Download Board Papers 26th April 2013

NHS City and Hackney Clinical Commissioning Group (CCG) Board
Friday 26 April 2013, 1415-1615
Bandura 2, Tomlinson Centre, Queensbridge Road, London, E8 3ND
AGENDA
Chair: Dr Clare Highton
Agenda Items
Led by & Appendix Timing
number
1.
Welcome, introductions and declarations of
Interests
Clare Highton
1415-1420
(5 mins)
2.
CCG Committee business:
a. Minutes of the last meeting;
b. Register of Interests;
c. Matters arising:
o Joint Response to: Urological
cancer: why we need change
Clare Highton
Papers 2a, 2b, 2c,
2d & 2e
Pages 3-19
1420-1425
(5 mins)
3.
Questions from the public
Clare Highton
Verbal
1425-1435
(10 mins)
CLINICAL STRATEGY (FOR DECISION)
4.
East London Foundation Trust Serious
Incident assurance
Clare Highton /
Robert Dolan /
Kevin Cleary
Papers 4a & 4b
Pages 20-22
1435-1450
(15 mins)
5.
Out of Hours service
• Quality and safety handover from
PCT Cluster / NHS England
regarding Harmoni;
• Contract monitoring arrangements for
Harmoni contract;
• Procurement of new service.
Karl Thompson
Papers 5a, 5b, 5c,
5d & 5e
Pages 23-61
1450-1505
(15 mins)
6.
Safeguarding Assurance
Clare Highton
Papers 6a, 6b, 6c &
6d
Pages 62-86
1505-1520
(15 mins)
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
7.
Prescribing Budgets
Haren Patel
Papers 7a & 7b
Pages 87-96
1520-1530
(10 mins)
8.
St Joseph's Hospice - 2013/14 Contract
Philippa Lowe
Paper 8a & 8b
Pages 97-105
1530-1540
(10 mins)
PERFORMANCE
9.
Commissioning Support Unit (CSU) City and Clare Highton /
Hackney Quarterly Quality report
Jenny Singleton
Paper 9a & 9b
Pages 106-165
1540-1600
(20 mins)
FOR INFORMATION
10. CCG Finance update
Philippa Lowe
Paper 10
Pages 166-174
1600-1610
(10 mins)
11. Reports from Subcommittees of the Board:
a. Key issues from the Monday 25
February 2013 Audit Committee;
b. Key issues from the Wednesday 20
March 2013 Audit Committee;
c. Key issues from the Wednesday 13
March 2013 Remuneration Committee;
d. Key issues from the Wednesday 10
April 2013 Clinical Executive
Committee;
e. Key issues from the Wednesday 17
April 2013 Finance and Performance
Committee.
Clare Highton
Papers 11a, 11b,
11c, 11d & 11e
Pages 175-179
1610-1615
(5 mins)
12. Friday 31 May 2013 CCG Board agenda
Clare Highton
Paper 12
Pages 180-181
1615-1620
(5 mins)
13. Any Other Business
Clare Highton
1620-1630
(10 mins)
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
MINUTES OF THE NHS CITY AND HACKNEY COMMISSIONING GROUP BOARD
HELD ON FRIDAY 22 MARCH 2013
AT THE LAWSON PRACTICE, NUTTALL STREET, LONDON, N1 5HZ
PRESENT:
Dr Clare Highton (CCG Chair)
Dr Haren Patel (Clinical Vice Chair)
Dr Gary Marlowe (CCG Board GP)
Mariette Davis (CCG Governance Lay Member)
Jaime Bishop (CCG Public and Patient Involvement Lay Member)
Honor Rhodes (NHS NELC Associate Lay Member)
Siobhan Clarke (CCG Board Nurse)
Christine Blanshard (CCG Board Consultant)
Paul Haigh (CCG Chief Officer)
Philippa Lowe (CCG Chief Financial Officer)
IN ATTENDANCE: Cynthia White (City of London LINk)
Michael Vidal (Hackney LINk)
Emma Craig (Hackney HealthWatch)
Simon Currie (CSU Interim Director of Contracts)
Maggie Harding (CSU Public Health Consultant) for agenda item 9
Susan Beecham (CSU Deputy Director, Individual Funding Requests)
for agenda item 9
Margaret O’Donovan (CSU Quality Lead) for agenda item 13
The Chair, Dr Clare Highton (CH) welcomed members to the March 2013 meeting of the
NHS City and Hackney Clinical Commissioning Group (CCG) Board.
Agenda Item 1 – Declaration of Interests
Haren Patel (HP) declared an interest, as documented in the Register of Interests, in
agenda item 9 and Philippa Lowe (PL) requested that the Register of Interests be updated
to remove reference to Tower Hamlets CCG as the post was no longer shared between
CCGs.
Agenda Item 2 – CCG Committee business
Minutes of the last meeting
The minutes of the Friday 22 March 2013 CCG Board meeting were cleared without
change.
CCG Board Forward Plan
The Board noted the forward plan.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
Register of Interests
The Board accepted the Register of Interests.
Matters arising
CH updated the Board that following the February 2013 CCG Board meeting that the
Homerton University Hospital Foundation Trust (HUHFT) had reported that the recent
Clostridium Difficile (C Diff) infections at the Trust had been tested and confirmed to be
different strains, ruling out the infections spreading on site.
The CCG had requested a report into the clinical quality of the InHealth service from the
Commissioning Support Unit (CSU) following on from an alert about reporting and the
service will be covered in the quarterly quality report from the start of 2013/14.
CH briefed the Board on developments in the Out of Hours procurement exercise, including
that the NHS Commissioning Board (NCB, now NHS England (NHSE)) quality handover
had been delayed and would now be taking place in April 2013. A report on the progress of
the exercise will follow to the April 2013 CCG Audit Committee and CCG Board.
The Board discussed Lay Member representation and input at the Clinical Quality Review
Meetings (CQRMs), concluding that the CCG would discuss the matter with the PPI
Committee, CSU and Trusts and reach a conclusion early in 2013/14.
PL tabled a single tender action waiver, asking the Board for agreement to enter into a
contract with RSM Tenon to provide internal audit services for twelve months through
2013/14.
DECISION: CCG Board agreed the single tender action to contract with RSM Tenon for the
provision of internal audit services.
Paul Haigh (PH) announced that Honor Rhodes (HR) had agreed to continue as an
Associate Lay Member of the CCG Board in a non-voting capacity. The Board agreed the
appointment and congratulated HR.
DECISION: Honor Rhodes appointed as Associate Lay Member to the CCG Board.
Agenda Item 3 – Questions from the public
David King (DK) joined the meeting to raise the ownership of Harmoni, the Out of Hours
service provider for the City of London and Hackney to the CCG Board. DK asked the CCG
Board to confirm that the CCG’s Constitution contained a commitment to prohibit or restrict
the use of off shore or tax avoidance schemes for its providers. The Board confirmed that it
had committed to this clause and also to complying with the relevant UK and European
Law, for which it had received advice that this clause was compliant with. DK suggested
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
that this clause could be used to annul the contract with Harmoni as it was owned by Care
UK, which was known to use tax avoidance schemes.
The Board replied that the Harmoni contract was one of the many contracts novated from
the NHS North East London and the City (NELC) Primary Care Trust (PCT) Cluster and
that the PCT Cluster had secured Harmoni’s services without the CCGs involvement. Due
to the national process currently underway to close PCTs and transfer contracts to CCGs,
there was no option available for the CCG to refuse to accept a contract and there was no
valid option available to annul the contract. The Board confirmed that the Harmoni contract
was a six month extension and that a procurement exercise will be undertaken to secure a
long term Out of Hours service provider after April 2013. That procurement process will be
in line with the CCGs commitments and policies as laid out in its Constitution.
Agenda Item 4 – Sustainability policy
PH presented the CCGs Sustainability Policy as circulated with Board papers for the
Boards comment and approval. The Board supported the policy, but asked how the policy
would be put into practice and whether the measures laid out in the policy were compliant
with procurement law.
PH explained that as a public body from April 2013, the CCG would be obligated to cut
carbon emissions under the 2008 Climate Change Act but that the CCG could embrace the
evidence based measures set out in policy while saving money for the local NHS and
improving the health of the population. These measures would include requiring providers
to develop Sustainable Development Management Plans and procuring using the
‘Procuring for Carbon Reduction’ toolkit.
The Board discussed how the policy could be applied to the CCGs selection of providers,
both big and small and whether it could be widened to include social as well as
environmental measures, for instance making the London living wage the minimum wage
across the areas services staff or requiring that a set percentage of providers employ local
residents. The Board noted that some of this was included in the good corporate citizen
section of the policy and the policy’s commitment to consider health and wellbeing and
prevention alongside treatment in the development of the CCGs pathways.
DECISION: The CCG Board approved the adoption and implementation of the Sustainable
Commissioning and Procurement Policy which would be bought into use across currently
commissioned providers and in procurement exercises.
Agenda Item 5 – Safeguarding assurance
CH briefed the Board that further information will come to the April 2013 CCG Board in
order for it to receive assurance on the wider Adults and Children safeguarding processes
in place across the area. This Board meeting was receiving information to assure it that the
proper procedures with regards to placements in continuing care including Nursing Homes.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
The Board discussed the circulated paper, noting how important it was for care home
providers to treat staff well and how that is reflected in the staff’s treatment of patients. The
Board requested that the CCG and CSU investigate whether providers can be tied into the
CCGs principles and policies through the contracting process. Simon Currie replied that
this could be challenging and would need to be worked through in partnership with the
relevant lead commissioner who has responsibility for the providers when they are out of
the CCGs area. The CSU currently conducts reviews with each patient in the continuing
care area and any alerts regarding a service provider are received by the CSU quality team
and notified to the CCG.
Assessment of quality of all care home providers is challenging due to the numbers of
individuals providers involved, but continuing healthcare will be covered in the 2013/14
quarterly quality report and any exceptions reported to the CCG as they may arise.
Emma Craig (EC) raised that this is an area that HealthWatch may be able to help with in
the future, perhaps via sharing of information across London HealthWatches.
Agenda Item 6 – PPI Service User Policy
Jaime Bishop (JB) presented a revised Public and Patient Involvement Service User Policy
following the Boards discussion of a previous version at the January 2013 meeting. The
Board agreed the revised policy.
DECISION: PPI Service User Policy agreed.
Agenda Item 7 – PCT Handover Document
PL updated the Board that the Audit Committee has seen and been assured that the PCT
Handover document is correct. The document contains details of all equipment, assets,
staff and contracts being novated from the PCT Cluster to the CCG. The equipment and
assets transfer list is small, however the staff and contracts list is larger. The CCG will be
receiving a quality and performance handover briefing from the PCT executive team in the
before the end of March 2013 and have already received a quality briefing from the CSU.
The PCT has set limits and funding aside to deal with any historic claims in continuing
healthcare and to deal with any other claims arising after 1 April 2013. If that funding limit is
reached, the CCG will be liable for further claims.
Agenda Item 8 – POLCV policy
Maggie Harding, CSU Public Health Consultant (MH) joined the Board to present the
2013/14 Procedures of Limited Clinical Value (POLCV) policy which had previously been
consulted on with the Clinical Executive Committee (CEC). The policy is based on the
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
historic PCT policy and is based on an ‘exception’ basis – that anything not covered in the
policy is assumed to be part of the areas normal services. Any procedure mentioned in the
policy will require an Independent Funding Request to be submitted before the procedure
can be cleared for funding using NHS resources.
The Board discussed the policy, noting that it was in line with NICE best practice and solidly
evidence based. The Board did request that the language used in the breast implant and
reduction section be revisited to ensure consistency and that Botox treatment might be a
recommended treatment alongside Endoscopy in some cases.
The Board agreed the policy with its minor requested changes but it was noted that as this
is an annual process, work on the 2014/15 proposals should commence sooner to allow for
patient engagement. MH responded that the CSU will be devising a programme of policy
review shortly.
DECISION: CCG Board cleared the CSU 2013/14 POLCV policy with minor changes.
MH noted that NHSE will be producing their own POLCV policy for the services they
commission and that in the future we will need to ensure that the documents are consistent.
Bariatric surgery could pose particular local issues, but the CCG will need to address any
problems when the policy is shared.
The Board clarified that the policy will apply to all local providers – practice based minor
surgery providers as well as acute Trusts.
Agenda Item 9 – Establishment of independent funding review (IFR) panel
Susan Beecham (SB) joined the meeting to present the Individual Funding Request (IFR)
policy. PH also asked the Board to consider and agree the establishment of the Individual
Funding Review Panel (IFRP).
The IFRP will be a Waltham Forest, East London and the City (WELC) wide Panel, the City
and Hackney clinician representative will be Dr Suresh Tibrewal (ST) and the Lay Member
representative will be Honor Rhodes. The CSU will provide pharmaceutical input and the
Local Authorities will send a Public Health representative. Any decisions needing to be
escalated to the CCG from the Panel will be processed through the Planned Care
Programme Board (PCPB).
The Board discussed the appeals panel makeup, electing to nominate Dr Gary Marlowe
(GM) as the City and Hackney representative, who could also deal with any IFRs from ST
so to prevent any conflict of interest (ST will also act for GM to cover his conflicts).
The Board asked that the CSU Medicines Management team monitor drug IFRs to consider
repeat requests for treatment as ‘business as usual’.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
DECISION: CCG Board approved the IFR policy, agreed to establish the IFR Panel and
agreed Dr Suresh Tibrewal and Honor Rhodes to sit on the IFRP with Dr Gary Marlowe
sitting on the appeals panel on behalf of the CCG.
Agenda Item 10 – Establishment of Intermediate Care Board with London Borough of
Hackney and associated governance
The Board received a paper outlining plans to improve intermediate care services. The
CCG had embarked on joint work with the City of London (CoL) and the London Borough of
Hackney (LBH) to improve the coordination of services covered by the section 75
agreement for reablement and intermediate care services which the CCG will inherit from
the PCT on 1 April 2013. These cover four services provided between LBH social services
and HUHFT and represent spend of £3,607k of which the NHS contribution is £760k.
The Board noted that this was the first step of developing integrated care services for local
people and was therefore an important strategic building block. It welcomed the plans and
direction and endorsed the service benefits outlined.
The Board made a number of comments on the proposed service specification which is
also out to consultation with member practices. These were:
• The need to support safe and effective discharge from the acute setting;
• The need for robust communications with other clinicians, including GPs as
providers;
• The need for the service to develop and share individual care plans which have been
agreed with patients and their users/carers.
And these will be fed back to LBH.
The Board noted the plans to develop a lead provider arrangement for the services.
The Board noted that arrangements for CoL residents still needed to be resolved and
requested that the commissioning arrangements were clarified asap and outlined in the
requirements for the new service.
DECISION: The CCG Board agreed to:
• Establish as a formal Sub Committee of the Board the Reablement and Intermediate
Care Board (RICB) which would also be a formal Sub Committee of LBH and also
report to the Health and Wellbeing Board (HWB);
• The Terms of Reference for the RICB and the CCG membership of Dr Lucy
O’Rourke, older people's lead supported by Richard Bull, Programme Director;
• The proposed governance arrangements, including the three sub groups of the RICB
covering service quality, performance and user views;
• The Board reemphasised the importance of ensuring safe high quality clinical
services in the community and the need for users to drive the development of the
service and be actively involved in service monitoring and requested that clinical and
user outcomes are developed which can be used to assess the service;
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
•
Delegate to the RICB the following functions:
o Oversight of the selection of the lead provider arrangements;
o Monitoring of the new service;
o Oversight of the pooled budget between the CCG and LBH to manage the
service and development of a new section 75 agreement;
o Development of a performance based contract management arrangement and
in year management of this.
The Board also noted that there was no agreement to any additional funding to deliver the
new service model and that a contractual agreement would be developed which
incentivised performance and improvements.
Agenda Item 11 – Sign off of 2013/14 CQUIN proposals for HUHT
SC apologised that the CSU had not been able to produce a final proposal for HUHFT
Commissioning for Quality and Innovation (CQUIN) measures as of the CCG Board
meeting. The document will be distributed in early April 2013 based on the NHS Outcomes
Framework and taking into account CCG feedback and will be consulted on with the CCG
CEC before coming to the Board for agreement.
ACTION: CSU to circulate final proposals for 2013/14 HUHFT CQUINs in early April 2013.
SC noted that HUHFT still had progress to make on meeting the pre-qualification criteria for
the 2013/14 CQUIN system. The East London Foundation Trust (ELFT) CQUINs have
been delegated to the East London Mental Health Consortium for consultation and
agreement.
Agenda Item 12 – CCG 2013-16 Plans
CH presented the 2013-16 CCG ‘plan on a page’ required for an NHS England return and
the extended CCG planning document. The documents formed the basis for the
‘prospectus’ that is due for production in May 2013 and will come to a future CCG Board
meeting.
The Board discussed the documents, requesting that ‘professional awareness’ be included
in the sections regarding integrated care and dementia care in addition to patient
awareness. The Board also asked that an explicit commitment be made to evidencing how
the CCG acts on ‘what people tell us’ in order to improve the openness of the organisation.
The Board discussed including specific professional groups through the document,
including Paediatricians in the ‘working together’ section and inclusion of practice
receptionists in the training programme being rolled out across the area.
PH advised the Board that the CCG has requested NHSE’s commissioning intentions for
inclusion in the CCG prospectus in order to deliver an integrated document.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
DECISION: The CCG Board agreed the plan for submission to the NCB.
Agenda Item 13 – ELFT Serious Incident Review action plan
Margaret O’Donovan (MOD) joined the CCG Board to discuss the Serious Incident (SI) at
ELFT in 2010 and the action plan produced by ELFT to address the findings of the review
into the incident. The Board discussed the findings, expressing concern that there were
indications of ELFT being short staffed on the wards, although they recognised that the
incident wasn’t directly related to a staff shortage but was related to patient management.
MOD advised the Board that she had met with ELFT through the drafting of the action plan
and that the process had revealed systemic issues. MOD and the CSU could not assure
the CCG that the current ELFT position was acceptable or that all measures in the action
plan had been met. ELFT have offered to attend a meeting of the CCG Board to discuss
the review, action plan and assure the CCG of its services directly.
ACTION: ELFT to be invited to the April 2013 meeting of the CCG Board to discuss the
Trusts services and SI action plan.
The Board agreed to ask ELFT to report on staffing levels and skill mix ratios at the time of
the incident and subsequently and that CSU ensure these are included in the quarterly
quality report on an on-going basis. The quarterly report should also include staff sickness
levels.
ACTION: ELFT to report on staffing levels and skill mix ratios and report the findings to the
next CCG Board meeting.
ACTION: CSU to detail ELFT staffing levels, skill mix ratios and sickness levels in the
quarterly quality report.
ACTION: CSU to investigate whether an audit can be implemented in the 2013/14 ELFT
contract to assure the CCG that safe staffing levels are in place.
MOD noted that the action plan did include a requirement for ELFT to carry out a workforce
training assessment.
Agenda Item 14 – CCG Finance update
PL briefed the Board on the current financial position and recent developments, noting that
there had been no significant change to previous months position with a forecast year end
overspend of £1.2m and year to date over spend at month eleven of £1.1m. This remained
within the PCT control total but was still red rated as a risk for the CCG. Quality,
Innovation, Productivity and Prevention (QIPP) savings targets remained ahead of plan and
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
were rated green. Activity at HUHFT remained above plan and activity at other providers
has been rising and is also above plan at some providers.
The CCG has bid for and secured two tranches of non-recurrent investment from NELC so
far, totalling £3m. PL is receiving regular updates from NHS England, mostly regarding
increases in the size of the specialist commissioning budget. The CCG has already been
informed that a further £3.4m is being removed from its budget for transfer to the specialist
commissioning budget and this movement is not expected to be the final position.
PL has encountered issues with the transfer of the pharmacy Local Enhanced Service
budgets which appear to have been assigned to NHS England in error, totalling £1.4m.
The CCG is in communication with NHSE in order to agree either the transfer of
responsibility for the LES to NHSE or the budget back to the CCG. The final GP IT budget
arrived with a 25% ‘topslice’ retained by NHSE – PL is investigating and pursing the issue
with NHSE but the current service may be in danger of becoming unsustainable with the
loss of funding.
PL continued to update the Board on the progress of contract negotiations. Discussions
were proceeding well with ELFT, with the major outstanding issue being the high cost area
supplement which had been funded by City and Hackney on behalf of the other local areas
historically, but that now required splitting on a fair shares basis across CCGs.
PL informed the Board that the CCG Finance function was ready for the 1 April 2013, with
confirmation that the ledger system will be up and running. The NHSE system however
was delayed, which is expected to cause a backlog across the NHS system due to the
changes in responsibility.
Agenda Item 15 – CCG Authorisation
PH confirmed that there was no change in the progress of the CCG towards the 1 April
2013 ‘go live’ date and two remaining ‘red conditions’ remained in place.
Agenda Item 16 – Any Other Business
PL tabled a short paper detailing the CCGs banking arrangements from 1 April 2013, which
was accepted by the Board.
DECISION: Banking arrangements paper agreed by the Board.
AGREED BY:
AGREED ON:
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group
Register of Interests
Name
Date of
Declaration
CCG Position / Role
Nature of Business / Organisation
Nature of Interest / Comments
Dr Clare Highton
18/04/2013
CCG Chair and Long Term Conditions Clinical Lead GP
Lower Clapton Group Practice
Dr Clare Highton
18/04/2013
CCG Chair and Long Term Conditions Clinical Lead GP
Tavistock and Portman NHS Trust
Principal Partner at Lower Clapton Group Practice,
our practice now provides a CCG Commissioned
community ENT clinic run by my GP partner
Dominic Roberts with our local ENT consultant. The
practice also employs 3 Heart Failure nurses and
their HCA.
Lower Clapton is a research associate practice, so
does not hold grants but does participate in
research that is funded.
Rob Senior, the Medical Director at the Tavistock
and Portman NHS Trust is my husband.
Dr Haren Patel
16/04/2013
CCG Clinical Vice Chair, Clinical Executive Committee Chair
and Prescribing Clinical Lead GP
Latimer PMS Plus Practice
Senior Clinician and Management Lead for Project
and Intermediate/Secondary Mental Health Service
Provision. Interest in mental health services at the
Latimer PMS Plus Practice.
Dr Haren Patel
16/04/2013
Latimer PMS Plus Practice
Dr Haren Patel
16/04/2013
Dr Haren Patel
16/04/2013
CCG Clinical Vice Chair, Clinical Executive Committee Chair
and Prescribing Clinical Lead GP
CCG Clinical Vice Chair, Clinical Executive Committee Chair
and Prescribing Clinical Lead GP
CCG Clinical Vice Chair, Clinical Executive Committee Chair
and Prescribing Clinical Lead GP
Partner, Dr Geeta Patel clinician with special
interest.
Co-Chair of North East London Medicine
Management Committee
Member of the City and Hackney Local Medical
Committee (the representative body for GPs)
Dr Haren Patel
16/04/2013
CCG Clinical Vice Chair, Clinical Executive Committee Chair
and Prescribing Clinical Lead GP
Acorn Lodge Nursing Home
Lead Clinician providing NHS GMS and Enhanced
Services under Nursing Home LES to the Acorn
Lodge Nursing Home. Interest in intermediate care
and community services under PMS contract.
Dr Gary Marlowe
16/04/2013
CCG Board GP and Planned Care Clinical Lead GP
De Beauvoir Surgery
Partner at De Beauvoir Surgery of GMS services and
a provider of Locally Enhanced Services.
Dr Gary Marlowe
16/04/2013
CCG Board GP and Planned Care Clinical Lead GP
London-wide Medical Committee
Dr Gary Marlowe
16/04/2013
CCG Board GP and Planned Care Clinical Lead GP
British Medical Association
City and Hackney Representative at the Londonwide Medical Committee, the representative body
for London’s GPs.
London Regional Council Representative for the
British Medical Association (the major trades union
for medical practitioners) - regional representative,
representing doctors professional and working
interests.
North East London Medicine Management Committee
City and Hackney Local Medical Committee
Name
Date of
Declaration
CCG Position / Role
Nature of Business / Organisation
Nature of Interest / Comments
Christine Blanshard
N/A
CCG Board Consultant
Salisbury Hospital NHS Foundation Trust
Siobhan Clarke
N/A
CCG Board Registered Nurse
YOUR HEALTHCARE CIC
Medical Director at Salisbury Hospital NHS
Foundation Trust that does not hold any contracts
with the CCG.
MANAGING DIRECTOR OF YOUR HEALTHCARE CIC
WHICH HOLDS CONTRACTS FOR HEALTH AND
SOCIAL CARE IN KINGSTON AND RICHMOND.
Mariette Davis
16/04/2013
Governance Lay Member, Audit Committee Chair and
Remuneration Committee Chair
Acanthus Advisers Private Equity Limited
Acanthus Advisers Private Equity Limited, a
placement agency not operating in or with the NHS.
Mariette Davis
16/04/2013
Governance Lay Member, Audit Committee Chair and
Remuneration Committee Chair
Aletheia Partners LLP
Aletheia Partners LLP, a Private Equity advisory firm
not operating in or with the NHS.
Mariette Davis
16/04/2013
Jaime Bishop
16/04/2013
Governance Lay Member, Audit Committee Chair and
Tower Hamlets CCG
Remuneration Committee Chair
Public and Patient Involvement Lay Member and Public and Fleet Architects LTD
Patient Involvement Committee Chair
Lay Member for Governance for Tower Hamlets
CCG
Director of Fleet Architects LTD, a company working
on socially valuable buildings. We do not currently
have any involvement in the City and Hackney area.
50% shareholder in Fleet Architects.
Jaime Bishop
16/04/2013
Public and Patient Involvement Lay Member and Public and HealthPorts LTD
Patient Involvement Committee Chair
Fleet Architects own 33% of HealthPorts LTD, a (as
yet not trading at all) company established to
design accessible sustainable modern health
centres. Fleet provide design services. There are
currently no projects although in the course of
researching new projects HealthPorts has contact
both with the NHS, GPs and other health providers
outside of the City and Hackney Area.
Jaime Bishop
16/04/2013
Public and Patient Involvement Lay Member and Public and Architects for Health
Patient Involvement Committee Chair
Executive Committee Member and Head of
Education at Architects for Health, I run annual
Student Design Competitions in conjunction with
other healthcare stakeholders including NHS Trusts.
2011 and 2012 were in conjunction with Guys and
St Thomas NHS FT.
Jaime Bishop
16/04/2013
Public and Patient Involvement Lay Member and Public and Barretts Grove Practice
Patient Involvement Committee Chair
Patient as a Hackney General Practice, Barretts
Grove.
Name
Date of
Declaration
CCG Position / Role
Nature of Business / Organisation
Jaime Bishop
16/04/2013
Public and Patient Involvement Lay Member and Public and ELIC (East London Integrated Care) LTD
Patient Involvement Committee Chair
Honor Rhodes
Honor Rhodes
16/04/2013
16/04/2013
CCG Associate Lay Member
CCG Associate Lay Member
Barton House Practice
Tavistock Centre for Couple Relationships
Honor Rhodes
16/04/2013
CCG Associate Lay Member
Children and Family Courts Advisory and Support Service
(CAFCASS)
Honor Rhodes
Honor Rhodes
16/04/2013
16/04/2013
CCG Associate Lay Member
CCG Associate Lay Member
Early Intervention Foundation
The Institute of Wellbeing
Honor Rhodes
16/04/2013
CCG Associate Lay Member
Oxleas CAMHS
Paul Haigh
16/04/2013
CCG Chief Officer
ELIC (East London Integrated Care)
Paul Haigh
16/04/2013
CCG Chief Officer
NHS England
Philippa Lowe
16/04/2013
CCG Chief Financial Officer
GreenSquare Group
Philippa Lowe
16/04/2013
CCG Chief Financial Officer
PIQAS Ltd
Simon Currie
16/04/2013
CSU Director
IGC Consulting Limited
Nature of Interest / Comments
Member of the ELIC (East London Integrated Care)
LTD (a Practice Based Commissioning body) Audit
Committee that is overseeing the wind up of the
dormant social enterprise.
ELIC is now defunct save some final legal winding up
proceedings underway.
Patient at Barton House, Albion Rd Practice
Director of Strategy at the Tavistock Centre for
Couple Relationships.
Non Executive Director at Children and Family
Courts Advisory and Support Service (CAFCASS).
Trustee at the Early Intervention Foundation.
Mentor to CEO of The Institute of Wellbeing, a
voluntary agency who may seek to contract with
the NHS in future in South London.
Partner is a Consultant Family Therapist with Oxleas
CAMHS
Chief Executive of ELIC (East London Integrated
Care) (a Practice Based Commissioning body
registered as a social enterprise). The social
enterprise has now ceased trading and is being
wound up
Also member of ELIC’s Audit Committee that is
overseeing the wind up of the dormant social
enterprise.
Partner - Helen Bullers is Regional Director of HR
and Organisational Development (London), NHS
England.
Group Audit Committee Chair and Group
Development Committee member for GreenSquare
Group, a Group of Housing Associations. KPMG are
internal audit provider to the HA and external
auditors to the CCG. GSG hold many contracts with
public and private sector bodies.
Director of PIQAS Ltd, a Consultancy firm. Dormant
company from 1/4/13.
Managing Director of IGC Consulting Limited, a
private company that provides consultancy services
to the health sector.
Name
Date of
Declaration
CCG Position / Role
Nature of Business / Organisation
Nature of Interest / Comments
Emma Craig
N/A
London Borough of Hackney Healthwatch Representative
No return
No return
Dianne Barham
16/04/2013
London Borough of Hackney Healthwatch Representative
Urban Inclusion Community
Director of Urban Inclusion Community
Dianne Barham
16/04/2013
London Borough of Hackney Healthwatch Representative
Healthwatch Tower Hamlets
Dianne Barham
16/04/2013
London Borough of Hackney Healthwatch Representative
Lynn Strother
18/04/2013
City of London Healthwatch
ELFT
Tower Hamlets CCG
Hackney and the City PCT
Age UK London
The Greater London Forum for Older People
Chief Operating Officer of Healthwatch Tower
Hamlets
Undertaken research for ELFT, Tower Hamlets CCG,
Hackney and the City PCT.
The charities I am employed by – Age UK London
and The Greater London Forum for Older People
are funded by grants and donations.
Joint CCG response to Urological Cancer – why we need change
•
Board to note the following collective Waltham
Forest, East London and the City response to
the Urological Cancer consultation.
Tower Hamlets Clinical Commissioning Group
2nd Floor, Alderney Building
Mile End Hospital
Bancroft Road
London E1 4DG
Tel: 020 8121 4380
Kathy Pritchard-Jones
Programme Director for Cancer, UCL Partners
Chief Medical Officer, London Cancer
3rd floor, 170 Tottenham Court Road
London W1T 7HA
April 2013
Dear Kathy
Joint Response to: Urological cancer: why we need change
The WELC Clinical Commissioning Groups (Waltham Forest, City and Hackney, Newham and Tower
Hamlets) are fully supportive of the urological cancer case for change which has built a robust clinical
evidence base to ensure the best outcomes for patients.
All four CCGs recognise the importance of primary care in delivering cancer diagnosis and care
management and would welcome the opportunity to work closely to develop a seamless pathway for
urological cancers. In furtherance of this ambition we would also like to explore with you the potential
of new technologies and innovative solutions that limit the impact of and decrease lengthy,
unnecessary travel arrangements for patients and relatives, and help patients to stay in touch with
family members which can aide speedier recovery.
The WELC CCGs would like to take this opportunity to state how much they value the Barts Health
Renal Team. We look forward to fostering close working relationships with all hospitals in the sector
involved in the care of people with urological cancers, including the sharing of clinical expertise and
resources.
We would welcome the opportunity to be involved in any further consultation, engagement and the
forthcoming full equality impact assessment to analyse and mitigate any potential increase in health
inequalities and look forward to hearing from you in the near future.
Yours Sincerely
Chairs of Waltham Forest, Tower Hamlets, City and Hackney and Newham CCGs
cc.
Dr Andy Mitchell
Sue McLellen
Regional Medical Director, NHS England (London Region)
Head of Specialised Commissioning, NHS England (London Region)
Peter Morris
Stephen O’Brien
Dr Caz Sayer
Dr Gillian Greenhough
Dr Alpesh Patel
Dr Sue Sumners
Dr Helen Pelendrides
Richard Murley
Dominic Dodd
Andrew Ridley
Alwen Williams
Chief Executive, Barts Health NHS Trust
Chair Barts Health NHS Trust
Chair Camden CCG
Chair Islington CCG
Chair Enfield CCG
Chair Barnet CCG
Chair Haringey CCG
Chairman, University College Hospitals NHS Foundation Trust
Chairman, Royal Free London NHS Foundation Trust
Managing Director, NHS North and East London Commissioning Support
Unit
Director of Delivery & Development (London), NHS Trust Development
Authority
London Cancer
170 Tottenham Court Road
London W1T 7HA
Tel: 0203 108 6393
Web: www.londoncancer.org
Chairs of Waltham Forest, Tower Hamlets, City and Hackney and Newham CCGs
c/o Tower Hamlets Clinical Commissioning Group
2nd Floor, Alderney Building
Mile End Hospital
Bancroft Road
London E1 4DG
Sent via Email
12 April 2013
Dear Colleagues,
Thank you for your letter in response to London Cancer’s proposals to improve the care of patients with
urological cancers. It is very encouraging to hear that you are supportive of our ambitions, and that you
welcome the opportunity to work closely with our clinicians to improve the care pathway.
Our colleagues in the North and East London Commissioning Support Unit are developing an engagement
report that will include all the feedback received so far, as well as feedback from the ongoing
engagement activities that are taking place during April. The report should be available to share with
NHS England in early May, together with an equality impact assessment, and we anticipate that NHS
England would be in a position to make decisions from May. The engagement report and equality impact
assessment will also be shared with the CCGs and made publicly available.
Your involvement in the process to further develop our proposals and implementation plans is critical,
and we would very much value your input and your expertise. If a decision is made by NHS England to
proceed with our plans, we will invite you to participate in the discussions with our providers (including
the local diagnostic and treatment centres and the specialist surgical centres) throughout the
accreditation process. As part of this, we are keen to consider all options for new, innovative ways of
working that will promote earlier and more efficient diagnosis, reduce variation in access to best practice
and clinical trials and enhance the experience for our patients and their relatives. We look forward to
welcoming you to our discussions and hearing your views in the near future.
Please do feel free to contact me if you would like to discuss anything further in the meantime.
Yours sincerely,
Professor Kathy Pritchard-Jones
Chief Medical Officer
QUALITY IN MENTAL HEALTH
SERVICES
•
•
•
1
Following discussion at the last Board meeting, the
CCG sent the attached letter to East London
Foundation Trust (ELFT) seeking further information
and assurance;
Robert Dolan, Chief Executive and Dr Kevin Cleary,
Medical Director from ELFT will be attending the
Board meeting to provide the Trust response;
The original report and action plan considered at the
March 2013 CCG Board meeting is available at
http://www.elic.org.uk/uploads/City/An%20independ
ent%20investigation%20into%20the%20care%20an
d%20treatment%20of%20service%20user%20Mr%2
0C%20and%20Mr%20E.pdf.
To Robert Dolan, Chief Executive,
East London Foundation Trust
Dr Kevin Cleary, Medical Director,
East London Foundation Trust
Second Floor, The Lawson Practice
Nuttall Street
London
N1 5HZ
Tel: 020 7683 4192
Email: [email protected]
Thursday, 28 March 2013
Dear Robert and Kevin,
Serious incident KU/PD
The Clinical Commissioning Group (CCG) Board reviewed the action plan produced by
East London Foundation Trust (ELFT) in response to the above at our meeting on Friday,
22 March 2013.
To receive further assurance from the Trust about the safety of the services we commission
and the lessons for the Trust from this incident, we would like to invite you to our next Board
meeting on Friday, 26 April 2013, in a slot lasting approximately 15 minutes between 14151615.
For that meeting:
• We would like to receive the updated action plan to the attached and given that all
actions should have been completed by then, we would like you to outline what are
the findings of each action, what have you put in place and how are you assured of
the impact;
• We are concerned about the potential impact on patient care of staffing levels and
practices highlighted in the report. How can you assure us that the issues raised in
relation to handover and observation practice have now been addressed and what
checks are in place to monitor this? It will be helpful to see through your monitoring
process of how the action plan is going to be implemented, the outcome of any local
clinical audit activity relating to the following areas:
o Patient observations;
o Transfer of patient information checklist implementation;
o Pilot of the function team model.
• In relation to addressing the concern the independent homicide inquiry panel picked
up relating to mixed sex accommodation on Roman Ward at Mile End Hospital, it
would be helpful to know why you have decided to pilot implementing single sex
accommodation in City and Hackney as opposed to Tower Hamlets in the first
instance?
• We note the actions you are taking with the Trust’s Human Resources Department
with reviewing the job descriptions and outline for the Matron and Practice Innovation
Nurse (PIN) roles. We are keen to hear how you intend to inform junior nursing staff
on the escalation process they should use in light of the proposed plan for
developing distinct role job descriptions and functions? In your action plan response
to recommendation eight, you have outlined plans for implementing an Objective
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
•
•
Structured Clinical Examination (OSCE) framework for ward staff and we note the
Director of Nursing plans to lead a discussion on this recommendation at the April
2013 Quality Committee. It will be helpful to receive feedback from discussions held
and plans for Trust wide implementation of this framework going forward;
We would also like to know your policy for how front line staff report unsafe levels,
how any such concerns are addressed by the Trust and details of any alerts by staff
over the last six months and what action was taken both at the time and
systemically. We would like these details in the context of further details about your
staff survey results, your overall whistleblowing policy and the number of cases you
have had under this policy and the key lessons. We are keen to see trends over the
last three years;
We would also like to receive the following in advance of the meeting - reflecting the
situation both at the time of the incident and again in March 2013:
o The staffing establishment – working time equivalent (WTE) by grade on each
in-patient ward across the 24/7 period and the staff patient ratio;
o The staff in post, sickness, turnover, and vacancy rates and how these
benchmark then and now against other mental health providers and best
practice.
We are also keen to know:
• How these staffing levels are monitored on an operational basis?
• How the Trust senior managers and Board monitor staffing levels and overall
workforce information to ensure that the staffing levels are not impacting on patient
quality and safety?
• What actions are put in place to avoid damaging patient safety if staffing levels fall?
We look forward to the meeting.
Yours sincerely,
Dr Clare Highton
Chair
NHS City and Hackney Clinical Commissioning Group
CC Paul Haigh, Sue Tokley. Simon Cole, David Maher, Dr Rhiannon England, Dr Sam
Everington and Jane Milligan
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
Out of Hours
UPDATE TO CCG BOARD
For information and for decision
26 APRIL 2013
CONTEXT
Attached is a suite of papers for board decision;
•
Proposed contract management arrangements for the OOH
contract inherited by the CCG
•
Proposed process for the procurement of a new OOH provider
•
The latter paper is being discussed by the City and Hackney
Audit Committee on 22 April to provide the Board with
assurance on compliance with legislation and conflicts of
interest. The CCG has also asked for its own legal advice on
the proposal. This plus the outcome of the Audit Committee will
be available at the Board meeting
•
The National Quality Requirements in the Delivery of Out-ofHours Services is available at
http://www.elic.org.uk/uploads/City/National%20Quality%20Re
quirements%202006.pdf.
DECISIONS
The Board is asked to;
•
Agree the proposed contract monitoring arrangements
and the establishment and membership of the Out of
Hours Quality and Service Performance Group
•
Note that contract monitoring info will be available for the
Board as part of the suite of reports produced by CSU
•
Agree the process and timescale for the procurement of
a new Out of Hours provider
•
Agree to the establishment of the Out of Hours Steering
Group and the Out of Hours Evaluation Panel to manage
this process
•
Note that the Audit Committee will be asked to provide
the Board with assurance on the evaluation process and
that the CCG will obtain legal advice on this as well
Developing a contract management approach
for the Out-of-Hours primary care service in City
and Hackney
Ryan Ocampo 16.04.13
Contents
Background and context
Contract monitoring the existing picture
Contract monitoring what will be different
Contract monitoring engagement and briefing
Progress and next steps
Background and Context
City and Hackney CCG has responsibility for commissioning out-of-hours primary
care services in the City and Hackney locality
The CCG has inherited an existing contract from the legacy PCT cluster
The CCG is seeking assurances from the CSU that the contract monitoring
arrangements are:
• robust,
• focused on clinical quality outcomes,
• able to highlight, mitigate and escalate potential risk, and
• able to facilitate a process whereby GPs can express concerns about individual
case and that these are captured and followed up
Contract Monitoring – what will be different?
The existing contract enables the CCG to seek assurances from the provider around the recommended priority areas and to
amend the contract monitoring framework in order to give assurances sought by the CCG. A proposed framework for
achieving this is set out as follows:
Immediate reporting
We would expect to implement a no surprises standard way of working where the provider reports anything to the
commissioner that is considered as a serious incident or to report potential serious incidents before they occur this could be
along the lines of
•
Significant staff shortfall that may affect performance
•
Potential for closing a face-to-face centre as a result of staff shortfall
•
Any Serious Untoward Incident (or possible)
•
Details of each contact and the care provided to every patient that is known to have died after an initial call to the OOH
service
•
Any complaint suggesting significant harm or failure
•
Any potential professional/financial/legal/patient care issue
Weekly reports
•
Performance against national quality requirements
•
Rota fill – including explanation and escalation of risks for any unfilled rotas
•
Performance concerns/trends/changes made or planned
•
Review of GP feedback with the provider and any other clinical concerns
Contract Monitoring – what will be different?
(continued)
Monthly reports and reviews - Chaired by the CCG
•
Review of standards and action plans and recovery trajectory for below par performance
•
Recommend breach audits if performance slips,
•
Patient perceptions (GPPS and own findings)
•
Use of local GP feedback to inform areas of interest at the monthly meetings
•
Audit of outcomes/dispositions, numbers referred, trends
•
Staff effectiveness
•
Opportunities for integration and improved care – Hospitals, community services, GP practices (also winter/pressure
surge planning)
•
Analysis of comparative performance from benchmark
•
Future direction (and formal review/feed-back) – commissioner to lead
•
Review of urgent GP feedback and clinical concerns will be picked up should a clinically led meeting not fall within the
cycle of the meeting
Quarterly Clinical Quality Review Meetings - Chaired by CCG clinical lead and supported by CSU quality team,
looking specifically at:
•
outcomes/dispositions/number referred/trends
•
outstanding breaches and effect on quality
•
feedback from GPs
•
significant incidents
•
complaints
•
feedback from audits
•
Providers own staff surveys
•
Patient feedback – a proposal for patient involvement is being taken to the PPI subcommittee on 27 April
with a recommendation to have a PPI member and patient representative attend the quarterly review meetings
Contract Monitoring – engagement and briefing
The CSU recommends that the performance data of the out-of-hours service is reported alongside
other contracts in the monthly finance and activity report and that committees as outlined below are
provided with an out-of-hours summary in order to maintain the visibility and grip on this contract
Finance and
Performance
Subcommittee
Other
contracts eg,
LAS
Urgent Care
Board
Out of Hours
Performance
CCG Board
(issues to be
escalated to
the board as
appropriate)
Links and
Health and
Wellbeing
Board
Patient and
Public
Involvement
subcommittee
Progress and next steps
•
An initial meeting with the provider, the CSU and the CCG has been set-up for 24 April 2013, this will
be the first of the monthly monitoring meetings
•
Haren Patel and Kirtsen Brown have been nominated to jointly Chair the monthly quality and
performance meetings
•
The CSU has requested the provider’s escalation policy and will conduct a review of its fitness for
purpose and robustness
•
The CSU quality team have been engaged in developing the monitoring review process and will
support the review of the provider’s quality measures, including:
– Patient safety, experience and effectiveness
– How the provider manages its safety alerts
– Mortality rates
– Governance of processes
– Trends around incidents and complaints
– Compliance with CQC and NICE guidance
– Review of annual plan of clinical audits
– Staff training and staff surveys
Progress and next steps (continued)
•
The CQC visited the provider on Monday 11th and Tuesday 12th March as part of a scheduled visit, the
report is currently with the provider, who have 14 days to respond. The CSU will update the CCG
through the Board and Urgent care programme board as soon as the report is released.
•
An initial process for formally capturing GP feedback where there are any clinical or patient safety
concerns is being developed. Our aspiration is to act on both GP and patient feedback, whether this is
provided in through formal reporting or acquired through soft intelligence, such a process would include
but not be limited to:
– proactive sampling – taking a random set of sample dispositions to assess the quality of the care
pathway recommended
– Reactive GP and patient concerns raised – acting upon anecdotal feedback as well as formal data
to ensure all intelligence is taken seriously and acted upon , through both monthly contract
monitoring and weekly updates with the provider
– Review of identified breaches through the monthly contract monitoring meetings
– Practices will be able to highlight concerns and we will put something on the website allowing
patients to feedback similar to the 111 form.
•
A governance process to enable us to achieve these aims will need to be developed to protect patient
confidentiality and adhere to information governance requirements
Out-of hours primary care service in City and Hackney
Clinical quality and service and performance review
Draft Terms of Reference v1
Introduction
The clinical quality and service performance review meeting is a monthly forum between
City and Hackney CCG, supported by NHS NELC Commissioning Support Services,
and the out-of-hours primary care service provider, Harmoni. The meeting is designed to
facilitate a collaborative approach to providing the best possible care for the patients
and users of out-of-hours primary care, focusing on patient safety and the clinical quality
of services whilst improving performance, and ensuring value for money.
Objectives
To undertake a monthly review of services and performance as set out in terms and
conditions of Appendix 1, the contract to provide an out-of-hours primary care service.
To monitor the contract and to review any matters considered necessary, including
without limitation:
o the activity plan;
o the annual contract values;
o the schedules;
o the performance of the provider, including any warning points issued
o performance of the provider against the national quality requirements and
to recommend where applicable clinical audits where quality requirements
are not met
The definition of quality
For the purpose of quality assurance the proposed approach is to use the definition first
set out by Lord Darzi in his report “High Quality Care for All” 2010.
This definition sets our three dimensions to quality, all three of which must be present in
order to provide a high quality service:
 Clinical effectiveness – quality care is care which is delivered according to the
best evidence as to what is clinically effective in improving an individual’s health
outcomes;

Safety – quality care is care which is delivered so as to avoid all avoidable harm
and risks to the individual’s safety; and

Patient experience – quality care is care which looks to give the individual as
positive an experience of receiving and recovering from the care as possible,
including being treated according to what that individual wants of needs and with
compassion, dignity and respect.
Accountability and reporting
The clinical quality and service performance group will report to the CCG’s urgent care
programme board and escalate any immediate concerns to the urgent care board chair
and nominated GP lead in City and Hackney CCG. The CCG board will be apprised of
any urgent or important matters as appropriate.
Roles and responsibilities
The clinical quality and service performance review group will be responsible for:

Providing assurance to the CCG regarding the delivery of by Harmoni as set out
in schedules 1 and 2 of the out-of-hours contract.

Reviewing the quality indicators found in schedule 2 and where applicable agree
any recommendations or actions required arising from this review.

For ensuring that all contractual requirements relating to clinical care, quality and
outcomes are met by scrutinising, and monitoring the data provided in the
monthly performance reports

Providing a forum for a broader review of quality and safety issues and allow
triangulation of information.

Providing the contractual forum where all clinical quality matters between
Harmoni and City and Hackney CCG can be formally addressed. This will include
reviewing escalated events including serious incidents, exceptions to
performance and commissioning ad hoc audits, as and when necessary.

Receiving reports and agreeing recommendations or actions from any
unannounced quality assurance visits undertaken by commissioners.

Agree an annual work plan using clinical audits or other appropriate
benchmarking tools to review identified provider services

Assess complaints and incidents that have a bearing on delivery of clinical
services and where appropriate make recommendations for how these
complaints and incidents are addressed

Monitor and assess patient experience reports and make recommendations as
appropriate

Monitor and assess the training of clinical staff employed by the ouf of hours
service provider

Assess relevant policies and procedures in relation to the delivery of services and
ensuring staff are aware of and are capable of implementing relevant policies

To provide a forum for GP concerns around patient safety to be formally
registered and to make appropriate recommendations to address any risks

Monitor the filling of weekly rotas and ensure that any unfilled slots do not present
clinical risks to patients

Monitor the projection of anticipated activity and ensure that appropriate capacity
is given to address patient demand
Membership:
Name
Organisation/Job title
Role on the monthly
review group
Dr. Haren Patel
City and Hackney CCG
Vice Chair
Co-Chair of the monthly
review group
Dr. Kirsten Brown
City and Hackney CCG
Chair of the Urgent Care
Programme Board
Co-Chair of the monthly
review group
Karl Thompson
City and Hackney CCG –
Urgent Care Programme
Board lead
Provide managerial steer to
group and feedback issues
to the appropriate forums
within the CCG
Ryan Ocampo
Senior Contracts Manager
– NEL CSU
Performance and Contract
Manage the out-of-hours
service
Jenny Singleton/Jenny
Goodridge
Quality leads
Provide quality steer and
input to the out-of-hours
service
Laura ORiordan
Harmoni Contract Manager
Provide information and
data on monthly
performance of Harmoni’s
service
Dr. Bobby Nicholas
Harmoni clinical lead
Provide clinical steer to
Harmoni’s performance
matters
Eileen Lock
Harmoni, Regional Director
Provide Director input to
monthly contract meetings
Frequency of meetings
The group will meet monthly in the third week of each month (reviewed periodically).
Quorum
1 x CCG representative
1 x CSU contract manager
1 x Out-of-hours contract manager
1 x out-of-hours clinical lead
Monthly Timeline –
1st week – data/reports received
2nd week – CSU internal review of data and propose outline agenda for meeting
2nd week – CSU provide briefing to CCG clinical and programme director lead and seek
approval of agenda items
3rd week – meeting to be held
4th week actions to be distributed
Appendix 1
Existing out of hours contract
Appendix 2
National quality requirements for delivering an out of hours primary care service
CSU OOH Procurement
Process and Decision Making for
Out of Hours Procurement
City and Hackney CCG
Decisions required from the CCG Board
1.
2.
3.
4.
5.
Agree the formation of the Steering Group to support the procurement
process;
Agree the decision making process to initiate and progress the procurement
process;
Agree the Engagement Plan;
Agree the indicative timetable for implementation;
Note the Risks attributed to the process.
The Audit Committee is asked to
• Review the process recommended in this document by CSU
• Provide assurance to the CCG Board that the recommended process is
robust
Equality Impact Assessment
The Equality Impact Assessment will be drafted in conjunction with the local
authority who support this part of the process and it will be will be available at the
same time as the Business Plan for consideration (May 2013).
Content
1.
2.
3.
4.
Background to the contractual arrangements.
What the CSU will provide.
What the expected outputs will be from the CSU?
How the process will work and where the key decisions will be made?
5.
What are the terms of reference for the Out of Hours Steering Group - to aid
understand their role, accountability and scope.
6.
What are the terms of reference for the Evaluation Panel - to understand
their role, accountability and possible constraints?
7.
8.
Outline engagement process and timetable.
Initial Risk Register.
Appendix A: Ghant chart outlining the timetable and activity that needs to
take place.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
Introduction
1. Background
1.1 City and Hackney PCT entered into a consortium arrangement with Camden,
Islington and Haringey to jointly commission out of hours (OOH) care for all
four organisations.
The successful bidder was a GP out of Hours
organisation called CAMIDOC. Unfortunately CAMIDOC experienced severe
financial difficulties in 2010 and were unable to mobilise the new contract
(they were the out of hours provider at the time). An organisation called
Harmoni was awarded a temporary contract to allow time for a new
procurement process to take place. This type of award is allowed as a short
term measure, to secure the service, in the absence of CAMIDOC. However
under procurement rules there must be a fair and transparent procurement
process following this to allow all interested providers to compete for the
contract.
1.2 Following this all of the individual PCTs reviewed their out of hours
arrangements. The development of shadow CCG and opportunity to develop
greater integration of unscheduled care for individual boroughs became a
transformational opportunity. Haringey signalled a wish to develop a more
integrated model with the North Middlesex Hospital and to make better links
with both Enfield and Barnet, where there were mutual resources used by
Haringey residents. Camden and Islington made the decision to reshape
their out of hours service and to pilot the delivery of the majority of face to
face consultations from their Urgent Care Centres, using primary care GPs
already based in those facilities. They hope to link this to a major reprocurement of unscheduled care, including 111 Services in late 2014. City
and Hackney indicated a desire for their GPs to opt back into providing out of
hours services via a GP social enterprise organisation called HUHSE.
1.3 In August 2012 Camden and Islington concluded a procurement of a discreet
home visiting service, with a small amount of face to face consultations (for
when the Urgent Care Centres (UCC) were closed). Haringey participated in
a traditional OOH procurement with Barnet and Enfield and awarded this to
Barndoc. This commenced on April 1, 2013. City and Hackney separately
developed a model of care where local GPs, who previously opted out of
offering this service, would opt back in and then delegate this to HUHSE.
Harmoni were advised that the contract would end for all four PCTs on 1
April 2013. Haringey then gave notice to withdraw formally from the
consortium agreement. Camden and Islington developed a new consortium
agreement to support their partnership arrangements moving forward. They
also negotiated a three month extension to the existing contract to allow time
to implement the delivery of a pilot of face to face consultations at local
UCCs. Haringey raised no objection to the consortium dissolving as they
had advanced plans for their GP Social Enterprise Organisation taking over
on the 1 April 2013.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
1.4 Unfortunately very late in the process, when seeking final ratification for their
plans, NHS NELC Cluster PCT refused the request by GP practices to vary
their core GMS etc contracts, allowing them to opt back in and take personal
responsibility for the provision of ooh care. As a consequence of this,
individual GPs could not delegate these responsibilities to a third party. This
had a major impact on City and Hackney’s plans.
1.5 To secure the continuation of the OOH service the NELC Board agreed to a
six to twelve month extension of the current contract. Harmoni in response
only agreed to extend the current contract by six months, up to the end of
September 2013 to allow time for a procurement of out of hours services to
commence.
It is acknowledge that a procurement process takes
approximately nine months as a minimum so this narrow extension builds in
some additional tensions later in the process. There is a formal Letter of
Understanding between the City and Hackney PCT and Harmoni to support
this action. The contract novated to City and Hackney CCG on the 1 April
2013.
1.6 City and Hackney CCG has approached the CSU and requested that they
support them with the procurement of a new out of hours primary care
service for City and Hackney. However while this process is starting City
and Hackney CCG will complete an options appraisal in parallel with this
process to establish finally, whether there is any scope to re-introduce the
“opted in” option for the majority of individual GPs in City and Hackney. Our
advice is that this process should be concluded by the time City and
Hackney CCG Board give permission to proceed with the procurement of out
of hours services. The reason for this is to avoid a risk of bidders bringing a
claim at a later date for costs for preparing their bids, if the CCG were still
considering other options.
2.
What the CSU will provide?
2.1 Procurement Expertise

Full procurement service including administration and all procurement
documentation and framework for delivery of the process.

Expert procurement advice and development of tools to evaluate the process
compliant with procurement rules;

Legal advice as appropriately linked to the procurement of an out-of-hours
primary care service provider;

Dedicated project manager time to run the procurement process and oversee
the development of a service specification as well as supporting the process
for final decision making and awarding of the contract;

External resource with out of hours procurement experience to support the
management of this procurement project.

Specialist procurement tools related to the pre-qualification questionnaire
and other preliminary stages in the procurement, e.g. PQQ and Invitation to
Tender framework;
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4



Financial evaluation both in terms of the business plan, assessment of
fitness of individual organisations and financial evaluation of the individual
bids and contribution to the assurance process for the CCG.
Communication and engagement support
Mobilisation of the contract.
3.
What are the expected outputs from the CSU?



Business Case;
Finalised service specification that meets with contractual requirements;
Online computerised procurement tools that are fully compliant with
procurement requirements and assessable to members of the Evaluation
Panel;
Development of the assessment and evaluation tools in conjunction with a
clinical subgroup and patient involvement;
Financial evaluation of the fitness of the bidding organisations plus
evaluation of the bids.
Out of Hours contract plus all the individual Schedules related to this;
All materials and outputs relating to an efficient and robust procurement
exercise, this will include:
o Organising of provider events;
o Liaison with providers to clarify the brief and service specification, ITT
and PQQ ;
o Briefing and associated paperwork to inform CCG decision making;
o Briefing and associated paperwork to support stakeholder;
communications, for example, with local authority overview and scrutiny
boards, health and wellbeing boards;
o The development of a service specification in conjunction with Primary
Care Foundation which is robust fit for purpose, clinically driven and
offers value for money;
Preparing reports for key stakeholders i.e. Audit Committee, CCG Board, LB
Hackney Overview and Scrutiny Committee, Hackney Health and Wellbeing
Board, if required.
Final report to CCG Board describing the full assurance process related to
the procurement with recommendations regarding the award of the contract.






Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
4.
How will the Procurement Process work?
Key:
4.1
Denotes final approval process for key decision
Denotes Recommendation for approval of proposal
Process map 1: Pre Advertisement of Procurement process
CSU requested to lead on the
procurement process on
behalf of the CCG.
CSU to support clinical sub group
to prepare evaluation tools
(quality + patient experience) plus
provider presentation topics.
CSU to supply financial evaluation
tools.
CSU prepares all contract
documentation and will lead on
the completion of the evaluation
tools. They will complete the
Business Case and finalise
specification and share with
Steering Group.
Audit Committee recommends
the business case and
specification to the CCG Board
for approval and seeks
agreement to proceed with
formal procurement.
The CSU will present decision
making and procurement
process to Audit Committee for
scrutiny.
Audit Comm. recommends
procurement and decision
making process to CCG
Board.
CSU presents Business Case and
evaluation tools Specification to
Audit Committee as part of their
assurance process.
City and Hackney CCG Board
approves the Business Case
and specification and gives
permission to proceed to
procurement.
CSU commences formal
Procurement process.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
4.2
Open Procurement Process
Process Map 2
Publish Supply2health
Contract notice and Open
Tender ITT on e-procurement
site. + receive expressions of
Evaluation Panel meet to discuss process
and expectations.
Tender submission
deadline (received on
Pro-contract)
Bidders event
Procurement removes the
seal and verifies the
submissions.
Part A (Pass or
Fail) Evaluation
Part B Moderation
Meeting (if Required).
Moderates where
there are 2 or more
points difference in
scoring
Panel members completes
assessment and score
Part A Moderation
Meeting (if required).
Moderates split decisions
Presentation
/
interview of all
shortlisted
bidders
online
Part B Evaluation of
bidders who passed
Part A
Collation of all
scores and selection
of a preferred
bidder plus reserve
bidder.
Award approved by
CCG Board
Inform successful +
unsuccessful
bidders
Commence 10 day
Standstill period
Award Contract /
Contract Signing
Publish Contract
Award Notice in
Supply2health
Debrief bidders if
requested
Mobilisation and
service
commencement
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
5. What are the Out of Hours Steering Group Terms of Reference?
City and Hackney Out of Hours Steering Group
Terms of Reference
Accountability
The Out of Hours (OOH) Steering Group will be a time-limited group to secure
OOH services for City and Hackney. It is accountable to City and Hackney CCG
Board.
The Steering Group will have delegated authority from the CCG Board to set up
the procurement process in line with EU procurement requirements. The
expectation is that they will employ standardised methodology and documentation
to achieve this, thus avoiding the risk of legal challenge and ensuring that the
process complies with both procurement rules and NHS Guidance relating to the
management of conflict of interest (March 2013). They will be responsible for
preparing the Business Case, Procurement Assessment Tools, Service
Specification and Public and Patient Engagement in relation to this process. They
will report to the Audit Committee on aspects of assurance and the CCG Board for
decision making.
Overview & Purpose of the Steering Group










To ensure that the CCG commissions a high quality out of hours service for
City and Hackney patients in line with best practice;
To ensure that the process and service is commissioned in accordance with
the CCG constitution;
Clarify and secure the most appropriate contractual arrangements for OOH
services.
Develop the assessment tools to ensure a robust evaluation process.
Take account of the impact of the new 111 service and reflect this in the
service specification and contract.
Incorporate the views of patients and other key stakeholders in the
development of the service specification.
Take account of the impact of the City and Hackney Health Joint Strategic
Needs Assessment and reflect this in the service specification.
Understand the different planning cycles and aspirations of all interested
parties and achieve as much synergy as possible, across the CCG and CSU to
avoid duplication of effort and to maximise financial efficiencies.
Achieve Value for Money in the procurement process.
Support the mobilisation process of the new contract so there is a seamless
transition between different providers.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
Activities for this Group














Develop the OOH service specification and consult patients, stakeholders and
clinicians incorporating their views prior to presenting this to the CCG Board for
approval;
Develop a business case to support the procurement process setting out the
affordability and value for money aspects and any known risks to the CCG.
Present this to CCG Board for approval;
Undertake activities mindful of potential conflicts of interest and ensure robust
governance arrangements are in place to address this.
Develop and approve the communications plan for OOH procurement;
Be responsible for strengthening stakeholder involvement, including patient
and public involvement;
Develop the evaluation tools, including the clinical tools with the support of a
clinical sub group who will primarily be GPs. (This process will develop the
questions that bidders will be asked to assess their clinical competence, quality
and robustness of provision they will provide (staffing levels, training provided,
assessment of individual GP practitioners competency, communication with
local GPs, governance arrangements, and scenario responses to see how they
would manage risk, escalation plans, complaints etc.).
Similarly work with patient representative to develop assessment tools to
address patient experience, responsiveness of the organisation, dignity, choice
and control etc.
Fitness of the organisation tools are standardised as pass or fail. However
Legal advice will be sought about potentially failing companies who do not pay
tax in Great Britain but deliver services in Britain, to see if this can be legally
applied as part of the process
Agree the contractual terms of the contract;
Ensure that the OOH project contributes to fit the strategic priorities of City and
Hackney CCG as well as the NHS outcomes framework. The CCG’s strategic
aims are:
· Improve the equality of health care for Hackney & City of London residents;
· Ensure our health care system is affordable of high quality & improves
patient experience;
· Work with our partner commissioners & our Health & Wellbeing Boards to
reduce health inequalities & improve outcomes for local people;
· Develop integrated out of hospital services to mitigate the increasing cost of
hospital based unscheduled care;
· Reduce the early death rates from Cardiovascular & Respiratory Diseases.
Ensure that OOH services are considered within the context of whole system
unscheduled care to avoid duplication of effort, maximise efficiencies and
ensure a seamless service to patients.
Ensure that all plans are developed in consultation with relevant stakeholders
including the LMC and other professional bodies.
Prepare the contractual terms of the contract.
Keep the CCG Board updated on progress.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4



Be responsible for delivering quality assurance and risk management for the
programme.
Ensure that the process meets procurement rules and EU procurement
requirements.
Deliver on the efficiency targets determined for this project.
Core Principles for Service Design












The service developed should be equitable in terms of access and quality of
provision, regardless of where it is provided and positively promoting inclusion
of vulnerable or disadvantaged groups of patients.
The service developed should be evidence-based and meet all the national
quality and clinical governance requirements including but not limited to NICE,
Care Quality Commission, National Service Frameworks and agreed local care
pathways.
Patient access should be as simple and straightforward as possible.
There should be sufficient capacity within the service to deal with peaks in
demand and seasonal changes.
The service should be patient focused and have systems in place to involve
patients in their own care and to feedback on the service received.
Treat patients in local settings, unless clinical need requires alternative
arrangements.
The model(s) of service developed must demonstrate value for money, be
sustainable and be cost effective.
Ensure service supports reductions in acute activity;
Ensure service meets the diverse needs of the populations of both London
Borough of Hackney and Corporation of the City of London and decreases
inequalities
Service commands local clinical and patient confidence
Service seeks to manage patient demand and works as a partner alongside
core primary care and other commissioned services with integrated pathways
and clinical protocols and approach to clinical risk ;
Need to be of high quality and work in partnership with its staff, local patients
and partners to constantly assess and measure the quality of what it is doing.
Membership










Dr. Haren Patel (Chair) Vice Chair CCG
Karl Thompson Programme Director Clinical Commissioning Group
Dr Kirsten Brown, Clinical Lead for Unscheduled Care
Eilis Kilfeather, Programme Manager (NELCSU)
Ryan Ocampo Project Manager (NELCSU)
Shaju Jose, Procurement Manger (NELCSU)
Adam Shields Lead Finance Support (NELCSU)
Shaju Jose, CSU Procurement Manager
Finance representative from CCG
Representative from Public and Patient involvement
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4

CSU Quality Manager to input on documentation.
Frequency of Meetings
Meetings will take place weekly up to the point the CCG Board approves the
Business Case and agrees the service specification. This is anticipated to be the
end of May 2013. There after the Steering Group will stand down for a period of
three months to allow the procurement process to take place but can be
reconvened at any point to support this process. Once this procurement is
completed and the CCG will award the contract and the Steering Group will
reconvene bi-weekly to facilitate the mobilisation of the contract.
Quorum of Group
For this Project Board to be quorate the following should be present:


One Representative of the CCG
One Representative from CSU who are responsible for delivering the
procurement process.
Compliance
The Steering Group is monitored by the CCG Board which meets monthly.
Mobilisation
The Steering Group will reconvene to support the mobilisation process and report
progress back to the Urgent Care Programme Board. CCG commissioning staff
and CSU staff will work collaboratively during this period to ensure a positive and
timely conclusion to the introduction of the new contract. Lead role will be agreed
within the Steering Group to support this process.
Date:
Reviewed:
Next review:
23 April 2013
24 June 2012
Not applicable: This Group is expected to disband by February
2014.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
6.
What are the Out of Hours Evaluation Panel Terms of Reference?
Out of Hours Evaluation Panel
Terms of Reference
Accountability and Governance
The Out of Hours (OOH) Evaluation Panel will be a time-limited group to evaluate
the bids submitted for the OOH services for City and Hackney. Members of the
group will be selected on the basis of their clinical expertise, commissioning
knowledge, HR, IT, Estates, financial expertise and patient experience. They will
be asked to declare any conflict of interest to ensure that they are able to assess
the bids in an impartial and transparent manner. They will be asked to make a
commitment to maintain a code of strict confidentiality to support the transparency
and probity of the process.
The Evaluation Panel are not at liberty to take account of any information relating
to the providers, either written, orally or through other media channels, other than
that formally presented as evidence by individual providers, as part of the
tendering process. Any other information gleaned from personal experience, or
other sources, cannot be considered as part of the tender evaluation, thus
ensuring there is an even handed, transparent and non discriminatory practices
employed.
The Evaluation Panel will report their recommendations directly to the City and
Hackney CCG Board, who will in turn ratify the recommendation of the Panel and
confirm the award of the contract.
Overview & Purpose of the Evaluation Panel




Complete the evaluation process on time and to agreed standards of
procurement.
Evaluate the written and oral submissions and attribute scores and rationale
for scores for each provider. Each member will individually submit them online
as part of the tendering process.
Each of the Panel members will have particular roles to play in the evaluation
process. For example patients will be asked to assess areas concerning
patient experience such as choice, dignity, clinical engagement etc., but will
not be expected to assess issues related to clinical competence or financial
sustainability. All of the panel members scores relating to quality, finance and
provider presentation will be combined together to determine the overall
winner.
The Panel is tasked to make a recommendation to the City and Hackney CCG
Board when the full evaluation is completed and a provider identified as the
winner.
Activities for this Group
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4






Individual members will be expected to participate fully in the process and to
adhere to the governance requirements and evaluation timetable.
Panel members will agree the evaluation tools at the start of the process and
confirm the weighting that will be attributed to Quality, Finance and the
Provider presentation.
Panel members will need to independently complete the scoring online and to
an agreed timetable.
Panel members will need to comment on the scores they have attributed to aid
the moderation process and ensure transparency. The notes will be used to
provide feedback to unsuccessful candidates and minimised the risk of
challenge.
Individual members will attend two separate moderation meetings, to reflect
the different stages of the process and discuss scores where there is a
significant variance observed, in the overall scoring.
Panel members will agree which provider is the winner and make a
recommendation to the City and Hackney CCG Board.
Core Principles




The evaluation process will be carried out in a fair and transparent way.
There will be equality of treatment for each of the providers and all providers
will be treated in a non discriminatory way.
The whole evaluation process will be confidential and members of the Panel
will not be at liberty to discuss, or disclose, any aspect of the evaluation
process either during the process or thereafter.
Providers will be offered the opportunity for formal feedback on their
submission once the process is completed.
Membership

















Dr. Haren Patel (Chair), Vice Chair CCG
Karl Thompson Programme Director Clinical Commissioning Group
Dr Isabel Hodkinson, Independent GP
Independent GP via RCGP
Cynthia White Chair of the OPRG
Jamie Bishop Chair of the Patient and Public Involvement Sub-committee
1 other patient representative (to be advised by Health Watch)
Representative from London Borough of Hackney OSC
Representative of the corporation of the city of london
Ryan Ocampo Project Manager or deputy (NELCSU) non scoring member
Shaju Jose, Procurement Manger (NELCSU) non scoring member
LMC Representative (Londonwide LMC) Observer, non scoring member
Adam Shields Lead Finance Support (NELCSU)
Finance representative from CCG (shared vote with NELCSU finance support)
CSU HR, IT and Estates will contribute as required in an observer capacity
CSU Quality representative in an observer capacity
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
Frequency of Meetings and process
A meeting will take place at the start of the process to explain how the process will
work and to set out the timetable of involvement. Members will need to complete
a conflict of interest and confidentiality agreement before they can proceed past
this stage. Following this, individual members will be asked to independently
complete the scoring online without reference to other members. Panel members
will need to allow at least one to two days to assess the individual providers and to
input this online. This is of course dependent on how many applicants there are
and how confident members are using technology. The Procurement Team will
support those Panel members who require additional support to complete their
section of the evaluation process electronically.
Once the scores have been submitted the procurement lead will evaluate them
and arrange for a moderation of those areas where there is considerable variance
in the response. There will be a maximum of two separate moderation meetings
to reflect the different stage of the process. (See Part A and Part B in Process
map 2).
Depending on the size of the short listing there will be one to two half days for
provider presentations / interview. Where possible the presentation scores will be
collated at the end of the final interview process by the Procurement Lead. The
Procurement Lead will share the financial assessment scores and the scores from
the Quality evaluation section at this point. The CSU financial expert will be
available to address any queries relating to this at that meeting. The Procurement
Lead will collate and share with the Panel the outcome of the scores from the
evaluation process which are Quality (including provider interview) and Financial
sustainability. The winner will be identified as the provider who gets the highest
combined score and at that point the Evaluation Panel will make a
recommendation to the City and Hackney CCG Board to award the contract to
them. The CSU will prepare a CCG Board paper outlining the process employed,
information on the submitted bids as they relate to the areas evaluated (quality,
cost and provider interview) and a recommendation as to the preferred provider
and reserve bidder to the CCG Board for ratification.
Quorum of Group
For this Evaluation Panel to be quorate, the following should be present.
 Two GPs to assess the clinical competency of the organisations.
 One Patient representative
 Lead Finance representative or deputy for final recommendation meeting.
Compliance
The Evaluation Panel is monitored by the CSU on the basis of whether
procurement requirements have been adhered to as part of their assurance
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
process. It will confirm this assurance to the City and Hackney CCG Board when
it submits its final report recommending the preferred provider.
Date:
Reviewed:
Next review:
23 April 2013
27 September 2013
Not applicable:
This Group is expected to disband by
September 2013.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
7.
Outline engagement proposal and timetable
Partner
Involve and Engage
Inform
•
Patient forum
•
C&H GPs and practices
•
NHS England
•
NHS 111 CSU team
•
Local Medical Committee
•
NHS Staff
•
Local Medical
Committee
•
Health Watches / Health
and Wellbeing Boards
•
Faith groups
•
ELC CCGs
•
Acute/CHS Trust
Providers (Emergency
Departments and
UCCs)
•
Health Scrutiny
Committees
•
Pharmacists
•
Councillors
•
Adult Social Services
•
London Ambulance
Service
•
Optometrists
•
Emergency Dental
Providers
•
Palliative Care
Providers
•
Local Councils
•
•
MH Trust
•
•
Care homes
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
7.1
Proposed Engagement activities
Audience
Meeting /
activity
CCG
Initial
project 20/3/13
proposal
Audit
Committee
Date
Project proposal - 28/3/13
PPI
Project
update 10/4/13
Clinical Executive
Project
update 11/4/13
clinical
commissioning
forum
Revised Plan and 22/4/13
governance
process approval
Audit Committee
26/4/13
Governance
process
CCG
Board
Clinical Executive 8/05/13
Board
31/05/13
NHS 111 CSU Facilitate meeting tbc
team
with Spec author
and 111 team
Patient
representatives
Hold sub-group w/c 29/4
meeting with PPI
chair
and
nominated reps
C&H GPs and Post engagement w/c 29/4
practices
document
on
website and draft
article
in
newsletter
Purpose / objective
Status
Propose
outline Complete
project plan, CSU
support and roles,
responsibilities
Project update and Complete
invitation to engage
Project update and Complete
invitation to engage
Project update and Complete
invitation to engage
Approval for revised In plan
plan and governance
process
Process ratified
CCG board
by In plan
Engagement with the In plan
clinical
exec
on
outline spec
Final specification and In plan
business case
Ensure spec aligns Complete
with 111 delivery,
ensure
patient
experience and safety
Get patient feedback In plan
on spec
Receive
feedback In plan
from GP practices in
C&H
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
Audience
Meeting /
activity
Date
Purpose / objective
Status
Acute and CHS Letter
and w/c 29/4
provider
meeting
with
acute
provider
Director
of
operations
Mental
Health Letter
and w/c 29/4
provider
briefing to ELFT
CEO
Get clarity on estates In plan
options for existing
spec
and
future
provision
Local
medical Letter
and w/c 29/4
committee
briefing to LMC
(LMC)
Chair
Letter
and w/c 29/4
Local Councils
briefing
to
Cabinet Members
for Health and
HWB Chairs
Update
and
offer In plan
opportunity for clinical
review and feedback
Update
and
offer In plan
opportunity for review
and feedback
Update
and
offer In plan
opportunity for review,
meeting and seek
support
in
membership of project
board/decision
making panel
All other interested stakeholders can be informed of the process and be given the
service specification once the specification is advertised on supply to health. This
can be done through standard communication routes, e.g. the CCG website and
newsletter. Once the final specification has been published all material can be
published on the CCG website
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
8. Risk Assessment
No. Date risk Risk
Identified
1
2
3
4
14/04/13
14/04/13
14/04/13
14/04/13
Proposed action
Gaps
The Procurement timetable is
extremely tight and there is not
insufficient time to mobilise the
contract by the end of September
2013.
We will need to extend
the current arrangements
by eight to ten weeks
(early January 2014).
The procurement timetable does
not allow for panels members
unavailability due to annual leave
over the summer period or other
delays.
Any delay in decision making,
legal advice or need for additional
actions by CCG Board, prior to
commence-ment of the
procurement process will impact
on the overall time table.
We have adjusted the
procurement timetable in
August to allow
additional time to receive
their submission.
Weekly meetings of the
Procurement Board up to
end of May 2013 to
quickly resolve any
issues as they emerge.
A.C. and CCG Board to
make timely decisions +
only request essential
changes.
Do everything possible to
complete the
procurement on time but
the lack of mobilisation
time means that there is
likely to be a need to
extend the current
contract to early January
2014.
Review in July
2013 and
determine whether
notification /
negotiation of
contract is required
We have tried to
minimise this risk
but we currently do
know Panels
availability.
None at this time
Extension with Harmoni only
secured to end of September and
any need to extend by weeks may
either cost more or there is a risk
of Harmoni refusing the extension.
Will need to make
this determination
by July 2013 in
order to give the
appropriate notice
or have
alternatives in
place.
Conseq
uence
Likelyhood
Risk
Rating
4
4
16
4
4
16
4
4
12
4
4
16
Date
risk
closed
No. Date risk Risk
Identified
5
6
7
14/04/13
14/04/13
14/03/13
The commencement date of the
new OOH contract coincides with
the introduction of 111 by a local
provider. There is a risk that the
111 provider will not have bedded
in the process sufficient well and if
there is a new OOH provider there
are risks that the service may be
fragmented in the transition
stages.
There is considerable scope for
conflict of interest as part of the
procurement process which could
undermine the process.
The new contract will cost more as
there will not be the same
economy of scale as currently
experienced (only one as opposed
to four boroughs participating).
Consequently the anticipated
1.3% saving is unlikely to be
achieved. In addition the
introduction of 111 services will
drive up demand based on current
experience.
Proposed action
Gaps
The current introduction
of the 111 Service
across London is facing
severe difficulties at
present. By introducing
more time for
mobilisation this should
move the timetable to be
less of a challenge.
This needs to be
reviewed regularly
to understand the
risk.
CCG to carry out due
diligence and ensure that
members of the Audit
Committee or CCG
Board who have a
conflict of interest, do not
participle in the decision
making process.
This will be addressed in
the business case to
scope the likely extent of
this risk. However given
the dis-economy of scale
and other factors
outlined this will continue
to be a risk.
CCG to confirm
they have carried
out this activity.
Conseq
uence
Likelyhood
Risk
Rating
3
4
12
5
3
15
4
5
20
CCG to consider
the impact of this
as part of their
financial planning.
Option 1 Process and Decision Making for OOH Contract/EK/RO/190413/V4
Date
risk
closed
COMMERICIALLY SENSITIVE - CONFIDENTIAL DRAFT - OPEN PROCEDURE PROJECT PLAN FOR CITY & HACKNEY OOH PROCUREMENT
Option 1
Action
Number of
Number of
working days calendar days
Responsibility
Start Date
Finish Date or
expected completion
date
28/03/2013
28/03/2013
05/04/2013
completed
02/04/2013
completed
10/04/2013
completed
Governance a weekly project board will be convened to
track and monitor progress of the project
Project preparation processess
Seek legal advice in relation to contracts and procurement issues
5
Patient and Public engagement committee
1
CSU Project Manager to develop process, decision
making and panel
General update to Clinical Exec Committee on the
1
progress around Harmoni and the extension
Update to the Clinical Commissioning Forum
1
Prepare specification
10
1
14
CCG/PCF
11/04/2013
01/04/2013
completed
20/05/2013
Undertake equipment audit (if appl)
10
14
CCG/PCF
01/04/2013
20/05/2013
Confirmed equipment/funishings approach (if appl)
10
14
CCG/PCF
01/04/2013
20/05/2013
Confirm ICT arrangements required
Confirm building arangements
Confirm HR requirements
10
10
10
14
14
14
CCG/PCF
CCG/PCF
CCG/PCF
01/04/2013
01/04/2013
01/04/2013
20/05/2013
20/05/2013
20/05/2013
Confirm evaluation Panel, Prepare evaluation criteria
10
14
CCG/PCF
01/04/2013
20/05/2013
1
1
22/04/2012
22/04/2013
1
1
22/04/2013
22/04/2013
Receive recommendation from Audit Committee's
assuarance about the process (CCG Board)
1
1
26/04/2013
26/04/2013
Stakeholder engagement
20
28
22/04/2013
20/05/2013
Schedule 1 (Specification) to final draft stage
Legal Advice on Schedule 1
5
7
10/05/2013
17/05/2013
CSU presents decision making process and
procurement process to CCG Audit Committee
Assurance of overall process (CCG Audit
Committee)
Version 1 June 26 2012
8
1
Eilis Kilfeather
1
CCG/PCF
1
COMMERICIALLY SENSITIVE - CONFIDENTIAL DRAFT - OPEN PROCEDURE PROJECT PLAN FOR CITY & HACKNEY OOH PROCUREMENT
Option 1
Action
Audit Comitte Recommends Business Case and
Specification
CCG Board approves the Business Case and
Specification and gives permission to proceed with
procurement
Commence Procurement Process
Number of
Number of
working days calendar days
Responsibility
Start Date
Finish Date or
expected completion
date
1
1
CSU/ steering
Group
20/05/2013
20/05/2013
1
1
CSU/ steering
Group
31/05/2013
31/05/2013
Prepare draft Supply2health advert
10
14
CCG/PCF/Project
Support
22/05/2013
28/05/2013
Prepare Memorandum of information, Information
and Guidance, and Open Tender ITT (online
questions)
10
14
CCG/PCF/Project
Support
22/05/2013
28/05/2013
1
1
CCG/PCF/Project
Support (CSU)
29/05/2013
29/05/2013
5
7
SJ (CSU)
30/05/2013
31/035/2013
1
1
SJ (CSU)
03/06/2013
03/06/2013
1
1
SJ (CSU)
03/06/2013
03/06/2013
1
1
SJ (CSU)
10/06/2013
15/06/2013
Clarification (Q&A) period
35
47
03/06/2013
19/07/2013
Attend OSC for city Corporation and Hackney
2
2
TBC
TBC
Market Event (bidders event)
1
1
Procurement/Proj
ect Support/CCG
24/06/2013
24/06/2013
Deadline for submission of Tenders
Evaluation of Open Tender Part A (Pass/Fail
questions) - online scoring
43
59
N/A
03/06/2013
31/07/2013
5
Evaluators
01/08/2013
07/08/2013
Approve Memorandum of information, Information
and Guidance, and Open Tender ITT (online
questions)
Upload Memorandum of information, Information and
Guidance, and Open Tender ITT (online questions)
on Pro-contract
Place Advert
MOI, PQQ Part 1 and Part 2 Published on ProContract (e-procurement solution)
Training for pro-contract - evaluators training on
procurement
Version 1 June 26 2012
SJ/Project
Support/CCG
CCG/ CSU
2
COMMERICIALLY SENSITIVE - CONFIDENTIAL DRAFT - OPEN PROCEDURE PROJECT PLAN FOR CITY & HACKNEY OOH PROCUREMENT
Option 1
Action
Moderation Meeting - Pass/Fail Questions (if
required)
Invitation to Interview/Presentation
Evaluation of Open Tender Part B (Scoring)
Questions
Number of
Number of
working days calendar days
Responsibility
1
1
1
1
Evaluators,
SJ(CSU) and
Project Support
(CSU)
SJ (CSU)
10
15
Evaluators
Start Date
Finish Date or
expected completion
date
09/08/2013
09/08/2013
12/08/2013
12/08/2013
12/08/2013
27/08/2013
29/08/2013
29/08/2013
29/08/2013
29/08/2013
05/09/2013
05/09/2013
05/09/2013
05/09/2013
09/09/2013
20/09/2013
27/09/2013
27/09/2013
18/09/2013
20/09/2013
27/09/2013
27/09/2013
Moderation Meeting - Scoring Questions (if required)
1
1
Recommendation of Shortlist for
Interview/Presentation (If required)
1
1
Interview and Presentation
1
1
Award Recommendation by Evaluation Panel
1
1
Prepare Report for CCG board
Deadline for Board papers
Present to CCG Board
Award approval by CCG Board
Notifying Preferred Bidder/unsuccessful bidders - ITT
Stage
10 days cooling off period
Procurement Completion
Draw up contract
2
2
1
1
1
1
Evaluators,
SJ(CSU) and
Project Support
(CSU)
Evaluators,
SJ(CSU) and
Project Support
(CSU)
Evaluators,
SJ(CSU) and
Project Support
(CSU)
Evaluators,
SJ(CSU) and
Project Support
(CSU)
Project Support
CSU
Will Huxter
CCG
1
1
SJ (CSU)
30/09/2013
30/09/2013
6
10
N/A
01/10/2013
10/10/2013
7
9
30/09/2013
10/10/2013
1
1
11/10/2013
11/10/2013
Contracts AWARD / signing
Version 1 June 26 2012
CCG/successful
bidder
3
COMMERICIALLY SENSITIVE - CONFIDENTIAL DRAFT - OPEN PROCEDURE PROJECT PLAN FOR CITY & HACKNEY OOH PROCUREMENT
Option 1
Action
Commence mobilisation (dependent on provider)
Version 1 June 26 2012
Number of
Number of
working days calendar days
Responsibility
Start Date
Finish Date or
expected completion
date
Successful
provider
14/10/2013
13/01/2014
4
SAFEGUARDING
UPDATE TO CCG BOARD
For information and for decision (slide 3)
APRIL 2013
CONTEXT
•
•
•
The CCG developed its interim safeguarding
arrangements for authorisation in Autumn 2012
NHSE published in March 2013 a new
safeguarding assurance framework –
http://www.elic.org.uk/uploads/City/Safeguarding
%20Vulnerable%20People%20in%20the%20Re
formed%20NHS.pdf
This paper provides information on the CCGs
current arrangements and plans – see Appendix
1
DECISIONS
•
The Board is asked to
•
•
•
•
•
•
Note the current arrangements for childrens safeguarding
Note that guidance is still awaited from NHSE on the role
of the designated professionals
Agree to the establishment of the CCG Safeguarding
Assurance Group which will report to the CCG Clinical
Executive Committee and oversee safeguarding
arrangements in contracted services – Appendix 2
Support the establishment of a Clinical lead role for adults
safeguarding
Note the further work to be undertaken with the Local
Authorities
Note the handover work on people with Learning
Disabilities following Winterbourne (see Appendix 3)
OUTSTANDING ISSUES
•
Guidance is awaited from NHSE on
•
•
•
The arrangements for the CCG employed designated
professionals to provide safeguarding advice to other local
commissioners
Who is responsible for the named GP for safeguarding
and the interface with practices as providers
Whether the CCG carries responsibilities only for its
registered patients and those C&H residents who are
unregistered
CONTRACT MONITORING
•
•
The CCG contracts with the CSU to undertake contract
monitoring of all commissioned services, including
safeguarding arrangements
The CCG carries responsibility for 4 homes within Hackney
•
•
•
•
•
•
Mary Seacole (part of Homerton Hospital)
Acorn Lodge
Beis Pinchas
St Annes
Page 12 in Appendix 1 outlines where other local residents are in care
homes and quality in these in monitored via the “home” CCG reporting to
CSU – this model will also apply under the AQP arrangements for
continuing care
There are other homes which are under the responsibility of the
LA
•
•
Those where patients with Learning Disabilities are housed (LBH is the
lead commissioner for LD) – see Appendix 3
Those within LBH where residents are not under the responsibility of
NHS Continuing health care
•
To ensure that the CCG has a grip on
safeguarding
•
•
A Safeguarding Assurance Group will be established to
receive assurance from CSU on safeguarding in all
commissioned services and address any issues (see
appendix two);
A 2 session per month clinical lead for adult safeguarding
will be appointed:
• to develop working arrangements, ensure a clinical
focus on safeguarding and develop processes for
joint working with the Local Authorities and systems
for GPs and others in contact with residents to raise
any issues.
LEARNING DISABILITIES
•
The Department of Health response to the
Winterbourne Review required the NHS to
Develop a register of all people with LD
•
Review all LD placements
Appendix 3 outlines the progress by CSU on these issues
•
• The CCG has inherited arrangements from the
PCT for the delegation of lead commissioning
responsibility for LD to LBH
• However the CCG has a lead GP – Dr Steph
Coughlin – who works on LD, interface with
primary care and is a member of the Long Term
Conditions Board
APPENDIX 3 –
LEARNING DISABILITIES
•
There are 45 CH residents with learning disabilities
(identified to date)
•
•
•
8
These all appear to be Hackney residents and their status in
terms of GP registration is not yet known
Of the 45, 8 clients are in NHS forensic inpatient
beds and 1 in an assessment and treatment unit the LBH LD team is leading the work to complete
care plans to assess their potential for discharge to
community settings
As part of this we have asked CSU for assurance on
the quality of the units being used and this will be
brought to the Safeguarding Advisory Group
Appendix One - The Safeguarding Functions of Clinical Commissioning Groups
All organisations commissioning or providing healthcare should ensure there is board level focus on the needs of vulnerable adults and children and that
safeguarding is an integral part of their governance systems. The CCG needs to have policies, systems and processes in place to fulfil its specific duties of
cooperation and partnership around safeguarding including;
•
Demonstrating the CCG meets best practice in safeguarding
•
The CCG has established appropriate systems for safeguarding.
•
The CCG plans to train staff in recognising and reporting safeguarding issues.
Functions
CCG
CSU
Appropriate arrangements in place to safeguard and promote the welfare of children and vulnerable adults
CHILDREN - Clear line of
accountability for safeguarding is
reflected in CCG governance
arrangements, and the CCG has
arrangements in place to co-operate
with the local authority in the
operation of the Local Safeguarding
Children Board
CCG Board
• Dr Clare Highton (CCG Executive
lead for safeguarding Children
• Paul Haigh (CCG Chief Operating
Officer & CCG representative of
the CHSCB)
CCG Children’s Board Membership
• Dr Clare Highton (CCG Executive
lead for safeguarding Children)
• Maureen Gabrielle (CCG
Designated Nurse for
Gaps / Questions / Risks
• What systems do we have in
place to identify patients at risk
• Audits & monitoring
• Evidence of shared learning
• Patient feedback
Functions
CCG
Safeguarding Children)
• Frances Schmocker (Programme
Director Children & Maternity)
City and Hackney Safeguarding
Children Board
• Frances Schmocker (Programme
Director for Children and
Maternity)
• Maureen Gabrielle (CCG
Designated Nurse for
Safeguarding Children)
• Dr Ruth Hallgarten Salaried GP
& City & Hackney Named GP for
Safeguarding Children
• Dr Nick Lessof (CCG Designated
Doctor for Safeguarding Children)
Multiagency Inspection
Safeguarding Inspection Meeting
(Children)
• Maureen Gabrielle (CCG
Designated Nurse for
Safeguarding Children)
• Frances Schmocker (Programme
Director Children & Maternity)
• Dr Ruth Hallgarten Salaried GP
& City & Hackney Named GP for
Safeguarding Children
• LBH / Homerton / ELFT / VCS
CSU
Gaps / Questions / Risks
Functions
ADULTS - Clear line of accountability
for safeguarding is reflected in CCG
governance arrangements, and the
CCG has arrangements in place to
co-operate with the local authority
in the operation of the Safeguarding
Adults Board
CCG
CSU
Gaps / Questions / Risks
CCG recruitment of an adult
safeguarding clinical lead
Adults - This should reflect the pan
London arrangements
CCG Board
• Dr Clare Highton (CCG Executive
lead for safeguarding Adults
• Paul Haigh (CCG Chief Operating
Officer)
• Caldicott Guardian – Dr Haren
Patel
Programme Director Adult
Safeguarding Lead: Karl Thompson
CCG Assurance Group – see
appendix two
CHC manager for City and Hackney
sits as a member of the LBH Quality
and Safeguarding Adults Board
City and Hackney Adult
Safeguarding Board
• Dr Clare Highton (CCG Executive
lead for safeguarding Adults
CCG has secured the expertise of a
designated doctor and nurse for
safeguarding children and for looked
after children and a designated
paediatrician for unexpected deaths
in childhood
• Maureen Gabrielle (City and
Hackney Designated Nurse for
Safeguarding Children) CCG
hosting the post
• Dr Nick Lessof (Designated
Role of the designated doctor and
nurse and clinical supervision of
services that are commissioned by
others e.g. NHSE for health visiting
and specialist services, LAs for school
nursing
Functions
CCG
CSU
Doctor for City and Hackney) –
Arrangements will be through an
SLA with GOSH
Gaps / Questions / Risks
Role of the designated doctor and
nurse for Hackney residents
registered with a GP out of Borough
Still awaiting confirmation of
employment transfer to the NCB in
April 2013
• Dr Ruth Hallgarten Salaried GP
& City & Hackney Named GP for
Safeguarding Children
Child Death Overview Panel
• Maureen Gabrielle (City and
Hackney Designated Nurse for
Safeguarding Children)
• Dr Nick Lessof (Designated
Doctor for City and Hackney)
• Frances Schmocker (Programme
Director for Children and
Maternity)
LAC Health Team & Designated LAC
Nurse
Clinical support and supervision of
the Designated Nurse will be
provided by Dr Clare Highton
Training
Children - level 1 (to be provided by
designated nurse) with Board
The CCG will need assurance that
the CSU staff and Board have
All CCG staff need to have
completed safeguarding training
Functions
CCG
members and those with additional
safeguarding responsibilities level 2
(which requires some additional
bespoke focus for us as a
commissioning organisation)
CSU
received training in the same way as
has been identified for the CCG (left)
Gaps / Questions / Risks
There needs to be a rolling
programme of training to identify
and cater for new staff, and to
provide updates for staff who have
already received training.
Adults – Safeguarding adults at risk
training should be level 1 for all
staff(Available online)
Training for CCG staff will be
completed by the end of June
Commissioners training through
reading DH Safeguarding Adults: The
Role of Commissioners.
CSU producing a training DVD for
commissioners including CCG’s
reading by end of March
Service Design, & contracting –
embed safeguarding in the daily
functioning of commissioned
services
Safeguarding & commissioning
policy – Input from the designated
nurse and doctor into current
policies within contracts
A similar requirement for adults i.e.
using the CCG Safeguarding adults at
risk from abuse procedure, agreeing
service standards to be integrated
into contracts
CSU’s role in embedding
safeguarding into the commissioning
and contracting process and the ongoing monitoring of those contracts
and ensuring organisations are
compliant – this is a particular issue
for non-acute contracts e.g.
Harmoni, Richard House.
To be assured via the Safeguarding
Assurance Group.
Functions
Quality assurance & contract
monitoring
• Performance management
• Compliance
• Audits
• KPIs
• Quality Standards
• Dashboard
• Patient feedback
CCG
Safeguarding reports to
• CCG Board via the quarterly
quality report from CSU;
• CCG Children’s Board (monthly)
• Monthly safeguarding bulletins &
all information uploaded onto
the website
Section 11 audits area a statutory
duty on key organisations to make
arrangements to ensure that in
discharging their functions they have
regard to the need to safeguard and
promote the welfare of children.
These will be completed by
Designated Nurse.
CSU
Reporting of Provider KPIs
Agree performance monitoring
dashboard for adults plus system for
collecting data, monitoring and
review
SAAF demonstrates arrangements
for patient feedback
Assurance around compliance will be
reported through the Safeguarding
Assurance Group & the CQRMs
City and Hackney CCG Draft
Safeguarding Children Policy
Agree with other CCGs revised set of
outcome-focused KPIs consistent
across providers and CCGs
Performance monitoring dashboard
(children)
How do we communicate & ensure
compliance of updated safeguarding
requirements by DH, CQC, NCB –
CQRM
Development of an adults
safeguarding dashboard
Regular audits carried out by
Providers – findings of audits
reported back to the CCG via the
Designated Nurse
CCG Safeguarding Policies
• Children’s policy
Gaps / Questions / Risks
Adult safeguarding policies will be
developed once the service line has
Functions
•
Adults policy
CCG
September 2012 –
Adults - Cluster version of policy to
be adopted and amended as
necessary
Safer recruitment processes
Managing SUIs / Serious Case
Reviews / Domestic Homicide
Reviews
Managing complaints
CSU
Gaps / Questions / Risks
been agreed and the responsibilities
identified. Pan London procedures
will be used till then
All safeguarding policies to be
reviewed in June
Designated nurse to complete
section 11 audit of safer recruitment
practices
All CCG staff, volunteers / PPI are
CRB checked and attend
safeguarding training (as per the SLA
with CSU HR)
Attend Review Panels and contribute CSU – Quality Team for both children
content as and when required.
& adults
From a safeguarding adults at risk
acute provider perspective the SAAF
identifies HUHT and ELFT
arrangements. Action Plan
developed agreed by respective
trust Boards. Action plans monitored
by HSAB and internal safeguarding
committees
Managed through CSU
Safer recruitment processes will be
the same for adult safeguarding as
children in acute providers.
Audits are commencing as part of
the quality in CHC settings
Functions
Information sharing
CCG
CSU
Gaps / Questions / Risks
Information sharing protocols
developed by CHSCB – CCG will need
to formally sign up to the local
information sharing protocols
Information sharing protocols
developed by SAB – CCG will need to
formally sign up to the local
information sharing protocols
Mental capacity act & Deprivation of
Liberty Standards
Whistle blowing
• Staff whistleblowing
• CCG staff receiving
information from whistle
blowers
Appoint Mental Capacity Act lead
Continued responsibility for cases
authorised by predecessor PCT
Processes to access archived
information on closed cases
Assuring compliance with the MCA
and DoLS of all providers
Work with providers and LAs to
ensure capacity of professionals
qualified to carry out best interest
assessments
Support training and education of
health professionals and best
interest assessors
CCG Lead – Dr Haren Patel
Cluster HR version of policy to be
adopted and amended as necessary
by the CCG
Will CCG staff be covered by the
CCG’s revised policy & are sessional
clinical leads included within that
Policy to be reviewed in June
What is the process for raising
Functions
CCG
CSU
Whilst safeguarding of vulnerable
adults is everyone’s responsibility
the lead role falls to the Local
Authority who use the pan London
Multi Agency Safeguarding Adults
policies and procedures. Locally LBH
will often request health staff to
help with investigations where
health care is a key component of a
concern that has been raised.
Care Homes
The contracts monitoring officers of
the borough make regular visits to
all local providers where they fund
placements to look at contract
compliance and quality issues. The
CHC manager for City and Hackney
CSU also visits the in borough care
homes with nursing three times each
year
City and Hackney CCG will be invited
to join the metrics project over the
coming months
The CSU has recently been involved
in the piloting in Newham a set of
Care Home metrics which homes
have been asked to complete in
order to provide further assurance
of quality and to help monitor
performance and improvement.
Gaps / Questions / Risks
complaints about providers when
raised with CCG staff
The City has no care homes with
nursing within its boundary,
London Borough of Hackney (LBH)
has four.
• Mary Seacole Nursing Home
• Acorn Lodge
• Beis Pinchas
• St Anne’s care home (with very
small numbers of nursing
patients)
Awaiting assurance from CSU on all
Learning Disability placements
Need to identify who is responsible
for monitoring of all homes within
City and Hackney and are we
assured of clinical input
Functions
Monitoring out of borough
placements
• Monitoring of alternative
providers where the CCG is
not the lead commissioner
CCG
For Children all providers will be
audited through the section 11
audits carried out by the Designated
Nurse to ensure compliance
Safeguarding Assurance Group to
receive reports from CSU
CSU
See Appendix A for current out of
borough placements
All placements in private care homes
with nursing are reviewed at three
months and from then on at least
annually by the individual patients
case manager (normally a member
of the Community Discharge
Planning Team or the Adult
Community Rehabilitation Team)
All City and Hackney reviews are
currently up to date.
All London Local Authorities work to
the London Multi Agency
Safeguarding Policies and
Procedures.
Where serious concerns arise in a
care home the host local authority
safeguarding team contacts those
who are funding residents to make
them aware of the alert. For CHC
patients unless there was an
immediate risk we would usually
respond by arranging a review of the
patients care to ascertain whether
the placement remained appropriate
and to consider a move if that was
Gaps / Questions / Risks
Functions
Relationship with other
commissioners including the NHSE &
LA & the services they commission
including GPs, Health Visitors &
school nursing
Co-operation with LAs & joint
commissioning
CCG
The designated nurse & doctor will
continue to support services locally
though clarification is still being
sought from the NCB and a
memorandum of understanding will
need to be agreed
Co-operate and participate in Health
& Wellbeing Board
Contribute to the Joint Strategic
Needs Assessment (JSNA) and the
Joint Health and Wellbeing Strategy
(JHWS)
Have regard to any relevant JSNA or
JHWS to which the CCG has
contributed
PPI involvement in safeguarding
issues
• Patient complaints
Shared learning across agencies at
the CH SCB & SAB
CSU
indicated. We would also maintain
contact with the local safeguarding
team and where concerns are felt to
be establishment wide we would be
invited to safeguarding strategy and
planning meetings
Gaps / Questions / Risks
APPENDIX A: OUT OF BOROUGH PLACEMENTS
LA
Provider Name
Site (If Different)
Waltham Forest
Albany Nursing Home
Blackheath Brain Injury &
Neuro Rehabilitation Centre
Bupa Care Home (Gallions
View Nursing Home)
Bupa Care Home (Meadbank
Nursing Home)
Bupa Care Home (Mornington
Hall)
Bupa Care Home (Nairn
House)
Bupa Care Home (The
Highgate Nursing Home)
Care + Limited (Harcourt
House)
Enable Care
Forest Health Care (Bridgeside
Lodge)
Lady Sarah Cohen House
Lennox House (Care UK)
Life Style Care (Beech Court
Care Centre)
Life Style Care (Springfield
Care Centre)
Marillac Care
Priory Grange
Ross Wyld Nursing Home
Royal Hospital for Neurodisability
Sage Nursing Home (Service
to the Aged)
Springdene Care Homes
Winkfield Resource Centre
Leyton E10 7EL
Blackheath Hill SE10 8AD
Lewisham
Greenwich
Battersea
Newham
Enfield
Islington
Lewisham
Essex
Islington
Barnet
Islington
Havering
Redbridge
Essex
Hertfordshire
Waltham Forest
Wansdsworth
Barnet
Barnet
Haringey
No. of CHC
patients
3
Thamesmead, SE28 0FH
1
Battersea, SW11 4NN
1
Manor Park, E12 5DA
1
Enfield, EN1 4TR
London N6 5LX
3
London SE6 3BP
1
London E4 7RD
Islington, London
2
1
Colney Hatch Lane, London
Islington, London
Essex RM1 2AJ
1
2
2
Barkingside, Essex IG2 6BN
1
Brentwood, Essex
Potters Bar, Hertfordshire EN6 2SE
Walthamstow, London E17 4PZ
Putney, London SW15 3SW
1
2
1
1
Golders Green Road, London
1
55 Oakleigh Park North, London
Wood Green, Haringey, London
1
1
Appendix Two - Safeguarding Assurance Group
The Safeguarding Assurance Group (SAG) brings together the clinical commissioners for
City and Hackney residents to oversee the monitoring of the quality of services with respect
to adult and children’s safeguarding and to provide assurance during the first year of
operation of the Clinical Commissioning Group (CCG).
Accountabilities
The CCG is responsible for the quality of services it commissions and ensuring these
address safeguarding. The CCG needs to provide assurance to the local Safeguarding
Boards that the services and systems it commissions are safe and ensure there are robust
processes to address any issues arising from the Safeguarding Boards.
The CCG commissions its support service from North Central and East London (NCEL)
Commissioning Support Unit (CSU) who undertake for day to day contract management
and monitoring of all commissioned providers and providing assurance to the CCG.
This SAG will play a key role in meeting this two way accountability.
Other commissioners of local NHS services (eg NHS England (NHSE), Local Authorities
(LAs) or Public Health England (PHE)) are also responsible to the Safeguarding Boards for
the quality of the services they commission. At this stage their work falls outside the role of
this group although there will need to be good liaison with the other commissioners.
What does the group do?
•
•
•
•
•
•
Reviews and assesses the assurance from CSU that all services used by City and
Hackney residents are proactively assessed and monitored for their safeguarding
arrangements;
Receives reports, agrees and monitors any action plans where improvements are
required;
Considers the outcomes of any serious case reviews, relevant Serious Incidents
(SIs), and HealthWatch reports, complaints and other hard and soft intelligence and
ensures that remedial action plans are developed, implemented and monitored;
Receives reports from the local Safeguarding Boards (adults and children's) and
consider any actions needed;
Ensures that the CCG can provide the requisite assurance to the local Safeguarding
Boards on the quality of what is commissioned;
Considers the detailed safeguarding reports from commissioned providers which
form part of the quality report.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
As well as the main acute (Homerton University Hospital Foundation Trust (HUHFT)) and
mental health provider (East London Foundation Trust (ELFT)) for which the CCG carries
lead commissioning responsibility, the CCG will expect the CSU to be able to report on all
commissioned services, e.g.:
• Other, non-local, acute, Community Health Services (CHS) and mental health
providers;
• Out of hours provider and 111;
• Continuing health care providers;
• Primary care providers holding enhanced service contracts with the CCG.
The SAG will also ensure that the CCG is meeting its responsabilities in relation to its
employed staff and contractors for safeguarding.
Frequency
The SAG would meet quarterly with timing to fit around the two local Safeguarding Boards.
Reporting
The group would report to:
• The local Safeguarding Boards;
• The CCG Clinical Executive Committee (CEC);
• Relevant CCG Programme Boards if there are specific commissioning issues.
Membership
•
•
•
•
•
•
•
CCG GP Clinical Leads for:
o Learning Difficulties (Dr Stephanie Coughlin);
o Older People (Dr Lucy O’Rourke);
o Children (Dr Dorothy Briffa);
o Mental health and dementia (Dr Rhiannon England).
The CCGs designated doctor and nurse (Dr Nick Lessof (TBC) and Maureen
Gabriel);
The CCG Chair (Dr Clare Highton);
A representative of the Older Peoples Reference Group (ORPG) (Cynthia White);
CSU Quality Lead (TBC);
CCG Chief Officer (Paul Haigh) / Programme Directors from the CCG;
The group would be chaired by Honor Rhodes, Associate Lay Member for the CCG.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
Way of working
The SAG can decide how it wants to work. It may decide to do "deep dives" into particular
areas at each meeting e.g. continuing health care, acute services, looked after children etc.
It will want to hold specific discussions with provider clinical leads as required.
It can refer specific items to individual CCG Programme Boards to action.
Paul Haigh
Chief Officer
NHS City and Hackney CCG
April 2013
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
APPENDIX 3 –
LEARNING DISABILITIES
•
There are 45 CH residents with learning disabilities
(identified to date)
•
•
•
1
These all appear to be Hackney residents and their status in
terms of GP registration is not yet known
Of the 45, 8 clients are in NHS forensic inpatient
beds and 1 in an assessment and treatment unit the LBH LD team is leading the work to complete
care plans to assess their potential for discharge to
community settings
As part of this we have asked CSU for assurance on
the quality of the units being used and this will be
brought to the Safeguarding Advisory Group
NHS City and Hackney CCG
Financial year 2013/14
Prescribing Budgets
Budget Management – 2012/13 Headlines
In 2012/13
1.
At month 12 an underspend of £2.9m or 10% of the Primary Care
Prescribing Budget is forecast.
1.
2.
By Month 6 (April- June 2012) the financial activity in 9 practices from ePACT
were showing a forecast of an overspend.
From Month 9 (ePACT Nov 2012) indicated 3 practices with an overspend.
•
Practice 1 to taking on additional patients due to the closure of a practice
in Jun 12,
•
Practice 2 reduced the forecast overspend in June to 1% with joint working
and sessional pharmacy support
•
Practice 3 has reduced its forecast overspend from 17% at Jun12 to 6% at
Nov12; as a result of QiPP initiative
2013/14 Budget
Primary Care GP Prescribing
2012-13
Budget 29,375
City & Hackney – GP Prescribing Budget 2013-14
£000s
Forecast Outturn 26,414
£000s
2012/13 Month 8 Forecast Outturn
27,382
Transfer to Local Authority - Imms and Contraceptives
-886
Revised Baseline
26,496
Price Uplift ( 8% ) less Efficiency (4%)
1,060
Growth – Demographic and Non Demographic
Transfer to Category M Contingency
Total 2013/14 Budget Baseline
QIPP Savings
1,157
-500
28,213
- 425
Primary Care GP Prescribing - 2013/14 Budget
27,788
Investment Reserve for Prescribing QIPP
Other Primary Care Prescribing Costs
FP10's (OOH’s)
Pharmacy Drugs
Central Drugs
Oxygen
Scriptswitch
Other
Category M drugs
Sub Total - Other Prescribing Costs
3
333
Indicative
38
985
729
353
115
49
500
2,769
Underspend
2,961
10%
Budget Principles – 2013/14 Headlines
st
31 March 2013 Outturn
£000s
Proposed 2013/14 Budget capped
and uplifted £000s
Budget Envelope
29,375
27,788
Total GP and Commissioned Services
Non Allocated Funds 2013/14 (Underspend 12/13)
26,414
2,871
27,375
413
Practices 2013/14 Prescribing Budget
•
•
•
•
•
•
•
•
•
The budget is based on the DoH Fair Share Methodology after an allowance
adjustment for High Cost Drugs.
All the practices within City and Hackney received a share of the prescribing
budget within the range 0.28% to 4.56%
Dependent on the practice list size.and QoF achievements.
The allowance for High cost Drugs is then added back into the Budget
An uplift of 5% applied to the budget
The New Budget is then measured against the Forecast Outturn and either
capped of an uplift applied.
Practices receiving more than 15% capped at 15%
Practices requiring a uplift a mid point is selected
Practices with lower thresholds no uplift had been applied.
Budget Setting Process
Managed budget
Evaluate the forecast outturn of the high cost
drug allowance and deduct from the overall FO
Apply the fair share quota for the
practice
Prescribing budget less high cost drugs
Prescribing budget plus high cost drug
allowance
Apply agreed % uplift
Proposed fair share budget including HCD’s
allowance and uplift
Is total budget within allocation for CCG?
Cap on uplift using set parameters
Is total budget within the allocation for
CCG?
Evaluate proposed budget against FOO, and budget set for FY 2012/13
Review the variance and adjust if necessary
Budget for FY 2013/14 contain, high cost drugs allowance
High cost drug budget allowance
(HCD’s)
CCG Board:
The Board is asked to:
1. Agree the Fair Share methodology underpinning
budget setting.
2. Receive the Fair Share budget distribution
across practices.
3. Note that prescribing budget remains
provisional until the final CCG financial plan is
agreed.
Budget Setting profile Comparison tool NHS City and Hackney for FY 2013-14
Prescriber Code
F84624
F84060
F84008
F84038
F84072
F84601
F84080
F84720
F84015
F84719
F84021
F84003
F84117
F84035
F84711
F84621
F84635
F84033
F84041
F84013
F84716
F84036
F84668
F84063
F84685
F84632
F84119
F84692
F84096
F84105
F84640
F84018
F84619
F84043
Y03049
F84115
F84636
F84694
F84686
F84042
F84659
F84620
Y01177
Y00403
F84069
Prescriber Name
Practice ABNEY HOUSE MEDICAL CENTRE
Practice ATHENA MEDICAL CENTRE
Practice BARTON HOUSE GROUP PRACTICE
Practice BEECHWOOD MEDICAL CENTRE
Practice DE BEAUVOIR SURGERY
Practice ELSDALE STREET SURGERY
Practice FOUNTAYNE ROAD HEALTH CENTRE
Practice HEALY MEDICAL CENTRE
Practice KINGSMEAD HEALTHCARE
Practice LATIMER HEALTH CENTRE
Practice LONDON FIELDS MEDICAL CENTRE
Practice LOWER CLAPTON GROUP PRACTICE
Practice QUEENSBRIDGE GROUP PRACTICE
Practice RICHMOND ROAD MEDICAL CENTRE
Practice ROSEWOOD PRACTICE
Practice SANDRINGHAM PRACTICE
Practice SHOREDITCH PARK SURGERY
Practice SOMERFORD GROVE PRACTICE
Practice SOUTHGATE ROAD MEDICAL CENTRE
Practice STAMFORD HILL GROUP PRACTICE
Practice THE ALLERTON ROAD SURGERY
Practice THE CEDAR PRACTICE
Practice THE CLAPTON SURGERY
Practice THE DALSTON PRACTICE
Practice THE ELM PRACTICE
Practice THE GREENHOUSE WALK-IN
Practice THE HERON PRACTICE
Practice THE HOXTON SURGERY
Practice THE LAWSON PRACTICE
Practice THE LEA SURGERY
Practice THE NEAMAN PRACTICE
Practice THE NIGHTINGALE PRACTICE
Practice THE RIVERSIDE PRACTICE
Practice THE SORSBY HEALTH CENTRE
Practice THE SPRINGFIELD HEALTH CENTRE
Practice THE STATHAM GROVE SURGERY
Practice THE SURGERY (BARRETTS GROVE)
Practice THE SURGERY (BROOKE ROAD)
Practice THE SURGERY (CRANWICH ROAD)
Practice THE SURGERY (KINGSLAND ROAD)
Practice THE TOWER OF LONDON SURGERY
Practice THE WICK HEALTH CENTRE
Practice TOLLGATE LODGE PRACTICE
Practice TROWBRIDGE PRACTICE
Practice WELL STREET SURGERY
Commissioned Services
Y01617
Y01911
Y02380
5C3999
Y01299
Y00703
Practice CARDIOLOGY SERVICE
Practice CHYPS PLUS
Practice COUNTED4 EQUINOX
Practice DEPUTISING SERVICES
Practice DERMATOLOGY SERVICE
Practice DERMATOLOGY SERVICE
Fair Share Mar
2012-13
1.09%
1.97%
4.43%
1.32%
1.63%
1.98%
1.78%
2.20%
1.99%
1.67%
3.05%
4.17%
2.99%
1.35%
0.69%
1.78%
2.54%
3.96%
2.35%
4.30%
1.55%
2.36%
2.12%
2.58%
0.97%
0.28%
3.08%
1.98%
4.21%
3.79%
2.95%
3.26%
1.47%
1.96%
1.95%
2.65%
1.24%
1.01%
1.71%
0.84%
0.66%
2.03%
2.19%
1.39%
4.55%
Y01821
Y02346
Y03168
Y00487
Y03626
Y00546
Y00163
5C3998
Y02381
F84712
Practice EAR NOSE & THROAT SERVICE
Practice ELIC HEART FAILURE SERVICE
Practice HARMONI LTD OOH
Practice LIFELINE PROJECT LTD
Practice MEDIAN ROAD RESOURCE CENTRE
Practice PRIMARY & URGENT CARE CENTRE
Practice THE SAFE HAVEN SERVICE
Practice UNIDENTIFIED DOCTORS
Practice WDP HACKNEY DIP
Practice ST.JOSEPH'S HOSPICE
F84695
F84029
F84748
F84630
F84653
Y01256
Practice KINGSLAND MEDICAL CENTRE(CLOSED)
Practice OLDHILL MEDICAL CENTRE(CLOSED)
Practice THE SANCTUARY PRACTICE (BURNETT)(CLOSED)
Practice THE SURGERY (BROOKSBY'S WALK)(CLOSED)
Practice THE SURGERY (PATEL)(CLOSED)
Practice LIVERPOOL STREET NHS WIC
Closed Practices
NHS City and Hackney- total for all practices
NHS City and Hackney- total Commissioned Services
NHS City abd Hackney Practices and Comm Services
Budget Adjustment
100.00%
Budget Setting profile Comparison tool NHS City and Hackney for FY 2013-14
Prescriber Practice ID
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Prescribe
r Code
F84624
F84060
F84008
F84038
F84072
F84601
F84080
F84720
F84015
F84719
F84021
F84003
F84117
F84035
F84711
F84621
F84635
F84033
F84041
F84013
F84716
F84036
F84668
F84063
F84685
F84632
F84119
F84692
F84096
F84105
F84640
F84018
F84619
F84043
Y03049
F84115
F84636
F84694
F84686
F84042
F84659
F84620
Y01177
Y00403
F84069
Prescriber Name
Practice ABNEY HOUSE MEDICAL CENTRE
Practice ATHENA MEDICAL CENTRE
Practice BARTON HOUSE GROUP PRACTICE
Practice BEECHWOOD MEDICAL CENTRE
Practice DE BEAUVOIR SURGERY
Practice ELSDALE STREET SURGERY
Practice FOUNTAYNE ROAD HEALTH CENTRE
Practice HEALY MEDICAL CENTRE
Practice KINGSMEAD HEALTHCARE
Practice LATIMER HEALTH CENTRE
Practice LONDON FIELDS MEDICAL CENTRE
Practice LOWER CLAPTON GROUP PRACTICE
Practice QUEENSBRIDGE GROUP PRACTICE
Practice RICHMOND ROAD MEDICAL CENTRE
Practice ROSEWOOD PRACTICE
Practice SANDRINGHAM PRACTICE
Practice SHOREDITCH PARK SURGERY
Practice SOMERFORD GROVE PRACTICE
Practice SOUTHGATE ROAD MEDICAL CENTRE
Practice STAMFORD HILL GROUP PRACTICE
Practice THE ALLERTON ROAD SURGERY
Practice THE CEDAR PRACTICE
Practice THE CLAPTON SURGERY
Practice THE DALSTON PRACTICE
Practice THE ELM PRACTICE
Practice THE GREENHOUSE WALK-IN
Practice THE HERON PRACTICE
Practice THE HOXTON SURGERY
Practice THE LAWSON PRACTICE
Practice THE LEA SURGERY
Practice THE NEAMAN PRACTICE
Practice THE NIGHTINGALE PRACTICE
Practice THE RIVERSIDE PRACTICE
Practice THE SORSBY HEALTH CENTRE
Practice THE SPRINGFIELD HEALTH CENTRE
Practice THE STATHAM GROVE SURGERY
Practice THE SURGERY (BARRETTS GROVE)
Practice THE SURGERY (BROOKE ROAD)
Practice THE SURGERY (CRANWICH ROAD)
Practice THE SURGERY (KINGSLAND ROAD)
Practice THE TOWER OF LONDON SURGERY
Practice THE WICK HEALTH CENTRE
Practice TOLLGATE LODGE PRACTICE
Practice TROWBRIDGE PRACTICE
Practice WELL STREET SURGERY
Total Forecast
Outturn at 31
March 2013 based
on Jan 2013
projection
Total Annual
Amount budget
allocated FY
2012-13
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
£
259,911.00
609,302.00
1,173,192.00
458,629.00
376,600.00
634,524.00
539,256.00
520,054.00
555,557.00
354,280.00
721,199.00
1,159,547.00
804,636.00
298,909.00
239,156.00
519,003.00
567,668.00
1,070,157.00
649,345.00
1,108,022.00
513,670.00
585,565.00
518,907.00
531,815.00
232,997.00
66,611.00
905,758.00
402,452.00
1,222,037.00
901,625.00
764,378.00
892,562.00
317,300.00
623,806.00
483,911.00
732,620.00
340,345.00
222,313.00
509,738.00
132,224.00
25,527.00
686,490.00
441,956.00
268,814.00
1,253,540.00
304,829.00
634,559.00
1,294,893.00
481,685.00
376,932.00
672,633.00
588,550.00
625,854.00
612,832.00
486,537.00
859,754.00
1,272,626.00
890,939.00
352,934.00
235,775.00
612,600.00
628,773.00
1,130,164.00
764,068.00
1,176,323.00
509,488.00
593,447.00
597,849.00
647,159.00
264,727.00
71,517.00
886,091.00
557,816.00
1,380,728.00
933,518.00
742,875.00
957,956.00
390,233.00
720,026.00
494,869.00
802,018.00
357,024.00
259,613.00
482,747.00
233,118.00
25,000.00
700,515.00
504,250.00
304,727.00
1,538,022.00
Budget based on "FairShare"
Variance (%)
14.74%
3.98%
9.40%
4.79%
0.09%
5.67%
8.38%
16.90%
9.35%
27.18%
16.12%
8.89%
9.69%
15.31%
-1.43%
15.28%
9.72%
5.31%
15.01%
5.81%
-0.82%
1.33%
13.20%
17.82%
11.99%
6.86%
-2.22%
27.85%
11.49%
3.42%
-2.89%
6.83%
18.69%
13.36%
2.21%
8.65%
4.67%
14.37%
-5.59%
43.28%
-2.11%
2.00%
12.35%
11.79%
18.50%
Value of
Variance in
(£'s)
£ 44,918.00
£ 25,257.00
£121,701.00
£ 23,056.00
£
332.00
£ 38,109.00
£ 49,294.00
£105,800.00
£ 57,275.00
£132,257.00
£138,555.00
£113,079.00
£ 86,303.00
£ 54,025.00
-£ 3,381.00
£ 93,597.00
£ 61,105.00
£ 60,007.00
£114,723.00
£ 68,301.00
-£ 4,182.00
£ 7,882.00
£ 78,942.00
£115,344.00
£ 31,730.00
£ 4,906.00
-£ 19,667.00
£155,364.00
£158,691.00
£ 31,893.00
-£ 21,503.00
£ 65,394.00
£ 72,933.00
£ 96,220.00
£ 10,958.00
£ 69,398.00
£ 16,679.00
£ 37,300.00
-£ 26,991.00
£100,894.00
-£
527.00
£ 14,025.00
£ 62,294.00
£ 35,913.00
£284,482.00
Budget with HCD's
and 5% uplift as % Change
"FairShare"
between
Budget
and
Cost Per
Outtturn Astro PU Astro PU
£295,494.57
13.69% 14663.6
£20.15
£531,393.90 -12.79% 23609.7
£22.51
£1,196,742.00
2.01%
53285
£22.46
£360,025.07 -21.50% 16733.2
£21.52
£453,414.43
20.40% 19374.6
£23.40
£550,073.95 -13.31% 22910.1
£24.01
£494,719.57
-8.26% 22702.8
£21.79
£599,493.24
15.28% 26612.1
£22.53
£551,172.02
-0.79% 25641.2
£21.50
£445,332.36
25.70% 22048.9
£20.20
£831,396.54
15.28% 34930.1
£23.80
£1,167,160.88
0.66% 50524.3
£23.10
£806,629.25
0.25%
38050
£21.20
£368,208.17
23.18% 17063.1
£21.58
£189,128.08 -20.92%
9144.8
£20.68
£495,275.48
-4.57% 19446.8
£25.47
£698,271.85
23.01% 27230.2
£25.64
£1,076,573.97
0.60% 46159.1
£23.32
£631,819.34
-2.70% 31641.6
£19.97
£1,220,947.72
10.19% 48118.6
£25.37
£439,664.39 -14.41% 17340.1
£25.36
£637,814.24
8.92% 27963.6
£22.81
£595,453.43
14.75%
22896
£26.01
£699,984.47
31.62% 31156.2
£22.47
£258,499.67
10.95%
12487
£20.70
£86,436.28
29.76%
3807
£22.70
£857,990.80
-5.27% 39908.6
£21.50
£538,074.64
33.70% 22802.8
£23.60
£1,156,936.75
-5.33% 47429.4
£24.39
£1,019,262.58
13.05% 44038.9
£23.14
£819,795.18
7.25% 47450.1
£17.28
£914,519.78
2.46% 37784.5
£24.20
£402,499.47
26.85% 16580.8
£24.28
£536,422.65 -14.01% 24182.9
£22.18
£526,978.37
8.90% 22566.5
£23.35
£736,099.58
0.47% 34666.4
£21.23
£341,560.75
0.36% 15724.3
£21.72
£275,478.26
23.91% 12651.2
£21.77
£517,491.28
1.52% 17798.2
£29.08
£225,700.08
70.70% 11354.9
£19.88
£172,520.38 575.83%
410.6 £420.17
£562,208.08 -18.10% 26504.3
£21.21
£597,926.41
35.29% 25450.8
£23.49
£376,930.57
40.22% 14060.3
£26.81
£1,245,348.50
-0.65% 54788.1
£22.73
Proposed
2013/14 Budget
capped and
uplifted
Cap to
apply
0.00%
-6.39%
0.00%
-10.75%
15.00%
-6.65%
-4.13%
15.00%
-0.39%
15.00%
15.00%
0.00%
0.00%
15.00%
-10.46%
-2.29%
15.00%
0.00%
-1.35%
0.00%
-7.20%
0.00%
0.00%
15.00%
0.00%
15.00%
-2.64%
15.00%
-2.66%
0.00%
0.00%
0.00%
15.00%
-7.00%
0.00%
0.00%
0.00%
15.00%
0.00%
15.00%
5.00%
-9.05%
15.00%
15.00%
-0.33%
£295,494.57
£570,347.95
£1,196,742.00
£409,327.04
£433,090.00
£592,298.98
£516,987.78
£598,062.10
£553,364.51
£407,422.00
£829,378.85
£1,167,160.88
£806,629.25
£343,745.35
£214,142.04
£507,139.24
£652,818.20
£1,076,573.97
£640,582.17
£1,220,947.72
£476,667.19
£637,814.24
£595,453.43
£611,587.25
£258,499.67
£76,602.65
£881,874.40
£462,819.80
£1,189,486.87
£1,019,262.58
£819,795.18
£914,519.78
£364,895.00
£580,114.33
£526,978.37
£736,099.58
£341,560.75
£255,659.95
£517,491.28
£152,057.60
£26,803.35
£624,349.04
£508,249.40
£309,136.10
£1,249,444.25
% Change
between
capped
Budget
and
Outtturn
13.69%
-6.39%
2.01%
-10.75%
15.00%
-6.65%
-4.13%
15.00%
-0.39%
15.00%
15.00%
0.66%
0.25%
15.00%
-10.46%
-2.29%
15.00%
0.60%
-1.35%
10.19%
-7.20%
8.92%
14.75%
15.00%
10.95%
15.00%
-2.64%
15.00%
-2.66%
13.05%
7.25%
2.46%
15.00%
-7.00%
8.90%
0.47%
0.36%
15.00%
1.52%
15.00%
5.00%
-9.05%
15.00%
15.00%
-0.33%
Commissioned Services
Total for All Practices
Total for Commissioned
Services
Total Gp and Commissioned
Services
NHS City and Hackney- total for all practices
£
NHS City and Hackney- total Commissioned Services
£
NHS City abd Hackney Practices and Comm Services
£
26,195,908.00
9.54%
£27,504,868.96
5.00%
226,251.00
31.17%
£161,042.96
3.41%
£
26,413,713.00
£ 29,184,844.00
9.50%
£27,665,911.92
4.74%
£ 27,375,165.73
£ 27,788,000.00
155,730.00
£ 28,958,593.00
£
1201693
£22.89
£ 27,169,476.63
205,689.10
Financial Envelope for FY 2013-14
Budget Envelope
Total GP and Commissioned
Services
Proposed GP Prescribing Budget for 2013-14
£
27,788,000.00
Matrix proposed Budget with Uplift on FS
£
26,413,713.00
Non Allocated Funds
Difference Between Budget and Budget Envlope
£
1,374,287.00
£ 27,788,000.00
£27,665,911.92
£
122,088.08
£ 27,788,000.00
£ 27,375,165.73
£
412,834.27
St Joseph’s Hospice Business Case
•
•
•
•
•
•
It is recommended that St Josephs Hospice (SJH) is awarded a single tender
for one year until March 2014;
The SJH contract ends on 31st March 2013 and requires contract stabilisation
in order to meet the commissioners’ expectations;
Community Specialist Palliative Care Service (an element of SJH core service)
requires a standard tender approach based on a choice of local providers in
the area; however, a 12-month period is necessary to re-design the care model
and test the market;
SJH is the only provider in the local area of inpatient palliative care to complex
needs patients. This presents a limited choice of specialist providers to
patients in the community;
A single tender award allows time to re-design care model of Community
Specialist Palliative Care with a view to proceed to a standard tender process
by March 2014. A single tender award for the Inpatient Service is the only cost
effective solution based on a limited choice of providers in the local area;
Newham contracting team is leading on the contract negotiation process with
the provider to ensure that 2013/14 contract is signed off by the leading and
associate commissioners by 31st March 2013.
BUSINESS CASE
Service Description:
Tender Code Number:
St Joseph’s Hospice
Proposed Procurement Method:
Community
Specialist
Palliative
Care Single Tender Award until 31 March 2014
Provision for patients with palliative and end
of life care needs for City and Hackney,
Tower Hamlets, Newham and Waltham
Forest
Anticipated Annual Spend: : £6,932,873
(Newham, City & Hackney, Tower Hamlets,
Waltham Forest, Redbridge)
Annual Budget: £7,172,086
(Newham, City & Hackney, Tower Hamlets,
Waltham Forest, Redbridge)
Author:
Anetta Toudji / Caroline Gilmartin
Organisation:
NHS North East London and the City
1
Introduction
St Joseph’s Hospice is a well-established charity that has been providing services in the
community since 1905. The provider relies on 35-56% of its income coming from NHS. The
Hospice is an active fund raiser and a well-respected charitable organisation in London.
St Joseph’s Hospice (SJH) provides community specialist palliative care in East London and City
(ELC) for high complex needs adults at the end of their lives. The Hospice goes beyond the
essential pain and symptom control and enables patient access to social workers,
physiotherapists, complementary therapists and members of the chaplaincy team – taking into
account patients and families’ psychological, social and spiritual needs as well their physical
needs.
The service strategic drive is for every adult patient with a life-limiting or life-threatening
condition to have access to high-quality, family-centred, sustainable care and support. This
aligns with the Department of Health (2008) Better Care: Better Lives program to provide patient
choice to the local population.
With the contract coming to an end in March 2013, it is being requested that a single tender
award is agreed for a year followed by a waiver process signed off by the CCGs. This is mainly
requested based on: local access to patients and 12-months period that allows preparing for an
open procurement with regards to specialist palliative care currently as part of the core service
provided by SJH.
2
National & Local Strategic Context
A number of national initiatives and policies were identified that directly affect the provision of the
service:
•
•
•
•
•
•
•
Department of Health (2008) Better Care: Better Lives;
Department of Health, (2008), End of Life Care Strategy;
Department of Health, (2009), End of Life Care Quality Markers;
NICE Guidance for Improving Supportive and Palliative Care for Adults with Cancer,
(2004);
NICE Guidance for Improving Supportive and Palliative Care for Adults with Cancer
(2004);
NHS London A Framework for London (2007);
The Department of Health, End of Life Care Strategy: Quality Markers and Measures for
End of Life Care (2008).
3
Current Context
3.1
Activity
In 2012/13, SJH is expected to provide service to 1,354 patients in ELC/ONEL, which is 5%
increase from the last year. All CCGs individual patient activity is projected to increase from the
last year with the most noticeable increase in Newham at 8% (Table 1).
Table 1: St Joseph’s Hospice patient activity in 2011/12-2012/13
2011/12
2012/13
Tower Hamlets
399
411
City & Hackney
456
478
Newham
407
440
Waltham Forest
17
18
6
1,285
7
1,354
Redbridge
Total
3.2
Spend and Service Cost
It’s anticipated that in 2012/13, TH, C&H and Newham CCGs will meet the expected contract
values due to SJH’s ability to cover the remaining cost of the service. Waltham Forest CCG is
expected to have a marginal underspend; while Redbridge CCG allocations continue to be
underutilised. Table 2 shows spend for 2012/13 compared to the year before.
Table 2: St Joseph's Hospice spend in 2011/12-2012/13
2011/12
2012/13*
Actual
spend
Contract value
Variance
Actual
spend
Contract
value
Variance
Tower Hamlets
£2,701,214
£2,701,214
£0
£2,701,214
£2,701,214
£0
City & Hackney
£2,106,051
£2,106,051
£0
£2,106,051
£2,106,051
£0
Newham
£2,125,608
£2,125,608
£0
£2,125,608
£2,125,608
£0
£179,095
£190,394
£11,299
£189,630
£190,394
£764
£63,210
£128,556
£65,346
£52,675
£128,556
£75,881
Waltham Forest
Redbridge
Total
£7,175,178
£7,251,823
£76,645
£7,175,178 £7,251,823 £76,645
* 2012/13 values were projected for year-end based on average monthly activity data to 31st Dec 2012
The provider’s contributions to the cost of the service are between 35-56% through the
independent fundraising that the Hospice undertakes. The SJH’s pension contributions
historically paid by the NHS have ceased and the commissioners contribute only to the cost of
the core service.
3.3
Quality
In 2012/13, SJH had no Serious Incidents to date. And the provider met the CQC essential
standards of quality and safety at the point of recent routine inspection dated January 2013.
The Hospice patient survey in 2010/11 undertaken by an independent research unit of University
of Kent found that SJH provides services that meet the patients and their families’ satisfaction.
The patients were highly complementary about both inpatient and outpatient services
commissioned from the provider. The 2012/13 patient satisfaction survey have been undertaken
and the findings will be submitted to the commissioners in due time.
3.4
Contract
Current NHS Standard Contract expires on 31st March 2013. The contract is a multilateral
agreement between the Tower Hamlets, City & Hackney, Newham, Waltham Forest, Redbridge
PCTs and SJH. A single tender award is being requested for one year until March 2014. The
process will need to be followed by a waiver on behalf of the relevant CCGs.
It is proposed that the 2013/14 contract terms / conditions and values should remain the same
for Tower Hamlets, City & Hackney and Newham. Waltham Forest and Redbridge CCGs are
proposing, although, these arrangements have to be formalised, that they will not continue with
the block contract arrangements in 2013/14 due to the underutilisation of their current funding
but would prefer an option of spot purchase. The Newham CCG, as the lead commissioner is
expected to lead the process on behalf of the associates.
In addition, it is proposed that a year contract award will allow for the following to take place:
•
Community Specialist Palliative Care Service – to extend the current contract by 12
months, at current cost, with a view to service re-design and market testing (in line with
their standing financial instructions).
During 2013/14 Newham, Tower Hamlets and City and Hackney CCG’s will undertake a
procurement exercise for the community specialist palliative care service. This is
intended to be implemented via an open and transparent procurement process and the
ELC CCGs will develop new models of care at the first half of 2013/14.
•
4
Inpatient Service – Newham, City and Hackney and Tower Hamlets CCG’s to extent the
current contract by 12 months, at the current costs, to enable future commissioning
arrangements to be made.
Current Service Provision
The aim of the service is to provide high quality specialist palliative care that includes:
• Expert assessment, advise, care and support for patients and cares with complex needs
including physical, social, psychological/emotional and spiritual care;
• Expert assessment, advise, support and education for health and social care staff caring
for patients with palliative and end of life care needs;
• Support to all staff to deliver palliative and end of life care in line with best practice
guidelines;
• Improvement to the quality of care to all patients which respects their wishes in regard to
their preferred place of care and death.
SJH provides the following services to the local population in ELC / ONEL:
In-Patient Specialist Palliative Care Service: available to patients with complex problems that
cannot be managed adequately in other community settings and who would benefit from the
continuous support of a multi-disciplinary specialist palliative care team. The service provides:
• Assessment of need in the last days of life and provision of care using Liverpool Care
Pathway principles;
• Provision of medical interventions to manage complex symptoms using a variety of
interventions;
• Provision of bereavement care to families and carers after a death in the in-patient unit;
• Provision of medication.
Community Specialist Palliative Care Service that covers:
• Provision of expert clinical advice to GPs and community health care staff including
attending GP based GSF/palliative care meetings;
• Provision of expert clinical advice to care homes, community hospital and mental health
units;
• Provision of expert clinical advice and training to community health and social care staff;
• Provision of out-patient clinic/review in the community setting;
• Provision of bereavement care to families and carers.
Day Care Specialist Palliative Care Service that includes:
• Provision of day care to prevent hospital admission;
• Provision of ongoing information to empower patients and family to make informed
choices and signpost to services;
• Support to patients providing effective symptom control to enable them to remain at
home and achieve quality in their life;
• Provision of carers respite from their caring activities;
• Provision of bereavement care to families and carers.
5
Stakeholder Engagement
The relevant stakeholder engagement would need to include Tower Hamlets, City & Hackney,
Newham, Waltham Forest and Redbridge CCGs.
6
Actions Already Underway
The provider has been informally informed of the possible route. Further work is required to
discuss with the CCG’s.
7
Expected Benefits from this Process
7.1
Financial
It is estimated that the commissioners are likely to make £1.4m of cost savings in a year having
SJH providing the specialist palliative care service in the community (Table 3). An assumption
was made that the complex needs patients could be managed alternatively in a specialist acute
hospital at a conservative bed day unit cost of £459 (the price doesn’t not include the crises
management). The average length of stay at SJH is currently 14 days.
Table 4: SJH potential cost savings in a year based on 2012/13 activity
Tower Hamlets
No
Patients
411
City & Hackney
478
Newham
440
Waltham Forest
18
Redbridge
7
Total
1,354
of
SJH
Days
Bed
Acute Provider Cost
at £459/bed day*
Variance
£2,641,086
SJH Cost
£2,701,214
£3,071,628
£2,106,051
£965,577
£2,827,440
£2,125,608
£701,832
252
£115,668
£190,394
-£74,726
98
£44,982
£128,556
-£83,574
18,956
£8,700,804
£7,251,823
£1,448,981
5,754
6,692
6,160
-£60,128
*National Schedule of Reference Costs (2011-12) NHS trusts and NHS foundation trusts
Specialist Palliative Care: Inpatient (19 years and over)
7.2
Non-Financial
The service in the community delivers the following benefits:
• Provision of specialist palliative care to the patients and their families in ELC and ONEL;
• Provision of local access to specialised services for the patients and their families;
• Delivery of patient choice in the community in the provider landscape that poses
limitations on the choice and quality of providers available;
• Holistic service offered by the provider that encompasses the clinical, social, economic
and cultural aspects of the patients and their families;
• CCG’s ability to meet the requirements of NHS Commissioning Board (2012) Everyone
Counts: Planning for Patients 2013/14; and, The CCG Outcomes Indicator Set 2013/14;
and, Department of Health (2008) Better Care: Better Lives
8
Options Appraisal
8.1 Option 1 – Do nothing
Advantages
1.
2.
Disadvantages
Not having NHS Standard Contract with the provider
exposes the commissioners to a risk of destabilising
the contract and a weak position to be able to
performance review a specialist service in the
community. This presents a significant risk to high
complex needs patients treated by the Hospice.
Current contract is based on a block contract
arrangement and exposes Waltham Forest and
Redbridge commissioners to poor value for money
situation based on the activity levels to date.
Summary: - The contract ends in March 2013 and the option is not viable due to a level of
risk to commissioners and patients.
8.2
Option 2 – Standard Tender process
Advantages
1.
Disadvantages
The commissioners run out of time to deliver
A tender process would ensure a procurement by March 2013 and a 12-month period
contract stabilisation.
is required to re-design the care model and
implement an open procurement process.
Summary: - The commissioners run out of time to deliver a standard tender process and a
longer time is required.
8.3
1.
2.
3.
4.
Option 3 – Single Tender Award
Advantages
Stabilisation of palliative care contract and
commissioners’ ability to performance review
the service and care pathways.
Continuity of specialist palliative care to the
ELC / ONEL patients with a local access to
service.
Allowing for a 12-month period to re-design and
market test Community Specialist Palliative
Care Service; and, to undertake a procurement
exercise for this element of core service.
Currently, there are a few providers in the local
area that will be able to provide specialist
palliative care in the community.
SJH is the only provider in the area that can
deliver Inpatient Service and the single tender
award is a cost effective solution.
Disadvantages
Summary: - A single tender award allows time to re-design care model of Community
Specialist Palliative Care with a view to proceed to a standard tender process by March
2014. A single tender award for the Inpatient Service is the only cost effective solution
based on a limited choice of providers in the local area.
9
Preferred & Recommended Option
Based on the financial, non-financial benefits and options appraisals, it is recommended that
SJH is awarded a single tender for one year until March 2014. Principally, this is based on the
following:
•
•
•
•
10
The SJH contract ends on 31st March 2013 and requires contract stabilisation in order to
meet the commissioners’ expectations.
Community Specialist Palliative Care Service (an element of SJH core service) requires
a standard tender approach based on a choice of local providers in the area; however, a
12-month period is necessary to re-design the care model and test the market.
SJH is the only provider in the local area of inpatient palliative care to complex needs
patients. This presents a limited choice of specialist providers to patients in the
community.
A year contract would ensure stabilisation of the provider whose income depends on the
fund raising sources, which poses a risk in the current climate of economic downturn.
Tracking of Progress against Agreed Actions
Newham contracting team is leading on the contract negotiation process with the provider to
ensure that 2013/14 contract is signed off by the leading and associate commissioners by 31st
March 2013.
.
CS010
Request for Waiver of Standing Orders
PCT CC3: City & Hackney
SECTION 1: NOTES
1.1
This form is to be completed in all circumstances where the competitive quotation/tendering
procedures required under the Trust’s Standing Orders are to be waived.
1.2
All sections of the form must be completed in full by the Consortium Procurement Manager
and/or requisitioning officer before submitting for approval to an authorising officer.
1.3
The authorised waiver form should be forwarded to the Consortium Procurement Department to
enable the order to be raised.
SECTION 2: DETAILS OF REQUEST
Department
NELC Commissioning Support Service, Newham Contracting
Requisition Number
Requisition Date
Requisitioning Officer
Anetta Toudji
Description of goods
Community Specialist Palliative Care Provision for patients with
palliative and end of life care needs
Or services requested
Supplier
28/02/2013
Net Value
Purchase Value
St Joseph’s Hospice
VAT
£
Total Value
£2,106,051
SECTION 3: INFORMATION TO SUPPORT WAIVER REQUEST
It is recommended that St Joseph’s Hospice is awarded a single tender for one year until
March 2014 due to the following:
st
 The SJH contract ends on 31 March 2013 and requires contract stabilisation.
 Community Specialist Palliative Care Service requires a standard tender approach;
however, a 12-month period is necessary to re-design the care model and test the
market.
 SJH is the only provider in the local area of inpatient palliative care to complex needs
patients.
 A year contract would ensure stabilisation of the provider whose income depends on
the fund raising sources, which poses a risk in the current climate of economic
downturn.
SECTION 4: SUBMISSION OF WAIVER REQUEST
Request submitted by: Anetta Toudji
Signature: …………………………………………
Date: 05/03/2013
SECTION 5: APPROVAL OF WAIVER REQUEST
Request approved by: ………………………………
Designation: Director of Finance
Signature: …………………………………………
Date: …………………
…….
April 2013 CSU Quarterly Quality Report
•
•
The CCG Board is asked to note the Quarter
Four 2012/13 report on quality at the three main
providers which has been produced by the
Commissioning Support Unit;
Future Quality Reports will provide information
on clinical quality across all services
commissioned by the CCG for City and Hackney
patients.
Quality and Clinical Governance Report of the City and Hackney CCG Board
Executive Summary
This paper provides a quarterly borough-focused Quality and Clinical Governance Report, with collated information
for the major services commissioned in City and Hackney.
This report covers Homerton University Hospital Foundation NHS Trust (HUHFT) for the period 1 January 2013 – 31
March 2013, i.e. Quarter 4 2012/13(where information is available). Information for ELFT and BLT is also provided.
Key areas to note in this paper are outlined below:
Homerton:
• Infection Control – C. Diff: Homerton reported two cases in Quarter 4 12/13, for a year-end total of 13,
exceeding its maximum annual tolerance of 7.
• Infection Control – MRSA – Homerton reported no MRSAs in Quarter 4 2012/13, for a year-end total of 2,
exceeding its maximum tolerance of 1.
• Key Performance Indicators for Serious Incident (SI) reporting: the Trust Serious Incident reporting rate has
reduced since the previous quarter. Although Homerton has a high number of incidents open past their due
date, the Trust has reduced the backlog significantly in Quarter 4 12/13.
• A Lead Nurse has been appointed to lead on learning disabilities and mental health care
• CQC made an unannounced inspection of the Mary Seacole Nursing Home in Jan 2013 and assessed 6
standards, all of which were compliant
• Trust’s audit of fractured neck of femur – showed practice was not compliant with NICE and changes have been
made including appointment of a second consultant covering Orthogeriatrics in Oct 2012
ELFT:
•
•
ELFT has become the first Mental Health Trust with community services in England to achieve a level 3 risk rating
(the highest) from the NHSLA; they were assessed against 50 standards.
The Independent Enquiry relating to the homicide at the Tower Hamlets Centre for Mental Health was published
in Q4 and the action plan is being discussed at City and Hackney CCG Board meeting on 26 April 2013
Bart’s Health - BLT legacy Trust:
•
•
•
•
•
MRSA bacteraemia rates – no new MRSA reported in quarter 4; annual tolerance of 6 MRSA cases has been
breached: 9 MRSA cases have been reported to the end of 2012-13
Serious Incident (SI) Management: Barts Health overall (all three sites) had a combined total of 82 incidents
overdue at the end of March 2013, of which approximately 30 cases belong to BLT site.
NPSA Incident Reporting rates – Barts Health incident reporting rates for March 2012-September 2012 show it is
among lowest 25% reporters, a deterioration from BLT’s previous status among top 25%.
VTE risk assessment – the Trust exceeded 90% target for assessment in February, reversing the downward trend
of the previous two months. March data not yet available.
Mixed Sex Accommodation breaches – 374 breaches were reported in quarter 4 2012/13 by the legacy Barts
and the London sites
HOMERTON UNIVERSITY HOSPITAL FOUNDATION NHS TRUST
1
Patient Safety
1.1 Health Care Acquired Infections
1.1.1
MRSA target compliance
HUHT apportioned cases: 2 cases were reported in quarter 4 12/13, bringing the year-end total to 2 against the
annual tolerance of a maximum of one case.
One new case was reported early April 2013 against an annual tolerance of 0. A new process for investigating root
cause was introduced in April 2013 called Post Infection Review (PIR) meeting and has taken place, involving City and
Hackney CCG (where the patient was resident) although the Trust should have invited the CCG covering the GP
Practice that the patient was registered with (Haringey). This mismatch is being addressed. The PIR report has not
yet been completed.
1.1.2 C. Diff target compliance
HUHT apportioned cases HUHT has an annual 12/13 tolerance of a maximum of seven cases. Year End = 13 cases.
ACTION: The Q3 Infection Control Quarterly Report is on the CQRM agenda for April 2013.
1.2 Serious Incidents (SIs)
HUHT reported 12 new Serious Incidents (SIs) as having occurred in quarter 4 of FY 2012-13 (January – March 2013).
This is a 50% decrease from the previous quarter; this drop in reporting will be picked up during a CQRM. The table
below shows the numbers and types of incidents reported as having occurred over the past four quarters (1st April
2012 – 31st March 2013). The table is organised and colour-coded to highlight the most frequently-reported incident
types.
1st
2nd
3rd
4th
5th
Indicident Types
Maternity Services - Unexpected admission to NICU
Q1 12/13
Q2 12/13
4
Pressure Ulcer Grade 3
Q3 12/13
Q4 12/13
3
3
5
15
5
4
4
13
1
1
1
1
3
2
1
7
Abscond
Maternity Services - Unexpected neonatal death
1
Pressure ulcer Grade 4
2
2
Allegation against HC Non-Professional
Surgical Error
Other
1
1
2
3
1
1
1
1
Communicable Disease and Infection Issue
Attempted Suicide by Inpatient (not in receipt)
Pressure Ulcer - (Grade 3 or 4)
Grand Total
1
1
1
1
1
C.Diff & Health Care Acquired Infections
3
3
Allegation Against HC Professional (assault)
1
1
Child Death
1
Serious Self Inflicted Injury Outpatient
1
1
Delayed diagnosis
Radiology/Scanning incident
1
Maternity service
1
Slips/Trips/Falls
2
Venous Thromboembolism (VTE)
1
Maternity Services - Suspension of maternity services
Grand Total
15
1
1
1
Maternity Services - Intrapartum death
Maternity Services - Maternal unplanned admission to ITU
1
1
3
5
1
1
1
1
1
2
1
1
16
23
12
66
*pressure ulcers reported by an organisation are not necessarily acquired while under the care of that organisation; some may have been
acquired elsewhere. Those pressure ulcers acquired elsewhere will be de-escalated or closed without a report.
1.2.1
Key Performance Indicators (KPIs) for SI reporting
KPI 1: The national target for reporting of SIs is two working days.
The graph below shows the average number of working days between the date the incident occurred and the date it
was reported to NHS London and NHS NELC. The Trust’s performance on this KPI has improved this year, but this is
in the context of reduced reporting overall.
KPI 1: 2 working days to report SIs
KPI 2: The target for completing SI investigation reports is 45 working days; NHS NELC calculates and reports on this
KPI for foundation Trusts.
The graph below shows the average number of days it has taken for this Trust to complete and submit investigation
reports over the past four quarters (those investigations which are still ongoing are not included in the graph). The
Trust has been working on improving the quality of their investigation reports, rather than to meet this KPI, although
the emphasis has now been extended toward timeliness of investigations, in order to transfer as few overdue SIs in
the transition handover from PCTs to CCG.
average number of days to complete investigation report
1.2.2
NHS ELC / HUHT Quality Assurance feedback process
NHS NELC’s Quality and Clinical Governance team has been working with the Homerton’s risk management leads
and has implemented a system for NELC to feed back to the Trust the outcome of its quality assurance of the
investigation reports and associated action plan.
The Trust has 72 SIs open on StEIS, (the Department of Health Serious Incident management database), of which, 60
have due dates for submission of the final investigation report prior to 31 March 2013. The table below shows a
breakdown for the status of these open reports.
Report Status
not yet received
Received and being reviewed
Received, reviewed and fed back
Grand Total
Current
quarter
14
41
5
60
Previous
quarter
30
20
18
68
CSU’s safety manager has been working with the Trust to reduce the number of outstanding reports; as a result of
agreeing a recover plan, there has been a 50% reduction in the “not yet received” category. CSU is currently in the
process of reviewing 22 reports received on 27th March. A maternity workshop is planned for April, to feedback the
outcome of the quality assurance review of the maternity reports, and will be attended by the CSU’s maternity
clinical specialist expertise lead.
1.2.3
Never Events
HUHT did not report any Never Events in quarter 4, bringing the year-end total to 2 (4 were reported in 2011/12).
1.3 National Patient Safety Agency Incident Reporting Rates
All NHS organisations are required to report all incidents which affect patient to the National Reporting and Learning
System (NRLS). Responsibility for the NRLS transferred to the NHS Commissioning Board in July 2012. Reports are
published every 6 months, and the data within the report represent incidents reported between 6-12 months prior
to publication.
The most recent reports were published in March 2013. The report provides benchmarking data for patient safety
incident reporting rates, severity of harm arising from incidents and categories of incidents for incidents reported
over the period of 1st April 2012 to 30th September 2012.
Analysis of data shows that organisations with the most robust safety cultures report approximately 10 incidents per
100 admissions, which means that the higher the reporting rate, the better the safety culture.
The graph below shows the trends in incident reporting rates by this Trust since the first release, compared to other,
similar Trusts, i.e. 28 other small acute organisations.
The recently reported data indicates an increase in reporting rates from 7.2 in March 2012 to 8.0 in September 2012
(March 2013 report; represented by the blue columns in the graph below).
NPSA Incident Reporting Rates (HUHT)
15.0
14.0
13.0
12.0
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
5.47
6.1
Sep-08
5.3
5
4.6
5.2
Mar-09
Sep-09
HUHT's reporting rate
5.5
5.6
7.2
6.5
Mar-10
Sep-10
7.2
6.2
6.5
7.6
7.9
7.8
8.0
Mar-11
Sep-11
Mar-12
Sep-12
Similar Trusts' Median Reporting Rate
6.5
Target
When reviewing incident rates, it is also important to examine the split between the degree of harm arising from the
incident. Ideally, we are looking to see approximately 10 incidents per 100 admissions (Homerton reported 8.0 in
the most recent report); 95.8% resulting in no or low harm, compared to 92.2% for all small acute organisations (as
demonstrated in the graph below).
Nationally, 67 per cent of incidents are reported as no harm, and just under 1 per cent as severe harm or death.
However, not all organisations apply the national coding of degree of harm in a consistent way, which can make
comparison of harm profiles of organisations difficult.
Graph shows how Homerton compares against 28 other small acute organisations for the split between the degree
of harm.
Incidents reported by degree of harm: Homerton
90
80
70
60
percentage of incidents occuring
Homerton
50
40
percentage of incidents occuring
All Small Acutes
30
20
10
0
None
Low
Moderate
Severe
Death
1.4 Child and adult safeguarding
There have been no safeguarding reports provided by HUH from December to March 2013. A Domestic Homicide
Case is currently under investigation in City and Hackney which may have implications for HUH.
1.4.1
Homerton Foundation Trust Capability
The Homerton reported in their December 2012 Quality Report that 98% of all Trust staff have had
safeguarding adults training and that a Lead Nurse has now been appointed to lead on learning disabilities
and mental health care
Safeguarding children's training:
Level one – 99%
Level 2 – 81%
Level 3 – 87%
The Target is 80% for each category so they remain below target for level 2 training.
1.4.2
Homerton Safeguarding Governance
•
HUHT have an action plan in place in response to the CQC recommendations from the Ofsted/CQC
Safeguarding and Looked after Children inspection of London Borough of Hackney.
•
This can be reported on when HUH provide their next safeguarding report.
Self-Assessment Assurance Framework (SAAF) 2012: NELC undertook an exercise for NHS London reviewing the
arrangements in the cluster for safeguarding adults. The process known as SAAF Safeguarding Adults SelfAssessment Assurance Framework was completed at the end of 2012. The SAAF allowed providers and
commissioners to benchmark their safeguarding adult’s arrangements within five domains: Strategy, prevention,
workforce, partnerships and commissioning.
HUHT completed and submitted SAAF’s to commissioners for validation. HUHT self-assessed itself as “effective” on
the majority of standards. The following standards were rated as “working towards”:
•
•
•
2.7 Services can demonstrate patient/user led decisions about their safeguarding and that interventions are
person centred
3.4 The service provides supervision and support for staff involved in safeguarding adults procedures.
3.6 The service safeguards adults by addressing staff performance concerns.
Validation and action plans were received by NHS London in December 2012 and the local Safeguarding Adult Board
(SAB) approved and gave feedback on the process and results. Provider Action Plans will be monitored internally and
by the local SAB Further information is available on request.
1.5 CQC inspection of the Mary Seacole Nursing Home, 39 Nuttall Street, N1 5LZ on 8 January 2013
In relation to safeguarding the CQC reported that:
1.6 CQC Mortality Alert: Chronic obstructive pulmonary disease and bronchiectasis
The CQC asked Homerton to respond to an alert regarding raised mortality rates for patients admitted with chronic
obstructive pulmonary disease and bronchiectasis at the Trust. This alert was discussed on 10 January 2013 at the
CQRM where the Medical Director, Dr John Coakley, advised that the CQC accepted the data related reasons the
Trust gave for the COPD mortality alert; patients had COPD but COPD was not the cause of death. The Medical
Director advised that the CQC final response was received in January 2013 and the Trust has been advised that the
Alert is now closed.
1.7 Central Alert Systems (CAS)
HUHT has no overdue CAS alerts on the DH CAS system (including CHS) for the period up to 31 March 2013. However
at the Patient Safety Committee Meeting held on 4 April 2013 the Trust reported it has two CAS alerts open
internally on their risk register since November 11 and April 2012: see below.
2
Patient Experience
2.1 Eliminating Mixed Sex Accommodation
No reported breaches at HUHT since July 2011. HUHT has published a declaration of compliance for 12/13.
2.2 Formal Complaints
The Trust reported a total of 169 clinical complaints at the end of Q3 as well as 628 PALS queries.
3
Effectiveness of Care
3.1 Commissioning for Quality and Innovation (CQUIN)
CQUIN Report Quarter 3 2012/13
Report CQUIN
Description
Due Q3 Indicator Name
Target
Current
Trust
Progress
Requirement CQUIN %
Met for
achievem
Quarter 3
ent
ACUTE INDICATORS
90% Oct: 90.49% Yes
Percentage of adult inpatients with
Nov: 91.01%
VTE assessment on admission to
Dec: 91.8
hospital recorded on EPR System.
Yes
1a. VTE
assessment
Yes
1b. VTE
prophylaxis
% of audited adult patients having
a documented VTE risk
assessment who receive
appropriate prophylaxis based on
national guidance.
Q2 – 40%
Q3 – 60%
Q4 – 90%
July 64.4% Yes
August
61.6%
September
60.9%
October 86%
November
73%
December
60%
0.88%
Achieved
Yes
1c. VTE RCA
Root cause analysis of every case
of hospital-acquired VTE.
80% Yes
0.88%
Achieved
Yes
3a. Dementia
Screening
Q2:
establish
baseline
and agree
trajectory
for Q3, &
Q4
90%
Yes
Yes
% of all patients aged 75 and
above admitted as emergency
inpatients who are asked the
dementia case finding question
within 72 hours of admission or
who have a clinical diagnosis of
delirium on initial assessment or
known diagnosis of dementia.
3b. Dementia
% of all patients aged 75 and
Risk
above admitted as emergency
assessment
inpatients who have scored
positively on the case finding
question, or who have a clinical
diagnosis of delirium and who do
not fall into the exemption
categories reported as having had
a dementia diagnostic assessment
including investigations.
3c. Referral for % of all patients aged 75 and
Specialist
above, admitted as an emergency
diagnosis
inpatient who have had a
diagnostic assessment (in whom
the outcome is either “positive” or
“inconclusive” who are referred for
further diagnostic advice/follow up.
1.88%
Achieved
October:21 No
%
November:3
3%
December:4
8%
1.14%
Not
achieved
90%
October:21 No
%
November:3
3%
December:4
8%
1.14%
Not
achieved
90%
TBC No
although
not met due
to above
percentages
1.14%
Not
achieved
Report CQUIN
Description
Due Q3 Indicator Name
Yes
4. Safety
Thermometer
Yes –
baselin
e in Q2
6. Older
People’s
Nutrition
Experience
Target
Current
Trust
Progress
October:100
A completed Safety Thermometer Three
%
survey for all relevant patients
consecutiv
must be included for each month in e quarterly November:1
00%
the relevant quarter’s submission
submissio
December:1
to trigger payment.
ns of
00%
monthly
Q3:
survey
data
(partial
payments
for either
one or two
quarters of
three
consecutiv
e monthly
submissio
ns)
Target for
Q3:
Improving the nutritional
Q3:
Question 1
experience of over 75s
(all three
12%
targets
Q1 Baseline results (20.06.12)
Question 2
Q1: % did not get help needed to eat
must be
3%
meal: 35%
achieved)
Question 3
Q2: % not offered enough to drink: 4% Q1: <20%
79%
Q3: MUST assessment in 24hrs: 69%
Requirement
Met for
Quarter 3
Yes, subject
to verifying
the bed base
and activity.
CQUIN %
achievem
ent
3.42%
Yes
N/A
Q2: <5%
Q3: >=75%
COMMUNITY INDICATORS
Yes
2. Safety
Thermometer
Yes
3b. 0-5
Pathway:
Increase data
completeness
for all HV
teams for all
elements of 05 pathway
A completed Safety Thermometer
Three October:<10 Monthly data
0% to be
survey for all relevant patients
consecutiv
must be included for each month in e quarterly November:< uploaded on
100% quarterly
the relevant quarter’s submission
submissio
to trigger payment.
ns of December:< basis onto the
100% Safety
monthly
Thermometer
survey
portal
data
(partial
payments
for either
one or two
quarters of
three
consecutiv
e monthly
submissio
ns)
Demonstrate increase of data
100% by Q1 (data for Final indicator
completeness for all elements of
Q4 monitoring): period is
65% quarter 4.
the 0-5 pathway, and for all Health
Q2 (data for
Visitor teams. Excluding 6-8 Week
monitoring):
Reviews and Immunisations where
66%
the sole responsibility is not with
Q3 (data for
the provider. 100% data
monitoring)
completeness for Q4 (all months in
New Birth
Q4
Visit Baby –
85%
8.33%
Not
achieved
N/A
Report CQUIN
Description
Due Q3 Indicator Name
Yes
3c. 0-5
Pathway:
Increase
proportion of
NB visits
conducted in
10-14 days
Target
Increase proportion of New Birth
•
Visits conducted within 10-14 days
for all mothers eligible for a visit by
City and Hackney Health Visitors.
Excluding mothers whose baby is
in hospital, deaths or families who
have transferred out of area
(including temporary transfers).
•
•
Q3:
85%
NB
visits
within
10-14
days
Q4:
90%
NB
visits
within
10-14
days
Q4:
Mainta
in
100%
of NB
visits
within
21
days
from
Q1-Q4
Current
Trust
Progress
New Birth
Visit Mother
– 60%
8-10 Month
Review –
74%
27 Month
Review –
60%
Q1 (data for
monitoring):7
2%
Q2 (data for
monitoring):
76%
Q3: 83%
Requirement CQUIN %
Met for
achievem
Quarter 3
ent
Q3: No
2%
Final indicator Not
period is
achieved
quarter 4.
3.2 VTE Risk Assessment (CQUIN)
Most recent performance was 89.9 (Feb 2013) compared to 91.8% (December 2012), is just below the national
target and CQUIN threshold of 90%.
3.3 Summary Hospital Level Mortality Indicator (SHMI)
The SHMI is a ratio of the observed number of deaths in hospital or within 30 days of discharge, divided by the
number of expected deaths, given the characteristics of patients treated by that trust.
The latest data (published in January 2013) are shown in the table below. The next publication date is 24th April
2013, which will cover the period up to September 2012.
Apr 10-Mar
11
(published
Oct '11)
July 10June 11
(published
Jan '12)
Oct 10-Sept
11
(published
April '12)
Jan 11-Dec
11
(published
July '12)
Apr 11-Mar
12
(published
Oct ‘12
July 11 –
June 12
(published
Jan ‘13)
BHRUT
0.96
0.94
0.94
0.96
0.98
0.97
HUHT
0.95
0.98
0.98
0.97
0.98
0.98
BLT
0.69
0.69
0.68
NUHT
0.80
0.79
0.80
0.80
0.83
0.84
WX
0.92
0.90
0.89
Key: cells shaded green indicate values rated lower (better) than expected;
no shading indicates values within the expected range; amber indicates
values that are higher (worse) than expected.
A lower mortality ratio is an indicator of greater overall clinical effectiveness. HUHT’s mortality ratio of 0.98 is within
the expected range, just below the baseline value of 1.00).
3.4. HUH own internal mortality data
The following chart is an overview of the mortality benchmarking data from HUH’s own provider of mortality
benchmarking data - University of Birmingham / PwC. It gives SHMI and HSMR scores.
3.3 Fractured Neck of Femur (FNF)
The Homerton have identified that they are an outlier for mortality relating to FNF. They have undertaken an audit
using data from the National Hip Fracture Database The HUH CQRM discussed the results of this audit of FNF at their
meeting in March 2013.
The review had been carried out in response to the trust being flagged as an outlier for mortality from Fractured
Neck of Femur (FNOF) in the period October 2011-October 2012. In April 2012 a similar review was carried out
reviewing the case notes of patients who had died following this diagnosis in the period July 2010- June 2011.
Quality Standards were based on the joint British Orthopaedic Association and British Geriatrics Society ‘Blue book’
guidelines and NICE Guidance for Hip Fractures.
The review demonstrated:
Concerns that 100% of intra-capsular fractures were treated using an Austin Moore Hemiarthoplasty which is not
recommended in NICE guidance for hip fractures.
The majority of patients did not receive review by a consultant in Geriatric Medicine within 72hrs of admission &
6/10 patients did not see a medical consultant pre-operatively.
Response to Findings
•
•
•
Appointment of a second consultant covering Orthogeriatrics in Oct 2012. Since this time all patients are
reviewed by a Geriatrician within 72hrs.
Removal of Austin Moore prostheses from theatre.
Formalisation and launch of a FNOF Pathway in April 2012.
3.4 London Health Programmes – Quality and Safety Programme
HUHT had their site visit on 1 October 2012. Outcomes were discussed at the CQRM IN March 2013 with the Medical
Director working through the points of concern; a meeting has been held regarding the medical issues, plans have
been made to look at surgical and orthopaedics.
There appear to be weekend delays to discharge due to lack of care packages in the community provided by local
authorities. The Medical Director will be looking at weekend discharges in greater detail as he reported that there is
now between half and three quarters of a ward that can be apportioned to lack of post discharge home support
provided by local authorities.
4
Organisation integrity
4.1 Monitor governance risk rating
HUHT were rated “green” for governance in December 2012. Monitor advised in their letter of 10 December 2012
that CIPS achievement in Q2 2012/13 is behind, with implications for achieving planned CIPs targets for 13/14; this is
being offset by income from over performance.
East London Foundation NHS Trust
This is the Q4 report for East London Foundation NHS Trust however, due to reporting time lag, much of the data in
this report relates to Q3.
5
Patient Safety
5.1
Infection Prevention and Control
Following a formal tendering process, Homerton University Hospital has taken over the Trust-wide
contract to provide a specialist infection control service.
5.1.2
Cleanliness and the environment audit
The Trust undertakes a biannual inpatient infection control audit and an annual community infection control audit
based on standards derived from the Infection Prevention Society and the Trust’s Infection Control Policy. Below are
the results up to December 2012.
5.1.4
Infection Control incidents and training
There were no notification IC incidents in quarter 3. Following the low staff survey feedback on access to hand
hygiene facilities, an audit will take place in April 2013 to drive and monitor improved access. The PEAT inspection
guideline has been updated and will be replaced by PLACE.
IC training remains reasonable although there has been a notable drop in level 2 training which the Trust is
monitoring – see table below:
% compliance
Quarter 2
2012/13
Level 1
Level 2
97.87% 95.63%
Quarter 3
2012/13
Level 1
Level 2
100%
81.92
5.2
Serious Incidents
5.2.1
New Serious Incidents (SIs) reported incident types
ELFT reported 20 new SIs as having occurred during quarter 4 2012-13 (January – March 2013), a positive trend in
that unlike other Trusts in the area, its SI reporting rate has not deteriorated. The table below shows the numbers
and types of incidents reported over the past four quarters (1st April 2012 – 31st March 2013). The table is organised
in order of the most frequently reported incident types, and is colour-coded to highlight the same.
ELFT
Key to top 5 (highest number reported to lowest)
1st
2nd
3rd
4th
5th
Incident Type
Q1 12/13
Q2 12/13
Q3 12/13
Q4 12/13
Grand Total
Pressure Ulcer Grade 3
7
8
4
6
25
Suicide by Outpatient (in receipt)
1
3
3
3
10
1
2
3
Serious Incident by Inpatient (in receipt)
Serious Incident by Outpatient (in receipt)
1
2
3
Abscond
2
2
4
Unexpected Death of Outpatient (in receipt)
4
2
9
3
MRSA Bacteraemia
Other
2
Attempted Suicide by Outpatient (in receipt)
Sub-optimal care of the deteriorating patient
1
1
1
3
1
1
1
Assault by Inpatient (in receipt)
1
Suicide
1
Unexpected Death of Community Patient (in receipt)
1
Unexpected Death of Inpatient (not in receipt)
1
Unexpected Death of Inpatient (in receipt)
1
1
2
1
1
1
2
1
1
Confidential Information Leak
1
1
Homicide by Outpatient (in receipt)
1
1
Pressure ulcer Grade 4
1
2
1
4
Safeguarding Vulnerable Adult
1
1
1
3
22
19
15
Grand Total
5.2.2
20
76
Key Performance Indicators (KPIs) for SI reporting
The national target for reporting of SIs is two working days. The Trust’s performance against this KPI has been
continuously improving in 2012/13. In general, mental health trusts take longer than acute trusts to risk assess and
report SIs, due to the complexity of the case load.
The target for the completion of SIs is 45 working days. The graph below shows the average number of days taken by
the Trust to complete investigations (only for those SIs for which a report has been submitted.) The Trust’s
performance against this target has improved in quarter four.
The Trust has 66 SIs open on StEIS with due dates prior to 31 March 2013, organised by locality in the table below.
Locality
Current quarter
Previous quarter
City & Hackney Total
16
20
Newham Total
11
29
Tower Hamlets Total
14
15
Forensic Service Total*
2
3
66
Grand Total
63
*Forensic services are commissioned by London Specialised Commissioning Group, who is also responsible for quality assuring the
investigations.
Of the open 66 reports open at the end of quarter 4, 13 SI reports are overdue (i.e. no report has been received):
An additional 38 SI reports have been received by NHS NELC, the outcome of the SI review has been fed back to the
Trust, Trust’s response to NELC’s feedback is awaited. NELC has agreed to hold a workshop organised around
themes in order to gain assurance about Trust processes. Pressure ulcer and falls workshops were held in quarter 3,
and a workshop covering suicides, physical health, safeguarding and safety is scheduled to take place 15th April 2013.
It is expected that the majority of the 38 reports will be closed following satisfactory conclusion of the workshops.
CCG and CSU colleagues leading on mental health commissioning were invited.
An additional 15 SI reports have been received by NHS NELC, and are in the process of being reviewed.
5.2.5
Incident reporting
In March 2013 the Trust provided their Q3 Quality and Clinical Governance in Commissioning Report.
48 hr report data – Reports requested during month
Directorate
48 hr
reports
requested
Received
on time
City & Hackney
3
3
Newham MH
9
Tower Hamlets
Delayed
Average time
taken to submit
Graded
as SI (1a
or 1b)
Grading
still
pending
Working
days
Monthly
trend
0
1.7
▼
1
0
5
4
2.8
▲
0
0
6
4
2
1.8
▼
1
1
MHCOP
7
3
4
4.7
▲
0
0
Forensic
3
0
3
3.3
▼
0
0
Specialist
2
2
0
1.5
▼
0
0
Community
Health Newham
5
5
0
1.2
▼
1
0
Total
35
22
13
2.7
▲
3
1
Working days taken to report SUI to STEIS (from date of incident report)
3
2
SI's graded November
SI's graded December
1
0
0-2 days
3-4 days
5-6 days
>6 days
0% of SUIs notified to STEIS within 48hrs

Working days taken to complete SUI reports
1a (NPSA grade 2) reports
1
reports received November
0.5
reports received December
0
0-60 days 61-90 days 91-120 days >120 days
1b (NPSA grade 1) reports
3
2
reports received November
reports received December
1
0
0-45 days 46 - 60 days61 - 90 days >90 days

0% of Serious Incident reviews submitted within agreed timescale

0 extension requests made during month

0 open cases with >1 extension request
Current open reports – status as at 17.01.13
Breakdown of status report
Last month for comparison
Current
Completed reports forwarded
to Commissioners
36
41
De-escalation requested
2
3
Reports
overdue
Returned by PCT
for further work
Draft received
-
-
12
11
Incomplete
15
11
Reports in progress – not yet due
11
14
Total
76
80
5.2.3
Incidents reported by care setting
5.2.4
Top 6 most reported incidents – all services
The table below outlines the top 6 most reported incidents identified during Q3.
5.2.4 Serious Incidents Action plan implementation – Status report: Serious Incidents Sept
2010 to date
The table below outlines the numbers of outstanding SI action plan recommendations that are overdue in terms of
implementation.
Action Taken:
• The CSU will continue to closely monitor performance in light of this concerning trend
5.2.5
Themes emerging from SI reports received during the quarter
5.2.6
Homicide Update
The Independent Enquiry relating to the homicide at the Tower Hamlets Centre for Mental Health was published in
Q4 and the action plan is being discussed at City and Hackney CCG Board meeting on 26 April 2013.
5.2.7
Never Events
The Trust has not reported any Never Events in quarter 4 2012/13. The annual total of Never Events remains 1: the
Escaped Prisoner incident reported in June 2012 (in quarter 2 2012/13). The incident involved a patient on a ward
for people learning disabilities at the John Howard Centre, a Medium Secure Unit, which belongs to the Trust’s
forensic directorate. The patient removed window restrictors on a window in a room adjoining his, jumped down,
and was picked up by a silver car. He was not discovered missing until the following morning, and remained at large
until July 2012, when he was apprehended after trying to steal a car.
The Trust investigated the incident with expert advice from the Broadmoor security team, and submitted the
resulting investigation report to NHS NELC for quality assurance. The investigation identified a number of care and
service delivery problems, including that risk assessments were not revised following the discovery of a contraband
Blackberry in the patient’s possession and his expressed worry about being returned to prison, his reluctance to
engage with the therapeutic programme and isolating himself, and that the observations were not carried out per
policy. Faulty window restrictors were not replaced in a timely fashion and there was a lack of clarity about whether
the responsibility of checking the security of the premises belonged to nurses, estates or the security team.
Immediate actions taken included an urgent review of perimeter security, temporary measures to secure windows
while new restrictors were ordered, and additional fencing. The investigation report recommendations included
that the observation policy be made more specific, that responsibility for security among staff groups be clarified,
that window replacement be prioritised and that staff at the unit be developed through exchange of learning and
expertise between Pentonville prison security staff and forensic unit staff.
The workshop on 15th April held with the Trust will include a theme around security measures to allow
commissioners to gain assurance that sufficient measures have been taken to prevent recurrence.
5.2.8
Incident reporting rates
All NHS organisations are required to report all incidents which affect patient to the National Reporting and Learning
System (NRLS). Responsibility for the NRLS transferred to the NHS Commissioning Board in July 2012. Reports are
published every 6 months, and the data within the report represent incidents reported between 6-12 months prior
to publication.
The most recent reports were published in March 2013. The report provides benchmarking data for patient safety
incident reporting rates, severity of harm arising from incidents and categories of incidents for incidents reported
over the period of 1st April 2012 to 30th September 2012.
The graph below shows the trends in incident reporting rates by this Trust since the first release, compared to other,
similar Trusts, i.e. 56 other large acute organisations. Organisations that report more incidents usually have a better
and more effective safety culture.
Trusts are expected to make at least one submission per calendar month to the NRLS.
The recently reported data indicates, whilst the median for all 58 mental health trusts increased from 19.9 (March
2012) to 23.8 (September 2012), ELFT did not see a change in reporting.
NPSA Incident Reporting Rates (ELFT)
25.0
24.0
23.0
22.0
21.0
20.0
19.0
18.0
17.0
16.0
15.0
14.0
13.012.02
12.0
11.0
10.0
9.0
8.0
7.0
6.0 5.0
5.0
4.0
3.0
2.0
1.0
0.0
Sep-08
23.8
21.5
21.1
19.1
18.7
19.9
18.4
15.8
12.9
10.9
9.8
4.4
10.0
9.9
Mar-12
Sep-12
3.7
0.8
Mar-09
Sep-09
Mar-10
Sep-10
ELFT's reporting rate
Mar-11
Sep-11
Similar Trusts' Median Reporting Rate
When reviewing incident rates, it is also important to examine the split between the degree of harm arising from the
incident. In the most recent report, ELFT reported 9.9 incidents per 1000 bed days, with 95.2% resulting in no or low
harm; compared to 90.5% for all organisations (as demonstrated in the graph below).
Nationally, 67 per cent of incidents are reported as no harm, and just under 1 per cent as severe harm or death.
However, not all organisations apply the national coding of degree of harm in a consistent way, which can make
comparison of harm profiles of organisations difficult.
Graph shows how ELFT compares against 58 other mental health organisations for the split between the degree of
harm.
Incidents reported by degree of harm: ELFT
80
70
60
50
percentage of incidents occuring
ELFT
40
percentage of incidents occuring
All mental health organisations
30
20
10
0
None
Low
Moderate
Severe
Death
5.3
Safeguarding
5.3.1
Safeguarding Children Training Compliance Rates
5.3.3
Safeguarding Adults
5.3.3.1. Training
5.4
Central Alert Systems (CAS)
The Trust has no overdue alerts on the CAS website.
5.6
Coroner’s Rule 43 Recommendation
No Rule 43 recommendations were reported in Q3 and Q4.
5.7.
National Health Services Litigation Authority
ELFT has become the first Mental Health Trust with community services in England to achieve a level 3 risk rating
(the highest) from the NHSLA; they were assessed against 50 standards.
5.8
Bed occupancy audit
Bed occupancy was above target in Q3 and the result of an audit below shows the trend over time.
6
Patient Experience
6.1
Eliminating Mixed Sex Accommodation
ELFT has not reported any breaches to NHS NELC in 2012/13.
6.2
CQC Compliance with Essential Standards of Quality & Safety
The CQC carried out an unannounced inspection of the Forensic Services Directorate on 13 and 14 December 2012.
They inspected Clissold, Woodbury, Butterfield and Hoxton Wards at Wolfson House, and Westferry Ward at the
John Howard Centre. Full compliance has been awarded, and the CQC has confirmed that practice on seclusion and
restraint was in line with national guidelines and Trust policy.
The Trust has now declared full compliance with essential standards for all its sites.
6.3
Complaints
6.3.1
Complaints Handling Performance
During Q3, ELFT reported that performance against the timescales set down in the regulations for responding to
complaints is at 38%. This is a significant reduction and will require monitoring when Q4 data is reported.
Quarter 4
2011/12
125
Quarter 1
2012/13
101
Quarter 2
2012/13
123
Quarter 3
2012/13
105
Number of complaints with
responses due within this
reporting period
Complaints responded to within
25 working days or extension
agreed with complainant
Complaints withdrawn
86
64
78
92
67
59
58
35
-
2
4
12
% compliance with timescale
78%
92%
74%
38%
Number of complaints
6.3.2
Trust overview/breakdown of complaints by Directorates
Overall complaints numbers are fairly consistent.
6.3.2
Top 3 most reported complaints made during Q2 and 3
Complaint Subject
Attitude of staff
Communication/Information
(written/oral)
Medication
Number of Complaints Q2
25
Number of complaints Q3
21
24
37
16
12
No investigations are currently being undertaken by the Ombudsman.
6.4 Trust internal user survey
Scores across a number of domains have improved with the biggest improvement made in City and Hackney.
However, Newham and Tower Hamlets scores are quite mixed. The scores are similar to Q4 from the previous year.
7
Effectiveness of Care
7.1
CQUINS
7.1.1
MHS CQUINS progress up to end of Q3
The table below summarises the Trust’s Quarter 3 delivery of 2012/13 Mental Health CQUIN targets as at the
reporting date. Data presented below are derived from RiO and are accurate as of December 31st 2012 (end of
Quarter 3).
The CQUINs have been re-coded for local use. As such, they will not match the original codes developed by East
London and City Alliance. For example, all physical health CQUINs are now coded 1a to f.
CHN - CQUIN SCHEME FOR CHN ELNFT 2012/2013 – Q3 Progress
Update
Goa
l
no.
1
Description
of goal
Quality
Domain(s)
Re
f
Indicator
name
Improving the
experience of
patients
Patient
Experience
1a
To increase
the number of
patients
completing
PROMS and
PREMS in
Virtual Ward
and Extended
Primary Care
Team
(EPCT).
1b
To roll out
PROMS and
PREMS to a
further 4
services
(Continence,
MSK, Stroke
and Cardiac
rehab).
Lead
Indicator
weightin
g
Target
Average
of
PROM’s
&
PREM’s
EPCT
Q3 20%
Q4 25%
Kate
Corlet
t
Progress
Update
Current progress
(average):
EPCT = 13%
VW = 42%
VW
Q3 60%
Q4 75%
20%
Average
of
PROM’s
&
PREM’s
Contienc
e 60%
Stroke
60%
Cardiac
Rehab
60%
Current progress
(average):
Continence =
62%
Stroke = 12%
Cardiac Rehab =
47%
MSK = 17%
Targe
t
status
and
result
s
CHN - CQUIN SCHEME FOR CHN ELNFT 2012/2013 – Q3 Progress
Update
Goa
l
no.
Description
of goal
Quality
Domain(s)
Re
f
Indicator
name
Lead
Indicator
weightin
g
Target
Progress
Update
MSK
20%
1c
A Patient
Survey is
to be
complete
d in
Novembe
r 2012.
Increase the
responses
and level of
satisfaction in
the patient
questionnaire
in all other
services
(excludes
services
included in
PROMS and
PREMS).
5%
increase
across all
services
(If
services
are 95%
or above
then this
is
considere
d as
achieved)
Baseline has
been set using
2011.12 Q4
results.
5 questions
have increased
by 5% or are
above 95%
4 questions
are either :
• at 94%, just
below the
95% target
• are lower
than previous
results, but
with
justifyable
reasons for
this and
when taken
into
consideration
, total a
higher %
1 question has
a lower
response rate.
2
Safeguarding
Safeguardin
g
2a
Safeguarding
paediatrician
input to child
protection
conferences
2b
Input of
fathers name
onto RIO
system by HV
(exclusions
100% by
year end
Ian
McKa
y
20%
This data has
been recorded
since May 2012.
100% of cases
have received
paediatrican
review
Currently 9% of
15% of
fathers to new
have a
births YTD have
RiO
a
record in
father link
Targe
t
status
and
result
s
CHN - CQUIN SCHEME FOR CHN ELNFT 2012/2013 – Q3 Progress
Update
Goa
l
no.
Description
of goal
Quality
Domain(s)
Re
f
Indicator
name
Lead
Indicator
weightin
g
Target
Progress
Update
apply if father
has not
consented
due to
Information
Governance
and Data
Protection
Act)
order to
be put
onto the
system
ny year
end.
recorded.
Recording of
child ethnicity
on RIO
system
Year end
target :
97.5%
Ethnicity
recorded YTD is
currently 97.5%
% of
patients
will be
signposte
d to their
GP for
referral to
DSN’s
(Average
of
services)
Information and
Sign posting
begun in DRSS
& Foot Health.
2c
3
Self Care
Clinical
Effectivene
ss
3a
Deliver
diabetic self
care
education
and advice
via Diabetic
Specialist
Nurses
(DSNs) for
the following
services:
Diabetic
Retinopathy
Screening
Service
(DRSS), and
Foot Health.
3b
Make
available
'Telehealth' to
a proportion
of patients
with Long
Term
Conditions.
Q3: 85%
Q4: 90%
Kate
Corlet
t
20%
Full year
trajectory
for 12/13
is to
make
Telehealt
h
available
to 350
patients –
target to
reach
Current
performance is
67%.
Underperforman
ce is mainly due
to a drop in
figures in
November due
to DRSS service
moving servers
which created
ICT problems
and a disruption
in business as
usual.
There have so
far been 287
telehealth units
in the
community YTD.
Targe
t
status
and
result
s
CHN - CQUIN SCHEME FOR CHN ELNFT 2012/2013 – Q3 Progress
Update
Goa
l
no.
Description
of goal
Quality
Domain(s)
Re
f
Indicator
name
Lead
Indicator
weightin
g
Target
Progress
Update
part year
effect of
175
patients
receiving
Telehealt
h in
Q3/Q4.
4
5
Smoking
Cessation
GP
Communicati
on
Clinical
Effectivene
ss
Clinical
Effectivene
ss
4a
5a
Delivery of
opportunistic
smoking
cessation
intervention
at
appointments
for 3
additional
CHN services
(Looked After
Childrens
Team (1215yrs), Foot
Health and
Venous Leg
Ulcer Clinics).
Agree a
format with
CCG
representativ
es in Q1 of
the format of
notifications
and
discharge
summaries
as per 5b and
5c
Q3: 75%
Q4: 80%
Kate
Corlet
t
20%
Current
performance
based on Foot
Health and
LAC. Delay in
implementation
of VLU Clinics
due to RiO
Upgrade
however
recording is
now taking
place for Q4.
100% of
relevant
patients have
been offered
smoking
cessation
leaflets. 68%
of leaflets have
been accepted
by patients.
Kate
Corlet
t
20%
To roll out
notificatio
n letters
on
admissio
n and
discharge
to all GP
clusters
Pilot now in
place (since
01/09) with NE
and South
Clusters.
Extended to all
clusters for Q4
reporting
Q3 performance
(average across
Targe
t
status
and
result
s
CHN - CQUIN SCHEME FOR CHN ELNFT 2012/2013 – Q3 Progress
Update
Goa
l
no.
Description
of goal
Quality
Domain(s)
Re
f
5b
5c
Indicator
name
Send out
notifications
of
acceptance
of referral
with outline
care
summaries
Lead
Indicator
weightin
g
Target
Progress
Update
Targe
t
status
and
result
s
clusters):
Admission: 64%
Discharge: 57%
Send out
discharge
summaries
with outline
care
summaries
7.2. Medication
The Trust has undertaken an audit of medication errors and has a quality target to reduce medication errors of three
high risk medications (insulin, lithium and Clozapine). Below are results by borough for Q3; medication errors appear
to be reducing.
8
Organisation specific update from the Clinical Quality Review Meeting (CQRM)
8.1
Clinical Quality Review Meetings
Three monthly Clinical Quality Review Meetings (CQRMs) have been held with ELFT during Q4. The key areas of
concern discussed are outlined below:
•
Poor performance in terms of outstanding serious incident action plans not implemented
•
Bed occupancy rates
•
Medication errors and issues
•
CQC inspections
Full sets of minutes are available from: [email protected]
From April 2013 ELFT CQRMs will change and there will be monthly CQRMs for City and Hackney, Tower Hamlets and
Newham CCGs with quarterly mental health consortia meetings commencing in July 2013.
BARTS AND THE LONDON legacy sites
1
Patient Safety
1.1
Health Care Acquired Infections
1.1.1
MRSA target compliance
•
BLT Apportioned Cases – There were no new cases of MRSA reported in quarter 4 2012/13; BLT reported a total
of nine cases of MRSA in FY 2012/13, exceeding the maximum number threshold of 6 MRSA for the year.
The graph below shows monthly actuals (red columns), cumulative actuals (blue line) and cumulative threshold
(dotted green line) against the maximum tolerance of 6 (dashed green line).
The table below provides a summary of the cases for 2013/14 (note there is no change from last quarter)
MRSA
No.
Date
admitted
Date
blood
culture
taken
Hospital
Ward
Specialty
1
01/4/12
11/4/12
Royal London
4E ITU
Neurosurgery
2
3
4
14/11/11
17/4/12
04/5/12
13/4/12
11/6/12
16/6/12
Royal London
Royal London
London Chest
13D
12E
ITU
Hepatobiliary
Neurology
Cardiothoracic
Line-related or CVC or
arterial
Line-related
Chest infection
Infected arterial line
5
29/6/12
08/7/12
London Chest
Riviere
Cardiology
Vascular access device
6
12/7/12
14/7/12
Royal London
Renal
Vascular access device
7
21/9/12
26/9/12
Royal London
Trauma
Delay in screening,
decolonisation and isolation
of patient
9F
12D
Probable cause
MRSA
No.
Date
admitted
Date
blood
culture
taken
Hospital
Ward
8
22/9/12
3/10/12
Royal London
4E
9
28/11/12
5/12/12
St.
Bartholomew’s
5B
Specialty
Probable cause
Neurosurgery
Chest
infection/tracheostomy
Oncology
Blood sample contaminant
The HCAI action plan for Barts Health has been reviewed at the Barts Health CQRM and will continue to be
monitored to close of all actions.
The MRSA target for 2013/14 is a zero tolerance. Barts Health have in addition set a local internal target for a 25%
reduction of all septicaemia; including MSSA and E.coli to further drive improvement in infection control practices.
1.1.2
•
Clostridium difficile (C. difficile) target compliance
BLT apportioned cases:
The graph below shows monthly actuals, cumulative actuals (blue line) and cumulative threshold with maximum of
59 (green dotted line).
Seven new cases of C.Difficile were reported by BLT in quarter 4 2012/13, bringing the annual total to 43 cases,
which is well under the annual tolerance of 59 cases.
The target for C.difficile for 2013/14 is 75 for Barts Health, compared to 99 for 2012/13. Barts Health is driving the
reduction of C.difficile through the CAGs, with targets based upon outturn for each CAG last year. Through the sitespecific CQRM, the need for cases to still be reported by site has been emphasised. This target will present a
significant challenge for the Trust as a whole.
1.2
Serious Incidents (SIs)
1.2.1
New Serious Incidents reported
BLT legacy sites reported 28 new SIs as having occurred during the period covered by this report (January – March
2013). The table below shows the numbers and types of incidents that occurred over the past four quarters (1st April
2012 – 31st March 2013). The table is organised in order of the most frequently reported incident types in the
current reporting quarter, and is colour-coded to highlight these.
Although there is normally variation between the numbers of SIs reported in any quarter, the Trust’s SI reporting
rate appears to decrease each quarter of this year. The decrease has occurred roughly at the same time that BLT
merged with NUH and WX to form Bart’s Health, and it is possible that the focus shifted to completing the high
number of outstanding legacy investigations across the three sites and establishing the new CAG governance
structures, which drew resources away from the reporting of new incidents. Another contributory factor leading to
the apparent decrease in SI reporting could be a new feature of the SI database, which allows Trusts to indicate
when a pressure ulcer was detected on admission, (those pressure ulcers are excluded from the numbers below –
there were 10 such pressure ulcers reported in quarter 4). The reasons behind the apparent slowing of SI reporting
will be further explored in 2013/14 CQRM. (Please also see section 1.2.3 on NPSA incident report rates, a related
measure.)
Although pressure ulcers are the most frequently reported incident type, the number of the most severe grade 4
pressure ulcers reported by the Trust has been decreasing steadily this year. This indicates that the Trust is focusing
on less severe grades of pressure ulcers, and preventing these from deteriorating to a grade 3 or 4. As reported
previously, the Trust has been working on Quality Improvement Collaborative since December 2012, with a focus on
pressure ulcer reduction. The NEL Quality Surveillance Group is in the process of designing a piece of work to review
pressure ulcer care across the patch in May 2013.
BLT
Key to top 5 (highest number reported to lowest)
1st
2nd
3rd
4th
5th
Incident Type
Pressure Ulcer Grade 3
Q1
12/13
Q2
12/13
Q3
12/13
Q4
12/13
Grand
Total
10
18
6
5
39
Other
1
3
4
3
11
Delayed diagnosis
2
3
3
8
Maternity Services - Maternal unplanned admission to ITU
2
2
3
2
9
Unexpected Death (general)
Maternity Services - Unexpected admission to NICU (neonatal intensive care
unit)
2
1
3
2
8
2
5
1
1
9
Radiology/Scanning incident
1
1
Allegation Against HC Professional (assault)
1
1
1
1
2
6
1
10
2
1
8
1
1
1
1
2
3
1
23
Communication issue
Sub-optimal care of the deteriorating patient
2
Confidential Information Leak
5
1
Medical equipment failure
Allegation against HC Non-Professional
Pressure ulcer Grade 4
12
7
BLT
Key to top 5 (highest number reported to lowest)
1st
2nd
3rd
4th
5th
Q1
12/13
Incident Type
Q2
12/13
Q3
12/13
Q4
12/13
Dentistry
Safeguarding Vulnerable Adult
Safeguarding Vulnerable Child
1
2
Surgical Error
1
1
Post Mortem
1
Hospital Transfer Issue
1
C.Diff & Health Care Acquired Infections
1
Drug Incident (general)
3
1
1
1
2
1
4
1
4
1
1
2
1
2
Screening Issues
5
1
Drug incident (Insulin)
Pressure Ulcer - (Grade 3 or 4)
2
Grand
Total
1
Maternity Services - Unexpected neonatal death
1
1
1
1
2
3
3
Hospital Equipment Failure
2
2
Failure to act upon test results
1
1
2
Communicable Disease and Infection Issue
3
2
5
Failure to obtain consent
1
1
Outpatient appointment delay
3
3
Slips/Trips/Falls
1
1
Wrong site surgery
1
1
Child Death
1
1
Allegation against HC Professional
1
1
Maternity service
2
2
Accident Whilst in Hospital
1
1
Maternity Services - Intrauterine Death
Grand Total
1
58
52
42
1
28
Details of the three SIs reported under the “Other” incident type in Quarter 4 are in the table below:
Description of what happened
Patient developing a complication (haematoma) following orbital floor repair. The
haematoma was subsequently evacuated but patient suffered loss of vision.
Patient who had been admitted with a stroke had an NGT inserted, before feeding was
commenced an x-ray was performed that confirmed the tube was in the right bronchus. The
patient returned to the ward and the tube was removed, a short time later the patient
deteriorated and was diagnosed with a pneumothorax. (did not fit Never Event criteria).
180
Description of what happened
Relates to G2 System issue where letters appear to have become stuck in the workflow (i.e.
they have been transcribed, put into the system but have not been sent out to patients /
GPs or attached to EPR). The issues have been raised to G2 who is working with the Trust IT
department to solve the concerns raised.
1.2.2 Key Performance Indicators (KPIs) for SI reporting
KPI 1: The national target for reporting of SIs is two working days from the date the incident occurred or was
discovered, to the day that it was reported to the Department of Health / NHS London via its reporting system,
StEIS. BLT’s performance against this KPI has been good historically, but has begun to deteriorate since quarter 1
2012/13. A possible reason for this is delayed identification of the incident. One of the new features of the SI
reporting database is that it
allows providers to note the date they learned or identified the incident, which will allow for more accurate
measuring of this KPI in the future.
KPI 1: average number of days to report SI (target: 2 working days)
KPI 2: The target for completing SI investigation reports is 45 working days; NHS London calculates and reports on
this KPI for non-foundation Trusts. These are shown in the table below. Please be aware that as of October 2012,
only Barts Health statistics were collected by NHS London; legacy site-specific numbers are no longer available.
NHS London Provider Metrics dashboard - BLT
Month
% reports received
that were due in
past 3 months
London average %
reports received
due in past 3
months
KPI 2: Average
no. days to
submit reports
(target=45)
London avg. no.
days to submit
reports
April ‘12
70%
45%
40
62
May ‘12
63%
49%
45
55
June ‘12
59%
51%
40
58
Month
% reports received
that were due in
past 3 months
London average %
reports received
due in past 3
months
KPI 2: Average
no. days to
submit reports
(target=45)
London avg. no.
days to submit
reports
July ‘12
57%
59%
67
52
August ‘12
75%
63%
74
51
September’12
100%
67%
60
65
October’12
(Barts Health)
November’12
(Barts Health)
December’12
(Barts Health)
January’13
(Barts Health)
February’13
(Barts Health)
38%
53%
48
50
32%
45%
47
46
27%
49%
57
52
24%
50%
61
54
14%
41%
50
47
(data not available
until 30 April’13)
(data not
available until 30
April’13)
(data not
available until 30
April’13)
(data not available
until 30 April’13)
March’13
(Barts Health)
KPI2 Average number of days to submit investigation report (target=45) and related metrics
NHS London handed over the management of non-foundation Trust Serious Incident processes to CCGs as of 1st April
2013. NHSL Patient Safety Manager handed over the history of the open and overdue SI cases to TH CCG and NEL
CSU, and the noted that Barts Health was a trust of concern with regard to its investigation process management,
with a high number of overdue Serious Investigation reports. Overall, Barts Health had a combined total of 82
incidents for which investigation reports were overdue at the end of March 2013; approximately 30 of these
originated at legacy BLT site. The quality of the submitted reports is considered by NHS London to be “acceptable”,
the highest possible rating, or “good”; however, the timeliness of investigations will be addressed by the CCGs and
CSU working on behalf of CCGs.
1.2.2.1 Serious Incident Action Plan implementation – a part of the SI management responsibility is the periodic
monitoring of the implementation of actions arising from SIs, particularly in the more severe Grade 2 incidents.
Barts Health has deferred the requested status report from January to April 2013.
1.2.3 Incident reporting rates
All NHS organisations are required to report all incidents which affect patient to the National Reporting and Learning
System (NRLS). Responsibility for the NRLS transferred to the NHS Commissioning Board in July 2012. Reports are
published every 6 months, and the data within the report represent incidents reported between 6-12 months prior
to publication.
The most recent reports were published in March 2013. The report provides benchmarking data for patient safety
incident reporting rates, severity of harm arising from incidents and categories of incidents for incidents reported
over the period of 1st April 2012 to 30th September 2012.
Analysis of data shows that organisations with the most robust safety cultures report approximately 10 incidents per
100 admissions, which means that the higher the reporting rate, the better the safety culture.
As of 1st April 2012, Bart and the London Trust, Newham General University Hospital and Whipps Cross Hospital
merged to form Barts Health. The data submitted to the NRLS from Barts Health from 1st April will not separate the
3 legacy sites. The black bar in the graph below shows the rate of incidents submitted by Barts Health (4.9; national
median: 6.8). Prior to the merger, the data published in March 2012, each of the legacy sites reported BLT: 7.5;
NUH: 7.0; WX: 4.4 (national median: 6.7).
When reviewing incident rates, it is also important to examine the split between the degree of harm arising from the
incident. Ideally, we are looking to see approximately 10 incidents per 100 admissions (Barts Health reported 4.9 in
the most recent report) together with the majority resulting in no or low harm (as demonstrated in the graph
below).
Nationally, 67 per cent of incidents are reported as no harm, and just under 1 per cent as severe harm or death.
However, not all organisations apply the national coding of degree of harm in a consistent way, which can make
comparison of harm profiles of organisations difficult.
Graph shows how Barts Health compares against 30 other Acute teaching organisations for the split between the
degree of harm.
Incidents reported by degree of harm: Barts Health
80
70
60
50
percentage of incidents occuring
Barts Health
40
percentage of incidents occuring
All large Acutes
30
20
10
0
None
1.2.4
Low
Moderate
Severe
Death
Never Events
BLT did not report any new Never Events in quarter 4 2012/13. The total number of Never Events in FY 2012/13 is
two (2), listed in the table below:
Date of Incident
Mon 11 Jun 12
Wed 07 Nov 12
Reported Date
Thu 21 Jun 12
Thu 22 Nov 12
STEIS Ref
Never Event
Type
Description of what happened
2012/14976
Wrong Site
Surgery
Upper left second deciduous molar tooth extracted in error of upper
right second deciduous molar.
Retained foreign
object postoperation
A patient was admitted via A&E with bowel obstruction and taken to
theatre for emergency laparotomy. During surgery, a retained swab
was found to have caused the bowel obstruction. It was removed
and the patient has gone on to have a good recovery from her
surgery. The patient's last recorded abdominal surgery was at the
Royal London Hospital in 2007.
2012/29513
The investigation report for the retained swab was due in March 2013, and is now overdue; it was one of the backlog
of overdue SI investigations handed over by NHS London. It will be followed up at the April CQRM.
1.2.5 CRB Compliance Update
Following the concerns raised at the BLT site in relation to CRB checks, reported to the CCG in the Quarter 3 quality
report, Barts health have undertaken checks across all sites within the organisation, This has highlighted issues
relating to approximately 500 missing personal files, although these have all been staff at Whipps Cross site. The
Trust HR Director will be presenting the overall findings of the look back exercise to the Barts Health CQRM in May
2013.
1.2.6 CQC visit to St Bartholomew’s Hospital
A compliance review was carried out over two days at St Bartholomews Hospital on 27/28 February. The assessors
visited wards 5a, 5b, 4a and Percival Pott and the Macmillan Vicky Clement Jones Cancer Information Centre. The
Trust has received a draft report and the findings are positive and all standards have been fully met. The outcomes
inspected were: respect and involvement, infection control, staffing and complaints management.
1.2.9 Ofsted CQC Integrated Inspection of Safeguarding and Looked After Children’s Services in Tower Hamlets
As reported in Quarter 3 report, an Inspection of Safeguarding and Looked After Children’s Services in Tower
Hamlets was undertaken in June 2012. Although the report was positive about the senior management’s
leadership, ambitious vision, the contribution of health to safeguarding children, professional standards and clear
lines of accountability, the report highlighted that there were concerns relating to the low safeguarding children
training levels of staff, which were below 80% (the statutory threshold). In response to this Barts Health developed a
Trust wide action plan to improve uptake with safeguarding training. The action plan was reviewed at the Barts
Health CQRM in March 2013 and will continue to be monitored to completion. The action plan aims to ensure that at
least 80% of staff have received the appropriate level of training by August 2013.
1.2.10 CQC Quality and Risk Profiles (QRP)
The CQC no longer produces individual Quality and Risk Profiles for BLT, NUHT and WX – the last published profile
for the legacy trusts was in March 2012. The latest QRP for Bart’s Health was issued on 6 March 2013. It highlighted
no significant changes to the risk estimates for the 16 outcomes since the previous versions. There remain no high
(red or amber) risk estimates.
The following changes were noted:
• An improvement has been seen against Outcome 13 (staffing), from a “high yellow” to a “low yellow”.
• A slight increase in the risk status against Outcome 16 (assessing and monitoring the quality of services) was
seen; from “high green” to “low Yellow”, although there are no significant changes to any of the
performance indicators other than previous QRP versions still had some indicators separated for the 3 legacy
trusts.
The only indicators within the 16 outcomes that are highlighted as areas of concern relate to the adult in-patient
survey, adult outpatient survey and the staff survey. The results of these and the associated action plans are
monitored at the Barts Health CQRM.
See below the key to the risk rating colour schemes used by CQC in Quality & Risk Profiles:
1.4
Central Alerting System
There is one overdue CAS alert at Barts Health, which is open for each of the legacy sites, including BLT. The alert is
an NPSA alert relating to the introduction of Safer spinal (intrathecal), epidural and regional devices. The
implementation of this alert is being led by the Medical Director and the Clinical Procurement Group. Each CAG has
been asked to complete a risk assessment, which are not yet all complete. This will be monitored to closure at
CQRM.
2
Patient Experience
2.1
Eliminating Mixed Sex Accommodation (EMSA)
The EMSA action plan was presented to the Barts Health CQRM in March 2013. The Trust reported that compliance
is affected by activity but the action plan aims to drive a zero tolerance of breaches. Amongst the actions to improve
compliance are daily internal reports of MSA breaches to allow analysis of individual breaches in real time. The Royal
London continues to be the site where most of the breaches occur and is the focus of the actions to improve.
Barts Health Mixed Sex Accommodation Breaches for 2012-13
Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Total
Newham General Hospital
15
4
0
9
28
THE ROYAL LONDON HOSPITAL
15
110
114
98
134
471
Whipps Cross University Hospital
3
31
29
3
1
2
4
7
5
1
86
The London Chest Hospital
26
26
St Bartholomew's Hospital
2
2
Total by month
3
31
29
3
1
0
0
17
129
125
103
144
585
2.2 Complaints
Complaints Management – Legacy
In October, Barts Health had a total of 122 legacy complaints, which progressively exceeded the timescales
negotiated with complainants. A number of contributory factors were identified as the reason for the delays. Some
of these included:
• Difficulties accessing ICT systems across different hospital sites post the 1 October
• Delays with accessing records across different hospital sites
• Inadequate handovers due to staff absence pre and post the merger
An action plan was put in place to address the outstanding complaints. This included contacting all the complainants
to give them an update and agree reasonable deadlines for providing responses to complaints, the Patient
Experience Team supporting the CAGs with drafting response letters and the provision of training for new staff not
familiar with the processes. The aim was for all legacy complaints to be closed by the end of January 2013.
To the end of February, a total of 88 legacy complaints have been closed and 34 remain open at the time of
reporting; 28 of these are from the Royal London site. Staff absence due to sickness and a high number of incoming
complaints are cited as some of the reasons why a number of legacy complaints remain open. In addition to this,
difficulties with ICT systems and accessing records across sites are reported to be a continuing problem.
Complaints by CAGs
The complaints are reported by CAG. The table below indicates the number of complaints and the number that are
acknowledged by each CAG within the required 3 days:
Clinical Academic Group
Ambulatory
Number of
complaints
Acknowledged within
3 working days
Percentage
22
21
95%
Cancer
2
1
50%
Cardiovascular
5
4
80%
Children's
6
6
100%
COO
3
2
67%
CSS
10
8
80%
1
1
100%
Nursing & Quality Governance
Number of
complaints
Clinical Academic Group
Acknowledged within
3 working days
Percentage
ECAM
44
28
64%
Surgery
23
22
96%
Women's
16
16
100%
132
109
83%
Total
Number of
complaints
CAG
Ambulatory
Response
performance
Percentage
22
13
59%
Cancer
2
2
100%
Cardiovascular
5
5
100%
Children's
6
2
33%
CSS
10
8
80%
COO
3
2
67%
Nursing & Quality Governance
1
0
0%
ECAM
44
38
86%
Surgery
23
18
78%
Women's
16
13
81%
132
101
77%
Grand Total
The top themes/ areas of concerns for quarter 4 by site are identified in the table below.
Diagnosis /
Treatment
Communication - verbal /
written / electronic
London Chest
1
0
0
1
Mile End
1
0
1
2
Newham
0
3
4
7
25
15
5
45
1
3
0
4
15
9
8
32
Royal London
St. Bartholomew's
Whipps Cross
Delays in care
Total
Diagnosis /
Treatment
Communication - verbal /
written / electronic
43
30
Total
Delays in care
18
Total
91
2.2.4
Parliamentary Health Service Ombudsman (PHSO)
During the year (data available to end of February 2013), the PHSO has indicated interest in 61 complaints concerning Barts
Health. Of these cases:
30 are currently active (24 at the request for information stage 6 referred back for further local resolution
and are currently being considered by the services)
31 have been closed with no further action required of the Trust
1 complaint from last financial year remains open at the time of reporting, has been investigated and is
currently in the action planning stage.
The completion/embedding of actions identified is monitored through the CQRM.
The distribution of complaints reported to the PHSO on each site are included in the chart below:
No. of active PHSO cases by site
1
1
5
10
Newham
13
Whipps Cross
Royal London
Mile End
Barts
2.5
Friends and Family Test
The Friends and Family Test is a single measure of patient experience based on patients’ answers to the question:
“how likely are you to recommend (ward or A&E department) to friends and family”? and is mandatory in 2013/14.
Barts Health reports that they achieved 100% coverage (asking the Friends and Family question) in all appropriate
areas at the beginning of February. Results for this month show a high percentage of the patients who responded
would be extremely likely (64%) to recommend the ward or area to their friends and family.
The graph below indicates a breakdown of the responses received to date from the Friends and Family Test
Barts Health overall response
2% 2% 2%
30%
64%
Extremely likely
Likely
Neither likely nor unlikely
Unlikely
Extremely unlikely
Although gradual improvement in uptake is evident from December to February, this is not reflective of the total
number of eligible discharges across Bart’s Health. The plan to improve response rates focuses on the need to
improve staff awareness and engagement in the process at discharge. The aim is to have a response rate of at least
the 15% target from 1 April.
Implementation and progress will continue to be reviewed at CQRMs. Implementation of the FFT in maternity by
October 2013 and improvement in response rates are parts of a national CQUIN for 2013/14.
3
3.1
Effectiveness of Care
VTE
The graph below shows the Trust’s VTE assessment (% VTE Risk Assessment for adult inpatient admissions)
performance over the course of the past 23 months. The Trust has exceeded the 90% target since April 2012, but fell
below 90% in December and January, due to underperformance in cancer and cardiovascular wards at Barts and the
Chest Hospital. Following work led by the Medical Director, performance recovered in February to 91%. March data
will be available by the third week of April 2013; it will then be possible to calculate cumulative quarter 4
performance. YTD cumulative performance at the end of February 2013 is 90.71%.
Compliance with VTE is a national CQUIN for 2013/14. The CQUIN details are currently being discussed with Barts
Health, but it is expected that the Trust will work towards the national target of 95% for 2013/14. The CQUIN also
requires all patients with thromboembolisms to have a full root cause analysis.
3.2
Summary Hospital Level Mortality Indicator
The SHMI is a ratio of the observed deaths within 30 days of discharge in a trust divided by the expected number
given the characteristics of patients treated by that trust. The latest data (published in January 2013) are shown in
the table below. The next publication date is 24th April 2013, which will cover the period up to September 2012.
BLT’s mortality ratio is better than expected (below the control limits). SHMI provides a broad level of assurance
regarding overall clinical effectiveness in provider organisations. A higher (worse) than expected mortality ratio is
expected to operate as a warning sign and prompt for further investigation into the underlying causes. None of the
trusts in NE London have a SHMI that indicates potential concern.
Apr 10Mar 11
(published
Oct '11)
July 10June 11
(published
Jan '12)
Oct 10Sept 11
(published
April '12)
Jan 11-Dec
11
(published
July '12)
Apr 11-Mar
12
(published
Oct ‘12
July 11 –
June 12
(published
Jan ‘13)
BHRUT
0.96
0.94
0.94
0.96
0.98
0.97
HUHT
0.95
0.98
0.98
0.97
0.98
0.98
BLT
0.69
0.69
0.68
NUHT
0.80
0.79
0.80
0.80
0.83
0.84
WX
0.92
0.90
0.89
Key: cells shaded green indicate values rated lower (better) than
expected; no shading indicates values within the expected range; amber
indicates values that are higher (worse) than expected.
3.3
London Health Programme Quality and Safety Audits
In 2011 a review of London hospital-based acute medicine and emergency general surgery services identified
significant variability and inadequate involvement of consultants in the assessment and subsequent management of
acutely ill patients. This was particularly related to overnight and at the weekend, when average consultant cover
was found to be half of what it was during the week. It was estimated that patients admitted to hospital as an
emergency at the weekend in London had a significantly increased risk of dying compared to those admitted on a
weekday. It was indicated that 500 lives in London could be saved every year if the mortality rate for patients
admitted at the weekend was the same as for those admitted on a weekday.
In response to this, improving the quality and safety of acute emergency and maternity services was identified as
one of the NHS in London’s key priorities for 2012/13. Most notably, the priority was to address the variation that
existed in service arrangements and patient outcomes in these services between hospitals and within hospitals,
between weekdays and weekends.
In response to this the Quality and Safety Programme was developed. The audit programme was developed by
clinical experts and patient panels and quality assured by an independent academic review. The programme began
in January 2012 and had two key components:
•
•
Auditing all acute London hospital sites against the agreed and commissioned adult acute medicine and
emergency general surgery standards
Driving the development and commissioning of clinical quality standards for further services not covered by
the previous review; including:
o Emergency departments
o Critical care
o Fractured neck of femur
o Maternity services
o Paediatric emergency services
A report of the findings of the LHP audit programme is being presented to the Clinical Commissioning Group in April
2013.
The LHP audit report for Barts Health, which was legacy site-focused, was reviewed at the CQRMs. Barts Health
report that the improvements are being addressed by the CAGs, taking into account site-specific shortfalls. CAGs will
be feeding back to the Strategy Advisory group to identify their plans and risks to full implementation of
recommendations in April and a full report will be presented to the Barts Health May CQRM.
4
Organisation integrity
4.1
CQUINs Q4 12/13 assessments are not yet available at time of writing this report. Achievement will be
finalised in May 2013.
4.2
Clinical Quality Review Meeting
Following the Bart’s Health merger, the CQRM was re-configured. Three site-specific meetings are currently held on
a monthly basis with attendance from the deputy director of nursing, and operational lead. In addition, there is one
top level Bart’s Health meeting held every other month, with attendance from the Chief Nurse, Medical Director and
Chief Operating Manager to take a strategic overview of issues.
4.3 National In patient Survey results 2012
The results of the national inpatient survey 2012 were published on 16 April 2013. The CQC reports that nationally
there have been improvements in the results for many questions, including issues such as cleanliness and
relationships with doctors. However, scope for continued improvement remains in some areas including
fundamental aspects of care such as receiving assistance to eat meals where needed, involving patients in their care
and treatment, information provision and discharge arrangements. An analysis of the findings will be undertaken by
NEL CSU, including benchmarking against these national outcomes. Barts Health will be asked to provide a summary
of their own results and an associated action plan for improvement where required at the next CQRM.
Financial Plan Update 2013/14
NHS CITY & HACKNEY CCG
BOARD MEETING
26 April 2013
NHS City & Hackney CCG
Overview
 The process of refining the CCG’s Financial Plan for
2013/14 continues to develop
 Another submission of the Plan was submitted on 17th
April.
 This paper highlights the key elements and
assumptions in the Plan
 There remain a number of risks to the Plan, in
particular, there is additional risk and uncertainty with
the Specialist Services deductions and the impact on
the CCG’s allocation and contracts.
NHS City & Hackney CCG
Summary
Recurrent
£000
2013/14 Notified allocation
Programme Baseline allocation
Growth uplift
NHSE Notified Adjustments
Anticipated adjustments
Return of 12-13 surplus
Sub-total Notified allocation
Expenditure Plan -(Programme - see below)
333,416
7,669
-618
6,767
Total
resources
available
£000
Non recurrent
£000
*
347,234
8,384
8,384
333,416
7,669
-618
6,767
8,384
355,618
330,316
21,746
352,062
Planned In-year Surplus/(deficit) - Programme
3,556
1%
Planned surplus %
Running Costs 2013/14
2013/14 Running Cost Allocation
2013/14 Running Cost Expenditure
Under / (Overspend)
Constrained Population size
spend/head(£)
NHS City & Hackney CCG
The table shows the CCG
allocation with growth at 2.3%
and an assumed return of a
proportion of the PCT’s 2012/13
surplus. The Plan meets the
mandatory requirement of 1%
surplus.
£000
6,543
6,543
0
£000
0
0
0
£000
6,543
6,543
0
261,712
25.00
The CCG receives a separate
allocation for running costs
calculated at £25 per head of
constrained population. Funding
can be moved to Programme
activities (the table above), but
not vice versa.
Allocations
2013/14 Notified allocation
Programme Baseline allocation (Dec 2012)
Growth uplift (Dec 2012)
NHSE Notified Adjustments (Jan-March 2012)
Anticipated adjustments (tbc)
Return of 12-13 surplus (April 2012)
Sub-total Notified allocation
Anticipated allocations
Community Pharmacy
Mental Health in Primary Care
WIC closure transfer from NCB
NHS Direct funding transfer
LSCG adjustment
GP IT
GP IT shortfall
£288m Specialist Care Adj
£288m Specialist Care Adj
Total Anticipated allocations
NHS City & Hackney CCG
Recurrent
£000
333,416
7,669
-618
6,767
347,234
Recurrent
£000
1,447
702
500
1,500
1,200
1,118
300
9,742
-9,742
6,767
Total
resources
available
£000
Non recurrent
£000
*
8,384
8,384
Non recurrent
£000
333,416
7,669
-618
6,767
8,384
355,618
Total
resources
available
£000
1,447
702
500
1,500
1,200
1,118
300
9,742
-9,742
0
15,151
The table shows the CCG allocation
and the status of adjustments. The
return of 12-13 surplus is the CCG
share of the PCT anticipated surplus
of £12.464m. The CCG has
requested the formula for calculation
of the share as it would appear
c£1m short of the CCG estimate.
The table shows the anticipated
allocation adjustments under
discussion with NHSE. The top 7 have
been under discussion for some time to
ensure the service and the funding
align. The £9.7m Specialist adjustment
is new and is a prorata London CCG
value of a £288m shortfall the NHSE
have identified. It is unclear if this is an
issue of funds being in the wrong place
or a real shortfall. A deduction of
£9.7m is expected and this will be
added back monthly. This is a major
risk.
Spending Plans & Reserves
Expenditure Plan
Acute services
Mental Health Services
Community Health Services
Continuing Care services
Primary Care services
Other Programme services
Total - Commissioning services
Operating Plan requirements & reserves
Contingency (Minimum 0.5%)
Re-admissions credit
2% Headroom (Subject to NHSE Business Case Approval)
Other CCG Risk reserves
Non-recurrent Reserve from B/F Surplus
Total - Reserves
Total Application of Funds
NHS City & Hackney CCG
Non Recurrent
recurrent 2013/14
£000
Plan £000
£000
173,268
4,164 177,432
46,511
1,171
47,682
53,041
1,032
54,073
5,474
0
5,474
36,748
173
36,921
2,223
0
2,223
317,265
6,540
323,805
6,822
8,384
3,476
2,220
6,822
7,355
8,384
13,051
15,206
28,257
330,316
21,746
352,062
3,476
2,220
7,355
The table shows the CCG spending plans
by service area. These plans remain best
estimates on contract settlements, none
of which have been signed yet. The major
caveat is the Specialist deduction and it is
unclear what impact the £9.7m deduction
will have on individual contracts. The CCG
and CSU have assessed the overall impact
to be £1.2m too great a deduction for
specialist, but highly variable by contract.
The CCG Plan includes a number of
reserves and contingencies. These
include a mandatory contingency and
mandatory non-recurrent reserve, the
latter can only be spent with agreement of
NHSE. Re-admissions funding arises from
penalties on providers for exceeding target
readmission rates and is required to be
reinvested. The other sums are being held
to cover assessed risks eg baseline
adjustments or held for further investment
eg in integrated care. Until the Specialist
issue is resolved it will necessitate caution
on investments (committed and
uncommitted reserves).
Key Assumptions & QIPP
2013-14
Demographic
Acute
CHS
Mental Health
Other Healthcare
Prescribing
CCG Operating Costs
QIPP
3.00%
0.50%
0.50%
3.24%
3.20%
0.50%
Non demo
1.00%
1.00%
1.00%
1.00%
1.00%
1.00%
Efficiency
-4.00%
-4.00%
-4.00%
-4.00%
-4.00%
-4.00%
inflation
2.90%
2.70%
2.70%
2.70%
8.00%
2.70%
Total
2.90%
0.20%
0.20%
2.94%
8.20%
0.20%
The table opposite shows the default
assumptions the CCG has used in its
plans to calculate change from
2012/13 forecast outturn. On some
contracts, eg Homerton, more detailed
analysis has been undertaken jointly
with the provider to agree the growth at
specialty level.
QIPP schemes have been identified across the CCG portfolio, excluding maternity services in
2013/14. The total of these is £5.5m or 1.6%. The total includes a limited risk adjustment for
slippage or QIPP failure. Detailed project templates are due for review with each Programme
Director for each scheme and a process for scheme monitoring is being developed with CSU.
Wherever possible, QIPP is being built into the baseline contracts with providers.
The CCG is planning to use its NR funding capacity in 2013/14 to ensure it is well placed to
deliver much more challenging QIPP targets in 2014/15 to 2016/17 based on a more
transformational approach.
NHS City & Hackney CCG
Investments
Female Psychiatric Intensive Care Unit
Mental Health Locally Enhanced Service
NHS City & Hackney CCG
The CCG is planning a number of
investments in 2013/14 and has built
most of the list opposite into the current
plan but most are subject to further
negotiation with providers, business
cases and resolution of the Specialist
issue referred to above. However ,some
of these are previously agreed business
cases which have been authorised and
will be funded from the 2% Nonrecurrent Fund. The Barts Health
transition commitment is also a precommitted sum by the PCT and NELC
Cluster Board against the 2% Fund and
will be pro-rata to contract value,
although unclear if that will include a
contribution from Specialist Services.
Risks
Description of risks
Events that may happen
Activity risks
QIPP Under-Delivery
Assessment
Calculation of 5% activity over planned levels on noncontrollable activity
Calculation of assumed 50% slippage
Risks from Service changes Detailed assessment of potential impact
Baseline funding
A log is being maintained of potential liabilities which
are assumed to happen and benefits which are
assumed to not accrue.
Specialist Services
adjustments
An assessment based on 12/13 unknown run-rate
legacy, national shortfall, London shortfall, in year
disputes on responsibilty for funding.
Contract risks
Assessment based on contract discussions
Potential sources of funds to mitigate risk
Uncommitted Funds (Excluding 2% NR Headroom):
Contingency mandatory
Contingency local
PCT surplus brought forward
Local reserve for specific badged risks
Further QIPP extensions
Non-recurrent savings measures
Delay / reduce Investment plans
NHS City & Hackney CCG
The CCG is taking the same approach to risk
management as discussed at previous Board
meetings. Contractual risks are being assessed
by provider, QIPP schemes are being assessed
for risk and the impact of funding/baseline
changes are being assessed. There are
additional risks for new services such as 111,
where the financial impact of the contract and
the commuter issue are also assessed should
this service progress. Specialist services,
because of the scale of the issue, is now a
separate risk and will need to be reassessed
throughout the year.
The CCG has a number of sources to cover
potential risks. The financial plan submitted
to NHSE will be revised given the new risks on
Specialist and the latest contract status.
Previously, the Plan showed a worst case
shortfall of £1m if all risks materialised and a
surplus of £9m if none materialised.
The risk models will continue to be refined as
risks crystallise or are eliminated.
Conclusions
The Board is asked to note the detail of the revised submission of the 2013/14 financial
plan, note progress and risks and to comment on any aspects or concerns included
within it.
A final submission is expected to be made April and indicative budgets are being set on
the basis of this version of the plan.
NHS City & Hackney CCG
NHS City and Hackney Clinical Commissioning Group Shadow Audit Committee
Monday 25 February 2013 key issues
Due diligence on Transfer Scheme
The PCT will own the contracts, assets and liabilities, property and staff transfer scheme
from the PCT to the CCG and there will be no requirement for the CCG to sign it.
Contract novation
SAC requested a list of risks covering the contract transfers for the next audit committee
meeting.
Business critical systems set up
There is some indication that SBS may not be ready for a 1 April start. PL will circulate
email received from CSU providing updated assurance.
CSU SLA
PL confirmed that it would be a standard set of KPIs and that she had been proactive in
ensuring that City and Hackney’s requirements were met.
Internal Audit and Counter Fraud
CCG Board had delegated authority to PL to make the urgent appointment of internal
auditors for 2013/14, subject to value for money considerations.
Funding Risks and Baseline adjustments
The CCG was still awaiting information on the value of Specialised Services and the impact
on contracts being negotiated.
Procurement and Conflicts of Interest where GPs are providers
The audit committee would be asked to confirm payments regarding the CC LES. It was
accepted that as a one off for this year that these practices should be offered part payment
based on the work done, provided value had actually been added by the partial work done.
Scheme of Delegation
The recommendation that the Audit Committee note these arrangements which will be
presented for Board approval on 22 February was agreed.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group Shadow Audit Committee
Wednesday 20 March 2013 key issues
Out of Hours (OOH) procurement process
The Committee requested a comprehensive progress update to allow the Committee to
assure themselves on the process being followed and in particular avoidance of conflicts of
interest and stakeholder involvement would be required to demonstrate that the CCG is
following appropriate law, procurement guidance and best practice.
Due Diligence on Transfer Scheme
Due diligence had been carried out over the detailed transfer documents and the following
were noted:
• Staffing – High level of assurance – Remuneration Committee has reviewed the list
of staff transferring to the CCG. Assurance document circulated by Karl Thompson;
• Assets – Property – none to transfer;
• Equipment – none to transfer;
• IT Assets – CCG have submitted list of those they wish to receive;
• Records – 4 Boxes of paper records will transfer. Electronic files will be transferred
on disc;
• Quality Handover – Chair and AO have had two meetings re the quality handover
and are clear about the issues. The OOHs quality handover will take place in April.
A paper is going to the CCG Board about continuing healthcare issues.
Contract novation
The CCG did not accept the extension and novation of community pharmacy contracts as
the £1.4m budget was not confirmed as being returned from the NCB to the CCG.
Internal Audit and Counter Fraud
The appointment of RSM Tenon will cover both internal audit and counter fraud for the CCG
for 2013/14. The draft internal audit and counter fraud plans would be agreed at a future
audit committee.
NHS Litigation Authority
No action.
CC LES
The 2012/13 CCLES and the process and timetable for authorising payments and it was
confirmed that:
• The Audit Committee is comfortable with the process;
• The Audit Committee will be responsible for signing off payments for 2012/13;
• The CCLES continues for 2013/14 and a similar process will be put in place;
• The Primary Care Quality Board will undertake a detailed review of the scheme and
make recommendations to the Audit Committee.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group Shadow Remuneration
Committee
Wednesday 13 March 2013 key issues
Terms of Reference
Terms of Reference agreed.
Due diligence on current CCG ‘staff’
CSU to confirm all payments to clinicians for 2012/13 are up to date to ensure no inherited
risk for the CCG.
Appointments to the CCG
Confirmed arrangements for appointment to CCG governance structure:
• Lay members, Board Nurse and Secondary Care Consultant to be appointed for two
years from April 2013;
• GP members including Programme Board and Consortia Leads a one year term with
new elections and appointments during 2013/14.
Appointments to CCG governance arrangements and Clinical Lead arrangements
Legal advice still awaited on contractual mechanisms for Board members and clinicians.
Employment arrangements
Due diligence completed on managerial staff transferring to the CCG and new contracts to
be sent to individuals for April.
A one point increase in salary to be given to all CCG managers to reflect the additional
responsibilities of being a stat org subject to a satisfactory appraisal.
Employment policies as at 1 April 2013
Agreed to use old NHS City and Hackney PCT employment policies from 1 April 2013 but
develop a programme to negotiate new CCG policies.
Ad Hoc Clinical Lead rate for 2013/14 agreed at £80 per hour.
User reimbursement
User reimbursement policy agreed.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group Clinical Executive Committee
Wednesday 10 April 2013 key issues
Committee Business
Long Term Conditions Programme Board to propose revised clinical audit requirements for
the Clinical Commissioning Local Enhanced Service.
Urgent Care Programme Board to prioritise the investigation of antibiotic use across
providers.
List of Clinical Lead vacancies to be circulated to Programme Board Chairs prior to
discussion at the Clinical Commissioning Forum.
All Clinicians working with the CCG to declare any conflicts of interest via the CCG
standard form.
Feedback from the Clinical Executive Committee
Consortia agendas and papers to be sent to practice nurses as well as GPs and Managers.
Planned Care Programme Board update
Review of work programme.
CCG to raise the provision of the screening service with Public Health England to highlight
the impact on patient choice and the Homerton University Hospital Foundation Trust.
Long Term Conditions Programme Board update
Review of work programme.
Initial proposals for the development of integrated care presented.
Practice Prescribing Budgets
Prescribing budgets discussed and agreed to pass to CCG Board for approval.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group Finance and Performance
Committee
Wednesday 17 April 2013 key issues
M12 finance based on M11 activity report
No CQUIN payments to be released without explicit CCG approval.
CSU-CCG meeting to take place to discuss and resolve financial control governance
issues.
Audit Committee to review CSU financial controls.
HUHFT hypertension charges to be investigated and challenged if found to be clinically
inappropriate.
2013/14 financial planning
CSU-CCG to discuss and implement a ‘complete loop’ system to ensure payments are
made correctly for specialist commissioning and the CCG.
Full 2013/14 financial plan to be presented to the CCG Board on completion.
Due diligence to be sought over the specialist commissioning split of services and funding
from CCG budgets.
2013/14 contract negotiations
CSU to produce 2012/13 plan, out turn and growth for HUHFT and analysis to be
conducted on productivity and savings.
Long Term Conditions Programme Board
Noting the over-performance on non-elective respiratory medicine, the FPC requested
some investigation into the increases in non elective spend and activity and review whether
there is anything that can be done.
Planned Care Programme Board
Following an increase in day attendances link up with your CSU representative to explore
this and report back.
Explore digestive system diseases, noting over-performance for elective and day cases.
Do Not Attends in Community Health Services
Asked CSU to benchmark DNAs against other CHS providers and against the acute to
explore whether this is significant.
Chair: Dr Clare Highton
Chief Officer: Paul Haigh
NHS City and Hackney Clinical Commissioning Group (CCG) Board
Friday 31 May 2013, 1415-1615
Bandura 2, Tomlinson Centre, Queensbridge Road, London, E8 3ND
DRAFT AGENDA
Chair: Dr Clare Highton
Agenda Items
Led by & Appendix Timing
number
1.
Welcome, introductions and declarations of
Interests
Clare Highton
1415-1420
(5 mins)
2.
CCG Committee business:
a. Minutes of the last meeting;
b. Register of Interests;
c. Matters arising.
Clare Highton
Papers 2a, 2b & 2c
1420-1425
(5 mins)
3.
Questions from the public
Clare Highton
Verbal
1425-1435
(10 mins)
CLINICAL STRATEGY (FOR DECISION)
4.
Out of Hours specification and procurement
signoff
Dr Kirsten Brown
Papers TBC
1435-1455
(20 mins)
5.
Neck of Femur mortality review
Dr Gary Marlowe
Papers TBC
1455-1510
(15 mins)
6.
Board development plan
Clare Highton
Papers TBC
1510-1525
(15 mins)
PERFORMANCE
7.
TBC
FOR INFORMATION
8.
CCG Finance update
Chair: Dr Clare Highton
Philippa Lowe
Papers TBC
Chief Officer: Paul Haigh
1525-1540
(15 mins)
9.
Reports from Subcommittees of the Board:
Clare Highton
a. Key issues from the Wednesday 8 May Papers TBC
2013 Clinical Executive Committee;
b. Key issues from the Monday 20 May
2013 Audit Committee;
c. Key issues from the Tuesday 21 May
2013 Remuneration Committee;
d. Key issues from the Tuesday 21 May
2013 Finance and Performance
Committee.
1540-1550
(10 mins)
10. Friday 28 June 2013 CCG Board agenda
Clare Highton
Papers TBC
1550-1600
(10 mins)
11. Any Other Business
Clare Highton
1600-1610
(10 mins)
Chair: Dr Clare Highton
Chief Officer: Paul Haigh