meeting (held in public) - bexley ccg · governing body members – see sarah valentine email...

DATE: 24 March 2016

Title

Decision Log from other Fora

This paper is for the standing agenda

Recommended action for the Governing Body

That the Governing Body: Note no decisions taken by the Governing Body since the public meeting on 28 January 2016.

Potential areas for Conflicts of interest

None.

Executive summary

Sometimes decisions need to be made by the Governing Body in private session that “having regard to the confidential nature of the business to be transacted, which relates to financial and commercial issues upon which would be prejudicial to the public interest.” Section 1(2) of the Public Bodies (admission to Meeting) Act 1960. NHS Bexley CCG endeavours to be as open and transparent as possible and therefore will report decisions that have been made in fora other than a public meeting at the most appropriate time. This report covers decisions made since the Governing Body (public) meeting held on 28 January 2016. The Governing Body Noted: Chair’s Action No. 5 7.12.15 Procurement of Non-Emergency Patient Transport Services (Dartford & Gravesham Hospital Trust Non –emergency conveyances only) Chairs Action No.6 24.02.2016 Better Care Fund Q3 Submission Approval of the award of the contract for the provision of Anticoagulation services to Drs WA Cotter & JCJM Bohmer T/A Bellegrove Surgery. 28.01.16

ENCLOSURE: D Agenda Item: 26/16

Governing Body meeting (held in public)

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Approval for the CCG Chair and Chief Officer could sign the contract extension via Chair’s Action following agreement with Oxleas on reasonable adjustments made to the current CAHMs services within the current contract.

How does this paper support the CCGs objectives

Patients: Improve the health and wellbeing of people in Bexley in partnership with our key stakeholders.

People: Empower our staff to make NHS Bexley CCG the most successful CCG in (south) London.

Pounds: Delivering on all of our statutory duties and become an effective, efficient and economical organisation.

Process: Commission safe, sustainable and equitable services in line with the operating framework and which improves outcomes and patient experience.

What are the Organisational implications

Key risks

None.

Equality

None.

Financial

None.

Data

None.

Legal issues

None.

NHS constitution

None.

Engagement None.

Audit trail None.

Comms plan None.

Author: Mary Stoneham Board Secretary

Clinical lead: Dr Nikita Kanani NHS Bexley CCG Chair

Executive sponsor: Simon Evans-Evans Director of Governance and Quality

Date 8 March 2016

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Governing Body Decisions log (for decision made whilst meeting in Private or via Chair’s action)

Date of Decision Authorised

Person

Reason the Decision was not taken at a

public Meeting

Title Decision Governing

Body Notified

Agenda item at

Governing Body

(public) Meeting

07.12.15 Governing Body Chairs Action 2015/16 No. 5

Decision needed due to time constraints

Procurement of Non-Emergency Patient Transport Services (Dartford & Gravesham Hospital Trust No- Emergency conveyances only)

Approved by CCG’s Chair the Procurement of Non-Emergency Patient Transport Services (Dartford & Gravesham Hospital Trust No- Emergency conveyances only) 7.12.2015

24.03.16 24.03.16

24.02.16 Governing Body Chairs Action 2015/16 No.6

Decision needed due to time constraints

Better Care Fund Submission Q3

Approved by CCG’s Chair the Better Care Fund (BCF) Q2 submission. 24.02.2015

24.03.16 24.03.16

28.01.16 Governing Body Private Meeting

Commercial in Confidence

Anti-Coagulation Procurement – Award Recommendations

Approved the award of the contract for the provision of Anticoagulation services to Drs WA Cotter & JCJM Bohmer T/A Bellegrove Surgery.

24.03.16 24.03.16

28.01.16 Governing Body Private Meeting

Commercial in Confidence

Oxleas Request For Contract Extension

Approval for the CCG Chair and Chief Officer could sign the contract extension via Chair’s Action following agreement with Oxleas on reasonable adjustments made to the current CAHMs services within the current contract.

24.03.16 24.03.16

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Excellent healthcare – locally delivered Chair: Dr Nikita Kanani | Chief Officer: Sarah Blow

GOVERNING BODY

Chair’s Action No. 5

Title: Procurement of Non – Emergency Patient Transport Services (Dartford &

Gravesham Hospital Trust Non-emergency conveyances only)

Revised paper for Chairperson’s action leading on from GB private meeting

requirements in November.

Decision: The Governing Body:

Approve the award of the contract for the provision of Non –Emergency Patient Transport

Services for Dartford & Gravesham Hospital Trust Non-emergency conveyances to Bidder B

(this is the company G4S).

Note the contents of the report, in particular the Financial Implications as outlined at Section 6 of this report. Documentation:(report attached) The current Non– Emergency Patient Transport Services contract (Dartford & Gravesham Hospital Trust Non-emergency conveyances) expires at the end of June 2016. This contract is currently held by NSL Ltd. A full procurement in line with EU requirements has been undertaken led by the Kent CCGs (via the CSU). Bexley CCG will be an associate to this contract. This paper seeks permission for the award of the Contract for Non–Emergency Patient Transport Services to G4S. Decision made by: Dr Nikita Kanani, Sarah Blow, Sarah Dr Sid Deshmukh, Dr Varun Bhalla, Graham Rehling,

Keith Wood and Mary Currie

After consultation with: Governing Body members – see Sarah Valentine email Governing Body members on 14 October 2015 By authorisation of: (for decisions made on behalf of Chief Officer or Chair) Reason for Chair’s Action: Time constraints - decision needed before the November Governing Body meeting. . Communicated to: 24 March 2016 Locality Chairs on 24 March 2016

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Governing Body Public Meeting on 24 March 2016 _____________________________ ________________________ Dr Nikita Kanani, Bexley CCG Chair Date email 7 December 2015 _____________________________ ________________________ Sarah Blow – Chief Officer Date email 7 December 2015 ________________________ ________________________ Keith Wood Bexley CCG Governing Body Member Date email 7 December 2015 _____________________________ ________________________ Dr Sid Deshmukh Bexley CCG Governing Body Member Date email 7 Decemver 2015

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As set out within Bexley Clinical Commissioning Group Constitution 3.2.21 Emergency powers 3.2.21 Emergency powers and urgent decisions 3.2.21.1 It is recognised that there will be times when urgent decisions are required. The Chair has the discretion to define urgent decisions. 3.2.21.2 In an emergency, where a decision must be made by the governing body

before its next meeting, the powers and duties of the governing body may be exercised by the Chair (Emergency Action).

3.2.21.3 or this purpose “emergency” means circumstances in which:- 3.2.21.4 The governing body will be unable to discharge its statutory functions or be

exposed to a significant level of risk if urgent action is not taken; or urgent action must be taken to prevent loss, damage or significant disadvantage to the CCG.

3.2.21.5 To ensure transparency, any urgent decisions will be recorded and notified in

the minutes of the next regular meeting of the CCG governing body, and a log maintained for inspection by the Audit and Integrated Assurance Committee

3.2.21.6 If decisions have an immediate impact on the wider CCG and constituent

members, the locality chairs will be informed at the earliest convenience, so information can be shared with localities.

3.2.21.7 The Chair and/or the Accountable Officer have the authority to make an urgent

decision without consultation with the localities or governing body. 3.2.21.7.1 Where possible, the Accountable Officer will always discuss decisions with the

Chair, clinical vice-chair or Deputy Chair, and in their absence will notify a governing body GP lead.

3.2.21.7.2 If chair’s action is required, the chair will consult with at least two other governing

body representatives before confirming the action. 3.2.21.8 The Emergency Action functions of the Chair and Accountable Officer may be

exercised by such other persons as the Chair and Accountable Officer may respectively nominate in writing.

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DATE:

Title

Procurement of Non – Emergency Patient Transport Services (Dartford & Gravesham Hospital Trust Non-emergency conveyances only) Revised paper for Chairperson’s action leading on from GB private meeting requirements in November.

Recommended action for the Governing Body

That the Governing Body: Approve the award of the contract for the provision of Non –Emergency Patient Transport Services for Dartford & Gravesham Hospital Trust Non-emergency conveyances to Bidder B (this is the company G4S). Note the contents of the report, in particular the Financial Implications as outlined at Section 6 of this report.

Executive summary

The current Non– Emergency Patient Transport Services contract (Dartford & Gravesham Hospital Trust Non-emergency conveyances) expires at the end of June 2016. This contract is currently held by NSL Ltd. A full procurement in line with EU requirements has been undertaken lead by the Kent CCGs (via the CSU). Bexley CCG will be an associate to this contract. This paper seeks permission for the award of the Contract for Non–Emergency Patient Transport Services to G4S.

Which objective does this paper support?

Patients: Improve the health and wellbeing of people in Bexley in partnership with our key stakeholders

People: Empower our staff to make NHS Bexley CCG the most successful CCG in (south) London

Pounds: Delivering on all of our statutory duties and become an effective, efficient and economical organisation

ENCLOSURE: D Agenda Item: 26/15

Governing Body (private) meeting – Chairperson’s Action

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Process: Commission safe, sustainable and equitable services in line with the operating framework and which improves outcomes and patient experience

Organisational implications

Key risks (corporate and/or clinical)

Providers may challenge the procurement process, even though such challenges may be without substance.

Equality and diversity

Awarding a new Contract incorporating revisions to the specification will have a positive impact.

Patient impact

Awarding a new Contract incorporating revisions to the specification will have a positive impact.

Financial

Opportunity for benchmark costs against current market costs.

Legal issues

The re-procurement has been conducted in accordance with the Public Contracts Regulations 2015, and the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013.

NHS constitution

Patients’ rights under the NHS Constitution will be safeguarded

Consultation(public, member or other)

Although no statutory consultation is required, the results from patient feedback surveys, complaints, and other forms of more informal feedback have been incorporated into the process of revising the specification.

Audit(considered/approved by other committees/groups)

Further detailed plans will be considered by the Finance sub-Committee in accordance with the CCG’s established governance framework as they develop.

Communications plan A communications plan will be developed by the project team and tailored to suit the needs of the population of Bexley.

Author Mark Abrahams, Interim Head of Procurement. Jonathan Manuelpillai, Assistant Director Contracting.

Clinical lead TBA

Executive sponsor Sarah Valentine, Director of Commissioning

Date 3 December 2015.

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1.0 Background: The current contract for the provision of Non-emergency Patient Transport Services (NePTS) for Dartford & Gravesham Hospital Trust (DGH Trust) conveyances expires at the end of June 2016 (the current provider is NSL). The new contract would commence on 1st July 2016. Having made the decision to re procure the contract across Kent & Medway the eight Kent & Medway Clinical Commissioning Groups (CCGs) established a project structure to ensure delivery of the required outcomes. The lead commissioning CCG for the Kent and Medway PTS is West Kent. Bexley CCG will be an associate to the contracts and the Governing Body provided their approval for the CCG to be named within the contract (to procure). This paper seeks permission to award the contract to a new provider at the increased amount.

2.0 Non-emergency Patient Transport Services: Non-emergency PTS is provided for patients who are being transported to an NHS funded service for NHS treatment and who are deemed medically eligible based on the Department of Health (DOH) eligibility criteria. The DOH defines Non-emergency Patient Transport Service (NePTS) activity as being typified by the non-urgent, planned transportation of patients, with a medical need for transport, to and from premises providing NHS healthcare and between such Providers. This encompasses a wide range of vehicle types and levels of care consistent with the patients’ medical needs. The overarching principle of NePTS is that patients who are eligible for transport will receive safe, timely and comfortable transport, without detriment to their medical condition. A non-emergency patient is one who whilst requiring treatment which may or may not be of a specialist nature, does not require an immediate or urgent response.

3.0 Procurement Process: South East Commissioning Support Unit (CSU) was commissioned in March 2014 by the eight Kent and Medway CCGs to deliver the project. A formal project structure was subsequently established to govern the project. Representatives from the eight Kent and Medway CCGs have been fully involved through membership of the Project Board, Group and the evaluation and interview panels. As an associate, Bexley was not a member of the Board, but did receive regular updates and also provided input into the specification. Patients also took part in the service redesign and tender evaluations. Agreement to procure was provided by the Bexley Governing Body.

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A Prior Information Notice (PIN) was published 3rd December 2014 alerting the market that a procurement process and market engagement process was to be undertaken. A market engagement event was held in Tonbridge on 23rd March 2015 advising potential providers on the process, timeframes and drivers behind the whole project. The OJEU advert Ref 2015/S 087-157440 was placed in 17th April 2015. A restricted procurement process was used. The Pre-Qualification Questionnaire (PQQ) stage closed on 1st June 2015. The top scoring 6 companies in each Lot were invited to the tender stage. The Invitation to Tender (“ITT”) was issued on 17th July 2015 and closed on 1st September 2015. The contract period will be six years from the date of commencement. The effective period may be extended for a further 3 years but will not be extended beyond nine years.

4.0 Bids Received: The ITT was split into the following Lots -

Lot 1: Non-Renal (excluding DGH Trust)

Lot 2: Renal

Lot 3: Non-Renal (DGH Trust only) (Note although Renal Services are mainly commissioned through NHS England it does not include the transportation of the patients which continues to be commissioned by CCGs). The responses to the ITT were as follows:

4 bids were received for Lot 1

4 bids were received for Lot 2

5 Bids were received for Lot 3

5.0 Bexley Specific Issue: A key challenge with any procurement being let on a collaborative basis is to ensure it meets our specific needs. Bexley CCG has been consulted at various stages regarding the progress of the procurement, including with regards to the development of the specification. Some key issues we have fed into the specification development have been –

The importance of recruiting, retaining, training, and managing staff in order to minimise staff turnover and the use of temporary staff,

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The standard of the vehicles, ensuring that modern, safe, and low-emission vehicles are used,

Processes must be in place to ensure the eligibility criteria are met, and that full records are available as to the patients name, address, destination, date, time, etc.,

Technology should be used to plan the optimum route, establish the nearest available driver, monitor standards of driving, and avoid traffic delays where possible.

6.0 Financial & Case Mix Implications for Bexley CCG: The cost will of this contract will be £302k per year for lots 1, 2, & 3. A full breakdown of the Lots and costs can be found at Appendix B. Overall the costs are:

1. Lot 1 - £17k (table 8) 2. Lot 2 - £0.5k (table 9) 3. Lot 3 – £277k (table 10)

All of the above prices are plus CQUIN. The current cost is a historic block contract at £131k per year, the proposed new arrangement will represent an increase of £171k per year. In view of the size of this increase, CCG officers have carried out further research to understand the reasons as to why this increase has occurred. When the changes in the complexity of the journeys (e.g. number of escorts etc.) is considered the main area of cost pressure is in Lot 3, journeys to / from Darent Valley Hospital, as this would be the key element of the tender that would be used by the CCG (see Appendix B). Four key reasons have been established as to why the costs have increased –

Historical agreement existed as a block (with both low rates and also journey complexity (e.g. single to double handed escorts “casemix” inaccuracies),

An enhanced specification for the new contract (to improve quality),

Activity changes (casemix),

Configuration of the tender. Officers within the CCG have sought an alternative quotation from a provider that had not been involved in the process, and have satisfied themselves that the price from Bidder B is competitive within the market. It was also noted that Bidder B’s price was broadly similar to Bidder F’s price. Officers concluded that the preferred bidder’s price is average as opposed to being an outlying price. As outlined at section 4.0, the tender will be awarded on the MEAO (Most Economically Advantageous Offer) basis; Bidder B was not the cheapest. However, it is worth noting that the lowest 2 bids (circa £190k & £205k a year excl. CQUIN, received from bidders C & E) were awarded the lowest scores in terms of quality. It therefore appears that if we approach the market directly we may find ourselves being faced with low price bids that are not acceptable in terms of quality.

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Appendix D contains 2 sets of analysis:

The first chart shows the change in activity by the current cost (table 14) (see section 6.1 below) and

The second chart (table 15) then shows the change this change in activity at the new tendered rates.

6.1 Historical under-charges & activity “case mix” (complexity of transport e.g. single or double escorts) inaccuracies: It has been established that the activity case mix volumes in the last contract were incorrect. As the last contract was let on a block contract basis, this did not impact upon the price paid and the CCG has encountered a historical financial benefit. As the correct activity and case mix has been disclosed within the current tender, the price is higher. Appendix C (tables 11-13) illustrates the activity figures used in the last procurement against those used in the 2015 procurement. Although in many instances the overall activity has decreased, there has been a shift in the activity case mix profile (complexity) that has resulted in increases in areas that attract higher costs. Case mix (complexity) examples:

The activity level for 1 crew ambulance journeys has decreased by 301 journeys, but there has been an increase in 2 crew ambulance journeys by 348.

The activity level for 1 crew wheelchair journeys has decreased by 406 journeys, but there has been an increase in 2 crew wheelchair journeys by 404.

These changes to the case mix have impacted upon the overall total cost. Additionally, the activity for transport for bariatric patients has significantly increased. Appendix D shows the financial implications of the case mix changes in detail. 6.2 An enhanced specification for the new contract: The specification has addressed a number of deficiencies that existed within the old contract. For example, currently the provider is contracted to a 5 hour on the day discharge pick up time, and will not accept a pick up time of less than 2 hours from booking. The provider then picks up patients within 3 hours of this booked ready time, meaning some patients are left for 5 hours in total. The new threshold is 2 hours, which represents a significant improvement in the service to patients.

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Appendix A provides a KPI summary that compares the current Key Performance Indicators (KPIs) against the new service KPIs. Additionally there are now penalties within the contract which are applicable on a CCG level. Although it is not possible to calculate the exact cost of the specification enhancements, it is estimated that the activity levels will add circa 30% to 35% to the overall contract value. 6.3 Activity (growth) uplift: An uplift of 2.25% for growth has been applied to the activity for 2016-17. 6.4 Configuration of the tender: The tender process separated out the requirements into 3 separate Lots, the main area of expenditure is for transport to / from Dartford & Gravesham Hospital Trust (Lot 3). The intention of this was that as the geographical scope for Lot 3 was considerably smaller, it may be suitable for smaller bidders and therefore may result in greater competition. It appears that one additional bid was received, compared to Lot 1, and it was hoped that this would result in lower prices. Conversely, prices for the journeys in Lot 3 were more expensive. Given the tender has not been formally awarded at the time of writing it is not possible to interrogate bidders to challenge their rationale for this. It may be that economies of scale may have been lost because of the lot being smaller, or because it was separate from Lot 1. As Bidder B has won all three lots, the CSU has advised that discussions regarding the opportunity for economies of scale benefits to be applied will take place prior to the contract being formally signed. The below table compares the prices submitted as part of Lot 1 against those submitted as part of Lot 3. This comparison indicates that this could add an average of 46% to the contract value. Table 1: Lot 1 compared to Lot 3 prices:

Lot 1 price: Lot 3 price: Increase: Increase:

0-10 miles 0-10 miles £ Percentage

A1 Ambulance 1 Person Crew 20.01£ 32.11£ 12.09£ 60%



BV Bariatric Adapted PCV 147.43£ 180.02£ 32.59£ 22%

C Walker No Assistance Car 18.48£ 29.61£ 11.13£ 60%

C1 Walker With Assist By Car 23.54£ 39.31£ 15.76£ 67%

HD High Dependancy 2 Person 147.43£ 180.02£ 32.59£ 22%

ST Stretcher 2 Person Crew 65.15£ 105.85£ 40.70£ 62%

W1 Wheel Chair 1 Person Crew 51.14£ 80.45£ 29.31£ 57%

W2 Wheel Chair 2 Person Crew 65.24£ 107.46£ 42.22£ 65%

677.03£ 990.93£ 313.90£ 46%

Vehicle Type

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7.0 The Proposed Contract with Cap & Collar: The existing contract arrangement has been on a block contract basis. The new arrangement is also being let on a block basis, but with thresholds for under activity and over activity (so a cap and collar arrangement). If activity falls below the lower threshold (the collar) then we will receive a % of the budget back, if it increases above the upper threshold (the cap) then we would only pay for the activity between the block and the cap (so up to 10% above the contract activity). These risks have been mitigated against as follows –

The activity levels have been verified (see 6.1 above), so the CCG has assurances that the baseline figures are correct (based on current usage) as inaccurate data can often be the root of activity increases.

If activity varies then a cap and collar arrangement is in place. The range of 95% (the collar) and 105% of contract activity (the cap). This will be calculated for each CCG party at a mobility and distance level and based on a quarterly reconciliation on the following basis -

Table 2 below explains the cap and collar within this agreement and marginal rates (or refunds). Table 2 – Implications of Activity Variations:

Less than 95% activity

95% - 100% activity

100-105% activity

105% - 110% activity

Above 110% activity

Refundable back to the CCG at 75% of tariff.

Fee unchanged £302,267

Fee unchanged £302,267

£302,267

Each additional journey at 75% of

marginal rate.

Over performance above the 10%

upper cap will not be paid for.

Variance Reviews: Where activity variance is 10% above or below plan for more than three consecutive months (e.g. a quarter) for any individual CCG it will prompt an activity review between the co-ordinating commissioner and provider. There should be no expectation that price will be increased should activity be above 10% above plan for three months. A price review would only be triggered if total contract activity over or under performs and this would only apply to those CCG commissioners whose activity is materially different from plan. Where mobility bandings have low planned activity volumes, e.g. high dependency or ambulance with four person crew, over and under performance must be calculated over one year rather than over one quarter to avoid triggering regular over/under performance activity reviews.

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8.0 Results of Quality and Financial Evaluations The ITT was evaluated on the Most Economically Advantageous Offer (MEAO) basis, whereby technical / quality questions as well as the commercial (price) score are evaluated. The technical / quality questions had a 65% weighting, and the commercial (price) score had a 35% weighting applied. The technical/ quality score was broken down into the key areas.

Section 1 – Service Delivery 25% weighting

Section 2 – Management Process 22% weighting

Section 3 – Patient Experience & Safety 18% weighting Following the technical / quality evaluation a site visit was carried out for each bidder. Bidders were then invited to give a presentation and attend interview for each bid submitted. Finally a moderation session was held for each Lot to reach the final scores on 19th October 2015. At the end of the process Bidder B scored the highest overall MEAO score in Lot 1, Lot 2 and Lot 3 as follows – Table 3 - MEAO Scores for Lot 1, Kent and Medway:

Position Bidder Technical/Quality Score Commercial Score Total Score

1 Bidder B 50.52 31.07 81.59

2 Bidder A 39.04 35.00 74.04

3 Bidder D 41.38 20.99 62.37

4 Bidder C 35.01 27.02 62.03

Table 4 - MEAO Scores for Lot 2 – Renal:


1 Bidder B 44.11 35.00 79.31

2 Bidder A 39.22 24.63 63.85

3 Bidder E 27.19 28.90 56.09

4 Bidder D 42.82 10.91 53.73

Table 5 - MEAO Scores for Lot 3 - Dartford and Gravesham NHS Trust:


1 Bidder B 56.57 24.02 80.58

2 Bidder C 35.29 35.00 70.29

3 Bidder F 44.09 24.54 68.63

4 Bidder D 43.32 19.85 66.18

5 Bibber E 30.59 32.41 62.96

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9.0 Identities of Bidders: CONFIDENTIAL Table 6 – Identities of Bidders:

Position Bidder Technical/Quality Score Commercial Score

Total Score

1 Bidder B G4S 56.57 24.02 80.58

2 Bidder C Medical Services 35.29 35 70.29

3 Bidder F Dartford & Gravesham

44.09 24.54 68.63

4 Bidder D NSL 43.32 19.85 66.18

5 Bibber E Thames Ambulance 30.59 32.41 62.96

10.0 Recommendation: It is recommended by the Patient Transport Procurement Project Board that the Contract for Lot 1, Lot 2 and Lot 3 be awarded to Bidder B (this is G4S). Bidder B has submitted the Most Economically Advantageous Offer, and has consistently shown a great understanding for the needs of the customer and the requirement to deliver this service in each Lot. Sarah Valentine Director of Commissioning

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Appendix A - Specification improvements: Table 7:

Ref KPI Ref KPI Required service standard

Sectio

Outpatient appointments (includes transfers to and from inpatient care to outpatient appointments at other sites e.g. diagnostic scans)

1a Journey booked in advance- Outpatient arrival 1.1 Arrival Time Patients to arrive prior to their appointment

1bJourneys booked in advance - Time bound arrival. Only includes : Haematology-oncology patients

that are receiving IV chemotherapy and children.

1c Kent and Medway bound journey booked on the day - Outpatient arrival 1.2aReturn

journeys

Return Journey patients to be collected within 60 minutes after their

identified booked ready time (excluding renal or 'on the day

requests')

1d Kent and Medway bound journey booked on the day. Time bound outpatient arrival

1e Appendix 2 site journey booked on the day. Outpatient arrival

1f Appendix 2 site journey booked on the day. Time bound outpatient arrival

1g Outpatient return journey.All bookings

Section 2 Discharges

Section 2 KPIs are preceded by a minimum two hour planning window

2a Journey booked in advance. Discharge

2b Journey booked on the day. Discharges 1.3Discharged

patients

Discharged and transfer patients booked 'on the day' should be

collected from agreed locations within agreed timescales after the

time for the booking has been accepted (Min 2 hours to booked

ready time)

2c Journey booked in advance. Time bound discharge - care package

Section 3 Transfers of care (note transfer for outpatient appointments are covered in part 1)

3a In advance transfer of care

3b Appendix 2 site journey booked on the day. Transfer of care

3c Appendix 2 site journey booked on the day. Time bound transfer of care

3d Kent and Medway bound journey booked on the day. Transfer of care.

3eOut of area journey for a child or a mental health unit inpatient admission booked on the day.

Transfer of care

Aborted/cancelled journeys

4 Aborted/cancelled journeys 1.4Aborted

journeysJourneys aborted as a result of the provider

Patient Experience

5a Travel time (up to 10 miles) 2.1a Travel time

Patients travelling up to 10 miles to / from their destination should

not spend longer than 90 minutes on either an inward or outward

journey

5b Travel time (more than 10 miles less than 35 miles) 2.1b Travel time

Patients travelling from 11 - 35 miles to / from their destination

should not spend longer than 120 minutes on either an inward or

outward journey

5c Travel time (over 35 miles) 2.1c Travel time

Patients travelling over 35 - 50 miles to / from their destination

should not spend longer than 150 minutes on either an inward or

outward journey

5d Initial Contact 1.1 Initial Contact

All calls should be answered by a person within 30 seconds

including the introductory message which should be no more than

30 seconds long i.e. 60 seconds in total. If no introductory message

is used calls must be answered within 30 seconds.

No KPI

No KPI

No KPI

No KPI

New Service KPIs NSL Service KPIs

No KPI

No KPI

No KPI

No KPI

No KPI

No KPI

No KPI

No KPI

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Appendix B – Total Costs for Lots 1, 2, & 3: Table 8, 9, & 10: Lot 1, Lot 2, & Lot 3 prices:

Lot 1 - Total costs

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+ £A1 Ambulance 1 Person Crew 490 105 511 148 - - 137 1,391

A2 Ambulance 2 Person Crew 3,593 106 - - - - - 3,699

A4 Ambulance 4 Person Crew - - - - - - - -

BV Bariatric Adapted PCV - - - - - - - -

C Walker No Assistance Car - - 2,796 - - 259 - 3,055

C1 Walker With Assist By Car 240 - 1,659 2,073 - - 1,194 5,166

HD High Dependancy 2 Person - - - - - - - -

ST Stretcher 2 Person Crew 1,196 294 - 692 - - - 2,182

W1 Wheel Chair 1 Person Crew - 1,159 127 - - - - 1,286

W2 Wheel Chair 2 Person Crew - 294 322 - - - - 616

5,519 1,957 5,415 2,913 - 259 1,331 17,395

Lot 2 - Total costs

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+ £A1 Ambulance 1 Person Crew 59 - - - - - - 59

A2 Ambulance 2 Person Crew 128 - - - - - - 128


BV Bariatric Adapted PCV - - - - - - - -

C Walker No Assistance Car - - - - - - - -

C1 Walker With Assist By Car 101 85 - - - - - 185

HD High Dependancy 2 Person - - - - - - - -

ST Stretcher 2 Person Crew - - - - - - - -

W1 Wheel Chair 1 Person Crew 150 - - - - - - 150

W2 Wheel Chair 2 Person Crew - - - - - - - -

437 85 - - - - - 522

Lot 3 - Total costs

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+ £A1 Ambulance 1 Person Crew 25,347£ 6,736£ 446£ 132£ -£ -£ -£ 32,662£

A2 Ambulance 2 Person Crew 59,227£ 11,698£ 4,149£ -£ -£ -£ -£ 75,073£

A4 Ambulance 4 Person Crew -£ -£ -£ -£ -£ -£ -£ -£

BV Bariatric Adapted PCV 29,013£ 383£ -£ -£ -£ -£ -£ 29,395£

C Walker No Assistance Car 2,476£ 1,499£ 97£ -£ -£ -£ 215£ 4,288£

C1 Walker With Assist By Car 24,618£ 516£ -£ -£ -£ -£ -£ 25,134£

HD High Dependancy 2 Person -£ -£ -£ -£ -£ -£ -£ -£

ST Stretcher 2 Person Crew 34,334£ 4,868£ -£ -£ 322£ -£ -£ 39,523£

W1 Wheel Chair 1 Person Crew 20,515£ 3,745£ 420£ -£ -£ -£ -£ 24,680£

W2 Wheel Chair 2 Person Crew 32,007£ 494£ 13,721£ -£ -£ -£ -£ 46,221£

227,536£ 29,938£ 18,834£ 132£ 322£ -£ 215£ 276,977£

£

Total cost = 294,895

CQUIN 2.50% 7,372

302,267

Distance

Vehicle Type

Distance

Vehicle Type

Distance

Vehicle Type

12 of 14

Appendix C –Activity Case Mix: Table 11: Historical activity (Lot 3):

Table 12: New tender activity (Lot 3):

Table 13: Comparison Existing to New Activity (Table 11 & 12) for Lot 3 only:

Number of journeys

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+

A1 Ambulance 1 Person Crew 974 253 36 2 0 0 0 1,265

A2 Ambulance 2 Person Crew 533 81 5 0 0 0 0 619


BV Bariatric Adapted PCV 21 8 0 0 0 0 0 29

C Walker No Assistance Car 1,011 153 54 0 0 0 2 1,220

C1 Walker With Assist By Car 0 0 0 0 0 0 0 0

HD High Dependancy 2 Person 63 12 2 0 0 0 0 77

ST Stretcher 2 Person Crew 359 110 0 0 2 0 0 471

W1 Wheel Chair 1 Person Crew 579 89 38 0 0 0 0 706


3,540 706 135 2 2 0 2 4,387

Distance

Vehicle Type

Number of journeys

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+A1 Ambulance 1 Person Crew 789 155 8 2 0 0 0 955



BV Bariatric Adapted PCV 161 2 0 0 0 0 0 163

C Walker No Assistance Car 84 39 2 0 0 0 2 126

C1 Walker With Assist By Car 626 10 0 0 0 0 0 636

HD High Dependancy 2 Person 0 0 0 0 0 0 0 0

ST Stretcher 2 Person Crew 324 41 0 0 2 0 0 367



3,331 424 157 2 2 0 2 3,919

Distance

Vehicle Type

HISTORICAL NEW CHANGE

A1 Ambulance 1 Person Crew 1265 955 -310

A2 Ambulance 2 Person Crew 619 967 348

A4 Ambulance 4 Person Crew 0 0 0

BV Bariatric Adapted PCV 29 163 134

C Walker No Assistance Car 1220 126 -1094

C1 Walker With Assist By Car 0 636 636

HD High Dependancy 2 Person 77 0 -77

ST Stretcher 2 Person Crew 471 367 -104

W1 Wheel Chair 1 Person Crew 706 300 -406

W2 Wheel Chair 2 Person Crew 0 404 404

4387 3919 -468

13 of 14

Appendix D – Financial Implications of Activity Case Mix Changes: Table 14: Historical activity multiplied by new tender costs (Lot 3) (ex CQUIN):

Table 15: New tender costs (Lot 3) (ex CQUIN):

Table 16: Comparison of existing to new tendered costs (Table 14 against Table 15 – Lot 3 only:

Total costs

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+ £

A1 Ambulance 1 Person Crew 31,271 10,992 1,969 132 - - - 44,364

A2 Ambulance 2 Person Crew 39,779 7,146 508 - - - - 47,433


BV Bariatric Adapted PCV 3,780 1,500 - - - - - 5,281

C Walker No Assistance Car 29,933 5,917 2,574 - - - 215 38,638

C1 Walker With Assist By Car - - - - - - - -

HD High Dependancy 2 Person 11,341 2,250 390 - - - - 13,982

ST Stretcher 2 Person Crew 38,000 13,123 - - 322 - - 51,444

W1 Wheel Chair 1 Person Crew 46,580 8,169 3,916 - - - - 58,665

W2 Wheel Chair 2 Person Crew - - - - - - - -

200,684 49,097 9,357 132 322 - 215 259,807

Distance

Vehicle Type

Total costs

Total

0-10 10-20 20-30 30-40 40-50 50-60 60+ £A1 Ambulance 1 Person Crew 25,347£ 6,736£ 446£ 132£ -£ -£ -£ 32,662£

A2 Ambulance 2 Person Crew 59,227£ 11,698£ 4,149£ -£ -£ -£ -£ 75,073£

A4 Ambulance 4 Person Crew -£ -£ -£ -£ -£ -£ -£ -£

BV Bariatric Adapted PCV 29,013£ 383£ -£ -£ -£ -£ -£ 29,395£

C Walker No Assistance Car 2,476£ 1,499£ 97£ -£ -£ -£ 215£ 4,288£

C1 Walker With Assist By Car 24,618£ 516£ -£ -£ -£ -£ -£ 25,134£

HD High Dependancy 2 Person -£ -£ -£ -£ -£ -£ -£ -£

ST Stretcher 2 Person Crew 34,334£ 4,868£ -£ -£ 322£ -£ -£ 39,523£

W1 Wheel Chair 1 Person Crew 20,515£ 3,745£ 420£ -£ -£ -£ -£ 24,680£

W2 Wheel Chair 2 Person Crew 32,007£ 494£ 13,721£ -£ -£ -£ -£ 46,221£

227,536£ 29,938£ 18,834£ 132£ 322£ -£ 215£ 276,977£

Distance

Vehicle Type

Total costs

HISTORICAL NEW CHANGE

A1 Ambulance 1 Person Crew 44,364£ 32,662£ -11,702

A2 Ambulance 2 Person Crew 47,433£ 75,073£ 27,640

A4 Ambulance 4 Person Crew -£ -£ 0

BV Bariatric Adapted PCV 5,281£ 29,395£ 24,115

C Walker No Assistance Car 38,638£ 4,288£ -34,350

C1 Walker With Assist By Car -£ 25,134£ 25,134

HD High Dependancy 2 Person 13,982£ -£ -13,982

ST Stretcher 2 Person Crew 51,444£ 39,523£ -11,921

W1 Wheel Chair 1 Person Crew 58,665£ 24,680£ -33,984

W2 Wheel Chair 2 Person Crew -£ 46,221£ 46,221

259,807£ 276,977£ 17,170£

Vehicle Type

14 of 14

Appendix B

GOVERNING BODY

Chair’s Action No. 6 – 15/16

Title: Better Care Fund Q3 Submission Decision: Chairs Action is requested for approval by the Governing Body to agree the submission of the Better Care Fund (BCF) quarter 3 reports by end of February 2016 which will be presented to the Governing Body at the March Governing Body public meeting. Both the Governing Body and Health & Wellbeing Board have agreed to jointly process the Bexley quarterly submissions but unfortunately submission dates do not fit with either of organisations formal meeting dates. Documentation: Attached documentation which explains that the report has reflects where Bexley is in terms of contracts, systems and data – it is in the format for the HWB and contains the guidance (please see App 1 document attached). Decision made by: Dr Nikita Kanani and Sarah Blow following emails and documentation circulated by Sarah Valentine to Governing Body members. Consultation with: Emails and documentation circulated by Sarah Valentine to Governing Body members. Dr Nikita Kanani, Sarah Blow, Dr Sid Deshmukh, Dr Varun Bhalla, Graham Rehling, Keith Wood, Dr Sonia Khanna-Deshmukh, Tina Khanna, Sandra Wakeford, and Theresa Osborne. By authorisation of: (for decisions made on behalf of Chief Officer or Chair) Reason for Chair’s Action: Chair’s Action required to enable the CCG and the London Borough of Bexley to submit the Better Care Fund: New Quarterly Reporting Template in line with statutory requirements (via email) The Governing Body is asked to APPROVE the Better Care Fund: New Quarterly Reporting Template submission by the end of February which will be reported to the March Governing Body meeting. This will be the on-going process for future submissions.

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Communicated to: Locality Chairs on 24 March 2016 Governing Body Public Meeting on 24 March 2016 Staff on 24 March 2016 Email confirmation _________________________ Date: 24 February 2016 Dr Nikita Kanani, NHS Bexley CCG Chair Email confirmation _______________________ Date: 24 February 2016 NHS Bexley CCG Governing Body Member Sarah Blow – Chief Officer Email confirmation _____________________________ Date: 24 February 2016 Bexley CCG Governing Body Member Dr Sid Deshmukh Governing Body Locality Lead Frognal Email Confirmation _____________________________ Date 24 February 2016 Bexley CCG Governing Body Member Keith Wood – Lay Member Governance

As set out within Bexley Clinical Commissioning Group Constitution 3.2.21 Emergency powers 3.2.21 Emergency powers and urgent decisions

3.2.21.1 It is recognised that there will be times when urgent decisions are required. The Chair has the discretion to define urgent decisions. 3.2.21.2 In an emergency, where a decision must be made by the governing body before its

next meeting, the powers and duties of the governing body may be exercised by the Chair

(Emergency Action).

3.2.21.3 or this purpose “emergency” means circumstances in which:-

3.2.21.4 The governing body will be unable to discharge its statutory functions or be exposed

to a significant level of risk if urgent action is not taken; or urgent action must be taken to

prevent loss, damage or significant disadvantage to the CCG.

3.2.21.5 To ensure transparency, any urgent decisions will be recorded and notified in the

minutes of the next regular meeting of the CCG governing body, and a log maintained for

inspection by the Audit and Integrated Assurance Committee

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3.2.21.6 If decisions have an immediate impact on the wider CCG and constituent members,

the locality chairs will be informed at the earliest convenience, so information can be shared

with localities.

3.2.21.7 The Chair and/or the Accountable Officer have the authority to make an urgent

decision without consultation with the localities or governing body.

3.2.21.7.1 Where possible, the Accountable Officer will always discuss decisions with the Chair,

clinical vice-chair or Deputy Chair, and in their absence will notify a governing body GP

lead.

3.2.21.7.2 If chair’s action is required, the chair will consult with at least two other governing body

representatives before confirming the action.

3.2.21.8 The Emergency Action functions of the Chair and Accountable Officer may be

exercised by such other persons as the Chair and Accountable Officer may respectively

nominate in writing.


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Quarterly Reporting Template - Guidance

Notes for Completion

The data collection template requires the Health & Wellbeing Board to track through the high level metrics and deliverables from the Health & Wellbeing Board Better Care Fund

plan.

The completed return will require sign off by the Health & Wellbeing Board.

A completed return must be submitted to the Better Care Support Team inbox ([email protected]) by midday on 26th February 2016.

The BCF Q3 Data Collection

This Excel data collection template for Q3 2015-16 focuses on budget arrangements, the national conditions, payment for performance, income and expenditure to and from the

fund, and performance on BCF metrics.

To accompany the quarterly data collection Health & Wellbeing Boards are required to provide a written narrative into the final tab to contextualise the information provided in

this report and build on comments included elsewhere in the submission. This should include an overview of progress with your BCF plan, the wider integration of health and

social care services, and a consideration of any variances against planned performance trajectories or milestones.

Cell Colour Key

Data needs inputting in the cell

Pre-populated cells

Question not relevant to you

Throughout this template cells requiring a numerical input are restricted to values between 0 and 100,000,000.

Content

The data collection template consists of 9 sheets:

Checklist - This contains a matrix of responses to questions within the data collection template.

1) Cover Sheet - this includes basic details and tracks question completion.

2) Budget arrangements - this tracks whether Section 75 agreements are in place for pooling funds.

3) National Conditions - checklist against the national conditions as set out in the Spending Review.

4) Non-Elective and Payment for Performance - this tracks performance against NEL ambitions and associated P4P payments.

5) Income and Expenditure - this tracks income into, and expenditure from, pooled budgets over the course of the year.

6) Metrics - this tracks performance against the two national metrics, locally set metric and locally defined patient experience metric in BCF plans.

7) Understanding support needs - this asks what the key barrier to integration is locally and what support might be required.

8) New Integration metrics - additional questions on new metrics that are being developed to measure progress in developing integrated, cooridnated, and person centred care

9) Narrative - this allows space for the description of overall progress on BCF plan delivery and performance against key indicators.

Checklist

This sheet contains all the validations for each question in the relevant sections.

All validations have been coloured so that if a value does not pass the validation criteria the cell will be Red and contain the word "No" and if they pass validation they will be

coloured Green and contain the word "Yes".

1) Cover Sheet

On the cover sheet please enter the following information:

The Health and Well Being Board

Who has completed the report, email and contact number in case any queries arise

Please detail who has signed off the report on behalf of the Health and Well Being Board.

Question completion tracks the number of questions that have been completed, when all the questions in each section of the template have been completed the cell will turn

green. Only when all 9 cells are green should the template be sent to [email protected]

2) Budget Arrangements

This plays back to you your response to the question regarding Section 75 agreements from the Q1 and Q2 2015-16 submissions and requires 2 questions to be answered. Please

answer as at the time of completion. If you answered 'Yes' previously the 2 further questions are not applicable and are not required to be answered.

If your previous submission stated that the funds had not been pooled via a Section 75 agreement, can you now confirm that they have?

If the answer to the above is 'No' please indicate when this will happen

3) National Conditions

This section requires the Health & Wellbeing Board to confirm whether the six national conditions detailed in the Better Care Fund Planning Guidance are still on track to be met

through the delivery of your plan (http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/). Please answer as at the time of completion.

It sets out the six conditions and requires the Health & Wellbeing Board to confirm 'Yes', 'No' and 'No - In Progress' that these are on track. If 'No' or 'No - In Progress' is selected

please provide a target date when you expect the condition to be met. Please detail in the comments box what the issues are and the actions that are being taken to meet the

condition.

'No - In Progress' should be used when a condition has not been fully met but work is underway to achieve it by 31st March 2016.

Full details of the conditions are detailed at the bottom of the page.

4) Non-Elective and Payment for Performance

This section tracks performance against NEL ambitions and associated P4P payments. The latest figures for planned activity and costs are provided along with a calculation of the

payment for performance payment that should have been made for Q4 - Q2. Two figures are required and one question needs to be answered:

Input actual Q3 2015-16 Non-Elective Admissions performance (i.e. number of NEAs for that period) - Cell O8

Input actual value of P4P payment agreed locally - Cell F19

If the actual payment locally agreed is different from the quarterly payment suggested by the automatic calculation in cell AR8 (which is based on your input to cell O8 as

above) please explain in the comments box

Please confirm what any unreleased funds were used for in Q3 (if any) - Cell F34

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5) Income and Expenditure

This tracks income into, and expenditure from, pooled budgets over the course of the year. This requires provision of the following information:

Forecasted income into the pooled fund for each quarter of the 2015-16 financial year

Confirmation of actual income into the pooled fund in Q1 to Q3

Forecasted expenditure from the pooled fund for each quarter of the 2015-16 financial year

Confirmation of actual expenditure from the pooled fund in Q1 to Q3

Figures should reflect the position by the end of each quarter. It is expected that planned income and planned expenditure figures for Q4 2015-16 should equal the total pooled

budget for the Health and Wellbeing Board.

There is also an opportunity to provide a commentary on progress which should include reference to any deviation from plan or amendments to forecasts made since the

previous quarter.

6) Metrics

This tab tracks performance against the two national supporting metrics, the locally set metric, and the locally defined patient experience metric submitted in approved BCF

plans. In all cases the metrics are set out as defined in the approved plan for the HWB and the following information is required for each metric:

An update on indicative progress against the four metrics for Q3 2015-16

Commentary on progress against the metric

If the information is not available to provide an indication of performance on a measure at this point in time then there is a drop-down option to indicate this. Should a patient

experience metric not have been provided in the original BCF plan or previous data returns there is an opportunity to state the metric that you are now using.

7) Understanding support needs

This tab re-asks the questions on support needs that were first set out in the BCF Readiness Survey in March 2015. These questions were then asked again during the Q1 2015-16

data collection in August. We are keen to collect this data every six months to chart changes in support needs. This is why the questions are included again in this Q3 2015-16

collection. The information collected will be used to inform plans for ongoign national and regional support in 2016-17.

The tab asks what the key barrier to integration is locally and what support might be required in putting in meeting the six key areas of integration set out previously. . HWBs are

asked to:

Confirm which aspect of integration they consider the biggest barrier or challenge to delivering their BCF plan

Confirm against each of the six themes whether they would welcome any support and if so what form they would prefer support to take

There is also an opportunity to provide comments and detail any other support needs you may have which the Better Care Support Team may be able to help with.

8) New Integration Metrics

This tab includes a handful of new metrics designed with the intention of gathering some detailed intelligence on local progress against some key elements of person-centred, co-

ordinated care. Following feedback from colleagues across the system these questions have been modified from those that appeared in the last BCF Quarterly Data Collection

Template (Q2 2015-16). Nonetheless, they are still in draft form, and the Department of Health are keen to receive feedback on how they could be improved / any complications

caused by the way that they have been posed.

For the question on progress towards instillation of Open APIs, if an Open API is installed and live in a given setting, please state ‘Live’ in the ‘Projected ‘go-live’ date field.

For the question on use and prevalence of Multi-Disciplinary/Integrated Care Teams please choose your answers based on the proportion of your localities within which Multi-

Disciplinary/Integrated Care Teams are in use.

9) Narrative

In this tab HWBs are asked to provide a brief narrative on overall progress in delivering their Better Care Fund plans at the current point in time with reference to the information

provided within this return.

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Better Care Fund Template Q3 2015/16

Data collection Question Completion Checklist

1. Cover

Health and Well Being Board completed by: e-mail: contact number:

Who has signed off the report

on behalf of the Health and

Well Being Board:

Yes Yes Yes Yes Yes

2. Budget Arrangements

S.75 pooled budget in the Q4 data

collection? and all dates needed

Yes

3. National Conditions

1) Are the plans still jointly agreed?

2) Are Social Care

Services (not

spending) being

protected?

3) Are the 7 day services to

support patients being

discharged and prevent

unnecessary admission at

weekends in place and

delivering?

i) Is the NHS Number being used

as the primary identifier for

health and care services?

ii) Are you pursuing open

APIs (i.e. systems that

speak to each other)?

iii) Are the appropriate

Information Governance

controls in place for

information sharing in line

with Caldicott 2?

5) Is a joint approach to assessments

and care planning taking place and

where funding is being used for

integrated packages of care, is there

an accountable professional?

6) Is an agreement on the

consequential impact of

changes in the acute

sector in place?Please Select (Yes, No or No - In

Progress) Yes Yes Yes Yes Yes Yes Yes YesIf the answer is "No" or "No - In

Progress" estimated date if not

already in place (DD/MM/YYYY) Yes Yes Yes Yes Yes Yes Yes YesComment Yes Yes Yes Yes Yes Yes Yes Yes

4. Non-Elective and P4P

Actual Q3 15/16

Actual payment

locally agreed

Cumulative quarterly Actual

Payments >= Cumulative

suggested quarterly

payments

If the actual payment locally

agreed is suggested

quarterly payment

Any unreleased funds

were used for: Q3 15/16Yes Yes Yes Yes Yes

5. I&E (2 parts)

Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16

Please comment if there is a

difference between the annual

totals and the pooled fund Forecast Yes Yes Yes Yes Yes

Actual Yes Yes Yes

Forecast Yes Yes Yes Yes Yes

Actual Yes Yes Yes

Commentary Yes

6. Metrics

Please provide an

update on indicative

progress against the

metric? Commentary on progress

Admissions to residential Care Yes Yes

Please provide an




Reablement Yes Yes

Please provide an




Local performance metric Yes Yes

If no metric, please specify

Please provide an




Patient experience metric Yes Yes Yes

7. Understanding support needs

Which area of integration do you see

as the greatest challenge or barrier to

the successful implementation of

your Better Care plan Yes

Interested in support?

Preferred support

medium

1. Leading and Managing successful

better care implementation Yes Yes

2. Delivering excellent on the ground

care centred around the individual Yes Yes3. Developing underpinning

integrated datasets and information

systems Yes Yes4. Aligning systems and sharing

benefits and risks Yes Yes5. Measuring success Yes Yes

6. Developing organisations to enable

effective collaborative health and

social care working relationships Yes Yes

8. New Integration MetricsGP Hospital Social Care Community Mental health Specialised palliative

NHS Number is used as the

consistent identifier on all relevant

correspondence relating to the

provision of health and care services

to an individual Yes Yes Yes Yes Yes Yes

Staff in this setting can retrieve

relevant information about a service

user's care from their local system

using the NHS Number Yes Yes Yes Yes Yes Yes

To GP To Hospital To Social Care To Community To Mental health To Specialised palliative

From GP Yes Yes Yes Yes Yes Yes

From Hospital Yes Yes Yes Yes Yes YesFrom Social Care Yes Yes Yes Yes Yes Yes

From Community Yes Yes Yes Yes Yes Yes

From Mental Health Yes Yes Yes Yes Yes YesFrom Specialised Palliative Yes Yes Yes Yes Yes Yes

GP Hospital Social Care Community Mental health Specialised palliative

Progress status Yes Yes Yes Yes Yes Yes

Projected 'go-live' date (mm/yy) Yes Yes Yes Yes Yes Yes

Is there a Digital Integrated Care

Record pilot currently underway in

your Health and Wellbeing Board

area? Yes

Total number of PHBs in place at the

beginning of the quarter Yes

Number of new PHBs put in place

during the quarter YesNumber of existing PHBs stopped

during the quarter YesOf all residents using PHBs at the end

of the quarter, what proportion are

in receipt of NHS Continuing

Healthcare (%) Yes

Are integrated care teams (any team

comprising both health and social

care staff) in place and operating in

the non-acute setting? YesAre integrated care teams (any team

comprising both health and social

care staff) in place and operating in

the acute setting? Yes

9. Narrative

Brief Narrative Yes

Income to

Expenditure From

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Q3 2015/16

Health and Well Being Board

completed by:

E-Mail:

Contact Number:

Who has signed off the report on behalf of the Health and Well Being Board:

Question Completion - when all questions have been answered and the validation

1. Cover

2. Budget Arrangements

3. National Conditions

4. Non-Elective and P4P

5. I&E

6. Metrics

7. Understanding support needs

8. New Integration Metrics

9. Narrative

Bexley

Cover

Alison Rogers

[email protected]

2082986025

Sarah Blow

13

1

No. of questions answered

5

1

24

17

9

5

67

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Selected Health and Well Being Board:

Have the funds been pooled via a s.75 pooled budget? Yes

If it has not been previously stated that the funds had been pooled can you now

confirm that they have?

If the answer to the above is 'No' please indicate when this will happen

(DD/MM/YYYY)

Footnotes:

Source: For the S.75 pooled budget question which is pre-populated, the data is from the Q1/Q2 data collection previously filled in by the HWB.

Budget Arrangements

Bexley

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Condition

Q4 Submission

Response

Q1 Submission

Response

Q2 Submission

Response

Please Select (Yes,

No or No - In

Progress)

If the answer is "No"

or "No - In Progress"

please enter

estimated date when

condition will be met

if not already in place

(DD/MM/YYYY)

1) Are the plans still jointly agreed? Yes Yes Yes Yes

2) Are Social Care Services (not spending) being protected? Yes Yes Yes Yes

3) Are the 7 day services to support patients being discharged and prevent

unnecessary admission at weekends in place and delivering? Yes Yes Yes

Yes

4) In respect of data sharing - confirm that:

i) Is the NHS Number being used as the primary identifier for health and care services? No - In Progress No - In Progress No - In Progress

Yes 01/12/2016

ii) Are you pursuing open APIs (i.e. systems that speak to each other)? Yes Yes Yes Yes

iii) Are the appropriate Information Governance controls in place for information

sharing in line with Caldicott 2? No - In Progress No - In Progress No - In Progress

Yes 01/04/2016

5) Is a joint approach to assessments and care planning taking place and where

funding is being used for integrated packages of care, is there an accountable

professional? No - In Progress No - In Progress Yes

Yes

6) Is an agreement on the consequential impact of changes in the acute sector in

place? Yes Yes Yes

Yes

National conditions - Guidance

Footnotes:

Source: For each of the condition questions which are pre-populated, the data is from the quarterly data collections previously filled in by the HWB.

Bexley

• confirm that they are using the NHS Number as the primary identifier for health and care services, and if they are not, when they plan to;

4) Better data sharing between health and social care, based on the NHS number

National Conditions

Local areas must include an explanation of how local adult social care services will be protected within their plans. The definition of protecting services is to be agreed locally. It should be consistent with 2012 Department of Health guidance to NHS England on the funding transfer from the NHS to social care in 2013/14:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213223/Funding-transfer-from-the-NHS-to-social-care-in-2013-14.pdf

The Spending Round established six national conditions for access to the Fund.

Please confirm by selecting 'Yes', 'No' or 'No - In Progress' against the relevant condition as to whether these are on track as per your final BCF plan.

Further details on the conditions are specified below.

If 'No' or 'No - In Progress' is selected for any of the conditions please include a date and a comment in the box to the right

Commentary on progress

Local areas should:

3) As part of agreed local plans, 7-day services in health and social care to support patients being discharged and prevent unnecessary admissions at weekends

Local areas are asked to confirm how their plans will provide 7-day services to support patients being discharged and prevent unnecessary admissions at weekends. If they are not able to provide such plans, they must explain why. There will not be a nationally defined level of 7-day services to be provided. This will be for local determination and agreement. There is clear evidence that many patients are not

discharged from hospital at weekends when they are clinically fit to be discharged because the supporting services are not available to facilitate it. The recent national review of urgent and emergency care sponsored by Sir Bruce Keogh for NHS England provided guidance on establishing effective 7-day services within existing resources.

The Spending Round established six national conditions for access to the Fund:

1) Plans to be jointly agreed

The Better Care Fund Plan, covering a minimum of the pooled fund specified in the Spending Round, and potentially extending to the totality of the health and care spend in the Health and Wellbeing Board area, should be signed off by the Health and Wellbeing Board itself, and by the constituent Councils and Clinical Commissioning Groups. In agreeing the plan, CCGs and councils should engage with all

providers likely to be affected by the use of the fund in order to achieve the best outcomes for local people. They should develop a shared view of the future shape of services. This should include an assessment of future capacity and workforce requirements across the system. The implications for local providers should be set out clearly for Health and Wellbeing Boards so that their agreement for the

deployment of the fund includes recognition of the service change consequences.

Work in prpgress through Connectcare Board has investment form BCCG, LBB and LGT. DVH and Kings may come on board later through Linked Care.

Local areas should identify, provider-by-provider, what the impact will be in their local area, including if the impact goes beyond the acute sector. Assurance will also be sought on public and patient and service user engagement in this planning, as well as plans for political buy-in. Ministers have indicated that, in line with the Mandate requirements on achieving parity of esteem for mental health, plans

must not have a negative impact on the level and quality of mental health services.

6) Agreement on the consequential impact of changes in the acute sector

Local areas should identify which proportion of their population will be receiving case management and a lead accountable professional, and which proportions will be receiving self-management help - following the principles of person-centred care planning. Dementia services will be a particularly important priority for better integrated health and social care services, supported by accountable

professionals. The Government has set out an ambition in the Mandate that GPs should be accountable for co-ordinating patient-centred care for older people and those with complex needs.

5) Ensure a joint approach to assessments and care planning and ensure that, where funding is used for integrated packages of care, there will be an accountable professional

Mapping required to ensure in place across all relevant organisations

2) Protection for social care services (not spending)

The safe, secure sharing of data in the best interests of people who use care and support is essential to the provision of safe, seamless care. The use of the NHS number as a primary identifier is an important element of this, as is progress towards systems and processes that allow the safe and timely sharing of information. It is also vital that the right cultures, behaviours and leadership are demonstrated

• confirm that they are pursuing open APIs (i.e. systems that speak to each other); and

• ensure they have the appropriate Information Governance controls in place for information sharing in line with Caldicott 2, and if not, when they plan for it to be in place.

NHS England has already produced guidance that relates to both of these areas. (It is recognised that progress on this issue will require the resolution of some Information Governance issues by DH).

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2 3 4 5 6 7 8 9 46 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 38 39 40

Q4 13/14 Q1 14/15 Q2 14/15 Q3 14/15 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 15/16 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16

% change

[negative values

indicate the plan is

larger than the

baseline]

Absolute

reduction in non

elective

performance

Total

Performance

Fund Available Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16 Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16

Total

Performance

fund

Total Performance

and ringfenced

funds

Q4 Payment

locally agreed

Q1 Payment

locally agreed

Q2 Payment

locally agreed D. REVALIDATED: HWB version of plans to be used for future monitoring. 4,814 5,076 5,525 5,683 4,766 5,026 5,470 5,637 4,889 4,766 5,002 5,015 5,146 0.9% 199 £295,944 48 98 153 199 £71,013 £74,887 £81,503 £68,540 48 74 510 537 £71,013 £74,887 £81,503 £68,540 £295,944 £3,962,000 £0 £0 £0

0 0 0 0

Which data source are you using in section D? (MAR, SUS, Other) SUS If other please specify

Cost per non-elective activity £1,490

Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16

Suggested quarterly payment (taken from above)* £71,013 £74,887 £81,503 £68,540

Actual payment locally agreed £0 £0 £0 £25,000

If the actual payment locally agreed is different from the suggested quarterly payment (taken from

above) please explain in the comments box (max 750 characters)

Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16

Suggested amount of unreleased funds** £0 £0 £0 £0

Actual amount of locally agreed unreleased funds £71,013 £74,887 £81,503 £43,540

Q4 14/15 Q1 15/16 Q2 15/16 Q3 15/16

Confirmation of what if any unreleased funds were used for (please use drop down to select): acute care acute care acute care acute care

Footnotes:

HWBs should consider whether there is a need to make adjustments to Q3 payments where over or under payments may have occurred in Q4 2014/15, Q1 2015/16 or Q2 2015/16 due to changes

made to NEA baselines and targets.

*Suggested quarterly payment (taken from above) has been calculated using the technical guidance provided here http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/. The

key steps to calculating the quarterly payment are:

a. take the cumulative activity reduction against the baseline at quarter end and divide it by the cumulative Q3 2015/16 target reduction;

b. multiply that by the size of the performance pot available; and

c. subtract any performance payments made for the year to date.

The minimum payment in a quarter is £0 (there will not be a negative payment or ‘claw back’ mechanism) and the maximum paid out by the end of each quarter cannot exceed the planned cumulative

performance pot available for release each quarter.

**Unreleased funds refers to funds that are withheld by the CCG and not released into the pooled budget, due to not achieving a reduction in non-elective admissions as set out in your BCF plan. As

payments are based on a cumulative quarter end value a negative (-) quarter actual value indicates the use of surplus funds from previous quarters.

Source: For the Baselines, Plans, data sources, locally agreed payment and cost per non-elective activity which are pre-populated, the data is from the Better Care Fund Revised Non-Elective Targets -

Q4 Playback and Final Re-Validation of Baseline and Plans Collection previously filled in by the HWB. This includes all data received from HWBs as of 11th December 2015.

Performance against baseline

Planned Absolute Reduction (cumulative) [negative values

indicate the plan is larger than the baseline]

The plan numbers are overstated but cannot be revised as the CCG has not been permitted to revise. The CCG is not seeing a

non-elective reduction and therefore no payment is due.

Maximum Quarterly Payment

***Cumulative quarterly Actual Payments exceed

Cumulative suggested quarterly payments*** This is not

permitted - please see the BCF guidance

Suggested Quarterly Payment

Total Unreleased Funds

Bexley

Baseline

Better Care Fund Revised Non-Elective and Payment for Performance Calculations

Actual

Total Payment Made

Plan

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Income

Previously returned data:

Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 Annual Total Pooled Fund

Plan £8,443,000 £2,967,000 £2,967,000 £2,958,000 £17,335,000 £17,521,000

Forecast £8,443,000 £2,818,750 £2,818,750 £2,834,750 £16,915,250

Actual* £8,294,750 £2,818,750 - -

Q3 2015/16 Amended Data:


Plan £8,443,000 £2,967,000 £2,967,000 £2,958,000 £17,335,000 £17,521,000

Forecast £8,443,000 £2,818,750 £2,818,750 £2,834,750 £16,915,250

Actual* £8,294,750 £2,818,750 £2,818,750 -

Please comment if there is a difference between either annual

total and the pooled fund

Expenditure

Previously returned data:


Plan £4,336,000 £4,336,000 £4,336,000 £4,327,000 £17,335,000 £17,521,000

Forecast £4,336,000 £4,187,750 £4,187,750 £4,203,750 £16,915,250

Actual* £4,187,750 £4,187,750 - -

Q3 2015/16 Amended Data:


Plan £4,336,000 £4,336,000 £4,336,000 £4,327,000 £17,335,000 £17,521,000

Forecast £4,336,000 £4,187,750 £4,187,750 £4,203,750 £16,915,250

Actual* £4,187,750 £4,187,750 £4,187,750 -

Please comment if there is a difference between either annual

total and the pooled fund

Commentary on progress against financial plan:

Footnotes:

*Actual figures should be based on the best available information held by Health and Wellbeing Boards.

Source: For the pooled fund which is pre-populated, the data is from a quarterly collection previously filled in by the HWB.

The EoLC scheme is operation but to date the reductions in NEL activity have not been seen

Plan, forecast, and actual figures for total income into, and total expenditure from, the fund for each quarter to year end (in both cases the

year-end figures should equal the total pooled fund)

There have been minor changes in the values of projects within the Better Care Fund giving a £186k difference between planning and actuals for

2015/16. However, the value is still in excess of the required value of the Better Care Fund. Tha mian difference is a result of the non-payment of the

performance fund as the Q4 14/15 reduction in activity was not achieved and therefore no payments for this were made in Q1 15/16. Likewise in Q1,

Q2 and Q3 15/16, the reduction in activity has not been made and therefore no payment will be made. No reduction is expected for Q4 either.

However, a payment of £25,000 to the pooled fund has been agreed between the CCG and LBB.

There have been minor changes in the values of projects within the Better Care Fund giving a £186k difference between planning and actuals for

2015/16. However, the value is still in excess of the required value of the Better Care Fund. Tha mian difference is a result of the non-payment of the

performance fund as the Q4 14/15 reduction in activity was not achieved and therefore no payments for this were made in Q1 15/16. Likewise in Q1,

Q2 and Q3 15/16, the reduction in activity has not been made and therefore no payment will be made. No reduction is expected for Q4 either.

However, a payment of £25,000 to the pooled fund has been agreed between the CCG and LBB.

Bexley

Please provide, plan, forecast and actual of total income into

the fund for each quarter to year end (the year figures should

equal the total pooled fund)

Please provide, plan, forecast and actual of total expenditure

from the fund for each quarter to year end (the year figures

should equal the total pooled fund)

Please provide , plan , forecast, and actual of total income into



Please provide , plan , forecast, and actual of total income into



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Please provide an update on indicative progress against the metric?




Footnotes:

Source: For the local performance metric which is pre-populated, the data is from a local performance metric collection previously filled in by the HWB.

For the local defined patient experience metric which is pre-populated, the data is from a local patient experience previously filled in by the HWB.

National and locally defined metrics

Bexley

Commentary on progress:

Admissions to residential Care % Change in rate of permanent admissions to residential care per 100,000

Commentary on progress:

There have been 142 new admissions to residential or nursing care between April and Dec

meeting (held in public) - bexley ccg · governing body members – see sarah valentine email...

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