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DUDLEY CLINICAL COMMISSIONING GROUP BOARD AGENDA

Thursday, 11 September 2014 1.00pm – 4.00pm

Boardroom, Brierley Hill Health & Social Care Centre, Venture Way, DY5 1RU

Time Agenda Item Attachment Presented By 1 pm 1. Apologies

1 pm 2. Declarations of Interest To request members to disclose any interest they have, direct or indirect, in any items to be considered during the course of the meeting and to note that those members declaring an interest would not be allowed to take part in the consideration for discussion or vote on any questions relating to that item.

1pm 3. Minutes from 10 July 2014 meeting Enclosed Dr D Hegarty

1pm 4. Matters Outstanding Enclosed Dr D Hegarty

1.05pm

5. Public Voice 5.1 Questions from the Public; To respond to questions from members of the public present

at the meeting on the provision of health care to the population served by the CCG.

5.2 Feet on the Street: NHS – Navigating Healthcare Systems 5.3 Public Update

Presentation Enclosed

Dr D Hegarty Dr D Hegarty Mrs L Broster

1.30pm 6. Chairman’s & Chief Officer Report Verbal Mr P Maubach

1.40pm

7. Strategy 7.1 Strategic Issues Update

Enclosed

Mr N Bucktin

1.50pm

8. Quality & Safety 8.1 Report from Quality and Safety Committee

Enclosed

Dr R Edwards

2.00pm

9. Commissioning 9.1 Report from Clinical Development Committee

Enclosed

Dr S Mann

2.10pm

10. Communications & Engagement 10.1 Report from Communications & Engagement Committee

Enclosed

Mrs L Broster

2.20pm 2.30pm 2.40pm 2.50pm 3.00pm

11. Governance 11.1 Report from Audit Committee 11.2 Combined Board Assurance Framework and Risk Register 11.3 Governing Body Election Process 11.4 Dudley CCG Constitution 11.5 Report from Remuneration Committee

Enclosed Enclosed Enclosed Enclosed Enclosed

Mr M Hartland Mr M Hartland Mr S Wellings Mr S Wellings Mr S Wellings

3.10pm ** BREAK **

3.20pm

12. Finance and Performance 12.1 Report from Finance & Performance Committee

Enclosed

Dr J Rathore

3.30pm

13. Primary Care 13.1 Report from Primary Care Development Committee

Enclosed

Dr J Rathore

Close

14. For Information 14.1 Glossary 14.2 Dates for 2015

Enclosed Enclosed

Time and Date of Next Meeting 1pm – 4pm, Boardroom, BHHSCC Thursday 13 November 2014

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD

PUBLIC MINUTES

MINUTES OF THE MEETING HELD IN PUBLIC ON THURSDAY 10 JULY 2014 AT 1.00 PM, BOARDROOM BRIERLEY HILL HEALTH AND SOCIAL CARE CENTRE

ATTENDEES: Dr D Hegarty GP Board Member (Chair of CCG) Miss R Bartholomew Chief Quality & Nursing Officer Dr S Cartwright Clinical Executive – Integration & Partnerships Dr R Edwards GP Board Member (Kingswinford, Amblecote and Brierley Hill) Ms J Emery Chief Officer - Health Watch Dr P D Gupta GP Board Member (Dudley & Netherton) Dr C Handy Lay Member for Quality & Safety Mr M Hartland Chief Finance Officer Dr M Heber Secondary Care Clinician Dr T Horsburgh LMC Representative Dr R Johnson GP Board Member (Halesowen & Quarry Bank) Dr M Mahfouz GP Board Member (Dudley & Netherton) Dr S Mann Clinical Executive – Acute & Community Commissioning Mr P Maubach Chief Accountable Officer IN ATTENDANCE: Mr N Bucktin Head of Commissioning Mrs S Cartwright OD Practitioner Mrs T Curran Interim Director – Strategic Support Dr R Gee GP Engagement Lead Mr R Haynes Interim Head of Communications Ms S Johnson Deputy Chief Finance Officer Mr D King Head of Membership Development Mrs E Smith Minute taker APOLOGIES FOR ABSENCE: Dr J Darby GP Board Member (Halesowen & Quarry Bank) Dr K Dawes GP Board Member (Sedgley, Coseley & Gornal) Mrs J Jasper Lay Member for Patient & Public Engagement Ms V Little Director of Public Health Mr J Polychronakis Chief Executive Officer - Dudley MBC Dr J Rathore Clinical Executive – Finance & Performance Mr S Wellings Lay Member for Governance

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CCG78/2014 APOLOGIES Apologies were received from Dr Rathore, Mr Wellings, Mr Polychornakis, Mrs Jasper, Dr Darby, Dr Dawes and Ms Little. CCG79/2014 DECLARATIONS OF INTEREST Members were asked to disclose any interest they may have, direct or indirect, in any of the items to be considered during the course of the meeting and to note that those Members declaring an interest would not be allowed to take part in the consideration or discussion or vote on any questions relating to that item. None were declared CCG80/2014 MINUTES FROM 8 MAY 2014 The minutes of the meeting held on 8 May 2014 were accepted as a true and accurate record. CCG81/2014 MATTERS OUTSTANDING CCG040/2014 No further update with regards LAT representation at a POPs meeting. Mr

Haynes was asked to chase Mr Williams for a response. CCG074/2014 Mr Hartland confirmed that this item had been completed and that all of the

Board Member via email approved the statement regarding the annual accounts. Resolved:

1) The Board noted the matters outstanding CCG82/2014 QUESTIONS FROM THE PUBLIC Question 1(a) – Age Discrimination Colin Burch (PPG Member) In a recent report produced by the RCS and Age UK they listed 17 CCG`s throughout the country where breast cancer surgery is not offered to women over 75 years old . The RCS said that "health decisions should be based on individual requirements not age discrimination". Can the CCG explain if there is a policy in Dudley regarding breast cancer treatment which would contravene age discrimination laws ? Question 1(b) Age Discrimination David Stenson In a recent national press article about alleged discrimination of the elderly, reference was made to a report by the Royal College of Surgeons which indicated that there is no evidence that there has been an improvement in care being provided to elderly people despite legislation in October 2012 making it illegal for NHS staff to deny surgery to patients on the basis of age alone. The article referred to 17 Clinical Commissioning Groups that did not offer any breast cancer operations to patients over 75 years last year which included Dudley. Has the Royal College accurately reflected the position in Dudley in 2013? As the local leader of the NHS, Dudley CCG is committed to delivering the best possible health outcomes for all patients. We do not have any policy of withholding treatment on the grounds of age, nor would we tolerate any unfair discrimination by any healthcare provider against any group of patients for whose care we are responsible.

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As far as the unfounded allegations of age discrimination in Dudley which appeared in parts of the media last week are concerned, neither we nor Dudley Group NHS Foundation Trust were offered any opportunity to comment in advance on the figures used in the survey by Age UK and the Royal College of Surgeons. These figures dated back to 2011/12 (before the creation of CCGs) and in Dudley’s case were far from clear when viewed as a whole. They showed activity levels which varied significantly across the treatments selected and showed a range of patient numbers, some of which were significantly higher than expected, some in line with what would be expected and some lower than would be expected. Subsequent investigations carried out by colleagues at Dudley Group have shown that in fact significant numbers of patients in the 65-plus and 75-plus age groups received active treatment for breast cancer – including the specific procedure (breast excision) which the report claimed had not been carried out at all during the period. We are a clinically led organisation and we would like to take this opportunity to reassure all our patients that we will continue to make sure that every single one of them gets the right care in the right place at the right time. Question 2 - Procurement John Payne, Loughton Grove, Halesowen The Dudley CCG Procurement Strategy, April 14 Version, section 5.1.2 General Requirements includes the condition: 'a) the services being provided in a more integrated way'. This condition appears rather at odds with the rest of the section which refers to 'one or more providers'. Could I ask the board whether they agree with my observation and, also, how they view the procurement of services in the light of it? NHS Dudley CCG is committed to delivering better health services and improved health outcomes for local people. Developing networks of care which work efficiently and effectively offers the best chance for patients, healthcare staff, providers and commissioners to realise the shared benefits that more integrated health and social care systems can deliver. These networks may cover services which are managed by a range of different providers across health, social care and the voluntary and community sector who have the required skills, expertise and capacity (which is why we refer to one or more providers) However, it is important that all those providers work well together so that the care they provide appears seamless to patients. This is why we stress the importance of integration - which is all the organisations providing the different aspects of a patient's care working together to deliver a service in which they take shared responsibility for focussing as much as possible on putting the patient’s needs first, rather than the convenience of an individual organisation.

Question 3 – Provision of Care Mr Alan Ward Mr Ward posed a question to the Board with regards the provision of care in Dudley for his wife. Mr Maubach and Dr Hegarty confirmed that unfortunately this was not the right forum to discuss Mr Ward’s specific case due to patient confidentiality and suggested that the detail of his wife’s case be discussed outside this meeting. Dr Hegarty also suggested that the Patient and Engagement Team from the CCG liaise with Mr Ward and create a “patient story” to highlight any economy wide problems that need addressing. CCG83/2014 CHAIRMANS & CHIEF OFFICER REPORT Mr Maubach spoke to this item and began by introducing to the Board, the latest member, Dr Ruth Tapparo. Dr Tapparo is a representative of the Kingswinford, Amblecote and Brierley Hill Locality and the Board welcomed her to her new post.

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Mr Maubach updated the Board on the following: Clinical Lead posts The trial Clinical Lead post which looks into business systems and processes is proving to be extremely useful. Therefore it is the intention to develop this position into a permanent function of the CCG and there will also be a need to develop capacity for overseeing workforce development in primary care. AGM and Awards Mr Maubach reported that the CCG’s AGM was held on 17 June, and was extremely well attended. The event was a very positive evening which included learning about and celebrating the numerous successes of our CCG and primary care staff over the last 12 months. A particular mention went to Dr Richard Gee who received the Dr Liz Pope Outstanding Contribution Award for all the fantastic work that he does to support quality improvement with member practices. National pilot for 7-day working NHS IQ have asked Mr Maubach to present at a national conference on 7-day working on 22 July to showcase the CCG’s work in Dudley and provide a commissioners perspective on this important issue. System Resilience NHS England recently issued a requirement that all CCGs establish a System Resilience Group to oversee the coordination of both urgent care and elective referral to treatment times (RTTs). Mr Maubach confirmed that the CCG already had such a group in place. This was the Dudley Health & Social Care Leadership Group, chaired by Paul Maubach, which reports to the Health and Wellbeing Board and oversees the work of both the urgent care working group and integrated care working group. NHS England also recently issued new requirements for CCGs to improve Referral To Treatment (RTT) performance. The CCG has submitted a bid for additional resources and anticipates receiving circa £700k additional funds. This will be spent on additional elective activity at both Russell’s Hall Hospital and Ramsay Hospital. In addition, NHS England have issued additional funds to CCGs to support urgent care resilience over the winter period. Dudley CCGs share of that resource is circa £2m and will be submitting detailed proposals via the urgent care working group on plans for the use of this resource to be spent across both health and social care at the end of July. Better Care Fund The CCG has been put forward as an exemplar case to NHS England which could potentially be fast-tracked to obtain final approval for Dudley CCGs local Better Care Fund (BCF) arrangements. However, there is currently a lack of clarity nationally on how NHS England will manage the performance element of the funding and on how they expect risk management arrangements to operate. Consequently, whilst this lack of clarity still exists, the CCG has decided jointly with Dudley MBC not to be fast tracked Urgent Care Centre The specification for the new centre (which has been consulted upon widely with stakeholders, partners and patient groups) will be forwarded tomorrow to the bidders for the new service. The project is currently on target to have the new centre in place by the end of this financial year. Strategic Clinical Board The CCG has established a Strategic Clinical Board with Dudley Group Foundation Trust (DGFT) to work with them on enabling the transformation of their services. The membership includes: Dr David Hegarty, Dr Paul Harrison, Dr Steve Mann, Dr Jonathan Darby, Dr Matt Banks, Dr Matt Weller and Mr Richard Cattell. Mr Maubach highlighted that this was a positive development in bringing together clinical leadership across the two organisations. Monitor assessment of Dudley Group FT Last week Monitor initiated regulatory action with DGFT which is as follows: ‘Monitor is investigating governance concerns and the financial position of the Trust, triggered by multiple breaches of the 4 hour A&E target and receipt of operational and financial plans for 2014/15 and 2015/16.’

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Our CCG has been invited to participate in the review and the first round-table discussion with Monitor will be taking place later this month. NHS England Area Team Assurance Meetings Following the Q4 Assurance meeting, the NHS England Area Team has recently informed Dudley CCG, along with 5 other CCGs in the area that support from them will be provided. This is solely due to the continued poor performance by DGFT on the A&E 4 hour target. The support involves Dr Kiran Patel, Area Team Medical Director, attending the CCGs System Resilience Group and Mr Maubach welcomed the addition to the group as he will offer a great deal of constructive advice and experience. Commissioning for Outcomes Mr Maubach confirmed that the Commissioning for Outcomes paper takes an important step in enabling the vision in the CCGs long-term strategy. It sets out how the CCG will change the way services are commissioned: moving from commissioning by service lines into looking at how the CCG commissions for outcomes. The work that follows will also enable the CCG to develop shared outcomes across the system – looking at how providers take shared responsibility for working together to jointly achieve better outcomes for the population of Dudley. Resolved:

1) That the Board note the report for assurance

CCG84/2014 FEET ON THE STREET - PRIMARY CARE Dr Hegarty introduced this item and reported that the presentation was focusing on speaking to front line staff in primary care and the question asked was “What would help you to make a difference to primary care?”. Dr Hegarty confirmed that there would be a further part to this topic at the next Board meeting in September. After the presentation, Dr Gee stressed how important this insight in to primary care was and the benefit that this information will bring. Dr Heber addressed the issue around there not being a Practice Managers group and maybe this is something that should be looked at. Mrs Cartwright highlighted that the biggest disconnect for the practices was around who they should contact within the CCG for information, not having this knowledge in the practices was something that needed urgent attention. Resolved:

1) The Board noted the presentation for assurance 2) The Board agreed that CCG contact information will be shared with the practices

STRATEGY CCG85/2014 CO-COMMISSIONING EXPRESSION OF INTEREST Mr Maubach spoke to this report and confirmed that the paper presented was the expression of interest for the co-commissioning of primary care services which was developed and submitted to NHS England by the CCG. He reported that a decision had to be taken around three levels of co-commissioning that NHS England were inviting CCGs to bid engagement on and the CCG decided to go for the third option which was devolved commissioning as this would enable the CCG to work at its own pace. The Board is asked to note the report for assurance. Resolved:

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1) The Board noted the report for assurance

QUALITY & SAFETY CCG86/2014 QUALITY & SAFETY COMMITTEE REPORT Dr Edwards spoke to this item and confirmed that the report summarises the key issues discussed at the Quality & Safety (Q&S) Committee on the 20 May and 17 June 2014. She highlighted to the Board the key areas of the paper: Secretary of state Announcements -

• Nurse staffing levels at Trusts across England were published for the first time in June under new rules on transparency introduced in response the Robert Francis’s report following the Staffordshire Public Inquiry. The data on actual versus planned staffing levels will be published on the safety section of the NHS Choices website.

• In June the Secretary of State announced the launch of a new “Sign up to Safety” campaign, under the leadership of Sir David Dalton, Chief Executive of Salford Royal NHS Foundation Trust. Trusts are being encouraged to sign up the 3 year objective is to reduce avoidable harm by 50% and save 6,000 lives.

• In a drive on transparency, the Secretary of State also announced in June the publication of safety data shed a swathe of safety data on a new safety section on NHS Choices. This covers several measures including staffing levels in adult and paediatric hospital wards, including mental health and community hospitals. The public are being encouraged to see how well hospitals are doing on some key safety measures

MRSA and C.difficile - Dr Edwards reported that the Office of Public Health provides support and advice to the CCG on Infection, Prevention and Control matters, the OPH also provide epidemiology reports to the CCG, which are discussed by the Quality & Safety Committee. In 2014/15 C.difficile thresholds have been set at 48 cases for DGFT and 108 cases for the CCG, to date there has been 4 cases at the Trust and 17 cases within the community (CCG attributed). Also in 2014/15 the MRSA threshold set is zero for the Trust and CCG – there have been no cases reported to date. Adult Safeguarding - Dr Edwards confirmed that the Committee was updated on a report received from West Sussex CCG about an incident reported to the CCG arising from Orchid View Nursing Home in West Sussex. This home was part of the former Southern Cross group. It was noted that the incident raised related to the deaths of 19 patients deaths over a two year period. This is being investigated and West Sussex CCG will circulate findings to all CCGs in due course – the Committee will review these findings when received. She confirmed that all necessary actions have been taken by the Trust to the full satisfaction of Dudley Adult Safeguarding Board and no further action is required – the case has been closed. Court Ruling – Deprivation of Liberty - The Committee received a report on a recent court ruling regarding Deprivation of Liberty (DOL) (P versus Cheshire West and Chester Council, and P & Q versus Surrey County Council - ruling in the Supreme Court 2014) as a result there is an expectation that there will be an increase in referrals for DOL assessments. The CQC undertook a visit to Dudley Group Foundation Trust in March 2014 as part of a national review of the 14 Trusts reviewed by NHS England because of concerns regarding mortality rates. The CQC inspection included two days on site and focused on 8 services. The summit meeting took place on Monday, 23 June 2014. Members of Dudley CCG were invited to attend the Quality Summit organised by the CQCDGFT has had sight of the initial CQC report which has yet to be finalised. It is anticipated that a full update will be available for the July 2014 Quality & Safety Committee. Inspection at DWMHPT –

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Dr Edwards reported that the CQC inspected the Trust in February 2014, a Quality Summit was held following this, attended by the CCG. The CQC report although largely positive also identified areas for further action particularly the need for a vision for older people services. Resolved:

1) The Board noted the report for assurance. CCG87/2014 COMMISSIONING FOR OUTCOMES Mrs Curran introduced this item and confirmed that this report summarises the policy context around commissioning for outcomes and the alignment between national initiatives and the CCGs five year plan. She confirmed that the CCG has sufficient assurance processes in place to evaluate compliance with known quality and safety requirements and targets, with reporting mechanisms in place to track and investigate errors and non-compliance, such as incidents, mortality alerts, safeguarding issues and other care indicators. However, she highlighted that there was sometimes confusion about how clinical commissioning groups looked at quality. She reported that quality is embedded into the contracting process and there are robust systems in place for it to be monitored. The national regulators are part of the quality assurance process of care however, the CCG has its own statutory duty of quality. Mrs Curran confirmed that the NHS Outcomes framework was still one of the best currently in place and should be utilised more to express the intended outcomes of commissioning strategies and to support transformation, either structurally or culturally. This helps to tell the story of why, to both the staff working in the system of care, users of care services, and to the wider public. It was proposed that a small task and finish group is formed by the CCG with colleagues who have stated an interest in developing health outcome on a local population basis from the NHS England Area Team and other parts of the NHS architecture. The Governing Body is asked to approve and agree the recommendations highlighted in the report. Dr Hegarty on behalf of the Board thanked Mrs Curran for all her hard work whilst at the CCG. Resolved:

1) The Board noted and approved the intention to continue announced and unannounced clinical visits as part of the quality assurance cycle.

2) The Board agreed that the Board sub-committee membership and terms of reference should be reviewed in order to strengthen the links between them and that a graphic illustrating the CCG integrated assurance framework should be produced.

3) The Board agreed that the Board Assurance Framework should be updated to reflect the objectives in the 5 year plan, which in turn should be mapped to the NHS Outcomes Framework and the risks identified mapped to these domains.

4) The Board supported the proposal to form a small task and finish group with colleagues from NHS England Area Team and other parts of the NHS architecture to develop outcome based measures for population health at a local community level.

5) The Board supported the proposal for a replacement set of measures in line with the co-commissioning agenda, and agreed to seek support from NHS England to replace the current Primary Care QOF.

6) The Board agreed to receive a report on the work done by the task and finish group on commissioning for outcomes in September 2014.

COMMISSIONING CCG88/2014 CLINICAL DEVELOPMENT COMMITTEE REPORT Dr Mann spoke to this item and confirmed that the report summarises the key issues discussed at the Clinical Development Committee on the 21 May and 18 June 2014.

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Dr Mann highlighted that an item that required Board approval was the Black Country, Birmingham and Solihull Assisted Conception Harmonisation Policies and whilst not wishing to accept the entire policy, there are a number of opportunities to tighten the CCG’s existing policy, which were highlighted in the paper. Dr Mann reported that the Committee had considered a proposal to broaden the remit of the existing Area Medicines Management Committee, which was to be renamed the Area Clinical Effectiveness Sub-Committee and would include; Quality assurance and ratification of clinical policies and guidelines; Management of the Wound Care Formulary; Management of the Nutrition Formulary and monitoring of high cost drugs. Dr Mann confirmed that this item was on separate paper on the agenda. The Committee received a briefing on the prescribing budget for 2014/15 and associated risks from Dr Duncan Jenkins, Specialist in Pharmaceutical Public Health and within the paper the Committee were informed that prescribing growth remained difficult to predict but remained lower than previous years when cost inflation was typically 10%. The level of budget set for 2014/15 was challenging but still allowed for the uptake of NICE recommended developments and the forecasting formula had led to volatility in terms of an accurate outturn forecast for 2013/14. Dr Mann highlighted that the Committee discussed the intention to commission a community based respiratory service with Dr Brammer, Dudley Group NHS Foundation Trusts (FT) respiratory consultant. The intention was to have a community based service providing “reach in” to the hospital, as part of an overall community based service model. Dudley Group NHS FT has displayed a reluctance to accept proposal and it has now been proposed to issue a final service specification for their consideration. If this is not acceptable, notice will be given of the CCG’s intention to re-procure the service. Dr Heber expressed concern that in relation to the Area Effectiveness Sub Committees membership seems to be heavily weighted towards prescribing and that this would not be effective in the delivering of polices from across the health economy. Mr Bucktin confirmed that subject to Boards approval today, the Committee would formally write to the Medical Director at DGFT and ask them to nominate representatives to sit on the Committee to ensure that equal representation is available. Resolved:

1) The Board noted the report for assurance 2) The Board approved the proposed changes to the criteria for accessing Assisted

Conception services. CCG89/2014 TERMS OF REFERENCE FOR ASSURANCE OF CLINICAL EFFECTIVENESS SUB COMMITTEE Mr Bucktin spoke to this item and confirmed that the purpose of the report was to outline proposed changes to the remit of the Area Medicines Management Committee (AMMC) and seek approval for new Terms of Reference. Mr Bucktin reported that for the last 10 years, Dudley PCTs have managed three committees which oversee prescribing and medicines management. This paper proposes changes to the committee structures, remits, and reporting arrangements to meet the changing demands on CCG governance and clinical leadership. As part of the transition, commissioning responsibility for a significant proportion of PBR excluded high cost drugs transferred from PCTs to NHS England. However, there remains a significant portfolio of technologies under the CCG remit, with an annual budget of around £6m for which there is currently no formal monitoring process. There are two further gaps identified in the local ‘system’. These relate to wound management and nutrition; areas associated with a high level of clinical need and growing spend. The former is overseen by a formulary group which does not formally report to any other committee. There is currently no health economy wide oversight of nutrition. Mr Bucktin asked the Board to approve the proposed changes to the governance structures as outlined in the document; that the draft terms of reference for the Area Clinical Effectiveness Sub-Committee be approved; That the terms of reference for the Wound Management and Nutrition Sub-Groups be approved; That the terms of reference for the Nutrition Sub-Group be considered by the Clinical

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development Committee in due course and that a further report on the appointment of the “Medicines Safety Officer” be considered in due course. Resolved:

1) The Board approved the proposed changes to governance structures be approved. 2) The Board approved the draft terms of reference for the Area Clinical Effectiveness Sub-

Committee. 3) The Board approved the terms of reference for the Wound Management and Nutrition

Sub-Groups. 4) The Board approved that the terms of reference for the Nutrition Sub-Group be

considered by the Clinical development Committee in due course. 5) The Board agreed to consider a further report on the appointment of the “Medicines

Safety Officer” in due course.

CCG90/2014 NHS 111 EXPRESSION OF INTEREST FORM Mr Hartland spoke to this item and confirmed that the purpose of the report was to make the Board aware of the options appraisal taking place regarding the NHS 111 Service. He confirmed that the paper presented to Board highlights the options for re-procurement of the NHS 111 service which has been received from Sandwell CCG who are acting as lead commissioner. He confirmed that the model will allow ‘local’ influence to specifications and that there were still a lot of service areas that needed to be agreed. The deadline for the return of the proforma will be the 25 July 2014. Resolved:

1) That the Board delegate authority to Accountable Officer, Chief Finance Officer and Clinical Executive for Acute and Community Commissioning to submit the proforma on behalf of the Board.

CCG91/2014 HEALTH & WELLBEING BOARD REPORT Mr Bucktin spoke to this item and reported that Cllr. R. Harris had been elected as Chair of the Health & Wellbeing Board for 2014/15 and the West Midlands Fire and Rescue Service have been invited to nominate a representative to also serve on the Board.

He reported that the Health & Wellbeing Board had received, for information, updates on:-

• Dudley Healthwatch • Health and Wellbeing Board annual conference scheduled to take place on 4th July 2014 • the Dudley Health Protection Cooperation Agreement to which the CCG is a party • the development of the Better Care Fund • Dudley Group NHS FT Quality Account • Pharmaceutical Needs Assessment

Resolved:


COMMUNICATIONS & ENGAGEMENT CCG92/2014 COMMUNICATIONS & ENGAGEMENT COMMITTEE REPORT Mr Haynes spoke to this item and confirmed that the report summarises the key issues discussed at the Communications & Engagement Committee on the 3 June 2014. The CCGs first ‘Celebrating Our Year’ Awards were held on Tuesday 10 June, after the CCGs Annual General Meeting (AGM). The inaugural awards ceremony was a well-attended event which generated a lot of positive feedback and the opportunity for staff to be recognised for the hard work and invaluable contribution made by so many people. Mr Haynes confirmed that following on from the submission of the AGM, a wash up session will be scheduled and preparation will begin for next year.

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Mr Haynes confirmed that he hoped to bring a revised format of the Committee report, which will still contain the assurance that the Board requires, but will also be expanded to enable a stronger patient voice and highlight in more depth the work that the Communications and Engagement Team do. The Board echoed the recognition of thanks for the hard work that has gone in to the AGM and award ceremony. Resolved:


GOVERNANCE CCG93/2014 AUDIT COMMITTEE REPORT Mr Hartland spoke to this item and confirmed that the report summarises the key issues discussed at the Audit Committees on 1 May 2014 and 29 May 2014 Mr Hartland confirmed that the Board can be assured that under the powers delegated by the CCG Board the Audit Committee approved the final changes to the Audited Accounts, Annual Governance Statement, Annual Report & Accounts and also approved and adopted the Audited Accounts, Annual Governance Statement and Annual Report & Accounts The Committee received two final reports on Safeguarding and the Francis Enquiry Implementation Report, both of which had been given significant assurance. The Committee considered the Rebates on Prescribed Products in Primary Care policy which had been brought to the Audit Committee for approval due to the wide-ranging governance implications and potential conflicts of interest. Mr Hartland reported that it had been developed by the prescribing advisers and the intention of the policy was to ensure savings secured against the prescribing budget were in accordance with a robust and transparent policy and procedure. Resolved:

1) The Board noted the report for assurance CCG94/2014 COMBINED BOARD ASSURANCE FRAMEWORK & RISK REGISTER Mr Hartland spoke to this item and reported that in accordance with the CCG’s Risk Management Strategy, the combined BAF and Risk Register for those risks scored 16 and over was presented to the Board. The report was based on the position as at 6 June 2014. He highlighted the changes to the risks as follows: Risk 6 – this risk referred to failure of a main provider due to financial pressures. It was agreed at the Finance & Performance Committee that the existing risk (6) about the failure of a main provider was too general as the issues faced by Black Country Partnership and Dudley Group Foundation Trust (DGFT) were very different. Risk 6 was amended to refer to DGFT only and a new risk (48) was agreed for Black Country Partnership NHS FT. Risk 44 – The Finance & Performance Committee agreed to reword the Risk Description to reflect the risks around the overall achievement of the Quality Premium rather than the specific failure in respect of C.Difficile. As it was too early in the year to forecast the achievement, the probability was reduced taking the residual score down from 20 to 12. Mr Hartland reported that the following risks have either been closed after Board approval or are proposed for approval: Risk 46 – The Finance & Performance Committee recommended that this risk – “Uncertainty in the system regarding the funding available for premises development to support delivery of the primary care strategy leading to delays in improving the quality of primary care being provided in Dudley” be

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merged with Risk 33 “Premises development - uncertainty regarding process for new premises developments following closure of PCT could have impact on development of primary care, especially in deprived areas of the borough.” Risk 33 does not appear in the table and appendix presented to the Board as it had an initial risk score of 12 and a current residual score of 6. Mr Maubach reported that the Clinical Quality Committee (CQC) highlighted significant risks in relation to staffing levels in the maternity department at DGFT which links to Risk 6 and will be looked at and an action plan to manage this will be developed. Resolved:

1) The Board noted the report for assurance 2) The Board approved the merger of risk 46 with risk 33 and the consequent closure of risk

46 FINANCE & PERFORMANCE CCG95/2014 FINANCE & PERFORMANCE COMMITTEE REPORT Mr Hartland confirmed that the report summarises the key issues discussed at the Finance and Performance Committee at its meetings on 29 May 2014 and 26 June 2014. Mr Hartland highlighted key areas of the report: 18 Weeks Referral to Treatment (RTT) Performance (DGFT) - The 2013/14 Provider RTT figures show that DGFT achieved the aggregate RTT targets, but at specialty level failed the 90% target in ENT and Urology for admitted patients. Year to date in 2014/15 ENT and urology were under-performing.

There was significant pressure on the CCG to ensure the CCG, and its providers, met the 18 week target. Additional funding is expected to be received to ensure there are no breaches and alternative providers to DGFT are being explored. The Board will be informed of progress. Commissioning Support Unit (CSU) – Re-procurement and Business Case Update Mr Hartland informed that the Board about the re-procurement of CSU. He confirmed that the Committee was updated on the position in respect of the re-procurement elements of the service level agreement with Midlands and Lancashire CSU. The CCG has submitted a business case to NHS England and there is an agreed joint action plan. Discussion took place around TUPE costs with the CSU but at the moment the CCG do not expect the decision that the Board made to be challenged and it was anticipated to take those services back on 1 October. CCG IT Strategy group - Another important point for the Board to note is the proposal regarding the procurement of an IT system for use by all providers of community services to the CCG. This is a different model to that historically adopted in the NHS where providers procure and manage information systems. The proposal is for the CCG to define and procure a system that seamlessly enables the implementation and operational delivery of our integration model. The IT Strategy Group is now considering the legal and operational impact of this approach and the Board will be kept informed of progress. Dr Johnson felt that more head room could be made with regards the financial accounts and suggested that practice prescribing is looked at further due to huge inefficiencies. Mr Hartland referred to the paper that Dr Gupta had produced to the Clinical Development Committee around prescribing which highlighted how the team fully understand the situation and are working hard to try and reduce inefficiencies and Dr Hegarty suggested an update to the next Board. Dr Gee reported that there was a prescribing report included in the practice visits that he carries out and recently the practice based pharmacists have been attending the meetings as well which he confirmed was extremely useful.

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Dr Tapparo asked if there was a way of using IT systems to assist in reducing these inefficiencies and Dr Johnson confirmed there were operational systems, but none that match the requirements needed. Dr Mann also suggested focusing on the waste involved in the amount of drugs that are thrown away, for example when patients die, the community nurses have to throw any leftover medications away. Mr Maubach assured the Board that ECIST who are the experts in looking at emergency care would be bringing a report to the Systems Resilience Group over the next few months which will look at how inefficiencies can be improved across the health economy. Resolved:

1) The Board is asked to approve the report. 2) The Board agreed to receive an update around prescribing to the next Board

PRIMARY CARE CCG96/2014 PRIMARY CARE DEVELOPMENT COMMITTEE REPORT Mr King confirmed that the report summarises the key issues discussed at the Primary Care Development Committee on 15 May 2014 and 12 June 2014. The Committee received a letter inviting expressions of interest for the co-commissioning of primary care services and agreed that the CCG would pursue an expression of interest. The co-commissioning of primary care services was something that had already been expressed within both the strategic and operational plans of the CCG, supported by the Health and Wellbeing Board and Patient Opportunity Panel.

The co-commissioning proposal was developed and discussed via GP membership events, locality groups, Patient Opportunity Panel (POPs), the Local Medical Committee (LMC), the CCG Governing Body development sessions and NHS England Area Team (half day working group to discuss and understand functions). All of this took place in June 2014, and the expression of interest was submitted reflecting the feedback from these discussions, on the 20 June 2014. The CCG are awaiting instructions on the next steps. The Committee received a proposal from NHS England to support the associated prescribing costs arising from a Minor Ailments Scheme to be commissioned by NHS England. The Committee recommended that this be discussed with locality groups, and referred to the Clinical Development Committee for consideration. Dr Hegarty raised concern that the minor ailments scheme had been commissioned previously and did not meet expectations therefore suggested opening the lessons learnt from that previous scheme and ensuring that the same thing does not happen again. Dr Gee confirmed that this had been done and the governance of the process was now far more robust. Mr King reported that the Committee received the quarterly immunisation report, and noted that Dudley practices have achieved higher than National average uptake rates for Rotavirus and Pertussis. Dr Heber highlighted how important this achievement is especially in relation to the reduction of child admissions into hospital. The Committee reviewed the Terms of Reference and proposed changes to include representation from the elected member of the Patient Opportunity Panel and a representative of Healthwatch to be included as non-voting members of the Committee. This proposal will be reviewed as part of the wider review of committees and governance arrangements. Resolved:


DATE OF NEXT MEETING

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Thursday 11 September 2014 1pm – 5pm Boardroom, Brierley Hill Health & Social Care Centre MINUTES ACCEPTED AS A TRUE AND CORRECT RECORD Name Title

Signed Date

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MATTERS OUTSTANDING

UP TO THURSDAY, 11 SEPTEMBER 2014 – PUBLIC BOARD MEETING

ITEM NO AGENDA ITEM ACTION TO BE TAKEN ACTION FOR DEADLINE

CCG040/2014

COMMUNICATIONS & ENGAGEMENT REPORT

The Board noted that Mr Williams would establish if LAT representation would attend a POPs. Mr Williams

Update 11 September

2014

CCG87/2014 COMMISSIONING FOR OUTCOMES

The Board agreed to receive a report on the work done by the task and finish group on commissioning for outcomes in September 2014.

Mr P Maubach 11 September 2014

CCG95/2014 FINANCE & PERFORMANCE The Board agreed to receive a verbal update on prescribing wastage to the next Board. Dr PD Gupta 11 September

2014

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Date of Report: 11 September 2014

Report: Public Update Agenda item No: 5.3

TITLE OF REPORT: Public Update

PURPOSE OF REPORT:

• To update the Board on items of interest including recent media activity and issues raised by patients and public.

• This new report is positioned at the start of Board to add to the other public voice items

• This report is intended to add value by giving the Board insight into what the patients & publics views on the NHS locally are.

AUTHOR OF REPORT: Richard Haynes/ Laura Broster- Head of Communications and Engagement

MANAGEMENT LEAD: Richard Haynes/ Laura Broster- Head of Communications and Engagement

CLINICAL LEAD: Dr David Hegarty, Chair

KEY POINTS: • New report • Media activity including 2 rebuttals • New communications protocol for members

RECOMMENDATION:

• Note the contents of the report • That the Board is assured that the CCG has mechanisms in

place to hear the voice of the patient & public and that issues raised are being reflected on internally with appropriate actions taken.

FINANCIAL IMPLICATIONS: • The CCG has a statutory duty to involve. Failure to do so could

result in costly judicial proceedings. • All activity reported is covered by the existing communications &

engagement budget unless stated otherwise.

WHAT ENGAGEMENT HAS TAKEN PLACE:

ACTION REQUIRED: Assurance Decision Approval

Introduction

This new report is presented with the aim of keeping Board members up to date with important communications and engagement issues and ‘hot topics’ that may be outside or beyond the assurance required from the Communications and Engagement Committee Report.

It is also produced with the specific aim of further strenghtening the patient voice at our board meetings by including sections dedicated to feedback from our Patient Participation Groups, Patient Opportunities Panel and Healthwatch – a response to a series of requests from some of our more active patient representatives.

Not all the sections are fully populated in this report, and that reflects the evolving nature of the document. However, the section headings have been included to provide further guidance for Board members on what to expect in future and to encourage further discussion and feedback.

The Feet on the Street video screened at today’s Board meeting features a collection of patient stories reflecting the widely differing experiences of local people as they move through the health care system from one provider to another.

When the system works in a joined up way to meet the needs of patients, we see the NHS at its best – but when people fall ‘between the cracks’ or their needs or conditions challenge the system’s limited ability to work in an integrated way, the result is inconvenience, distress and poorer clinical outcomes.

Our vision of integration is designed to address some of these issues, and move to a model where health and social care staff are able to work together to deliver a truly patient centred service that encourages innovation and is flexible, agile and adaptable to meeting the changing needs of the communities we serve.

We have recently included ‘prompt questions’ at the end of the video to prompt a discussion from Board members.

This section includes specific updates from, and issues raised by, Public and Patients in our forums plus snapshots of what our patients are saying on social media and other relevant arenas.

Under plans to expand the remit of the CCG’s Communications and Engagement Team to take on more of the work around patient experience, future versions of this report will also include updates on issues identified from our analysis of a comprehensive suite of patient experience data and feedback. To support this area we will be out to advert for a Patient Experience Analyst in the near future.

Public Update

Patient Participation Groups (PPGs) – individually and, as they develop, from the locality based PPG networks Recent PPG developments include the establishment and first meeting of a locality group for Kingswinford, Amblecote and Brierley Hill (KAB) locality. We are supporting them with any development that they may need. Patient Opportunities Panel (POPs) We held a recent development session to see how they can better influence the Board. We are working with Deloitte to facilitate a conversation around 7 day working with a patient representative as this is an area of interest for this group and the patients they represent. Our Accountable Officer also attended a recent POPs and was able to answer several queries that the panel had around premises. Healthcare Forum (HCF)

Our next healthcare Forum is on, Thursday 25 September at 4.30 pm in Dudley College Great Hall, The Broadway, Dudley DY1 4AS.

The title of the event is: ‘Healthcare Without Walls – Putting You at the Heart of Your Care’. The HCF provides an opportunity for people to hear more about our plans to integrate health care services to provide more joined up, patient centred services.

Update from Jayne Emery, Chief Officer, Healthwatch Dudley

Young people’s views on visiting a doctor’s surgery : We are working with Dudley Youth Service to hear young people’s views about health and wellbeing.

A group of 12 young people between the ages of 13 and 23 have produced a questionnaire based on their own awareness of access to GP services. Many of them thought that young people (under 18) could not talk to a doctor without being accompanied by a parent or carer, so they decided to get more views and have asked around 300 other young people about their understanding and also their wider experience of visiting their GP.

The group will be meeting again in September to analyse their results and to plan how they would like to present their findings.

Special Inquiry into hospital discharge: We recently carried out a survey as part of a Healthwatch England Special Inquiry to find out people’s experiences of discharge from hospital.

Initial analysis suggests key issues are likely to include:

• Care plans not given when leaving hospital. • Delays when leaving hospital • Discharge procedures not discussed • Patients discharged although they did not feel ready or well enough to leave hospital. • Patients’ family not involved in decisions

Excluded Patient’s Scheme: A Dudley resident contacted us with regards to exclusion from a local GP practice (due to personality disorder) and problems with accessing mental health services.

The GP issue has resulted in Healthwatch Dudley making contact with NHS England Local Area Team to obtain further information and clarity about the Excluded Patient’s Scheme. Findings will be shared with CCG colleagues as soon as they are available.

In response to requests from Board members, this section of the report will include updates on proactive and reactive media activity and any other current issues.

Proactive and Reactive Media Activity

Communications and Engagement – Media Monitoring – August 2014

Title/weblink Summary Release Date

Coverage (with links where available) Comments

Dancing In Memory

Dedicated staff at Dudley CCG held a charity ball which has helped raise thousands of pounds for the late Dr Liz Pope’s chosen charity.

31 July 2014

Stourbridge News Express and Star (All Locals) http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Dancing-In-Memory-Ball.pdf

Also circulated via CCG Facebook and Twitter Feeds

Patients Face Long Wait to see GP

Coverage including: Reactive statement to Labour candidate Natasha Millward concern about GP access & waiting times

31 July 2014

Stourbridge News http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Patients-Facing-Long-Term-Wait.pdf

Also circulated via CCG Facebook and Twitter Feeds Information has been filed for Annual Report 2014/15

Top Award for Surgery

Coverage of press release reporting on staff awards ceremony

31 July 2014

Halesowen News http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Top-Award-For-Surgery.pdf

Full statement also emailed directly to the Council’s scrutiny officer

Health bosses move ease parking concerns

Coverage including: Reactive statement to Councillor Hemingsley from NHS Dudley CCG and The Dudley Group NHS Foundation Trust

1 August 2014

Stourbridge Chronicle Dudley Chronicle http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Health-Bosses-Move-to-Ease-Parking-Concerns.pdf

Patients having to wait over a week for GP

Coverage including:

4 August 2014

Hereford Times (Web) Stourbridge News (Web) Cotswold Journal (Web)

http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Dancing-In-Memory-Ball.pdf



http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Patients-Facing-Long-Term-Wait.pdf



http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Top-Award-For-Surgery.pdf



http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Health-Bosses-Move-to-Ease-Parking-Concerns.pdf



appointments in Halesowen

Reactive statement to Labour candidate Natasha Millward concern about GP access & waiting times

Dudley News (Web) Evesham Journal (Web) Malvern Gazette (Web) Ludlow Advertiser (Web) Droitwich Spa Advertiser (Web) Tewkesbury Admag (Web) Bromsgrove Advertiser (Web) Halesowen News (Web) http://www.stourbridgenews.co.uk/news/blackcountry/11385794.Patients_having_to_wait_over_a_week_for_GP_appointments_in_Halesowen/?ref=rss

Patients wait over a week to see their GP


7 August 2014

Halesowen News – Main http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Patients-Wait-Over-a-Week-to-See-GP-in-Halesowen.pdf

Week's wait to visit your GP


13 August 2014

Dudley News http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Weeks-Wait-to-Visit-Your-GP.pdf

New review on threat to Dudley drop-in centre future

A new consultation is being held over the future of a drop -in centre for people who suffer mental health problems in Dudley. People who use Dove House have also started to apply for grants and intend to hold fundraising events to keep the centre open

28 August 2014

Express & Star Dudley & Stourbridge http://www.expressandstar.com/news/2014/08/28/new-review-on-threat-to-dudley-drop-in-centre-future/ http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/New-review-on-threat-to-Dudley-drop-in-centre-future-Dove-House.pdf

Response to enquiry on number of jobs/staff at new urgent care centre:

Coverage including: Reactive statement from Jason Evans: Jobs pledged for urgent care centre

28 August 2014

Express & Star Dudley (Web) http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Jobs-Pledged-for-Urgent-Care-Centre.pdf

http://www.stourbridgenews.co.uk/news/blackcountry/11385794.Patients_having_to_wait_over_a_week_for_GP_appointments_in_Halesowen/?ref=rss




http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Patients-Wait-Over-a-Week-to-See-GP-in-Halesowen.pdf



http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Weeks-Wait-to-Visit-Your-GP.pdf



http://www.expressandstar.com/news/2014/08/28/new-review-on-threat-to-dudley-drop-in-centre-future/



http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/New-review-on-threat-to-Dudley-drop-in-centre-future-Dove-House.pdf




http://www.dudleyccg.nhs.uk/wp-content/uploads/2014/08/Jobs-Pledged-for-Urgent-Care-Centre.pdf



This section includes further details where the CCG has had cause to correct some information already in the public domain. This month there have been two issues of note.

Rebuttal to Commissioning Review- Better Care Fund

In response to the story dated 21 August 2014 titled “Eight areas axed from BCF 'fast-track' scheme” http://www.thecommissioningreview.com/article/eight-areas-axed-bcf-fast-track-scheme We were concerned that the headline and accompanying article did not accurately reflect the true position with regard to the Better Care Fund – and certainly not in relation to Dudley which was described as one of the ‘axed’ areas. Neither Dudley CCG or Dudley Council were offered an opportunity to comment on the story before it was published and as such we issued the jointly agreed statement below and requested that this be reflected in the tone and content of the article. “It is not correct to suggest that Dudley has ‘fallen behind’ or been ‘axed’ or ‘excluded’ from the Better Care Fund fast track. NHS Dudley CCG and Dudley Council made a joint decision to withdraw from the fast track due to a lack of clarity at the time following the change of policy linked to both funding and performance. We remain firmly on course to submit our plans in line with national timetable of 19 September.”

We have received confirmation that this correction will be carried by the publication.

Concerns over Royal College of Surgeons(RCS) , Access all Ages Report & Subsequent Coverage.

As discussed at the last Board meeting the resulting coverage from these reports including the Daily Telegraph coverage at http://www.telegraph.co.uk/health/healthnews/10942295/NHS-defies-the-law-to-deny-pensioners-vital-operations-warns-Royal-College-of-Surgeons.html raised questions for us on the validity of the data used in the initial report.

We have raised these concerns with the RCS and produced the figures below which accurately reflect the Dudley position.

“The data published in a report by Age UK and the Royal College of Surgeons, on which the Daily Mirror and Daily Telegraph based their articles, wrongly states that in 2011/12 only seven people in Dudley over the age of 65 received ‘breast excision’ surgery; and no patients aged 75 had surgery.

The facts are that the Trust carried out 219 operations in 2011/12 on patients with breast cancer and almost half (45 per cent) of these were aged 65 or over, and almost half of these (42 per cent) were over the age of 75.

http://www.thecommissioningreview.com/article/eight-areas-axed-bcf-fast-track-scheme

http://www.telegraph.co.uk/health/healthnews/10942295/NHS-defies-the-law-to-deny-pensioners-vital-operations-warns-Royal-College-of-Surgeons.html

http://www.telegraph.co.uk/health/healthnews/10942295/NHS-defies-the-law-to-deny-pensioners-vital-operations-warns-Royal-College-of-Surgeons.html

These correct figures show absolutely that there is no age discrimination in Dudley: we hope our patients are reassured that surgery, if required, is offered to patients of all ages. An alternative to surgery (for example hormone therapy) may be offered to patients who are too unwell to have an anaesthetic or those who choose not to have surgery.

Even the term ‘breast excision’ is imprecise. A range of surgical procedures for breast cancer is required including mastectomy, wide local excision (lumpectomy), wire guided procedures etc.. and it is unclear which procedure codes have been used in the report published by Age UK. Our analysis included all the relevant operations for breast cancer.

With most external audits, if unexpected data are identified the relevant bodies (e.g. Dudley Clinical Commissioning Group and The Dudley Group) are normally contacted to validate the findings. This did not happen and therefore we did not have an opportunity to exclude data issues before publication, and newspaper articles drawing the wrong conclusions.”

At the time of producing this report we had not heard back from the RCS. A verbal update will be provided at the public meeting of Board.

Communications and Engagement with our Member Practices

In a bid to further improve the effective cascade of information to our member practices, we held a series of discussions with GPs through locality meetings, Clinical Forum and Clinical Executive about what they wanted from our corporate communications.

As a result of feedback from GPs, we introduced the end of August a new weekly email brief designed to reduce the number of emails sent out, summarise key issues and raise awareness of who the clinical and managerial leads are for key areas of work.

This is supported by a protocol to prioritise messages to GPs and further reduce the amount of email ‘noise’ – a subject many of them were kene to see the CCG tackle.

A show of hands at a recent members meeting suggested that the new style news was being well received.

Laura Broster Head of Communications August 2014

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Date of Report: 11 September 2014 Report: Strategic Issues - Progress

Agenda item No: 7.1

TITLE OF REPORT: Strategic Issues - Progress

PURPOSE OF REPORT: To advise the Board of progress with a number of key strategic issues

AUTHOR OF REPORT: Mr N. Bucktin, Head of Commissioning

MANAGEMENT LEAD: Mr N. Bucktin, Head of Commissioning

CLINICAL LEAD: Dr S Mann, Clinical Executive, Acute and Community Services Dr S Cartwright, Clinical Executive, Partnerships and Integration

KEY POINTS:

1. Strategic Plan submitted to NHS England – final submission is required in September for NHS England Assurance.

2. Operational Capacity and Resilience Plan submitted to NHS England – final confirmation of assurance awaited.

3. Main elements of integrated services model being established, confirmation awaited from Dudley Group NHS FT in relation to clinical governance arrangements for community rapid response team.

4. Better Care Fund submission to be made on 19th September. 5. Urgent Care Centre procurement process nearing completion. 6. Establishment of a CCG Task and Finish Group to develop our

plans for co-commissioning

RECOMMENDATION:

1. That progress in relation to:- • the Strategic Plan; • the Operational Capacity and Resilience Plan; • service integration; • the Better Care Fund; • the urgent care centre;

be noted. 2. That approval be given to establish the Task and Finish Group, chaired by Steve Wellings, to develop our plans for co-commissioning

FINANCIAL IMPLICATIONS: The financial implications of the plans identified, the service integration model and the urgent care centre are all addressed in the CCG’s Financial Plan.


Engagement has taken place in relation to individual proposals contained within the planning documents referred to, the development of the service integration model and the urgent care centre, as necessary.

ACTION REQUIRED: Decision Approval Assurance

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 KEY STRATEGIC ISSUES - PROGRESS 1.0 PURPOSE OF REPORT

1.1 To note progress in relation to a number of key strategic issues. 2.0 STRATEGIC ISSUES 2.1 The Board will be aware of the significance of a number of key strategic issues. This report sets out

progress to date on:-

a. development of the Strategic Plan; b. development of the Operational Capacity and Resilience Plan; c. service integration; d. the Better Care Fund; e. the urgent care centre.

3.0 STRATEGIC PLAN 3.1 Following approval by the CCG Board and the Health and Wellbeing Board, the Strategic Plan was

submitted to NHS England in June 2014. Initial feedback has been received from NHS England on the outcome of their assurance process and a further meeting with NHS England is scheduled to take place on 8th September, prior to a final submission being made in late September.

3.2 An update on the outcome of the meeting to be held on 8th September will be given to the Board. 4.0 OPERATIONAL CAPACITY AND RESILIENCE PLAN 4.1 The Board will recall that in June, 2014, NHS England issued guidance on the preparation of

Operational Capacity and Resilience Plans, designed to deal with two key issues – elective care and the 18 week referral to treatment target, as well as urgent care and the 4 hour ED waiting target.

4.2 These plans were to be overseen by “System Resilience Groups” (SRGs) consisting of all key

partners in the health and social care economy and chaired by the CCG’s Chief Accountable Officer. The System Resilience Group would also deal with the allocation of resources made available non-recurrently by NHS England to be set out in the plan. Plans would also identify what further local resources were being committed as part of this process.

4.3 Due to DGFT breaching the 4 hour A&E target during 2013/14 and 2014/15, the Dudley health

Economy has been classed as ‘High Risk’ in terms of delivery of the 4 hour target and referral to treatment times.

4.4 NHS England therefore will not release the assigned funding for the CCG until the Systems

Resilience Plan has been approved. 4.5 Items included within the plan for further investment are:

- discharge to asses model - additional activity and to achieve 18 week target - additional capacity in intermediate care - mental health psychiatric liaison service - voluntary sector link workers - additional capacity in walk-in-centre over winter - mental health crisis concordat pilot

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4.6 The first plan submission was made on 30th July. Given the particular challenges faced by the Dudley health and social care economy, our plan has been subjected to a higher level of scrutiny than other areas. Initial feedback on the outcome of the assurance process was received in early August and a resubmission made on 29th August. Feedback on the final outcome of the assurance process is now awaited.

5.0 SERVICE INTEGRATION 5.1 Progress has been made in relation to the development of the agreed service integration model as

follows:-

a. community rapid response team – the team is now operational and recruitment is underway for its associated services. Further discussions have taken place in relation to clarifying the clinical governance arrangements for the team and its ability to take responsibility directly for responding to calls which would ordinarily be managed by the West Midlands Ambulance Service NHS Trust. Dr. Cartwright will provide a further update at the meeting;

b. development of practice based teams – 5 early implementers, with input from all partners,

have been established and are meeting. Following the re-organisation of community nursing services, teams will now be established across all practices;

c. GP locality leads – job descriptions for these posts have now been agreed and a

recruitment process for the 5 posts has commenced;

d. locality link workers – these 5 workers have been recruited. Their role will be to ensure statutory services are appropriately connected to the voluntary sector and develop new capacity in the voluntary and community services sector;

e. social prescribing scheme – this has now been commissioned from Age UK.

5.2 With the establishment of teams at practice and locality levels, teams will now be expected to review

performance data in relation to the population they are responsible for. CCG locality meetings will have a role in ensuring the system is held to account properly for performance.

6.0 BETTER CARE FUND (BCF)

6.1 Revised guidance on the BCF has now been published. This has amended the original

arrangements, such that the performance related element of the BCF (£ 5.787m out of a total base fund of £ 23.841 m in Dudley) is now solely dependent upon performance in reducing emergency admissions.

6.2 Whilst performance in relation to delayed transfers of care, admissions to care homes and

reablement no longer feature in terms of determining access to the performance element of the BCF. The guidance expects performance in relation to these issues to be part of local plans. Work is taking place with Dudley MBC and the CSU to develop a comprehensive performance framework which will include these and other measures. The intention is that this will be disaggregated down to practice team level and each team will receive a monthly report on performance against its share of the total performance picture.

6.3 Further work also needs to take place so that all parties are clear about the financial implications of

the revised guidance and reach agreement on a risk sharing arrangement to underpin this. 6.4 The BCF submission needs to be made to NHS England by September 19th.

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7.0 URGENT CARE CENTRE (UCC) 7.1 The procurement process for the UCC is nearing its conclusion. Presentations from short listed

bidders are scheduled to take place on 3rd September, following which a contractor will be selected. In addition arrangements are being made to appoint a QS to assess the capital infrastructure proposal

8.0 CO-COMMISSIONING OF PRIMARY CARE 8.1 We included our intent to undertake co-commissioning with NHS England in our strategic plan. This

was reciprocated by the local NHS England Area Team in their strategic plan. Subsequently national guidance was issued and we submitted proposals to undertake the maximum devolved co-commissioning of primary care in order to maximise the potential to be able to retain appropriate resources in Dudley and fully integrate primary care commissioning into our strategic plans. It should be noted that even with the maximum scope resting with the CCG, NHS England will still retain responsibility, within the co-commissioning arrangements, for issues such as managing the performers list and individual performance issues.

8.2 However, to date, NHS England nationally has not responded with any subsequent follow-up on the

next stages to establish the co-commissioning arrangements. Nevertheless we are continuing to work with the local Area Team to progress the plans and we expect a timetable to be issued which would see successful CCGs taking on co-commissioning from April 2015.

8.3 We therefore need to ensure that we put in place the necessary preparation to meet the requirements that are set out by NHS England once they are published. This will inevitably include ensuring we have clarity on appropriate governance arrangements; implement changes to our constitution; and have clarity of purpose on the outcomes we expect to achieve. A particular concern will be to ensure that we appropriately manage any potential conflicts of interest.

8.4 We therefore recommend that we establish a Task and Finish Group with the specific remit to

establish the governance arrangements for co-commissioning and develop the initial outcome objectives and timetable for implementation. Proposed membership to include:

• Non-executive Board member as chair (Steve Wellings) • One other non-executive Board member • One GP Board member • LMC representative and one other GP from the wider membership • Chief Accountable Officer • Chief Finance Officer • Head of Membership Development • Head of Commissioning

9.0 RECOMMENDATION 9.1 That progress in relation to:-

a) the Strategic Plan; b) the Operational Capacity and Resilience Plan; c) service integration; d) the Better Care Fund; e) the urgent care centre;

be noted.

9.2 That approval be given to establish the Task and Finish Group, chaired by Steve Wellings, to

develop our plans for co-commissioning. Mr. N. Bucktin Head of Commissioning August 2014

of 12


Date of Report: 11 September 2014 Report: Quality & Safety Committee Report

Agenda item No: 8.1

TITLE OF REPORT: Report from the Quality & Safety Committee

PURPOSE OF REPORT: To provide on-going assurance to the Governing Body regarding quality and safety in accordance with the CCG’s statutory duties.

AUTHOR(s) OF REPORT: Rebecca Bartholomew, Chief Quality & Nursing Officer

MANAGEMENT LEAD: Rebecca Bartholomew, Chief Quality & Nursing Officer

CLINICAL LEAD: Ruth Edwards, Clinical Executive Lead for Quality

KEY POINTS:

Report of the Quality and Safety Committee Meetings held on 22 July 2014 and 19 August 2014. • Unannounced visit undertaken to DGFT in response to anonymous

whistle-blowing allegation • Increase in Serious Incident reporting at DGFT (as a result of

pressure ulcers being reported in line with national guidance) • Trend in Serious Harming Behaviour identified via D&WMHT

Serious Incidents

RECOMMENDATION:

The Board is asked to accept this report as a source of on-going assurance that the CCG Quality & Safety Committee continues to maintain forensic oversight of all clinical quality standards in line with the CCG’s statutory duties.

FINANCIAL IMPLICATIONS: None to report


User experience is an essential component of quality assurance and surveillance and as such public views and feedback form part of the triangulation of hard and soft intelligence.

ACTION REQUIRED: Assurance Approval Decision

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 QUALITY & SAFETY COMMITTEE REPORT TO GOVERNING BODY ___________________________________________________________________________ 1. INTRODUCTION 1.1 To provide assurance to the Governing Body that the CCG Quality & Safety Committee

continues to maintain forensic oversight of all clinical quality and patient safety standards in line with the CCG’s statutory duties.

1.2 The CCG Quality & Safety Committee meets monthly and is chaired by Dr Ruth Edwards,

clinical executive lead for quality. This report is a material summation of the Committee’s meetings in July and August 2014.

1.3 The Governing Body will be briefed on any contemporaneous matters of consequence arising

after submission of this report at its meeting. 2. SECRETARY OF STATE ANNOUNCEMENTS 2.1 The Quality & Safety Committee will discuss these announcements at its next meeting, but it is

important that the Board are sighted on these developments. Introduction of car parking principles 2.2 On 23 August 2014 the Department of Health published NHS patient visitors and staff car

parking principles, stating that NHS organisations should work with patients, staff and local authorities to take steps to ensure that:

• charges are reasonable; • concessions are available for people with special needs, e.g. people with disabilities,

frequent attenders, visitors with relatives who are gravely ill, etc.; • the priority for staff parking should be based on need.

Safer Staffing levels 2.3 Nurse staffing levels at Trusts across England were published for the first time in June 2014

under new rules on transparency. Dudley CCG is working closely with the providers to review workforce planning and safer staffing levels. Data on actual versus planned staffing levels will be published on the safety section of the NHS Choices website. This information forms part of the suite of surveillance by the Quality team.

Standards for food 2.4 In August 2014 the Department of Health has published the Hospital Food Standards Panel

Report which recommends a set of food standards which should become routine practice across NHS hospitals. These standards will be required through NHS contracts, meaning that the hospitals will have a legal duty to comply with the following recommendations:

• Hospitals should screen patients for malnutrition; • Patients should have a food plan; • Hospitals must take steps to ensure patients get the help they need to eat and drink,

including initiatives such as protected meal times where appropriate; • Hospital canteens must promote health diets for staff and visitors; • Food must be sourced in a sustainable way.

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3. UPDATE 3.1 The following sections provide a brief update on issues discussed by the Committee, or matters

arising which the Governing Body need to be aware of. 4. DUDLEY GROUP FOUNDATION TRUST (DGFT) 4.1 Dudley CCG received information on an anonymous whistle-blowing allegation from the Care

Quality Commission in August 2014 regarding DGFT. The allegation specifically mentioned three wards at Russells Hall Hospital, and made reference to the care and treatment provided to patients.

4.2 In response to the information received, an unannounced visit to DGFT was planned and

undertaken by members of the Quality team on Friday 15 August 2014. 4.3 Interim plans to gain assurance of patient safety will be discussed at the next DGFT Clinical

Quality Review Meeting (CQRM). 4.4 A draft report has been completed and forwarded to DGFT on 29 August 2014. DGFT’s initial

comments are expected by 12 September 2014, and a copy of the report will be made available to the Quality & Safety Committee, for comments, at the next meeting on 16 September 2014.

Serious Incident reporting and management

4.5 The Board will note the increase in the reporting of Serious Incidents (SIs). This represents a

further increase in the reporting of pressure ulcers. Figure 1 (below) provides a summary of the incidents reported by DGFT on the national Strategic Executive Information System (STEIS) throughout 2013/14, and 2014/15 to date. Predominant themes are medication, patient falls, pressure ulcers, clinical care, and information governance issues.

4.6 A total of 76 SIs have been reported by DGFT year-to-date (April to July) during 2014/15, with

an average of 19 SIs reported each month. Figure 1: Serious Incidents reported by DGFT

4.7 Quarter 2 results are not yet complete.

Never Events 4.8 There was discussion at the August 2014 CQRM regarding a potential Never Event. DGFT’s

Medical Director provided a detailed explanation and rationale to support the decision not to report the issue as a Never Event, and a detailed Route Cause Analysis found that medical

Year 2013/14 2014/15

Subject Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Total SIs reported 28 28 42 45 39

Never Events reported 0 0 1 1 0

72-hour briefs raised

(including NEs) 7 13 14 12 8

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equipment failure had occurred. The CCG has focused on ensuring appropriate senior clinical staff are aware of this and similar incidents in the future. The Quality team is gaining assurance that governance and reporting mechanisms are implemented in a timely manner for any future incidents. The Area Team has been informed of this decision.

Safety Thermometer 4.9 The NHS Safety Thermometer provides a quick and simple method for surveying patient harms

and analysing results so that this can be measured and monitored over time. For acute providers this focuses on reducing the incidence of four harms; pressure ulcers, venous thromboembolism, catheter acquired urinary tract infections, and falls. This provides organisational context for the services we commission.

4.10 The methodology is to audit a sample of patients from across the Trust each month. The figure

below shows the percentage of sampled patients reported by DGFT as having no harm identified, and reflects the consistently high levels of harm free care reported by DGFT. However, there is more that can be done to improve this. The results reported by DGFT are in line with peer Trusts.

Figure 2: Harm Free Care reported by DGFT July 2013 – July 2014

Falls resulting in Harm 4.11 The figure below shows the number of patient falls resulting in harm reported by DGFT year-to-

date (April to July) during 2014/15. This has been a key feature of discussions with DGFT at CQRMs, particularly around risk assessments and roll out of the falls care bundle. The CQRM in August 2014 focused on the work carried out by DGFT, who reported that there had been a reduction in falls between June 2013 and May 2014 when compared with the period June 2012 to May 2013. However, DGFT accepts that work needs to be done to reduce the percentage of avoidable falls currently at almost 60%.

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Figure 3: Falls resulting in harm 4.12 Quarter 2 results are not yet complete. New Grade 3 or Grade 4 pressure ulcers 4.13 DGFT continues to do a significant amount of work to eliminate avoidable pressure ulcers, and

is reporting higher numbers of pressure ulcers as a result of challenge at CQRM. A total of 39 pressure ulcers have been reported by DGFT year-to-date (April to July) during 2014/15, with 38 reported as Grade 3 and one reported as Grade 4.

4.14 Figure 4 (below) shows the incidence of Grade 3 and Grade 4 pressure ulcers reported by

DGFT since 2011/2012. Quarter 2 results are not yet complete.

Figure 4: Incidence of Grade 3 and Grade 4 pressure ulcers

Mortality 4.15 DGFT has had an improving focus on mortality and has undertaken a lot of work to understand

mortality drivers. 4.16 An updated DGFT mortality trend and position using HED data for both HSMR and SHMI is

expected to be available in September 2014. 4.17 There are no Care Quality Commission / Dr Foster Intelligence mortality outlier alerts. Friends and Family Test (FFT) 4.18 FFT scores can range from -100 to +100. The higher the score, the better reported patient

experience. 4.19 Figure 5 (below) shows that DGFT’s FFT scores are generally higher than the national score.

Year 2013/14 2014/15


Falls resulting in fracture 1 1 3 7 0

Falls resulting in injury / death 3 4 4 5 3

Year 2013/14 2014/15


Grade 3 pressure ulcers 1 2 13 18 13

Grade 4 pressure ulcers 0 0 0 0 0

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Figure 5: FFT scores and response rate for inpatient services at DGFT

FFT Inpatients Score

40

50

60

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100

Apr-1

3

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-13

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DGFT Inpatients England Inpatients

FFT Inpatients Response Rate

0%

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DGFT Inpatients England Inpatients

4.20 Figure 6 (below) shows that DGFT’s FFT response rates have generally fluctuated above and

below the national rates Figure 6: FFT scores and response rate for A&E at DGFT

FFT A&E Score

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100

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-13

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DGFT A&E England A&E

FFT A&E Response Rate

0%

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DGFT A&E England A&E

4.21 FFT is operational in maternity services across four touch-points (antenatal, birth, postnatal ward

and postnatal community). DGFT continues to do better than the national average at all these stages based on the information shown below in Figure 7 (below).

Figure 7: FFT scores for maternity service at DGFT

FFT Maternity (Q1) Antenatal Score

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100

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3

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DGFT England

FFT Maternity (Q2) Birth Score

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DGFT England

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FFT Maternity (Q3) Postnatal Score

40

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100Oc

t-13

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Dec-1

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Jan-1

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DGFT England

FFT Maternity (Q4) Postnatal Community Score

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DGFT England

Staff Friends and Family Test

4.22 Staff FFT is to be implemented from April 2015. The primary purpose of Staff FFT is to support local service improvement work and NHS England has adopted a flexible approach for how organisations implement Staff FFT.

4.23 Staff FFT data is to be collected and submitted quarterly for Q1, Q2 and Q4 after the end of

each quarter. For Q3 (when the annual NHS staff survey is undertaken) there is no requirement to undertake Staff FFT, although organisations may wish to do so.

4.24 A proportion of staff should have the opportunity to respond to Staff FFT in each of the three

quarters, with all staff having the opportunity once per year, as a minimum requirement. Organisations are expected to provide all staff with the opportunity to respond during each quarter if they so wish.

Clinical Quality Review Meeting (CQRM) 4.25 CQRMs are held monthly with DGFT together with other associate commissioners and

colleagues from the Office of Public Health as appropriate. All stakeholder commissioners receive copies of reports and minutes. Meetings are focused on reviewing the quality of care given supported by surveillance data and reports and data / analysis. Meetings are attended by senior management from DGFT and CCG(s) and operate on the basis of scrutiny and challenge. All providers are now subject to monthly meetings and have a schedule of dates going forward.

5. DUDLEY & WALSALL MENTAL HEALTH TRUST (D&WMHT) Serious Incident (SI) reporting and management 5.1 Receipt of Serious Incident notification and Route Cause Analysis (RCA) reports continues via

Walsall CCG. Investigation reports are reviewed by the Quality Team, and feedback has been provided to Walsall CCG that there is room for improvement in relation to some RCAs. Issues are addressed via monthly CQRMs.

5.2 A trend of serious harming behaviour has been identified, and further detail and assurance is

being sought via CQRM.

Never Events 5.3 There have been no Never Events reported by D&WMHT.

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Safety Thermometer 5.4 The safety thermometer is a national initiative focused on reducing harm at the point of care – in

mental health providers this focuses predominantly on reducing harm related pressure ulcers and falls, other work looks at reducing the risk of harm from violence and aggression and at the point of handover. This provides organisational context for the services we commission.

Figure 8: Harm Free Care reported by D&WMHT July 2013 – July 2014

Friends and Family Test 5.5 Recent updated guidance from DoH confirms that reporting on Friends and Family Test has

been deferred to January 2015. Results of CQC Mental Health Survey April 2014 5.6 CQC recently published the results of a survey looking at the experiences of service users

receiving care and treatment from mental healthcare providers. CQC did not detail how many service users were approached or responded, or the period during which care was assessed. D&WMHT agreed at the August 2014 CQRM to compare the findings of CQC with relevant internal audits. D&WMHT plan to identify themes to improve the experience of service users.

Clinical Quality Review Meetings 5.7 From June 2014, the CCG is having monthly CQRMs with D&WMHT, prior to this meetings were

held jointly with commissioners from Walsall CCG. The changed arrangements are so a greater focus can be placed on Dudley residents. Dudley CCG now has greater scrutiny of the quality of care offered to Dudley patients and is shaping KPIs, innovation and safety.

5.8 Dudley CCG is currently reviewing D&WMHT’s workforce plans.

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6. BLACK COUNTRY PARTNERSHIP FOUNDATION TRUST (BCPFT) 6.1 Dudley CCG has been advised of areas of concern around BCFPT commissioned services, and

current performance in services is being reviewed, with detailed reports being requested from BCPFT to understand the full extent of the concerns. The CCG is committed to ensuring that BCPFT understand the matters raised and that they are being dealt with appropriately. A full report will be submitted to the Quality & Safety Committee in September 2014, with a subsequent update to the Board in November 2014.

Serious incident reporting and management

6.2 Receipt of Serious Incident notification and Route Cause Analysis (RCA) reports continues via

Wolverhampton CCG. No Serious Incidents were reported during June and July 2014. Issues would be addressed via monthly CQRMs.

Never Events 6.3 There have been no Never Events reported by BCPFT. Safety Thermometer 6.4 The safety thermometer is a national initiative focused on reducing harm at the point of care – in

mental health providers this focuses predominantly on reducing harm related pressure ulcers and falls, other work looks at reducing the risk of harm from violence and aggression and at the point of hand over. Figure 9 (below) shows the high reporting percentage of harm free care at BCPFT, this is one of the highest figures across the country, and provides organisational context for the services we commission.

Figure 9: Harm Free Care reported by BCPFT July 2013 – July 2014

Patient Experience / Friends and Family Test

6.5 Recent updated guidance from Department of Health has been advised that reporting on the

Friends and Family Test has been deferred to January 2015.

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Clinical Quality Review Meetings 6.6 Monthly CQRMs are now being held, prior to this the meetings were quarterly and this was

insufficient to maintain oversight on the quality of services commissioned by the CCG. BCPFT is now compliant with reporting data at strategic and service level. Greater scrutiny is now in place to ensure that services delivered are effective and responsive to new legislation with regard to children’s services.

7. HEALTHCARE AQUIRED INFECTION MRSA and C difficile 7.1 The Office of Public Health provide support and advice to the CCG on Infection, Prevention and

Control matters, and provide epidemiology reports to the CCG which are discussed by the Quality & Safety Committee.

7.2 In 2014/15 C difficile thresholds have been set at 48 cases for DGFT and 108 cases for the

CCG. At the time of reporting, there have been nine confirmed cases at DGFT and 27 confirmed cases within the community (CCG attributed).

7.3 In 2014/15 the MRSA threshold set is zero for DGFT and the CCG – there have been no cases

reported to date. 7.4 The Quality team is reviewing the contents of a draft report on C difficile in collaboration with

OPH staff. This report will be received by the Quality & Safety Committee at its next meeting to particularly focus on what further action is needed to reduce rates further.

8. CHILDRENS SAFEGUARDING 8.1 The CCG continues to ensure that it meets its statutory functions regarding the safeguarding of

children. The Designated Senior Nurse post meets NHS England accountability framework and Working Together 2013 requirements and the post-holder works closely with other members of the team including the Designated Doctor and Named GP.

8.2 An independent company has been commissioned to undertake a review of safeguarding

arrangements within Dudley CCG; findings are due to be presented in September 2014 and will be reviewed by the committee following which the Board will be briefed.

8.3 It is expected that the CQC will be undertaking a themed inspection nationally on safeguarding

and Looked After Children’s services in the near future – date as yet unknown. Special Educational Needs and Disabilities (SEND) 8.4 The CCG Designated Nurse for Safeguarding Children updated the Quality & Safety Committee

on forthcoming changes to the Children & Families Bill, which transforms the system for children and young people with Special Educational Needs and Disabilities (SEND).

8.5 The Designated Nurse has highlighted this group’s requirement with the appropriate providers

on behalf of Dudley CCG. New duties will include support from the Core Assessment Framework team from September 2014 system wide work is well established. CQR meetings will continue to:

• Increase focus on the effectiveness of the transition pathway paediatric to adult care; • Promote listening to the voice of the child and young person, their experience and that of

their parents / carers;

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• Creation of single system spanning 0-25 years for all children and young people and their families through reforms that include the creation of a simplified assessment system, improved co-operation between health and social care, greater choice, and control to parents;

• Encourage services to work with Local Authorities to publish a clear and transparent ‘Local Offer’ of services to support children and their families.

9. ADULT SAFEGUARDING 9.1 The Q&S Committee was updated on a report received from West Sussex Adult Safeguarding

Board about an incident reported to the local CCG arising from Orchid View Nursing Home in West Sussex. This home was part of the former Southern Cross group. It was noted that the incident raised related to the deaths of 19 patients deaths over a two year period. An independent serious case review was carried out with 34 recommendations made. There are implications for Clinical Commissioning Groups across the country. Many of the recommendations are currently being implemented in Dudley. Ongoing updates will be forwarded to the Board.

Court Ruling – Deprivation of Liberty 9.2 The Committee received a report on a recent court ruling regarding Deprivation of Liberty (DOL)

(P versus Cheshire West & Chester Council, and P & Q versus Surrey County Council - ruling in the Supreme Court 2014) as a result there is an expectation that there will be an increase in referrals for DOL assessments. This information to include additional detail has been forwarded to all providers. Dudley CCG is monitoring DoLs assessments in collaboration with Dudley Borough Council.

10. NATIONAL REGULATORS Care Quality Commission (CQC) Inspection at DGFT 10.1 CQC undertook a visit to DGFT in March 2014 as part of a national review of the 14 Trusts

reviewed by NHS England following identification of concerns regarding mortality rates. The CQC inspection included two days on site and focused on eight services. A summit meeting took place on Monday 23 June 2014, and we are awaiting the final report (progress monitored via monthly CQRM).

Inspection at D&WMHT 10.2 CQC inspected the Trust in February 2014, a Quality Summit was held following this attended

by the CCG. As a result of this inspection, D&WMHT has completed an action plan to comply with identified actions. The action plan will be shared at the next CQRM in September 2014.

11. INDEPENDENT PROVIDERS UPDATE 11.1 Dudley CCG commissions services from Ramsay Healthcare at its West Midlands Hospital.

There are no quality concerns to report.

12. QUALITY VISITS 12.1 A timetable of announced and unannounced visits is being formulated.

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13. COMPLAINTS TO CCG 13.1 There are currently five active complaints which are reviewed each week at the CCG’s Clinical

Executive meeting. There are no common emergent themes. 14. RISK REGISTER 14.1 The Committee reviewed the CCG risk register, added new items during the meetings in July

and August, and changes have been submitted to the Audit Committee. 15. CONCLUSION 15.1 The Quality & Safety Committee continues to provide forensic oversight of the quality agenda

supported by the CCG Quality Team. Any matters of relevance are contained in this report to the Board. If there are material issues that arise after submission of this report, the Chair of the Quality & Safety Committee will provide an oral briefing to the Board.

16. RECOMMENDATIONS 16.1 The Board is asked to:

1) accept this report as a source of ongoing assurance that the CCG Quality & Safety

Committee continues to maintain forensic oversight of all clinical quality standards in line with the CCG’s statutory duties.

Miss R Bartholomew Chief Quality & Nursing Officer September 2014

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Date of Report: 11 September 2014 Report: Clinical Development Committee Report

Agenda item No: 9.1

TITLE OF REPORT: Clinical Development Committee Report

PURPOSE OF REPORT: To advise the Board of matters considered by the Clinical Development Committee at its meetings on 23rd July and 20th August 2014

AUTHOR OF REPORT: Mr N. Bucktin, Head of Commissioning

MANAGEMENT LEAD: Mr N. Bucktin, Head of Commissioning

CLINICAL LEAD: Dr S Mann, Clinical Executive

KEY POINTS:

1. QIPP progress noted. 2. Risk register updated to include risks associated with urgent care

centre and community rapid response team. 3. Service developments approved for:-

• development of a therapeutic programme for people with autistic spectrum disorder;

• mental health crisis telephone line; • minor ailments scheme to be provided by community

pharmacists; • re-commissioning dementia services in order to increase the

capacity available for people with more challenging needs; • expansion of the NHS Continuing Healthcare/Intermediate Care

Team. 4. Job description approved for GP leads – Integrated Locality

Teams. 5. Competencies and remuneration approved for GP Locality

Prescribing Leads. 6. Guidelines approved on the basis of advice from the Area Clinical

Effectiveness Sub-Committee in relation to the management of diabetes, osteoporosis and Vitamin D.

7. Initial review of policies and guidelines, for which the Committee

has oversight, noted and process for their continued review and development approved.

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RECOMMENDATION:

1. That matters considered by the Clinical Development Committee be

noted.

2. That the service developments in relation to:-

a) re-commissioning dementia services to provide additional capacity for people with more challenging needs;

b) expansion of the NHS Continuing Healthcare/Intermediate Care Team; be approved.

FINANCIAL IMPLICATIONS:

1. Financial risks are associated with the non-delivery of QIPP targets. These are reported separately to the Finance and Performance Committee.

2. Revenue implications of individual schemes are identified in the

report.


Engagement has taken place in relation to individual proposals considered by the Committee as necessary through CCG locality meetings and with service users.


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 REPORT OF THE CLINICAL DEVELOPMENT COMMITTEE 1.0 BACKGROUND 1.0 This paper advises the Board of matters considered by the Clinical Development Committee at the

meetings held on the 23 July and 20 August 2014.

2.0 KEY INDICATOR SUMMARY

QIPP

2.1 The Committee has noted that the QIPP target for 2015/16 within the current financial plan is £9.261m. The target for 2014/15 is likely to underachieve by £0.980m. Additional schemes must therefore be identified to recover the gap. A consequence of the potential shortfall is that the 2015/16 target will increase.

2.2 Analysis of the likely impact of schemes in 2015/16, indicates expected savings of £11.229m, a

potential overachievement against the revised target. 3.0 MATTERS CONSIDERED BY THE COMMITTEE

Risk Register

3.1 The Committee has reviewed the risk register and risks associated with the implementation of the Urgent Care Centre and the Community Rapid Response have been added. Service Developments Approved Under Delegated Powers

3.2 The Committee has approved a number of service developments, with a value below £100,000 under its delegated powers, as follows:-

• a therapeutic programme for people with autistic spectrum disorder that will enable 48 people to access a programme for a 12 week period;

• an out of hours telephone support line to be provided to enable a suitable response for

people with mental health problems experiencing a crisis.

• a minor ailments scheme to be provided by community pharmacists, on the basis of advice from the Primary Care Development Committee.

Service Developments Requiring Board Approval

Expansion of NHS Continuing Healthcare/Intermediate Care Team

3.3 The Committee has approved a proposal to expand this team in order to provide the necessary capacity to deal with an increasing level of referrals and the provision of services 7 days per week.

3.4 Without any expansion of the team to provide a service 7 days per week, the existing increased

level of activity suggests that an increase in capacity is required to deal with existing referral levels.

3.5 In addition, there is a need to consider ensuring the intermediate care team has the necessary capacity to operate on a 7 day basis in order to ensure that there is a consistent level of discharges to step down bed, 7 days a week. This will make an important contribution to the functioning of the urgent care system, as well as supporting our agreed model of service integration.

3.6 Expansion of the team will also:-

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• support dual training so staff can function as both continuing healthcare and intermediate care assessors;

• create greater resilience within the team at peak times, during annual leave and during

periods of sickness absence;

• enable timely assessment to take place, reduce the risk of institutionalisation, reduce inappropriate admissions and speed up the discharge process.

3.7 The cost of expanding the team to deal with existing service pressures is £168,394. The cost

associated with 7 day working, is subject to out of hours payments, £122,976.

Re-provision of Existing Capacity Commissioned for People with Dementia

3.8 The CCG currently commissions a service for people with dementia and NHS Continuing Healthcare needs at Woodview Nursing Home.

3.9 In order to respond to this demand, it is proposed to re-model the provision at Woodview in order to

reverse the current level of provision and move from 8 challenging behaviour and 16 general dementia beds to 16 challenging behaviour and 8 general dementia beds.

3.10 This will involve some building works to create an appropriate environment and an increase in

support staff hours Other matters considered by Committee

GP Lead – Integrated Locality Teams

3.11 The Committee has approved the job description for these 5 posts. These posts will have a key role in the implementation and development of the integrated services model and will provide clinical leadership to the 5 locality teams. A key role for these teams will be to review and hold to account the performance of each practice team in delivering its share of a borough wide set of key performance indicators. GP Locality Prescribing Leads – Competencies and Remuneration

3.12 The Committee has approved, on the basis of advice received from its Prescribing Sub-Committee, the competencies for these posts and remuneration. Guidelines

3.13 The Committee has approved, on the basis of advice from the Area Clinical Effectiveness Committee, guidelines for:-

• Diabetes management • Osteoporosis management • Vitamin D management

Policies and Guidelines Review

3.14 The Committee has received the outcome of an initial review of those policies and guidelines for which it has oversight.

3.15 Those policies and guidelines in need of urgent review will now be examined by no later than February 2015. Remaining policies and guidelines will be reviewed within a timescale to be agreed by the Head of Commissioning and the Office of Public Health.

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4.0 RECOMMENDATION 4.1 That matters considered by the Clinical Development Committee be noted. 4.2 That the service developments in relation to:-

a) re-commissioning dementia services to provide additional capacity for people with more challenging needs;

b) expansion of the NHS Continuing Healthcare/Intermediate Care Team; be approved Dr. S. Mann, Clinical Executive Mr. N. Bucktin, Head of Commissioning August 2014

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Report: Communications & Engagement Committee Report Agenda item No: 10.1

TITLE OF REPORT: Communications & Engagement Committee Report

PURPOSE OF REPORT:

To update the Board on the activity of the Communications & Engagement Committee. To provide the Board with assurance that the committee is responding to its delegated duties as set out in the Scheme of Delegation

AUTHOR OF REPORT: Richard Haynes - Interim Head of Communications and Engagement

MANAGEMENT LEAD: Richard Haynes - Interim Head of Communications and Engagement

CLINICAL LEAD: Dr David Hegarty

KEY POINTS:

• The committee held its most recent bi monthly meeting on Tuesday 12 August 2014.

• This report includes details of key discussions at the meeting • The summary table details progress in key areas around the CCG

Communication & Engagement Strategy

RECOMMENDATION:

• That the Board is assured that the committee is fully functioning and that statutory duties are being met with regard to engagement with the public & patients.

• That the Board is assured that the Communications & Engagement Strategy is being progressed well.

FINANCIAL IMPLICATIONS:

• The CCG has a statutory duty to involve. Failure to do so could result in costly judicial proceedings.

• All activity reported is covered by the existing communications & engagement budget unless stated otherwise.

• AVE is a method of estimating the value of editorial media coverage, which is widely used throughout the PR industry.


• The committee is responsible for ensuring that appropriate mechanisms are in place for Engagement to take place. Progress on this is included in the report.

ACTION REQUIRED: Assurance Decision Approval

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 COMMUNICATIONS & ENGAGEMENT COMMITTEE REPORT

1.0 INTRODUCTION

1.1 This is a report to the CCG Governing Body (Board) from the Communications & Engagement Committee. The Committee had its latest meeting on Tuesday 12 August 2014. Also included is the Key Performance Indicator Summary (section 2.0)

2.0 KEY INDICATOR SUMMARY (Produced 28 August 2014)

Communications and Engagement Strategy Summary Report

Number of Patient Participation Groups (PPGs)

42 groups established. Work under way to establish two more. Three practices still to set up PPGs are all being offered support.

Date of next Patient Opportunity Panel (POPs)

18 September, 10.30 am – 12.30 pm at Lion Health

Date of next Healthcare Forum (HCF) 25 September 4.30 – 6.30 at Dudley College. Topic - Integration

Twitter Followers 2,017 (up by 79 since last Board)

Facebook Likes 143

Media Coverage - Advertising Value Equivalent (AVE)

Jul/Aug 2014: Total £10,943

• On message £6,940 (CCG Ball, Lapal Medical Practice) • Neutral £4,003 (Patient wait to see GP) • Off message £0

Media Coverage Topics

• Patients wait over a week to see their GP • Award for Lapal Medical Practice • CCG Ball

Collaborative Work • ‘Contact a Family’ project with DCVS and Dudley MBC • Community Engagement network with Dudley MBC • Development of the Dudley Community Information Directory

Key Projects • PPG Development • Youth Health Summit (see note below and separate

communications report) • PPI Internal audit and work on action plan

Next Membership Meeting • Tuesday 7 October

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3.0 ITEMS DISCUSSED

PPG/Patient Opportunities Panel (POPs) Update

3.1 Members were updated on continuing progress towards the evolution of a locality structure for PPGs, PPG/POPs development sessions and the implementation of the scheme to award grants of up to £1,000 in direct funding for each of our PPGs.

3.2 The POPs meeting in July was facilitated at the request of members as they wanted to discuss the influence they had within their roles. DCVS helped to facilitate the session. Participants were split into locality groups to enable a more focussed discussion. The group agreed that they wanted to maintain their focus as influencing the CCG in its decision making, wanted to be more representative and would like to see more involvement from other PPGs.

Engagement Update 3.3 In addition to the PPG update above, members were advised of a number of other significant pieces of

work which had taken place since the last meeting, or were under way or at the planning stage, including:

3.4 Building Health Partnerships: A meeting took place in July to discuss the Dudley Community

Information Directory. The meeting was facilitated by an external company Comms2point0 and partners from DCVS, DMBC and Healthwatch were in attendance. Comms2point0 will develop a marketing and promotional work plan. The group did echo that they wanted the DCID to be the place to look for information about health and wellbeing in Dudley but agreed there was further work to be done in developing the site and in promoting and getting GPs confident to use the system and have faith in it.

3.5 Health and Wellbeing Annual Conference: The team have actively contributed towards and helped

deliver the HWB annual conference. A range of social media was supported by the team and workshops were also facilitated by the team. The conference was well attended by a range of stakeholders.

Freedom of Information (FOI) Update

3.6 The Freedom of Information (FOI) Update was presented to the committee. The purpose of this report is to provide the Communication and Engagement Committee with an overview of the CCG activity in relation to Freedom of Information requests received and to provide assurance that this key function is being managed well by the team and the contract with CSU is delivering to agreed KPIs.

• Dudley CCG received a total of 116 Freedom of Information requests between 1 May and 31 July 2014 • No trend in terms of request topics • Proportionally more requests from the public than other sources • The average time taken to complete a Freedom of Information during this period was 9.9 days, well

within the statutory 20 working day limit.

Improving GP Communications

3.7 The committee discussed a series of proposals to improve communications with member practices which had been drawn up following engagement with GPs through locality meetings.

Communications and Engagement Board Report – proposed new format

3.8 The committee discussed a proposed template for a revised communications and engagement report to the CCG Board

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Post-meeting note. Following further discussions with the Chief Accountable Officer and CCG Governance lead, the committee report to September board has remained in its original format, with the proposed template being used for the Public Update which is Board Agenda Item 5.3. Terms of Reference

3.9 Members discussed the committee’s terms of reference and membership and provided comments and feedback which have been fed into the CCG’s wider governance review.

Draft report on Internal Audit of Public and Patient Involvement

3.10 Members received and welcomed a draft report from the CCG’s internal auditors on Public and Patient Involvement which scored the function at Level 4 ‘Significant Assurance’ – the second highest level of assurance.

3.11 A supporting action plan has been produced – progress against recommendations will be reported to

future meetings of the committee.

Job Description and Person Specification for new post of Patient Experience Information Analyst

3.12 The committee discussed the revised job description and person specification drafted following a previous joint meeting of the committee and the Quality and Safety Committee.

Other issues discussed

3.13 A number of other issues were discussed, which are covered in more detail in the communications update (Agenda Item 7) including the Youth Summit, GP communications and media coverage.

4.0 DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD None 5.0 DECISIONS REFERRED TO THE BOARD No decisions were referred to the Board. 6.0 RECOMMENDATION

1) That the Board is assured that the committee is now fully functioning and that statutory duties are being met with regard to Engagement with the Public & patients.

2) That the Board is assured that the Communications & Engagement Strategy is being progressed well.

Richard Haynes Interim Head of Communications and Engagement August 2014

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Date of Report: 11 September 2014 Report: Audit Committee Report

Agenda item No: 11.1

TITLE OF REPORT: Audit Committee Report

PURPOSE OF REPORT: To advise the Board of the key issues discussed and agreed at the Audit Committee on 31st July 2014

AUTHOR OF REPORT: Mr M Hartland, Chief Finance Officer

MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer Mrs J Jasper, Chair – Audit Committee

CLINICAL LEAD: Dr J Rathore, Clinical Lead for Finance and Performance

KEY POINTS:

• Proposals for reviewing committee effectiveness considered and approved.

• Combined BAF & Risk Register reviewed; outcome of annual review discussed prior to submission for 7th August update.

• Updates from Information Governance, Auditors and LCFS received. • Prime Financial Policies-Assurance received. • Other matters considered–Terms of Reference for Audit Committee

reviewed.

RECOMMENDATION: The Board is asked to note the issues discussed at the Audit Committee on 31st July 2014.

FINANCIAL IMPLICATIONS: None

WHAT ENGAGEMENT HAS TAKEN PLACE: None


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 AUDIT COMMITTEE REPORT 1.0 INTRODUCTION 1.1 The report summarises the key issues discussed at the Audit Committee on 31st July 2014.

2.0 KEY INDICATOR SUMMARY

2.1 The following items are indicators of the current position in relation to the main responsibilities and

obligations of the Committee as defined in the CCG Constitution and Terms of Reference. Indicator Position RAG 1. Regulation and Control Good progress CCG Governance Arrangements – Constitution Changes agreed by

Board 13/03/14 approved by NHS England. Update to Board 11th September

Scheme of Delegation Changes implemented Compliance with Prime Financial Policies No issues 2. Annual Report and Accounts – CCG 2013/14 All deadlines and

targets met. Approved by Audit Committee under delegated authority; published and AGM held.

3. Operational & Risk Management Good Progress Counter Fraud and Security Committee updated Risk Management Arrangements – Combined BAF & Risk Register in

place; Chairs/Management Leads of committees attending & updating Audit Committee; Annual Review July 2014

Good Progress

Report newly commissioned services Revised Procurement Strategy approved by CCG Board 13/03/14

External Audit Annual Reports & Accounts signed off.

Internal Audit 2013/14 Head of Internal Audit Opinion issued; 2014/15 audits progressing.

- Other Policies – 6 of total of 7 received and approved Good progress - Other Policies – Business Continuity Policy Work progressing 4. Information Governance Good progress Information Governance Group established Met 16th June. Information Governance Breaches – Provider Regular updates Compliance with Information Governance toolkit IG Toolkit submitted by

31/03/14 – final score satisfactory at 69%

Information Asset Management structure to be established with IAOs and IAAs identified from CCG staff

IAOs identified, IAAs identified by IAOs. CCG staff briefed

IG Policies – 17 of total of 17 received and approved Good progress 3.0 ITEMS DISCUSSED – 31st JULY 2014 Committee Reporting/Effectiveness 3.1 The Audit Committee considered and approved a proposal for the review of its effectiveness based on

the completion of two checklists. It was agreed that the first relating to “Committee Processes” would be completed by the Chair working with the governance lead and committee secretary. The second on “Committee Effectiveness” would be sent as a questionnaire for completion by the Audit Committee

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members and auditors. The results would be presented to the next Audit Committee. This model will be used to assess the effectiveness of all CCG committees.

3.2 Additionally the Committee considered and recommended changes to the Audit Committee Terms of Reference. A revised version would be presented to the next Audit Committee for their approval prior to submission to the Board for final approval.

Information Governance 3.3 The Audit Committee received the minutes from the Information Governance Sub-Committee held on

the 16th June for information. 3.4 The Committee also received a Policy Update. The policies that fall under the Audit Committee, most of

which relate to information governance, were due for review in June 2014. The Committee agreed to extend them until 30th September under its delegated powers. Additionally the Committee approved the Password Management Policy under its delegated authority.

3.5 The Committee received verbal updates about progress in the preparation of the Business Continuity

Plan and changes to the Information Governance service provided by the CSU. Board Assurance Framework and Risk Register 3.6 The Committee received the Combined Board Assurance Framework (BAF) and Risk Register as at 7th

July 2014. The Audit Committee felt that it still needed further development and it was confirmed that the management lead for the relevant committees should be updating the BAF and Risk Register whilst the responsible Committee should be providing challenge.

3.7 The Committee received a verbal update on the Annual Review of the BAF and Risk Register that had taken place on 24th July. This had included representatives from all the CCG’s Committees. The Audit Committee agreed that the outcome from this review and updates from Committees should be reflected in the 7th August iteration of the BAF and Risk Register. The outcome of this is detailed in a separate paper to the CCG Board including recommendations to approve the closure of a number of risks.

Internal Audit

3.8 The Committee received a number of documents from Internal Audit for information and assurance:

• Internal Audit Annual Report for 2013/14 for information. • Internal Audit Operational Plan for 2014/15 which reflected the profiling of assignments into

quarters for this financial year. • Internal Audit Progress Report for 2014/15. The complaints handling review had been completed

and a draft report had been issued; the fieldwork had been completed for the Patient and Public Involvement review and terms of reference had been issued for the Information Governance Toolkit 2014/15 review.

• Briefing paper on the recently issued NHS Audit Committee Handbook. 3.9 There was also a verbal update on the Internal Audit Annual Customer Satisfaction Survey.

Local Counter Fraud Specialist

3.10 The Committee received the following for assurance and approval:

• The Counter Fraud Annual Report 2013/14 and noted that a formal report on the proactive exercise on contracting with non-NHS providers would be presented to a future meeting. The Committee was also updated on on-going investigations.

• The Counter Fraud Workplan 2014/15 based on NHS Protect guidance tailored for local knowledge and concerns. The Committee approved this under its delegated authority.

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External Audit

3.11 The Committee received the final version of the Annual Audit Letter 2013/14 which concluded the

following:

• “Financial statements opinion - We provided an unqualified opinion on the financial statements which give a true and fair view of the CCG's financial position as at 31 March 2014 and of net expenditure recorded by the CCG for the year. However, the CCG was not provided with the relevant information, by the NHS Pensions Agency, in order to make the required disclosures regarding GP Board Member pensions. As a result, we were required to issue a modified "Opinion on other matters" in respect of the Remuneration Report for GP Board Member pensions.

• Regularity opinion - As well as an opinion on the financial statements, we are required to give a regularity opinion on whether expenditure has been incurred 'as intended by Parliament'. Failure to meet statutory financial targets automatically results in a qualified regularity opinion. We are pleased to report that, based on our review of the CCG's expenditure, we gave an unqualified regularity opinion.

• Value for money (VfM) – We concluded that there were no issues to report arising from our work assessing the CCGs arrangements for securing economy, efficiency and effectiveness in its use of resources.”

3.12 External Audit also presented a report on “Delivering value to you” which summarised the services provided by Grant Thornton throughout the year and drew attention to a programme of seminars and workshops. The Audit Committee found this most useful.

Other Issues

3.13 The Audit Committee considered and received assurance in respect of:

• Waivers and No Orders. • Scheme of Delegation • Aged Receivables and Payables • Compliance with laws and regulations governing the NHS.

4.0 DECISIONS TAKEN BY COMMITTEE UNDER DELEGATED POWERS FROM BOARD

• Extension for all currently approved policies to 30th September 2014 • Approval of Password Management Policy • Approved Counter Fraud Workplan 2014/15

5.0 DECISIONS REFERRED TO THE BOARD

• None 6.0 RECOMMENDATION

1) The Board is asked to note the issues discussed and approved at the Audit Committees on 31st July 2014 for assurance.

M Hartland Chief Finance Officer September 2014

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Report: Combined Board Assurance Framework and Risk Register Agenda item No: 11.2

TITLE OF REPORT: Combined Board Assurance Framework and Risk Register

PURPOSE OF REPORT: To update the Board on the combined Board Assurance Framework (BAF) and Risk Register and present it as at 7th August 2014.


MANAGEMENT LEAD: Mr M Hartland, Chief Finance Officer

CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS:

• Annual review and update of combined BAF and Risk Register completed

• Further updates arising from committee meetings added • Summary of risks as at 7th August 2014 presented

RECOMMENDATION:

• The Board is asked to receive the report for assurance • The Board is asked to approve the closure of risks 1, 9, 20 and 32 • The Board is asked to approve the merger of risk 44 with risk 36

and the consequent closure of risk 44

FINANCIAL IMPLICATIONS: None direct. Potential consequence if risks materialise.



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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) AND RISK REGISTER 1.0 INTRODUCTION 1.1 In accordance with the CCG’s Risk Management Strategy, the combined BAF and Risk

Register for those risks scored 16 and over (which comprise the Board Assurance Framework) is presented to the CCG Board. This is based on the position as at 7th August 2014.

1.2 An annual review of the BAF and Risk Register was undertaken on 24th July with representatives of the Audit and other CCG Committees. Although the BAF and Risk Register is regularly reviewed and updated through the Committees and reported to the Board, this was an opportunity for a fresh look at the document as a whole. This noted the addition of a new corporate objective of system effectiveness with certain existing risks being aligned to this and a number of changes to the risks being proposed including some closures.

1.3 The Audit Committee received the overall combined BAF and Risk Register as at 7th July 2014 at its meeting on 31st July but focused on the updates received from Committees and in particular the outcome of the review held on the 24th July. It approved the changes within its delegated powers and these were included in the version now presented to the Board. There are a number of closures proposed requiring CCG Board approval and these are detailed below.

2.0 COMBINED BOARD ASSURANCE FRAMEWORK (BAF) & RISK REGISTER 2.1 Those risks with an initial or residual score (after actions having been taken and controls

implemented) of 16 or higher are presented to the Board in detail at Appendix 1. These risks are also summarised in the table below. Risk

Initial Risk

Residual Risk

Accountable Committee

1. Failure to resolve potential mortality issues at Dudley Group results in avoidable deaths. PROPOSED THAT THIS RISK BE CLOSED

25 15 Quality & Safety

6. Failure of a main provider (Dudley Group NHS FT) due to financial pressures will result in inadequate care for the local population (note: this accounts for legacy risk brought forward from Cluster regarding failure to manage demand, creating financial pressures within the local health system).

20 20 Up from

16

Finance & Performance

9. Risk of poor relationship management with the Area Team through the transition/bedding down resulting in breakdown of relationship with GPs and/or disconnected primary care/medical service priorities. PROPOSED THAT THIS RISK BE CLOSED

16 6

Primary Care Development

10. Failure of the health economy to work together to implement service changes which will adversely impact commissioning and delivery of health services.

16 12 Clinical Development Committee

14. Failure to engage with Public Health, Health and Well Being Board and the Local Authority will limit the effectiveness of health care commissioning.


16. Providers may be reluctant to develop and implement alternative approaches to service delivery


17. Tensions between innovation, quality and financial pressures could limit the innovation shown by the CCG


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Risk

Initial Risk

Residual Risk

Accountable Committee

19. Failure to ensure meaningful public engagement will prevent effective commissioning and patient centred services

16 8

Communications & Engagement

20. Failure of providers due to quality failures will result in inadequate care for the local population. PROPOSED THAT THIS RISK BE CLOSED


21. Challenges to resources within the CSU (REWORDED FROM: Failure of the CSU) to deliver a service offering that delivers the CCG's requirements (particularly quality framework) which underpin the CCG strategy


22. The delivery of efficiency savings could impact the drive for quality in health care

20

20

Quality & Safety

26. Risks to women and neonates as a result of increased volume of patients which has led to inadequate staffing levels at certain times with particular issues around specialist medical staffing and capacity issues in triage area.


32. Current reorganisation of Health Visiting Service could result in breakdown in continuity of care to patients and consequent risks to safeguarding children. PROPOSED THAT THIS RISK BE CLOSED


34. Being unsighted on significant performance issues identified by the Area Team in relation to primary medical services that could result in removal of GP member from the Performers' List.

16 6

Primary Care Development

36. Failure to achieve whole of Quality Premium resulting in lost income and reputational damage. PROPOSED THAT RISK 44 BE CLOSED AND MERGED WITH THIS RISK


39. Lack of a systematic approach to ascertaining the quality of the care in our commissioned nursing homes, potentially resulting in harm to vulnerable adults.

16 12

Quality & Safety

41. Lack of capacity in the right place for patient access to phlebotomy services.


43. Failure to deliver significant QIPP targets in 14/15 and 15/16 puts the future financial stability of the CCG at risk.

25 20 Finance & Performance

44. Overall achievement of the Quality Premium is impacted by performance issues with the delivery of Local and National Targets by the local provider and reduces the Quality Payment the CCG receives with the consequent financial and reputational impact. PROPOSED THAT THIS BE CLOSED AND MERGED WITH RISK 36

20

12

Finance & Performance

45. NHS England terminating primary medical service contracts of member practices leading to a gap in primary care service provision or pressure on other primary care providers.

16 9 Primary Care Development

48. Failure of Black Country Partnership FT due to financial pressures will result in inadequate care for the local population.

20 15 Finance & Performance

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3.0 RECENT AMENDMENTS TO THE BAF AND RISK REGISTER 3.1 Following consideration of the BAF and Risk Register at Committee meetings and the Review

meeting, the following amendments to risks 16 and over have been made since the Board meeting on the 10th July:

New Risks – No risks 16 or over added. Changes to the Risks – The following amendments have been made to the risks:

• Risk 6 – failure of a main provider (Dudley Group NHS FT) due to financial pressures. The residual risk has been increased from 16 to 20 given the current reported position by the Trust.

• Risk 21 – The Audit Committee approved the rewording of this from “Failure of the CSU” to “Challenges to resources within the CSU” to more accurately reflect the issue.

• Closed Risks/Risks Proposed for Closure – The following risks have either been closed after Board approval or are proposed for approval:

• Risk 46 has been closed and merged with risk 33 following approval at the last Board meeting.

• Risk 1 – “Failure to resolve potential mortality issues at Dudley Group results in avoidable deaths.” The Quality & Safety Committee recommended that this risk be closed on the basis that assurance has been received that this is no longer a risk and that they would be alerted if anything changed. The Board received a report at its July meeting on mortality which provided this assurance.

• Risk 9 – “Risk of poor relationship management with the Area Team through the transition/bedding down resulting in breakdown of relationship with GPs and/or disconnected primary care/medical service priorities”. The Primary Care Development Committee recommended that this risk be closed as the relationship with the Area Team is managed through the Interface Group.

• Risk 20 – “Failure of providers due to quality failures will result in inadequate care for the local population”. The Quality & Safety Committee recommended this risk for closure on the basis that there are robust controls and assurance processes in place and these are working well. If specific quality issues were identified through these processes, they would be reported by the committee to the Board and potentially a new risk would be raised.

• Risk 32 – “Current reorganisation of Health Visiting Service could result in breakdown in continuity of care to patients and consequent risks to safeguarding children”. The Quality & Safety Committee proposed that this specific risk be closed as it was time-limited and has now been resolved.

• Risks 36 & 44 – The review group considered that Risks 36 and 44 were duplicates. It is proposed that Risk 44 “Overall achievement of the Quality Premium is impacted by performance issues with the delivery of Local and National Targets by the local provider and reduces the Quality Payment the CCG receives with the consequent financial and reputational impact” (under the Finance & Performance Committee) be merged with Risk 36 “Failure to achieve whole of Quality Premium resulting in lost income and reputational damage” (under the Clinical Development Committee). Risk 44 would then be closed.

4.0 RECOMMENDATIONS

• The Board is asked to receive the report for assurance • The Board is asked to approve the closure of risks 1, 9, 20 and 32

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• The Board is asked to approve the merger of risk 44 with risk 363 and the consequent closure of risk 44

5.0 APPENDICES

Appendix 1 – Combined BAF & Risk Register as at 7th August 2014 (risks 16 and over)

M Hartland Chief Finance Officer August 2014

Dudley CCG Combined Board Assurance Framework and Corporate Risk Register 2014/1507-Aug-14

NOTE: TREND IN RESIDUAL RISK AGAINST PREVIOUS MONTH IS SHOWN //=

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Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I Initial Risk Score (PxI)

Score before any

controls are in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

P I Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

ActionsTo improve control, ensure delivery ofprincipal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

1 01/05/2013 04/08/2014 1 Failure to resolve potential mortality issues at Dudley Group results in avoidable deaths.

Q&S Ruth Edwards Rebecca Bartholomew

5 5 25 Contract review meetings and clinical quality review meetings linked to contract mechanisms, performance management, joint strategic planning. Monitoring via the defined quality indicators. Attendance at DGOH specialty mortality rate meetings. Consistently report and monitor upon mortality rates at specialty level. Q&S committee. CQC. Governing Body.

Current contract does not specify information requirement for specialty level mortality rate.

Need to ensure mortality rate information needs are specified within contract.

3 5 15 = Board Reports. CQRMs. Now established consistent reporting to Q&S Committee and governing body of specialty level mortality information. Specialty mortality rate data.

Keogh Review, Monitor and CQC reporting. Announced and unannounced visits

1. Ensure mortality rate information needs are specified within contract.2.Ensure skills required to interpret mortality data are put in place.

Systems significantly improved with access to more robust data. Active discussions taking place with DGFT. Attendance at Mortality review meetings reinstated provide assurance. RECOMMENDED FOR CLOSURE AS THE DUDLEY BOARD HAVE RECEIVED A PRESENTATION FROM QUALITY TEAM WHICH OUTLINED THE FACTORS WHICH PROVIDE ASSURANCE THAT THIS AREA NO LONGER REMAINS A RISK

6 01/05/2013 04/08/2014 2 Failure of a main provider (Dudley Group NHS FT) due to financial pressures will result in inadequate care for the local population (note: this accounts for legacy risk brought forward from Cluster regarding failure to manage demand, creating financial pressures within the local health system)

F&P Jas Rathore Matt Hartland 4 5 20 Robust contract management via contract review meetings, performance management, joint strategic planning. Financial Plan and contracts agreed with providers. Financial Assurance KPIs reported to Board. Joint monthly payment reconciliation process including validation of activity.

Review of methods to mitigate financial risk to provider and CCG.

5 4 20 Reports to F&P & Q&S, Board reports - minutes of CRM and QRM meetings. Performance report across a range of KPIs. Monthly meetings between CCG and DG FT Senior Manager Teams now being held. Board to Board (including lay member only) meetings being held.

AT review, Monitor financial rating-under formal review due to deficit position in financial plans, Internal Audit review.

Implement new methods to mitigate financial risk (e.g. reinvesting penalties) - awaiting response from DGH to CCG proposal.CCG is expecting formal letter from Monitor to which it must respond.CCG & DGH FT Senior Teams meet regularly as do other staff members to share understanding and agree mitigating

Jun-14 Probabilty of risk increased from likely to almost certain by the committee as the trust is under formal review by Monitor due to its financial plans forecasting a deficit.Committee noted changes in trust senior management.

9 01/05/2013 17/02/2014 2 Risk of poor relationship management with the Area Team through the transition/bedding down resulting in breakdown of relationship with GPs and/or disconnected primary care/medical service priorities

PCD Jas Rathore Dan King 4 4 16 CCG & NHSE Directors developing local processes to deliver CCG strategic developments e.g. QOF changed to support EMIS roll-out.

2 3 6 = Primary Care Strategy Implementation Group established reporting to PCD. Ongoing report to Board on progress in developing primary care strategy

CCG and NHSE Interface Group established. Reports to CCG PCD and NHSE Area Team on quality and safety and contractual performance

Recommend closure to Board

Sep-14 Review proposed closure of this risk as timelimited. New risk developed - 51. RECOMMEND CLOSURE TO CCG BOARD SEPTEMBER 2014.

10 01/05/2013 01/04/2014 2 Failure of the health economy to work together to implement service changes which will adversely impact commissioning and delivery of health services.

CDC Steve Mann/ Steve Cartwright

Neill Bucktin 4 4 16 QIPP plan and implementation. Joint approach to QIPP development with Dudley Group. Service Improvement Delivery Plans in place with providers. Collaborative Leadership Teams - DGFT and DWMHPT Health and Social Care Leadership Group. BCF Section 75 Agreement.

4 3 12 = QIPP reporting to CDC and governing body

Internal and external audit reviews

1.Develop and implement service improvement development plans with JHWS External peer plans with all providers.. 2. health and Social Care Leadership Group to be responsible for major system change: - Urgent Care- Service Integration

1. April 20142. April 2014

To what extent is this risk the sole responsibility of CDC?

14 01/05/2013 01/04/2014 2 Failure to engage with Public Health, Health and Well Being Board and the Local Authority will limit the effectiveness of health care commissioning.

CDC Steve Cartwright Neill Bucktin 4 4 16 Memorandum of Understanding with Public Health, membership of H&W Board, contribution to JSNA

None 2 3 6 = Report to Board on CCG contribution to HWB activity. CCG compliance with JHWS. Extend peer review process for 14/15.

Sep-14 Appropriate mechanisms in place. CCG has contributed to JSNA JHWS and agreed Operational Plan for 14/15 and 15/16 takes account of JHWS External peer review to take place in 14/15.

16 01/05/2013 01/04/2014 2 Providers may be reluctant to develop and implement alternative approaches to service delivery

CDC Richard Johnson Neill Bucktin 4 4 16 Commissioning intentions, Change Meetings with providers

Reporting process not yet in place for all providers

Reporting to CDC 3 4 12 = None Internal audit review Commissioning intentions lay out case for change. Contracting round for 14-15 will require providers to sign up to explicit change programme

Sep-14 Significant alternative approaches in Operational Plan.

17 01/05/2013 01/04/2014 2 Tensions between innovation, quality and financial pressures could limit the innovation shown by the CCG

CDC Richard Johnson / Jas Rathore

Neill Bucktin 4 4 16 £200k to be invested in innovation pilots for 2013-14. Innovation bid process to be handled through localities

4 3 12 = reports to CDC Significant innovation programme in Operational Plan.

Sep-14

19 01/05/2013 01/04/2014 2 Failure to ensure meaningful public engagement will prevent effective commissioning and patient centred services

C&E David Hegarty Neill Bucktin/Richard Haynes (Rockhouse Communications)

4 4 16 Communications & Engagement StrategyHealth Care ForumIndividual Service User Groups, Business case process, Compact

ith l l it R l ti hi

Business cases / service change proposals need to identify that appropriate engagement has taken place

Reporting on proper engagement through the business case process

2 4 8 = Report to Commissioning Development Committee through business cases, assurance that engagement is taking place t C & E t

Health Watch, Overview & Scrutiny Committee

Establish revised business case process. Ensure clear exposition of engagement process i f ll d b f

Jun-13

20 01/05/2013 04/08/2014 3 Failure of providers due to quality failures will result in inadequate care for the local population


4 5 20 Robust contract management via contract review meetings and regular monthly clinical quality review meetings for all providers, stringent adherence to contract mechanisms, performance management, joint strategic planning. Monitoring via the defined quality indicators.

Need risk profiling system for each provider and review of nursing care homes quality. An adequate suite of performance measures (dashboard) needs to be carefully scrutinised in conjunction with contracts.THERE ARE NO GAPS IN ASSURANCE, ALL MONITORING PROCESSES ARE WORKING WELLEscalation process needs to be put in place to deal with significant failures in provision.

Initial nursing home reviews are only partially completed and reported upon. Safeguarding Lead maintains oversight.

2 5 10 = Reports to Q&S, Board reports - minutes of CRM and QRM meetings. Performance report across a range of Quality KPIs

CQC reports when appropriate. Monitor for 2 providers, Healthwatch, Keogh review at DGOH

1. Develop and implement risk profiling system for each provider.2. Establish dashboard of performance measures.3. Establish escalation process to deal with significant failures.4. Complete initial reviews of nursing homes.

The Committee will be receiving all the RAG rates on a quarterly basis within the Quality and Safety Report and the amber and red will be received by the Board. A clear criteria is being developed and brought back to Quality and Safety Committee. CLOSURE RECOMMENDED WITH OVERSIGHT OF THE GOVERNING BODY FOR APPROVAL

CORPORATE OBJECTIVES

1. Reducing health inequalities2. Delivering best possible outcomes3. Improving quality and safety4. System effectiveness

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VE (S

EE K

EY

AB

OVE

)

Risk Description Accountable Committee

Accountability Sponsor & Owner

Management Lead

P I Initial Risk Score (PxI)

Score before any

controls are in place.

Key ControlsWhat controls/systems are in place to assist in securing delivery of ourobjective. Such as strategies, policies and procedures

Gaps in ControlWhere are we failing to put controls/ systems in place. / Where are we failing in making them effective. For example lack of training or no regular review of performance

Gaps in Assurance Where are we failing to gain evidence that our controls/ systems, on which we place reliance, are effective. Such as no assurance a strategy or policy is effective

P I Residual Risk Score

(PxI)Score

following controls put

in place

Risk Trend Internal AssurancesBoard Reports, Minutes of meetings

External AssurancesInternal and External Audit Reports, CQC Reports

ActionsTo improve control, ensure delivery ofprincipal objectives, gain assurance

TimescalesDate action will be completed

COMMENTS

21 01/05/2013 04/08/2014 3 Challenges to resources within the CSU to deliver a service offering that delivers the CCG's requirements (particularly quality framework) which underpin the CCG strategy


4 5 20 Regular meetings with CSU. Reporting to Q&S and other committees established . Performance resolution process in place. PLANS IN PLACE TO BRING QUALITY SERVICES IN HOUSE TO CCG, DISCUSSIONS TAKING PLACE WITH CSU MANAGEMENT TEAM

Roles and responsibilities of the CCG and CSU need to be clearly defined.There is inconsistent reporting of information between committees (validation processes need to be improved, teething problems prevail).Access to MiCS needs to be consistently available to appropriate staff.

Quality and safety reporting still not fully developed and delivered by CSU.

3 4 12 = Q&S committee reports to Board

Clinical Surveillance Meeting at Area Team, Internal Audit review.

1.Finalise quality assurance framework and reporting arrangements.2. Define CCG/CSU roles and responsibilities and implement.3. Improve validation of reporting to various sources to ensure consistency.4. Ensure MiCS access.

Issues remain with regard to MiCS and dashboard CSU offer agreed. Systems being tested. This is an ongoing risk. Alison Hughes is now the substantive Nurse lead and provides support to CSU delivery.

22 01/05/2013 04/08/2014 3 The delivery of efficiency savings could impact the drive for quality in health care


5 4 20 QIPP programme monitoring through F&P. Involvement of quality leads in QIPP projects through Quality Impact Assessments.

Board 2 Board meeting has taken place with DGFT.

Quality Impact Assessments not yet completed and provided by DGOH for 2014/15.

5 4 20 = Reports to F&P, Q&S, CDC, and Board reports

Quality Surveillance Meetings with Area Team, Internal Audit review

1. Set up regular Board 2 Board meetings.2. Review QIA by DGOH once produced.

Q&S assured that DGFT involving their quality leads. BCPFT and DWMHP aware of ongoing challenge. Meet with Medical and Nursing Director at DGFT and this will be replicated for BCPFT, D&WMH and Ramsay require meetings with Directors.

26 26/09/2011 01/04/2014 2 Risks to women and neonates as a result of increased volume of patients which has led to inadequate staffing levels at certain times with particular issues around specialist medical staffing and capacity issues in triage area.

CDC TBC Neill Bucktin/ Mark Curran

4 4 16 Any GP practice located within a 16 minute travel time from City Hospital is not able to book patients at Russell Hall Hospital. New cap agreed for 13/14 through contracting round which allows for sufficient staffing for demand.

Outcome of maternity services review across the Black Country by Sandwell & West Birmingham CCG.

None 1 4 4 = Monitoring via Clinical Quality Review Meetings (DPCT/DGFT). Monitoring of SIs (DPCT/DGFT). Maternity ratios within acceptable range

None Specific request made to DGFT to assure that sufficient staff are in place to undertake triage

Apr-14 Cap in place however concerns raised re quality of triage service which are currently being investigated. Therefore risk is being kept on until response received.Update requested from Quality and Safety Committee - Feb 2014. Further update requested - March 14.

32 12/04/2013 19/03/2014 2 Current reorganisation of Health Visiting Service could result in breakdown in continuity of care to patients and consequent risks to safeguarding children.


4 4 16 Monthly performance review meeting with Trust, GPs escalating concerns through locality meetings and GP Lead

Quarterly performance review meetings need to be formally reviewed and agreed by the Q&S Committee.

None 3 4 12 = Reporting to Q&S Committee

None Recommend closure to Board

Sep-14 RECOMMENDED FOR CLOSURE BY GOVERNING BODY BY REVIEW GROUP AS TIME-LIMITED ISSUE & NOW RESOLVED

34 22/04/2013 17/02/2014 2 Being unsighted on significant performance issues identified by the Area Team in relation to primary medical services that could result in removal of GP member from the Performers' List

PCD Jas Rathore Dan King 4 4 16 CCG and Area Team Interface Group developing joint processes including support mechanisms for under-performing GPs/practices.

2 3 6 = CCG and NHSE Interface Group established. Reports to CCG PCD on quality and safety and contractual performance.

CCG and NHSE Interface Group established. Reports to NHSE Area Team on quality and safety and contractual performance

36 (to be merged

with 44)

16/05/2013 03/07/2014 3 Failure to achieve whole of Quality Premium resulting in lost income and reputational damage.

CDC Neill Bucktin Neill Bucktin 4 4 16 Plans for local targets mostly in place and on track, but still significant risk of not achieving national domains 1 and 5 (PYLL and HCAI)

Successful plans for domain 1 and 5 need to be put in place

None 4 4 16 = Quality Premia achievement reporting to CDC and governing body

None Regular report on actions and performance to CDC linked to Outcome Ambitions and Better Care Fund.

May-14 Review recommended merger of risks 36 (under CDC) and 44 (under F&P). Responsibility to be determined and recommendation for closure of one of these risks to be put to next Board on 11th September.

39 16/07/2013 04/08/2014 3 Lack of a systematic approach to ascertaining the quality of the care in our commissioned nursing homes, potentially resulting in harm to vulnerable adults


4 4 16 (some) nursing home provision is provided under suitable commissioning contracts. Self-assessment reporting by nursing homes

No systematic approach to monitor and act upon poor quality. No consistent on-site review process. Some providers don't have suitable contracts in place

Reporting on quality 3 4 12 = MATRIX DEVISED FOR ASSURANCE OF CARE HOME EFFECTIVENESS IN PLACE

Rolling CQC inspection programme

1. Systematic on-site reviews introduced.2. Ensure NHS contracts in place with all nursing homes.

Work in nursing homes has commenced. Report to Q&S delivered in presentation, however remaining monitoring needs identified, Risk remains, Safeguarding reps form CCG provide support.

41 03/10/2013 01/04/2014 2 Lack of capacity in the right place for patient access to phlebotomy services.

CDC Steve Mann Neill Bucktin 4 4 16 Performance management of phlebotomy service through contracts.

Service specification does not have sufficient performance standards.

Phlebotomy service not on priority list for CCG.

3 2 6 = CDC sighted on complaints and concerns raised by practices.

Service being reviewed. Potential for AQP Procurement.

May-14 Report on AQP.

43 05/12/2013 04/08/2014 2 Failure to deliver significant QIPP targets in 14/15 and 15/16 puts the future financial stability of the CCG at risk.

F&P Jas Rathore Matt Hartland 5 5 25 The QIPP challenge process is robust and the CCG has a history of delivery. The process has been enhanced in 14/15 with project plans required for schemes; monthly challenge meetings; and creation of a £2m QIPP reserve. The revised process reflects internal audit recommendations.

None identified. None identified 4 5 20 = QIPP challenge process; F&P Committee oversight; internal audit reviews.

Reports to NHS England. Final sign off of PIDs Identification of new schemes/schemes to bring forward to meet gap

Aug-14

44 (to be merged

with 36)

07/01/2014 04/08/2014 2 Overall achievement of the Quality Premium is impacted by performance issues with the delivery of Local and National Targets by the local provider and reduces the Quality Payment the CCG receives with the consequent financial and reputational impact.

F&P Jas Rathore Matt Hartland 5 4 20 Report to Board. F&P Committee. Q&S Committee. Regular performance meetings. Assurance visits.

None known. None known. 3 4 12 = Regular reports from F&P and Q&S Committees to Board. Regular performance reports. Assurance visits. 14/15 Budgets reflect 13/14 actual achievement.

Reports from Dudley Group NHS FT.

Action plan required for 14/15 to ensure target met.

Aug-14 Review recommended merger of risks 36 (under CDC) and 44 (under F&P). Responsibility to be determined and recommendation for closure of one of these risks to be put to next Board on 11th September.

45 07/01/2014 17/02/2014 2 NHS England terminating primary medical service contracts of member practices for non-clinical performance issues leading to a gap in primary care service provision or pressure on other primary care providers.

PCD Jas Rathore Dan King 4 4 16 CCG and Area Team interface group have agreed process should termination for non-clinical performance reasons be required.

None identified. 3 3 9 = CCG and Area team interface group in place to agree process and respective responsibilities in the event of termination.

The interface group will report into the NHS England Area Team Primary Care Committee.

Actions will be identified by the interface group if and when NHS England Area team issues termination notices.

As required See also Risk 34 (similar).

48 05/06/2014 04/08/2014 2 Failure of Black Country Partnership FT due to financial pressures will result in inadequate care for the local population.

F&P Jas Rathore Matt Hartland 4 5 20 Performance management. CQRM to monitor quality.

Not determined at this stage. Not determined at this stage. 3 5 15 = CCG CAO has met the FT CE and agreed a number of actions to ensure the CCG receives regular updates and assurance.

Monitor action plan and oversight.

Meetings to be held initially between CCG and FT managers followed by Management Teams then Board to Board. Range and level of risk to be determined. Gaps in control and assurance to be identified and action plan agreed.

Initial meetings held

Board to Board Sept/Oct 2014.

Concerns have been raised about the long term viability of the FT especially as some significant services may be placed with other providers. The FT has agreed an action plan with Monitor.

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Date of Report: 11 September 2014 Report: Governing Body Election Process


TITLE OF REPORT: Governing Body Election Process

PURPOSE OF REPORT: To update the board on the Election process for posts where the 3 year tenure ends on 30 September 2014


MANAGEMENT LEAD: Mr P Maubach, Chief Accountable Officer

CLINICAL LEAD: n/a

KEY POINTS:

• Election process commenced 11 August 2014 • Current GP members nominated for re-election • No opposing nominations • Competency assessments completed • Recruitment to Chair underway

RECOMMENDATION:

• To note the re-election of seven governing Body GP members • To note the recruitment process for the Chair is underway with an

appointment expected by 30 September 2014 • To note that Dr Rathore and Dr Mann to continue as Clinical

Executives


WHAT ENGAGEMENT HAS TAKEN PLACE: With GP membership


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 GOVERNING BODY ELECTION PROCESS 1.0 INTRODUCTION 1.1 The Governing Body of Dudley Commissioning Group consists of 10 GP members elected from

localities within the Dudley Borough. 1.2 In line with the CCG Constitution, all elected members are in office for a period of 3 years. The tenure

for seven elected members expires on 30 September 2014. 1.3 This paper outlines to the Board the processed followed to elect members for the seven vacant posts

with effect from the 1 October 2014. 2.0 GOVERNING BODY

Locality Elected Member Tenure end

Stourbridge, Wollescote and Lye Dr Steve Mann 30 September 2014 Dr David Hegarty 30 September 2014

Halesowen & Quarry Bank Dr Richard Johnson 30 September 2014 Dr Jonathan Darby 31 January 2015

Sedgley, Coseley & Gornal Dr Jaswant Rathore 30 September 2014 Dr Kevin Dawes 30 September 2015

Dudley & Netherton Dr P D Gupta 30 September 2014 Dr Mona Mahfouz 30 September 2014

Kingswinford, Amblecote and Brierley Hill Dr Ruth Edwards 30 September 2014 Dr Ruth Tapparo 1 June 2017

2.1 Therefore, with effect from 1 October 2014, the CCG is required to elect new members as follows:

• 2 GP Members for Stourbridge, Wollescote and Lye Locality • 1 GP Member for Halesowen & Quarry Bank Locality • 1 GP Member for Sedgley, Coseley & Gornal Locality • 2 GP Member for Dudley & Netherton Locality • 1 GP Member for Kingswinford, Amblecote and Brierley Hill Locality

2.2 The remaining three elected members will remain in post until the dates shown below:

• Dr Jonathan Darby, Halesowen & Quarry Bank Locality, tenure end 31 January 2015 • Dr Kevin Dawes, Sedgley, Coseley & Gornal Locality, tenure end 30 September 2015 • Dr Ruth Tapparo, Kingswinford, Amblecote and Brierley Hill Locality, tenure ends1 June 2017

3.0 CONSTITUTION 3.1 The CCG constitution describes the process the CCG must follow in the election of members to the

Board.

2.2.5 The elected GP representatives of member practices, as listed in paragraph 6.6.2 of the group’s constitution, is subject to the following appointment process:

a) Nominations – any GP from the Dudley Performers list may self nominate to stand for election in one of the 5 CCG localities, in line with the electoral process agreed and overseen

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by the LMC. (Up to 2 GP elected representative governing body members will be appointed from each locality). Nominees will only be eligible to stand for election if they have met the eligibility criteria (see below)

b) Eligibility – must be assessed as meeting the eligibility criteria set out in the agreed role

description. This assessment will be carried out by an independent committee, accountable to the Remuneration Committee.

c) Appointment process – appointed via election from an electorate comprising all GPs on the

Dudley Performers list. d) Term of office - 3 years e) Eligibility for reappointment - there is no limit to the number of terms of office served by an

individual providing that they continue to meet the eligibility criteria and are subject to a nomination and election process every 3 years.

f) Grounds for removal from office - where the individual is no longer a member of the group;

where the individual is no longer on the Dudley Performers list; where the individual does not comply with the code of conduct.

g) Notice period – 2 months notice provided in writing to the chair of the governing body

4.0 ELECTION PROCESS 4.1 The process followed by the CCG was in line with the constitution and agreed with Dudley Local

Medical Committee. The following principles were adopted:

1. Elections and Governing Body representation to be based upon locality structure 2. Governing Body members representing localities are to be GP’s only 3. Practice Nurses and Practice Managers are not eligible to vote for GP’s. 4. Governing Body members to be subject to competency assessment. The competences to be

achieved are: • GMC registration without conditions • Evidence of commissioning experience • Evidence of clinical leadership

5. All GP’s on the Dudley Performers List are eligible to vote. 6. GP’s are only entitled to vote within one CCG. Therefore, if a GP votes within Dudley, they are not

eligible to vote in alternative boroughs 7. GP’s will self-nominate with no requirement for a seconder 8. If GP’s are unopposed, they will be appointed into post subject to meeting the competency

assessment. 9. There is no limit to the number of terms elected members can be in post.

4.2 The election process commenced on 11th August 2014. 4.3 The timescale for the process was published as follows:

• Deadline for return of Nomination forms Friday, 22nd August 2014 (5pm) • Ballot papers distributed Friday, 29th August 2014 • Deadline for return Ballot papers Friday, 12th September 2014 (5pm) • Results announced Monday, 15th September 2014

4.4 At the closing date of 22nd August, seven nominations had been received. The seven nominations were in line with the vacancies within localities.

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4.5 All nominations were from existing elected Board members standing for re-election. There were no nominations from elsewhere within the GP membership, therefore all current members were unopposed.

4.6 A competency assessment was completed for all nominees when initially appointed and re-tested. In

addition, Dr Hegarty, CCG Chair, was requested to provide a statement of assurance that there were no issues in relation to the performance of relevant elected Board members that should prevent them from being re-elected. This assurance was provided. A similar statement was provided by Mr S Wellings, Lay Member for Governance and CCG Vice-Chair, in relation to Dr Hegarty.

4.7 Therefore, as existing members are nominated, are unopposed, and meet competency criteria, there

was not a requirement for a full election of the GP membership. The re-elected members of the Governing Body are confirmed in the table below. The appointment is for a period of 3 years and the posts will be subject to re-election on 1st October 2017.

Confirmed Elected Member Locality Dr Steve Mann Stourbridge, Wollescote and Lye Dr David Hegarty Stourbridge, Wollescote and Lye Dr Richard Johnson Halesowen & Quarry Bank Dr Jaswant Rathore Sedgley, Coseley & Gornal Dr P D Gupta Dudley & Netherton Dr Mona Mahfouz Dudley & Netherton Dr Ruth Edwards Kingswinford, Amblecote and Brierley Hill

5.0 APPOINTMENT OF THE CHAIR 5.1 The constitution describes the process for the election of the Chair as follows:

2.2.2. The Chair of the governing body, as listed in paragraph 6.6.2 of the group’s constitution, is subject to the following appointment process:

a) Nominations –the chair of the governing body may be nominated by any voting member of the governing body from amongst the elected GP members of the governing body;

b) Eligibility –nominees for chair of the governing body must be an elected GP member of

the governing body and meet the person specification of the agreed role description of chair of the governing body.

c) Appointment process – should there be more than 1 eligible nominee for the role then

this role will be appointed via election from within the voting members of the Board. Should there be only 1 eligible nominee then the individual will be confirmed in post.

d) Term of office -3 years e) Eligibility for reappointment -there is no limit to the number of terms of office served by

an individual providing that they continue to meet the eligibility criteria and are subject to a nomination and election process every 3 years.

f) Grounds for removal from office - where the individual is no longer a member of the

group, where the individual is no longer an elected GP member of the governing body, where the individual is no longer on the Dudley Performers list; where the individual does not comply with the code of conduct.

g) Notice period - A minimum of 2 months’ notice is required, which notice must be

provided in writing to the accountable officer and vice chair of the governing body.

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5.2 The tenure of Dr Hegarty ends on 9th November 2014. 5.3 The process for the recruitment of the Chair is underway with an appointment expected by 30th

September 2014 with an effective date of 10th November 2014. 6.0 CLINICAL EXECUTIVE POSTS 6.1 The Constitution defines the process by which Clinical Executives are appointed. 6.2 The currently appointed Clinical Executives are described below:

Clinical Executive Responsible Area Tenure End Date Dr Steve Mann Acute & Community Commissioning 31st January 2015 Dr Jaswant Rathore Finance & Performance 31st January 2015 Dr Steve Cartwright Integration & Partnerships 31st October 2016 Dr Ruth Edwards Quality & Safety 31st March 2017

6.3 As Dr Rathore and Dr Mann have been re-elected, they will continue in their posts as Clinical

Executives. A separate paper to Board suggests a revision to the Constitution in relation to the appointment process for Clinical Executives.

7.0 RECOMMENDATION

1) The Board is asked to note the re-election of seven GP members of the Governing Body with effect from 1st October 2014

2) The Board is asked to note that the Chair is expected to be appointed by 30th September 2014.

3) The Board is asked to note that Dr Rathore and Dr Mann will continue in their roles as Clinical Executives.

Mr Matthew Hartland Chief Finance Officer August 2014

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Date of Report: 11 September 2014 Report: Dudley CCG Constitutional Changes


TITLE OF REPORT: Dudley CCG Constitutional Changes

PURPOSE OF REPORT: To seek Board approval for changes to the CCG Constitution prior to their submission to NHSE by 1 November 2014



CLINICAL LEAD: Dr D Hegarty, Chair

KEY POINTS: • Changes to the Constitution are proposed to reflect GP practice

changes • To note changes to the CCG Constitution are to be submitted to

NHSE by 1 November 2014

RECOMMENDATION: • The Board adopts the changes to the Constitution in respect of GP practice changes for submission to NHS England for approval, subject to final confirmation they have taken place




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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 DUDLEY CCG CONSTITUTIONAL CHANGE 1.0 INTRODUCTION 1.1 Guidance states that CCG’s have two opportunities per year to amend their constitution, in

June and November. Any application for variation which will change a CCG’s boundary or its list of members, and therefore have a potential impact on its financial allocation, can only be made at the 1st June deadline so that the change can be reflected in the allocations for the following financial year.

1.2 In relation to 2014/15, the NHS England Local Area Team (LAT) are required to review new proposals for change at a local level to ensure that they fit with the national guidance on CCG Constitutions as well as taking an overview to make sure that suggested changes in CCG membership do not adjust CCG boundaries. They also have a requirement to ensure that the appropriate consultation with both patient and CCG members has been undertaken in relation to proposed changes that may involve more than one CCG in practice transfers.

1.3 In order to allow sufficient time to review CCG proposals and provide appropriate feedback prior to submission to the regional office by 1st June, the LAT has requested that CCGs submit any proposals to them by 1st May.

1.4 The 1st November deadline is for all other proposed changes, such as amendments to

Committee Structure, Governing Body Membership, Member Practices and general ‘housekeeping’ updates.

1.5 The CCG Governing Body (the Board) has delegated authority from the group to adopt any changes proposed and approve the application to the NHS Commissioning Board (NHS England)

2.0 PROPOSED CHANGES TO DUDLEY CCG CONSTITUTION 2014/15

2.1 Following a review of the Constitution, only one item is proposed to change with effect from 1st November 2014 as described below:

Clinical Executive Roles 2.2 Paragraph 2.27 of the constitution currently states:

2.2.7. The Clinical Executive roles, as listed in paragraph 6.6.2 of the group’s constitution, is subject to the following appointment process:

a) Nominations – any elected GP representative member of the governing body (Board) may self-nominate for these roles. (In circumstances where there is no willing or eligible elected GP representative member of the governing body to fulfil the role, then any GP member on the Dudley Performer’s list would be eligible to self nominate, following advertisement of the vacancy.)

b) Eligibility – must be assessed as meeting the eligibility criteria set out in the agreed

role description. This assessment will be carried out by an independent committee, accountable to the CCG Remuneration Committee.

c) Appointment process – should more than 1 eligible elected GP representative apply

for the same Clinical Executive role, then an interview process will be held to determine the appointee. The interview panel and process will be overseen by a sub-committee of

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the Remuneration Committee. If only 1 eligible elected GP representative member of the CCG governing body is nominated, then they will be appointed to the role. In circumstances where the role is advertised to all Dudley GPs, then a competitive recruitment process will be held, overseen by an independent committee, accountable to the Remuneration Committee;

d) Term of office – 3 years e) Eligibility for reappointment -- there is no limit to the number of terms of office

served by an individual providing that they continue to meet the eligibility criteria and are subject to a competitive appointment process (as outlined above) after each term

f) Grounds for removal from office - where the individual is no longer a member of the

group; where the individual is no longer on the Dudley Performers list; where the individual does not comply with the code of conduct.

g) Notice period – A minimum of 2 months notice is required, which notice must be

provided in writing to the accountable officer and Chair of the governing body.

2.3 It is proposed to amend 2.2.7 e) – Eligibility for reappointment to:

e) Eligibility for reappointment - there is no limit to the number of terms of office served by an individual providing that they continue to meet the eligibility criteria. The Chair and Chief Accountable Officer can jointly agree for a reappointment to be renewed automatically; otherwise the post will be subject to a competitive appointment process (as outlined above) after each term

3.0 ITEMS FOR BOARD TO NOTE Member Practices 3.1 There are no proposed changes to the Constitution at this point in time with regards to

Member Practices. The number of practices within the CCG remains at 47. 3.2 The CCG is in discussions with the Area Team however, regarding the process and timeframe

for a potential change in CCG membership. We are not in a position to finalise any amendments at this point in the Constitution, however appropriate flexibility is being sought form NHS England to allow any change to happen in a timely manner.

4.0 RECOMMENDATIONS

1. The Board adopts the changes to the Constitution in respect of GP practice changes for submission to NHS England for approval, subject to confirmation they have taken place.

M Hartland Chief Finance Officer April 2014

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Date of Report: 11 September 2014 Report: Remuneration Committee Report


TITLE OF REPORT: Remuneration Committee Report

PURPOSE OF REPORT:

To provide assurance to the Board with regards key issues discussed and approved by the Extraordinary Remuneration Committee on the 26 June 2014



CLINICAL LEAD/LAY MEMBER: Mr S Wellings, Lay Member for Governance

KEY POINTS:

• On-call policy approved • Workforce data reviewed • Office holder contracts to be reviewed • Restructure of CCG commission function approved • VSM performance pay agreed

RECOMMENDATION: That the Board note the report for assurance.

FINANCIAL IMPLICATIONS: Within Financial Plan

WHAT ENGAGEMENT HAS TAKEN PLACE: n/a


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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 REMUNERATION COMMITTEE REPORT 1.0 INTRODUCTION

1.1 This report provides assurance to the Board with regards key issues discussed and approved by the

Extraordinary Remuneration Committee on the 26 June 2014 and no further meeting has taken place since. The following items are a description of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference.

1.2 Due to the nature of the Committee, there is not a set of key indicators to report to Board this month. 2.0 HR POLICIES

2.1 The Committee received and approved the following policy:

On-Call Policy Approved 26 June 2014

3.0 WORKFORCE DASHBOARD 3.1 An independent review of workforce information was discussed, including absence, sickness, level

of appraisals and personal development plans, mandatory training and use of agency staff. 3.2 No issues of significant concern were raised. 4.0 OFFICE HOLDER CONTRACTS 4.1 It was reported that there were a number of contradicting issues and concerns regarding the office

holder contracts held by Lay Members and Clinical Leads. An independent review was agreed to be commissioned.

5.0 CCG RESTRUCTURE 5.1 The Committee received a paper outlining proposed changes to the establishment and structure of

the commissioning function of the CCG. One outcome of the restructure was the disestablishment of the Head of Acute Commissioning post and subsequent redundancy of one individual. Following vigorous challenge and assurance received, the paper was approved.

6.0 VSM PERFORMANCE PAY 2014-2014/ PAY AWARD 2014-2015

6.1 In line with national VSM contracts, the Committee agreed the performance payment and pay award

for 2014/15, for the Chief Accountable Officer and Chief Finance Officer in relation to performance against agreed individual and organisational objectives.

7.0 RECOMMENDATION

1) The Board is asked to note the report for assurance. Mr Matthew Hartland Chief Finance Officer March 2014

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Date of Report: 11 September 2014 Report: Finance and Performance Committee Report


TITLE OF REPORT: Finance and Performance Committee Report

PURPOSE OF REPORT: To advise the Board of key issues discussed at the Finance and Performance Committee on 31 July and 28 August 2014.



CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance

KEY POINTS:

• CCG expects to meet its financial duties in 2014/15 based on the robust financial plans previously presented to the Committee.

• The CCG expects to achieve its control total of £5.4m as agreed with the Area Team, which reflects the carry forward of the surplus achieved in 2013/14.

• Committee approved GP Engagement Scheme 2014/15 • Committee agreed to adopt the NHS England model to

calculate GP Practice Budgets in 2014/15 • Performance issues discussed

RECOMMENDATION: The Board is asked to approve the report.

FINANCIAL IMPLICATIONS: As described in the report.



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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMER 2014 FINANCE AND PERFORMANCE COMMITTEE REPORT 1.0 INTRODUCTION

The report summarises the key issues discussed at the Finance and Performance Committee at its meetings on 31 July 2014 and 28 August 2014.

The following items are indicators of the current position in relation to the main responsibilities and obligations of the Committee as defined by the CCG Constitution and Terms of Reference. The finance indicators summarise the CCG’s key financial indicators and performance against its statutory financial duties for the first four months of the financial year ending 31 May 2014 as reported to the Committee on 28 August.

2.0 KEY INDICATOR SUMMARY The table below identifies key financial indicators as at 31 July 2014.

Performance ItemPlan

£000's

Year To Date

£000's

Forecast Variance

£000'sRAG

Statutory Financial DutiesAchieve Revenue Resource Limit Control Tota l (5,400) (422) (5,400)

Capita l Resource Limit 0 0 0

Running Costs 7,647 (227) 0

Cash Limit 0 1,714 0

Better Payment Practice Code - NHS 95% 99.18% 97%

Better Payment Practice Code - Non NHS 95% 99.07% 97%

LAT Assurance IndicatorsUnderlying Recurrent Surplus (11,937) (3,980) (11,965)

Programme Surplus - Year to date performance (192) (195)

Running Cost Surplus - Year to date performance (224) (227)

Programme Surplus - Ful l year forecast (5,400) (5,400)

Running Cost Surplus - Ful l year forecast 0 0Management of 2% Non Recurrent funds within agreed processes

Yes YES YES

QIPP - Year to date del ivery (1,712) (1,759)

QIPP - Ful l year forecast (7,166) (7,164)

Activi ty trends - Year to date (IP/ OP / A&E) 190 193

Activi ty trends - Ful l year forecast (IP/ OP/ A&E) 569 574Clear identi fication of ri sks aga inst financia l del ivery and mitigations

Met in ful l Met Met

Internal & External Audit Opinions and an assessment of the timel iness and qual i ty of returnsBalance Sheet indicators including cash management and BPCC

DUDLEY CLINICAL COMMISSIONING GROUP FINANCIAL PERFORMANCE DASHBOARD JULY 20

There were no exceptions to report this month

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3.0 EXCEPTION REPORTING 3.1 Statutory Financial Duties

The CCG is on target to achieve all statutory duties by 31 March 2015. The CCG did not achieve its financial performance target of ensuring the month end cash balance is within 5% of the cash drawn down from NHS England. The reasons for this are reported below under 4.4.

3.2 Area Team Assurance Indicators The CCG is currently achieving all its Area Team Assurance indicators, with the exception of year to

date activity, which is being driven by an over-performance in A&E against plan. 3.3 Local Indicators

Activity reporting is based on final data for month 2 and initial data for months 3 and 4. At the end of July activity continued to show a year to date over-performance. The reasons for this are being investigated and an update and the findings would be report to the Committee in September.

4.0 ITEMS DISCUSSED – FINANCE

4.1 Revenue Resource Limit

At the end of July the CCG’s commissioning budget was £384,751,990. 4.2 Capital Resource Limit

The CCG has submitted a nil return for capital plans and therefore was not planning to receive a capital allocation for 2014/15.

Performance ItemPlan

£000's

Year To Date

£000's

Forecast Variance

£000'sRAG

Local IndicatorsRevenue Resource Limit

Planned Care 168,104 (548) (709)

Urgent Care 78,069 542 652

Preventative Care 37,619 299 746

Reablement 21,547 151 383

Corporate 7,647 (227) 0

Non Recurrent 9,273 8 0

Reserves including Surplus 19,402 (417) (5,755)

Other 43,091 (230) (717)

Tota l 384,752 (422) (5,400)

Activity

Emergency Activi ty 34 1 2

Elective Activi ty 38 0 0

A&E Activi ty 73 2 3

Outpatient Activi ty 424 0 0

Tota l Activi ty 569 3 5

Memorandum ItemsTota l Revenue Resource Limit 384,752Movement in Revenue Resource Limit s ince las t month

0

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4.3 Running Costs The CCG has a running cost allowance of £7,647,000 for 2014/15 and is reporting a year to date underspend of £227,000. It is expected that the full running cost allowance will be utilised by the end of the year.

4.4 Cash Limit

The CCG is required to meet two targets in relation to cash management - to remain within the allocated cash limit and to ensure that monthly cash balances are within 5% of the cash requested from NHS England. The CCG did not achieve the target for July with a balance of £1,714,000 (representing 6.35%) remaining from the cash drawn down from NHSE England. This was principally due to the late receipt and non-payment of invoices from NHS Property Services. Cash plans are being monitored closely by the CCG and Commissioning Support Unit to ensure the target is met.

4.5 Better Payment Practice Code Compliance with the prompt payment code requires the CCG to pay all NHS and non-NHS trade payables within 30 days of receipt of goods or a valid invoice (whichever is later) unless other payment terms have been agreed. The CCG has a target of 95% for these transactions, which are both being achieved.

4.5.1 Better Payment Practice Code – NHS

At the end of July the CCG’s cumulative performance was 99.18%.

4.5.2 Better Payment Practice Code – non-NHS At the end of July the CCG’s cumulative performance was 99.07%.

4.6 QIPP 2014/15

The QIPP target for 2014/15 is £7.166m. A shortfall of £0.980m has been identified against schemes in the plan. It is imperative that new schemes are identified to retrieve this shortfall, although a non-recurrent QIPP reserve is proposed to mitigate this risk. If this were used it would increase next year’s QIPP target to £10.241m.

4.7 Activity At the end of July activity was over-performing mainly in emergencies and A&E attendances at

Dudley Group Foundation Trust (DGFT). This is due to higher than planned same day emergency care within the emergency assessment unit. Planned care activity for outpatients and electives is under-performing. However, activity is expected to increase in this area over the coming months as a result of the waiting list initiative. Sufficient funding has been identified to pay for such activity.

4.8 Statement of Financial Position The Committee noted the statement of the financial position of the CCG at the end of July 2014. No areas of concern were reported.

4.9 Workforce An establishment register has been constructed with employees and contracted staff reported against the funded established posts. Workforce issues pertinent to provider organisations are managed by the Quality and Safety Committee.

4.10 Localities Due to the non-availability of validated activity data, the year to date locality position could not be reported.

4.11 Area Team Assurance The CCG has achieved green ratings for all Area Team financial indicators for the first quarter of

2014/15 with the exception of activity trends which highlighted an amber/green rating, only missing a green rating by 0.5%.

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4.12 Risks The main risks facing the CCG financial position relate to the non-approval of 2% non-recurrent funds by the Area Team; slippage in the QIPP programme; potential cost pressure relating to NHS 111; potential cost pressure following the transfer of buildings and services to NHS Property Services and Community Health Partnerships, and over-performance on acute service level agreements.

4.13 Non-Recurrent Spend/Balance of Reserves Plans are focused on the delivery of performance issues; investment in the CCG’s strategic priorities and pump priming of further initiatives. The delivery of the plans is key to the achievement of the CCG’s statutory duties.

5.0 COMBINED BOARD ASSURANCE FRAMEWORK AND RISK REGISTER The risks assigned to the Committee were reviewed and accepted. No new risks were added to the register.

6.0 QIPP 2014/15 The Financial Plan included a QIPP target of just over £7.164m. Each scheme has been risk assessed and a shortfall against the target identified of £0.98m. The shortfall is largely due to slippage in the urgent care centre and the Rapid Response Team. The shortfall would increase next year’s QIPP target to £10.241m. Monthly challenge meetings are held with commissioners to assess progress on implementation and actions required, which are proving beneficial in managing the overall QIPP programme. Additional schemes are required, however, to mitigate the financial risk to the organisation.

7.0 GP ENGAGEMENT SCHEME The Committee approved the GP Engagement Scheme 2014/15. 8.0 PRACTICE BUDGET SETTING

In previous years the PCT/CCG used a local approach to set practice level budgets as there was no definitive formula for doing so. However, NHS England announced that the formula used to set 2014/15 CCG allocations could be used for setting practice budgets. Options in relation to setting practice commissioning budgets were considered. This formula had been compared to that currently used by the CCG to set practice budgets. The impact was that nine practices would receive budget reductions. The GP Engagement Lead was consulted on the budget and agreed with the principle of using the NHS England formula to derive practice budgets.

The Committee agreed to adopt the NHS England model to calculate GP practice budgets in 2014/15 and to amend practice list sizes in the model to actual list sizes as at 1st April 2014. The finance team would work with the nine practices to carry out an in-depth study of their spending profile. A separate comparison was being undertaken between the NHS England model and the local model proposed by the Medicines Management Team for prescribing. A recommendation would be made to the next Clinical Development Committee.

9.0 COMMISSIONING SUPPORT UNIT (CSU) – REPROCUREMENT AND BUSINESS CASE

UPDATE The Committee was updated on the position in respect of the re-procurement of elements of the service level agreement with Midlands and Lancashire CSU. The Committee reached agreement on the CCG’s contribution to stranded costs.

10.0 KEY INDICATOR SUMMARY – PERFORMANCE The table below identifies key performance indicators as at 31t July 2014, the last period for which

validated data has been received.

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Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb MarYTD

Performance RAG

Category A Red 1 Response 75% 87.9% 88.1% 93.8% 89.9%

Category A Red 2 Response 75% 78.2% 77.7% 76.6% 77.5%

Category A 19 Minute Response 95% 99.3% 99.6% 99.5% 99.5%

Ambulance Crew Readiness (a) Target 15m, Threshold =30m

11 10 11 32

Ambulance Crew Readiness (b) Target 15m, Threshold =60m

0 0 0 0

West Midlands Ambulance Service

Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb MarYTD

Performance RAG

Improved Access to Psychological Therapies

Trust 10585 (882 mth)

1003 925 1928

IAPT - 2 Sessions completed 51% 56.8% 46.9% 51.9%

Dudley & Walsall Mental Health

DUDLEY GROUP OF HOSPTALS FOUNDATION TRUST Indicator Target/ Threshold Apr May Jun Jul YTD RAG

MRSA Acute 0 0 0 0 0

Clostridium difficile Acute =<48 Annum 3 1 3 7RTT waits over 52 weeks 0 1 0 1

Ambulance Handover between 30mins & 60mins Target 15m, Threshold =30m 277 337 306 920Ambulance Handover > 60mins Target 15m, Threshold =60m 29 28 24 81

Trolley Waits in A & E Any trolley wait > 12 hours 0 0 0 0

Cancelled Operations (Urgent)Number of urgent operations cancelled for a second time

0 0 0

Publication of Formulary Yes/No Yes Yes Yes

Duty of Candour

Each failure to notify the Relevant Person of a suspected

or actual Reportable Patient Safety Incident (as per

Guidance)

Yes Yes Yes

18 Weeks RTT (Admitted) 90% 90.15% 90.04% 90.09%18 Weeks RTT (Non Admitted) 95% 99.22% 99.17% 99.20%

18 Weeks RTT (Incomplete) 92% 93.60% 95.40%Diagnostic Waits 99% 98.80% 98.998% 98.90%A&E 4 Hour Wait 95% 91.4% 91.4% 93.4% 96.9% 93.26%

Cancer 2 Week Waits 93% 97.72% 97.84% 97.78%Breast Symptoms 2 Week Waits 93% 96.81% 97.18% 97.00%

Cancer 31 day Waits 96% 100% 100% 100.00%31day - Susequest Surgery 94% 100% 95% 97%

31 day Anti Cancer Drug Regimens 98% 100% 100% 100%31 day wait - Radiotherapy 94% 100% 100%

62 day - RTT Cancer 85% 92.6% 87.4% 89.99%62 day - RTT (Screening) 90% 100% 100% 100.0%

62 day - RTT (Upgraded Priority) 85% 99% 96% 97.42%MSA Breaches 0 0 0 0 0

Cancellations of Operations 0 0 0 0 0

National Quality Requirements

Operational Standards

Apr May Jun Jul Aug Sep Oct Nov Dec Jan YTD

Mortality (SHMI) CSU HED Data - Rolling 12 months

1.00 1.098 1.07 1.07 1.04 N/A

Mortality (SHMI) CSU HED Data - monthly 1.00 1.18 1.07 0.95 0.97 0.89 0.98 0.93 1.03 0.95 1.04

Mortality (HSMR) CSU HED Data - Rolling 12 months

2.00 1.023 1.020 1.030 1.03 N/A

Mortality (HSMR) CSU HED Data - monthly

3.00 1.1422 0.8851 0.9773 1.1065 0.9587 1.0549 1.1663 1.0162 98.29 97.33 1.03

DUDLEY GROUP OF HOSPTALS FOUNDATION TRUST

Indicator Target / Threshold

2013 2014

RAG

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Item Indicator Target Apr May Jun July Aug Sep Oct Nov Dec Jan Feb Mar YTD RAG

National Quality Requirements

1 MRSAZero

0 0 0

352 Week

Waits >00 0 0

5Publication of

Formulary Yes/NoY Y Y

6Duty of

CandourCompliancy Y Y Y

Operational Standards

718 Weeks RTT

(Admitted)Operating

standard of 90%100% 100% 100.0%

818 Weeks RTT

(Non-Admitted)

Operating standard of 95%

99% 99% 99.1%

918 Weeks RTT (Incomplete)

Operating standard of 92%

100% 100%

10Diagnostic

WaitsOperating

standard of >99%100% 100% 100%

11 MSA Breaches >0 0% 0% 0%

12Cancellation

of Operations

Progressive targets measured

Quarterly to be agreed based on

2011/12 achievement data.

0% 0% 0%

Ramsay Healthcare 2014/15

11.0 EXCEPTION REPORTING

11.1 National Quality Requirements - Dudley Group Foundation Trust (DGFT) • Greater than 52 week waits • Ambulance Handovers >30 minutes • Ambulance Handovers >60 minutes

11.2 Greater than 52 week waits

DGFT had one patient during the report period that waited longer than 52 weeks from referral to treatment. This patient has now been treated. The contractual fine for this breach has been applied.

11.3 Ambulance Handover

The breaches at +30 minutes and +60 minutes have continued at the previous levels. A&E turnaround measures are likely to have a positive impact on this performance. The Trust has been fined based on previously agreed methodology.

11.4 National Operational Standards

DGFT failed one National Operational Standard (A&E 4 hour waits). In April performance was 91.6% and in May 91.4% against the target of 95%.

11.5 A&E 4 hour waits DGFT failed the A&E 4 hour waits for April through to June in 2014. However, performance has improved significantly in July. Recent daily data confirms that this achievement has been sustained through August. In 2014/15 A&E waits carry an increased penalty, which is approximately three times greater than in previous years.

11.6 18 Weeks Referral to Treatment (RTT) Performance (DGFT)

The 2014/15 Provider RTT figures show that DGFT achieved the aggregate RTT targets in April and May, but at specialty level failed the 90% target in ENT, Ophthalmology, Trauma and Orthopaedics and Urology for admitted patients. Detailed recovery plans have been introduced with a range of initiatives such as extra sessions and outsourcing. These recovery plans have continued to deliver reductions in the waiting lists and progress is monitored by the CCG on a weekly basis.

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11.7 Mortality Indicator (DGFT)

Although the recently published quarterly results of SHMI indicate that DGFT is a statistical outlier with greater mortality than the modelled prediction; more recent HED (health evaluation data) shows that this situation has improved markedly over recent months. Also the hospital specific metric (HSMR) shows DGFT within normal variance of the number of expected deaths.

Mortality as an issue is discussed in greater detail at the Quality and Safety Committee.

11.8 Improving Access to Psychological Therapies (IAPT) (Dudley and Walsall Mental Health Trust) Dudley and Walsall Mental Health Partnership are achieving the service targets for this indicator. However the Black Country Partnership and Big White Wall IAPT providers do not currently submit IAPT information to UNIFY. These providers have been requested to submit figures to Dudley CCG in Quarter 2 so that a complete assessment of the CCG’s level of achievement against target can be made.

11.9 Quality Premium Indicators (CCG Focused Indicators) Quality Premium performance for Potential Years Life Lost and Avoidable admissions in 2014/15 is difficult to assess at the moment due to baseline discrepancies. These issues are being worked through with the CSU.

12.0 GP ENGAGEMENT REPORT The GP Engagement Lead provided a report on the performance of GP practices highlighted as outliers in the Scorecard report.

13.0 SCORECARD REPORT The CCG Scorecard Report was presented to the Committee.

13.1 Community Indicators Almost all of the aggregated practice scores for localities demonstrated performance at the Platinum or Gold levels. However, it is worth noting that many of the percentage achievements at practice level were derived from very low levels of activity. This is less of an issue with the aggregated locality view, but is important when comparing individual practices.

13.2 Secondary Care Indicators Emergency admissions is the one indicator which demonstrated a Red category performance.

13.3 Primary Care Indicators

All localities performed between the Silver and Platinum standard for primary care indicators.

13.4 Finance Indicators This indicator scored red on the basis the aggregated achievement was an overspend of 0.72%. Balanced Scorecard performance exceptions are reported at the Finance and Performance Committee and addressed in the Practice Performance reviews. The scorecard is being reviewed and a revised version is to be submitted to Committee and localities in due course.

14.0 REPORTS FROM GROUPS ACCOUNTABLE TO THE COMMITTEE 14.1 CCG IT Strategy Group

All practices have migrated to EMIS Web. A Development Group, which would meet monthly, has been established to explore the benefits of having all practices on one system. It is intended that an EMIS employee would be seconded into the CCG a couple of day a week. Patient self-check in screens and SMS text messaging have been identified as priorities within the IT Strategy. At its meeting on 6 August the IT Strategy Group agreed to fund touch screen

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technology for practices and linked into this the introduction of digital signage, and to fund SMS text messaging for all practices. Another important point for the Board to note is the proposal regarding the procurement of an IT system for use by all providers of community services to the CCG. This is a different model to that historically adopted in the NHS where providers procure and manage information systems. The proposal is for the CCG to define and procure a system that seamlessly enables the implementation and operational delivery of our integration model. A working group is being established to progress this. The Group considered proposals for remote technology. It agreed to increase the use of remote technology for heart failure pathways, which would be funded from slippage in the IT Strategy action plan and to a pilot in primary care to support COPD pathways approved through the innovation fund. If the pilot were successfully evaluated the intention would be to roll this out across the health economy. A pilot to test mobile solutions for GPs to carry out home visits and for community nurses to support the integration model has been agreed. The first phase has been completed with the outcome that the software is not of the standard of functionality required. Revised software solutions are expected from suppliers in September that will then be retested.

14.2 Estates Strategy Group The development of the Health Infrastructure Strategy is progressing the deadline for which is

completion by 31 March 2015. A significant element is an audit of all primary care facilities, both NHS and privately owned, which has recently been commissioned. The Chief Finance Officer and Mr Richard Darch, who has been engaged to lead on the development of the Strategy, would be attending each of the September/October locality meetings to discuss estates developments within primary care. Meetings with providers to bring their estate plans into the Strategy have also commenced.

15.0 DECISIONS TAKEN UNDER DELEGATED POWERS

None 16.0 RECOMMENDATION The Board is asked to approve the report.

Matthew Hartland Chief Finance Officer August 2014

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Date of Report: 11 September 2014 Report: Primary Care Development Committee Report


TITLE OF REPORT: Primary Care Development Committee Report

PURPOSE OF REPORT: To advise the Board on key issues discussed at the Primary Care Development Committee on 17th July 2014 and 14th August 2014

AUTHOR OF REPORT: Mr D King, Head of Membership

MANAGEMENT LEAD: Mr D King, Head of Membership

CLINICAL LEAD: Dr J Rathore, Clinical Executive for Finance and Performance

KEY POINTS:

• Primary Care Incentive Scheme for 2013-14 results received that show audit and improvements to patient access within member practices

• Ideas for the Primary Care Transition Fund 2014-15 are being developed for prioritisation

• Actions agreed to support member practices in preparation for the new CQC inspection process

• GP survey data received on access revealing CCG responses similar to national median

• E-learning package supported and funded for practices to ensure CQC compliance

• New risks added

RECOMMENDATION: The Board is asked to note, for assurance, the issues discussed at the Primary Care Development Committee.



ACTION REQUIRED: Assurance Approval Decision

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DUDLEY CLINICAL COMMISSIONING GROUP BOARD – 11 SEPTEMBER 2014 PRIMARY CARE DEVELOPMENT COMMITTEE REPORT 1.0 INTRODUCTION 1.1 This report summarises the key issues discussed at the Primary Care Development Committee on

17th July 2014 and 14th August 2014.

2.0 ITEMS DISCUSSED Primary Care Incentive Scheme 2013-14

2.1 The Committee received a report summarising performance against the incentive scheme developed and implemented in 2013-14. The key points from the report were noted in that 45 (91%) of practices had completed and shared and action plan with the CCG in response to the Primary Care Foundation Audit, identifying ways in which practices could improve access. 38 practices (78%) demonstrated to their patient panels that access had been improved as a result of the actions taken in response to the audit.

Primary Care Transition Fund

2.2 The Committee discussed use of the transition fund and noted that a paper will be developed for consideration of the Finance and Performance Committee for consideration. The Committee noted that ideas would be canvassed from the wider membership, through locality meetings, and the membership event taking place in August and that a process of prioritisation would have to be agreed.

Care Quality Commission Inspection

2.3 The Committee received an update following feedback from member practice experiences. As a

result of this feedback the Committee agreed to following actions:

• Paul Maubach will write to Professor Steve Field, Chief Inspector of General Practice about the experiences of member practices to date.

• The membership engagement team will liaise with the Dudley Practice Management Alliance to ensure that the practice notifies the CCG of a CQC inspection.

• The membership engagement team will offer support and advice to the individual practice in advance of the visit

• The membership engagement team will schedule time into the locality meeting for the practice to feedback its experience and learning from the visit.

• The GP engagement lead will ensure that this learning is then cascaded to other locality groups. • The membership engagement team will be making contact with Sandwell and West Birmingham

CCG. Practices within this CCG have been identified for the new inspection process, so the CCG will gather intelligence on their experiences and share these through the locality meetings and DPMA.

• The community engagement team will make contact with those Dudley practices who have been visited previously to film and produce a ‘top tips’ guide that will be shared with other practices through the web-site, publicised through locality meetings, DPMA meeting and membership event.

GP Patient Survey 2.4 The Committee received a summary of “the GP Patient Survey” an independent survey run by Ipsos

MORI on behalf of NHS England. The Committee considered the results focussed on access. The Committee noted that the CCG responses were broadly similar to the national median, and one question (from nine) revealed a national outlier. The Committee agreed to use the report as a measure of performance for the actions being undertaken by the CCG to support improvements in access. The Committee agreed that the report would receive routinely and that the results would be compared to the previous results to track the changes.

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E-Learning Package

2.5 The Committee received a presentation on behalf of the Dudley Practice Management Alliance whose members had been piloting an e-learning training package. The Committee supported the package being funded and rolled out to all practices in response to fulfilling CQC recommendations. The Committee agreed that the roll out and implementation of the package will be co-ordinated and managed by the Dudley Practice Management Alliance.

Risk Register

2.6 The Committee on the 14th August agreed a new risk regarding “failure to work in partnership with NHS England Area Team to successfully co commission primary care medical services resulting in an inability to deliver the outcomes set out in the Primary Care Development Strategy and expression of interest for co-commissioning”.

3.0 DECISIONS TAKEN BY THE COMMITTEE UNDER DELEGATED POWERS FROM BOARD None 4.0 DECISIONS REFERRED TO BOARD None 5.0 RECOMMENDATION

1) The Board is asked to note the issues discussed at the Primary Care Development Committee on 17th July and 14th August.

Dr J Rathore Clinical Executive, Finance and Performance August 2014

1

GLOSSARY

ABBREVIATIONS Abbreviation Meaning #NOF Fractured Neck of Femur

£K £1,000 equivalent

A&E Accident and Emergency

ABC / ABCD Above and Beyond the Call of Duty (Local surveys which include praise for

nominated staff members as well as assessment of services)

ACRA Advisory Committee on Resource Allocation

ACS Acute Coronary Syndrome

AD Assistant Director

AfC Agenda for Change

AHSN Academic Health Science Networks

ALE Auditors Local Evaluation

ALOS Average Length of Stay (in hospital)

AMI Acute Myocardial Infarction

AMMC Area Medicines Management Committee

Anti-D An antibody occurring in pregnancy

Anti-TNF Drugs used in the treatment of rheumatoid arthritis and Crohn’s disease

ARIF Aggressive Research Intelligence Facility

ASAP As soon as possible

AVE Advertising Value equivalent

BACs Bank Automated Credit

BCC Black Country Cluster

BCG Bacillus Calmette-Guerin

BCPFT Black Country Partnership Foundation Trust

BCUCG Black Country Urgent Care Group

BFT Behavioural Family Therapy

BLCCB Black Country Local Collaborative Commissioning Board

BME Black Minority Ethnic

BMJ British Medical Journal

BPAS British Pregnancy Advisory Board

2

BSCCP British Society of Colposcopy and Cervical Pathology

CAB Citizens Advise Bureau

CABG Coronary Artery Bypass Graft

CAO Chief Accountable Officer

CAMHS Children and Adolescent Mental Health Service

CASH Contraception and Sexual Health

CAT Change Agent Team

CBSA Commissioning Business Support Agency

CCBT (CBT) Computerised Cognitive Behavioural Therapy

CCF Capable Care Forum

CCG Clinical Commissioning Group

CCRN Comprehensive Clinical Research Networks

CDC Clinical Development Committee

CEO Chief Executive Officer

CFO Chief Finance Officer

CHADD The Churches Housing Association of Dudley & District Ltd

CHC Continuing Healthcare

CHD Coronary Heart Disease

CIS Community Investment Strategy

CMO Chief Medical Officer

CNST Clinical Negligence Scheme for Trusts

CNT Community Nursing Team

CONNECT Mental Health information website for staff

COSHH Control of Substances Hazardous to Health Regulations 2002

CPA Care Programme Approach

CPN Community Psychiatric Nurse

CRL Capital Resource Limit

CSSD Central Sterile Services Department

CT scan Computer Topography

CQUIN Commissioning for Quality and Innovation

CQRM Clinical Quality Review Meeting

CVD Cardio Vascular Disease

CWAS Coventry and Warwickshire Audit Services

DACHS Directorate of Adult Children and Housing Services

DCS Dudley Community Services

DCVS Dudley Community Voluntary Service

DES Directed Enhanced Service

DfES Department for Education and Skills

DGoH Dudley Group of Hospitals

DNA Did not attend

3

DoH Department of Health

DoLS Deprivation of Liberty Safeguards

DoS Directory of Service

DTC Diagnostic and Treatment Centre

DWMHPT Dudley and Walsall Mental Health Partnership Trust

DXA Dual X-ray Absorptiometry (measures bone density).

E&D Equality and Diversity

EAU Emergency Assessment Unit

EBME Electro Bio-Mechanical Engineer

ECA Extra Care Area

ECM Every Child Matters

ECT Electroconvulsive Therapy

ED Emergency Department

EI Early Implementer

EI Early Intervention

EMI Older People with Mental Illness (Elderly Mentally Ill)

EPP Expert Patients Programme

EPR Electronic Patient Record

ERMA Emergency Response & Management Arrangements

ERT Enzyme Replacement Therapy

ESR Electronic Staff Record

FCEs Finished Consultant Episodes

FED Forum for Education and Development

FHS Family Health Services

FIP Computerised data collection facility used by community health teams.

FMC Facility Management Centre

FOI Freedom of Information

FYE Full Year Effect

GMS General Medical Services

GOWM Government Office for the West Midlands

GP General Practitioner

GPAQ General Practice Assessment of Quality

GPwSI GPs with Special Interest

GU Genito-urinary

GUM Genito-urinary Medicine

HCAI Health Care Acquired infection

HENIG Health Economy NICE Implementation Group

HF Heart Failure

HIC Health Improvement Centre

HIV Human Immunodeficiency Virus

4

HPA Health Protection Agency

HPS/S Health Promoting Schools / Service

HPU Health Protection Unit

HR Human Resources

HSC Health and Safety Commission

HSCQC Health and Social Care Quality Centre

HSE Health and Safety Executive

HT Home Treatment

HV Health Visitor

IAPT Improved Access to Psychological Therapies

IC Infection Control

ICAS Independent Complaints Advocacy Service

ICNA Infection Control Nurses Association

ICP Integrated Care Pathway

ICSM Interim Customer Services Manager

IFR Individual Funding Request

IG Information Governance

IOSH Institute of Occupational Safety and Health

IT Information Technology

IUCD Intrauterine Contraceptive Device

JCAB Joint Clinical Advisory Board

JCC Joint Consultative Committee

JD Job Description

JE Job Evaluators

JM Job Matching

KLOE Key lines of enquiry

KSF Knowledge and Skills Framework

KPI Key Performance Indicators

LAA Local Area Agreement

LAC Looked After Children

LAT Local Area Team

LBC Liquid Based Cytology

LD Learning Disability

LDP Local Delivery Plan

LEA Local Education Authority

LIFT Local Improvement Finance Trust

LIG Local Implementation Group

LIT Local Implementation Team

LMC Local Medical Committee

LNG Local Negotiating Committee

5

LPS Local Pharmaceutical Scheme

LRF Local Resilience Forum

LTC Long Term Conditions

LVD Left Ventricular Dysfunction

LVSD Left Ventricular Systolic Dysfunction

MAPA Management of Actual and Potential Aggression

MAU Medical Assessment Unit

MBC Metropolitan Borough Council

MDT Multi Disciplinary Team

MIMT Major Incident Management Team

MIRE Major Incident Response Executive

MLSOs Medical Laboratory Scientific Officers

MRSA Methicillin Resistant Staphylococcus Aureus

MSS Medium Secure Service

NCA Non contract activity

NCB National Commissioning Board

NCRS National Care Record System

NELHI National Electronic Library for Health Information

NICE National Institute for Clinical Excellence

NGMS New General Medical Services

NHS National Health Service

NHSCPT NHS Community Practice Teacher

NHSCSP NHS Cancer Screening Programme

NHSE NHS England

NHSLA NHS Litigation Authority

NHSP National Healthy Schools Programme

NICE National Institute for Clinical Excellence

NOF New Opportunities Fund

NPfIT National Programme for IT

NPSA National Patient Safety Agency

NRF Neighbourhood Renewal Fund

NRLS National Reporting and Learning System

NRT Nicotine Replacement Products

NSF National Service Framework

OAT Out of Area Treatment

OBD Occupied Bed Day

OD Organisational Development

ODM Oesophageal Doppler Monitoring

OOH Out of Hours

OSC Overview and Scrutiny Committee

6

OT Occupational Therapist

PALS Patient Advice and Liaison Service

PAF Positive Assurance Framework

PAS Patient Administration System

PAU Paediatric Assessment Unit

PbR Payment by Results

PC Personal Computer

PCDB Primary Care Delivery Board

PCDC Primary Care Development Committee

PCT Primary Care Trust

PDF Portable Document Format

PDP Personal Development Plan

PDS Personal Dental Services

PDSA Plan, Do, Study, Act

PDU Professional Development Unit

PE Pulmonary Embolism

PEAK Database holding the main registered details of patients and associated referral,

contact, caseload, outpatient, inpatient, MH Act and clinic information.

PEAT Patient Environment Action Team

PEC Professional Executive Committee

PEPP Pooled Budget External Placement Panel

PFI Private Finance Initiative

PGD Patient Group Directives

PICU Psychiatric Intensive Care Unit

PID Project Initiation Document

PIN Personal Identification Number

PMLD Profound and Multiple Learning Difficulties

PMS Primary Medical Services

POP Patient Opportunity Panel

PPA Prescription Pricing Authority

PPG Patient Participation Group

PPIF Patient and Public Involvement Forum

PSA Public Service Agreement

PSHE Personal and Social Health Education

PTCA Percutaneous Transluminary Coronary Angioplasty

Q&A Questions and Answers

Q&S Quality & Safety

QA Quality Assurance

QIPP Quality, Innovation, Productivity and Prevention

QMAS Quality Management and Analysis System

7

QOF Quality and Outcome Framework

QPDT Quality and Practice Development Teams

RACPC Rapid Access Chest Pain Clinic

RAS Respiratory Assessment Service

RCA Root Cause Analysis

RES Race Equality Scheme

RHH Russells Hall Hospital

RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RMO Responsible Medical Officer

RRL Revenue Resource Limit

RSL Register Social Landlords

RTT Referral to Treatment Target

SAP Single Assessment Process

SEPIA Mental health computer system

SFBH Standards for Better Health

SFI Standing Financial Instructions

SIC Statement of Internal Control

SLA Service Level Agreement

SRE Sex and Relationship Education

SSD Social Services Department

SSDP Strategic Services Development Plan

STI Sexually Transmitted Disease

STRW Support, Time & Recovery Worker

TB Tuberculosis

TIA Transient Ischaemic Attack

TP Teenage Pregnancy

TPT Teenage Pregnancy Team

UHBT University Hospital Birmingham Trust

Vaccs & Imms Vaccinations and Immunisations

WAN Wide Area Network

WCC World Class Commissioning

WIC Walk in Centre

WMAS West Midlands Ambulance Service

WMCSU West Midlands Commissioning Support Unit

WMHTAC West Midlands Health Technology Advisory Committee

WMSCG West Midlands Strategic Commissioning Group

WMSSA West Midlands Specialised Services Agency

WTE Whole Time Equivalent

Dudley Clinical Commissioning Group

Governing Body Board Dates - 2015

Date Time

Meeting Room

Thursday, 8 January 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

Thursday, 12 March 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

Thursday, 2 April 2015 1pm – 3pm Boardroom, 2nd Floor, BHHSCC

Thursday, 14 May 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

Tuesday, 16 June 2015 (AGM) 6pm – 9pm Venue TBC

Thursday, 9 July 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

Thursday, 10 September 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

Thursday, 12 November 2015 1pm – 5pm Boardroom, 2nd Floor, BHHSCC

dudley clinical commissioning group board agenda · dudley clinical commissioning group board...

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