Item Number: 9.1 Governing Body Meeting: Report … · accountable Clinical Commissioning Group CCG Values X 1 Respect and Dignity x 2 Commitment to Quality of Care x ... Y ork P

CCG Strategic Objective X 1 Engage and enable local people to be involved in decisions made about the

healthcare we commission x

2 Commission services to ensure and improve quality and safety of services and improve outcomes

x

3 Achieve a sustainable Health Economy x 4 Deliver our 2 year Operational and 5 year Strategic plan to transform

services x

5 Strengthen and develop partnerships to collectively deliver our shared strategic objectives

x

6 The continuous development of a strong, sustainable, successful and accountable Clinical Commissioning Group

CCG Values X 1 Respect and Dignity x 2 Commitment to Quality of Care x 3 Compassion x 4 Improving Lives x 5 Working Together for Patients x 6 Everyone Counts x

Item Number: 9.1

Governing Body Meeting: 4 June 2015

Report Sponsor Janet Probert Director of Partnership Commissioning unit

Report Author Janet Probert Director of Partnership Commissioning Unit

1. Title of Paper: Update from the Partnership Commissioning Unit

2. This Paper is for:

Approval Decision Assurance – For Discussion

Assurance – For Information Only

x

3. CCG Strategic Objectives supported by this paper

4. CCG Values Underpinned in this paper

1

YES NO

Principle Risk No

Principle Risk Outline

Ref: Risk No Outline YES NO

5. Does this paper provide evidence of assurance against the Governing Body Assurance Framework?

If you answered yes above, please indicate which principle risk and outline

6. Does this paper mitigate risk included in the CCGs Risk Registers? If Yes, please outline.

7. Executive Summary

This report has been produced to update the Governing Body and provide assurance on the key elements of the Partnership Commissioning Unit (PCU) work programme.

8. Any statutory / regulatory / legal / NHS Constitution implications

The PCU is managing the delivery of a number of key performance targets and national priorities in relation to the Children and Families Act, parity of Esteem, Safeguarding and Integration.

9. Equality Impact Assessment

N/A 10. Implications / actions for Public and Patient Engagement

N/A

11. Recommendations / action required

The Governing Body is required to receive and note the contents of this report.

2

1. INTRODUCTION The table below details the main elements of the Partnership Commissioning Unit’s (PCU) work programme and provides an update on key objectives. Where necessary it also highlights areas of risk and outlines how these risks will be managed.

Children and Families Act 2014

We have been meeting with local provider leads to advise on the Local Agreement presented at the PCU Management Board in December. This agreement outlines the North Yorkshire and York CCGs’ requirements for those services they commission in relation to the Act.

The Local Agreement gives direction from commissioners to providers as they mobilise their teams with CCG contract managers progressing through Quality and Performance Groups. The PCU will continue to follow the progress of the Local Agreement to ensure that contractually it has been signed off by the CCGs with all NHS providers. The PCU is progressing the Local Agreement through the contracting boards of Leeds York Partnership Foundation Trust and Tees, Esk and Wear Valley Trust.

The Act is wide ranging but the Local Agreement sets out, amongst other things, specifically the roles of the Designated Medical Officer (DMO), Clinical Leads and Education and Health and Care Plans (EHCP). The shortened time frame for completed plans from 26 to 20 weeks will be monitored via a dashboard arrangement and we are in discussions with Local Authority colleagues to see how we can aggregate the information down to CCG level. Some other aspects of the pathway will be monitored by key performance indicators which are supporting the North Yorkshire County Council (NYCC) Special Educational Needs or Disabilities (SEND) strategy.

The PCU will be making contact with local providers to establish and map DMO’s and Clinical Leads and their professional and geographical coverage.

Mediation and Disagreement Resolution Service NYCC has recently drafted an invitation to tender for this service. The tender and proposal to jointly commission will be reviewed by the PCU and will be shared with the CCG for consideration as soon as it is complete.

Children with complex needs and disabilities

North Yorkshire County Council’s consultation period on a strategy to meet the care needs of disabled children ended in March 2015. Feedback from the consultation is awaited and will be shared once available. The PCU is in discussion with North Yorkshire County Council to understand how existing CCG commissioning in relation to this area might need to change. To support the discussions a PCU mapping of training provision to support children and young people with medical needs is underway. It is planned to have this information available to support discussions at the next meeting scheduled in May. CCGs will be asked to approve any commissioning recommendations in due course

3

Training and Education Service for Short Breaks (TESS)

Formal notice has been serviced by the PCU on behalf of the collaborative CCGs. The training provision mapping work referred to above will also inform the next steps. The contract will expire mid June 2015. An exit strategy is being planned and communications with partners and stakeholders, including service users, is planned following purdah.

Autism Monthly Waiting List Data Autism assessment waiting list data continues to be received on a monthly basis, and the PCU now has 12 full months of data. This provides CCGs with a much clearer picture of the number of referrals to the service, the number of children waiting for an assessment, the length of time waited, and the conversion rate. Data continues to be reviewed and cleansed where required to ensure robust information is available to support quality reviews of services and CCG commissioning intentions. A final outturn position is planned for the end of May 2015 which will address some of the anomalies with clock start and stop times which have impacted on the data. Moving into 2015/2016, the provider data collection sheet has been revised to reflect ‘pauses’ in the system for example watchful waits.

Data received from providers continues to be forwarded to contract leads on a monthly basis. There have been productive meetings between the CCG and PCU to discuss 2015/2016 commissioning intentions and a delivery plan is expected from Harrogate and District NHS Foundation Trust within the month. Any necessary actions will be agreed with CCG colleagues following receipt of the report. The current CCG position is attached as Appendix A.

Waiting list data as at the end of March 2015 indicates that activity is slightly above the trajectory (+13), reflecting the additional waiting list initiative assessments commissioned by the CCG. The longest weeks wait for those offered a first appointment within the reporting month has reduced month on month since December 2014. The longest weeks waiting for a first appointment within the reporting month was 54 weeks in April 2014, peaking at 80 weeks in November, and was 45 weeks in March 2015.

The 2014/2015 annual average was 51 weeks, this is a slight improvement from April 2014 when the average weeks wait from referral to first appointment was 53 weeks. On a monthly basis, the average wait for those offered a first appointment has reduced month on month since September 2014 (average 63 weeks) to a March 2015 average of 36 weeks.

There has been a gradual reduction in the waiting list since a peak in September of 127 children. As at the end of March 2015, there are 97 children still on the waiting list, 59 (61%) of these have been waiting over 3 months. The longest of those still waiting is 46 weeks. The conversion rate has declined since September and is now at 73%. This is being monitored with CCG colleagues.

4

Autism Quality Review

The draft scoping document has been circulated for comment, with a presentation to the Autism Strategy Group. The Case for Change was discussed at the February PCU Management Board.

There is support for a review, and comments made have been incorporated into the scoping document: the methodology has altered, and following comments, now proposes that there will be discussions with clinicians in localities regarding pathways and approaches, and meetings with parents in localities to gain feedback on their experience of the diagnostic service and how the positive aspects of service can be built on further. The review will be further strengthened through joint delivery with North Yorkshire County Council and providers.

All Age Autism Strategy 2015-2020 The PCU continues to represent the four North Yorkshire CCGs in the production of this joint strategy with North Yorkshire County Council. It is currently in draft format and undergoing review from key strategic groups prior to consultation, which is scheduled to commence in the next month. A consultation event will take place in the Harrogate and Rural locality and details will be shared with the CCG in due course.

Looked After Children

CCG Commissioning Intentions 2015/2016 – Looked After Children and Safeguarding Service

All the collaborative CCGs have agreed to re-commission the looked after children service. An update paper was discussed at the February Partnership Commissioning Unit Management Board, including the proposed service specification for CCG approval. It is hoped to progress this contractually in May 2015.

The safeguarding service specification is also complete and the PCU continues to work with the CCG to disaggregate the contract value across the collaborative. Once this detail is known, the collaborative CCGs will be advised and commissioning intentions moving forward agreed.

From April 2015, following the re-commissioning of the Healthy Child Programme, historic gaps for review health assessments have been addressed as has the introduction of Health Passports for care leavers.

CCG Commissioning Intentions 2015/2016 - Initial Health Assessments

Engagement has been undertaken with locality providers and colleagues within North Yorkshire County Council. It is anticipated that an agreed service specification will be available for each CCG by the end of May 2015 to proceed through contract route. The PCU, with the support of the CCG Designated Professionals, intend to engage with North Yorkshire County Council looked after children to advise how their previously shared insights on being looked after have helped shape the development of the aforementioned service specifications.

5

HDFT Looked After Children Service – Dataset An activity dataset is now available, and was shared at the February Partnership Management Board. For the first time CCGs will now have monthly activity and baseline information about their looked after population. It is intended to share this with CCGs through the monthly PCU Performance Matrix.

Healthy Futures: CAMHS for Looked After Children in Out Of Area Placements The objective of this project is to improve access to emotional well-being and mental health services for looked after children in out of area placements to ensure that needs are met in a timely manner. The PCU was scheduled to attend a meeting on 12.05.15 to look at the options appraisal but unfortunately this was cancelled at short notice. Further dates are awaited.

Healthy Futures: Acute Paediatrics Service Provision

This review seeks to understand the local issues affecting acute paediatrics across the West Yorkshire region (including Harrogate and Rural District CCG) and to consider ways in which these can be overcome. The purpose of the next meeting at the end of May is to review the information which has been collected and thereby obtain an understanding of the workforce pressures across West Yorkshire and to launch discussions about solutions to these problems. This will be shared with the CCG next month.

DISCOVER! The Discover! workshop on 13 February was very successful, with 20 people attending including providers, third sector and service users. A report has been circulated detailing the discussion and setting out key priorities outlining the key priorities:

1. Prevention: early work to prevent problems escalating

2. Good linkages between tiers and organisations: too many children get ‘stuck’ in the system

3. Co-ordination: to ensure children get the treatment they need and

organisations are joined up in approach

4. Training for frontline schools and hospital staff so they are confident and equipped to respond

The feedback has been used to support preliminary work on building resilience and preventing mental health problems (see below under CAMHS).

Child and Adolescent Mental Health Services (CAMHS)

The national taskforce report, Future in Mind was published in March, and a report has been circulated to CCGs. The PCU and Vale of York CCG, on behalf of the North Yorkshire CCGs, is leading in writing a Transformation Plan for the area in partnership with LA colleagues drawing on existing health, public health and LA strategies, which will address the 5 themes in the report:

1. Promote resilience, prevention and early intervention 2. Improve access to effective support – a system without tiers 3. Care for the most vulnerable 4. Accountability and transparency 5. A well- developed workforce

6

The Transformation Plan Forum held its first meeting on 6 May, agreeing terms of reference and an outline work programme. Subject to guidance from NHS England expected in mid-June, the next stage of work will involve pulling together data from all stakeholders into a gap analysis and draft set of priorities. These will be considered by the Forum in June, and circulated to CCGs, partners and stakeholders.

The specification for specialist CAMHS services is in negotiation with TEWV: the specification includes provision for intensive support to provide step-up step down care with Tier 4, and avoid admission where possible, multi-agency triage to help ensure the most appropriate pathway of support at referral stage, and strengthening communications both between specialists and children and also partner agencies to ensure smooth pathways of care and support (an issue highlighted in the TEWV GP survey in the CCG area). Additionally a strong suite of KPIs will mean clear monitoring of activity and quality of service.

Additionally, a CQUIN on crisis response is proposed for negotiation with TEWV: this would ensure an assessment by a mental health professional within 4 hours for any child or young person in crisis: concerns have been raised regarding response times and availability of support, particularly but not exclusively, out of hours .

Work has continued on drafting a specification to improve the offer of support to universal and targeted Tier 2 services within schools; this is an area of service delivery prioritised within Future in Mind, and also from local Discover! feedback. A business case is also being drafted for the CCG that should put it in a good position to bid for national funds previously announced for CAMHS services.

The PCU presented a report on Future in Mind to the CCG Quality and Clinical Governance Committee on 12 May: whilst noting the likelihood that additional national funding for CAMHS will be one-off and also at this stage it is not possible to state what specific actions might flow from the Transformation Plan, the committee commented on:

• difficulties for GPs in referring children and young people who are not ill enough for specialist support, but need more targeted support than schools can provide;

• paucity of services for victims of CSE to prevent mental illness developing

• reported difficulties for children at independent schools in obtaining support

Maternity Services

A draft specification has been shared with Providers and will be shared with CCGs following further refinement.

Service user engagement to inform the strategy for commissioning maternity services is planned for the summer. A proposal for the engagement will be shared with the CCG for approval in the next month.

The North Yorkshire and York maternity network continues to meet and it is planned to commence discussion and scoping for the perinatal mental health work in anticipation of the national review expected in the autumn.

7

The PCU has been notified of the forthcoming Local Supervising Authority Audit visit to Harrogate and District NHS Foundation Trust (17.07.15), and will attend the feedback session at the visit, and share the information with the CCG.

Mental health DISCOVER!

The DISCOVER! engagement programme, as a whole, was selected as a finalist in the 2015 Patient Experience Network National Awards in two categories-

• Commissioning for patient experience • Staff engagement/improving staff experience. The PCU was one of

three organisations from the North Yorkshire and Humber area to reach the final stage. Whilst we were not category winners, we are delighted that DISCOVER! has been exhibited on a national platform.

The data and feedback received as part of Phase 2 of the DISCOVER! mental health engagement programme is being analysed and collated into emerging themes. This includes intelligence gathered at DISCOVER! events (those organised by the PCU/CCGs and also by local groups) and feedback from Twitter, the DISCOVER! postcards and dedicated email address. It is envisaged that the locality reports will then be disseminated, at the same time, to all stakeholders/participants in order to check that they accurately reflect the nature of the café discussions and other comments that have been received. This also presents an opportunity to receive further feedback, which can be incorporated into the final reports and emerging themes.

Mental Health Crisis Concordat

The North Yorkshire and York Mental Health Crisis Care Concordat Declaration was signed by all essential North Yorkshire and York organisations in December 2014 and uploaded onto the official Crisis Care Concordat website.

At the January meeting of the Police Health and Social Care Implementation Board Silver Group, a clear developed process to produce an action plan for the end of march was identified. This involves six task and finish groups which will be the bronze groups and will report into the silver group. The leads for these groups have been identified and each lead will be responsible for ensuring delivery of their section of the action plan. At the February Silver Group meeting each lead presented the draft action plans, revised the Terms of Reference and the attendee list A gold command group has been established and met for the first time on 16 March 2015 in order to monitor the work programme of the silver group and ensure delivery of the action plan.

Adult Autism and ADHD

The PCU Mental Health commissioning team has been working to address growing demand for assessment and diagnosis of autism and ADHD. The PCU has been reviewing opportunities to develop a joint health and social care pathway for adult autism and ADHD that is close to home and links with wider social care and other support services. The specification is complete and the invitation to tender is expected to be live by 15th May. We expect this service to be operational by October 2015.

8

Dementia • The commissioning team is taking forward the following actions: • Sharing information from the region on progress against the 67%

diagnosis rate and other initiatives including available funding • Supporting the CCG in its implementation of the new dementia

pathway for October 2015. The decision on the bid for grant monies is expected in August 2015 at which point we will look to move to procurement.

Learning Disabilities

• Work is ongoing with Local Authority colleagues in NYCC to produce a joint commissioning strategy.

• The North Yorkshire Self-Assessment Framework (SAF) and the York SAF were submitted on 30 January 2015 to NHS England. There will be increased scrutiny on progress in the coming year with quarterly update reports on action plans expected to NHS England for monitoring.

• PCU is drafting a business case for service redesign for people with complex needs by June.

Mental Health Strategy

• A first draft of the joint Mental Health Strategy with NYCC and North Yorkshire Police has been written.

TEWV CQC Inspection

• PCU attended the TEWV CQC summit at which the official feedback from the January inspection was shared. TEWV were given a ‘good’ status overall. They were also awarded ‘outstanding’ in its leadership. They are the only Mental Health Trust nationally to be given that rating. CQC found that Cedar Ward at The Briary Wing had environmental limitations. TEWV are establishing next steps and are planning to engage with commissioners on possible solutions imminently.

S136 Suite • The S136 suite has been delayed due to environmental factors. It is expected to be operational from June.

Crisis Call • The North Yorkshire Crisis Call Service was an open access telephone service available to residents of HaRD (and other areas of North Yorkshire) who felt they were in a Mental Health Crisis. The service was funded pro rata by the North Yorkshire CCGs, Tees Esk and Wear Valley NHS Foundation Trust (TEWV) and North Yorkshire County Council (NYCC). The service was de-commissioned from 1st

May 2015 due to not being fit for purpose. A re-commissioning exercise for a new service was undertaken at the end of 2014. A number of bids were received that were all significantly over budget. An interim position has been reached whereby the North Yorkshire service was taken on by the City of York Council Mental Health Support Line for a period of three months pending a review of future commissioning arrangements.

Continuing Health Care (CHC)

Fast Track There is now a well embedded system within the CHC department. From the 9 referrals received a month 50%-60% were completed within the target times; the normal turn round for most cases is 4 hours. The team occasionally find it difficult to source care in the Harrogate area, particularly in rural areas.

Finding providers can prove difficult at times, and work is continuing with procurement to consider how we improve the access to Fast Track packages.

9

CHC There has been a reduction in the total number of patients awaiting an assessment since the end of November, particularly people waiting longer than a year. In total there are 70 Continuing Care Assessments to complete for Harrogate CCG. In agreement with the North Yorkshire CCGs the target is to ensure no one is waiting longer than 6 months by October.

Waiting Times 3 – 4 years 1 case 2 – 3 years 0 cases 1 - 2 Years 1 case 9 - 12 months 6 cases 6 - 9 months 8 cases 3 - 6 months 12 cases 0 - 3 months 42 cases

Clear targets are set for each CHC team and for individual staff members and performance is being managed by Clinical Team leaders. Productivity of all assessments and performance of clinical staff is reported weekly to the Director and Deputy Director. Nursing/admin processes are starting to be implemented and work is due to be completed on development of the Standing Operating Procedures to establish more robust processes in line with the National Framework.

Case management models will be reviewed for fully funded CHC clients and Standing Operating Procedures are in progress. Case summaries are in place to maintain effective case management.

After a recent internal audit of CHC, the aim is to develop a strategy for CHC for the next 3 years which will be shared with all the Harrogate CCG. Key deliverables will include national policy requirements, team roles, developing relationships and a joint approach with LA’s/ joint commissioning.

Children - the CHC team has implemented the use of new children’s CHC paperwork in line with the National Framework which was agreed at the last Management Board and will be presenting this along with the process to disability teams over the next few weeks. The CHC team is meeting with the children’s commissioners and will work towards formalising a transition pathway in the next few months. This will then come to the PCU Management Board and social care partners for agreement. This will be a challenging piece of work as we have to link in with the new Education, Health and Care Plan (EHCP) and Personal Health Budgets (PHB) as well as moving them from one framework to another. Most packages are joint in children’s case management but many will move to fully funded CHC once children are 18 years old. This will be an extensive piece of work.

Retrospective CHC Inspections

NHS England has issued guidelines for all retrospective CHC cases to be completed by March 2017. The retrospective team continues to work on cases being returned by UKIM. The total number of retrospective cases outstanding for Harrogate CCG is 185. Examworks UK Ltd (previous name was UKIM) have been commissioned by the 4 North Yorkshire CCG’s to source and collate all records, then carry out a CHC checklist for each period of claim before December 2015.

10

The PCU maintain communication with claimants and have regular contact with Examworks UK Ltd. Cases are returned to the PCU for DST process and panels with Local authorities. Progression of completed records returned from Examworks UK Ltd has been slow due to the difficulty in obtaining medical records from other agencies. Work is taking place to expedite this through engagement with outside agencies, NHSE and local authorities.

Weekly monitoring of Retrospective cases remains in place and staff performance of the retro clinical team is also recorded. The team currently has 63 hours of clinical staffing per week but will be kept under review to be able to respond to more cases as they are returned.

Standing Operating Procedures have been written and are currently going through the approval process.

Provider issues

Regular updates are provided by the safeguarding team to the CHC team and the CHC nurses are regularly capturing soft intelligence.

Soft intelligence through needs portrayal has been recorded by nursing staff when special measures have been placed on nursing homes where fully funded CHC clients are placed.

Equipment All equipment needs are now ordered through the ELMS system based in Harrogate District Foundation Trust. Bed packages are still ordered through Huntley.

Transforming Care

The Transforming Care commitment made by NHS England in respect of ‘Care and Treatment Reviews (CTR)’ has now defined that from April 2015 the CTRs will be rolled out to all new admissions within non and non-secure hospitals. The PCU will undertake CTRs for those in-patients who are hitting the six month timeline unless directed otherwise by NHS England. To date we await the assessment tools from NHS England for the CTRs. We are informed that there is limited funding available for the CTRs for 2015/16, Experts by Experience and Clinic Advisors will be sourced form a range of professional as previously undertaken for the March 2015 cohort, coordinated by the vulnerable People Team. CTRs for the March 2015 cohort continue to have their discharge plans closely monitored in order to achieve successful discharge planning. NHS England submissions for the Transforming Care cohort has now shifted from weekly to fortnightly reporting. Monthly data submissions are live with the Health & Care Social Information Centre.

Personal Health Budgets (PHB)

The Personal Health Budget audit was completed April 2015 with Significant Assurance being achieved. Governance arrangements are in place to monitor and oversee the use of Personal Health Budgets, including management of the Service Level Agreement with the Yorkshire and Humber Commissioning Support Unit, risk and financial management, and arrangements to report to the CCGs. Discussions are being undertaken with respective CCG lead in respect to “Getting Started” for Mental Health and Long Term conditions. In the HaRD locality the PCU have had a total of 5 applications for a PHB, I is

11

live with 3 others being considered the remaining patient is deceased.

Vulnerable People

Extensive work is being undertaken with North Yorkshire County Council to review packages of care which are fully health funded in respect to Section 117 Aftercare to achieve joint funded status to relevant cases. Significant cost reductions are being witnessed and this work continues, in the Harrogate and Rural District CCG locality Year to date there are 9 service users who were fully funded by the PCU of these, 3 have been successfully transferred to joint funding with the local authority. And one transferred to an alternate appropriate placement. Standard Operating Procedures have been reviewed to strengthen governance in respect of clinical case management for vulnerable people in line with the out of contract activity

Adult Safeguarding Team

Key Issues The Care Act (2014) came fully into being on 1st April 2015 and although it covers the whole spectrum of health and social care it also represents a significant change for all agencies involved in adult safeguarding. As with other aspects of the Act personalisation is at the centre of it and we all share a responsibility to modernise practice in order to facilitate more choice.

Implications/Risks

Multi-agency Working The Adult Safeguarding team at the PCU are currently in discussion with the NY Safeguarding Adults Lead in regard to information sharing and decision making. The Care Act describes the local authority’s responsibilities on safeguarding and these are undergoing a process of interpretation. The PCU team are looking to ensure effective multi-agency decision making at the early stage of safeguarding concerns and this requires the timely sharing of key information, the inception of the Care Act changes present us with an opportunity to improve these processes. Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a DASM (Designated Safeguarding Adults Manager) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox.

Quality Assurance

Steve Wilcox the Designated Professional for Adult Safeguarding has met with John Pattinson to discuss the pressing issue of assurance in regard to care homes. Concern in this area is consistent across North Yorkshire. The PCU and Local authority recently held a care home workshop event in York which was well attended and an action plan is being developed. The PCU are developing a matrix which will go into the weekly updates for HaRD and the Quality and Clinical Governance Safeguarding reports which will give an overview of how care homes are performing in relation to safeguarding issues particularly in terms of their reporting, response and rectifying of concerns. The Safeguarding Report to HaRD Quality and Clinical Governance Committee will be revised in other areas to include information on provider safeguarding returns and ‘Prevent’ returns.

12

The PCU Designated Professional for Adult Safeguarding is co-chair of the North Yorkshire Safeguarding Adults Board Quality and Performance Group along with Mike Webster of NYCC. A performance framework has been designed by the group in order to monitor the quantity and quality of adult safeguarding activity across the county. This will take the form of a balanced score card an example of which is appended. More work has now been done by the group to improve the scorecard in order to make the headings and definitions clearer. When the process becomes a fully working component of how the Safeguarding Adults Board operates we’ll be able to move on from reporting on what we know towards reporting on what we need to know. The Internal Audit of Adult Safeguarding is complete and the draft reports completed the report for HaRD has provided a significant level of assurance.

Constitutional and Legal

The Care Act (2014) This gained full Royal Ascent on 1st April 2015. The Act brings together and updates a good deal of the post 1948 health and social care legislation and has implications for the delivery of services across the whole health economy. It has particular relevance for adult safeguarding as it places the local Safeguarding Adults Boards on a statutory footing similar to Safeguarding Children’s Boards as opposed to the voluntary partnership arrangements that have hitherto been in place. The Designated Professional for Adult Safeguarding at the PCU is working with main partners; the Police and Local Authority in a task and finish group to adjust Safeguarding Policy and Procedure to reflect the new safeguarding terminology and structure as defined in the Act.

The Care Act brings those funding their own care into the care system with obligations on local authorities relating to information and advice, universal services, assessments and market shaping among others all applying to self-funders. It also sets out a new model of paying for care, putting in place a cap on the care costs which an individual is liable for. Importantly, the Act strengthens the rights and recognition of carers in the social care system, including, for the first time giving carers a clear right to receive services. These are by far the strongest rights for carers yet.

The Care Act covers adult social care in England only. The Children and Families Act 2014 includes new duties for the assessment of young carers and parent carers of children under 18.

Designated Safeguarding Adults Manager Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a Designated Safeguarding Adults Manager (DASM) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox.

13

MCA/DoLS

The PCU Safeguarding Team bid successfully for NHSE funding to develop the awareness of the legal framework around the Mental Capacity Act (2005) The Year 1 programme (2013-14) raised the profile of MCA/DoLS with CCG leads and managers engaging key staff with the complexities, risks and legal requirements of the legislation. Year 2 of the project will provide front line staff with tools, materials and training in order to understand how to operate safely within the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) legal framework.

The ‘Cheshire West’ Supreme Court Judgement has brought MCA/DoLS into focus with the interpretation of what constitutes continuous supervision. This has placed the Local Authority and Court of Protection under some pressure as hospitals and care homes have a legal responsibility to apply for a DoL if someone is subject to ‘continuous supervision’ what, when and how to do this remains very challenging for front line staff.

Counter Terrorism

Prevent The Designated Professional for Adult Safeguarding is the health lead for the ‘Prevent’ arm of HM Government’s Counter Terrorism Strategy. York and North Yorkshire are not defined as Priority Areas and as such do not have to make declarations of Prevent activity and assurance to the Regional Coordinator anymore. There remains, however, a statutory duty for all health providers to have a Prevent structure, training and audit framework. The PCU Safeguarding Team will ensure that compliance assurance continues to be reported and fed back to the CCGs and SABs.

Safeguarding Team The team have recently encountered various staffing issues due to the retirement of a key member of the team, resignations and sickness. The Safeguarding team are ensuring HaRD. CCG have cover available and the team will prioritise work appropriately. A new structure has been approved and vacant posts are to be advertised on NHS jobs.

Appendix A Children’s Autism Monitoring - Trajectories and Waiting List

Appendix 1 - Autism Monitoring (HaRDCCG

14

3



We have been meeting with local provider leads to advise on the Local Agreement presented at the PCU Management Board in December. This agreement outlines the North Yorkshire and York CCGs’ requirements for those services they commission in relation to the Act. The Local Agreement gives direction from commissioners to providers as they mobilise their teams with CCG contract managers progressing through Quality and Performance Groups. The PCU will continue to follow the progress of the Local Agreement to ensure that contractually it has been signed off by the CCGs with all NHS providers. The PCU is progressing the Local Agreement through the contracting boards of Leeds York Partnership Foundation Trust and Tees, Esk and Wear Valley Trust. The Act is wide ranging but the Local Agreement sets out, amongst other things, specifically the roles of the Designated Medical Officer (DMO), Clinical Leads and Education and Health and Care Plans (EHCP). The shortened time frame for completed plans from 26 to 20 weeks will be monitored via a dashboard arrangement and we are in discussions with Local Authority colleagues to see how we can aggregate the information down to CCG level. Some other aspects of the pathway will be monitored by key performance indicators which are supporting the North Yorkshire County Council (NYCC) Special Educational Needs or Disabilities (SEND) strategy. The PCU will be making contact with local providers to establish and map DMO’s and Clinical Leads and their professional and geographical coverage. Mediation and Disagreement Resolution Service NYCC has recently drafted an invitation to tender for this service. The tender and proposal to jointly commission will be reviewed by the PCU and will be shared with the CCG for consideration as soon as it is complete.



4



Autism Monthly Waiting List Data

Autism assessment waiting list data continues to be received on a monthly basis, and the PCU now has 12 full months of data. This provides CCGs with a much clearer picture of the number of referrals to the service, the number of children waiting for an assessment, the length of time waited, and the conversion rate. Data continues to be reviewed and cleansed where required to ensure robust information is available to support quality reviews of services and CCG commissioning intentions. A final outturn position is planned for the end of May 2015 which will address some of the anomalies with clock start and stop times which have impacted on the data. Moving into 2015/2016, the provider data collection sheet has been revised to reflect ‘pauses’ in the system for example watchful waits.





5






CCG Commissioning Intentions 2015/2016 – Looked After Children and Safeguarding Service All the collaborative CCGs have agreed to re-commission the looked after children service. An update paper was discussed at the February Partnership Commissioning Unit Management Board, including the proposed service specification for CCG approval. It is hoped to progress this contractually in May 2015. The safeguarding service specification is also complete and the PCU continues to work with the CCG to disaggregate the contract value across the collaborative. Once this detail is known, the collaborative CCGs will be advised and commissioning intentions moving forward agreed. From April 2015, following the re-commissioning of the Healthy Child Programme, historic gaps for review health assessments have been addressed as has the introduction of Health Passports for care leavers. CCG Commissioning Intentions 2015/2016 - Initial Health Assessments Engagement has been undertaken with locality providers and colleagues within North Yorkshire County Council. It is anticipated that an agreed service specification will be available for each CCG by the end of May 2015 to proceed through contract route. The PCU, with the support of the CCG Designated Professionals, intend to engage with North Yorkshire County Council looked after children to advise how their previously shared insights on being looked after have helped shape the development of the aforementioned service specifications.

6

HDFT Looked After Children Service – Dataset

An activity dataset is now available, and was shared at the February Partnership Management Board. For the first time CCGs will now have monthly activity and baseline information about their looked after population. It is intended to share this with CCGs through the monthly PCU Performance Matrix. Healthy Futures: CAMHS for Looked After Children in Out Of Area Placements The objective of this project is to improve access to emotional well-being and mental health services for looked after children in out of area placements to ensure that needs are met in a timely manner. The PCU was scheduled to attend a meeting on 12.05.15 to look at the options appraisal but unfortunately this was cancelled at short notice. Further dates are awaited.



DISCOVER!

The Discover! workshop on 13 February was very successful, with 20 people attending including providers, third sector and service users. A report has been circulated detailing the discussion and setting out key priorities outlining the key priorities:



3. Co-ordination: to ensure children get the treatment they need and organisations are joined up in approach






7

The Transformation Plan Forum held its first meeting on 6 May, agreeing terms of reference and an outline work programme. Subject to guidance from NHS England expected in mid-June, the next stage of work will involve pulling together data from all stakeholders into a gap analysis and draft set of priorities. These will be considered by the Forum in June, and circulated to CCGs, partners and stakeholders. The specification for specialist CAMHS services is in negotiation with TEWV: the specification includes provision for intensive support to provide step-up step down care with Tier 4, and avoid admission where possible, multi-agency triage to help ensure the most appropriate pathway of support at referral stage, and strengthening communications both between specialists and children and also partner agencies to ensure smooth pathways of care and support (an issue highlighted in the TEWV GP survey in the CCG area). Additionally a strong suite of KPIs will mean clear monitoring of activity and quality of service. Additionally, a CQUIN on crisis response is proposed for negotiation with TEWV: this would ensure an assessment by a mental health professional within 4 hours for any child or young person in crisis: concerns have been raised regarding response times and availability of support, particularly but not exclusively, out of hours . Work has continued on drafting a specification to improve the offer of support to universal and targeted Tier 2 services within schools; this is an area of service delivery prioritised within Future in Mind, and also from local Discover! feedback. A business case is also being drafted for the CCG that should put it in a good position to bid for national funds previously announced for CAMHS services. The PCU presented a report on Future in Mind to the CCG Quality and Clinical Governance Committee on 12 May: whilst noting the likelihood that additional national funding for CAMHS will be one-off and also at this stage it is not possible to state what specific actions might flow from the Transformation Plan, the committee commented on:

difficulties for GPs in referring children and young people who are not ill enough for specialist support, but need more targeted support than schools can provide;

paucity of services for victims of CSE to prevent mental illness developing

reported difficulties for children at independent schools in obtaining support

Maternity Services

A draft specification has been shared with Providers and will be shared with CCGs following further refinement. Service user engagement to inform the strategy for commissioning maternity services is planned for the summer. A proposal for the engagement will be shared with the CCG for approval in the next month. The North Yorkshire and York maternity network continues to meet and it is planned to commence discussion and scoping for the perinatal mental health work in anticipation of the national review expected in the autumn.

8




Commissioning for patient experience Staff engagement/improving staff experience. The PCU was one of




The North Yorkshire and York Mental Health Crisis Care Concordat Declaration was signed by all essential North Yorkshire and York organisations in December 2014 and uploaded onto the official Crisis Care Concordat website. At the January meeting of the Police Health and Social Care Implementation Board Silver Group, a clear developed process to produce an action plan for the end of march was identified. This involves six task and finish groups which will be the bronze groups and will report into the silver group. The leads for these groups have been identified and each lead will be responsible for ensuring delivery of their section of the action plan. At the February Silver Group meeting each lead presented the draft action plans, revised the Terms of Reference and the attendee list A gold command group has been established and met for the first time on 16 March 2015 in order to monitor the work programme of the silver group and ensure delivery of the action plan.



9

Dementia

The commissioning team is taking forward the following actions: Sharing information from the region on progress against the 67%

diagnosis rate and other initiatives including available funding Supporting the CCG in its implementation of the new dementia



Work is ongoing with Local Authority colleagues in NYCC to produce a joint commissioning strategy.

The North Yorkshire Self-Assessment Framework (SAF) and the York SAF were submitted on 30 January 2015 to NHS England. There will be increased scrutiny on progress in the coming year with quarterly update reports on action plans expected to NHS England for monitoring.

PCU is drafting a business case for service redesign for people with complex needs by June.


A first draft of the joint Mental Health Strategy with NYCC and North Yorkshire Police has been written.

TEWV CQC Inspection

PCU attended the TEWV CQC summit at which the official feedback from the January inspection was shared. TEWV were given a ‘good’ status overall. They were also awarded ‘outstanding’ in its leadership. They are the only Mental Health Trust nationally to be given that rating. CQC found that Cedar Ward at The Briary Wing had environmental limitations. TEWV are establishing next steps and are planning to engage with commissioners on possible solutions imminently.

S136 Suite

The S136 suite has been delayed due to environmental factors. It is expected to be operational from June.

Crisis Call The North Yorkshire Crisis Call Service was an open access telephone service available to residents of HaRD (and other areas of North Yorkshire) who felt they were in a Mental Health Crisis. The service was funded pro rata by the North Yorkshire CCGs, Tees Esk and Wear Valley NHS Foundation Trust (TEWV) and North Yorkshire County Council (NYCC). The service was de-commissioned from 1st May 2015 due to not being fit for purpose. A re-commissioning exercise for a new service was undertaken at the end of 2014. A number of bids were received that were all significantly over budget. An interim position has been reached whereby the North Yorkshire service was taken on by the City of York Council Mental Health Support Line for a period of three months pending a review of future commissioning arrangements.


Fast Track There is now a well embedded system within the CHC department. From the 9 referrals received a month 50%-60% were completed within the target times; the normal turn round for most cases is 4 hours. The team occasionally find it difficult to source care in the Harrogate area, particularly in rural areas. Finding providers can prove difficult at times, and work is continuing with procurement to consider how we improve the access to Fast Track packages.

10

CHC There has been a reduction in the total number of patients awaiting an assessment since the end of November, particularly people waiting longer than a year. In total there are 70 Continuing Care Assessments to complete for Harrogate CCG. In agreement with the North Yorkshire CCGs the target is to ensure no one is waiting longer than 6 months by October. Waiting Times 3 – 4 years 1 case 2 – 3 years 0 cases 1 - 2 Years 1 case 9 - 12 months 6 cases 6 - 9 months 8 cases 3 - 6 months 12 cases 0 - 3 months 42 cases Clear targets are set for each CHC team and for individual staff members and performance is being managed by Clinical Team leaders. Productivity of all assessments and performance of clinical staff is reported weekly to the Director and Deputy Director. Nursing/admin processes are starting to be implemented and work is due to be completed on development of the Standing Operating Procedures to establish more robust processes in line with the National Framework. Case management models will be reviewed for fully funded CHC clients and Standing Operating Procedures are in progress. Case summaries are in place to maintain effective case management. After a recent internal audit of CHC, the aim is to develop a strategy for CHC for the next 3 years which will be shared with all the Harrogate CCG. Key deliverables will include national policy requirements, team roles, developing relationships and a joint approach with LA’s/ joint commissioning. Children - the CHC team has implemented the use of new children’s CHC paperwork in line with the National Framework which was agreed at the last Management Board and will be presenting this along with the process to disability teams over the next few weeks. The CHC team is meeting with the children’s commissioners and will work towards formalising a transition pathway in the next few months. This will then come to the PCU Management Board and social care partners for agreement. This will be a challenging piece of work as we have to link in with the new Education, Health and Care Plan (EHCP) and Personal Health Budgets (PHB) as well as moving them from one framework to another. Most packages are joint in children’s case management but many will move to fully funded CHC once children are 18 years old. This will be an extensive piece of work.



11

The PCU maintain communication with claimants and have regular contact with Examworks UK Ltd. Cases are returned to the PCU for DST process and panels with Local authorities. Progression of completed records returned from Examworks UK Ltd has been slow due to the difficulty in obtaining medical records from other agencies. Work is taking place to expedite this through engagement with outside agencies, NHSE and local authorities. Weekly monitoring of Retrospective cases remains in place and staff performance of the retro clinical team is also recorded. The team currently has 63 hours of clinical staffing per week but will be kept under review to be able to respond to more cases as they are returned. Standing Operating Procedures have been written and are currently going through the approval process.

Provider issues

Regular updates are provided by the safeguarding team to the CHC team and the CHC nurses are regularly capturing soft intelligence. Soft intelligence through needs portrayal has been recorded by nursing staff when special measures have been placed on nursing homes where fully funded CHC clients are placed.


Transforming Care




12


Vulnerable People



Key Issues The Care Act (2014) came fully into being on 1st April 2015 and although it covers the whole spectrum of health and social care it also represents a significant change for all agencies involved in adult safeguarding. As with other aspects of the Act personalisation is at the centre of it and we all share a responsibility to modernise practice in order to facilitate more choice. Implications/Risks Multi-agency Working The Adult Safeguarding team at the PCU are currently in discussion with the NY Safeguarding Adults Lead in regard to information sharing and decision making. The Care Act describes the local authority’s responsibilities on safeguarding and these are undergoing a process of interpretation. The PCU team are looking to ensure effective multi-agency decision making at the early stage of safeguarding concerns and this requires the timely sharing of key information, the inception of the Care Act changes present us with an opportunity to improve these processes. Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a DASM (Designated Safeguarding Adults Manager) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox. Quality Assurance Steve Wilcox the Designated Professional for Adult Safeguarding has met with John Pattinson to discuss the pressing issue of assurance in regard to care homes. Concern in this area is consistent across North Yorkshire. The PCU and Local authority recently held a care home workshop event in York which was well attended and an action plan is being developed. The PCU are developing a matrix which will go into the weekly updates for HaRD and the Quality and Clinical Governance Safeguarding reports which will give an overview of how care homes are performing in relation to safeguarding issues particularly in terms of their reporting, response and rectifying of concerns. The Safeguarding Report to HaRD Quality and Clinical Governance Committee will be revised in other areas to include information on provider safeguarding returns and ‘Prevent’ returns.

13


Constitutional and Legal The Care Act (2014) This gained full Royal Ascent on 1st April 2015. The Act brings together and updates a good deal of the post 1948 health and social care legislation and has implications for the delivery of services across the whole health economy. It has particular relevance for adult safeguarding as it places the local Safeguarding Adults Boards on a statutory footing similar to Safeguarding Children’s Boards as opposed to the voluntary partnership arrangements that have hitherto been in place. The Designated Professional for Adult Safeguarding at the PCU is working with main partners; the Police and Local Authority in a task and finish group to adjust Safeguarding Policy and Procedure to reflect the new safeguarding terminology and structure as defined in the Act. The Care Act brings those funding their own care into the care system with obligations on local authorities relating to information and advice, universal services, assessments and market shaping among others all applying to self-funders. It also sets out a new model of paying for care, putting in place a cap on the care costs which an individual is liable for. Importantly, the Act strengthens the rights and recognition of carers in the social care system, including, for the first time giving carers a clear right to receive services. These are by far the strongest rights for carers yet. The Care Act covers adult social care in England only. The Children and Families Act 2014 includes new duties for the assessment of young carers and parent carers of children under 18. Designated Safeguarding Adults Manager Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a Designated Safeguarding Adults Manager (DASM) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox.

14

MCA/DoLS

The PCU Safeguarding Team bid successfully for NHSE funding to develop the awareness of the legal framework around the Mental Capacity Act (2005) The Year 1 programme (2013-14) raised the profile of MCA/DoLS with CCG leads and managers engaging key staff with the complexities, risks and legal requirements of the legislation. Year 2 of the project will provide front line staff with tools, materials and training in order to understand how to operate safely within the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) legal framework. The ‘Cheshire West’ Supreme Court Judgement has brought MCA/DoLS into focus with the interpretation of what constitutes continuous supervision. This has placed the Local Authority and Court of Protection under some pressure as hospitals and care homes have a legal responsibility to apply for a DoL if someone is subject to ‘continuous supervision’ what, when and how to do this remains very challenging for front line staff. Counter Terrorism Prevent The Designated Professional for Adult Safeguarding is the health lead for the ‘Prevent’ arm of HM Government’s Counter Terrorism Strategy. York and North Yorkshire are not defined as Priority Areas and as such do not have to make declarations of Prevent activity and assurance to the Regional Coordinator anymore. There remains, however, a statutory duty for all health providers to have a Prevent structure, training and audit framework. The PCU Safeguarding Team will ensure that compliance assurance continues to be reported and fed back to the CCGs and SABs. Safeguarding Team The team have recently encountered various staffing issues due to the retirement of a key member of the team, resignations and sickness. The Safeguarding team are ensuring HaRD. CCG have cover available and the team will prioritise work appropriately. A new structure has been approved and vacant posts are to be advertised on NHS jobs.



3



We have been meeting with local provider leads to advise on the Local Agreement presented at the PCU Management Board in December. This agreement outlines the North Yorkshire and York CCGs’ requirements for those services they commission in relation to the Act. The Local Agreement gives direction from commissioners to providers as they mobilise their teams with CCG contract managers progressing through Quality and Performance Groups. The PCU will continue to follow the progress of the Local Agreement to ensure that contractually it has been signed off by the CCGs with all NHS providers. The PCU is progressing the Local Agreement through the contracting boards of Leeds York Partnership Foundation Trust and Tees, Esk and Wear Valley Trust. The Act is wide ranging but the Local Agreement sets out, amongst other things, specifically the roles of the Designated Medical Officer (DMO), Clinical Leads and Education and Health and Care Plans (EHCP). The shortened time frame for completed plans from 26 to 20 weeks will be monitored via a dashboard arrangement and we are in discussions with Local Authority colleagues to see how we can aggregate the information down to CCG level. Some other aspects of the pathway will be monitored by key performance indicators which are supporting the North Yorkshire County Council (NYCC) Special Educational Needs or Disabilities (SEND) strategy. The PCU will be making contact with local providers to establish and map DMO’s and Clinical Leads and their professional and geographical coverage. Mediation and Disagreement Resolution Service NYCC has recently drafted an invitation to tender for this service. The tender and proposal to jointly commission will be reviewed by the PCU and will be shared with the CCG for consideration as soon as it is complete.



4



Autism Monthly Waiting List Data

Autism assessment waiting list data continues to be received on a monthly basis, and the PCU now has 12 full months of data. This provides CCGs with a much clearer picture of the number of referrals to the service, the number of children waiting for an assessment, the length of time waited, and the conversion rate. Data continues to be reviewed and cleansed where required to ensure robust information is available to support quality reviews of services and CCG commissioning intentions. A final outturn position is planned for the end of May 2015 which will address some of the anomalies with clock start and stop times which have impacted on the data. Moving into 2015/2016, the provider data collection sheet has been revised to reflect ‘pauses’ in the system for example watchful waits.





5






CCG Commissioning Intentions 2015/2016 – Looked After Children and Safeguarding Service All the collaborative CCGs have agreed to re-commission the looked after children service. An update paper was discussed at the February Partnership Commissioning Unit Management Board, including the proposed service specification for CCG approval. It is hoped to progress this contractually in May 2015. The safeguarding service specification is also complete and the PCU continues to work with the CCG to disaggregate the contract value across the collaborative. Once this detail is known, the collaborative CCGs will be advised and commissioning intentions moving forward agreed. From April 2015, following the re-commissioning of the Healthy Child Programme, historic gaps for review health assessments have been addressed as has the introduction of Health Passports for care leavers. CCG Commissioning Intentions 2015/2016 - Initial Health Assessments Engagement has been undertaken with locality providers and colleagues within North Yorkshire County Council. It is anticipated that an agreed service specification will be available for each CCG by the end of May 2015 to proceed through contract route. The PCU, with the support of the CCG Designated Professionals, intend to engage with North Yorkshire County Council looked after children to advise how their previously shared insights on being looked after have helped shape the development of the aforementioned service specifications.

6

HDFT Looked After Children Service – Dataset

An activity dataset is now available, and was shared at the February Partnership Management Board. For the first time CCGs will now have monthly activity and baseline information about their looked after population. It is intended to share this with CCGs through the monthly PCU Performance Matrix. Healthy Futures: CAMHS for Looked After Children in Out Of Area Placements The objective of this project is to improve access to emotional well-being and mental health services for looked after children in out of area placements to ensure that needs are met in a timely manner. The PCU was scheduled to attend a meeting on 12.05.15 to look at the options appraisal but unfortunately this was cancelled at short notice. Further dates are awaited.



DISCOVER!

The Discover! workshop on 13 February was very successful, with 20 people attending including providers, third sector and service users. A report has been circulated detailing the discussion and setting out key priorities outlining the key priorities:



3. Co-ordination: to ensure children get the treatment they need and organisations are joined up in approach






7

The Transformation Plan Forum held its first meeting on 6 May, agreeing terms of reference and an outline work programme. Subject to guidance from NHS England expected in mid-June, the next stage of work will involve pulling together data from all stakeholders into a gap analysis and draft set of priorities. These will be considered by the Forum in June, and circulated to CCGs, partners and stakeholders. The specification for specialist CAMHS services is in negotiation with TEWV: the specification includes provision for intensive support to provide step-up step down care with Tier 4, and avoid admission where possible, multi-agency triage to help ensure the most appropriate pathway of support at referral stage, and strengthening communications both between specialists and children and also partner agencies to ensure smooth pathways of care and support (an issue highlighted in the TEWV GP survey in the CCG area). Additionally a strong suite of KPIs will mean clear monitoring of activity and quality of service. Additionally, a CQUIN on crisis response is proposed for negotiation with TEWV: this would ensure an assessment by a mental health professional within 4 hours for any child or young person in crisis: concerns have been raised regarding response times and availability of support, particularly but not exclusively, out of hours . Work has continued on drafting a specification to improve the offer of support to universal and targeted Tier 2 services within schools; this is an area of service delivery prioritised within Future in Mind, and also from local Discover! feedback. A business case is also being drafted for the CCG that should put it in a good position to bid for national funds previously announced for CAMHS services. The PCU presented a report on Future in Mind to the CCG Quality and Clinical Governance Committee on 12 May: whilst noting the likelihood that additional national funding for CAMHS will be one-off and also at this stage it is not possible to state what specific actions might flow from the Transformation Plan, the committee commented on:

difficulties for GPs in referring children and young people who are not ill enough for specialist support, but need more targeted support than schools can provide;

paucity of services for victims of CSE to prevent mental illness developing

reported difficulties for children at independent schools in obtaining support

Maternity Services

A draft specification has been shared with Providers and will be shared with CCGs following further refinement. Service user engagement to inform the strategy for commissioning maternity services is planned for the summer. A proposal for the engagement will be shared with the CCG for approval in the next month. The North Yorkshire and York maternity network continues to meet and it is planned to commence discussion and scoping for the perinatal mental health work in anticipation of the national review expected in the autumn.

8




Commissioning for patient experience Staff engagement/improving staff experience. The PCU was one of




The North Yorkshire and York Mental Health Crisis Care Concordat Declaration was signed by all essential North Yorkshire and York organisations in December 2014 and uploaded onto the official Crisis Care Concordat website. At the January meeting of the Police Health and Social Care Implementation Board Silver Group, a clear developed process to produce an action plan for the end of march was identified. This involves six task and finish groups which will be the bronze groups and will report into the silver group. The leads for these groups have been identified and each lead will be responsible for ensuring delivery of their section of the action plan. At the February Silver Group meeting each lead presented the draft action plans, revised the Terms of Reference and the attendee list A gold command group has been established and met for the first time on 16 March 2015 in order to monitor the work programme of the silver group and ensure delivery of the action plan.



9

Dementia

The commissioning team is taking forward the following actions: Sharing information from the region on progress against the 67%

diagnosis rate and other initiatives including available funding Supporting the CCG in its implementation of the new dementia



Work is ongoing with Local Authority colleagues in NYCC to produce a joint commissioning strategy.

The North Yorkshire Self-Assessment Framework (SAF) and the York SAF were submitted on 30 January 2015 to NHS England. There will be increased scrutiny on progress in the coming year with quarterly update reports on action plans expected to NHS England for monitoring.

PCU is drafting a business case for service redesign for people with complex needs by June.


A first draft of the joint Mental Health Strategy with NYCC and North Yorkshire Police has been written.

TEWV CQC Inspection

PCU attended the TEWV CQC summit at which the official feedback from the January inspection was shared. TEWV were given a ‘good’ status overall. They were also awarded ‘outstanding’ in its leadership. They are the only Mental Health Trust nationally to be given that rating. CQC found that Cedar Ward at The Briary Wing had environmental limitations. TEWV are establishing next steps and are planning to engage with commissioners on possible solutions imminently.

S136 Suite

The S136 suite has been delayed due to environmental factors. It is expected to be operational from June.

Crisis Call The North Yorkshire Crisis Call Service was an open access telephone service available to residents of HaRD (and other areas of North Yorkshire) who felt they were in a Mental Health Crisis. The service was funded pro rata by the North Yorkshire CCGs, Tees Esk and Wear Valley NHS Foundation Trust (TEWV) and North Yorkshire County Council (NYCC). The service was de-commissioned from 1st May 2015 due to not being fit for purpose. A re-commissioning exercise for a new service was undertaken at the end of 2014. A number of bids were received that were all significantly over budget. An interim position has been reached whereby the North Yorkshire service was taken on by the City of York Council Mental Health Support Line for a period of three months pending a review of future commissioning arrangements.


Fast Track There is now a well embedded system within the CHC department. From the 9 referrals received a month 50%-60% were completed within the target times; the normal turn round for most cases is 4 hours. The team occasionally find it difficult to source care in the Harrogate area, particularly in rural areas. Finding providers can prove difficult at times, and work is continuing with procurement to consider how we improve the access to Fast Track packages.

10

CHC There has been a reduction in the total number of patients awaiting an assessment since the end of November, particularly people waiting longer than a year. In total there are 70 Continuing Care Assessments to complete for Harrogate CCG. In agreement with the North Yorkshire CCGs the target is to ensure no one is waiting longer than 6 months by October. Waiting Times 3 – 4 years 1 case 2 – 3 years 0 cases 1 - 2 Years 1 case 9 - 12 months 6 cases 6 - 9 months 8 cases 3 - 6 months 12 cases 0 - 3 months 42 cases Clear targets are set for each CHC team and for individual staff members and performance is being managed by Clinical Team leaders. Productivity of all assessments and performance of clinical staff is reported weekly to the Director and Deputy Director. Nursing/admin processes are starting to be implemented and work is due to be completed on development of the Standing Operating Procedures to establish more robust processes in line with the National Framework. Case management models will be reviewed for fully funded CHC clients and Standing Operating Procedures are in progress. Case summaries are in place to maintain effective case management. After a recent internal audit of CHC, the aim is to develop a strategy for CHC for the next 3 years which will be shared with all the Harrogate CCG. Key deliverables will include national policy requirements, team roles, developing relationships and a joint approach with LA’s/ joint commissioning. Children - the CHC team has implemented the use of new children’s CHC paperwork in line with the National Framework which was agreed at the last Management Board and will be presenting this along with the process to disability teams over the next few weeks. The CHC team is meeting with the children’s commissioners and will work towards formalising a transition pathway in the next few months. This will then come to the PCU Management Board and social care partners for agreement. This will be a challenging piece of work as we have to link in with the new Education, Health and Care Plan (EHCP) and Personal Health Budgets (PHB) as well as moving them from one framework to another. Most packages are joint in children’s case management but many will move to fully funded CHC once children are 18 years old. This will be an extensive piece of work.



11

The PCU maintain communication with claimants and have regular contact with Examworks UK Ltd. Cases are returned to the PCU for DST process and panels with Local authorities. Progression of completed records returned from Examworks UK Ltd has been slow due to the difficulty in obtaining medical records from other agencies. Work is taking place to expedite this through engagement with outside agencies, NHSE and local authorities. Weekly monitoring of Retrospective cases remains in place and staff performance of the retro clinical team is also recorded. The team currently has 63 hours of clinical staffing per week but will be kept under review to be able to respond to more cases as they are returned. Standing Operating Procedures have been written and are currently going through the approval process.

Provider issues

Regular updates are provided by the safeguarding team to the CHC team and the CHC nurses are regularly capturing soft intelligence. Soft intelligence through needs portrayal has been recorded by nursing staff when special measures have been placed on nursing homes where fully funded CHC clients are placed.


Transforming Care




12


Vulnerable People



Key Issues The Care Act (2014) came fully into being on 1st April 2015 and although it covers the whole spectrum of health and social care it also represents a significant change for all agencies involved in adult safeguarding. As with other aspects of the Act personalisation is at the centre of it and we all share a responsibility to modernise practice in order to facilitate more choice. Implications/Risks Multi-agency Working The Adult Safeguarding team at the PCU are currently in discussion with the NY Safeguarding Adults Lead in regard to information sharing and decision making. The Care Act describes the local authority’s responsibilities on safeguarding and these are undergoing a process of interpretation. The PCU team are looking to ensure effective multi-agency decision making at the early stage of safeguarding concerns and this requires the timely sharing of key information, the inception of the Care Act changes present us with an opportunity to improve these processes. Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a DASM (Designated Safeguarding Adults Manager) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox. Quality Assurance Steve Wilcox the Designated Professional for Adult Safeguarding has met with John Pattinson to discuss the pressing issue of assurance in regard to care homes. Concern in this area is consistent across North Yorkshire. The PCU and Local authority recently held a care home workshop event in York which was well attended and an action plan is being developed. The PCU are developing a matrix which will go into the weekly updates for HaRD and the Quality and Clinical Governance Safeguarding reports which will give an overview of how care homes are performing in relation to safeguarding issues particularly in terms of their reporting, response and rectifying of concerns. The Safeguarding Report to HaRD Quality and Clinical Governance Committee will be revised in other areas to include information on provider safeguarding returns and ‘Prevent’ returns.

13


Constitutional and Legal The Care Act (2014) This gained full Royal Ascent on 1st April 2015. The Act brings together and updates a good deal of the post 1948 health and social care legislation and has implications for the delivery of services across the whole health economy. It has particular relevance for adult safeguarding as it places the local Safeguarding Adults Boards on a statutory footing similar to Safeguarding Children’s Boards as opposed to the voluntary partnership arrangements that have hitherto been in place. The Designated Professional for Adult Safeguarding at the PCU is working with main partners; the Police and Local Authority in a task and finish group to adjust Safeguarding Policy and Procedure to reflect the new safeguarding terminology and structure as defined in the Act. The Care Act brings those funding their own care into the care system with obligations on local authorities relating to information and advice, universal services, assessments and market shaping among others all applying to self-funders. It also sets out a new model of paying for care, putting in place a cap on the care costs which an individual is liable for. Importantly, the Act strengthens the rights and recognition of carers in the social care system, including, for the first time giving carers a clear right to receive services. These are by far the strongest rights for carers yet. The Care Act covers adult social care in England only. The Children and Families Act 2014 includes new duties for the assessment of young carers and parent carers of children under 18. Designated Safeguarding Adults Manager Under the Care Act (2014) each main partner of the Safeguarding Adults Board should have a Designated Safeguarding Adults Manager (DASM) for the Local Authority that is; Geraldine Mahon, for the police; Det. Insp. Nigel Costello and for Health; Steve Wilcox.

14

MCA/DoLS

The PCU Safeguarding Team bid successfully for NHSE funding to develop the awareness of the legal framework around the Mental Capacity Act (2005) The Year 1 programme (2013-14) raised the profile of MCA/DoLS with CCG leads and managers engaging key staff with the complexities, risks and legal requirements of the legislation. Year 2 of the project will provide front line staff with tools, materials and training in order to understand how to operate safely within the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) legal framework. The ‘Cheshire West’ Supreme Court Judgement has brought MCA/DoLS into focus with the interpretation of what constitutes continuous supervision. This has placed the Local Authority and Court of Protection under some pressure as hospitals and care homes have a legal responsibility to apply for a DoL if someone is subject to ‘continuous supervision’ what, when and how to do this remains very challenging for front line staff. Counter Terrorism Prevent The Designated Professional for Adult Safeguarding is the health lead for the ‘Prevent’ arm of HM Government’s Counter Terrorism Strategy. York and North Yorkshire are not defined as Priority Areas and as such do not have to make declarations of Prevent activity and assurance to the Regional Coordinator anymore. There remains, however, a statutory duty for all health providers to have a Prevent structure, training and audit framework. The PCU Safeguarding Team will ensure that compliance assurance continues to be reported and fed back to the CCGs and SABs. Safeguarding Team The team have recently encountered various staffing issues due to the retirement of a key member of the team, resignations and sickness. The Safeguarding team are ensuring HaRD. CCG have cover available and the team will prioritise work appropriately. A new structure has been approved and vacant posts are to be advertised on NHS jobs.



CHILDRENS AUTISM MONITORING – TRAJECTORIES AND WAITING LIST (HaRDCCG)

Item Number: 9.1 Governing Body Meeting: Report … · accountable Clinical Commissioning Group CCG Values X 1 Respect and Dignity x 2 Commitment to Quality of Care x ... Y ork P

Documents