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NHS DARLINGTON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

Tuesday 2nd December 2014 12.15 – 15.00

The Board Room, Doctor Piper House

AGENDA

The Chair invites you to attend a meeting of the Governing Body on Tuesday 2 December 2014.

This is a formal meeting of the Governing Body, held in public, to enable people to hear the

debate and decisions taken. At the discretion of the Chair, questions may be raised by members of the public.

Apologies for absence

Jackie Kay Time Documents

GB/14/56 Declarations of Interest/Register of Interests

12.15 Attached

GB/14/57 Identification of any other business items and to hear relevant representation from Members on items on this agenda and commissioning responsibilities

12.15

GB/14/58 Minutes of the NHS Darlington Clinical Commissioning Group (CCG) Governing Body held on 16 September 2014

12.20

Attached

GB/14/59

Matters arising from the minutes of the Darlington CCG governing body

12.25

GB/14/60 Action Log

12.30 Attached

2

GB/14/61 Local Authority Public Health Commissioned Services - Current and Planned Director of Public Health - Miriam Davidson Public Health Principal - Ken Ross

12.40

DELIVERY

GB/14/62

Chair and Chief Officer Report – December 2014 Chief Officer – Martin Phillips Chair – Andrea Jones

13.00 Attached

GB/14/63 GB/14/64 GB/14/65 GB/14/66 GB/14/67 GB/14/68

Patient and Public Involvement Report Lay Member, Public and Patient Involvement – Michelle Thompson Quality and Performance Report Director of Nursing – Gill Findley Finance & Performance Report Chief Finance Officer – Lisa Tempest Risk Management Chief Finance Officer – Lisa Tempest Q1 Assurance Feedback Chief Finance Officer – Lisa Tempest Business Continuity Plan Chief Finance Officer - Lisa Tempest

13.10 13.20 13.30 13.40 13.50 14.00

Attached

Attached

Attached

Attached

Attached

Attached

GB/14/69

NHS England EPRR Core Standards Self Assessment Chief Finance Officer – Lisa Tempest

14.10 Attached

GB/14/70 GB/14/71

Winter Plan and System Resilience Chief Officer – Martin Phillips TEWV – Trust Quality Strategy 2014-2019 Director of Nursing – Gill Findley

14.20 14.30

Attached

Attached

MINUTES TO RECEIVE

GB/14/72 Formal Executive committee - August, September, October

Quality and Innovation committee

- August, September, October

14.40 Attached

Attached

3

Finance and Performance committee

- August, September, October Governance, Audit and Risk committee

- July Community Council of Patients, Public & Carers

- August, September

Attached

Attached

Attached

GB/14/73 Any other business

14.45

Date and time of next meeting The next meeting will be held on Tuesday 3rd March 2015 commencing at 12.15pm in The Hackworth Room, Community Safety Centre, Park Place, Darlington.

Register of Interests A register of members’ interests is available for viewing by the public. The Register will be available at the meeting, on the Darlington CCG website or during working hours via Glenda Lynn, PA to the Chief Officer at Doctor Piper House, King St, Darlington, DL3 6JL.

Contact for the meeting: Glenda Lynn, Darlington Clinical Commissioning Group Tel: 01325 746239 or email [email protected]

mailto:[email protected]

Darlington CCG Register of Interests

Members Name Designation Gifts & Hospitality

Remuneration Related Undertakings

Contracts Houses Land &

Buildings

Shares & Securities

Non-Financial Interests

Election Expenses

Andrea Jones CCG Chair No interest declared

No interest declared





Co Durham and Darlington NHS

Health Improvement Fund – panel

member


Richard Harker DCCG Quality Lead

GP Partner and Practice Lead for Whinfield

Medical practice

Partner, Whinfield Medical Practice

GMC Associate

DCCG Quality Lead






Vice Chair of Board of

Trustees St Theresa’s Hospice


Martin Phillips

Chief Officer No interest declared


Chairman

Darlington

Harriers and

Athletic Club




Wife is employed as a

Paediatric Physiotherapist

at CDDFT. Member of

UNITE


Andie MacKay Lay Member No interest declared








26/11/2014 V2




Buildings

Shares & Securities


Election Expenses

John Flook Lay Member Governance


As a lay governor from CCG

NHS Professionals Ltd – Senior

Non Executive Hummersknott

Academy Trust –

Director.

Sport England – Independent Member Audit

Committee






Michelle Thompson

Lay Member PPI/PPE







Chair of Healthwatch

Darlington and Fundraiser and

advocate for Macmillan

Cancer Support


Lisa Tempest

Chief Finance Officer




Sister is employed

as Podiatrist by North Tees and Hartlepool

FT





Gill Findley Chief Nurse No interest declared

Company Secretary for Magnitas Ltd (Magnitas is an

environmenta l





Related by marriage to the McCardle family

of Helen


26/11/2014 V2




Buildings

Shares & Securities


Election Expenses

consultative service).

Governing Body member of Durham Dales, Easington and Sedgefield

CCG

McCardle Care.

Jackie Kay Assistant Chief Officer







Partner is an employee of ISS Mediclean who provide hard

and soft facilities management services to

County Durham & Darlington NHS Trust


Murray Rose Director of Services for

People, Darlington

Borough Council


Employed by Darlington Borough

Council





Member of the National Union of Teachers (no

office)

Member of the Associated of Directors for Children’s

Services


Miriam Davidson Director of No interest No interest No interest No interest No interest No interest No interest No interest

26/11/2014 V2




Buildings

Shares & Securities


Election Expenses

Public Health, DBC

declared declared declared declared declared declared declared declared

Gail Linstead

Quality Manager No interest declared








James Carlton Salaried GP No interest declared








Charlotte Holt PA to Chief Officer & Chair, Darlington CCG









Glenda Lynn PA to Chief Officer & Chair, Darlington CCG









Patrick Holmes GP and Practice Lead for Felix

House Surgery

Occasionally receives

funding to cover travel

and accommodation to attend the National

& International Congresses

by Pharmaceuti

cal Companies

Occasionally works for a number of pharmaceutical

companies. Research grants

State/Education + Industry

Director of Middleton

Pharmacy Ltd, DL2 1BN

Partner at Felix House Surgery DL2

1AA


Part-own some land

in Middleton St George,

close to High

Scrogg Farm

(potential land for

developing a future surgery)

Owns shares in a managed fund – it is possible that this may be

healthcare related.

Fund is not managed

by Dr Holmes



Sarah Dodsworth Practice Nurse Representative









26/11/2014 V2




Buildings

Shares & Securities


Election Expenses

Sally Hutchinson Practice Manager Lead for Denmark St

Surgery


Employed by Denmark St

Surgery







Matthew Sawyer GP and Practice Lead for Clifton Court Medical

Centre









Chris Mathieson

GP Member Representative for Neasham Road Surgery









James Nevison GP Partner and Practice Lead, Denmark St

Surgery

Partner at Denmark St

Surgery


Partner in GP Practice who

may hold contract with

new CCG






Jenny Steel

GP and Practice Lead for Blacketts Surgery



Director of Blacketts Skin & Laser Clinic






Gomathy Umashankar

GP Blacketts Survery





Hold one fifth share

of Blacketts Medical Practice building




26/11/2014 V2




Buildings

Shares & Securities


Election Expenses

Charles McGarrity GP and Practice Lead for Parkgate Surgery


Member of the Sedgefield locality

executive committee of DDES

CCG







Anthony Shaw GP and Practice Lead for

Moorlands Surgery









Prof Ahmet Fuat GP and Member of Q&I









Alison MacNaughton-

Jones

GP and Practice Lead for

Rockliffe Court









Richard Stevens GP and Practice Lead for

Orchard Court

Partner at Orchard

Court








Basil Penny GP and Practice Lead for Carmel

Surgery









DARLINGTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Tuesday 16 September 2014

12.15 – 15.00

The Hackworth Room, Community Safety Centre, Park Place, Darlington

UNCONFIRMED MINUTES

Present: Andrea Jones (AJ) Clinical Chair Gill Findley (GF) Chief Nurse Andie Mackay (AM) Lay Member - Finance Martin Phillips (MJP) Chief Officer Lisa Tempest (LT) Chief Finance Officer Michelle Thompson (MT) Lay Member – Patient and Public Involvement In attendance: Jackie Kay (JK) Assistant Chief Officer Richard Harker (RH) GP Quality Lead Ben Smith (BS) Joint Commissioning Manager, Mental Health (Item 52) Glenda Lynn (GL) PA/Minute Taker Welcome

Andrea Jones welcomed the visitors to this Governing Body meeting being held to enable members of the public to observe the governing body at work. Members of the public present were advised that though not able to contribute during the meeting, there would be opportunity to ask questions at the end.

Martin Phillips apologised for the lateness of the availability of the papers for this meeting and advised that this should not be repeated.

Action Apologies for Absence

Miriam Davidson (MD), Murray Rose (MR), John Flook (JF)

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GB/14/34 Declarations of Interest/Register of Interests There were no declarations of interest for agenda items and no changes were made to the Register of Interests.

GB/14/35 Identification of any other business items and to hear relevant representation from Members on items on this agenda and commissioning responsibilities None.

GB/14/36 Minutes of the NHS Darlington Clinical Commissioning Group (CCG) Governing Body held on 3 June 2014 The minutes of the meeting held on 3 June 2014 were accepted as a true record, with the following amendment: Page 9 - GB/14/27 – Finance and Performance Report/Health Care Acquired Infection: To read – ‘One MRSA case has been attributed to Darlington CCG following the completion of a post infection review’.

GB/14/37 Matters arising from the minutes of the Darlington CCG governing body No matters arising were recorded.

GB/14/38 Action Log GB/13/21 – MD had provided by email to Governing body members, an update on the Protocol for Management of Antenatal and Post Natal Depression paper. Complete. GB/14/13 – MT confirmed the Annual Report of the Director of Public Health has been received by Healthwatch, Darlington. Complete.

Completed

Completed

GB/14/39 Chair and Chief Officer Report – September 2014 The Governing Body considered a report that provided an update from the Chief Officer and the Chair. MJP highlighted some of the areas within the report and provided updates since the production of the written report: Update on Contracting Position 2014/15 – The Governing Body was advised that at the present time no agreement had been reached with County Durham and Darlington Foundation Trust (CDDFT). Three local CCGs were to begin mediation on 6th October. The Governing Body was given assurance that during these negotiations, usual business will not be affected.

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Strategic Partnership with Darlington Borough Council - The Governing Body was informed that work with Darlington Borough Council continues and progress is being made in terms of leadership and co-ordination of commissioning across health and social care. A Memorandum of Understanding has been drafted to govern the strategic partnership and articulates the clear focus of the Strategic Partnership. This was to be reviewed by Members. The Governing Body was assured that these arrangements do not involve any changes to the CCGs statutory responsibilities or governance arrangements. NHS England – The Governing Body was informed that Darlington CCG will in future come under North East and Cumbria Area Team. The Executive of Darlington CCG will work with the Area Team to ensure that changes of personnel do not impact on the relationship the CCG has with the Area Team. CQC Inspection of Darlington GP Practices – The Governing Body was advised that all eleven GP Practices would be inspected during October, the first of which will be on 1st October. Practices will receive two weeks’ notice. The Governing Body:

i) received the report ii) noted the updates and considered the issues

highlighted

GB/14/40 Public Patient and Involvement Report The Governing Body considered the Patient and Public Involvement report that provided an update on key patient and public involvement and engagement activities since June 2014 and identified future actions to be delivered over the next three months. MT highlighted a number of issues as follows: Patient Experience The Community Council meeting has received a number of speakers over the period June - August. In June members were informed of the Talking Therapies service. North Durham CCG, Durham Dales, Easington and Sedgefield CCG and Darlington CCG are working together to commission this service. The Community Council had expressed concern at the lack of

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patient involvement in the decision for the temporary move from Darlington to Bishop Auckland, of the breast cancer outpatient service. These concerns had been conveyed by Healthwatch Darlington to the Breast Cancer Service Review Group. In July the Community Council received an update on the Frail/Elderly Multi-Disciplinary Team (MDT) by Andrea Jones, Chair, Darlington CCG. The Community Council received information on Individual Funding Requests at the meeting in August. It was explained to members that this funding was available for treatment outside the remit of services usually commissioned by the CCG. Review of Wheelchair Services in County Durham and Darlington – The three local CCGs are undertaking a review of the wheelchair services in County Durham and Darlington. Community Roadshows – Alongside Healthwatch the CCG have held four pilot community events across Darlington over the summer. Attendance was disappointing. Both organisations will continue to consider ways of communicating with Darlington residents. The Governing Body received the report and noted the content.

GB/14/41 Better Care Fund The Governing Body considered a revised version of the Better Care Fund (BCF) that needed to be sumitted no later than 19 September 2014. JK advised the Governing Body had previously agreed a submission of the Better Care Fund in April 2014. She added that the Department of Health raised concerns about the viability of some of the schemes nationally in terms of securing the necessary shift of activity and spend from acute to outside of hospital care. This culminated in a decision which requires local authorities and CCGs to revise and resubmit their BCF plans with an improved level of detail and necessary assurance of delivery from across the local health and social care system. The Chief Finance Officer assured the Governing Body that costings for schemes will be monitored closely and quality reviews of schemes will be carried out. The Governing Body:

endorsed the revised BCF submission agreed to delegate authority to the CCG Chief Officer to

make amendments to the final submission, in consultation

5

with the Health and Well Being Board.

GB/14/42 Clinical Quality Summary Report – July/September 2014 The Governing Body considered a clinical quality report for July – September 2014 that provided an in depth review of the acute and community services providers. GF highlighted the following: Key points to note:

CDDFT are now providing information to the trauma, audit research network. Further details around the quality of the data being submitted are awaited.

CDDFT has a higher than expected rate of mortality for gastro intestinal haemorrhage. Actions are in place to provide a 24 hour rota for therapeutic endoscopy

CDDFT has a higher than average rate of falls resulting in injury. The quality review group meeting has seen a detailed action plan to address this. GF informed the Governing Body work is being done to look at whether these falls are happening on the wards and if so could this be linked to a shortage of staff on the wards.

The Royal Colleges are visiting CDDFT to discuss radiology and ophthalmology concerns. Staffing levels remain problematic, especially at the weekend which may impact on arrangements for MDT. A number of options are being considered including the possibility of outsourcing for routine cases, with CDDFT taking the more complex cases. CDDFT currently has a high profile recruiting process, it is however recognised that this is a difficult profession to recruit to.

All organisations have submitted staffing data in line with requirements. Organisations are identifying and managing wards where there may be specific issues. The CCG is beginning to link incidents of harm to areas of poor staffing.

HCAI performance has deteriorated. CDDFT has now three cases of MRSA bacteraemia. Review meetings have taken place for each of the cases. GF informed the Governing Body that there is no indication that these cases are linked.

The Governing Body noted the content of the report and the mechanism for monitoring and performance management.

GB/14/43 Finance and Performance Report The Governing Body considered the Finance and Performance

6

report that outlined the CCG’s financial position for the first five months ended 31 August 2014. The report also provided an overview of the CCG’s performance against key national targets as set out in the NHS Constitution and NHS Outcomes Framework, and the delivery of the CCG’s key work programmes for 2014/15. LT highlighted the following issues

(a) Financial Position Overview - At the end of August 2014 the CCG is currently forecasting that it will deliver the target 1% surplus required by NHS England of £1.438m.

Acute Services – The position reflects higher than planned spend on Acute services, with an excess spend of £413k currently forecast for the full year. Higher than planned levels of activity for ophthalmology is giving rise to a forecast cost pressure of £2.1k.

Community Health – expenditure is broadly in line with budget with higher than planned spend on hospice care.

(b) Performance Issues

Accident and Emergency 4 hour target - There had been a deterioration of performance during quarter 3 and 4 of 2013/14 in the performance of Accident and Emergency 4 hour wait targets. Following the introduction of initiatives by the Trust an improved performance for Q1 have been sustained in Q2.

Cancer – As at the end of June all national cancer targets had been achieved on a year to date basis at CCG level, although some providers have failed to achieve their targets.

Ambulance Responses – 19 Minutes – In July 2014, NEAS failed to achieve the target of 95% of calls responded to within 19 minutes for Darlington with 94.76% of calls being responded to within the timescale. A number of actions have been put in place to improve these targets.

Patients Waiting for Diagnostic Tests for over 6 weeks CDDFT have reported that in May 2.2% of patients were waiting longer than 6 weeks for referral for a diagnostic test, and in June this performance deteriorated to 4.67%

7

against a target of 1%. CDDFT have advised that they expect to also fail the target in July, but are confident that the position and performance will be delivered from August onwards following measures to increase capacity. CDDFT are anticipating an increase in demand as a result of a forthcoming ‘blood in pee’ campaign, and will look to plan their capacity accordingly.

The Governing Body received the report and noted the current financial and performance position.

GB/14/44 Risk Management The Governing Body considered a report that provided an overview of the CCG’s risk register as of September 2014. The CCG has a Risk Management Policy in place and a process by which all risks are assigned to one of three committees for review. However, the Governance, Audit and Risk Committee (GARC) is responsible for the overall CCG register. GARC met on 22July 2014 and reviewed the current risk register, controls and mitigations. It had been agreed that there were no risks to be escalated to the Governing Body. The Governing Body received the report and noted the content of the register.

GB/14/45 Equality Strategy 2014-2016 The Governing Body considered a draft Equality Strategy for 2014/15. MJP advised that the Equality Strategy 2014-16 is the first step in outlining the CCG’s strategic direction to ensure compliance with the Public Sector Equality Duty and highlights the national and local drivers that will shape and influence the CCG’s approach. MJP advised that the strategy sets out the CCG’s commitment to taking Equality and Human Rights into account in everything it does. He also reminded the Governing Body of their previous commitment to monitoring progress and had requested regular reporting on the implementation of the strategy through the GARC. The Governing Body approved the Equality Strategy.

GB/14/46 Individual Funding Requests The Governing Body considered a proposal to extend the use of the existing individual funding request (IFR) process where procedures of limited clinical value are subject to a peer reviewed, approval process.

8

A recent review of the numbers of procedures being undertaken across the North East reveals significant differences in the different CCG areas, leading to a view that the procedures are not being universally applied. The Governing Body approved the refresh and implementation of the regional procedure for individual funding requests.

GB/14/47 Darlington CCG Organisational Development Plan The Governing Body considered a report that set out the CCG’s refreshed organisation development plan and supporting action plan for identified priorities. JK assured the Governing Body that the CCG continues to refresh the Organisational Development plan where and when needed with progress on the priority areas for organisational development is overseen and reported through the Executive. The Governing Body received the report and approved the refresh of the Organisational Development Plan.

GB/14/48 Francis Action Plan The Governing Body considered a report that provided an update on the actions taken by Darlington CCG in response to the Francis Report. GF assured the Governing Body that she was confident that there is no resistance from providers. Work has been undertaken with secondary care around continuity of care following discharge from hospital, this has linked with the MDT work. GF added that she has been invited to be a member of a Patient Experience Committee set up by CDDFT. The Governing Body received the report and noted the content and the progress made against actions.

GB/14/49 Healthwatch Darlington Annual Report The Governing Body was advised that the Healthwatch Darlington Annual report had been circulated for information. The Governing Body noted the report.

GB/14/50 CCG Annual Assurance 2013/2014 The Governing Body considered a report that set out the outcome of the most recent Assurance of the CCG. It was noted that NHS England has a responsibility to assure that CCGs are capable commissioning organisations and to support them to

9

develop and improve. The CCG Assurance Framework has been developed to enable NHS England, through area teams, to meet the statutory responsibility to make an assurance assessment. The CCG assurance process includes formal quarterly check point meetings, run by area teams. A key focus of these meetings is a balanced scorecard which incorporates six domains:

Are patients receiving clinically commissioned, high quality services

Are patients and the public actively engaged and involved Are CCG plans delivering better outcomes for patients Does the CCG have robust governance arrangements Are CCGs working in partnership with others Does the CCG have strong and robust leadership

The Q4 assurance meeting for Darlington CCG was held on 22nd May and the CCG received its annual assurance letter from NHS England on16th July. The headline assessment for Darlington CCG was ‘assured’, although domain 3 was assured with support due to the financial challenges experienced by the CCG in 2013/14. The Governing Body noted receipt of the annual assurance letter received from NHS England.

GB/14/51 Palliative and End of Life Care Strategic Commissioning Plan The Governing Body considered a strategic plan for commissioning palliative and end of life care. JK advised that this report was to allow the Governing Body to view the changes to the palliative and end of life strategic commissioning plan and to provide assurance that the strategic group have formally signed up to the plan. This report has also been presented to the Darlington Health and Wellbeing Board on 15 July 2014. The Governing Body noted that work is progressing to develop costed implementation plans to inform commissioning plans and priorities. The Governing Body received the plan and supported the direction of travel and development work required in primary care to take this work forward locally.

GB/14/52 No Health without Mental Health Darlington Implementation Plan The Governing Body considered a report that provided an update of the Mental Health Implementation Plan for Darlington.

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BS said that the strategy sets a number of high level objectives to improve mental health and wellbeing of the population. The Darlington Mental Health Implementation Plan aims to introduce the objectives locally. BS advised that the plan incorporated changes following input from clinicians, service users, carers and other stakeholders. It now reflects both national and local objectives and is able to locally identify gaps in service provision. Subject to approval an action plan will be devised around identified priorities. JK explained that the implementation plan would be discussed at Unit of Planning and the October Health and Wellbeing Board. In discussion, to increase investment in mental health and wellbeing, LT was asked to calibrate current levels of investment. The Governing Body approved the Implementation Plan, agreeing the priorities set out in the plan.

LT

GB/14/53 Scheme of Delegation The Governing Body considered an updated Scheme of Delegation report. LT advised that in March 2013 the Governing Body approved a paper detailing arrangements for decision making, financial management and budgetary delegation for the CCG and agreed to adopt the arrangements from 1 April 2013. In consideration of a recommendation made by Audit North, following an audit of the CCGs financial management and recent changes to staffing within the CCG, LT has updated the scheme of delegation and authority to incorporate a number of changes. The Governing Body approved the proposed amendments to financial authority limits as detailed.

GB/14/54 Committee Minutes The Governing Body received minutes from its Committees Formal Executive Committee – May, June, July 2014 Quality and Innovation Committee – May, June, July 2014

Finance and Performance Committee – April, May, June

2014

11

Governance, Audit and Risk Committee – May 2014

Community Council of Patients, Public and Carers – April, May, June, July 2014

The Governing Body asked that future confirmed minutes of these Committees be circulated to them periodically rather than with Governing Body papers.

GL

GB/14/55 Any other business No other business was discussed.

Date and time of next meeting The next meeting will be held on Tuesday 2nd December commencing at 12.15pm, The Board Room, Doctor Piper House, Darlington DL3 6JL

Signed………………. Chair.…………………. Date……………………

1

Updated: 02.12.14

Governing Body

Action Log

No Date of

meeting agreed

Action Responsible officer

Agreed completion

date

Progress Outcome

1. 16.09.14 GB/14/52

No Health without Mental Health Darlington Implementation Plan In discussion, to increase investment in mental health and wellbeing, LT was asked to calibrate current levels of investment.

LT

2. 16.09.14 GB/14/54

Committee Minutes Future confirmed minutes of CCG Committees to be circulated to Governing Body members periodically.

GL Ongoing

2 December 2014

NHSDCCG/GB/2014/December/Item No. 62


Governing Body

Chair/Chief Officers Report – December 2014

1. Introduction This report provides a brief update for the Governing Body of NHS Darlington Clinical Commissioning Group (CCG). The Governing Body are asked to receive the report, note the updates and consider the issues highlighted. 2. Implications and risks Members of the Governing Body need to be kept up to date with CCG developments and involved in key decisions. 3. Recommendations The NHS Darlington Clinical Commissioning Governing Body is asked to:

receive the report note the updates and consider the issues highlighted

4. Author, Clinical Sponsor and Executive Lead Author and Executive Lead: Martin Phillips Title: Chief Officer, Darlington Clinical Commissioning Group Clinical Sponsor: Andrea Jones Title: Chair, Darlington Clinical Commissioning Group Date: November 2014

2

Purpose of Paper Information Sharing x

Development / discussion Decision / action

This paper supports/has implications for:

Strategy – working together to improve the health and wellbeing of Darlington

Addresses the needs of the changing age profile of the population

Commissioning the right services in the right place

Security safe high quality services

Implications for NHS Constitution

None specific to this report

Implications for Quality & Safety

As outlined in the report

Financial Implications As outlined in the report

Legal\Regulatory Implications

The proposed change to the CCG’s constitution comply with the Public Interest Disclosure Act 1998

Details of Patient and Public Involvement and\or Implications


Details of Clinical Engagement and\or Implications


Implications for Governance, Audit and\or Risk Management

None

Implication for Partners None specific to this report

Equality and Diversity None specific to this report

Attachment(s) Chair/Chief Officer Report

3

NHS DARLINGTON CLINICAL COMMISSIONING GROUP GOVERNING BODY CHAIR/CHIEF OFFICERS REPORT – December 2014

1. Introduction This report provides a brief update for the Governing Body of Darlington Clinical Commissioning Group [CCG] since the last report. The Governing Body are asked to receive the report, note the updates and consider the issues highlighted. 2. Update on Contracting Position 2014/15 We have not yet agreed an agreement with County Durham and Darlington FT [CDDDFT] and remain formally in dispute, along with North Durham and Durham Dales, Easington & Sedgefield CCGs. We escalated through the provisions set out in the NHS Standard Contract, i.e. negotiation with Chiefs, through formal mediation on 7th October 2015, with the help of CEDR and are now working to resolve through expert determination. It is planned that the outcome of expert determination should be secured before the end of the year. 3. CQC Inspections The CCG has been notified that our two main providers, of mental health and learning disabilities services and acute and community services respectively, will be inspected by the CQC in the New Year. Tees Esk and Wear Valley FT will be inspected with effect from 26th January 2015 with County Durham and Darlington FT following on 2nd February 2015. The inspection of GP practices in Darlington, planned for October 2014 was abandoned by the CQC and these will need to be programmed towards the end of the inspection cycle. IN the meantime the CQC has published ‘Intelligent Monitoring Reports’ for all practices across England that put practices into one of six bands. One practice in Darlington, Moorlands, was identified as being as ‘high risk’ with five areas of concern being identified. Understandably these reports have been subject to considerable media interest. The GPs at Moorlands have invested significantly in more doctors, nurses and telephone system so as to improve access and care for their patients and as the body responsible for the quality of GP services and whilst there are issues for the practice to address the CCG has no concerns about the clinical quality of care provided for patients at Moorlands. This view is supported by the CQC who set out that they have no concerns about the effectiveness of care in the practice and recognises that patients felt that the doctor treated them with care and concern and that nurses involved them in decisions about their care. I am assured that the arrangements that the doctors have put in place mean that patients who need to be seen on the day that they contact the practice. I would encourage anyone with any concerns or suggestions of how things might be improved contact the practice directly, perhaps joining their patient participation group, the Clinical Commissioning Group or Darlington Healthwatch, an independent body established to ensure local patients and users are listened to. I am persuaded that that when practices are inspected by the CQC that they will be found to be outstanding or good

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4. Operational Resilience and Capacity Plan 2014/15 All of the CCG’s providers have now been awarded a further allocation of money; CDDFT is £1,781,141 TEWV’s allocation is £608,880, from NHS England to support their projects to improve performance over the winter period. This should allow many more of the proposals planned by FTs to be delivered. A letter, “Winter Resilience and the Delivery of A&E NHS Constitution Standards” is attached together with a letter from the Department of Health to Health and Wellbeing Board Chairs entitled “Getting Ready for Winter”.

Activity is already seeing a significant rise in demand and it is important that in primary care, practices continue to focus on the better management of long-term conditions, the implementation of the MDT for the frail elderly and ensuring that staff and eligible patients are immunised against flu this year. The successful ‘Minor Ailments’ scheme will continue also. CCGs are also working with NEAS to put GPs in the 111 centre to make sure that the 111 service is as efficient as possible. A reprise of the ‘Keep Calm’ programme is also being repeated. 5. Strategic Approach to Primary Care A key responsibility of the Clinical Commissioning Group is to lead the improvements in primary care; this report includes both a proposed strategy for improvement and the supporting business case. Primary care must respond to known pressures in order to still be able to provide effective universal health care in the foreseeable future. Without a clear strategy to meet the impact of the increase in demographic pressures there is a strong likelihood that the current system will fail to meet the needs of the population, particularly those most in need. The approach to the development of the primary care strategy was in two phases. The first phase included engagement with stakeholders, including General Practitioners (GP), to understand the issues facing primary care. The second phase consisted of an application to the Prime Minister’s Challenge Fund made by Darlington’s GPs, who wished to demonstrate different ways of working. The attached paper outlines these phases in more detail, describes the case for change, outlines a strategic approach for primary care and finally proposes some metrics 6. Secondary Care Clinician

We were not successful in recruiting to the vacancy created by Lucy Hanson as the secondary care clinician on the Governing Body. However, we have been fortunate to be able that Angela Galloway has agreed to be our secondary care clinician on an interim basis. Angela is a Pathologist by background and current fulfils the same role for North Durham. We will advertise again in the New Year. 7. Clinical Support Information A new resource for GPs has been launched on GPTeamnet, Clinical Support Information, or CSI. This provides GPs will valuable clinical information to support their clinical management of patients, including where appropriate guidance on referral to a specialist.

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CSI represents collaboration across the County Durham and Darlington CCGs, based upon work done by Kernow CCG. The first clinical area covered cardiology. 8. Youth Engagement Fund The CCG has been approached by Tees Valley Unlimited [TVU] to become a local contributor to a scheme, under the Youth Engagement Fund, to reduce the number of young people who are not in education, employment or training [NEETS]. The application for £4.5m of resource is due to be submitted by 28th November 2014. 9. Achieving Better Access to Mental Health Services

As part of its commitment to achieving parity of esteem for mental health services, NHS England has looked to assure timely access to services and then treatment through the introduction of ‘waiting times’ standards for Improving Access to Psychological Therapies [IAPT] and psychosis. For IAPT the standard is treatment within 6 weeks for 75% of people referred with 95% being treated within 18 weeks; for psychosis treatment is expected within 2 weeks for more than 50% of people experiencing their first episode. NHS England reports that these standards will be accompanied by new investments and delivery will need to be considered as part of the Commissioning Intentions. 10. Community Innovations Fund ‘Dragons Den’ Following the success last year applications have been invited from the local community and voluntary sector, to bid to secure resources from the CCGs Community Innovations Fund. This fund was created to support and nurture health-related projects into practical and inspiring enterprises. The theme for this years’ Community Innovation Fund theme is ‘Children and Young People’ and bids will be invited to demonstrate how it engages our local children and young people in creative and inspiring ways to enhance their quality of life, confidence and health and wellbeing.’ The successful ‘pitches’ in the Dragons Den came from 700 club for ‘Arts for Wellbeing’ British Sports Trust for ‘Sports Leaders’ Skerne Park Youth & Community Centre for ‘Sports Activity’ North Road Parents Group for ‘Veg patch kids’ Following the ‘Showcase’ event, it is proposed that the 700 Clubs ‘Coaching for Healthy Lifestyles’ is supported for a further year. 11. Co-commissioning of Primary Medical Services The next steps have been set out by NHS England and are available at the follow URL http://www.england.nhs.uk/2014/11/11/co-commissioning/. The status quo is not an option with three models outlined as [i] greater involvement in decision making [ii] formal joint commissioning [iii] full delegation from NHS England. We will need to consider which of the three outlined Darlington follows and will need to formulate a view by the New Year.

http://www.england.nhs.uk/2014/11/11/co-commissioning/

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When this was previously discussed Members were alone in the local health community in not wishing to actively pursue this agenda. We have continued the conversation with Members and others up and until Christmas to inform our position. In considering it will be important to link co-commissioning with the PMS Review and a desire that we share to ensure that PMS resource remains within primary care in Darlington. At an extended Clinical Leadership Group held on 18th November 2014 the prevailing view was the CCG should express interest in option 3 full delegation. It is hoped to be further tested in a wider clinical discussion before Christmas. 12. MSK

Work is progressing with Workshop arranged on 17th December 2014 [Flyer attached] at the Dolphin Centre. 13. Diabetes Services An engagement event for patients and the public is planned to map out a model service for diabetes for 29th November 2014. 14. Commissioning Intentions Commissioning Intentions are being developed that take forward year two of the CCGs operational plans. Although there is not expected to be any surprises, we will know the detail of the planning guidance when it is published in early December. It is already clear that the centre will be looking for even closer alignment in the plans of CCGs and FTs between the BCF and wider CCG plans for service change. As always key dates fall at the end of February and end of March. NHS England is putting in place an assurance process to support delivery. It is propose that a development session be dedicated to the Governing Body to consider the CCGs commissioning intentions. 15. Healthy Darlington Darlington Borough Council has launched the ‘Healthy Darlington’ programme with a ‘hub’ sited within the Dolphin Centre. This represents a huge opportunity to co-ordinate activities to impact on the health and inequalities in Darlington and for people to eat well, feel good and live longer. The benefits of exercise on health and well-being are significant and the CCG is looking at how it can capitalise on this initiative to engage with young people in a fit and active lifestyle. 16. Back Pain Pathway The CCG has led, with clinicians at James Cook University Hospital a proposal to implement an evidenced pathway of care for both simple low back pain and acute radiculopathy [sciatica] across the north east. The proposal with the Health Foundation is now down to the final interviews, to be held on 26th November 2014. If successful it will bring £500,000 in from the ‘Scaling Up Improvement’ Programme.

17. Lead Provider Framework The CCG, along with most other CCGs in England, commissions a number of support services from a Commissioning Support Unit (CSU), the North of England Commissioning

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Support. NECS was established alongside CCGs, under the wing of NHS England on 1st April 2013 with the aim of providing commissioners with effective commissioning support services at scale. NHS England and the Department of Health, in acknowledging that CSUs were new organisations, has had an ongoing business development programme to ensure that NECS are fit for purpose. NHS England has also been taking forward the development of the market for commissioning support services enabling providers from the public, voluntary and private sectors to be able to more easily provide support to commissioning organisations. CCGs, over the next coming months, will need to review the services currently commissioned from CSUs decide whether they wish to continue to commission these services from an external provider, share with another organisation or bring services in house. If the decision is taken to continue to commission from a third party, then a procurement exercise will need to be undertaken. In anticipation of this, NHS England have set up a commissioning support Lead Provider Framework (LPF) for CCGs to use from February 2015, this should shorten the procurement exercises that CCGs need to undertake for these services. The LPF has been divided into lots and commissioners can choose to procure any combination whether as end to end support or specialty services: Lot 1: Business support services, Healthcare Procurement and Provider Management,

Transformation and Service Redesign, Communications and PPE and Business Intelligence.

Lot 2a: Medicines Management. Lot 2b: Individual Funding Request, Continuing Healthcare and funded nursing care. 18. Securing Quality in Health Services [SeQIHS] Update There are three items of progress within the Phase 3 of the SeQIHS programme, [i] The establishment of the Clinical Leadership Group under the leadership of Andrew Cant together with the establishment of clinical working groups to work through models of service, patterns of service delivery that can better meet the agreed clinical standards [ii] The commissioning of some independent research with the intention of gaining an understanding of what local people feel is important to them about hospital services [iii] Continued development of the ‘case for change’ identified in Phase 2. 19. NHS England organisational reviews

The functional and organisational review [Organisation Alignment and Capability Programme] is continuing within NHS England. This is being done both to achieve management cost savings in the order of 15% running cost reduction and to better align NHS England’s functions with those of partners It is expected that there will be a reduction in the number of Area Team senior managers which will result in larger geographical Area Team management. In our case this will be within a combined North East and Cumbria. The two Area Teams and their bases within Newcastle and Darlington will remain. The initial changes have concentrated on national director posts and their portfolios. This work has concluded with Karen Wheeler heading the Transformation and Corporate Operations directorate, and Ian Dodge our Commissioning Strategy directorate. A national

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specialised commissioning taskforce has also been created and a substantive director is expected to be appointed to shortly. The second phase has been to better focus and align the work of NHS England on core priorities. NHS England has already identified several provider-led or regulatory functions that might in future better be undertaken by other national NHS partners, such as oversight of individual practitioner medical revalidation, some aspects of our work on patient safety, and sponsorship of some provider-focused IT programmes. We have also identified core commissioning skills where we are going to be strengthening capabilities, including specialised commissioning, the design and implementation of new local care models, support for new CCG and local government integrated commissioning models, payment reform and incentive design, and operational research. Finally work is now underway to look at regions and Area Teams across the country. There has been mention of formal staff consultation commencing in September 2014 relating to structural revisions as it is indicated there will be changes in Area Teams. We do not yet know the details of this or how it will affect staff in Durham, Darlington and Tees Area Team as discussions continue in advance of any formal process. Cameron Ward, Director of the Area Team, has said that the County Durham, Darlington and Tees Area Team will continue to focus on its core agenda around commissioning, assurance, delivery, quality and safety, strategic oversight as well as looking at new care models, integrated personal commissioning, and co-commissioning of GP services with CCGs. 20. Five Year Forward View for the NHS

In October NHS England along with other organisations has produced a five year forward view for the NHS working with other national bodies which articulates how the NHS needs to evolve over the next five years. Please find the report at http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 21. North of England “Tripartite Meeting”

NHs England, Monitor and the Trust Development Agency hosted a session for NHS leaders across the North of England in Leeds on 4th November 2014 with the respective CEOs setting how from their perspective the NHS should meet the current service and financial pressures in the light of the Forward View, the session also included a sneak preview of some of the planning guidance from Barbara Hakin, COO at NHS England. 22. Urgent and Emergency Care Review NHS England has published an update on the Urgent and Emergency Care Review, which builds on NHS England’s future vision for urgent and emergency care in Transforming urgent and emergency care services in England. Urgent and Emergency Care Review End of Phase 1 Report. This work intends to make it easier for patients to get the right care, in the right place, first time. The vision is simple: firstly, for those people with urgent but non-life threatening needs we must provide highly responsive, effective and personalised services outside of hospital - as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families. Secondly, for those people with life threatening needs we should ensure they are treated in centres with the very best expertise and facilities.

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf

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The update reports on progress with NHS England’s work with local commissioners and the development of their five year strategic and two year operational plans as well as updates on planning to develop demonstrator sites to trial new models, including the new NHS 111 service specification. To underpin these changes, a new approach to reimbursing providers of health and care services is essential. 23. Learning Disabilities There is continued pressure nationally, as part of the NHS five year plan and post the Winterbourne review to move people from assessment and treatment beds into community care. This is proving difficult and the North East has considerably more people than the average in assessment and treatment beds. This may be due to the number of assessment and treatment beds in both Tees, Esk and Wear Valley Foundation Trust and Northumberland Tyne and Wear Foundation Trust but also in independent sector provision. 24. Academic Health Science Network The CCG has joined others across the north east and Cumbria in joining the Academic Health Science Network. 25. Changes in Portfolios The Executive Team continually reviews its working arrangements and this has resulted in a change in director portfolios. The new portfolios are attached. 26. Strategic Partnership with Darlington Borough Council Members are content with the proposed memorandum of understanding [MOU] with Darlington Borough Council [DBC] which will be formally placed in front of the Members Assembly in December. The MOU has already been considered by the Cabinet of DBC. A copy of the MOU is attached. Work with the Borough Council continues and progress is being made in terms of leadership and coordination of commissioning across health and social care. Darlington Borough Council has created the post of Director of Commissioning, a post held by Murray Rose that will provide leadership in partnership with the CCG. 27. CCG Assurance

As part of its ‘CCG Assurance Framework’, NHS England undertakes a quarterly assurance and review process of CCGs. At these quarterly checkpoints the NHS England Area Team meets with each of its CCGs and reviews how well the CCG has met its statutory responsibilities during the preceding quarter. The assessment seeks assurance against the six domains of the Assurance Framework. The outcome of our Q1Assurance is covered elsewhere on the agenda and our next Assurance meeting with NHS England is planned for 26th November 2014

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28. Better Care Fund Following the revised guidance and assurance arrangements the Darlington Better Care Fund [BCF] was ‘approved with support’. The requirement for support is indicated through a small number of minor conditions and these are all to be remedied in partnership with the Area Team. A copy of the approval letter is attached. The focus of the BCF is the ‘multidisciplinary teams’ which went live for the practices in October 2014 with the next phase of ‘rapid response’ planned for January 2015. It will be important to review the first six months operation to celebrate success and spread good practice. 29. Best of Darlington Each year the Northern Echo hosts the ‘Best of Darlington’ Awards recognising

achievement and excellence. As last year the CCG intends to sponsor on of the categories, ‘achievement in sport’. The Awards are presented in May 2015.

30. Be clear on cancer ‘Blood in pee’ campaign NHS England, in partnership with Public Health England and the Department of Health has announced a Be Clear on Cancer “Blood in Pee” campaign which will run from 13 October to 23 November 2014. The campaign which has been designed to promote earlier diagnosis of kidney and bladder cancer will encourage people to see their GP earlier if they spot blood in urine. More information on this will be made available on the National Awareness and Early Diagnosis Initiative (NAEDI) website. 31. Sustainable Cancer Drugs Fund NHS England has pledged a further £160m increase in funding over two years for the Cancer Drugs Fund, giving more patients access to innovative drugs not routinely available on the NHS. Two new drugs will now also be added to the fund; enzalutamide for prostate cancer and lenalidomide for a group of patients with myelodysplastic syndrome, a rare blood condition. With an annual budget of £200m, now rising by 40% to £280m, the fund has delivered important benefits for more than 55,000 patients since it began in 2010. Professor Peter Clark, Chair of the Cancer Drugs Fund (CDF), has written to NHS England Chief Executive Simon Stevens recommending that the Cancer Drug Fund’s panel of experts re-evaluate a number of drugs currently on the list, making evidence-based decisions about what will deliver greatest benefit to patients. NHS England has accepted and agreed these proposals. Copies of the letters are on the NHS England website.

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32. Partnership Working The Chair and Chief Officer continue to progress a range of commissioning business in partnership with other CCGs. These supplement a range of partnership work involving other individuals and teams. These predominantly focus on the following meetings Chief Officers meetings [for County Durham & Darlington CCGs]; Chairs meeting [for CCGs across Durham, Darlington & Tees] Southern CCG Forum [for CCGs across Durham, Darlington & Tees] Northern CCG Forum [for the thirteen CCGs across the North East and Cumbria]

33. Recommendations The Governing Body are asked to receive the report and note the updates. Authors: Andrea Jones Martin Phillips

Chair Chief Officer Clinical Sponser: Andrea Jones Chair Date: 24 November 2014

From Jane Ellison MP

Parliamentary Under Secretary of State for Public Health

Richmond House

79 Whitehall London

SW1A 2NS

Tel: 020 7210 4850

22 October 2014

Dear Health and Wellbeing Board Chairs,

Getting Ready for Winter

I am writing to make you aware of the ‘Get Ready for Winter’ campaign which was

launched on Wednesday, 22nd October 2014. This campaign has cross-government input and is hosted by the Met Office. Other key elements of winter preparedness for the health and care system are: Influenza – ‘Flu’ Flu is an unpredictable but recurring pressure that the NHS, the social care system and the public face each winter. For most healthy people, it is an unpleasant but usually self-limiting disease with recovery generally within a week but for at-risk groups it is much more serious. Effective local flu planning is an integral part of wider winter planning and the annual flu immunisation programme is a critical element of the system-wide approach for delivering robust and resilient health and care services. I urge everyone to continue to support delivery of the Annual Flu Plan (accessible here https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/306638/FluPlan2014_accessible.pdf), published on 28 April 2014, with as much energy as possible. Flu immunisation really is crucial in protecting those at risk and GPs will as you know, offer free flu vaccinations to: people aged 65 years and over clinical at-risk groups pregnant women carers and Health and social care workers and residents in long-stay care homes

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/306638/FluPlan2014_accessible.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/306638/FluPlan2014_accessible.pdf

Uptake of the vaccine in some of these groups remains disappointingly low and we hope that, with your support, we can help to encourage individuals eligible for free vaccinations to take them up. Key actions are: Encourage flu vaccination in at-risk groups and ensure that staff in contact with

vulnerable individuals have access to flu vaccination (particularly social care and NHS staff).

Encourage good hand hygiene, to reduce the spread of flu and other infections in all settings e.g. “catch it, bin it, kill it” campaign.

Information about the annual flu programme and resources can be found here https://www.gov.uk/government/collections/annual-flu-programme and if you would like further information please email [email protected].

Norovirus Norovirus is the most common cause of infectious gastroenteritis (diarrhoea and vomiting) in England and outbreaks occur regularly each winter with disruptions to the provision of public services such as closures of hospital wards or schools. It is generally mild and people usually recover fully within 2-3 days but it can be dangerous for the very young and elderly.

The most effective control measures are:

attention to good infection control practice, including hand washing with soap and water (not relying on alcohol gels as these do not kill the virus);

prompt segregation of affected patients, and good communication with staff, patients, visitors and other local organisations.

Guidance on norovirus, including management in community health and social care settings and a poster for winter can be found here https://www.gov.uk/government/collections/norovirus-guidance-data-and-analysis Health and Social Care integration Actions to reduce winter mortality, and morbidity, and winter pressures on the NHS and social care system provide opportunities for greater integration of health and care commissioning. PHE has recently published tools that:

forecast total non-elective and avoidable emergency admissions. Local area can use this data to confirm that their Better Care Fund (BCF) plans address any adverse trends identified by the tool (accessible here

https://www.gov.uk/government/collections/annual-flu-programme


https://www.gov.uk/government/collections/norovirus-guidance-data-and-analysis

http://www.yhpho.org.uk/default.aspx?RID=203927).

give local areas access to indicators related to the BCF and enables comparison with other local authority areas and to the national average. For access to the site and feedback please contact Justin Robinson at [email protected]

Cold Weather Plan The Cold Weather Plan for England launched on 21st October is operationally led by Public Health England, NHS England and the Local Government Association. The Plan focuses on reducing harm to health in winter and unnecessary hospital visits and should be considered by all orgnaisations, including Health and Wellbeing Boards. The 2014/15 edition and its associated documents are available here: https://www.gov.uk/government/publications/cold-weather-plan-for-england-2014. I know that for many, local authorities winter plans are well developed and I am sure that as the clocks go back this weekend, many people will be encouraged to prepare for the winter ahead. As ever, I would like to thank you for the work that you do to promote the health of your communities. Kind regards,

JANE ELLISON

http://www.yhpho.org.uk/default.aspx?RID=203927


https://www.gov.uk/government/publications/cold-weather-plan-for-england-2014

28 October 2014 To: System Resilience Group Chairs NHS Trust and NHS Foundation Trust Chief Executives Cc: CCG Clinical Leads and Accountable Officers NHS England Area Directors Dear Colleague, Winter Resilience and the Delivery of A&E NHS Constitution Standards We are grateful for the significant effort and commitment providers and commissioners have shown in the development of System Resilience and Capacity Plans. Delivery of a maximum waiting time of 4 hours in A&E is part of the NHS Constitution and is a critical indicator of overall success in the delivery of high quality health services to NHS patients. To support the delivery of the A&E standards this winter, NHS England, Monitor and the NHS Trust Development Authority have secured additional non-recurrent investment. This funding is in addition to the initial tranche of system resilience money, which is being released through the Month 7 revenue transfer forms to CCGs. Based on indicative investment information provided by System Resilience Groups and discussions with individual providers, the Tripartite Regional Directors for the North have agreed an additional funding allocation for each provider. These allocations have already been discussed with NHS Trusts and NHS Foundation Trusts by the NHS Trust Development Authority and Monitor respectively. This letter provides formal and final confirmation that providers are guaranteed to receive the allocation that has been agreed with them. If SRGs or providers are unclear about the funding which has been allocated to them, they should contact their NHS England Area Team operations director, Monitor regional account manager or TDA portfolio director as soon as possible. This funding will also be released through the Month 7 revenue transfer forms to CCGs. The Regional Tripartite expects that CCGs will pass the funding directly to providers without additional conditions. But the Tripartite also expects that providers will work with their local SRGs when deciding the final schemes to be implemented, taking into account the indicative schemes submitted during this process.

It is critical that providers now quickly put in place the agreed service enhancements to increase system resilience and secure delivery of the A&E standards. Any spending slippage should be identified to the Tripartite as early as possible so that funding can be reallocated elsewhere if necessary. Trusts will be required to account for their spending of the funding and the impact of the schemes to the Regional Tripartite. Further details of the process and timings for this will be provided shortly. For absolute clarity, this additional funding, together with your System Resilience Group plans is to secure consistent delivery of the maximum 4 hour wait in A&E in at least 95% of cases throughout winter and to March 2015. Please do not hesitate to contact us should you require any further information or assistance. Yours sincerely

Lyn Simpson Director of Delivery and Development (North) NHS Trust Development Authority

Paul Chandler Regional Director (North) Monitor

Richard Barker Regional Director (North) NHS England

Developing Primary Care in Darlington – A Strategic Approach

Introduction

1. Darlington Clinical Commissioning Group (CCG) is a membership organisation made up of 11 GP practices and is co-terminus with Darlington Borough Council boundaries. As a newly formed statutory organisation, the CCG is responsible for commissioning (purchasing) health care services for the population of Darlington. The CCG has an overarching 5 year commissioning plan describing its vision of “Working together to improve the health and wellbeing of Darlington”. For the people of Darlington this means:

Health services which are safe and of the highest quality Best possible health outcomes Joined up services which benefit patients and the public and give best value

for money

2. In order to achieve the vision, Darlington CCG has developed the following strategic aims To improve the health status of the people of Darlington To address the needs of the changing age profile of Darlington To commission the right services in the right place, and To manage resources effectively and responsibly

3. Further details about the CCG’s commissioning strategy can be found in its five

year strategic plan. This report is focused on one element of the work of the CCG within the context established, above. A key responsibility of the CCG is to lead the improvements in primary care; this report includes both a proposed strategy for improvement and the supporting business case.

4. It is the case that over 90% of patient contact is with primary care. It is also the

case that older people and those with long term conditions make proportionately more use of health services. Primary care, therefore, must respond to these known pressures in order to still be able to provide effective universal health care in the foreseeable future. Without a clear strategy to meet the impact of the increase in demographic pressures there is a strong likelihood that the current system will fail to meet the needs of the population, particularly those most in need.

5. If General Practice accounts for over 90% of patient contacts with the health

service it is not the case that every patient experience is necessarily the same. Primary care is absolutely critical in terms of addressing the changing pattern of health conditions but it will only be effective in doing this if the variation in the quality of patient experiences in General Practice is reduced. The CCG has a statutory duty to improve quality in primary care, both through support to primary care to address the changing demographics and ensuring that all

patients receive the best possible care. These duties underpin this strategy and business case.

6. It is widely accepted that the financial envelope for the NHS will not keep pace

with the demographic growth, the growth in complex needs and the growth in expectations and so there is recognition that primary care can play a key role in making better use of scarce resources. The rapid growth in emergency admissions between 2003 and 2012 (34%) cannot be wholly put down to the increase in population or complexity of needs; it is evidenced that current arrangements are not delivering what was expected of them. This need to make better use of resources is also a driver for this strategy and business case.

7. If it is recognised that primary care has a key role to play in making the health

system sustainable and delivering better outcomes, then it must also be recognised that there are real workforce issues within primary care. Demand for services is increasing but resources are not keeping pace. More than 30% of Darlington GPs are in an age bracket where retirement is a real possibility. At the same time, recruitment of new partners or of salaried GPs is a real challenge and so a credible strategy and business case for primary care can play a part in sustaining key frontline health services.

Developing a primary care strategy and business case 8. Darlington CCG, Durham, Darlington and Tees Area Team and primary care

clinicians have worked together to address the issues identified in paragraphs 4-7. The first phase of work included a review of current pressures in primary care and an overview of the health economy. This is attached as Appendix 1.

9. In summary, phase 1 of the work identified the demographic pressures of an ageing population and an increase in the number of people with multiple long term conditions, set against a context of rising costs and expectations but limited resources.

10. The second phase consisted of an application to the Prime Minister’s Challenge Fund made by Darlington’s GPs, who wished to demonstrate different ways of working. Subsequently, this application led to a requirement to form a legal entity to hold the grant funding but it is expected that this collaborative arrangement will continue beyond the life of the Challenge Fund allocation. This is, attached as Appendix 2.

11. The pressure on health and care services has been growing for a number of years but came to crisis points during winter months in 2011/12 and 2012/13 as a result of increased demand and raised expectations, compounded by systems of working that are no longer fit for the present and certainly not fit for the future.

12. Within Darlington there is a culture of over-dependency on the acute hospitals

with an increasing ageing population and subsequent pressures on acute

beds. The nursing homes have culturally changed over the last 10 years and appear to be less able / willing to care for acutely unwell patients or cope with uncertainty.

13. There has been silo working within the health economy by all organisations and

limited integration, often putting the organisational interest before the needs of the patient.

14. This is compounded with the budgetary constraints that will seriously start to hit

the health service over the next two years. Across the country it is likely that hospitals and services will be ‘re-configured’ to increase efficiency and improve outcomes. The North East is set to be hit by another potential financial pressure as a new proposed financial allocation formula for CCGs budgets underplays the importance of deprivation, as it has already done in the allocation of local authority budgets, which cover social care costs.

15. Other drivers for change include a policy direction to implement seven day

working in primary and hospital care with an emphasis on improving the quality of out of hours cover, workforce changes including low morale amongst the clinical workforce. The King’s Fund enquiry into general practice reported trends that generally apply in Darlington and included:

a fall in the number of single-handed GPs, and a trend towards larger practices a steady increase in the proportion of female GPs a significant increase in the proportion of sessional and salaried GPs increasing demand for part-time and flexible working arrangements

fewer partnership opportunities and fewer GPs wanting to commit to partnerships at such an uncertain time The acquisition of commissioning responsibilities that has exacerbated the current workload crisis seen nationally. Projected shortfalls in the number of practice nurses and GPs as a ‘retirement bulge’ occurs in the current decade. Over fifty cohort retiring early Inadequate intake into GP training, not matching expected quotas as GP unattractive career prospect with current pressures.

16. The National Health Service is a system originally designed for people with episodic illnesses before the onset of any long term conditions. Its current

configuration will not be able to cope with a growing number of older people and those with increasingly complex long term conditions.

17. That people live longer is a cause for celebration, although an acknowledged

pressure for reform of the health care service. A second demographic change, people choosing to live less healthy lives (or not having the resources to live healthy lives), is not to be celebrated but is equally a cause for pressure within the system. Obesity, smoking, alcohol consumption and a lack of exercise are all behaviours which the health system has to respond to.

18. In order to deal with these changes our aim is for a system whereby patients are

better informed about their choices and the consequences of choices, commissioning is better informed and integrated, providers are more flexible, co-production with patients and with providers is central to our thinking, the workforce includes those with more generic or diverse skills as well as seeking to secure robust succession planning and better use is made of technology and data.

19. The second phase of work, looking at different ways of working and subsequently the collaborative arrangements, identified areas that new ways of working would bring benefits to and these are shown, below. They include both efficiencies delivered through scale and improvements in processes and practice. Importantly, the collaborative approach is also shown as a tool to secure improve primary care and to improve succession planning. Phase two areas for consideration are as follows:

Human Resources and management of staff Contract management and delivery Premises-current and future provision Education and training Audit and Clinical Effectiveness Data and information Use of systems and Information Technology Managing referrals & choose and book, Appointments and systems of access Patient tracking Finance Primary Care development Succession planning

20. In preparing this strategy and business case we consulted with patients and

service users and they have told us that they are in tune with the need for change. For example, patients told us that they were happy to see any doctor or other relevant medical practitioner rather than their own GP if they had a pressing need. They were even happy to be seen by other practices if needs be in these circumstances. Of course, those with long term conditions, for example, valued the continuity of care they received from a known health

professional. Patients were willing to test out telephone and email contact as well. These were systems and approaches that were also proposed by primary care staff.

21. GPs are supportive of the health education/preventative work streams,

particularly those that will be promoted through our Public Health programme. They report seeing too many patients who have unrealistic expectations of the current system. Practice nurses have welcomed working with other disciplines.

22. The larger providers have acknowledged the need to improve the links between

primary and secondary care.

23. Our assets as a health and social care community are immense. The council and the CCG serve the same population; there is a large general hospital in the very centre of the community; co-location, integrated management and shared services have long been established in parts of the service; GP practices are well-regarded; social care services have a robust transformation programme in place; and, our evidence shows that concerted efforts collectively delivered by partners has delivered real change.

24. If funding for primary care is tight and potentially under pressure as population

growth outstrips funding growth, then we also recognise that there is inefficiency in the current system and unmet need. For example, unnecessary bed stays cost the health economy over £1 million annually whilst at the same time only 40% of learning disabled adults receive an annual health check. Removing the inefficiencies will allow us to deploy resources differently to meet currently unmet needs.

The case for change

25. Our case for change is based on three key underlying assumptions: prevention has to become a reality, people should become less passive consumers of healthcare and become active partners in promoting health and integration is better than fragmentation in all parts of the system. These three assumptions also mean that there are three changes required from how we currently do our business. In future our focus should be on outcomes and not on activity, we must make more use of the data and evidence that we have and we must be bold in promoting innovation.

26. Primary care is already at the forefront of these necessary changes.

Recognising that admission to hospital from care homes is higher than the national average and has increased from 540 to 735 in two years prompted primary care to initiate the Care Homes pilot, which is already delivering some positive results although it is still in a very early phase.

27. The development of multi-disciplinary teams in GP surgeries from October 2014

is another example of primary care leading the innovations necessary to reduce the waste of resources in the system and to enable more resources to come to primary care where the bulk of patient contact takes place.

28. Delayed Transfers of Care from hospital, usually as a result of ineffective

processes, stands at 544 bed days per month/100,000 population. The national figure, for comparison, is 273 and achieving national average rates would save the £1 million annually set out in paragraph 22.

29. It is widely accepted that the stresses of living in poverty are particularly harmful

to a number of vulnerable groups including older people. Darlington has some of the most deprived areas in England, and is ranked 79th most deprived local authority out of 324 in England (compared to 87th in ID2007). Almost 35% of Lower Super Output Areas (LSOAs) are in the 30% most deprived nationally, and 11% of its LSOAs in the most deprived 10% of LSOAs nationally; indicating that income deprivation for older people is a significant issue in Darlington. Poverty may well be a root cause for people presenting to primary care but primary care alone is not in a position to solve the associated health problems so long as poverty exists. Primary care must, therefore, work within a wider partnership of public and voluntary sectors to improve the health and well-being of the community.

30. The health of people in Darlington is varied compared with the England average.

The 2014 Health Profile ( Public Health England, July 2014) provides a picture of people’s health and needs e.g. while life expectancy for both men and women is similar to the England average, differences within Darlington remain. Life expectancy is 12.4 years lower for men and 8.1 years lower for women in the most deprived areas of Darlington than in the least deprived areas.

31. The diagram, above, summarises the current context that primary care operates

in. It shows a series of pressures to illustrate the starting point for this new strategy: the current situation is untenable.

The strategy for primary care

32. The proposed draft strategy for primary care in Darlington, based on the context

set out above is as follows:

Primary care takes on the role of innovator in developing new health systems which remove inefficiencies in the system

Shared services becomes the norm wherever practical – as a response to seven day working, to deliver support service/back office efficiencies and to improve the workforce

Primary care should actively enter the market place as a potential provider of services

Investment in primary care is increased

The business assumptions underlying the proposed strategy

Primary care takes on the role of innovator in developing new health systems which remove inefficiencies in the system

33. A sustainable health economy can only be created if the system focuses more

on prevention and is proactive in supporting people to be independent for longer. The primary care led work on reducing hospital admissions from care homes has already delivered improvements, both in personal care and in financial savings. The proposed multi-disciplinary teams starting in October 2014 have already been externally validated as a model and have evidence that they will reduce unnecessary acute spend by £1 million each year.

34. Primary care sees the vast majority of patients and is most in tune with the mismatch between the services on offer and the needs of their patients. In particular, this includes wanting much greater access to a range of alternative approaches, including social prescribing and engagement with the voluntary and community sector.

35. Primary care has well located community bases which provide ideal locations for specialist services to be run from and from where acute staff can engage with some of their patients. The scope provided by improved technology enhances this.

Shared services becomes the norm wherever practical – as a response to 7 day working, to deliver support service/back office efficiencies and to improve the workforce

36. The current configuration of primary care in Darlington is of 11 practices, with patient populations of between 4,000 and 14,000. Some of the practices are in better financial health than others but all are potentially sustainable. The economic growth strategy for Darlington suggests that a further 4,000 homes may be built, which, combined with demographic growth may increase the population by up to 10,000 people over the next 10-15 years. Although there is a trend nationally for larger practices to be developed, the current configuration appears to be the best balance between financial viability and community based services. Research from the King’s Fund (Ham, 2010) describes 100,000 population as ideal for effective running of a federation or collaboration approach. Primary care in Darlington recognises the advantages of smaller practices, some of whom are the best performers against a number of indicators. However, further work would be required to demonstrate if good performance was attributed more to size or to funding. Whilst recognising the strengths of the current configuration, the collaborative also recognises the benefits of scale where it is in the best interests of the practices.

37. In addition to the rising demands, there are concerns regarding the numbers of

trainees entering the profession and the Centre for Workforce Intelligence reported that these numbers were under the government target. Other workforce trends have seen an increase in non GP provision such as nursing and health care assistant roles, along with the increasing role of pharmacists and other Allied Health Professionals. Funding for primary care services has remained relatively static, and so is, in real terms, a reduction - due to staff / premises costs along with ever increasing business costs. There will be a further financial squeeze due to the constrained health and social care funding and the rising demand. This may impact smaller practices more than larger practices but it is also recognised that some of the larger practices can also expect financial pressures, particularly if the PMS Premium is removed. Practices which may be run very efficiently could also be affected by patients moving to them and away from other practices. Action now can secure the best possible configuration of services.

38. The system needs to move away from sometimes independently minded (not

away from independent) practices to a new form of organisation that gets the benefits of scale from 11 practices working together. Darlington CCG, with the support of the NHS England Area Team, worked with the 11 GP practices to develop a plan for co-ordinated primary healthcare in Darlington. Darlington is a well-defined geographical area with strong partnerships in place and a longstanding culture of collaboration between General Practices. There is a real opportunity to set out a 5 to 10 year vision which might take into account improved use of technologies, es ta tes , the future workforce and required skills, alongside the anticipated national primary care policy changes, in the context of an increasingly challenging financial environment.

39. If 24 hour/ seven day a week care is to become a reality then it will require collaboration between practices, as well as between practices and hospitals and social care.

40. One significant benefit of collaborative working is the likely improvement in

quality across the patch. Where locally shared services are in place there is more likelihood of a stronger performing practice supporting a less well performing practice in key areas because of the very nature of a shared service or shared accountability.

Primary care should actively enter the market place as a potential provider of services

41. National research has identified that some GPs report being distanced from

public health since its move into local authorities. This is a shame and is not voiced as an issue in Darlington (although it may be an as yet unvoiced issue). The reason it is raised as a concern elsewhere is because of the need to promote population wide health initiatives and a fear that GP knowledge and experience is less influential in delivering public health contracts.

42. The introduction of CCGs was about giving primary care greater influence in commissioning health services but there is a sense that much of the initial enthusiasm has waned and that the focus for GPs is back in their practices. As services are reconfigured around multi-disciplinary teams, social care integration and voluntary sector capacity building then it is realistic to see primary care taking on a more central role and potentially contracting as a collaborative to run more of the preventative contracts.

Investment in primary care is increased

43. Key to all of the recommendations in the strategy is an increase in sustained

investment in primary care. National evidence suggests that GPs in smaller practices have not always taken up initiatives such as Locally Enhanced Services because of the staffing implications and risks of under-delivery for what are time limited contracts. In Darlington, it was also the case that the nursing home LES was not taken up by a larger practice.

44. There is a danger that this could create a two tier system for patients,

exaggerating variation between practices and not reducing it. If the collaborative arrangements are successful in Darlington and smaller practices are supported through the collaboration through shared back office working and shared support staff then risks are also shared and there is greater opportunity to fund more and more local initiatives.

Proposing the metrics for the primary care strategy

45. Primary care innovation can be quantified as at least the £3.9 million of efficiencies from acute care through the Better Care Fund.

46. The primary care collaboration should be formally established and operating from October 2014 and should identify and release efficiencies greater than the start-up costs by March 2016

47. The primary care collaborative, or individual practices, secure an agreed number or value of new contracts by April 2017

48. The CCG sets a target of annual incremental increases in funding allocated to primary care over the 5 years of the strategic plan or from the strategic plan and from other sources.

MSK Service Review Workshop

Wednesday 17th December 2014

9am -1pm

The Studio

Dolphin Centre

Horse Market, Darlington,

County Durham

Contact Details __________________________________________________________________ If you have questions about this pathway, please do not hesitate to contact Lorrae

Rose, Commissioning Manager, North of England Commissioning Support Unit, either

by email [email protected] or telephone (office) 0191 374 2760 or Mobile

07787 757 675.

A sandwich lunch will be provided

Aims

To look at the current MSK Service Model within Darlington

Driving improvements in MSK services, and what we can do to help

With the overall objective of the workshop to create a new viable MSK Service Model for Darlington

Working together to improve the health and wellbeing of Darlington

MSK Service Review Workshop

Wednesday 17th December 2014

9am -1pm

The Studio

Dolphin Centre

Horse Market, Darlington,

County Durham

Contact Details __________________________________________________________________ If you have questions about this pathway, please do not hesitate to contact Lorrae

Rose, Commissioning Manager, North of England Commissioning Support Unit, either

by email [email protected] or telephone (office) 0191 374 2760 or Mobile

07787 757 675.

A sandwich lunch will be provided

Aims

To look at the current MSK Service Model within Darlington

Driving improvements in MSK services, and what we can do to help

With the overall objective of the workshop to create a new viable MSK Service Model for Darlington

Working together to improve the health and wellbeing of Darlington

Lead Provider Framework - Lots

Lisa Tempest Gill Findley Martin Phillips Glenda Lynn

Chief Finance Officer Director of Nursing Chief Officer Admin Co-ordinator

Finance Quality, Innovation & Performance Executive Admin support to Chair, CO and SeQIHS

Governance, Audit & Risk Prescribing Community Council\RATS

Finance Clinical Leadership

- Financial Planning - Nurse leadership Strategy

- Financial Services - Clinical Quality [*] Relationship Management [#]

- Corporate Finance - Quality in Primary Care [*] Partnerships

- QIPP - Safeguarding [inc MCA] SeQIHS

- Commissioning Finance - CQRGs\QSGs VWALS

- Payroll - Clinical Leadership [**] Meaningful Engagement

- Internal Audit\External Audit Liaison - Practice Nurse development Communication - reactive media

Contracting - Continuing Health Care Equality & Diversity Rachael White - Admin Assistant

- Provider Management (incl NECS) Performance Dragons Den

- Contract Management - Service Primary Care Strategy [#]

- Procurement Caldicott Guardian Meetings: Finance, QPI, GARC & NECS SLA

Governance Corporate

- Resiliance Planning - Research & Development [*]

- Premises Strategy - Innovation

Informatics [inc GP-IT] - QOF [*]

SIRO - IFR

Corporate - Prescribing Quality Sarah Chaplin - Admin Assistant

- Business Continuity Planning & LRHP

- Complaints

- HR & Mandatory Training

- Prescribing Finance

- Health and Safety

Other: Unit of Planning, GP Access Report

Jackie Kay Gail Linstead Andrea Jones Richard Harker

Assistant Chief Officer Quality Manager Clinical Chair GP Quality Lead

Service Strategy Quality Governing Body Quality, Innovation & Performance

- Cancer & Palliative Care - South Tees Quality Review Group Members Assembly\CLG Clinical Quality [*]

- Mental Health & Dementia - Safeguarding Adults (liaison) Clinical Leadership [**] Quality in Primary Care [*]

Planning - Continuous QI Forum PLT Research & Development [*]

- Unit of Planning\BCF\Ops - Care Homes Pilot MSK Lead IFR

- Service Planning & Reform - Dragons Den LTC\Elderly Frail Lead CQRG

Delivery - FFT (primary care/mental health) Relationship Manangement [#] QOF [*]

- Delivery Plan Mental Health & LD Lead Primary Care Strategy [#] Primary Care Assurance [*]

- MDT Transformation - Network Meeting Planned Care Medicines optimisation

- HELS - Dementia CCG Lead for Health Inequalities Prescribing

- Care Home Pilot - Task and Finish Planning Groups Performance Triage

- Urgent Care inc UCB - TEWV QRG & CQUIN

- Cancer - Improving Care for LD Patients

Joint Commissioning/Partnerhips - Self Harm

- VCS\CAB\Evolution Primary Care Development

- H&WBB, H&P Scrutiny & C&YP Collective - Liaison with Practice Managers

- PC assurance\liaison - Liaison with Practice Nurses

Communications

- Named\Paid for Media

- Annual Report\Prospectus

Business Intelligence

Organisational Development

Meetings - Governing Body, JMT/Executive,

Members Assembly, RATS, MDT

Transformation, Planned Care Group Fragility

Fracture Group

Meetings: Community Council, HELS, Clincial

Leadership Group, Clinical Leads and Leaders,

Integrated Urgent Care, MDT, Primary Care

Strategy Group

LEAD PORTFOLIO'S\RESPONSIBILITIES

Admin Support to ACO, Quality Manager

(Care Homes and Dragons Den), Michelle

Thompson

Other: Manage Admin Assistants, office

management

Admin support to CFO, DN, Quality Lead,

Quality Manager & SGP

Other: Oracle, GP TeamNet, Policies, Contact

Inbox, Practice Visits

High quality care for all, now and for future generations

Dear colleague, Thank you for submitting your revised Better Care Fund (BCF) plan. We know that the BCF is an ambitious programme and preparing the plans at pace has proved an immensely challenging task. However, your plan is now part of an ongoing process to transform local services and improve the lives of people in your community. It is clear that your team and partners have worked very hard over the summer, testing out ways of working and finding innovative solutions to some of the challenges our services face in order to improve people's care. NHS England is able to finally approve plans once the 2015/16 Mandate is published. I am pleased to let you know that, following the Nationally Consistent Assurance Review (NCAR) process, provided there is no material change in circumstance and the 15/16 Mandate is published as expected, your plan will be classified as ‘Approved with Support’ once the 15/16 Mandate has been published. This recognises that whilst your plan is strong the review process identified a number of areas for improvement which once addressed will enable you to move to a fully approved status. This category means that your plan will be approved and your BCF funding will be made available to you subject to the following standard conditions which apply to all BCF plans:

• That you complete the agreed actions from the NCAR in the timescales agreed with NHS England;

• The Fund being used in accordance with your final approved plan and through a section 75 agreement;

• The full value of the element of the Fund linked to non-elective admissions reduction target will be paid over to CCGs at the start of the financial year. However, CCGs may only release the full value of this funding into the pool if the admissions reduction target is met as detailed in the BCF Technical Guidance1. If the target is not met, the CCG(s) may only release into the pool a part of that funding proportionate to the partial achievement of the target. Any part of this funding that is not released

Publications Gateway Ref. No. 02396 Quarry House Quarry Hill

Leeds LS2 7UE

E-mail: [email protected]

To: Darlington Health and Wellbeing Board NHS Darlington CCG Copy to: Darlington Borough Council

29th October 2014

High quality care for all, now and for future generations

into the pool due to the target not being met must be dealt with in accordance with NHS England requirements. Full details are set out in the BCF Technical Guidance.

The conditions are being imposed through NHS England’s powers under sections 223G and 223GA of the NHS Act 2006 (as amended by the Care Act 2014). These allow NHS England to make payment of the BCF allocation subject to conditions. If the conditions are not complied with, NHS England is able to withhold or recover funding, or direct the CCG that it be spent in a particular way. Appended to this letter is your NCAR Outcome Report which documents the agreed actions. Please work with your Area Team Lead Cameron Ward ([email protected]) to agree a timetable for when you will submit the additional information/evidence required on the back of the NCAR report. We are confident that there were no areas of high risk in your plan and as such you should progress with your plans for implementation. Although the areas of support the review identified are essential to successful delivery in the medium term we do not consider them as material at this stage. Any ongoing support and oversight with your BCF plan will be led by NHS England Regional/Area Team along with your Local Government Regional peer rather than the BCF Taskforce from this point onwards. Non-elective (general and acute) admissions reductions ambition As there is a considerable amount of time between the submission of BCF plans and their implementation from April 2015, we recognise that some areas may want to revisit their ambitions for the level of reduction of non-elective admissions, in light of their experience of actual performance over the winter, and as they become more confident of the 2014/15 outturn, and firm-up their plans to inform the 2015/16 contracting round. Any such review should include appropriate involvement from local authorities and be approved by HWBs. NHS England will assess the extent to which any proposed change has been locally agreed in line with BCF requirements, as well as the risk to delivery of the ambition, as part of its assurance of CCGs’ operational plans. Once again, thank you for your work and we look forward to the next stage. Yours sincerely,

Dame Barbara Hakin National Director: Commissioning Operations NHS England 1 http://www.england.nhs.uk/wp-content/uploads/2014/08/bcf-technical-guidance-v2.pdf

2 December 2014 NHSDCCG/GB/2014/December/Item No. 63


Governing Body

Patient and Public Involvement 1. Introduction

The purpose of this report is to update the Governing Body on key patient and public involvement and engagement activities since September 2014 and identifies future actions to be delivered over the next three months.

2. Implications and risks

Health impact: Involving patients and the public in identification of their health

needs, care experiences and service priorities strengthens effective commissioning of health services.

Financial implications: There are no direct financial implications. Legal or compliance implications: Health and Social Care Act 2012 – duty to

involve patients and the local community in health planning. Link to key objective and/or principal risks: Putting patients at the heart of

everything we do. Patient and public engagement: The report describes key Patient and Public

Involvement activity during the reporting period. Equality impact assessment completed: Not required for this update.

3. Recommendations

The NHS Darlington Clinical Commissioning Group Governing Body is asked to note the report.

4. Author, Clinical Sponsor and Executive Lead

Author: Michelle Thompson Title: Lay Member for Patient and Public Involvement Clinical Sponsor: Andrea Jones Title: Chair Executive Lead: Martin Phillips Title: Chief Officer Date: 2nd December 2014

2

Purpose of Paper Information Sharing Development / discussion

Decision / action

x




Commissioning the right services in the right place Security safe high quality services

x

x

x


Delivering ambition for “No Decision about me without me!”


No significant impact

Financial Implications None


None


To update the Governing Body on involvement and engagement activities


None


No issues

Implication for Partners None

Equality and Diversity None

Attachment(s) Patient and Public Involvement Report

of 6

Patient and Public Involvement Report Introduction The purpose of this report is to update the Governing Body on key patient and public involvement and engagement activities since September 2014 and identifies future actions to be delivered over the next three months.

Community Council September

Neeraj Sharma, Chief Executive of Citizens Advice Bureau (CAB) gave the group an overview of the organisation and the assistance it can provide especially with the benefits system. He focused on a case study about a cancer patient and the support they delivered including help with bereavement, finance, employment and housing. Neeraj explained that at times more than one organisation may be involved with the benefit system and that often a decision made by one may have a knock on effect with another. Questions were asked about how much input a GP may have with regards to the benefit system and Neeraj explained that the CAB advisors will sometimes contact them to provide evidence on a patient’s condition and they also provide an advice

service within some of the practices. He advised that he was finalising a paper that sets out the health benefit of their work and he hoped the CCG would consider it when completed. Discussions were held with regard to the Patient Transport Service (PTS). Members were informed about the national criteria for PTS Services adopted in Darlington. If transport to hospital is required the GP will signpost the patient to the Transport Information Service (TIS). Posters have been produced with information and contact numbers. Members felt it should be advertised far and wide as many people may not be aware of what is available and the eligibility criteria. Members were asked for their views on the CCG commissioning occupational health services for clinicians. The group felt that failure to commission GP Choices would have a detrimental impact on GP recruitment in Darlington and they unanimously agreed that the CCG should recommission this service. .

October

A new diabetes newsletter was circulated to the group for comments about the

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information and services provided throughout the region. It was noted that the newsletter seemed focussed on the Durham area rather than Darlington but the group felt the newsletter was well written and very informative. Members who are themselves diabetic were keen to attend the focus groups advertised and to circulate the information further afield.

Members gave updates on their individual PPG groups:

Felix House are gathering information from patients regarding the potential relocation of the practice. 99% of patients asked are against the move from the village.

Moorlands highlighted problems with the electronic prescription service which is a known issue across Darlington. They also complimented the surgery’s triage

system which is working well.

Carmel surgery has started to think about the annual survey and is hoping to obtain a higher percentage of returns this year.

Whinfield held their first face to face PPG meeting in September where unplanned admissions were discussed. It was explained this is regarding the Better Care Fund and Frail Elderly Multi-Disciplinary Teams (MDT) work that is currently being implemented.

Parkgate, Blacketts and Denmark PPG’s are due to have meetings in the next few

months and will update accordingly.

Members were informed that PPG’s are to become a contractual requirement in 2015 and groups can register for regular information, support and updates via the National Association for Patient Participation. Members were directed to the website and informed of a phone number to request regular newsletters.

November A verbal update will be given at the Governing Body meeting due to the Community Council taking place after formal distribution of documentation.

Recent Involvement and Engagement Activities: Town Centre Market Stall in October

Healthwatch Darlington (HWD) held a successful market stall in October attracting local resident’s especially young people to chat about health and social care issues.

Although the CCG could not attend on the day, awareness was raised for the organisation as part of the #AskTheCCG mini consultations event. The CCG hope to attend in the month’s to follow.

MS Group meeting to listen to issues and concerns Members of the Darlington Multiple Sclerosis Group brought numerous issues to the attention of HWD who in turn ensured the CCG were aware of these issues. Due to this

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involvement, investigations were made and responses were fed directly back to the group followed by a meeting via HWD to discuss concerns directly with the CCG.

Joint Patient and Public Involvement and Engagement Group This is a joint working group between Darlington Borough Council (DBC), the CCG, North of England Commissioning Support (NECS) and HWD to work together with engagement and involvement strategies so as not to duplicate work and to share resources. Discussions are currently taking place for joint communications to patients, carers, the public and the third sector regarding the Care Act 2014.

Mental Health Strategy HWD fed directly into the Mental Health Strategy via their own Mental Health task and finish group which includes service user and carer representation along with representation from voluntary and community sector organisations and those providing services in Mental Health. Public feedback was gathered via access points within the town and a general survey. Concerns were brought to the group around post natal depression and the change in current service provision. This was then fed directly to the Clinical Commissioning Group and into the strategy.

Breast Cancer Service Review The CCG were joined by the local authority Health Scrutiny Committee and HWD on a visit to Bishop Auckland Breast clinic to review the current practice and speak to staff and patients. Meetings have been held with the County Durham and Darlington Foundation Trust (CDDFT), MP Jenny Chapman and the Breast Cancer Service Review Steering Group. HWD are in the process of setting up focus groups with patients and carers including the Darlington and Teesdale Breast Cancer Support Group.

Securing Quality in Health Services Project (SEQUIS) The CCG have commissioned independent research currently being carried out with the public via telephone interviews and focus groups. It is to gain an understanding of what local people feel is important about hospital services, gauge levels of understanding of the balance that has to be achieved between quality, access and affordability and gauge levels of understanding about the need for change in the NHS generally. The CCG have worked closely with Healthwatch colleagues and CCG Lay Members across the region to obtain their advice about the questionnaires and development of further meaningful engagement with local people.

Better Care Fund/Multidisciplinary Team New MDT’s have been formed with staff from GP surgeries, Darlington Memorial

Hospital, community and mental health staff, social workers and the voluntary sector. They will work jointly with patients to ensure they get the right help as and when they need it, working more in the community with the aim of speeding up treatment and reducing unnecessary hospital visits. They will improve support by increasing the care people receive in their own homes, with the aid of voluntary organisations and providing seven days a week diagnostic specialists into Accident and Emergency.

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HWD is running a competition to give this new way of working and our new local MDT’s

a name. The name will represent all the staff and work planned under this new umbrella of services by working together to plan long lasting improvements and better outcomes for the people of Darlington. The author of the winning name will receive a Festive hamper, Further details can be found on the HWD website. Closing date is 12th December 2014

Future involvement and engagement activities Engagement activities planned via Healthwatch Darlington for the next three months

include: o BME and Young People project – task group set up and events planned for

Spring launch. o Commissioning Intentions – working group set up to assist CCG and local

authority with a number of short and long term involvement and engagement projects including events early in the New Year.

#AsktheCCG – small consultations across the Borough via community groups and online Twitter

Summary

The CCG are continuing with their pledge to ensure the involvement of patients, carers and the public is at the very heart of their decision making. Consulting and engaging with individuals and organisations and ensuring it is meaningful and effective, fosters good relationships and encourages a mutual understanding. Future engagement activities reflect the CCG’s ongoing commitment to reach out to as many residents as possible by working on an ongoing basis with others, such as patient leaders, community leaders, schools and businesses and the voluntary and community sector.

Author: Michelle Thompson Title: Lay Member for Patient and Public Involvement

Clinical Sponsor: Andrea Jones Title: Chair

6

2 December 2014



Governing Body

Quality & Performance Report

1. Introduction

In line with the newly agreed reporting arrangements for quality, this paper provides a summary overview of the Quality & Performance of Darlington Clinical Commissioning Group (CCG). This report provides:

A summary of the areas of concern at page 4 with detailed exception reports of the actions being taken on the following pages

Page 5 shows the DCCG performance with spark lines to follow trends An at a glance summary of the key indicators for the NHS constitution, quality

outcomes and clinical quality. A review of the final quality premium indicators for 2013/14 Page 32 shows the standards that the CCG are monitoring itself against are

replicated in the quarterly balanced scorecard developed by NHS England. Page 34 shows more details of reporting in primary care

2. Implications and risks The target for diagnostics is being breached at both South Tees and County Durham and Darlington Trusts. The CCG has been provided with details of the tests where the trusts are failing. It predominantly relates to endoscopy. Extra capacity is being funded but is limited due to the national push to lower referral to treatment times. Emergency department waiting and handover times have been breached at both South Tees and County Durham and Darlington Trusts. This is being followed up by both trusts at the contract meetings. Details of winter and surge preparedness are being evaluated by the area team. Both trusts have received a significant non recurrent investment via system resilience funding. Cancer screening targets have been breached. This is a regional problem and is being investigated by NECS. Quality, performance and innovation committee is to receive a detailed presentation on this matter. North East Ambulance Service (NEAS) has breached its red call 8 minute response time as a Trust, but performance remains strong in the Darlington CCG area, with response

2

times consistently above 80%. The 111 service has failed a number of indicators. The service has been subject to a peer review and challenge from the Emergency Care intensive Support Team (ECIST). Details of the report and action plan will be discussed at the NEAS quality review group. 3 of our provider Trusts (County Durham and Darlington FT, Tees, Esk and Wear Valleys FT and South Tees FT) are subject to the new style CQC inspections in the next few months with high numbers of inspectors visiting multiple sites over the course of a week. Darlington CCG has been asked to feed into the evidence gathering process with the CQC. 3. Recommendations The Governing Body is asked to:

Receive current performance report; Note the progress of performance management processes

4. Author, Clinical Sponsor and Executive Lead Author: Andrew Rowlands Title: Senior Commissioning Support Officer Clinical Sponsor: Gill Findley Title: Director of Nursing Executive Lead: Gill Findley Title: Director of Nursing

3

Purpose of Paper Information Sharing

Development / discussion X Decision / action




X

Commissioning the right services in the right place X

Security safe high quality services X


The NHS constitution is incorporated throughout the report and is at the core of services commissioned and therefore reported within this report


Addressed throughout the report

Financial Implications Financial implications are not reported through this document


Not applicable


Not applicable


Not applicable


Addressed throughout the report

Compliant with PPE Framework

Not applicable

Implication for Partners Not applicable

Equality and Diversity Not applicable

Attachment(s) D'ton CCG QP Report Nov-14

Quality and Performance Report

November 2014

Contents

Slide Number Title

3 Background and Timetable

4 Executive Summary

5 – 26 NHS Constitution Performance including exceptions

27 – 30 Quality Premium & Outcomes Framework

31 Activity Analysis

32 – 39 Quality Performance including exception

40 Glossary

2

Please find attached the Quality and Performance report (QP) for NHS Darlington CCG for November 2014. The report uses the latest published metric data for quality and performance, and where possible if later unpublished data (white text) is available this has been included. If information is not available it has been flagged within the report. NECS will continue to work with the CCG to ensure the content and format of the report fits with the needs of the organisation. In addition to the formal QPF report the Quality and Performance published data is now available in RAIDR.

Background & Timetable

3

Report Amendments This months report includes a few amendments: • The inclusion of ‘spark lines’ particularly on slide 5. Spark lines improve the reporting of the trend position where previously the ‘up or down

arrow’ only showed movement from previous month • Change of format to exception reports. Now include ‘timescales for improvement’ section and ‘other intelligence’ section • Addition of NEAS Ambulance Handover analysis slide – slide 23 Future developments: • On-going development as per CCG requirements

Recommendation: This report is for the CCG to note current performance and the risks to national indicators in 2014/15. The committee is asked to endorse the actions to address underperformance and suggest further remedial action if appropriate.

Executive Summary

Headlines The headlines for this report are summarised as follows:

Performance Indicator Provider/Commissioner Description of

Performance Update Exception Report No. Diagnostic Tests CDDFT YTD Breaches CDDFT ER01 A&E and Handover CDDFT Monthly Breaches CDDFT ER02 Cancer Screening CDDFT YTD Breach CDDFT ER03 Choose & Book CDDFT Breach of local indicator CDDFT ER04 Diagnostic target STHFT Breach Apr-Sep STHFT ER01 A&E 4 hr. target STHFT Breach in Sep & Oct STHFT ER02 Hospital Handover STHFT Monthly breaches STHFT ER03 Cancer 14 day, Breast Symptoms & 62 day NTHFT YTD breaches NTHFT ER01 8 min response times NEAS CCG & Provider breach NEAS ER01 111 performance NEAS Various breaches NEAS ER02 Mental Health Performance TEWV YTD breach MH ER01 HCAI CCG and Acute Providers Update HCAI01

Quality Indicator Provider/Commissioner Description of

Performance Failure Exception Report No. CQC Enforcement NEAS CQC Visit & Report QER01 Monitor STHFT Monitor Risk QER02 Friends & Family CDDFT & STHFT Performance update QER03 Serious incidents All Unclosed Sis QER04

4

Darlington CCG - NHS Constitution Performance Summary

5

Indicator Description Frequency Data Period Threshold

Referral to treatment access times% of patients initial treatment within 18 weeks for admitted pathways 90.0% 95.13% 91.26% 93.81% 92.33%

% of patients initial treatment within 18 weeks for non- admitted pathways 95.0% 98.58% 98.40% 98.69% 98.31%

% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 95.29% 95.57% 95.19% 97.18%

Number patients waiting more than 52 weeks for treatment 0 0 0 0 0

Diagnostic waits

% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology) Monthly Sep-14 1.00% 5.40% 5.90% 1.03% 0.60%CDDFT ER01STHFT ER01

A&E waits% patients spending 4 hrs. or less in A&E or minor injury unit To 9th November-14 95.0% 95.58% 95.94% 95.88% STHFT ER02

Handover between ambulance and A&E over 30 minutes 0 1527 434 27 3218

Handover between ambulance and A&E0ver 60 minutes or more 0 426 79 0 676

Cancer patients 2 week wait% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 96.30% 95.10% 93.80% 92.20%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 94.70% 95.10% 93.90% 92.60%

Cancer patients - 31 days% of patients treated within 31 days of a cancer diagnosis 96.0% 98.60% 99.30% 97.80% 98.50%

% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 100.00% 99.50% 99.80% 100.00%

% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 100.00% 97.30% 98.90% 97.40%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 100.00% 98.90%

Cancer patients - 62 days% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 85.20% 86.40% 85.00% 83.70%% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.0% 100.00% 79.40% 93.20% 95.00%% of patients treated for cancer within 62 days of consultant decision to upgrade status N/A 80.00% 100.00% 96.60% 93.80%Ambulance response timesCat A response in 8 mins (red 1&2) 75.0% 80.34% 74.67%

Cat A Response within 19 mins 95.0% 94.97% 95.13%

Number of crew clear delays over 30 mins Trend 1,379

Number of crew clear delays over 60 mins Trend 80

Mixed Sex accommodationMixed Sex accommodation - number of unjustified breaches Monthly YTD Sep -14 0 0 0 0 0

Mental Health% people followed up within 7 days of discharge from psychiatric in patient care Monthly YTD Sep-14 95.0% 97.73%HCAIIncidence of MRSA (QP) 0 1 4 3 1

Incidence of C Diff (QP) - threshold relates to CCG performance 20 13 7 32 11

YTD Oct-14

Monthly

CDDFT ER03NTHFT ER01

NEAS ER01

NTHFT ER01

Exc

epti

on

Rep

ort

Weekly To 10th Nov -14 HCAI01

Monthly YTD Sep-14

YTD Sep-14

Monthly YTD Sep-14

Monthly YTD Sep-14

Monthly

CDDFT ER02STHFT ER03

YTD Sep-14

Monthly

YTD Oct-14

NE

AS

Dar

lin

gto

n C

CG

Darlington CCG - Performance Summary

ST

HF

T

CD

DF

T

NT

HF

T

NHS Constitutional Indicators by month – Darlington CCG 2014/15

6

Quality Indicator Operational

StandardSep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 2013/14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 YTD Exception Report No.

Admitted patients to start treatment within a maximum of 18 weeks from referral 90% 94.20% 94.00% 95.50% 93.90% 94.70% 95.00% 94.60% 94.30% 96.08% 94.53% 93.29% 95.15% 95.86% 96.02% 95.13%

Non-admitted patients to start treatment within a maximum of 18 weeks from referral 95% 98.80% 98.80% 98.80% 98.10% 98.10% 98.70% 98.50% 98.70% 98.48% 98.75% 98.62% 98.82% 98.75% 98.17% 98.58%

Patients on incomplete non emergency pathways (yet to start treatment) should have been waiting no

more92% 93.80% 94.00% 93.50% 93.70% 93.30% 94.40% 95.00% 95.00% 95.01% 95.20% 95.44% 95.75% 95.58% 95.29% 95.29%

Number of patients waiting more than 52 weeks 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0

Percentage of patients waiting 6 weeks and over 1% 0.50% 0.70% 0.30% 1.20% 0.50% 0.10% 0.18% 0.98% 1.58% 2.81% 2.91% 4.14% 5.40% CDDFT ER01

Maximum two-week wait for first outpatient appointment for patients referred urgently with

suspected cancer by a GP 93% 95.70% 99.50% 95.69% 95.20% 91.80% 96.40% 93.40% 96.10% 97.10% 94.66% 98.61% 94.90% 96.70% 96.00% 96.30%

Maximum two week wait for first out patient appointment for patients referred urgently with breast

symptoms (where cancer was not initially suspected) 93% 95.70% 96.10% 90.90% 97.60% 94.60% 92.00% 95.60% 95.40% 91.70% 93.75% 100.00% 95.90% 96.80% 89.70% 94.70%

Maximum one month (31 day) wait from diagnosis to first definitive treatment for all cancers 96% 100.00% 100.00% 100.00% 100.00% 92.90% 100.00% 97.80% 98.60% 100.00% 93.61% 100.00% 97.90% 100.00% 100.00% 98.60%

Maximum 31 day wait for subsequent treatment where that treatment is an anti-cancer drug regimen 98% 100.00% 100.00% 100.00% 100.00% 90.00% 100.00% 100.00% 96.10% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum 31 day wait for subsequent treatment where the treatment is surgery 94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 99.20% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum 31 day wait for subsequent treatment where the treatment is a course of radiotherapy 94% 100.00% 100.00% 100.00% 96.20% 100.00% 100.00% 100.00% 99.40% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85% 81.50% 84.00% 68.42% 86.70% 92.30% 94.40% 70.80% 84.10% 94.70% 78.26% 87.50% 92.30% 76.50% 78.90% 85.20%

Maximum 62 day wait from referral from an NHS screenng service to first definitive treatment for all

cancers90% 100.00% 100.00% 100.00% 100.00% 100.00% 85.70% 100.00% 98.20% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the

priority of the patients (all cancers)N/A 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 50.00% 100.00% 100.00% 100.00% 80.00%

Category A calls resulting in an emergency reponse arriving within 8 minutes (Red 1&2) 75% 80.63% 84.19% 82.09% 76.36% 78.46% 81.84% 77.78% 81.42% 78.51% 84.23% 81.18% 77.69% 80.52% 80.26% 80.34%

Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 98.13% 95.91% 96.82% 93.52% 96.63% 94.40% 94.61% 96.02% 94.10% 96.52% 95.28% 93.34% 94.83% 95.94% 94.97%

Minimise MSA breaches 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Care Programme Approach (CPA): The proportion of people under adult mental i l lness specialities on

CPA95% 95.00% 100.00% 95.83% 98.16% 98.36% 100.00% 100.00% 98.50% 92.86% 100.00% 100.00% 100.00% 100.00% 100.00% 97.73%

Incidence of MRSA to 10th November 2014 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 1

Incidence of CDIFF to 10th November 2014 20 1 0 1 1 0 1 1 15 0 0 1 3 3 4 1 1 13HCAI01

Category A ambulance calls

Mixed sex accomodation breaches

Mental Health

HCAI Incidence

NEAS ER01

Cancer waits - 62 days

Referral to Treatment waiting times for non urgent consultant led treatment

Diagnostic test waiting times

Cancer patients - 2 week wait


NHS Constitutional Indicators by month – CDDFT 2014/15

7


StandardSep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 2013/14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 YTD Exception Report

% of patients initial treatment within 18 weeks for admitted

pathways90.00% 91.70% 90.20% 90.20% 90.70% 90.40% 90.30% 90.30% 91.10% 90.29% 89.24% 90.57% 92.30% 93.10% 92.09% 91.26%

% of patients initial treatment within 18 weeks for non-

admitted pathways95.00% 98.80% 98.70% 98.00% 98.30% 97.90% 98.40% 98.60% 98.50% 98.60% 98.46% 98.43% 98.14% 98.64% 98.22% 98.40%

% patients waiting for initial treatment on incomplete

pathways within 18 weeks92.00% 93.90% 94.40% 93.90% 93.80% 93.70% 93.50% 94.00% 94.00% 94.97% 95.29% 95.47% 95.91% 95.47% 95.57% 95.57%

Number patients waiting more than 52 weeks for treatment

(Incomplete pathways only)0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0

Patients waiting for a diagnostic test should have been

waiting less than 6 weeks from referral 1% 0.19% 0.20% 0.20% 0.70% 0.30% 0.00% 0.01% 0.55% 2.22% 4.67% 6.61% 6.56% 5.90% CDDFT ER01

% patients spending 4 hrs. or less in A&E or minor injury unit

to 9th November 201495% 94.73% 93.04% 95.96% 95.68% 92.71% 93.50% 96.58% 94.90% 95.49% 95.41% 96.28% 96.23% 95.82% 95.95% 94.37% 94.76% 95.61%

Handover between ambulance and A&E over 30 minutes 0 165 222 147 222 289 278 256 2,402 273 210 182 176 171 219 296 1,527

Handover between ambulance and A&E over 60 minutes or

more0 35 75 62 97 159 129 91 898 83 71 44 42 40 57 89 426

% of patients seen within 2 weeks of an urgent GP referral for

suspected cancer93% 96.20% 97.00% 96.70% 96.70% 94.50% 97.20% 95.30% 96.50% 97.00% 91.71% 95.97% 94.30% 95.80% 96.30% 95.10%

% of patients seen within 2 weeks of an urgent referral for

breast symptoms93% 92.30% 94.70% 89.80% 95.80% 94.60% 93.30% 96.60% 94.10% 93.00% 96.55% 95.58% 94.10% 94.69% 97.50% 95.10%

% of patients treated within 31 days of a cancer diagnosis 96% 100.00% 98.60% 100.00% 100.00% 99.40% 100.00% 100.00% 99.,5% 100.00% 97.36% 98.68% 99.40% 100.00% 100.00% 99.30%

% of patients receiving subsequent treatment for cancer

within 31 days - drugs98% 100.00% 100.00% 100.00% 100.00% 96.90% 100.00% 100.00% 99.70% 100.00% 100.00% 100.00% 100.00% 100.00% 97.60% 99.50%


within 31 days - surgery94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 96.29% 92.30% 100.00% 94.70% 100.00% 97.30%


within 31 days - radiotherapyN/A 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

% of patients treated within 62 days of an urgent GP referral

for suspected cancer85% 88.80% 88.30% 84.60% 85.00% 86.20% 91.00% 87.00% 88.20% 85.90% 83.50% 87.81% 90.50% 86.40% 84.10% 86.40%

% of patients treated within 62 days of an urgent GP referral

from an NHS Cancer Screening Service90% 100.00% 75.00% 50.00% 100.00% 84.60% 100.00% 100.00% 91.30% 66.70% 100.00% 100.00% 60.00% 100.00% 80.00% 79.40%

% of patients treated for cancer within 62 days of consultant

decision to upgrade status85% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Mixed Sex accommodation - number of unjustified breaches0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0


Incidence of CDIFF to 10th November 2014 37 2 3 2 0 4 2 3 27 3 0 1 0 2 1 0 0 7HCAI01



A & E waits




Mixed sex accommodation breaches

FALSE

CDDFT ER02

CDDFT ER03

NHS Constitutional Indicators by month – STHFT 2014/15

8



Admitted patients to start treatment within a maximum of 18

weeks from referral 90.00% 86.40% 86.87% 85.50% 87.10% 85.10% 85.83% 86.58% 86.65% 90.09% 93.98% 94.22% 94.63% 95.45% 94.45% 93.81%

Non-admitted patients to start treatment within a maximum

of 18 weeks from referral95.00% 98.90% 98.73% 98.20% 98.10% 98.30% 98.50% 98.52% 98.79% 98.68% 98.82% 98.80% 98.94% 98.76% 98.05% 98.69%

Patients on incomplete non emergency pathways (yet to start

treatment) should have been waiting no more92.00% 94.60% 93.94% 94.60% 93.30% 94.90% 95.71% 96.53% 94.72% 96.59% 96.70% 96.34% 96.50% 96.43% 95.19% 95.19%



waiting less than 6 weeks from referral 1% 0.42% 0.09% 0.30% 1.00% 0.60% 0.40% 0.89% 1.83% 2.26% 1.60% 1.56% 2.82% 1.03% STHFT ER01


to 9th November 201495% 96.43% 96.49% 96.46% 95.54% 96.93% 97.90% 97.57% 96.68% 97.37% 96.35% 96.57% 96.20% 95.79% 94.81% 94.81% 95.07% 95.94% STHFT ER02

Handover between ambulance and A&E between 30 and 60

minutes YTD0 35 28 92 51 29 21 59 718 39 73 42 60 40 78 102 434

Handover between ambulance and A&E 60 minutes or more

YTD0 2 5 13 17 4 6 6 172 2 6 4 21 7 27 12 79

Maximum two-week wait for first outpatient appointment for

patients referred urgently with suspected cancer by a GP 93% 96.50% 96.00% 94.60% 94.70% 94.60% 95.30% 95.40% 95.30% 93.40% 94.21% 93.85% 93.70% 92.60% 94.70% 93.80%

Maximum two week wait for first out patient appointment for

patients referred urgently with breast symptoms (where

cancer was not initially suspected)

93% 97.30% 98.90% 95.74% 93.80% 98.20% 95.70% 96.50% 96.50% 93.60% 95.68% 95.18% 91.80% 93.20% 94.90% 93.90%

Maximum one month (31 day) wait from diagnosis to first

definitive treatment for all cancers 96% 99.00% 99.00% 98.54% 99.00% 98.90% 97.30% 97.30% 98.30% 96.70% 98.94% 97.59% 97.80% 97.30% 98.20% 97.80%

Maximum 31 day wait for subsequent treatment where that

treatment is an anti-cancer drug regimen98% 97.60% 98.30% 100.00% 100.00% 100.00% 100.00% 98.60% 98.60% 100.00% 100.00% 100.00% 100.00% 98.70% 100.00% 99.80%

Maximum 31 day wait for subsequent treatment where the

treatment is surgery94% 98.00% 100.00% 98.64% 100.00% 98.10% 100.00% 100.00% 99.40% 98.20% 100.00% 98.46% 100.00% 98.10% 98.60% 98.90%


treatment is a course of radiotherapy 94% 98.70% 96.20% 97.18% 98.80% 99.40% 99.40% 99.50% 98.90% 98.90% 99.41% 100.00% 98.50% 100.00% 96.70% 98.90%

Maximum two month (62 day) wait from urgent GP referral to

first definitive treatment for cancer 85% 82.50% 81.70% 82.19% 92.10% 81.70% 81.30% 86.80% 84.70% 89.20% 85.09% 83.80% 87.00% 85.30% 79.10% 85.00%

Maximum 62 day wait from referral from an NHS screenng

service to first definitive treatment for all cancers90% 100.00% 80.00% 100.00% 100.00% 100.00% 94.10% 94.10% 94.80% 92.30% 100.00% 93.75% 90.90% 80.00% 100.00% 93.20%

Maximum 62 day wait for first definitive treatment following

a consultants decision to upgrade the priority of the patients

(all cancers)

90% 90.90% 100.00% 100.00% 100.00% 88.90% 100.00% 75.00% 92.80% 100.00% 100.00% 92.60% 100.00% 100.00% 91.70% 96.60%



Incidence of CDIFF to 10th November 2014 49 8 3 4 10 2 5 3 57 4 7 4 4 1 4 6 2 32



HCAI Incidence

HCAI01



A & E waits

STHFT ER03



NHS Constitutional Indicators by month – NTHFT 2014/15

9



Admitted patients to start treatment within a maximum of 18

weeks from referral 90.00% 92.90% 91.66% 92.90% 93.60% 92.60% 92.90% 91.90% 92.80% 93.64% 92.65% 93.46% 91.94% 90.16% 91.95% 92.33%

Non-admitted patients to start treatment within a maximum

of 18 weeks from referral95.00% 98.90% 98.91% 98.40% 98.70% 98.50% 98.80% 98.30% 98.80% 98.65% 98.09% 98.33% 98.61% 98.22% 97.97% 98.31%

Patients on incomplete non emergency pathways (yet to start

treatment) should have been waiting no more92.00% 96.80% 97.47% 97.20% 97.00% 97.40% 97.49% 97.40% 97.40% 97.05% 97.34% 97.39% 96.96% 96.89% 97.20% 97.18%



waiting less than 6 weeks from referral 1% 0.00% 0.00% 0.00% 0.40% 0.20% 0.10% 0.08% 0.03% 0.02% 0.04% 0.08% 0.08% 0.60%


to 9th November 201495% 95.75% 96.22% 95.86% 93.31% 96.20% 96.30% 97.13% 96.13% 95.61% 95.81% 94.91% 95.85% 95.46% 96.49% 96.95% 95.97% 95.88%

Handover between ambulance and A&E between 30 and 60

minutes YTD0 0 1 2 2 4 3 2 25 6 3 3 4 3 5 3 27

Handover between ambulance and A&E 60 minutes or more

YTD0 0 0 0 0 0 0 1 3 0 0 0 0 0 0 0 0

Maximum two-week wait for first outpatient appointment for

patients referred urgently with suspected cancer by a GP 93% 95.00% 94.50% 94.82% 95.20% 92.10% 94.60% 95.80% 94.50% 89.90% 93.59% 92.23% 91.70% 92.30% 94.00% 92.20%

Maximum two week wait for first out patient appointment for

patients referred urgently with breast symptoms (where

cancer was not initially suspected)

93% 96.40% 97.20% 91.72% 95.60% 97.50% 94.10% 95.70% 94.70% 83.90% 95.15% 92.02% 93.80% 94.30% 97.90% 92.60%

Maximum one month (31 day) wait from diagnosis to first

definitive treatment for all cancers 96% 100.00% 99.30% 99.12% 100.00% 97.40% 100.00% 100.00% 99.50% 96.40% 98.34% 100.00% 100.00% 96.30% 99.30% 98.50%

Maximum 31 day wait for subsequent treatment where that

treatment is an anti-cancer drug regimen98% 100.00% 94.10% 100.00% 100.00% 94.10% 100.00% 94.70% 98.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%


treatment is surgery94% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 94.70% 100.00% 100.00% 95.50% 95.80% 100.00% 97.40%


treatment is a course of radiotherapy N/A 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

Maximum two month (62 day) wait from urgent GP referral to

first definitive treatment for cancer 85% 88.20% 89.10% 87.27% 88.40% 87.20% 84.20% 89.20% 87.60% 85.80% 86.50% 73.48% 81.00% 84.80% 91.70% 83.70% NTHFT ER01

Maximum 62 day wait from referral from an NHS screenng

service to first definitive treatment for all cancers90% 93.50% 98.50% 100.00% 94.40% 100.00% 86.00% 96.30% 96.80% 100.00% 95.54% 90.47% 93.90% 88.60% 98.00% 95.00%

Maximum 62 day wait for first definitive treatment following

a consultants decision to upgrade the priority of the patients

(all cancers)

95% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 75.00% 93.80%



Incidence of CDIFF to 10th November 2014 40 4 5 1 0 2 1 0 30 0 1 1 0 5 1 2 1 11


HCAI Incidence

HCAI01



A & E waits




NTHFT ER01

10

NHS Constitutional Indicators by month – NEAS

NHS Constitutional Indicators by month – NEAS 111


StandardOct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 2013/14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 YTD Exception Report

Category A calls resulting in an emergency reponse arriving within 8

minutes (Red 1&2)75.00% 79.38% 78.88% 75.67% 77.78% 75.60% 74.56% 78.46% 74.55% 77.70% 75.64% 72.86% 76.00% 75.40% 70.80% 74.67%

Category A calls resulting in an ambulance arriving at the scene within

19 minutes95.00% 97.17% 97.66% 96.20% 96.41% 96.10% 95.43% 96.99% 95.50% 96.40% 95.27% 94.69% 95.78% 95.16% 93.37% 95.13%

No. of ambulance crews not ready to accept new calls within 30

minutes of handover to A&E (Clearance Time) YTD0 139 154 144 152 125 113 10,760 170 168 178 235 181 205 242 1,379

No. of ambulance crews not ready to accept new calls within over 60

minutes of handover to A&E (Clearance Time)0 12 7 14 15 9 10 555 9 7 12 18 5 10 19 80

Handover between ambulance and A&E over 30 minutes 0 369 309 407 504 488 531 4,537 484 458 364 428 390 485 609 3,218

Handover between ambulance and A&E over 60 minutes or more 0 101 86 132 197 180 124 1,318 127 92 69 86 62 102 138 676

Category A ambulance calls

NEAS ER01


StandardApr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Exception Report

(NQR8) Total number of calls abandoned <5% 0.9% 0.6% 1.2% 2.8% 1.6% 2.2%

(NQR8) Total number of calls engaged <0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%

(NQR8) No of calls answered within 60 seconds at the end of the introductory message

>=95% 93.9% 96.5% 93.8% 87.7% 92.1% 89.4%

(LQR8) Percentage of answered calls triaged 60% 87.5% 86.7% 86.9% 86.8% 86.4% 86.7%

(NQR9) No of calls referred to Ambulance Service within 3 minutes which are life threatening

100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

(LQR7) Time taken for call back <10 minutes 100% 54.6% 41.9% 47.0% 48.4% 58.3% 43.6%

(LQR5) Warm Transferred to NHS 111 service Clinician where required

98% 96.4% 94.4% 95.6% 96.4% 96.7% 95.3%

(LQR3) Percentage of answered calls transferred to 999 <10% 14.3% 14.4% 15.1% 15.2% 14.4% 15.2%

(LQR4) Percentage of patients advised to attend Accident and Emergency Department

<5% 5.9% 5.9% 6.5% 6.4% 6.2% 7.0%

(LQR9) Provision of all consultations (including appropriate clinical information) to the practice the patient is registered with by 8am the next working day

100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

(LQR10) Percentage of frequent users (who call 111 more than 4 times a month) whose use is immediately highlighted to their registered GP

100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

(LQR1) Frontline staff and Advisors training in recognition of safeguarding issues for adults and children to an appropriate level

100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

(NQR13) Provision of interpretation service/ appropriate provision where required within 15 minutes of initial contact

100% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

NEAS ER02

11

NHS Constitutional Indicators by month – TEWV/MH


StandardSep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 2013/14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 YTD Exception Report No.

Proportion of people that enter treatment against the level of

need in the general population 12.8% 8.6% 9.1% 8.4% 7.5% 13.2% 10.4% 9.6% 10.5% 9.6% 17.8% 13.9% 12.5% 12.3% 12.61% 13.25%

Proportion of people who complete treatment who are moving

to recovery 50.0% 50.0% 50.9% 47.3% 50.0% 56.1% 51.4% 45.8% 49.0% 50.0% 61.9% 60.0% 46.8% 61.7% 56.04% 55.53%

%AGE OF CPA DISCHARGES FOLLOWED UP WITHIN 7 DAYS95.0% 100.0% 100.0% 100.0% 98.5% 92.9% 100.0% 100.0% 100.0% 100.0% 100.00% 97.73%

%AGE OF CPA FOLLOW UPS UNDERTAKEN ON A FACE TO FACE

BASIS95.0% 100.0% 100.0% 100.0% 97.4% 100.0% 100.0% 100.0% 95.0% 100.0% 100.00% 100.00%

%AGE OF ADMISSIONS GATE KEPT BY THE CRISIS SERVICE95.0% 100.0% 100.0% 100.0% 97.1% 90.0% 100.0% 100.0% 85.7% 100.0% 83.33% 97.50%

%AGE OF DELAYED DISCHARGES<7.5% 0.0% 0.0% 0.0% 0.6% 0.4% 1.3% 1.3% 0.0% 0.0% 0.00% 0.47%

%AGE OF CPAS REVIEWED IN THE LAST 12 MONTHS98.0% 89.4% 91.9% 91.9% 98.3% 97.5% 96.60% 96.60%

%AGE OF CRISIS REFERRALS SEEN WITHIN 4 HOURS95.0% 95.0% 58.6% 58.6% 94.4% 92.3% 100.00% 94.92%

%AGE OF ADULTS WAITING LESS THAN 9 WEEKS FOR 1ST

APPOINTMENT 90.0% 99.3% 99.3% 98.3% 99.4% 95.8% 96.0% 96.0% 94.6% 95.5% 93.63% 96.02%

%AGE OF CAMHS WAITING LESS THAN 9 WEEKS FOR 1ST

APPOINTMENT 90.0% 100.0% 100.0% 100.0% 99.8% 96.9% 100.0% 100.0% 96.9% 100.0% 100.00% 98.80%

%AGE OF OPMHS WAITING LESS THAN 9 WEEKS FOR 1ST

APPOINTMENT 90.0% 100.0% 100.0% 97.9% 99.9% 100.0% 100.0% 100.0% 100.0% 98.0% 100.00% 99.72%

%AGE OF LD WAITING LESS THAN 9 WEEKS FOR 1ST

APPOINTMENT 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00% 100.00%

%AGE OF MEDICINES RECONCILIATIONS 90.0% 96.0% 100.0% 100.0% 99.6% 95.7% 100.0% 100.0% 100.0% NA 100.00% 97.30%

NUMBER OF RE-ADMISSIONS WITHIN 30 DAYS OF DISCHARGE

(A&T)INFO 1 0 0 1 0 1 7

TEWV Other Performance Indicators

IAPT

MH ER01

Performance Issue CDDFT have breached the 1% target for 5 consecutive months May-Sep 2014.

May-14 – 2.22%, Jun-14 4.67%, Jul-14 6.61%, Aug-14 6.56% and Sep-14 5.90%.

Actions Taken The Trust has experienced increased referrals for colonoscopy and endoscopy linked to recent cancer referral campaigns.

CDDFT have always experienced a high uptake in relation to cancer campaigns and in this case demand has outstripped capacity. The Trust are now

developing plans in preparation for the next cancer campaign ‘blood in pee’ which is scheduled for later in the year to ensure that they do not have a repeat of

the capacity problems. Assurance around this has been requested via the Contract Management Group and the Trust have provided their internal plans around

ensuring that the appropriate level of capacity is available, these plans include:

• Ops/Performance and Patient Access are now tracking the backlog and waiting list position weekly

• CDDFT have agreement for the private sector (the Spire and TSS) to undertake 100 procedures per month

• CDDFT have appointed a new locum doing 8 sessions per week

Timescale for performance improvement The Trust have advised they do not expect to deliver the target until January 2015.

Other Intelligence The financial penalty which is a consequence of the failure against the target continues to be applied . This is in line with the NHS Standard Contract. The

financial penalty (Trust level) up to and including September is £340,000 (May to September).

Commissioners have formally sought and been given assurance that they are planning robustly for the upcoming cancer campaigns to ensure that they can sustain the target going forward.

12

Indicator Threshold Trend Line Sep-14

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1.00% 5.90%

CCG or Director Comments

Exception Report CDDFT ER01

12

Performance Issue Year-end performance for 2013/14 was 94.9%. CDDFT have sustained an improvement in A&E performance since March 2014. 2014/15 overall Quarter 1 performance was 95.71% and overall Quarter 2 performance was 95.99%. Performance dropped below target in Oct-14 to 94.37% however YTD performance is still above target at 95.61%

The recent reduction in ambulance handovers was sustained through to August 2014 but in September we saw an increase to previously high levels with October being the highest this year which is also being reflected with other providers. CDDFT remain an outlier across the region. Actions Taken • Reinstatement of the weekly A&E escalation meetings

• Further work to implement the Emergency Care Intensive Support Team (ECIST) recommendations

• Monthly meeting to review delayed transfers of care and implement improvements to patient flow and discharge management processes

• Development of a bed predictor tool to improve the management of inpatient beds

• Progress implementation of GP’s working into A&E

• To support the handover indicators, ambulance handovers have been allocated a specific indicator within the 2014/15 CQUIN scheme

• Regional resilience monies have funded 6 Hospital Ambulance Liaison Officer (HALO) officers across the region.

• Ongoing review of impact of resilience monies • Significant resilience funding has also been made available to CDDFT to implement winter plans

Timescale for performance improvement Work is ongoing with the provider to determine the timescales fro improvement however the intention is to work towards achieving the 95% target for Quarter 3.

Other Intelligence NECS are planning to arrange a meeting with Sunderland CCG to discuss A&E performance and what support can be offered to understand any impact this is having on other services.

13

Indicator Threshold Trend Line YTD Oct-14

% patients spending 4 hrs. or less in A&E minor injury unit 95.0% 95.6%

Handover between ambulance and A&E over 30 minutes 0 1,527

Handover between ambulance and A&E over 60 minutes or more 0 426



13

Performance Issue YTD performance against this indicator is 79.4% against a 90% target. CDDFT failed the 62 day (Screening) target in April, July & September reporting 66.7%, 60.0% and 80.0% respectively but achieved it in May, June and August reporting 100%.

Actions Taken A Cancer Operations Group meeting took place 24 October 2014 involving CDDFT, NTHFT, STHFT, Newcastle FT, representatives from Durham, Darlington and Tees CCGs, DDT Area Team and NE Strategic Clinical Network (NESCN) to discuss the issues facing cancer performance. Concerns regarding the pressures being placed on diagnostic services as a result of Be Clear on Cancer campaigns and a general increase in 2WW referrals have been escalated to the NESCN Steering Group to raise at a national level via the National and Regional Task Force Groups being established by Sean Duffy, National Cancer Lead. In addition key Network Site Specific Groups are being targeted to request they undertake a review of their pathways to see if there is any opportunity to rationalise any diagnostic tests to streamline the process from a patient perspective and to relieve pressure on individual pathways where possible.

Timescale for performance improvement The numbers within the screening service are very small. However they are subject to pressures elsewhere within the system i.e. waiting times for Endoscopy.

Other Intelligence This YTD breach relates to 3.5 patients from a total of 17.0 referrals.

14

Indicator Threshold Trend Line YTD Sep-14

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.00% 79.4%



14

Performance Issue There are no longer national performance targets for Choose and Book however CDDFT still report the above indicator on a monthly basis through the contract

as it remains a local quality requirement with a target of 4%

CDDFT reported 20% in April, 17% in May, 23% in June, 27% in July with an improvement to 15% in August and a further improvement to 14% in September,

against the 4% target.

Actions Taken The 4% target is for patients that are referred via choose and book and are unable to book their appointment. These patients are then passed to the Telephone

Advice Line (TAL). TAL provides a telephone booking service for patients to book, check, change or cancel their appointments via Choose and Book. It also

supports choice discussion with the aid of the NHS Choices website and the information held within the Directory of Services.

Where a patient tries to book an appointment with a specific provider, but no appointments are available, TAL will use the 'defer to provider' function to inform the relevant provider. The provider then has responsibilities to ensure that the patient is contacted, kept informed and given an appropriate appointment.

The Trust are currently undertaking the following actions :

• Increased polling ranges (to expand the range of dates that bookings can be made into) for specialties where 18 week position is strong and

would not be adversely affected

• Care Group, service specific demand and capacity models being formulated

• Additional Clinics in Colorectal

Timescale for performance improvement Performance continues to improve on a month by month basis and will be closely monitored until it is in line with the 4% target.

Other Intelligence There is a local penalty attached to this indicator which is applied monthly as a consequence of the performance breach . This penalty is being applied as per

the NHS Standard Contract.

The YTD penalty is £120,000 (£20,000 per month for a failure of this level)

15

Indicator Threshold Sep-14

Choose & Book – provider failure to ensure that ‘sufficient appointment slots’ are

made available on the Choose and Book system 4% 14%



15

Performance Issue

STHFT:

This performance indicator is an Operational Standard within the NHS Standard contract and any failure of this target carries a consequence of breach to the Provider including financial penalties. Performance has been published which highlights a continued breach against the standard.

Exception Report STHFT ER01

Actions Taken Initial failure against this standard was linked to the pressures experienced within the Neurophysiology service. An action plan was put in place to resolve the

problems; this was largely centred around the repatriation of a consultant that worked sessions for City Hospitals Sunderland. This was completed by STHFT

and the pressures in this area were corrected as planned in September. Whilst correcting this issue a further diagnostic test (Sleep Studies) has provided the

Trust with pressures that have been significant enough to cause a marginal breach of the standard

Timescale for performance improvement It was anticipated that performance would be back on track by September however due to the recently published failure in a different area this is not the case. At

the Contract Management Board Meeting, 10th November 2014, the Trust was formally challenged on this issue and made the commitment to go away to fully

understand the pressures and feedback to Commissioners.

Other Intelligence

Indicator Threshold Trend Line Sep 14

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral 1.0% 1.03%

Period Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2014/15 1.83% 2.30% 1.60% 1.55% 2.82% 1.03%

2013/14 0.15% 0.51% 0.38% 0.00% 0.07% 0.42% 0.09% 0.30% 1.00% 0.60% 0.40% 0.89%

Patients waiting for a diagnostic test

should have been waiting less than 6 weeks

from referral


16

Performance Issue STHFT failed the A&E 4 hour 95% target in September & October reporting 94.81% in both months. YTD performance against the target is still above the target at 95.97%.

Exception Report – STHFT ER02

Actions Taken In response the usual 3 weekly A & E breach meetings STHFT have changed one of these to a full hour performance meeting with senior members of supporting services and specialty centres. An action plan has been agreed with commissioners, STHFT update this on a weekly basis with a key focus on preventing breaches.

Timescale for performance improvement The Trust are achieving this indicator at a YTD position reporting 95.97% to week ending 2nd November 2014.

Other Intelligence In the first two weeks of September the trust has seen a dip in performance in the main due to medical delays as a result of A & E being in escalation and patients in resus. This results in the medical staff requiring to spend more time with poorly patients and in turn creates delays in the flow in and out of A & E. Very few breaches have been due to bed availability. In October STHFT breached 2 of the 5 weeks. Unconfirmed data for the week ending 9th November indicates that STHFT have achieved the target. Some other reasons for delays are: New cohort of junior doctors in post which is causing issues in terms on their reliance on more senior team members Sickness within the fracture clinics means that A&E staff are being called upon to do plaster casts etc. which is taking them away from usual duties Flow doesn’t appear to be a major problem – issues are multi-factorial as described above. At the South Tees Contract Management Board, 10th November 2014, it was raised with the Trust that a number of issues had been raised regarding a large number of vacancies within the A&E department. The Provider is going to look in depth into the staffing compliment within the department and map this against the pressure points experienced throughout the days. Work is to be undertaken to understand the anecdotes that the acuity of patients is causing the largest issue. In addition to this exploratory work ; additional funding is being provided to the Trust through the SRG monies in order to implement schemes that are envisaged to support the department throughout the winter period.

17

Indicator Threshold Trend Line Oct-14 – STHFT

% patients spending 4 hrs. or less in A&E or minor injury unit 95.0% 94.81%


17

Performance Issue

South Tees NHS Foundation Trust (STHFT) have historically experienced significant pressures within their A&E department and this has resulted in some patients waiting an excessive amount of time to be handed over by the ambulance crew.

Exception Report STHFT ER03

Actions Taken The South Tees System Resilience Group has been tasked to look at this issue in detail to try and resolve. Handovers continue to be an issue and work is needed to understand other processes from around the region to try and look at alternative ways of handling handover. At the South Tees Contract Management Board, 10th November 2014, Commissioners requested that STHFT look closely at the Handover issues to understand what is causing the continued breach of the standard. The Trust were asked to visit other Providers within the North East to understand how they manage Ambulance Handovers to understand if there are any process changes required.

Timescale for performance improvement Although never acceptable, instances of handover delay remain lower than the previous period last year; data will continue to be interrogated with the contractual penalties enforced fully.

Other Intelligence Following a great deal of national attention and the publication of the Zero Tolerance document (December 2012) Ambulance Handover performance became a National Quality Requirement within the 2013/14 NHS Standard contract.

18

Indicator Threshold Trend Line YTD Oct 14

Handover between ambulance and A&E over 30 minutes 0 422


Period Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar YTD

2014/15 39 73 42 60 40 78 90 422

2013/14 136 100 48 47 72 35 28 92 51 29 21 59 718

2014/15 2 6 4 21 7 27 12 79

2013/14 55 34 9 9 12 2 5 13 17 4 6 6 172

Handover between ambulance and

A&E over 60 minutes or more

Handover between ambulance and

A&E over 30 minutes


18

Performance Issue

NTHFT have struggled to achieve a number of the national cancer indicators across 14/15.

NTHFT are currently failing YTD on the following:

2 Week Wait 92.2% and 2 Week Wait Breast Symptomatic 92.6% against a 93% target.

62 Day Wait from referral to first definitive treatment 83.7% against an 85% target.

Exception Report NTHFT ER01

Actions Taken Root Cause Analysis carried out across all breaches identified Patient Choice as the primary reason for failure to meet the targets. A number of actions have been instigated to address general cancer performance at NTHFT including: A full recovery plan has been implemented including strengthening operational and clinical accountability, reviewing the tracking system in place, embedding the internal escalation process and undertaking capacity and demand daily meetings. Daily Exec meetings are also now taking place, weekly PTL meetings are taking place and the Trust have taken steps to work more closely with South Tees where required for shared breaches/patients. The intensive support team visited the Trust on Thursday to do a full review which included review of all policies and procedures and interviews with staff. The initial feedback from this visit was excellent with only a couple of small issues being picked up for improvement including the exec sign off process of breach reviews and they recommended that the Trust review their breaches with patient choice taken out to identify any themes/trends.

Timescale for performance improvement The Trust have identified that they have achieved all targets for September and are on track to achieve all in October which in turn will have a positive impact on the YTD position.

Other Intelligence In terms of the new cancer campaigns, the Trust have implemented an extra 4 slots per week to support the blood in pee campaign and with regards to endoscopy pressure, have a process in place to add lists as needed. The Trust feel that the plans they have put in place and the extra clinics they have put on to manage capacity has helped. The impact of patient choice isn't as significant now the summer months are over and referrals have reduced slightly from circa 1,00 per month to circa 700-800 per month.

19

Indicator Threshold Trend Line YTD – Sep-14

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP 93.0% 92.2%

Maximum two week wait for first out patient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) 93.0% 92.6%

Maximum two month (62 day) wait from urgent GP referral to first definitive treatment for cancer 85.0% 83.7%

CCG or Director Comments 19

Performance Issue North East Ambulance Service are commissioned to provide the operational standards at a service level. At a Trust level NEAS have now fallen below the 8 minute standard at a YTD position and there are significant concerns amongst Commissioners that NEAS may fail to maintain these response standards; historically the provider would have achieved a significant “buffer” of performance in the first part of the year in the lead up to the Winter period. This is clearly extremely concerning and puts both the Provider and Commissioner at risk for 2014/15. It is worth making it clear that demand is not considered to be a contributing factor to the performance issues; in fact activity levels are broadly in line with 2013/14 where performance standards were achieved consistently.

Actions Taken An action plan was developed by NEAS and discussed with commissioners at an extraordinary performance meeting on 16th September 2014. Following receipt of the October performance a Performance Summit was urgently arranged for Thursday 13 th November 2014 in which NEAS Executives were requested to attend to try and collectively work to revise the original action plan into something that is agreeable for all parties but more importantly will deliver the improvements required. The results of this meeting will be shared with all commissioners.

Timescale for performance improvement There is an urgent requirement for NEAS to turnaround this performance issue and has been escalated internally within NEAS to gain the necessary corporate support.

Other Intelligence An additional period of strike action in planned for Monday 24th November 2014 between the hours 07:00am to 11:00am. As with the previous strike action it is anticipated that there will be further adverse impact upon performance. NEAS will continue to communicate with Commissioners on this issue. NEAS performance against the 8 minute target carries a 25% weighting within the Quality Premium and current performance has meant a reduction in the forecasted award for the Quality Premium. Nationally there has been pressure placed on Ambulance Services with regards to the number of Red 1 Incidents they are required to respond to. Red 1 incidents are deemed the most critical and have historically been classified as those patients in cardiac arrest or with life-threatening traumatic injuries. For NEAS, this definition resulted in circa 8/9 Red 1 incidents per day of which the service is required to respond to within 8 minutes (75% threshold). From April 2014 the definition of Red 1 incidents has been amended and has been expanded to include any patient in peri-arrest (period prior or following cardiac arrest). This has increased the number of Red 1 incidents to around 24/25 per day for NEAS and has increased the pressure on the services ability to reach these serious incidents at the detriment to the Red 2 incidents (still serious but less immediately time critical) and therefore the overall response to all Red incidents within 8 minutes.

20

Indicator Threshold CCG – YTD

Oct-14 NEAS – YTD

Oct-14

8 minute response 75.0% 80.34% 74.67%

19 minute response 95.0% 94.97% 95.13%

Exception Report NEAS ER01


20

Performance Issue Following a great deal of national attention and the publication of the Zero Tolerance document (December 2012) Ambulance Handover performance became a National Quality Requirement within the 2013/14 NHS Standard contract.

Action Taken Work continues by all stakeholders to try and address this issue along with the wider urgent care system. NEAS teams are working closely with the A&E department management team to try and establish and implement jointly beneficial plans for improvement. It is worth noting that significant improvements have been made within the Trust in terms of handover delays and this will continue to be monitored through the remainder of the year. Any key themes that are identified will be shared across with stakeholders to try and improve Ambulance handovers within the North East. Commissioners continue to work with the Provider to improve the capture of Ambulance Handover data and have included this as a CQUIN measure within the 2014/15 contract. Regional resilience monies have funded 6 Hospital Ambulance Liaison Officer (HALO) officers across the region. The officers will be employed by NEAS and situated in A&E where there are issues. This was signed off at the regional system resilience group and contracts will run to 31 March 2015.

Indicator Threshold YTD Oct-14

No. of ambulance crews not ready to accept new calls within 30 minutes of handover to A&E (Clearance Time) 0 1,379

No. of ambulance crews not ready to accept new calls within >60 minutes of handover to A&E (Clearance Time) 0 80

Handover between ambulance and A&E over 30 minutes 0 3,218


21

Timescale for performance improvement

It is expected that the introduction of the HALO officers will have a positive impact on performance from November 2014 on-wards.

Other Intelligence

Exception Report NEAS ER01 Continued


Performance Issue Performance of the 111 Provider is monitored in line with the specification that was used nationally. Although a number of indicators are highlighted as red, the national contract allows for sliding scale of achievement within payment bands. The main area of concern that has been highlighted locally and nationally is the providers ability to achieve the indicator aimed at answering calls within 60 seconds.

Actions Taken An extraordinary performance meeting was held with NEAS to discuss the action plan submitted to recover the position for the calls answered within 60 seconds standard. As previously cited; there are a number of themes that NEAS believe are contributing to the failure to date: • Staff retention – There is a high level of attrition with the call centre. Circa 23 WTE. • Staff recruitment – NEAS are looking to recruit part time staff and have signed an agreement with an agency to speed up the recruitment process with 6 annual cycles

already planned. • Change in call demand patterns – NEAS are making changes to shift patterns to accommodate demand • All calls receive the same level of triage regardless of complexity – NEAS are looking at implementing low level call takers that would be able to deal with the lower acuity

calls – e.g. simple requests for information on opening times of GP’s/Pharmacies etc.

Timescale for performance improvement NEAS are currently developing a Workforce Plan and once completed this will identify timescales for improvement..

Other Intelligence In addition for the following 2 indicators NEAS are able to submit audit results in order to mitigate against the over-performance: • (LQR3) Percentage of answered calls transferred to 999 • (LQR4) Percentage of patients advised to attend Accident and Emergency Department If the results of the audit confirm that the call taken was clinically appropriate to be referred to 999 or ED then the provider is not penalised for this. For these two indicators NEAS have evidenced that this is the case. Commissioners have confirmed that they will be undertaking an audit themselves to gain assurances that the NEAS audit process is robust and appropriate. The following indicators are the responsibility of NEAS’ sub-contractor Northern Doctors (NDUC). NEAS have put in place performance management steps with NDUC and continue to update Commissioners regarding the progress being made. • (LQR7) Time taken for call back <10 minutes • (LQR5) Warm Transferred to NHS 111 service Clinician where required

22

Indicator Threshold YTD Sep 14

(NQR8) No of calls answered within 60 seconds at the end of the introductory message >=95% 89.44%

(LQR7) Time taken for call back <10 minutes 100% 43.63%

(LQR5) Warm Transferred to NHS 111 service Clinician where required 98% 95.29%

(LQR3) Percentage of answered calls transferred to 999 <10% 15.23%

(LQR4) Percentage of patients advised to attend Accident and Emergency Department <5% 6.95%

Exception Report NEAS ER02 111


Analysis of NEAS Ambulance Handovers 2014/15

30-60 % 60-120 % >120 % 30-60 % >60 %

Darlington Memorial A&e 11,081 527 187 11 107 11

Uni Hsp Of North Durham A&e 15,935 574 206 22 179 18

CDDFT Total 27,016 1,101 43.31% 393 62.28% 33 73.33% 286 22.02% 29 36.25%

STHFT - James Cook A&e 15,597 382 15.03% 76 12.04% 3 6.67% 135 10.39% 7 0

NTHFT - University Hsp Of North Tees A&e 12,625 27 1.06% 0 0.00% 0 0.00% 160 12.32% 4 0

CHSFT - Sunderland Royal A&e 18,919 403 15.85% 104 16.48% 7 15.56% 174 13.39% 11 0

Gateshead - Queen Elizabeth A&e 13,575 18 0.71% 0 0.00% 0 0.00% 74 5.70% 3 0

Newcastle - Rvi A&e 21,211 27 1.06% 2 0.32% 2 4.44% 148 11.39% 9 0

North Tyneside General A&e 11,121 348 13.69% 45 7.13% 0 0.00% 106 8.16% 6 0

South Tyneside Hosp A&e 9,981 36 1.42% 4 0.63% 0 0.00% 73 5.62% 3 0

Hexham General A&e 2,202 0 0.00% 0 0.00% 0 0.00% 39 3.00% 1 0

Wansbeck A&e 12,923 200 7.87% 7 1.11% 0 0.00% 104 8.01% 7 0

TOTAL 145,170 2,542 100.00% 631 100.00% 45 100.00% 1,299 100.00% 80 100.00%

Provider/Site Handover to ClearArrive at hospital to handover

Grand Total YTD

Total

Arrivals

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14

CDDFT 273 210 182 176 171 219 296

STHFT 39 73 42 60 40 105 102

NTHFT 6 3 3 4 3 5 3

CHSFT 117 74 67 56 49 24 127

G'Head 0 2 0 0 9 4 3

N'castle 0 9 3 6 1 8 4

Ntyne 22 45 47 70 74 96 39

Styne 7 14 4 4 3 0 8

Hexham 0 0 0 0 0 0 0

W'beck 20 28 16 52 40 24 27

TOTAL delays over 30 minutes - Arrive at hospital to handover

Trend

Provider/

Site

23

Performance Issue The Year to Date position in September is just below target at 96.6% against a target of 98.0%. The performance in September was accountable to 12 breaches which were due to staff capacity.

Exception Report MH ER01

Actions Taken TEWV have reported that all breaches to this target have been followed up within two weeks. The reasons for breaches have been around staff capacity and data quality issues. This is a new target within the performance framework for 2014/15 and TEWV have been asked to implement additional processes to ensure further achievement.

Timescale for performance improvement The cumulative position is expected to be achieved at the year end.

Other Intelligence TEWV have been asked to evaluate the current process to ensure that potential breaches to this target are highlighted significantly in advance to ensure staff have adequate time to plan.

24

Indicator Threshold YTD Sep-14

The percentage of CPAs reviewed in the previous 12 months 98.0% 96.6%


Performance Issue The Year to Date position in September is slightly below target at 94.9% against a target of 95.0%. The performance for September is 100.0%.

Exception Report MH ER01

Actions Taken The current pressure on services has been validated through a Commissioner led review and the need for additional resource has been identified as a recommendation. TEWV have submitted a proposal for non-recurrent funding to deliver a telephone triage model which should release clinicians to deliver a crisis service. The local development and implementation of the Crisis Care Concordat is currently being delivered across Durham and Darlington and will have an effect on resource allocation through improved processes and national definitions.

Timescale for performance improvement The current position is reported at 100% for September.

Other Intelligence Service Resilience Funding through NHS England has focussed on Crisis Care. TEWV successfully secured monies in the first phase and have submitted proposals for the second round of bids.

25

Indicator Threshold YTD Sep-14

Percentage of Crisis Referrals Seen within 4 hours 95.0% 94.9%


Performance Issue MRSA to 10th November 2014 There is a zero tolerance of MRSA which means that all commissioner and provider targets are zero. Darlington CCG reported 1 case of MRSA in June. CDDFT reported 2 cases in April, 1 in August and 1unpublished case in October – 4 cases in total. STHFT reported 1 case in June, July and September – 3 cases in total. NTHFT have reported 1 unpublished case in October.

Exception Report HCAI01

Actions Taken All breaches are discussed through monthly Clinical Quality Review Group meetings. The post infection review process has been followed for all identified cases with relevant lessons learnt identified and actions implemented as appropriate.

Timescale for performance improvement There is a zero tolerance of MRSA which means that all commissioner and provider targets are zero and therefore any breaches will remain for the whole of 2014/15.

Other Intelligence C.Diff to 10th November 2014 D’ton CCG – 13 cases reported against an annual target of 20 CDDFT – 7 cases have been reported against an annual target of 37 STHFT – 32 cases have been reported against an annual target of 49

NTHFT – 11 cases have been reported against an annual target of 40

Indicator Threshold D’ton CCG Trend Line

Incidence of MRSA 0 1

Incidence of C.Diff 20 13


Quality Premium Introduction

The 'quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and the associated improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2015/16 will reflect the quality of the health services commissioned by them in 2014/15 and will be based on five national measures and one local measure. The total payment for a CCG based on performance against the five national measures and the one local measure will be reduced if providers do not meet the NHS Constitutional rights or pledges for patients (RTT 18 week, A&E 4 hr, Cancer 2 week waits & 8 min Cat A ambulance calls). The total amount possible for CCGS to receive in achievement of the Quality Premium will be £5 per patient in the CCG, according to the same formula as the payment of the running cost allowance. For Darlington CCG this amounted to £522,935 in 2013/14 and the 2014/15 figure will be confirmed in future reports. The following 2 pages include the 2013/14 & 2014/15 quality premiums and highlight the indicators against which the quality premium will be determined, together with the relevant financial value attributed to each indicator and the latest assessment of performance. This summary now includes a ‘best, worst and likely’ scenario as due to the timing of published data it is uncertain at this stage whether a number of the indicators will be achieved or not. The 2013/14 Quality Premium has now been finalised and the position reported is the final award confirmed by NHS England. For Darlington CCG achievement would have resulted in £163,417 but this was reduced to £0 following an adjustment due to financial performance.

27

National and Local Quality Premium Indicators 2013/14

28

Population 104,587 Potential Fund 522,935

Measure

Percentage of Quality Premium Value for CCG's Threshold

Outcome and data published Measure Achieved/Forecast

Eligible QP Funding

Domain 1: Preventing people from dying prematurely

12.5 65,367Reduction 3.2%

between 2012 and 2013 2013 data autumn '14

Not achieved £0

Domain 2&3 : Enhancing quality of life for people with long term conditions and helping people to recover from episodes of ill health or following injury

25 130,734ISR 13/14 < ISR 12/13 or

ISR 13/14< 1,000 per 100,000 population

2013/14 data Summer '14

Achieved £130,734

Domain 4: ensuring that people have a positive experience of care

12.5 65,367Implement FFT in Q13/14 and

Increase score between Q1 13/14 and Q1 14/15

Not known yet

Not achieved £0

Domain 5: treating and caring for people in a safe environment and protecting them from avoidable harm.

12.5 65,367Zero MRSA and Decrease

C-diff on target 2013/14 data Summer '14

Not achieved £0

Measure

Percentage of Quality Premium Value for CCG's Threshold

Outcome and data published Measure Achieved/Forecast

Eligible QP Funding

U75 mortality rate from cancer 12.5 65,367 <142.8 per 100,000 population2013 data autumn

'14 Achieved £65,367

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s 12.5 65,367

<395 admissions per 100,000 population

2013 data autumn '14 Achieved £65,367

Emergency admissions for children with lower respiratory tract infections 12.5 65,367

<586 admisisons per 100,000 population

2013 data autumn '14 Achieved £65,367

100 522,935 £326,834

Quality Premium Darlington CCG 2013/14 - Final confirmed award

Indicator

DarlingtonForecast Achievement

Value

Referral to treatment times (18 weeks - Incomplete) - 92% target Yes - 95.0% to Mar-14 0%

National

Indicator

Value Achievement

Darlington

Total

NHS Consitutional rights and pledges Measures Achieved/Forecast Adjustment to funding Quality Premium Funding Adjustment

Total Adjustment -326,834

A&E waits - 95% target No - 94.9% to Mar-14 25% -81,709

Cancer waits - 62 days - 85% target No - 84.1% to Mar-14 25% -81,709

Financial Adjustment 0% -163,417

Revised Total £0

Category A Red 1 ambulance calls - 75% target Yes - 78.46% to Mar-14 0%

National and Local Quality Premium Indicators 2014/15

29

Population 104,587 £522,935

MeasurePercentage of

Quality PremiumValue for

CCG's ThresholdOutcome and data

publishedMeasure Achieved/Forecast

Likely Best Worst

Preventing people from dying prematurely 15.00% 78,440% reduction 2014 from 2014 from

2013Summer 2015

2013 rate was 2,229.20Data for 2014 will not be available

until Sep-15£78,440 £78,440 £0

IAPT 15.00% 78,440 15% by 31.03.15 Monthly updatesCurrently reporting 13.2% which is

above the local target of 12.8% but QP Indicator is 15%

£0 £78,440 £0

Avoidable emergency admission 25.00% 130,734Composite measure for 2014/15 is

less than or equal to 2013/14Summer 2015

Currently failing YTD to Sep-14reporting 1,220.8 against the

target of 1,189.8£0 £130,734 £0

F&F Test 15.00% 78,440Action plan, assurance on actions &

roll outMonthly updates

Average ED score in 14/15 greater than 13/14

£78,440 £78,440 £0

Improved reporting of medication safety incidents

15.00% 78,440Agreed increase in reporting from Q4

2013/14 to Q4 2014/15Quarterly updates TBC £78,440 £78,440 £0

Percentage of Quality Premium

Value for CCG's

ThresholdOutcome and data

publishedMeasure Achieved/Forecast Likely Best Worst

D'ton CCG Local Indicator

Emergency admissions within 30 days of discharge

15.00% 78,440 13.79% Quarterly updates 13.14% to Jul-14 £78,440 £78,440 £0

100.00% 522,935 £313,761 £522,935 £0Exception

Report

-£78,440 NEAS ER01

-£78,440 £0 £0£235,321 £522,935 £0

Exception Report

NHS D'ton CCG - Quality Premium 2014/15Potential Fund

Indicator

D'tonAchievement Exception

ReportValue

Referral to treatment times (18 weeks - Incomplete) - 92% target 95.29% Sep-14 0%

National Indicators

Indicator

Value Measure Achievement

Total

NHS Consitutional rights and pledges Measures Achieved/Forecast Adjustment to funding Quality Premium Funding Adjustment

A&E waits - 95% target 95.58% to 9th Nov 14 0%

Cancer 2 ww - 93% target 96.30% Sep-14 0%

Revised Total

Category A Red 1 ambulance calls - 75% target 74.67% Oct-14 25%

Total Adjustment

Darlington CCG - Outcome Framework Indicators

30

Quality Indicator Threshold 2010/11 2011/12 2012/13 2013/14 2009 2010 2011 2012 2013 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 YTD 14-15Exception

Report

Under 75 mortality rate per 100,000 from cardiovascular disease

Trend 86.9 80.2 76.6 80.4 66.2

Under 75 mortality rate per 100,000 from respiratory disease

Trend 29.4 32.9 29.7 27.9 27.5

Under 75 mortality rate per 100,000 from liver disease

Trend 15.0 14.9 13.3 17.5 17.4

Under 75 mortality per 100,000 rate from cancer Trend 145.2 131.4 138.5 120.0 130.7

Unplanned hospitalisation for chronic ambulatory care sensitive conditions rate per 100,000

Trend 1,023.8 946.6 904.2 877.7 66.34 70.36 87.43 61.40 50.42 64.19 400.14

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s rate per 100,000

Trend 437.0 478.8 513.1 321.2 30.70 37.03 55.54 26.38 17.43 50.69 217.78

Emergency admissions for acute conditions that should not usually require hospital admission

Trend 1,533.7 1,547.9 1,702.2 1,576.4 146.26 132.80 147.86 142.68 126.64 112.21 808.45

Emergency readmissions within 30 days of discharge from hospital

Trend 12.95% 13.68% 13.74% 11.28% 13.40% 13.14%

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI)

Trend 627.5 722.4 620.4 551.4 23.67 24.48 0.00 4.11 0.00 14.80 67.06

% of people who enter treatment against the level of need in the general population (IAPT)

12.80% 10.5% 9.58% 17.75% 13.90% 12.49% 12.26% 12.61% 13.25%

% of people who complete treatment who are moving to recovery (IAPT)

50.00% 49.0% 50.00% 61.90% 60.00% 46.75% 61.67% 56.04% 55.53%

Total Health gain Hip replacement Trend TBCTotal Health gain Knee replacement Trend TBCTotal Health gain Groin hermia Trend TBCTotal Health gain Varicose veins Trend TBC

FFT Maternity Antenatal Score (CDDFT) 86 68 74 79 72 120

FFT Maternity Birth (CDDFT) 77 81 85 85 85 123

FFT Maternity Postnatal Ward (CDDFT) 79 76 83 86 78 120.00

FFT Maternity Postnatal Community (CDDFT) 88 89 89 84 83 64

FFT A&E Response (CDDFT) 15% 22.6% 26.2% 34.8% 31.5% 44.6% 26.6%

FFT A&E Score (CDDFT) 50 47 40 45 42 44

FFT A&E % Recommended (CDDFT) 96%

FFT Inpatient Response (CDDFT) 15% 34.8% 32.3% 39.1% 47.9% 46.7% 36.0%

FFT Inpatient Score (CDDFT) 50 71 74 73 72 70

FFT Inpatient % Recommended (CDDFT) 89%

FFT Maternity Antenatal Score (STHFT) 100 N/A N/A N/A N/A N/A

FFT Maternity Birth (STHFT) 76 65 77 52 83 15

FFT Maternity Postnatal Ward (STHFT) 76 83 71 73 68 18

FFT Maternity Postnatal Community (STHFT) N/A N/A N/A N/A N/A N/A

FFT A&E Response (STHFT) 15% 16.6% 11.8% 23.5% 11.0% 7.3% 9.7%

FFT A&E Score (STHFT) 50 74 65 59 74 86

FFT A&E % Recommended (STHFT) 85%

FFT Inpatient Response (STHFT) 15% 38.2% 39.1% 27.9% 56.4% 30.9% 43.2%

FFT Inpatient Score (STHFT) 50 81 80 81 79 83

FFT Inpatient % Recommended (STHFT) 91%

FFT Maternity Antenatal Score (NTHFT) 71 67 76.0% 81 66 29

FFT Maternity Birth (NTHFT) 71 70 78 67 72 88

FFT Maternity Postnatal Ward (NTHFT) 69 71 90 68 83 79

FFT Maternity Postnatal Community (NTHFT) 76 78 50 76 74 30

FFT A&E Response (NTHFT) 15% 23.0% 8.6% 20.1% 12.8% 9.8% 27.8%

FFT A&E Score (NTHFT) 50 54 69 57 56 59

FFT A&E % Recommended (NTHFT) 86%

FFT Inpatient Response (NTHFT) 15% 57.4% 50.2% 46.6% 45.3% 40.0% 51.2%

FFT Inpatient Score (NTHFT) 50 67 72 73 72 70

FFT Inpatient % Recommended (NTHFT) 94%

Healthcare acquired infection (HCAI) measure (MRSA) to 10th November 2014

0 0 0 1 0 0 0 0 0 1

Healthcare acquired infection (HCAI) measure (clostridium difficile infections) to 10th November 2014

20 0 0 1 3 3 4 1 1 13

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

HCAI01

Domain 4 - Enusring that people have a positive experience of care

Figure shown in Financial Year

No Data Available No Data Available

Figure Shown in Financial Year

No data available

Figures reported on a monthly basis only from NHS England QER03

Domain 1 - Preventing people from dying prematurely

Domain 2 - Enhancing quality of life for people with long-term conditions

Domain 3 - Helping people to recover from ill health or injury

No monthly data - Yearly Figure Reported Only Figure Shown in Calender Year

Figure shown in Financial Year

Darlington CCG MAR Activity Analysis 2014/15

Monthly Activity Returns (MAR) Activity Analysis 2014/15 Below is an update on the CCG MAR activity against plans submitted to the Area Team at the start of the year. The table shows plan, actual and then variance against plan in number and % terms. The Area Team have informed that CCGs should be aware of their performance against the MAR plans. It is critical to point out that CCG Finance activity and costs are driven by SUS data and this differs from the MAR data provided below. A piece of work is underway to understand the differences and will be provided in future iterations of this report. CDDFT notified commissioners that they would be undertaking additional OP and elective activity in Q1 to reduce the backlog and improve their RTT performance. This was not included in commissioners plans and would therefore show as a pressure / increased activity. This has been communicated previously to DDT as is also in addition to the work undertaken as part of the RTT system resilience additional funding. The Trust are providing further information so that the commissioners can identify this additional work separately as it did not continue past Q1. However there was then the additional work undertaken as part of system resilience which was undertaken in September and October. In addition, as part of the contract report the provider and commissioner agree the areas of increased demand / pressures / capacity issues and then agree the actions accordingly i.e. information fed back to practices to reduce demand. There is also ongoing work around specialty reviews which is looking at specific areas to look at pathways and / or pressures. The first of these is in Ophthalmology which is main area of pressure and increase in demand. There has been a significant increase in Ophthalmology day cases which are mainly for ARMD procedures and cataracts. Alongside this there is currently an ophthalmology review which is being undertaken with CDDFT as this is a recognised pressure for both commissioners and the provider in terms of capacity. There is an increase in referrals both from GP but more significantly from ‘other’. Further analysis is on-going with regards to ‘other’ and a review of the C2C referral policy is to

be undertaken in the next couple of months. A contract query will be raised with regards to the significant increase in non –GP referrals as this is a breach of the Activity Planning Assumptions. The CCG are also working with member practices to look at demand which is supported by NECS Primary Care Support Officers.

31 CCG or Director Comments

31

Activity Trajectories

Month Target Actual Variance % variance Target Actual Variance % variance Target Actual Variance % variance Target Actual Variance % variance Target Actual Variance % variance

Apr-14 1,128 1,285 -157 -13.92% 1,144 1,035 109 9.53% 1,533 1,631 -98 -6.39% 1,179 1,237 -58 -4.92% 2,271 2,505 -234 -10.30%

May-14 1,275 1,450 -175 -13.73% 1,108 1,136 -28 -2.53% 1,643 1,681 -38 -2.31% 1,268 1,348 -80 -6.31% 2,545 2,544 1 0.04%

Jun-14 1,286 1,436 -150 -11.66% 1,069 1,113 -44 -4.12% 1,608 1,815 -207 -12.87% 1,291 1,358 -67 -5.19% 2,576 2,820 -244 -9.47%

Jul-14 1,320 1,572 -252 -19.09% 1,050 1,164 -114 -10.86% 1,737 1,930 -193 -11.11% 1,265 1,503 -238 -18.81% 2,670 2,892 -222 -8.31%

Aug-14 1,224 1,306 -82 -6.70% 1,077 1,047 30 2.79% 1,593 1,466 127 7.97% 1,182 1,165 17 1.44% 2,449 2,333 116 4.74%

Sep-14 1,295 1,468 -173 -13.36% 1,067 1,058 9 0.84% 1,682 1,757 -75 -4.46% 1,293 1,354 -61 -4.72% 2,656 2,953 -297 -11.18%

Oct-14 1,355 1,355 1,093 1,093 1,707 1,707 1,279 1,279 2,652 2,652

Nov-14 1,402 1,402 1,057 1,057 1,596 1,596 1,192 1,192 2,714 2,714

Dec-14 1,136 1,136 1,190 1,190 1,251 1,251 1,073 1,073 2,186 2,186

Jan-15 1,279 1,279 1,099 1,099 1,604 1,604 1,203 1,203 2,581 2,581

Feb-15 1,253 1,253 1,074 1,074 1,596 1,596 1,120 1,120 2,380 2,380

Mar-15 1,425 1,425 1,169 1,169 1,714 1,714 1,257 1,257 2,605 2,605

YTD Jul-14 Total 6,233 8,517 -2,284 -36.64% 6,515 6,553 -38 -0.58% 9,796 10,280 -484 -4.94% 7,478 7,965 -487 -6.51% 15,167 16,047 -880 -5.80%

TOTAL 15,378 8,517 6,861 13,197 6,553 6,644 19,264 10,280 8,984 14,602 7,965 6,637 30,285 16,047 14,238

Plans

2015/16 15,372 13,054 19,061 14,448 29,963

2016/17 15,492 13,150 19,009 14,405 29,883

2017/18 15,547 13,184 18,874 14,304 29,671

2018/19 15,628 13,182 18,758 14,217 29,489

NHS D'ton CCG Activity 2014/15

Non Elective FFCEs GP Referrals Other Referrals First Outpatient FFCEsElective FFCEs

Quality Overview Ta

rge

t

Re

po

rtin

g

pe

rio

d

Fre

qu

en

cy

CC

G

CD

DFT

STH

FT

NEA

S

TEW

V

Exce

pti

on

r

ep

ort

re

qu

ire

d

OVERALL Key l Not Applicable l No concern l Concern

l l l l l

Regulators

Has any local provider been subject to local enforcement action by the CQC? Y/N Oct-14 Monthly l l l l l Yes - QER01

Has any local provider been flagged as a 'quality compliance risk' by Monitor and /or are requirements in place around breaches of provider licence conditions? Y/N Oct-14 Monthly l l l l l Yes - QER02

Clinical effectiveness

Has any provider been identified as a 'negative outlier‘ or below expectation on SMHI? Y/N Oct -14 Monthly l l l l l No

Has any provider been identified as a 'negative outlier' or below expectation on HSMR? Y/N Oct -14 Monthly l l l l l No

Patient experience

Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern / exceptions for any provider? Y/N Sept-14 Monthly l l l l l Yes- QER03

Safety

Does any provider currently have any 72 day reports outstanding ? Y/N Oct -14 Monthly l l l l l

Yes- QER04

Does any provider currently have any 45 day reports outstanding ? Y/N Oct -14 Monthly l l l l l

Yes- QER04

Does any provider currently have any 60 days reports outstanding? Y/N Oct -14 Monthly l l l l l

Yes - QER04

Has any provider experienced any 'Never Events' during the last month ? Y/N Oct-14 Monthly l l l l l No

CCG

GP PTG - Referrals to Area Team (DDES CCG Practitioners) ● indicates referral made Y/N Oct -14 Monthly l l l l l No

CCG Complaints ● indicates formal complaints received Y/N Oct -14 Monthly l l l l l No

HIGHLIGHTS CDDFT

• 12 hour trolley breach (October) under investigation.

• Radiology & Ophthalmology remain hot spots for the Trust in relation to capacity and staffing. These are standard agenda items on the CQRG. The Royal College will be visiting the Trust on the 4/5th December 2014.

• Quality dashboard for October - indicates CDDFT is still showing a concern against an outlier for diagnostics 6 week waits, and are an outlier for NRLS potential under-reporting and MRSA with 1 case reported for period August. Cancer 62 day wait urgent screening referrals and never events are no longer showing as outliers.

• Safer Staffing: overall staffing levels reported across CDDFT by hospital sites during October 2014 are within acceptable levels.

• Lung Service Peer Review - recent review identified no immediate risks, however a serious concern was identified relating to radiology capacity and use of imaging in the lung pathway against national guidance. The Trust confirmed that the inspector had raised a concern regarding the PET scan for stage 1-3 lung cancers. The Trust is seeking further advice about this and will refute the recommendation as it considers that it is adequate for the pathways using PET. The CCG will raise PET capacity at the Cancer Network Meeting.

• Colorectal Service Peer Review - recent peer review identified 3 immediate risks namely oncology/support from Newcastle Hospitals, number of surgeons and HPB Pathway. The Trust advised there will be 4 surgeons performing cancer procedures. The Clinical Lead has confirmed in writing the details of HPD pathway and any future delays with the pathway should be reported as incidents. There were serious concerns around the management of CT guided biopsy at BAGH and the Trust report that a risk assessment is in place and supported by medical support. The Trust advised that cancer work was a priority for Radiology and that local arrangements were in place to prevent delays. The issue with Oncology is a long standing issue and the Trust is addressing this with Newcastle Hospitals.

STHFT

• Staffing levels at both JCUH and The Friarage are within

acceptable range.

• Quality dashboard for October shows Trust as statistically

worse for Monitors Governance ands Continuity Services

ratings and an outlier for Diagnostics - over 6 week waits (Aug

2014), Cancer - Two week wait (GP referrals), Cancer – 62

day wait urgent screening service referrals (Aug 2014), A&E 4

hour waits (Sept 14).

TEWVFT

• Overall safer staffing levels were within an acceptable range.

• CQC Inspection Update - The Trust informed the CQRG the

full CQC service inspection will take place on 26 January by

CQC with all wards, hospitals and services being inspected.

The group were informed that letters have been sent to staff

outlining the whistle-blowing and information sharing policy

and letters to stakeholders will be issued shortly. A Project

Group has been established and they are currently meeting bi-

weekly to plan for the inspection.

NEAS

• Handovers and response times remain a concern.

33

The information provided about primary care, relates to information received by NHS North of England Commissioning Support (NECS) clinical quality team, via the Safeguard Incident Reporting & Management System (SIRMS). The information shared below is critical to measuring quality. The drive to increase incident reporting across Darlington practices is pivotal to understanding quality concerns across providers and commissioned services and impacts on our increased ability to take appropriate action.

Practices reporting no incidents in October: • Felix House Surgery • Neasham Road • Moorlands • Denmark Street

A total of 30 incidents were reported in October 2014, which was less than in the previous month (56). 43% (13) of these incidents were reported by Darlington GP practices compared to 73% the previous month.

Jan Feb Mar Apr May Jun Jul Aug Sep Oct

59 26 43 28 40 40 24 49 56 30

Primary Care Incident Reporting - Darlington CCG

34

Consent, Communication & Confidentiality: This was the main theme identified and there was a total of 4 incidents of this type reported during the month compared to 6 in September. The incidents relate to incorrect information on a clinical letter to the late receipt of a letter by a practice which meant that there was a delay the correct course of action for a patient. Medication: Of the 3 incidents reported by GP practices, 2 of them relate to incidents of Medication not being ready or delivered, when they should have been. The HUB was involved in both of these incidents. The remaining incident involved a child being given the wrong immunisation booster at his 13 month vaccinations. Reporting across CCGs: All 3 CCGs report a common theme regarding Discharge Information / Documentation, Implementation of Care and Access Issues. In response to discharge communication issues one GP practice in the DDES area is maintaining a log of all clinical/discharge letters received in error and this will be shared with CDDFT who will be conducting a root cause analysis investigation on the cases to determine why this is a repetitive issue. The Trust are also looking at implementing an out patient proforma designed by the CCGs, to improve outpatient communications. NECS are still investigating the increasing trend in relation to access issues and patients being admitted via A&E rather than via Wards, the outcome of which will be reported to the QPF committee in due course.

Reporting by Type of Incident and Themes

Reporting Departments: 13 Incidents (43%) were reported by GP practice. 9 (30%) by NECS. The remaining 8 incidents (27%) were reported by independent providers.

Incident Category Jan Feb Mar Apr May Jun Jul Aug Sep Oct Sparkline

Medication 2 7 4 3 4 4 2 7 21 3

Self harm 0 0 0 0 0 0 9 16 7 0

Consent, communication, confidentiality 7 1 2 4 6 6 6 1 6 4

Access/Admission/Discharge Issue 1 2 2 3 4 4 3 0 2 2

Documentation 6 4 5 0 3 4 1 0 2 1

Implementation of care 5 0 18 1 6 10 0 2 2 2

Clinical assessment 0 1 0 2 1 0 0 0 1 0

Controlled drugs 9 0 3 1 0 2 0 0 0 0

Infection, Prevention & Control 0 0 1 0 0 0 0 0 0 0

IG 0 0 0 0 0 0 1 0 0 1

Medical Device/Equipment 0 0 0 0 0 0 1 0 0 0

Violence and Aggression 0 0 0 0 0 0 1 0 0 0

35

Quality Exception Report - Care Quality Commission – QER01

CCG CDDFT STHFT NEAS TEWV

Has any local provider been subject to local enforcement action by the CQC ? ● ● ● ● ●

11

Performance Issue: NEAS: as reported previously to the CQP&F committee this indicator will remain as an alert until the CQC concludes its review and action plan following NEAS reporting themselves in April to the CQC. This was after discovering paramedics had given patients 75 doses of out-of-date drugs, including morphine.

Actions taken: The Trust action plan ( implemented following the CQC inspection) is reviewed every week by their Executive Team. Timescale for Improvement : The Trust have advised that they have an interim plan and vacancies should be filled by February 2015. There have been some challenges from unions regarding pay protection and to facilitate the workforce changes required. The only other “red”

area is in relation to the ESR system and work is required to ensure data is being recorded. The CQRG felt that updates at the CQRGs have provided assurance of progress.

Other Intelligence: No other concerns to report re CQC activity.


36

Quality Performance Issue

STHFT: Please note the position / actions remain unchanged from previous month: Monitor, the sector regulator for Health Services in England, published information (December 2013) in relation to performance and risk ratings where STHFT was flagged as a ‘quality compliance risk’.

Indicator CCG NTHFT STHFT TEWV NEAS

Has any local provider been flagged as a 'quality compliance risk' by Monitor and/or are requirements in place around breaches of provider licence conditions?

● ● ● ● ●

Quality Exception Report – Monitor – QER02

Actions Taken STHFT: Monitor attended the Trust in September 2014 with a focus on C.Difficile and financial issues, a presentation will be shared at the Board to Board executive meeting in October 2014. The Trust have been asked to undertake a Governance review and have appointed Deloittes to conduct this. A new Transformation Director has also been appointed and the Trust continues to work closely with McKinsey on transformation and cost improvements. Continuity of services rating: Risk rating remains at 2 due to a continued material level of financial risk (this is being addressed via the Star Chamber processes of Quality Impact Assessment (QIA)/Cost Improvement Programme (CIP)) Governance: Monitor is investigating concerns at the Trust, triggered by multiple breaches of referral to treatment (RTT) targets and deterioration in its financial position.

Timescale for performance improvement STHFT: Currently no indication of when monitor will lift the ‘quality compliance risk.

Other Intelligence No further intelligence


37

Quality Exception Report - Friends and Family Test – QER03

Indicator Does feedback from the Friends and Family test (or any other patient feedback) indicate any causes for concern /exceptions for any provider?

CCG CDDFT STHFT NEAS TEVW

● ● ● ● ● From October 2014 nationally FFT data is presented differently - data has moved away from using the Net Promoter Score (NPS) as a headline score and uses an alternative measure which is the percentage of respondents that would recommend/wouldn’t recommend the service. Performance issue : The following exceptions have been identified: CDDFT: In Patient response rate : Overall the trust are within acceptable levels however when interpreting the data at site level UHND is indicating an amber flag with a rate of 25.9% against England average of 36.6%. STHFT: A&E response rate: the Trust are identified as an outlier against the response rate with a position of 9.7% against the 15% target and England average of 19.5%. When reviewing the sites James Cook only achieved a response rate of 6.7%. A&E % recommendation: The Trust have a greater percentage of patients not recommending A&E services when compared to England average of 6.6%. JCUH site achieved a % of 12.5% and Friarage 9.1%.

Actions taken: CQRG continue to monitor performance and receive regular updates. on FFT. The recalculation of the FFT from score to % recommended means that CDDFT are no longer showing as a outlier. Latest data releases will be discussed at the CQRG Timescale for improvement: Will continue to be monitored monthly. Other Intelligence: NHS England report that it is anticipated that the new dashboard will include maternity and staff data sometime in the new year.

14


38

Quality Exception Report - Outstanding Serious Incident Reports – QER04

Indicator Does any provider currently have any 72 day reports outstanding ? Does any provider currently have any 45 day reports outstanding? Does any provider currently have any 60 day reports outstanding?

CCG CDDFT STHFT NEAS TEVW

● ● ● ● ●

● ● ● ● ●

● ● ● ● ● This indicator reflects national and contractual requirements for submission of reports within 72hrs, 45 and 60 days per provider. The lead CCG for STHFT do not request 72 hour reports. This requirement has not yet been initiated with NEAS. Performance Issue The following extract highlights were Trusts have failed to submit reports that were expected in the month of October. CDDFT: 45 days - 36% of the reports were submitted within the timescale. 60 days - No reports received. STHFT: 45 days - 50% of reports were received within timescale TEVWFT: 72 hrs - 50% were received (1/2) compared to 66% Sept and 0% Aug. 45 days - No reports were submitted within timescale. 60 days - No reports were submitted within timescale.

Actions taken: Performance related activity is monitored through the serious incident panel and informal 1:1 meetings with providers. CDDFT continue to make significant progress in achieving / maintaining their report timescales. TEWV are in the process of reorganising their structures to support SI investigations and to streamline arrangements which will speed up the flow of reports. Other Intelligence - The publication of the national guidance has been postponed till next year.


39

Glossary

Under 75 mortality rate from cardiovascular disease

Mortality rate from cardiovascular disease, ages under 75, per 100,000

populationTrend Annually

Under 75 mortality rate from respiratory diseaseMortality rate from respiratory disease, ages under 75, per 100,000

populationTrend Annually

Under 75 mortality rate from liver disease Mortality rate from liver disease, ages under 75, per 100,000 population Trend Annually

Under 75 mortality rate from cancer Mortality rate from cancer, ages under 75, per 100,000 population Trend AnnuallyLocal (12.5% or

Quality premium)

Unplanned hospitalisation for chronic ambulatory care sensitive conditions

The proportions of people with chronic conditions admitted to hospital as an

emergency admissionsTrend

Mothly via

Hospital Episode

Statistics

Local (12.5% or

Quality premium)

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Rate of emergency admissions episodes in people under 19 (0-18 years) for

asthma, diabetes or epilepsy per 100,000 populationTrend

Mothly via

Hospital Episode

Statistics

Emergency admissions for acute conditions that should not usually require hospital admission

Emergency admissions to hospital of persons with acute conditions

(ear/nose/throat infections, kidney/urinary tract infections, heart failure,

among others) that usually could have been avoided through better

management in primary care

Trend

Mothly via

Hospital Episode

Statistics

Emergency readmissions within 30 days of discharge from hospital

Percentage of emergency admissions to any hospital in England occuring

within 30 days of the last, previous discharge from hospital after admission Trend

Mothly via

Hospital Episode

Statistics

Emergency admissions for children with Lower Respiratory Tract Infections (LRTI)

Emergency admissions to hospital of children with selected types of Lower

Respiratory Tract Infections (bronchiolitis, bronchopneumonia and

pneumonia)Trend

Mothly via

Hospital Episode

Statistics

Local (12.5% or

Quality premium)

% of people who enter treatment against the level of need in the general population (IAPT)

% of people who enter treatment against the level of need in the general

population

Green: Greater than 12.8%

Monthly

% of people who complete treatment who are moving to recovery (IAPT)

% of people who complete treatment who are moving to recovery Green: Greater than 50%Monthly

Total Health gain Hip replacement Trend Quarterly

Total Health gain Knee replacement Trend Quarterly

Total Health gain Groin hermia Trend Quarterly

Total Health gain Varicose veins Trend Quarterly

FFT Combined ResponseGreen: Greater than 15% response rate

Monthly National

FFT Combined ScoreGreen: Greater than 50 satisfaction score

Monthly National

FFT A&E ResponseGreen: Greater than 15% response rate

Monthly National

FFT A&E % Recommended Green: Recommended 86% or above

Monthly National

FFT Inpatient ResponseGreen: Greater than 15% response rate

Monthly National

FFT Inpatient % Recommended

Green: Recommended 94% or above Monthly National

Healthcare acquired infection (HCAI) measure (MRSA)

Number of cases of Methicil l in-resistant Staphylococcus aureus (MRSA)

bacteraemia

Green: zero cases

Red: Greater than zeroWeekly National

Healthcare acquired infection (HCAI) measure (clostridium difficile infections)

Number of Clostidium difficile infections, for patients aged 2 or more on the

date the specimen was taken

Green: less or equal to target

Red: greater than targetWeekly National

Patient reported outcome measure for elective procedures

Domain 4 - Enusring that people have a positive experience of careTest will measure whether people recievieving NHS treatment would

recommend the place where they received care to their friends and family.

Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm

OUTCOMES FRAMEWORK INDICATORSDomain 1 - Preventing People from dying prematurely

Domain 2 - Enhancing Quality of life for people with long term conditions

Domain 3 - Helping people to recover from ill health or injury

21 November 2014 NHSDCCG/GB/14/December/Item No. 65


Governing Body

Finance and Performance Report

1. Introduction This report is to inform the Governing Body of the CCG’s financial position for the five months ended 31 October 2014. The report also provides an overview of the CCG’s performance against key national targets as set out in the NHS Constitution and NHS Outcomes Framework, and the delivery of the CCG’s key work programmes for 2014/15.

2. Implications and risks 2.1 Financial Position General - At the end of August 2014 (month 7) Darlington CCG reported a year-to-date surplus of £840k which was in line with the forecast for the year. The CCG is currently forecasting that it will deliver the target 1% surplus required by NHS England of £1.438m It should be noted that the position does not currently include any financial benefit or cost resulting from risk share arrangements for high cost CHC and mental health cases as the risk share methodology for 2014/15 has not yet been agreed by Chief Officers. Once agreed and implemented this will have an impact on the actual and forecast position which may be positive or negative. Acute Services - The position reflects higher than planned spend on Acute services, with an excess spend of £486k currently forecast for the full year. As illustrated in the Operational Status Report, acute spend with contracted NHS providers is expected to be £8k below plan for the full year. Higher than planned levels of activity for ophthalmology and orthopaedic services provided by BMI Woodlands is giving rise to a forecast cost pressure of £271k, with the remaining cost pressure being related to non-contract activity which is expected to exceed the planned level by £258k. Mental Health – The mental health budget has been adjusted to reflect the cessation of one specialist package. Expenditure for the year is expected to be in line with the revised budget.

2

Community Health – expenditure higher than planned for hospice care due to a rebasing of costs between Durham Dales and Easington CCG and Darlington CCG, and costs relating to orthotics and continence products in excess of budgeted amounts. Continuing Health Care - Expenditure is lower than planned for fully funded and fast track packages, Funded Nursing Care costs are in line with plan. Costs for the full year are expected to be £134k lower than planned. Prescribing – Actual spend is currently in line with budget however an increase in costs is expected towards the end of the year due to national pricing agreements relating to some category M drugs. Spend for the year is estimated to be £55k higher budget based on current information. Running Costs - The CCG is reporting spend of £48k below plan for 2014/15 and does not expect to experience financial pressures in this area of expenditure during the remainder of the year. Financial Risks Although the financial position of the CCG is currently positive, there are a number of risks to delivery of the planned surplus which are being closely monitored by the CCG.

Impact of the agreement of the CDDFT contract value should the negotiation be resolved by expert determination which is expected to be concluded by the end of December 2014.

Costs relating to patients discharged from secure mental health units – NHS England funds secure units, however when patients are discharged into other facilities the cost of their care becomes the responsibility of the CCG

Increase in prescribing costs due to changes in nationally agreed drug prices which gave rise to a financial pressure of £800k in 2013/14.

Potential financial pressure resulting from risk share arrangements for high cost mental health and continuing health care packages across Durham and Darlington.

Should any of these risks materialise the CCG will need to reprioritise committed funding in order to mitigate against the financial impact of this. Should a number of the risks materialise the CCG may be unable to fully mitigate them and would then be unable to achieve its financial targets. Quality Innovation Productivity and Prevention (QIPP) An overview of QIPP schemes is provided in the status report. Darlington Clinical Commissioning Group is on track to deliver its QIPP target of £1.784m with the exception of one scheme which is part of the ongoing contract negotiation with CDDFT. Further details regarding prescribing related schemes are awaited from the Meds Optimisation team. The Finance Committee is looking to work with practices to identify additional schemes to mitigate the risk of non-delivery of existing schemes.

3

2.2 Performance – NHS Constitution Accident and & Emergency 4 hour target

In addition to the initiatives implemented by CDDFT in Q1 and Q2 the following actions are also being progressed:

A bed predictor tool is being developed to improve the management of inpatient beds and a new bed management IT system is being implemented later in 2014.

Visits to other providers have taken place including North Tees & Hartlepool NHS FT Emergency Department (ED) and Emergency Assessment Unit (EAU) and CHSFT Intermediate Care Beds to learn from examples of good practice.

CDDFT have successfully reviewed and improved their ED Ambulatory and Rapid Assessment & Treatment (RAT) Streams for patients arriving at Emergency Departments at Darlington Memorial Hospital (DMH) and UHND.

CDDFT have also recently announced plans to increase the footprint of both Medical Assessment Unit (MAU) and ED at UHND, as well as increasing medical bed capacity by 20 beds. The plans are to be implemented by December 2014 and are intended to enable the full implementation of the Ambulatory and RAT Pathway and improve patient flow by enabling direct referral to MAU without the need for patients to go through ED.

CCG Chief Officers are continuing to monitor A&E Performance and will re-introduce fortnightly meetings with the Trust and Area Team Chief Executives, to agree actions if A&E Performance falls below the 95% target. Cancer As at the end of June all national cancer targets have been achieved on a year to date basis at CCG level, although some providers have failed to achieve all of their targets. Ambulance Response – 19 Minutes In response to recent failure to meet targeted response times a recovery plan has been developed by North East Ambulance Services and was discussed at an extraordinary performance meeting on 16th September 2014. A number of key themes are included within this recovery plan including (not exhaustive):

• Recruitment of Paramedics • Sickness Absence levels – NEAS are proactively working with all managers to

identify issues

A&E Performance All Types

Target 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2

County Durham and Darlington NHS FT 96.9 98.2 95.1 95.2 95.2 95.7 94.7 94.0 95.7 95.8

North Tees and Hartlepool NHS FT 97.2 97.5 96.7 96.6 96.8 95.7 95.2 96.9 95.5 95.7

2012/13 2013/14 2014/15

4

• Shift rosters – use of 3rd party providers to fill gaps • Additional Rapid Response Vehicle Staffing overnight • Better use of Voluntary Agencies • Overtime payments to staff to cover pressure times • Increased First Responders in rural communities • Enhanced Care Paramedic Cars – better utilisation • Vehicle maintenance • Reduction in vehicle down time – clearance at hospitals etc. • Increased Clinical support in call centre

NEAS are to report regularly against this action plan and will maintain regular dialogue with commissioners. Patients Waiting for Diagnostic Tests for Over 6 Weeks The Trust has experienced increased referrals for colonoscopy and endoscopy linked to recent cancer referral campaigns.

CDDFT have always experienced a high uptake in relation to cancer campaigns and in this case demand has exceeded capacity. The Trust is now developing plans in preparation for the next national cancer campaign ‘blood in pee’ which is scheduled for later in the

year to ensure that they do not have a repeat of the capacity problems. Assurance has been requested via the Contract Management Group and the Trust has provided internal plans developed to ensure that the appropriate level of capacity is available.

The Trust originally advised that the plans that they had put in place would deliver the target in August, however they have further advised that they do not expect to deliver the target until December 2014 / January 2015.

Following on from the action plan that was shared previously the Trust had advised that they are updating this to include the additional activity that they are looking at each month. This information has been requested and when received and will be shared with CCG colleagues.

The financial penalty which is a consequence of the failure against the target continues to be applied. This is in line with the NHS Standard Contract. The financial penalty (Trust level) up to and including July is £172,000 (May, June and July).

5

3. Recommendations The Governing Body is asked to:

Receive and consider the financial and performance position

4. Author, Clinical Sponsor and Executive Lead Author: Lisa Tempest Title: Chief Finance Officer Clinical Sponsor: Andrea Jones Title: Chair and Clinical Lead Executive Lead: Lisa Tempest Title: Chief Finance Officer Date: 21 November 2014

6

Purpose of Paper

Information Sharing

Development / discussion

Decision / action Strategy – Working Together to Improve the Health and Wellbeing of Darlington

Addressing the needs of a changing population Commissioning the right services in the right place Securing safe, high quality services


Aspires to higher standards of excellence



Financial Implications As outlined in report


Performance of statutory financial duties






No issues noted Financial risks monitored by Finance and Performance Committee and escalated to Governance Audit and Risk Committee as required.

Implication for Partners Supports delivery of relevant partner targets

Equality and Diversity No significant impact

Attachment(s) None

Darlington CCG Monthly Operational Status Report (December 2014)

Quality Premium

Financial Performance (Month 7) Acute Spend by Provider

National Targets QIPP

Darlington CCGRevenue Expenditure 2014/15 Budget Actual Variance Budget Outturn Variance

Acute Services 42,441 42,858 417 72,443 72,929 486

Mental Health / Learning Disabilities 9,333 9,365 32 16,000 16,019 19

Community / Primary Care Services 8,057 8,381 324 13,813 14,250 437

Continuing Health Care 5,733 5,653 (80) 9,458 9,324 (134)

Primary Care Services 10,552 10,552 0 17,898 17,953 55

Other 738 1,049 311 1,245 1,336 91

Total Commissioning Expenditure 76,854 77,858 1,004 130,857 131,811 954

Running Costs 1,475 1,464 (11) 2,597 2,597 0

Reserves (includes surplus) 1,833 0 (1,833) 6,234 3,842 (2,392)

Total Corporate and Reserves 3,308 1,464 (1,844) 8,831 6,439 (2,392)

Total Revenue Expenditure 80,162 79,322 (840) 139,688 138,250 (1,438)

YTD October 2014 Annual YTD Annual

Provider Budget Actual Variance Budget Outturn Variance

County Durham and Darlington FT 32,910 33,117 207 56,104 56,266 162

South Tees Hospitals NHS FT 3,378 3,324 (54) 5,780 5,681 (99)

Newcastle Hospitals NHS FT 1,029 853 (176) 1,761 1,466 (295)

North Tees and Hartlepool NHS FT 528 654 126 894 1,116 222

NHS Acute Non Contracted Activity 612 821 209 1,047 1,319 272

Non NHS Acute (BMI Woodlands, Spire) 2,248 2,375 127 3,881 4,139 258

Ambulance Services 1,736 1,714 (22) 2,976 2,942 (34)

Total 42,441 42,858 417 72,443 72,929 486

Indicator Target YTD Forecast

Revenue Allocation To deliver 1% Surplus

Runnng Costs Limit To keep expenditure within allocation

Cash Limit To keep cash outgoings within the cash limit

Better Payment Practice Code To pay creditors within 30 days of receipt of invoice or goods

QIPP Delivery To deliver £1.997m savings in year

Darlington CCGPopulation* 104,587

Possible Quality Premium Funding (£5 per head) £522,935

* ADS registered population adjusted to new ONS13 projections

% of QPValue for

CCG

Outcome

data

published

Outcome data

publishedThreshold

Measure

Achieved/Forecast

Measure

Achieved

Eligible QP

funding

15.0% £78,440 Summer 2015 Summer 2015% reduction 2014

from 2013

2013 rate was 2229.20Data

for 2014 will not be

available until Sept 15

Yes £78,440

15.0% £78,440 Monthly Monthly 15% by 31.3.15

Currently reporting 13.2%

which is above the local

target of 12.8%

No £0

25.0% £130,734Not yet

known

Not yet

known

Composite measure

for 14/15 is <or= to

13/14

Currently failing YTD to

Aug 14 - 1023.7 against

target of 1009.3

No £0

15.0% £78,440

Action plan,

assurance on actions

and roll-out

Average ED score in 14/15

is greater than 13/14Yes £78,440

15.0% £78,4402013/14 data

Summer-14

2013/14 data

Summer-14

Average ED score in

14/15 > 13/14TBC Yes £78,440

Qu

alit

y P

rem

ium

13

/14

Lo

cal M

eas

ure

s

15.0% £78,440

13/14 data

Summer-14

13/14 data

Summer-14 < 13.79% 13.14 YTD Jul 14

Yes £78,440

100.0% £522,935 £313,761

Outcome data

publishedLatest Data

Measure

Achieved/ForecastThreshold

Measure

Achieved

Adjustment to

QP funding

2013/14 data

Summer-14Aug-14 95.58% >92% Yes

2013/14 data

Summer-14Oct-14 95.81% >95% Yes

2013/14 data

Summer-14Aug-14 96.30% >85% Yes

2013/14 data

Summer-14Aug-14 75.31% >75% Yes

£0

£313,761

TOTAL ADJUSTMENT

REVISED TOTAL

TOTAL

NHS Constitution rights and pledges

>92% patients on an incomplete pathway treated within 18 weeks over course

of 13/14

>95% patients seen within 4 hours of arrival at A&E (All types) over course of

13/14

>85% patients treated within 62 days from urgent referral for suspected cancer

over course of 13/14

>75% Category A Red 1 ambulance calls responded to <8 mins over course of

13/14

Qu

alit

y P

rem

ium

13

/14

Nat

ion

al M

eas

ure

s

Domain 1: Preventing people from dying

prematurely

IAPT

Avoidable Emergency Admissions

Improved Reporting of Medication Safety

Incidents

Assumptions The CCG achieves its target 1% surplus for 2014/15

Measure

Emergency admissions within 30 days of

discharge

Family and Friends Test

Target Devivered Identified

894 798 9610% 89% 11%

Target Devivered Unidentified

1,784 1,784 010% 100% 0%

2014/15 Forecast

2014/15 YTD


QIPP

The table below summarises the forecast savings by key programme area as at 31st October 2014, compared to the QIPP plan for the year:


NHS Constitution Performance


NHS DARLINGTON

CLINICAL COMMISSIONING GROUP Governing Body

Risk Management

1. Introduction The purpose of this paper is to provide an overview of the Darlington Clinical Commissioning Group (CCG) risk register as of November 2014. 2. Implications and risks Management of risk is a continual activity, which must be performed throughout the organisation. Without on-going and effective risk management processes it is not possible to give confidence that the organisation will meet its objectives. Hence effective risk management is a prerequisite of continued organisational management The risks identified within the CCG risk register have to date been identified from the CCG Clear and Credible Plan 2012-2017, from CCG meetings and also identifies those risks to be inherited from the PCT Cluster as part of the on-going development work related to the Integrated Strategic Operational Plan 2011/12 – 2014/15. The CCG has a Risk Management Policy in place and a process by which all risks are assigned to one of the formal CCG committees (Executive, Finance and Performance or Quality and Innovation) who actively monitor and manage their own risk register. However the Governance, Audit and Risk committee is responsible for the overall CCG register and therefore all committees are required to report into the GAR committee on a bi-monthly basis. Any exceptions from the CCG risk register (risks with a score over 15) are reported to the Governing Body (via the Executive Management meeting) on a quarterly basis. A summary of the risk register is included as Appendix A. As the CCG continues to develop its risk management processes enhancements to procedures have been made to ensure risks are identified and recorded in a timely manner. This has resulted in a further increase in the number of risks recorded on the CCG risk register last Governing Body Meeting.

Two red risks have been reduced to amber since the last Governing Body meeting: Risk 121 Prescribing Costs – prescribing costs are within budget for 2014/15 and information currently available indicates that costs will remain within planned levels for the remainder of the year. Risk reduced to amber (residual rating 12) by Finance Committee. Risk 1023 Concerns regarding the radiology service provided by County Durham and Darlington NHS Foundation Trust have partially been addressed by the recent appointment of agency staff and a second outsourcing company to reduce waiting times. Risk reduced to amber (residual rating 12) by Quality and Innovation Committee. The Governance, Audit and Risk Committee met on the 25 November 2014 and reviewed the current risk register, controls and mitigations. It was agreed that there were no risks to be escalated to the Governing Body. 3. Recommendations The NHS Darlington Clinical Commissioning Group Governing Body is asked to:

note content of the register note the progress made in terms of managing the risks rated as extreme (red).

4. Author, Clinical Sponsor and Executive Lead Author: Lisa Tempest Title: Chief Finance Officer, Darlington CCG

Clinical Sponsor: Andrea Jones, Darlington CCG Title: Chair and Clinical Lead Date: November 2014

Purpose of Paper

Information Sharing


Decision / action Strategy – Working Together to Improve the Health and Wellbeing of Darlington



Aspires to higher standards of excellence



Financial Implications As outlined in report






Communication and engagement


No issues noted Financial risks monitored by Finance and Performance Committee and escalated to Governance Audit and Risk Committee as required.



Attachment(s) None

Darlington CCG - Overall Summary of Risks - November 2014

RegisterGreen

PreviousGreen

CurrentMove

Yellow Previous

Yellow Current

MoveAmber

PreviousAmber Current

MoveRed

PreviousRed

CurrentMove

Total Previous

Total Current

Total Move

Darlington CCG

0 0 u 7 11 18 20 2 0 q 27 31

Executive

RegisterGreen

PreviousGreen

CurrentMove

Yellow Previous

Yellow Current

MoveAmber


MoveRed

PreviousRed

CurrentMove

Total Previous

Total Current

Total Move

Darlington CCG

0 0 ► 3 4 10 11 0 0 ► 13 15

Quality and Innovation Committee

RegisterGreen

PreviousGreen

CurrentMove

Yellow Previous

Yellow Current

MoveAmber


MoveRed

PreviousRed

CurrentMove

Total Previous

Total Current

Total Move

Darlington CCG

0 0 ► 3 6 4 3 q 1 0 q 8 9

Finance and Performance Committee

RegisterGreen

PreviousGreen

CurrentMove

Yellow Previous

Yellow Current

MoveAmber


MoveRed

PreviousRed

CurrentMove

Total Previous

Total Current

Total Move

Darlington CCG

0 0 ► 1 1 ► 4 6 1 0 q 6 7



Governing Body

CCG Assurance Quarter 1 2014/15

1. Introduction NHS England has a responsibility to assure that CCGs are capable commissioning organisations and to support them to develop and improve. A CCG Assurance Framework has been developed to enable NHS England, through area teams, to meet the statutory responsibility to make an assurance assessment. The CCG assurance process has been designed to provide confidence to internal and external stakeholders and the wider public that CCGs are operating effectively to commission safe, high quality and sustainable services within their resources. The Assurance Framework sets out six broad assurance domains under which this assessment will be made. 2. Implications and risks The CCG assurance process includes formal quarterly check point meetings, run by area teams. A key focus of the check point meetings is a balanced scorecard which incorporates six domains: Domain 1: Are patients receiving clinically commissioned, high quality services? Domain 2: Are patients and the public actively engaged and involved? Domain 3: Are CCG plans delivering better outcomes for patients? Domain 4: Does the CCG have robust governance arrangements? Domain 5: Are CCGs working in partnership with others? Domain 6: Does the CCG have strong and robust leadership? In addition to the six domains, there are a number of issues highlighted in the planning framework which run through and across more than one assurance domain, and are an important part of the assurance conversation because they represent the core of what a successful CCG should be striving to achieve. These issues are:

Parity of esteem Focussing on equality, reducing inequality Better care

2

Every quarter, following assurance conversations, NHS England area teams make a summary assessment under each assurance domain on the basis of the assurance conversation and any additional information presented. The judgement is based on the level of risk associated with the CCG’s current plans and progress, and wherever possible, is a joint decision made with the CCG. Each assurance domain is assessed as:

Assured Assured with support Not assured, intervention required

A headline judgement is made as to whether the area team are ‘assured’ or ‘not assured’ on the basis of assessment against each of the domains and assurance discussions The quarter 1 assurance meeting for Darlington CCG was held on 18th September 2014, and the CCG received its quarter 1 assurance letter from NHS England on 31 October 2014. A number of the CCGs key achievements in quarter 1 were discussed and noted in the assurance report. The headline assessment for Darlington CCG was ‘assured’, although domain 3 was assured with support due to the status of contract negotiations with County Durham and Darlington NHS Foundation Trust and the ongoing performance issues relating to urgent care provided by the Trust. The assurance assessments will be publicised nationally by NHS England. We have been advised that the assured with support category will continue to be drawn from those CCGs that have one or more domains with assured with support rather than whether their overall category is assured.

As Darlington CCG has been assured with support for one domain we will be reported as being assured with support in the national publication. This will also apply to a number of other CCGs nationally.

A copy of the letter is included in Appendix 1, with a summary report of the outputs of the assurance review in Appendix 2. 3. Recommendations The Governing Body asked to:

Receive the quarter 1 letter issued by NHS England Note the content of the assurance report and actions agreed to address the issues

highlighted.

4. Author and Clinical Sponsor Author: Lisa Tempest, Chief Finance Officer Date: 19 November 2014 Clinical Sponsor: Dr Andrea Jones, Chair

3

Purpose of Paper

Information Sharing


Decision / action

Strategy – Working Together to Improve the Health and Wellbeing of Darlington






Financial Implications No direct impact




Assurance outcomes are publicised nationally




Ongoing monitoring and remedial action to address performance issues required.



Attachment(s) Q1 assurance letter from NHS England Summary Report of the Q1 assurance review

Dear Angela and Martin QUARTER 1 2014/15 ASSURANCE MEETING Thank you once again to you and your team for the approach taken to preparing for and participating in the quarter 1 assurance meeting. As with the previous quarters, albeit working with the new Assurance Framework for 2014./15, the opportunity to have an open and honest dialogue with your team proved to be a valuable part of the assurance process. The timing, and emphasis, of the meeting enabled us to hear about your key risks, challenges and performance issues during the early part of 2014/15 and what you are doing to deliver better outcomes for patients.

Please find attached a list of the key issues and actions as a result of the meeting, along with a summary of the key issues and assurance judgments for each of the assurance Domains. This highlights that you are assured overall, with each of the 6 Domains all Domains assured except Domain 3. This is primarily due to the ongoing unresolved contractual situation with CDDFT and the knock on implications on patients, yourselves and the wider health economy, as well as your ongoing financial challenges. If you have any questions please get in touch. We look forward to an ongoing, collaborative dialogue with you between now and the quarter 2 assurance process.

Yours sincerely

Caroline Thurlbeck Director of Operations and Delivery

Durham, Darlington and Tees Area Team The Old Exchange

Barnard Street Darlington DL3 7DR

Email address: [email protected]

Telephone Number: 0113 2851605

31 October 2014


Summary report of quarterly assurance review – Darlington CCG assurance report

Quarter 1 2014/15 Headline assessment – Assured

Domain Assurance level

Particular achievements noted/examples of good practice

Issues identified

Any issues identified requiring further action and actions agreed

Are patients receiving clinically commissioned, high quality services?

Assured

Clear clinical leadership being demonstrated across the priority work stream programmes.

Are patients and the public actively engaged and involved?

Assured

Patient and Public Engagement work plan continues to be delivered with the support of Darlington Healthwatch including development of a sustainable approach to capturing the views of the working population.

Are CCG plans delivering better outcomes for patients?

Assured with Support

Performance at CDDFT in respect of 4 Hour waits and ambulance handovers improved in Quarter 1.

A number of issues and challenges associated with urgent/unscheduled care given the performance levels of the main Acute provider. Contract with main acute provider not yet agreed – now moving to formal mediation. Date to be agreed – expected to be early October.

Ensure robust challenge and scrutiny across a number of key performance indicators, in particular Diagnostics, A and E and Referral to Treatment. Ensure a continued focus on the important area of Cancer 62 day waits to consistently achieve the performance standards required in this area. Engage proactively with NEAS

regarding the performance of the NHS 111 service and its capacity during winter.

Focus Assurance level

Particular achievements noted/examples of good practice

Issues identified


Does the CCG have robust governance arrangements?

Assured

Risk Management within the CCG is evolving. Processes are in place to ensure practice member representatives are involved in the identification and monitoring of risks within the CCG.

Are CCGs working in partnership with others?

Assured

Formal strategic partnership with Darlington Borough Council governed through Memorandum of Understanding between organisations.

Area Team to organise a discussion regarding strategic partnership working between NHS England, CCG, Darlington Borough Council and CDDFT including review of Clinical Programme Board.

Does the CCG have strong and robust leadership

Assured

Each of the six priority projects has a clinical lead.

Cross-cutting themes Particular achievements noted/examples of good practice

Issues identified


Parity of Esteem

The CCG has increased the investment in mental health services in 2014/15. Arrangements for ring fencing of mental health funding for Darlington and Durham are currently being finalised and are expected to be in place from Quarter 3. In its meeting on 16th September the Governing Body agreed that the CCG should aim to increase investment in mental health over the coming years. Benchmarking to be performed in order to determine target increase.

Ensure that the IAPT performance levels continue to deliver sustained performance, building on the progress to date.

Focus on equality, reducing inequality

Latest public health profiles show an improved position across Darlington though still work to do to close the gap with the national picture.

Better Care Fund

Excellent integrated working arrangements with Darlington Council, as well as a creative vision that underpins the BCF Plan.



Governing Body

Business Continuity Planning

1. Introduction The purpose of this report is to seek Governing Body approval of the Business Continuity Plan for NHS Darlington Clinical Commissioning Group (CCG). 2. Implications and risks The NHS needs to be able to plan for, and respond to, a wide range of incidents that could impact on health or patient care. These could be anything from extreme weather conditions to a major transport accident.

The Civil Contingencies Act 2004 requires Category One responders to show that they can deal with such incidents while maintaining services for patients. Clinical commissioning groups, whilst not Category One responders, must demonstrate that they can deal with such incidents by taking part in a programme of work around emergency preparedness, resilience and response (EPRR). NHS England is operating an assurance process to ensure that CCGs along with acute, community, mental health and ambulance service providers meet the core standards for emergency preparedness.

Business continuity management is an essential tool in establishing an organisation’s resilience and provides a framework for identifying and managing risks that could disrupt normal service. Attached at Appendix A is the Business Continuity Plan for NHS Darlington CCG. Work is ongoing to finalise detailed business impact analysis for each service priority, and to develop recovery plan for each service. The Executive reviewed the plan in its meeting on 18th November prior to presentation to the Governing Body for final approval. Section 6 of the plan outlines the responsibilities for the BCP with each role identified being a member of the incident response team. The following leads were proposed and agreed by the Executive on 18th November 2014:

BCP lead – CCG Chief Officer Communications Lead – Senior Communications and Engagement Manager, NECS Estates and Facilities Lead – awaiting name from NHS Property Services Ltd Human Resource Lead – HR Business Partner, NECS

2

Finance Lead – Chief Finance Officer, CCG IT lead – IT Manager, NECS Administration co-ordinator – Administrative Assistant, CCG

The existence of the plan will inform that the CCGs annual Governance Statements. It is a requirement that the plan be tested by a table top exercise annually. The North of England Commissioning Support Unit is providing support to the development and testing of CCG business continuity plans and will coordinate the testing of plans. 3. Recommendations The Governing Body is requested to:

approve the Business Continuity Plan for Darlington CCG note that work is ongoing to finalise the suite of supporting business impact

analyses and to develop recovery plans, note that arrangements will be made to train members of the incident response

team and to test the plan by a table top exercise.

4. Author and Sponsor Director Author: Lisa Tempest Title: Chief Finance Officer Clinical Sponsor: Dr Andrea Jones Title : Chair and Lead Clinician Date: November 2014

3

Purpose of Paper Information Sharing x Development / discussion x Decision / action x




x

Commissioning the right services in the right place x

Security safe high quality services x












As outlined in the risk register



Attachment(s) Version 1 Business Continuity Plan

Page | 1

NHS DARLINGTON

CLINICAL COMMISSIONING GROUP

Business Continuity Plan

Version Control Version Date Amendment

1.00

Ratified

Status Draft

Issued Version 2

Approved by

Consultation Executive 11.11.14 Governing Body 3.12.14

Implementation date 01/04/14

Core Standard reference

ISO 22301, NHSE Emergency Preparedness Framework 2013, NHSE Core Standards for Emergency Preparedness, Resilience and Response 2013, NHSE Command and Control Framework 2013.

Equality Impact Assessment

Distribution

Review October 2015

Author Chief Finance Officer

Version 1.0

Reference No

Location I:\Governance & Audit & Risk\BCP\Business Continuity Plan 00C.doc

Page | 2

Contents Page

1 Introduction 3 2 Purpose and Scope 4 3 Catagorisation and Prioritisation of Services 5 4 Business Impact Analysis (BIA) 6 5 Activating the Business Continuity Plan (BCP) 8 6 Responsibilities for the BCP 10 7 Communications 13 8 Incident Room 14 9 Service priorities 14 10 Plan activation sequence 14 11 Debrief 15 12 Training and Exercises 15

Appendix 1 Adverse weather conditions 16 Appendix 2 Initial assessment form 17 Appendix 3 Business Impact Analysis 18 Appendix 4 Incident assessment and situation report 19 Appendix 5 First meeting agenda 21 Appendix 6 Business continuity communications 23 Appendix 7 Debrief template 24 Appendix 8 Incident room contents 27

1. Introduction

Page | 3

1.1 This Business Continuity Plan (BCP) describes how NHS Darlington Clinical Commissioning Group (CCG) will discharge its functions in the event that a major incident or other issue causes serious interruption of business operations involving one or more directorates. This is a corporate level BCP which would be implemented when any incident cannot be contained and managed within a single directorate.

1.2 Business Interruption can be defined as; ‘An unwanted incident which threatens personnel, buildings, operational procedures, or the reputation of the organisation, which requires special measures to be taken to restore things back to normal’

1.3 The CCG will maintain specific prioritised activity recovery plans for each

function which outlines its critical functions and services, and provides details of how it is intended that business continuity is maintained when faced with loss of premises, staff and other resources

1.4 Business continuity management (BCM) is a business driven process that establishes a fit-for-purpose strategic and operational framework to –

proactively improve the organisation’s resilience against severe interruption;

provide a rehearsed method of restoring the organisation’s ability to

supply its key services to an agreed level within an agreed time after an interruption;

deliver a proven capability to manage a business interruption and

protect the organisation’s reputation and brand.

1.5 BCM can be defined as:

“A holistic management process that identifies potential threats to an organisation and the impacts to business operations that those threats, if realised might cause, and which provides a framework for building organisational resilience with the capability for an effective response that safeguards the interests of its key stakeholders, reputation, brand and value creating activities.” (BS 25999 Business Continuity Management – Part 1 2006: Code of Practice, British Standards Institute)

Page | 4

At the heart of business continuity planning are four key areas:

damage/denial of access to premises;

non availability of key staff;

loss or damage to other resources;

loss/damage to IT or data.

1.6 Business continuity is complementary to the risk management framework that sets out to understand the risks to operations or business, and the consequences of those risks. Reference should be made to the organisation’s risk management strategy and risk register which relate to corporate and directorate risk assessments that may be considered in conjunction with this continuity planning process.

2 Purpose and scope

2.1 The purpose of this plan is to ensure business continuity arrangements

are in place which –

identify and maintain critical activities during and after any interruption;

restore them to full functionality;

promote recovery as quickly as possible.

2.2 To perform its duty on a day-to-day basis, Darlington CCG depends upon a wide range of complex systems and resources, and seeks to maintain a good reputation. Inevitably, there is potential for significant interruption to normal business or damage to the organisation’s reputation through loss of those systems and resources. The priorities of Darlington CCG when faced with a significant interruption (whether actual or impending) will always be to:

ensure the safety and welfare of its personnel and visitors;

endeavour to meet its obligations under legislative requirements;

secure replacement critical infrastructure and facilities;

protect its reputation;

minimise the exposure to its financial and reputational position;

Page | 5

facilitate a return to normal operations as soon as practicable. 2.3 The scope of this BCP will centre on conformity with BS 25999, legislative requirements within the Civil Contingencies Act (CCA) 2004 and NHSE

guidance.

3.0 Categorisation and prioritisation of services 3.1 Successful business continuity planning includes the ability to define the essential business services of the organisation and must be identified at all levels. These can be broken down into critical, vital, necessary and desired. Determining and categorising services in this way is the responsibility of heads of service within the organisation.

3.2 CRITICAL services must be provided immediately or the loss of life,

infrastructure destruction, loss of confidence and significant loss of revenue will result. These services will require continuity within 24 hours of interruption.

3.3 VITAL services are those that must be provided within 72 hours or loss of life, infrastructure destruction, loss of confidence and significant loss of revenue or disproportionate recovery costs will result.

3.4 NECESSARY services must be resumed within two weeks or considerable loss, further destruction or disproportionate recovery costs could result.

3.5 DESIRED services could be delayed for two weeks or longer, but are required in order to return to normal operating conditions and alleviate further disruption or disturbance to normal conditions. 3.6 This is a list of the possible interruption factors that represents the potential impact for the organisation;

loss of life or inacceptable threat to human safety;

disruption of essential services;

loss of public/stakeholder confidence;

Page | 6

loss of vital records;

loss of expertise;

significant damage or total loss of infrastructure;

significant loss of revenue or public funds;

disproportionate recovery costs.

3.7 Within the organisation the interruption factors may include;

access to or the ability to operate normal services from a site which can be either fully or partially interrupted due to an incident occurring e.g. fire, loss of utilities;

IT systems are interrupted or the network fails, causing significant disruption to either a single or more department;

failure of service provision arising from a key 3rd party supplier or provider organisation;

greatly reduced staffing levels e.g. severe weather conditions (appendix 1), flu pandemic;

loss of telephone communications.

And as a result there is impact upon –

health and safety,

possibility of either adverse financial or reputational damage,

a requirement to relocate to alternative working premises or service delivery resources.

4.0 Business Impact Analysis (BIA) 4.1 To begin the process of assessing services, department managers should categorise and prioritise services into critical, vital, necessary and desirable functions by using the initial assessment form (appendix 2). 4.1 From this initial assessment BIA should then be carried out to identify the vital resources required to provide a service. It will also help determine which services should have priority, which services will be the most difficult to resume, the minimum resources to resume a service and an indication of the timeline in which it should be accomplished. Each service

function is subject to a separate BIA ( appendix 3).

Page | 7

4.2 A key element within the BIA is the maximum tolerable period of disruption and a recovery time objective (figure 1). Timelines are crucial when establishing ‘cut-off’ points and setting targets. The ‘timelines’ extracted from ISO 22301 are as follows;

Maximum Tolerable Period of Disruption (MTPoD) ‘Duration after which an organisation’s viability will be irrevocably

threatened because of the adverse impacts that would arise as a result of not providing that service (function) or performing that activity.’

Recovery Time Objective (RTO) ‘Target time set for –

resumption of the service (function) after an incident; or

resumption of a performance or activity after an incident; or

resource recovery after an incident. Note – the recovery time objective has to be less than the maximum period of disruption…’

For ‘critical’ functions, the maximum periods of disruption have been suggested to be four hours and 24 hours, depending upon the service or function.

The recovery time objective will be less than the identified MTPoD. Both are incorporated into the BIA for the critical function identified.

BIAs also include information on recovering the service and/or mitigating its temporary loss. Sections of the BIA document focus on; People: Premises: Processes: Providers: Profile.

Page | 8

Figure 1 – Recovery Time Objective

5 Activating the Corporate Business Continuity Plan (BCP) 5.1 Something has happened that impacts on critical business functions. Buildings, facilities or other resources, including staff need to be managed. This plan lists the critical functions that need to be maintained, and sets out emergency steps to manage the incident. Generally, the chain of events will be;

An alert is raised and brought to notice by any member of staff to their manager who will inform the Chief Officer or deputy and the assigned BCP Lead.

The CO or deputy and BCP lead will consider the appropriate response and whether to activate this BCP in full or in part. Figure 2, considers the activation levels.

Page | 9

Figure 2 – Plan activations

Incident dynamic Reported to CO

Activation Potential considerations for Plan

activation

Incident Response Team (IRT) Strategic, Tactical, and Operational

responsibilities

1 The incident is contained to single function and able to be managed effectively to conclusion by that function.

‘Declare Directorate Business Continuity Incident’

Initiate functional Emergency BCP

Establish functional IRT

Responsible functional Executive as Lead Officer

BCP lead

Communications lead

Estate and facilities lead

HR lead

Finance lead

IT lead

Administration coordinator

2

Does the incident affect more than one function?

‘Declare Corporate Business Continuity Incident’

Initiate Corporate BCP

Establish Corporate IRT

CO or deputy as Strategic Lead

BCP lead

Communications lead

Estates and facilities lead

HR lead

Finance lead

IT lead

Administration Coordinator

5.2 Criteria for escalation

increase in geographic area or staff affected (pandemic, flooding etc)

the need for additional internal/external resources

increased severity of the business interruption

increased demands from government departments, the service or commissioned service

heightened public or media interest

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5.3 In the event of the activation of the BCP, the business continuity lead will

identify an Incident Room, for the Incident Response Team (IRT), giving a general status report for the IRT to consider appropriate actions.

6 Responsibilities for BCP

6.1 The CO has overall responsibility for emergency response planning and for ensuring that an effective BCP strategy is in place, ensuring the

continuation of critical functions until normal services are restored to their

pre-incident capacity, in the minimum timeframe possible.

6.2 BCP lead

The BCP lead is responsible for;

leading the Incident response Team (IRT),

collating incident assessment and situation report (appendix 4),

facilitating meetings ( appendix 5: suggested agenda format for first meeting),

liaising with senior management,

overseeing the activation of the plan,

managing the Incident Room for continuing activities during an emergency response or locating an alternative Incident Room where necessary within the CCG footprint ,

coordinating recovery,

leading the lessons learned and compiling final report.

6.3 Communications Lead

The communications manager is responsible for;

developing an information and media response plan;

preparing for and advising senior management on crisis

communications messaging surrounding disruptions to critical and vital services.

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6.4 Estates and Facilities Lead The estates and facilities coordinator is responsible for;

ensuring suitable Incident Room is available,

overseeing and coordinating the assignment of alternate facilities where required,

liaising with governance team and finance lead regarding asset registers of equipment, insurance and reporting arrangements of damage assessment,

liaising with the building owner where there is damage to infrastructure,

liaising with emergency agencies where appropriate,

ensuring the security of employees and buildings during the emergency response,

liaising with the senior governance officer (health and safety) to assess safety and fire risks where appropriate,

working with the finance manager to adhere to emergency expenditure and procurement procedures.

6.5 Human Resource Lead The HR lead is responsible for;

having available a list of up-to-date contact list of current employees, agencies that can supply temporary staff, a list of recently retired staff, all to support essential services during a human resource shortage,

liaising with the senior governance officer (health and safety) to ensure there are no risks to the health and safety of staff where appropriate,

liaising with Occupational Health to secure post-incident counseling where appropriate;

advising on anticipated personnel concerns e.g. payroll, child care, transportation ,

liaising with operational areas and the senior governance officer (information governance) in identifying, prioritising and protecting all paper vital records.

Page | 12

6.6 Finance Lead The finance lead is responsible for;

ensuring that appropriate insurance is available,

ensuring asset registers are available,

ensuring appropriate staff are authorised to make emergency expenditures when required,

liaising with the appointed estates and facilities manager to ensure that emergency expenditure and procurement procedures are adhered to.

6.7 IT Lead The IT lead is responsible for;

ensuring that IT systems are recovered in business critical areas where necessary,

liaising with operational areas and ensuring IT systems are recovered within time objectives set or set up if staff have been relocated,

ensuring that IT policies have been adhered to when storing/backing up information,

liaising with the finance manager where assets require replacing due to loss/damage,

maintaining a list of suppliers and qualified contractors for emergency procurement,

liaising with operational areas and the senior governance officer (information governance) in identifying, prioritising and protecting all vital electronic information.

6.8 Administration Coordinator The administration co-ordinator is responsible for:

liaising with the BCP lead,

ensuring available resources in the Incident Room e.g. hard copies of

plans, stationery, writing materials, flip chart, telephone, computer

Page | 13

and printer,

taking notes ,

typing final reports. 6.9 Criteria for de-escalation

Reduction in internal resource requirements.

Reduced severity of the incident.

Reduced demands from government departments, the service and commissioned services.

Reduced public or media interest.

7. Communications Effective communications are crucial. It is essential to disseminate accurate and timely information to staff, partners, stakeholders and where necessary the public during the response to a business interruption. The BCP Lead will liaise with the communications manager as needed to ensure effective, on-going communications. This will be overseen by the senior manager in charge. A checklist is given as appendix 6.

8. Incident Room

The purpose of the Incident Room is to provide a place where the CCG can implement and co-ordinate the organisation-wide initial response and recovery operations; to provide a single point of contact for requests for assistance allowing the business continuity team an immediate overview of the organisation-wide response and to provide an area for information collation and preparation of any briefings The Incident Room for the CCG is the Emmerson Room with the CCG’s office space at Dr Piper House, King Street, Darlington. In the event that the CCG’s incident room is not useable the back-up Incident Room is the Board Room at John Snow House, Durham University Science Park, Durham City . The suggested equipment to be kept in the room can be seen in appendix 8.

9. Service Priorities

All functions of the organisation have been provisionally designated a level of priority. This assumes IT functionality is maintained, in line with IT business continuity and disaster recovery plans.

Page | 14

PRIORITY AND DEFINITION Darlington CCG activities/functions

Priority One Functions – An essential function needing to be restored within 0-24 hours

Clinical quality / patient safety management of continuing care cases management of serious incidents

Corporate Office

communications and media relations Hosted service

adults and children’s safeguarding

Priority Two Function – An important function needing to be restored within 3 working days

Corporate Office complaints handling responding to correspondence received including MPs

Finance payment of suppliers – assurance from Shared Business

Service (SBS) financial reporting payroll function (time sensitive to payroll schedule)

Priority Three Function – A function needing to be restored within 7 working days

Corporate office management of freedom of information requests maintenance of information governance Commissioning individual funding requests (IFR) commissioning contract management procurement

Priority Four Function - A function which can be restored progressively after 7 working days

Corporate office senior leadership function – including decision-making

processes of statutory and regulatory meetings administrative and clerical function access to legal advice

Clinical quality / patient safety clinical governance quality assurance medications optimisation Commissioning Primary care support

Page | 15

Finance Estates - assurance from NHS Property Services

NB A number of these functions are administered by NECS on behalf of the CCG but

the CCG is required to assess them. 10. Plan activation sequence

The following activation sequence will normally be used when informing staff of the activation of this plan: standby phase, implement phase, stand down phase.

‘Standby’ will be used as an early warning of a situation which might at some later stage escalate and thus require implementation of this plan. This is particularly important if an interruption occurs towards the end of office hours and staff may need to be asked to stay at work until the situation becomes clear.

‘Implement’ is the immediate activation of this plan.

‘Stand Down’ will be used to signify the phased withdrawal of the activation of the plan e.g. the standing down of the incident room.

11. Debrief At the conclusion of the incident, the Business Continuity Lead will lead a debrief session and prepare a report on the incident (appendix 7), to include issues identified by the debriefing process. This should take place between 24 hours and fourteen days following the incident. The report will be considered at a meeting of the Incident Response Team and submitted to the

Risk and Audit Committee together with any recommendations and action plan. The report should be submitted to the Governing Body for approval.

12. Training and exercises Members of the Incident Response Team will be trained in line with the required competencies for their role. An example of this is the strategic leadership in a crisis course. This plan will be tested by table top exercise annually.

Page | 16

Appendix 1

Adverse weather – staff attendance 1. The need to balance business continuity and staff availability during periods

of adverse weather is the responsibility of the whole staff team, led by the CO and Executive team. The safety of patients and staff is paramount.

2. Individual members of staff should make contact with their line manager (or a member of the Executive team or CO in the absence of their line manager) to discuss their options and plans. This should be at the earliest opportunity, even the evening before when adverse weather starts or is forecast.

2.1 The first option to consider is that the member of staff attends their usual

place of work (the CCG office), taking into account any particular travel arrangements (e.g. allowing extra time, using public transport).

2.2 If the employee and manager agree that it is not practical for the employee to get to the office, then the second option is to consider going to the nearest CCG office where the employee can access the necessary IT systems, i.e. If this is agreed, the employee should speak to the senior manager in charge at that office immediately on arrival, as well as notifying their own line manager.

2.3 If the employee and manager agree that neither option 1 nor 2 is practical, then the line manager may consider option 3 - that the employee can work from home. The work to be done and how contact will be maintained whilst the employee is working at home should be clearly agreed.

2.4 If the employee and manager agree that none of these options are practical, then the employee will take leave.

3. It is essential that communication is maintained between the employee and manager, to keep the situation under review, maintain the safety of the employee and ensure adequate oversight of the work. As a minimum the manager should speak to the employee at the start of each working day, at least once during the day and at the end of each working day.

4. During prolonged periods of adverse weather the CO and Executive team will

keep the matter of workload and office cover under daily review.

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Appendix 2

Initial Assessment Form

Imp

act

Co

nti

nu

um

Det

erm

inat

ion

of h

ighe

st fa

ctor

s sh

ould

be

adju

sted

acc

ordi

ng to

ex

pect

atio

ns a

nd p

riorit

ies

of s

ervi

ce

K

J

I

H

G

F

E

D

C

B

A

Less than one day

2-3 days

4-7 days

7-14 days

More than 14 days

Time Continuum

The significance and length of the time continuum is based on your

services and time expectations for recovery

Page | 18

Appendix 3

Business Impact Analysis Form Complete ONE form for each function identified *Tick box as appropriate

Directorate: Service:

Service Function: Service Disruption:

*Maximum Tolerable Period of Disruption:

≤24 hours ≤72 hours ≤2 weeks ≥2 weeks

Recovery Time Objective: Insert planned timescale

*Risk rating: Extreme High Medium Low

Key Staff What staff are required to carry out key functions?

Can staff be contacted? Could extra capacity be built into your staffing to assist you in coping during an incident?

Peo

ple

Skills / Expertise / Training Skills / expertise required?

Could staff be trained in other roles? Could other members of staff undertake other non-specialist roles, in the event of an incident?

Minimum Staffing Level to support essential service?

What is the minimal staffing level to continue to deliver your key functions at an acceptable level? What grade of staff do you require? What measures could minimise impact?

Buildings Primary site locations?

Could you operate from more than one premise? Could staff work remotely? Could you relocate operations in the event of a premise being lost or if access was denied?

Pre

mis

es

Facilities What is essential to carry out key functions?

Are any of your facilities multi-purpose? Are alternative facilities available in the event of an incident?

Equipment / Resources What is required?

Could alternative equipment be acquired? Could key equipment be replicated or do manual procedures exist?

IT Is data backed-up and are back-ups kept off site? Do you have any disaster recovery arrangements?

Pro

cess

es What IT is essential?

Documentation Essential documentation and how are these stored?

Is essential documentation stored securely (e.g. fire proof safe, backed-up or stored elsewhere)?

Systems / Communications What is required to carry out key functions?

Are your systems flexible? Do you have alternative systems in place (manual processes)? What alternative means of communication exist?

Pro

vid

ers

Reciprocal arrangements Any arrangements with other organizations?

Do you have agreements with other organisations regarding staffing, use of facilities in the event of an incident?

Contractors With whom and for what?

Alternative contractors or reliant on a single contractor? Do your contractors have contingency plans?

Suppliers On whom you depend for key functions?

Do you know of suitable alternative suppliers? Could key suppliers be contacted in an emergency?

Pro

file

Reputation Key stakeholders?

How could reputational damage to your organisation be reduced? How could you provide information to staff and stakeholders in an emergency (e.g. press release)?

Legal Considerations Legal, statutory and regulatory requirements?

Do you have systems to log decisions; actions; and costs, in the event of an incident?

Page | 19

Appendix 4 Incident Assessment and Situation Report

Report details

Date

Time

Name of person completing form

Name of people contributing

Summary of the current situation

What are the facts about the incident? Use the aide memoir below as a guide C – Number of casualties, if they require any primary care treatment

H – Hazards i.e. chemical, gas

A – Access (road closures etc)

L – Location (address of incident, type of building, where appropriate)

E – Emergency Services (who should be contacted for more information)

T – Type (i.e. chemical/road traffic accident/outbreak/closure of building

Other facts

What are the assumptions about the incident? What additional information is required?

Page | 20

Alerting and informing

What agencies are involved in the incident? Who has been informed (when and by whom, if known?) Do we need to inform or request actions of other individuals/services/partner organisations?

Risks

What are the main risks and consequences of the incident? What are the knock-on effects to other services and/or partner organisations?

Media

Will the incident attract media interest? What is the current situation with the media? Are actions required?

Page | 21

Appendix 5

FIRST MEETING AGENDA - MEETING OF INCIDENT RESPONSE TEAM DATE, TIME AND PLACE: ATTENDEES: CHAIRED BY: No Item Action Action

By Who Action

By When

1 Analysis of Impact Review Service Impact Analysis Sheets Brief team on nature, severity and impact of disruption. Identify information gaps Agree immediate action necessary Adjourn to take immediate action as needed Agree time to reconvene

2 Confirm Roles Agree roles and responsibilities of staff during the disruption. If required revise roles and determine if additional staff/deputies are required. Identify additional team members that may be required Stand down members not required

3 Confirm Key Contacts at Scene of Disruption Main points of contact for ongoing information updates

4 Logs Ensure personal logs in place. (Written record of significant events and all communications)

5 Recovery Management Review recovery priorities Determination of support requirements.

6 Welfare Issues Have members of staff, visitors or third parties been affected?

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No Item Action Action By Who

Action By

When What is their location? What immediate support and assistance is required? What ongoing support and assistance might be required?

7 Communications Who should we inform? Are Communications managers required / present? Professional Public Relations/Media advisors required? Determine which, if any external regulatory bodies should be notified. Determine any internal communications that need to take place (other sites, affected services etc.

8 Media Strategy Determine the media strategy to be implemented. What is the story? What is the deadline?

9 Legal Perspective Determine what legal action or advice is required.

10 Insurance Position Determine whether insurance cover is available and if so, how best to use the support it may provide.

11 Next meeting Date, time, place and attendees of next meeting

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Appendix 6

Business Continuity Communications (internal)

During the response to a business interruption it is important that staff are kept fully informed of progress. Staff directly affected by a business interruption will obviously be very concerned about the impact upon them personally. Staff not directly affected by a business interruption also need to be kept informed of progress as they may be impacted upon e.g. they may need to take on additional work, be relocated to alternative accommodation, etc. A clear, concise and accurate flow of information is essential; it will ensure that all staff are fully aware of developments and can work together to ensure that the organisation overcomes the interruption. The severity of the business interruption will influence the level of detail and amount of information which needs to be issued to staff.

The BCP Lead will liaise with the communications manager as needed to ensure effective, on-going communications. This will be overseen by the senior manager in charge and will cover, as a minimum:

1 Are the normal day-to-day communication links with staff still in place? If yes, these should be used to issue information to staff.

2 If normal day-to-day communication links are no longer in place, use any

agreed fall-back procedure for issuing information to staff.

3 In the case of a business interruption, the Chief Operating Officer and senior management team will continually monitor staff instructions and ensure that all staff are aware of the current situation and plans.

4 If information needs to be relayed to the public then this should be arranged

with the communications manager:

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Appendix 7 NHS Darlington CCG

Debrief template Post incident

Incident date: Outline:

This debrief template provides the framework for undertaking a structured De-brief and will assist in the development of the post incident Report which will cover –

What was supposed to happen?

What actually happened?

Why were there differences?

What lessons were identified?

Issue Response How prepared were we?

What went well?

Page | 25

What did not go well?

What can we do better in the future?

Page | 26

Is there a need to modify the plan/training?

Other issues Communications

Equipment

Human resources

Planning and briefing

Other issues

Completed by - ……………………………………….. Role - …………………………………………..

Page | 27

Appendix 8

INCIDENT ROOM The Incident Room should include;

Workstation and computer

Access to a dedicated Email account and backup account

Access to an A3 colour print

Access to a Fax machine

Access to a photocopier

Sufficient telephone lines

A stationery pack

White boards and pens/Flip charts and pens

Log books (call logs/decision logs)

Hard copy plans, directories and maps

2 December 2014 NHSDCCG/GB/2014/December/69

NHS DARLINGTON

CLINICAL COMMISSIONING GROUP Governing Body

NHS England Emergency Preparedness, Resilience and

Response (EPRR) Assurance Process and NHS Darlington Clinical Commissioning Group Self-Assessment

1. Introduction NHS England is operating an assurance process across the country in respect of the NHS England Core Standards for Emergency Preparedness, Resilience and Response (EPRR) issued in July 2014. NHS England regional and area teams and Local Health Resilience Partnership Boards have been asked to conduct this assurance process during Q2 and Q3 of 2014-15. All organisations who receive NHS funding are required to perform a self-assessment against the NHS England Core Standards for EPRR, with the exception of primary care. Organisations must state overall whether they believe they are fully, substantially, partially or non-compliant with the NHS England Core Standards for EPRR. Definitions of these assurance levels are included at Appendix A. As a recipient of NHS funding, Darlington Clinical Commissioning Group is required to perform a self-assessment and declare its compliance level to NHS England. This exercise has been undertaken and the self-assessment submitted to NHS England on 29th October 2014. In accordance with the NHS England assessment process CCG Governing Body approval is required prior to 31st December 2014. The purpose of this paper if to advise the Executive of the outcome of the self-assessment in advance of it being presented to the Governing Body for approval on 3rd December 2014. 2. Implications and risks A copy of the self-assessment for NHS Darlington CCG is included at Appendix B. A number of standards have been assessed as having been met by the work undertaken in performing Business Impact Analyses and the development of a Business Continuity Plan for the CC, and by ongoing work coordinated by the Local Health Resilience Board on behalf of providers and commissioners in the Durham and Tees area which is now attended by Lisa Tempest who represents Darlington, Durham and Tees CCGs.

2

Core Standards which have been assessed as not currently being met have been identified and an action plan developed to ensure that the standards are met by the CCG before 31 March 2014. These standards are predominantly those which relate to the training of CCG responders and participation in multi-agency training exercises. A copy of the action plan is included at Appendix C. 3. Recommendations The Governing Body is requested to:

Approve the core standards self-assessment and declaration Note the action plan developed to ensure areas of non-compliance are addressed

by 31March 2014

4. Author and Sponsor Director Author: Lisa Tempest Title: Chief Finance Officer Clinical Sponsor: Dr Andrea Jones Title : Chair and Lead Clinician Date: November 2014

3

Purpose of Paper Information Sharing x Development / discussion x Decision / action x




x














As outlined in the risk register



Attachment(s) Appendix A – Definition of EPRR Assessment Levels Appendix B - EPRR Self- Assessment Darlington CCG Appendix C - EPRR Action Plan

Durham Darlington and Tees Local Health Resilience Partnership

EPRR self-assessment 2014/15

Compliance Level Evaluation and Testing Conclusion

Full The plans and work programme in place appropriately address all the core standards that the organisation is expected to achieve.

Substantial The plans and work programme in place do not appropriately address one or more of the core standard themes, resulting in the organisation being exposed to unnecessary risk.

Partial The plans and work programme in place do not adequately address multiple core standard themes; resulting in the organisational exposure to a high level of risk.

Non-compliant The plans and work programme in place do not appropriately address several core standard themes leaving the organisation open to significant error in response and /or an unacceptably high level of risk.

NHS England Core Standards for Emergency preparedness, resilience and responsev2.0

The attached EPRR Core Standards spreadsheet has 3 tabs: EPRR Core Standards tab - with core standards nos 1 - 37. HAZMAT/ CBRN core standards tab: with core standards 38- 51. Please note this is designed as a stand alone tab. HAZMAT/ CBRN equipment checklist: designed to support acute and ambulance service providers in core standard 43.

Core standard Clarifying information

Acu

te h

ealth

care

pro

vid

ers

Sp

ecia

list p

rovi

der

s

Am

bu

lan

ce s

ervi

ce

pro

vid

ers

Co

mm

un

ity s

ervi

ces

pro

vid

ers

Men

tal h

ealth

care

pro

vid

ers

NH

S E

ng

lan

d A

rea

team

s

NH

S E

ng

lan

d R

egio

nal

&

nat

ion

al

CC

Gs

CS

Us

(bu

sin

ess

con

tinu

ity

on

ly)

Pri

mar

y ca

re

(GP

, co

mm

un

ity p

har

mac

y)

Oth

er N

HS

fun

ded

o

rgan

isat

ion

s Evidence of assurance

Self assessment RAG

Red = Not compliant with core standard and not in the EPRR work plan within the next 12 months.

Amber = Not compliant but evidence of progress and in the EPRR work plan for the next 12 months.

Green = fully compliant with core standard.

Action to be taken Lead Timescale

Governance

1Organisations have a director level accountable emergency officer who is responsible for EPRR (including business continuity management) Y Y Y Y Y Y Y Y Y

2

Organisations have an annual work programme to mitigate against identified risks and incorporate the lessons identified relating to EPRR (including details of training and exercises and past incidents) and improve response.

Lessons identified from your organisation and other partner organisations. NHS organisations and providers of NHS funded care treat EPRR (including business continuity) as a systematic and continuous process and have procedures and processes in place for updating and maintaining plans to ensure that they reflect: - the undertaking of risk assessments and any changes in that risk assessment(s)- lessons identified from exercises, emergencies and business continuity incidents- restructuring and changes in the organisations- changes in key personnel- changes in guidance and policy

Y Y Y Y Y Y Y Y Y

3

Organisations have an overarching framework or policy which sets out expectations of emergency preparedness, resilience and response.

Arrangements are put in place for emergency preparedness, resilience and response which: • Have a change control process and version control

• Take account of changing business objectives and processes

• Take account of any changes in the organisations functions and/ or organisational and structural and staff changes

• Take account of change in key suppliers and contractual arrangements

• Take account of any updates to risk assessment(s)

• Have a review schedule

• Use consistent unambiguous terminology,

• Identify who is responsible for making sure the policies and arrangements are updated, distributed and regularly tested;

• Key staff must know where to find policies and plans on the intranet or shared drive.

• Have an expectation that a lessons identified report should be produced following exercises, emergencies and /or business continuity incidents

and share for each exercise or incident and a corrective action plan put in place. • Include references to other sources of information and supporting documentation

Y Y Y Y Y Y Y Y Y

4

The accountable emergency officer will ensure that the Board and/or Governing Body will receive as appropriate reports, no less frequently than annually, regarding EPRR, including reports on exercises undertaken by the organisation, significant incidents, and that adequate resources are made available to enable the organisation to meet the requirements of these core standards.

After every significant incident a report should go to the Board/ Governing Body (or appropriate delegated governing group) .Must include information about the organisation's position in relation to the NHS England EPRR core standards self assessment.

Y Y Y Y Y Y Y Y Y

BCP to be presented to Governing Body in Dec 14 Annual reporting to be included in Govening Body annual plan

Lisa Tempest By 31/12/14

Duty to assess risk

5

Assess the risk, no less frequently than annually, of emergencies or business continuity incidents occurring whichaffect or may affect the ability of the organisation to deliver it's functions.

Y Y Y Y Y Y Y Y Y Y Y

6

There is a process to ensure that the risk assessment(s) is in line with the organisational, Local Health ResiliencePartnership, other relevant parties, community (Local Resilience Forum/ Borough Resilience Forum), and nationalrisk registers.


7There is a process to ensure that the risk assessment(s) is informed by, and consulted and shared with yourorganisation and relevant partners.

Other relevant parties could include COMAH site partners, PHE etc. Y Y Y Y Y Y Y Y Y Y Y

Duty to maintain plans – emergency plans and business continuity plans

Incidents and emergencies (Incident Response Plan (IRP) (Major Incident Plan)) Y Y Y Y Y Y Y Y Y Y

corporate and service level Business Continuity (aligned to current nationally recognised BC standards) Y Y Y Y Y Y Y Y Y Y Y

HAZMAT/ CBRN - see separate checklist on tab overleaf Y Y Y Y Y Y N/ASevere Weather (heatwave, flooding, snow and cold weather) Y Y Y Y Y Y Y Y Y Y Y

Pandemic Influenza Y Y Y Y Y Y Y Y Y Y YMass Countermeasures (eg mass prophylaxis, or mass vaccination) Y Y Y Y Y Y Y N/A

Mass Casualties Y Y Y Y Y Y Y N/AFuel Disruption Y Y Y Y Y Y Y Y Y Y Y

Surge and Escalation Management (inc. links to appropriate clinical networks e.g. Burns, Trauma and Critical Care) Y Y Y Y Y Y Y Y Y Y

Infectious Disease Outbreak Y Y Y Y Y Y Y Y Y YEvacuation Y Y Y Y Y Y Y Y Y Y YLockdown Y Y Y Y Y Y Y Y Y

Utilities, IT and Telecommunications Failure Y Y Y Y Y Y Y Y Y Y YExcess Deaths/ Mass Fatalities Y Y Y Y Y Y N/A

having a Hazardous Area Response Team (HART) (in line with the current national service specification, including a vehicles and equipment replacement programme)

YN/A

firearms incidents in line with National Joint Operating Procedures; Y N/A

9

Ensure that plans are prepared in line with current guidance and good practice which includes: • Aim of the plan, including links with plans of other responders

• Information about the specific hazard or contingency or site for which the plan has been prepared and realistic assumptions

• Trigger for activation of the plan, including alert and standby procedures

• Activation procedures

• Identification, roles and actions (including action cards) of incident response team

• Identification, roles and actions (including action cards) of support staff including communications

• Location of incident co-ordination centre (ICC) from which emergency or business continuity incident will be managed

• Generic roles of all parts of the organisation in relation to responding to emergencies or business continuity incidents

• Complementary generic arrangements of other responders (including acknowledgement of multi-agency working)

• Stand-down procedures, including debriefing and the process of recovery and returning to (new) normal processes

• Contact details of key personnel and relevant partner agencies

• Plan maintenance procedures

(Based on Cabinet Office publication Emergency Preparedness, Emergency Planning, Annexes 5B and 5C (2006))


• Being able to provide documentary evidence that plans are regularly monitored, reviewed and systematically

updated, based on sound assumptions:• Being able to provide evidence of an approval process for EPRR plans and documents

• Asking peers to review and comment on your plans via consultation

• Using identified good practice examples to develop emergency plans

• Adopting plans which are flexible, allowing for the unexpected and can be scaled up or down

• Version control and change process controls

• List of contributors

• References and list of sources

• Explain how to support patients, staff and relatives before, during and after an incident (including

counselling and mental health services).

10

Arrangements include a procedure for determining whether an emergency or business continuity incident has occurred. And if an emergency or business continuity incident has occurred, whether this requires changing the deployment of resources or acquiring additional resources.

Enable an identified person to determine whether an emergency has occurred- Specify the procedure that person should adopt in making the decision- Specify who should be consulted before making the decision- Specify who should be informed once the decision has been made (including clinical staff)


• Oncall Standards and expectations are set out• Include 24-hour arrangements for alerting managers and other key staff.

11

Arrangements include how to continue your organisation’s prioritised activities (critical activities) in the event of an

emergency or business continuity incident insofar as is practical. Decide: - Which activities and functions are critical- What is an acceptable level of service in the event of different types of emergency for all your services- Identifying in your risk assessments in what way emergencies and business continuity incidents threaten the performance of your organisation’s functions, especially critical activities


Develop recovery plans for all corporate functions based on Business Impact Asessments

Lisa Tempest By 31/12/14

12Arrangements explain how VIP and/or high profile patients will be managed. This refers to both clinical (including HAZMAT incidents) management and media / communications management of VIPs and / or high profile

management Y Y Y Y YN/A

13Preparedness is undertaken with the full engagement and co-operation of interested parties and key stakeholders (internal and external) who have a role in the plan and securing agreement to its content Y Y Y Y Y Y Y Y Y Y Y

• Specifiy who has been consulted on the relevant documents/ plans etc.

14 Arrangements include a debrief process so as to identify learning and inform future arrangements Explain the de-briefing process (hot, local and multi-agency, cold)at the end of an incident. Y Y Y Y Y Y Y Y Y Y Y

Command and Control (C2)

15

Arrangements demonstrate that there is a resilient single point of contact within the organisation, capable of receiving notification at all times of an emergency or business continuity incident; and with an ability to respond or escalate this notification to strategic and/or executive level, as necessary.

Organisation to have a 24/7 on call rota in place with access to strategic and/or executive level personnel

Y Y Y Y Y Y Y Y Y

Explain how the emergency on-call rota will be set up and managed over the short and longer term.

16

Those on-call must meet identified competencies and key knowledge and skills for staff. NHS England publised competencies are based upon National Occupation Standards .

Y Y Y Y Y Y Y Y Y

Training is delivered at the level for which the individual is expected to operate (ie operational/ bronze, tactical/ silver and strategic/gold). for example strategic/gold level leadership is delivered via the 'Strategic Leadership in a Crisis' course and other similar courses.

NHS England DDT Area Team to arrange

Lisa Tempest/Andy Summerbell

By 30/4/15

17Documents identify where and how the emergency or business continuity incident will be managed from, ie the Incident Co-ordination Centre (ICC), how the ICC will operate (including information management) and the key roles required within it, including the role of the loggist .

This should be proportionate to the size and scope of the organisation. Y Y Y Y Y Y Y Y Y Y Y

Arrangements detail operating procedures to help manage the ICC (for example, set-up, contact lists etc.), contact details for all key stakeholders and flexible IT and staff arrangements so that they can operate more than one control/co0ordination centre and manage any events required.

18Arrangements ensure that decisions are recorded and meetings are minuted during an emergency or business continuity incident.

Y Y Y Y Y Y Y Y Y Y YLoggist Training for CCG staff Lisa Tempest By 30/4/15

19Arrangements detail the process for completing, authorising and submitting situation reports (SITREPs) and/or commonly recognised information pictures (CRIP) / common operating picture (COP) during the emergency or business continuity incident response.


20 Arrangements to have access to 24-hour specialist adviser available for incidents involving firearms or chemical, biological, radiological, nuclear, explosive or hazardous materials, and support strategic/gold and tactical/silver command in managing these events.

Both acute and ambulance providers are expected to have in place arrangements for accessing specialist advice in the event of incidents chemical, biological, radiological, nuclear, explosive or hazardous materials Y Y

N/A

21 Arrangements to have access to 24-hour radiation protection supervisor available in line with local and national mutual aid arrangements;

Both acute and ambulance providers are expected to have arrangements in place for accessing specialist advice in the event of a radiation incidentY Y

N/A

Duty to communicate with the public

• Ensuring accountaable emergency officer's commitment to the plans and giving a member of the executive management board and/or governing body overall responsibility for the Emergeny Preparedness Resilience and Response, and Business Continuity Management agendas• Having a documented process for capturing and taking forward the lessons identified from exercises and emergencies, including who is responsible.• Appointing an emergency preparedness, resilience and response (EPRR) professional(s) who can

demonstrate an understanding of EPRR principles.• Appointing a business continuity management (BCM) professional(s) who can demonstrate an understanding of BCM principles.• Being able to provide evidence of a documented and agreed corporate policy or framework for building resilience across the organisation so that EPRR and Business continuity issues are mainstreamed in processes, strategies and action plans across the organisation. • That there is an approporiate budget and staff resources in place to enable the organisation to meet the requirements of these core standards. This budget and resource should be proportionate to the size and scope of the organisation.

• Being able to provide documentary evidence of a regular process for monitoring, reviewing and updating

and approving risk assessments• Version control

• Consulting widely with relevant internal and external stakeholders during risk evaluation and analysis

stages• Assurances from suppliers which could include, statements of commitment to BC, accreditation, business

continuity plans.• Sharing appropriately once risk assessment(s) completed

8

Effective arrangements are in place to respond to the risks the organisation is exposed to, appropriate to the role, size and scope of the organisation, and there is a process to ensure the likely extent to which particular types of emergencies will place demands on your resources and capacity.

Have arrangements for (but not necessarily have a separate plan for) some or all of the following (organisation dependent) (NB, this list is not exhaustive):

Risk assessments should take into account community risk registers and at the very least include reasonable worst-case scenarios for:• severe weather (including snow, heatwave, prolonged periods of cold weather and flooding);

• staff absence (including industrial action);

• the working environment, buildings and equipment (including denial of access);

• fuel shortages;

• surges and escalation of activity;

• IT and communications;

• utilities failure;

• response a major incident / mass casualty event

• supply chain failure; and

• associated risks in the surrounding area (e.g. COMAH and iconic sites)

There is a process to consider if there are any internal risks that could threaten the performance of the organisation’s functions in an emergency

as well as external risks eg. Flooding, COMAH sites etc.

Relevant plans:• demonstrate appropriate and sufficient equipment (inc. vehicles if relevant) to deliver the required responses• identify locations which patients can be transferred to if there is an incident that requires an evacuation;

• outline how, when required (for mental health services), Ministry of Justice approval will be gained for an

evacuation; • take into account how vulnerable adults and children can be managed to avoid admissions, and include appropriate focus on providing healthcare to displaced populations in rest centres;• include arrangements to co-ordinate and provide mental health support to patients and relatives, in collaboration with Social Care if necessary, during and after an incident as required;• make sure the mental health needs of patients involved in a significant incident or emergency are met and that they are discharged home with suitable support• ensure that the needs of self-presenters from a hazardous materials or chemical, biological, nuclear or

radiation incident are met.• for each of the types of emergency listed evidence can be either within existing response plans or as stand

alone arrangements, as appropriate.


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22 Arrangements demonstrate warning and informing processes for emergencies and business continuity incidents. Arrangements include a process to inform and advise the public by providing relevant timely information about the nature of the unfolding event and about: - Any immediate actions to be taken by responders- Actions the public can take- How further information can be obtained- The end of an emergency and the return to normal arrangementsCommunications arrangements/ protocols: - have regard to managing the media (including both on and off site implications)- include the process of communication with internal staff - consider what should be published on intranet/internet sites- have regard for the warning and informing arrangements of other Category 1 and 2 responders and other organisations.

Y Y Y Y Y Y Y Y Y Y

• Have emergency communications response arrangements in place • Be able to demonstrate that you have considered which target audience you are aiming at or addressing in publishing materials (including staff, public and other agencies)• Communicating with the public to encourage and empower the community to help themselves in an emergency in a way which compliments the response of responders• Using lessons identified from previous information campaigns to inform the development of future campaigns• Setting up protocols with the media for warning and informing• Having an agreed media strategy which identifies and trains key staff in dealing with the media including nominating spokespeople and 'talking heads'.• Having a systematic process for tracking information flows and logging information requests and being able to deal with multiple requests for information as part of normal business processes.• Being able to demonstrate that publication of plans and assessments is part of a joined-up communications strategy and part of your organisation's warning and informing work.


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23Arrangements ensure the ability to communicate internally and externally during communication equipment failures

Y Y Y Y Y Y Y Y Y Y Y• Have arrangements in place for resilient communications, as far as reasonably practicable, based on risk.

Information Sharing – mandatory requirements

24

Arrangements contain information sharing protocols to ensure appropriate communication with partners. These must take into account and inclue DH (2007) Data Protection and Sharing – Guidance for Emergency Planners and Responders or any

guidance which supercedes this, the FOI Act 2000, the Data Protection Act 1998 and the CCA 2004 ‘duty to communicate with the public’, or

subsequent / additional legislation and/or guidance.


• Where possible channelling formal information requests through as small as possible a number of knownroutes. • Sharing information via the Local Resilience Forum(s) / Borough Resilience Forum(s) and other groups.• Collectively developing an information sharing protocol with the Local Resilience Forum(s) / BoroughResilience Forum(s). • Social networking tools may be of use here.

Co-operation

25Organisations actively participate in or are represented at the Local Resilience Forum (or Borough Resilience Forum in London if appropriate) Y Y Y Y Y Y Y Y Y Y

26Demonstrate active engagement and co-operation with other category 1 and 2 responders in accordance with the CCA

Y Y Y Y Y Y Y Y Y Y

27 Arrangements include how mutual aid agreements will be requested, co-ordinated and maintained. NB: mutual aid agreements are wider than staff and should include equipment, services and supplies. Y Y Y Y Y Y Y Y Y Y

28Arrangements outline the procedure for responding to incidents which affect two or more Local Health Resilience Partnership (LHRP) areas or Local Resilience Forum (LRF) areas.

Y Y Y YN/A

29 Arrangements outline the procedure for responding to incidents which affect two or more regions. Y Y Y N/A

30Arrangements demonstrate how organisations support NHS England locally in discharging its EPRR functions and duties

Examples include completing of SITREPs, cascading of information, supporting mutual aid discussions, prioritising activities and/or services etc. Y Y Y Y Y Y Y

31Plans define how links will be made between NHS England, the Department of Health and PHE. Including how information relating to national emergencies will be co-ordinated and shared Y

N/A

32Arrangements are in place to ensure an Local Health Resilience Partnership (LHRP) (and/or Patch LHRP for the London region) meets at least once every 6 months Y Y

N/A

33Arrangements are in place to ensure attendance at all Local Health Resilience Partnership meetings at a director level Y Y Y Y Y Y Y Y Y

Training And Exercising

34

Arrangements include a training plan with a training needs analysis and ongoing training of staff required to deliver the response to emergencies and business continuity incidents

• Staff are clear about their roles in a plan

• Training is linked to the National Occupational Standards and is relevant and proportionate to the organisation type. • Training is linked to Joint Emergency Response Interoperability Programme (JESIP) where appropriate

• Arrangements demonstrate the provision to train an appropriate number of staff and anyone else for whom training would be appropriate for the purpose of ensuring that the plan(s) is effective• Arrangements include providing training to an appropriate number of staff to ensure that warning and informing arrangements are effective


Training Needs Analysis and training plans for CCG staff participating in on-call rota to be developed in conjunciton with NHS England DDT Area Team


By 30/4/15

35

Arrangements include an ongoing exercising programme that includes an exercising needs analysis and informs future work.

• Exercises consider the need to validate plans and capabilities

• Arrangements must identify exercises which are relevant to local risks and meet the needs of the organisation type and of other interested

parties.• Arrangements are in line with NHS England requirements which include a six-monthly communications test, annual table-top exercise and live exercise at least once every three years.• If possible, these exercises should involve relevant interested parties. • Lessons identified must be acted on as part of continuous improvement.• Arrangements include provision for carrying out exercises for the purpose of ensuring warning and informing arrangements are effective


36Demonstrate organisation wide (including oncall personnel) appropriate participation in multi-agency exercises

Y Y Y Y Y Y Y Y Y

37Preparedness ensures all incident commanders (oncall directors and managers) maintain a continuous personal development portfolio demonstrating training and/or incident /exercise participation. Y Y Y Y Y Y Y Y Y

CCG staff participating in on-call rota to participate in training exercises


Ongoing

• Attendance at or receipt of minutes from relevant Local Resilience Forum(s) / Borough Resilience Forum(s)

meetings, that meetings take place and memebership is quorat.• Treating the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience

Partnership as strategic level groups• Taking lessons learned from all resilience activities• Using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience

Partnership to consider policy initiatives• Establish mutual aid agreements

• Identifying useful lessons from your own practice and those learned from collaboration with other responders and strategic thinking and using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience Partnership to share them with colleagues• Having a list of contacts among both Cat. 1 and Cat 2. responders with in the Local Resilience Forum(s) / Borough Resilience Forum(s) area

• Taking lessons from all resilience activities and using the Local Resilience Forum(s) / Borough Resilience Forum(s) and the Local Health Resilience Partnership and network meetings to share good practice• Being able to demonstrate that people responsible for carrying out function in the plan are aware of their roles• Through direct and bilateral collaboration, requesting that other Cat 1. and Cat 2 responders take part in your exercises• Refer to the NHS England guidance and National Occupational Standards For Civil Contingencies when identifying training needs.• Developing and documenting a training and briefing programme for staff and key stakeholders• Being able to demonstrate lessons identified in exercises and emergencies and business continuity incidentshave been taken forward• Programme and schedule for future updates of training and exercising (with links to multi-agency exercising

where appropriate)• Communications exercise every 6 months, table top exercise annually and live exercise at least every three

years

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Red = Not compliant with core standard and not in the EPRR work plan within the next 12 months. Amber = Not compliant but evidence of progress and in the EPRR work plan for the next 12 months.Green = fully compliant with core standard.


Q Core standard Clarifying information Evidence of assurance

Preparedness38 There is an organisation specific HAZMAT/ CBRN plan (or dedicated annex) Arrangements include:

• command and control interfaces

• tried and tested process for activating the staff and equipment (inc. Step 1-2-3 Plus)

• pre-determined decontamination locations and access to facilities

• management and decontamination processes for contaminated patients and fatalities in line

with the latest guidance• communications planning for public and other agencies

• interoperability with other relevant agencies

• access to national reserves / Pods

• plan to maintain a cordon / access control

• emergency / contingency arrangements for staff contamination

• plans for the management of hazardous waste

• stand-down procedures, including debriefing and the process of recovery and returning to

(new) normal processes• contact details of key personnel and relevant partner agencies

Y Y Y Y Y • Being able to provide documentary evidence of a regular process for monitoring,

reviewing and updating and approving arrangements• Version control

39 Staff are able to access the organisation HAZMAT/ CBRN management plans. Decontamination trained staff can access the plan Y Y Y Y Y • Site inspection

• IT system screen dump

40 HAZMAT/ CBRN decontamination risk assessments are in place which are appropriate to the organisation.

• Documented systems of work

• List of required competencies

• Impact assessment of CBRN decontamination on other key facilities

• Arrangements for the management of hazardous waste

Y Y Y Y Y • Appropriate HAZMAT/ CBRN risk assessments are incorporated into EPRR risk

assessments (see core standards 5-7)

41 Rotas are planned to ensure that there is adequate and appropriate decontamination capability available 24/7.

Y Y • Resource provision / % staff trained and available

• Rota / rostering arrangements

42 Staff on-duty know who to contact to obtain specialist advice in relation to a HAZMAT/ CBRN incident and this specialist advice is available 24/7.

• For example PHE, emergency services. Y Y Y Y Y • Provision documented in plan / procedures

• Staff awareness

Decontamination Equipment

43 There is an accurate inventory of equipment required for decontaminating patients in place and the organisation holds appropriate equipment to ensure safe decontamination of patients and protection of staff.

• Acute and Ambulance service providers - see Equipment checklist overleaf on separate tab• Community, Mental Health and Specialist service providers - see Response Box in 'Preparation for Incidents Involving Hazardous Materials - Guidance for Primary and Community Care Facilities' (NHS London, 2011) (found at: http://www.londonccn.nhs.uk/_store/documents/hazardous-material-incident-guidance-for-primary-and-community-care.pdf)• Initial Operating Response (IOR) DVD and other material: http://www.jesip.org.uk/what-will-jesip-do/training/

Y Y Y Y Y • completed inventory list (see overleaf) or Response Box (see Preparation for

Incidents Involving Hazardous Materials - Guidance for Primary and Community Care Facilities (NHS London, 2011))

44 The organisation has the expected number of PRPS suits (sealed and in date) available for immediate deployment should they be required (NHS England published guidance (May 2014) or subsequent later guidance when applicable)

There is a plan and finance in place to revalidate (extend) or replace suits that are reaching the end of shelf life until full capability of the current model is reached in 2017

Y Y

45 There are routine checks carried out on the decontamination equipment including: A) SuitsB) TentsC) PumpD) RAM GENE (radiation monitor)E) Other decontamination equipment

There is a named role responsible for ensuring these checks take place Y Y

46 There is a preventative programme of maintenance (PPM) in place for the maintenance, repair, calibration and replacement of out of date Decontamination equipment for: A) SuitsB) TentsC) PumpD) RAM GENE (radiation monitor)E) Other equipment

Y Y

47 There are effective disposal arrangements in place for PPE no longer required. (NHS England published guidance (May 2014) or subsequent later guidance when applicable) Y Y

Training48 The current HAZMAT/ CBRN Decontamination training lead is appropirately trained to

deliver HAZMAT/ CBRN trainingY Y

49 Internal training is based upon current good practice and uses material that has been supplied as appropriate.

• Documented training programme

• Primary Care HAZMAT/ CBRN guidance

• Lead identified for training

• Established system for refresher training so that staff that are HAZMAT/ CBRN

decontamination trained receive refresher training within a reasonable time frame (annually). • A range of staff roles are trained in decontamination techniques

• Include HAZMAT/ CBRN command and control training

• Include ongoing fit testing programme in place for FFP3 masks to provide a 24/7 capacity and

capability when caring for patients with a suspected or confirmed infectious respiratory virus• Including, where appropriate, Initial Operating Response (IOR) and other material:

http://www.jesip.org.uk/what-will-jesip-do/training/

Y Y Y Y Y • Show evidence that achievement records are kept of staff trained and refresher

training attended• Incorporation of HAZMAT/ CBRN issues into exercising programme

50 The organisation has sufficient number of trained decontamination trainers to fully support it's staff HAZMAT/ CBRN training programme.

Y Y

51 Staff that are most likely to come into first contact with a patient requiring decontamination understand the requirement to isolate the patient to stop the spread of the contaminant.

• Including, where appropriate, Initial Operating Response (IOR) and other material:

http://www.jesip.org.uk/what-will-jesip-do/training/ • Community, Mental Health and Specialist service providers - see Response Box in 'Preparation

for Incidents Involving Hazardous Materials - Guidance for Primary and Community Care Facilities' (NHS London, 2011) (found at: http://www.londonccn.nhs.uk/_store/documents/hazardous-material-incident-guidance-for-primary-and-community-care.pdf)

Y Y Y Y Y

Hazardous materials (HAZMAT) and chemical, biological, radiolgocial and nuclear (CBRN) response core standards (NB this is designed as a stand alone sheet)

HAZMAT CBRN equipment list - for use by Acute and Ambulance service providers in relation to Core Standard 43.

No Equipment Equipment model/ generation/ details etc. Self assessment RAGRed = Not in place and not in the EPRR work plan to be in place within the next 12 months. Amber = Not in place and in the EPRR work plan to be in place within the next 12 months.Green = In place.

EITHER: Inflatable mobile structureE1 Inflatable frame

E1.1 LinerE1.2 Air inflator pumpE1.3 Repair kit

E1.2 Tethering equipment

OR: Rigid/ cantilever structureE2 Tent shell

OR: Built structureE3 Decontamination unit or room

AND: E4 Lights (or way of illuminating decontamination area if dark)E5 Shower headsE6 Hose connectors and shower headsE7 Flooring appropriate to tent in use (with decontamination basin if

needed)E8 Waste water pump and pipeE9 Waste water bladder

PPE for chemical, and biological incidentsE10 The organisation (acute and ambulance providers only) has the

expected number of PRPS suits (sealed and in date) available for immediate deployment should they be required. (NHS England published guidance (May 2014) or subsequent later guidance when applicable).

E11 Providers to ensure that they hold enough training suits in order to facilitate their local training programmeAncillary

E12 A facility to provide privacy and dignity to patientsE13 Buckets, sponges, cloths and blue roll

E14 Decontamination liquid (COSHH compliant)

E15 Entry control board (including clock)

E16 A means to prevent contamination of the water supplyE17

Poly boom (if required by local Fire and Rescue Service)

E18 Minimum of 20 x Disrobe packs or suitable equivalent (combination of sizes)

E19 Minimum of 20 x re-robe packs or suitable alternative (combination of sizes - to match disrobe packs)

E20 Waste binsDisposable gloves

E21 Scissors - for removing patient clothes but of sufficient calibre to execute an emergency PRPS suit disrobe

E22 FFP3 masksE23 Cordon tapeE24 Loud HailerE25 SignageE26 Tabbards identifying members of the decontamination teamE27 Chemical Equipment Assessement Kits (ChEAKs) (via PHE)

(replaced Toxboxes in 2010)Radiation

E28 RAM GENE monitors (x 2 per Emergency Department and/or HART team)

E29 Hooded paper suitsE30 Goggles

E31 FFP3 Masks - for HART personnel onlyE32 Overshoes & Gloves

Version 1 October 2014

Darlington Clinical Commissioning Group

EPRR Core Standards Action Plan

Core Standard

Clarifying Information

Gap Identified

Actions to be Taken

Lead

Timescale

4 The accountable emergency officer will ensure that the Board and/or Governing Body will receive as appropriate reports, no less frequently than annually, regarding EPRR, including reports on exercises undertaken by the organisation, significant incidents, and that adequate resources are made available to enable the organisation to meet the requirements of these core standards.

After every significant incident a report should go to the Board/ Governing Body (or appropriate delegated governing group) . Must include information about the organisation's position in relation to the NHS England EPRR core standards self- assessment.

Business Continuity Plan has not been approved by Governing Body Annual updates to Governing Body not scheduled

Plan to be presented to Governing Body for approval Updates to be included in the Governing Body forward plan

Lisa Tempest Lisa Tempest

2 December 2014 By 30/11/14

11 Arrangements include how to continue your organisation’s prioritised activities (critical activities) in the event of an emergency or business continuity incident insofar as is

Decide: - Which activities and functions are critical - What is an acceptable level of service in the event of different types of emergency for all your services Identifying in your risk assessments in what way emergencies and business

Recovery plans not in place for corporate functions

Develop recovery plans for all corporate functions based on Business Impact Assessments

Lisa Tempest (CCG)

To be completed by 31/12/14


practical.

continuity incidents threaten the performance of your organisation’s functions, especially critical activities

16 Those on-call must meet identified competencies and key knowledge and skills for staff.

NHS England published competencies are based upon National Occupation Standards.

CCG staff who participate in on-call rota have not been formally assessed against required competencies and no formal training has been provided

NHS England DDT Area Team to provide details of competencies and to support CCG in assessment of on-call staff

Lisa Tempest (CCG) Andy Summerbell (NHS England)


18 Arrangements ensure that decisions are recorded and meetings are minuted during an emergency or business continuity incident.

CCG staff have not received appropriate training in order to be able to document decisions made during incidents

Identify CCG staff who require loggist training and schedule dates for this to take place – NHS England to provide details of available training courses

Lisa Tempest (CCG)


34 Arrangements include a training plan with a training needs analysis and ongoing training of staff required to deliver the response to emergencies and business continuity incidents

- Staff are clear about their roles in a plan - Training is linked to the National Occupational Standards and is relevant and proportionate to the organisation type. - Training is linked to Joint Emergency Response Interoperability Programme (JESIP) where appropriate - Arrangements demonstrate the provision to train an appropriate number of staff and anyone else for whom training would be appropriate for the purpose of ensuring that the plan(s) is effective - Arrangements include providing training to an appropriate number of staff to ensure that warning and

No training needs assessment has been performed for CCG staff participating in on-call rota. No formal emergency response training has been undertaken by these staff.

Training needs analysis to be performed for relevant staff and results used to inform training plan. NHS England DDT Area Team to provide support and identify appropriate training sessions.

Lisa Tempest (CCG) Andy Summerbell (NHS England)



informing arrangements are effective

36 Demonstrate organisation wide (including on-call personnel) appropriate participation in multi-agency exercises

CCG staff participating in on-call rota have not been involved in local exercises

Local Health Resilience Partnership Forum

Lisa Tempest (CCG)

Ongoing

Document Management

Version Date Presented to (meeting)

Commissioning Consideration

Finance Consideration

Clinical Sponsor

Approved

2nd December 2014

NHSDCCG/GB/2014/December/14/70


Governing Body

Winter Plan and System Resilience 1. Introduction The purpose of this report is to provide an update on system resilience funding and winter planning following an initial report produced in August 2014. The role of the System Resilience Group (SRG) is to support and drive the delivery of operational resilience and capacity ensuring quality, performance and financial balance. This group will be the forum where capacity planning and operational delivery across the health and social care system is coordinated. Bringing together both elements of elective and urgent care within one planning process underlining the importance of whole system resilience and recognising that both parts need to be addressed simultaneously in order for local health and care systems to operate effectively in delivering year round services for patients.

In June 2014 the Planning for Operational Resilience in Health and Social Care during 2014/15 was published by NHS England, NHS Trust Development Authority, Monitor and the Association of Directors of Adult Social Services. During the summer of 2014 organisations involved in the delivery of urgent care and emergency care across County Durham and Darlington were invited to submit bids to the Resilience Fund, adding capacity to the system to ensure smooth delivery of services to patients over the winter period. As a general principle County Durham and Darlington SRG supported the bids with an expectation that Trusts deliver on the projects they have submitted bids for. Organisations were asked to consider that the majority of their proposals were already funded through their core funding, existing contract agreements (e.g PbR) or through existing capital programmes. A robust analysis of 13\14 winter activity and performance was carried out and each provider submitted potential schemes based on the winter analysis of 13/14 facilitating additional capacity to be put in place.

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The timeline followed by County Durham and Darlington SRG for this process is shown in the diagram below:

2. Implications and risks 2.1 Award of Resilience Funds – Tranche 1 On 11th July 2014, an Extraordinary Systems Resilience Group meeting was held to determine the outcome of the bids submitted. During this meeting the Clinical Commissioning Groups recommended and the SRG, with the exception of County Durham and Darlington NHS Foundation Trust agreed to allocate the resilience funding on a fair shares basis across all major providers. Clinical Commissioning Groups agreed the allocation and their Executive meetings received a report on the outcome of the Extraordinary Systems Resilience Group meeting. During this meeting County Durham and Darlington SRG agreed that any remaining monies be allocated to a communications/media campaign around winter and better use of health care resources. The table below shows the overall funding allocations by Clinical Commissioning Group and Provider. The total amount allocated for Tranche 1 was £4,698,000.

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2.2 Award of Resilience Funds – Tranche 2 In October 2014 the Area Team advised all three Clinical Commissioning Groups within County Durham and Darlington that additional money may be available. The Area Team asked for details of the shortfall between original bids made by organisations and actual allocations made on the fair shares basis. This was provided by North of England Commissioning Support Unit to the Area Team for;

County Durham and Darlington NHS Foundation Trust; North Tees and Hartlepool NHS Foundation Trust; City Hospitals Sunderland NHS Foundation Trust; and Tees, Esk and Wear Valleys NHS Foundation Trust.

The table below shows the total value of Trusts original bids, their fair shares allocation for Tranche 1 monies and the shortfall.

Organisation Value of Bid Total Funds

Allocated by SRG Shortfall CDDFT Non - Elective

£3,639,589

£1,627,000

£2,012,589

TEWV £1,224,000

£536,000

£688,000

NTHFT (Elective* and Non Elective)

£404,555

£171,000

£233,555

CHSFT (Non Elective)

£343,536

£201,000

£142,536

Total £5,611,680

£2,535,000

£3,076,680

* NTHFT Elective Projects 15 and 16 totalling £25,170

As a result of this process the NHS England allocated additional monies as follows:

Organisation

Tranche 2 Resilience Monies Allocation

CDDFT (Non – Elective) £1,781,141.00

TEWV £ 608,880.00

Total Tranche 2 £2,390,021.00 For clarity, including Tranche 1 and Tranche 2 monies County Durham and Darlington NHS Foundation Trust have been awarded a total of £3,784,141 from the Resilience Fund. Tees, Esk and Wear Valleys NHS Foundation Trust have been awarded Tranche 2 monies with a focus on Durham and Darlington but not exclusively so it can be used wider, and for the use of the activity and money to be managed via the SRG tracker for Durham and Darlington. 2.3 Award of Resilience Funds – Tranche 3 Separately a further Tranche of money has been made available for mental health services with a specific focus on crisis assessment and Early Intervention Psychosis (EIP).

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Original bids from County Durham and Darlington SRG consisted of the following during November 2014:

A further two proposals amounting to £600,000 for the ‘improved service capacity for the Crisis Team’ and ‘improved service capacity for the Acute Liaison Service’

A range of services specifically targeted at addressing gaps within Early Intervention Psychosis totalling £312,918

Recently the Area Team have confirmed that County Durham and Darlington Systems Resilience group will receive £387,000 from Tranche 3 of the Resilience Fund. The Area Team have asked for local prioritisation of their original Tranche 3 bid with a need to focus on Early Intervention Psychosis in line with NICE guidance and the access and waiting standard will be introduced in 2015/16 which expects "More than 50% of people experiencing a first episode of psychosis will be treated with a NICE approved care package within two weeks of referral. This process is currently ongoing and Clinical Commissioning Groups will shortly be asked to approve suggested priorities prior submission to the Area Team. 2.4 Monitoring and Accountability The SRG have implemented monthly monitoring of the system resilience plan & resilience funding allocated in accordance with the NHS England resilience monies tracker. In addition all recipients of resilience monies will be monitored through contract management arrangements as well as being required to complete a full evaluation of initiatives against agreed Key Performance Indicators and outcomes, for the SRG in April 2015. To facilitate this process North of England Commissioning Support Unit are co-ordinating responses from organisations who have been allocated resilience monies to ensure that the tracker is kept up to date and submitted in accordance with Area Team deadlines. The resilience tracker will be shared with the SRG on a monthly basis, providing an opportunity to discuss progress, any outstanding data required and provide a checking mechanism that the money allocated is being spent in accordance with local resilience plan. 3. Recommendations NHS Darlington Clinical Commissioning Group Governing Body is asked to receive this report for information. 4. Author, Clinical Sponsor and Executive Lead Author: Anita Porter Title: Senior Commissioning Support Officer, NECS Clinical Sponsor: Andrea Jones Title: Clinical Chair DCCG Executive Lead: Jackie Kay Title: Assistant Chief Officer DCCG Date: 24th November 2014

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Purpose of Paper Information Sharing X





Commissioning the right services in the right place

Security safe high quality services X



Financial Implications






Implication for Partners

Equality and Diversity

Attachment(s) None

2 December 2014



Governing Body

Tees, Esk and Wear Valleys NHS Foundation Trust Quality Strategy 2014-19

1. Introduction The Tees, Esk and Wear Valleys NHS Foundation Trust Quality Strategy for 2014-19 is presented to Governing Body for information. 2. Implications and risks The Trust states that its purpose is to improve lives by minimising the impact of mental

ill health or a learning disability, and to help people lead a healthy, self determined life.

The Quality Goals and Objectives are: Everyone who uses the services has a positive experience and feeds back that they

were listened to, engaged in their care and treated with compassion, respect and dignity

We will reduce to a minimum the harm that people who use our services suffer We will deliver excellent outcomes as reported by patients and clinicians Our staff feel positively engaged with the trust The strategy outlines how these goals will be delivered and measured in terms of the 3 domains of quality: patient experience, patient safety and clinical effectiveness. 3. Recommendations The NHS Darlington Clinical Commissioning Group Governing Body is asked to note the content of the strategy. 4. Author, Clinical Sponsor and Executive Lead Author: Gill Findley Title: Director of Nursing Clinical Sponsor: Gill Findley Title: Chief Nurse Executive Lead: Gill Findley Title: Chief Nurse Date: 27.10.14

2

Purpose of Paper Information Sharing x





x




None noted


Included in the strategy

Financial Implications None noted


None noted


Service Users were included in the development of the strategy


Clinicians in TEWV and CCGs were invited to take part in the strategy development


Nothing new noted


compliant

Implication for Partners None noted

Equality and Diversity Nothing noted

Attachment(s) TEWV Quality Strategy

DARLINGTON CLINICAL COMMISSIONING GROUP FORMAL EXECUTIVE

Tuesday 26th August 2014

09.00 – 10.15

Board Room, Dr Piper House

CONFIRMED MINUTES

Present: Lisa Tempest (Chair) Chief Finance Officer, DCCG Gill Findley Director of Nursing, DCCG Richard Harker GP Quality Lead, DCCG Jackie Kay Assistant Chief Officer, DCCG In attendance: Ada Burns Chief Executive, DBC Miriam Davidson Director of Public Health, DBC Murray Rose Director of People, DBC Rachael White Administration Assistant, DCCG Cath Whitehead Assistant Director, DBC Elizabeth Davison Assistant Director, DBC

Action

Exec/14/129 Apologies for Absence Apologies were received for: Martin Phillips Chief Officer, DCCG Andrea Jones Chair, DCCG

Exec/14/130 Declarations of Interest No declarations were submitted.

Exec/14/131 Minutes of the last Formal Executive meeting – 22 July 2014 The minutes of the meeting were agreed as an accurate record. Matters Arising Gill Findley advised that the Care Quality Commission (CQC) report following the visit in July was still awaited.

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Exec/14/132 Action Log 1. Minor Ailments Scheme – Jackie Kay advised that the posters were to be delivered to community pharmacies and would be included in the Northern Echo and Darlington Together magazine. 2. Care Homes – The Committee were advised that the care home pilot was being aligned to the Multi-Disciplinary Team (MDT) work and a meeting was to be scheduled in the near future to share the information from the evaluation. In regards to 111, Gill advised that a review of the current clinical input into 111 for the Clinical Commissioning Groups (CCG) was to be undertaken. 3. Risk 975 – Lisa Tempest reported that the Local Authority were now involved and the meeting had taken place with the relatives of the care home the previous week. The situation would remain on the risk register. 4. Community Matrons – The notice had been served and work would now be linked with the MDT Frail and Elderly work. 5. Procurement and Evaluation Strategy – This was not considered as an action for the Executive. 6. HELS Review – Discussed at agenda item Exec/14/143. 7. Paediatric Speech and Language Therapy Services – Not an action and to be removed. 8. Safeguarding Children Inspection – As above, Gill Findley advised that the CQC report was still awaited. 9. Risk Register – To be removed from the action log. 10. PBR Management Framework Presentation – Glenda had circulated it to the group. 11. Q1 Delivery Report – No feedback had been received. Ada Burns advised that there were aspects of the Chief Officers minutes from the meeting on the 5th August that would be beneficial for the Executive to see and also confirm the information was correct. Ada to circulate to the group.

AB

Exec/14/133 Clinical Quality Update The Executive were provided with a verbal update from Gill

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Findley which highlighted any issues currently arising from the Trusts. Gill reported that County Durham and Darlington Foundation Trust (CDDFT) were on trajectory for C.Diff however had reported a case of MRSA. Route cause analysis had been undertaken for each case and there had been no trends or similarities. The Liverpool Care Pathway had now been phased out and confirmation had been received by all providers that provisions were in place and the standard of care provided would not be affected. In regards to patient safety, there was an issue with the number of falls being reported at CDDFT. Gill advised that there was a lot of work being undertaken to resolve this which was linking in with staffing levels and serious incidents. Concern was expressed that the number of falls reported by the trust had been an ongoing issue that never seemed to be resolved. Gill reported that falls would now be included in CQUIN targets and a target of 50% reduction had been requested. Training would also be provided for staff for patients with sensory impairments. Jackie Kay advised that at the Quality and Innovation Committee the previous week Sarah Dodsworth, Practice Nurse Representative, had queried the reasoning behind the number of staff on duty being noted outside the wards as in once incidence there was 1 nurse to 13 patients which was a concern. Gill advised that this was part of a national scheme that was being enforced and the number of staff who were on duty were to be noted as well as the number of staff expected to be on duty. Gill would speak to Sarah to gain further information. The Executive noted the information provided.

GF

Exec/14/134 Finance Report The Executive considered the report which provided an update on the financial performance of NHS Darlington CCG as well as an indication of the outturn position for the 2014/15 financial year. Lisa Tempest highlighted that the budget was currently overspent on Acute Services relating to the CDDFT contract and work was on-going to scrutinise the activity and cost data received from providers. The contract with North Tees and Hartlepool Hospital was also over budget and unfortunately in the contract arrangements the Clinical Commissioning Group (CCG) would not be protected under a cap and collar arrangement.

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In regards to the CDDFT contract, an agreement was still to be made and the contract dispute process was to be followed starting with mediation. If this provided unsuccessful, the CCG would need to then go through arbitration. The issues being disputed related to contract values, SeQiHS indicators, penalties and how money would be reinvested. As there was no timescale at the moment, a Payment by Results arrangement would continue. Following query, the Committee were advised that the situation did not seem to be having a negative effect on the work currently being undertaken e.g. transformation and the Multi-Disciplinary Team work. However the CCG had to be mindful of the elements it was involved in e.g. system resilience were some changes in behaviour had been noted. Lisa advised that legal support was being provided by the North of England Commissioning Support Unit (NECS) and the potential risk of having to pay over and above what was affordable as a result of arbitration had been highlighted to NHS England. The Executive noted the contents of the report and the information provided.

Exec/14/135

NECS Performance Update The Executive were advised that due to annual leave a NECS Performance meeting had not taken place since the previous Committee meeting however if there were any issues officers were asked to feedback to Lisa Tempest who would raise them at the next meeting in September. Lisa advised that the issues log had now been reinstated and would be circulated with Formal Executive agenda papers.

Exec/14/136

Management of Risks The Executive considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Risk 975 - Negative impact on patients and CCG of closure of St Johns care facility – Lisa Tempest reported that the meeting with relatives of the patients currently residing in St John’s had taken place the previous week and representatives from the CCG, NECS, Local Authority and staff from St John’s were present. A group of relative agreed that they would like to have patients moved forward as a group to another facility if possible and also have staff from St John’s moved with them if needed. The CCG would continue to support the transition of patients alongside the Continuing Health Care team at NECS. Lisa would update the risk register following the meeting.

LT

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Risk 969 - No Business Continuity Plan in place – Lisa advised that she would make contact with NECS colleagues to discuss. Risk 1063 - MSK ICATS service not performing in accordance with specification – Lisa advised that the contract with Virgin Care had been extended for one year and that the procurement process was underway and it was hoped that provision would be in place by this time in 2015. Risk 967 - Failure to deliver BCF plans – Jackie Kay advised that the register would be updated with details of the resubmission, requirements and check points that the NHS England had put in place. Risk 1022 - Reconfiguration of breast services within CDDFT – Richard Harker advised that meetings were still taking place to discuss the issue regarding breast services and the Trust had agreed to reopen outpatient services at Darlington with immediate effect so that follow up appointments could be held there. Gill Findley advised that a position statement could be produced for the Committee and presented at the following meeting. Risk 965 - Absence of Tier 3 services for Obesity management of adults – Miriam Davidson advised that a report would be brought to the Joint Management Team meeting in September. Risk 966 - Local Authority changing commissioning arrangements – Murray Rose advised that a Memorandum of Understanding had been drafted and both Martin Phillips and Ada Burns had reviewed it and could be brought to the Committee.

LT

GF

MR

Exec/14/138

Quality Reporting Arrangements The Executive considered the report which outlined a new schedule for reporting matters relating to quality throughout the CCG. Gill Findley advised that there had been a review of the reports currently being produced and NECS were spending a significant amount of time producing reports that were not really fit for purpose. A draft new style of report was shared at the Quality and Innovation Committee and positive feedback was received. It was felt that the indicative timetable in the paper could be extended to include other CCG meetings to make a forward planner for the CCG. Jackie Kay to include items for Governing Body meetings and Lisa Tempest to draft items for the Finance Committee.

JK LT

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The Executive noted the report and approved the proposed changes.

Exec/14/137

Mental Health Implementation Plan The Committee were advised that representation from NECS was no longer available due to unforeseen circumstances. The Executive considered the report which provided an update and sought approval of the Mental Health Implementation Plan for Darlington. Murray Rose advised that since the report had been submitted for circulation some amendments had been made/suggested to the document:

There was no mention of the joint partnership between the CCG and Darlington Borough Council

A breakdown of what the budget had been spent on be included

Suggestions made by the Unit of Planning group were to be included.

It was also felt that the Police should be included in the action plan as they had been involved in aspects of the work and that benchmarking data could be included to show comparison with others when looking into future projects/schemes. It was suggested that a ‘Plan on a Page’ document would also be useful. The Executive agreed to the document subject to the necessary amendments being made.

Exec/14/139 System Resilience Bids and Deployment of Unallocated Funding The Executive considered the report which provided an overview of the collaborative approach being taken by County Durham and Darlington System Resilience Group (SRG) to the document Planning for Operational Resilience in Health and Social Care during 2014/15 and to request CCG Executives to consider and approve the allocation of NHS England Resilience Funding. In developing the approach to the allocation of Resilience Funding for 2014/15 the CCGs recommended and the SRG, with the exception of CDDFT, agreed to allocate the resilience funding on a fair shares basis across all of our major providers. Details of the allocation were included in the report. NHS England had stated that if CDDFT did not sign up to the scheme the CCG would be compromised in terms of the overall system resilience allocation. Jackie Kay reported that the group had collated a number of ideas and work was under way in order to

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ensure the CCG had a list of priorities as the proposal needed to fit with NHS England’s expectations. Following query, Lisa Tempest advised that the allocation was worked out based on how each CCG spends its budget and because Darlington spend less on primary care than other CCG’s, a smaller allocation was offered. As a result a benchmarking exercise would be undertaken with the other CCG’s in the area in relation their budgets for primary care. The Executive noted the contents of the report and approved the allocation of funding.

Exec/14/140 Individual Packages of Care The Executive we presented with the report produced by the CHC team at NECS which provided a quarterly update on the cost and activity of individually funded packages of care for adults and children. This included information around continuing healthcare, funded nursing care, section 117, personal health budgets, restitution and children’s packages of care. Gill Findley advised that this was the first report received as the CCG had requested detailed information of the work that was being undertaken by CHC. The team hold a lot of information that it was felt would be beneficial for the CCG to understand especially when trying to address any issues. The Executive noted the contents of the report and agreed that the quarterly reports be presented to this committee for information purposes.

Exec/14/141 Procurement Progress Report The Executive reviewed the procurement progress report which provided details of the services being procured and the start dates of any completed procurements. Lisa Tempest highlighted that despite the initial procurement for Speech and Language Therapy being unsuccessful, the responses to the concerns raised were made and the standstill period was extended to midnight on 04 August 2014. The contract due to commence on 01 October 2014. Initial discussions had taken place in regards to the Musculo-Skeletal Therapy service and a draft timeline had been agreed. There was an intention to carry out market engagement to inform the service model and the aim was to have the provision in place for July 2015. Darlington Borough Council suggested that in order to provide

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consistency, if the CCG could keep them updated the same approach could be used for both. Lisa advised she would send the relevant contact details for the Procurement team to Cath Whitehead.

CW

Exec/14/142

Any New Risks Identified Jackie Kay advised that work was being undertaken with Darlington Borough Council around dermatology which currently fell within Public Health’s remit however as commissioners it was quite complicated in terms of understanding liabilities. Jackie to add this to the risk register.

JK

Exec/14/143 Any Other Business HELS Procurement Jackie Kay reported that a meeting had taken place the previous week whereby there were still some outstanding factors in the procurement e.g. the financial envelope for Darlington Borough Council and some aspects of the CCG’s finance that would be completed once an agreement had been reached. Darlington Borough Council colleagues were required to agree and sign off their financial envelope and due to the restricted timescale, delegated authority was needed for Lisa Tempest to authorise and sign off the procurement. The Executive agreed to the sign off of the procurement once complete.

Date and time next meeting Tuesday 23rd September 2014 commencing at 9am in the Boardroom, Dr Piper House.

Signed……………………… Chair.…Lisa Tempest……. Date………………………….


Tuesday 23 September 2014

9am – 10.15am

Ground Floor MR1 and 2, Dr Piper House

CONFIRMED MINUTES

Present: Martin Phillips (Chair) Chief Officer Gill Findley Director of Nursing Andrea Jones Chair Jackie Kay Assistant Chief Officer

Lisa Tempest Chief Finance Officer In attendance: Murray Rose Director of Commissioning Tracey Murray Procurement Officer (Item 153) Andrew Stainer Head of Transformation (Item 157, 158)

Action

Exec/14/144 Apologies for Absence Richard Harker, GP Quality Lead

Exec/14/145 Declarations of Interest Andrea Jones, Chair declared an interest in item 158 GP Choices Review

Exec/14/146 Minutes of the last Formal Executive meeting – 26 August 2014 Jackie Kay to be noted as Assistant Chief Officer. Subject to the above, the minutes of the meeting were agreed as an accurate record.

Exec/14/147 Action Log The action log was discussed and updated accordingly.

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Exec/14/148 Clinical Quality Update

The Executive received the Clinical Quality Update.

Exec/14/149 Finance Report The Executive considered a Finance Report. For the period ended 31 August 2014. LT advised that this report provided an update on the financial performance of NHS Darlington CCG was the same report received by Governing Body on 16th September. GF advised that she had recently attended BMI Woodland Quality and Review meeting. Being discussed was the volume of work from South Tees resulting in Saturday and Sunday working at BMI Woodland. This has recently come to an end. However, an approach has been made from CDDFT to carry out some work on their behalf. The Executive noted the need to ensure DCCG is only charged once for this work. The Executive received the Finance Report and noted its contents

Exec/14/150

NECS Performance Update The Executive considered the NECS SLA performance meeting action log, circulated for information. LT requested that anything highlighted by Executive members not on the action log be brought to her attention. The Executive discussed concerns about NECS staff not always attending meetings when required. JK advised on changes within the Communications and Engagement Team. Paul Parsons is now leading on Communications. Sam Harrison on Engagement. A number of temporary staff have now left the team. When asked when the SLA would be available, LT advised that she was aware that this was being developed. The Executive received the Update and detail of the SLA meeting action log and agreed to advise LT of any additions needed.

LT

Exec/14/151

Management of Risks The Executive considered the report which provided details of

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the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. In discussion it was agreed to include concerns around NECS staff not always attending meetings, discussed in the previous item, be included on the Risk Register. The Executive were reminded of the need to review the register and update on a monthly basis. An entry of no change will amend the date column, showing that a review has taken place. The Executive received report and agreed to continue to review the Risk Register on a monthly basis.

LT

ALL

All

Exec/14/152

Procurement Progress The Executive reviewed the procurement progress report which provided details of the services being procured and the start dates of any completed procurements. The Executive raised some concerns around the sharing of information within the report outwith the CCG but agreed drawing together current commissioning arrangements would be helpful. MR recognised the concerns but explained that he believed it would be useful to be aware when contracts are due to expire as this could enable joint procurement. HELS - JK pointed out that this is a service in which there could be potential interest from other organisations. IAPT – Not included in the report. Executive were informed that negotiations are currently underway. MSK – JK to speak to Lorrae Rose to understand timescales and the work undertaken to date. To be available for next Formal Executive meeting. SALT – proceeding with recommended bidders. The Executive received and noted the contents of the report together with the updates provided

JK

Exec/14/153

Community Eye Care Services – Recommended Bidder Report The Executive received a report that outlined the outcome of the service procurement for Intraocular Pressure Referral Refinement (IOP RR) and Cataracts Pre-Operative Assessment (CPOA) Services.

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This report is also being presented to North Durham CCG and has previously been agreed by DDES CCG. Executive were informed that following market engagement the single tender action was deemed to be the most suitable to follow for this service. The Executive raised a question around the scoring process used as the evaluation summarised the outcomes only as passes. It was explained that a scoring system had not been used. The questions were structured to require only a pass or fail answer. LT pointed out that she felt that scores should be recorded to indicate if the service provider was deemed to be weak, satisfactory or excellent in some areas. MJP asked for some insight into the strength of the pass mark. This would help to inform any area of the service that may need to be monitored. Referring to 3.1.1 within the report – reducing a significant proportion of patients with eye problems who attend hospital for advice and/or treatment, when it is possible to deal with their problems much more quickly in the community …. JK suggested it would be useful to be able to track if these improvements are made. The CCG does not monitor the performance of opticians, this is carried out by the Area Team. The Executive agreed the need to link with the Area Team for this information. GF agreed to speak to Rowena Howard to ask how data is collected. TM agreed to feedback these concerns and request actions as outlined. The Executive approved the recommended bidder, with the request that concerns are noted and acted upon.

TM

GF

TM

Exec/14/154 Developing an Integrated Model of Care for Diabetes – Project Mandate The Executive considered the report which outlined a project to develop an integrated model of care for diabetes across County Durham and Darlington. The aim of the project is to review existing service provision across acute, community, primary care and social care in order to develop an integrated health care system and co-ordinated services. JK explained that a report has been to North Durham and DDES CCG, though the content before Executive today relates to

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Darlington CCG. The report has been supported by Dr Patrick Holmes. The Executive considered the content of the report, raising and discussing issues which need to be given consideration when taking forward this project, such as whether there is a role for social care in the project; the project management team structure does not include other teams such as social care; there is no indication of timescales; has consideration been given to the clinical input requirements. The Executive agreed the need for a rapid review after three months. The Executive approved the Project Mandate, with the request that comments are noted and acted upon.

NT

Exec/14/155 Personal Health Budgets [PHB] Procedure and Guidance for Adults Continuing Healthcare [CHC] The Executive received a report that set out its responsibilities for Personal Health Budgets Procedure and Guidance for Adults Continuing Healthcare. The Executive were advised PHBs for adults with CHC have been piloted since October 2013 in the Durham and Darlington areas and this service has set up working processes and documentation that have produced effective outcomes from small scale delivery. These processes now need to be formalised in anticipation of expanding client eligibility. Also that from 1st April 2014 everyone eligible for NHS Continuing Healthcare (CHC) funding will have a right to ask for a PHB, and this becomes a right to have a budget in October 2014. This is to be discussed at a future Governing Body Development Session. The Executive received the report and noted the adoption of the personal health budget procedure and supporting guidance.

JK

Exec/14/156 Practice Nurse Link and Career Start Service Transfer The Executive considered a report that set out employment options for the practice nurse link consequent upon their and their transfer of service from County Durham and Darlington Foundation Trust to CCGs. The current practice nurse link and career start service transferred to CDDFT as part of the transfer of community

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service in 2010. It is felt that their placement in CDDFT is inappropriate as their work revolves around primary care staff. Within Darlington CCG the post of practice nurse link is currently vacant, following the recent retirement of the postholder. It is proposed that this post will be filled as a Band 6. The Executive received the report and agreed to the service transfer.

GF

Exec/14/157 A Strategic Approach to Primary Care The Executive considered a report setting out the strategic approach being taken to primary care in Darlington. The report outlined the phases in more detail, described the case for change, outlined a strategic approach for primary care and proposed some metrics. Taken in two phases, the paper outlined the phases in detail: Phase one, led by Dr Jenny Steel, identified demographic pressures of an aging population and an increase in the number of people with multiple long term conditions, set against a context of rising costs and expectation but limited resources. Phase two consisted of an application to the Prime Minister’s Challenge Fund made by Darlington GPs, who wished to demonstrate different ways of working. Following discussion, the Executive endorsed the approach outlined in the report and noted the progress to date and approved the release of the Area Team funding for phase two and agreed to provide a mandate for the Primary Care Strategy group (to become the Primary Care Development Group), to progress to develop a delivery plan. The Executive agreed that strategy be considered the Governing Body.

GL

Exec/14/158 GP Choices Review The Executive considered a report detailing a review of the GP Choices Occupational Health Service and outlined the options for the future of the service. The Executive discussed the current arrangements, possible options available and the proposals within the report for the future of the service.

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LT explained the need for an understanding of the true share of this service and costs for Darlington CCG and any implications if Darlington CCG were to operate a different service to the other CCGs in the area. The Executive received the report and considered the recommendation to renegotiate 2013 service specification into current contract

LT

Exec/14/159 Learning and Disabilities Joint Health and Social Care Self Assessment Framework The Executive noted the content of this report.

Exec/14/160 Home Oxygen MJP reported that the ongoing procurement of the home oxygen supply regional contract continues. This is being led nationally in accordance with the national framework agreement for home oxygen CCGs have now received further notification from the Department of Health to confirm a contribution towards costs, £10,000 split between the CCGs in 2015 and this was endorsed by the Executive

Exec/14/161 Update on the co-commissioning of Primary Care Services JK update the Executive on the current position and reminded those present to engage with members on proposals.

AJ

Exec/14/162 Any Other Business No other business was discussed.

Date and time next meeting Tuesday 21st October 2014 commencing at 9am in Emerson Doctor Piper House.

Signed……………………… Chair.…………………….…. Date………………………….


Tuesday 21 October 2014

9am – 11am

Emerson, Dr Piper House

CONFIRMED MINUTES

Present: Martin Phillips (Chair) (MJP) Chief Officer Gill Findley (GF) Chief Nurse Andrea Jones (AJ) Chair Jackie Kay (JK) Assistant Chief Officer

Lisa Tempest (LT) Chief Finance Officer Richard Harker (RH) GP Quality Lead In attendance: Murray Rose (MR) Director of Commissioning Vince Lacey Commissioning Manager Fiona McQuiston (FMcQ) Commissioning and

Development Lead NECS (Item 175) Dean Cuthbert (DC) Commissioning Manager,

NECS (Item 179) Glenda Lynn (GL) PA (minute taker)

Action Exec/14/164 Apologies for Absence

No apologies were received.

Exec/14/165 Declarations of Interest Richard Harker declared an interest in item Exec/14/175. It was agreed that he would absent himself if directed by the Chair (MJP)

Exec/14/166 Minutes of the last Formal Executive meeting – 23 September 2014 The minutes of the meeting held on 23 September 2014 were agreed as an accurate record.

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Exec/14/167 Action Log The action log was discussed and updated accordingly.

Exec/14/168 Clinical Quality Update The Executive received a clinical quality update from GF. Diagnostics – remains an area of concerns for the Foundation Trust. Some sites seem to be managing the workload whilst others continue to have difficulties. This may be due to patient choice. The forthcoming ‘Blood in Pee’ campaign will increase the pressure in this area. QOF Outcomes – GF informed Executive that she has not as yet received feedback for Darlington CCG. GF to follow up. SUI – GF advised of a SUI which had occurred at UHND the previous week, involving a patient admitted following a heart attack. James Cook Hospital Delay – MJP informed Executive that he had been made aware of reported delays at James Cook Hospital recently. Executive agreed that this need to be monitored as winter approaches. In this respect the Executive noted the allocation of Winter Resilience monies for 2014/15. Medical Assurance Meeting – GF had recently attended the Medical Assurance meeting which had discussed quality indicators The Executive noted the content of the report and approved actions.

GF

Exec/14/169 Management of Risks The Executive considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG together with a copy of the risk Executive register. All Executive members confirmed that they had updated the risks assigned to them. The Executive received the report, agreed mitigation actions and to continue to review the Risk Register on a monthly basis.

Exec/14/170 Finance Report – September 2014 The Executive considered the Finance Report for the period ended 30 September 2014. LT advised that the CCG’s financial position is under continual review and the current position shows the organisation to be on track to achieve its key financial

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targets. The current position shows a YTD under-spend of £718k delivering the required surplus of £1,438. LT then itemised some of the detail: Acute Services is showing a forecast outturn overspend of £77k. (This contract remains unsigned and is moving through mediation process). Mental Health Services – currently £16k over forecast. AQP – pressure on Audiology / Ophthalmology raised with Kirsty Kitching. Kirsty will attend future Finance Committee to discuss. MJP explained a clearer understanding is needed on the mechanisms in place. MJP felt more options would be helpful. Continuing Health Care – Under spending at the moment. Oxygen Contract – More information has been requested from Provider Management. Running Costs – Tighter than last year because of the 10% savings needed this financial year. Patient Transport – Arrangements for Medical Services North East and EMS being looked at in detail, together with DUCT. Prescribing – Paper to next QP&I Committee. Barbara Nimmo has confirmed £3k savings. BN to provide report to future Formal Executive for information. A finance meeting will be held in the near future to look at the month 7 position. LT indicated she would not wish to see any further deterioration. The Executive received the Finance Report and noted its contents.

LT

LT

BN

Exec/14/171 Procurement Progress The Executive reviewed the procurement progress report which provided details of the services being procured and the start dates of any completed procurements. Some dissatisfaction was expressed over the quality of the reports, particularly Community Pulmonary Rehabiliation and this will be fed back to NECS.

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The Executive was advised that service commencement date for MSK is likely to be moved to September 2015. The Executive received and noted the contents of the report.

Exec/14/172

NECS Performance Update The Executive considered the NECS SLA performance meeting action log, discussed with NECS at the regular meeting last week. LT requested feedback on the action log, details of anything missing or which the Executive would like to be discussed at these meetings to contact her. As discussed in the previous item, the quality of reports will be highlighted at the next meeting. The Executive received the update and detail of the SLA meeting action log and agreed to advise LT of any additions needed.

Exec/14/174 Wheelchair Review The Executive considered the paper provided outlining the outcome of the Wheelchair Service Review. This service serves Durham Dales, Easington and Sedgefield CCG, North Durham CCG and Darlington CCG and is provided by County Durham and Darlington NHS Foundation Trust (CDDFT) and North Tees and Hartlepool Foundation Trust (NTHFT) for Easington only. The Executive were advised there is currently a waiting time of circa 5 months for a referral to assessment and 6 months from assessment to provision of a wheelchair. CDDFT has stated the service is underfunded by circa £300k currently funded at £1.2 million. There is no waiting time issue for the Easington locality using the NTHFT service. The options regarding RREMS are essentially to stay with the current service with a view to market engagement at a point in the future, or take a share of the regional budget and procure a service. The Executive were recommended to stay with the current service given the short timescales. In the short term the CCG are asked to consider funding a non-recurrent initiative cost of £28k to reduce waiting times from 11 months in total to a maximum of 3 months for standard wheelchairs. The Executive discussed the range of recommendations outlined in the paper, expressing views on pressures on this service and concerns at the waiting times. The possibility of

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giving patients a choice of which hospital trust they use to access the service was also considered as a possible solution to the backlog. It was felt the contract should be offered to NTHFT. The Executive were advised that the non-recurrent funding would be used to purchase additional wheelchairs. Measures are also being taken to reduce the waiting time for a referral into the service. The Executive considered the recommendations and agreed:

Re-procurement of services to provide assessment, equipment provision and maintenance of wheelchairs to commence on agreement of recommendation by the three CCGs.

To maintain current RREMS service in the short term, dependent on other CCGs decision and review of RREMS service.

CCG to undertake market engagement for the service provided by NTHFT, CDDFT and RREMS

Non-recurrent funding to be offered to NTHFT to assist with the clearing of the backlog and reduce waiting times.

Exec/14/175 Palliative Care Rapid Response Update

RH expressed an interest in this item. The Executive Committee agreed RH should remain for the discussion however, would be asked to leave if deemed appropriate. The Executive considered an update on the Palliative Care Rapid Response procurement proposal. JK explained that the report being considered by the Executive provided an update on the Palliative Care Rapid Response Service re-procurement process following the release of the Prior Information Notice (PIN) in July 2014 and to outline the procurement timeline and decisions required. The current service provider is Marie Curie, which works collaboratively with St Teresa’s Hospice to deliver the service for Darlington CCG. Two options have been drafted which reflect two different project timelines. Option 1 would result in a go live date of July 2015 and option 2 a go live date of 1st October 2015. Both options extend beyond the existing contract of 31st March 2015. All CCGs have been asked to consider and endorse the extension of Marie Curie’s contract to secure continuity of service. FMcQ explained that agreement is needed across the three CCGs.

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In February/March 2014 all three CCGs agreed a financial envelope, based on a fair share population split, with Darlington CCG paying £295,871 (17%). It was agreed that FMcQ would seek to verify this figure and to seek assurance that Darlington CCG is not double paying. FMcQ agreed to raise these concerns at a meeting on Friday of this week and feedback to a future Formal Executive Committee.

Exec/14/176 Quality Impact Assessment of Provider Cost Improvement Plans The Executive considered the report, which provides a summary of the position in relation to the assessments undertaken on the impact of quality of any cost improvement programme, following the report by Sir Robert Francis QC into the failings at the Mid Staffordshire NHS Foundation Trust, by local Foundation Trusts. The Executive received the paper for information purposes.

Exec/14/177 CHC Joint Pricing and Procurement The Executive considered the proposals documented in relation to joint commissioning arrangements and approved the recommendations outlined within the report.

Exec/14/178 Quarter Two Delivery Report The Executive considered the report to support the implementation of NHS Darlington CCGs delivery plan for 2014/15. The Executive were informed that this is a refreshed document which recently went to Q&I Committee. A discussion ensued around whether the information provided within the highlight report provides the detail required in the format which is most helpful. The Executive received the report and agreed that more detail is required.

JK

Exec/14/179 Integrated Model for Primary Care Mental Health – Update The Executive considered a report which outlined recommendations to revise a procurement timetable and the extension of current contracts to cover the revision, following a desire across Durham and Darlington for a revised service model for this service. DC explained that an issue for consideration for Darlington CCG was that under current arrangements, targets are being achieved. However, this revision is for a service across the three CCGs.

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Patient engagement feedback across Durham indicated that patients had some dissatisfaction with the service, mentioning stress after discharge from the service back to GPs. DC explained that views on the way forward with this service vary across the CCGs involved and the service is now very much in limbo. North Durham CCG have expressed a desire to look at alternatives before considering an integrated model. LT expressed her concerns about the finances needed to extend the contract. The Executive discussed that Darlington CCG is currently achieving targets, however this may not be maintained. The Executive received the report and agreed that the current arrangements be extended.

Exec/14/180 Any Risks Identified NECS performance – organisational risk, capability and capacity.

Exec/14/181 Any Other Business Community Matrons Procurement in June. Discussions regarding new specification using existing providers have taken place. CDDFT Contract No progress to report on CDDFT contract. Agreement to be sought by the end of today. If agreement not received, a letter will be drafted to move forward with arbitration and will have a three month timescale. MDT JK explained issue of funding of MDT work. Consideration to be given to the creation of a ‘pot’ including other organisations within the MDT.

Date and time next meeting The next Formal Executive will be held on Tuesday 18 November 2014 commencing at 8.30am in Emerson, Doctor Piper House.

Signed………………………

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Chair.…………………….…. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP QUALITY AND INNOVATION COMMITTEE

Tuesday 19th August 2014

09.00 – 11.00

Boardroom, Whinfield Medical Practice

CONFIRMED MINUTES

Present: Richard Harker (Chair) Title, Organisation Sarah Dodsworth Practice Nurse, Clinical Representative Gail Linstead Quality Manager Jackie Kay Assistant Chief Officer Andie Mackay Lay Member Finance Michelle Thompson Lay Member, Patient & Public

Involvement In attendance: Barbara Hudson Practice Nurse Link Barbara Nimmo Medicines Optimisation Pharmacist Helen Osborn Senior Clinical Quality Officer Rachael White Administrative Assistant

Action

QI/14/97

Apologies for Absence Apologies for absence were received from: Carole Atherton Designated Nurse Safeguarding Children Debra Elliott Senior Governance Manager Gill Findley Director of Nursing Ahmet Fuat GP, Carmel Medical Practice Charles McGarrity GP, Parkgate Surgery Alison McNaughton-Jones GP, Rockliffe Court Surgery Sue Nuttall Safeguarding Adults Senior Manager

QI/14/98 Minutes and confidential minutes of the meeting held on 15th July 2014 and matters arising The minutes of the meeting with agreed as an accurate record.

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QI/14/99 Action Log 1. TEWV SI Reporting Timescale – Gail Linstead advised that once the minutes of the meeting had been confirmed the breakdown of the reporting timescales could be circulated. 2. Care Home Inspection Process – Michelle Thompson advised that Committee that Infection Control were liaising with Healthwatch regarding the process. 3. GP Performance Triage Group – Helen Osborn advised she would chase this up as Kirstie Hesketh may have actioned. 4. GP Performance Triage Group Membership – Helen advised that she was unsure as to whether the conversation had taken place. Richard Harker advised that it was agreed to be a good idea however before anything could be taken forward the Terms of Reference for the group would need to be reviewed. 5. Diabetes Structured Education – Gail advised that she had spoken with Lorrae Rose and Nicole Theobald and had been advised that the dates in the report did not match the dates when the online education tool was piloted. The diabetes education programme was being monitored and improvements were being made. 6. Radiology Service – The report had been circulated to the group. Concern was expressed that the situation regarding the lack of radiologist had also been linked to the closure of the breast services in Darlington. Jackie Kay advised that the situation regarding breast services had been escalated. It was suggested that it also be escalated through the Quality Review Group due to the significance of the risk and the need for an action plan to resolve the issues. 7. Risk Register – Discussed at agenda item QI/14/106. 8. Communication with the Public – Michelle advised that the meeting hadn’t taken place due to annual leave.

HO

Changes to reporting arrangements: Gail Linstead advised that as part of the changes to the committee arrangements a schedule of reports had been agreed in order to focus on specific areas for example the quality reports would now focus on and alternate between acute and community services, mental health and ambulance services. Infection Control reports would now be 6 monthly and Safeguarding would be quarterly however if there were any exceptions a separate report would brought to the Committee at

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the time.

QI/14/100 Quarterly Clinical Quality Update - Acute and Community Services The Quality and Innovation Committee considered the report which focused on acute and community services at County Durham and Darlington Foundation Trust (CDDFT) and South Tees Hospital Foundation Trust (STHFT) providing information relating to mortality, Healthcare Acquired Infection, and serious incidents. Helen Osborn advised that the report in future would detail information regarding BMI Woodlands Hospital however for this report the information wasn’t available on time. In regards to CDDFT’s Safer Staffing Programme, they were showing as among the worst for infection control/cleanliness and also for recommendation by staff (with a value of 56.88%). Safety Thermometer data showed that CDDFT was a positive outlier on pressure ulcers and was markedly lower than national levels, however the Trust continued to be a negative outlier on falls with harm. Between 1 April 2013 and 13 June 2014, the Trust reported 46 serious incidents where patients had suffered significant harm as a result of a fall and this was the most reported category to the National Reporting Learning System. CDDFT’s falls group continues to monitor issues and report these to Safety Committee. The STHFT Serious Incident report slide was to be recirculated after the meeting due to some discrepancies with the information. The NHS Safety Thermometer for the trust showed that STHFT was a negative outlier on pressure ulcers with a higher prevalence and on falls with harm however there has been a significant reduction in the rate. The trust had 7 cases of C.Diff reported in May 2014 which was above the trajectory of 5 and continued to be monitored by the Quality Review Group (QRG). A never even had been reported where by the incorrect intraocular lens had been inserted during eye surgery and the patient was awaiting surgery to correct this. It was queried as to whether a lesson learnt sharing process could be introduced between the trusts as CDDFT had reported the same incident recently and it was felt that a recurrence could have been avoided. Helen advised that she would discuss this with Kirstie Hesketh and a patient safety alert newsletter to trusts could be used as a method of communication. It was queried as to whether more in-depth information could be provided in the report as a lot of percentages and statistics were provided but no details of patient experience was given. It was

HO

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felt that any trends or examples that could be gained would be useful. Gail Linstead advised that a request had been made to Patient Opinion for monthly reports to be sent to the Clinical Commissioning Group (CCG) however it was unsure at this stage as to what content would be provided. It was queried as to the purpose of wards now stating how many staff they have working on the ward compared to the number of patients and if this information was recorded as on one occasion there was 1 nurse to 13 patients. Helen Osborn advised she would speak to Kirstie Hesketh regarding how the information was reported and advised that it was a new indicator that the trusts were being monitored on. The Trust weren’t being flagged as an outlier in terms of capacity however it was suggested that if any practices were receiving soft intelligence regarding capacity or any other issues if they make the NECS Quality Team aware it would be logged on the Safeguarding Incident Risk Management System (SIRMS). Michelle advised that Healthwatch maintained a spreadsheet of soft intelligence received from the public which could be shared. Helen advised that a report could be produced regarding soft intelligence, what the team have and where it is shared and present it to the Committee in September. The Quality and Innovation Committee noted the contents of the report.

MT

HO

QI/14/101 Liverpool End of Life Pathway Replacement The Quality and Innovation Committee considered the report which detailed the One Chance to get it Right report (June 2014) which sets out the Alliance for the Care of the Dying’s replacement approach for the care of all dying people irrespective of setting following the phase out of the Liverpool Care Pathway. The approach focused on achieving Five Priorities for Care which would also inform the CQC’s new approach to hospital inspections as well as the inspection of end of life care in hospices, adult social care, community health services and general practice. Gail Linstead reported that providers across the patch had taken on these priorities and the feedback received had been that the report had been useful and the CCG were satisfied with the standard of care being provided. Gail advised that care homes across the patch had also been actively involved in the decision to taken on the five priorities which were to be included in future care home training and all appropriate contact details had been circulated. The Quality and Innovation Committee noted the contents of the

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report and acknowledged the ongoing work streams/ programmes that were underway.

Barbara Nimmo joined the meeting QI/14/102 Prescribing Update and Prescribing Sub-Committee

Minutes The Quality and Innovation Committee noted the content of the minutes from the 15th July 2014 Prescribing Sub-Committee and were given a verbal update from the Sub-Committee by Barbara Nimmo. Barbara advised that the Medicines and Healthcare products Regulatory Agency (MHRA) had advised that patients should have two Jext pens at all times however the team were not able to enforce this due to an issue with the supply. As a result the Sub-Committee would be monitoring the situation. All practices had work plans and a baseline of achievements had been agreed. It had also been made clear as to what work would be undertaken by the Medicines Optimisation Team and what would need to be actioned by the practices themselves. Barbara advised that once the team had a few months’ data a progress report would be presented to the Committee. Practices should also have been set up with the Electronic Prescribing System (EPS). However a new problem had been identified in using EPS with drug action groups as when scripts were sent via EPS, the patient friendly text that was added was disappearing. This was currently being investigated. Barbara reported that there were concerns regarding the prescribing of sub-cutaneous fluids in the community. The fluids were meant for patients in hospices and it was becoming a recurring incident that they were prescribed for patients coming out of hospices as part of their palliative care. Jackie Kay advised that this could be raised with Community Services and the necessity for staff to be suitably trained. Sarah Dodsworth raised the queries of colleagues in the practices in regards to new born babies receiving hepatitis B injections. It was thought that a baby would be given the first injection before leaving the hospital and then would go to their GP practice for the second however letters had been received that babies would now have to go back to the hospital for the second. Gail Linstead advised that she would seek clarification through the contracting team and Ken Ross, Public Health Team at Darlington Borough Council. The Quality and Innovation Committee noted the information provided.

JK

GL

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Barbara Nimmo left the meeting QI/14/103 Compliance with NICE Guidance at CDDFT

The Quality and Innovation Committee noted the information provided which advised that NICE guidance contributes to the maintenance of the quality and safety standards set by Care Quality Commission (CQC). CQC states that healthcare organisations should take into account nationally agreed guidance when planning and delivering treatment and care. In addition, commissioners set standards within their Acute/Community Annual Quality Requirements which the Trust is required to meet for which NICE had produced a range of guidance (included in the agenda papers).

QI/14/104 Quarter 1 2014/2015 Research and Development Report The Quality and Innovation Committee reviewed the routine quarterly report provided to the CCG and Research GP leads. Jackie Kay advised that a meeting had taken place with Andrea Jones and Ahmet Fuat to agree Ahmet’s involvement in research and development and he was to have a session a month for Darlington to progress this. The Quality and Innovation Committee noted the contents of the report.

QI/14/105 NEQOS Chronic Obstructive Pulmonary Disease NICE Quality Standards The Quality and Innovation Committee reviewed the report which provided information and intelligence about the current prevalence of Chronic Obstructive Pulmonary Disease (COPD), how effectively and accurately it was being diagnosed, if evidence-based treatment guidelines were being followed and how effective the treatments were in terms of patient outcomes. The Committee highlighted the need for the NEQOS reports to be sent to the relevant Clinical Lead for feedback/comments and suggested that the lead provide a summary report of any issues and key recommendations. Rachael White to send to Basil Penney and Claire Adams for comments. The Quality and Innovation Committee noted the contents of the report.

RW

QI/14/106 Risk Register and Any New Risks Identified The Quality and Innovation Committee considered the report which provided details of the Risk Management Policy which

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had been developed for Darlington CCG and a copy of the risk register for the Committee. Following the previous meeting controls and assurance had been updated on the register and the item would be discussed in further detail at the next meeting. The Quality and Innovation Committee noted the contents of the report.

QI/14/107 Any other Business Smoking Cessation Training for Nurses It was queried as to who facilitated the training for nurses as there was currently no training being provided. Barbara Hudson advised that the Public Health Team that would provide this had been decommissioned and the service was currently under review. Jackie Kay advised that she would clarify the situation with Ken Ross, Public Health at Darlington Borough Council. Wound Dressings Sarah Dodsworth reported that there had been confusion as to where patients could attend to have their dressings refreshed. If a practice wasn’t able to provide an appointment and the patient attended the Urgent Care/Walk in Centre they were being told to go to their practice. The Committee advised that it was the practice’s responsibility to have provision for dressing services and they would need to look at how they manage their appointments if this was becoming a problem. Admission Charges Clarification was sought as to how charges were being monitored as practices were receiving notifications from A&E when a patient had been to the Urgent Care Centre. Sarah Dodsworth to send information to Jackie Kay who would look into this. Practice Appointments Specification Richard advised that the a request had been made for there to be access through SystmOne to the GP access data and the idea was to provide GP practices with information regarding their appointment activity and capacity. It had been thought that this was a pilot that was to end in April however Jackie Kay advised that the CCG had not realised this and thought it was to be an ongoing process. Jackie advised that the North of England Commissioning Support Unit (NECS) could access the information and collate it on behalf of practices if they were happy for NECS to do so. Jackie to speak to Sara Woolley to provide further background to the request for practices.

JK

SD / JK

JK

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Barbara Hudson Retirement The Committee thanked Barbara for her support to the CCG and wished her well for the future.

Date/Time/Venue of Next Meeting 09.00 – 11.00 am, Tuesday 16 September, Board Room, Whinfield Medical Practice, Darlington.

Signed……………………… Chair.…Richard Harker…. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP QUALITY, PERFORMANCE AND INNOVATION COMMITTEE

Wednesday 24th September 2014

12.00 – 14.00

Ground Floor Meeting Room 1 and 2, Doctor Piper House

CONFIRMED MINUTES

Present: Gill Findlay (Chair) Chief Nurse, Darlington CCG Dr Victoria Foot GP, Clifton Court Medical Centre Dr Tony Shaw GP, Moorlands Surgery Dr Alison McNaughton-Jones GP, Rockliffe Court Surgery

Michelle Thompson Lay Member, Patient & Public Involvement

In attendance: Barbara Nimmo Medicines Optimisation Pharmacist Sara Woolley Snr Commissioning Support Officer –

Service Planning and Reform Helen Osborn Senior Clinical Quality Officer Jill Simpson Clinical Strategy, NHS England Andrew Rowlands Snr Commissioning Support Officer – Service Planning and Reform Glenda Lynn PA (minute taker)

Gill Findlay, Chief Nurse welcomed those in attendance to this the first Quality, Performance Innovation Committee. Gill explained that apologies had been received from Richard Harker, Chair of the Committee and she would be Chairing the meeting on Richard’s behalf. It is proposed to give consideration to the scheduling of these meetings. Details will be circulated prior to the next meeting.

Action

QPI/14/01

Apologies for Absence Apologies for absence were received from: Richard Harker, Sarah Dodsworth, Gail Linstead, Sue Nuttall, Debra Elliott, Carole Atherton, Andie MacKay

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QPI/14/02 Minutes of the Quality and Innovation Committee held on 19th August 2014 and matters arising The minutes of the meeting with agreed as an accurate record.

QPI/14/03 Action Log

1. RAMAC – To have been discussed at Finance Committee week commencing 28.07.14. Feedback required.

2. CHC Activity – Completed

3. NEAS Clearance Times – Andrew Rowlands to confirm

NEAS clearance times.

4. TEWV SI Reporting Timescale – Completed.

5. Care Home Inspection Process – Ongoing

6. GP Performance Triage Group – HO advised PTG policy is under review and Kirstie Hesketh will discuss the LADO process, which had been removed from the flowchart, further with Carole Atherton and the PTG group. Action completed.

7. GP Performance Triage Group – Action completed.

8. Risk Register – Review of risk register actions outlined in action log completed.

9. Communication with the Public – Date in diary for discussion MT/GF

10. Never Event Lessons Learnt Sharing – Completed.

11. Healthwatch Soft Intelligence – Ongoing

12. Soft Intelligence Report – On agenda

13. Sub-cut Fluids – No update available

14. Hep B Injections for Babies – No update available

15. NEQOS Reports – No update available

16. Smoking Cessation Training – Ongoing. JK to chase response from Public Health

17. Admission Charges – No update available

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18. Practice Appointments Spec – No update available

QPI/14/04 Primary Care Incidents Report – July and August 2014 The Quality, Performance and Innovation Committee considered the report which focused on the incidents raised by the member practices about the care and experience service users have received during the months of July and August 2014 across the health system. Helen Osborn (HO) explained the need to encourage a culture of reporting incidents. HO advised that 102 incidents were reported on SIRMS in July and August which related to Darlington CCG member practices or commissioned local services. This was a slight increase on the previous two months which saw 80 incidents reported. Of the 102 incidents 49% had been reported by the Darlington CCG member practices compared with 45% during the previous 2 month period. HO explained that a number of practices have not reported any incidents, with only seven practices reporting incidents in period July and August. Whinfield Medical Practice was again the highest reporter of incidents. The incident reporting contained 36 internal incidents, such as medication prescribing errors, information governance/patient confidentiality breaches, patient aggression towards clinical staff and self harm events. Of the incidents reported, self harm was the main theme identified, a total of 25 self-harm incidents were reported by 4 GP practices. Medication incidents were reported on 17 occasions, 8 related to late or no delivery of prescribed medication from the Rowlands Pharmacy hub in Darlington and these have all been passed to NHS England Area Team for action. Of the other 9 incidents, 3 related to different care homes. One was a mix-up with two patients with the same name and the other two were near misses of incorrect dosage amount which were quickly spotted by staff. The remaining six incidents were prescription errors, missing analgesia patches and a delay for one patient where they had not had any insulin over the weekend because they had been told that their prescription would not be ready until Monday. There were 6 soft intelligence concerns reported on SIRMS.

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HO agreed to prepare a shortened version, highlighting types of incidents to be reported for the next meeting. Helen McNaughton-Jones advised that she had been made aware of two incidents of carers being unwilling to administer drugs as dosage was unclear. GF to seek further information. The Quality, Performance and Innovation Committee noted the content of the report.

HO

GF

QPI/14/05 Soft Intelligence Report The Quality, Performance and Innovation Committee considered the report which provided a briefing on what constitutes soft intelligence and the importance of recording this type of intelligence. Helen Osborn explained that the recommendations of the Francis Inquiry stated that commissioning healthcare organisations to do more to gather and act on soft intelligence to ensure the quality of healthcare services. Soft intelligence is a term used to describe information that cannot always be verified, or proven. In a healthcare context soft intelligence can come from a wide range of sources, such as service users, their relatives, members of the public and health and social care professionals. It is a vital source of business commissioning intelligence to support healthcare commissioners in identifying potential problems and providing objective challenges to improve service quality. The Quality, Performance and Innovation Committee discussed possible methods to collect soft intelligence, such as contacting patients after appointments. GF explained that in DDES CCG one of the patient groups had drafted a form for recording soft intelligence that patients can fill out themselves or that can be completed on behalf of the patient. GF agreed to provide a copy of this questionnaire for the next Quality, Performance and Innovation Committee. The Quality, Performance and Innovation Committee accepted the summary report provided.

GF

QPI/14/06 Safeguarding Adults and Children Quarterly Update The Quality, Performance and Innovation Committee were informed that this report sought to provide assurance that the systems and processes for Safeguarding Adults and Children are in place and to give a quarterly update on current

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development work and key operational issues undertaken by the teams. Dr James Carlton, Named GP for Adult Safeguarding for Darlington CCG will be visiting local practice manager meetings to provide information about his role and that of the team. Dr John Gledhill has recently resumed his role as the named GP for Safeguarding Children. John is proposing to carry out an audit of how practices raise safeguarding issues. This will include discussions around the use of the Childsafe Trigger Tool. Indications are that some practices have identified some issues with the time taken to complete, others believe the tool to be useful. These issues will be explored by John with Practice Managers to monitor their impact. GF advised that Dr Carlton and Dr Gledhill will be invited to a future meeting of the Quality, Performance and Innovation Committee. The Quality, Performance and Innovation Committee accepted the report and noted the work undertaken by the Safeguarding Adults and Children’s Team.

GF

QPI/14/07 Quarter 1 Prescribing Incentive Scheme Update The Quality, Performance and Innovation Committee were advised by Barbara Nimmo, Medicines Optimisation Pharmacist, NECS that the report before them provided Quarter 1 data from April – June 2014 and is available to allow practices and the CCG to monitor the progress against each of the compulsory indicators for the scheme. The Quality, Performance and Innovation Committee considered the report and raised a number of queries:

Diabetes – patients advised if experiencing any problems with new devises to return to GP

Dressing issues – To be discussed with podiatry

The Quality, Performance and Innovation Committee accepted the report for information, adding it would be helpful to have some clear guidance on whether practices should strive to be above or below the lines on the graphs within the report.

QPI/14/08 Eye Health Needs Assessment Jill Simpson from the Clinical Strategy Team, NHS England presented to the Quality, Performance and Innovation Committee on the assessment of Eye Health Needs across

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Durham, Darlington Tees carried out of the last six months. Undertaken by the North East and Cumbria Local Eye Health Network along with specialist public health expertise and supervision through Durham County Council. Jill Simpson explained that Darlington CCG faces increasing eye health needs, aligned to increased risk factors such as deprivation, poor lifestyle choices and age etc. Early diagnosis and intervention can save sight or prevent further loss. The assessment process included professional and public engagement, speaking to ophthalmology teams, screening professionals, GPs and services users etc. Jill Simpson outlined for the Quality, Performance and Innovation Committee some of the headline findings for Darlington CCG area such as:

Variable children’s screening approach with 50% of orthoptist referrals consultant led

Little prevention and health promotion activity relating to eye health

Poor awareness of low vision services and pathways into social care, rehab and reablement

Service users reported attending for routine sight tests less frequently than other local areas

Identified opportunities for Darlington CCG include:

Integration of sight loss prevention activity – such as sight test reminders – into routine general practice activity such as chronic disease reviews

Potential improvement across primary and secondary care with greater sharing of discharge letters with GPs and feedback to optometry

Increasing ECLO provision locally Jill Simpson explained that the Eye Health Needs Assessment highlights opportunities for the CCG to integrate sight loss prevention activity into existing primary care pathways, to review and streamline pathways to deliver more eye care in community settings and to increase knowledge and awareness of eye health referral and management pathways. The Quality, Performance and Innovation Committee considered the presentation by Jill Simpson and suggested that it would be helpful if this could be shared with colleagues at a future Protected Learning Time event. The Quality, Performance and Innovation Committee

GF/JS

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acknowledged the current and future eye health need for Darlington and noted the opportunities to commit to areas of improvement.

QPI/14/09 Quality and Performance Report The Quality, Performance and Innovation Committee were advised by Andrew Rowlands, Senior Commissioning Support Officer, NECS that the report before them today was the new performance report, the finance element having been removed. The report is for the Quality, Performance and Innovation Committee to note current performance and the risks to national indicators in 2014/15. Andrew Rowlands explained that the report covers monthly constitutional indications, where there are exceptions an exceptions report is provided explaining what is being done to rectify the situation. Indicators highlighted in exception reports included:

Patients waiting for a diagnostic test should have been waiting less than 6 weeks for a referral – target 1%. CDDFT reported a deterioration between May/July to 6.6%. Endoscopy and colonoscopy referrals have increased. A cancer campaign ‘blood in pee’ scheduled for later this year has resulted in the Trust now developing plans in anticipation of increased demand for these services

Choose and Book – Trust failing to ensure sufficient appointment slots are available on the Choose and Book system – target of 4% of patients unable to book an appointment via Choose and Book. CDDFT current has 27% of patients unable to book an appointment via Choose and Book.

Quality Premium – rewards the CCG for improvements in quality of services commissioned and the associated improvements in health outcomes and reducing inequalities. The Quality, Performance and Innovation Committee reviewed the report and confirmed that they were happy with the style of the report .

QPI/14/10 Resilience and Capacity Planning 2014/15 The Quality, Performance and Innovation Committee considered the report produced by Chris Callan, Assurance and Delivery Manager Durham, Darlington and Tees, NHS England Area

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Team and presented by Sara Woolley, using data sourced from North East Ambulance Service NHS FT. GF explained that within the performance report some issues of concern are evident month after month. It had been previously agreed that this Committee would concentrate on one area each month. It was agreed that ambulance handover delays would be the issue looked at this meeting. A review taken last December highlighted this as an issue and it has continued to be a problem throughout the year. The data relates to ambulance handover delays at CDDFT, with pressures greater at UHND. However this does in turn create greater pressure on DMH Some work has been done at UHND to improve patient flow. CDDFT are working closely with NEAS to manage handovers. The data suggests that there is limited evidence to show signs of improvement in performance at CDDFT when the data is considered as a twelve month rolling average. While the 30 – 60 minute handover delays have shown an improving trend in recent months, viewed over a longer time the position is no better than where it was two years ago. The more than 60 minute delays are the area of greatest concern. Sara Woolley informed the Committee that plans outline what is being done regarding resilience throughout the year. Funding is allocated on a fair share basis. Some funding is also allocated to the Police to work collaboratively with NEAS over the Christmas period. NEAS is proposing to have a GP in their call centres so that paramedics have access to a GP for any questions they may have. Some paramedics will also be given enhanced training. These proposals were piloted in Newcastle last year and will be rolled out more across the region. Information on ambulatory pathways has been recirculated to GPs. SW agreed to have this recirculated and will provide a copy for the next Quality, Performance and Innovation Committee to be included in matters arising. The Quality, Performance and Innovation Committed received the report for information.

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QPI/14/11 Risk Register and Any New Risks Identified The Quality, Performance and Innovation Committee considered

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the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. GF advised the Committee that she would update the register with any new risks identified today The Quality, Performance and Innovation Committee noted the contents of the report.

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QPI/14/12 Any Other Business Changes to Meeting Arrangements The Quality, Performance and Innovation Committee were informed of the need to reschedule these meetings, due to performance data, which now comes to this meeting, not being available until later in the month. Rachael White, Administrative Assistant is currently looking at new dates and will circulate this information when available.

Date/Time/Venue of Next Meeting To be confirmed.

Signed……………………… Chair.…Gillian Findlay…. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP QUALITY, PERFORMANCE & INNOVATION COMMITTEE

Tuesday 28th October 2014

09.00 – 11.00

Boardroom, Whinfield Medical Practice

CONFIRMED MINUTES

Present: Richard Harker (Chair) GP Quality Lead, Whinfield Medical Practice Sarah Dodsworth Practice Nurse, Clinical Representative Gail Linstead Quality Manager Andie Mackay Lay Member Finance Michelle Thompson Lay Member, Patient & Public

Involvement In attendance: Gail Cook Senior Infection Prevention & Control Nurse Debra Elliott Senior Governance Manager Barbara Nimmo Medicines Optimisation Pharmacist Helen Osborn Senior Clinical Quality Officer Andrew Rowlands Senior Commissioning Support Officer – Service Planning and Reform Lisa Trimble Commissioning Support Officer – Provider

Management Rachael White Administration Assistant

Action

QPI/14/13

Apologies for Absence Apologies for absence were received from: Carole Atherton Designated Nurse Safeguarding Children Gill Findley Director of Nursing Victoria Foot GP, Clifton Court Medical Centre Jackie Kay Assistant Chief Officer Charles McGarrity GP, Parkgate Surgery Alison McNaughton-Jones GP, Rockliffe Court Surgery

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QPI/14/14 Declarations of Interest No declarations were submitted.

QPI/14/15 Minutes of the meeting held on 24th September 2014 and matters arising The minutes of the meeting were agreed as an accurate record.

QPI/14/16 Action Log 1. RAMAC – Andrew Rowlands advised he would raise this with Kirsty Kitching and Kevin Scollay. It was agreed that this action should be transferred back over to the Finance Committee. 2. NEAS Clearance Times – Due to clashing diary commitments Andrew and Gill had not had the opportunity to meet however this would be included in the Quality and Performance report discussions. 3. Care Home Inspection Process – Gail Cook advised that a meeting had taken place with Healthwatch who had offered to support the Infection Control Team in their inspections. 4. Communication with the Public – Michelle Thompson reported she and Gill had met however further exploration was needed and it was felt that this discussion may be more suited for the Communication and Engagement Team. 5. Healthwatch Soft Intelligence - Michelle advised that a quarterly Healthwatch report could be produced giving details of the soft intelligence received with a member of Healthwatch to attend to present. 7. Hep B Injections for Babies – Gail Linstead had received an email from NHS England advising that the pathway for the injections had been reviewed and a draft specification had been produced. In some cases a heel prick injection is required and the baby would need to be taken back to hospital for it. There was training available for nurses in Primary Care however it was not clear as to whether there was any funding for this. Gail advised she would continue to look into this. 8. NEQOS Reports – The COPD report was included on the agenda as requested. It was asked that when future reports were received they be sent to Rachael White who would organise for the clinical lead to produce a summary for the Committee. 9. Smoking Cessation Training – Public Health had advised that

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CCG that a letter had been sent to Practices at the beginning of the financial year providing the opportunity for practice to invoice them for £500 to cover the costs of training. This would have been the responsibility of the practice to organise. 10. Admission Charges – Sarah Dodsworth would review this again. 12. Primary Care Incident Report – July and August 2014 – Helen Osborn reported that the primary care incident report data would be presented at Members Assembly. This would outline the top three themes practices had been reporting. Helen advised that the information could be requested for the meeting in November and be brought to the Committee. 14. Soft Intelligence Report – Gill Findley had circulated a document the previous day which patients could complete in practice which could then be added onto SIRMS. 17. Resilience and Capacity Planning 2014-15 – The ambulance pathway information had been circulated.

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QPI/14/17 Quarter 1 and Quarter 2 Commissioner Visit Programme Report The Quality, Performance and Innovation Committee reviewed the report which provided an update regarding the commissioner visit programme in relation to visits undertaken during the reporting period and visit findings. There had been 8 visits so far and the reports had been completed for 6 of them. A list all sites visited was included in the report. The Assessment Team look for good practice but also areas for improvement which are all included in the report shared with the provider. Key themes so far were the 15 Steps Challenge, cleanliness, meal choices and information displayed regarding staff uniforms. The Quality, Performance and Innovation Committee noted the contents of the report.

QPI/14/18 Mental Health Services Quarterly Clinical Quality Update The Quality, Performance and Innovation Committee considered the report which was based on the main provider Tees, Esk and Wear Valleys NHS Foundation Trust (TEWVFT), outlining key issues and providing assurance that actions were being undertaken where appropriate. Helen Osborn highlighted that there had been an improvement

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in regards to patient safety serious incident 72 hour reporting however there were still issues with the timescales. Part of the issue was also the presentation of the reports as they would provide graphs but no narrative to support it. Liz Herring, Director of Nursing at North Durham Clinical Commissioning Group (CCG) had been working with TEWV to improve this. The National Reporting Learning System (NRLS) continued to show that TEWV were an outlier in relation to unexpected deaths. The North of England Commissioning Support Unit (NECS) was asked to undertake a review of the data covering the previous 12 month period and how TEWV compared to similar Mental Health Trusts. Despite being an outlier, the data showed only the slightest of variance between them and other trusts. This was due to be discussed at the October Clinical Quality Review Group. The Safety Thermometer had highlighted there was a continuing issue with patient falls with 75 occurring in quarter 1 alone. Work was being undertaken to review the method of categorising incidents and more training was to be provided. In relation to patient experience, the Carer Feedback Team had been visiting the wards regularly talking with patients and carers to gain feedback. The Care Quality Commission (CQC) had also announced that they would be visiting the Trust in early 2015. The Quality, Performance and Innovation Committee noted the contents of the report and agreed that necessary actions were being taken to improve quality and experience for patients.

QPI/14/19 Infection Control Update The Quality, Performance and Innovation Committee were provided with an update on Healthcare Associated Infections within the Darlington area. In terms of C.Diff, the CCG had 11 cases reported and were within the trajectory for the year. Gail Cook advised that there had been another 4 cases reported in September that were not included in the report due to the scheduling of the report. The themes that had been identified were that 8 of 10 patients had been admitted to hospital in the last 3 months and 5 patients had been prescribed antibiotics, 3 of which were found not to be compliant with the formulary. All cases had been followed up and confirmed with primary care that there had been no recurrences. The had been one reported case of MRSA whereby one pre 48hr case patient had a complex lung disease and had recently

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been discharged from hospital. The lessons learnt were around times of data entry not always recorded in patients’ notes, infection prediction tool not scored correctly and severity of patient’s lung disease not made evident within documentation. A urinary catheter prevalence survey was carried out in care homes across County Durham and Darlington between the 24th of March and the 4th of April 2014. For Darlington the overall prevalence rate was 7.3% with a response rate of 43%. In one particular care home 11.4% of residents sampled were found to be on prophylactic antibiotics and as a result a joint visit is planned with the continence adviser and the Infection Control Team. The Quality, Performance and Innovation Committee noted the contents of the report.

QPI/14/20 Medications Issues in Care Homes The Quality, Performance and Innovation Committee agreed to defer the item until the next meeting due to the apologies received.

QPI/14/21 Out of Hours Service The Quality, Performance and Innovation Committee were advised that Sally Lavender was now involved in the monitoring of the Out of Hours Service. There was a contractual commitment for all practices to contribute to the quality of service provided as well as the CCG. It was felt that there was a need to emphasise the need for all practices to report any issues relating to A&E etc. in order to monitor the situation. Work was being undertaken to develop a monitoring system that would be split into two sections: 1. Are practice reporting incidents 2. Practice/CCG feedback from patients. Michelle Thompson reminded the Committee that Healthwatch keep a log of any feedback received regarding services and would be able to help provide information. The Quality, Performance and Innovation Committee noted and supported the work being undertaken and asked that Richard Harker provide Sally with this feedback.

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Barbara Nimmo joined the meeting QPI/14/22 Quality & Performance Report

The Quality, Performance and Innovation Committee reviewed

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the information in the Quality and Performance report for September 2014. Andrew Rowlands advised that a lot of the quality aspects were already being discussed throughout the meeting. As a result the discussion focused mostly around the performance aspect of the report: CDDFT ER01 - Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral – Andrew advised that the threshold for this target was 1% yet in August; data showed that 6% of patients were waiting for tests. An action plan had been developed and it had been flagged with County Durham and Darlington Foundation Trust (CDDFT) as a major issue. As a result CDDFT were looking to gain extra capacity through however they had advised that they did not expect to deliver the target until December 2014 / January 2015. CDDFT ER02 - Handover between ambulance and A&E over 30 minutes and 60 minutes or more – This was major concern not only in Darlington across the region. As a result, the North East Ambulance Service (NEAS) had appointed 6 Hospital Ambulance Liaison Officers (HALO) over the winter period to aid patient flow in emergency departments across the region. CDDFT ER04 - Choose & Book – provider failure to ensure that ‘sufficient appointment slots’ are made available on the Choose and Book system – Andrew advised that this had been a significant issue for several months and in August, 15% of patients were unable to make appointments. An action plan was in place and was being monitored on a monthly basis. STHFT ER01 - Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral – South Tees Hospital Foundation Trust (STHFT) had failed this target every month up to August and had mentioned that it was felt that an increase in activity was due to the recent cancer awareness campaigns. The Trust had advised that they would be achieving the target from October. STHFT ER02 - % patients spending 4 hrs. or less in A&E or minor injury unit to 10th October 2014 – The Trust failed the September target which had caused concerns regarding performance over the winter period. However the year to date target was being achieved. NTHFT ER01- Maximum 2 Week Waits for Cancer Screening and Treatment – A regional meeting had taken place to understand the issues with the targets and it was established that patient choice, capacity and the flow between different organisations was having an impact. In regards to patient choice, other CCG’s had decided to write out GP’s asking them

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to emphasise the need for the patient to attend the appointment that has been booked for them and explain why it is so important. A full recovery plan has been implemented including strengthening operational and clinical accountability, reviewing the tracking system in place, embedding the internal escalation process and undertaking capacity and demand daily meetings. NEAS – 19 minutes responses – Andrew advised that NEAS were commissioned to provide the operational standards at a service level. At Trust level; NEAS were achieving both standards at a year to date position however there were significant concerns amongst Commissioners that NEAS may fail to maintain these response standards. It was expected that the recent strike action throughout October would adversely affect performance and would have affected the ability to respond to emergency calls with the exemption given to emergency calls (RED) calls only. The action plan produced by NEAS was discussed at an extraordinary performance meeting on 16th September 2014. A number of key themes were included within this recovery plan including; recruitment of paramedics, sickness absence levels, shift rosters, vehicle maintenance and increased clinical support on the call centres. Some members of the Committee were aware of at least two incidents that would have been reported in previous weeks relating to waiting times for ambulances and also difficulties with the call centre staff. In response to query, the Committee were advised that any patient experience issues reported would be investigated and the phones calls would be listened to. Andrew advised he would look to provide an update at the next meeting as to what patient information was recorded and how complaints were dealt with. The Quality, Performance and Innovation Committee noted the contents of the report.

QPI/14/23 Prescribing Report October 2014 The Quality, Performance and Innovation Committee considered the report which outlined some of the key issues relating to prescribing including budget, prescribing pressures and prescribing incentive scheme performance. Future pressures were expected to come from two recently published pieces of NICE guidance: 1. CG180 - Atrial fibrillation: the management of atrial fibrillation 2. CG 181 - Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease Both were expected to cause an increase in budget but would save money in terms of hospital costs over time as the clinical pathways would be revised as a result. Further details of the

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guidance were provided in the report. The appended report provided practice cumulative Item/spend comparisons, details of the CCG’s spends on top 20 drugs from April – June 2014 and incentive scheme guidance notes. The Quality, Performance and Innovation Committee noted the contents of the report.

QPI/14/24 Prescribing Sub-Committee Minutes The Quality, Performance and Innovation Committee reviewed the latest Prescribing Sub-Committee minutes. Barbara Nimmo highlighted that there were still issues regarding the electronic prescription service and the possibility of changing the system display was being investigated to avoid any confusion as some prescription were being split into two depending on the time of authorisation. Discussion had taken place with the Area Team and Darlington Borough Council to update them on the work that was being undertaken. There had been two incidents reported involving doses of medication prescribed for neonates and premature babies. As a result a Patient Safety Alert had been issued to GP’s to highlight the need to check to amount prescribed. The Quality, Performance and Innovation Committee noted the information provided.

QPI/14/25 CDDFT Peer Review: Notification of Immediate Risks and Serious Concerns The Quality, Performance and Innovation Committee were provided with a letter sent to Sue Jacques, Chief Executive of CDDFT from NHS England regarding the finding of the Notification of Immediate Risks and Serious Concerns Peer Review. The Committee noted the information provided.

QPI/14/26 COPD NICE Quality Standards Summary Report The Quality, Performance and Innovation Committee reviewed and noted the contents of the report which highlighted the Quality Standards activity in relation to COPD diagnosis and management in Darlington CCG in comparison to national and North East activity.

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QPI/14/27 NEQOS Hospital Mortality Monitoring Report – September 2014 The Quality, Performance and Innovation Committee reviewed and noted the contents of the report of which the objective was to give both providers and commissioners hospital mortality monitoring and benchmarking data to assist with assurance across the North East.

QPI/14/28 PROMS Best Practice Tariff May 2014 The Quality, Performance and Innovation Committee reviewed and noted the report which provided details of the likelihood that the Best Practice Tariff (designated BPT by Monitor) for primary hip and knee replacement will be payable to NHS providers. Guidance for primary hip and knee replacement recommended that, for 2014/15, NHS commissioners would only pay the full tariff for these procedures where the provider’s Patient Reported Outcome Measures (PROMs) data is not significantly lower than national norms.

QPI/14/29 Research and Development Activity Summary Quarter 2 2014/2015 The Quality, Performance and Innovation Committee reviewed and noted the quarterly report which provided details of Key Performance Indicators, current research projects, potential research evidence to support commissioning and a strategic update.

QPI/14/30 Risk Register and Any New Risks Identified The Quality, Performance and Innovation Committee considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Debra Elliott advised that Committee that the register had been updated on the 8th October and any would query the risks that had no assurances noted with Gill Findley. Gail Linstead advised that there was concern regarding one of the care homes in Darlington as several issues had been brought to the CCGs attention. Gail would discuss with Gill as the situation may need to be added to the risk register. The Quality, Performance and Innovation Committee noted the contents of the report.

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QPI/14/31 Any other Business Clinical Support Information Project Richard Harker presented the Committee with information provided by Richard Stevens advising that work had commenced to review clinical referral guidelines from a huge variety of sources, including Kernow CCG in Cornwall to complete what could be implemented in Darlington, North Durham and Durham Dales, Easington and Sedgefield to support referral management and manage demand. A report had been expected from NECS however it had not yet been received. Rachael White would chase this with the aim to have it on the next agenda. Future Committee Arrangements The Committee discussed and agreed the following arrangements: 1. The Committee would take place on the 4th Tuesday of the month 2. A start time of 11am would be trialled 3. The meetings would take place at Dr Piper House from December 2014.

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Date/Time/Venue of Next Meeting Tuesday 25 November, Whinfield Medical Practice, Darlington, 11-1pm

Signed……………………… Chair.…Richard Harker…. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP FINANCE AND PERFORMANCE COMMITTEE

Monday 26th August 2014

12.00 – 14.00

Meeting Room 1&2, Dr Piper House

CONFIRMED MINUTES

Present: Lisa Tempest (Chair) Chief Finance Officer Gill Findley Director of Nursing James Nevison GP, Denmark Street Surgery Richard Stevens GP, Orchard Court Surgery Gomathy Umashankar GP, Blacketts Medical Practice In attendance: Gail Linstead Quality Manager Andrew Rowlands Senior Commissioning Support Officer NECS Rachael White Administration Assistant

Action

FP/14/53

Apologies for Absence Apologies were received from: Karen Crook Practice Manager, Carmel Medical Practice Kirsty Kitching Senior Manager Provider Management NECS Andie Mackay Lay Member, Finance Kevin Scollay Senior Finance Manager, NECS Andrew Stainer Senior Commissioning Management, NECS

FP/14/54 Declarations of Interest No declarations were submitted.

FP/14/55 Minutes of the meeting held on 28th July 2014 and matters The minutes of the meeting were agreed as an accurate record.

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FP/14/56 Action Log 1. CDDFT Monthly Performance and Exec Meetings – Andrew Rowlands and Kirsty Kitching would be attending the meeting and it was agreed that they would provide feedback to the Clinical Commissioning Group (CCG). 2. RAMAC – Lisa Tempest advised that she would raise this with Kirsty Kitching. 3. CHC Activity – A quarterly report was submitted to the Executive Committee earlier that day which could be circulated to the group. 4. Meds Optimisation Website – Date still to be confirmed. 5. Committee Terms of Reference – The document had been updated and uploaded onto the website 6. Committee Arrangements – Complete. 7. NEAS Clearance Times – Andrew Rowlands advised that he would pick this up would meet with Gill to discuss how the report would be formatted under the new arrangements. 8. Quality Premium – Completed. 9. North Tees and Hartlepool Contract – Lisa Tempest advised that the overspend had been queried as the CCG thought it was protected under a cap and collar arrangement however this had not been factored in to the contract. There had been some confusion as to how this arrangement had come about as the CCG had not agreed to it. North Tees and Hartlepool Foundation Trust would not review the contract and as a result was now on a Payment by Results (PBR) contract. Lisa advised that this was a risk that would be monitored and that it was felt that due to underspending in other areas it may even out overall. 10. Prescribing – Rachael White to ask Barbara for an update on the report. 11. Risk Register – Discussed as part of item FP/14/60.

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Gomathy Umashankar joined the meeting Committee Reporting Arrangements

Lisa Tempest advised the Committee that at the next meeting which will be the first Finance Committee a new finance report would be produced that would contain aspects of information from the current Quality, Performance and Finance report and

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also the report received by the Executive Committee on a monthly basis. The reports submitted would also be targeting specific areas and representative from North of England Commissioning Support (NECS) would attend to aid understanding.

FP/14/57 Performance, Finance Position and Contracting and Business Analysis The Finance and Performance Committee reviewed the information in the Quality, Performance and Finance report for June 2014 and discussed the following aspects. DCCG ER01 - Maximum 62 day wait for first definitive treatment following a consultants decision to upgrade the priority of the patients (all cancers) – It was expected that the performance would improve over the year however Andrew Rowlands would clarify the indicator and the group of patients it referred to with Kevin Scollay for the next meeting. CDDFT ER01 - % of patients initial treatment within 18 weeks for admitted pathways – County Durham and Darlington Foundation Trust (CDDFT) were achieving the target to date and had been given an allocation of money form NHS England in order to clear the back log however it they were still struggling with activity. A meeting was taking place later that week and discussion would take place regarding their action plan to resolve the issue. Andrew advised he would provide an update following the meeting. CDDFT ER02 - Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral – The Trust had advised that additional slots at Spire had been secured however this hadn’t seem to impact on performance. This would also be raised in the meeting later in the week. The Committee expressed concerns regarding whether the Trust would be able to cope with possible increase in demand as a result of the upcoming ‘blood in pee’ campaign. CDDFT ER03 - Handover between ambulance and A&E over 30 minutes and 60 minutes and more – CDDFT were still outliers and failing the handover target. Work was still ongoing to improve this and update reports would continue to be provided. It had been highlighted through comparing data from 2013 onwards that the number of breaches seemed to increase during winter and increase in summer. CDDFT ER04 - % of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service – The breach was reported in April and it was expected that

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performance would continue at 100% in the coming months and the target would be achieved following the additional activity. STHFT ER01 - Admitted patients to start treatment within a maximum of 18 weeks from referral – The target had been achieved since April 2014 however it would continue to me be monitored. STHFT ER02 - Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral – Andrew Rowlands advised that the trust had made reference to the recent cancer awareness campaigns having an impact on performance. An action plan was in place and this was being monitored. STHFT ER03 - Handover between ambulance and A&E over 30 minutes and 60 minutes and more – The data for South Tees Hospital Foundation Trust (STHFT) were lower than CDDFT however they were still significantly above the threshold. There had been a spike in breaches in July and this was being investigated. NTHFT ER02 - Cancer 14 days & 62 days breaches to date – North Tees and Hartlepool Foundation Trust (NTHFT) had stated that they had experienced significant pressure regarding capacity and work was being undertaken to understand they issues experienced. An action plan was in place and it was being monitored via the contract meetings. Gill Findley advised that the issue could be raised with the Quality Review Group (QRG) as well. NEAS ER01 – 8 and 19 minutes responses – Andrew advised that historically the North East Ambulance Service (NEAS) had met the contractual arrangements however in July 2014 they failed the target. This was raised as high priority issue. It was felt that they had an increase in capacity that they weren’t prepared for and that an action plan was being produced to avoid this in the future. NEAS ER02 – 111 performance breaches - The main area of concern that has been highlighted locally and nationally is the providers’ ability to achieve the indicator aimed at answering calls within 60 seconds. Andrew advised that if the target is failed NEAS are able to submit an audit report to show that the breach was clinically appropriate. Gill reported that the System Resilience Group had begun work regarding the 111 system and where undertaking comparisons of the pathways to identify which was most beneficial. HCAI01- Incidents of MRSA and C.Diff – CDDFT had failed the

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target for MRSA with 5 cases being reported up to the 8th August. All cases had been investigated. Quality Premium – The Committee were advised that the current forecast was showing that the CCG would achieve all national and local indicators. QER01 – Care Quality Commission – NEAS had recently reported itself to the Care Quality Commission (CQC) after discovering its paramedics had given patients 75 doses of out-of-date drugs. The Clinical Team at NEAS would be providing an update against the full CQC action plan for the QRG on 9th September 2014. This would be included within September’s quality, performance and finance report. QER02 - Monitor – Gill advised that South Tees would continue to be monitored until all issues had been resolved. QER03 – Friends and Family Test – CDDFT’s A&E score continued to be lower than the national average and the Clinical Quality Review Group would continue to monitor performance. QER04 – Outstanding Serious Incident Reports - Breaches continued to be the result of Trust internal governance systems delaying the release of reports to the Commissioner. Work was being undertaken to resolve the issues with the timescale and to complete the reports as soon as possible. QER05 – Never Events - There was 1 never event reported by STHFT in July 2014 which related to the wrong strength lens diopter being inserted into a patient who was undergoing ophthalmic surgery. The error was discovered before the patient left theatre, the incorrect lens was removed and the patient is awaiting implantation of the correct lens at a later date. Full route cause analysis would be undertaken. Finance Activity – The Committee were advised that CDDFT were currently over budget and contract arrangements were still to be agreed. A letter had been sent to CDDFT outlining the key points of difference and that the mediation process would be undertaken. As there was no timescale at the moment, a Payment by Results arrangement would continue. Lisa advised that there was a potential risk of having to pay over and above what was affordable as a result of arbitration which had been highlighted to NHS England. It was suggested that form the next meeting an update on the CDDFT contract situation be added as a standing agenda item. In regards to the North Tees contract, Lisa had requested that route cause analysis be undertaken in order to establish how

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and why the contract had been agreed with out the authorisation from the CCG. It was thought that there could have been confusion between NECS colleagues who were organising the contract on the CCGs behalf who may have thought that the Durham, Dales, Easington and Sedgefield Chief Finance Officer had been liaising on behalf of the patch. South Tees Hospital were still experiencing significant challenges meeting waiting list targets and were still sub-contracting to BMI woodlands hospital to help improve capacity. Demand and activity would continue to be monitored. On reviewing the slides, Andrew advised that he would confirm that narrative for the NEAS slide as it referred to it being under a block contract when it wasn’t. The CCG were still on track to achieve its surplus and were in a reasonable financial position. Lisa advised that provisions were in place regards specialised commissioning to ensure that a significant overspend could not re-occur. The Finance and Performance Committee noted the contents of the report.

FP/14/58 GP Variation Update for May 2014 The Finance and Performance Committee reviewed the report which outlined the work being completed on GP Variation for Practices in Darlington. Lisa Tempest advised that at future meetings it would be requested that there be representation from NECS in order to aid understanding of the information in the report. The Committee highlighted the need for understanding of the report and data in order to ensure that the work was being targeted in the right areas and that a means of escalation needed to be agreed. It was requested that each practice’s action plan be brought to the next meeting in order to review the situation in Darlington. The Finance and Performance Committee noted the report.

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FP/14/59 NEAS 111 Call Answering Performance Briefing The Finance and Performance Committee were provided with a report from the North East Ambulance Service (NEAS) which provided a summary of the demand NEAS as experiencing in its 111 service, actions to better manage this demand and performance against the KPI for call answering.

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Gill Findley highlighted that there was currently an issue around staffing level and NEAS had acknowledged that performance was not where they would like it to be and actions had been undertaken to date to improve the current situation e.g. re-profiling of shifts and specific part time recruitment. The Finance and Performance Committee noted the contents of the report.

FP/14/60 Risk Register and Any New Risks Identified The Finance and Performance Committee considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Risk 1056 - Financial pressure resulting from the outcome of the arbitration process in relation to the 2014/15 contract with CDDFT – This risk had been added following the previous meeting and Lisa would continue to provide updates regarding the situation. Risk 142 - Introduction of tariffs for Mental Health Services – the risk had been updated as it was possible that a ring fencing arrangement could be agreed with TEWV. Gill Findley advised that discussion had taken place regarding the situation and it had been agreed that the wording of the risk should be consistent across all CCG’s and Gill would update this once received. Risk 165 - CCG does not have an up to date and full profile of financial reporting of CHC packages – Lisa advised that once the report was received rag rating and assurances could be reviewed. Risk 121 - Prescribing Costs Exceed Budget – It was agreed that due to the lack of data for the year the risk should remain on the register. Risk 932 - Impact of National Risk Share requirement on CCG Financial Position in 2014/15 – No guidance had been received as yet so the risk would remain on the register. The Committee agreed that the situation regarding the North Tees and Hartlepool foundation Trust contract be added to the register. The Finance and Performance Committee noted the contents of the report.

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FP/14/61 Any Other Business September’s Agenda Lisa Tempest advised that she would meeting with Kevin Scollay to discuss how the new reports would look for the Committee later that week and discussion could take place in regards to what the Committee would like to see in the report. Andie Mackay had requested that ‘QIPP’ become a standard agenda item and a report would be brought to the meeting. As part of the review at the next meeting, the Committee would go through the areas of spend and contract by acute providers and a breakdown of current CCG reserves would be provided. It was requested that at future meetings the Quality, Performance and Finance report be displayed on a projector.

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Date/Time/Venue of Next Meeting Monday 22nd September 2014, 12.00 – 14.00 in Meeting Room 1&2, DPH

Signed……………………… Chair.…Lisa Tempest……. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP FINANCE COMMITTEE

Monday 22nd September 2014

12.00 – 14.00


CONFIRMED MINUTES

Present: Andie Mackay (Chair) Lay Member of Finance Gill Findley Director of Nursing James Nevison GP, Denmark Street Surgery Richard Stevens GP, Orchard Court Surgery Lisa Tempest Chief Finance Officer Gomathy Umashankar GP, Blacketts Medical Practice In attendance: Andrew Stainer Senior Commissioning Manager Kevin Scollay Senior Finance Manager – Commissioning Finance Rachael White Administration Assistant

Action

FC/14/01

Apologies for Absence No apologies for absence were received.

FC/14/02 Declarations of Interest No declarations were submitted.

FC/14/03 Minutes of the meeting held on 26th August 2014 and matters arising The minutes of the meeting were agreed as an accurate record.

FC/14/04 Action Log 1. Meds Optimisation Website – The website had been established and Rachael White would send the link to the

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Committee members. 2. North Tees & Hartlepool contract – Lisa Tempest advised that the situation regarding how the contract had been agreed had been escalated to Mike Brierley and route cause analysis was to be undertaken. Feedback was expected at the Service Level Agreement meeting on the 6th October. 3. Prescribing – Rachael would chase this information as no response had been received. 4. 62 Day Cancer Waits – It had been established that part of the pathway may need to be revised as patients were being referred quite late in the process. Andrew Stainer advised that this had been discussed before and there had been resistance in the past. 5. CDDFT Performance meeting feedback – this action was linked to the above. 6. Future Agenda Items/ Meetings – Complete. 7. GP Variation – There were still concerns that the information was out of date however the Committee were pleased that a North of England Commissioning Support (NECS) officer had been able to attend the meeting. 8. Risk Register – Discussed in item FC/14/09.

FC/14/05 Finance Report The Finance Committee reviewed the report which provided an update on the position of the contracts held by NHS Darlington Clinical Commissioning Group (CCG) for the period 1st April – 31st July 2014/15. Kevin Scollay provided a supplementary document to accompany the report with further details on the CCGs financial position and contract information. Kevin Scollay advised that page three of the report provided the overall financial position for the CCG for the year to date, the forecast and the actual costs. The full year budget for running costs was underspent and any funding that hadn’t been allocated and the surplus was included in the reserves in the table. At month five the CCG was overspent in acute services and it was expected that this figure would continue to increase. The analysis showed that the largest variances were with the BMI Woodlands, North Tees and Hartlepool Hospital and non-contract activity. Activity at BMI Woodlands Hospital continued

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to increase and it was felt that this could be due to activity shifting from other providers such as South Tees Hospital. Kevin advised that the North Tees and Hartlepool contract would be discussed in further detail at the next meeting as activity was increasing. The CCG did not have a ‘cap and collar’ mechanism in the contract which was currently being investigated. It was queried as to how the smaller contracts were reviewed and Kevin advised that each contract had a contract manager who would work towards bringing spends back in line. Lisa advised that for future meetings the Committee could agree on a specific area they would like to discuss e.g. patient transport and representatives from NECS could be asked to attend the meeting to provide an update and details of the contracts etc. Gomathy Umashankar joined the meeting Overall there had been an decrease in outpatient activity however there had been an increase in A&E and daycase activity and a benchmarking exercise was to be undertaken. One of the main areas of increasing activity was regarding eye care and Members of the Committee felt that this could be due to opticians referring patients to secondary care for glaucoma monitoring. It was suggested that a method of reducing this could be for opticians to take a photograph of the patient’s eye and send it to the consultant rather than the patient having to make an appointment. Lisa suggested that this could be reviewed through Commissioning Intentions. Specsavers opticians were one of the larger variances in Community Services contracts and it was suggested by the Committee that this be discussed further at the next meeting and that a representative form Provider Management attend the meeting to discuss how the contract was being managed and what was felt to be causing the increase in costs. In regards to CDDFT, the Committee were advised that there had been an increase in A&E admissions and it was thought that a change in coding could be contributing to this. The Committee suggested that when CDDFT were looking to make a coding change, it was built into their process that clinicians could review the suggestion in order to aid understanding of the change. It had also been noticed that consultants were no longer seeing paediatric patients in A&E. Gill Findley advised that Committee that the front of house nursing staff that had been directing paediatric cases had been a pilot which had also been tested in North Durham however the Trust felt they didn’t have the resources to continue this. Kevin highlighted to the Committee that the Mental Health – Northumberland Tyne and Wear NHS Foundation Trust contract

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was currently overspending and the other CCGs in the area were facing the same situation. As a result the team were investigating the reasoning behind the overspend. Lisa advised that work had been undertaken in regards to the costs for patient transport as it had been highlighted that the CCG had paid for every private ambulance that had left Darlington Memorial Hospital regardless of the destination. The Committee were advised that there was an issue with two providers in the area being used for patient transport despite not being on a contract and CDDFT would invoice the CCG directly for the costs. This was being investigated and the CCG were looking to start a procurement process to ensure that only contracted providers were being used. Primary Care contract forecasts were based on data that changed regularly so it was likely that the figures in the report would vary month to month. Lisa advised that the oxygen contract, which was national, seemed to increase regularly and it was felt that it would be beneficial to have the contract manager attend a future meeting to explain the contract. In regards to the prescribing forecast for practices, it was queried as to whether a 5 year comparison graph could be produced that would show any trends in practice spending. Kevin advised he would ask if someone could access the Primary Care Trust archive folders to obtain the information from before the CCG was in operation. The Finance Committee noted the contents of the report.

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FC/14/06 QIPP The Finance Committee were advised by Lisa Tempest that it had been requested that Quality, Innovation, Prevention and Productivity (QIPP) would be a standard agenda item on the Committee agenda. The CCG had a QIPP plan for the year which tracked progress of the schemes in place which could be circulated with the papers for the next meeting in October. It was felt that the Committee in its new role could investigate potential schemes for the year and it was felt that GP Variation data could help provide some initiatives. It was important that the CCG aim to become more sustainable and that ensuring that the CCG weren’t being double charged for hospital admissions could help with this. The Finance Committee noted the suggestion and would discuss further at the next meeting.

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FC/14/07 CDDFT Contract Negotiation Update The Finance Committee were provided with a verbal update regarding the contract situation with County Durham and Darlington Foundation Trust (CDDFT) from Lisa Tempest. An agreement had still not been made with CDDFT however it had been agreed that the formal mediation process would commence on the 7th October. This would be facilitated by CEDR and Chief Officers from each CCG would be in attendance as well as the Chief Finance Officers for consultation if required. Lisa advised that the CCG had been asked to document the process so that the experience could be shared with other CCGs across the country if facing a similar situation. The Finance Committee noted the information provided.

FC/14/08 GP Variation Update for June 2014 and Practice Action Plans The Finance Committee considered the report which provided an update on work being completed on GP Variation for Practices in Darlington. NECS worked with the practices to develop action plans to attempt to reduce overspending against CCG affordable spend. The overspend being on all Points of Delivery in the GP Practice Variation in Spend table: A&E/Urgent Care Centre attendances, Emergency admissions, Elective admissions, Outpatient attendances and Outpatient procedures. The Committee were advised that there were still some inconsistencies in the data and information provided and it was felt that if the 12 month rolling data was used it would help to link with the financial information being produced in the finance report. There was slight concern as to whether the work was having the desired impact and if it wasn’t how it could be made more effective as some practice felt it was clear that this piece of work have drove the improvement practices were showing. It was also felt that it would be helpful if the information was refreshed regularly and could focus of certain aspects to ensure constant engagement. Jill Smith was due to revisit practices in the near future and it was suggested that feedback be requested from practices regarding the presentation of information and if the practice felt the work was having a positive impact. The Finance Committee noted the contents of the report and the information provided.

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FC/14/09 Risk Register and Any New Risks Identified The Finance Committee considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Risk 165 - CCG does not have an up to date and full profile of financial reporting of CHC packages – Lisa Tempest advised that reporting for CHC had vastly improved and information was now included in the Finance report and a quarterly report was to be submitted to the Executive Committee. As a result it was suggested that the risk be closed. Risk 121 - Prescribing Costs Exceed Budget – Due to the current forecast position for prescribing and data showing that prescribing costs per head of weighted population had decreased slightly compared with 2013/14 for most practices if was suggested that the residual rating of the risk be reduced to 12 – amber. Lisa advised the Committee of a possible risk regarding the arrangements for premises monitored by NHS Property Services. Current arrangements state that any costs of void space will be paid for by the CCG and there was a possibility that part of Dr Piper House was to become void due to CDDFT relocating staff. If this were to happen it would have a significant impact on the financial position of the CCG. An estates group had been established which Lisa would be attending who would review the void space across the patch and create a strategy for moving forward. It was suggested that a representative from NHS Property Service attend the meeting to provide the Committee to explain what work was being undertaken to minimise the cost to the CCG. It was suggested that this should be added to the risk register. Gomathy Umashankar and Richard Stevens left the meeting. Jackie Kay reported that the latest section of the Better Care Fund bid had been submitted and a requirement of the plan was to reduce elective activity by 3.5%. Financial modelling had been undertaken around this and discussed were taking place with CDDFT with the aim to reduce their overheads costs etc. and to make the service more efficient. The risk to the CCG was that if the Multi-Disciplinary Team (MDT) work was not as successful as hoped, the CCG would still need to fund the cost for the team undertaking the work as well as the admissions to hospital. As the CCG did not necessarily have the funding for this it was felt that the situation should be added to the risk register.

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The Finance Committee noted the contents of the report and agreed: 1. To close risk 165 2. That the residual rating of risk 121 could be reduced. 3. To add the risk regarding additional costs for premises be added. 4. To add the risk regarding the Better Care Fund and MDT work

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FC/14/10 Any Other Business No other business was raised.

Date/Time/Venue of Next Meeting Monday 27th October 2014, 12.00 – 14.00 in Meeting Room 1&2, DPH

Signed………………………. Chair.…Andie Mackay……. Date………………………….

DARLINGTON CLINICAL COMMISSIONING GROUP FINANCE COMMITTEE

Monday 27th October 2014

12.00 – 14.00


CONFIRMED MINUTES

Present: Andie Mackay (Chair) Lay Member of Finance James Nevison GP, Denmark Street Surgery Richard Stevens GP, Orchard Court Surgery Lisa Tempest Chief Finance Officer Gomathy Umashankar GP, Blacketts Medical Practice In attendance: Cecilia Collingwood Medical Student Angela Hornsey Senior Commissioning Manager Kirsty Kitching Senior Commissioning Manager –

Provider Management Ian Morris Senior Medicines Optimisation

Pharmacist Andrew Stainer Head of Transformation Kevin Scollay Senior Finance Manager – Commissioning Finance Rachael White Administration Assistant

Action FC/14/11

Apologies for Absence Apologies for absence were received from Gill Findley, Director of Nursing.

FC/14/12 Declarations of Interest No declarations were submitted.

FC/14/13 Minutes of the meeting held on 22nd September 2014 and matters arising The minutes of the meeting were agreed as an accurate record.

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FC/14/14 Action Log 1. Meds Optimisation Website – Complete 2. North Tees & Hartlepool Contract – Included in item FC/14/15. 3. Prescribing – Ian Morris advised that prescribing trends were included in the report at item FC/14/18 which would be focusing on high pressure areas. 4. 62 Day Cancer Waits – It was felt that this should be transferred to the Quality, Performance and Innovation Committee action log. 5. To be discussed in more detail – The North Tees & Hartlepool contract would be discussed in item FC/14/15 and Angela Hornsey had joined the Committee to discuss the Specsavers contract. Lisa Tempest advised that she had been in discussions with NHS Property Services and it was thought that someone would be attending the next meeting. The Oxygen contract was to remain on the action log until a representative was able to attend to discuss it. 6. Optician Glaucoma Referrals – Andrew Stainer advised that he would raise this with the Service, Planning and Reform team. 7. CDDFT Coding Changes – Kirsty Kitching reported that providers and commissioners produce a code of conduct for changes and before the 30th September a notice had been sent to County Durham and Darlington Foundation Trust (CDDFT) identifying the areas we wanted to review. Kirsty would bring a summary of the suggested changes to the next meeting. 8. Prescribing Forecasts – Ian advised that due the Clinical Commissioning Group (CCG) having a different organisation code to the former Primary Care Trust (PCT) it may prove difficult to gain previous data however he would look to see what he could obtain. 9. GP Variation Feedback – A meeting was to take place with the Business Intelligence team to review data sources to see if any amendments could be made to ensure consistent data was being provided. It was hoped that an update would be available for the next meeting. 10. Risk Register – Discussed in item FC/14/19.

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FC/14/18 Prescribing Budget Report October 2014 The Finance Committee considered the report which detailed the current spend position of practices in Darlington using August 2014 prescribing Data. Ian Morris reported that the team were unable to report against the budgets as they had not yet been agreed at an individual practice level. The figures in the report were all linked with the profit margins in the community contracts and pharmacies etc. and the report provided an overarching financial position. It was felt that it would be beneficial in future reports for the budget to be broken down per practice once agreed. James Nevison joined the meeting Ian reported that future pressures were expected to come from two recently published pieces of NICE guidance: 1. CG180 - Atrial fibrillation: the management of atrial fibrillation 2. CG 181 - Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease Both were expected to cause an increase in budget but would save money in terms of hospital costs over time as the clinical pathways would be revised as a result. Further details of the guidance were provided in the report. In October there had been a change in Category M drug prices and there had been increases on the majority of them. It was predicted that Darlington would see a 12% increase in costs which would be an increase of £23,000 each month from October. It was highlighted that there were differences in the figures in the prescribing report and the finance report. Kevin Scollay advised that the Finance team start with the same figures however as the data was so volatile they had been trying to keep it stable. There was an audit trail of the differences that could be brought to future meetings if further detail was requested. The appended report provided details of the CCG’s spends on top 20 drugs from April – June 2014. In regards to glucose strips, it was queried as to whether the hospitals were using the same products as practices. There had been occasions where patients had been changed onto the new product in practice but then following a visit to the hospital had raised concerns as they had been told it wasn’t as good. Ian asked that if there were any instances where negative feedback had been given it be reported to the team so that it could be addressed. The Finance Committee noted the contents of the report.

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FC/14/15 Finance Report The Finance Committee reviewed the report which provided an update on the position of the contracts held by NHS Darlington Clinical Commissioning Group (CCG) for the period 1st April – 30th August 2014/15. The month 6 position data showed that the acute contract variance had continued to increase. It was a concern that if this continued the CCG would need to evaluate how costs could be reduced in other areas for the remainder of the year. The two main areas of concerns were still BMI Woodlands Hospital and North Tees and Hartlepool Foundation Trust (NTHFT). BMI Woodlands had seen a 27% increase in activity however South Tees Hospital Foundation Trust’s activity had also increased despite making referrals to BMI Woodlands. Work was to be undertaken to ensure there was no patient duplication and also where the funding for Referral To Treatment (RTT) had been spent. For NTHFT the majority of the overspend was due to elective procedures and possibly as a result of the breast service clinic being closed in Darlington. Work was to be undertaken to determine exactly why there had been an increase at NTHFT as there had not been a drastic reduction of activity at CDDFT. Kevin Scollay advised that he would review whether some patients could be being still treat at CDDFT as part of the pathway and the increase at NTHFT was due to new referrals. A contract was still to be agreed with County Durham and Darlington Foundation Trust (CDDFT) despite mediation and a formal letter had been drafted to CDDFT advising that the CCG would like to move to arbitration. It had not yet been decided as to who would facilitate the arbitration as it was felt that the individual would need NHS experience but also a legal background. Arbitration timescales could be quite short and it was hoped that the situation could be resolved quickly in order to prevent it reoccurring in 2015-16. In regards to community contracts, Angela Hornsey form Provider Management, advised that the Business Intelligence Team had been asked to collate information regarding ophthalmology to establish why the contract was overspending. It was felt that the increase in activity could be due to a change in the pathway. Kirsty Kitching advised that Teesside were undertaking an audit of activity at Specsavers as they are only supposed to refer patients on the grounds of deterioration. Kirsty would review the progress of this and feedback to the group at the following meeting. The Provider Management team were also developing a framework to ensure a more robust monitoring

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and management of contracts moving forward. Kevin Scollay advised the Committee that the Northumberland, Tyne and Wear Foundation Trust contract was still over performing in Darlington and also in Durham. The forecast was being reviewed on a monthly basis and work was being undertaken to review the pathways. Kevin would ask for an update for the next meeting or ask if a representative could attend the Committee meeting. Following the closure of St John’s Care Home shortly after the Committee meeting, Kevin advised that the forecast would be updated accordingly for the next meeting. It was also requested a representative attend the Committee to discuss the changes. When reviewing the Primary Care slides, Lisa advised that information had been providing in relation to the oxygen contract however it wasn’t as specific as needed so it was hoped that someone could attend the next Committee meeting. It was queried as to who was responsible for the ‘Dummy Practice and Minor Surgery’ costs. Kevin advised he would review this for the next meeting. Lisa reported that it had been established that the CCG should have only being paying for transport for Darlington patients rather than each patient leaving Darlington Memorial Hospital. The provider had been asked to note NHS numbers and GP Practices on the invoices so that payment could be tracked and also to avoid duplications. Gomathy Umashankar left the meeting. In regards to ‘Exceptions and Prior Approval’ on the Other Contracts slide, Kirsty reported that and audit of procedures was being undertaken to ensure that the Individual Funding Request process was being followed appropriately. This had been discussed at the Governing Body and it was felt that this may be more secondary care related and that it was vital that the referral was checked thoroughly when received. Kevin highlighted that there were additional slides towards the end of the report which provided details of the year to date position with a comparison from 2013-14 to present and market share analysis. It was queried as to whether the business rules between A&E and the Urgent Care Centre were monitored as it had been noticed that quite regularly patients would be directed towards the Urgent Care Centre when struggling with capacity. Kevin would check the business rules were being applied. The Finance Committee noted the contents of the report.

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FC/14/16 QIPP The Finance Committee were provided with a document summarising the forecast savings by key programme area as at 30th September 2014, compared to the QIPP plan for the year. Lisa Tempest advised that more information would be provided at the next meeting and encouraged members of the Committee to continue to consider suggestions for addition schemes. The Finance Committee noted the information provided.

FC/14/17 CDDFT Contract Negotiation Update The Finance Committee were provided with a verbal update regarding the contract situation with CDDFT from Lisa Tempest. As discussed earlier in the meeting, Lisa advised that an agreement had still not been reached despite mediation and arbitration had been suggested. A decision was yet to be made as to who would facilitate the arbitration. The Finance Committee noted the information provided.

FC/14/19 Risk Register and Any New Risks Identified The Finance Committee considered the report which provided details of the Risk Management Policy which had been developed for Darlington CCG and a copy of the risk register for the Committee. Lisa Tempest advised that the necessary changes had been made following the last meeting and NHS Property Services had advised that they were working on Quarter 3 figures and a representative would hopefully be attending the next meeting. The Finance Committee noted the contents of the report.

FC/14/20 Any Other Business No other items were raised.

Date/Time/Venue of Next Meeting Monday 24th November 2014, 12.00 – 14.00 in Meeting Room 1&2, DPH

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Signed……………………. Chair.…Andie Mackay…. Date………………………..

DARLINGTON CLINICAL COMMISSIONING GROUP GOVERNANCE, AUDIT AND RISK COMMITTEE

Tuesday 22nd July 2014

14.30 – 16.30

Emerson Room, Dr Piper House

CONFIRMED MINUTES

Present: John Flook (Chair) Lay Member, Governance, Audit and Risk Andrea Jones Chair Andie Mackay Lay Member Finance Michelle Thompson Lay Member, Patient and Public Involvement In attendance: Luke Armstrong Audit Manager, PwC Kelly Douglas Senior Manager, Government and Public

Sector, PwC Debra Elliott Senior Governance Manager, NECS

Stuart Irvine Acting Audit Manager Lisa Tempest Chief Finance Officer

Rachael White Administrative Assistant John Whitehouse Director of Audit, Audit North

Action

GARC/14/38

Apologies for Absence Apologies were received from: Richard Harker Quality Lead/GP, Whinfield Medical Practice Greg Wilson External Audit Engagement Leader, PwC

GARC/14/39 Minutes of the meeting held on 27th May 2014 and matters arising The minutes of the meeting were agreed subject to minor amendments.

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GARC/14/40 Action Log 1. Audit Committee Handbook Questionnaire – The questionnaire was to be circulated following the meeting to members for them to provide feedback and then a report of the consolidated responses would be provided at the next meeting. John Whitehouse advised that there was another version of the questionnaire that could be considered and this would be sent to Lisa Tempest. 2. Freedom of Information Report - A breakdown of the requests solely for Darlington CCG was provided in item GARC/14/44. 3. Risk Policy – The register had been updated and was discussed in item GARC/14/47.

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GARC/14/47 Risk Management Policy Update The Governance, Audit and Risk Committee considered the revised Risk Management Policy developed in line with Clinical Commissioning Groups (CCG) governance requirements. The purpose of the policy is to provide a support document to enable staff to undertake effective identification, assessment, control and action to mitigate or manage the risks affecting the normal business. Debra Elliott advised the Committee that the same framework had been used in order to keep the format consistent with the previous version and that an update in regards to the Safeguard Incident Risk Management System (SIRMS) had been included. The policy outlined the roles and responsibilities around the risk management system and the assessment and escalation process was included in the document to provide guidance if required. An audit mechanism was also in place to ensure that all staff using the system was aware of how to escalate an incident. The CCG risks were now linked with NHS England Direct Commissioning Assurance Framework domains rather than the CCG’s strategic aims in order to provide a clearer position in regard to risk. Rachael White to recirculate the policy as the version included in the papers still showed tracked changes. Debra advised that she would produce an implementation plan which would be circulated via Rachael to aid forward planning and to also ensure that the actions for the Committee and the CCG were completed in the required timescales. The Governance, Audit and Risk Committee approved the policy.

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Debra Elliott left the meeting GARC/14/41 Internal Audit Plan & Counter Fraud Plan 2014/15

The Governance, Audit and Risk Committee considered the report which set out the draft three year strategic internal audit plan covering the period 2014/15 to 2016/17; the annual internal audit plan for 2014/15; and the draft counter fraud plan for 2014/15. Stuart Irvine reported that discussion had taken place with Lisa Tempest as to what would be included in the strategic plan and with the other Chief Finance Officers across the patch. It was felt that the plan was too large to complete within one year and was therefore split across three years and the areas had been prioritised. For any areas that were flagged as red it was agreed that a risk assessment be undertaken. Lisa advised that there were some areas where it was not clear as to whether the responsibility would be with the CCG or the North of England Commissioning Support Unit (NECS) and the areas flagged as red would be addressed and prioritised further. In the process of creating the three year strategic plan it had been established that some aspects of the audit plan were not reflected in the board assurance or risk management processes. John Whitehouse advised that discussion had taken place with other CCG’s in relation to this situation and the process followed previously could be shared with Lisa. In regards to counter fraud, John W advised that guidance was yet to be received from NHS Protect in regards to what they would like to see in regards to counter fraud activity for CCGs. A detailed risk assessment was being undertaken focusing on the main areas of concern e.g. invoices under £1000 to ensure the CCG was protected as much as possible. It was requested by the Committee that for the next report a prediction of how the other two years would look and Stuart advised that this would be included in the next report. The internal audit plan for 2014/15 indicates areas which because of perceived risk require review and there can be no guarantees that the process will not derive one or more ‘limited assurance’ reports. This could impact on the ‘inspection and performance review process’ undertaken by the NHS England and cause inappropriate pressure on internal audit to report a potentially misleading result. Lisa advised that the CCG are monitored against the NHS England assurance framework and that the CCG have to self-certify the elements of it. If a limited assurance audit report was received there was a section in the framework to complete and the issue would then be discussed

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at the quarterly assurance meeting. If NHS England then felt that the CCG did not have the mechanisms in place to deal with the issue they would intervene. The Committee advised that the Executive and CCG staff were to be made aware that there was no additional pressure from the Committee in relation to this concern and that it was felt that if limited assurance was given, the CCG would have processes in place to deal with the issue accordingly. Another concern was that NECS commissioned a number of additional third party assurance reports which may not be repeated in 2014-15 which would provide the CCG with less than sufficient assurance coverage to make positive year end statements. This was due to Commissioning Support Units only being able to commission work for Internal Audit purposes from their appointed provider (Deloitte) and NHS England had also appointed Deloitte as their provider. Therefore some of the work which was undertaken by various other Internal Audit sources such as payroll and quality aspects of CHC etc. may not be available. It was felt that it was essential that there was a full understanding of the service user report provided by NECS and that the CCG was clear as to what scope the report was to cover for the year. It was requested that the third party assurance issue was to tracked as a separate issue and that it be added as a standing agenda item. Lisa to produce a report tracking the progress for each meeting. The Governance, Audit and Risk Committee received and approve the draft three year strategic internal audit plan, the draft annualised internal audit plan for 2014/15 and draft counter fraud plan for 2014/15.

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GARC/14/42 Internal Audit Progress Report The Governance, Audit and Risk Committee considered the report which provided an update on the remaining audits for 2013/14; a summary of completed audit assignments since the last progress report; and an update on support provided to the CCG to assist in ensuring effective assurance is received in 2014/15. Stuart advised that four audit reports had been completed and finalised and work was still being undertaken on the Francis II report. Recommendations from the completed reports were outlined in the report. In preparation for 2014/15 an internal audit protocol a document had been developed which set out the roles and responsibilities of Audit North as the service provider and the CCG. The details were currently being finalised and a draft version would be presented to the next Committee meeting for approval.

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The Committee were advised that there was one overdue high priority recommendation for safeguarding arrangements and a response was still awaited. Lisa advised that the reason behind the delay was due to a change in staff. Gill Findley was now in the role of Director of Nursing and Lisa would ensure that this action was followed up. Lisa advised that a spreadsheet had been created logging all of the recommendations made in the individual reports to allow the CCG to track the progress of the actions and it would be reported to the Executive Committee for monitoring. In regards to counter fraud the Committee were advised that participation in the National Fraud Initiative (NFI) is mandatory for CCGs and the CCG should have been contacted about this. It was requested that at the end of each update report a log of all high and medium recommendations be provided so that the Committee could also track the progress. Stuart advised that this would be included in future reports as an appendix. The Governance, Audit and Risk Committee noted the contents of the report.

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GARC/14/43 External Audit Update The Governance, Audit and Risk Committee were provided with a verbal update from Luke Armstrong who advised that he annual accounts had been approved and that a meeting would be scheduled with Lisa to discuss the risks to the CCG and how to move forward. The Committee advised that PwC would aim to have the annual audit plan for the next year ready to present to the Committee. The specific date to be confirmed once the committee schedule for 2015 was complete. The Governance, Audit and Risk Committee noted the information provided.

GARC/14/44 Freedom of Information Report The Governance, Audit and Risk Committee considered the report which gave an update in relation to statutory compliance with the Freedom of Information (FOI) Act 2000 and Data Protection Act 1998 (DPA) by Darlington Clinical Commissioning Group. The report provided a breakdown of how many requests had been received since the start of the year and the timescales they had been responded to in. The report stated that 23 requests had been received in May 2014; 19 requests had been received in June 2014 and as of 16th July 2014, 5 requests had been received. All requests

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received were acknowledged in line with the Information Commissioner’s Office (ICO) requirements and responded to within the statutory timescale with no exceptions applied. Lisa highlighted that a graph had been provided showing a comparison to the previous year which showed that there had been an increase in requests. A breakdown of requested had also been provided as requested and it was noted that there had been an increase in requests regarding mental health spending. Lisa reported that if the information requested was available from a public source e.g. the CCG website the individual would be directed to where they could find the information. NECS were now to publish responses to requests on the CCG website so that individuals asking similar questions can be directed to the response already given. It was highlighted by the Committee that some information in the spreadsheet appended to the report needed to be anonymised. The Governance, Audit and Risk Committee noted the contents of the report.

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GARC/14/45 Revised Committee Terms of Reference The Governance, Audit and Risk Committee considered the revised Terms of Reference (ToRs) for the CCG Committees. Lisa advised that following the appointment of Gill Findley as Director of Nursing, the Executive portfolios were reviewed and Gill was now the performance lead for the CCG and Lisa had taken on more corporate responsibilities. As a result the Committee arrangements had been reviewed and agreed that the Finance and Performance Committee would now be a dedicated Finance Committee and take responsibility for the QIPP agenda and the performance aspect would now sit with the Quality and Innovation Committee to fit with Gill’s portfolio. The membership had been reviewed in the ToRs and Andie Mackay had now been appointed as Chair for the Finance Committee and Martin Phillips had been removed. However regular finance and quality reports were provided to the Executive and Governing Body which would provide feedback. In response to query, Lisa advised she would look to have a written schedule of when the ToRs would be reviewed in the future. The Governance, Audit and Risk Committee approved the changes to the Terms of Reference for the Committees.

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GARC/14/46 Review of Continuing Healthcare Decision Making Arrangements The Governance, Audit and Risk Committee considered the information provided regarding the review of arrangements in place around consistency of decision making in relation to Continuing Healthcare. Following the Workshops with CCGs carried out between June and October 2013 around their assurance requirements, Continuing Healthcare (CHC) commissioned the Northern Internal Audit and Fraud Service to carry out a review of the consistency of decision making in relation to eligibility for Continuing Healthcare. The work that had been undertaken since then regarding reporting mechanisms and risks around decision making and delegating were stated in the letter provided. Lisa advised that it was felt that the letter didn’t fully highlight the issues with the arrangements and it was thought that a report would have been provided giving more details. NECS have scheduled a meeting in September to review the outstanding issues regarding delegation and decision making relating to CHC cases. The Governance, Audit and Risk Committee noted the information provided.

GARC/14/48 Risk Management The Governance, Audit and Risk Committee reviewed the full risk register for Darlington Clinical Commissioning Group with appendices providing an overall summary, details of the corporate risks, a distribution matrix and risks closed since the last report. Lisa advised that there was a new report included in the papers which showed how the risks had been aligned to the six domains in the Direct Commissioning Assurance Framework. There were a number of risks on the register that showed no controls or assurances, Lisa advised that this had been discussed with the risk owner and it was established that there may have been a glitch in the system when saving as information had been added. The risk owner would enter the information again and ensure this was completed by the next Quality and Innovation Committee where the risks would be discussed. Lisa highlighted that Risk 1023 - Critical Royal College report received relating to radiology, was rated red on one report and amber on another however this would become clear after the controls and assurances had been updated. Andie Mackay

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advised that Chris Gray, Executive Medical Director and Chris Shaw, Manager for Radiology Services for County Durham and Darlington Foundation Trust (CDDFT) had attended the July Quality and Innovation Committee to provide an update on the service. The Committee had been advised that there were difficulties with the staffing levels at Darlington Memorial Hospital and that aspects of the service had been outsourced. The Committee agreed that in order to highlight the necessity of the risks register being updated on a regular basis, the responsible officer would be asked to attend the Committee to explain why the task had not been undertaken. In response to query, Lisa advised that the updating of the register was a very easy process and the NECS had an automated reminder that was sent to the responsible officers on a monthly basis. The Governance, Audit and Risk Committee noted the content of the report.

GARC/14/49 Any Other Business No other items were raised.

GARC/14/50 Private discussions with Internal and External Audit No discussions took place.

Date/Time/Venue of Next Meeting 14.30 – 16.30, Tuesday 30 September 2014, Emerson Room, Dr Piper House

Signed……………………. Chair.…John Flook……. Date……………………….

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DARLINGTON CLINICAL COMMISSIONING GROUP COMMUNITY COUNCIL

Thursday, 28th August 2014

18.00 – 20.00

Meeting Room 1&2, DPH

CONFIRMED MINUTES

Present: Michelle Thompson (Chair) Lay Member, Patient & Public Involvement

Jodie Craggs Healthwatch Darlington Kenneth Frid Patient, Parkgate Surgery Carole Ferguson Patient, Carmel Surgery Graham Levitt Patient, Felix House Surgery Betty Hoy Patient, Moorlands Surgery Jenny Withington Young Patient, Blacketts Surgery Kath Wall Patient, Denmark Street Surgery

In attendance: Jackie Kay Assistant Chief Officer, Darlington

CCG Sarah Chaplin Administration Assistant, Darlington

CCG

Action

CCM/14/138 Welcome and Introductions

Michelle Thompson opened the meeting and welcomed those present.

CCM/14/139 Apologies for Absence

John Hodge Patient, Whinfield Surgery Terry Taylor Patient, Neasham Surgery Karen Grundy eVOlution

CCM/14/140 Minutes of the meeting held on Thursday 26th June 2014

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The minutes of the previous meeting were checked and one inaccuracy was noted for amendment on the PPG updates.

CCM/14/141 Matters Arising Two members expressed concern over comments recorded in July’s minutes regarding the Mental Health Event. MT apologised for any misunderstanding and stipulated the comments recorded were merely a different perspective on the event. MT proposed that future attendance at similar events should be assessed for suitability for members beforehand in order to ensure attendees feel fully prepared. Felix House – Following the last meeting regarding GL’s concerns over rumours surrounding the potential re-location of Felix House to elsewhere within the Borough (dependent on funding), JK stated that as far as she is aware the practice have logged a funding request with NHS England. However, this is complicated and both parties are currently in discussions. GL informed that a questionnaire has been placed in the surgery to gather patient’s views. GL said he will bring the results to the next meeting. JH had asked at the last meeting whether when leaving the armed forces, patient records are made available to the GP. MT spoke to MP who said he felt that this would be the case upon request.

CCM/14/142 Individual Funding Requests JK explained the paper to the group and informed that this is funding that may be requested by a patient for specialist treatment such as infertility treatment or a medical procedure. This paper discusses a proposal to extend the use of the existing individual funding request process where procedures of limited clinical value are subject to a peer reviewed, approval process. This process leads to an equitable application of agreed levels of care within agreed criteria. The list of procedures is agreed on the basis of research and evidence available by a multi- agency group of clinicians representing the North East. For many years the commissioners across County Durham and Darlington have had an agreed list of procedures that are of limited clinical value. Where a patient attends requesting to have a procedure of limited value the patient’s General Practitioner is required to submit an individual funding request to the North of England Commissioning Support unit. Each Clinical Commissioning Group has trained clinicians who review the

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funding requests and approves or rejects the request in accordance with the guidelines. This process works well where all clinicians adhere to the process. Recent review of the numbers of procedures being undertaken across the North East reveals significant differences in the different CCG areas, leading to a view that the procedures are not being universally applied. There are 2 main issues that are preventing the system being applied as expected: GPs are not referring patients to the individual funding

request process Secondary care providers take a referral letter to their service

to mean that approval has been granted in primary care and proceed to surgery without further approval

To address this situation it is suggested that there is a refresh of the procedures in a 2 stage process; Stage 1: primary care focused to reduce the flow of patients

into hospital for procedures contained in the policy Stage 2: secondary care focussed - establishing an IFR

ticket system - so a ‘ticket’ is needed before a procedure is carried out on a patient and paid for by the commissioner

In stage 1 there will be a focus on reminding primary care staff about the policy, training staff in use of the IT programme that supports the individual funding requests and discussion about the rationale for the policy and staff’s responsibilities. It is important for staff to understand that equitable application is important for this process to work well. During this stage there will also be a review of the evidence supporting the procedures that have been identified as of limited clinical value lead by Mike Lavender of the Public Health team in County Durham. The community council was asked to review the information included within the paper and agree the proposals. JWY expressed concerns that only a certain number of patients would benefit from this, however, JK explained this is not the case It is funding for treatment outside the remit of services that the CCG would usually commission and clinicians will look at the case history of the individual to decide whether the treatment is suitable and if funding would be provided. Following this explanation the Community Council all agreed the proposals.

CCM/14/143 PPG updates – Issues and Concerns. All PPG representatives MT informed that Whinfield are having their first face to face

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meeting on the 12th September.

CCM/14/144 VCS updates eVOlution MT informed the group she had spoken to Karen Grundy to encourage the attendance of different third sector groups on a regular basis. This will ensure members of the Community Council and the CCG learn more about the sector and for good news, issues and concerns to be heard. GOLD Cataract Treatment Waiting Time KW informed that she has been made aware that there is a 26 weeks waiting time at DMH for Cataract Treatment. JK informed the group that this is being looked at by Rowena Howard, Contract Manager at NECS who have contacted DMH for a response. Nail Cutting KW Read a letter received by Andrea Jones regarding the podiatry service and went on to explain she has been informed the service was never just a nail cutting service and other conditions are needed to be taken into consideration to qualify for this such as diabetes. JK said she was aware this had been raised at a previous Community Council meeting. She informed the group that after some research, she had found that the specification criteria had not been updated for some time and had flagged this with the relevant personnel. JK explained that being elderly does not qualify you for the service as there are some fit and healthy elderly people in the Borough. High risk patients do qualify. Moving of the MSK and back pain service KW raised concerns that have been expressed about the MSK and back pain service being re-located from Hundens Lane to the Arena given that there is a limited bus service. JK explained that there is a non-acute ambulance passenger service; however, there is a criteria for this such as limited mobility. BH informed that the Red Cross also provide a service. JK also informed the group that the MSK service is being reviewed as it is coming to the end of its service contract. She

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also explained that the reason the service was removed from Hundens Lane was due to a lack of clinical space which resulted in lengthy waiting times. Healthwatch JC informed the group that Healthwatch and the CCG had teamed up for community roadshows over 4 nights in July/August. JC also informed that Healthwatch are gathering data/information with regards to the Breast Clinic and are working with NECS on the Mental Health strategy.

CCM/14/145

Update on Darlington CCG Financial Health Lisa Tempest was unable to attend the meeting; however, she provided the latest performance report as detailed below. At the end of July 2014 (month 4) Darlington CCG reported a surplus of £480k and is forecasting a surplus of £1,438k for the full year which is in line with the 1% surplus required by NHS England. The position reflects slightly lower than planned spend on mental health and continuing healthcare services and higher than planned spend on acute services and prescribing. Costs for County Durham and Darlington Foundation Trust are higher than planned for excess bed days, high cost devices and outpatient follow ups, particularly in paediatrics and respiratory medicine. Although the financial position at this time is in line with our plans it should be noted that this could change, and the CCG is monitoring all activity and costs very closely. Following the deterioration in performance at CDDFT during quarter 3 and 4 of 2013/14 the initiatives implemented by the Trust resulted in an improvement in performance for Q1 which is being sustained in Q2. The CCG continue to monitor this closely and are in the process of evaluating plans for additional measures to be put in place during the winter to ensure the improvement in performance is sustained. Cancer As at the end of June all cancer targets have been achieved on a year to date basis. Ambulance Response – 19 Minutes

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In July 2014, North East Ambulance Services failed to achieve the target of 95% of calls responded to within 19 minutes for Darlington, with 94.76% of calls being responded to within the timescale. In order to address this, the following actions have been taken:

Increased capacity – utilisation of third party providers increased and increasing fleet cover to maintain vehicles on the road

Reduce demand – call taker audits to identify outliers within the call centre. Clinical hub is operational to assist decision making; i.e. alternative dispositions, alternative transport solutions (not always paramedic required)

Incentivising shifts to increase staffing levels Change skill mix of staff to best utilise vehicles and

increase service coverage

CCM/14/146

Any Other Business BH expressed concerns over the lack of service where frail/elderly people have someone come to their home and cook a meal for them. KW informed the group that he had attended the NHS People’s March meeting in Darlington which had a very good turnout.

Date and time of next meeting Thursday 25th September 2014, 18:00 - 20:00pm in Meeting Room 1&2, Dr Piper House

Signed………………..……………. Chair.…Michelle Thompson……. Date…………………………….……

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DARLINGTON CLINICAL COMMISSIONING GROUP COMMUNITY COUNCIL

Thursday, 25th September 2014

18.00 – 20.00

Meeting Room 1&2, DPH

CONFIRMED MINUTES

Present: Michelle Thompson (Chair) Lay Member, Patient & Public Involvement

Andrea Goldie Healthwatch Darlington Kenneth Frid Patient, Parkgate Surgery Carole Ferguson Patient, Carmel Surgery Grahame Levett Patient, Felix House Surgery Betty Hoy Patient, Moorlands Surgery Terry Taylor Patient, Neasham Surgery Ken Brown Patient, Denmark Street Surgery Audrey Lax Patient, Blacketts Surgery John Hodge Patient, Whinfield Surgery Louise Hoggatt Practice Manager, Whinfield Surgery

In attendance: Martin Phillips Chief Officer, Darlington

CCG Sarah Chaplin Administration Assistant, Darlington

CCG Neeraj Sharma Citizens Advice Bureau (item 42

only)

Action

CCM/14/47 Welcome and Introductions

Michelle Thompson opened the meeting and welcomed those present.

CCM/14/48 Apologies for Absence

No apologies were received.

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CCM/14/49 Minutes of the meeting held on Thursday 28th August 2014 Grahame Levett noted that his name was incorrectly spelt on the attendance list. Subject to the above correction the minutes of the meeting were deemed as accurate.

CCM/14/50 Matters Arising There were no matter arising.

CCM/14/51 CAB Health Advice and Cancer Support Event Neeraj Sharma gave the group an overview of the Citizens Advice Bureau and the help it can provide such as help with bereavement, financial, employment and housing. He illustrated the overview with a PowerPoint presentation that detailed how they had helped a Darlington resident. GL asked whether the benefits that the CAB had secured were because other people weren’t doing their job and making entitlement clear. Neeraj explained that at times more than one organisation may be involved with the benefit system and that often a decision made by one may have a knock on effect with another. JH asked how much input a GP may have with regards to the benefit system and NS explained that the CAB advisors will sometimes contact them to provide evidence on a patient’s condition. NS advised that he was finalising a paper that sets out the health benefit of their work. He hoped that the CCG would consider it when completed.

CCM/14/52 Patient Transport Service The council considered proposed changes being considered across the North East in respect of the eligibility of the Patient Transport Service. MP informed that there are national criteria for PTS Services that have been adopted in Darlington. If transport to hospital is required the GP will signpost the patient to the TIS (Transport information Service). These criteria are now to be rolled out across the whole of the North East.

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MP asked the group to read the information provided and provide feedback. BH explained that she is aware the Red Cross provide a transport service; however, they are short of drivers, and there are also voluntary drivers within the hospitals. It was felt that knowledge of local arrangements was not universally held. Action – County Durham and Darlington Foundation Trust to be informed of local arrangements. It was felt that contact details should be made clear of all types of transport. BH said she thought that funding had been cut for NEAS; however, MP explained that this was not the case and the issue was due to a high volume of demand for the service. MT asked where the information regarding the PTS will be held and MP explained it will be made public via Healthwatch Darlington and GP Surgeries. BH said she felt the telephone numbers should be provided on the front of the documentation to make is easier to see and the group agreed. The council noted the changes and found the material to be helpful and informative with the additions set out above.

CCM/14/53 PPG updates – Issues and Concerns. All PPG representatives GL informed the group of on-going concern relating to a survey that would carry patient views of Felix House practice moving out of the village had not yet been completed. He said that there is a PPG meeting in October and he will request that it be brought to a close so that the result and figures can be recorded.

CCM/14/54 VCS updates Andrea Goldie gave the group the following updates:

Healthwatch are continuing to support engagement with the Mental Health strategy. Timescales for this are to still be established.

Continued concern surrounding the Crisis Team and a

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Commissioner summit is to be held to discuss this.

Healthwatch are involved in the dementia strategy and are hoping to put together a Dementia strategy group.

Further work is being carried out with the breast service. Visiting on 30/09/14 Further information included:

Attended the CAB Darlington has Cancer event and hosted a table during consultation workshops.

In the process of putting together a second version of the

service directory and want to involve local small services who may not be able afford standard advertising.

Recently been out to rural areas on the mobile libraries.

Hosting a data gathering market stall on the 27th October

to collate public feedback on services within Darlington.

Putting together a project group to focus on ethnic minority communities to ensure that all communities are captured within the Borough. MT asked the group if they knew of any groups or leaders within their own communities to encourage them to get involved either with Healthwatch or through their respective PPG’s.

CCM/14/55

Update on Darlington CCG Financial Health The Community Council considered the report of the financial Health of the CCG. At the end of July 2014 (month 4) Darlington CCG reported a surplus of £480k and is forecasting a surplus of £1,438k for the full year which is in line with the 1% surplus required by NHS England. The position reflects slightly lower than planned spend on mental health and continuing healthcare services and higher than planned spend on acute services and prescribing. Costs for County Durham and Darlington Foundation Trust are higher than planned for excess bed days, high cost devices and outpatient follow ups, particularly in paediatrics and respiratory medicine. Although the financial position at this time is in line with our plans it should be noted that this could change, and the CCG is monitoring all activity and costs very closely. Performance:

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Accident and & Emergency 4 hour target Following the deterioration in performance at CDDFT during quarter 3 and 4 of 2013/14 the initiatives implemented by the Trust resulted in an improvement in performance for Q1 which is being sustained in Q2. The CCG continue to monitor this closely and are in the process of evaluating plans for additional measures to be put in place during the winter to ensure the improvement in performance is sustained. Cancer As at the end of July all cancer targets have been achieved on a year to date basis. Ambulance Response – 19 Minutes April performance fell below the national target of response to 75% of Red1 and Red2 calls in 8 minutes, however, following a deep dive analysis into causes of the drop, May and June performance recovered. July performance dropped below target for both indicators but August figures recovered and the year to date performance is in excess of the national targets at a provider level. Darlington CCG are reporting 94.78% against the 95.00% 19 minute target at a Jul-14 YTD position. There are significant concerns amongst Commissioners that NEAS may fail to maintain these response standards; historically the provider would have achieved a significant “buffer” of performance in the first part of the year in the lead up to the Winter period, It is worth making it clear that demand is not considered to be a contributing factor to the performance issues; in fact activity levels are broadly in line with 2013/14 where performance standards were achieved consistently. Patients Waiting for Diagnostic Tests for Over 6 Weeks County Durham and Darlington Foundation Trust reported in May that 2.20% of patients were waiting longer than 6 weeks from referral for a diagnostic test, in June this performance deteriorated to 4.67% and in July deteriorated further to 6.6% against the target of 1%. The Trust has experienced increased referrals for colonoscopy and endoscopy linked to the upper GI referral campaign. CDDFT have always experienced a high uptake in relation to cancer campaigns and in this case demand has outstripped capacity. The Trust are now developing plans in preparation for the next cancer campaign ‘blood in pee’ which is scheduled for later in the year to ensure that they do not have a repeat of the capacity problems. Assurance around this has been requested via the Contract Management Group.

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The Trust had originally advised that the plans that they had put in place would deliver the target in August, however they have updated that they will continue to fail this target in August and we are seeking an updated position with regards to September The Community Council received the report on financial health.

CCM/14/56

Any Other Business GP Choices MP asked for views on whether the CCG should commission and fund occupational health services for GP’s, dentists etc., and went on to explain that some CCG’s in the North East are funding this service whereas others aren’t. The group felt that failure to commission GP Choices would have a detrimental impact on GP recruitment in Darlington and they unanimously agreed that the CCG should recommission this service. .

Date and time of next meeting Thursday 30th October 2014, 18:00 - 20:00pm in Meeting Room 1&2, Dr Piper House

Signed………………..……………. Chair.…Michelle Thompson……. Date…………………………….……