposed a discussion

take place on how we co-ordinate this work with Tracy Turley and for Tracy to lead on linking

that patient engagement including voluntary groups, for example the local diabetic groups.

Next steps will include CCG Board members to receive training (although the training will need

to be different). CP made a proposal which was accepted that a paper will go to board

recommending that governing bod members undertake the PPE framework training.

Action: CP/PD

7. Communications/Media (update)

AS updated members on the current communications work being undertaken.

AS had met with Jo McRae at the TFT Listening Event to see how CCG communications can get

involved with the campaign.

A meeting had taken place recently to discuss the Winter Campaign and it was proposed that

we replicate last year’s arrangements for this and include ‘right treatment right place’. Clare

Watson had recently sent out last year’s materials to GPs asking for their feedback. AS

confirmed that the basic messages would be communicated asap and a plan is being

formulated with Healthwatch and voluntary organisations to support getting those message out

and PD proposed linking in with Anna Hynes on this. NL suggested linking in with the national

vehicle of self care week in November.

AS updated that the Tameside Radio show is covering various topics.

8. CQUINS (update)

NL had received a brief update on the Patient Experience CQUIN and reported that there is

scope now to support the SMS text service once again with Meridian and NL has been given

assurance that this will be picked up.

27

4

NL hopes to provide a further update on the patient experience CQUIN at the next meeting in

November.

Action: NL

9. Planning Process

LR presented a paper which outlines the proposed planning process for 2014/15.

The Plans for 2014/15 need to reflect the following National and GM requirements:

Local Integrated Care Programme

GM Primary Care Commissioning strategy

Healthier Together

Members were asked to endorse the approach taken in the development of the plans and

were further asked to identify any additional key stakeholders and engagement mechanisms to

ensure we have demonstrated our value of Listening to Patients.

LR noted that although the plan is still being scoped there are plans in place for public and

patient engagement events in Tameside and Glossop to take place in December led by

clinicians. Members added that these events should include a much wider consultation. CP

raised a query on the timeline matrix within the plan of the April to September 2014 timescale

for feedback on how public and patients have helped to shape the plans. LR clarified that the

annual plan will be published in March/April 2014 and the refresh of the 5 year plan after that in

September 2014, the timeline therefore allows time to gather views and opinions on the seven

clinical challenges, to help scope and influence the plan.

Members agreed that they are happy with the initial proposal.

10. T&G CCG Corporate Identity Proposal (update)

Corporate Identity proposal. CB had circulated this proposal to members and AS requested

feedback that he could highlight to the CSU.

Members were in agreement to hold back on this proposal for the moment as it may clash with

branding and identity work required for the integration programme. It was agreed to review

further along the line of the transformation and integration agenda.

11. Communications and engagement for integration programme (update)

Members were presented with a paper on communications and proposed key messages for

the integration programme. AS had circulated a Survey Monkey link with proposed names and

straplines for the integration programme banding and requested that CB collate comments by

Friday 11th October as a deadline.

12. Any other business

Healthwatch

PD reported that a plan is being worked up setting out priorities for Healthwatch PD will request

that Tracy Turley engages with PPGS on this.

PD provided members with handouts of surveys for both public and partners.

28

5

Healthier Together workshop

CP had attended the workshops along with Local Authorities, other CCGs and voluntary

organisations. These were held to establish the criteria as to how Healthier Together will

potentially cluster the different hospital arrangements.

The workshops were designed to decide on the different criteria as follows:

- Accessibility

- Quality

- Sustainability

- Travel

13. Date and time of next meeting – Wednesday 20th November 2013 9.30am-11.30am

Boardroom, New Century House

Meeting closed: 12.00pm

29


Title of Subject: Patient and Public Engagement Framework Training

for all Governing Body members

Date of paper:

November 4, 2013

Prepared By:

Celia Poole

History of paper:

The CCG made a commitment at authorisation, as

part of its declaration of compliance, that it would

‘have regard to and promote the NHS Constitution’.

One of the seven principles within the constitution is to

involve patients and carers in deciding about their

care. As part of its authorisation, the CCG promoted

the Patient and Public Engagement Framework as

being integral to its ability to meet this principle.

Executive Summary:

Training in the purpose and use of the Public and

Patient Engagement Framework has been delivered

to the CCG Commissioning Team and is now routinely

used to inform their patient engagement and

consultation activities in relation to services to be

commissioned or re-commissioned. The Governing

Body has already demonstrated its commitment to

the Framework and agreed at the April 2013 Board

that the training be extended to all staff handling

front-of-house, public-facing commissioning work. At

PPIC (September 2013) it was recommended that

training of the Public and Patient Engagement

Framework be undertaken by the Governing Body.



(for Discussion and

Decision)

That the Governing Body supports the PPIC ‘s

recommendations that Governing Body members

undertake training in the Public and Patient

Engagement Framework in order to have a complete

understanding of how the framework underpins the

CCG’s commitment to the NHS Constitution.

30


by proposal:

All

Direct questions to: Celia Poole/Dr Amir Hannan

31

Public and Patient Engagement Training for Governing Body Members

Background

Tameside & Glossop CCG’s commitment to patients being at the centre of its

decision-making was integral to its submission for authorisation as a Clinical

Commissioning Group.

Our governance clearly upholds that commitment; it requires all new commissioning

and re-commissioning intentions be brought to the Public and Patient Impact

Committee to demonstrate that their impact on public and patients has been taken

into account and factored into each commissioning intention before they are

brought before the Planning, Implementation and Quality Committee for approval.

Tameside & Glossop CCG Governing Body is leading the way in developing and

implementing this approach to patient engagement. It is understood that this

framework is unique across Greater Manchester’s Clinical Commissioning Groups.

The Principles of the Framework

The Framework has four key stages which are applied to commissioning intentions in

order to establish what level of patient engagement is required:

1. Checklist – to get the ‘green light’ for engagement to go ahead

2. Impact – to assess the potential impact of any proposed changes; to assess

the scale and scope of the engagement required and to identify whether the

s242 statutory duty to consult applies.

3. Planning – to plan the delivery of the engagement activity

4. Evaluating – to evaluate the engagement activity

CCG Commissioners undertook training between March and May 2013 and learned

how to use the framework effectively to inform and shape commissioned services

such that the patient is at the heart of them.

32

The training sessions were offered over a number of different dates to

accommodate commissioners’ schedules and to provide an element of choice with

regard to the dates they attended the training.

Healthwatch who developed and delivered the training brought a report which

reviewed the training to the September 2013 meeting of the Public and Patient

Impact Committee.

The review stated: “It was clear to the trainers that all trainees had skills and

experience in public and patient engagement. It was felt that the framework and

the training provided a more structured way to go about these activities.”

Proposal

Tameside & Glossop CCG has a strong commitment to ensuring we put patients and

their opinions at the heart of our commissioning.

The Governing Body has signed up to the principles contained in the NHS

Constitution.

The Governing Body has given assurances to the authorisation panel of its

commitment to ensuring that the patient voice is heard and that patients are

put at heart of the commissioning process for services.

Governing Body GP members are closely involved in the development of

commissioning intentions for services.

It is, therefore, important that Governing Body members have a clear understanding

of the Public and Patient Engagement Framework and how it integral to the

commissioning process.

The workshops would be tailored to meet the requirements of the Governing Body

and a number of dates offered for the training sessions to accommodate Governing

Body members’ work schedules.

Recommendation

It is recommended that the Governing Body accepts the proposal made by the

Public and Patient Impact Committee and agrees that all Governing Body members

will undertake a Public and Patient Engagement Framework training workshop.

33

CCG Governing Body

Paper prepared by: Nikki Leach, Director of Nursing and Quality

Gill Gibson, Deputy Director of Nursing, Quality and Safeguarding

Date of paper: 25th October 2013

Subject: Safeguarding Key Issues Update For Governing Body

History of paper: N/A Executive Summary: This paper provides an overview and update on key

safeguarding issues for information and consideration.

Update on outcome of September conditions review Adult Safeguarding

- Peer Challenge - Domestic Abuse - Prevent - Safeguarding Adult Learning Review

Safeguarding Children - OFSTED Inspection - Serious &Significant Cases

Outcome Required of CCG: Governing Body is requested to receive this paper

For Discussion or Approval:

Discussion


by proposal:

Safeguarding, Quality and Patient Safety

Direct questions to: Nikki Leach

34

1

Safeguarding Update for Governing Body

November 2013

Introduction

This paper provides an update to The Governing Body on current issues in

safeguarding within Tameside &Glossop.

This paper will mainly focus on issues related to adult safeguarding.

CCG Safeguarding Conditions Authorisation

On the 8th October 2013 CCG authorisation committee agreed that in regard

to safeguarding all authorisation conditions were met.

Progress on actions outlined in authorisation submission.

CCG Safeguarding Policy is being taken to Locality meetings to ensure

member practices are familiar with the commissioning safeguarding

policy.

The policy is being incorporated into provider contracts and will be

audited using the standards audit within usual contractual and

performance meetings.

The GP safeguarding member practice leads meeting has been

established with the first meeting being held on November 15th 2013.

Terms of reference for adult, children and GP Safeguarding forums are

being reviewed and developed to be presented to the next meetings.

Following training to the Transformation Directorate, the safeguarding

commissioning framework has been implemented.

Adult Safeguarding

Peer Challenge

Tameside Local Authority have requested a peer challenge to take place at

the end of November 2013 to look at their own and interagency adults at risk

safeguarding arrangements. A peer challenge is when another authority is

asked to come and carry out a “mock inspection” of services.

The peer challenge lines of enquiry look at the following areas:

Outcomes for people who use services

Participation

Vision, Strategy and Leadership

Working Together

Resource and Workforce Management

Service Delivery and Effective Practice

Commissioning

35

2

Improvement and Innovation

Though this is ostensibly an inspection of the Local Authority, The CCG will be

involved at strategic level through the Adult Safeguarding Partnership, Health

and Wellbeing Board and integrated commissioning levels. The outcome of

The Peer Review will result in an action plan for safeguarding adults

improvements going forward.

Domestic Abuse

The Tameside Domestic Abuse Strategy has now been agreed by The Crime

and Disorder Reduction Partnership. The strategy puts greater emphasis on

prevention, early intervention and working with perpetrators. The strategy is a

cross organisational and also embraces the safeguarding children aspects of

domestic abuse. The strategy requires greater awareness and safe routine

enquiry by all professionals in the area of domestic abuse with health services

being at the forefront of recognition. To this end all health providers are

required to train staff in these areas. The training on domestic abuse for

health staff will be monitored through The CCG safeguarding forums. The

Derbyshire Domestic Abuse Strategy includes the same high level principles

as Tamesides’ and therefore is reflected within our monitoring of provider

performance.

Prevent

Prevent is The Department of Health strategy to prevent the radicalisation of

vulnerable people.

The new Prevent Strategy focuses on preventing people becoming terrorists

or supporting terrorism. To achieve this, the revised strategy also contains a

number of initiatives that can proactively contribute to the protection and

safeguarding of vulnerable individuals. There are many opportunities for

healthcare staff to help to protect people from radicalisation – the key

challenge is to ensure that healthcare workers are confident and

knowledgeable in addressing situations that cause concern.

The Department of Health have rolled out a training programme that requires

all front line staff to have training in this agenda. The CCG’s role is to monitor

providers on their training and reporting of prevent concerns. The Prevent

lead for the CCG is Nikki Leach Director of Nursing and Quality. Prevent is

monitored through The CCG safeguarding forums.

Safeguarding Adult Learning Review

The Deputy Director of Nursing, Quality and Safeguarding chaired an adult

safeguarding learning review on 14th October 2013. This review involved a

man with long term conditions who had been through the whole health and

social care system who had sustained severe pressure ulcers and sub optimal

care. From the original safeguarding investigation neglect was founded.

36

3

The purpose of the learning review was to learn lessons that could be fed

back into the health and social care commissioning and provider system to

prevent such occurrences happening again.

The main themes of the learning review are:

The lack of a lead professional role in complex cases.

Complex cases need multi-disciplinary meetings and joint working

agreements / arrangements.

Discharge planning and processes.

Poor decision making.

Communication, information sharing issues.

Self neglect.

Lack of transfer of medical care.

Assessment of capacity and the lack understanding of fluctuating

capacity.

Visible man known to plethora of services but remained invisible.

Emotional health and wellbeing of a vulnerable individual.

Referral processes between services and across organizational

boundaries.

An action plan is currently being developed to address the issues identified.

The Tameside Adult Safeguarding Partnership will monitor the multi agency

actions within the plan and the Health provider actions will be monitored and

impact evaluated via The CCG Adult Protection Forum.

Safeguarding Children

OFSTED Inspection

Tameside MBC recently underwent an OFSTED inspection as part of a pilot

of the new inspection framework.

Themes which arose from the inspection and required improvement:

Lack of the voice of the child at an operational and strategic level

Assessment and risk management needs to be improved

Improvement needed at both an operational and strategic level in

safeguarding children

Strategic partnerships need more interagency collaboration in

performance monitoring , service development and scrutiny

An action plan has been developed to respond to the requirements to

improve and the CCG will be involved at a strategic and commissioning

level.

37

4

Serious and Significant Cases

One multi agency case review of a young person’s suicide is nearing

completion and the report and actions will be available to the Coroner.

Tameside LSCB is conducting a review with Salford LSCB on a young woman

who has seriously self harmed leading to permanent neurological damage.

Tameside LSCB is awaiting the outcome of toxicology reports on a young

persons’ death to determine if abuse has occurred prior to making a decision

as to whether a review will be undertaken.

Two cases of serious harm have occurred to two children under 2 years of

age. The cases will be presented to the next review panel which will consider

whether a serious case review is undertaken.

Recommendation

Governing Body is requested to receive and note this update.

38


Title of Subject:

System Accountabilities for Health Protection

Date of paper:

30th October 2013

Prepared By:

Dr Anna Moloney, Consultant Public Health Medicine,

TMBC

Nikki Leach, Director Nursing and Quality, Tameside

and Glossop CCG

History of paper:

Paper prepared for CCG Governing Board November

2013

Executive Summary:

The paper summarise the role and responsibilities of

health and local authority bodies with regard to health

protection. This function seeks to prevent or reduce

harm caused by communicable disease and the

health impact of environmental hazards. The local

governance structures are explained. Infection

control arrangements are highlighted.



(for Discussion and

Decision)

CCG Governing Board to note the governance

structures for health protection.


by proposal:

Health protection aims to protect population health,

preventing and reducing harm, from a range of

hazards, by risk mitigation and quality improvement

plans.


39

1

Tameside and Glossop Clinical Commissioning Group Governing Board 6th November 2013

System Accountabilities for Health Protection

1. Background

Health protection seeks to prevent or reduce the harm caused by communicable disease and

minimise the health impact from environmental hazards such as chemicals and radiation. The Secretary of State has the core duty to protect the health of the population in the new system.

2. Partners’ roles and responsibilities

2.1 There are a range of organisations that have roles in health protection. 2.2 Department of Health (DH) - Policy decisions and they hold NHSE and Public Health

England (PHE) to account. 2.3 PHE - Support Directors of Public Health (DPHs) with surveillance data and expert input.

Also deliver health protection functions to the public. 2.4 NHSE - Working with DPHs to ensure local population needs are addressed by providers.

Within the GM Area Team the GM Screening and Immunisation Team have a key role in leadership and co-ordination of screening and immunisation. Each borough has a named link officer from this team that supports local implementation. An NHSE Emergency Planning Officer also services the Local Health Resilience Partnership (LHRP) which is a GM strategic planning group for emergency preparedness.

2.5 Local Authorities - from April 2013, Local Authorities are required under section 6C of the

NHS Act to protect the health of their local population. There is no expectation for a single “health protection” plan but rather to ensure there is a comprehensive portfolio of plans, MOUs and commissioned services to ensure a whole system approach to protect the population. DPHs are to provide oversight, advocacy for their local population (LA boundary) and independent scrutiny to the arrangements of NHSE, PHE work with partners to ensure threats to health are understood and properly addressed DPHs are to provide leadership working with partners, if required, to respond to infectious disease outbreaks and environmental hazards that impact on health.

2.6 Clinical Commissioning Groups - Quality assurance and improvement of primary care

services. Fulfil commissioning accountabilities working with GMCSU. The CCG is required to have an Accountable Emergency Officer for emergency preparedness.

2.8 NHSE and CCGs have a duty to cooperate with Local Authorities on health and wellbeing

under the NHS act 2006. The Health and Social care Act 2012 states that NHSE and CCGs are under a duty to obtain appropriate advice including professional expertise in “the protection or improvement of public health”.

2.9 NHS Providers - Deliver a range of preventative and treatment services. NHS Trusts are

required to have Accountable Emergency Officers to oversee emergency preparedness and business resilience at Board level.

40

2

3. Local System Governance 3.1 Tameside Health and Wellbeing Board’s (HWB) function is to build strong and effective

partnerships which improve the commissioning and delivery of services across NHS and local government, leading in turn to improved health and wellbeing for local people. In the context of understanding the health risks these should be informed by the Joint Strategic Needs Assessment (JSNA) and joint Health and Wellbeing Strategies (JHWS) with health and social care commissioning plans based upon them.

3.2 Tameside Health Protection Group (HPG) is a subgroup of the HWB. The purpose is to

provide assurance to the Tameside HWB that robust plans and arrangements are in place and to draw attention to the Board any matter of concern. The HPG will consider issues in or relevant to the borough of Tameside. The draft Terms of Reference are included in Appendix 1.

3.3 Topics that are within the scope of the HPG are:

-Infectious disease in the community -Health care acquired infections, especially MRSA and Clostridium Difficile -Immunisation programmes -Tuberculosis -Sexually transmitted diseases -Blood borne viruses -Environmental hazards -Seasonal and pandemic flu

3.4 It is particularly important that there are arrangements for responding to public health

emergencies and therefore the Tameside Health Protection Group is closely aligned to the Tameside and Glossop Health Emergency Resilience Group (HERG). The latter is a local emergency preparedness group chaired by the CCG Director of Nursing and Quality. The HERG is part of the command and control structure for GM Emergency Preparedness and business resilience and is a sub-group of the LHRP.

4. Infection Control Clinical and NHS senior management have established mechanisms for jointly examining

lessons learnt from root cause analyses (RCA). The Whole Health Economy Root Cause Analysis Group reports to the newly formed Health Protection Group summarising causative trends and actions taken to prevent further cases.

CCG Medicine Management Committee and CCG Quality Board have important roles in

challenging performance and improving patient safety working with the Commissioning Support Unit (CSU) through contractual performance and risk management mechanisms. Tameside Foundation Trust has its own internal regulatory system which is overseen by the Director of Infection Prevention and Control (DIPC) at Board level. Similarly, Stockport Foundation Trust (SFT) has internal governance systems and a requirement for a DIPC. SFT are currently commissioned to provide the specialist commissioning infection control function on behalf of Public Health. In other GM boroughs staff providing this function sit within Local Authority Public Health department. TMBC Social Care Commissioners have a responsibility for the contractual monitoring of infection control (but not prescribing) practices within care homes. This is assisted by nursing home infection control audits.

41

3

Currently both DCC and TMBC are reviewing arrangements for commissioning the infection control specialist function that is required by Local Authorities. All NHS providers need to ensure they have a robust infection control function within their organisations. Recommendation The CCG Governing Board note the governance structures in place for health protection.

42

1

Tameside Health Protection Group

Terms of Reference: version 2 draft Purpose of the group

The primary role of the Health Protection Group is to enhance partnership working on health protection in Tameside and to assist the Director of Public Health in their role of ensuring appropriate oversight of health protection within Tameside and in providing, “strategic challenge to health protection plans/arrangements produced by partner organisations”.1 The group will provide assurance to the Tameside Health and Wellbeing Board that robust plans and arrangements are in place and to draw to the attention of the Board any matter of concern in this context. It is particularly important that there are clear arrangements for responding to public health emergencies and therefore the Health Protection Group is closely aligned to the Tameside and Glossop HERG. Scope The group will consider health protection issues in, or relevant to, the Borough of Tameside. Topics that are within the scope of the group are, but are not restricted to:

infectious diseases in the community healthcare acquired infections, especially MRSA and Cl. difficile immunisation programmes tuberculosis sexually transmitted infections, including HIV blood borne viruses environmental hazards pandemic influenza

Issues that are specifically out of scope of the group are:

health services emergency planning and response arrangements and business continuity arrangements that are not related to public health emergencies (such as a fuel shortage or extreme weather events)

similarly, health/social care winter planning, except where there is a health protection element, such as flu vaccination

population screening programmes Key responsibilities of the Health Protection Group

To provide assurance to the Health and Wellbeing Board as to the adequacy of local arrangements for the prevention, surveillance, planning for, and response to, health protection issues and problems in Tameside

To highlight concerns about significant health protection issues and the appropriateness of health protection arrangements in Tameside, raising any

1 ‘The new public health role of local authorities’. Department of Health, October 2012.

43

2

concerns with the relevant commissioners and/or providers or, as necessary, escalating concerns to the Health and Wellbeing Board or relevant Chief Executives/Chief Officer.

To provide an expert view on health protection concerns that the Health and Wellbeing Board request advice on from the group

To develop a health protection data set - bringing together data and intelligence from a variety of sources including from Public Health England, NHS provider trusts, NHS England and Environmental Health - in order to assess local performance in addressing the key health protection issues in Tameside

To review significant areas of poor performance and to expect recovery plans to be in place, though performance management will be conducted through the relevant contractual mechanisms between commissioner and provider.

To identify the need for, and review the content of, significant local plans relevant to the health protection agenda

To make recommendations as to health protection issues that should be included in the local Joint Strategic Needs Assessment

To consider the lessons identified from any serious incidents or outbreaks and to expect that learning from incidents has been embedded into future working practices

Meeting arrangements

The group will be chaired by the Consultant in Public Health on behalf of the Director of Public Health and will normally meet 6 times per year. Meetings will normally be of no longer than two hours duration. The meetings will be convened by Public Health Tameside. Items for inclusion on the agenda will be sought from all members in advance of each meeting. Draft minutes will be sent electronically to members and then approved at the next meeting.

Reporting arrangements for the Health Protection Expert Advisory Group

The Health Protection Group will report to the Health and Wellbeing Board. The minutes of the group will be routinely provided to the Health and Wellbeing Board for information. The Director of Public Health, with the assistance of the Consultant in Public Health Medicine – Health Protection, and other members of the Group will, as required, raise any concerns or recommendations and submit formal reports to the Health and Wellbeing Board as agreed by the group, or as requested by the Health and Wellbeing Board.

Health Protection Group affiliated Reporting Groups

Existing local health protection groups will report to the Health Protection Group, namely: 1. Whole Health Economy Root Cause Analysis Panel 2. Sexual Health Advisory Group

44

3

3. CCG Medicine Management Committee Representatives of each of these groups should attend the group to provide a report from their group. Membership and quorum

The quorum for the Tameside Health Protection Group will be one third of its membership. Representation within that number must include the Chair or Vice-Chair. The Chair and Vice-Chair are as indicated in the list of group members below. Role Representative

1. Consultant in Public Health Medicine – Health Protection Dr Anna Moloney

2. Consultant in Communicable Disease Control for Public

Health England (??Vice-Chair)

Dr Lorraine Lighton

3. CCG Quality Clinical Lead Group ? Dr Jamie Douglas

4. Social Care Commissioning Rep Sandra Whitehead

5. Director of Nursing and Quality Tameside and Glossop

Clinical Commissioning Group/ Chair of Tameside Health

Economy Resilience Group

Nikki Leach

6. Immunisation Coordinator for Tameside (NHS England) Pam Southcombe

7. Environmental Health representative(s) TBC

8. Representative of provider trust Infection Control Teams

9. SFT

10. TFT

TBC

?Nesta

Debbie Pritchard

11. Representative of Directors of Infection Prevention

Control from provider trusts?

John Goodenough

Dr Catania

?? Pennine care MH

Trust

12. Medicine Management Partnership representative Peter Howarth

13. GM Commissioning Support Unit NHS emergency

planning representative

Brian Dillon

14. Sexual health commissioner David Armitage

45

4

18th September 2013 Contact Officer: Name: Dr Anna Moloney Position: Consultant in Public Health Medicine – Telephone: 0161 342 2189 E-mail: [email protected]

46


Title of Subject:

Draft October PIQ Minutes

Date of paper:

16th October 2013

Prepared By:

Graham Curtis/Clare Watson

History of paper:

n/a

Executive Summary: The Committee was brought together in order to discuss

and make decisions on items prior to being presented to

CCG. Items for discussion and recommendation included

Clinical Lead for Quality Improvement, Primary Care

Development, Strategic Planning, Carers, Memorandum of

Understanding 13-14 For Public Health, Health & Wellbeing

Strategy 13-16, RAID and Mental Health Supported

Accommodation.



(for Information, Discussion

or Decision)

CCG are asked to note and consider any

recommendations within the minutes for approval.


by proposal:

All

Direct questions to: Graham Curtis/Clare Watson

47

1

Draft Minutes of the PIQ Committee

Wednesday 16th October 2013, 13.00pm, Boardroom

Attending: Graham Curtis (Chair)

Clare Watson – Director of Transformation

Kathy Roe – Chief Finance Officer/Interim COO

Nikki Leach – Director of Nursing & Quality

Dr Ram Jha – CCG Governing Body Member

Dr Guy Wilkinson - CCG Governing Body Member

Dr Amir Hannan – CCG Governing Body Member

Dr Christina Greenough – CCG Governing Body Member

Dr Jamie Douglas - CCG Governing Body Member

Clare Symons – Mental Health and Learning Disability Commissioning Mgr

Dr Syed Asad Ali – Denton Locality Lead

Dr Saif Ahmed – Stalybridge Locality Lead

Celia Poole – Lay Member

Peter Howarth – Head of Medicines Management

Michelle Rothwell – Head of Individual commissioning, Quality & Patient

Safety,

Alison Lewin – Deputy Director of Transformation

Dr Gideon Smith – Consultant in Public Health

Mike Woodhead – Finance Support

Simon Morton – Locality Commissioning Manager/Children & Families

Commissioner

David Walsh

David Milner – Head of Finance/Locality Support Manager

Paul Nuttall – Head of Finance/Locality Support Manager

Tori O’Hare – Head of Finance/Locality Support Manager

Stephen Beswick – Head of Finance/Locality Support Manager

Debbie Ashforth – Commissioning Business Manager

Stuart Allan - Secretary, West Pennine LDC

Rob Mitchell – Local Prescribing Committee

Tony Okotie - CVAT

Debbie Bishop - Head of Health & Wellbeing, TMBC

Clare Raw – Carers Lead, Derbyshire County Council

Emma McDonough, Strategic Lead- Early Help, TMBC

Carole Abrams, Service Unit Manager, TMBC

Sarah Hadfield – Minute Taker

1. Apologies for Absence

Alan Dow/Andy Hershon/Elaine Richardson


The declarations would be stated against each relevant item.

48

http://nww.tamesideandglossop.nhs.uk/

2

3. Minutes of the Previous Meeting

The minutes were agreed as a true record with the exception that GC felt it

should be reflected within the CVAT part that a proposal be brought back

specifically to address current funding per year.

4. Matters Arising

Integration

The PPIC paper in relation to integration comms and engagement had not yet

been submitted.

Action: SH to attach PPIC PAPER around integration comms and engagement to

PIQ.

Integrated respiratory service update

It was reported that the business case had not yet been submitted to PPIC.

Action: SR to ensure business case is submitted to PPIC.

5. Locality Issues

SAA gave an update on behalf of the Denton locality advising that in relation to

the telephone lines for A&E it appeared that enough lines were available. It was

also apparent that patients were using A&E most during the daytime period whilst

practices were open. Positive feedback for IRIS had been received.

SA gave an update on behalf of Stalybridge also reporting that in terms of the

telephone lines, data suggested that a true representation was hard to gage. Of

the few referrals to IRIS most feedback had been positive though some negative

had also been received. This was thought to be around clarification of what role

the IRIS team performed.

RJ raised how those practices saving money were not receiving any incentive.

CW explained that the newly implemented Commissioning incentive Scheme had

been brought to PIQ and the Governing Body and was signed off. GC felt that

the issue should be felt amongst GPs as a peer pressure and it was the GPs

corporate responsibility to act upon. GC added that he would be happy to talk

to localities if required. SAA felt that frustration was felt by practices when faced

with poor financial positions. GC suggested that localities must share ideas of

how it could be rolled out more effectively. AL added that a summary was being

pulled together by Heather Palmer collating feedback and would be passed to

the finance team to consider.

49

3

6. Finance Update

KR emphasised how serious the financial position was with a current overspend

within secondary care of £2.5m. Work was being carried out to understand these

figures via deep dives within the localities. NHS reforms have created pressures

though we are still reporting an activity surplus set by NHS England of £3m. It is

thought that the allocation process due mid December will set a two year

allocation which is advantageous. However the new allocation formula suggests

that Tameside may lose out on around £8m.

AH referenced a graph which indicated the areas throughout the region and

country had gained or lost in relation to the allocation. AH asked whether we

would have MP involvement in relation to this. GC confirmed that meetings with

MPs happened on a three monthly basis. GW asked that in relation to Keogh how

this would be funded. KR clarified that it had been made clear with the Trust and

Monitor that we would not have to find any extra monies for this. KR reported a

30/50k validation to be in our favour and that the impact of Lorenzo would be a

constant feature in any contract conversations.

For Discussion and Recommendation

7. Clinical Lead for Quality Improvement

JD presented the business case which outlined the current role of clinical lead for

quality improvement and the need for it to be extended until March 2015. It was

noted that the business case should be clear that the extension is that of the post

and not the post holder. GC suggested the group recommend the extension of

Joanna Bircher until December and for the post to be re-advertised in January

2014. CW added that the principles could be circulated to clarify process. SAA

asked what the commitment of the session would be. It was confirmed that it is

for 1 session per week. GW raised whether this be relooked into with the

appointment of Jamie Douglas as Quality lead. NL informed that agreement of

the role continuing had been recently reviewed and agreed with Alan Dow. CW

confirmed that there was slippage in the relevant budget.

Voting PIQ members agreed that the current clinical lead for quality improvement

is funded for a further 18 month period with Joanna Bircher continuing in her role

until December 2013.

Action: SH to include principle for clinical engagement work alongside minutes

from the meeting.

8. Primary Care Development/Discussion paper

Declarations of Interests received from: - TG/JD/RJ/SA/SAA/AH/GW

50

4

CW explained that the paper would be used as a discussion document to enable

the start of a debate which raised questions and challenges to any potential

development within Primary Care in line with the Healthier Together agenda and

Out of Hospital agenda. JD felt an agreement would need to be made on how

long the issue is debating before a formal paper is brought to PIQ. GC felt that

localities should have sight of the paper to enable feedback to be brought back

to PIQ. This would then allow a view for something more formal to be brought

back to the December PIQ.

AH felt supportive of the paper in principal but felt that the paragraph within the

paper asking for views around extended opening hours should be omitted. CW

explained that the statement was not the only option but an opportunity to

discuss.

CP felt that that response from patients may suggest that this is what they would

want and that though patients with Long Term Conditions may realise more

benefit in seeing the same doctor not all patients would favour that kind of

exclusive relationship. TG felt that we need to think differently to achieve the best

solution locally and that a balance must be achieved between those patients

within vulnerable groups and those previously discussed by CP. SA felt it would be

beneficial to approach the matter more evidence based and to see if we could

investigate any models which may have run. GW stated that cost and value

would have to figure in any opportunity to redesign and should be costed up to

see if it is viable. GW felt that Alan Dow’s views should be noted in his absence.

CW felt that everyone’s views were important and gave the opportunity for

debate at future PIQs. CW added that if the Health & Social Care system wanted

practices to extended opening hours then a resource issue would be apparent

but that it formed part of the integration agenda. GC noted that GPs may run

the risk of appearing defensive on this subject and that caution must be

recognised to ensure a negative view is not perceived.

TG felt that the proposal for discussions to go to localities was positive and that it

may be beneficial to set up a small focus group to develop this work further. JD

agreed adding that he would be happy to be involved with this work.

Action: SH to circulate ADs response to the primary care development paper via

email alongside minutes.

Action: JD/CW to develop primary care development focus group.

Action: JD to set up primary care development briefing sessions to each locality

meeting.

51

5

9. Strategic Planning/Finance Presentation

DW gave a presentation around strategic and financial planning which looked at

what outcomes would be faced against the impact of future issues. It outlined

how these outcomes may help to meet any objectives and targets set. DW

highlighted what goals were outlined including how our commitment, vision,

inspiration, values and influence would be utilised. Primarily it would be a

sustainable financial plan which would be fundamental to achieving these goals

and the need should be recognised that any financial assumptions and plans be

updated to reflect new challenges ahead.

LR referred to the 14/15 planning process. Where annually we are required to set

out our plans to detail how we will meet the national requirements. We must also

ensure that it aligns with our 5 year commissioning strategy and the seven clinical

challenged aligned to the Health and Wellbeing Boards key priorities. It is

expected that the CCG will be required to submit its first draft of the plan in

January 2014. Development of the 14/15 plan will ensure engagement with the

public and member practices with recent feedback from sessions held in the

Glossop locality suggesting that patients were pleased to have been involved

within the process.

DM demonstrated how the financial model looked when showing an example of

allocation growth change up to 17/18. The model demonstrated the sensitivity

that any small changes to allocation growth would affect the QIPP target of the

CCG. The severity of the change demonstrated showed a possible QIPP target of

£73m to be achieved by 2018/19. Savings to be identified from TFT totalling £55m

could be considered from any existing QIPP schemes e.g. an increase in

intermediate care beds and the successful roll out of IRIS, though even this would

leave a gap of £36m to find. PH raised whether TFT were prepared to work with us

and did they have their own agenda to consider. KR explained that this would

not affect only the CCG but the Trust and TMBC also. KR added that a ‘Southern

Sector’ proposition was being considered where the Trust would join up with

Stockport, South Manchester and East Cheshire which may aid any pressures with

the trust. It was also raised that Monitor had commissioned consultancy firm

McKinsey to undertake a large review of the trust. GC offered members to attend

any Finance Committee or IGAR meeting if they wished to do so. GC thanked

the finance team for their presentation.

10. Integration Update

CW reported that Board to board were due to meet on the 23rd October.

Suggested governance with project team reports to co-costing board with

delegated authority. The CCG are still expected to go ahead with TCS2 from April

2015. A briefing has been a will be provided before and after this PIQ meeting.

11. Update on Business KPIs and Spend to Date

LR provided the update for the business cases to date explaining that each lead

is responsible for the monitoring of the KPI attached which the spreadsheet will

indicate. Slippage of £700k has been identified which should cover any

additional mop up costs. Items to note include £40k to fund a nurse within care

homes, improving infection prevention, notably CDiff and funding for a specialist

alcohol nurse which was recently approved by PIQ.

52

6

CP commented that where the KPI was not green were we struggling to gain a

benefit. It was also noted whether the delivery of quality was apparent and

whether this should be monitored via the Quality Committee. AH felt that

performance review could also be another point to consider. CW agreed

suggesting that if providers had been approved questions should be raised on

why it had taken so long to initiate. It was raised that in relation to the dementia

specialist nurse there had been an overspend and correspondence had been

sent to Willow Wood as this was not identified within the financial forecasting. AH

questioned figures around the integrated respiratory services being incorrect with

GC adding that any services not started must be reviewed to see if funding could

be utilised elsewhere.

Action: CW to pick up with Transformation team what stages business cases were

at and review relevance of these.

Action: Business Case KPIs to be monitored through the Quality Committee to be

reported back to PIQ.

12. Carers Presentation

Tony Okotie, Debbie Bishop, Clare Raw, Emma McDonough and Carol Abrahams

were in attendance to provide as requested what outcomes and value for

money are being delivered from the funding for the carers strategy.

Clare from Derbyshire explained that key issues being addressed at present

include development of the Memorandum of Understanding between partners to

ensure the elimination of any ‘postcode lottery’ The MOU has not passed through

any committees as yet with any funding for Glossop remaining very localised.

Current projects within Glossop include the Glossop Decaf project of which

written reports would are available. Grants for hardship are available which may

cover breakage of domestic appliances or decorating required. There is also a

respite fund where up to 10 breaks are permitted and all feedback from carers is

very positive. CR added that within the Mental Health support services monies are

ring fenced which would redirect back any underspend.

Debbie Bishop discussed the responsibility of the carers centre explaining that

they took a more preventative approach with a wider mixed service model that

potentially frees up any crisis management. Self directed support was available

on a one aon one basis with extensive monitoring reports across all the different

projects. All case studies have outcomes attached. A survey was distributed to

the 4000 carers within Tameside of which 1500 were returned. This high response

proved positive with a common response of carers enabling to have their

batteries recharged and allowing time for themselves to be beneficial. DB also

opened up the invitation to visit the carers centre to allow a closer look into what

they do.

53

7

EM gave an overview of the young carers service. Feedback from what the

funding provided suggested that around 90% of this was used for family holidays

and a variety of activities. It was also apparent that young people benefited from

help in their domestic setting and child care for siblings. Each young carer is privy

to an assessment with new referrals being brought in all the time. Contact with

schools is in place so they are aware of the service. GC conveyed his thanks to

the representatives for providing this overview explaining that these contracts

were operated under a predecessor operation and we now had to be a lot more

refined in how we set our targets and recoup any potential slippage.

CS recognised that some KPIs were loose and it was suggested that this be

revisited in six months time to demonstrate progress. DA added that further work

would be rolled out with the community development worker attaching to GP

surgeries. Carers show a high risk of stroke and diabetes through neglect of

themselves and this work will be mapped to any acute activity. RJ asked if a

carers list was available to practices. TG also recognised that the drive on

identifying carers was in need of a refresh. CW added that when the carers

report is due back to PIQ this would need to identify any slippage.

13. Memorandum of Understanding

GS presented the MOU which had been drafted with Steve Allinson, PH and

himself. GS explained that the document was mandatory and though we had

one last year a revised version would need to be finalised with the newly formed

CCG. Similar arrangements were specified in relation to services such as sexual

health and smoking cessations. PH raised that Steve Allinson had noted that

further refinement was needed around the N3 connectivity and access to

data/data sharing in relation to newly formed CSU roles. CP noted there was no

specific reference to engaging with public and partners. GC agreed that if this

was not included then it would need to be. KR also felt that section 28 may have

been superseded and would need to be looked into.

It was agreed that the document be referred to CMT for further comment and

refinement to be then brought back to PIQ.

Action: Draft MOU to be presented at CMT for further refinement.

14. Health & Wellbeing Strategy

GS presented the strategy to PIQ which would then go to the Governing Body

meeting. GS explained that the document had been approved at the Health &

Wellbeing Board meeting. GC noted concern with the sequencing of

governance around the document questioning whether it should have been

approved before Governing Body ratification. Omissions from the document

included the Learning Disabilities partnership board and reference to dentistry. S

Allen felt that this was particularly important as Tameside scored high regionally

and nationally at poor dental performance. RJ also noted the lack of Gurajti

representation within the imaging.

54

8

It was raised that CCG did have sufficient representation on the Health and

Wellbeing Board and that we need to ensure greater engagement and system

wide issues are sighted off this the Health & Wellbeing Board.

Action: GS to feedback comments around governance process to TMBC

15. Briefing on RAID

CS reported that a CQUIN had been in place for the last 18 months and had

been successful in outcome for patients. Staffordshire Trust are carrying out a full

evaluation which is expected to be completed by the end of October. RAID has

provided support to staff on wards, training of staff and rapid access to A&E.

Once the final outcome is realised a paper will be presented to the PPIC and PIQ

in November or December, with a view to moving resource from TFT to Pennine

Care for the continuation of the service going forward. GW asked whether

readmissions and Length of Stay would be monitored as part of the process. CS

explained that a commitment could not be given until the full evaluation has

taken place. KR asked for details of the costings. CS explained the figures given

verbally of £370k and £428k were being finalised.

16. Rational for Tender - Mental Health Supported Accommodation

CS presented the paper explaining that the CCG currently commission properties

for patients with mental health needs that host active rehabilitation for

approximately 12-18 months. After this period TMBC fund the patient to ensure

social care and supported living. The cost of the contract for the CCG is

approximately £753k with the Local Authority’s contribution totalling £558k. This

contract is now coming to an end and revaluation of needs to determine all

pathways is required. A waiver was suggested to extend the CCGs contract

whilst the re-assessment took place but TMBC are not prepared to use this process

and would rather adopt section 75 processes which will force the CCG to PQQ in

terms of the tender. GC felt that a clearer understanding was needed against

the governance process and asked if we could consider advising that the CCG

commission alone. CS noted the risk to patients if we were to explore this option.

It was felt that this need further discussion and that clinical input was involved with

this. AL added that any procurement process can continue whilst deciding on

best course of action.

Action: Mental Health accommodation matter to be urgently discussed by CMT

to determine best way forward.

Action: Ensure that clinical input from Tina Greenough or Alan Dow is factored into

any decision.

Action: Chairs action to clarify recommendation for Governing Body.

17. 111 Update

KR handed to the group an update around NHS 111 mobilisation. KR reported

that we were currently on target to sign with the stability partner of NWAS on the

55

9

29th October. Feedback suggests that Dame Barbara Hakin does not expect any

re-procurement of 11 to take place until 2015. Costs to put in to place are

expected to be around £9.8m which is an increase of around £800k. GW asked

what mechanism would be coming out in terms of comms. KR was not sure as to

who will pick up between the CCG and the area team but would seek

clarification.

Action: KR to pick up with communications department what arrangements are in

place with regard to 111 updates.

18. Emergency Care Network Minutes

CW presented the minutes, highlighting core business to note. The final winter

plan submission had been submitted that week. The draft plan had been recently

subject to a table top exercise which had been well received by the area team.

An interim has recently been recruited who will oversee the winter plan, the

recovery plan and provide assurance of how the A&E monies are spent. CW

added that a monitoring process will be put in to place to oversee these monies.

19. IM&T Sub Committee Draft Minutes & Draft TORs

AH presented the minutes and TORs to the group. AH noted that membership

had been reduced but included KR/CS as Caldicott Guardian, three

representatives from the CSU and one lay member. AH made reference to issues

around Lorenzo at the Trust adding that though challenges were being faced, it

seemed to be holding itself up at the moment. It was reported that feedback

from the recent LMC meeting suggested that members were not assured with

concerns of breaches in relation to data sharing between practices and the Trust.

A joint letter would be issued on behalf of the CCG and LMC to reflect these

concerns.

PIQ agreed the title of the IM&T Sub Committee.

20. Medicines Management Minutes

PH presented the minutes to the group highlighting that though Scriptswitch had

achieved savings of £95k, these were overestimated but there were further

savings to be considered. In relation to HCI, the UK 5 year Antimicrobial resistance

strategy had been tabled. The prescribing budget report showed a £500k

overspend which was thought to be in relation to category M changes.

21. Any other business

GW noted his thanks to the admin team for the proficient collation of the agenda.

It was noted that GC would not be present at the November PIQ with CP

agreeing to chair for the meeting.

22. Date & Time of Next Meeting – Wednesday 16th October 2013, 1pm, BR

56


Title of Subject: SYSTEM TRANSFORMATION IN TAMESIDE &

GLOSSOP

INTEGRATION

Date of paper:

October 2013

Prepared By:

Clare Watson

History of paper:

NHS Tameside & Glossop CCG and TMBC met on 23rd

October to reconfirm the recommendations that both

organisations signed up to in July, in terms of:-

Moving forward with the direction of

travel for future integration of health and

social care services in Tameside &

Glossop

Provide this work as the foundation of

our ‘place based’ and ‘Out of Hospital’

plan

Agree a joint governance framework to

support the work

The spirit of these recommendations was reconfirmed,

and both organisations agreed that we needed to

move the agenda at pace within the proposed

governance structure.

Executive Summary: There are a number of key strategic issues which

mean we cannot stand still and which give the

Integration Programme greater impetus, all of

which are outlined in the accompanying paper.

57



(for Discussion and

Decision)

The Governing Body members are asked to:

Agree the governance model and

support systems (incl. engagement) Support the increased pace around

piloting new integrated workstream

Progress discussions to build a new

provider delivery system to deliver the

vision of integration and meet all the

challenges and system issues, outlined in

2.1


by proposal:

ALL


Clare Watson

58

SYSTEM TRANSFORMATION IN TAMESIDE & GLOSSOP

INTEGRATION 1 Introduction

1.1 This paper is to update Board members on the next steps in the integration programme.

Board members will be aware that NHS Tameside & Glossop and TMBC met on 23rd October to reconfirm the recommendations that both organisations signed up to in July. At that time we had agreed to:

Move forward with the direction of travel for future integration of health and social care services in Tameside & Glossop

To provide this work as the foundation of our ‘place based’ and ‘Out of Hospital’ plan

A joint governance framework to support the work The spirit of these recommendations was reconfirmed, and both organisations agreed that we needed to move the agenda at pace within the proposed governance structure.

Suggested Governance

Derbyshire County Council Board

Tameside & Glossop CCG Governing Body

Whole Systems Integration Board

Whole System/implementation Group Project capacity & pace setting

Comms/engagementInfo, standards & evaluation

(Quality/safeguarding)

Finance Workforce development & HR

CCG ProcurementModels of care/specifications

(Quality/safeguarding)

Prevention/early intervention, neighbourhood offer

strengthening individuals and communities

Integrated localities Rapid response and

interventionSpecialist health care pathways

IT & data

TMBC Health & Wellbeing Board

TMBC Board / Cabinet

59

1.2 Both organisations have agreed to a project support team to drive the work forward. We have identified short term interims, CSU and core CCG staff to lead this work. We also agreed the need for additional interim senior leadership capacity to provide challenge and co-ordination across the economy to ensure that this programme of work delivers the new vision for a health and social care economy which focuses on:

Better health and social care outcomes both in and out of hospital

Improved experience for service users and carers

Reduced health and social care costs

2 Current system issues

2.1 There are a number of key strategic issues which mean we cannot stand still and which give the Integration Programme greater impetus:

Our local hospital being in Keogh recovery mode with ongoing quality and performance issues

Our local hospital’s financial position

The CCG’s and TMBC’s (and DCC’s) financial pressures now and ongoing

Pressures on the urgent care system driving costs up and performance down

Provider and commissioner sector working at a greater pace than Healthier Together

Healthier Together itself

Formulating a Primary Care plan as part of the Community services (out of hospital) agenda

Our requirement to re-procure community health services

Our commissioning relationship with DCC

Our local authorities’ plans for service reform 2.2 We need to start the specification of our community health services as part of a new

integrated model/pathway of health and social care. We will build on the 4 levels of care for our integrated care model:

Building up the strength of individuals and communities

Integrated teams based in localities

Rapid response

Specialist pathways and hospital based care

Underpinning the model is the need for a targeted risk based approach with the development of a stratification tool, a single point of access for care, support for local community assets and a reduction in poor quality estates.

2.3 We will work with TMBC to ensure that the commissioning framework sets out the vision for

integrated care, including prevention and early intervention. Our final desired model of delivery includes:

Community health services

Adult and children’s social care

Public health and Health and wellbeing

Dementia services

Acute care

60

2.4 The Governing Body needs to be aware of the work that the FT has commissioned from McKinsey's to scope the best business and service model going forward to guarantee clinically safe and high quality acute health care services in Tameside & Glossop into the future.

2.5 The Governing Body also needs to be aware of other services, e.g. GP OOHs, the WIC and both local authorities’ public health departments prevention and early intervention services as part of the Health Improvement Teams which were part of the original TCS contracting process, and which are being redesigned.

2.6 TMBC is currently considering options for its ‘in house’/provider adults and children’s services, but will not be putting these out to tender in the future.

2.7 The CCG has continued to work with Derbyshire CC to ensure that any proposed service

models in Glossopdale are consistent with those in Tameside. Glossopdale is the 5th locality within any future integrated delivery model for the CCG and local authorities. DCC has considerable experience of working with different CCGs and has different delivery arrangements across Derbyshire, and therefore will support the integrated health and social care service offer to its residents. At this stage, DCC is not putting its Glossopdale social care budgets ‘in scope’ to the business case.

2.8 The commissioners partners agreed the need to urgently engage with, and communicate our

plans to, key stakeholders. This needs to happen immediately to ensure that the public understand the locality/place based plans for integration including acute care in Tameside & Glossop, before the Healthier Together consultation/conversation starts to take place across GM. We need to drive this work forward, re-focusing Healthier Together to our local programme, and leading the messaging and public relations.

3 Next steps/recommendations 3.1 The Governing Body members are asked to:

Agree the governance model and support systems (incl. engagement)

Support the increased pace around piloting new integrated workstream

Progress discussions to build a new provider delivery system to deliver the vision of integration and meet all the challenges and system issues, outlined in 2.1

Clare Watson 31st October 2013

61


Title of Subject:

Transformation Report

Date of paper:

30th October 2013

Prepared By:

Ali Lewin

History of paper:

Reintroduction of reports previously presented to

(Shadow) CCG Board pre April 2013

Executive Summary:

The aim of this report is to provide Governing

Body with an overview of the transformation work

which is ongoing, supporting the GB Clinical

Leads, in addition to the QIPP projects reported

separately. This is the first report, so in addition to

the content, we are looking to Governing Body to

confirm whether this is a useful report, and

provide comments / feedback on the content

and style / layout. The aim is to ensure the report

is concise and informative, and provides

assurance across all areas of work.



(for Discussion and

Decision)

To note the content of the report, and provide

feedback / comments to inform future Governing

Body reports


by proposal:

ALL


Clare Watson

62

Transformation Report – November 2013

The aim of this report is to provide Governing Body with an overview of the transformation work which

is ongoing, supporting the GB Clinical Leads, in addition to the QIPP projects reported separately. This is

the first report, so in addition to the content, we are looking to Governing Body to confirm whether this

is a useful report, and provide comments / feedback on the content and style / layout. The report does

not include information on ALL projects, but aims to ensure the report is concise and informative,

identifying areas which are our priorities and which demonstrate both success and the challenges we

face.

Although this report is in 4 sections – one for each of the Directorate’s “teams” - we do work closely

together and NOT in silos, supporting each other and ensuring cross working wherever possible.

The Directorate

The Transformation Directorate covers a wide range of commissioning areas, and works through 4

“teams”. We work closely with colleagues in other directorates and are represented on all CCG

Committees, ensuring the work we produce receives appropriate discussion, input and ultimately “sign

off” prior to implementation.

Directorate wide work, linking with the nursing and quality and finance directorates, includes:

Locality Support: We have convened a team across the finance and transformation directorates to support our member practices via the locality meetings. We not only support the locality meetings and

clinical leads’ meetings, but also work together to provide the required information, support, and monitoring to measure the impact of the locality work. Each of the 4 members of the Directorate senior team, with the Deputy CFO, takes the lead for a locality, ensuring senior cross-directorate leadership of

this work within the CCG

Integration: The Directorate has the lead for the CCG in taking forward the integration agenda, working with colleagues in social care and our provider organisations

QIPP: The directorate works closely with colleagues in finance to produce the QIPP report, which outlines progress with our QIPP projects, in financial and qualitative terms.

Reports from each of the 4 teams can be seen below.

63

Medicines Management

Pharmacy Repeat Ordering: A series of audits carried out in the first half of the year across a

number of geographically spread practices indicated that there was on average 10% excess

ordering occurring when pharmacies ordered scripts on behalf of patients. The

Medicines Management Team will be working with practices in the second half of the year to try to set in place practice specific responses to counter this activity. There are significant QIPP issues with this

including cost efficiencies and patient safety

Care Provider audits: The Medicines Management Team have been working with L.A. partners to

support the monitoring of the standards of medicines storage, administration and recording in

care homes where concerns have been flagged. This has involved working with both CCG

Continuing Care Teams and CQC inspectors and supporting commissioners in negotiations with providers to ensure plans are in place to improve

standards

HCAI: Within the context of organisational restructurings, challenging trajectories and a rise in c.diff numbers the MMT are working to try and

ensure that the root cause analysis process provides data sufficient to promptly learn and disseminate messages from cases such that we

come back within trajectory. This continues to be an area which presents ongoing difficulties

Substance Misuse Enhanced Services: Providing training for pharmacists and pharmacy staff in

substance misuse. Working with Local Authority colleagues to review and update the service level agreement s for pharmacy enhanced services of needle exchange and substance misuse in 2014

Non-Medical Prescribing: Continuing to support Non-Medical Prescribers (NMPs) to maintain appropriate governance within their practice, by leading training, providing ePACT prescribing

information, supporting production of P Lists etc. Also, facilitating clinicians to undertake Non Medical Prescribing qualifications and supporting them during their training. Working with colleagues across

Greater Manchester and the North West region to ensure sharing of good practice and effective networks for NMP Leads

Strategic Programmes / Planned Care & Cancer

CCG Performance - The work to develop 'at a glance' dashboards showing how well we as a CCG are performing against our Clinical Challenges and

Everyone Counts Domains is almost complete. Challenges still exist around sourcing data for

some of the indicators but Clinical and Commissioning Leads are leading the process of

indentifying how we can improve our performance and work towards delivering excellence for our

patients

2014/15 Planning - Work has started on planning for 14/15. The process by which we are

developing our plans reflects our commitment to stakeholder involvement. 'The NHS belongs to the

people: a call to action' and 'Planning for a sustainable NHS: responding to the ‘call to action’' publications are being used to develop our plans so we will be able to respond to the NHS England

planning guidance when it is received in December

Increasing Direct Access/Straight to Test Diagnostics - We are evaluating the Cancer Straight to Test pathway for Colonoscopy to identify how it could be developed to increase access to colonoscopy

and flexisigmoidoscopy for all patients. A Direct access pathway for OGD has been agreed at procedure tariff and we are hoping THFT will go live in November. Lung 2 Week Wait referrals are also following a

straight to test 2 stop shop pathway and early indications are that patient experience is improved through faster diagnosis and treatment and less appointments. There has also been reduced

bronchoscopes which represents improved value for money

64

Winter Planning: The 2013/14 Winter Plan for the local Health and Social Care Economy has been developed and the process for monitoring how well we are managing has started. Increased

communication across the system is designed to support organisations to work together to manage

pressures and improve patient flow through the Urgent Care system

Tier 3 Local Specialist Obesity Service (LSOS) - The new service started in July 2013 and ensures

we have the services required by national standards available to patients. Whilst too early to evaluate impact it is hoped it will help reduce the

level of obesity locally

Mental Health & Learning Disability / Children & Families

Dementia: A GP clinical lead is required to support the dementia agenda to provide clinical advice

across the health and social care system and this request will be going to PIQ in November 2013. A

review of dementia services is currently underway, including the memory service, dementia specialist

nurse pilot and gap analysis with a view to developing a local dementia pathway. The

dementia specialist nurse pilot is due to end in June 2014 and therefore a paper will be brought to

PPIC and PIQ with a view to next steps in December 2013. The dementia local

implementation (LIG) group is also being reinstated to ensure that the local Joint Dementia Strategy for T&G CCG, TMBC and DCC (2010-15), is delivered by working towards the achievement of six local dementia strategy action plan priorities (these reflect the national priorities from “Living

Well with Dementia” - National Dementia Strategy, DoH, 2009)

Children & Families Commissioning: The vacant Children and Families Commissioner post was

appointed to in the summer and was filled at the beginning of October. This will enable

focussed work with partners to drive forward whole system improvements around promoting early booking with maternity service, reducing

smoking at time of delivery, and improving breastfeeding rates. Clinical Lead time will be used

to review pathways and admissions for children with diabetes, epilepsy, and asthma. The

Maternity Service Liaison Committee is to be reviewed in terms of its continued ability to be the

main means of giving service users an influence over maternity strategy and delivery of the

service, and to be a strategic advisory group which can help create and maintain high quality

maternity services

Learning Disabilities: We are in the process of completing the Learning Disability self assessment with a deadline of the end of November. As part

of this process we are working with CSU to look at how we can capture more of the information

needed for the data collection part of this, specifically in relation to cancer screening for

people with a learning disability as well as ongoing work to increase the uptake of the learning

disability health check

Mental health: We have been working with commissioners across the Pennine footprint to review the governance arrangements to ensure

that they are fit for purpose. The RAID CQUIN work is currently being evaluated and we are expecting the results of this at the end

of October 2013.

65

Long Term Conditions / Admission Avoidance / End of Life Care / Primary Care

Diabetes: A Long Term Conditions QIPP project for 2013-14 is the redesign and re-procurement of

diabetes services. The tender for a new community based diabetes service was completed

at the end of September, and a provider identified. This project will deliver c£400k savings each year compared with previous investment in diabetes care, but at the same time will deliver improvements in quality and patient care. The service will be operational early February 2014

Primary Care Quality: Tameside and Glossop CCG as part of its authorisation process has developed procedures for dealing with issues and concerns in

relation to “quality”, and is required to have in place a Primary Care Quality Local Improvement

Group. The CCG will lead on quality improvement and capability for primary care and will use the established systems and knowledge of member

practices to improve quality. The LIG is an operational sub group of the Quality Committee and will advise on issues of concern which arise

from The NHS England Primary Care Primary Care Web Tool and the Tameside and Glossop CCG

Local Quality Scorecard. The LIG is chaired by Dr Joanna Bircher, and has the remit to set the

agenda of visits to practices to discuss quality issues and brief the visiting team, review

issues/plans/progress, and escalate significant areas of concern about practice or individual

performance after initial investigation to the area team when necessary, and assure the LAT that low

level issues are being addressed locally

Electronic palliative care co-ordination systems (EPaCCS): EPaCCS provide a shared locality record for health and social care professionals. They allow

rapid access across care boundaries, to key information about an individual approaching the end of life, including their expressed preferences

for care. We have established a local task group to take this forward in T&G, working with the local

NHS providers, Willow Wood Hospice, the Commissioning Support Unit, and Strategic Clinical

Network

IRIS: A team comprising members of staff from Stockport FT and Tameside MBC has been

operational since early September to support patients presenting at times of crisis with the

objective of supporting them at home and preventing hospital attendance and admission.

The team work within a joint management structure and are co-located in the MBC offices in

Ashton. Work is ongoing to ensure robust evaluation of the pilot, including gathering patient and referrer feedback. The aim of the service is to achieve savings of £1,401,242 over the duration of

the 12 month pilot. This is a key project in the integration agenda

Expert Patient Programme: We have commissioned patient self care support from Self Management UK (formerly known as the Expert

Patient Programme) which are designed to support patients to manage their own long term condition, thus reducing the demand on health

services in primary care, the community and secondary care. We are also running courses for

health and social care staff to educate them in the role self care can play in patients' care plans, thus

encouraging referral to the formal patient programmes. We are evaluating the impact of

these courses on patients' health and their use of NHS services. We received positive feedback from

primary care at a recent TARGET session

Recommendations

Governing Body are asked to note the content of the report and provide feedback on the content and

the presentation, which will inform the layout and content of future reports.

66


Title of Subject: Tameside and Glossop Health & Social Care Economy

Winter Plan 2013/14

Date of paper: 29 October 2013

Prepared By: Elaine Richardson

History of paper: The 2013/14 Winter Plan has been developed through

the Emergency Care Network (ECN). Version 1.1

attached is the latest version and incorporates the

feedback from:

The formal review by the ECN on 4th October

The assessment by GM Local Area Team (GM

LAT) against national guidelines

The GM Winter Plan test on 9th October

Executive Summary:

The 2013/14 Winter Plan has been developed through

a process agreed with ECN designed to ensure that

the expectations of GM LAT would be met.

The plan is a new format that demonstrates the

demand planning, lessons learnt from 12/13 and our

level of preparedness for winter 13/14.

It also sets out how each service within the system will

react should volume and capacity dictate in order to

manage any pressures internally.

It incorporates a process for monitoring and reporting

potential pressures across the system. Focussing

forward across six days to enable organisations to

plan interventions to prevent performance failures

rather than react when failure has occurred.

It places an expectation on all organisations to

communicate as required to manage effective

patient flow through the system.

The plan is already being implemented and the

reporting arrangements will be fully functional by 11

November.

ECN will ensure that adherence to the plan and the

need for further development are monitored.

67



(for Discussion and

Decision)

The Governing Body are asked to receive and

approve the Tameside and Glossop Health & Social

Care Economy Winter Plan 2013/14 v1.1


by proposal: Quality, Innovation, Productivity and Prevention

Direct questions to: Elaine Richardson/Clare Watson

68

Tameside and Glossop Health & Social Care Economy Winter Plan 2013/14

Introduction

Each CCG is required to demonstrate that it has planned sufficient capacity within

the Urgent and Emergency Care system to manage demand across Winter 2013/14.

We are expected to lead across the local health and social care economy ensuring

that individual organisations and the system as a whole has robust and tested

escalation plans to maintain performance and quality despite surges in activity.

Greater Manchester Local Area Team (GM LAT) required us to develop a plan that

assured them that we had:

Reviewed the response to the quarter 3 & 4 urgent and emergency care

activity in 2012/13 and used the learning to inform our plan for the same

period in 2013/14

Undertaken activity and demand planning to include seasonal variation and

engagement between health and social care service providers, to include:

Patient flow

Bed occupancy modelling

Discharge planning

Tested the surge and escalation plans and ensured that they are linked to

activity assumptions

Reviewed Business Continuity plans and amended as necessary.

NHS England (NHSE) provided a Winter Assurance Checklist for our use and a system

wide assurance template against which GM LAT reviewed our draft plan.

Development of the 2013/14 Winter Plan

The ECN recovery plan was developed in May 2013 and includes a range of

schemes designed to reduce A&E and Acute bed demand and improve waiting

times for those patients who require A&E support. Whilst not focussing on winter it

was recognised that we needed to increase capacity for same day support and to

provide alternatives to A&E to reduce demand at the hospital in order to bring the

system out of escalation. Whilst not yet formally reviewed it appears that schemes

that have been implemented are having a positive impact and an improvement in

quality has been achieved. Our challenge is to maintain and increase that

improvement across winter and beyond.

We started work on developing a more robust monitoring and reporting system in

June 2013 with the intention of adopting this for winter 2013/14. The intention is to be

69

more forward focussed to enable organisations to plan interventions to prevent

performance failures rather than react once failure has occurred.

In August the ECN agreed a process through which we would develop the 2013/14

Winter Plan. Each organisation reviewed winter 2012/13 and were asked to develop

their own capacity plans to meet the expected demand using the learning from

12/13.

Following advice from the Urgent & Emergency Care Intensive Support Team we

adopted a new format based on an example of a good format that had been

shared from Bolton.

Following reviews by individual organisations and the ECN a draft was submitted to

GM LAT for assessment. GM LAT assured our plan in all but one area namely de-

escalation (feedback can be found in Appendix A). They stated that they felt it was

a strong plan and had used it as an example of a good plan in the area team peer

review process (GM was twinned with Lancashire AT).

GM Urgent Care Leads agreed that it would be beneficial to hold a GM Wide test of

plans to maximise learning and ensure that we considered the impact of our plans

on other areas. The test event on 9th October was well attended by ourselves and

others and provided a useful insight into which areas of our plans needed

strengthening. The key areas we identified were

1. Children's and Adolescents Mental Health Services

2. Cross organisation communication around discharges

3. Inclusion of a prediction of pressures for next 4 days not just 24 hours

The plan was revised in light of the feedback and an updated version v1.0 was

submitted to GM LAT on 15th October. Unfortunately there were still some aspect

outstanding as not all organisations had submitted their final actions cards or

nomination for the system reporting. Version 1.1 attached contains the latest action

cards and nominations.

Implementation of the plan

Many of the schemes in the ECN Recovery plan have already been implemented so

we should be in a stronger position as we move into winter. All organisations are

expected to maintain their capacity to meet the anticipated demand and to

escalate in line with their action cards when volume and capacity dictates. The

new monitoring arrangements are due to commence on 31st October, initially

running in parallel with the existing scheduled calls on Monday, Tuesday and

Thursday. The intention is to switch over totally by 11 November unless issues occur

during this test phase.

70

A review of the monitoring and system status reporting is being scheduled for the

end of November to ensure we are able to adapt if there are any concerns about

our ability to maintain performance.

Whilst the plan is constantly under review at both organisation and system level a

formal review of performance and the robustness of our plan will be undertaken at

January ECN to inform any further development required to bring us out of winter

achieving the required standard.

Recommendation

The Governing Body are asked to receive and approve the Tameside and Glossop

Health & Social Care Economy Winter Plan 2013/14 v1.1

71

Appendix A

Urgent Care Board winter plan assurance - system wide assurance

Area Team:

Assurance Check Assured/No

t Assured Comments

Review

Has the urgent care board reviewed the lessons learned from winter 2012/13 as a collective and included any system wide improvements in the plan?

Assured

Feedback from all organisations from Winter reviews. ECIST review and feedback. They have the ECN Recovery plan and A&E non recurrent funding initiatives referenced in the plans.

Risk Management

Has the UCB identified the risk associated with the winter period and what is being done to manage and minimise them?

Assured

The plan has a risk and impact log which identifies: Patient behaviour, Staffing and Service failure as key risks they reference seasonal impact on disease groups and severe weather impacting on transport links.

Governance

Is it clear which group and individuals are responsible for overseeing operational response to winter pressures and taking decisions as required?

Assured

The plan describes communications for in and out of hours during seasonal pressures. They are developing a programme of training for role out across Organisations, departments and to individuals regarding responsibilities and response to escalation. And there is an unpopulated list of Tactical command/ resilience leads across partner organisations. This is an early draft and expect the key contacts to be populated, no implementation dates/ timescales for the training.

Partnership working

Is each stakeholder's role clear and agreed within the UCB?

Assured

Partners are represented in the plan with key responsibilities - at this stage the role of primary care has not been populated -awaiting Direct Commissioning response, also Arriva plan is included however quality of content is poor.

Are all parts of the local health community aligned to support each other?

Assured

The plan refers to capacity management as a co-ordinated model across the Health and Social Care economy

Are contingency plans and business continuity plans aligned?

Assured

The plan says that all organisations have resilience and Business Continuity plans which are considered along side the Winter Plan

72

Safety

Are circumstances when patient safety could be compromised understood and mitigations included in contingency plans? Do all the plans uphold the recommendations identified in the Francis report?

Assured

Tameside and Glossop and the Trust have undergone a Francis review and have action plans as a result of this. All services now aspire to the Francis recommendations

Monitoring and

Communication

Are there named executive leads for each member organisation to whom issues can be escalated?

Assured

The plan identifies the organisational requirements - however it is not populated with specific as yet

Is there an agreed communication and management plan detailing metrics and data reporting across the system to monitor pressures, and a process to work together to provide an appropriate and timely response?

Assured

Service escalation and action plan and the communications plan cover this

Plan Alignment

Have individual organisations winter plans been reviewed by all members to ensure plans are aligned across the health and social care community and support each other? E.g. An increase in 7 day discharges in an acute trust may mean that agencies supporting discharge may also need additional capacity.

Assured

This is lead by the Emergency Care Network and the plan summarises the plans

Demand and Capacity analysis

Has a detailed analysis and predictive modelling been undertaken across all stakeholders which has informed planned activity and business continuity plans. i.e. surges in activity associated in the first week of January. In real terms, has planned activity been reduced at expected peak periods of urgent care activity?

Assured

Predictive modelling based on the 5 years data has been used which identified a strong seasonal component indicating that the seasonality is part predictable. Patterns have been identified and are being managed

Escalation

Are system wide triggers for escalation clearly defined and understood by all agencies?

Assured

Triggers are based on Capacity and Volume and have been identified across organisations. A rag rating has been developed for the system relating to service escalation

Is there a consistent approach to escalation across all stakeholders?

Assured Identified in the plan

Are internal escalation levels within each organisation understood by all stakeholders?

Assured

Organisational escalation levels are appended to the plan. Actions are to be agreed across the Health Economy if they will impact on partner organisations.

Is it clear what individual stakeholders' roles are in relation to escalation i.e what is response of secondary care, primary care, social care, mental health, ambulance, 111 and NHS England.

Assured

Most areas are clearly referenced however - awaiting the Direct Commissioning response - No ref to 111 or NHSD

73

Has an impact analysis of individual escalation actions on the wider system been undertaken with any identified risks and mitigating actions fed back into individual plans? e.g. the stopping of elective activity by an acute trust has impacts on ambulance patient transfer.

Assured

Is there an agreed process for de-escalation?

Not Assured

Not referenced in the plan

Finance

Where provision for the 70% emergency tariff has been made, the allocation and use of the monies across the economy has been agreed?

Has there been collaborative discussions across the health system about use of the Health Section 256 monies that have been invested in Adult Social Care? Are these resources supporting local winter plans?

Should increased pressures be experienced, have organisations agreed contingency (headroom) funds available?

Has there been any local analysis on the effectiveness of schemes funded by the additional winter pressures monies allocated last year? If any additional resources are released centrally this year do local areas have a plan of how these could add value to the system?

Links to other polices

Are links to other policies up to date? For example is the winter plan aligned to provider contingency plans, cold weather plans etc

Assured

Referenced in the plan

Are these tested?

Part of CSU facilitated testing 9th October 2013

Are these in use? Assured Part of the ECN

Notes: Issues with supported discharge - Lack of internal capacity to escalate in the FT - relianet on community beds (issues of outcomes in spot beds) - reliaant on the Critical care network plan not internal plan referenced for the Trust - LA governance reliant on individuals and extra capacity for some teams based on OT and for identified staff - Awaiting Area Team response for Direct Commissioned services - response for home oxyen service is vague at best - the referenced BC plans are assumed in the plan - reference agencies to provide staff short falls this needs testing as the resource may be stretched or not have the appropriate skills - separate Health and Social Care directories

Version 5.0 DMacG

74

IINNIITTIIAALL DDRRAAFFTT

Page 1 of 59

C:\Documents And Settings\Jbell\Local Settings\Temporary Internet Files\Content.Outlook\BUHQ96FI\TG Winter Plan13-14

V1 1.Docx

Tameside and Glossop

Health & Social Care Economy

Winter Plan

2013/14

75

http://nww.tamesideandglossop.nhs.uk/

http://www.nwas.nhs.uk/


Page 2 of 59


V1 1.Docx

Document Control

Title: Tameside and Glossop Health & Social Care Economy

Winter Plan 2013/14

Status: Final Draft

Version: V1.0

Date Issued: 15 October 2013

Originator of Document Elaine Richardson

Document purpose To enable Tameside & Glossop Health Economy to

respond to a surge in health and Social Care demands

Document Location S:Strategy & Redesign/Urgent Care/ 13 14 Winter

Planning

Document Owner and

Contact

T&G ECN

Sarah Hadfield 0161 304 53

Change History

Version Summary of Changes Status Date Issued

0.1 Initial Draft Replaced

0.4 Final Draft Replaced 13 Oct 2013

1.0 Agreed Plan Current 15 Oct 2013

1.1

Additional Action cards, Updated Contacts

list and Renaming Community Service to

Stockport FT

Test Date

Tested through Test Date

GM Testing Event 9 Oct 2013

Review

Reviewed by Date

76


Page 3 of 59


V1 1.Docx

T&G ECN 4 Oct 2014

GM LAT 8 Oct 2014

T&G ECN November

Approval

Approved by Organisation Date

ECN Health and Social Care Economy

Steve Allinson NHS Tameside & Glossop CCG

Karen James Tameside NHS Hospital Foundation Trust

Michelle Lee Stockport Foundation Trust

Stephanie Butterworth Tameside Metropolitan Borough Council

Michael Peers Derbyshire County Council

Susan Firth Meridian

Lisa Woodworth Go To Doc

Pennine Care

77


Page 4 of 59


V1 1.Docx

Contents 1. Purpose ................................................................................................................................ 6

2. Introduction ......................................................................................................................... 7

3. Lessons Learned from Winter 2012/13 ............................................................................... 8

3.1. Planning ..................................................................................................................... 8

3.2. Service Development .............................................................................................. 8

3.3. System Monitoring .................................................................................................... 9

3.4. Integrated Working .................................................................................................. 9

4. Demand Planning for 2013/14 ......................................................................................... 11

4.1. Activity Levels ......................................................................................................... 11

4.2. System Risks and impact ....................................................................................... 13

5. Tameside and Glossop Urgent Care System .................................................................. 14

6. System Capacity ............................................................................................................... 15

6.1. Primary Care ........................................................................................................... 15

6.2. 111 ............................................................................................................................ 17

6.3. Go To Doc ............................................................................................................... 18

6.4. North West Ambulance Trust (NWAS) ................................................................. 18

6.5. Arriva Patient Transport Service ........................................................................... 19

6.6. Tameside Hospital NHS Foundation Trust (THFT) ................................................. 19

6.7. Stockport Foundation Trust ................................................................................... 22

6.8. Meridian ................................................................................................................... 22

6.9. Pennine Care .......................................................................................................... 23

6.10. Tameside Metropolitan Borough Council ....................................................... 24

6.11. Derbyshire County Council ............................................................................... 25

6.12. Individual Funding Decisions ............................................................................. 25

78


Page 5 of 59


V1 1.Docx

6.13. Residential and Nursing Homes ........................................................................ 26

7. System Status ..................................................................................................................... 27

7.1. RAG Reporting ........................................................................................................ 27

7.2. Escalation ................................................................................................................ 31

7.3. De-escalation ......................................................................................................... 31

7.4. Service Escalation Levels and Actions ................................................................ 32

7.5. System Escalation Levels and Actions ................................................................ 49

8. Communications ............................................................................................................... 52

9. Awareness Raising ............................................................................................................ 52

10. Tactical Commanders and Resilience Leads ................................................................ 52

11. Delegated Authority ......................................................................................................... 56

12. Appendices ....................................................................................................................... 57

13. Agreement to Tameside and Glossop Health and Social Care Economy Winter

Plan ........................................................................................................................................... 58

79


Page 6 of 59


V1 1.Docx

1. Purpose

This document sets out how we will ensure that we are able to provide a high

quality and responsive health and social care service in Tameside and Glossop

through the winter period 2013/14 and beyond. It describes what services will be

in place to meet expected demand and the agreed processes when the demand

on the system is greater than anticipated.

The plan seeks to ensure that:

Organisations are prepared for the anticipated demand from October 2013

to September 2014;

Potential risks have been identified and contingencies have been put in

place;

The local escalation process is understood and has defined escalation levels

and triggers;

The impact of pressures on the levels of service, national targets and finance

are managed;

A process is in place to meet the winter reporting requirements of our

governing bodies;

Key organisational contacts are identified.

Each provider and the CCG will have their own Resilience Plans and Business

Continuity Plans and this document should be considered alongside those plans. It

complements the escalation and surge planning that is undertaken at a Greater

Manchester and North West level aiming to maintain the system at level Zero -

Manageable within business as usual operations, in the ‘NHS England (Greater

Manchester) Incident Response Plan’ (Appendix A). And to respond if it becomes

necessary to escalated to NHSE (GM) Level One - Manageable within a single

health economy (Significant incident).

This document and plan are subject to continuous improvement and evaluation

and as such is a ‘working document’. The initial detailed review of the plan took

place at the 4th October Emergency Care Network (ECN) this was followed by a

review by GM Local Area Team (GM LAT) with comments fedback to NHS

Tameside and Glossop CCG on 8th October 2013. The plan was then tested

through a GM event on 9th October. The plan has been updated in line with these

three reviews and version 1.0 was submitted to GM LAT on 15th October 2013.

80


Page 7 of 59


V1 1.Docx

81


Page 8 of 59


V1 1.Docx

2. Introduction

This 2013/14 plan incorporates the lessons learned from managing winter 2012/13

and the ongoing performance in Urgent Care. It reflects the current ECN

Recovery Plan and the projects funded through the non-recurrent A&E funding

made available to the health and Social Care economy in Oct 2013.

The approach builds on the whole system approach, which acknowledges the

usual peaks in demand over the Christmas and New Year period, plus unusual

peaks in demand for other reasons, e.g. as a result of adverse weather conditions.

Our commitment is to ensure that we have an adequate ‘system wide’ resilience

plan, to respond to operational difficulties in parts of the system.

It is an inherent understanding that organisations will work to manage variations in

demand internally but that no action should be undertaken by one service, which

may undermine the ability of other parts of the system to manage their core

business, without prior consultation / discussion.

The plan has been developed through collaboration of all organisations in the ECN

and has been approved by both the ECN and the constituent organisations. The

organisations involved in its development and implementation include:

Derbyshire County Council

Go to Doc

GM Local Area Team Primary Care Commissioning

Meridian Healthcare

NHS Tameside & Glossop CCG

North West Ambulance Service (NWAS)

Pennine Care NHS Foundation Trust

Stockport NHS Foundation Trust

Tameside Metropolitan Borough Council (TMBC)

Tameside NHS Foundation Trust

The implementation of the plan and the resulting performance within the system

will be monitored by the ECN and it will be standing item on the monthly ECN

agenda. This does not replace the monitoring systems in individual organisations;

however, it incorporates the Urgent Care System performance monitoring

undertaken by NHS Tameside and Glossop CCG.

82


Page 9 of 59


V1 1.Docx

3. Lessons Learned from Winter 2012/13

All organisations were asked to review winter 2012/13 and consider how well they

followed the plans operating at that time and whether they supported the delivery

of effective Urgent Care. In addition to this feedback the findings from the June

2013 Emergency Care Intensive Support Team (ECIST) review have been used to

identify improvements for 2013/14.

3.1. Planning

Planning needs to start mid-summer at the latest to ensure any new schemes

required have a lead in time. This year planning started with the development of

the ECN Recovery Plan in June. The consolidation of the 2013/14 Winter Plan

started August 2013. Some organisations have already implemented schemes and

used bank/locum cover to reduce delays due to recruitment processes.

Planning capacity for all resources not just beds is vital. The system needs to use

current demand as the baseline for ‘normal’ capacity planning and use previous

years to understand the typical winter demand. This year organisations have been

asked to ensure their capacity going into winter will be enough to meet the

anticipated demand so that we do not start winter in escalation.

3.2. Service Development

A proactive approach to managing patients proved successful e.g. Case finding

of patients for early intervention. This is being encouraged again this year.

Rapid intervention services were identified as important in reducing the admission

of frail elderly and vulnerable patients. The Integrated Rapid Intervention Service

(IRIS) started in September and other schemes are being developed for

implementation November/December.

CARA were identified as a key enabler to delivering Urgent Care. Benefit of

integrated teams to smooth the flow of patients between providers within the

system was recognised. This year integrated teams can be found in CARA, IRIS

and the Integrated Transfer Team.

Early commitment to service development through the ECN Recovery Plan and

Non-recurrent A&E funding has enabled services to be brought on stream more

quickly so they will be fully functioning before the impact of winter is felt.

83


Page 10 of 59


V1 1.Docx

3.3. System Monitoring

The use of data to predict and drive performance was highlighted. Extensive

development of urgent care data and new performance management

arrangements are now in place with THFT and metrics are being agreed with other

members of the ECN to ensure system wide monitoring.

The need to set triggers at a level that enables management before the system

becomes overwhelmed was identified. Services have reviewed their own triggers

and considered the impact of those of others to increase the level of confidence

that the system has time to rebalance itself should demand increase.

The system of conference calls was widely regarded as being ineffective as it was

used to gather historical information rather than focus on action to mitigate any

risks in the future. The future arrangements involve predictive information being

fed into the system each day prior to any conference calls so if they are required

they focus on the effectiveness of the proposed solutions not the identification of

problems.

3.4. Integrated Working

The power of early co-operation and collaboration between providers was

highlighted both at a general operating level and when in escalation. Since last

year the ECN has become a key forum and is a driver of change across urgent

care.

Individual organisations stated they followed their plans correctly and implied that

failures in the system were down to others. The culture of an integrated urgent

care system that supports patients along an urgent care pathway rather being

services that ‘hand over’ patients to others at set points is developing but further

work is required particularly when in escalation.

Lack of understanding of the criteria and operational policies across services may

account for the reporting of ‘inappropriate transfers of care’. Integrated teams

should help this but further development is required to ensure fully understood, and

where possible common, operational policies. In addition factoring the timelines

for transfer of patients would increased capacity management and identify when

alternative services need developing e.g. out of hospital beds for medically fit

patients waiting for housing or complex packages of care.

Patient flow through THFT is affected by internal processes as well as discharges to

other services and could be improved by developing a culture of ‘pulling’ patients

84


Page 11 of 59


V1 1.Docx

through the system. The use of Expected Date of Discharge (EDD) systematically

and undertaking pre-emptive work could reduce delays. Ensuring ward and

medical staff understand and enact their role in ‘driving’ discharges should reduce

length of stays. Implementation of a new PAS system (LORENZO) at the acute trust

from October will allow for tighter monitoring of EDDs.

85


Page 12 of 59


V1 1.Docx

4. Demand Planning for 2013/14

4.1. Activity Levels

Historical data (2008/09 to 2012/13) suggest there is a strong seasonal component

to pressures indicating they are in part predictable. Although there is some

variation between the years there are reoccurring patterns and the main periods

of pressure are;

At the start of October

From the start to mid December.

A ‘pressure’ lull before re-emerging in January, typically as elective activity

resumes following the Christmas and New Year lull.

March

ED attendance numbers are generally typical or ‘expected’ during these periods

suggesting that numbers per se are not the driver for pressure. Whilst Emergency

admissions via ED can provide a proxy for acuity; other factors come into play, e.g.

the threshold for admission, ‘pressure’ (backlog) in ED and availability of

alternative services. There appears to have been an overall increase in

emergency admissions last winter with a peak of around 37% in December 2012;

the average is around 23%. There was only one day with higher than expected

emergency admissions via ED.

The profile of Direct Admissions is very variable even taking account of weekend

lulls when it is likely there would be fewer GP referrals this is probably due to the DA

route not being consistently available last year.

Elective admissions display considerable variation across the days of the week

from 0 to 22, the daily average being nine.

Discharges display substantially more variation than admissions which can lead to

bed availability issues across days of the week. The low numbers at the weekend

compared to admissions are likely to lead to bed availability issues on Mondays.

The timing of discharges is fundamental in balancing the flow of activity through

the hospital.

Periods of pressure manifest after periods of variation in activity, i.e. decreased

discharges (at weekends and Bank Holidays) and electives during holiday periods

such as the half-term and especially the Christmas and New Year period.

86


Page 13 of 59


V1 1.Docx

Whilst demand is unlikely to substantially increase we need to ensure our capacity

can cope with increased acuity which may increase both admissions and length

of stay. We can expect variation between the days of the week and this should

be acknowledged when planning the appropriate level of resource to manage

variable activity levels. We need to be able to balance our capacity around the

average and the upper control limit activity levels as the former is likely to lead to

‘failure’ in managing on around 50% of the days as half the activity is above the

average and the later is comparatively costly and has the inherent problem of

under-utilisation of resources. Resourcing between the average and the upper

control limit of activity should support more proactive management of the ‘flow’.

Elective activity should be scheduled around the expected non-elective profiles in

order to minimise the interactions and therefore pressures between the two flows.

Table 1: Upper Control Limits for expected activity by day of week

Day ED

Attendances

Emergency

admissions via

ED

Direct

admissions

Emergency

admission total

Elective

Inpatient

Ambulance

arrivals

Average

Upper

Control

Limit

Average

Upper

Control

Limit

Average

Upper

Control

Limit

Average

Upper

Control

Limit

Average

Upper

Control

Limit

Average

Upper

Control

Limit

Mon 233 291 61 87 16 38 77 124 11 29 82 108

Tue 223 273 60 86 14 28 75 107 9 19 75 100

Wed 214 276 57 82 14 29 71 99 16 35 74 91

Thu 217 256 60 83 17 32 76 102 9 28 78 103

Fri 200 261 59 80 16 29 75 97 9 18 76 103

Sat 206 257 56 82 10 28 65 101 3 18 81 113

Sun 213 265 53 73 7 17 60 84 4 11 78 106

NB Emergency admissions and direct admissions will not sum to the total due to; variation within the two admission streams

limits and the figures displayed are the upper control of the two admission streams.

Whilst concentrating on activity within THFT all services need to consider what

levels of demand they are required to take out of the system either through

admission avoidance or discharge. Our typical discharge flow is being

determined to support capacity planning and will be shared across the system to

support local plans.

87


Page 14 of 59


V1 1.Docx

4.2. System Risks and impact

Risks Impact Mitigation/Response

Seasonal holiday causing

patients to present because:

They have not accessed

timely care

Of drug/alcohol related

conditions

Additional

attendances at

ED/WIC

Increased demand for

IRIS

Plans to support fast

increase of capacity

Adverse weather resulting in

rise in specific conditions e.g.

falls, COPD

Additional

attendances at

ED/WIC

Increased demand for

IRIS

Preventative case

management from

Primary Care and

others

Flexible workforce

Adverse weather causing

transport problems

Reduced staffing

available in services

Flexible workforce

Delays in reaching

domiciliary patients

Alternative transport

plans in place

Staff sickness reducing

capacity

Delays in care for

patients

Robust locality sickness

management/preventi

on strategy in place

Service Failures Patients requiring

transfer to alternative

services

Robust service level

resilience plans in

place

The current version of the UC System Risk log can be found in Appendix B. The Log

is held by the Winter Planning Project Manager and is updated when new risks are

identified as well as being subject to a weekly review.

88


Page 15 of 59

C:\Documents And Settings\Jbell\Local Settings\Temporary Internet Files\Content.Outlook\BUHQ96FI\TG Winter Plan13-14 V1 1.Docx

5. Tameside and Glossop Urgent Care System

Community Based Hospital Based

Front

Door

Primary Care

Bed

Based

Home

Based

Walk in Centre

Shire Hill Intermediate Care Unit

Grange View

Ambulatory Emergency Care

A & E

Integrated Transfer Team

NWAS

MAU

THFT Wards

Out of Hours

CARA

IRIS

Short Stay Intervention Unit

PTS

Domiciliary Care

LTC

Nursing and Care Homes

Manual Handling District Nursing

Mental Health Community Services

Mental Health RAID Team (A&E + Alcohol)

Mental Health Older People’s RAID

Team

Mental Health Inpatient

111

Palliative Care/Macmillan Nursing

89


Page 16 of 59


V1 1.Docx

6. System Capacity

Each health and social care organisation has its own internal arrangements for

capacity management and escalation to meet surges in demand. This is a

contractual requirement. This plan recognises the need for capacity

management as a co-ordinated model across the Health and Social Care

Economy.

6.1. Primary Care

NHS England plans to optimise the existing capacity within GP practices by writing

to all practices reminding them of their contractual responsibilities to provide

services during core hours and encouraging sign up to the extended hours DES.

Practices that routinely close for a half day will be required to provide assurance to

the Area Team of what provision is in place for patients during this time.

Practices will be encouraged to review their usual appointment systems to

schedule enough free appointments on the days immediately before and after

the bank holidays.

Practices will also be encouraged to ensure that there are agreed ‘buddy’

arrangements in place in case a situation arises that could prevent GP practices

from offering routine appointments, for example a pandemic flu outbreak.

The Area Team will be seeking assurance from all GP practices that they have

robust business continuity plans in place, a letter including a ‘self declaration’ and

an example business continuity template will be circulated to practices week

beginning 7/10/13 to be returned by 31/10/13. Single handed practices will also be

asked to provide assurance in respect of ‘buddy’ arrangements in the event of an

incident.

Confirmation of the local arrangements for General Practice will be sought from

NHS England.

There is an expectation that Dental Practices remain open between the hours of

09:00 to 18:00 Monday to Friday. Between the hours of 08:00 and 18:30 patients

are able to ring the Dental Urgent Care line to access one off urgent dental care.

And between the out of hours period of 18:30 and 22:00 patients can access

urgent dental care. After 22:00 patients can access services and are triaged via

NHS 111 helpline.

90


Page 17 of 59


V1 1.Docx

All Dental, GP, Pharmacy and Optometry Practices have been sent information

regarding accessing NHS Dental Services both in-hours and out of hours. NHS

England plan to refresh the campaign and raise further awareness by working with

Practices to ensure that messages are being publicised within the local area. All

A&E departments are informed of the in-hours and out of hours dental pathways,

and are advised to direct patients appropriately.

Twelve of the 64 pharmacies in Tameside & Glossop are 100hr contracts with

extended opening hours.

GM LAT will provide CCGs with details of pharmacy opening times and information

relating to urgent care dental services for inclusion in any Winter Planning

Directories or local press releases that they are preparing.

The Area team also intends to provide a Winter Planning Newsletter to CCGs and

the four primary care independent contractor groups that will promote key

messages such as ‘Choose Well-Winter Campaign 2013/14’

The Greater Manchester Area Team Winter Planning Assurance 2013/14 document

can be found in Appendix C.

2013/14 Developments to strengthen Winter Plan

Development Impact

All GP practices have been asked to ensure there is robust

call and recall of patients who would benefit from

preparing for winter including those with COPD

Ensuring high coverage

so improved

prevention so less

patients needing

urgent care due to

exacerbation of an

existing condition

GP practices have been asked to follow up patients who

do not respond to invitations for flu vaccines or fail to

attend scheduled clinics

Improved prevention

so less patients needing

urgent care due to

exacerbation of an

existing condition

Using Patient information guides on how to stay well with a

chest condition

Improved self

management

GPs are aware of alternatives to direct admission (IRIS) More patients

supported at home

rather than being

91


Page 18 of 59


V1 1.Docx

admitted

25 pharmacies have applied to provide the NHS seasonal

flu vaccination service that is being commissioned by

NHSE Area Team


Pharmacists across GM will be vaccinating 18-64 yr old at

risk patients, particularly targeting those who find it difficult

to attend their GP’s flu clinics


Minor ailments scheme for a set range of conditions

operating in some of our pharmacies

Reduced pressure on

GPs

Emergency medicines at some extended hours

pharmacies for access to end of life drugs and a limited

range of non-CD end of life medicines at Shire Hill for

emergency access

Improved access to

medication outside of

hospital

Antibiotic Specialist Pharmacists who can give advice on

patient specific issues

Effective use of

antibiotics

Pharmacy pathways in place for COPD exacerbations Increased out of

hospital support

Developing medical and specialist support to Nursing and

Care homes to reduce the need to transfer patients to

hospital

More patients

supported at home

rather than being

admitted

6.2. 111

The present contract remains with NHSD, at least for a short while whilst

agreement is secured to the proposed Stability Partnership contract with NWAS.

Thus once this formal agreement is concluded NWAS will be required and in a

position to provide the necessary assurances to urgent care boards once the

formal handover has taken place. As part of the negotiations with NWAS specific

attention has been paid to the resilience of their service delivery proposals

including additional capacity to handle calls through the peak winter period.

There are no plans to proactively market NHS 111 at this time as part of the step-in

/stability partner arrangements. The activity plans being discussed with NWAS are

on the same basis as current activity levels i.e. with OOH Providers continuing to

provide call handling where they are currently doing so. Where CCGs OOH

services' continue to provide call handling services, the OOH contact details will

continue to be promoted as the route to access urgent primary care in the Out of

Hours period, and the public should be directed to contact their GP practice for

instructions in all other cases in-hours.

92


Page 19 of 59


V1 1.Docx

In the event that the service transfer to NWAS is completed as planned, NHS 111

service activity will be reviewed daily through automated reporting by both Lead

Commissioners and Providers; including the onward referral routes (dispositions),

the referral rates to GP services and A&E and in particular the referral rate to the

NWAS 999 service. Where trends emerge demonstrating increases in activity and

particular system impacts, these will be communicated to the relevant CCG/Area

Team Commissioners as part of the regular sitrep reporting process. Where

unusually high activity presents unexpectedly, NWAS will have immediate dialogue

with Commissioners to ensure that the wider health economy can be briefed via

existing reporting routes.

NWAS are currently planning to integrate NHS 111 Service winter arrangements

e.g. increased levels of activity, actions in severe weather, flu vaccinations for staff

etc. within their existing 999 service winter planning and preparations to ensure an

integrated and resilient approach.

6.3. Go To Doc

Go To Doc (GTD) provides the following services

Out of Hours

Walk in Centre

Alternative to Transport

GTD’s internal winter plans include how activity and performance are monitored

and capacity flexed to meet demand.


Development Impact

Alternative to Transport scheme to enable GP assessment

as an alternative to transport to ED for specified patients

Reduced ED

attendances

Promotion of the Walk in Centre as the choice for minor

illness

Reduced ED

attendances

6.4. North West Ambulance Trust (NWAS)

NWAS provides the following services

999 Responses

Alternative To Transport

Ambulance Conveyance

93


Page 20 of 59


V1 1.Docx

NWAS has its own escalation plan including Resource Escalation Action Plan

(REAP) arrangements (v3.0 currently under review) and Clinical Escalation Plan

(2.3.1) all underpinned by Major Incident Plan (v2.0) and On Call Procedures and

Deployment Plan (EP 011 v1.0), Regional Operational Coordination Centre and

Urgent Care Desk monitoring activity and performance.

The REAP, is an integral part of the NWAS Business Continuity management

strategy and is in operation at all times. It enables NWAS to ensure that its service

can respond to challenges in the local environment, such as increased activity,

significant loss of staff, buildings and resources, or pressures within the wider NHS.

The health economy will continue to work with the NWAS in reporting escalation

and local pressure status on the Capacity Management System and working to

the Gold Control and SHA diversion process and policy.

To meet national indicators for the Ambulance Service patient response and

turnaround times, standard operational guidelines are in place to support minimal

delays in emergency response times and hospital turnaround times.


Development Impact

Alternative to Transport scheme to enable GP assessment

as an alternative to transport to ED for specified patients

Reduced ED

attendances and

admissions

Community Pathway for Falls and COPD to reduce need

to transfer to hospital

Reduced ED

attendances and

admissions

Developing standardised protocols for nursing and Care

homes to reduce calls for emergency ambulances

Reduced ED

attendances and

admissions

6.5. Arriva Patient Transport Service

Arriva provides the following services

Patient Transport Service

The contract specifies the level of service to be maintained and monitoring of

service reliability for patient flow in/out of hospital. Contingency plans are in place

to ensure service delivery.

94


Page 21 of 59


V1 1.Docx

6.6. Tameside Hospital NHS Foundation Trust (THFT)

THFT provides the following services

ED

MAU

SSIU

Integrated Transfer Team

Inpatient and Outpatient Care

It has its own detailed capacity and service development plans designed to meet

the anticipated demand for Urgent and Planned Care. The internal winter plans

includes details of how staff will be re-allocated to ensure performance is

maintained and what actions will be taken when bed occupancy exceeds normal

operational levels.

THFT will review elective activity on an ongoing basis to use beds as efficiently as

possible whilst ensuring patients are treated in line with NHS constitution standards.

Where possible patients will be treated as a day case/23-hour stay and additional

Pre-op assessment appointments will be made available to book in patients.

Capacity will be identified in the independent sector as well as additional internal

capacity. In the event of restricted access to ITU/HDU an alternative model for

management of Epidurals will be identified and options for increasing HDU facilities

and development of flexible bed usage between level 2 & 3 beds.


Development Impact

Increased qualified nursing capacity in ED by

20wte

More patients assessed in 15

minutes. Fewer ambulance

handover delays. Improved

quality of care, Improved Patient

experience

Increased Advanced Nurse Practitioner

capacity in ED, Paediatrics ED and MAU

Emergency Nurse Practitioner in ED to

support minors

Patients with minor illness/injury

treated in a timelier manner by an

appropriately trained clinic

decision maker

Rapid Enhanced Assessment Clinical Team in

ED for a minimum of 12 hours comprising

More patients treated within 15

mins and seen by Doctor within an

95


Page 22 of 59


V1 1.Docx

Senior doctor, junior doctor and nurse hour. Reduced ambulance

handover times, Improved

decision making

2-hourly Board Rounds by consultant, team

leader and manager

Increased focus on those patients

waiting longer than desired.

Improved quality by

supervision/monitoring of junior

doctors

Increased management capacity focusing

on ED processes, team building and staff

empowerment

Patient flow improved, Staff

morale improved. Productivity,

efficiency and quality improved

Increased use of Ambulatory Emergency

Care pathways e.g. Chest Pain, PE, Cellulitis,

DVY, UTI and CAP

Reduced admissions and ED waits,

Increased patient/staff

satisfaction. Reduction in referrals

for diagnostics

Increased responsiveness of diagnostics by

increasing capacity in MR and Ultrasound

and building on a successful pilot of new,

leading edge, point of testing technology

along with access to CT reporting

Reducing waits in ED and MAU

Reducing Risk of unnecessary

admissions

Improved access to medical support

Additional medical team Sat and Sun to

supplement on-call team in review and

management of medical patients, including

support from CDFs.

Extend middle grade rota to 1:12 with

increased presence over 7 days

Reduced admissions and

improved discharges. Improved

medical cover to wards at

weekends. Improved junior

doctor supervision

Improved medical support to MAU Reduced admissions and

improved discharges. Patients are

seen by a senior clinician in a

timely manner, improves junior

doctor supervision

Integration of the Transfer Team to increase

skill mix and strengthen links with other IC&R

services. Increased Social work and shift

changes have improved cover within ITT

across 7 days

Improved discharge processes by

reduce assessment process and

improving continuity of care for

patients by locality teams

Seven day a week Pharmacy with two

pharmacists on bleep for ‘take home’

Improved 7 day discharge

96


Page 23 of 59


V1 1.Docx

medication

Increased laboratory capacity and faster

turnaround

Reduced LoS

Private transport to support discharges Reduced late discharges due to

waits for transport

A Patient Flow Manager is in position and will

support all teams in the effective discharge

of patients. Improved patient tracking and

sharing of information around patients

awaiting discharge with partners will help

ensure all services work to discharge patients

as quickly as possible

Reduced LoS

Acute Alcohol Team supporting alcohol use

behaviour change to reduce attendances

and supporting discharge to specialist

services

Reduced admissions and length of

stay

6.7. Stockport Foundation Trust

Stockport Foundation Trust (SFT) provides the following services

CARA

Long Term Conditions Team

Shire Hill Intermediate Care Unit

District Nursing

Palliative Care/Macmillan Nursing

In addition to the above SFT staff are involved in the Integrated Rapid Intervention

Service which is the responsibility of Tameside Metropolitan Council, the Short Stay

intervention Unit and the Integrated Transfer Team which are the responsibility of

THFT.

SFT’s plans set out how they will manage demand across their services.


Development Impact

Community Pathway for Falls and COPD to reduce need

to transfer to hospital

Reduced ED

attendances and

admissions

CARA and LTC provide in reach to general wards at THFT

to facilitate discharge

Improved discharge

97


Page 24 of 59


V1 1.Docx

6.8. Meridian

Meridian working with Pennine Care Foundation Trust provides:

Grange View inpatient Intermediate Care

Grange View has 40 short stay in patient beds for patients requiring rehabilitation,

recuperation or clinically enhanced care.


Development Impact

Fully operational Supports patient flow

Triage and assessment of patients in hospital prior to

discharge

Identifies appropriate

patients and reduces

the number that need

to be readmitted

6.9. Pennine Care

Pennine Care provides the following services

Inpatient Mental Health beds

The Access and Crisis Service and Rapid Assessment Interface and

Discharge Team (RAID).

The Home Treatment Team

Accident and Emergency liaison and response

Community mental health services Child and Adolescent Mental Health Services (CAMHS) Drug and Alcohol Services (DAS)

Pennine Care operate across a range of health and social care economies and

have robust plans to ensure they are able to flex capacity to meet demand

including providing cross cover. Plans also prioritise appointments or contacts with

service users according to need. In addition to the mental health services they

support Meridian in the delivery of inpatient Intermediate Care.

CAMHS have a community team which is split between two buildings

at Springleigh Clinic (Stalybridge) and Clarence Arcades. This team works closely

with the CAMHS inpatient unit based in Bury and also with the Tameside Paediatric

ward and Accident & Emergency Dept to provide mental health support and

advice to any young people requiring mental health assessment and/or input who

are currently being treated or cared for in those departments.

98


Page 25 of 59


V1 1.Docx

The DAS community team work in close liaison with local pharmacies to ensure

minimal disruption to service users receiving prescribed medicines.


Development Impact

A&E RAID Team available 24/7 to attend A&E within 1 hour

of patient referral.

Reduced mental

health ED breaches

Older People’s RAID team available across 7 days to

attend THFT wards within 1 working day of patient referral.

Reduced LoS

Introduction of a Divisional Bed Manager

Reduced ED breaches

6.10. Tameside Metropolitan Borough Council

TMBC provides the following services that support the Urgent Care system

IRIS

Domically Care

Reablement

Residential and nursing care

TMBC aims to provide a number of services designed to maintain people in their

own homes and to optimise independence. It has internal systems for identifying

pressures in terms of demand and capacity and can refocus resources when

required. Key services such as assessment and care management are available

on a 24 hour seven day a week basis albeit restricted during out of hours times. All

residential and nursing home care and domiciliary care is provided by the

independent sector and is commissioned and contract monitored by TMBC.


Development Impact

Commencement of IRIS to provide rapid assessment and

subsequent management in an individual’s home

Reduce admissions to

hospital and long term

care

IV therapies to facilitate earlier discharge for patients

completing their treatments and for the enhanced

treatment infective conditions and dehydration in the

community

Improved discharge

and admission

prevention

New Care Home tender in place Capacity in the system

both on the on frame

99


Page 26 of 59


V1 1.Docx

work and Off frame

work homes

Fund out of panel

within capacity for

patients in hospital/IC

New reablement staff who will be in place for winter

pressures

Improved discharge to

reablement

6.11. Derbyshire County Council

DCC provides the following services that support the Urgent Care system

Domiciliary Care

Reablement

Approximately 14% of T&G patients come under the responsibility of DCC. The

domiciliary care needs of these patients are managed by one team of assessors

including social work and occupational therapy. Reablement is provided by DCC

in-house staff with home care commissioned from DCC mainstream and the

independent sector or via a direct payment. Availability for the home care plus

admissions to care homes is monitored and accessed through the DCC brokerage

team.

There are two reablement beds within an apartment at Whitfield House extra care

centre in Glossop. Both of these are accessed via DCC Adult Care.

Out of hours service is accessed via Call Derbyshire on 08456 058058


Development Impact

Close working with the IRIS and CARA teams ensures timely

discharge

Patient flow improved.

Improved assessment

to minimise readmission

or transfer into care

home

Additional social work capacity to strengthen links with

hospital staff and other teams

Two reablement beds at Whitfield House

Improved intelligence about bed capacity within

Tameside borough to compensate for reduced capacity

in Derbyshire (Glossopdale)

100


Page 27 of 59


V1 1.Docx

6.12. Individual Funding Decisions

NHS Tameside and Glossop CCG alongside the Integrated Transfer Team (ITT) at

THFT manage the process for providing care through the individual funding

decision process. Patients who require Funded Nursing Care are identified and the

care authorised by the ITT seven days a week. Patients who require Continuous

Health Care are identified by ITT and following a Multidisciplinary Team assessment

the case would be presented to NHS Tameside and Glossop CCG. Weekly panels

are held on a Thursday however fast track cases are managed outside of panel

when it is it is in the best interests of the patient to do so.

6.13. Residential and Nursing Homes

The infection control status of local homes is monitored by NHS Tameside and

Glossop Nursing and Quality Directorate. If any home develops infection control

issues which affect the health of residents or the home’s ability to accept new

residents the Urgent Care Project Manager and ECN will be notified.

101


Page 28 of 59


V1 1.Docx

7. System Status

It is the responsibility of NHS Tameside and Glossop as the lead commissioner to

‘declare’ the Health and Social Care Economy status. This will be based on the

predictive RAG reported by each service, historical performance and demand

predictions.

7.1. RAG Reporting

Each service is required to submit a daily (Monday to Friday) capacity/demand

assessment by 11:00 using the standard template shown below. Prior to submitting

assessments and on Saturday, Sunday and Bank Holidays organisations are

expected to communicate directly with each other when pressures experienced

by services are having, or shortly will have, a direct impact on others. Services are

expected to work in partnership to improve patient flow through the system.

Whilst there is no formal reporting from General Practice consideration will be

given to collecting locality based information on demand within General Practice.

102


Page 29 of 59


V1 1.Docx

Each service will have named individuals who have the authority to declare the

status of the service and through whom escalation will be agreed Appendix D.

The service RAG is based on agreed criteria and these will be combined to

provide a system RAG that reflects the risk of underperformance against urgent

care targets. All organisations, the ECN and GM LAT will be notified of the system

status and follow up actions as described below.

103


Page 30 of 59


V1 1.Docx

Urgent Care Daily Reporting

Process

Service assesses status

Follows appropriate action cards

Contacts other providers as required

Lead contact or deputy ensures

available and has latest information for

teleconference if required

System Daily Report Produced

Telephone lead contacts if further

information required

RAG and Escalation level identified

System Report circulated to ECN,

Tactical subgroup, GM LAT and all

Urgent Care Providers by 12:00 M-F

Manages teleconference and any

additional calls.

Confirms all actions cards being

followed and facilitates identification of

further action

Inform lead contacts if teleconference

required at 13:30

Advise Tactical Subgroup on whether

input is likely to be required

As required

Lead contact or deputy participates in

teleconference between 13:30 -14:00

M-F

Urgent Care Services/Providers NHS Tameside & Glossop CCG

As required

Convenes Tactical subgroup to identify

further actions

Undertakes agreed actions

Update sent to ECN, Tactical subgroup,

GM LAT and all Urgent Care Providers

Submits Daily Update on standard

template by 11:00 M-F

104


Page 31 of 59


V1 1.Docx

THFT is also responsible for reporting their performance through various systems.

These include:

A daily SITREP report from THFT to GM Utilization Management Team which is

combined with NWAS information to produce the UMGold Report

A weekly ED performance update that is ratified through the Urgent Care

Action group at THFT and shared with the CCG. This report includes a

breach analysis and improvement plans which the CCG and THFT discuss

weekly.

If all organisations report Green the system status will be Green and no escalation

will be required. However, when Ambers or Reds are reported the system will set

the RAG as shown below and follow the system escalation process to ensure that

appropriate actions are undertaken to mitigate any risk of underperformance

across the system.

System RAG Levels

System

RAG

Indicative

Service RAG Level Characteristics Impact

Area

Team

RAG

Green

SYS0

All services

report Green

Individual organisations managing

their own pressures within normal

capacity planning parameters,

liaison between commissioners and

providers, and provider to provider

within the economy will be standard

practice

No impact on

service

delivery

Level 0 Green

Amber

SYS1

At least one

service

reports

Amber

Low surge effect activity evident in

the system.

Or an organisation failing to

manage own pressures.

Early warning

increasing

impacting on

service

delivery

Amber

SYS2

3 or more

Ambers or 1

Red (service

dependent)

Medium surge effect moderate to

severe effects

on service

delivery

Red

SYS3

1 or more Red Major disruption to services high impact

on service

delivery

Level 1

105


Page 32 of 59


V1 1.Docx

7.2. Escalation

Individual organisations are expected to initially manage their own pressures and

escalation Appendix E. However, no action should be taken that may adversely

impact on other services and organisations without prior agreement.

NHS T&G is the lead for managing the Health and Social Care Economy status and

will seek assurance that services are following their own escalation processes and

have identified any additional actions required to bring performance back in line

when the planned mitigation is insufficient.

Where assurance cannot be provided, or actions are not resulting in solutions, then

the Tactical Subgroup of the ECN will co-ordinate a solution.

The Tactical Subgroup of the ECN will be formed as part of the ECN review. It will

be made up of representatives from the organisations involved in the urgent care

system. Its responsibility during winter will include identifying and agreeing solutions

to mitigate risks around performance and keep the system stable and at level 0 of

the Area Team Incident Response Plan. The Terms of Reference were agreed at

October ECN Appendix F. It is anticipated that weekly meetings will be scheduled

but the group will only meet when required.

7.3. De-escalation

Individual organisations will manage their own de-escalation in line with their

internal plans. If the system escalates to Amber or Red it will only de-escalate fully

when all services anticipate they will be able to maintain Green for five

consecutive days.

106


Page 33 of 59


7.4. Service Escalation Levels and Actions

Green - Level 0

Normal operational status – No impact on service delivery

Org Service Volume & Capacity Infection

Control Actions

THFT

ED

95% achieved previous day and being maintained today

Time to initial ED assessment <15 minutes

Time to ED treatment median <60 minutes

No diagnostic delays

No IT issues affecting patient care

No staffing issues impacting on care

Ambulance Handover Times <30mins

Infection control status normal (no

significant containment

issues

Normal Working practices in place

MAU

No assessment delays in MAU

No IT issues affecting patient care

No staffing issues impacting on care

Ambulatory Area available


SSIU

75% of patients or more have a LOS of <72hrs

No Staffing Issues

No diagnostic delays


ITT Discharges being managed appropriately

10% or less of medical bed base occupied by Medically Fit Patients (27 beds)

Normal Working to facilitate early discharge

Ward based

care Beds available across all specialities for immediate transfer

Ensure patients have a predicted date for discharge and ensure regular review of management plans

SFT

CARA No capacity issues

No delays in handovers back to LA

Normal Working to facilitate early discharge and provide intensive multidisciplinary rehabilitation

LTC

No capacity issues. No interuption to routine visits, follow-ups, telehealth,

pulmonary rehab and case finding from any team members

On-call system fully covered i.e. Respond to telehealth, NWAS & acute episodes

from LTC caseloads

Normal Working to review and support patients

107


Page 34 of 59


All referrals triaged and assessed within agreed response time

Shire Hill ICU

Beds Available

Planned discharges in the coming week

No / minimal delayed discharges

Normal Working to prevent delays in patient flow to inpatient beds at SHICU and discharges from SHICU

District Nursing

No Capacity issues

All patients assessed within agreed timescales

Patient allocations managed routinely

Normal working practices in place

Macmillan

Nursing/Palliative

Care

9am-5pm 5 days MacMillan full service – 1 x per locality

9am-5pm Weekends, Bank Holidays – 1 x MacMillan

Respite team 9am-5pm 7 days – 1 weekend

1 sit 7 nights

Normal working Urgent palliative care patient

Urgent family/patient support over night

Meridian Grange View ICU

Beds Available

Planned discharges in the coming week

No / minimal delayed discharges

Normal Working to prevent delays in patient flow to inpatient beds

at Grange View and discharge from Grange View

TMBC

IRIS Capacity within the system

All referrals assessed within one hour.

Normal Working to prevent admission to hospital

Manual handling Capacity for the day after assessment for moving and handling & equipment

Normal working to prevent delays in assessment time scales.

Elements within IRIS can now do manual handling assessments

Domiciliary care Capacity within the system

Service commences within 48 hours of commissioned request

Reablement Capacity within the system

Service commences within 48 hours of commissioned request

Residential and

Nursing Home

care

Residential and nursing beds available across the sector

Placements managed within allocated funding

108


Page 35 of 59


DCC Domiciliary care

Capacity to assess needs on the day of referral within reablement, mainstream and

bed base

Capacity in the domiciliary service for the day after assessment including moving

and handling & equipment

Normal Working in line with discharge planning

arrangements/protocols

NHS T&G

Individual

Funding

Requests

Five or less CHC requests a week


Pennine

Care

Ward Based

Care

Beds Available both male and female in both Older People and Adult Services,

delayed discharge procedure in place (90% Occupancy)

Staffing 85% or above.

Normal Working

Home Treatment

Teams

Capacity in Home Treatment Team in Adult Services

Capacity in Home Intervention Team in Older People’s Services

Normal Working

A&E RAID Staff able to response within 1 hour

Normal Working

OP RAID Triage of referrals in 1 working day

Normal Working

GoToDoc

Walk in centre Activity levels within normal seasonal variation.

KPI's are fully compliant


OOH Activity levels within normal seasonal variation

NQR's fully compliant


NWAS Ambulances

Majority of handovers <20 minutes

No anticipated delays to offload

No identified increased activity within local economy

No handovers waiting >30 minutes

109


Page 36 of 59


Arriva PTS

NW Critical Care Availability / Capacity within Unit and / or North West Critical Care Network

Amber - Level 1

Medium surge effect – Moderate to severe effects on services


Control Actions

THFT

ED

95% not achieved previous day and a prediction that 95% may not be achieved

today

Time to treatment >2hrs

Attendances upto 10% higher than expected levels

Staffing issues with plans to resolve same day

Time to initial assessment 15-30mins

Increase in resus activity requiring extra staffing

IT failures causing delays

Diagnostic delays impacting patient flow

Ambulance Handover Times >30mins

Slow Internal Bed Capacity restricting flow > 2hr from bed request

Infection control

issues escalating

and requiring

implementation

of special

measures

Liaise with

Infection

prevention team

and microbiology

Potential ward

closure – consider

cohorting patients

As Green +

Communication maintained with NWAS Officer

A/E Consultant and Medical Team leader (MAU) informed

Check that all specialities have bed capacity

Predict number of patients currently in department who may

require admission and which speciality they are likely to be

referred to.

Ensure nursing and medical staff review patients in a timely

manner

Identify any shortfalls and failings in diagnostic /support services

Continue REACT protecting cubicles 1&2

MAU

Admissions higher than expected >10% or within range with other factors/delays in

in-patient bed availability

Delays in MAU assessments

Discharges from MAU >10% lower than normal

IT failures causing delays


As Green +

Instigate Secondary Review of patients to facilitate discharges

where possible.

Check that all specialities have bed capacity with the Bed

Manager.

Ensure response times to review speciality patients are in

110


Page 37 of 59


Ambulatory Area restricted accordance with the Internal Professional Standards

Predict number of patients who may require admission and

identify relevant speciality


manner


Escalate delays with PTS and Internal Ambulance

Review threshold for ambulatory care patients with a view to

expanding the cohort of patients

SSIU

50% of patients have a LOS of <72hrs



As Green +

Transfer patients to speciality wards

Escalate and expedite diagnostic delays

Additional review of patients

Main communication streams regarding A/E waiting times/Bed

capacity/assessment times

Authorise any extra staffing required to maintain patient safety

Authorise the use of outlying beds across all specialities

Approval of additional Consultant / Registrar ward rounds

Facilitate wards rounds with the CDFS or Bed Managers (out of

hours)

Involve the CDFs to review medical fit patients with a view to

expediting discharges.

Review delayed discharge / medically fit for transfer data base

and liaise with relevant agencies.

Review any planned Elective Admissions and ensure no breaches

ITT

Have beds available in the morning or predicted +'ve bed status by 4.00pm

Discharges being managed appropriately - or some delay themes beginning to

emerge 15% or less of medical bed base occupied by

Medically Fit Patients (40 beds)

As Green +

Arrive at a range of predictions of discharges required and

implement the necessary actions to reach those targets with

unscheduled care system delegating any actions as necessary.

Review capacity within community services taking any actions as

necessary

111


Page 38 of 59


Ward based

care


Bed closures for infection/isolation

As Green +

Escalate and expedite diagnostic delays

Additional review of patients

Main communication streams regarding A/E waiting times/Bed

capacity/assessment times

Authorise any extra staffing required to maintain patient safety

Authorise the use of outlying beds across all specialities

Approval of additional Consultant / Registrar ward rounds

Facilitate wards rounds with the CDFS or Bed Managers (out of

hours)

Involve the CDFs to review medical fit patients with a view to

expediting discharges.

Review delayed discharge / medically fit for transfer data base

and liaise with relevant agencies.

Review any planned Elective Admissions and ensure no breaches

SFT

CARA Have limited capacity, reviewing referrals case by case

Handover delays back to LA

As Green with

Assess inpatients referred into the service within 12-24 hours

Provide a low level of rehabilitation in the community

Ensure patient flow is reviewed daily

Provide live data on current capacity

LTC

Winter pressures: experiencing increased activity Reduced capacity due to staffing

issues

Potential operation/strategic challenges linked to patient flow & winter pressures

As Green +

Review capacity within LTC teams taking any necessary action to

resolve

Ensure pathway is aware of priority patients

Shire Hill ICU No available beds with planned discharges through the coming week OR Beds

available but no planned discharges this coming week

As Green +

Monitor and review discharges planned and any other predicted

or potential discharges

Identify shortfalls and failings in the diagnostic tests required to

meet the above target and prompt remedial action

Identify any short falls and failings within community services

which are required to meet the predicated discharge date

112


Page 39 of 59


Review the situation at 12 mid-day each day as required

Ensure clear communication channels are established to achieve

affective patient flow

District Nursing

Unable to complete all allocated visits

Telephone triage required to prioritise patient need

Daily Service-wide review of staff allocation

Cancellation of non essential visits

Priority given to patients who are insulin dependent, or at end

stages of life

Remaining visits prioritised to ensure those with greatest need

receive care

Re-direction of lower priority care to other clinical

environments/other aligned health services

Macmillan

Nursing/Palliative

Care

Reduced capacity due to staffing

Prioritise urgent symptoms/end of life patients

Routine visiting limited

Education cancelled

Meridian Grange View ICU No available beds with planned discharges through the coming week OR Beds

available but no planned discharges this coming week

As Green +

Identify shortfalls and failings in the diagnostic tests required to

meet the above target and prompt remedial action

Identify any short falls and failings within community social

services which are required to meet the predicated discharge date

and escalate.

Review the situation at 12 mid-day each day as required



TMBC IRIS

Lack of capacity within the triage process

Lack of capacity within reablement

As Green +

Keep strategic managers informed overall situation and accurately

informed of any potential whole system causes of blockages with

system.

Ensure there is an accurate prediction of movement within IRIS

from assessment – delivery – to exit / transfer to relevant team.

Delegate any actions as required.

Review capacity within IRIS taking any actions as necessary.

113


Page 40 of 59


Move staff from delivery to support triage as required

Review LOS for patients currently in reablement

Manual handling

Equipment delays

Staffing shortages causing delays

family/carer delays with access to complete environmental visit

As Green +

Increase staffing capacity using additional community resources

Domiciliary care No immediate capacity within zoned area

As Green +

Commission out of zoned area’s

Reablement Reablement response up to 72 hours

As Green +

Review reablement capacity on a daily basis and Increase use of

casual workers as required

Residential and

Nursing Home

care

More placements required than funding available

As Green +

Prioritise hospital and intermediate care inpatient facilities

DCC Domiciliary care

Social work and OT capacity to assess and plan service but response up to 72 hours

Unable to commission some reablement/mainstream due to capacity

Equipment delays

As Green +

Respond to notifications about named individual patients and

work closely with Clinical Discharge Facilitators to identify

blockages and complex cases.

DCC Hospital social workers and fieldwork colleagues will respond

to expedite and co-ordinate hospital discharge.

DCC Fieldwork Team will deploy additional assessment capacity to

prioritise referrals from hospital and make arrangements to

secure home care packages or interim residential placements.

DCC Brokerage team will support with live information about

capacity and vacancies.

DCC Staff will liaise with IRIS and CARA teams.

Reablement capacity will be reviewed on a daily basis to maximise

availability.

114


Page 41 of 59


NHS T&G

Individual

Funding

Requests

Six to ten CHC requests a week

As Green +

Utilise Restitution panel capacity

Pennine

Care

Ward Based

Care

Beds Occupancy >90%

Staffing <85%.

As Green +

Inform all consultants and junior medical staff of potential bed

difficulties

Ask Home Treatment Team to prioritise ward discharges

Repatriate Out of Area patients

Initialise bank and agency staff

Service managers to equalise staffing across areas

Home Treatment

Teams

No capacity in Home Treatment

Access Team capacity issues

As Green +

Review existing caseload to see if safe discharges can be achieved

Cancel non-urgent follow ups to facilitate urgent referrals

Inform potential referrers of capacity problems inc Junior Doctors,

ward and community teams and Access & Crisis

Triage GP referrals and respond to most urgent inc mental health

act assessments

Initialise bank and agency staff

Service managers to equalise staffing across areas

A&E RAID Gaps in staff rota

As Green +

Move Access & Crisis Team staff onto A&E rota

Employ junior doctor cover

OP RAID Gaps in staff rota

As Green +

Senior staff review staff across older People’s Service to ensure 7

day cover

Repatriate Out of Area patients

GoToDoc Walk in centre

Increased activity levels outwith expected seasonal tolerance

Potential operational challenges (volumes exceed staffing levels)

Risk of partial KPI compliance

Assess service activity and demand pressures

Consider implementing ‘fast track’ triage protocols (if appropriate)

Ensure that all patients are informed of the triage process (see

and treat)

Review and revise visiting plans for registered patients.

115


Page 42 of 59


Authorise any extra staffing required

Consider redeploying clinical staff to assist with patient flow

Gain authorisation for any extra staffing required

Request any changes of shift

Distribute updated information to the team.

Update colleagues within local Health Care Services of pressures

(if appropriate)

OOH

Increased activity levels outwith expected seasonal tolerance

Potential operational challenges (urgent v rourtine disposition variance)

Risk of partial NQR compliance

Assess service activity and demand pressures

Consider implementing ‘fast track’ triage protocols (if appropriate)

Ensure that all patients who are affected receive a comfort call

Ensure appointments are actively managed for routine patients

Ensure a clinical review is undertaken for same day access (where

the case is from 111 with a 12, 24 or 48 hour disposition)

Review and revise visiting plans

Consider redeploying clinical staff to assist with patient flow

Gain authorisation for any extra staffing required

Gain authorisation for any changes of shifts, Treatment Centre to

Mobile Shifts

Agree update arrangements with the on call manager

NWAS Ambulances

2 or more ambulances waiting >30 minutes

2 or more crews en route to ED/MAU

> 2 resus cases

Arriva PTS

NW Critical Care Critical care capacity compromised

Local / Network escalation required

116


Page 43 of 59


Red - Level 2 Major disruption - high impact on service delivery


Control Actions

THFT

ED

95% not achieved previous 2 days or <93% previous day and predicted not to

achieve today

Attendances >10% higher than expected or within range with other factors

Staffing issues unresolved


IT failures impacting patient flow

No resus facilities available

Ambulance Handover Times >60mins

No Internal Bed Capacity restricting flow

Further escalation

of infection

control issues

requiring

implementation

of special

measures.

1 or more ward

closures

As Amber +

Discharge patients directly where possible

Ensure A/E Consultant and Medical team leader is aware and

action taken (see action card)

MAU

Admissions higher than expected >20% or within range with other factors

Discharges from MAU >20% lower than normal

Staffing issues unresolved



Ambulatory Area Closed

As Amber +

CMS Screen updated every 2-4 hrs

Inform concerns to Speciality Consultants if delays in patient

review occur

Discharge patients directly where possible

Ensure Medical Team/Registrar is aware and action taken


manner


Ambulatory Area closed

SSIU

25% of patients have a LOS of <72hrs



As Amber +

Facilitate emergency bed management meeting

Commission additional ward rounds within relevant specialities.

Review Nursing/Medical workforce and skills in and out of hours

Authorise cancellation of any elective planned admissions

Expedite discharges where possible.

Consultant review in A/E and MAU to ensure appropriate

admission

117


Page 44 of 59


Review any outstanding diagnostic reports to promote speedier

discharge

Ensure team registrar or on call team review patients on outlying

wards to ensuring they are reviewed and have clear management

plans.

Ensure teams provide cross speciality assistance

ITT

Unacceptable numbers of delayed discharges

No beds available for next 12 hours

No diversion beds available

>15% of medical bed base occupied by Medically Fit Patients (40 beds)

As Amber +

Liaise with senior managers to satisfy themselves the relevant

people are attending discharge status meetings to identify where

pressure is greatest and review deployment of staff to maximise

their utilisation in pressure areas

Senior manager to alert hospital and Community Social work

teams of escalation status and pressures

Identify staff who may be redeployed at short notice from other

areas

Ensure adequate co-ordination of pathways services with

designated co-ordinator

If unable to maintain services, contact the pathway lead and the

SFT/TFT Director on Call

Ward based

care

Beds closed due to staffing shortages, causing blocks in patient flow



Active management of elective lists Escalation Areas in use

As Amber +

Facilitate emergency bed management meeting

Commission additional ward rounds within relevant specialities.

Review Nursing/Medical workforce and skills in and out of hours

Authorise cancellation of any elective planned admissions

Expedite discharges where possible.

Consultant review in A/E and MAU to ensure appropriate

admission

Review any outstanding diagnostic reports to promote speedier

discharge

Ensure team registrar or on call team review patients on outlying

wards to ensuring they are reviewed and have clear management

plans.

118


Page 45 of 59


Ensure teams provide cross speciality assistance

SFT

CARA Capacity for Rapids only

As Amber +

Reduce rehabilitation provided in community to urgent care only

Move staff within the pathway to provide support to CARA

Ensure that there are no delays associated with discharge when

patients are fit to transfer

Ensure close links with the wards and SSIU

Review staff shifts / patterns so as to accommodate the needs of

the service

Participate in regular debrief sessions

Close liaison with in patient staff to identify patients who can be

safely discharged

Use the CARA vehicle to facilitate discharge to prevent delays




PCT Director on call

LTC

Service experiencing significant increased activity levels

Significant operational challenges/Strategic challenges linked to patient flow &

winter pressures

Major staffing issues

As Amber +

Move staff within the pathway to support other services and

ensure adequate cover

Ensure close links with other pathways




Director on Call

Shire Hill ICU No beds available AND no planned discharges for the coming week

As Amber +

Review situation at 12 mid-day and 15:00 each day



If unable to maintain services, contact the pathway AD and the

119


Page 46 of 59


Director on Call

District Nursing Capacity for essential visits only

Insulin dependent diabetes, Palliative patients on end of life pathways

As amber +

Designated shift co-ordinator identified

Service wide allocation of essential visits

4 hourly situation review and reporting to Director on Call

Macmillan

Nursing/Palliative

Care

Staffing numbers significantly reduced

Only urgent palliative care patients seen

Education cancelled

Night sitting service suspended

Weekend service on call by phone

Meridian Grange View ICU No beds available AND no planned discharges for the coming week

As Amber +



Review situation at 12 mid-day and 15:00 each day

If unable to maintain services, contact the Senior Manager /

Director on Call

TMBC

IRIS Capacity for RAPIDS only

As Amber +

Strategic managers to alert health economy of escalation / surge

status.


areas into IRIS

Ensure adequate co-ordination of pathways and delivery services

within IRIS with strategic managers.

If unable to maintain services contact the strategic leads within

Adult Social Care and Stockport Foundation Trust.

Review 48 hour time scales

Commission direct with home care agencies

Manual handling

Experiencing increased activity

Do not have sufficient capacity to assess

As Amber +

Review referrals case by case to prioritise workload.

Increase capacity by accessing agency staff

120


Page 47 of 59


Domiciliary care Do not have sufficient social work or OT capacity to assess

No residential OR home care capacity

As Amber +

Review none priority tasks within reablement and home care

Look at increasing providers not already on the approved list

Reablement Reablement response over 72 hours

As Amber +

Review non-priority tasks within reablement and home care

Identify staff from other in-house services that maybe deployed

into reablement to reduce impact on home care

Residential and

Nursing Home

care

More placements required than funding available

As Amber +

Also fund out of panel and consider funding additional beds

DCC Domiciliary care Do not have sufficient social work or OT capacity to assess

No residential or home care capacity

As Amber +

Re-prioritisation of routine work and community referrals to

maximise capacity to deal with hospital discharge pressures.


areas.

Increase capacity within homecare sector by approaching

additional providers on the approved homecare provider list.

NHS T&G

Individual

Funding

Requests

11 or more CHC requests a week

As Amber +

Prioritise out of panel assessments Monday to Friday 09:00 to

17:00

Report to director on Call for urgent out of hours decisions

Pennine

Care

Ward Based

Care

No beds available in Tameside

Limited capacity to cover service critical areas

As Amber+

Facilitate admissions in other boroughs

Urgently review all inpatients in Tameside

Discuss use of private beds with CCG

121


Page 48 of 59


Liaise with High Support Directorate regarding short term use of

forensic beds

Liase with Local authority re spot purchased beds in residential

homes with Home Intervention Team support

Utilise Business continuity

Staff in corporate Services and management roles provide cover

Silver Command Team

Home Treatment

Teams

No capacity in Home Treatment

Access Team capacity issues

As Amber

A&E RAID Gaps in staff rota

As Amber

OP RAID Gaps in staff rota

As Amber

GoToDoc

Walk in centre

Significant increase in activity levels

Significant operational challenges

Failure to achieve KPIs compliance

As Amber +

Extend shift sessions and/or call in extra staff where possible

Contact other GTD 8 to 8 centres to utilise staff

Deploy additional staff to specific ‘hotspots’ within the service

Link into GTD OOH service / on call manager

Consider enhancing staffing plans for next shift/next day where

appropriate

OOH

Significant increase in activity levels

Significant operational challenges

Failure to achieve NQR compliance

As Amber +

In conjunction with the on call manager extend shift sessions

and/or call in extra staff where possible

Deploy additional staff to specific ‘hotspots’ within the service,

increasing treatment centre capacity where possible

122


Page 49 of 59


NWAS Ambulances 2 or more ambulances waiting >60 minutes

4 or more crews en route to ED/MAU

Arriva PTS

NW Critical Care No Availability/Capacity. Full local escalation required

Local/Local escalation required

123


Page 50 of 59


7.5. System Escalation Levels and Actions

Green Level SYS0

All Services Reporting Green

Organisation Action

NHS T&G Communicate status through email to ECN, Tactical subgroup, GM LAT and all organisations

Continue to monitor and use available data to predict performance for next 7 day period

All Organisations Continue to ensure internal management of own performance

Ongoing demand and capacity monitoring

Communication with CCG and relevant others if risks identified

Green Amber Level SYS1

At least one service reports Amber

NHS T&G Communicate status through email to ECN, Tactical subgroup ,GM LAT and all organisations

Direct Contact with organisation responsible for service reporting amber to identify any early

warnings for the system

Communication any risks identified to Tactical subgroup, ECN and all organisations

Consider convening meeting of Tactical subgroup dependant on risk

Continue to monitor and use available data to predict performance for next 7 day period



Communication with CCG and relevant others if risks identified

Non Green

Organisations

Direct Contact with CCG to provide additional assurance that service is following own action plan.

And to identify any early warnings for the system

Communication with other organisations that may be impacted by any internal actions or who have

staff working within the effected service

124


Page 51 of 59


Amber Level SYS2

3 or more Ambers or 1 Red that has significant impact


Direct Contact with organisations responsible for service reporting amber or red through calls with

individual providers and/or jointly via conference call dependent on narrative submitted to provide

assurance that service is following own action plan and recovery plans

Convene meeting of Tactical subgroup

Recovery expected within 24 hours - if no assurance given or not delivered, twice weekly conference

call with all amber/red providers Monday & Thursday

Inform LAT of system escalation and Health and Social Care Economy response



Communication with CCG and relevant others if risks identified. All services to enact action defined in

the escalation plan

Non Green

Organisations

Direct Contact with CCG to provide additional assurance that service is following own action plan.

Identification of when recovery is expected.

Communication with other organisations that may be impacted by any internal actions or who have

staff working within the effected service

Recovery expected within 24 hours - if no assurance given or not delivered, twice weekly conference

call with all amber/red providers Monday & Thursday

Red Level SYS3

1 or more Red


Direct Contact with organisations responsible for service reporting amber or red to through calls with

125


Page 52 of 59


individual providers and/or jointly via conference call dependent on narrative submitted to provide

assurance that service is following own action plan and recovery plans.

Convene meeting of Tactical subgroup

Daily system conference call with all providers. Recovery expected within 24 hours

Inform LAT of potential Area Team Level 1 and Health and Social Care Economy response

All Organisations Continue to ensure internal management of own performance and move to recovery when

applicable


Communication with CCG and relevant others if risks identified. All services to enact action defined in

the escalation plan

Daily system conference call with all organisations.

Recovery expected within 24 hours

126


Page 53 of 59


V1 1.Docx

8. Communications

Communications will be mobilised appropriate to the level of escalation as shown

in plan below.

During usual daytime working hours each organisation will have communication

arrangements in place, (both internal and external) to manage escalation within

and across the Health and Social Care Economy.

Out of hours the NHS Tameside and Glossop on-call arrangements will have

responsibility for leading escalation and necessary communications including

declaring the health economy status.

9. Awareness Raising

A programme of training and development will be implemented to ensure

individuals, departments and organisations are aware of obligations, processes

and individual responsibilities regarding the escalation process.

10. Tactical Commanders and Resilience Leads

The NHS England (Greater Manchester) Incident Response Plan requires each

health heath economy to ensure they can respond effectively to an incident and

coordinate a local response. They refer to this role as the “Tactical Commander”.

This role will be undertaken by Tameside and Glossop CCG through a nominated

individual in hours and out of hours through the on-call arrangements.

The Health and Social Care Economy Resilience Leads are


HERG Members

Name Contact – e mail

Tel

CCG Accountable

Emergency Officer

Nikki Leach

[email protected]


CCG – AEO

Anna Moloney [email protected]

k

CSU Resilience Manager

(Secretariat)

Brian Dillon [email protected]

Head of EPRR Derbyshire

NHS England

Kay Wyatt

[email protected]

Chief Operating Officer

Stockport FT

James Sumner

[email protected]

Director of Performance, Kathy Calvin- [email protected]

127


Page 54 of 59


V1 1.Docx

Planning and Information

Pennine Care

Thomas

Adult Services

Tameside MBC

Mark Whitehead

[email protected]

AGMA CCRU

Business Partner

Pauline Patton

[email protected]

Head of Environmental

Services

Michael Gurney

[email protected]

NWAS Paul Bailey [email protected]

Chief Operating Officer Paul Williams [email protected]

128


Page 55 of 59


Communications Plan

Level of

Escalation

Green Green-Amber Amber Red

Communication

Activity

Flu campaign

Promotion of self-care and 'prepare for winter' messages as outlined in the Right Treatment, Right Place campaign

Promotion of services that look after people in the community.

Keeping staff informed

Health and Care Professional’s guidance – awareness of where patients can go

Encouraging our partners to promote

Public promotion of services out of hospital

ECN Alert

Health and Care Professional’s alert – reminder of where patients can go

Organisation Internal alerts


ECN Alert

LAT Alert



Alert to PALS & Complaints staff


ECN Alert

LAT Alert



129


Page 56 of 59


self-care and 'prepare for winter' messages to patients and public

130


Page 57 of 59


V1 1.Docx

11. Delegated Authority

This Plan will be taken for agreement through organisations as follows:

NHS Tameside & Glossop

ECN October

Planning Implementation and Quality Committee November

Governing Body November

THFT

Executive Board October/November

SFT

Executive Board October/November

TMBC

Communities, Children’s, Adults and Health Directorate Management Group

October

Meridian

Executive Board

131


Page 58 of 59


V1 1.Docx

12. Appendices

Appendix A: NHS England (Greater Manchester) Incident Response Plan

Appendix B: Urgent Care System Risk Log

Risks and Issues Log Oct 151013.xls

Appendix C: Greater Manchester Area Team Winter Planning Assurance 2013/14

Primary Care Assurance Document October 13v2.docx

Appendix D: Nominated Status and Escalation Leads

Tameside & Glossop Urgent Care System - nominated status and escalation leads.docx

Appendix E: Organisation/Service Action Cards

action cards THFT.docx

TG Escalation Plan SFT Action Cards 13 09 13.docx

TMBC_-_action_cards_manual_handling.docx

TMBC_-_action_cards_Funding_panel.docx

TMBC_-_action_cards_Domiciliary_Care.docx

TMBC_-_action_cards_IRIS_service.docx

action cards Grange View.docx

action cards WIC.doc

action cards gotodoc.docx

action cards DCC.docx

THFT Elective Winter_Planning_Oct_2013.doc

Macmillan_&_Palliative_Care_Team BIA.docx

Escalation action cards DN.DOCX

Appendix F: Tactical Subgroup of the ECN

ECN_Tactical_SubgroupToR_v1.0.docx

Appendix G: Winter Assurance Checklist, providing a Summary of readiness of

Tameside and Glossop Health and Social Care Economy

T&G Assurance Checklist v0.3.docx

Area_Team_Incident_Response_Plan_GM_FINAL_VERSION.doc

132


Page 59 of 59


V1 1.Docx

13. Agreement to Tameside and Glossop Health and Social Care

Economy Winter Plan

This joint plan has been produced by the Health and Social Care Economy.

Individual organisations are responsible for ensuring that appropriate training and

communications systems are in place to deliver the actions required in the Plan

and in particular the Escalation Plan at Section 7.

Steve Allinson Signature: Date:

On behalf of NHS Tameside & Glossop CCG

Karen James Signature: Date:

On behalf of Tameside NHS Hospital Foundation Trust

Michelle Lee Signature: Date:

On behalf of Stockport Foundation Trust

Stephanie Butterworth Signature: Date:

On behalf of Tameside Metropolitan Borough Council

Name: Signature: Date:

On behalf of Derbyshire County Council

Susan Firth Signature: Date:

On behalf of Meridian

Lisa Woodworth

Signature: Date:

On behalf of Go To Doc

Name: Signature: Date:

On behalf of Pennine Care

133


Title of Subject: Delivering Excellent, Compassionate, Cost Effective

Care – Governing Body Performance Update.

Date of paper: 06/11/13

Prepared By: Louise Roberts / Elaine Richardson

History of paper: Regular Updates are presented on a monthly basis to

Quality and CCG.

Executive Summary: This paper outlines the changes in the CCG Assurance

process focusing on Quarter 2 and summarises the key

challenges and improvements we are seeing in the

assurance domains.

It summarises the overall performance and

improvement milestones in the Clinical Challenge

Dashboards and expands on key areas in the

narrative.




or Decision)

The Governing Body is asked to

Formally sign off the self certification for Q2

checkpoint.

Note the Quarter 2 draft CCG Assurance Framework

Balanced Scorecard and assurance process.

Note the performance and plans for improvement


by proposal:

Delivery of NHS Tameside and Glossop’s Operating

Framework commitments for 2012/13 and 2013/14. Direct questions to:

Clare Watson

Has ‘due regard’ been

given to Analysis of the

Effects on equality (AoE)

prior to sign off by the

Governing Body?

134

S:\Contracting & Performance\HCC performance team folder\2013-14\CCG\November 13

1

Delivering Excellent, Compassionate, Cost Effective Care

Governing Body Performance Development Update

1. Introduction

1.1 This paper outlines the changes in the CCG Assurance process focusing

on Quarter 2. It summarises the key challenges and improvements we

are seeing in the assurance domains.

1.2 The overall performance and improvement milestones are shown in the

Clinical Challenge Dashboards. The developing NHS Outcomes Domain

Dashboards are available in Appendix 1, these have been set as Red

RAG rating because they have not yet been discussed with clinical leads

and the manager leads have not yet been confirmed.

2. Overall Performance

2.1 The current and forecast position for our Clinical Challenges is shown

below. The forecast RAG reflects a lack of confidence that planned

actions will deliver the level of improvement wanted. Improved data

availability may increase confidence as should time and increased

familiarity with the indicators.

3. Assurance Framework Process

3.1 As we move towards the Q2 checkpoint we have a greater

understanding of the outcomes of Q1 and the changes planned for Q2

and beyond. In the initial framework published in May NHSE outlined the

methodology that would be used for Q1 and Q2 and committed to

review the assurance process and develop it further for Q3 and Q4. They

have undertaken a series of events and are planning to take the revised

framework to the NHSE Board on 8th November.

3.2 Whilst Q2 will follow the same process a few improvements have been

made to the Balanced Score Card (BSC) namely:

The ability to define the what type of service is commissioned from

each provider

135


2

Amending the first three finance indicators

1. Underlying recurrent surplus on exit of 2013/14

2. Plan- year to date (variance to plan as % of YTD allocation)

3. Plan – full year (forecast variance to plan as % of allocation)

A new finance indicator

11. Financial plan meets the 2013/14 surplus planning requirement

3.3 The Friends and Family Test response rate will only be applied to the first 3

providers and the RAG will be based on the lowest score. The rate will

be taken from national data.

3.4 In our Q2 self certification the fact we have indicated we mainly

commission Community services from Stockport FT should mean we are

not assessed against its A&E performance.

3.5 Some indicators will still not be populated as data will not be available

and some indicators do not affect the Domain RAG status i.e. Domain 1,

Does provider currently have any unclosed Serious Untoward Incidents

(SIs)? and Domain 3 Friend and Family Test and IAPT

3.6 We were required to submit the attached Q2 self certification to GM LAT

on the 30th October who did an initial check and provided feedback

ready for us to upload onto Unify by the 1st November. Governing Body

is required to formally sign off the self certification and in Q1 we were

fortunate that the timing of meetings supported us in this prior to

uploading. However, this was not possible in Q2 so the Chair and

Directors were asked to approve prior to submission to Unify.

3.7 The populated BSC will be sent to us around 22nd November and our

checkpoint meeting with GM LAT is scheduled for 5th December. The

final BSC will be released to us January 21st. There is no longer a

requirement for us to publish our BSC but we are encouraged to do so.

3.8 Our Q1 RAG is shown below with support being available to improve

136


3

performance in Domain 3. Our RAG was in line with the majority of

CCGs except for Domain 3 which had 53 other CCGs similarly rated.

Most CCGs has an Amber-Red for Domain 3.

3.9 We anticipate that our Q2 BSC will be similar to Q1 but our ability to

confirm this is limited as THFT have been given an extension (31st

October) to the submission of the18 week referral to treatment data due

to the switch over to the new PAS (Lorenzo).

3.10 Domain 3 may change to Amber Red as C.Diff has come back on track.

3.11 The methodolgy that will be used for Q3 and Q4 will rely less on the BSC

which will be renamed the Delivery Dashboard and will focus on the

following six assurance domains. Further detail will be included in the

December report.

Are patients receiving clinically commissioned, high quality services?

Are patients and the public actively engaged and involved?

Are CCG plans delivering better outcomes for patients?

Does the CCG have robust governance arrangements?

Are CCGs working in parnership with others?

Does the CCG have stong and robust leadership?

4. Are our people getting good quality of care?

4.1 This domain includes a range of quality indicators from existing

frameworks e.g. CQC and Monitor. These include Clinical Governance,

Friends and Family Test, and Health Care Acquired Infections. The latter

two are also scored in domain 3 ‘Are health outcomes improving for

local people?’ but commentary is only included in this domain.

4.2 The Quality agenda remains a high priority for the CCG with a focus on

continuous quality improvement to deliver the highest standard of care

to our patients. The Nursing and Quality dashboard will be presented to

Quality Committee to provide assurance to the CCG that strategic

objectives are being delivered and to direct attention to significant risk,

issues, exceptions and areas for improvement.

4.3 We are fostering a culture of openness and honesty with regard to

reporting adverse incidents or issues of sub-standard care so we can

address them, learn from them and prevent them from happening

again. One of the key challenges continues to be working with providers

to drive up quality with the recent Keogh review and the national high

profile cases and recommendations. We remain committed to working

137


4

in partnership with providers both supporting them and holding them to

account to make real improvements in Nursing and Quality.

4.4 In order to address the key priorities and issues an improvement plan is

currently being developed.

4.5 C.diff - Annual Target 88 Cumulative Actual 49

4.5.1 We are currently five under our plan of 54 but provisional figures for

October (as at 27th) report nine more cases taking us closer to the Oct

YTD plan of 60.

4.5.2 It is anticipated that the whole Health Economy plan will need to be

refreshed to ensure we continue to see a stepped reduction as

planned to support achievement of the target ( see graph below)

4.5.3 We are working closely with our providers to decrease the number of

cases; supported through the Infection Control Mandatory Training. We

are also working with other GM Quality leads to look at areas of best

practice and innovation.

4.6 MRSA - Annual Target 0 Cumulative Actual 8

4.5.4 There were no additional cases of MRSA in September.

4.5.5 Post Infection review shows five assigned to Acute (4 THFT, 1

Wythenshawe), three (2 T&G Community) to Community. Two of the

community cases have been classed as avoidable and are currently

under further review.

138


5

5. Are patient rights under the NHS Constitution being promoted?

5.1 This domain focuses on the standards within the NHS Constitution. The

targets and actual positions can be found in the enclosed Planned Care

and Cancer and Urgent Care dashboards.

5.2 RTT

5.1.1 The agreement between THFT and the RTT Measurement Team NHS

England (Analytical Service) means that September data is not

available so we cannot be assured of performance at this stage. If

possible a revised position will be tabled at the meeting.

5.3 Over 52 Week Waits

5.3.1 There are no patients (exc THFT) on an incomplete pathway waiting

more than 52 weeks. However we do have an increasing number of

patients waiting over 40 weeks and providers are being challenged

regarding this.

5.4 Diagnostic performance

5.4.1 Whilst overall performance has improved with 0.4% (13 people) waiting

between 6 and 13 weeks our endoscopy performance has got worse

with more patients waiting over 6 weeks for colonoscopy and

flexisigmoidoscopy than acceptable with issues at both THFT and

CMMC. Discussions are taking place with THFT on direct access to

release consultant time to carry out tests.

5.5 A&E Waiting Times

5.4.2 The Q2 position was 95.35% following a September achievement of

97.07%, which gave YTD as at 30th Sep of 94.87%. However, THFT have

only submitted performance for 14 days in October with a range of

99.12% to 87.79%. They have also suggested they expect to fail

October overall.

6 Are health outcomes improving for local people?

6.1 This domain covers the five NHS Outcome Domains and It also includes

the local outcomes; IAPTs, GP Disease Registers for Long Term Conditions

and Dementia and Smoking Quitters. The developing dashboards for

each of the NHS Outcomes Domains can be found in appendix 1.

139


6

6.2 The availability of outcomes data is limited and work is ongoing to ensure

all available data is included in the local performance monitoring

system.

6.3 Local Priority 1 Increased Uptake on GP Disease Registers

6.3.1 We have asked GM LAT if we can review this measure to capture the

actual number on our Disease Registers (prevalence) rather than the

number of registers above GM average. It is not anticipated this will

cause problems as it is a better measure of quality.

6.3.2 We anticipate numbers on registers will increase once we rerun the

searches and we will deliver on this priority.

6.3.3 Discussions are however, still ongoing with Public Health about the

uptake of Health Checks as these are important in delivering the priority.

6.4 Local Priority 2 Dementia

6.4.1 The change in measurement also related to this measure and once we

are able to check registers we will understand whether we are on track

to deliver this priority.

6.5 Local Priority 3 Smoking Quitters

6.5.1 Public Health are working with the Smoking Cessation service to identify

how they will increase the number of smoking quit dates set for clients

with respiratory disease by 10% in 2013/14. Numbers are currently low

and without significant focus on this group we are unlikely to achieve this

priority.

6.5.2 Public Health are also working with a range of providers (including the

THFT Respiratory nurses and Primary Care) to increase uptake.

6.6 The proportion of people who have Depression/ Anxiety who receive

Psychological Therapies (IAPT)

6.6.1 The CCG have raised a contract query with Pennine Care NHS

Foundation Trust to address current performance.

7 Are CCGs commissioning services within their financial allocations?

7.1 This domain covers how well we are meeting our own financial plans and

updates are covered in finance reports.

8 Organisational Health/Authorisation

140


7

8.1 This domain focuses on initial authorisation and the CCG’s ability to

discharge outcomes and standards.

9 Development and publication of 2013/14 Performance Reports

9.1 We have made considerable progress in ensuring we have access to the

data. We have now identified the data source for the three key

frameworks; however not all the data is currently available.

9.2 We are working to identify local monitoring data sources and are

cleansing the performance measures to remove measures where we

cannot source data or where measures are no longer required.

10 Provider Performance management

10.1 Provider performance reports are attached for information (appendix 2

to 4). Where available these are summary reports.

11 Recommendation

11.1 The Governing Body is asked to formally sign off the self certification for

Q2 checkpoint.

11.2 Note the Quarter 2 draft CCG Assurance Framework Balanced

Scorecard and assurance process.

11.3 Note the performance and plans for improvement.

141

Planned Care & Cancer

2012/13 2013/14

106 0

0 19.30%

30/10/2013

THFT & CMMC have failed at test level for Colonscopy & Flexi Sigmoidoscopy. In

total 13 patients waited between 6-13 weeks.

It is anticipated Direct Access Gastroscopy (OGD) will be live Nov / Dec 2013.

A Business case is being developed for Colonscopy & Flexi Sigmoidoscopy.

Recovery Milestones

RAG Red status reflects the lack of THFT data and the current

month dip in the Cancer 62days performance.

- Plans to achieve RTT at speciality level identified - Nov 2013.

- C2C referrals are at or below threshold - January 2014.

- Plans to improve endoscopy performance identified - Nov 2013.

RAG Rating -

Current Position:

RAG Rating -

Forecast Position:

Consistently meeting Target.

% of Patients not offered another binding date within 28 days of a

cancelled operation (Q1 THFT data only)

September data not available until 29th October 2013.

An audit is being undertaken with THFT on Intra-hospital referrals to identify

adherence to protocol.

Organisational Leads

CCG:

Clinical Lead: Guy Wilkinson /

Ram Jha.

Manager: Elaine Richardson

Provider:

Clinical Lead: ************

Manager: Kay Holland

Number of 52 week waiters for Incomplete

Pathways (YTD to August 2013)

Mixed Sex Accommodation Breach Rate (YTD up to Sep)

67Total Number of

Indicators:

Dr Guy Wilkinson / Dr Ram Jha, Responsible CCG Governing Body Member


The drop in 62days is due to 7 patient breaches due to a mixture of complexity and

pathway delays. THFT are forecasting to achieve Q2 with 91% which should mean

we will achieve the Q2 at CCG level.

No update from August reporting due to delay in THFT submission.

Improvement Impact Date: Jan 2014

88%

90%

92%

94%

96%

98%

100% Ja

n-1

3

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% s

ee

n w

ith

in t

arge

t w

ee

ks

RTT / Diagnostics

Admitted Plan Admitted Actual

Admitted Trajectory Non-Admitted Plan

Non-Admitted Actual Non-Admitted Trajectory

Incomplete Plan Incomplete Actual

Incomplete Trajectory Diagnostics < 6 weeks Plan

Diagnostics < 6 weeks Actual Diagnostics < 6 weeks Trajectory

80%

85%

90%

95%

100%

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

% s

ee

n w

ith

in t

arge

t w

ee

ks Cancer

2ww Plan 2ww Actual 31-days Plan

31-days Actual 62-days Plan 62-days Actual

86% 88% 90% 92% 94% 96% 98%

100%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% in

less

th

an 6

we

eks

Diagnostic Tests in less than 6 weeks

Endoscopy Actual Endoscopy Trajectory

Non-Endoscopy Actual Non-Endoscopy Trajectory

5,500 6,000 6,500 7,000 7,500 8,000 8,500 9,000

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

OP

FA

OP First Attendances

Actual Trajectory Plan

2,250

2,500

2,750

3,000

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

EL F

FCEs

Elective FFCEs


90%

92%

94%

96%

98%

100%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% in

less

th

an 6

we

eks

DEXA Scan in less than 6 weeks


142

Urgent Care

YTD (at 30 Sept) 94.8% 4 hour std. Qtr 2 position 95.35%, so improved achievement

supported via ECN recovery plan. October is currently missing 10 days of data due to

issues with the Lorenzo System Migration.

Attendance numbers in Sept is generally as expected.

Improvement in Time to Assess appears to be counteracted by treatment time. Discussion will be held with ED to understand this.

Recovery Milestones

Forecast Position at AMBER reflects the instability in achieving the

A&E 4 hour standard. The expectation is that the ECN recovery plan

will bring this back to green. However as we move in to Winter we

need to be sure plans are delivering.

The data issues due to the Lorenzo System Migration are causing

concern.

Recovery milestones are as specified in the ECN recovery plan.

Local Response rates are shown above. The significant decrease in Cat A R1 of 68.04% is

reflective of the North West overall.

The CCG will be measured against the regional NWAS figures. Sept figs:

75% Targets: CAT A 8mins R1 YTD 76.6% CAT A 8mins R2 YTD 78.9%

95% Targets: CAT A 19mins R2 YTD 96%

Utilisation of the HAS screened 81.9%. Average handover times in week ended 13th

October were Arrival -Notify 5:29mins, Notify-Handover 09:20mins and Handover to Crew

Clear 11:38mins.

Improvement Impact Date: January 2014Dr Richard Bircher, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Dr Richard Bircher

Manager: Elaine Richardson

Provider:

Clinical Lead:

Manager: Mike Griffiths

RAG Rating - Current

Position:

RAG Rating - Forecast

Position:

Total Number of

Indicators:39

80.0%

85.0%

90.0%

95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% S

ee

n w

ith

in 4

ho

urs

A&E 4 hour Waits

Actual trajectory Plan

4,000

4,500

5,000

5,500

6,000

6,500

7,000

7,500

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

No

. A&

E A

tte

nd

ance

s

A&E Attendances


60%

65%

70%

75%

80%

85%

90%

95%

100%

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

% w

ith

in T

arge

t m

inu

tes

Ambulance Response Rates

CAT A R1 8mins Plan CAT A R1 8mins Actual CAT A R1 8mins Trajectory

CAT A R2 8mins Plan CAT A R2 8mins Actual CAT A R2 8mins Trajectory

19mins Plan 19mins Actual 19mins Trajectory

0

20

40

60

80

100

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Nu

mb

er

of

De

lays

Ambulance Handover Delays / Crew Clear Delays

Plan Amb Handover > 30mins Amb Handover > 30mins Trajectory Amb Handover > 60mins Amb Handover > 60mins Trajectory Crew Clear > 30mins Crew Clear > 30mins Trajectory Crew Clear > 60mins Crew Clear > 60mins Trajectory

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% T

arge

t

Re-attendance in 7 days / Left without being seen

Left without being seen Left without being Seen Trajectory Plan Re-attendance within 7 days Re-attendance in 7days Trajectory

50 60 70 80 90 100 110 120

10

15

20

25

30

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Trea

tmen

t (M

inu

tes)

Ass

ess

men

t (M

inu

tes)

Time to Initial Assessment / Time to Treatment (Minutes)

Time to assessment actual Time to assessment trajectory Time to treatment actual Time to treatment trajectory Time to assessment plan Time to Treatment plan

200

250

300

350

400

450

500

550

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Min

ute

s

Total Time Spent in A&E (Minutes)


143

Urgent Care

0

30/10/2013

September data not available until 25th October 2013

Delayed Transfers of Care September data not available until 25th October 2013.

Data for the Effectiveness of Reablement has not yet been published.

The Rapid Response ind only reflects CARA data and further investigation is required in to

the significant performance drop.

No. Patients waited >12 hours in A&E from Decision to Admit (YTD to Aug)


Number of Urgent Operations Cancelled for a Second Time (Aug. data)

September data not available until 27th October 2013.0

September data not available until 25th October 2013

0

2

4

6

8

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

No

. o

f D

ela

yed

Dis

char

ges Delayed transfers of care from hospital

Actual Plan (11/12 Actual)

65%

70%

75%

80%

85%

90%

95%

100%

2011/12 2012/13

% T

arge

t

Delaying and reducing the need for care and support - Effectiveness of Reablement

Actual Plan

DATA CURRENTLY UNAVAILABLE - SEE COMMENTS BELOW

20.0%

40.0%

60.0%

80.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% o

f P

atie

nts

% of Patients Referred to Rapid Response maintained at home


65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% o

f P

atie

nts

% of Patients remaining at home after 91 days after discharge


20.0%

40.0%

60.0%

80.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% o

f A

dm

issi

on

s A

void

ed % of Admissions avoided for patients in A&E and MAU


65.0% 70.0% 75.0% 80.0% 85.0% 90.0% 95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% C

om

ple

ted

% of Nursing Assessments completed within 24 hours of Referral


20.0%

40.0%

60.0%

80.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% o

f P

atie

nts

% of patients discharged from Shire Hill remaining at home after 91 days


0

10

20

30

40

50

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Ave

rage

LO

S (D

ays)

Average LOS of Patients at Shire Hill


144

End of Life

2010/11 2011/12

N/A N/A 101.1 102

Consistently meeting target.Latest Data Available sourced from HSCIC is Dec 2012. Data shown here is in Financial

Years rather than Calendar Years.

The services delivered in the community by the Specialist Palliative Care Team

(Macmillan Nurses) was increased from 5 to 7 day provision in April 2013. The service

has maintained its high level of performance against KPIs across 7 days.

Hospital deaths', SUS data being sourced from CSU BI in Nov.

'find your 1%' and 'six steps' disscussions to be held at the EOL Strategy Group meeting on the 1 Nov on activities to support the indicators.

Advised by Public Health England Knowledge and Intelligence Team that this is not

collated nationally 15/10/2013.

Percentage of Deaths in Preferred Place of CareHospital Standardised Mortality Ratio (HSMR) Actual deaths divided by expected * 100 (Plan = 100)

Recovery Milestones

- 'Hospital deaths', SUS data being sourced from CSU BI in Nov.

- The End of Life Care Strategy Group meet Nov.

30/10/2013

Dr Richard Bircher, Responsible CCG Governing Body MemberImprovement Impact Date: ******** 2013


CCG:

Clinical Lead: Dr Richard Bircher

Manager: Alison LewinRAG Rating -

Current Position:

RAG Rating -

Forecast Position:

15Total Number of

Indicators:

80.0%

85.0%

90.0%

95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% P

atie

nts

% Non urgent Patients referred to Macmillan Nursing seen within 10 days of date of referral


80.0%

85.0%

90.0%

95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% P

atie

nts

Palliative Care & Respite - % Patients seen within 5 days for Non-Urgent and 24 Hours for Urgent

Non-Urgent Urgent Trajectory Non-Urgent Trajectory Urgent

50

70

90

110

130

150

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Ho

spit

al D

eat

hs

Reduction in Expected Hospital Deaths


0

5

10

15

20

25

Ap

r-1

2

Jul-

12

Oct

-12

Jan

-13

Ap

r-1

3

Jul-

13

Oct

-13

Jan

-14

Nu

mb

er

of

GP

s

GP sign up to "find your 1% campaign" / GP Practices using Gold Standard Framework operating at Level 4 of adoption

1% Campaign Actual Gold Standards Framework Actual

1% Campaign Plan Gold Standards Framework Plan

4

6

8

10

12

14

16

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

No

. Car

e H

om

es

Number of Care Homes to be implementing the six steps care home programme


0.0

0.5

1.0

1.5

2010/11 2011/12 2012/13 2013/14

Act

ual

Div

ide

d b

y Ex

pe

cte

d

Summary Hospital Level Mortality (SHMI) Actual deaths divided by expected


80.0%

85.0%

90.0%

95.0%

100.0%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% P

atie

nts

% Urgent patients referred to Macmillan Nursing contacted as a minimum within 24 hours


145

Long Term Conditions

Recovery Milestones

30/10/2013

2011 data released by the HSCIC December 2012. Therefore expecting 2012 data to be

available December 2013.

The latest CVD mortality data shows that the trajectory set by the PCT through the 2009

World Class Commissioning processes has been achieved. The aim was to reduce deaths

from CVD to 91.7 per 100,000 population. The latest data (relating to deaths reported in

2011) shows that we have achieved a rate of 84.1/100,000. Although we have achieved

a significant local reduction we are still an outlier when compared with NW and National

Quality Premium Payment Local Indicator (£150k) if achieved.

We are seeking approval from the LAT to revise the measure in place to demonstrate

increases in the number of patients identified and added to disease registers for AF,

Diabetes and COPD. An updated trajectory and data will be available for the next report.

% People feeling supported to manage their LTCs - Annual GP Survey data. 2013/14 not

yet been completed.

% With Personalised Mgt plan consistently meeting target.

September data not available until 29th October 2013.Sourced from the National Diabetes Audit. 2010/11 data wasn't published until January

2013 so expecting 2011/12 data to be published January 2014

Amir Hannan, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Amir Hannan

Manager: Alison Lewin

Improvement Impact Date: ******** 2013

62


Position:


Position:

Total Number of

Indicators:

50%

60%

70%

80%

90%

100%

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

% P

atie

nts

% of Patients who spend at least 90% of their stay on a stroke unit

Actual Plan

50%

60%

70%

80%

90%

100%

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

% P

atie

nts

% of patients arriving in a designated stroke bed within 4 hours of arrival

Actual Plan

THFT T&G CCG Patients

40%

50%

60%

70%

Jun-13 Sep-13 Dec-13 Mar-14

% T

arge

t

GP Disease Registers - Increased uptake for Atrial Fibrillation, Diabetes and COPD

Actual Plan

DATA UNAVAILABLE - SEE COMMENTS BELOW

60%

70%

80%

90%

100%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% T

arge

t

% Patients with a personalised management plan within 10 days of initial assessment


50%

60%

70%

80%

90%

100%

2009/10 2010/11 2011/12

% D

iab

ete

s P

atie

nts

Improving function with LTC - % of Diabetes Patients receiving all nine key processes of care

Actual Plan

55.0

65.0

75.0

85.0

95.0

105.0

115.0

2007 2008 2009 2010 2011

Rat

e p

er

10

0,0

00

po

p

Under 75 Mortality Rate: CVD (Rate per 100,000 Population)

CCG Actual NW SHA Avg England Avg

60%

62%

64%

66%

68%

2011/12 2012/13

% T

arge

t

% People Feeling Supported to Manage their Long Term Conditions

Plan(England Avg) Actual

146

Mental Health

31

Tina Greenhough, Responsible CCG Governing Body MemberImprovement Impact Date: March 2014


CCG:

Clinical Lead: Tina Greenhough

Manager: Clare Symons

PENNINE:

Manager: Stan Boaler

SFT: John Scholing

30/10/2013

Recovery Milestones

• A Business Case will be presented to PIQ in December 2013 to

propose a LES for Annual Health Checks for people with Learning

disabilities. This will recommend all GP surgeries to have had yearly

visits by LD Primary Care Specialist Nurse.

• Submit Self Assessment framework Action plan to iHal by

30/11/2013 and action plan by March 2014

• Increase referrals rates to IAPT service by minority groups ( older

people, BME ) by actively promoting the service by targeting these

groups by March 2014.

• Review delivery of dementia programmes for professionals to

improve knowledge and competencies in dementia care by mid 2014.Data source is the IAPT Access to Psychological Therapies dataset which we don't have

access to.

The data source stopped providing this information after May 2013. DATA UNAVAILABLE -

LAST CHECKED 16/10/2013 Help has been requested from Chris Coupe at GMCSU on

16/10/2013.

Dementia Data only available up to July 2013. August data published November

2013.Target set using National Dementia tool. The Dementia DES will support this

measure. Whilst 39 of our practices have signed up to the Dementia DES to increase

awareness; there are still a number of perceived barriers to the scheme.

Locally plan to review predicted and recorded prevalence in primary care and wider

integration across Health and Social Care to ensure patients with dementia supported in

their own home or usual place of residence to enable greater independence.

IAPT - Data source is the Mental Health Minimum dataset and the IAPT Access to

Psychological Therapies dataset which we don't have access to.

% People receiving Psychological Therapies - Consistently not meeting target.

CPA Discharges followed up within 7 days - Quarter 2 figure is only July and August. The full Q2 figure is not available until 30th October 2013.

% of People moving to recovery - 2013/14 Q2 data not available until 30th October 2013.

We had predicted a drop in performance for IAPT due to the large numbers coming through the service nationally with a view to a 15% prevalence rate by March 2015, it is unlikely

that we will achieve this. The reasons for this are; capacity of the IAPT team and Economic downturn resulting in increase demand. Across GM we are one of the top performing

CCGs.


Position:

Total Number of

Indicators:


Position:

20% 25% 30% 35% 40% 45% 50% 55%

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

% T

arge

t

Diagnosis Rate for People with Dementia


THFT Data

0.0%

1.0%

2.0%

3.0%

4.0%

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

2013/14 Q1

2013/14 Q2

2013/14 Q3

2013/14 Q4

% T

arge

t

Proportion of People who have Depression/Anxiety who receive Psychological Therapies

Actual Plan

20%

30%

40%

50%

60%

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

2013/14 Q1

2013/14 Q2

2013/14 Q3

2013/14 Q4

% T

arge

t

IAPT - % of People who Complete Treatment who are Moving to Recovery

Actual Plan

0%

20%

40%

60%

80%

100%

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

% T

arge

t(C

um

ula

tive

)

% of people with a learning disability receiving an annual health check


20% 30% 40% 50% 60% 70% 80% 90%

100%

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

% T

arge

t

IAPT - Recovery following talking therapies-over 65

Actual Plan

80%

85%

90%

95%

100%

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

% T

arge

t

IAPT - Access to community health BME groups and Psychological Therapies BME Groups

Community Actual Psychological Therapies Actual Community Plan Psychological Therapies Plan

Data unavailable - See Comments Below

90%

92%

94%

96%

98%

100%

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

2013/14 Q1

2013/14 Q2

2013/14 Q3

2013/14 Q4

% T

arge

t

% of Patients on CPA Discharged from InpatientsCare who are followed up within 7 days

Actual Plan


147

Lifestyle Choices

5

30/10/2013

The CCG has invested monies into a number of schemes/projects to be delivered

jointly with TMBC. It is too early yet to be assured if the acute costs is greater than the

AAT.

Emergency admissions for Alcohol related liver disease - September data not available

until 30th October 2013.

Tina Greenhough, Responsible CCG Governing Body MemberImprovement Impact Date: TBC


CCG:

Clinical Lead: Tina

Greenhough


Provider:

Clincial Lead: TBC

Manager: TBC

Total Number of

Indicators:


Position:

Chlamydia diagnosis has risen on last year's figure for Tameside Local Authority

The CCG has invested monies into a number of schemes/projects to be delivered

jointly with TMBC. It is too early yet to be assured if the acute costs is greater than the

AAT.

Emergency admissions for Alcohol related liver disease - September data not available

until 30th October 2013.

Recovery Milestones

Work in partnership with Local Authority and Public Health to

review workstreams.

Multi-Disciplined Approach to Brief Intervention.

Supporting Business Intelligence as responsibility of other

providers' data sources.

NHS Health checks supporting this workstream.


Position:1,400.0

1,600.0

1,800.0

2,000.0

2,200.0

2,400.0

2,600.0

2007/08 2008/09 2009/10 2010/11 2011/12

Rat

e p

er 1

00,0

00

Po

pu

lati

on

Rate of Alcohol Related Harm Hospital Admissions

Tameside LA Rate England Average

300

400

500

600

700

800

2011/12 Q1

2011/12 Q2

2011/12 Q3

2011/12 Q4

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

Nu

mb

er o

f Q

uit

ters

Number of self-reported four-week smoking quitters aged 16 +

Actual Plan

1,900

2,100

2,300

2,500

2,700

2,900

3,100

3,300

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

2013/14 Q1

2013/14 Q2

2013/14 Q3

2013/14 Q4

Rat

e p

er

100,

000 P

op

ula

tio

n Rate of Chlamydia Diagnoses per 100,000 young adults age 15-24

Tameside LA Rate Plan

0.0

2.0

4.0

6.0

8.0

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Rat

e p

er

100,

000

Po

pu

lati

on

Emergency Admissions for Alcohol Related Liver Disease


2,000.0

3,000.0

4,000.0

5,000.0

6,000.0

7,000.0

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

2013/14 Q1

2013/14 Q2

2013/14 Q3

2013/14 Q4

Nu

mb

er

scre

en

ed

No. Adults on a Caseload who have been Screened for Alcohol Intake

Actual Plan

148

Children & Families

30/10/2013

Need to ensure Midwives engage more in Health Prevention in Primary care from booking

onwards as they play a key role. 2011/12 Data shows that we have less mothers locally initiating

breastfeeding ( 59.7% compared to the European average of 89.1%).

Years shown are school years. Vaccinations for the school year 2013/14 will run from September

2013 to July 2014. September data will be available 25th October 2013.

Although we are seeing a downward trend we are still a regional and England outlier. Plans

include targeting resources on Looked After Children and on schools through Boards of

Governors. Younger people are currently directed towards Sexual Health Clinics and older

people to GPs; this may need to be reviewed. ·

Outline Plan: Double the number of Pharmacies available to offer FREE condoms & Emergency

Contraception; Commence with a pharmacy offer campaign to let YP know of the new services

by January using online media; Ensure sexual health and contraception is escalated to members

as a priority agenda; Improve FREE access to condoms; Improve knowledge about contraception

choices; Explore LARC campaign options and operationalize; Secure GP leadership on sexual

health and contraception


There is a National impact as we are struggling to recruit across Greater Manchester. There is

currently a national recruitment drive. Stockport Business Group (SBG) struggling to recruit

partly because neighbouring Trusts offering enhanced pay and/or training rates

Recovery Milestones

• Review Health Promotion roles of midwives by 1/1/14 to improve Health

Prevention roles.

• Review all existing children and families work programmes by 1/2/14

service providers and HWBB to improve performance in preparation for Deep

Dive

• National Health Visitors recruitment - to receive recruitment trajectory plan

from SBG by 18/11/13.

• Review how younger people access contraceptive services to improve

access - by 1/1/14 with TMBC Public Health and YouThink.Years shown are school years. Measurements for the school year 2013/14 do not start until

January 2014. The 2011/12 NCMP for T&G PCT showed a participation rate of 98.1% (3,106

children) for reception aged children and 95.3% (2,615 children) for year 6 aged children.

Prevalence in reception year of underweight children was 0.7%, healthy weight 75.7%,

overweight 14.8% and obese 8.8%. Prevalence in year 6 of underweight children was 1.1%,

healthy weight 63.9%, overweight 15.9% and obese 19.2%. The 2012-13 data will be published in

December 2013. Whilst we are good at recording the height and weight of children in both

reception and year 6 we still have a higher percentage classified as obese compared to the

England average.

Tina Greenhough, Responsible CCG Governing Body MemberImprovement Impact Date: TBC


CCG:

Clinical Lead: Tina Greenhough


Total Number of

Indicators:58


Position:


Position:70%

75%

80%

85%

90%

95%

100%

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

% In

fan

ts

% of infants for whom breastfeeding status is recorded at 6-8wk check


80%

85%

90%

95%

2012/13 2013/14

% C

hild

ren

% of children receiving booster dose of tetanus, diphtheria and polio vaccine (teenage booster)

Plan Actual

60%

65%

70%

75%

80%

85%

90%

95%

100%

2011/12 2012/13

% C

hild

ren

% of children with height and weight recorded

Plan Reception Year Children Year 6 Children

50%

60%

70%

80%

90%

100%

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

% 1

2/1

3 y

ear

old

gir

ls

% of 12/13 year old girls who receive the human papilloma virus (HPV) vaccination for cervical cancer

Actual Plan

10%

20%

30%

40%

50%

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

% In

fan

ts

% of infants being breastfed at 6-8wks


40 45 50 55 60 65 70

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

wte

Number of wte health visitors


0

10

20

30

40

50

60

70

2011/12 Q1

2011/12 Q2

2011/12 Q3

2011/12 Q4

2012/13 Q1

2012/13 Q2

2012/13 Q3

2012/13 Q4

Rat

e p

er

10

00

po

pu

lati

on

Under 18 Conception Rate

GM Rate Tameside LA Rate

149

DOMAIN 1 - Preventing people from dying prematurely

30/10/2013

Need to ensure Midwives engage more in Health Prevention in Primary care from booking

onwards as they play a key role. 2011/12 Data shows that we have less mothers locally initiating

breastfeeding ( 59.7% compared to the European average of 89.1%).

2011 data released by the HSCIC December 2012. Therefore expecting 2012 data to be available

December 2013.

The latest CVD mortality data shows that the trajectory set by the PCT through the 2009 World

Class Commissioning processes has been achieved. The aim was to reduce deaths from CVD to 91.7

per 100,000 population. The latest data (relating to deaths reported in 2011) shows that we have

achieved a rate of 84.1/100,000. Although we have achieved a significant local reduction we are

still an outlier when compared with NW and National data so still need to strive to make further

reductionsRecovery Milestones

In development HSCIC only currently publishing England data

The definition for the Potential Years of Life lost by Age Group has changed for this year to be

split out by Adult and Child. However, the most up-to-date data available is 2012 which is a

combined total


CCG:

Clinical Lead: Tina Greenhough / Ram

Jha

Provider:

Clinical Lead: TBC

Improvement Impact Date: ******** 2013Tina Greenhough / Ram Jha, Responsible CCG Governing Body Member

Total Number of

Indicators:


Position:


Position:

29

2,800

2,850

2,900

2,950

3,000

3,050

2009 2010 2011 2012

Rat

e P

er

10

0,0

00

po

p

Potential Years of Life Lost (PYLL) by Age Group - (Adults and Children Combined)

Plan Actual

0

2

4

6

8

10

12

14

2006 2007 2008 2009 2010

De

ath

s p

er

10

00

Bir

ths

Reduce Infant & Neonatal Mortality

Deaths < 1 year England Average Deaths < 1 year Actual Stillbirths England Average Stillbirths Actual

0%

10%

20%

30%

40%

50%

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

% B

abie

s

Supporting Measures to reduce deaths in babies

Breastfeeding Prevalence 6-8 wks Actual Antenatal Assessments < 13 wks Actual

Breastfeeding Prevalence 6-8 wks Plan Antenatal Assessments < 13 wks Plan

0

20

40

60

80

100

120

140

160

2006 2007 2008 2009 2010 2011

Rat

e P

er

10

0,0

00

po

p

Under 75 Mortality Rate

CVD Actual Respiratory Actual Liver Disease Actual Cancer Actual CVD England Avg Respiratory England Avg Liver Disease England Avg Cancer England Avg

10%

20%

30%

40%

50%

60%

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

% T

arge

t

Five Year Survival Rate

Breast Plan Breast Actual Breast Trajectory

Lung Plan Lung Actual Lung Trajectory

Colorectal Cancer Plan Colorectal Cancer Plan Colorectal Cancer Trajectory


1,600

2,000

2,400

2,800

3,200

3,600

4,000

2009 2010 2011 2012

Rat

e P

er

10

0,0

00

po

p

Potential Years of Life Lost (PYLL) by Gender

Female Actual Male Actual

Female Plan Male Plan

60%

70%

80%

90%

100%

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

% T

arge

t

CVD - Cardiac Rehabilitation / MI ,Stroke, Diabetes / Stroke Mortality

Cardiac Rehab Plan Cardiac Rehab Actual

Cardiac Rehab Trajectory MI/Stroke/Diabetes Plan

MI/Stroke/Diabetes Actual MI/Stroke/Diabetes Trajectory

Stroke Mortality < 30 days admission Plan Stroke Mortality < 30 days admission Actual

Stroke Mortality < 30 days admission Trajectory


150

DOMAIN 2 - Enhancing quality of life for people with long-term conditions

England 2012/13

64.00% 65.6%

30/10/2013

Improvement Impact Date: ******** 2013Amir Hannan, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Amir Hannan

Provider:

Clinical Lead: TBC

Total Number of

Indicators:18


Position:


Position:

% of People Feeling Supported to Manage their Long Term

Condition

Diagnosis Rate for Dementia Data only available up to July 2013. August data published

November 2013.

Data source is the IAPT Access to Psychological Therapies dataset which we don't have

access to.Considerably lower than % all Tameside population Employed.

Sourced from the National Diabetes Audit. 2010/11 data wasn't published until January 2013

so expecting 2011/12 data to be published January 2014Need to confirm plan. Could source monthly plan from SUS actual data for previous year.

0.69

Recovery Milestones

2011/12Average Health Status Score for Adults with a Long Term

Condition 0.73

England

20%

25%

30%

35%

40%

45%

50%

55%

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

% P

eo

ple

Diagnosis Rate for People with Dementia


THFT Data

50%

60%

70%

80%

90%

100%

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

% P

atie

nts

IAPT - Access to community health BME groups and Psychological Therapies BME Groups

Community Health Actual Community Health Trajectory

Psychological Therapies Actual Psychological Therapies Trajectory

Community Health Plan Psychological Therapies Plan


10%

20%

30%

40%

50%

60%

70%

80%

2009 Q3 2009 Q4 2010 Q1 2010 Q2 2010 Q3 2010 Q4 2011 Q1 2011 Q2

% P

eo

ple

in E

mp

loym

en

t

Employment of people with Long Term Conditions

Actual % Population Employed

20

40

60

80

100

120

140

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3 R

ate

pe

r 1

00

,00

0 p

op

Emergency Admissions Rate

Chronic ACS Actual Chronic ACS Trajectory Asthma/Diabetes/Epilepsy Actual Asthma/Diabetes/Epilepsy Trajectory Diabetes Actual Diabetes Trajectory Chronic ACS Plan Asthma/Diabetes/Epilepsy Plan Diabetes Plan

0%

5%

10%

15%

20%

25%

2006 2007 2008 2009 2010 2011

% P

atie

nts

% Dementia Patients prescribed Anti-Psychotic Medication

Actual Plan

50%

60%

70%

80%

90%

100%

2009/10 2010/11 2011/12

% T

arge

t

Improving function with LTC - % of Diabetes Patients receiving all nine key processes of care

Actual Plan

50%

60%

70%

80%

90%

100%

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

% P

atie

nts

IAPT - Recovery following Talking Therapries by Age Group

All Ages Actual All Ages Trajectory Over 65s Actual

Over 65s Trajectory All Ages Plan Over 65s Plan


Tameside LA data

151

DOMAIN 3 - Helping people to recover from episodes of ill health or following injury

30/10/2013

Improvement Impact Date: ******** 2013Guy Wilkinson, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Guy Wilkinson

Provider:

Clinical Lead: TBC

Total Number of

Indicators:18


Position:

Recovery Milestones

HSCIC only currently publishing England data Improvement on previous year.


Position:

Need to confirm plan. Could source monthly plan from SUS actual data for previous year. All accept Varicose Veins have a lower Score than the Previous Year.

40%

50%

60%

70%

80%

90%

100%

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

% P

atie

nts

Improving Recovery for Stroke Patients

On Stroke Unit < 4 hours Actual Given plan on discharge Actual

Received Follow-up Actual On Stroke Unit < 4 hours Plan

Given plan on discharge plan Received Follow-up plan

T&G CCG @ THFT data

0 20 40 60 80

100 120 140 160 180

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Rat

e p

er

10

0,0

00

po

p Emergency Admission Rate

Children with LRTI Actual Children with LRTI Trajectory Acute Cond not require Hosp Adm Actual Acute Cond not require Hosp Trajectory Children with LRTI Plan Acute Cond not require Hosp Adm Plan

50%

60%

70%

80%

90%

100%

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

% P

atie

nts

Effective Recovery Stroke / Improving Recovery Acute Stroke

Given Thrombolytis Therapy Actual Given Thrombolytis Therapy Trajectory

6mth Review Rankin Scale Actual 6mth Review Rankin Scale Trajectory

Given Thrombolytis Therapy Plan 6mth Review Rankin Scale Plan


0%

3%

6%

9%

12%

15%

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

% R

e-a

dm

issi

on

s

Emergency Re-admissions Rate within 30 days


50%

60%

70%

80%

90%

100%

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

% S

urv

ivin

g P

atie

nts

Proportion of Surviving Patients aged 60+ who have descended 1 mobility

At 30 days Actual At 30 days Trajectory At 120 days Actual

At 120 days Trajectory At 30 days Plan At 120 days Plan


0%

20%

40%

60%

80%

100%

2011/12 2012/13

% P

eo

ple

Helping Older People

Offered Rehab Actual At Home 91days after discharge Actual

Offered Rehab Plan At Home 91days after discharge Plan

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

2009/10 2010/11

Ave

rage

He

alth

Gai

n S

core

PROMS - Total Health Gain Assessed by Patients

Hip Replacement Actual Knee Replacement Actual Groin Hernia Actual Varicose Veins Actual

152

DOMAIN 4 - Ensuring that people have a positive experience of care

30/10/2013

Annual GP Survery data. 2013/14 not yet been completed. Meeting scheduled for the 29th October to

meet with Lyndsey Stuart, Interim Deputy Director of Nursing at THFT to discuss actions to improve

patient experience at THFT. Working with LAT and THFT to agree a joint action plan and process to

improve Patient experience of hospital care.

THFT collect feedback through the productive ward and another process currently bring used in

paeds.There is a plan to survey children similar to the plans for adult patients using iPads and direct

feedback. The equipment has been purchased and there is a plan for roll out. KS is working with the

head of Children’s services at TFTH and also the Strategic Service Pathway lead in community services

at SFT to discuss how this can be driven forward in respect of feedback from children and young

people as currently there is no data or current process in the patient experience of children and

young people.

Latest data available sourced from the NHS England Website.Roll out of Friends and family test in THFT

to Maternity October 2014. THFT have an action plan in place to improve the F&F Tests – this will be

implemented by November 2013.

The Friends and family Test was rolled out across Adult Inpatient and A&E. THFT have now rolled this

out in Maternity (card given in the welcome pack and asked in ante natal, post natal and labour). The

drop in A&E performance may be due to the SMS pilot ending; THFT are looking to re invest in this to

increase uptake, assurance has been given to the CCG that this is a priority peice of work for the acute

Trust. Will consider adding a flag to Lorenzo to remind staff to hand out the F&F test.

Recovery Milestones

• Quality and Nursing Directorate to develop an Improvement plan by November 2013,

following stakeholder involvement.

• Nursing and Quality Directorate are Developing an Internal Complaints Process and

policy. This is currently going through the governance process and will be implemented

by January 2014.

• THFT to implement the action plan for Friends and Family test to improve response

rates and Net Promoter score – November 2013

• CCG staff meeting Lyndsey Stuart, Interim Deputy Director of Nursing at THFT on the

29th October 2013, to discuss actions to improve patient experience at THFT.

• Tameside and Glossop CCG helping to support the LAT to facilitate the development of

a Clinical Collaborative for patient experience across GM by March 2014

2012 Latest data available sourced from HSCIC.

Working with the Commissioners/Pennine Care to continue to improve performance.

Unable to source any data. Help requested from Lyndsey Stewart from TFHT on 17/10/2013. CCG to

meet with the bereavement team at THFT.

Improvement Impact Date: January 2014Richard Bircher, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Richard Bircher

Provider:

Clinical Lead: TBC

Total Number of Indicators: 16


Position:


Position:

Annual GP Survery data. 2013/14 not yet been completed. CCG liaising with LAT and Patient Experience

Leads to support the CCG with relevant primary care data and information. TT has recently met with the

LAT and has been asked by the Patient Experience and Patient Engagement LAT leads to help support

and assist them in the development of a Clinical Collaborative for patient experience across GM. CCG

continues to progress this work and will sit on this clinical collaborative group.

Unable to source any data. Survey scores for lots of questions. Can't see an overall score. Latest

Survey is 2010. Help requested from Lesley Tones from TFHT on 17/10/2013

40%

50%

60%

70%

80%

90%

100%

2011/12 2012/13

% P

eo

ple

% of People with a Positive Experience of Primary Care

Making an appointment Actual Out of Hours Actual Dental Services Actual

Making an appointment Eng Avg Out of Hours Eng Avg Dental Services Eng Avg

0

20

40

60

80

100

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13

Ave

rage

Sco

re

Patient Experience of Hospital Care

Hospital Care Actual Hospital Care Trajectory

OP Care Actual OP Care Trajectory

A&E Actual A&E Trajectory

Patients Personal Needs met Actual Patients Personal Needs met Trajectory

Hospital Care Plan OP Care Plan

A&E Plan Patients Personal Needs met Plan

80

82

84

86

88

90

2010 2011 2012

Sco

re

Patient Experience of Mental Health Services

England Average Actual (Pennine Care data)

0

10

20

30

40

50

60

0%

5%

10%

15%

20%

25%

30%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Pe

rfo

rman

ce S

core

% R

esp

on

se R

ate

Friends & Family Test (Response Rate & Scored Performance)

Increased Response Rate Actual Improved Performance Actual

Increased Response Rate Plan Improved Performance plan

0

20

40

60

80

100

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

Sco

re

Patient Experience of Maternity Services



0

20

40

60

80

100

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Sco

re

Patient Experience - Children & Young People



0

20

40

60

80

100

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Sco

re

Patient Experience - Bereaved Carers



153

2012/13 M6 2013/14 M6 2012/13 M6 2013/14 M6

5 8 54 49

30/10/2013

HSCIC only currently publishing England data Latest figure shows an increase compared to same period in the previous year.

Recovery Milestones

The CCG is currently reporting 49 vs a plan of 54 ( 5 under plan). Provisional figures as of

27/10/13 report 9 cases taking the actual to 58 against a YTD plan of 60 (end Oct 13).

It is anticipated that the whole Health Economy plan will support the maintenance within

target, providing we continue to see a stepped reduction in the number of reported cases.

As of September we have 8 reported cases of MRSA (3 Acute, 5 community) The target is

Zero Tolerance on this indicator

Overall Number of Cases of MRSA (Target Zero) Overall Number of Cases of C. Difficile (Reduction on last Year)

In time, the outcome sought is a reduction in the number of incidents recorded. Latest

figure shows an increase compared to same period in the previous year.

In time, the outcome sought is a reduction in the number of incidents recorded. Latest figure

shows a reduction compared to same period in the previous year.Latest figure shows a reduction compared to same period in the previous year

Improvement Impact Date: ******** 2013

Jamie Douglas, Responsible CCG Governing Body Member


CCG:

Clinical Lead: Jamie Douglas

Provider:

Clinical Lead: TBC

Total Number of

Indicators:10


Position:


Position:

HSCIC only currently publishing England data

As there is room to improve the levels of reporting safety incidents, for the time being this

indicator will be seen as a positive indicator of outcome – reflecting increased willingness to

recognise and address safety problems.

DOMAIN 5 - Treating and caring for people in a safe environment and protect them

from avoidable harm

0

2

4

6

8

10

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

Ap

r-1

3

Nu

mb

er

of

Inci

de

nts

Incidence of harm to children due to failure to monitor



0.00

0.02

0.04

0.06

Apr-Sep 2012/13 Oct-Mar 2012/13

Rat

e p

er

10

0 A

dm

issi

on

s

Safety Incidents Involving Severe Harm or Death

Previous Years Actual Actual

0

2

4

6

8

10

Apr-Sep 2012/13 Oct-Mar 2012/13

Nu

mb

er

of

Inci

de

nts

Patient Safety Incidents Reported


0

1

2

3

4

5

6

Apr-Sep 2012/13 Oct-Mar 2012/13

Nu

mb

er

of

Inci

de

nts

Reducing Harm due to Medication Errors


4.0

6.0

8.0

10.0

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

Rat

e p

er

10

0,0

00

Po

p Incidents of VTE


40%

50%

60%

70%

80%

90%

100%

Ap

r-1

2

May

-12

Jun

-12

Jul-

12

Au

g-1

2

Sep

-12

Oct

-12

No

v-1

2

Dec

-12

Jan

-13

Feb

-13

Mar

-13

% B

abie

s

% of Full Term Babies being Admitted to Neonatal Care



0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

Ap

r-1

3

May

-13

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

Dec

-13

Jan

-14

Feb

-14

Mar

-14

% N

ew

Pre

ssu

re U

lce

rs Reducing Harm - % New Pressure Ulcers (Category 2,3,or 4)


154

Tameside & Glossop Community Healthcare Business Group

CCG Performance Report Executive Summary

September 2013

The datasets within in this report reflect the changed commissioning arrangements from 1.4.13 so that

organisations only receive the workforce, activity and performance related to services they commission.

Comments or suggestions on ways to better present this summary are welcome

Introduction

This report summarises the Business Group’s performance against its national and local targets for period September 2013. High level performance is summarised below (details can be found within the full performance report). The datasets have been prepared to reflect national, contractual and organisational target priorities.

Performance & Efficiency

Activity

Cumulatively the Business Group is over performing by 4.5% at the end of month 6. Down on the August position of 5.5%. Face to Face is above target at +7.6% and Telephone Activity below target at -7.0%.

The DNA rate at the end of September was +5.3% of face to face contacts, the same as the target of 5.3%. Services that demonstrate a DNA rate significantly higher than target are expected to complete action plans to address issues identified where appropriate. Action plans are currently in place for the Health Visiting, Paediatric Speech & Language Therapy, HIV and Diabetes and Vascular services. See performance report for details The cancellation rate in September was 1.2% of total activity. This is below the 1.3% target and is the same as the August figure.

Performance

In September 88.15% of the total service specific KPIs reported were achieved. One remains unreported and relates to training planned in the future. Of those services commissioned by the CCG 93.33% of the reported KPIs were met in the month

Status Green Amber Red NR

Achievement 56 0 4 1

Exception reports with remedial actions are provided for all reds and any downward trend ambers. Plans detailing the actions being undertaken to address the issues identified can be found in the performance report.

In September there were 4 reds and 0 downward trend amber reported for services commissioned by the CCG. These are:

SSIU At the end of September only 69.2% of patients received referred to CARA had received a direct intervention from the team within 72 hours of admission. This in the main was due TFT being in escalation and there being no capacity to move medically unfit patients to other areas of the hospital. From 1.11.13 CARA is now sub contracted to in reach to the SSIU via TFT so these KPIs will be amended and become part of the TFT reporting framework in the future.

155

Pulmonary Rehab

Safeguarding

KPI 1 –37 patients were referred for PR in September, just short of the monthly target of 40. Cumulatively for 2013/14 174 patients have been referred. This takes the total to 364 patients referred since the start of the programme against a cumulative target of 480. A number of initiatives are being employed to increase referrals including attending GP liaison meetings and arranging a TARGET session. KPI 2 – Completion rates for the PR programme is currently at 40.4% (below the 75% target). A literature search has indicated that an expected successful completion rate for PR is around a third of patients referred in to the service. Fewer people have completed a programme in part due to the holiday period. A home therapy programme has been put in place to enable patients who find travelling to the venues offered difficult in an attempt to improve completion rates.

KPI 1 – In the quarter only 63% of eligible staff received supervision reducing the cumulative achievement to 85.2% (target 95%). This is due to 2 main factors having an impact in the quarter; a reduction in the number of trained supervisors from 4 to 2 due to turnover and; the fact that 6 of the 13 weeks of the quarter are the school holiday period when many of the staff are unavailable to attend due to holidays or because they work term time only. All outstanding supervision will be complete before the end of October.

Quality & Safety

Access 99.23% of patients referred to services managed within the business group were seen within 18 weeks of referral in September. This is a reduction on the August position of 99.85% in the main due to the increase in waiting times for MSK Podiatry appointments.

All (100%) patients referred for a diagnostic test were seen within 6 weeks of referral in September.

Incidents

138 incidents were reported in September for services commissioned delivered to Tameside and Glossop residents. 42.4% of these were rated as moderate none were rated above this level. All of the incidents were reported by services commissioned by the CCG. Of the incidents reported 36 were categorised as wound care, 17 as falls and 9 as medication incidents. The number of communication incidents reported decreased to 8 from the August position of 10.

Of the 68 remaining incidents 16 were reported as being of moderate severity all related to three medically unstable patients in Shirehill whose blood sugar levels were reported as low on a number of occasions during their stay. The patients were all known to the Dietician and medical review sought as appropriate

No Never Events were reported in September.

HCAI

No avoidable cases of MRSA, C Difficile or GDH were attributed to T&G CH in September. Three cases of C Diff were reported with community provider contact was reported in month.

Harm Free The target set to reduce the number of medication incidents (by 5%) in year, which equates to an incidence of approximately 5 per month was exceeded in September with 9 incidents reported.

The number of pressure ulcers on the District Nurses caseload is breached the target of 50 per 1000 has reduced in September to 50.08 from the August position 51.67 per 1000.

The mini CQC inspections commenced in July are continuing and services will be expected to reassess themselves against the actions identified in Qtr 4.

10 falls were reported in Shire Hill in September. Of these 8 were recorded as resulting in minor harm and 2 as moderate harm.

No patient developed an avoidable pressure ulcer whilst admitted to Shire Hill.

156

Effective

50.0% of venous leg ulcers reviewed in September had healed within 16 weeks of start of treatment. Cumulatively achievement for the year to date is 80.8% exceeding the 70% target.

The new HPV immunization programme commenced in September with 85.5% of the first dose of the vaccine being delivered to girls aged 12/13 (target 90%). Three doses are required with a minimum gap of 6 months between dose one and three to complete the programme.

The programme to provide all year 10 children with a booster dose of tetanus, diphtheria and polio vaccine will commence in January.

Patient Experience

46 compliments were received about services commissioned by the CCG in September of which 41

were from patients/families, 1 other health organisations and 4 other.

Complaints data is reported 6 weeks in arrears to allow time for responses to be gathered. In August

4 complaints were received for CCG commissioned services all were concluded within timescale and

all were concluded to the satisfaction of the complainant.

In September the number of records of dementia patients that have carer comments included was

reported at 60.61% bringing the cumulative total to 83.33% (target 50%).

CQUINs

Both the ‘classic’ and medication safety thermometer data continues to be collected

monthly. The Business Group are confident that they have met the Qtr 2 CQUIN

requirements but await confirmation of this from the commissioners.

Contract Variations

The Qtr 2 variations have now been signed off. Items for Qtr 3 include: -

• LAC - Inclusion of the service specification (with agreement to work towards delivering all KPIs from

1/4/14).

• Amendment to the Infant Feeding KPI 1 now that a new target has been set for achievement of level

3 BFI (May /June14).

157

NHS Tameside & Glossop CCG Performance Report Summary - August 2013 National, Regional and Local KPIs, CQUINs and Specification KPIs

Tameside Hospital Foundation Trust

158

Authors: David McBride, Deanne Yates & Timothy Ball (GM CSU)

2

Performance dashboard

Thresho ld A pril M ay June July A ug F Y

Admitted - 90% 90.10% 93.30% 91.30% 93.20% 93.90% 93.50%

Non-admitted - 95% 96.10% 96.80% 96.30% 96.50% 96.10% 96.30%

Incompletes - 92% 95.00% 95.80% 95.00% 95.20% 93.70% 94.40%

Diagnost ic test wait ing t imes >99% 99.40% 99.40% 99.10% 99.50% 99.10% 99.30%

A&E waits - >4 hours 95% 90.10% 96% 96.70% 94.4% 95.0% 94.8%

First outpat ient appointment - 93% 96.10% 96.60% 95.60% 98.00% 98.50% 97.00%

First outpat ient appointment (breast) -

93%94.00% 88% 93.00% 100.0% 98.7% 94.8%

First t reatment - 96% 100% 97.30% 100% 100.00% Data unavailable 99.50%

Subsequent treatment is surgery - 94% 100% 100% 100% 100.00% Data unavailable 100%

Subsequent treatment is drugs - 98% 100% 100% 100% 100.00% Data unavailable 100%

First t reatment - 85% 94.90% 84.00% 92.1% 94.30% Data unavailable 91.80%

NHS Screening service referral to f irst t reatment -

95%100% 100% 100% 100.00% Data unavailable 100%

First t reatment since decision to upgrade

priority - 85%100% 83.30% 88.9% 100.00% Data unavailable 93.3%

M ixed sex accommodation breaches >0 0 0 0 0 0 0

Cancelled operat ions

No. of pat ients not of fered another binding date within 28 days >0

6 5 0 4 Data unavailable 15

Zero tolerance M RSA >0 2 0 0 0 0 2

Cdif f 31 6 5 2 2 2 17

RTT 52 weeks >0 0 0 0 0 0 0

Ambulance _ A&E Handovers

Handover >15 minutes (>30M INS) 85 35 33 67 28 248

Handover > 15

minutes (>60M INS)

Formulary Yes/No Yes Yes Yes Yes Yes Yes

Duty of Candour - Achieved Achieved Achieved Achieved Achieved Achieved

Oral surgery 87.50% 95% 88.10% 95.10% 93.20% NA

Neurosurgery 80.00% 92.00% 90.00% 87.50% 84.60% NA

Orthodont ics 90.60% 96.70% 100.00% 90.00% 98.10% NA

Plast ic surgery 100.00% 100.00% 100.00% 100.00% 75.00% NA

Neonatology 50% 100% 100.00% 100.00% 100.00% NA

Oral Surgery 90% 94.4% 90.60% 80.80% 93.10% NA

T&O 78.50% 85.50% 82.10% 90.30% 90.10% NA

T&O 90.00% 92.50% 93.60% 93.50% 92.20% NA

Nephrology 96.2% 100.00% 91.60% 90.30% 88.40% NA

0

0

Cancer waits - 62 days

0 0

25

No urgent op to be cancelled for a 2nd t ime

42

0

0

0

7

A&E Trolley waits 0

OP

ER

AT

ION

AL

ST

AN

DA

RD

S

RTT wait ing t imes for non-urgent consultant led

treatment

Cancer waits - 2 week wait

Cancer waits - 31 days

NA

TIO

NA

L R

EQ

UIR

EM

EN

TS

Ambulance _ A&E Handovers

No. of urgent operat ions cancelled for a 2nd t ime

RTT

by

spe

cial

ity

Non admitted = 95%

Incomplete = 92%

Any trolley wait > 12 hours

Admitted = 90%

4 4

0 0

0 0

2

Thresho ld A pril M ay June July A ug FY

Spend 90% t ime on stroke ward - 80% 54% 89% 94% 91% 82% 82%

Stroke bed in 4 hours - 80% 57% 74% 67% 77% 70% 69%

TIA in 24 hrs - 60% 14% 6.25% 37.5% 46.00% 25.00% 26.00%

M aternity Early access - 90% 91.24% 89.35% 91.70% 92.50% 89.74% 90.86%

Awareness training - 98% by year end 90.40% 92.20% 89.10% 84.00% 88.80% NA

To be determined locally from 12/13 baseline

informationCase notes have carer views recorded - 50%

A&E 95% 86.10% 92.30% 93.60% 92.40% 90.50% NA

Inp 95% 65.10% 74.30% 75.30% 72.50% 73.20% NA

GP 95% 81.90% 75.40% 77.00% 62.30% 55.40% NA

To be agreed locally by longstop date

Outpat ients<3% cancelled within 72

hours 1% 1.20% 0.7% 0.60% 0.90% 1.00%

ComplaintsResponded to within

agreed t imescale - 95% 75% 84% 95% 68% 75% NA

ComplaintsAcknowledged within 3

working days of receipt - 90%

100% 100% 100% 100% 100% 100%

VTERCA of hospital acquired

cases - 100% 100% 100% 100% 100% 100% 100%

Q1 90%

Excluding pat ients discharged within 24 hours of admission

50% overall

(80% for grades 3 and 4)

Falls

Baseline to be determined from quarters 3&4 of

2012/13 0.49% 0.73% 0.00% 0.47% 0.00% NA

UTI 95% 99.20% 98.29% 0.00% 0.47% 0.00% NA

Quarterly

0.00%

86% 86%

D omain 1: Prevent ing peop le dying p remat urely

Bi-Annual

GR

EATE

R M

AN

CHES

TER

REQ

UIR

EMEN

TS

Dementia

Discharge Summaries

Pharmacy - medicines reconciled by a pharmacist

within 24 hours

Pressure Ulcers

Stroke

0.00% 0.70%

D omain 2 : Enhancing t he qualit y o f l i f e o f peop le wit h long - t erm cond it ions

NA

D omain 5: T reat ing and caring f o r peop le in a saf e environment and p ro t ect ing t hem f rom avo idab le harm

0.49%

Bi-Annual

D omain 4 : Ensuring t hat peop le have a posit ive experience o f care

TBC

0.24%

159


3

Performance IndicatorReporting

Frequency

Indicator

Lead

ED

ResponsibleThreshold April May June July August YTD

Exception

ReportComments

13

Percentage of A&E attendances

where the patient spent four

hours or less in A&E from

arrival to transfer, admission

or discharge

M MG PW 95% 90.10% 96.0% 97.6% 94.4% 95.0% 94.6%

14

- unplanned re-attendance rate

within 7 days (Patient Impact

Indicator)

M LH PW 5% 7.30% 7.8% 7.8% 7.8% 6.9% 7.5%

15- left department without being

seen (PII)M LH PW 5% 3.90% 2.8% 2.7% 3.6% 2.8% 3.2%

16

Total time spent in A & E, less

than 4 hrs (Timeliness

Indicator)

M LH PW 240 mins 355 239 238 272 240 NA

17 Time to initial assessment (95th

percentile) (TI) above 15 mins

M LH PW 15 mins 21 18 14 18 16 18

18time to treatment in department

(median)(TI) (60 MINS)M LH PW 60 mins 101 69 67 72 80 NA

Am

bu

lan

ce

19 HAS screen usage M LH PW 78% 82% 86% 85% 84% 81.90%

A&E Quality Measures - 2013/14

A&E

Friends & Family Test benchmarking data

A&E

AreaResponse

rateAv. score

Response

rateScore Commentary

Tameside FT 12.1 24 9.7 22

GM 6.3 62 12.2 58

Keogh special

measures

Trusts

7 33 8.0 37

England 7.8 53 10.4 54

A higher score is better. Tameside's performance represents a drop on quarter 1, both in terms of the score and the response rate.

Response rates are improving across all comparator groups, Tameside's score remains lower than all comparator groups.

Quarter 1 July

Inpatient

AreaResponse

rateAv. score

Response

rateScore Commentary

Tameside FT 27 68 27.5 68

GM 20.3 74 21.4 73

Keogh special

measures

Trusts

27.3 69 29.1 68

England 24.4 72 27.8 71

A higher score is better. Tameside's score remains the same as quarter 1, the response rate has slightly increased.

All comparator groups have increased their response rates but scores have dropped slightly.

Quarter 1 July

160


4

SUMMARY

1. A&E – 4 hour waits was exactly on the threshold in August, although it remains under the threshold for the year to date. New weekly performance calls are in

place, between Provider Management and the Trust, based on the interim ED manager’s weekly performance report. This report is viewed and ratified by the

Urgent Care Action Group at the Trust. Indication is that this target will be met for the quarter by the end of September. Assurances have been sought by

Provider Management that the measures put in place are not of a temporary nature, but are embedded in the processes of ED.

2. Friends & Family Test – the Trust are reporting a significant dip in the response rate due to the completion of the SMS pilot supported by Good for Health (this

data is not on NHS England yet). Going forward this element of support is being costed by Meridian to provide this service. Additional support has been given

to A/E to further embed the card process, and a Kiosk has been installed in the waiting area to collect general patient experience information and FFT.

3. Diagnostics – Even though overall this performance indicator has been achieved for this period, there are a number of cases where the threshold has been breached. MRI 6 >6weeks, gastroenterology 4 >6weeks, Cardiology ECG 1 >6weeks, NOUS 7 >6weeks and 1 >13 weeks.. These cases had already been raised by the GMCSI BI team, and a request to the Trust regarding assurance and action plan has been sent.

4. Cancer waits –2ww (breast) was 100% for July – however the indicator failed overall in quarter 1 and attracted financial consequences for the trust. There is

still an issue regarding the patients understanding importance of the deadlines for referral and appointments for 2ww and the CCG is working with the GPs to

develop a letter to better explain the process to patients. 31 and 62 days have all improved and are achieving threshold year to date. We are still waiting to

receive data for August due to the time lag on these indicators.

5. HCAI – 2 cases of MRSA in April were both unavoidable according to the Case Review Group (held 12th

September). The new case of MRSA in July has been re-assigned to the CCG and does not show in this report. 2 new cases of Cdiff in August. Cdiff trajectory for year-end gives limited room for increasing cases. Consequence applied at year end. MSSA cases has risen and is above full year trajectory – YTD 8 cases, verses FY 13 cases. This has been raised at the Quality and Performance meeting for update/action plan.

6. RTT – weekly update is being received for RTT so we can pick up on any patients over 40 weeks+ and raise with the Trust. 7. Stroke – performance has dipped slightly in August for ‘stroke bed within 4 hours’ and the TIA indicators, both remain off target for the year to date. Issues

have been raised with the Trust regarding the methodology of the stroke bed within 4 hours indicator, new figures have been received by the Trust but not

reported by them. ‘Patients spending 90% of their time on a stroke unit’ remains on target.

8. Cancelled elective ops – Trust have submitted validated data for quarter 1 that correlates to NHS England data (11 cancelled ops not rescheduled within 28

days). Data for July has been submitted but is validated on a quarterly basis (next update 26th

October). The financial consequence of each breach is non-

payment of costs associated with cancellation, and non- payment or reimbursement (as applicable) of re-scheduled episode of care.

9. Dementia training – dementia training has increased in August to 88.8%, this is an annual target that needs to be increased throughout the rest of the year.

10. Discharge Summaries – a fifth month of underperformance has resulted in financial consequences to be applied in both indicators (A&E and Inpatient).

11. Complaints – ‘responses to agreed timescale’ remains off target in August (75%). Possible reasons are staff absence and the merger of PALs and Formal

Complaints Team. Provider Management are discussing this issue with the Trust.

12. EoL - query over use of Liverpool Care Pathway and inclusion in the contract. This may need further review nationally regarding the LCP and the impact on the

contract, awaiting further information on this from within CSU.

13. Ambulance – A&E Handover – financial consequences from quarter 1 held in abeyance. Performance improved in August, where there were 28 breaches over

30 minutes (compared to 67 in July).

161


5

14. CQUINs – quarter 1 CQUIN evidence has been disseminated to the relevant CCG commissioners for review, some issues are being taken up directly with the

Trust lead for each CQUIN. Finance now involved in the process and will be informed if any claw back is agreed between the CCG and Trust. Further evidence

has been received in August and has also been disseminated to CCG leads. Provider Management to facilitate further discussions with the Trust.

15. Sickness/absence of nursing & midwifery staff – this has risen for the third month in a row to 4.6% of all nursing & midwifery staff (excluding Healthcare

Assistants). Provider Management are in discussions with the Trust regarding this indicator and the potential knock on effects to patient care. Update to follow.

16. IV Iron Infusion - Even though this KPI has been agreed as no longer contractual this is still being monitored by the Provider Management team with a view towards patient safety. There has been a significant increase in the use of this service within maternity and has been reported to the CCG’s Medicines Management Team for them to raise with the Trust.

17. Hand hygiene - the submission for August has reported that the indicator requesting evidence that all clinical staff are competent and compliant at hand hygiene, by peer hand hygiene audits, has dropped below the 97% threshold. This has therefore triggered a request for an exception report and improvement plan with the Trust.

162


6

Contractual Performance Measures

(Operational Standards) SCHEDULE 4 – QUALITY REQUIREMENTS

National Quality Requirements

Performance Indicator Thresh

old April May June July Aug FY Trust commentary/issues

Consequence of Breach

RTT

CB_B1

Percentage of admitted patients starting treatment within a maximum of 18 weeks from referral

90% 90.1% 93.3% 91.3% 93.2% 93.9% 93.5% Target achieved in all specialties with the exception of Oral Surgery Penalties to be applied by speciality

CB_B2

Percentage of non-admitted patients starting treatment within a maximum of 18 weeks from referral

95% 96.1% 96.8% 96.3% 96.5% 96.1% 96.3% Target achieved in all specialties with the exception of Neurosurgery , oral surgery and plastics

Penalties to be applied by speciality

CB_B3

Percentage of patients on incomplete non-emergency pathways (yet to start treatment) waiting no more than 18 weeks from referral

92% 95.0% 95.8% 95% 95.2% 93.7% 94.4%

Penalties to be applied by speciality

Diagnostic

waits CB_B4

Percentage of patients waiting less than 6 weeks from referral for a diagnostic test

99% 99.4% 99.4% 99.1% 99.5% 99.1% 99.3%

MRI 15 >6 wks Gastroscopy 4 >6 wks Cardiology ECG 1>6 weeks NOUS 7 >6 weeks and 1 >13 weeks

2% of revenue derived from the provision of the locally defined service line in the month of the under-achievement (definition as outlined in schedule 4 – quality requirements section A (Appendix A)

A&E waits

CB_B5

Percentage of A & E attendances where the patient was admitted, transferred or discharged within 4 hours of their arrival at an A&E department

95% 90.10% 96% 96.7% 94.4% 95% 94.8%

Penalty to apply in Q1, Q2 to be assessed in October

Cancer waits –

2 weeks

CB_B7

Percentage of patients referred urgently with breast symptoms (where cancer was not initially suspected) waiting no more than two weeks for first outpatient appointment

93% 94% 88% 93% 100% 98.7% 94.8%

Breach to be reviewed on a quarterly basis, for any financial consequence.

Cancer waits -

62 days

CB_B12 To

CB_B14

Percentage of patients waiting no more than two months (62 days) from urgent GP referral to first definitive treatment for cancer

85% 94.9% 84% 92.1% 94.3%

Data not yet availab

le

91.8%


163


7

Performance Indicator Thresh

old April May June July Aug FY Trust commentary/issues

Consequence of Breach

Cancer waits -

62 days

CB_B12

To CB_B1

4

Percentage of patients waiting no more than 62 days for first definitive treatment following a consultant’s decision to upgrade the priority of the patient (all cancers)

85% 100% 83.3% 88.9% 100%


le

93.3%


CB_B18 Cancelled operations -

no. of patients who are not offered another binding date within 28 days

>0 6 5 0 4


le

15 July data not yet validated - this is validated on a quarterly basis and will be finalised by 26/10/13

CB_A15 Zero tolerance MRSA

>0 2 0 0 0 0 2

In Q1 there were 2 MRSA bacteraemia’s. Both were pre 48hr cases but were re-assigned to THFT following the post infection review (PIR). Both cases were deemed as unavoidable following the reveiw process. A 3rd pre 48hr MRSA has a final assignment to the CCG not THFT but was also deemed as unavoidable.

Non-payment of inpatient episode. Cases in April classed as unavoidable, awaiting an RCA for case in July

CB_A16 Rates of Clostridium difficile

31 6 5 2 2 2 17

Breach is reviewed on an annual basis.

CB_S7a All handovers between ambulance and A & E must take place within 15 minutes

100% 83.90% 82.1% 82.4% 78.3% 79.7% 85.2%

Consequences in Q1 held in abeyance

CB_7a All handovers between ambulance and A & E must take place within 15 minutes

No handover

s >30 mins

85 35 33 67 28 248


CB_S7b All handovers between ambulance and A & E must take place within 15 minutes

No handover

s >60 mins

25 7 4 4 2 42


NAL

164


8

Local Quality Requirements

Greater Manchester

Quality Requirement

Threshold April May June July Aug FY Trust commentary/issue Consequence of Breach

Domain 1: Preventing people from dying prematurely

Stroke

80% 54% 89% 94% 91% 82% 82% Exception report attached. To be calculated at end of 2nd

quarter, quarter 1 penalties to be confirmed 80% 57% 74% 67% 77% 70% 69% August data unvalidated.

60% 14% 6.25% 37.5% 46% 25% 26%

Maternity 90% 91.24% 89.35% 91.7% 92.53% 89.74% 90.86%

General Condition 9, Remedial Action Plan . Should be joint primary and secondary care plan. CCGs to support this. Need feedback fron Trust regarding drop in performance

Domain 2: Enhancing the quality of life of people with long-term conditions

Dementia 98% (by YE) 90.4% 92.2% 89.1% 84% 88.8% N/A Remedial Action Plan or Immediate Action

Plan as appropriate per General Condition 9.

Domain 3: Helping people to recover from episodes of ill-health or following injury

Not Applicable

Domain 4: Ensuring that people have a positive experience of care

Discharge Summary A&E

95% 86.10% 92.3% 93.6% 92.4% 90.5% N/A 456 summaries breached out of 4778 total

Cap for financial consequence (£20K)

Discharge Summary INP

95% 65.10% 74.3% 75.3% 72.5% 73.2% N/A 922 summaries breached 24 hrs out of 3442

Cap for financial consequence (£30K)

Discharge Summary GPs

95% 81.90% 75.4% 77% 62.3% 55.4% N/A GC 9 RAP/IAP

Complaints 95% 75% 84% 95% 68% 75% N/A GC9 RAP/IAP

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Pharmacy 90% (Q1) 86% Qtrly 86%

Remedial Action Plan or Immediate Action Plan as appropriate per General Condition 9.

HCAI MSSA -13 1 4 1 1 1 8


165


9

Quality Requirement

Threshold April May June July Aug FY Trust commentary/issue Consequence of Breach

E coli - 29 3 3 3 0 1 10


Ambulance 85% (Q1) 58.35% 73% 86.2% 84.6% N/A See national quality requirements.

166


10

Local Quality Requirements

Quality Requirement

Threshold April May June July Aug FY Trust Comments Consequence of Breach

Domain 1: Preventing people dying prematurely

EoL 75% 68% Qtrly N/A Discussion required regarding the use of LCP due to national changes.

As set out in general condition GC9 (Contract Management)

Domain 2: Enhancing the quality of life of people with long-term conditions

No Breaches

Domain 3: Helping people to recover from episodes of ill-health or following injury

Intravenous Iron Infusion

30 per year 19 1 0 3 18 41

GC9 Peter Howarth is taking this up with the trust. This is part of the maternity pathway, but needs to reviewed for patient safety

DDD of high risk antibiotics

126 per month

152.4 124.2 117.8 Qtrly N/A As set out in general condition GC9 (Contract Management)

Domain 4: Ensuring that people have a positive experience of care

No Breaches

Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm

Sickness and absence of nursing and midwifery staff (HIA) excluding Healthcare Assistants

3% 4% 3.7% 4% 4.4% 4.6% N/A As set out in general condition GC9 (Contract Management)

Evidence that all clinical staff are competent and compliant at hand hygiene by peer hand hygiene audits.

97% 98.4% 98.9% 99.65% 100% 94.85% N/A

Reports of peer hand hygiene audits below 97% will trigger an exception report with an improvement plan. Variance from target should reviewed as part of the Clinical Quality Review & Performance monitoring contract monitoring process. An improvement plan should be produced for negative variance from the target.

167


11

LOCAL SPECIFICATIONS

Performance Indicator Threshold April May June July Aug Trust Comments. Consequence of

Breach

Community Children’s

Nursing Svcs

Number & % of GP referrals to service, total with subset of children with acute illnesses

Min21% of which 80% are acute

207 (overall 22%). 70% were acute illnesses

66 (overall

20%) 66% were acute

illnesses

48 (overall 23%) 65%

were acute illnesses

GC 9 RAP/IAP

Number and % of referrals to CCTN

from A&E

Increase from 22%

192 (23%) 100 (30%) 48

(23%)

GC 9 RAP/IAP

NOUS

Appointment within 7 working days of referral

and within 6weeks RTT

100% 99% 99% 99% 99% 99.4%

GC 9 RAP/IAP

SSIU

LOS no longer than 72 hours 3 days 3.1 3.3 2.7 2.4 2.0

Raised within Contract Reviews and escalated accordingly to severity

Admissions from SSIU to other wards

<10% 28.90% 17.2% 22.8% 22.4% 24.1% Raised within Contract Reviews and escalated accordingly to severity

Increase the percentage of patients who have an appropriately completed discharge letters via fax as per RCGP standards, within a

90% 69.4% 88.4% 81.8% 65% 70.2%


168


12

maximum of 48 hours following discharge

Reduction in readmission rates from SSIU for same condition

<5% 8.8% 8.9% 13.6% 11.4% 9.5%


No. of NEW patients discharged to care homes, with care packages’ and to their own homes

N/A Data to be collected

from TMBC

Data to be collected from

TMBC

Data to be

collected from TMBC

Data to be

collected from TMBC

Data to be collected

from TMBC

GC 9 RAP/IAP

Stroke

Percentage of patients who spend at least 90% of their time on a stroke unit

80% 52% 89% 94% 83% 82%

GC 9 RAP/IAP

Commissioning for Quality and Innovation (CQUIN) – progress to August 2013

Ref CQUIN Subheading CCG

Commissioner TFT Lead Apr May June July Aug Notes

Nati

on

al (2

0%

)

A Friends &

Family

Phased expansion

Tracey Turley Bev Tabernacle

Bi-annual - The A/E response rate has been affected by the completion of the SMS pilot supported by Good for Health. Going forward this element of support is being costed by Meridian to provide this service. Additional support has been given to A/E to further embed the card process, and a

Increased Response Rate

A&E – 12.1%, Inp 27%

A&E 9.7% Inp

27.6%

A&E 4.77%

Inp 34.01%

Improved Performance on the Staff Friends and Family Test Bi-annual

169


13



Kiosk has been installed in the waiting area to collect general patient experience information and FFT.

B Safety

Thermometer

Data Collection Nikki Leach

Bev Tabernacle

Submitted Submitted Submitted Submitted Submitted

- Data submitted and available here – www.safetythermometer.nhs.uk

Reduction in the prevalence of pressure ulcers

Margaret Mason 8 3 4 3 3 - Not assessed until

quarter 2

C Dementia

Find, Assess, Investigate and Refer

Sara Roscoe Bev Tabernacle

1/ 42.6% 2/ 40% 3/ 100%

1/ 34.8% 2/ 42% 3/ 100%

1/ 83.1% 2/ 28.6% 3/ 100%

Qtrly - Sara reviewing, Trust

reporting ‘not achieved’

Clinical Leadership Bi-annual - Bi annual reporting

Supporting Carers of People with Dementia

Bi-annual - Bi annual reporting

D VTE

Risk Assessment

Nikki Leach Stephanie

Sloan (interim)

96% 96% 96% 95.5% Data not

yet available

- Risk assessment data supplied by Trust states ‘achieved’, data published on NHS England validates this

Root Cause Analyses 100% 100% 100% 100% 100%

- Need further data / assurances around RCAs, Trust reporting 100% but there is no supporting evidence. Nikki reviewing with Trust

Gre

ate

r M

an

ch

este

r (2

5%

)

GM1

Avoidable Admissions Reducing Avoidable Admissions Elaine Richardson Mike

Griffiths Achieved Qtrly

- Trust reporting ‘achieved’, Elaine to review supporting evidence

GM2

Transfers of Care

Peer review

Ali Lewin

Heads of Nursing Achieved Qtrly

- Ali to review supporting documents, Trust reporting achieved

End of life Kate Fisher Achieved Qtrly

- Ali to review supporting documents, Trust reporting achieved

170

http://www.safetythermometer.nhs.uk/

http://www.safetythermometer.nhs.uk/


14



Homelessness Bev Tabernacle Achieved Qtrly

- Trust reporting achieved, awaiting finalised documentation following meeting

GM3

Alcohol Reducing Alcohol Abuse Elaine Richardson / Kate Benson

Kerry Lyons Not achieved Qtrly

- Trust reporting ‘not achieved’, Elaine to review supporting documentation with PH input

GM4

Academic Health

Science Network

Improve collection of data in relation to medication errors Nikki Leach John

Goodenough Achieved Qtrly

- Nikki reviewing with JG, Trust reporting ‘achieved’ but no support evidence submitted

Reg

ion

al (5

%)

R1 AQUA

AQ AMI

Sara Garrett New

commissioner to be identified

Viv Buckett

81.8% - Data not yet available

post April, usually 3 to 6 months in arrears

- Evidence needs to be reviewed by nominated commissioner

AQ Heart Failure 33.3%

AQ Hip and Knee 88%

AQ Pneumonia 63.9%

AQ Stroke 56.5%

Lo

cal (5

0 %

)

1 Patient

Experience Improving the experience of

Patient & Families Tracy Turley Bev Tabernacle Need to set baseline

- No reporting until April 2014. CCG and TFT need to agree baseline no. of patients to be surveyed per month, meeting taking place w/c 30th Sept

2 Learning

Disabilities

Reasonable Adjustments for people with Learning Disabilities

Clare Symons Naz Khadim

Achieved Qtrly - Reviewed by Clare

Symons, evidence is sufficient

Patient satisfaction for people with learning disabilities Achieved Qtrly

- Reviewed by Clare Symons, evidence is sufficient

3 Paediatrics Children’s Urgent & Emergency Care

Clare Symons Awaiting start of

new commissioner

Stephen McLaughli

n Achieved Qtrly

- Trust reporting achieved, meeting was arranged (16/9/13) to review evidence but Trust did not reply or

171


15



attend

4 Cancer

Improve Completeness of cancer staging date

Elaine Richardson Stephen Ashworth

Breast 88.6% Lower GI 72.1%

Thorax (Lung) 95.9% Upper GI (OG) 68.2%

Trust Performance 81.2%

Qtrly

- Target of 90%, Trust has not achieved in quarter 1 with exception of thorax. Elaine R to review

Straight to test for cancer patients - Not reported until

31/10/13

5 Care bundles Increase compliance of the use of established care bundles for

COPD Sara Roscoe

Stephen Ashworth /

Mike Griffiths

A&E – 69% MAU – 60% Qtrly

- Trust reporting achieved, Sara said she is happy with evidence submitted but following up on a few areas

6 PARS

Appropriate treatment and escalation through a PARS

assessment within one hour of admission.

Nikki Leach Bev Tabernacle Data not available Qtrly

- Data for Q1 & Q2 will be made available 26/10/13 from case notes

7 Prescribing

Reduce transactions of prescribing Pregabalin

Peter Howarth Tony Sivner

30.6% Qtrly

- Trust reporting achieved, need confirmation from Peter Howarth

GMMMG

- Nothing reported by Trust, no commentary either. Peter H to review

8

Estimated Date of

Discharge (EDD)

Implement EDD for all non elective admissions

Sara Garratt New

commissioner to be identified

Heads of Nursing

94.4% EDDs

implemented

96.2% EDDs

implemented

85% EDDs

implemented

98% EDDs

implemented

- Trust reporting ‘achieved’

- Audits on EDD implementation for Q1 & Q2 underway, CCG commissioner to review

9 End Of Life End Of Life: AMBER Care Bundle Ali Lewin Kath

Fisher To be reviewed with Ali

- No evidence submitted as national guidance is to not use Liverpool Care Pathway, Ali to follow up and TPM to support in discussions

172


16



10 Dementia Improving Dementia Care Debbie Ashforth Bev Tabernacle Achieved Qtrly

- Trust reporting achieved, further evidence received (27/09/13)

- Debbie / Sara to review and report suitability

HIT Scheme Measures – to be further developed into Performance Indicators

Performance IndicatorReporting

Frequency

Indicator

Lead

ED

ResponsibleThreshold April May June July August YTD

Predicted

Year End

Performance

Exception

ReportComments

Conseque

nces of

Breach

1 No more than 100% planned occupancy at any time on each w ard

Monthly GP GP 100% 100 100 100 100 100 100 achieve

2

95% of inpatients episodes w ill not involve an external transfer w ithin the hospital site

Monthly SA/LH SA/MG 95% 99.7 99.7 99.7 99.7 99.7 99.7 achieve

3

90% of inpatient episodes and outpatient attendances for children w ill take place entirely in facilities dedicated to the care of children

Monthly SMc SMc 90% 100 100 100 100 100 100 achieve

4

95% of patients admitted on a day case basis w ill be cared for in dedicated day service facilities (ie w ill not utilise an inpatient w ard or theatre)

Monthly SMc SMc 90% 100 100 100 100 100 100 achieve

5

All new build w ards w ill have a minimum single bedded complement of 33%

Monthly GP GP 33% 42 42 42 42 42 42 achieve

173


17

Appendix 1 – RTT Recovery Plan

Week ending 04/08/13 11/08/13 18/08/13 25/08/13 01/09/13 08/09/13 15/09/13

203 203 203 203 203 203 203

175 194 194 181 143 174 202

128 125 135 159 168 178 164

623 638 854 974 834 796 974

92.6% 94.3% 93.3% 94.5% 93.7% 94.3% 94.1%

95.9% 93.1% 92.7% 94.0% 93.0% 93.2% 94.7%

51 63 37 22 60 48 60

50 75 56 44 53 45 56

86 84 88 106 112 115 114

56 54 66 64 57 47 46

Patients treated under 18 weeks 43 69 50 40 50 41 49

Patients treated over 18 weeks 7 6 6 4 3 4 7

86.0% 92.0% 89.3% 90.9% 94.3% 91.1% 87.5%



100.0% 83.3% 88.2% 100.0% 100.0% 100.0% 100.0%



99.3% 89.5% 97.5% 97.1% 97.1% 82.5% 93.6%



91.5% 95.0% 90.9% 98.0% 93.3% 85.1% 97.3%

Number of patients cancelled by hospital in the last 7 days < 18 weeks+0 1 0 0 0 0 1

Number of patients cancelled by hospital in the last 7 days > 18 weeks+0 0 0 0 0 0 0

0 0 0 0 0 0 0

95.6% 94.2% 94.9% 95.1% 95.5% 96.9% 97.9%

Data Source= Tameside FT

* Unable to provide projected stops until June as we will not have fully booked yet up

until this date so would not be a true estimate. Instead the figure we have provided is

an average of the same month last year as guidance.

+This represents where the hospital cancel and TCI Date are both within that

particular week. Also includes patients who are cancelled because they are medically

unfit.

Total Patients treated

Projected numbers of patients treated for week* Orthopaedics

Total Patients treated

Non Admitted performance- 95% Target

Total open pathways >18 weeks - The Backlog-Admitted Orthopaedics

Total open pathways >18 weeks - The Backlog-Non Admitted Orthopaedics

Non Admitted-Orthopaedics

Non Admitted-Oral surgery

Admitted-Orthopaedics

Projected numbers of patients treated for week*

Total open pathways >18 weeks - The Backlog-Admitted

Total open pathways >18 weeks - The Backlog-Non Admitted

Confirmed Admitted RTT Performance for Week ending- 90% Target

Admitted-Oral surgery

>52 Week Waiters

A&E

Name of OrganisationTameside NHS FT

174

Pennine Care NHS Foundation Trust

(Mental Health)

Contract Activity and Performance Report

2013/14 Contract

Discussion paper: October 2013

For discussion at 29 October 2013 meeting.

175

2

Report details

Contract 2013/14 – Pennine Care NHS Foundation Trust (Mental Health) Multilateral contract

Report Prepared by: Paul Dolan, Senior Business Partner, GMCSU

Marie Higgin, Contracts Manager, GMCSU

Documents referred to: Contract Activity reports from PCFT dated May 13 and June 13

To be presented at: PCFT Monitoring and Contract Development Sub-Group 29 October 2013

Reporting Period Used: 2013/14 contract – August 2013 Activity reports

Page number

Contents 1. Introduction

2. Activity Performance Reports

3. Local CCG Performance

4. Quality KPI’s and CQUINS

5. Service Variations

6. PbR Update

3

3

3

5-6

7

8

APPENDICES 1. Activity reports supplied by PCFT

2. PbR workplan

Separate attachment

176

3

Monitoring and Contract Development Sub-Group

PENNINE CARE NHS FOUNDATION TRUST

(MENTAL HEALTH) Report for October 2013

Introduction / Overview

This report has been compiled using the information obtained from the PCFT MH Activity reports up to and including September 2013.

A summary of the Exception reports issued are supplied within this document for any further discussion at the Contract Monitoring meeting on 29 October 2013.

Performance

Attached as Appendix 1 (Separate attachments due to size) are 5 embedded Contract Activity Reports provided by the Trust for each of the 5 Principal CCGs:

Bury Heywood Middleton and Rochdale Oldham Stockport Tameside and Glossop

These normally cover the previous month’s activity and are provided by the 15th day of the following month. The reports attached include Months 1-6.

Trust wide Exceptions raised:-

Exception reporting

Description Area affected Exception

CAMHS South Ward x 1 North Ward x 1 Norbury Ward x 3 Taylor Ward x 1

6 Admissions to Adult wards this year YTD (information taken from StEIS up to 18/10/13 Numbers : 20572/21033/23371/25574/29987/30614)

Suggested Action:

Maintain the monitoring of the reported incident via StEIS and retain in the SUI report discussed within the Quality Sub-Group. Have raised the use of Adult beds with the provider who has suggested that the issues arises because of increased Tier 4 demand at regional level but we have asked for this to be confirmed. Report to follow.

177

4

Waiting times Trust Wide Target % of patients to be seen under 11 weeks is 100% / YTD this is below target. Adults = 95.5% Older People = 91.80%

Suggested Action:

Concerns have been raised that this target has been consistently not reached. To request what actions are in place to address this trust wide?

Stansfield Place HMR / Bury Average LOS Concerns raised

Suggested Action:

To request a report detailing:- Average length of stay per individual at Stansfield Where the stay exceeds 2yrs ask for discharge summary plant with dates Where the stay exceed 3 yrs review the tariff payment as the model is based on intensive

rehab rather than slow stream rehabilitation

PICU beds – Cobden Unit

HMR HMR usage to date exceeding local plan. Need to look at average length of stays. Why exceeding optimum 3 weeks Admission/Discharge arrangements with Acute Mental Health wards

Suggested mitigation for PICU exception:

To mitigate risks, all HMR admission requests to PICU to be screened for approval with Commissioner and weekly updates required?

Local CCG Performance

In advance of the final agreement around the Quality performance Framework the above activity reports have been reviewed by the GMCSU TPM team per CCG and comments have been noted per CCG.

Bury:

IAPT Target Jul-13 Aug-13 Sept-13

% Entering into treatment 2.60% 2.46% 2.46% 2.68%

% Entering treatment/referrals 60.00% 49.00% 49.00% 52.72%

% Moving into recovery 40.10% 42.00% 42.00% 38.42%

Exception reporting


DNA rates – New Appointments and Existing Appointments (Adults)

Bury CCG Both areas are over 20% YTD

178

5

Oldham



% Entering treatment/referrals 32.02% 32.02% 46.01%

% Moving into recovery 37.23% 37.23% 38.49%

Exception reporting


No. of patients on the case load at month end

Oldham CCG Plan of 68 at month end but YTD have been consistently over 95.

DNA rates – Existing Appointments (Adults)

Oldham CCG Remains over 20%

Stockport

IAPT Target Jul-13 Aug-13 Sep-13




% Discharges 100.00% 81.31% 82.49% 73.59%

% No of referrals 100.00% 75.03% 75.03% 64.00%

Exception reporting



Stockport CCG Both areas are over 20% YTD

CAMHS Stockport CCG Reported on the August Activity figures. See Trust wide exceptions.

Tameside & Glossop


% Entering into treatment

1.60% 1.60% 1.08%

% Entering treatment/referrals

31.11% 31.11% 32.41%

% Moving into recovery

43.11% 43.11% 41.94%

179

6

Exception reporting



T&G CCG Both areas are over 20% YTD

Heywood, Middleton and Rochdale





Exception reporting


CPA Follow up HMR YTD figure remains under Target at 93.10%

Suggested Action:

Is there an Action plan in place to address this?

Quality KPIs and CQUIN

Dashboard Developments - KPI

As previously discussed the Contract gives high priority to Quality and Good Outcomes. A set of Nationally mandated and Greater Manchester KPIs have been developed and a Dashboard for reporting on both CQUINs and KPIs have been created.

This was presented at the Quality Sub-group on 4 October 2013 and Commissioners have been asked to review this and advise if there is anything further is to be included.

PCFT have been asked to update the details on the dashboard before the end of October.

CQUIN

Quarter 2 CQUINs evidence is due by the end of this month. This will be reviewed by HMR and GMCSU and discussed at the Quality Sub-Group on 1 November 2013.

Quarter one CQUINs evidence submission was accepted and signed off. However, tabled below are the exceptions noted within the Quality Sub Group Minutes for further action, which will be picked up once Quarter 2 submission has been received.

The values for the LA for the PCFT contract have not been included in the calculation of the CQUIN value reconciliation figures.

180

7

For this year an additional requirement is for the Trust to have committed to a Pre-Qualification Criteria (Appendix 5). For PCFT these were agreed to be Carers for people with Dementia and 3 million lives.

Exception reporting

Description Exception

GM CQUIN – Dementia This was not reported as PCFT advised this was optional. This has been discussed with Commissioners in the Quality Sub Group and rational for this was requested. Update: This is to be presented at the 1 November Quality sub-group

GM CQUIN – Academic Health Science Network

There are known problems surrounding the translation of this which is to be further looked into via the Quality Sub Group. Update: Meeting took place on 23 October.

Further information has been supplied by the GMCSU to PCFT.

Regional CQUINs – Advancing Quality There is a known information lag for this CQUIN. GMCSU due to meet with PCFT in quarter 2. Update: Meeting arranged with PCFT for 30 October.

181

8

Finance

Service variations YTD Service variations received Year to date are tabled below.

Contract Additions & Deductions to the 2013/14 Opening Heads of Terms for Associates Variation

Deed Complete Reference

Number Associate

CCG 2013/14 Impact

N/R

*

Full Year Impact (14/15)

Service Variation Description

1314A1 Oldham £620,062 R £620,062 Further investment in the IAPT Service Yes

1314A2 Oldham £38,024 R £38,024 Transfer of Finance for Social Workers Yes

1314A3 Oldham £127,000 R £127,000 Rowan & Cedar Wards Obs costs Yes

1314A5v2 Oldham/ OldhamLA £300,000 R £300,000 Oldham Memory Service Yes

1314A6 Bury CCG £31,000 N NA Additional funding for CAMHS Yes 1314A7 Oldham £70,860 R £132,600 Home Liaison Service Yes 1314A8 Stockport £85,000 R £230,00 IAPT Yes “ Stockport £76,666 N NA IAPT Yes

1314A9 Oldham £20,000 R £20,000 Agreed Additional adjustment for social workers Yes

Any queries with regard to the above contract service variations should be raised in the first instance with GMCSU. ([email protected] and [email protected]. PbR

A Greater Manchester Mental Health PbR Steering Group has been established, chaired by Tameside & Glossop and a GMCSU representative, Malcolm Semp. The Steering Group accountability is to the Greater Manchester Contracts Steering Group attended by Greater Manchester DOFs (Directors of Finance) and DOCs (Directors of commissioning).

The workplan is being developed and the updated version is shown as Appendix 2, for reference and the next meeting is scheduled for 24 October 2013.

A memorandum of understanding is in place to de-risk the financial impact to the Provider and the Commissioners during 2013/14 and for 2014/15, 2015/16.

The principles of the de-risking proposal are as per the GM Risk Share paper approved by the Association of Governance Groups (AGG) and includes a maximum adjustment for commissioners adversely affected by the new MH currencies of £250k.

The GM PbR Steering group have agreed to produce a standardized Cost Impact Statement for 31 October 2013 to be shared with the Commissioners.

182



Appendix 1 – Activity reports issued by PCFT MH

Please note that these are large documents and therefore are sent as a separate attachment.

Appendix 2 – Pbr Workplan (For reference only)

183


Title of Subject:

Finance Report for Month 6

Date of paper:

October 2013

Prepared By:

Finance Department

History of paper:

Presented to the Finance & QIPP Committee

Executive Summary:

To show the Governing Body the latest financial position.




or Decision)

To note contents


by proposal:

Yes


Kathy Roe, Chief Finance Officer

Has ‘due regard’ been

given to Analysis of the

Effects on equality (AoE)

prior to sign off by the

Governing Body?

Yes

184

1

Trend Result

Getting Better

No Change

Getting Worse (Actual vs. Target) from last period to current period

Finance & Activity

Executive Summary Report

September 2013

YTD

Variance

£000's

Forecast

Variance

£000's

Previous

Forecasts

£000's

Year to

Date RAG

Forecast

Outturn

RAG

Forecast

Trend

Financial Surplus

Target 1,529 3,059 3,059

Tameside FT Contract (1,474) (2,000) (1,400)

All Other Secondary

Care Contracts

(including Independent

Sector)

(195) (199) (57)

Primary Care Budgets

(Including Prescribing) (297) 43 154

QIPP Target 0 2,000 2,000

Running Costs Target 84 64 104

185

2

Summary of Financial Position as at September 2013

The CCG has a statutory duty of financial breakeven but “Everyone Counts: Planning for Patients 2013-14” requires commissioners collectively to plan for a 1% surplus to be carried forward for future years. The overall required surplus for the CCG is £3,059k and budgets have been set to deliver against this plan.

Following receipt of the most recent activity data from Tameside FT and other acute providers, forecast overspend has been revised upwards (a movement of £742k since last month). Further detail of the overspending areas is described later within this report.

Tameside & Glossop CCG is still reporting to be on target to deliver the required surplus in 2013-14. However, this is becoming increasingly high risk as activity continues to increase in secondary care. At this present time it is assumed the 2012/13 lodgement will be returned to NHSE in full for use in future years.

Budget Actual Variance Annual Forecast M6 Forecast M5 Forecast Movement in Movement in

YTD YTD YTD Budget Outturn Variance Variance Forecast Forecast

£000's £000's £000's £000's £000's £000's £000's £000's %

Admin

Running Costs 2,928 2,843 85 5,810 5,746 64 114 (50) (0.9)

Total Admin Costs 2,928 2,843 85 5,810 5,746 64 114 (50) (0.9)

Programme

Acute 88,374 90,042 (1,669) 176,386 178,585 (2,199) (1,457) (742) (0.4)

Mental Health 13,130 13,275 (145) 26,237 26,598 (361) (357) (4) (0.0)

Primary Care 21,747 22,044 (297) 43,452 43,409 43 154 (111) (0.3)

Continuing Care 5,132 5,084 48 10,265 10,265 0 0 0 0.0

Community Health Services 13,923 13,924 (1) 27,760 27,760 0 0 0 0.0

Other 4,763 4,668 95 9,076 8,955 121 19 102 1.1

Earmarked Reserves 1,884 0 1,884 15,043 12,711 2,332 1,527 805 5.4

Total Programme 148,952 149,037 (85) 308,219 308,283 (64) (114) 50 0.0

Total Expenditure in Ledger 151,880 151,880 0 314,029 314,029 0 0 0 0.0

Allocation 153,409 153,409 0 317,088 317,088 0 0 0 0

Surplus/(Deficit) 1,529 1,529 0 3,059 3,059 0 0 0 0

Period April - Sep 13 Year End Forecast

186

3

Acute Services – Month 06

Acute Services

The month six ledger position for total acute services is overspending by (£1,669k), which is based on five months actual SLAM data and an estimate for month six activity levels. Acute budgets are forecast to be overspent by (£2,199k) at the end of the financial year. There have been a number of key movements to the month 06 forecast representing an adverse movement of (£742k) from the previous month. This is due to movements on Tameside FT contract (£600k) and Salford Royal FT (£250k).

Appendix B details the cumulative month five SLAM position whereas the RAG ratings on the front sheet include accruals up to month 6 or the year end. Further details on the month 5 SLAM position are as follows:

Tameside FT (TFT) As detailed in Appendix B, planned expenditure at Tameside FT in the first 5 months of 2013/14 was £47,904k. Actual spend against this plan was £49,083k, which represents an overspend of (£1,179k). There was a provisional in month underspend of £393k during August. As always this provisional (or ‘flex’) data is the most accurate representation of August performance, but it is subject to change in accordance with flex and freeze regulations. Typically movement between flex data and freeze data is less than £100k, but the movement in Julys data was £400k. Should this be repeated for August, an apparent underspend could quite easily be wiped out.

This total overspend is made up of pressures in the following areas:

Emergency admissions (844k)

Outpatients (£208k)

Elective: Inpatients and Day cases of (£227k)

187

4

Monthly Variance by POD

Emergency/Non Elective Admissions are currently over performing by (£844k). Although activity has returned to within cumulative planned levels, emergency admissions are still a cause for concern as the HRGs driving the emergency admissions to date continue to be comprised of a more expensive case mix than planned. This can be seen from the top five overpeforming HRG's for month 05, all with signifying complications and/or co morbidities:

The average case mix price for 2013/14 is approximately 6% above planned levels. If non elective admissions remain at this case mix price until the end of the year, it would result in an overspend of approximately £2m.

Concerns around emergency admissions were highlighted by the Keogh Review. The CCG is working closely with the FT to support the remedial action plan, which will amongst other things seek to address the number of emergency admissions at Tameside FT. This will be supported by additional funding from NHS England of approximately £2.4m, which is part of the monies agreed nationally to support A&E departments.

A&E Attendances

In last month's report we referred to the significant rise in A&E attendances and the non-achievement of the 95% threshold four-hour waiting time target. This theme continued into August where there were a further 332 breaches, again falling short of the 95% threshold target.

However there has been a significant improvement for the month of September. The number of breaches in September has reduced by approximately 42% compared to August levels, which can be seen in the table below:

*October data is incomplete - up to and including 3rd October

The A&E conversion rate for September has remained in line with the trend seen in previous months and so the improvement in performance is not as a result of admitting extra patients.

Maternity – Spend across the maternity pathway is £228k lower than expectation. As maternity pathway is new, there were some initial concerns that the underspend may be related to undercounting activity. But following recent discussions with the Trust we are assured that the activity is being counted and charged correctly. Rather the underspend is being driven by changes to activity.

Apr May Jun Jul Aug Grand Total

POD £000's £000's £000's £000's £000's £000's

A&E (13) (5) (22) (67) (21) (128)

All other (PbR excluded, non activity services) (25) (70) (47) (113) (38) (292)

Critical Care 93 85 117 (36) 34 293

Elective: inpatients and day cases (224) 79 (18) (24) (40) (227)

Maternity/Non Emergency 62 25 127 (59) 72 228

Non-elective admissions (421) (212) (76) (321) 187 (844)

Outpatients (308) 25 118 (242) 199 (208)

Grand Total (837) (73) 198 (861) 393 (1,179)

Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13* A&E Attendances 6495 6565 6483 6989 6392 6424 613 4 hour Breaches 643 259 217 396 332 193 12 % Seen within 4 hours 90.10% 96.05% 96.65% 94.33% 94.81% 97.00% 98.04%

Actual A&E Attendances admitted 1694 1698 1614 1709 1607 1638 164 % of A&E Attendances admitted 26.08% 25.86% 24.90% 24.45% 25.14% 25.50% 26.75%

188

5

Daycase and Elective activity is over performing by (£227k). This is due to the Trust making a concerted effort to drive additional day case activity through the system during quarter one in order to clear the backlog associated with 18 weeks. Activity levels have now stabilised and come back within planned levels. This is consistent with recent discussions with the Trust who have informed the CCG that activity will fall back into line over the summer months; this is supported by the most recent data as seen below: Activity Plan

Although the activity has returned to within planned levels it must be noted that the £227k overspend is driven by a more expensive case mix in April as seen in the table below:

Outpatient First Attendances - are overspent by (£177k) on a year to date basis. This is driven by exceptionally busy months in April and July. Spend in August was actually £70k underspent.

Secondary Care Dental – Secondary dental is now commissioned by NHS England. A budget of £3m was transferred from the PCT to fund this activity. However the definition of secondary dental and the rules used to calculate the budget required by NHS England contained significant ambiguity.

This has resulted in providers billing activity which should be chargeable to the CCG to NHS England, while the other areas of spend were omitted from the budget transfer. As such the GM Contract Steering Group asked for a review to re-apply the rules as per the latest guidance and analyse the impact at a CCG level. Some of the finer points around this are still being debated, but we know it will result in a pressure to the CCG, which in the worst case scenario could be as high as £641k.

Overall Forecast Outturn (TFT) (£2,000k). Despite the in month savings the forecast outturn has been increased significantly from the M4 forecast (£1,400k). This is following an in-depth review using sensitivity analysis by point of delivery and modelling the consequential financial impact. This forecast outturn does not incorporate the secondary dental elements highlighted above therefore if the worst case scenario was to arise this outturn would rise to circa £2m.

The over-performance seen to date (£1,179k) has been funded from reprofiling and delaying investment schemes planned in 2013/14. Therefore the CCG is still forecasting to achieve its planned surplus at year end. The forecast has now been updated to reflect the ‘most likely’ case taking into consideration the level of overperformance on all points of delivery to date together with higher than planned cost of the case mix. However, if activity at the Trust continues to remain high as seen in the first five months of this year, this will place significant pressure on the CCG's financial plan, which could jeopardise the CCG meeting its statutory financial duties.

Central Manchester(CMFT)

Based on month five data the trust is currently overspending by (£56k). Further details of the month five position can be seen in the Table below:


Elective: inpatients and day cases - Plan 1,378 1,557 1,520 1,550 1,478 7,483

Elective: inpatients and day cases - Actual 1,536 1,454 1,441 1,574 1,482 7,487

Difference (158) 103 79 (24) (4) 3

Grand Total -11.5% 6.6% 5.2% -1.5% -0.3% 0.0%


£000's £000's £000's £000's £000's £000's

Elective: inpatients and day cases - Actual 1,649 1,521 1,587 1,660 1,567 7,983

Elective: inpatients and day cases - Plan 1,424 1,600 1,569 1,636 1,527 7,756

Difference (224) 79 (18) (24) (40) (227)

Grand Total -15.7% 5.0% -1.1% -1.5% -2.6% -2.9%

189

6

A number of retrospective adjustments were made to the month 4 SLAM data following recent contract challenges in respect of maternity activity, diagnostic imaging and drug costs. This is due to costs being correctly allocated between CCG and Specialist Commissioning (NHSE).

The Trust has completed a review of the drug spend (based on month 4 data), which has now been shared with CCG's. The review has been used to calculate a forecast outturn based on the revised split of CCG drugs. For Tameside and Glossop CCG it reports a marginal underspend, however for prudency the drugs budget is forecast to break even at the end of the financial year.

Overall forecast outturn (CMFT) - (£100k) overperformance is based on the most likely scenario after adjusting for one off exceptional items.

Salford Royal (SRFT) - is overperforming by (£121k) year to date. Overperformances in HDU (£40k) and ITU

(£130k) offset by an underperformance of £57k in Drugs & Devices.

There is some concern that some of this overspend is because activity which is the responsibility of NHS

England has been incorrectly charged to the CCG. A review is currently underway at the trust to ensure that

specialist commissioning rules are being correctly applied, which we hope will result in the reported pressure

being restated.

Based on the best information available to us (but ignoring the potential impact of specialist review), we are

forecasting an overperformance of (£288k).

Independent Sector - budgets are currently forecast to overspend by approximately (£320k).

We have seen a month on month increase in spend against Any Qualified Provider (AQP) contracts since the start of the financial year. We believe this increase is related to the fact that a number of contracts we not in place on April 1, therefore activity has increased as additional contracts have been implemented and patient choice has increased. AQP makes up a significant proportion of the forecast overspend on independent sector budgets for 13/14 (£232k).

Pressures have also been identified in respect of other independent sector providers e.g. BMI Healthcare (£88k) where we have experienced an increase in activity above planned levels.

The growth seen in independent sector providers in 13/14 is additional activity which has not been offset by a reduction in activity at our main acute providers.

CATS – Utilisation against the CATs contract with Care UK is currently 63.1%, against a guaranteed minimum

payment of 85%.

NCA’s - budgets are currently forecasting an underspend of approximately £600k at the end of the financial year. Following a detailed analysis of all invoices received to date and invoices which are outstanding, expenditure levels are significantly below budgeted levels.

190

7

Mental Health – Month 06

Mental Health - Mental Health budgets are currently (£145k) overspent as at month six and is forecast to overspend of (£361k) at year end. The forecast overspend relates to learning disabilities patients at Calderstones. This is discussed in more detail in the Focus Report.

The funding for section 12 invoices has now been agreed following a meeting with NHS England. It was agreed that £50k would be transferred back to the CCG in 13/14 which was actioned in month 06 via an IAT from NHS England. Total spend at month 06 is approximately £22k and therefore it is assumed this budget will breakeven at year end.

Primary Care – Month 06

GP Prescribing - budgets are forecast to under spend by £211k based on the PPA forecast outturn, after adjusting for income relating to Stockport FT and return of PH England funding. Further detail can be seen below.

At the time of writing this report it has come to light that drug costs relating to public health initiatives are being charged to GP practice budgets. The funding for these drugs was transferred to Public Health England as part of the PCT baseline exercise in 12/13. It has now been agreed that funding of approximately £575k will be transferred to the CCG in month 07, this has been incorporated into the forecast outturn position reported here. Due to the limited time window to report the year to date position to Area Team this amendment could not be reflected in the month 6 position, hence the year to date overspend on Primary Care with a forecast outturn underspend.

Specialist Drugs - given the recent changes in the commissioner landscape its felt that there could be incorrect charging to GP practice budgets. Following a review of specialist drugs carried out by CCG finance and the CCG Medicines Management team there are a number of specialist drugs being charged to GP practice budgets, approximately £67k for the period April to June (£201k full year effect).

However further discussions are required with NHSE as these drugs have been identified through the use of ePACT data. This does not allow identification of the indication (or reason for using) a drug. A number of the drugs identified are commissioned by both CCGs and NHSE, depending on the indication. Further searches are required at practice level to identify specific and indication. It’s unclear what proportion of this activity is attributable to NHSE and therefore for prudency the CCG has not made any changes in relation to specialist drugs.

In line with previous years a key element of the CCGs QIPP plan focuses on utilisation of more cost effective drug choices and the elimination of waste. In 2013/14 it's anticipated there will be further savings relating to drugs now off patent, which is being monitored closely in 2013/14. Early indications would suggest that QIPP schemes are on track and are expected to deliver savings of £750k, however further work is on-going with the Medicines Management Team to review forecast data and potential risks in 13/14.

Central Drugs Overspend

Central drugs are currently overspending by (£113k); with a forecast overspend of approximately by (£191k). There has been a national increase in 'unidentified prescribers' due to the NHS reforms and commissioning boundaries between services changing. Central drugs are charges that include ‘nationally unidentified prescribing’ which means that any prescriptions that cannot be identified to a CCG are recharged back to all CCGs on a weighted capitation split.

It was originally thought that the majority of this increase was due to non-medical prescribers in community services that had changed commissioners. A process has been established and CCGs are required to set up separate codes for non-medical prescribers where a service falls under the responsibility of the CCG. For services with medically prescribed drug costs that have transferred to other commissioners such as the local authority, codes are also required to be set up but may not have been implemented.

191

8

The issue has been raised at the Greater Manchester Deputy CFO's meeting and an urgent update has been requested from NHS BSA in regards to ensuring the new process is implemented as soon as possible.

Continuing Healthcare (CHC) – Month 06

Continuing Healthcare (CHC) - budgets are currently forecasting a breakeven position at the year end. This is following a detailed review completed validating entries at a patient level, which has been completed by GMCSU Finance and the CHC teams. Further work is needed to ascertain whether there is any risk associated with the provision reflected in 2012/13 accounts to manage retrospective claims and whether in year planning provisions are adequate. CHC remains a key strategic focus and will be monitored closely throughout 2013/14.

Running Costs

Based on the ADS registered population adjusted to new ONS13 projections the running costs per head is forecast to be £24.35 for the year end.

The YTD underspend on pay relates to vacancies predominately in the Transformation and Nursing and Quality Directorates.

YTD Budget YTD Actual

YTD

Variance

Annual

Budget

Forecast

Year End

Actual

Forecast Year

End Variance

£000 £000 £000 £000 £000 £000

Running Costs

Allocation 2,905 2,905 0 5,810 5,810 0

Admin Costs

Pay

All CCG staff costs 1,442 1,322 120 2,884 2,737 147

Non Pay

CSU Re-charge 845 845 (0) 1,690 1,690 (0)

NHS Property Services re-charge 225 225 0 450 450 0

Reserves 0 0 0 0 0 0

Other Non Pay 416 451 (35) 786 870 (84)

2,928 2,843 85 5,810 5,746 64

Total included in £25 a head 2,928 2,843 85 5,810 5,746 64

Under /(Over) spend against Allocation (23) 62 85 0 64 64

192

9

QIPP

The delivery of the CCG’s 2013/14 plan requires delivery of savings (QIPP) of £2.0m, the QIPP plan is

summarised in the table below, while further details can be found in Appendix C:

QIPP Work stream 13/14 Plan Forecast Planned Savings at

M5

Actual Savings at

M5

£000s £000s £000s £000s

Level 2

CVD/Stroke/LTC 543 535 39 180

Mental Health 350 350 146 146

Planned Care 212 212 72 33

Urgent Care 45 89 55 96

Sub-total 1,150 1,186 312 455

Level 1

Prescribing 750 750 313 125

Running Costs 100 64 42 85

Sub-total 850 814 354 210

Total 2,000 2,000 666 665

All QIPP schemes have been reviewed over the last month to ensure they are still relevant and fit with the

strategic aims and objectives of the CCG in light of Healthier Together and the integration agenda, while still

allowing for meaningful comparison against plan. As a result of this old schemes have been removed and

new schemes added to the more detailed report at appendix C. This process of review is ongoing and may

result in further evolution of the reported schemes over the coming months.

Financial Risks

Secondary Care expenditure continues to exceed budget. Tameside FT over performance has been funded from reprofiling and delaying investment schemes planned in 2013/14; however this isn’t sustainable going forward. Furthermore if activity levels remain high as seen in quarter one this represents a significant financial risk to the CCG and has the potential to jeopardise its statutory financial duties.

Baseline allocations – further anomalies are identified within baseline allocations. Several issues have already been highlighted within this report around specialist services and as new information is received in year further pressures could be identified. Whilst it is hoped that organisations (e.g. NHS Property Services, NHS England) will be pragmatic in how they resolve any emerging issues this does pose a potential financial risk for the CCG.

Contract Un-weaving - there has been a significant amount of work done to unweave contracts, split budgets between future receiver organisations. However there are an increasing number of challenges in relation to the budgets transferred as part of this exercise, which could present a financial risk going forward.

CHC –there is a risk that the provision reflected in 2012/13 may not be adequate to manage retrospective claims and that in year planning provisions are not adequate.

GP Prescribing – 2013/14 could see increases in some Cat M prices and new drugs coming into the market could prove expensive. Further work is ongoing to analyse current spend and forecast data. We are also working with the medicines management team to forecast the likely impact of any new drugs and horizon scan as far as possible what funding might be required in 13/14.

193

10

Outcomes of the Fundamental Review of Allocations Policy will impact on the distribution of resources between CCG’s nationally. Initial workings from the new allocation formula show that Tameside & Glossop CCG are approximately £8m above the target set by the new formula, resulting in a potential reduction in allocation. This will not impact in 2013/14 and future reductions in allocations are currently expected to phased through a multiyear transition programme. The new formula devised by the Advisory Committee on Resource Allocation (ACRA) is subject to consultation, so figures are indicative at this stage.

Recommendations

Members are asked to note the contents of the report focusing particular attention on the financial risks

detailed above and predominantly the risks associated with the following which is exacerbated by the legal

restrictions on data flows for patient level data:

Tameside FT month 5 over-performance

Specialist Services transfer and gaps in funding

Contract un-weaving challenges

Continuing Healthcare restitution claims

Review of Allocations policy

194

11

Focus on Mental Health

Expenditure in 2013/14

In total the CCG projects expenditure of £26.6m on mental health services in 2013/14 (approximately 8.6% of the

CCG total). Historically the vast majority of mental health spend has been characterised by block contracts. Because

there can be no over or under spend on a block contract mental health has typically received limited attention in

reports to Finance Committee. But it is important to appreciate that not all mental health expenditure falls under

these block contracts, as the pie chart below shows £4.57m is paid on a cost and volume basis and involves the risk

of under or over performance against the contract plan:

Services currently paid on a cost and volume basis include:

Secure placements with private providers

Learning disability placements at Calderstones

GP fees in relation to section 12 assessments

Non contracted/out of area treatment

In total we are currently forecasting to overspend by £361k across these cost and volume services. However spend

is broadly in line with expectation for all services with the exception of Calderstones.

The origins of our current arrangement with Calderstones dates back more than 25 years to the closure of large

institutions that previously cared for patients with mental illness and learning disability. Following the closures there

emerged a cohort of individuals who did not require continued admission to a secure service, but for whom local

services were unable deliver appropriate care packages which provided the enhanced levels of support required.

In response to this need, an Enhanced Support Service (ESS) programme was established to support individuals with

severely complex needs. The service was commissioned by Northwest Specialist Commissioning Team and provided

by Calderstones. There are currently two Tameside and Glossop registered patients being treated under the ESS

programme at Calderstones.

Following the closure of the PCT there was some concern and uncertainty about who would be the responsible

commissioner for these enhanced patients. During budget setting for 2013/14 the CCG did not anticipate that it

would be responsible for funding the care. However, it later transpired that CCGs would need to fund this activity,

hence the full £360k cost for ESS is shown as an overspend against budget. This is a pressure that has been felt

across all Greater Manchester and Lancashire CCGs, with T&G currently funding two beds.

There is also some concern about the ongoing cost of these placements (approximately £180k per patient per year).

Mental Health Commissioners believe that other more cost effective services now exist, which may be suitable for

the ESS patients. Contractual requirements mean that even if an immediate transfer was arranged for a patient, that

the CCG would not receive the financial benefit in 2013/14. But the CCG are actively investigating the use of

Block 83%

Cost & Volume

17%

195

12

clinically appropriate lower cost pleacements from April 2014. There is a collaborative piece of work being carried

out across GM to consider the needs of 90+ individuals from across GM who may benefit from this type of provision.

Mental Health Finances for 2014/15 and Beyond

2014/15 will see the proportion of mental health activity paid for under block contract further decrease, as a new

regime for funding mental health is implemented. This new ‘Payment by Results’ approach will use care clusters as

the basis for payment for most mental health services for working age adults and older people.

We currently estimate that approximately 84% of our contract with Pennine Care will be in scope for the purposes of

PbR, block contracts will remain in place for services excluded from the scope of PbR:

In Scope Out of Scope

Working Age Adults

Older People Children treated in specialist

adult mental health service (e.g. early intervention).

Substance misuse Learning Disability Liaison Psychiatry Acquired Brain Injury Improving access to psychological therapies (IAPT) High, medium and low secure mental health services Child and Adolescent Mental Health Services (CAMHS) Mental health services provided under a GP contract (GMS,

PMS, etc).

High level objectives for PbR in mental health are to:

Improve clarity for service users and carers about what they can expect from the service and the outcomes

they can achieve

Facilitate an understanding of clinical processes between commissioners and providers, and between

clinicians and service managers

Incentivise both commissioners and providers to deliver effective, efficient and equitable models of

treatment and care

Distribute the burden of financial risk fairly between commissioners and providers

To deliver this vision 21 cluster groups have been developed which reflect patient need over specific periods of time

that range from four weeks to 12 months:

196

13

A key difference in mental health PbR (when compared to acute PbR) is that payment is based on level of need

rather than treatment received. A provider would be reimbursed at the same level for two patients with comparable

need, despite the fact patient A is treated as an inpatient, while patient B is treated as an outpatient. This is

designed to counter some of the key criticisms of acute PbR, balancing the risks between commissioners and

providers while incentivising effective and efficient treatment closer to home. Commissioners do not have to pay

extra for each contact or intervention, while providers know they will be paid for each patient they care for and they

also have an incentive to innovate and support the patient in the most cost effective setting.

The practicalities of payment will involve local agreement of a ‘cluster day’ price for each of the 21 clusters while

developing new ways to focus on quality and outcomes. While earlier visions for PbR envisaged the swift

introduction of a mandated national tariff, this is no longer the case. Rather the use of clusters in contracting will be

mandated from 2014/15, but prices will be subject to local negotiation both in 14/15 and for the foreseeable future.

In order to provide continuity of service to patients and financial stability to providers during this period of

transition, a decision has been made at Greater Manchester level to protect provider income during 2014/15 and

2015/16. The principles of cost and volume will be maintained during this period but in the event of significant

activity changes (either growth or reductions), adjustments will be made to ensure the financial positions of both

providers and commissioners (as a collective group) are not negatively impacted.

While this principle of financial stability is agreed at high level, it is inevitable that amongst individual commissioners

the move from historic block contracts to payment based on actual activity will have a financial impact. The

agreement goes on to state that negative financial risk for an individual CCG in any one year will be capped at £250k.

For gaining CCGs the maximum benefit is limited only by available funds released by loosing CCGs. While the precise

calculated effect is not yet available, we currently expect that T&G will be one of the gaining CCGs in this process.

This anticipated benefit has been factored into future QIPP and integration forecasts.

Driving this change across Greater Manchester is a mental health steering group (chaired by Tracey Simpson) which

brings together providers and commissioners to implement PbR across the local health economy.

197

14

Appendix A – Financial Position at Practice Level Month 5 (August) 2013/14

198

15

Appendix B Contract Performance – Finance & Activity – M5 SLAM

199

Appendix C - 2013/14 QIPP Monitoring Report

QIPP Saving £ Apr 13 May 13 Jun 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Feb 14 Mar 14 YTD Outturn

Budget -8 -8 -8 -8 -8 -9 -8 -8 -8 -8 -41 -98

Actual/Forecast -9 0 0 0 -8 -9 -8 -8 -8 -40 -9 -98

Variance -1 8 8 8 0 0 0 0 0 -32 32 0

Proposal Q I P Long Term Conditions

Activity

Progress Risk to Delivery


Budget -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -4 -10

Actual/Forecast -8 -31 -38 -63 -1 -1 -1 -1 -1 -1 -171 -177

Variance -7 -30 -37 -62 0 0 0 0 0 0 -167 -167


Activity

August 2013C

ard

iolo

gy

FU

P f

oll

ow

ing

pa

tie

nt

rev

iew Jul 13 Jan 14

-9 -8

0 -8

9 0

PClinical Risk Implementation Risk

GP review of all patients treated under cardiology at Tameside FT was conducted during 2012/13. This resulted in

over 600 patients being transferred back to primary care. As a result of this a 20% reduction in the volume of

cardiology outpatient follow-ups is anticipated Financial RiskPatient Experience

Risk

April data showed a significant reduction in the number

of follow up appointments. But this has not been

sustained more recently with activity still being reported

in excess of plan on a YTD basis.

Stage 2 of the project was to review those patients

potentially eligible for review pending diagnostics and

cardiologist input which was in progress at the time of

the November review. Also plans to check FT reports to

ensure any patients discharged through the first stage

haven't returned into secondary care. Not able to do so

at the moment given current restrictions on access to

patient identifiable data

Re

du

ced

Ca

rdio

log

y R

efe

rra

ls Jul 13 Jan 14

-1

Clinical Risk Implementation Risk

-1

-31 -1

-30 0

P

Reduction in the number of first attendances at Tameside FT of 2%. To be achieved via cardiology clinical lead's

work with the FT clinicians on:

- Syncope (building on work done to date)

- Heart Failure

- Development of rapid access cardiology pathways – intention to pilot with one locality, review outcomes, and take

Financial RiskPatient Experience

Risk

Cardiology OPFUP - TFT

0

100

200

300

400

500

600

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4

Activity Plan Activity Actual

Activity



Budget 0 0 20 -11 -11 0 0 0 0 0 -2 -13

Actual/Forecast 0 0 0 0 20 -15 -15 -15 0 0 0 -40

Variance 0 0 -20 11 31 -15 -15 -15 0 0 2 -27


Activity


Re

du

ced

Ca

rdio

log

y R

efe

rra

ls

- Development of rapid access cardiology pathways – intention to pilot with one locality, review outcomes, and take

forward as CCG wide project if successful. Already have agreement from TFT

YTD planned activity to July was for 1,735 cardiology first

attendances (broken down as 1,017 regular and 719 one

stop shop attendances). We actually saw 1,374

attendances (900 regular, 474 one stop), so 20.8% less

than plan, but as one stop shop is charged at a premium

the financial savings are slightly larger (24.9%). Dr Jones

is scheduled to present proposals for the next phase of

the cardiology project to October locality meetings.

We need to gather further evidence from future months

to determine if the under performance against plan is

part of a trend or an anomaly in the data.

Dia

be

tic

Me

dic

ine

Pa

tie

nt

Re

vie

w Jul 13 Jan 14

-12 0

0 -15

12 -15

Clinical Risk Implementation RiskGP review (funded at £30 per patient) of all patients currently being treated by the diabetic medicine team at

Tameside FT to determine whether or not it is appropriate for the patient to remain under the care of a consultant

in secondary care, or if they can be discharged back into primary care. This follows a similar review in cardiology

during 12/13 which saw 19% of patients discharged back to the GP. This review of diabetes precedes the

commissioning of a new diabetes service to ensure only appropriate patients are transferred over.


Risk

Caseload review delayed - aim to commence September

and complete by end October to ensure "validation" of

the specialist caseload is in line with the timescales for

the implementation of the new service. There was

significant reduction in activity during August, but as the

caseload review had not started the reduction cannot be

connected to QIPP.

Because of slippage in the decommissioning of the

diabetes service the effects of this patient review will be

longer lasting than originally envisaged. Also need to

revised the process given regulations around section

251

P

Cardiology OPFA - TFT

Diabetes OPFUP - TFT

0

100

200

300

400

500

600

700

800A

pr

12

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4Activity Plan Activity Actual

0

50

100

150

200

250

300

350

400

450

Ap

r 1

2

Jul 1

2

Oct

12

Jan

13

Ap

r 1

3

Jul 1

3

Oct

13

Jan

14

Activity Plan Activity Actualconnected to QIPP. Ap

r 1

2

Jul 1

2

Oct

12

Jan

13

Ap

r 1

3

Jul 1

3

Oct

13

Jan

14


200


Budget 0 0 0 0 0 -51 -45 -42 -42 -45 0 -273

Actual/Forecast 0 0 0 0 0 0 0 0 -42 -45 0 -87

Variance 0 0 0 0 0 51 45 42 0 0 0 186


Activity Diabetes Outpatients - TFT



Budget 0 0 20 -5 -5 -6 -5 -5 -5 -5 9 -29

Actual/Forecast 0 0 0 0 20 -6 -5 -5 -5 -5 0 -12

Variance 0 0 -20 5 25 0 0 0 0 0 -9 17


Activity Respiratory Medicine OPFUP - TFT

De

com

mis

sio

n D

iab

eti

c M

ed

icin

e f

rom

M7 Jul 13 Jan 14

0 -48

0 0

0

Re

spir

ato

ry M

ed

icin

e C

ase

loa

d R

ev

iew Jul 13 Jan 14

-6 -6

0 -6

6 0


GP review (funded at £30 per patient) of all patients currently being treated by the respiratory medicine team at

Tameside FT to determine whether or not it is appropriate for the patient to remain under the care of a consultant

in secondary care, or if they can be discharged back into primary care. This follows a similar review in cardiology

during 12/13 which saw 19% of patients discharged back to the GP. This review of respiratory medicine precedes

the commissioning of a new diabetes service to ensure only appropriate patients are transferred over.


Risk

48


Decommission diabetic medicine services in secondary care and in the community. Go to tender to reprocure new

integrated service


Risk

Slippage in procurement, savings now anticipated from

February onwards.

Procurement completed. Recommendation re outcome

to be presented for approval to Governing Body 3rd

October. On target for service "go live" first week of

February.

No further delays or risks to delivery to report at this

stage.

0

100

200

300

400

500

600

Ap

r 1

2

Jul 1

2

Oct

12

Jan

13

Ap

r 1

3

Jul 1

3

Oct

13

Jan

14


Activity Respiratory Medicine OPFUP - TFT



Budget 0 0 0 0 0 -17 -17 -17 -17 -17 0 -100

Actual/Forecast 0 0 0 0 0 -17 -17 -17 -17 -17 0 -100

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity


Te

leh

ea

lth Jul 13 Jan 14

0 -17

0 -17

Re

spir

ato

ry M

ed

icin

e C

ase

loa

d R

ev

iew

the commissioning of a new diabetes service to ensure only appropriate patients are transferred over.

Caseload review to commence in September / October Change in process required due to impact of section 251

0


Expansion of telehealth scheme


Risk

No savings anticipated until Q3. Business case for

additional equipment to support expansion of telehealth

via QOF QP to be presented to PIQ in October

No risk to delivery of current service, but potential risk

to delivery of full potential via QOF QP if business case

not supported

0

Respiratory System Emergency

Admissions

0

100

200

300

400

500

600

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1


0

50

100

150

200

250

300

350

400

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4

0

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4


201


Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity



Budget -8 -8 -7 -8 -8 -8 -8 -7 -7 -8 -39 -94

Actual/Forecast 0 0 0 0 0 0 0 0 0 0 0 -94

Variance 8 8 7 8 8 8 8 7 7 8 39 0

Proposal Q I P Planned Care

Activity

Clinical Risk Implementation Risk4.2% of patients aged 65+ who attend A&E at Salford are admitted and go on to die in hospital. This figure is higher

(5.3%) at Tameside. If we were able to reduce admission to the Salford average 174 admissions could be prevented,

saving £600k Financial RiskPatient Experience

Risk

Death In Hospital

Tameside FT. All Specialties. Number patient who die

in hospital

En

d o

f Li

fe -

Re

du

cin

g D

ea

ths

in H

osp

ita

lJul 13 Jan 14

0 -3

0 -3

0 0

P

Intr

ah

osp

ita

l R

efe

rra

l/F

oll

ow

Up

Pro

toco

ls Jul 13 Jan 14

-8 -8

0 -94

8 -86

First/Follow up Ratios - TFT


Continuation of protocols from 12/13 & 13/14 Contract includes thresholds for FU ratios and C2C referrals.

FU- If in any quarter the THFT FU ratio exceeds North West Average at speciality level the trust must undertake a

review of the appropriate specialities and provide the CCG with an explanation and an action plan to bring the ratio

back in line.

C2C-Any month with >150 consultant referrals where referring consultant and referred to consultant are the same


Risk

0 50 100 150

September

November

January

March

May

July

12

/13

13

/14

Activity



Budget -6 -6 -6 -6 -6 -7 -6 -6 -6 -6 -33 -78

Actual/Forecast -6 -6 -6 -6 -6 -7 -6 -6 -6 -6 -33 -78

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity LCVI Procedures - All Providers


Low

Cli

nic

al

Va

lue Jul 13 Jan 14

-7 -7

-7 -7

0 0

P

Intr

ah

osp

ita

l R

efe

rra

l/F

oll

ow

Up

Pro

toco

ls

Clinical Risk Implementation RiskContinuation of 12/13 reduction in the number of referrals and procedures of low clinical value.

Threshold n 2013/14 THFT Contract so if in any Quarter there are more than the specified level of procedures for

any LCVI Policy the Trust and CCG must undertake a review to identify the explanation and agree a joint action plan

to show how the level of referrals will be reduced.

Qly values Carpal Tunnel-50, Circumcision-32, D&C under 40 – Hysteroscopy-19,Excision of skin lesions- 222,

Hysterectomy-31, Lumbar Spine-135, Myringotomy -35, Tonsillectomy-50,Varicose Veins-24.

GPs are asked to ensure referrals go through EUR procedure before sending to the provider


Risk

GPs have been reminded of procedures that fall under

the Effective Use of Resources protocols that are

considered to have Low Clinical Value and have been

requested to get prior approval BEFORE referring.

Activity across all providers is above plan in all except

Skin Lesions and Circumcision. In total at month 4 we are

6% above plan overall but 24% if exclude reductions in

If GPs refer without going through EUR process

additional activity may be undertaken.

Current activity levels suggest we have spent an average

of £200K more than planned in 4 months in LCVI

procedures.

First/Follow up Ratios - TFTC2C-Any month with >150 consultant referrals where referring consultant and referred to consultant are the same

person and/or >330 consultant referrals where referring consultant and referred to consultant are not the same

person but in the same speciality and/or >345 consultant non 2 WW referrals where referring consultant and

referred to consultant are in different specialities the trust must review and provide an explanation and action plan

to reduce referrals

Tameside FT. All Specialties. Number of follow up

attendances per first

C2C- Level remains above threshold. THFT have identified Non-

Elec activity is a significant driver of C2C. Clinical Audit agreed

for Pain Management, Obsterics, Gastroenterology and

Vascular Surgery with results available Jan. Financial

adjustment may occur where the protocol is not being adhered

to.

FU- YTD ratios above NW in 12 of the 35 monitored functions.

General surgery , General medicine and Clinical Haematology

are areas of key concern.

Financial benefit from reduced tariff for same speciality

C2C outweighed by additional activity.

Adherence to thresholds will be reinforced through

contract management to reduce additional activity.

without the protocol we would have paid FA for 4993

referrals instead of the FU. But these savings have been

swallowed up through the above plan C2C activity which

is also above 12/13 monthly average.

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4

0 100 200

September

November

January

March

May

July

12

/13

13

/14

Other Tameside FT

6% above plan overall but 24% if exclude reductions in

skin and circumcision activity. 0 100 200

September

Other Tameside FT

202


Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity CATs Utilisation



Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity Dermatology Outpatients - TFT

CA

Ts Jul 13 Jan 14

0

De

rma

tolo

gy Jul 13 Jan 14

0

Clinical Risk Implementation RiskTo ensure CATS contract is used appropriately and best use is made of the 'block funding' arrangement.

GPs follow guidelines on when most appropriate to refer to CATS


Risk

New guidelines issued to support GPs in deciding when

to refer to CATS.

Reports being developed that link to cost effectiveness

not just activity levels.

Overall CATs utilisation has fallen beneath the 85%

minimum payment threshold in the early part of

2013/14. Options for ensuring services available offer

value for money are being explored.

GPs refer to CATS when would be more cost effective to

manage in Primary Care or through Direct Access

Diagnostics.

GPs refer to Acute Trusts when CATS would be more

cost effective

-3

0 -3

0 0

P

Clinical Risk Implementation RiskIncreased use of Dermatology Nurse Service for Eczema, Psoriasis, Acne and Viral Warts (for cryotherapy).

Primary Care based Low Risk BCC service.

Increased delivery in community where cost effective to do so.

Payment of OP Procedure tariff instead a local daycase tariff - this accounts for the financial impactFinancial Risk

Patient Experience

Risk

-3

0 -3

0 0

P

0%

20%

40%

60%

80%

100%

120%

140%

160%

180%

Ap

r 1

2

Jul 1

2

Oct

12

Jan

13

Ap

r 1

3

Jul 1

3

Oct

13

Jan

14

Utilisation Guaranteed Minimum

Activity Dermatology Outpatients - TFT



Budget -11 -11 -11 -11 -11 -11 -11 -11 -10 -11 -55 -132

Actual/Forecast -11 -11 -11 -11 -11 -11 -11 -11 -10 -11 -55 -132

Variance 0 0 0 0 0 0 0 0 0 0 0 0

Proposal Q I P Urgent Care

Activity Excess Bed Days - TFT


Inte

rme

dia

te C

are Jul 13 Jan 14

-11

GPs are asked to refer directly to the Dermatology Nurses when appropriate and to use Primary Care services

where appropriate

Unable to gain agreement between Finance departments

on Dermatology Nurse Tariff

Low Risk BCC service final agreement pending

THFT being encouraged to make service changes

Failure to agree nurse tariff may result in less effective

use of nurses

Limited availability of Low Risk BCC service may reduce

cost saving through reduced tariff

Payment of OP tariff has been linked to Ophthalmology

procurement which is delayed

Clinical Risk Implementation RiskA new 40 bed intermediate care facility opened in November 2012. Which will reduce the number of excess bed

days. Current review of all intermediate care inpatient facilities to be completed by end December 2013.


Risk

Payment of emergency excess bed days at Tameside FT

have been wrapped up as part of our local approach to

managing and paying for medically fit patients. As such

achievement of the financial target associate with this

QIPP indicator is guaranteed.

-11

-11 -11

0 0

P

500

600

700

800

900

1,000

1,100

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1


0

500

1,000

1,500

2,000

2,500

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4


Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4


203


Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast -41 0 0 0 0 0 0 0 -3 -3 -41 -51

Variance -41 0 0 0 0 3 3 3 0 0 -41 -31


Activity Fragility Hip Fracture - TFT



Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity A&E Attendances - TFT

Pri

ma

ry c

are

ca

pa

city

an

d d

em

an

d w

ork

Jul 13 Jan 14

0

Fa

lls

serv

ice

Jul 13 Jan 14

0

Clinical Risk Implementation RiskImplement new falls prevention service in conjunction with Local Authority. Funding to Local Authority has been

ring fenced for 3 years, with an expectation that falls and resultant admissions can be avoided once service is

embedded. Financial RiskPatient Experience

Risk

Slippage on implementation of integrated falls service

which will be reconfigured relative to the original

specification, with a changed role for CARA being. While

this may delay PbR savings, slippage of our April

contribution to the new service represents a legitimate

spend reduction for 13/14.

-3

0 -3

0 0

P

Clinical Risk Implementation RiskTHIS WORK IS BEING RESCOPED


Risk

-3

0 -3

0 0

P

0

5

10

15

20

25

30

35

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4


Activity A&E Attendances - TFT



Budget 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Actual/Forecast 0 0 0 0 0 -3 -3 -3 -3 -3 0 -20

Variance 0 0 0 0 0 0 0 0 0 0 0 0


Activity Emergency Admissions - TFT


IRIS Jul 13 Jan 14

0

Pri

ma

ry c

are

ca

pa

city

an

d d

em

an

d w

ork

Clinical Risk Implementation RiskIRIS now in operation to deliver crisis intervention from health and social care for 8 specific pathways. Metrics and

evaluation measures in place and will be included in this report from October 2013 to indicate intended impact on

secondary care admissions Financial RiskPatient Experience

Risk

Service went live 2nd September 2013 - more detail to be

added to this report from October 2013

-3

0 -3

0 0

P

4,000

4,500

5,000

5,500

6,000

6,500

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1


1,000

1,100

1,200

1,300

1,400

1,500

1,600

1,700

1,800

1,900

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4

1,000

Ap

r 1

2

Jun

12

Au

g 1

2

Oct

12

De

c 1

2

Fe

b 1

3

Ap

r 1

3

Jun

13

Au

g 1

3

Oct

13

De

c 1

3

Fe

b 1

4


204


Budget 0 0 0 0 0 25 25 25 25 25 0 147

Actual/Forecast 0 0 0 0 0 0 0 0 0 134 0 134

Variance 0 0 0 0 0 -25 -25 -25 -25 109 0 -13


Activity



Budget -29 -29 -29 -29 -29 -29 -29 -29 -29 -29 -146 -350

Actual/Forecast -29 -29 -29 -29 -29 -29 -29 -29 -29 -29 -146 -350

Variance 0 0 0 0 0 0 0 0 0 0 0 0

Proposal Q I P Mental Health

Activity

Me

nta

l H

ea

lth

Sto

ckta

ke Jul 13 Jan 14

-29

Inte

gra

tio

n A

ge

nd

a Jul 13 Jan 14

0

Clinical Risk Implementation RiskTO BE REVIEWED


Risk

25

0 0

0 -25

P

Clinical Risk Implementation RiskStage two of the stocktake exercise intended to bring actual spend on the Pennine Care contract more into line with

actual usage.


Risk

-29

-29 -29

0 0

P

Activity



Budget -63 -63 -63 -63 -63 -63 -63 -63 -63 -63 -313 -750

Actual/Forecast -63 -63 0 0 -89 -89 -89 -89 -89 -89 -125 -750

Variance 0 0 63 63 -27 -27 -27 -27 -27 -27 188 0

Proposal Q I P Prescribing

Activity


GP

pre

scri

bin

g Jul 13 Jan 14

-63

Pennine Care is paid on a block contract. The £350k

efficiency is built into our agreed block, therefore the

QIPP saving for 13/14 is guaranteed.

Clinical Risk Implementation Risk There are a number of strands to this years QIPP. Working on key switching and discontinuation prorammes. E.g.

Omacor, ED meds, Cilostazol, GMMMG branded basket. Retreiving the harm reduction monies given to TMBC.

There are much lower scale genericisations compared to the last couple of years however there are a couple of

moderate generics savings. There has, at national level, been an over paying of pharmacies against their guaranteed

purchasing profits programme. In this case there will be some monies coming back into CCGs in the last part of the

year. The MMT will be working with practices to address the issue of waste caused by community pharmacy

ordering on behalf of patients.


Risk

At the moment after netting off Stockport Community re-charge and adding in

the PH funding we are preducted as underspending by £211,000. We have a QIPP

target of £750,000. The cat M adjustments for over paying of pharmacies against

their guaranteed purchasing profits programme should see us recoup £180,000.A

range of other switches and genericisations should recoup £270,000. This should

but us within £80,000 of achieving our QIPP. To help bridge this final gap we have

6 months worth of work against community pharmacy waste ordering. Whilst it is

very difficult to put an exact figue on this value if we can get enough practices

actively participating we should make the QIPP target.

Biggest risks are reduced staff availability. One tech on

mat leave. The pharmacy ordering issue is a big subject

to tackle and turn around. It won't be finished this year

but will give knock on benefit into future years. Lack of

engagement of practices this year in achieving financial

savings..

-63

0 -89

63 -27

P

205


Budget -8 -8 -8 -8 -8 -8 -8 -8 -8 -8 -42 -100

Actual/Forecast -8 -8 -17 22 0 0 0 0 0 21 -85 -64

Variance 0 0 -9 30 8 8 8 8 8 29 -43 36

Proposal Q I P Running Costs

Activity


Inte

rna

l E

ffic

ien

cie

s Jul 13 Jan 14

-8

Clinical Risk Implementation RiskSavings against running costs budgets


Risk

Based on the ADS registered population adjusted to new

ONS13 projections the running costs per head is forecast

to be £24.51 for the year end.

The YTD underspend on pay relates to vacancies

predominately in the Transformation and Nursing

Directorates.

Pressures relating to £25k Urgent Care consultant and

£9k NW Leadership Academy costs, which will be

funded from reserves.

-8

-73 0

-65 8

P

206

QIP

P S

um

ma

ry R

ep

ort

Pla

nA

ctu

al

Va

ria

nce

Pla

nO

utt

urn

Va

ria

nce

Lon

g T

erm

Co

nd

itio

ns

-39

-18

0-1

41

-52

3-5

15

9

Ca

rdio

log

y F

UP

fo

llo

win

g p

ati

en

t re

vie

w-4

1-9

32

-98

-98

03

5G

35

35

G3

53

5G

35

35

G3

5

Re

du

ced

Ca

rdio

log

y R

efe

rra

ls-4

-17

1-1

67

-10

-17

7-1

67

35

G3

53

5G

35

35

G3

53

5G

35

Dia

be

tic

Me

dic

ine

Pa

tie

nt

Re

vie

w-2

02

-13

-40

-27

35

G3

54

4A

44

44

A4

43

5G

35

De

com

mis

sio

n D

iab

eti

c M

ed

icin

e f

rom

M7

00

0-2

73

-87

18

63

5G

35

3R

33

R3

35

G3

5

Re

spir

ato

ry M

ed

icin

e C

ase

loa

d R

ev

iew

90

-9-2

9-1

21

73

5G

35

44

A4

44

4A

44

35

G3

5

Te

leh

ea

lth

00

0-1

00

-10

00

35

G3

54

4A

44

44

A4

43

5G

35

En

d o

f Li

fe -

Re

du

cin

g D

ea

ths

in H

osp

ita

l0

00

-20

-20

03

5G

35

44

A4

44

4A

44

35

G3

5

Pla

nn

ed

Ca

re-7

2-3

33

9-2

12

-21

20

Intr

ah

osp

ita

l R

efe

rra

l/F

oll

ow

Up

Pro

toco

ls-3

90

39

-94

-94

03

5G

35

44

A4

44

4A

44

35

G3

5

Low

Cli

nic

al

Va

lue

-33

-33

0-7

8-7

80

35

G3

54

4A

44

44

A4

43

5G

35

CA

Ts

00

0-2

0-2

00

35

G3

53

5G

35

44

A4

43

5G

35

De

rma

tolo

gy

00

0-2

0-2

00

35

G3

53

5G

35

35

G3

53

5G

35

Urg

en

t C

are

-55

-96

-41

-45

-89

-44

Inte

rme

dia

te C

are

-55

-55

0-1

32

-13

20

35

G3

53

5G

35

35

G3

53

5G

35

Fa

lls

serv

ice

0

-41

-41

-20

-51

-31

35

G3

53

R3

35

G3

53

5G

35

Pri

ma

ry c

are

ca

pa

city

an

d d

em

an

d w

ork

0

00

-20

-20

03

5G

35

44

A4

44

4A

44

35

G3

5

IRIS

00

0-2

0-2

00

35

G3

53

5G

35

44

A4

43

5G

35

Inte

gra

tio

n A

ge

nd

a0

00

14

71

34

-13

35

G3

54

4A

44

44

A4

43

5G

35

Me

nta

l H

ea

lth

-14

6-1

46

0-3

50

-35

00

Su

mm

ary

by

QIP

P W

ork

stre

am

£0

00

's

Au

gu

st 2

01

3

Ye

ar

to D

ate

Fo

reca

st O

utt

urn

Imp

lem

en

tati

on

Cli

nic

al

Fin

an

cia

lP

ati

en

t E

xp

eri

en

ce

Ris

k

Me

nta

l H

ea

lth

-14

6-1

46

0-3

50

-35

00

Me

nta

l H

ea

lth

Sto

ckta

ke

-14

6-1

46

0-3

50

-35

00

35

G3

53

5G

35

35

G3

53

5G

35

Pre

scri

bin

g-3

13

-12

51

88

-75

0-7

50

0

GP

pre

scri

bin

g-3

13

-12

51

88

-75

0-7

50

03

5G

35

35

G3

54

4A

44

35

G3

5

Ru

nn

ing

Co

sts

-42

-85

-43

-10

0-6

43

6

Inte

rna

l E

ffic

ien

cie

s-4

2-8

5-4

3-1

00

-64

36

35

G3

54

4A

44

44

A4

43

5G

35

-66

6-6

65

1-2

,00

0-2

,00

00

207


Title of Subject:

Minutes of the Integrated Governance & Risk

Committee

Date of paper:

2 October 2013

Prepared By:

Graham Curtis / Kathy Roe

History of paper:

Executive Summary:

This paper provides an update to the Governing Body

of discussions which have taken place at the

Integrated Governance and Risk Committee.




or Decision)

To note contents


by proposal:

Yes


Graham Curtis / Kathy Roe

208

1

NHS TAMESIDE & GLOSSOP CCG

INTEGRATED GOVERNANCE AUDIT & RISK COMMITTEE

2 October 2013

PRESENT Graham Curtis – Chair

Yvonne Pritchard – Lay Advisor

Celia Poole – Lay Member

Mark Heap – External Audit

Gareth Mills – External Audit

David Swift – Internal Audit

Dr Richard Bircher – Governing Body GP

Clare Symons – Governing Body Nurse

IN ATTENDANCE Dr Jamie Douglas – Governing Body Member

Kathy Roe – CFO

David Walsh – Financial Consultant

Stephen Beswick – Head of Finance – Locality Support Manager

David Milner – Head of Finance – Commissioning Analyst

Mark Simon – Head of Governance, Risk & Complaints

Clare Watson – Director of Transformation

Paul Hague – IG Lead, GM CSU

Joanne Keast – Admin Support

GC welcomed Gareth Mills to his first meeting of IGAR and everyone

introduced themselves.

GC also highlighted that the format of the meeting had been changed and

asked members to let JK know their views before he makes a final decision for

the future.

Action: All

1. Apologies

Steve Allinson – Chief Operating Officer

Beric Dawson – Local Counter Fraud Specialist. The Committee wished

him well with his interview taking place at the same time as this meeting.

2. Minutes of Previous Meeting held on 7 August 2013

Approved as a correct record.

3. Matters Arising / actions

Item No 2 – Strategic & Financial Plan Presentation

It was noted that the slides of the presentation has been circulated as

requested, although the financial model was more difficult to circulate.

Members were asked to contact JK if they still required a copy.

Item No 3 – Corporate Risk Register

All issues to be picked up under the agenda item No 13.

209

2

Item No 15 – CSU Assurance

JK reported that there is no staff survey planned for CCG staff as

present, although this is being looked into by HR. JK also reported that

she has spoke with Edna Gibson regarding attendance at the

December IGAR meeting to present the HR report.


GC reported that members would be asked at this point in all future

meetings if they have anything to declare and also throughout the

meeting note if anyone has anything further to note.

No further declarations were made.

5. Training Reports from Committee Members

Members attended the Governing Body Development Day which focused

on Board Finance. CP was unable to attend this event, GC therefore

agreed to forward his notes.

Action: GC

6. PCT Reports

6.1 Losses & Special Payment Register – no updates

6.2 Register of Waivers – no updates

6.3 Register of Interests – no further updates to note. CP asked for

her entry to be amended

Action: JK

6.4 Gifts and Hospitality – no updates.

7. Counter Fraud

No updates to note.

8. Internal Audit

DW presented the progress report. Within the first half of the year 3

completed audits giving significant assurance were issued. He re-

assured the committee that his review of the Constitution where

assurance was given showed that T&G CCG are ahead of the game in

this area and noted the good work being undertaken. It was noted

however that not all practices have signed upto the Constitution and

these would be chased up as a matter or urgency within the CCG. CP

asked about the consequences of not signing up, DS reported that

potentially GMS payments could be taken from them. He also

highlighted that having said we are ahead of the game; we are the only

CCG whose GPs are not fully signed up. It was felt that Alan Dow /

Richard Bircher need to pick this issue up on a peer to peer basis.

Particular issues relating to one of the practices and is being followed up

separately but the others will be investigated.

Action: MS to take forward with Alan Dow / Richard Bircher

210

3

DS reported that he will continue to liaise with GMCSU Auditors but is not

anticipating any gaps.

With regards ANW, DS reported that interview were taking place as we

speak to staff applying for jobs; he reported that he had his interview

yesterday and unfortunately was not appointed. He reported that he

will work his notice and has offered to cover the extra 2 months to the

end of the financial year but no decision has yet been made on this.

GC offered to support this offer and write to the appropriate person at

ANW if necessary. DS thanked GC for his offer.

9. External Audit

Fee Letter

GM presented fee letter which had previously been agreed with the CFO.

The fee of £77k including uplift was presented and a breakdown of how

the fees are calculated was included. It was highlighted that the fee

process is set outside of the CCG and Auditors, although it was noted that

this may change in the future.

The fee was noted by the Committee.

Progress Report

GM presented the progress report and started by explaining that the

Audit letter will not officially be presented to the CCG as it related to the

PCT. The next one for the CCG will be issued in June / July next year. He

explained the workplan for the year highlighting the fee letter,

managing conflicts of interest presentation, planning work, accounts

etc. He also explained that this report summaries emerging national

issues and developments relevant to the CCG and includes some

challenging questions in respect of those issues for the Committee to

consider.

A discussion took place around those emerging issues and the discussion

which need to take place between the CCG and GMCSU. Issues

relating to;

The transfer of closing / opening balances

Legacy issues

Assets or liability issues etc

Levels of responsibility between CCG and GMCSU, who is going

to do the work and give the re-assurance

Should a GMCSU rep be invited to attend this meeting in future.

DW felt that towards the end of the year it was probably be a

good idea but gave re-assurance that ongoing discussion are

with CSU staff.

It was noted that the Area Team is being asked to give assurance on

legacy issues. DW reported that Ros Slocombe who used to work with us

on closedown issues is now working with the Area Team on Legacy issues

and it might be a good idea to invite her to a future meeting to give that

assurance needed. It was noted that the deadline has been extended

again and could even move to the end of the year.

211

4

Other issues highlighted related to updating NHS Constitution,

Safeguarding issues and Putting Patients First: NHS England Business Plan

2013-14 - 2015/16.

The report was noted by the Committee.

10. CSU Assurance

DW reported on work so far and what we are trying to do in so far as

gaining assurance on the finance product we lead on for the 5 buying

CCG. It was noted that a CSU representative be invited to attend future

IGAR meetings to give the Committee the assurance it needs that the

work / process in place.

Action: JK / DW

KR reported on the process of assurance. She explained that each

month the CCG are asked to score each product. The scores are

discussed / decided at CMT before being presented to the CSU

Assurance Group and onto the Chief Operating Officers meeting where a

review of all overall scores taken place. If scores have significant

changed or issues have been raised it has been agreed that a working

group will be set up to look at the issues and investigate appropriately.

The Committee requested that the scores be presented to this committee

on a regular basis.

Action: JK for agenda

As we lead on the finance product, a regular report is produced for the

other buying CCGs. The next report is due by the end of October and will

be presented to the Finance Assurance Working Group that meets every

2 weeks, Chaired by T&G CCG. KR also reported on a workshop taking

place on 14 October which is the starting point of looking at what we

may want to buy in the future and to look at tendering process etc. T&G

CCG need to start to think about the products we buy and the length of

contract. It was noted that we are committed to an 18 months contract

with the GMCSU which can be extended until March 2015. CW reported

that we are currently waiting for National Provider Framework Contract

Information before we make too many decisions but this is not time lined

well.

KR spoke about the extension to the Internal Audit contract for a further

12 months, the process around tendering and the merger between ANW

and Mersey Internal Audit Services. It was agreed that KR and GC would

speak outside of this meeting regarding the details and report back to

the next meeting.

Action: KR / GC


No further business was raised.

12. Date and Time of Next Meeting

Wednesday 4 December 2013 at 9.30 am in the Boardroom, NCH

RISK - External Auditors left the meeting

212

5

13. Corporate Risk Register

MS presented the risk register and highlighted 11 high level risks, which is

one down from the August review. He also highlighted that he had met

with GC outside of this meeting to review the register.

The high levels risk noted were:

IM&T53 Number of obsolete desktop PC and Laptops across the PCT

This has been reduced from high level. The issue has been

wrapped up with contracts moving. A further meeting has

been set up to look further into the remaining issues. Agreed to

reduction.

PHHS12 Unscheduled Care systems

PP45 Rise in unscheduled admissions to acute sector

PP53 Failure of target of 5% initial assessment target of 15 mins…..

PP55 A&E 4 hour performance

Elaine Richardson has supplied self explanatory explanations to

all of these issues. IT was noted that TFT have achieved targets

in Q2 and can now focus on maintaining this. It is also felt that

the spotlight will increase on these areas due to the new A&E

monies.

The Committee noted and accepted these as high risk

PP60 Achieving all KPI and Quality Measures relating to urgent care...

This has been widened to include Keogh, therefore agreed to

keep as high risk

FO9 Secondary Care Performance

There is a tight financial position which we need to monitor.

Meetings are being held on a regular basis. Agreed to keep on

red risk.

PH103/107 Risk of T&G CCG population acquiring CDiff infection

Currently CDiff is on trajectory as there has been lots of work

ongoing. MRSA has already failed – funding issues to be pick up

outside of this meeting. Agreed to keep on red risk

IM&T26 Failure of data network which would deny access to key servers..

There is a delay in the development of GM COIN. Agreed to

keep as red risk

IM&T 64 Post TCS, procedures for procurement of IT hardware…….

There are wider procurement issues being looked into. Agreed

to keep as red risk

IM&T67 No signed SLA between SFT and GMCSU ……….

There is lots of work going on around this area and an extension

is currently on place on the contract. Issues around business

continuity are being addressed. John Winter will have greater

input into the risk register in the future. Agreed to keep as red

risk

No new high level risk were presented.

YP asked about M30 – failure of local nursing homes to implement proper

medicines management systems, although not a high risk she asked why

there is no longer a rolling programme of visit to care homes. CW agreed

to speak to Peter Howarth.

213

6

Action; CW

RB asked about PP51 – other referrals and questioned figures being up on

last year. CW agreed to look at how we merge activity / performance

and if we could do something to improve this. KR also reported that

consultant to consultant referrals was improving.

CCG06 Potential significant increase spend against the QOF budget……

This was questioned as why this is a risk to the CCG when is

relates more to the LAT. CW agreed to speak to Ali Lewin and

review.

Action: CW

Removals

The following were agreed for removal

CP67 Failure to deliver the key operating framework commitment in 2012/13

CP68 Any qualified provider: national specification now published……

CP65 Patient Experience Survey ….

IMT49 Some PCs and laptops may not be encrypted…….

A suggestion of how to present the risk register in the future for the CCG was

presented and discussed. It was noted that the current format needs to

change and re-focus for CCG business. The proposed version has had Steve

Allinson’s input who has proposed formatting around the 6 CCG objectives.

The committee was happy for MS to take forward and present to the next

meeting along with the current version. It was agreed that this would happen

until the end of the financial year and that the new version would run on its

own from April 2014.

Action: MS

It was also noted that there needs to be a formal process in place for

removing risks, therefore deleted risk should be done before the merger takes

place to ensure it’s done in the right order. CP suggested Quality be included

in the new format. RB suggested he be involved in the movement from old to

new, this was agreed.

Action; MS

DS from Internal Audit commented that he had viewed the proposal and was

happy with it and noted that again we are ahead of the game in this. DS

also suggested that Risk be included as a standing agenda item on all

Locality Lead meetings. This was noted.

Action: Locality Leads Meetings

CW asked about how we raise risk issues to the LAT – no formal process is in

place but MS was ask to develop a risk route for primary care.

Action: MS

14. StEIS

CCG

StEIS reference No 2013 / 19384 – it was agreed that this could now be

closed.

214

7

StEIS reference No 2013 / 27188 (StEIS Category: sub-optimal care of the

deteriorating patient) – new incident

It was noted that immediate actions have been undertaken and also

been raised at Quality Committee which will review what happens and

ensure it doesn’t happen again.

RB raised a few issues which MS agreed to look into putting on the register

which were around never incidents, sub optimal care, SUIs.

PH asked if practices should have there own risk register. GPs within the

room were unsure, CW agreed to pick this up and raise at locality

meetings and work out a process to take forward. The profile of risks

needs highlighting within locality leads meeting in genera.

Action: CW

YP raised concern over correct procedure between Quality Committee

and IGAR and needing to be clear what is a SUI / StEIS.

GMAS – should now read NWAS

StEIS No 2013 / 20913 (category: delayed diagnosis)

This relates to one of our patients and is currently being investigated, we

will be contacted by the Lead Commissioner when there is an action plan.

CW raised that there had been a review on transport at PIQ. YP asked if

there is a common approach to end of life across GM. KR reported that

there is a pathfinder in place.

Stockport FT

StEIS No 2013 / 18675 (Category: CDiff and Health are Acquired Infection)

To remain on the register until a review of responsibility has been decided.

Tameside FT

StEIS No 2013 / 15797 (Category: Allegation against HC Professional)

No further update at this time.

15. Information Governance

Paul Haigh, GMCSU presented the report which sets out the scene of IG

and how it is moving forward, the role of the committee and what it will

be asked to sign off later in the year. He explained that internal meetings

are taking place with officers of the CCG and will continue to do so

throughout the year. IG training has been rolled out to all CCG staff

which needs to be completed by the end of October 2013 to comply

with the IG toolkit requirements. PH further explained that IGAR will be

required to sign off policies and procedures following internal sign off by

SIRO, as timing of such sign offs might not fall within the timetable of the

IGAR meetings it was agreed that Chair’s action could be taken as long

as GC met with KR as SIRO, our Caldicott Guardian and PH. He explained

there is regular communication with SIRO, Caldicott Guardian and MS as

well as communicating with staff and he also attends the CCGs

Operational Group.

215

8

The second part of the report shows the IG requirement, levels and target

dates. The key objective is to show transparency of both CCG and

GMCSU work. The Committee was given the opportunity to comment on

the report and suggest amendments for future meetings, although they

did request that as deadlines get close more detailed report / information

needs to be presented on those areas.

Action: All

Internal Audit’s role was also highlighted and when they will carry out their

work. DS will liaise with PH to schedule the work noting the report

presented.

16. Lorenzo Risk Assessment

RB presented the item and paper. He explained that the Lorenzo project

was being switched on on 7 October 2013. The system will enable TFT to

view GP records, coded data, medication etc. It was noted that GPs are

supportive of this alongside the work on urgent care. It was noted that this

is a TFT led project which forms a direct relationship with GP practices

rather than the CCG. RB explained that although accepting the late

presentation, this it will be taken to LMC for their approval. The purpose of

presenting to IGAR was for CG assurance that they have not objections.

Questions raised included: is access ready only? Will GP practices get

notified if TFT look at their notes? – RB replied that no notification will be

received; CP asked if practices understand the benefits of the system and

also do patient understand? how will that be communicated? It was also

felt that we need reassurance that TFT will comply with the data

protection act that is in place. All these questions will be raised with TFT as

they are leading and reported back via LMC. It was also noted that there

are 4 mitigating risks:

Patients need to give consent, access can be over ridden, triggers in

place for audit process

There needs to be a legitimate reason at that time to access records,

access moves with the patient – LR not being switched on therefore no

control

Training – sign up to code of conduct

Caldicott rules – review risk of not sharing data

The process will be presented to LMC and outcome reported back to a

future IGAR meeting.

Action: RB

Finance – Internal Audit left the meeting

17. Finance & QIPP Report – Month 5

SB presented. It was reported that the CCG is on target to achieve its

required surplus although there is a significant increase in over

performance of the TFT contract which is putting pressure on that target.

Other areas highlighted were around:

Maternity and concern as its till in its new pathway

Prescribing which is currently overspending and therefore being

closely monitored by the Medicines Management Team who are

216

9

expecting month 4 figures to be better and are continuing to

review previous figures.

Other acute providers are on plan

CHC should break even at year end

Running costs are expected to be £24.51 at year end which is

under the target of £25 per head

QIPP is on target although a fundamental review is currently taking

place and a change to reporting will be presented next month

Financial risk – outcomes of the review of allocations policy which

will impact on CCGs nationally is expected to be finalised in

December. T&G are approx £8m above target which will result in

a reduction in allocation.

Recommendations – the following 5 issues were noted by the

committee as;

TFT over performance

Specialist services transfer and gaps in funding

Contract unweaving challenges

Continuing healthcare restitution claims

Review of allocations policy

DM presented the secondary care element of the report highlighting

that 83% of outpatient first attendances flows through TFT and

amounts to £12.7m, at M4 we are over performing by £308k, £251k of

this relates to TFT with other trusts forming the remainder. 37% of

patients at TFT re discharged during their first consultation which is the

second highest in GM and significantly more than the GM average of

23%. It was noted that not all referrals are from GPs, most are

consultant to consultant. A discussion took place on referrals against

discharge from GPs and intra hospital. An areas highlighted within

the report relates to vascular surgery where rates of discharge on first

attendance are high for both GP and hospital initiated attendances

at TFT. These rates 72% and 83% respectively and are both high

compared to neighbouring providers and costs the CCG £726k on

vascular surgery first attendances at TFT.

It was noted that with all the pressures highlighted we still have winter

to come and greater impact of Keogh which will give major problems

for the CCG both this year and next.

GC thanked the finance team for presenting the report and asked

that they feed comments back to JK on the format / their position on

the agenda of the meeting.

Action: Finance Team

217


Title of Subject:

Locality Leads Minutes of Meeting – 29 October 2013

Date of paper:

1 November 2013

Prepared By:

Sara Roscoe

History of paper:

N/A

Executive Summary:

The purpose of the clinical leads meeting will be to

act a clinical network across the five CCG Localities,

collecting and sharing experiences from the

respective constituent practices, acting as a conduit

between CCG Board and PIQ.

At the meeting in October, the main areas discussed

and agreed were:

Consultant to Consultant referrals

We have a policy in place with THFT to reduce

Consultant to Consultant referrals. Recent figures

show that they are still high and so it has been agreed

with THFT to conduct a ‘joint’ clinical audit across 4

specialties of C2C referrals from a different speciality.

Locality Leads agreed to discuss at Locality meetings

to identify any GPs to participate in the joint clinical

audits.

Primary Care Development Paper

It was agreed to establish a small but representative

Primary Care Development Group to explore the

options surrounding primary care development with a

view to preparing a paper to be presented to

December PIQ. The group will ideally involve 2-3

representatives from each locality to discuss the

options further with a view to writing an options paper

218

to go to December PIQ. Locality Leads will discuss

with their respective localities.



(for Discussion and

Decision)

To note the content of the minutes and actions

being taken forward.


by proposal:

N/A


Dr Richard Bircher

219

Tameside & Glossop Locality Leads (LLs) Minutes of the meeting Tuesday 29 October 2013

Churchgate Surgery, Denton In attendance: Dr Asad Syed Ali (AA) – Clinical Lead Denton Dr Saif Ahmed (SA) – Clinical lead Stalybridge Dr Richard Bircher (RB) CCG GB Member Tracy Simpson, (TS) – CCG Elaine Richardson (ER) - CCG Dr Jamie Douglas (JD) – CCG GB Member Sara Roscoe (SR) – CCG Louise Roberts (LR) – CCG Mohammed Islam, FY2 Millbrook Alison Whelan (AW) – CSU Communication

Apologies Dr Matt Kinsey, Clare Symons, Alison Lewin, Dr Hershon, Dr Joanna Bircher Notes of the last meeting Were accepted as an accurate record with the exception of the item ‘CCG Board feedback’, paragraph 2 where the minutes make reference to ‘TFT have designed an area wide Quality Strategy which the CCG have authorised.’ RB advised that this is incorrect and should be omitted from the minutes. Primary Care Development Dr Jamie Douglas (JD) referred to the discussions at PIQ and via e-mail surrounding primary care development and how these could be taken forward, citing Dr Greenough’s suggestion at PIQ of forming a smaller Primary Care Development Group. Discussion ensued as to what the extending primary care access actually meant and whether this is or should be restricted to GPs and the traditional models of General Practice. ER highlighted that this could be an opportunity to explore different ways of working and optimising skill mix. AA suggested costing a model of extending GP practice, 8am to 8pm, 7 days per week to ascertain the potential cost. It was felt that other options also needed to be considered rather than going ahead costing one model over another. Other potential models were discussed, such as Locality solutions, potential re-specification/location of WIC, building community resilience and reducing isolation, GP’s in A&E amongst others. It was agreed that all models/suggestions should be explored as there does not appear to be any prescribed models at the moment and so provides the opportunity to develop T&G’s own proposals. The group acknowledged the general consensus across T&G General Practices and considered the best means of engaging with member practices without exacerbating the situation whilst ensuring member feedback and input. JD advised that he intends to attend Locality meetings however wanted GP member’s direct input in order to formulate the options paper which is being presented to December PIQ. It was agreed to convene a small project group and request representatives from each locality. It was agreed to ideally have 2-3 representatives from each locality to attend the meeting in order to contain the meeting/discussion. It was suggested to hold the meeting at November TARGET, which allows member practices to attend with cover. JD agreed to discuss with Dr Dowling as TARGET Clinical Lead and LL’s obtain expressions of interest from their respective localities. Action: JD/LLs LIG Meetings AA fed back that he had attended the last LIG meeting and it would be beneficial to have LL representation at these meetings and had suggested operating a rota. SR advised that both AH and MK had agreed to this and would attend. SR agreed to co-ordinate. Action: SR

220

AA/SA advised that with the LIG as well as the attendance at the sub-committees of the GB undertaking practice visits, the LL capacity was almost at its limit. Consultant to Consultant Referrals – update ER updated the group of discussions with Tameside FT surrounding Consultant to Consultant referrals, advising that between April to July, the CCG have recorded 9703 C2C referrals however the Trust are reporting 8946. ER added that whilst there is a discrepancy in the numbers reported, both parties agree that the number is still high. ER provided further analysis of the data advising that for those C2C referrals where Consultants have referred to themselves this can be linked back to non elective activity; for those which are within the same specialty but to a different Consultant, this has been linked to capacity and waiting time issues. In order to progress the agenda, ER advised that the CCG and THFT have agreed to undertake a joint clinical audit across four specialties, where the problem appears more prevalent, these are:

1. Pain Management 2. Obstetrics 3. Gastro 4. Vascular Surgery

The audit will be undertaken by the end of December; the sample size has yet to be agreed. ER added that the audit will be undertaken jointly with the respective Consultant from each of the four specialties and a GP and would be asking for volunteers from member practices. GP time will be reimbursed on a sessional basis however it is unknown how many sessions will be required. LLs agreed to raise at Locality meetings to identify any expressions of interest. Action: LLs Feedback from Locality Meetings to CCG AA fed back from the recent QP audit looking for correlations between numbers of telephone lines within practices and A&E attendances, which concluded that there was no correlation at all within the Denton Locality. SA concurred in respect of the Stalybridge Locality. CCG Feedback to Locality Meetings SR circulated the revised GB summary, which had been condensed further. RB referred the group to the minutes relating to Lorenzo, advising that the issues are being resolved which arose through its implementation; RB encouraged the group to review the ‘Tameside Listens’ smartphone app. AA referred to the item concerning Choose and Book and felt the message that this has been put on hold is a positive one and demonstrated that member practices feedback is being considered. Any other business Dates of future meetings SR asked members whether Tuesdays were still a good day to meet, as it may prove difficult for all LLs. Members felt that the last Tuesday of the month was the better day to meet and was agreed to continue with this arrangement. Sharing Best Practice SR/LR raised a request from the Ashton Locality for information surrounding the impact of Locality initiatives which clearly demonstrate the benefits of Locality working. SR advised that this level of detail does not exist and whilst it is possible to provide a list of initiatives individual practices have implemented, the impact of these is not evidence. It was acknowledged that the benefits of the Locality meetings are the culmination of the clinical leadership, peer review and support, which the

221

meetings offer. SR asked LLs whether it would be more beneficial for a LL to attend a future meeting of the Locality to explain the benefits. RB suggested that the Ashton Locality attend a meeting of another Locality to see first hand the benefits of the locality meetings. JD offered to attend the next meeting of the Ashton Locality to discuss further and what it is the Locality require. Action: LR/SR/JD Winter Plan ER advised members that pharmacists can now support practices in their delivery of the flu campaign. AW explained that the Communications Team are preparing the material for this year’s campaign, which builds on last year’s campaign. AW disseminated copies of the material which is a guide outlining alternatives to A&E and requested the group’s feedback. The group felt that the material is sufficient with the accompanying narrative which is more specific. Members suggested using PPGs to disseminate the information and extending across health and social care, including care homes. AA enquired whether it would be possible to devise a DVD for practice’s TV’s in waiting rooms. AW agreed to progress. Action: AW Date & time of next meeting Tuesday 26th November, 12.30pm – Churchgate Surgery, Denton

222

Page 1 of 7

Item 2.1

Attendance: Kathy Roe NHS Tameside & Glossop CCG For Steve Allinson

Rob Bellingham Greater Manchester LAT Wirin Bhatiani NHS Bolton CCG Alan Campbell NHS Salford CCG Julie Danes NHS Oldham CCG Andrea Dayson GM Association of CCGs Chris Duffy Heywood, Middleton & Rochdale CCG

Ranjit Gill NHS Stockport CCG Denis Gizzi NHS Oldham CCG

Nigel Guest NHS Trafford CCG Gina Lawrence NHS Trafford CCG

Susan Long NHS Bolton CCG Lesley Mort Heywood, Middleton, & Rochdale CCG Gaynor Mullins NHS Stockport CCG Stuart North NHS Bury CCG Kiran Patel NHS Bury CCG Jenny Scott NHS England Specialised Commissioning Hamish Stedman (Chair) GM Association of CCGs Bill Tamkin NHS South Manchester CCG Martin Whiting North Manchester CCG Ian Williamson NHS Central Manchester CCG Craig Hall Wigan Borough CCG For Trish Anderson

Apologies: Wendy Meridith Bolton Council (Public Health) Mel Sirotkin Salford Council (Public Health) Ian Wilkinson NHS Oldham CCG

In Attendance: Will Blandamer GM Public Service Reform Team & GM Integrated Care

Programme Lead Janet Ratcliffe NHS England

Members were welcomed to the meeting and apologies were noted.

The Chair indicated that it would be helpful if everyone could introduce themselves when speaking, as this would be helpful for the minute taker and for other attendees.

GM ASSOCATION OF CCGs: Association Governing Group (AGG) Salford& Worsley Suites, St James’s House, Salford

Tuesday, 1 October 2013 (13.30 - 17.30 pm)

1.WELCOME & APOLOGIES FOR ABSENCE

223

Page 2 of 7

Item 2.1

2.1 MINUTES OF THE LAST MEETING: 3.9.13

A few corrections were highlighted from the previous meeting which was held on the 3 September 2013. These are as follows:

o Paul Laker’s surname was spelt inaccurately o Julie Danes was not on the attendance list o Nigel Guest was not on the attendance list o In Item 5.1 it was not mentioned when Salford came back to the room. Amendments

are to be made to correct these inaccuracies o In 5.2 – Needs confirming.

Action Log from previous meeting held on the 3.9.13.

Item 7 – Future meetings are either to commence at 8.30 am– 12.30 pm and – 13.30pm – 5.30pm

Item 3.1 – letter of confirmation has been sent to all providers and stroke task and finish group to be established

Item 4.3- on the agenda

Item 5.1- on the agenda

Item 5.2 – This has been re-deferred until 5 November 2013 as AD was recently on annual leave. 3.1 Familiar Hypercholesterolemia (FH) JR commenced the discussion by introducing the proposal on Familiar Hypercholesterolemia.

This proposal is a Greater Manchester approach to comply with NICE published guidance.

The proposal is to establish a Greater Manchester FH Team to diagnose and initially manage patients with FH.

There are over 5,200 people with FH.

The team will consist of specialist nurses or clinical practitioners with sufficient capacity to cope with new referrals.

BHF invested around £450k to support FH Staffing support in Wales some years ago. The BHF are planning to offer similar pump priming support to England.

Comments from Members: Certain questions were raised and answered during the discussion:

JD asked when was the proposal needed by and had we missed the deadline to submit plans for funding consideration. The deadline was by the end of October 2013 amount of funding available uncertain.

MW stated that cascade testing was the heart of this proposal there may well be other options in delivering the service rather than a GM Mobile team

JR agreed but reiterated that no plans/services have been supported by CCGs across GM

WBH we are financially stretched are these aligned with priorities; we need to be looking at clinics locally and what other options there are as this is unaffordable.

2. MATTERS ARISING

3. CLINICAL WORK PROGRAMME UPDATES

224

Page 3 of 7

Item 2.1

SN stated that a meeting with all Chairs was needed to be arranged shortly to discuss the legacy items.

DG highlighted that we cannot commission workforce which is being proposed.

JR confirmed that the network did not want to lose the option of bidding for the BHF funds and she has fulfilled her role by highlighted the opportunity to CCGs

3.2 Cancer Commissioning Board

The purpose of this paper is to inform discussions that have previously taken place at the former Clinical Strategy Board and more recently the HOC’s. It has been suggested that it is imperative to form a Cancer Commissioning Group where the various strands of cancer service development can be brought together.

Concern noted that the providers are meeting and reaching agreements that are not commissioner led

The proposal is to form a Cancer Commissioning Board which would provide a mechanism by which network level service change programmes can be considered.

The proposal was agreed and it was decided that within 2 weeks time we needed to agree a clinical chair both Trafford and Central Manchester have acknowledge support. With HOCs and SCN representation support the Board can be established.

3.3Stable Angina Pathway

The proposal is to improve the diagnosis of stable angina.

The pathway delivers functional imaging which has a higher sensitivity and specificity compared with conventional exercise ECG.

The pathway is cost effective as it will reduce levels of more expensive invasive angiography and high radiation imaging

This proposal has come to the AGG to support the GM pathway and to consider the CT perspective; a required element of the pathway.

The AGG: 1. Noted and approved the proposal to form a Cancer Commissioning Board 2. A Clinical lead to be identified to Chair the Cancer Commissioning Board – NG/ME. 3. Representation to be confirmed at the November Board 4. Noted that HOCs representation was required and LM will confirm members 5. SCN support - JR

The AGG: 1. Noted that the FH proposal had returned to the AGG to highlight the availability of BHF

funding which could support delivery of FH service across GM. 2. FH not supported at this time due to affordability issues also concerns that this was not

the most appropriate GM model. 3. CCGs may wish to develop local solutions and access the BHF funding 4. Chairs need to meet to review any legacy items as this has previously been considered and

rejected.

225

Page 4 of 7

Item 2.1

There was an overall consensus to support the GM pathway

CT requires a further options appraisal which need to be supported through CFOs and HOCs

AD reminded members that this was not a new proposal as the GM pathway has been included in GM Commissioning Intentions for the past 4 years. Many sites have already implemented the pathway and others need to be encouraged to do so to promote cost effectiveness and apply evidence base practice. CT is the part of the pathway that is now not NICE compliant.

JS outlined that Commissioning Intentions were published this week.

Hyperlink to NHS England website, where further information could be found.

There are 140 specialized lines.

130 national service specifications produced by 76 clinical reference groups (CRGs) aimed at driving national consistency.

There is a workshop organized at the Reebok Stadium on the 7 October 2013, and invitations have been sent out.

Comments from members

JS highlighted that quality indicators are in place based on the Keogh review

Issues identified around cancer drugs and bariatric surgery

CCGs are increasingly struggling financially thresholds may be required for determining treatment. JS the whole drive is on pathways of care and to ensure that there is no major impact of either end of the pathways

Issues relating to continued top slicing we need processes to decommission and stop certain services.

HS commissioning responsibilities have been dispersed to be addressed through the Contract Steering Group. JD needs to look at this further with the CFO’s.

5.1 Wider Leadership Team/HT briefing/HT Programme Update

A copy of the presentation was delivered to the informal leaders meeting (AGMA Leaders with Chief Execs) on the 27 September 2013.

A briefing paper and presentation was delivered to the AGG and discussed in detail. Background of the Briefing Paper

5. STRATEGIC WORK PROGRAMMES

4. SPECIALISED COMMISSIONING

The AGG: 1. Noted the proposal for stable angina and requirement for CT to be included as part of the

pathway 2. Noted overall consensus to support the GM Stable Angina Pathway to promote further

savings 3. Agreed that Janet Ratcliffe to bring the CT options appraisal to the January 2014 meeting –

to be considered through HOCs and CFOs with recommendations included to support decision making

226

Page 5 of 7

Item 2.1

The aim of the presentation is to strengthen the understanding of the Health and Social Care Reform in Greater Manchester to support this further all local CCGs need to invite local councilors to their Governing Body as a priority to further discuss and seek agreements for plans moving forward. Feedback from these local meetings would helpful in advance of the next informal leaders meeting on the 25 October 2013 to Will Blandamer.

RB gave an update from the Summit Meeting which was held on Wednesday 25 September 2013. At the event 6 demonstrator sites were confirmed – it was clear that there was huge support and ongoing activity driving changes

We need to be actively working with the local authorities and also working together as a team with strong leadership

IW and WB to draft a letter to GM Council Leaders and CM CCG Chairs to clarify the situation. In the letter it needs to endorse the proposed next steps in the presentation, which are as follows: a) further development of models of out of hospital care (integrated care and primary care) at a local level as a priority b) Informal discussions are to take place in each district with council, CCG and Acute Sector, and clusters before the end of October. c) Issues and challenges from local discussions to be brought back to informal leaders on the 27 October and the Association of CCGs meeting on the 5 November 2013 d) A proposal is to be developed for discussion with leaders and Association of CCGs in November.

CCGs confirmed that local meetings were to be arranged by Friday 4 October 2013 and confirm to Leila Williams as HT members are also to be in attendance.

Comments

We should progress with local discussions and share our Integrated Care Plans.

SL – local authority feedback the need for CCG’s perspective discussions from a bottom up approach

HS we need to commit individually and meet with local key leadership preferably by the end of October 2013.

GM stated that HT is a CCG led funded process; we need to have oversight of the decision making process. DG stated that on slide 7 of the presentation 2nd bullet point stated the delivery of integrated out of hospital services is a precondition before changes to hospitals can happen (subject to a judgment about patient safety). We need to understand how this will be staged

One of the lessons learned was that we need to meet and commit to those services that need to be in place between 6/12 months before we implement this.

IW positive example; before Withington hospital was closed there was visible work on the new hospital across the road.

AC explicit £3.8 billion between Salford CCG and Salford Council we need to work together and try and understand the implications

HT is not going to save us money it will cost us to deliver but the current situation is unsustainable.

A narrative would be helpful for clear consistency

The AGG: 1. Noted the presentation and briefing papers and thanked IW/WB for continued support 2. Hamish Stedman and Lord Peter Smith are to sign a letter which needs to be sent to GM

Council Leaders and GM CCG Chairs. 3. All to set local CCG meetings as a priority - feedback to WB before the next informal

leaders meeting on the 25 October.

227

Page 6 of 7

Item 2.1

6.1 111 Update

KR commenced the discussion by stating that the 111 service was going to go live on the 29 October 2013 and on the 11 October we needed to sign the contract for 12 months.

Contingences are in place with medical staff are being trained to support the service.

This will cost NWAS around the £9 million.

The calls will cost around £14.75 per call.

NWAS as expected will not commit to ‘pay as you go’ contract.

6.2 MERIT Proposal

SN stated that the MERIT Proposal will be discussed again within 2 months time at December’s AGG Meeting.

CFOs need further information before they can support the proposal 6.3 GM CQUIN

AD outlined that the expected number of GM CQUINs ranged from 3-5.

AD stated that we needed adopt last year’s principals 25% Greater Manchester 25% National and 50% Local.

AGG is to choose which GM CQUIN areas are to be adopted the AGG to also suggest/support high level of areas for GM KPIs.

There is to be CQUINs workshop to be held shortly and a proposal is to be devolved to the Contract Steering Group and HoCs.

6.4 Medicines Management ToR:

AW outlined the paper by indicating that medicines management has a clinical chair, Kath Sutton from Trafford CCG and Helen Burgess from South Manchester CCG as a Deputy Chair.

There are links to the HoCs and CFOs and representation with links to NHS England.

The declaration of interest policy was approved in May 2013.

Delegated decision making unchanged for all neutral or negative cost impacts - a proposed move from the current £250,000 to £500,000 impact across GM (subject to member HoC and CFO representatives approval)

Comments

RG indicated that this needs to remain as an advisory group and that a commissioning strategy is also needed.

6. ASSOCIATION OF GM CCGs

The AGG: 1. Noted the progress made on 111 service issues and thanked KR and T&G for leading on

behalf of the GM Association

The AGG: 1. Noted GM CQUINS as an important piece of work requiring effective management 2. Noted the process for confirming GM CQUINs and GM KPIs

228

Page 7 of 7

Item 2.1

DG this is a regulatory function.

SN this is a finance issue and needs to be assessed against the overall commitment to savings

Delegated authority not agreed; need to agree some changes though email exchange and CFO’s need to review and agree the limit.

IW indicated that we needed to invite Tony Lloyd (GM Police) to an AGG – AD has already made contact and invited him to the January 2014’s meeting.

HS stated that HT is a dedicated topic which was talked about, however, if there were any other topics then to address them to Andrea Dayson.

BT indicated that this is a good idea and that we should not be dealing with inappropriate legacy issues.

Tuesday 5 November 2013 from 8.30 am – 12.30am – St James’s House in the Salford & Worsley Suite.

7. ANY OTHER BUSINESS

8. DATE AND TIME OF NEXT MEETING

The AGG: 1. Noted the ToR paper but could not approve the increase in delegated decision from

£250,000 to £500,000. 2. CFOs need to review the proposal further; AGG mindful of the potential for an

unexpected amount of medicine decisions being asked of it. 3. We need to revisit the paper of Medicines Management between 3/6 month times. Any

governance issues need to be raised via Andrea Dayson via email.

229