nhs lincolnshire west clinical … · 6 patient story:- pain management ... apologies: dr s ansari...

Improving Healthcare, Improving Health

NHS LINCOLNSHIRE WEST CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING - WEDNESDAY 28 JANUARY 2015 AT 13:30 AT THE BENTLEY HOTEL,

NEWARK ROAD, SOUTH HYKEHAM, LINCOLN, LN6 9NH

A G E N D A

Item Standing items Enc Lead *Rec

1 To receive apologies for absence: John Bains, Tony McGinty,

2 To approve the minutes of the previous meeting held on 17.12.14

Enc A All

3 To consider matters arising not on the agenda

4 To receive any Declarations of Interest

5 To receive a verbal update from the Chair, Clinical Chief Officer and Chief Operating Officer

Verbal Mr Childs, Dr Hindocha/ Ms Newton

Consider/note

Quality (Safety, Effectiveness & Patient Experience) and Performance

6 Patient Story:- Pain Management

Verbal Ms Freeborn

7 To consider an update in relation to HealthWatch & Men’s Health Report

Enc B Ms Newton Consider/note

8 To consider an update in relation to Quality & Patient Experience including ULHT CHI Review

Verbal Ms Martin Consider/note

9 To consider the Performance and Quality Report Enc C Mr Bambro

Consider/note

10 To consider the Financial and QIPP Performance Report

Enc D Mr Croot Consider/note

Strategic Direction and Policy

11 To receive an update in relation to the Draft Five Year Strategic Plan and 2015/16 Planning

Verbal Mrs Lumb

Consider/note

12 To receive a Briefing Paper regarding Better Care Fund Section 75 Agreement 2015/16

Enc E Mr Croot/Mr Garrod Approve

13 To receive the Staff Survey Action Plan Enc F Mrs Lumb Consider/note

14 To receive the Programme Management Office Report and an outline of Projects for 2015/16

Enc G Mrs Lumb Consider/note


Governance

15 To ratify the following Co-Commissioning Documents:-

CCG Co-Commissioning Submission

Draft Delegation Agreement

Conflict of Interest Policy

Changes to the Constitution

Primary Care Commissioning Committee Terms of Reference

Enc H

Enc H1 Enc H2 Enc H3 Enc H4 Enc H5

Ms Newton

Ratify

Governing Body Committee Meetings, Minutes and Terms of Reference

16 To receive the CCG Council Meeting Minutes dated 3 December 2014

Enc I Dr Hindocha Consider/note

17 To receive the Quality & Patient Experience Committee Meeting Minutes dated 16.12.14

Enc J

Information

18 Freedom of Information Report – December 2014 Enc K Ms Newton Consider/note

19 Dates for future meetings: PLT – ENT – 10.02.15 Strategy Group Meeting – 03.03.15

Date and Time of next meeting

20

Wednesday 25 February 2015 at 13:30 at The Showroom, Tritton Road, Lincoln, LN6 7QY

Apologies to [email protected] 01522 515381

The items on this agenda are submitted to the Governing Body for discussion, amendment and approval as appropriate. They should not be regarded, or published, as organisation policy until formally agreed at a Governing Body meeting at which the press and public are entitled to

attend. Papers are available on the NHS Lincolnshire West CCG website: www.lincolnshirewestccg.nhs.uk In case of difficulty accessing the papers, please contact Sarah Behan, Board Secretary on 01522 515381

(via e-mail at [email protected])

The Governing Body will be asked to consider the following resolution: That representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the

confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest (Section 1(2) Public Bodies (Admission to Meetings) Act 1960) Items in the private part of the meeting are either commercial in

confidence or relate to individual staff and patients.

…………………………………………………………………………………………………………………Sarah Behan, Board Secretary

mailto:[email protected]



Recommendations to the Governing Body - Glossary of Terms

To approve

An item of business that requires the Governing Body to make a formal decision.

To endorse An item of business that requires the Governing Body to endorse the actions taken by NHS Lincolnshire West CCG as a signatory to a multi-organisational decision.

To ratify An item of business where the Governing Body is required to ratify the actions taken on behalf of NHS Lincolnshire West CCG, e.g. decisions taken by a Governing Body Committee

To discuss An item of business that requires discussion by the Governing Body prior to agreement of a formal resolution or a general policy steer to the Executive.

To consider A reporting containing a positional statement relating to the delivery of the organisation’s functions for which the Governing Body has a corporate responsibility but is not explicitly required to make a decision.

For information (to receive) An item of business that is of general interest, but is not of significance to the Governing Body’s corporate or operational activities. These items will be included on the agenda but will not be for discussion.

These terms apply to the Governing Body and sub committees.

*All members of NHS Lincolnshire West CCG Governing Body understand and are committed to the practice of

good governance and to the legal and regulatory frameworks in which they operate. As individuals, members

understand both the extent and limitations of their personal responsibilities (full copy available on request).

To justify the trust placed in me by patients, service users, and the public, I will abide by these Standards at all times when at the service of the NHS.

I understand that care, compassion and respect for others are central to quality in healthcare; and that the purpose of the NHS is to improve the health and well-being of patients and service users, supporting them to keep mentally and physically well, to get better when they are ill and, when they cannot fully recover, to stay as well as they can to the end of their lives.

I understand that I must act in the interests of patients, service users and the community I serve, and that I must uphold the law and be fair and honest in all my dealings.

*Professional Standards Authority – Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England

Sarah Behan Board Secretary

Improving Healthcare, Improving Health Page 1 of 8

Minutes of the NHS Lincolnshire West CCG - Governing Body Meeting Held on Wednesday, 17 December 2014

The Showroom, Tritton Road, Lincoln, LN6 7QY Present: Mr R Childs Lay Chair Mr R Buttery Lay Member for Governance & Chair of Audit Mr R Croot Chief Finance Officer Ms S Edge Lay Member for Patient, Public Involvement & Engagement Dr S Hindocha Chief Clinical Officer Dr S Imam Executive GP Dr M Latham Executive GP (Vice Chair) Ms S Newton Chief Operating Officer Dr S Protheroe Executive GP In Attendance: Ms S Behan Board Secretary Ms M Atkin Communications & Engagement Manager, GEM Mr J Bains HealthWatch Representative Mr M Bambro Head of Performance Mr R Barber Agenda Item 15 – Autism – (Lincolnshire County Council) Mrs C Cottingham Head of Service Redesign – Unscheduled Care Mr G Garrod Director of Adult Social Services (Lincolnshire County Council) Dr N Imam Executive GP Dr I Lacy Non-Executive GP Mrs A Lumb Head of Planning Ms J Minchin Patient Story – Agenda Item 15 – Autism Apologies: Dr S Ansari Executive GP Dr C Ash Executive GP Miss A Challans Head of Service Redesign – Planned Care Ms W Martin Executive Lead Nurse & Midwife Mr T McGinty Consultant in Public Health (Children’s Health) Dr J Parkin Executive GP Dr S Roychowdhury Secondary Care Consultant 14/268 MINUTES OF THE LAST MEETING DATED 26 NOVEMBER 2014 The minutes of the last meeting dated 26 November 2014 were received and approved. The Governing Body agreed to:-

Approve the minutes. 14/269 MATTERS ARISING NOT ON THE AGENDA None noted. 14/270 DECLARATIONS OF PECUNIARY AND NON-PECUNIARY INTERESTS The Executive GPs declared an interest in relation to Agenda Item 14 – Update in relation to Co-Commissioning Primary Care.


14/271 LAY CHAIR & CHIEF CLINICAL OFFICER UPDATE(S) Lay Chair Mr Childs advised members that a letter had been sent to United Lincolnshire Hospitals NHS Trust expressing concerns regarding the non-attendance of colleagues/representation from the Trust at the recent Mortality Review Summit meeting. Chief Clinical Officer Dr Hindocha wished members a Merry Christmas and Happy New Year and thanked staff for all their hard work and support over the past year. QUALITY (SAFETY, EFFECTIVENESS & PATIENT EXPERIENCE) AND PERFORMANCE

14/272 PATIENT STORY Mr Barber and Mrs Minchin were welcomed to the meeting. Mrs Minchin provided an overview of her medical condition Asperger’s syndrome and gave an update on the history, symptoms and access to the relevant care services. Mrs Minchin stated that there appeared to be no clear diagnostic pathway in place from the GP to the relevant service providers. It was noted that this was an area for review as part of the development of the Autism Strategy. Mr Bains sought clarification regarding the current level of support that Mrs Minchin is receiving, it was noted that there has been a significant decrease in the level of PA support provided as her level of need has been re-assessed as moderate. Mr Childs thanked Mrs Minchin for attending the meeting and presenting her story and that this feedback would be used to inform the development of the Autism Strategy. The Governing Body agreed to:-

Note the story. 14/273 HEALTHWATCH REPORT/UPDATE Mr Bains stated that Healthwatch have just completed four significant pieces of work with reports on:-

Hear our Voice – Children and Young People of Lincolnshire;

Residents view of pharmacy services in Lincolnshire;

Impact of Did Not Attend appointments by patients on GP Practices;

Views of patients, service users and carers of mental health services in Lincolnshire. These had been reviewed at a conference held earlier in the month attended by CCG officers. It was noted that the usual monthly report had seen a high level of reported items during November and the collation of this information is being produced and will be presented at the January 2015 meeting. Members were asked to read the four reports and provide feedback/comments.


Mr Childs referred to the Children and Young People report and the high levels of self-harm and that this is an issue which continues to rise. Mr Garrod advised that the Public Health Partnership Board review this information and it was noted that Lincolnshire is an outlier in relation to this. Mr Garrod added that the Public Health Partnership Board have been tasked with developing a multi-agency strategy to support all agencies to address this area. The Governing Body agreed to:-

Note the four reports. 14/274 HEALTH & WELLBEING BOARD & BETTER CARE FUND (BCF) UPDATE Dr Hindocha referred to the agenda of the last Health and Wellbeing Board that took place on 9 December 2014. It was noted that there had been a presentation on the Lincolnshire All-Age Autism Strategy and that Mrs Lumb had attended this meeting to provide an update in relation to the Draft Lincolnshire Unit of Planning Five Year Strategic Plan. It was noted that the updated Joint Strategic Needs Assessment (JSNA) Overview Report had also been presented at the meeting which had detailed the key changes within the JSNA over the last 12 months. Dr Hindocha stated that the Health and Wellbeing Board had also received an update in relation to the Better Care Fund which relates to three key areas: the work to produce a re-submission document that is required to be returned to NHS England by 9 January 2015, the second to the development of a Section 75 legal agreement that incorporates all pooled budgets across health and social care and equating to £197m and finally the details to agree funding for schemes and the protection of Adult Care supported by the BCF. Mr Buttery sought clarification regarding the governance arrangements and the host organisation for the Section 75 agreements. Mr Croot advised that independent legal advice is being sought in relation to this matter and a paper being drafted which will set out the legalities and provide assurance. It was agreed that Mr Buttery and Mr Croot would discuss this issue at a separate meeting.

Action: Mr Croot/Mr Buttery Mr Garrod advised that the Better Care Fund planning template will require sign off by CCG’s and will be presented at the January 2015 and March 2015 meetings. The Governing Body agreed to:-

Note the update

Discussions to take place with Mr Buttery and Mr Croot regarding the governance arrangements and Section 75 agreement.

Receive a copy of the Planning Template for sign off at the January 2015 and March 2015 Governing Body meetings.

14/275 QUALITY & PATIENT EXPERIENCE UPDATE INCLUDING ULHT CHI REVIEW Dr Latham provided a verbal update in relation to quality in Ms Martin’s absence. Dr Latham advised that the Quality & Patient Experience Committee (QPEC) took place on 16 December 2014 and that the minutes will be brought back to the next Governing Body meeting.

Action: Ms Martin

Dr Latham stated that the meeting had discussed the CQC National Cancer Patient Survey which provided the data in respect of our three local providers. It was noted that the results between the three providers were quite striking and that the source of most of the dissatisfaction related to communication issues. Discussions took place and if more emphasis should be placed on this area by the federated quality team and the contract review meetings with a request for a Communications action plan and pathway. A further CQC National Survey in relation to Mental Health was also discussed. It was noted that the results had seen a significant decline based on previous surveys.


It was noted that there had been good progress made in terms of patient experience and that the Patient Participation Groups were starting to work well. A total of 37 Groups are in place along with 38 Communication Engagement Groups. Furthermore, a recent Listening Event had taken place which had been well attended. Dr Latham expressed some concerns regarding the safeguarding action plan. It was noted that there had been an indication that a number of actions had been completed however, it was not clear what had been the impact. Dr Latham stated that the Committee had requested a Safeguarding presence at the next QPEC meeting to provide a formal update. Dr Latham referred to discussions that had taken place regarding United Lincolnshire Hospitals NHS Trust. It was noted that problems were still being encountered with the Medway Computer system and that a Serious Untoward Incident (SUI) had been raised and subsequently added to in respect of patients who had not been reappointed following clinic cancellation. A further area of concern at the Trust related to the infection control C Diff rates and that the Trust had agreed to increase funding for the housekeeping team as this had been identified. Dr Latham added that the CQUIN target set for the identification and referral of Dementia patients is an area that is not being met by the Trust and that Ms Martin has a meeting planned with ULHT to discuss this. Discussions ensued regarding the staffing levels within the Trust and that the Trust is moving forward with recruitment drives to secure more staff. On a positive note, it was discussed that the SHMI rate had improved and that there had been considerable work undertaken in relation to DNAR processes across the community and that there had been an improvement in relation to the clinical governance arrangements. The Governing Body agreed to:-

Note the update.

14/276 PERFORMANCE & QUALITY REPORT Mr Bambro presented the Month Eight Performance and Quality Report and highlighted to members the following areas:- The Never Events incidents for ULHT for 2012/13, 2013/14 and 2015 were shown. National benchmarking

against other providers had now been included within the report. MRSA infections for the CCG is shown as none assigned in 2014/15 however, there have been two cases

assigned so far in 2014/15 against a zero plan. C Diff infections for the CCG have shown four cases reported in November, totalling 35 year to date against a

plan of 28. For ULHT five cases were reported in November, totalling 53 year to date against a plan of 41. Friends and Family tests for inpatients and A&E shows percentages are well below the national average. In

addition to this the staff Friends and Family tests for quarter two are also well below national average scores. Dementia Diagnosis rates shows the CCG rate at 52.3% against a national commitment of 67%. It was noted

that ten practices are still not providing data, however, in conjunction with the Local Medical Committee letters had been sent to these practices.

RTT targets continue to be missed. Work with United Lincolnshire Hospitals NHS Trust continues to address underlying problems. A number of patients have been transferred to alternative providers, to enable them to be treated more quickly.

Discussions ensued regarding the delivery of targets at the provider Trust and that there needs to be some assurance for improving these areas. It was noted that the Trust is due to have another CQC review early February 2015. The Governing Body agreed to:-

Note the contents of the report.


14/277 FINANCE & QIPP REPORT Mr Croot presented the Month Eight Financial and QIPP Performance Report and advised that in terms of the summary financial performance there are amber risks. Mr Croot advised that as at 30 November 2014 the CCG had a balanced financial position for the year to date and forecast for the full year. Mr Croot referred members to Page 5 of the report and the receipt of £4.8m non-recurrent resource to support the winter pressures/system resilience, across Lincolnshire. Mr Croot added that in terms of the Better Payment Practice Code performance had decreased which had been due to the limitations of the cash resource in the month. The Governing Body agreed to:-

Note the update. 14/278 DRAFT LINCOLNSHIRE WIDE FIVE YEAR STRATEGIC PLAN Members discussed the Five Year Strategic Plan for Lincolnshire. Mrs Lumb advised members that the Draft Lincolnshire Wide Five Year Plan had been presented at the last Health and Wellbeing Board meeting. It was noted that the finance section includes high level detail and will be require further input at a later stage. Mrs Lumb added that a copy of the Plan had also been sent to NHS England and as yet comments were still awaited. The Governing Body agreed to:-

Note the Plan.

14/279 JOINT COMMISSIONING ARRANGEMENTS Ms Newton stated that as a result of the work to support the Better Care Fund and the LHAC programme new joint commissioning arrangements had been put in place between the four Lincolnshire CCGs and Lincolnshire County Council. As part of this process a monthly Joint Commissioning Board takes place across Lincolnshire. Mr Childs queried the future working arrangements in relation to the estate and property management. Mr Croot advised that work is taking place with Mrs Lumb on the primary care estate/strategy development and that a RAG rating will be used to determine the priority of estate management. The Governing Body agreed to:-

Note the update. 14/280 LINCOLNSHIRE HEALTH AND CARE CONSULTATION Dr Hindocha stated that work continues with the LHAC programme in particular the development of the Neighbourhood Teams and that there is still a considerable amount of work to be undertaken within the next six months. Dr Hindocha stated that as part of the LHAC programme the elective care work stream will sit within the CCG with Ms Newton being accountable. The Governing Body agreed to:-

Note the update. 14/281 CO-COMMISSIONING PRIMARY CARE Ms Newton advised members that work is taking place to complete the necessary paperwork to support the future primary care co-commissioning arrangements which requires submission by 9 January 2015. Along with the proforma, it is expected that any amendments to the Constitution and a revised Conflict of Interest Policy are also submitted. It was noted that further national guidance is awaited in relation to the budgetary arrangements.


Dr Hindocha stated that members had been asked to vote on the preferred model for primary care co-commissioning from 1 April 2015 with the deadline for the receipt of responses on 22 December 2014, it was noted that at present the favourable option was for delegated commissioning. Discussions took place regarding the delegated authority to support this area and it was agreed that this would be delegated to Dr Hindocha, Mr Childs, Ms Newton and Mr Croot.

Action: Dr Hindocha, Mr Childs, Ms Newton and Mr Croot Ms Newton advised members that the other Lincolnshire CCG’s were also submitting proposals for delegated commissioning. The Governing Body agreed to:-

Note the update.

Delegate authority to submit a submission for primary care co-commissioning dependent on the outcome of the members vote to Dr Hindocha, Mr Childs, Ms Newton and Mr Croot.

14/282 LINCOLNSHIRE’S ALL AGE AUTISM STRATEGY 2015-2018 Mr Barber attended the meeting and provided an update in relation to the development of the Lincolnshire All Age Autism Strategy. Mr Barber advised members that the Strategy had been developed through consultation, engagement and sharing ideas and experience with key people in services and communities and commissioners and providers of health care. The consultation on the Strategy closes on 19 December 2014. Dr Protheroe requested that additional detail is added in relation to the support for the over 18 year olds and further detail regarding parity of esteem on page 22. Mr Barber added that the Strategy had been based on a strategic model underpinned by eight core strategic principles:- equalities based, parity of esteem, strengths based, person-centred, proactive and preventive, safe, local, mainstream and inclusive and ambitious but sustainable. Subsequent to this, these principles had been translated into a local offer and clear action plan. The action plan incorporates four key strategic programmes to deliver the Strategy and will be overseen by the Autism Partnership Board. Mr Barber stated that a Senior Officer had also been recently appointed to lead and deliver this work stream. The Governing Body agreed to:-

Note the update and comments to be provided by 19 December 2014.

14/283 CRISIS CARE MENTAL HEALTH CONCORDAT Mrs Lumb presented the Mental Health Crisis Concordat – Declaration Statement for Lincolnshire and asked members to ratify the decision that the Executive Committee had signed the Concordat. It was noted that the Concordat was a national requirement that all local communities develop and signed up to by the 15 December 2014. It was noted that due to the timing of this, the Declaration had been discussed in detail at the Executive Committee on 9 December 2014. The Governing Body agreed to:-

Ratify the Mental Health Crisis Concordat – Declaration Statement for Lincolnshire

14/284 CONTINUING HEALTH CARE MANAGEMENT Mr Croot circulated copies of the options paper for the future provision of Continuing Healthcare Management Services paper and invited members to consider the options and approve the recommended option.


It was noted that the recommended option is option three for the CCGs to collaboratively conduct an open tender procurement, based upon a revised service specification, in order to select a provider for the CHC service. This approach will allow for a larger team and thereby help to ensure resilience and responsiveness across the area, as well as simplifying relationships with Lincolnshire County Council through a common county-wide approach. The Governing Body agreed to:-

Note the options paper for the future provision of Continuing Healthcare Management Services and support Option Three.

GOVERNANCE 14/285 GOVERNING BODY ASSURANCE FRAMEWORK Mrs Lumb presented the Governing Body Assurance Framework and referred members to the top twelve risks and stated that the risk status for all existing risks on the Framework remains unchanged. It was noted that actions for a number of risks had been edited and listed separately so that they are visible on the report to the Governing Body. Mrs Lumb added that no new risks have been opened and no risks closed on the corporate risk register this month.

Note the Assurance Framework 14/286 DECLARATION(S) OF INTEREST REGISTER Mr Croot presented the Declaration of Interest Register and advised members that managing conflicts of interest appropriately is essential for protecting the integrity of the overall NHS commissioning system. It was noted that the Register is a live document and is continually updated and maintained. It was discussed that the Register details the interests declared by members of the CCG, including the Governing Body, member practices, GP’s, practice staff and officers of the CCG. Discussions took place regarding the future co-commissioning arrangements for primary care and that the Conflict of Interest Policy will require updating and strengthening to support delegated commissioning. The Policy will also require the updating of the Declaration of Interest forms. Discussions ensued regarding safeguards to manage this. It was noted that it was proposed to create a new Primary Care Co-Commissioning Committee to oversee these functions. 14/287 RATIFICATION OF POLICIES Information Governance Policies: Privacy Notice – Public (Patient), Corporate Information Security Policy, Information Risk Policy, Safe Haven Procedure, E Mail Policy, Caldicott Function Action Plan, Information Assurance Documented Plan, IG Training Plan, Information Lifecycle Management Policy, Privacy Notice – Staff and the Lincolnshire Overarching Information Sharing Protocol Discussions took place regarding the Policies and it was noted that a hard copy of these policies were available at the meeting for members to inspect. Members agreed to ratify the Information Governance policies. Clinical Governance: Serious Untoward Incident Policy The Governing Body reviewed the Serious Untoward Incident Policy and ratified this. It was agreed to ratify this Policy with a review date in May 2015. Corporate Governance: PMO Framework, Health and Safety Policy, Information Policy for GPTeamNet and Patient and Public Involvement Reimbursement Policy Mr Bambro advised that these policies had been approved at the last Risk and Governance Management Committee and had been brought to the Governing Body for ratification.


The Governing Body agreed to:-

Ratify the Information Governance Policies

Ratify the Serious Untoward Incident Policy and review this in May 2015

Ratify the Corporate Governance Policies.

GOVERNING BODY COMMITTEE MEETING, MINUTES AND TERMS OF REFERENCE

14/288 CCG COUNCIL MEETING MINUTES DATED 5 NOVEMBER 2014

The CCG Council meeting minutes dated 5 November 2014 were noted for information.

14/289 AUDIT COMMITTEE MEETING MINUTES DATED 9 OCTOBER 2014

The Audit Committee meeting minutes dated 9 October 2014 were noted for information. 14/290 RISK & GOVERNANCE MANAGEMENT COMMITTEE MEETING MINUTES DATED 3 OCTOBER 2014

The Risk & Governance Management Committee meeting minutes dated 3 October 2014 were noted for information.

INFORMATION

14/291 FREEDOM OF INFORMATION REPORT – NOVEMBER 2014

The Freedom of Information report for November 2014 was presented. The report for December 2014 will be presented at the January 2015 Governing Body meeting.

14/292 DATES FOR FUTURE MEETINGS

Protected Learning Time – Headache – 20.01.15

14/293 DATE AND TIME OF NEXT MEETING Wednesday 28 January 2015 at 13:30 pm at The Bentley Hotel, Newark Road, South Hykeham, Lincoln, LN6 9NH

Minute Number

Action

Lead Deadline Comments

14/274

Better Care Fund

Meeting to discuss the governance arrangements.

Planning template submission to be included on the Governing Body for January 2015 and March 2015

RC/GG January 2015 January 2015 & March 2015

14/275 Quality & Patient Experience Committee meeting minutes to be presented at the January 2015 Governing Body meeting.

WM January 2015

14/281

Co-Commissioning – delegated authority for the submissions to be given to Dr Hindocha, Mr Childs, Ms Newton and Mr Croot.

SH, RCh SN, RCr

9 January 2015

14/282

Lincolnshire All Age Autism Strategy – comments on the consultation to be submitted by 19 December 2014.

ALL

Healthwatch Lincolnshire report for CCG Governing Body Oct 14 1

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LINCOLNSHIRE WEST CCG GOVERNING BODY

28 January 2015

HealthWatch Update

EXECUTIVE LEAD AND JOB TITLE John Bains, Director, Healthwatch Lincolnshire

AUTHOR AND JOB TITLE Sarah Fletcher, CEO

PURPOSE

To provide an update report to Lincolnshire West CCG of patient, carer and public feedback for the period October to 12th December 2014

PATIENT, PUBLIC AND STAKEHOLDER INVOLVEMENT

All information provided relates to patient, public and stakeholder feedback.

RECOMMENDATIONS

N/A

BACKGROUND

October 179 reported items – report attached. November to 12th December 153 report items – report attached. These relate to compliments, general comments & concerns and complaints. Of the individual provider items we have already reported these directly to the individual service providers. As part of the overall patient feedback Healthwatch Lincolnshire is receiving responses back from providers as to the actions they are putting in place to investigate comments raised, make any improvements to services or to merely acknowledge the items raised. Every response we receive is recorded against the individual reported item and we contact the originator to share the provider response. We have now collated some of the more significant areas into an impact document, which is also attached. Our current work includes:

1st December, 2014 we hosted an event to present the findings from our GP Did Not Attends; Pharmacy, Children & Young People and Mental Health reports, action plans for all 4 areas have been produced and circulated to all key Lincolnshire health and care organisations including CCG’s for response.

The second round of 4 area network meetings for health and care providers are being held in February

We are continuing to raise concerns about cancer Support Services in Lincolnshire. patient’s

Enter & View visits in November and December will include care homes, revisit to A & E, and GP surgeries.

Healthwatch Lincolnshire report for CCG Governing Body Oct 14 2

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ANALYSIS OF KEY ISSUES

Please see attached summarised report.

PROPOSALS AND CONCLUSIONS

EQUALITY AND DIVERSITY IMPACT

We continue to engage throughout Lincolnshire.

HEALTH INEQUALITIES IMPACT

Some issues have been raised as to the non-emergency patient transport service, changes in the service has resulted in a number of patients cancelling (or not booking in the first place) appointments due to lack of transport service. HWL is communicating with Lincolnshire East CCG on this issue.

SERVICE DELIVERY IMPACT

Information contained in our reports maybe used to guide gaps in service provision.

FINANCIAL IMPLICATIONS

N/A

HR IMPLICATIONS

N/A

LEGAL CONSIDERATIONS

N/A

ANALYSIS OF RISK INCLUDING THE LINK TO THE BOARD ASSURANCE FRAMEWORK AND RISK REGISTER

N/A

KEYWORDS

FURTHER INFORMATION (DETAILS TO INCLUDE OFFICE TELEPHONE CONTACT DETAILS)

Healthwatch Lincolnshire Unit 12 1 -2 North End Swineshead Boston Lincolnshire PE20 3LR Tel: 01205 820892 Email: [email protected] Website: www.healthwatchlincolnshire.co.uk

Sarah Fletcher CEO

Email: [email protected] Mobile: 074365 82000


http://www.healthwatchlincolnshire.co.uk/


Healthwatch Lincolnshire Ltd is a registered Company Limited by Guarantee No: 08336116

Healthwatch Lincolnshire is a registered charity – Registration No: 1154835

Healthwatch Lincolnshire Unit 12 1-2 North End Swineshead PE20 3LP Tel: 01205 820892 Email: [email protected] www.healthwatchlincolnshire.co.uk Report Date: 17th December 2014

INFORMATION SHARING AND REPORTING

Main Source of Information: Patients, carers and public contacting Healthwatch Lincolnshire to report comments, concerns, compliments and complaints for health and care services. Timescale: Items reported in October 2014 - 179 items were formally reported during the month.

Summary of CCG Issues

Breakdown per

geographical area (including all services )

No of Items Reported

Theme

Lincs East 51 Items relate to 12 GP surgeries, 3x pharmacy, 14 x hospital, 3 x transports, 2x ambulance, 1x blood donor, 3x cancer, 2 care homes, 1x mental health,

1xPALS

Lincs South 15 Items relate to 5 GP surgeries, 2x community hospital, and 1x EMAS

Lincs South West 44 Items relate to 5 GP surgeries, 16 comments regarding the local hospitals, 2 comments regarding cancer, 8 regarding Mental health, 1 regarding patient record

system and1 about a local pharmacy.

Lincs West 44 Items relate to 9 GP surgeries, 20 comments regarding local hospitals, 6x mental health, 1x patient record

system

All CCGs 1 Patients not always aware that they have patient choice and fully understand what this actually means.


2

Top Subject Themes from October 2014

1) Communication 2) Appointments 3) Access 4) Quality of service- General 5) Quality of Service - Positive

Themes from issues received in October 2014

The amount of monthly issues has continued to increase as can be seen in the graph opposite, where last month (October) we received the most so far with a total of 179 issues and comments regarding health and social care issues in Lincolnshire.

Top Medical Themes from October 2014

1) GPs 2) Hospitals 3) Dental 4) Mental Health

Comments received throughout October

Complaints- 57 (32%)

Compliments- 54 (31%)

General Comments- 53 (30%)

Signposting- 12 (7%)

0

50

100

150

200

Num

ber

of

issu

es

Monthly Issues Received

During Oct we received a similar amount of compliments to complaints about services

3

Key themes, Priorities and Current Consultations: On the 1st December Healthwatch Lincolnshire presented our research and reports from the following 4 areas of work, all the reports are now available to download from our website www.healthwatchlincolnshire.co.uk . We are currently collating the feedback received on the 1st December and will be presenting the recommendations and any suggested actions to all relevant organisations in early January 2015. 1. Mental Health – we have now completed 2 pieces of work to gather the views of people around mental health services and our interim report of their views has been made available. Some of the services were viewed as very good. However, 4 services were viewed as unsatisfactory by 50% of those respondents who receive these services. Healthwatch Lincolnshire has further work to complete to ensure we have gathered a sufficient range of views, this work includes countywide focus groups, Enter & View visits and some specialist work, we hope to complete our research by the end of March 2015 with the final report being made available as soon as possible after this. 2. Children and Young People – having surveyed over 1,600 children and young people as the basis of our work the findings highlighted concerns around drug and alcohol misuse; smoking; bullying and self-harm. The need for more support to young carers was also raised. 3. GP/DNA study – the impact of DNA’s on local GP services is now being recognised. Our work included both the views of GP Practices and patients in Lincolnshire and highlighted that around 184,000 missed appointments is potentially costing around £6m per annum. 4. Pharmacy – the main purpose of this work was to find out why customers use pharmacy services i.e. just to collect medicines and prescribed equipment or to access support for other things such as minor treatments or health advice. The work links to national focus on helping to alleviate A & E and other emergency treatment centres by signposting patients to alternative options for help with minor injuries and ailments. We were able to highlight that currently patients were not accessing the range of services they could at their local community pharmacy. January – March 2015 focus of our work Cancer - Healthwatch Lincolnshire continues to be aware of the performance data around cancer services and is working with the relevant organisations to consider how this might be affecting patients. Enter & View visits – we have visits planned to hospital wards, care homes, mental health services and GP Practices. Enter & View visits is another tool for Healthwatch Lincolnshire to gather the views of service users and their carers. Patient discharge – we are currently completing some research into the problems people face around discharge from hospital as we have received intelligence that suggests this is an area that requires significant improvement. Seldom Heard Voices – access to and the correct support from mainstream health and care services e.g. dentist, opticians, doctors, nurses, may not always be an equal experience for all of our counties residents. Our work will be finding out how people with sensory impairments, the homeless, people with mental health conditions, Lesbian Gay Bi-sexual and Transsexual (LGBT), Black Minority Ethnics (BME) and patients who are isolated or living in rural areas access mainstream services and when they do, do they consider their needs are understood. Patient choice – this work is to find out more about patients understanding and access to patient choice.


4

Patient transport – the importance of access to safe and reliable transport has been raised with us on numerous occasions. There is a link to this and patient safety and ability to attend appointments and treatments. We have listed below a summary of the individual items reported by patients, service users and carers during October. For all of the summarised information we maintain a database of each individually reported item. This information is shared (in more detail) with every service provider. If you require any more detailed information concerning any of the above please contact Sarah Fletcher, CEO to request this. Please note – where an item is reported as a complaint this has been informally requested by the person contacting Healthwatch Lincolnshire to identify it as such. However, it is important to note that this item may not have been formally reported to the service provider as a complaint.

Summary of Issues

Provider

CCG area (Item was

Raised or Commission

Service)

No of

Items Reported

Type of Item

Reported Theme

Parkside Surgery East 1 1x Complaint Patient commented had an awful time with cancer due to GP Practice

Beechfield Surgery

East 2

1x Compliment

1x General comment

The Nurses are really brilliant,

Changes to blood test procedure has resulted in patient dissatisfaction.

Marisco Medical

Practice East 7

1x General

comment

4x compliment

1x complaint

Patient at Marisco Surgery would like to

see an improvement in how you can book an appointment.

4x Very happy with the service. Felt that the Doctor wanted to get her to

take more tablets

Seacroft Care

Home East 1

1x complaint Saw relative with dried blood on his face

and bloodied, soiled tissues around him.

Beacon Medical Practice

East 3 1x General comment 2x Complaint

Usually have to wait at least a week before you can see a Doctor

Patient feels they cannot get an appointment at the surgery very easily.

Richmond Surgery West 2 1x Complaint

1xCompliment

GP is brilliant, does regular home visits.

Patient doesn't like having to tell the receptionist why they want to see the GP

Ruskington Surgery

South West 3 1x Compliment 2x Complaint

Impressed with service

Sarcastic comments from the receptionist about missed appointments

5

Problems getting appointments at local surgery.

Wainfleet Surgery East 1 1x Complaint Informed no appointments

Spilsby Surgery East 1 1x Complaint On attending the GP to ask for support for bereavement, was only offered pills. Patient would rather not have pills but to

work through with support in place

Stickney Surgery East 1 1x Complaint Patient has problems with their knee, but due to their age they have been told that

they are too young to have a knee replacement. Has been informed they will go on the waiting list for the operation

when they are much older.

Currently this is having an effect on their back and due to not being able to

exercise patient has weight problems, this impacts on the knee leaving them in constant pain and unable to walk long

distances.

Patient has had to give up a job they love to take a less paid job as they are unable

to do previous job role due to the pain etc.

Parkside Surgery East 1 1xGeneral comment

Patient feels a GP they sometimes see is very patronising will see someone else

rather than go to this GP

GP - Surgery

Stuart House

East 1 1xComplaint Young patient with serious depression

feels her GP is not helping her enough.

Marsh Medical Practice

East 1 1x Complaint

Patient commented they have to contact the surgery to arrange check-ups and has

to ask for appointments such as blood pressure checks.

Wragby Surgery East 2 2x Compliment

Patients commented Wragby GP surgery has great Doctors.

Patients seemed very happy with Wragby

GP Surgery; feel they are able to get appointments when required.

Cleveland Surgery West 1 1xCompliment Drs at Cleveland Surgery in Gainsborough

were excellent, very good listeners and always there for the patient.

Munro Medical Centre

South 4 1xGeneral comment

Patient not happy with the answer machine you have to leave message on to make an appointment, patient would

rather someone answer the phone

6

2x

Compliment

1x

Compliment

Patient has had every attention and

consideration and have had lots of support from hospital staff and Doctors.

Patient commented they do not like the triage service provided

Horncastle Medical centre

East 1 1x Complaint Concerned family member, parent suffers from depression and mental health problems went to see GP and asked for

assistance, to be told - divorce them that'll make them sit up. Family member went home in tears and felt this was not

helpful to their plight.

Chestnut Care Home

West 1 1x Complaint Resident feels the care they are receiving is inadequate

Gosberton GP South 1 1x Complaint Patient comments that they have to wait for 3 weeks. They dislike the new

arrangement of chairs feels like a theatre, very hard to move around especially if the patients are using a

stick.

GP Galletly Surgery

South 2 1xGeneral comment

1xCompliment

The on-line service for repeat prescriptions is very good. However feels

not so good when trying to get an appointment with a Doctor.

Patient's wife passed away July 2014 and

the day after his GP visited him to check everything was alright. Patient appreciated this greatly.

Greyfriars GP East 1 1x General Comment

Patient concerned as not heard anything with regards to their Dermatology

appointment. GP at Greyfriars has tried to chase but still not heard anything.

Birchwood GP South 2 1xCompliment

1xComplaint

Doctor is fantastic. The appointment

system makes it really easy to get an appointment.

The only way that you can get an

appointment is to ring the surgery at 8.30am like everybody else and the phone is constantly engaged. When you get

through you can never get to see a Dr straight away.

City Medical Practice

West 2 1xGeneral Comment

Patient has seen a different GP each time, over an ongoing health condition with each GP giving a different opinion

7

1x Compliment

and leaving the patient confused.

Patient commented very good surgery, if you need an appointment you can usually get on the same day.

GP - Caythorpe & Ancaster Medical

Practice

South West 1 1x Compliment

If patient needs to see a GP they feel they can always get an appointment

straight away. Staff are really friendly.

Newland Surgery West 1 1x Compliment

Really positive experience with healthcare at this practice. Never had to

wait longer than the following day for an appointment.

Lindum Medical Practice

West 1 1x General Comments

It can take on average about 2-3 weeks to get an appointment to see the GP if it is not a dire emergency.

Brant Road Surgery

West 1 1x General Comment

Patient commented it takes 3 weeks to get an appointment with their GP at this surgery.

The Old Vicarage East 1 1xCompliment Pleased with new online prescription service

GP - Arboretum Surgery

West 1 1xComplaint All staff and GPs are brilliant here apart from one GP. Lots of children refuse to see him as they are so rude. Complaints

have been raised in the past with no apparent resolution.

GP - Welton Medical Practice

West 1 1xCompliment Patient commented cannot fault my GP or the practice nurse.

GP - Sleaford

Medical Group

South West 1 1xComplaint Complaints procedure needs to be better;

there are no generic downloadable forms and no access to the Practice Manager. The organisation does not appear to be

patient focussed but more logistic focussed.

The Witham Practice

West 1 1x Compliment

Patient commented that Dr C is excellent. He works with staff supporting homeless people regardless as to the patient’s

situation. The practice nurse is also very good with patient's especially around problems to do with leg ulcers.

Care Home - Bill Baker

West 1 1x Complaint Residential facilities for people who are self-sufficient, seems there are people who require extra care and are not self-

sufficient. The lift has been broken since September 17th and no-one seems to be doing anything about it, residents on the

1st floor cannot get down and feels this is a health & safety risk.

8

Residents used to use the common rooms but now no-one uses these to meet up as

residents don't feel the same.

Peterborough &

Stamford Hospital Trust

South 1 1xComplaint Concerns with regards to wife who he felt

the hospital had failed.

Care home -

Newton House Grantham

South 1 1xComplaint They have been offered Physiotherapy

but only at a cost of £80 an hour, so it is possible but only at a cost why is this?

GP - St Peters Hill GP Surgery

South West 1 1xCompliment Patient commented that the GP and the surgery provide good care and good service by the practice.

GP - Market Cross Surgery

South West 1 1xGeneral Comment

5xCompliment

2xCompliant

Patient has the highest regard for GP, his team and the constructive way his surgery operates.

5 responses - Always find it to be a friendly/efficient service.

Have to wait at GP surgery 30 - 45 mins

often when they have an appointment. Very little or no physiotherapy available for long term patients.

Patient feels that diabetic medications have been cut without blood tests and there seems to be little knowledge with

regards to dietary requirements for patients with diabetes.

ULHT

53 14 complaints

20 general

comments

19

compliments

Pilgrim – regarding cancer services, lack of communication, staffing issues, staff attitudes, communication, quality of

service and appointments.

Lincoln – regarding communication, quality of care, homeless not treated

with dignity by staff, wrong cast used, cancelled appointments.

Grantham – charged extra parking for

late appointments.

General comments concerned , future plans, communication, quality of care and

service, discharge, appointments, training , A+E and staff attitudes

Lincoln – Breast clinic fantastic, good

experience with staff, Haematology is brilliant, intensive care staff are very good. Staff work well with support staff

from local charities

Pilgrim – Audiologist very kind and helpful. Maternity unit brilliant service,

easy to rearrange appointments

Grantham –excellent services, couldn’t

9

fault physio, praise for bloods, x-ray, readmission, and assessment units, and

waiting times were good.

Opticians -

Enderbys

East 1 1xGeneral Comment

Patient is being charged each time they visit. Glasses haven't been right since they have had them.

NHS England - Ophthalmology

2 1xGeneral Comment

1x Complaint

Patient is being charged each time they visit. Glasses haven't been right since they have had them.

Patient required new glasses so went to Boots optician in Boston, 2 x new pairs,

patient felt they were persuaded to add extras to the glasses by a member of staff, these enhanced the costs

dramatically. Patient took them back the day after purchase and was informed to try a bit longer.

Lincolnshire

Community and Voluntary Sector

East 1 1xCompliment Health Trainer at LCVS, rang when she

said she would. Had a good session, listened to my issues and we are going at my pace. Thank you

EMAS 5 1x Signposting

1x Compliment

3xComplaint

Patient signposted to services

Paramedics have always been very good with people who are homeless

The paramedic had no communication with them at all, disregarded what the

first responder had said and did not introduce themselves or register with the patient at all. The first responder was

trying to give the paramedic the information and paperwork; however they just weren't interested and ignored the

first responder.

Older lady, suffering from Breast cancer

was in dreadful pain, Dr came out on a home visit and called a “non-urgent” ambulance to take the lady to hospital,

he said to expect 3 hours waiting time, this was at 5pm. Four hours later the lady’s husband called to ask when the

ambulance would be coming. Another hour later a Paramedic arrived.

111 informed them that the ambulance

was on its way. No Ambulance arrived and

10

three further calls were made to 999, as the patient was getting progressively

worse, being violently sick and knee still swelling. A paramedic arrived at around 4.10pm he was alone in a car. He also

called for an ambulance and was told there were none available.

Paramedic and 2 other men then managed to place patient in the car after borrowing a wheelchair from a neighbour.

After arriving at Louth Hospital it was found that the patient had fractured the knee and may be suffering from internal

bleeding in the knee area,

NHS Dentistry 16 7xSignposting

4xGeneral

Comments

5xComplaints

Dentist required in the Holbeach/Spalding

area, Grantham area, Coningsby area, 3xStamford area. Resident in Skegness request for community dental services to

visit home as daughter has Learning disabilities and is severely disabled.

Patient commented had no problems with the Dental Practice at all, but was querying the cost of treatments.

Request for Dentist in Stamford Area

Patient required dentist in Grantham Area.

Patient commented, the dental practice had forgotten to send on referral to

Lincoln County Hospital to have wisdom tooth removed. This has been going on since July 2014

Patient concerned that they had been to Alford Dental Care with ESA benefits form

and now received a letter stating they were required to pay a penalty charge.

Patient had tooth extraction October 14

at Boston after initial examination in Sleaford. I was given aftercare leaflet but not an emergency out-of-hours contact

number should I be in extreme pain or need advice.

Patient commented they felt the dentist

at Johnsons Hospital in Spalding was very poor, did not numb the tooth properly, 2nd tooth had to stop them half way

11

through as the pain was so bad, in the end patient took the tooth out

themselves at home.

Patient commented unable to find an NHS dentist in Grantham area, has had to

travel to a different area - Nottinghamshire in order to find one.

NHS Pharmacy East 1 1xComplaint I look after my wife. I collect her

medication from the pharmacy at Marisco surgery. They fill a dossett box with

tablets but they frequently get it wrong. There are often tablets missing or the wrong ones put it. If I didn't check it, it

could kill my wife. I have informed them but it doesn't seem to improve.

CQC 3 3xComplaints Comments made in relation to Bill Baker

Court. The lift has been broken since September 17th and no-one seems to be doing anything about it

A comment made in relation to Newton House Nursing Home in Grantham offered Physiotherapy but only at a cost of £80 an

hour, so it is possible but only at a cost why is this?

Patient went into Seacroft nursing and

care home and they reduced the amount of medication he was on. Checked with the Consultant and he said it was the

wrong tablet.

LCC Adults 5 3xGeneral Comment 2xComplaint

Patient expressed that her daughter who suffers from an eating disorder was looked after very well under CAMHS, but now she is in the adult services they seem to be left waiting.

Relative feels that the care home they were in isn't suitable for them now, requires more nursing care.

Family member experiencing problems as wife suffers from Dementia.

Chestnut Care Home – Gainsborough Resident feels the care they are receiving

is inadequate

Would like to know how to access overnight support. Was informed to contact 111, 999 or the carer’s emergency team (LCC).

Oasis Dentist Sleaford

South West 1 1xComplaint Patient had tooth extraction October 14 at Boston after initial examination in

12

Sleaford. Given aftercare leaflet but not an emergency out-of-hours contact. On

contacting the Sleaford office in extreme pain and facial swelling, was told the pain was not linked to the extraction but to

another tooth and require extra cost.

Boots Sleaford South West 1 1xcompliment Boots - Sleaford are really good and co-

operative

LPFT 10 5xComplaints

2xCompliment

s

3xGeneral Comment

CAHMS - a 17yr old who had been using the services of CAHMS was removed

(because of age) from the service just before their 18th birthday without much of an explanation of where to go for

further support.

Patient commented that they had been waiting to see a counsellor for the past 18

months. Their GP has made a referral but this doesn't seem to be going anywhere.

Crisis Team, there are problems with this

service. Why does the service user have to visit the crisis team and not the other way round, as often in crisis the service

users are unable to go anywhere?

Patient commented: - There seems to be major problems with this service. If a

person is in genuine crisis they are told to go and see their GP or present themselves at A&E. The call taker seems to be the

gatekeeper for anyone wanting to access mental health services and those that don't get past this stage are left to fend

for themselves.

Young patient with serious depression feels her GP is not helping her enough

Staff on ward 12 work well with support staff from local charities who are helping the homeless and rough sleepers.

Consultant psychiatrist attends on site regularly and is always available on the end of a telephone. Therefore he is able

to quickly deal with any medication queries and adjustments necessary.

Mental Health Care needs to be better.

More qualified staff are needed on inpatient wards. There needs to be more community support for people with

mental health.

REME Association member expressed concern about the lack of support for ex-

military service personnel who present themselves on discharge from the forces

13

who have Mental Illness / conditions.

Praise for the staff who look after them

when they are admitted and they have all good intentions when coming home, but just feels that they don't always have the

skills to cope on their own.

Boots Opticians East 1 1x Complaint Patient required new glasses so went to

Boots optician in Boston, 2 x new pairs, patient felt they were persuaded to add extras to the glasses by a member of

staff, these enhanced the costs dramatically.

NHS England 12 2xComplaints

1xCompliment

9xGeneral

Comments

Patients not happy that Wragby GP

Surgery were not granted permission to have a pharmacy.

Generally very happy with Wragby Surgery, and the service that it offers. Is concerned about the dispensary

Patient has no complaints concerning the medical care they have received at the

Beacon Medical Practice in Chapel St Leonards.

Mental Health Care needs to be better. More qualified staff are needed on

inpatient wards. There needs to be more community support for people with mental health needs.

Patients not always aware that they have patient choice and fully understand what

this actually means. REME Association member expressed

concern about the lack of support for ex-military service personnel who present themselves on discharge from the forces

who have Mental Illness / conditions. Residents concerned that the 5 year plan

by ULHT does not take into account the thousands of temp residents along the East Coast who access the local GP

services and the drain it had on the surgeries.

Many Louth residents concerned about the fact that services are being changed across the border, (NE Lincs,

Grimsby/Hull & Scunthorpe) for some patients this is the preferred choice of

14

hospital including ease of access

Concerns as patient went for routine mammogram, was recalled for a 2nd mammogram with no explanation, patient

is 'petrified' of hospitals. He feels people in England do not

appreciate the wonderful health service they have and should not abuse it.

Patients commented Wragby GP surgery has great Doctors.

Boston West Hospital

East 1 1xCompliment Patient was referred to Boston West Hospital by their GP and had nothing but praise for the way he was treated and

follow up care.

LHAC 1 1xGeneral Comment

Residents concerned that the 5 year plan by ULHT does not take into account the

thousands of temp residents along the East Coast who access the local GP services and the drain it had on the

surgeries.

LCHS 6 3xGeneral

Comments

1xCompliment

2xComplaints

Can’t obtain walking sticks/wheelchair.

The community nurse makes appointments for certain dates but does not specify whether the appointment will

be am or pm. This causes great anxiety for the patient who has difficulties arranging care around these times.

Young man felt they wanted support to give up smoking, was referred to Phoenix Service. Patient felt that it wasn't very

good and lost interest in the group. Got support from family and friends but has struggled.

Louth hospital discharge. Patient felt the whole process was carried out professionally and was treated with

respect.

CAHMS - a 17yr old who had been using

the services of CAHMS was removed (because of age) from the service just before their 18th birthday without much

of an explanation of where to go for further support.

Patient commented they felt the dentist

at Johnsons Hospital in Spalding was very poor, did not numb the tooth properly, 2nd tooth had to stop them half way

15

through as the pain was so bad, in the end patient took the tooth out

themselves at home.

Public Health 1 1xComplaint Young man felt they wanted support to

give up smoking, was referred to Phoenix Service. Patient felt that it wasn't very good and lost interest in the group. Got

support from family and friends but has struggled.

Healthwatch England

6 1xSignposting

3xGeneral Comment

1xComplaint

Resident in Skegness request for

community dental services to visit home as daughter has Learning disabilities and is severely disabled.

Many Louth residents concerned about the fact that services are being changed

across the border, (NE Lincs, Grimsby/Hull & Scunthorpe) for some patients this is the preferred choice of

hospital including ease of access.

Many ex-military personnel find it difficult to find the appropriate

information regarding health and how to access the services.

Concerns as patient went for routine

mammogram, was recalled for a 2nd mammogram with no explanation, patient is 'petrified' of hospitals.

Patient concerned as letters have gone out to medical people and kept in patient’s notes, from Consultant

Gynaecologist that patient was suffering from deteriorating mental state possible dementia. Patient does suffer with

sensory ataxia

Macmillan East 1 1xCompliment Macmillan Nurse was amazing and helped

both of them through a very difficult time.

NHS Blood Donor

Sessions

East 1 1xCompliment Patient commented on giving blood, very

happy with the organisation. Appointment given at a convenient time, local venue good. Easy to cancel or

change the appointment if required and an alternative appointment offered to suit. Staff very friendly and helpful

Queen Elizabeth Hospital in Kings

Lynn.

Kings Lynn 1 1xComplaint Patient concerned as letters have gone out to medical people and kept in

patient’s notes, from Consultant Gynaecologist that patient was suffering

16

Also sent to Healthwatch

Norfolk

from deteriorating mental state possible dementia. Patient does suffer with

sensory ataxia.

LCC 2 1xSignposting

1x General Comments

Family member requested information

with regards to her mother.

People do not get enough pay to provide the care that is needed in the community

with many carers not even vetted properly

Swallowbeck

Dentist

1 1xComplaint Patient commented, the dental practice

had forgotten to send on referral to Lincoln County Hospital to have wisdom tooth removed. This has been going on

since July 2014

NSL Transport 1 1x General

Comment

A friend needed transport to Boston from

Grantham to take them to hospital. Staff were very helpful but it was a long journey for her as they picked up other

patients as well and found it very uncomfortable.

Healthwatch Lincolnshire share all formally reported items received from public, patient & carers with individual service provider organisations. However, it is important to note that we do not verify for accuracy any of the comments reported to us. In addition, we direct everyone who contacts us with areas of concern back to the service provider as their first and most important step. We do not deal with individual complaints but signpost people to relevant support agencies such as PALS and POWhER.



Healthwatch Lincolnshire Unit 12 1-2 North End Swineshead PE20 3LP Tel: 01205 820892 Email: [email protected] www.healthwatchlincolnshire.co.uk Report Date: 06th December 2014

INFORMATION SHARING AND REPORTING

Main Source of Information: Patients, carers and public contacting Healthwatch Lincolnshire to report comments, concerns, compliments and complaints for health and care services. Timescale: Items reported in between the 1st Nov-12th Dec 2014 - 153 items were formally reported during this period.

Summary of CCG Issues

Breakdown per geographical area

(including all services )

No of Items Reported

Theme

Lincs East 55 20 Items relate to GP surgeries, 1x pharmacy, 24 x hospital, 1x transports, 2x LCC Adult services,1x care

home, 1x EMAS, 1x Mental Health

Lincs South 29 13 comments regarding GP surgeries, 1x LCC, 7x

Hospital, 2x Mental Health, 1x Dentistry, 1 x Opticians, 1 x Pharmacy

Lincs South West 20 4 Items relate to GP surgeries, , 13 regarding Mental health, 1 x LCC Adult services, 1x hospital, 1x NHS

England

Lincs West 18 Items relate to 10 regarding local hospitals, 1x mental

health, 1x Allied healthcare, 4x GP surgeries, 1x LCC Adults services, 1x EMAS




Top Subject Themes from November 2014

1) Quality of Service-Positive 2) Access 3) Quality of service- negative 4) Appointments 5) Communication

Themes from issues received in November 2014 (between the 1st Nov- 12th Dec 2014)

Last month between the 1st of November and the 12th of December we received a total of 153 issues and comments regarding health and social care issues in Lincolnshire.

Top Medical Themes from November 2014

1) Hospitals 2) GPs 3) Dental 4) Mental Health 5) NSL-Transport

Comments received throughout November 2014

Complaints- 60 (41%)

Compliments- 48 (33%)

General Comments- 29 (20%)

Signposting- 10 (7%)

0

50

100

150

200

Nu

mb

er

of

issu

es

Monthly Issues Received



Key themes, Priorities and Current Consultations: Following the presentation of our reports four action plans have been created and are being disseminated to the key organisations involved in commissioning and delivering health and care services in Lincolnshire. We have asked for responses to these action plans to be returned by 28th February 2015 Men’s Health During November Healthwatch Lincolnshire has been learning more about Men’s access to health and care in Lincolnshire. From the 366 men that responded to our survey we can share with you that:

66% have actively improved their health by increasing the amount they exercise.

48% of men have actively altered their diet to improve their health.

52% of men would seek early medical attention for a physical symptom or change which is

out of the ordinary or for a long term health condition.

75% would act early for an accident or injury that hampers their daily functioning

But most worryingly 19% of men would avoid using health services at all cost for an

emotional or psychological issue, our recent mental health work has highlighted suicide

and self-harm as areas of concern in Lincolnshire.

January – March 2015 focus of our work Cancer - Healthwatch Lincolnshire continues to be aware of the performance data around cancer services and is working with the relevant organisations to consider how this might be affecting patients. Enter & View visits – we have visits planned to hospital wards, care homes, mental health services and GP Practices. Enter & View visits are another tool for Healthwatch Lincolnshire to gather the views of service users and their carers. Patient discharge – we are currently completing some research into the problems people face around discharge from hospital as we have received intelligence that suggests this is an area that requires significant improvement. Seldom Heard Voices – access to and the correct support from mainstream health and care services e.g. dentist, opticians, doctors, nurses, may not always be an equal experience for all of our counties residents. Our work will be finding out how people with sensory impairments, the homeless, people with mental health conditions, Lesbian Gay Bi-sexual and Transsexual (LGBT), Black Minority Ethnics (BME) and patients who are isolated or living in rural areas access mainstream services and when they do, do they consider their needs are understood. Patient choice – this work is to find out more about patients understanding and access to patient choice. Patient transport – the importance of access to safe and reliable transport has been raised with us on numerous occasions. There is a link to this and patient safety and ability to attend appointments and treatments. We have listed below a summary of the individual items reported by patients, service users and carers during October. For all of the summarised information we maintain a database of each individually reported item. This information is shared (in more detail) with every service provider. If you require any more detailed information concerning any of the above please contact Sarah Fletcher, CEO to request this.



Please note – where an item is reported as a complaint this has been informally requested by the person contacting Healthwatch Lincolnshire to identify it as such. However, it is important to note that this item may not have been formally reported to the service provider as a complaint.

Summary of Issues

Provider

CCG area

(Item was Raised or

Commission

Service)

No of Items

Reported

Type of Item Reported

Theme

Parkside Surgery East 1 1x Complaint Husband concerned change in

medication caused wife’s death

Westside Surgery East 2

1x Compliment

1x complaint

I have had the best care from friendly reception staff, Drs and Nurses alike.

Patient commented at one appointment was kept waiting for 45 minutes past the appointment time, next appointment was 1hour 10minutes late going in. No explanations offered and no apology given at either appointments.

Marisco Medical Practice

East 1

1xComplaint Patient commented that they had an appointment but had a letter to cancel this appointment 2 weeks prior due to staff sickness

Care Home- Priory Court

South 1

1x compliment Resident was very happy in there and we had peace of mind that they always took good care of her.

Peterborough Hospital

South 7 2xComplaints

4xCompliments 1x General

Some of the patient's notes were missing and there was a delay in finding them

Patient in Lincolnshire commented they were unhappy with the service provided at Peterborough Hospital.

The standard of care was brilliant, we felt very much looked after.

Excellent service all round.

The Peterborough City Hospital Cancer Care unit is 150% brilliant, I can't tell you how fantastic they have been. Thank you

I went into the A&E department and I felt very well looked after, very relaxing



comment time

Just not enough Disabled parking spaces

Woodhall Spa Surgery

East 2 2x Complaints Patient would like to say how disappointed they are that they feel patient confidentiality has gone out the medical profession.

Patient commented that whilst trying to collect prescription at the GP surgery they found the receptionist to be rude and unhelpful, not only to themselves but to all patients that were in the surgery at that time.

NHS England 4 2x Complaints 2x General Comments

Patient concerned as they have heard that CT & MRI scans are being sent overseas to be reported on and written up.

Patient received Misdiagnosis and lack of care and communication from both Pilgrim and Nottingham Hospitals for lung problems

Patient requested but was refused shingles jab, due to age

Patient stated they don't go to the Doctors often but when they do they can't understand them as they are all foreign.

NSL Transport

4 4x Complaints I have been informed today that I can no

longer have transport

It was noted that on going to Pilgrim Hospital the driver was using their mobile phone whilst driving.

84 year old gentleman with 75 year old wife had an appointment at Pilgrim Hospital. They had been told that they weren't eligible for transport.

I am disabled and use transport for hospital appointments, I have had to cancel 5 appointments as they could not offer transport.

Bridge House Dentist

South 1 1xGeneral Comment

Patient requested a dentist in Bourne area, as current dentist - Bridge House in Market Deeping have stated patients need to go private or have Denplan only. No other options for current patients



Grimsby Hospital East 2 2x Complaint It seems there is no ‘in-house’ referral system in place

Discharged from Grimsby Hospital with a promise of walking equipment to assist around the house. However when the hospital realised the patient lived in West Lindsey they withdrew the offer of equipment, the elderly patient has been sent home.

Home-Start - Spalding

South 1 1xCompliment This is an invaluable service and we could not be without it, we have had emotional, practical support from Home-start. They have helped with mental health as well as with my children.

Tanglewood-Care Home

East 1 1xComplaint There never seems to be enough staff on duty

Abbeyview Surgery

South 1 1xCompliment

Dr Panicker has been very supportive and encouraging. Patient doesn't feel rushed out the door, Doctor listens and if she doesn't know the answer she tells the patient to come back and she will look into it.

LCHS 8 3x Complaints

3x Compliments

Patient has progressive Multiple Sclerosis and commented they are experiencing problems in getting access to home care.

Patient commented that it had taken nearly 2 years to get a Dental appointment at Louth Hospital.

Patient has been in Skegness hospital for 17 weeks waiting for care package to be put into place.

The NHS is a wonderful service they saved my life after a road traffic accident. I have nothing but praise for Johnson Community Hospital

I am very happy with Johnson Community Hospital and the NHS

All services I have received at JCH have been excellent



2x General Comments

There is a rumour that continence services that currently exist for Lincolnshire patients delivered by Peterborough are to be removed as a continence nurse team has been employed at Lincoln, there is concern as to how that will affect patients on the Lincolnshire/Peterborough border that are already receiving services from Peterborough.

Patient expressed that it was good to have a minor injuries unit here in Skegness rather than having to travel to Boston/Lincoln.

Munro Medical Centre

South 1 1xCompliment Excellent service all round

Metheringham Surgery

East 1 1x Complaint Fairly positive but sometimes difficult to book appointment and lack of ability to see a single GP

EMAS 2 2xComplaint Patient commented that the Ambulance service refused to send an ambulance to a patient as they lived too close to the hospital. The person was in pain with their chest and therefore could not make the hospital journey.

Ambulance man did not seem that interested but was more interested in checking the medications the patient was on.

Old Leake Surgery East 1 1xGeneral Comment

Have moved from Old Leake as told it would be 7 weeks wait for an appointment

Vine Street Surgery

South West 1 1xCompliment Brilliant cannot fault them

Castlegate Practice Dentistry

South West 1 1x compliment Brilliant. All staff very friendly.

St Peters Hill South 2 1xCompliment

1xComplaint

Doctor is excellent. When you see him he actually listens to everything you say.

I have a history of heart problems and the Consultant at the hospital said that



my GP would want to see me on an annual basis to monitor this. My GP Dr P has never once asked me to see him for this.

Swingbridge GP West 1 1x Compliment Great practice, no problems

Arboretum Medical Practice

West 1 1x Complaint Patient commented they found it always hard to get an appointment and patient ends up having to use the walk-in centre.

Swineshead GP West 1 1x Complaint Diabetic nurse stated that the sachets would soon be coming to an end and would then need to go onto injections. Patient queried that Metformin does come in suspension form as would prefer this than injections on a daily basis. Surgery has stated this would be too expensive, yet patient has been informed that another surgery would dispense but they are out of the area.

Bracebridge Heath GP

West 1 1xComplaint Patients doesn’t feel like they are being listen too, suffers with Bi-Polar and other health issues and has been on the waiting list to see Mental Health Nurse since 2013.

Fitzwilliam Hospital

1 1xComplaint Patient had an Orthopaedic appointment and felt they had been unfairly treated, and felt lack of communication to support them during outpatient procedure

Stuart House Surgery

East 2 2xCompliment Patient feels they have been given exceptional care and compassion, they feel that doctor has gone the extra mile of which they are extremely appreciative.

Galletly Medical Practice


1xComplaint

1xGeneral comment

Doctor has been very supportive to me.

Patient unhappy as they are trying to get an appointment with their GP, but could only get a call back.

When you go into the practice automatic doors open towards you - feels strange



and awkward,

CQC East 1 1xComplaint Patient received Misdiagnosis and lack of care and communication from both Pilgrim and Nottingham Hospitals for lung problems

Allied Healthcare 1 1xComplaint A formal complaint was registered in August 2014 after an agency worker signed the medication sheet to say that she had given my Mother medication which was no longer in the house. The agency worker also signed to say that a tablet had been taken which was found in the bed.

Pharmacist – Superdrug- Stamford

South 1 1xCompliment Patient wanted it known that they felt the pharmacist at Stamford Superdrug was very helpful when they were experiencing dry eyes, he took time to listen and recommend some drops which have worked very well.

St Mary's Medical Centre

South 1 1xCompliment I would just like to give some well-deserved praise to doctors at St Mary's Medical Centre in Stamford, so helpful over the past 4 years.

Asda Opticians – Peterborough

1 1xCompliment I would like to offer some praise for Asda opticians in Peterborough. Went to see them for some new frames for glasses and they were very helpful

Deeping Practice 1 1xComplaint Son has autistic spectrum so Mother is required to do all paperwork for him.

At present he is unfit for work and requires an unfit for work certificate from the GP Surgery on a regular basis to go to DWP. DWP have stated that his sick note needs to be with them on a certain date - however, the Doctor will no longer pre-date unfit for work certificate to enable the DWP to have it in the post on time. DWP have said that due to the certificate not arriving on time then the benefit (ESA) may be stopped or cut.

GP - Springwells Surgery - Billingborough

South 2 2xGeneral comments

Very caring GPs, Patient feels they have difficulty sometimes getting an appointment with nurse or phlebotomist. Sometimes cannot clearly



understand information given by GPs in training. Patient stated they find a couple of the receptionists rather off hand & officious - which is a shame as they let the team down.

This is an excellent GP Practice, you sometimes struggle for an appointment with a Doctor you would like but I think this is because there is a demand for their services. They possibly need to expand the service and grow.

GP - Hereward Medical Practice - Bourne

South 1 1x Complaint It is extremely difficult to get a Doctor’s appointment. Being someone that hardly ever goes to the Drs. I find this frustrating when I genuinely need to see a doctor to be given a 3 week wait. Is there something that can be done to improve the availability of appointments for emergencies?

Bourne Health Clinic

South 1 1x General Comment

I have to attend the ulcer clinic twice a week and on public holidays they have to close the clinic and then the district nurse has to do a home visit. Surely it would make more sense if they open just the treatment room at the centre; patients could go in through the staff entrance near it and save the nurses coming out to people's house.

I understand from nurses they would rather do this but the centre is not allowed to open on public holidays. I think it would save time and resources.

Holbeach Medical Practice

East 1 1x Compliment Doctors are brilliant

Lincolnshire County Council

South 1 1xCompliment Social Services, (Spalding) They are absolutely 100% brilliant, I could not recommend them more highly.

Gosberton GP surgery

South 1 1xCompliment Excellent - we have been here 3 years and are really pleased with the surgery

GP - Moulton Practice


Fantastic GPs - couldn't fault. Always get an appointment on the same day. Only slight complaint is parking is a bit tight.



1xGeneral comment

Worried about rating at a 2, possibly because Drs are mostly part-time? Uncomfortable waiting area. Rather crowded in GP rooms, could be better

Littlebury Surgery South 1 1x Compliment All GPs very good. Waiting times for your appointment are acceptable as the Drs have time to listen

Newmarket Surgery

East 1 1xGeneral Comment

Patient commented there is a language barrier, Doctors not speaking with a clear accent. Trying to get a routine appointment waiting for 6 weeks.

GP - Beacon Medical Practice

East 4 2xCompliments

2xComplaints

Sometimes has to wait a few days to get an non-urgent appointment, but has always been well treated when they have attended the surgery, from receptionist through to the Doctor or Nurse.

Has been very happy with staff and service that they have received

Beacon Medical Practice told patient to go to A&E first and then be referred. The patient spent 4 hours at Skegness minor injuries unit had wound dressed and then was referred back to their GP who then continued the dressings for another 6 weeks.

Patient expressed concerns over mis-communications about their condition

Liquorpond Steet Surgery

East 3 3xCompliment Patient expressed great service from Liquorpond Street Surgery - from all staff both medical and non-medical

Practice nurse was the person who identified the numerous episodes of tonsillitis her daughter had had. Reviewed the child and tonsils have been removed, Child much better.

Support and advice given was superb.

Coop Pharmacist-Boston

East 1 1xCompliment Patient expressed great service from Co-Op Pharmacy in Liquorpond Steet.

Boston West Hospital

East 1 1xCompliment Very happy with service from GP through to follow up. Felt well looked after by all concerned.



GP - The Branston and Heighington Family Practice

West 1 1xCompliment Patient commented that they feel their GP went the extra mile for them, when there were communication issues with Maxillo-facial department at Lincoln County Hospital.

GP - Hawthorn Surgery

East 1 1xComplaint Patient noted that when trying to book an appointment with district nurse was informed if things did not improve to ring at once. Patient tried over 3 days first thing during the day with no answer. Message left on answer phone for someone to ring back, patient left phone number, but no-one rang.

LCC Adults 7 6xComplaints

1xGeneral Comments

Individual contacted social services immediately but it soon became clear that they would not fund 24hour care at home.

Lady has missed several appointments for an endoscopy due to fear of being on her own in the evening and night following the procedure (she is socially isolated) and she has been told there is no hospital bed for her.

Patient has progressive Multiple Sclerosis and commented they are experiencing problems in getting access to home care

Patient's husband in Pilgrim Hospital and needs to be transferred to Care Home. Has been waiting 5 weeks for suitable discharge package.

Worker signed the medication sheet to say that she had given my Mother medication which was no longer in the house

Daughter worries about the funding for Mother, the delay prevents the family purchasing other services for her which they feel she needs.

Willoughby Care Home, they were not happy with, as staff were not looking after their relative very well

ULHT

32 16xComplaints

Pilgrim – regarding, lack of communication, waiting for appointment, medical records, staff attitudes, communication, discharge



9xCompliments 7xGeneral comments

and quality of service and care. Lincoln – access to services, quality of care, uniformed of cancelled appointment, quality of care

Pilgrim & Lincoln –quality of care and service

Pilgrim- Taking over 4 months to get a Doctor to visit.

Volunteer driver felt that the Hospitals needed to provide suitable parking spaces for them when transporting patients.

Staff looking at watches and can't wait to leave. I don't wish to go back there.

The eye clinic is very hard to contact

Lincoln- Signage The letters that were sent out referred to either 'wing' or 'unit' and the signs in the hospital said the other way round.

Louth- Receptionist talking on phone, everyone in the waiting room can hear all the details of the conversation. Staff don't feel they are listened too when families abuse the staff.

Patient who had a need to attend A&E spent approximately 4 hours in the department

NHS Dentistry 12 10x Signposting

1xGeneral Comments

1xCompliment

Requests for dentists in Bourne x2, Grantham, Sleaford x5 and Corby Glen.

Request for dental practice , in Kings Lynn

Castlegate Dental Practice - Brilliant. All staff very friendly.

LPFT 4xComplaints

Patient has a diagnosis but has not been referred or seen a counsellor or

received therapeutic recovery support as yet.

Did not qualify for enough points to be

seen by Stamford Resource Centre He then had another "attack" due the anxiety of the situation.



6xGeneral comments

3xCompliments

The Mental Health Team at Louth let me

down seriously, my GP referred me and they discharged me without any help or advice because I had been bereaved

Keep being offered and told how to get money, but it is not money they need: it’s a one-stop social worker, not 1 dozen different people telephoning and visiting and nothing achieved

Mental health affects people in many different ways the service needs to be tailored to individual needs rather than

continually trying to apply one model fits all approach.

Patient sees psychiatrist 3 - 4 times a

year but this is the only input they have

There needs to be a thorough examination into how Mental Health

services - especially community services - are rolled out and the discharge process should be fully mutual and

agreeable to the service user and the carer, the CPN and social healthcare worker.

Found it difficult to get help with my condition. No help post military. No GP support. Just medication and referred to

Ash Villa in Sleaford. No Therapy, just respite.

The Archway Centre does not appear to

be communicating with other psychological services for patient needs and neither are they communicating

effectively with GPs.

Patient has been under the care of the

CMHT in Gainsborough for a number of years and would like it known that the services they have received have

definitely improved over the last few years.

I find the NHS Therapeutic Drama Group

an absolute God send. It's the most positive group I have ever been a member of. It is welcoming and

sustaining. Outstanding support and care with regular one to one support as well as group support

The care my daughter received from the



crisis team and then CAMHS was good.

More awareness sessions at work could help

Healthwatch Lincolnshire share all formally reported items received from public, patient & carers with individual service provider organisations. However, it is important to note that we do not verify for accuracy any of the comments reported to us. In addition, we direct everyone who contacts us with areas of concern back to the service provider as their first and most important step. We do not deal with individual complaints but signpost people to relevant support agencies such as PALS and POWhER.


1


28th January 2015

Performance & Quality Report

EXECUTIVE LEAD AND JOB TITLE Martin Bambro, Head Of Performance & Delivery

AUTHOR AND JOB TITLE Sue McDonald, Deputy Head Of Performance & Delivery

PURPOSE

This report has been prepared to provide the CCG Governing Body with timely details of performance against a range of key nationally mandated and local targets.


Results from CQC Inpatient Survey 2014/15, monthly Friends & Family patient feedback surveys for inpatients and A&E and key results from the national GP Patient Survey are incorporated within the report.

RECOMMENDATIONS

The Governing Body are asked to consider the contents of this report.

BACKGROUND

This is the ninth Governing Body Performance & Quality report for 2014/15. It provides details of performance for the majority of CCG and/or host provider targets within Patient Safety, Quality and Experience, the commissioning framework Everyone Counts 2014/15 and CCG Local Priority target. Each month the report includes a “Focus On” section; this month’s focus is on the newly published CCG Outcome measures for Stroke, Hip Fracture and Mental Health.

The report will continue to expand to encompass a wider scope of targets and priorities for the CCG in its commissioning and federated role with ULHT and the hosted Quality function.


Access to nationally published CCG level data is improving, but not available for all targets.Therefore where CCG data is not specifically shown any conclusions or analytical outputs should be seen as indicative until CCG level data is formerly published. The following text shown in GREY relates to indicators that have not had analysis updated in this months’ report.


2

Patient Safety, Quality and Experience (ULHT)

Challenging areas include

Never Events: 2 Never Events have been reported so far this this year.

Safety Thermometer: Currently in 2014/15 ULHT remains below (worse than) national average for overall New Harm-Free Care and worse than average for 3 of the 4 harm indicators.

SHMI: Latest data show rates continue above average levels at ULHT and NLAG and both have higher than expected death numbers; ULHT by 130 and NLAG by 151.

MRSA cases: ULHT have had 3 cases assigned so far in 2014/15.

CDiff infections: Up to December 2014, ULHT have exceeded plan by 9 cases with 55 cases reported so far this year.

Stroke Care: ULHT performance in October fell to 74% for “stroke patient spending 90% of time on ASU”, YTD is at 75%. Higher Risk Stroke patients (post TIA) treated < 24 hours” is at 59% YTD against a target of 60%.

Patient Experience of Hospital Care: results published by the CQC for the 2013/14 Inpatient Survey show the patient experience score for 13/14 only increased marginally at ULHT, but also remains well below the national average. Lack of clear patient feedback is one main are of concern.

Friends & Family Test Inpatients and A&E: NHS England has moved to using a percentage measure instead of Net Promoter Score. Currently the A&E survey shows only 81.4% of patients (YTD) would recommend the service and only 91.4% of Inpatients; both well below national average.

Friends & Family Test – The Staff Survey for Quarter 2 shows only 62% of staff surveyed said they would recommend the service to family or friends and only 54% as a place to work; both well below national average.

Everyone Counts: Planning For Patients 2014/15

ANNEX A – NHS Outcome Measures HIGH performing areas include:-

Healthy Related Quality of Life – LTC patients: Published data from the 2013/14 GP patient surveys show an improvement in the health status score for CCG patients with LTCs.

Unplanned admission for ACS and conditions not usually requiring hospitalisation: Recently published data for 2013/14 shows an 8% and 12% reduction year on year for each indicator respectively.

Challenging areas include:-

IAPT Access: CCG’s are now measured using HSCIC data. Quarter 2 data reports LWCCG performance as 9.6% YTD, below the 13.4% mid year target. With a year-end estimate of 19.2% and a drop in performance since a change of definition in July 2014, it is unlikely that the 26.8% annual target will be met.

PYLL: There has been a change in target definition, with a revision to CCG mapping methodology and update to age ranges used in the calculation, therefore historical and baseline data has been recalculated. Data now shows a significant deterioration (13.9% increase) in potential years of life lost from conditions amenable to healthcare. LWCCG failed to meet the Quality Premium Threshold.

Patient Experience of Hospital Care: The CCG performance is linked with the main provider ULHT. This new target definition measures the “poor” responses from patients for 15 key questions. HSCIC have recalculated the 2012/13 baseline score and also for 2013/14; where the poor response score increase from 125 to 129.


3

ANNEX A - Supporting NHS Outcome Measures HIGH performing areas include:-

CCG MRSA cases: Although ULHT have 2 cases recorded, none are assigned to LWCCG so far

in 2014/15.


IAPT Recovery: CCG’s are now measured using HSCIC data. Only quarter 1 data is available and currently shows LWCCG to be achieving 48.1% against a 51% target.

CCG CDiff cases: With 33 instances so far LWCCG is now 2 cases over plan YTD.

Dementia Diagnosis: To achieve the 67% national requirement in 2014/15 will require an increase in the register of at least 466 patients (155 a month).

ANNEX B – NHS Constitution Measures HIGH performing areas include:-

A+E 4 hour (CCG): December performance was 90.9% with a YTD figure of 96.0%, this is above the national threshold of 95%.


RTT 18 weeks – Admitted Pathways: November performance dropped to 78.2% against a 90% target.

RTT 18 weeks – Non-Admitted Pathways: November performance fell to 89.9% against a 95% target.

RTT 18 weeks – Incomplete Pathways: October performance increased to 83.0% against a 92% target.

Diagnostic 6 week waiters: The proportion breaching the 6 weeks is below (better than) the 1% national standard for the last 2 months; although breach numbers have fallen, the CCG has already failed this target for 2014/15.

A+E 4 hour (ULHT): ULHT performance YTD is 92.4%, which is below the 95% target.

Cancer 2WW: Current data show the suspected pathway fell to 84.4% YTD, which is below the 93% target. Breast Symptomatic pathways fell to 30%.

Subsequent Radiotherapy: November performance dropped to 72.9% against the national plan of 98%.

Cancer 62 Day First Definitive Treatment from GP referral: Performance has dropped to 68.2% YTD, against the 85% national expectation.

Ambulance response times: YTD trust performance for all 3 targets remains below national expectation and looking unlikely to achieve in 2014/15 (although achieving for CCG patient pathways).

ANNEX B - Supporting NHS Constitution Measures HIGH performing areas include:-

CPA – 7 day follow up: 100% of CPA patients were followed up within 7 days in Qtr. 2 of 2014/15.

RTT – 52 week breaches: none reported for CCG patients up until November 2014. However, there were data quality issues for ULHT in August and September.

Trolley Waits (12 hour): none reported at ULHT so far in 2014/15.

Urgent Operations cancelled for a 2nd time: none reported at ULHT so far in 2014/15. It should be noted that ULHT are currently unable to report on this measure.


4


Ambulance Handover Delays: YTD a 44% increase of delays between 30 and 60 compared to 2013/14.

Ambulance Handover Delays over 1 hour: YTD there is a 91% increase in delays over 1 hour compared to 2013/14.

ANNEX C Measures Challenging areas include:-

Prior to installation of Medway PAS system at ULHT, all CCG pathways were not over performing

against plan; data quality issues currently prevent accurate YTD monitoring.

A&E Attendances: a “proxy” measure is being used until data assurance is received on the

intended data source. The proxy measure is sourced using local data and shows increasing A&E attendances by site (and type).

CCG Local Priority Measure 2014/15

AF patients on optimum therapy: Current performance is deteriorating against the planned 5% increase.


Concerns remain regarding the ability of our main provider to deliver and maintain key national standards. To strengthen our approach and gain increased assurance, we are increasing the level and amount of time CCG Officers are spending with ULHT, with one senior CCG member now part-time seconded to ULHT.


Indicators highlight differences in health and employment for persons of varying ages, ethnicity and long term medical or mental health conditions.


Indicators within the NHS Outcomes Framework highlight differences in health and employment for persons of socio-economic backgrounds and geographical areas.


None identified.


5


None can be dentified.at the moment.

HR IMPLICATIONS

None identified.


None identified.


Risks are clearly identified in the main report and summarised using RAG rating tables. Red rated targets are fed into the BAF and risk register. Process to be developed further.

KEYWORDS

The report now includes a Glossary at the end of the report, highlighting key acronyms used. This list will be developed further.


Martin Bambro Head of Performance & Delivery T: (01522) 513355 x 5534 [email protected]

Sue McDonald Deputy Head of Performance & Delivery T: (01522) 513355 x 5534

[email protected]



Lincolnshire West CCG Governing Body - January 2015

Performance & Quality Report No. 9

LincolnshireWest

FaldingworthFaldingworthFaldingworthFaldingworthFaldingworthFaldingworthFaldingworthFaldingworthFaldingworth

GlenthamGlenthamGlenthamGlenthamGlenthamGlenthamGlenthamGlenthamGlentham

Kirton Kirton Kirton Kirton Kirton Kirton Kirton Kirton Kirton

in Lindseyin Lindseyin Lindseyin Lindseyin Lindseyin Lindseyin Lindseyin Lindseyin Lindsey

LeadenhamLeadenhamLeadenhamLeadenhamLeadenhamLeadenhamLeadenhamLeadenhamLeadenham

NewarkNewarkNewarkNewarkNewarkNewarkNewarkNewarkNewark

SwinderbySwinderbySwinderbySwinderbySwinderbySwinderbySwinderbySwinderbySwinderby

MartonMartonMartonMartonMartonMartonMartonMartonMarton

BlytonBlytonBlytonBlytonBlytonBlytonBlytonBlytonBlyton

ScamptonScamptonScamptonScamptonScamptonScamptonScamptonScamptonScampton

HemswellHemswellHemswellHemswellHemswellHemswellHemswellHemswellHemswell

SturtonSturtonSturtonSturtonSturtonSturtonSturtonSturtonSturton

EpworthEpworthEpworthEpworthEpworthEpworthEpworthEpworthEpworth

CaythorpeCaythorpeCaythorpeCaythorpeCaythorpeCaythorpeCaythorpeCaythorpeCaythorpe

RuskingtonRuskingtonRuskingtonRuskingtonRuskingtonRuskingtonRuskingtonRuskingtonRuskington

BillinghayBillinghayBillinghayBillinghayBillinghayBillinghayBillinghayBillinghayBillinghay

NavenbyNavenbyNavenbyNavenbyNavenbyNavenbyNavenbyNavenbyNavenby

WragbyWragbyWragbyWragbyWragbyWragbyWragbyWragbyWragby

NettlehamNettlehamNettlehamNettlehamNettlehamNettlehamNettlehamNettlehamNettleham

WeltonWeltonWeltonWeltonWeltonWeltonWeltonWeltonWelton

Market RasenMarket RasenMarket RasenMarket RasenMarket RasenMarket RasenMarket RasenMarket RasenMarket Rasen

CaistorCaistorCaistorCaistorCaistorCaistorCaistorCaistorCaistor

GainsboroughGainsboroughGainsboroughGainsboroughGainsboroughGainsboroughGainsboroughGainsboroughGainsborough

WillinghamWillinghamWillinghamWillinghamWillinghamWillinghamWillinghamWillinghamWillingham

ScotterScotterScotterScotterScotterScotterScotterScotterScotter

InghamInghamInghamInghamInghamInghamInghamInghamIngham

HibaldstowHibaldstowHibaldstowHibaldstowHibaldstowHibaldstowHibaldstowHibaldstowHibaldstow

SaxilbySaxilbySaxilbySaxilbySaxilbySaxilbySaxilbySaxilbySaxilby

LincolnLincolnLincolnLincolnLincolnLincolnLincolnLincolnLincolnWashingboroughWashingboroughWashingboroughWashingboroughWashingboroughWashingboroughWashingboroughWashingboroughWashingborough

Nth HykehamNth HykehamNth HykehamNth HykehamNth HykehamNth HykehamNth HykehamNth HykehamNth HykehamBranstonBranstonBranstonBranstonBranstonBranstonBranstonBranstonBranston

MetheringhamMetheringhamMetheringhamMetheringhamMetheringhamMetheringhamMetheringhamMetheringhamMetheringhamBassinghamBassinghamBassinghamBassinghamBassinghamBassinghamBassinghamBassinghamBassingham

CCG Localities

GainsboroughLincoln City SouthNorth LincolnSouth of Lincoln

Governing Body Performance & Quality Report 28th Jan. 2015 Lincolnshire West Clinical Commissioning Group

Improving Healthcare, Improving Health Page 1 Performance & Delivery



Table of contents

1 PATIENT SAFETY, QUALITY & EXPERIENCE ......................................................................................................... 4

1.1 SUMMARY TABLE ................................................................................................................................. 4

1.2 NEVER EVENTS ................................................................................................................................... 4

1.3 NHS SAFETY THERMOMETER .............................................................................................................. 5 1.3.1 SAFETY THERMOMETER NEW HARM FREE CARE ................................................................................. 5 1.3.2 SAFETY THERMOMETER NEW PRESSURE ULCERS ............................................................................. 5 1.3.3 SAFETY THERMOMETER FALLS WITH HARM ......................................................................................... 6 1.3.4 SAFETY THERMOMETER CATHETER & UTI'S .......................................................................................... 6 1.3.5 SAFETY THERMOMETER NEW VTES ......................................................................................................... 6

1.4 SUMMARY HOSPITAL-LEVEL MORTALITY INDICATOR (SHMI) .................................................................. 7 1.4.1 ULHT (TOTAL TRUST) ............................................................................................................................ 7 1.4.2 NLAG (TOTAL TRUST) ............................................................................................................................ 7

1.5 HCAI MEASURE - MRSA (E.A.S.4) ...................................................................................................... 7 1.5.1 LINCOLNSHIRE WEST CCG ..................................................................................................................... 7 1.5.2 ULHT ................................................................................................................................................... 7

1.6 HCAI MEASURE – CDIFF (E.A.S.5) ...................................................................................................... 8 1.6.1 LINCOLNSHIRE WEST CCG ..................................................................................................................... 8 1.6.2 ULHT ................................................................................................................................................... 8

1.7 PROMS SCORES ................................................................................................................................ 8 1.7.1 NATIONAL .............................................................................................................................................. 8 1.7.2 LINCOLNSHIRE WEST CCG (COMMISSIONER) ............................................................................................ 8 1.7.3 ULHT (PROVIDER LEVEL) ....................................................................................................................... 9

1.8 STROKE CARE (ULHT) ........................................................................................................................ 9 1.8.1 STROKE PATIENTS SPENDING 90% OF THEIR TIME IN HOSPITAL ON ASU ....................................................... 9 1.8.2 HIGHER RISK STROKE PATIENTS (POST TIA) TREATED < 24 HOURS ............................................................. 9

1.9 DEMENTIA ASSESSMENTS (ULHT) ..................................................................................................... 10 1.9.1 DEMENTIA CASE FINDING ....................................................................................................................... 10 1.9.2 DIAGNOSTIC ASSESSMENT FOR DEMENTIA ............................................................................................... 10 1.9.3 REFERRAL FOR SPECIALIST DIAGNOSIS .................................................................................................... 10

1.10 VTE ASSESSMENTS ........................................................................................................................... 11

1.11 PATIENT EXPERIENCE OF HOSPITAL CARE .......................................................................................... 11 1.11.1 ADULT INPATIENT SURVEY (CQC) .......................................................................................................... 11

1.12 FRIENDS AND FAMILY TEST – INPATIENTS AND A&E (NEW DEFINITION) ................................................ 11 1.12.1 ULHT - ALL SITES ................................................................................................................................ 12

1.13 FRIENDS AND FAMILY TEST – STAFF (NEW) ....................................................................................... 12 1.13.1 FRIENDS AND FAMILY TEST – STAFF WORK – ULHT ................................................................................ 12 1.13.2 FRIENDS AND FAMILY TEST – STAFF CARE – ULHT ................................................................................. 13 1.13.3 MATERNITY SURVEY (ULHT) ................................................................................................................. 13

1.14 MIXED SEX ACCOMMODATION ............................................................................................................ 14

2 EVERYONE COUNTS 2014-15 ................................................................................................................................ 15

2.1 BACKGROUND ................................................................................................................................... 15

2.2 ANNEX A – OUTCOME MEASURES ...................................................................................................... 15 2.2.1 SUMMARY TABLE .................................................................................................................................. 15 2.2.2 E.A.1 - POTENTIAL YEARS OF LIFE LOST (PYLL) .................................................................................... 15 2.2.3 E.A.2 - HEALTH RELATED QUALITY OF LIFE FOR PEOPLE WITH LONG-TERM CONDITIONS .............................. 16 2.2.4 E.A.3 - IAPT ROLL OUT - IMPROVED ACCESS ......................................................................................... 16 2.2.5 E.A.4 - COMPOSITE MEASURE ON EMERGENCY ADMISSIONS .................................................................... 17 2.2.6 E.A.5 – POOR PATIENT EXPERIENCE OF HOSPITAL CARE ......................................................................... 20 2.2.7 E.A.6 - FRIENDS AND FAMILY TEST ........................................................................................................ 20 2.2.8 E.A.7 - PATIENT EXPERIENCE OF PRIMARY CARE - GP SERVICES & OUT OF HOURS .................................. 20 2.2.9 E.A.9 - IMPROVING THE REPORTING OF MEDICATION-RELATED SAFETY INCIDENTS ....................................... 21

2.3 ANNEX A - SUPPORTING OUTCOME MEASURES ................................................................................... 22 2.3.1 SUMMARY TABLE .................................................................................................................................. 22



2.3.2 E.A.S.1 - ESTIMATED DIAGNOSIS RATE FOR PEOPLE WITH DEMENTIA ........................................................ 22 2.3.3 E.A.S.2 - IAPT - RECOVERY RATE ........................................................................................................ 22 2.3.4 E.A.S.3 - ADULT SOCIAL CARE - STILL AT HOME 91 DAYS AFTER HOSPITAL DISCHARGE INTO REABLEMENT .... 23 2.3.5 E.A.S.4 - HCAI MEASURE - MRSA ........................................................................................................ 23 2.3.6 E.A.S.5 - HCAI MEASURE - CDIFF ......................................................................................................... 23

2.4 ANNEX B – NHS CONSTITUTION MEASURES ...................................................................................... 24 2.4.1 SUMMARY TABLE .................................................................................................................................. 24 2.4.2 RTT TREATMENT PATHWAYS 18 WEEKS (E.B.1 TO E.B.3) ....................................................................... 24 2.4.3 E.B.4 - DIAGNOSTIC TEST WAITING TIMES .............................................................................................. 25 2.4.4 E.B.5 - A&E WAITING TIME ................................................................................................................... 26 2.4.5 CANCER 2 WEEK WAITS (E.B.6 TO E.B.7) ............................................................................................... 26 2.4.6 CANCER DAY 31 WAITS (E.B.8 TO E.B.11).............................................................................................. 27 2.4.7 CANCER 62 DAY WAITS (E.B.12 TO E.B.14)............................................................................................ 28 2.4.8 E.B.15 - AMBULANCE CLINICAL QUALITY ................................................................................................. 28

2.5 ANNEX B - SUPPORTING NHS CONSTITUTION MEASURES – ................................................................ 30 2.5.1 SUMMARY TABLE .................................................................................................................................. 30 2.5.2 E.B.S.1 - MIXED SEX ACCOMMODATION (MSA) BREACHES ..................................................................... 30 2.5.3 E.B.S.2 – CANCELLED OPERATIONS (28 DAY GUARANTEE) ...................................................................... 30 2.5.4 E.B.S.3 - MENTAL HEALTH MEASURE – CARE PROGRAMME APPROACH (CPA) ......................................... 30 2.5.5 E.B.S.4 - NUMBER OF 52 WEEK REFERRAL TO TREATMENT PATHWAYS ..................................................... 30 2.5.6 E.B.S.5 - TROLLEY WAITS IN A&E .......................................................................................................... 31 2.5.7 E.B.S.6 - URGENT OPERATIONS CANCELLED FOR A SECOND TIME............................................................. 31 2.5.8 E.B.S.7 - AMBULANCE HANDOVER TIME ................................................................................................. 31

2.6 ANNEX C – ACUTE ACTIVITY MEASURES ............................................................................................ 32 2.6.1 SUMMARY TABLE .................................................................................................................................. 32 2.6.2 E.C.1 TO E.C.3 - ELECTIVE FINISHED FIRST CONSULTANT EPISODES (FFCES) ........................................... 32 2.6.3 E.C.4 - NON-ELECTIVE (FFCES) ........................................................................................................... 32 2.6.4 E.C.5 - ALL FIRST OUTPATIENT ATTENDANCES ......................................................................................... 33 2.6.5 E.C.6 - ALL SUBSEQUENT OUTPATIENT ATTENDANCES ............................................................................ 33 2.6.6 E.C.7 & 8 - A&E ATTENDANCES ............................................................................................................ 33 2.6.7 E.C.9 - GP WRITTEN REFERRALS .......................................................................................................... 33 2.6.8 E.C.10 - OTHER REFERRALS FOR FIRST OUTPATIENT APPOINTMENT ......................................................... 34 2.6.9 E.C.11 - TOTAL REFERRALS.................................................................................................................. 34 2.6.10 E.C.12 - FIRST OUTPATIENT ATTENDANCES FOLLOWING GP REFERRALS .................................................. 34

3 CCG LOCAL PRIORITY MEASURE 2014/15 ........................................................................................................... 35

3.1 SUMMARY TABLE .............................................................................................................................. 35

3.2 AF PATIENTS WHO ARE PRESCRIBED OPTIMUM PREVENTATIVE THERAPY .............................................. 35

4 CCG OUTCOMES INDICATOR SET (NEW) ............................................................................................................ 36

4.1 SUMMARY TABLE .............................................................................................................................. 36 4.1.1 HIP FRACTURE INCIDENCE (C1.22) ........................................................................................................ 36 4.1.2 HIP FRACTURE: RECOVERY LEVELS AT 30 DAYS (C3.10.I) ........................................................................ 36 4.1.3 HIP FRACTURE: RECOVERY LEVELS AT 120 DAYS (C3.10.II) ...................................................................... 36 4.1.4 HIP FRACTURE: FORMAL HIP FRACTURE PROGRAMME (C3.11) ................................................................... 37 4.1.5 HIP FRACTURE: TIMELY SURGERY (C3.12)............................................................................................... 37 4.1.6 STROKE PATIENTS ADMITTED TO AN ACUTE STROKE UNIT WITHIN 4 HOURS (C3.5) ....................................... 37 4.1.7 ACUTE STROKE PATIENTS WHO RECEIVE THROMBOLYSIS (C3.6) ............................................................... 37 4.1.8 STROKE PATIENTS DISCHARGED WITH A JOINT HEALTH AND SOCIAL CARE PLAN (C3.7) ................................. 38 4.1.9 STROKE PATIENTS WHO HAVE A FOLLOW-UP ASSESSMENT (C3.8) .............................................................. 38 4.1.10 READMISSIONS TO MENTAL HEALTH SERVICES WITHIN 30 DAYS OF DISCHARGE (C3.16) ............................... 38 4.1.11 PROPORTION OF ADULTS IN CONTACT WITH SECONDARY MENTAL HEALTH SERVICES IN EMPLOYMENT (C3.17) 39

APPENDIX 1 – GLOSSARY OF ACRONYMS USED ...................................................................................................... 40



1 Patient Safety, Quality & Experience

1.1 SUMMARY TABLE

1.2 NEVER EVENTS

Never Events are very serious, largely preventable patient safety incidents that should not occur if the relevant preventative measures have been put in place by the healthcare provider. Further details available at: http://www.england.nhs.uk/ourwork/patientsafety/never-events

Comment: There were no Never Events reported in December 2014. National Benchmarking

Patient Safety, Quality & Experience (ULHT unless stated)CCG Lead

OfficerCurrent Risk Trend

Updated

(since last

report)

Never Events WM Medium

Safety Thermometer New HARM Free Care WM Medium

Safety Thermometer New PRESSURE ULCERS WM Medium

Safety Thermometer FALLS WM High

Safety Thermometer CATHETER & New UTI's WM High

Safety Thermometer New VTEs WM Low

Summary Hospital-Level Mortality Indicator (SHMI) WM Medium

HCAI measure - MRSA WM Medium

HCAI measure - CDiff WM High

PROMS Scores WM Medium

Stroke Care CC High

Dementia Assessments WM Medium

VTE Assessments WM Low

Patient Experience of Hospital Care WM High

Friends and Family Test - Inpatients & A&E - changed WM Medium

Friends and Family - Staff Survey - changed WM High

Friends and Family - Maternity - changed WM Medium

Mixed Sex Accommodation WM Low

Key

High High risk of non achievement or currently not achieving target

Medium Medium risk of non achievement or currently not consistently achieving target

Low Low risk of non achievement or currently achieving target on a consistent basis

Description

Improvement on previously reported period

Little or no change on previously reported period

Deterioration on previously reported period

"Never" Events at ULHT - month in which the event occurred

Category 2012/13 2013/14 Apr May Jun Jul Aug Sep Oct Nov Dec

Medication Administration Error 1

Retained foreign object post-operation 1 2 1

Transfusion of ABO-incompatible blood components 1

Wrong implant/prosthesis 1

Surgical Error 1

Wrong site surgery 1

Total 4 3 0 0 1 0 0 0 1 0 0

2014/15

"Never" Events at other local provider sites April to October 2014/15

Category NUH Sherwood NLAG QE - KL PSHFT

Not specified 1Retained foreign object post-operation 2 1Wrong implant/prosthesis 2Wrong site surgery 2 1Total 2 0 0 5 2

http://www.england.nhs.uk/ourwork/patientsafety/never-events



1.3 NHS SAFETY THERMOMETER

The NHS Safety Thermometer is a tool to support patient safety improvement. Further details and performance dashboards for all providers available at: http://www.safetythermometer.nhs.uk/

The following Safety Thermometer indicators are now displayed as “New” cases of harm i.e. directly attributable to the trust responsible for the patient care and not inherited from other providers or community.

1.3.1 Safety Thermometer NEW HARM FREE CARE

The Table below shows patients free of all new harms

Comment: ULHT performance is just below (worse than) the national average for New “Harm Free” care.

1.3.2 Safety Thermometer NEW PRESSURE ULCERS

A ‘new’ pressure ulcer is one that developed 72 hours or more after the patient was admitted. Incidence of newly-acquired category 2, 3 and 4 pressure ulcers” is now a key indicator within Domain 5 of the NHS Outcomes Framework; as well as a national mandatory CQUIN target for acute providers.

Comment: ULHT performance YTD is slightly above (worse than) the national average for New Pressure Ulcers.

New Harm Free Care - All 14/15

Provider Category Apr May Jun Jul Aug Sep Oct Nov Dec YTD

ULHT Patients 995 928 987 936 926 913 948 928 961 8,522

New Harms 44 37 30 24 32 25 42 33 35 302

% Free From New Harms 95.6% 96.0% 97.0% 97.4% 96.5% 97.3% 95.6% 96.4% 96.4% 96.5%

LCHS Patients 1,325 1,308 1,200 1,518 1,250 1,404 1,361 1,381 1,445 12,192

New Harms 13 23 17 28 27 18 22 18 26 192


LPFT Patients 69 79 87 68 71 66 64 65 40 609

New Harms 4 4 2 0 0 3 0 1 0 14


97.4% 97.5% 97.6% 97.7% 97.5% 97.6% 97.6% 97.7% 97.7% 97.6%England average

2014/15

Pressure Ulcers New 14/15

ProviderCategory Apr May June July Aug Sept Oct Nov Dec YTD

ULHT Patients 995 928 987 936 926 913 948 928 961 8,522

New Ulcers 12 10 6 8 10 7 16 7 12 88

% New Ulcers 1.2% 1.1% 0.6% 0.9% 1.1% 0.8% 1.7% 0.8% 1.2% 1.03%

LCHS Patients 1,325 1,308 1,200 1,518 1,250 1,404 1,361 1,381 1,445 12,192

New Ulcers 6 15 5 13 9 10 12 8 14 92

% New Ulcers 0.5% 1.1% 0.4% 0.9% 0.7% 0.7% 0.9% 0.6% 1.0% 0.8%

LPFT Patients 69 79 87 68 71 66 64 65 40 609

New Ulcers 0 1 0 0 0 0 0 0 0 1

% New Ulcers 0% 1.3% 0% 0% 0% 0% 0% 0% 0% 0.2%

1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 0.9% 1.0% 0.99%England average

2014/15

http://www.safetythermometer.nhs.uk/



1.3.3 Safety Thermometer FALLS WITH HARM

The Safety Thermometer records the severity of any fall that the patient has experienced within the previous 72 hours in a care setting (including home if the patient is on a district nursing caseload).

Comment: There has been a significant increase in falls with harm at ULHT sites in October, November and December, they currently rate above (worse than) the England average of 0.7% YTD.

1.3.4 Safety Thermometer CATHETER & UTI's

The Safety Thermometer records any UTI treatment and urinary catheterisation. If the patient is being treated for a UTI, the Safety Thermometer asks whether the clinical signs or treatment started before the patient was admitted (Old UTI) or after the patient was admitted (New UTI).

Comment: The ULHT rate is significantly above (worse than) the England average YTD, their risk rating is red.

1.3.5 SAFETY Thermometer New VTEs

The Safety Thermometer records whether a patient is being clinically treated for a venous thromboembolism (VTE). A patient is defined as having a new VTE if they are being treated for a deep vein thrombosis (DVT), pulmonary embolism (PE) or any other recognised type of VTE with appropriate therapy such as anticoagulants. If treatment for the VTE started after admission it is counted as a new VTE.

Comment: YTD shows ULHT rate is slightly below (better than) with the national average of 0.4% YTD.

Falls With Harm 14/15


ULHT Patients 995 928 987 936 926 913 948 928 961 8,522

All Falls w/Harm 14 9 10 10 10 11 20 19 16 119

% Falls w/Harm 1.4% 1.0% 1.0% 1.1% 1.1% 1.2% 2.1% 2.0% 1.7% 1.4%

LCHS Patients 1,325 1,308 1,200 1,518 1,250 1,404 1,361 1,381 1,445 12,192

All Falls w/Harm 3 1 4 4 8 3 8 7 12 50

% Falls w/Harm 0.2% 0.1% 0.3% 0.3% 0.6% 0.2% 0.6% 0.5% 0.8% 0.4%

LPFT Patients 69 79 87 68 71 66 64 65 40 609

All Falls w/Harm 4 2 1 0 0 3 0 1 0 11

% Falls w/Harm 5.8% 2.5% 1.1% 0% 0% 4.5% 0% 1.5% 0% 1.8%

0.7% 0.7% 0.7% 0.7% 0.7% 0.7% 0.6% 0.7% 0.7% 0.7%NHS England average

2014/15

Catheter +New UTI 14/15


ULHT Patients 995 928 987 936 926 913 948 928 961 8,522

Cath+New UTI 12 11 12 5 8 7 6 8 9 78

% cath+New UTI 1.2% 1.2% 1.2% 0.5% 0.9% 0.8% 0.6% 0.9% 0.9% 0.9%

LCHS Patients 1,325 1,308 1,200 1,518 1,250 1,404 1,361 1,381 1,445 12,192

Cath+New UTI 0 0 0 3 3 2 1 1 0 10

% cath+New UTI 0% 0% 0% 0.2% 0.2% 0.1% 0.1% 0.1% 0% 0.1%

LPFT Patients 69 79 87 68 71 66 64 65 40 609

Cath+New UTI 0 1 1 0 0 0 0 0 0 2

% cath+New UTI 0% 1.3% 1.1% 0% 0% 0% 0% 0% 0% 0.3%


2014/15

New VTE 14/15


ULHT Patients 995 928 987 936 926 913 948 928 961 8,522

New VTEs 7 7 3 1 6 0 2 0 0 26

% New VTE 0.7% 0.8% 0.3% 0.1% 0.6% 0% 0.2% 0% 0% 0.3%

LCHS Patients 1,325 1,308 1,200 1,518 1,250 1,404 1,361 1,381 1,445 12,192

New VTEs 4 6 7 8 8 3 1 3 1 41

% New VTE 0.3% 0.5% 0.6% 0.5% 0.6% 0.2% 0.1% 0.2% 0.1% 0.3%

LPFT Patients 69 79 87 68 71 66 64 65 40 609

New VTEs 0 0 0 0 0 0 0 0 0 0

% New VTE 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%


2014/15



1.4 SUMMARY HOSPITAL-LEVEL MORTALITY INDICATOR (SHMI)

The SHMI is a ratio of the observed deaths in a trust over a period divided by the expected number, given the characteristics of patients treated by that trust. It covers all deaths reported of patients admitted to acute, non-specialist trusts and either die while in hospital or within 30 days of discharge. Further details available at: http://www.hscic.gov.uk/SHMI

1.4.1 ULHT (Total Trust)

1.4.2 NLAG (Total Trust)

Comment: The tables show the most recently published SHMIs for local providers (for the period April 13 to March 14). Both ULHT and NLAG are categorised as Level 2 “As Expected”. Latest data show rates continue above average levels at ULHT and NLAG and both have higher than expected death numbers.

1.5 HCAI MEASURE - MRSA (E.A.S.4)

CCGs are monitored on cases assigned to the CCG after a Post Infection Review (PIR); not based on those attributed. Note figures shown are provisional pending PIR outcome. For more information: http://www.england.nhs.uk/ourwork/patientsafety/zero-tolerance/

1.5.1 Lincolnshire West CCG

Comment: The CCG has no cases assigned so far in 2014/15.

1.5.2 ULHT

Comment: ULHT are 3 cases over plan.

ULHT Total Trust

Indicator

Apr11 to

Mar12

Jul11 to

Jun12

Oct11 to

Sep12

Jan12 to

Dec12

Apr12 to

Mar13

Jul12 to

Jun13

Oct12 to

Sep13

Jan13 to

Dec13

Apr13 to

Mar14

Hospital Admissions 94,007 95,073 94,571 93,065 90,623 88,452 87,172 86,079 84,971

Observed Deaths 3,586 3,564 3,560 3,536 3,585 3,538 3,532 3,465 3,364

Expected Deaths 3,280 3,267 3,241 3,244 3,322 3,368 3,389 3,349 3,234

Deaths Variance +306 +297 +319 +292 +263 +170 +143 +116 +130

SHMI 1.093 1.091 1.099 1.090 1.079 1.050 1.042 1.035 1.040

Band using 95% limit from

random effects model*2 2 2 2 2 2 2 2 2

SHMI national ranking** 122 121 122 116 117 95 89 85 91

* (1= Higher than expected, 2= As expected, 3= Lower than expected)

** (1=Lowest, 143=Highest)

Period Covered (12 months)

NLAG Total Trust

Indicator

Apr11 to

Mar12

Jul11 to

Jun12

Oct11 to

Sep12

Jan12 to

Dec12

Apr12 to

Mar13

Jul12 to

Jun13

Oct12 to

Sep13

Jan13 to

Dec13

Apr13 to

Mar14

Hospital Admissions 59,034 58,742 58,782 58,783 57,801 57,605 57,469 57,305 57,864

Observed Deaths 2,266 2,286 2,236 2,275 2,269 2,234 2,217 2,209 2,107

Expected Deaths 1,934 1,934 1,938 1,978 2,037 2,048 2,028 2,020 1,956

Deaths Variance +332 +352 +298 +297 +232 +186 +189 +189 +151

SHMI 1.172 1.182 1.154 1.150 1.114 1.091 1.092 1.094 1.077

Band using 95% limit from

random effects model*1 1 1 1 2 2 2 2 2

SHMI national ranking** 139 140 138 138 128 119 123 119 116* (1= Higher than expected, 2= As expected, 3= Lower than expected)

** (1=Lowest, 143=Highest)

Period Covered (12 months)

Indicator 11/12 12/13 13/14 Apr May Jun Jul Aug Sep Oct Nov Dec YTD

Plan 0 0 0 0 0 0 0 0 0 0

Actual 8 2 0 0 0 0 0 0 0 0 0 0 0

Variance against plan +0 +0 +0 +0 +0 +0 +0 +0 +0 +0 +0

2014/15

Indicator 11/12 12/13 13/14 Apr May Jun Jul Aug Sep Oct Nov Dec YTD

Plan 8 6 0 0 0 0 0 0 0 0 0 0 0

Actual 4 6 4 0 0 0 1 1 0 0 0 1 3

Variance against plan +4 +0 +0 +0 +1 +1 +0 +0 +0 +1 +3

2014/15

http://www.hscic.gov.uk/SHMI

http://www.england.nhs.uk/ourwork/patientsafety/zero-tolerance/



1.6 HCAI MEASURE – CDIFF (E.A.S.5)

The number of Clostridium difficile infections (CDIs) for patients aged 2 or more; where the patient shows clinical symptoms of C. difficile infection and has a positive laboratory test result for CDI recognised as a case according to the Trust's diagnostic algorithm. Providers are only attributed cases where the sample was taken post 72 hours of admission. Note the PIR and assignment process as per MRSA cases does not apply to CDiff cases.

1.6.1 Lincolnshire West CCG

Comment: YTD outturn is now 2 cases over the November plan figure set by NHSE.

1.6.2 ULHT

Comment: Currently ULHT is 9 cases above the December plan figure of 46.5 set by NHSE.

1.7 PROMS SCORES

Patient Reported Outcome Measures (PROMs) measure quality from the patient perspective and calculate the health gain (EQ-5D) after surgical treatment using pre and post-operative surveys. The following tables show latest the latest data published in November 2014.

1.7.1 National

1.7.2 Lincolnshire West CCG (Commissioner)

Comment: The table shows adjusted health gain for CCG patients in 2014/15 is above national average for all 3 procedures with sufficient data numbers.

Plan

Indicator 11/12 12/13 13/14 14/15 Apr May Jun Jul Aug Sep Oct Nov Dec YTD

CCG Plan 33 42 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 3.5 31.5

Actual 40 48 43 2 2 4 6 2 8 5 4 0 33

Variance -2 -2 +1 +3 -2 +5 +2 +1 -4 +2

2014/15

11/12 12/13 13/14 Plan

Hopsital Site Total Total Total 14/15 Apr May Jun Jul Aug Sep Oct Nov Dec YTD

ULHT Plan 92 61 52 62 5.2 5.2 5.2 5.2 5.2 5.2 5.2 5.2 5.2 46.5

Lincoln cases 34 37 32 2 3 5 4 2 6 3 3 0 28

Pilgrim cases 28 29 25 2 4 1 1 3 3 2 2 2 20

Grantham cases 12 10 4 3 1 1 1 0 1 0 0 0 7

JCH cases 0 0 0 0 0 0 0 0 0 0 0

Actual 74 76 61 7 8 7 6 5 10 5 5 2 55

Variance -18 +15 +9 +2 +3 +2 +1 -0 +5 -0 -0 -3 +9

2014/15

Procedure

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Groin Hernia 20,161 17.8% 50.2% 0.085 20,666 17.8% 50.6% 0.085

Hip Replacement - Primary 31,984 5.0% 89.7% 0.438 31,387 5.3% 89.3% 0.436

Hip Replacement - Revision 2,700 16.1% 72.3% 0.270 2,389 15.6% 69.7% 0.254

Knee Replacement - Primary 34,777 9.8% 80.6% 0.318 33,354 9.1% 81.3% 0.323

Knee Replacement - Revision 1,754 18.1% 67.5% 0.251 1,514 17.9% 66.4% 0.244

Varicose Vein 4,462 16.5% 52.7% 0.093 4,474 16.5% 51.6% 0.093

** 2013/14 data is provisional (up-dated in November 14)

2012/13 (Apr-Mar) Final 2013/14** (Apr-Mar) Nov 2014 Release

Procedure

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Groin Hernia 36 16.7% 63.9% 0.120 44 15.9% 45.5% 0.114

Hip Replacement - Primary 172 7.6% 87.8% 0.431 153 4.6% 89.5% 0.458

Hip Replacement - Revision 10 40.0% 50.0% * 14 14.3% 57.1% *

Knee Replacement - Primary 221 12.2% 80.5% 0.329 161 7.5% 82.0% 0.329

Knee Replacement - Revision 10 10.0% 50.0% * 7 0.0% 85.7% *

Varicose Vein 13 30.8% 38.5% * 10 20.0% 50.0% *

* numbers too small or health gain not calculated on sample < 30




1.7.3 ULHT (Provider Level)

Comment: The provider level data shows the health gain of ULHT patients in 2013/14 is below national average for groin hernia. Please note that: 1) Data for 2013/14 is not complete yet, but data completeness will increase over coming months.

2) RAG ratings are based on variation from the national average adjusted health gains scores

1.8 STROKE CARE (ULHT)

Early initiation of treatment for Transient Ischaemic Attacks (TIAs) or minor stroke can reduce the number of people going on to have a major stroke by 80%. The following 2 national indicators monitor progress:- In addition to the data below, further stroke measures are featured in this month’s focus on the CCG Outcomes Framework, please refer to page 36.

1.8.1 Stroke patients spending 90% of their time in hospital on ASU

This measures the proportion of people who have had a stroke who spend at least 90% of their time in hospital on a stroke unit. National expectation is 80%.

Comment: In October 74% % of patients met the standard. YTD is 75%.

1.8.2 Higher Risk Stroke patients (post TIA) treated < 24 hours

This measures the proportion of people at High Risk of Stroke who experience a TIA are assessed and treated within 24 hours. National expectation is 60%.

Comment: At 59% October performance is just below the 60% expectation, YTD performance is 52%.

Procedure

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Modelled

records

Health

Worse

Health

Better

Adjust

Avg

Health

Gain

Groin Hernia 158 24.7% 50.0% 0.074 168 24.4% 45.2% 0.061

Hip Replacement - Primary 280 7.9% 84.3% 0.409 235 8.5% 84.7% 0.395

Hip Replacement - Revision 35 20.0% 62.9% 0.194 29 24.1% 62.1% *

Knee Replacement - Primary 315 11.4% 76.8% 0.292 281 11.4% 79.4% 0.313

Knee Replacement - Revision 8 0.0% 62.5% * 9 22.2% 77.8% *

Varicose Vein 37 16.2% 54.1% 0.138 35 20.0% 45.7% 0.085


All ULHT Sites 14/15

Qtr 1 Qtr 2 Qtr1 Qtr2 Oct

Plan % > 90% time on stroke unit 80% 80% 80% 80% 80%

Patients spending >90% time on

stroke unit160 218 195 201 67

Stroke Discharges 235 292 269 256 90

% > 90% time on stroke unit 68% 75% 72% 79% 74%

Indicator

Actual

2013/14 2014/15

All ULHT Sites 14/15

Qtr 1 Qtr 2 Qtr1 Qtr2 Oct

Plan % scanned < 24 hours 60% 60% 60% 60% 60%

High risk TIA patients < 24hrs

scan/treated67 55 59 60 29

Total patients with TIA & high risk 116 99 133 105 49

% scanned < 24 hours 58% 56% 44% 57% 59%

Actual

Indicator

2013/14 2014/15



1.9 DEMENTIA ASSESSMENTS (ULHT)

This indicator was introduced with the purpose of improving some areas of dementia care in hospital. This is also now a national CQUIN. The indicator consists of three parts:-

1.9.1 Dementia case finding

Members of staff will identify whether the patient has suffered any problems with their memory in the last 12 months by asking members of their family or friends.

1.9.2 Diagnostic assessment for dementia

If there is evidence to suggest a problem with their memory, they will be given a dementia risk assessment.

1.9.3 Referral for specialist diagnosis

A referral would be made for further support either to a liaison team, a memory clinic or a GP.

Comment: The following chart shows an overview of the 3 part target against the 90% expectation:

Part 1: Identify

Indicator Feb Mar Apr May Jun Jul Aug Sep Oct Nov YTD

National Threshold 90% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%

Patients with clinical diagnosis of delirium +

patients asked the question + people with

diagnosis of dementia

629 661 573 574 758 735 696 710 691 716 5,453

Emergency admissions >75 (minus

exclusions)698 746 685 732 974 915 897 899 893 886 6,881

Dementia Assessment % 90% 89% 84% 78% 78% 80% 78% 79% 77% 81% 79%

2013/14 2014/15

Part 2: Assess & Treat



Number of patients having the diagnostic

assessment387 429 357 401 479 474 441 489 471 470 3,582

People with a clinical diagnosis of delirium +

patients answering positively to the question512 542 457 526 640 629 602 611 586 605 4,656

Diagnostic Assessment % 76% 79% 78% 76% 75% 75% 73% 80% 80% 78% 77%

2013/14 2014/15

Part 3: Refer



Patients being referred on for further

assessment and investigation or to their GP52 55 51 90 72 85 88 95 70 83 634

Patients in whom the diagnostic assessment is

"positive" or "inconclusive"52 55 51 90 72 85 88 95 70 83 634

Specialist diagnosis referral % 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

2013/14 2014/15

50%

60%

70%

80%

90%

100%

Oct Nov Apr May Jun Jul Aug Sep Oct Nov

2014/15

Dementia Assessments

Dementia Assessment % Diagnostic Assessment %

Specialist diagnosis referral % National Threshold



1.10 VTE ASSESSMENTS

This measures the percentage of adult inpatients that had a VTE risk assessment on hospital admission.

Comment: Please note: ULHT have been unable to provide any updates since May 2014, due to the Medway system installation.

1.11 PATIENT EXPERIENCE OF HOSPITAL CARE

The data source for this target is the annual CQC Adult Inpatient Survey. Whilst the basis of the patient experience scores is the result of individual survey questions, results are currently summarised into 5 domains. An overall score is calculated on the average of the five domain scores. The following chart shows ULHT’s patient experience score over time in comparison to the national average. Further details available at: http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys/inpatient-survey-2013

1.11.1 Adult Inpatient Survey (CQC)

Comment: The results published for 2013/14 show the patient experience score for ULHT increased by only 0.1 to 73.9, still well below the national average score which has increased to 76.9. ULHT has been consistently below the national average for the past 8 years.

1.12 FRIENDS AND FAMILY TEST – INPATIENTS AND A&E (NEW DEFINITION)

On completion of their treatment the patient is asked, "how likely is it that you would recommend this service to a friend or family?" and patients are invited to respond to the question by choosing one of six options, ranging from 'extremely likely' to 'extremely unlikely'. Further details available at: http://www.nhs.uk/nhsengland/aboutnhsservices/pages/nhs-friends-and-family-test.aspx http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/ Following the FFT Review presentation of the data has moved away from using the Net Promoter Score. The NHS England statistical publication now uses the percentage of respondents that would recommend/wouldn’t recommend the service in place of the NPS from September 2014.

ULHT (Total Trust) 2014/15

Indicator Jan Feb Mar Apr May YTD

National Threshold 95% 95% 95% 95% 95% 95%

Total Admissions 10,641 9,579 10,121 10,076 10,009 20,085

VTE Assessments 10,151 9,192 9,718 9,714 9,663 19,377

Uptake % 95.4% 96.0% 96.0% 96.4% 96.5% 96.5%

2013/14

71.0

72.0

73.0

74.0

75.0

76.0

77.0

78.0

2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

National Average Pat Exp Score

ULHT Patient Experience Score:

Key Percentage Recommended Key Percentage Not Recommended

Over 20% under Eng Avg Over 20% over the Eng Avg

Over 10% under Eng Avg Over 10% under Eng Avg

Below Eng Avg Above Eng Avg

Equal to or Greater than Eng Avg Less then or equal to Eng Avg

http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys/inpatient-survey-2013

http://www.cqc.org.uk/public/reports-surveys-and-reviews/surveys/inpatient-survey-2013

http://www.nhs.uk/nhsengland/aboutnhsservices/pages/nhs-friends-and-family-test.aspx

http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/

http://www.england.nhs.uk/statistics/statistical-work-areas/friends-and-family-test/friends-and-family-test-data/



1.12.1 ULHT - All Sites

The following 2 tables show the results from the Inpatient and A&E surveys for ULHT’s total trust responses.

Comment: In the November survey the ULHT patients surveyed, who would recommend the Inpatient service was 89.8% against the England average of 94.0%, at 4.6% the percentage who would not recommend the service was also higher than the England average.

Comment: During November, the percentage of ULHT patients who would recommend the A&E service was 80.8% against the England average of 87.4%. The percentage who would not recommend the service (9.8%) was also higher than the England average.

1.13 FRIENDS AND FAMILY TEST – STAFF (NEW)

In addition to the annual Staff Friends and Family Test conducted in autumn in April 2014 the Staff FFT was introduced to allow acute staff to feedback on NHS Services based on recent experience. Staff are asked to respond to two questions. The ‘Care’ question asks how likely staff are to recommend the NHS services they work in to friends and family who need similar treatment or care. The ‘Work’ question asks how likely staff would be to recommend the NHS service they work in to friends and family as a place to work. Staff FFT is conducted on a quarterly basis (excluding Quarter 3 when the existing NHS Staff Survey takes place).

1.13.1 Friends and Family Test – Staff Work – ULHT

Comment: 53.9% of staff surveyed would recommend working at ULHT, below the England average of 61%.

Inpatient Survey - ALL ULHT sites

Data Ap

r-14

May-1

4

Ju

n-1

4

Ju

l-14

Au

g-1

4

Sep

-14

Oc

t-14

No

v-1

4

YTD

Total Responses 1,112 1,101 1,206 1,149 792 756 668 625 7,409

Total Eligible 2,847 2,918 3,160 3,101 3,029 2,863 2,626 2,363 22,907

Response Rate 39.1% 37.7% 38.2% 37.1% 26.1% 26.4% 25.4% 26.4% 32.3%

Percentage Recommended 95.0% 94.1% 94.9% 93.8% 85.9% 87.8% 83.2% 89.8% 91.4%

Percentage Not Recommended 1.7% 1.9% 2.3% 1.6% 8.1% 5.4% 5.5% 4.6% 3.5%

Eng Avg Recommended 93.9% 94.2% 94.1% 94.2% 93.8% 93.5% 93.7% 94.7% 94.0%

Eng Avg Not Recommended 1.5% 1.5% 1.5% 1.4% 1.6% 1.8% 1.7% 1.7% 1.6%

A&E Survey - ALL ULHT sites

Data Ap

r-1

4

May

-14

Ju

n-1

4

Ju

l-1

4

Au

g-1

4

Se

p-1

4

Oc

t-1

4

No

v-1

4

YTD

Total Responses 1,787 2,066 1,910 1,966 1,825 1,761 1,656 1,559 14,530

Total Eligible 8,174 7,194 8,564 9,063 8,528 8,111 8,043 7,691 65,368

Response Rate 21.9% 28.7% 22.3% 21.7% 21.4% 21.7% 20.6% 20.3% 22.2%





Data Qtr

1

Qtr

2

Qtr

3

Qtr

4

Total Responses 1700 786

Response Rate 22.5% 10.3%

Percentage Recommended - Work 55.8% 53.9%

Percentage Not Recommended - Work 20.8% 22.4%

Eng Avg Recommended - Work 62% 61%

Eng Avg Not Recommended - Work 19% 19%

2014-15



1.13.2 Friends and Family Test – Staff Care – ULHT

Comment: 62.2% of ULHT staff surveyed said they would recommend the service they work in to their friends and family, below the England average. At 14%, the percentage of staff who would not recommend ULHT care is significantly higher than the England average of 8%.

1.13.3 Maternity Survey (ULHT)

The NHS England statistical publication has moved to using the percentage of respondents that would recommend or wouldn’t recommend the service in place of the Net Promoter Score from September 2014. The survey asks each patient to respond to up to four potential questions, which may or may not be applicable depending on the type of services they receive at three touch points:

Antenatal care (question 1)

Birth and care on the postnatal ward (questions 2 and 3)

Postnatal community care (question 4)

1.13.3.1 Question 1: Antenatal

“How likely are you to recommend our antenatal service to friends and family if they needed similar care or treatment?” - surveyed at the 36 week antenatal appointment.

1.13.3.2 Question 2: Birth Care

“How likely are you to recommend our labour ward/birthing unit/homebirth service to friends and family if they needed similar care or treatment?” surveyed at discharge from ward/birth unit/following a home birth.

Data Qtr

1

Qtr

2

Qtr

3

Qtr

4

Total Responses 1700 786

Response Rate 22.5% 10.3%

Percentage Recommended - Care 63.0% 62.2%

Percentage Not Recommended - Care 13.7% 14.0%

Eng Avg Recommended - Care 76% 77%

Eng Avg Not Recommended - Care 8% 8%

2014-15

ULHT - Question 1

Data Ap

r-1

4

May

-14

Ju

n-1

4

Ju

l-1

4

Au

g-1

4

Se

p-1

4

Oc

t-1

4

No

v-1

4YTD

Total Responses 26 10 12 5 13 21 32 13 132





ULHT - Question 2

Data Ap

r-14

May-1

4

Ju

n-1

4

Ju

l-14

Au

g-1

4

Sep

-14

Oct-

14

No

v-1

4

YTD

Total Responses 87 66 82 51 5 34 64 63 452







1.13.3.3 Question 3: Post Natal Ward Care

“How likely are you to recommend our postnatal ward to friends and family if they needed similar care or treatment?” - surveyed at discharge from the ward/birth unit/following a home birth.

1.13.3.4 Question 4: Post Natal Community Care

“How likely are you to recommend our postnatal community service to friends and family if they needed similar care or treatment?” - surveyed at discharge from the care of the community midwifery team to the care of the health visitor/GP (usually at 10 days postnatal).

Comment: November data shows patients who would recommend services are below the England average for Question 1, but equal to or above England average for questions 2,3 & 4.

1.14 MIXED SEX ACCOMMODATION

Definition: All breaches of sleeping accommodation must be reported, for each patient affected, via the Unify2 system. Sleeping accommodation includes areas where patients are admitted and cared for on beds or trolleys, even where they do not stay overnight. It therefore includes all admissions and assessment units (including clinical decision units), plus day surgery and endoscopy units. It does not include areas where patients have not been admitted, such as accident and emergency cubicles.

Comment: During November there was 1 MSA breach at Lincoln County Hospital.

ULHT - Question 3

Data Ap

r-1

4

May

-14

Ju

n-1

4

Ju

l-1

4

Au

g-1

4

Se

p-1

4

Oc

t-1

4

No

v-1

4

YTD

Total Responses 86 65 83 50 9 34 89 70 486





ULHT - Question 4

Data

Ap

r-1

4

May

-14

Ju

n-1

4

Ju

l-1

4

Au

g-1

4

Se

p-1

4

Oc

t-1

4

No

v-1

4

YTD

Total Responses 13 3 26 4 22 9 17 10 104

Percentage Recommended 100.0% 95.5% 88.9% 100.0% 100.0% 97.2%

Percentage Not Recommended 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%



"Unjustified" breaches

Indicator Apr May Jun Jul Aug Sep Oct Nov

LWCCG (All providers) 0 0 0 0 0 0 0 1

ULHT (ALL sites) 0 0 0 0 0 0 0 1

LCHS (ALL sites) 0 0 0 0 0 0 0 0

LPFT (ALL sites) 0 0 0 0 0 0 0 0

2014/15



2 EVERYONE COUNTS 2014-15

2.1 BACKGROUND

The NHS England planning guidance Everyone Counts sets out the need for bold and ambitious five year strategic plans from NHS commissioners. It describes an approach to deliver transformational change with the first critical steps over the next two years, to achieve the continued ambition to secure sustainable high quality care for all, now and for future generations. NHSE have identified the measures to provide assurance in planning and delivery. For CCG commissioners, these are set in the guidance document as:

Annex A: Outcomes measures (+ supporting indicators)

Annex B: NHS Constitution measures (+ supporting indicators)

Annex C: Activity measures Further guidance is available at http://www.england.nhs.uk/wp- content/uploads/2013/12/5yr-strat-plann-guid.pdf

2.2 ANNEX A – OUTCOME MEASURES

2.2.1 Summary table

2.2.2 E.A.1 - Potential Years of Life Lost (PYLL)

Potential Years of Life Lost due to amenable causes are given for each CCG. Conditions considered amenable to healthcare should not result in premature deaths where timely and effective healthcare is available. The concept generally relates to deaths under the age of 75, although for some conditions the age limit varies. The PYLL by age and condition is then standardised in respect to national age and sex rates; shown as a Directly Standardised Rate per 100,000.

Cause defined as amenable include: Colorectal and Breast Cancers, CVA, Diabetes, Epilepsy, IHD, Asthma, Acute abdomen appendicitis/intestinal obstruction, Pneumonia and Influenza (inc. Swine Flu). This indicator is also a Quality Premium measure for 2013/14 and 2014/15. LWCCG failed to meet the 2013/14 Quality Premium Measure.

Everyone Counts 2014-15 - Annex ACCG Lead


Updated

(since last

report)

Potential Years of Life Lost (PYLL) TMc High

Health Related Quality of Life - LTC CC Low

IAPT Improved Access AL High

Emergency Admissions (Composite Measure) CC Medium

Unplanned hospitalisation for chronic ambulatory care sensitive

conditionsCC Low

Unplanned hospitalisation for asthma, diabetes and epilepsy in under

19sCC Medium

Emergency admissions for acute conditions that should not usually

require hospital admissionCC Low

Emergency admissions for children with lower respiratory tract

infections (LRTI)CC Medium

Patient Experience of Hospital Care - Poor Experience WM High

Patient Experience of Primary Care WM Medium no data

Reporting of medication-related safety incidents WM Medium

Key




Description




http://www.england.nhs.uk/wp-%20content/uploads/2013/12/5yr-strat-plann-guid.pdf



Please note: There has now been a change in target definition, with a revision to CCG mapping methodology and update to age ranges used in the calculation, therefore historical and baseline data has been recalculated.

Comment: Latest published data for 2013 shows a significant deterioration in the CCG PYLL rate for all persons. The PYLL methodology has changed and has been retrospectively updated for all previous years. A 3.2% decrease was required between 2012 and 2013 to qualify for the Quality Premium payment, LWCCG have therefore failed to meet the threshold. This indicator is also a Quality Premium Measure for 2014/15.

2.2.3 E.A.2 - Health Related Quality of Life for people with long-term conditions

Definition: Average health status score for individuals aged 18 and over reporting that they have a long-term condition. It assesses whether health-related quality of life is increasing over time for the population with long-term conditions, while controlling for measurable confounders (age, gender, disease mix, etc.). Health status is derived from responses to Q34 on the GP Patient Survey (GPPS), which asks respondents to describe their health status using the five dimensions of the EuroQuol 5D (EQ-5D) survey instrument:

Mobility

Self-care

Usual activities

Pain/discomfort

Anxiety/depression

This indicator is also a Quality Premium measure for 2014/15.

Comment: Average health scores have just been published (in Sept-14) for this indicator with a revised methodology and show a rise in the score for the CCG, just behind the national average of 74.3%.

2.2.4 E.A.3 - IAPT Roll Out - Improved Access

Definition: The proportion of people that enter treatment against the level of need in the general population (the level of prevalence addressed or ‘captured’ by referral routes) The primary purpose of this indicator is to measure improved access to psychological services (IAPT) for people with depression and/or anxiety disorders. This is achieved using two indicators (the other being E.A.S.2 – IAPT Recovery) This indicator is also a Quality Premium measure for 2014/15.

Lincs West CCG 2009 2010 2011 2012 2013 2014 2015

Plan 2,065 1,999 1,961

Potential Years Life Lost 4,907 5,008 5,048 4,730 5,498

GP registered population 220,906 220,906 220,906 220,906 227,262

Rate 2074.5 2166.4 2166.5 2049.8 2335.1

Yearly growth PYLL Rate: +4.4% +0.0% -5.4% +13.9%

-3.2% << QP Threshold

2,000.0

2,100.0

2,200.0

2,300.0

2,400.0

2009 2010 2011 2012 2013

PYLL from causes considered amenable to healthcare - All persons - DSR per 100,000

LWCCG Leic & Linc AT England

Lincs West CCG Jul 2011 to

March 2012

Jul 2012 to March

2013

July 2013 to

March 2014

Positive "weighted" Responses 1,514 1,474 1,319

Responses 2,045 2,030 1,820

Rate 75.0% 73.0% 74.0%

Growth on previous period: -2.1% 0.1%

National 74.3% 74.4% 74.3%



The following tables differ from previous reports as all Lincolnshire CCG’s are now using the HSCIC data to monitor performance, rather than the LPFT data.

Comment: HSCIC data reports LWCCG performance as 9.6% YTD, below the 13.4% YTD target. With a year-end estimate of 19.2% and a drop in performance since a change of definition in July 2014, it is unlikely that the 26.8% target will be met.

2.2.5 E.A.4 - Composite Measure on Emergency Admissions

Description: This measure is based on emergency admissions for conditions that could usually have been avoided through better management in primary or community care (sometimes referred to as ‘ambulatory care sensitive conditions’) and which are reflected in four NHS Outcomes Framework indicators. This indicator is also a Quality Premium measure for 2014/15. The Composite measure is a combined measure of:

unplanned hospitalisation for chronic ambulatory care sensitive conditions (all ages);

unplanned hospitalisation for asthma, diabetes and epilepsy in children;

emergency admissions for acute conditions that should not usually require hospital admission (all ages);

emergency admissions for children with lower respiratory tract infection

Comment: The 2013/14 DSR for the overall composite measure has now been published showing a 6.8% reduction in emergency admissions. The table above shows rates for the CCG for the period 2009/14 and plans submitted to achieve a 15% reduction over 5 years. Note the 2012/13 baseline rate has changed due to a recalculation by HSCIC.

2.2.5.1 Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

Description: Chronic ambulatory care sensitive conditions are those where the right treatment and support in the community can help prevent people needing to be admitted to hospital e.g. Heart Failure, Epilepsy, Dementia, Angina, Chronic IHD, Iron & Vitamin Deficiency, Diabetic and Respiratory related conditions etc.

Definition: Total number of emergency admissions episodes where chronic ambulatory care sensitive conditions was the primary diagnosis for all persons (all ages). The indicator will show information on the number of emergency admissions per 100,000 population. This indicator has been indirectly age and sex standardised.

LWCCG - HSCIC Data Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 YTD

LWCCG2014/15 Plan 2.2% 2.2% 2.2% 2.2% 2.2% 2.2% 13.4%

LWCCG prevalence 18,334 18,334 18,334 18,334 18,334 18,334 18,334

Patients entering IAPT 305 305 320 300 245 285 1760

Percentage entering IAPT 1.7% 1.7% 1.7% 1.6% 1.3% 1.6% 9.6%

Variance from plan -0.6% -0.6% -0.5% -0.6% -0.9% -0.7% -3.8%

England 1.0% 1.0% 1.1% 1.1% 0.9% 1.1% 6.2%

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Plan 1,931.2 1,871.4 1,811.7 1,752.0 1,692.3

Actual rate 1,907.6 1,983.8 2,062.0 1,991.0 1.856.2

-3% -6% -9% -12% -15%

-6.8%

Planned reduction

Actual reduction

E.A.4i - Unplanned hospitalisation for chronic ambulatory care sensitive conditions

Rolling 12

month data

2010/11 2011/12 2012/13

April 2013 to

March 2014

(Provisional)

July 2013 to

June 2014

(Provisional)

Inpatient Spells 1892 1873 1890 1806 1796


DSR per 100,000 816.50 806.50 818.70 759.00 744.00

Growth on previous period -1.2% 1.5% -7.3% -2.0%

National Rate 775.90 765.80 802.80 780.90 775.80



Comment: A data period of 12 months is used to produce an annual output i.e. April 2013 to March 2014 above, showing a decrease of 7.3% on previous year. The CCG rate is now below (better than) the national rate. There is also a quarterly release of rolling 12 month data (July to June above) which can be used for monitoring purposes

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

Definition: Total number emergency admissions episodes for people under 19 (0 to 18 years) where asthma, diabetes or epilepsy was the primary diagnosis. The indicator will show information on the number of emergency admissions per 100,000 population. This indicator has been indirectly age and sex standardised.

Comment: A data period of 12 months is used to produce an annual output i.e. April 2013 to March 2014 above, showing an increase of 11.9% on previous year. The CCG rate is above (worse than) the national rate. There is also a quarterly release of rolling 12 month data (July to June above) which can be used for monitoring purposes

E.A.4.ii - Unplanned hospitalisation for asthma, diabetes and epilepsy

Rolling 12

month data

2010/11 2011/12 2012/13

April 2013 to

March 2014

(Provisional)

July 2013 to

June 2014

(Provisional)



DSR per 100,000 401.40 301.50 331.50 370.80 367.70

Growth on previous period -24.9% 10.0% 11.9% -0.8%

National Rate 335.90 312.10 336.90 307.40 307.20

0

100

200

300

400

500

2010/11 2011/12 2012/13 April 2013 toMarch 2014(Provisional)

July 2013 to June2014 (Provisional)

E.A.4.ii - Unplanned hospitalisation for asthma, diabetes and epilepsy

LWCCG L&L AT



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

Comment: A data period of 12 months is used to produce an annual output i.e. April 2013 to March 2014 above, showing a decrease of 12.29% on previous year. The CCG rate is below (better than) the national rate. There is also a quarterly release of rolling 12 month data (July to June above) which can be used for monitoring purposes

2.2.5.4 Emergency admissions for children with lower respiratory tract infections (LRTI)

Definition: The proportion of children aged up to 19 years of age admitted to hospital as an emergency admission for Lower Respiratory Tract Infections (bronchiolitis, bronchopneumonia and pneumonia).

E.A.4.iii - Emergency admissions for acute conditions that should not usually require hospital admissions

Rolling 12

month data

2010/11 2011/12 2012/13

April 2013 to

March 2014

(Provisional)

July 2013 to

June 2014

(Provisional)



DSR per 100,000 1050.00 1116.30 1229.40 1079.80 1038.10

Growth on previous period 6.3% 10.1% -12.2% -3.9%

National Rate 1069.30 1084.60 1181.90 1164.70 1181.20

0200400600800

1,0001,2001,400


July 2013 to June2014

(Provisional)

E.A.4.iii - Emergency admissions for acute conditions that should not usually require hospital admission

LWCCG L&L AT National

E.A.4.iv - Emergency admissions for children with lower respiratory tract infections (LRTI)

Rolling 12

month data

2010/11 2011/12 2012/13

April 2013 to

March 2014

(Provisional)

July 2013 to

June 2014

(Provisional)



DSR per 100,000 295.90 338.30 345.80 374.70 390.40

Growth on previous period 14.3% 2.2% 8.4% 4.2%

National Rate 379.00 356.00 399.60 368.60 377.60



Comment: A data period of 12 months is used to produce an annual output i.e. April 2013 to March 2014 above, showing an increase of 8.4% on previous year. The CCG rate is above (worse than) the national rate. There is also a quarterly release of rolling 12 month data (July to June above) which can be used for monitoring purposes

2.2.6 E.A.5 – Poor Patient Experience of Hospital Care

Definition: Reduction in the proportion of people reporting a ‘poor’ experience of inpatient care, by measuring the average number of responses of a ‘poor’ experience of inpatient care per 100 patients (poor responses out of 15 selected questions). This indicator is also a Quality Premium measure for 2014/15. Note this target has a revised definition and methodology monitored against in previously, performance against the previous version is reported in the Patient Safety, Quality & Experience chapter of this report.

Comment: NHSE have discovered the original calculation of the experience score was incorrect and have proposed a new trajectory and accommodates the newly recalculated baseline score for the CCG of 125.1. NHSE proposed an alternative plan based on the new baseline and this was adopted by the CCG at the final Executive Committee in September. However newly published data shows and increase in poor patient experience of hospital care in 2014/15 for CCG patients and the proposed trajectory did not allow for this new data period being published.

2.2.7 E.A.6 - Friends and Family Test

Definition: Improving the number of positive recommendations to friends and family by people receiving NHS treatment for the place where they received this care. Local providers for Friends and Family Test purposes are providers that represented 10% or more of the CCG’s activity for Q1 and Q2 of 2013/14. Comment: This is a Quality Premium measure, finalised data at a CCG level is not currently available, but will be a combined score from providers that represent 10% or more of the CCG’s activity.

2.2.8 E.A.7 - Patient Experience of Primary Care - GP Services & Out of Hours

Definition: A composite measure of people reporting ‘poor’ experience of General Practice and Out-of-Hours services. It is measures as the rate of responses of a ‘fairly poor’ or ‘very poor’ experience across General Practice (GP) and Out-of-hours services per 100 patients.

Comment: The table above shows nationally published rates for the CCG for 2012/13 and also the planned reduction in the poor response rate over the next 5 years. The historic rate for the CCG is well below (better than) national average. Although the 2013/14 survey results are available, the patient experience score for the GP/OOH service are still awaited.

050

100150200250300350400450


July 2013 to June2014 (Provisional)

E.A.4.iv - Emergency admissions for children with lower respiratory tract infections

LWCCG L&L AT National

LWCCG patients 2012/13 2014/15 2015/16 2016/17 2017/18 2018/19

Plan 121.8 118.9 116.1 113.3 110.6

Actual Rate 125.1 129.7

Variance from Plan +7.9

LWCCG patients 2012/13 Baseline* 2014/15 2015/16 2016/17 2017/18 2018/19

Plan 4.9 4.8 4.7 4.6 4.5 4.4

Actual Rate 4.9

Patients surveyed 192

Benchmarks

England 6.1

ELCCG 6.1

SWLCCG 6.8

SLCCG 3.8



2.2.9 E.A.9 - Improving the reporting of medication-related safety incidents

Definition: A patient safety incident (PSI) is any unintended or unexpected incident(s) that could have, or did, lead to harm for one or more person(s) receiving NHS funded healthcare. Reporting is via the NRLS, where over 90 per cent of incidents reported are associated with no harm or low harm. Research shows that organisations which regularly report more patient safety incidents usually have a stronger learning culture where patient safety is a high priority. By improving reporting in the short term, the NHS can build the foundations for driving improvement in the safety of care received by patients.

Comment: The table shows ULHT reported incidents for the last 3 date periods; both all reported harms by degree of harm and those categorised as Medication Errors. The first table shows the reporting rate for ULHT is below the national median, but the second table shows of those reported a higher proportion are Medication Errors than the national average.

ULHT - Reported Safety Incidents

Degree of Harm Oct-12 to Mar-13 Apr-13 to Sep-13 Oct-13 to Mar-14

None 3,851 3,977 3,703

Low 642 692 570

Moderate 432 374 551

Severe 55 63 63

Death 11 13 5

Trust Total 4,991 5,119 4,892

Rate per 100 admissions 6.13 6.70 6.40

National median 6.70 6.79 6.93

Of which are Medication Errors: Oct-12 to Mar-13 Apr-13 to Sep-13 Oct-13 to Mar-14

Number reported 510 634 595

% Medication Errors of Trust Total 10.2% 12.4% 12.2%

Nat Avg (for Large trusts) 10.4% 10.6% 10.3%



2.3 ANNEX A - SUPPORTING OUTCOME MEASURES

2.3.1 Summary table

2.3.2 E.A.S.1 - Estimated Diagnosis Rate for people with dementia

Definition: Diagnosis rate for people with dementia, expressed as a percentage of the estimated prevalence. The number of people on the dementia register is derived from the QOF reporting mechanism and based on GP practice registers. Dementia prevalence figures are estimates modelled within the national dementia prevalence tool at http://www.dementiaprevalencecalculator.org.uk/ The recent 2 year planning exercise for Everyone Counts 2014/16 revised the 2014/15 target to 67% diagnosis for dementia patients (from 60%) and to maintain this in 2015/16.

Comment: Latest data received for 2014/15 shows the CCG register increased by 159 so far this year. This equates to a diagnosis rate of 54.60% which is below planned levels. Register numbers will have to increase approximately by over 466 in the remainder of 2014/15 (155 per month) to achieve the 67% target.

2.3.3 E.A.S.2 - IAPT - Recovery Rate

Description: The primary purpose of this indicator is to measure improved access to IAPT for people with depression and/or anxiety disorders. This is achieved using two indicators (the other being E.A.3 – IAPT Roll-Out).

Definition: The proportion of people who complete treatment who are moving to recovery. Definition of a ‘case’: A patient suffering from depression and/or anxiety disorders, as determined by scores on the Patient Health Questionnaire for depression and/or the Patient Health Questionnaire (GAD7) for anxiety disorders, or other anxiety disorder specific measure as appropriate for the patient’s diagnosis.

Comment: This report now uses the HSCIC data to monitor this indicator. Only Quarter 1 is available currently. Performance is below the plan figure of 51.0%.

Everyone Counts 2014-15 - Annex A supportingCCG Lead


Updated

(since last

report)

Estimated Diagnosis Rate for people with dementia AL High

IAPT - Recovery Rate AL Medium

Adult Social Care - at home 91 days after hospital discharge CC Medium

HCAI measure - MRSA (CCG) WM Medium

HCAI measure - CDiff (CCG) WM High

Key




Description




Baseline

Indicator 2011/12 2012/13 2013/14 Aug Sep Oct Nov Dec

Diagnosis rate plan 45.8% 47.8% 53.9% 67.0%

Population Estimate 3,051 3,128 3,099 3,155 3,155 3,184 3,157 3,181

Dementia Register Actual 1,396 1,486 1,579 1,617 1,638 1,664 1,673 1,738

CCG diagnosis rate: 45.8% 47.5% 51.0% 51.3% 51.9% 52.3% 53.0% 54.6%

2014-15

LWCCG - HSCIC Data Apr-14 May-14 Jun-14 Q1

LWCCG 2014/15 Plan 51.0% 51.0% 51.0% 51.0%

Finished treatment 240 210 225 675

Moved to recovery 100 90 120 310

Finished treatment but not caseness initially 15 5.4 10 30.4

Recovery Rate 44.4% 44.0% 55.8% 48.09%

http://www.dementiaprevalencecalculator.org.uk/



2.3.4 E.A.S.3 - Adult Social Care - still at home 91 days after hospital discharge into reablement

Description: The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement / rehabilitation services This measures the benefit to individuals from reablement, intermediate care and rehabilitation following a hospital episode, by determining whether an individual remains living at home 91 days following discharge – the key outcome for many people using reablement services. It captures the joint work of social services and health staff and services commissioned by joint teams, as well as adult social care reablement.

Comment: The table shows countywide performance and is part of the BCF ambition metrics for 2014/15. Lincolnshire did not achieve the plan figure and is significantly below the England Average outturn. CCG level is not currently available. Better Care Fund (BCF) is a single pooled budget to support health and social care services to work more closely together in local areas.

2.3.5 E.A.S.4 - HCAI measure - MRSA

Detailed analysis is shown in the previous chapter; Patient Safety, Quality & Experience.

2.3.6 E.A.S.5 - HCAI measure - CDiff


Lincolnshire 2011/12 2012/13 2013/14 2014/15

14/15 Plan (BCF) 76.0%

Discharges aged (65 & over) 902 1,165

Still at home after 91 days 653 870

Actual 74.4% 72.4% 74.7%

England Average 82.7% 81.5% 81.9%



2.4 ANNEX B – NHS CONSTITUTION MEASURES

2.4.1 Summary table

Please note due to missing ULHT September data the Cancer Wait trend is based on an August comparison.

2.4.2 RTT Treatment Pathways 18 weeks (E.B.1 to E.B.3)

Target: A calculation of the percentage within 18 weeks for the 2 completed RTT pathways for patients admitted or non-admitted or incomplete RTT pathways based on referral to treatment data provided by NHS and independent sector organisations and signed off by NHS commissioners. The operational standards are 90 per cent for admitted and 95 per cent for non-admitted completed waits for patient’s first definitive treatment. In order to sustain the delivery of these standards, trusts also need to ensure that a minimum of 92 per cent of patients on an incomplete pathway should have been waiting no more than 18 weeks. These RTT waiting time standards leave an operational tolerance to allow for patients who wait longer than 18 weeks to start their treatment because of choice or clinical exception. Please note that ULHT’s September RTT data still shows unexplained step variation, therefore has not been signed off as correct by GEM Commissioning Intelligence or LWCCG Performance.

2.4.2.1 E.B.1 - Admitted RTT Performance

Everyone Counts 2014-15 - Annex BCCG Lead


Updated

(since last

report)

RTT Treatment - Admitted Patients AC High

RTT Treatment - Non Admitted Patients AC High

RTT Treatment - Incomplete Pathways AC High

Diagnostic Test Waiting Times CC Medium

A&E Waiting Time CC Low

Cancer 2 week waits - all suspected cancers S-JM High

Cancer 2 week waits - Breast Symptomatic S-JM High

Cancer day 31 waits - first definitive treatment from decision date S-JM Medium

Cancer day 31 waits - subsequent surgery S-JM Low

Cancer day 31 waits - subsequent chemotherapy S-JM Low

Cancer day 31 waits - subsequent radiotherapy S-JM High

Cancer 62 day waits - to first definitive treatment (from GP referral) S-JM High

Cancer 62 day waits - first treatment from screening service referral S-JM Low

Cancer 62 day waits - first treatment following consultant upgrade S-JM Low

Ambulance – Category A (Red 1) 8 minute response (EMAS) WM High

Ambulance – Category A (Red 2) 8 minute response (EMAS) WM High

Ambulance - Category A 19 minute transportation (EMAS) WM Medium

Key




Description




All providersIndicator Apr May Jun Jul Aug Sep Oct Nov

National Threshold 90% 90% 90% 90% 90% 90% 90% 90%

Admitted pathways <18 weeks 861 907 753 874 DQ DQ 893 802

Total Admitted pathways 1,001 1,012 861 1,034 issue issue 1,067 1,026

LWCCG % <18 weeks 86.0% 89.6% 87.5% 84.5% 83.7% 78.2%

2014/15



Comment: November performance has dropped to 78.2%, below the 90% threshold, no YTD outturn is available due to data quality issues in August and September.

2.4.2.2 E.B.2 - Non-Admitted RTT Performance

Comment: November performance has dropped to 89.9%, below the 95% threshold, no YTD outturn available due to data quality issues.

2.4.2.3 E.B.3 - Incomplete RTT Performance

Comment: November performance below the 92% threshold, no YTD outturn available due to data quality issues.

2.4.3 E.B.4 - Diagnostic Test Waiting Times

Description: The number of patients waiting 6 weeks or more at the date of measurement for any of the 15 key diagnostic tests. The national standard is for no more than 1% should be waiting over 6 weeks.

Comment: The proportion of CCG patients breaching the 6 week waiting time target in November was below (better than) the 1% national standard; although breach numbers have fallen again in November, the CCG has already failed this target for 2014/15

All providers



Non-Admitted pathways <18 weeks 2,972 2,967 3,273 3,547 DQ DQ 3,836 3,629

Total Non-Admitted pathways 3,219 3,221 3,497 3,866 issue issue 4,177 4,037

LWCCG % <18 weeks 92.3% 92.1% 93.6% 91.7% 91.8% 89.9%

2014/15

All providersIndicator Apr May Jun Jul Aug Sep Oct Nov


Incomplete pathways <18 weeks 12,504 12,653 10,590 13,350 DQ DQ 11,514 11,537

Total Incomplete pathways 13,511 13,782 12,312 15,444 issue issue 14,449 13,899

LWCCG % <18 weeks 92.5% 91.8% 86.0% 86.4% 79.7% 83.0%

2014/15

Apr May Jun Jul Aug Sep Oct Nov

MRI 16 (2.3%) 36 (5.2%) 38 (5.5%) 38 (5.3%) 17 (3.7%) 7 (1.3%) 3 (0.4%) 8 (1.2%)

CT 2 (0.4%) 1 (0.2%) 4 (0.9%) 1 (0.4%)

Non Obstetric Ultrasound170

(12.6%)

259

(17.1%)

267

(19.8%)

110

(10.6%)10 (1.2%) 4 (0.6%) 2 (0.3%) 3 (0.5%)

Barium Enema

Dexa Scan 3 (4.6%)

Audiology Assessments 2 (1.0%) 9 (3.9%) 1 (0.4%) 2 (0.8%) 9 (4.6%) 5 (2.5%) 5 (2.0%) 1 (0.4%)

Echocardiography 1 (0.4%) 1 (1.3%) 12 (8.7%) 6 (8.5%) 7 (15.6%) 4 (3.1%)

Electrophysiology

Peripheral Neurophysiology 1 (0.5%) 4 (8.2%) 4 (7.3%) 2 (20.0%) 1 (25.0%) 1 (0.9%)

Sleep Studies 1 (6.3%) 1 (5.9%) 2 (5.6%) 3 (17.6%)

Urodynamics 3 (23.1%) 2 (40.0%)

Colonoscopy 1 (0.8%) 1 (0.8%) 1 (0.9%) 2 (2.0%) 1 (0.7%)

Flexi Sigmoidoscopy

Cystoscopy

Gastroscopy

All Providers 194 (5.4%) 308 (8.2%) 313 (9.3%) 157 (5.0%) 55 (2.3%) 27 (1.2%) 21 (0.8%) 24 (0.9%)

Diagnostic Test2014/15



2.4.4 E.B.5 - A&E Waiting Time

Target: 95% of A&E attendances for all A&E types (including Minor Injury Units and Walk-in Centres) should be discharged, admitted or transferred within 4 hours of arrival. The definitive data source for A&E is the weekly trust level SitRep return submitted by providers. As a result the DH has devised an A&E mapping table to convert provider based SITREP data into CCG based information. LWCCG performance is derived by aggregating 37% of LCHS total activity, 35% ULHT etc. CCG commissioner performance

Comment: As CCG level activity reporting has not formally commenced, the outputs shows CCG performance calculated locally from the national mapping algorithm. It shows CCG 4 hour performance YTD above the 95%. CCG performance is predominantly based on ULHT and LCHS performance (LCHS activity includes MIUs and urgent WIC activity).

ULHT provider performance

Comment: December provider performance at ULHT has dropped to 81.6%, YTD is below the national threshold. The chart below illustrates the decrease of patients being discharged or admitted within 4 hours, November to date.

2.4.5 Cancer 2 week waits (E.B.6 to E.B.7)

Description: A two part indicator - the percentage of patients seen within two weeks of an urgent GP referral for suspected cancer (E.B.6) and percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer was not initially suspected (E.B.7). Please note – due to an error with September Open Exeter upload by ULHT, September figures and

LWCCG (all provs)

Indicator Apr May Jun Jul Aug Sep Oct Nov Dec YTD

National Threshold 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Attendances 9,626 12,382 9,886 12,550 9,241 9,393 9,217 11,073 9,034 92,401

Attendances 4hrs+ 271 331 434 455 318 259 348 472 818 3,705

ULHT % <4 hours 97.2% 97.3% 95.6% 96.4% 96.6% 97.2% 96.2% 95.7% 90.9% 96.0%

2014/15

ULHT - All sites

Indicator Apr May Jun Jul Aug Sep Oct Nov Dec YTD

National Threshold 95% 95% 95% 95% 95% 95% 95% 95% 95% 95%

Attendances 12,184 15,816 12,742 15,991 11,883 12,286 12,146 14,646 11,611 119,305

Attendances 4hrs+ 673 846 1,143 1,045 654 555 821 1,193 2,132 9,062

ULHT % <4 hours 94.5% 94.7% 91.0% 93.5% 94.5% 95.5% 93.2% 91.9% 81.6% 92.4%

2014/15

70%

75%

80%

85%

90%

95%

100%

02/11/14 09/11/14 16/11/14 23/11/14 30/11/14 07/12/14 14/12/14 21/12/14 28/12/14 04/01/15

A&E 4 Hour performance

National Threshold LWCCG ULHT



YTD data is not representative of activity and therefore not reported.

2.4.5.1 E.B.6 - All suspected cancers

2.4.5.2 E.B.7 - Breast Symptomatic

Comment: CCG performance for the both 2 week cancer pathway targets are below (worse than) the 93% national standard.

2.4.6 Cancer day 31 waits (E.B.8 to E.B.11)

Description: A two part indicator:

patients receiving first definitive treatment within one month (31-days) of a cancer diagnosis (measured from ‘date of decision to treat’) (E.B.8)

patients receiving subsequent treatment for cancer within 31-days, where treatment is Surgery (E.B.9), an Anti-Cancer Drug Regimen (E.B.10) or a Radiotherapy Treatment Course (E.B.11)

2.4.6.1 E.B.8 - First definitive treatment from decision date

Definition: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis.

2.4.6.2 E.B.9 - Subsequent Surgery

Definition: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is Surgery.

2.4.6.3 E.B.10 - Subsequent Chemotherapy

Definition: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is an Anti-Cancer Drug Regime.

All providers 2013/14

Indicator Total Apr May Jun Jul Aug Sep Oct Nov

National threshold 93% 93% 93% 93% 93% 93% 93% 93% 93%

First seen in the period 6,018 587 574 483 555 476 38 603 553

First seen <14 days 5,636 496 484 439 474 423 35 547 467

% first seen under 14 days 93.7% 84.5% 84.3% 90.9% 85.4% 88.9% 92.1% 90.7% 84.4%

2014/15




First seen in the period 942 64 111 51 140 121 5 72 70

First seen <14 days 794 29 69 49 118 96 4 58 21


2014/15




Total patients treated 1,102 88 87 96 92 75 98 112 84

Patients treated <31 days 1,055 88 86 91 86 69 93 101 78

% first seen under 31 days 95.7% 100% 98.9% 94.8% 93.5% 92.0% 94.9% 90.2% 92.9%

2014/15




Total patients treated 256 28 19 23 25 25 18 12 17

Patients treated <31 days 243 27 18 22 23 24 17 11 16

% first seen under 31 days 94.9% 96.4% 94.7% 95.7% 92.0% 96% 94% 91.7% 94.1%

2014/15



2.4.6.4 E.B.11 - Subsequent Radiotherapy

Definition: Percentage of patients receiving subsequent treatment for cancer within 31-days where that treatment is a Radiotherapy Treatment Course.

2.4.7 Cancer 62 day waits (E.B.12 to E.B.14)

Description: A 3 part indicator:

E.B.12: Percentage of patients receiving first definitive treatment for cancer within two months (62 days) of an urgent GP referral for suspected cancer.

E.B.13: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service.

E.B.14: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status.

2.4.7.1 E.B.12 - First definitive treatment (from GP urgent referral)

2.4.7.2 E.B.13 - First treatment from screening service referral

(No September data available)

2.4.7.3 E.B.14 - First treatment following consultant upgrade

2.4.8 E.B.15 - Ambulance clinical quality

Description & Target: The Category “A” 8 minute measure is split into two parts, Red 1 and Red 2. The existing call connect time* will remain for Red 1 calls. This will ensure that patients who genuinely require






% first seen under 31 days 99% 100% 97.9% 97.3% 97.6% 96.3% 100% 100% 100.0%

2014/15






% first seen under 31 days 93.0% 89.7% 81.1% 69.2% 93.5% 85.2% 97% 84.4% 72.7%

2014/15







2014/15




Total patients treated 81 10 9 6 10 9 16 8

Patients treated <62 days 73 10 9 6 9 8 12 7

% first seen under 62 days 90% 100% 100% 100% 90.0% 88.9% 100% 75.0% 87.5%

2014/15



National threshold



% first seen under 62 days 100% 100% 100% 100% 100% 0.0%

2014/15



emergency ambulance care will continue to receive the most rapid response. *The existing performance standard remains at 75% for both Red 1 & Red 2 calls responded to within 8-minutes.

Note: Each CCG is judged by the performance of the ambulance trust that serves its geographic area and will be attributed the trust level performance. However CCG performance is shown in BLUE text.

2.4.8.1 E.B.15i - Category A (Red 1) 8 minute response time

Definition: Category A (Red 1) incidents: presenting conditions, which may be immediately life threatening and require a time critical response.

Comment: YTD position is 73.1% for EMAS and below (worse than) the national standard of 75%.

2.4.8.2 E.B.15 ii - Category A (Red 2) 8 minute response time

Definition: Category A (Red 2) incidents: presenting conditions, which may be life threatening but less time-critical and should receive an emergency response.

Comment: YTD position is 73.2% for EMAS and below (worse than) the national standard of 75%.

2.4.8.3 E.B.16 - Category A Calls Responded To Within 19 Minutes

Description: The proportion of Category “A” incidents which resulted in a fully equipped ambulance vehicle (car or ambulance) which is able to transport the patient in a clinically safe manner, arriving at the scene within 19 minutes of the request being made.

Comment: YTD position is 94.3% for EMAS, below (worse than) the national standard of 95%.

EMAS - RED1

Indicator Apr May Jun Jul Aug Sep Oct Nov YTD

National Plan Cat "A" 8 75% 75% 75% 75% 75% 75% 75% 75% 75%

Responses 1,640 1,657 1,616 1,837 1,618 1,130 1,061 1,054 11,613

Responses < 8 mins 1,254 1,228 1,203 1,299 1,143 821 770 769 8,487

Cat "A" RED 1 8 mins 76.5% 74.1% 74.4% 70.7% 70.6% 72.7% 72.6% 73.0% 73.1%

LWCCG patients 86.8% 87.5% 89.9% 82.4% 84.7% 85.2% 81.8% 90.9% 86.3%

2014/15

EMAS - RED2



Responses 19,344 19,802 19,088 19,935 19,163 19,635 21,064 20,805 158,836

Responses < 8 mins 14,898 14,767 14,170 14,273 13,889 14,121 15,218 14,883 116,219

CAT "A" RED 2 8 mins 77.0% 74.6% 74.2% 71.6% 72.5% 71.9% 72.2% 71.5% 73.2%

LWCCG patients 88.3% 88.7% 86.2% 85.6% 84.6% 86.8% 90.6% 86.8% 87.2%

2014/15

EMAS - RED1 & RED2



Responses 20,956 21,437 20,663 21,730 20,750 20,754 22,092 21,828 170,210

Responses < 8 mins 20,121 20,385 19,569 20,257 19,540 19,450 20,683 20,463 160,468

Cat "A" 19 mins 96.0% 95.1% 94.7% 93.2% 94.2% 93.7% 93.6% 93.7% 94.3%

LWCCG patients 97.4% 96.5% 95.0% 95.7% 96.2% 96.5% 95.8% 96.5% 96.2%

2014/15



2.5 ANNEX B - SUPPORTING NHS CONSTITUTION MEASURES –

2.5.1 Summary table

2.5.2 E.B.S.1 - Mixed Sex Accommodation (MSA) Breaches


2.5.3 E.B.S.2 – Cancelled Operations (28 day guarantee)

Description: The proportion of patients whose operation was cancelled, by the hospital, for non-clinical reasons, on the day of or after admission, who were not treated within 28 days i.e. breaches of 28 days readmission guarantee.

Comment: Since installation of the Medway PAS system within ULHT, the trust is unable to provide updated information in support of this target.

2.5.4 E.B.S.3 - Mental Health Measure – Care Programme Approach (CPA)

Definition: The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care.

Comment: The table shows the 95% standard was achieved for CCG patients in 2013/14 and at Q2 is at 100%.

2.5.5 E.B.S.4 - Number of 52 week Referral to Treatment Pathways

Description: The number of Referral to Treatment (RTT) pathways greater than 52 weeks for completed admitted pathways (un-adjusted), completed non-admitted pathways and incomplete pathways. Commissioner level 52 week breaches are monitored as part of the CCG Assurance Framework process Please note that ULHT’s September RTT data still shows unexplained step variation, therefore has not been signed off as correct by GEM Commissioning Intelligence or LWCCG Performance.

Everyone Counts 2014-15 - Annex B supportingCCG Lead


Updated

(since last

report)

Mixed Sex Accommodation (MSA) Breaches WM Low

Cancelled Operations (28 day guarantee) AC Mediumno ulht

data

Mental Health Measure – Care Programme Approach (CPA) AL Low

Number of 52 week Referral to Treatment Pathways AC Low

Trolley waits in A&E CC Low

Urgent Operations Cancelled for a second time AC Lowno ulht

data

Ambulance Handover Time CC High

Key




Description




ULHT Trust


Cancelled operations 84 42

Not readmitted <28 days 9 3

%Not readmitted <28 days 11% 7%

2014/15

no updates available

LWCCG (All Providers)

Indicator Total Q1 Q2 Q3 Q4 Total

National Threshold 95% 95% 95% 95% 95% 95%

Discharged 213 42 55 97

FU within 7 days 209 42 55 97

% followed up <7 days 98.1% 100.0% 100.0% 100.0%

National Rate 97.2% 97.0% 97.3% 97.2%

2013/14 2014/15



2.5.6 E.B.S.5 - Trolley waits in A&E

Description: Patients who have waited over 12 hours in A&E from decision to admit to admission. Comment: No 12 hour trolley wait delays have been reported at ULHT in 2014/15.

2.5.7 E.B.S.6 - Urgent Operations Cancelled for a second time

Description: Number of urgent operations that are cancelled by the trust for non-clinical reasons, which have already been previously cancelled once for non-clinical reasons. Comment: No Urgent operations cancelled for a second time had been reported at ULHT in May 2014. However since installation of the Medway PAS system within ULHT, the trust is unable to provide updated information in support of this target.

2.5.8 E.B.S.7 - Ambulance Handover Time

Description: The number of handover delays (within the A&E department) of longer than 30 minutes and of those the number over one hour. Also known as Pre-Handover Delays. The Consequence of Breach listed within the national standard contract for 2013/14 states acute providers will be fined £200 per 30-60 minute breach and £1,000 for those over 60 minutes. The following outputs are for delays at Lincoln site only.

2.5.8.1 E.B.S.7 I - Ambulance handover delays of over 30 minutes

The following table show delays between 30 and 60 minutes:

2.5.8.2 E.B.S.7 ii - Ambulance handover delays of over 1 hour

Comment: December shows an increase in monthly ambulance handover delays of between 30 and 60 minutes and in the handover days of over 1 hour. Year to date 2014/15 numbers are significantly higher than the comparative period in 2013/14 and 2012/13.

LWCCG: 52 week waits

Provider Apr May Jun Jul Aug Sep Oct Nov YTD

CCG 0 0 0 0 no data no data 0 0 0

Total 52 week+ 0 0 0 0 0 0 0

2014/15

Year Apr May Jun Jul Aug Sep Oct Nov Dec YTD

2012/13 188 162 159 219 162 208 245 336 355 2,034

2013/14 301 233 177 236 257 255 287 366 397 2,509

2014/15 324 398 435 406 319 322 429 418 555 3,606

Growth +8% +71% +146% +72% +24% +26% +49% +14% +40% +44%

Lincoln Site

Year Apr May Jun Jul Aug Sep Oct Nov Dec YTD

2012/13 33 7 11 19 20 33 65 91 81 360

2013/14 76 27 22 24 30 50 53 39 90 411

2014/15 57 41 93 53 25 57 68 117 276 787

Growth -25.0% +52% +323% +121% -17% +14% +28% +200% +207% +91%



2.6 ANNEX C – ACUTE ACTIVITY MEASURES

The rationale behind these measures is that Commissioners need to show that their plans for referrals and activity are realistic. Since the ULHT installation of Medway PAS system, data quality issues have arisen. Where the trend is not indicated below this is due to ULHT data inconsistency issues. For A&E attendances a proxy measure is being used.

2.6.1 Summary table

2.6.2 E.C.1 to E.C.3 - Elective finished first consultant episodes (FFCEs)

Definition: Number of finished first consultant episodes (FFCEs) for the G&A specialties; aggregated for Day case FFCEs and Ordinary admissions.

2.6.3 E.C.4 - Non-elective (FFCEs)

Description: The total number of non-elective FFCEs (first finished consultant episodes) for the General & Acute specialties in the period.

Everyone Counts 2014-15 - Annex CCCG Lead


Updated

(since last

report)

Elective finished first consultant episodes (FFCEs) AC Low

Non-elective FFCEs CC Low

All first outpatient attendances AC Low

All Subsequent Outpatient Attendances AC Low

A&E Attendances CC Medium

GP Written Referrals AC Medium

Other Referrals for first Outpatient Appointment AC High

Total Referrals AC Medium

First Outpatient Attendances following GP Referrals AC Low

Key




Description




E.C.1 G&A ordinary


Planned activity 432 512 485 520 492 480 513 490 3,923

Actual activity 452 462 487 484 394 460 509 467 3,715

Variance to Plan +4.6% -9.7% +0.4% -6.8% -19.9% -4.3% -0.8% -4.6% -5.3%

E.C.2 G&A daycase


Planned activity 2,069 2,145 2,089 2,230 1,974 1,956 2,157 2,191 16,811

Actual activity 2,012 2,062 2,003 2,263 1,942 2,121 2,208 2,100 16,711

Variance to Plan -2.8% -3.9% -4.1% +1.5% -1.6% +8.4% +2.4% -4.2% -0.6%

E.C.3 Total Elective



Actual activity 2,464 2,524 2,490 2,747 2,336 2,581 2,717 2,567 20,426

Variance to Plan -1.5% -5.0% -3.3% -0.1% -5.3% +5.9% +1.7% -4.2% -1.5%

2014/15

2014/15

2014/15

E.C.4 Non Elec FFCEs



Actual activity 1,795 1,819 1,726 1,887 1,727 1,762 1,886 1,818 14,420

Variance to Plan +1.8% -1.9% -4.6% +1.0% -2.0% +0.7% +2.6% -1.2% -0.5%

2014/15



2.6.4 E.C.5 - All first outpatient attendances

Definition: Number of first outpatient attendances (consultant-led) in General & Acute specialties; from all referral sources.

2.6.5 E.C.6 - All Subsequent Outpatient Attendances

Description: A count of all subsequent outpatient attendances taking place within the period, whether taking place within a consultant clinic session or outside a session.

2.6.6 E.C.7 & 8 - A&E Attendances

Description: Number of attendances at A&E department against plan (excluding LCHS activity). Please note: further data validation is required before these measures can be reported from their intended source. The following 4 tables are a “proxy” measure until data assurance is received.

2.6.7 E.C.9 - GP Written Referrals

Definition: The total number of GP written Referral Requests for a first Consultant Outpatient Episode in the period.

E.C.5 1st OP atts (All)



Actual activity 5,731 5,712 6,919 6,725 5,808 6,179 6,355 5,914 49,343

Variance to Plan -0.9% +0.3% +14.4% +2.1% +4.3% +2.4% +0.8% -2.4% +2.6%

2014/15

E.C.6 Sub OP Atts

Indicator Q1 Q2 Q3 Q4 YTD

Planned activity 34,679 34,413 33,467 35,157 69,092

Actual activity 33,995 36,076 70,071

Variance to Plan -2.0% 4.8% +1.4%

2014/15

ULHT - Lincoln Site (including A&E diverts)

A&E Atts (Type 1)

Activity Period Apr May Jun Jul Aug Sep Oct Nov Dec YTD

13/14 5,092 6,437 5,131 5,378 5,154 6,281 5,180 5,048 6,328 50,029

14/15 5,085 6,716 5,462 5,597 6,226 5,370 6,511 5,112 5,221 51,300

Growth on 13/14 -0.1% +4.3% +6.5% +4.1% +20.8% -14.5% +25.7% +1.3% -17.5% +2.5%

2014/15 (aggregated from weekly data)

ULHT Lincoln site A&E diverts

A&E Atts (Type 4)


13/14 402 468 317 396 457 264 394 319 456 3,473

14/15 419 491 356 372 460 297 531 403 241 3,570

Growth on 13/14 +4.2% +4.9% +12.3% -6.1% +0.7% +12.5% +34.8% +26.3% -47.1% +2.8%


LCHS - Walk In Centre

A&E Atts (Type 4)


13/14 2,854 3,448 2,660 2,606 2,473 3,355 2,894 2,871 3,605 26,766

14/15 2,863 3,632 2,670 2,634 2,997 2,582 3,605 2,773 2,874 26,630

Growth on 13/14 +0.3% +5.3% +0.4% +1.1% +21.2% -23.0% +24.6% -3.4% -20.3% -0.5%


LCHS - John Coupland MIU

A&E Atts (Type 3)


13/14 887 1,262 935 1,052 919 1,237 909 792 968 8,961

14/15 928 1,331 1,092 1,136 1,255 1,020 1,248 821 906 9,737

Growth on 13/14 +4.6% +5.5% +16.8% +8.0% +36.6% -17.5% +37.3% +3.7% -6.4% +8.7%




2.6.8 E.C.10 - Other Referrals for first Outpatient Appointment

Definition: The total number of other (non-GP) referral requests (written or verbal or electronic) for a first consultant outpatient episode in the period.

2.6.9 E.C.11 - Total Referrals

Definition: Aggregate of indicators E.C.9 and E.C.10

2.6.10 E.C.12 - First Outpatient Attendances following GP Referrals

Definition: First outpatient attendances (consultant-led) following GP referral in general and acute specialties.

E.C.9 GP Referrals



Actual activity 4,365 3,790 4,618 5,133 4,756 4,993 4,912 4,587 37,154

Variance to Plan -0.7% -10.6% +3.4% +6.4% +16.0% +13.3% +9.9% +8.7% +5.8%

2014/15

E.C.10 Other Referrals



Actual activity 1,927 1,938 2,736 3,217 2,146 1,983 2,637 2,291 18,875

Variance to Plan -3.2% +1.1% +35.4% +47.5% +16.1% -0.3% +30.5% +20.2% +18.9%

2014/15

E.C.11 Total Referrals



Actual activity 6,292 5,728 7,354 8,350 6,902 6,976 7,549 6,878 56,029

Variance to Plan -1.5% -6.9% +13.3% +19.2% +16.0% +9.1% +16.3% +12.3% +9.9%

2014/15

E.C.12 1st OP atts (GP)



Actual activity 3,794 3,836 3,938 4,380 3,732 4,065 4,025 3,956 31,726

Variance to Plan -5.3% -0.7% -3.3% -0.4% -0.2% +1.1% -1.1% +2.9% -0.9%

2014/15



3 CCG Local Priority Measure 2014/15

Everyone Counts Planning for Patients 2014/15 asks each CCG to identify a local priority against which it will make progress during the year. These priorities will be taken into account when determining if the CCG should be rewarded through the Quality Premium 2014/15.

3.1 SUMMARY TABLE

3.2 AF PATIENTS WHO ARE PRESCRIBED OPTIMUM PREVENTATIVE THERAPY

Definition: To increase by at least 5% from current baseline of AF patients who are prescribed optimum preventative therapy. (CHA2DS2-VASc score 1 or more). Note: extracted data using the AF-Grasp tool includes resolved AF patients; this differs to QOF registers.

Comment: For the CCG operational plan a baseline position was submitted of 89.19%; with an aspiration to achieve a 5% increase by Quarter 4 2014/15 (up to 94.19%). At 88.9% is below the 2014/15 Qtr. 2 target. The chart below gives a breakdown of prescribed medication.

Local PriorityCCG Lead


Updated

(since last

report)

AF patients who are on optimum preventative therapy CC High

Key




Description




CCG Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4

14/15 Target Trajectory 89.2% 90.0% 90.9% 91.7% 92.5% 93.4% 94.19%

AF patients (score 1+) 3,773 3,806 4,175 4,232 4,309

AF patients prescribed anti-

coag or anti platlet3,365 3,381 3,737 3,785 3,831

LWCCG rate 89.19% 88.8% 89.5% 89.4% 88.9%

2014/152013/14

88%

90%

92%

94%

96%

Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2 Qtr 3 Qtr 4

2013/14 2014/15

LWCCG rate 14/15 Target Trajectory

0

500

1000

1500

2000

2500

Qtr 2 Qtr 3 Qtr 4 Qtr 1 Qtr 2

2013/14 2014/15

On OAC only On OAC & Antiplatelet On Antiplatelet only No Rx



4 CCG Outcomes Indicator Set (NEW)

4.1 SUMMARY TABLE

4.1.1 Hip Fracture Incidence (C1.22)

Hip fracture is the most common reason for admission to an orthopaedic trauma ward, and incidence is projected to rise. Mortality is high – about 1 in 10 people with a hip fracture die within one month and about 1 in 3 within 12 months. Most of the deaths are a result of associated comorbidities and not the fracture itself, reflecting the high prevalence of comorbidity in people with hip fracture. A fall and fracture often signals underlying ill health. It measures the number of emergency admissions for people aged 60 and over with hip fracture as a directly standardised rate (DSR) per 100,000 registered patients.

Comment: with a rate of 473 emergency admissions LWCCG is above the England average – ranked 160 of the 211 CCG’s.

4.1.2 Hip fracture: Recovery levels at 30 days (C3.10.i)

The indicator helps inform the degree of effectiveness of treatment for a hip fracture including support after discharge. It measures mobility/walking levels at 30 days after admission.

Lincs West CCG

January 2013 to December

2013

Hip Fracture patients (age 60 to 110) 70

Hip Fracture patients recovering to their previous level of mobility at 30 days after admission

15

Percentage recovering to previous level at 30 days

21.4%

Comment: England average and previous year data is not available. Please be aware that data completeness for this indicator is poor, and therefore indicator values are unlikely to be robust. LWCCG rank 61 out of the 93 CCG’s represented.

4.1.3 Hip fracture: Recovery levels at 120 days (C3.10.ii)

As previous measure, but this checks mobility/walking levels at 120 days after admission.

Comment: England average and previous year data is not available. Indicator values are unlikely to be robust. LWCCG ranks 73 out of the 96 CCG’s represented.

Lincs West CCG

April 2013 to

March 2014

(Provisional)

July 2013 to

June 2014

(Provisional)

Registered patients (age 60+) 56,149 57,033

Emergency admissions for hip fracture

(age 60+)245 265

DSR Rate 446.5 473.4

England 432.7 421.3

* Provisional data

Lincs West CCG 120 Days

January 2013 to

December 2013

Hip Fracture patients (age 60 to 110) 70

Hip Fracture patients recovering to their previous

level of mobility at 120 days after admission30

Percentage recovering to previous level at 120 days 42.9%



4.1.4 Hip fracture: formal hip fracture programme (C3.11)

There is a high prevalence of comorbidity in people with hip fracture. A fall and fracture often signals underlying ill health. A formal hip fracture programme includes regular assessment and continued rehabilitation from a range of healthcare professionals with different skills.

Comment: At 97.8% LWCCG is above the England average, ranking 81out of 211 CCG’s.

4.1.5 Hip fracture: timely surgery (C3.12)

The NICE clinical guideline on hip fracture recommends that surgery is performed on the day of, or the day after, admission as this will have a high impact on outcomes that are important to patients.

Comment: LWCCG outturn of 82.8% is above the England average – ranked 36 of 211 CCG’s.

4.1.6 Stroke Patients admitted to an acute stroke unit within 4 hours (C3.5)

Measures the percentage of patients admitted to hospital with a primary diagnosis of stroke, except those who go directly to ITU, CCU or HDU, admitted directly to a stroke unit within 4 hours. No previous year data is available.

Comment: at 59.0% LWCCG is below the England average, ranked 110 of the 206 CCG’s represented (5 had data supressed).

4.1.7 Acute Stroke Patients who receive thrombolysis (C3.6)

This indicator measures a key component of high-quality care as defined in the NICE quality standard for stroke, “Patients with suspected stroke are admitted directly to a specialist acute stroke unit and assessed for thrombolysis, receiving it if clinically indicated”. No previous year data is available.

Lincs West CCG

January 2013 to

December 2013

No of patients on NHF Database 225

No of patients receiving a formal hip fracture programme 220

Percentage receiving a formal hip fracture programme 97.8%

England 93.6%

Lincs West CCG

January 2013 to

December 2013

No of patients on NHF Database* 223

No of patients receiving surgery on the same day of admission 184

Percentage of patients receiving surgery on the same day of

admission82.5%

England 74.9%

* Denominator differs from C3.11

Lincs West CCG

April 2013 to

March 2014

Patients admitted with primary diagnosis of stroke 244

Patients arriving on stroke unit within 4 hours of arrival 144

Percentage of patients arriving on stroke unit within 4 hours 59.0%

England 59.9%

Lincs West CCG

April 2013 to

March 2014

All acute stroke patients 246

Stroke patients given Thrombolysis for stroke 45

Percentage of people who have had an acute stroke that receive

thrombolysis18.3%

England 11.6%



Comment: at 18.3% LWCCG is above the England average – ranked 21 of the 206 CCG’s represented (5 had data supressed).

4.1.8 Stroke Patients discharged with a joint health and social care plan (C3.7)

This indicator relates to the NHS Stroke Improvement Programme (SIP) set up to support the development of stroke care networks and the implementation of the National Stroke Strategy. More information on SIP is available at http://www.improvement.nhs.uk/stroke/

Comment: at 27.1% LWCCG is significantly below the England average, ranked at 181 of the 193 CCG’s represented (18 had data supressed).

4.1.9 Stroke patients who have a follow-up assessment (C3.8)

The indicator also relates to the NHS Stroke Improvement Programme (SIP). The data source is Sentinel Stroke National Audit Programme (SSNAP). It measures the percentage of patients entered into SSNAP* who have a follow up assessment between 4 and 8 months after initial admission for stroke. * this excludes patients who died within six months, patients who decline an appointment and patients for whom an attempt is made to offer an appointment but are untraceable as they are not registered with a GP.

Comment: LWCCG was amongst 63 CCG’s with no patients receiving a follow up assessment. Of the other CCG’s the highest percentage was 94.4%, the lowest was 0.4%, but the denominator varies significantly.

4.1.10 Readmissions to mental health services within 30 days of discharge (C3.16)

Some emergency re-admissions within a defined period after discharge from hospital result from potentially avoidable adverse events, such as incomplete recovery or complications, including the post-discharge support offered to manage these. Emergency re-admissions are therefore used as a proxy for outcomes of care. This indicator is calculated as a ratio indirectly standardised by age and sex.

Comment: LWCCG is slightly below the England average – ranked 132 of 211 CCG’s

Lincs West CCG

April 2013 to March

2014

Patients with primary diagnosis of stroke 144

Stroke patients with evidence of joint care planning 39

Percentage of patients with a joint care plan 27.1%

England 69.1%

Lincs West CCG

April 2013 to March

2014

No. of stroke patients 96

Stroke Patients with a follow up assessment in 4-8

months.0

Percentage of patients with follow up assessment 0.0%

England 16.3%

Lincs West CCG 2013/14

No of discharged from mental health services in the period 395

No of unplanned readmissions to mental health services

within 30 days of discharge40

Ratio of unplanned re-admissions 100.1

England 100.0

http://www.improvement.nhs.uk/stroke/



4.1.11 Proportion of adults in contact with secondary mental health services in employment (C3.17)

Participation in paid employment is an indicator of recovery, and of the degree to which wider outcomes for individuals are being addressed, as well as having therapeutic value in itself. Measured as the percentage of adults receiving secondary mental health services who are in paid employment.

Comment: at 3.7% LWCCG is below the England average – ranked 156 of the 209 CCG’s represented.

Lincs West CCG

2012/13 2013/14

Adults aged 18 to 69 who have received secondary mental

health services2,291 3,560

Of the above, the number in paid employment 49 130

2.1% 3.7%

England 5.7% 7.1%



Appendix 1 – Glossary of Acronyms used

2WW ASCOF A&E AT BCF BMI

2 Week Wait – Performance metric for the referral element of a Cancer Pathway Adult Social Care Outcomes Framework Accident & Emergency Area Team (formerly known as LAT) – Leicestershire & Lincolnshire Better Care Fund Body Mass Index

CCG Clinical Commissioning Group CDiff CHD COPD

Clostridium difficile (infection) Coronary Heart Disease Chronic Obstructive Pulmonary Disease

CQC CQI CQUIN DES DPH DSR LECCG

Care Quality Commission Clinical Quality Indicator Contracting for Quality and Innovation Directly Enhanced Service Director of Public Health Directly Standardised Rate Lincolnshire East Clinical Commissioning Group

FFCE FFT GP

First Finished Consultant Episode (inpatient admission episode within a patient hospitalisation spell which can have one or many episodes) Friends & Family Test General Practitioner

HCAI HSCIC

Hospital Care Associated Infection Health and Social Care Information Centre

IAPT JCH L&L AT

Improving Access to Psychological Therapies John Coupland Hospital, Gainsborough Leicestershire & Lincolnshire NHSE Area Team

LAT Local Area Team (now known as AT) – Leicestershire & Lincolnshire LCHS LES

Lincolnshire Community Healthcare Services NHS Trust Local Enhanced Service

LPFT Lincolnshire Partnership NHS Foundation Trust (Mental Health) LWCCG MIU

Lincolnshire West Clinical Commissioning Group Minor Injuries Unit – Type 3 A&E e.g. JCH

MRSA Methicillin-resistant Staphylococcus aureus bacteraemia MSA NHSCB

Mixed Sex Accommodation NHS Commissioning Board (now NHSE)

NHSE NHS England (formerly NHS Commissioning Board) NHSL former Lincolnshire NHS Cluster (or Lincolnshire PCT) NLAG NUH NICE NOUS

Northern Lincolnshire & Goole Hospitals NHS Foundation Trust (Acute) Nottingham University Hospitals NHS Trust National Institute for Health and Clinical Excellence Non Obstetric Ultrasound

NPS NRLS OOH PbR

Net Promoter Score – Patient experience score from the Friends & Family Test National Reporting and Learning System Out Of Hours Payment by Results

PCT PIR PYLL

Primary Care Trust Post Infection Review – will identify why a MRSA infection occurred and how future cases can be avoided. Potential Years of Life Lost

PROMs RTT QOF

Patient Related Outcome Measures Referral To Treatment Quality Outcome Framework (Primary Care)

QIPP Quality, Innovation, Productivity and Prevention RTT Referral to Treatment Times (usually based on 18 or 52 weeks threshold) SHMI SLA

Summary Hospital Mortality Indicator Service Level Agreement

STAR-PU UHL

Specific Therapeutic Age Related Prescribing Unit (for standardising prescribing activity) University Hospitals of Leicester NHS Trust (Acute care)

ULHT WIC YTD

United Lincolnshire Hospitals NHS Trust (Acute care) Walk In Centre, Monks Road Lincoln Year To Date


1


28 January 2015

Month Nine Financial and QIPP Performance Report

EXECUTIVE LEAD AND JOB TITLE Rob Croot, Chief Finance Officer

AUTHOR AND JOB TITLE Mark Larway, Finance Manager

PURPOSE

This report provides the Governing Body with an update on the financial performance of the CCG as at 31 December 2014 (month 9, 2014/15).


Key stakeholders have been involved in the development of CCG objectives and plans for 2014/15.

RECOMMENDATIONS

Members are asked to consider the content of this report and to:

note that the CCG is forecasting delivery of the planned surplus and other financial duties for the year ended 31 March 2015.

endorse the arrangements in place for ensuring delivery of the surplus, including mitigating plans for identified risks.

BACKGROUND

The 2014/15 budget was approved by the Governing body and by Member Practices and included provision for:

total available resource of £271.945m, including in-year allocation adjustments. a planned surplus of £2.672m, equivalent to 1% of opening resource. corporate running costs (administrative expenses) within a limit of £5.548m. QIPP (Quality, Innovation, Productivity and Prevention) efficiencies of £5.341m. timely payment of creditors whilst operating within notified cash limits.


2


Summary Financial Performance The following summary is colour coded (Red, Amber or Green) to reflect the current risk rating in respect of full year performance.

Financial Duties & Responsibilities Limits Current Performance

Revenue resource (programme cost) must not exceed the amount specified in directions

£266.397m resource limit

Forecast surplus

Revenue administration (running cost) resource use must not exceed the amount specified in directions

£5.548m running cost limit

Forecast running cost surplus (includes £150k planned QIPP delivery)

Expenditure must not exceed income (aggregate of capital, programme, running costs and income)

£271.945m resource limit

Forecast surplus is £2.672m, 1% of allocation

Capital resource used must not exceed the amount specified in directions

£25k resource limit

No spend as at month 9

Deliver QIPP £5.341m planned QIPP

Full delivery is forecast but data quality and delivery risks remain.

To manage cash payments within the maximum cash drawdown (MCD)

£275.483m On plan

Public Sector Payment Policy 95% of bills paid within 30 days

See Annex 1

Key points to note: The CCG is forecasting the delivery of its planned £2.672m control total surplus, together with all

financial targets and duties for the year ending 31 March 2015. The CCG recognises a number of risks to achieve financial balance, including the risks of higher than

expected activity growth, higher than anticipated costs of continuing healthcare claims, non-contract activity and under delivery of the QIPP target. The CCG retains a small contingency reserve of £1.3m, (equivalent to 0.5% of programme resource.).

Cumulative BPPC performance is currently slightly under-target in respect of payment volumes to NHS suppliers. This performance is being closely monitored and has improved during the year.

In accordance with recent national guidance, the CCG’s cash balances are monitored closely. Annex 1 - Presents a more comprehensive assessment of year to date performance.


As at 31 December 2014 the CCG presents a balanced financial position for the year to date and forecast for the full year. Whilst the countywide Turnaround Group has not yet developed plans to release the savings targeted for 2014/15, the cost of countywide activity under-performance is forecast to equate to the saving targeted. The delivery of total expenditure within plan is classified as amber above as performance risks remain. As described in Annex 1, officers are taking action to address a number of small adverse variations from plan. This report highlights a number of key risk areas and associated mitigation strategies which may impact on the CCG’s ability to deliver its planned surplus. The CCG retains a small contingency reserve.


3


All contracts for 2014/15 reflect the national standard contractual terms and as such place obligations on providers to provide services in compliance with legislation and associated NHS guidance.


No direct implications.




Whilst identifying a number of risks, together with appropriate mitigations, this report forecasts achievement of the planned surplus for the full year 2014/15.

HR IMPLICATIONS





The biggest financial risks for 2014/15 are:

Securing resource to invest in ULHT transformation. Over-performance on acute contracts. Continuing Healthcare claims and associated expenditure. Under delivery of the CCG’s QIPP programme.

In order to mitigate against these risks, the CCG is:

Ensuring GEM CSU provide detailed information to enable management of contracts and activity with acute providers.

Receiving regular updates from GEM CSU regarding the outcome of continuing healthcare claims. Monitoring QIPP programmes in order to ensure that they are on track to deliver the planned goals. Retaining a contingency reserve in order to mitigate in-year cost pressures.

KEYWORDS

GEM CSU = Greater East Midlands Commissioning Support Unit RRL = Revenue Resource Limit RCA = Running Costs Allowance BPPC = Better Payment Practice Code MCD = Maximum Cash Drawdown


For further information please contact Rob Croot, Chief Finance Officer

[email protected] 01522 513355 ext. 5529



4

Annex 1

Contents

1 Financial Overview

2 Programme Spend

3 Running Costs

4 QIPP

5 Reserves

6 Transformation Funds

7 Better Payment Practice Code and Aged Creditors

8 Cash Management

9 Statement of Financial Position


5

1 Financial Overview

1.1 This report is produced in accordance with the national reporting timetable, NHS England national ledger system/chart of accounts and associated national closedown periods.

1.2 The CCG is forecasting achievement of its £2.672m planned surplus for the year, which equates to 1% of the CCG’s opening annual allocation. The forecast outturn is based on financial review of the latest available provider data and running costs and is refined as additional data becomes available from providers. This report reflects activity data for the first 7 months of the year, together with an estimate of activity for months 8 and 9. Table 1 below provides a summary of current performance and additional details are shown in tables 2 and 3.

Table 1

Budget SpendOver (+)

Under (-)

Percentag

e VarianceBudget Spend

Over (+)

Under (-)

Percentag

e Variance

£000 £000 £000 % £000 £000 £000 %

ALLOCATIONS

Programme Allocation 199,798 266,397

Running Cost Allocation 4,161 5,548

Total Allocations 203,959 271,945

SURPLUS

Programme Surplus / Deficit 2,007 1,896 111 2,672 2,522 150

Running Cost Surplus / Deficit 0 111 (111) 0 150 (150)

Total Surplus 2,007 2,007 0 2,672 2,672 0

Summary Financial Position

1 April 2014 to 31 December 2014 Forecast Outturn

1.3 The CCGs total resource allocation for 2014/15 is now £271.945m (including the carry-forward of the CCG’s surplus from 2013-14 of £2.592m), see table 2 below. In month 9, an additional allocation of £277,000 was received in respect of Quality Premium awards 2013-14.

Table 2

£000

Confirmed Allocation:

Programme Resource Revenue Limit (RRL) 258,490

Running Costs Allowance (RCA) 5,548

Anticipated Allocations:

Return of 2013-14 Surplus 2,592

NEL Marginal Rate collection -1,513

NEL Marginal Rate collection returned 1,513

Allocation (as per financial plan) 266,630

In Year Inter Authority Transfers:

GPIT 580

RTT Funding 586

Digital Eye Screening Programme -17

Digital Eye Screening Programme (DESP) PYE 6

2014-15 CEOV and non-rechargeable services allocation adjustment -115

Military Adjustment -261

Winter resilience Funding (2nd Tranche) 2,268

Winter resilience Funding 1,405

1415 RTT Funding 586

Quality Premium awards 2013-14 277

Total Inter Authority Transfers 5,315

Allocation 271,945


6

Table 3

Budget SpendOver (+)

Under (-)

Percentage

VarianceBudget Spend

Over (+)

Under (-)

Percentage

Variance

£000 £000 £000 % £000 £000 £000 %

PROGRAMME EXPENDITURE

Acute

Ambulance Services 5,160 5,159 -2 0% 6,881 6,878 -2 0%

BMI Healthcare Ltd 1,665 1,963 298 18% 2,220 2,568 348 16%

Doncaster and Bassetlaw Hospitals NHS Foundation Trust 711 580 -131 -18% 948 818 -130 -14%

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust 7,257 7,396 139 2% 9,676 9,911 235 2%

Nottingham University Hospitals NHS Trust 3,084 3,357 274 9% 4,112 4,400 289 7%

Sheffield Teaching Hospitals NHS Foundation Trust 698 907 209 30% 931 1,237 306 33%

Sherwood Forest Hospitals NHS Foundation Trust 1,531 1,586 55 4% 2,041 2,096 55 3%

United Lincolnshire Hospitals NFT 79,431 76,476 -2,956 -4% 105,398 102,012 -3,386 -3%

University Hospitals of Leicester NFT 1,168 1,459 290 25% 1,558 1,821 263 17%

Barlborough 1,223 1,716 492 40% 1,631 2,263 632 39%

Non Contract Activity 2,698 2,940 242 9% 3,598 3,953 355 10%

QIPP -1,734 -4 1,730 100% -2,312 0 2,312 100%

Other Acute 5,135 5,240 105 2% 6,847 7,010 163 2%

Community Health

The Lincolnshire Community Health Services NHS Trust 13,549 13,549 0 0% 18,065 18,065 0 0%

Other Community Health Services 3,436 3,709 273 8% 4,581 5,176 595 13%

Continuing Healthcare 10,595 11,272 677 6% 13,792 14,644 852 6%

Mental Health

Lincolnshire Partnership NHS Foundation Trust 13,807 14,022 215 2% 18,410 18,640 231 1%

Other Mental Health (Includes NCAs and OATs) 5,549 5,101 -447 -8% 7,398 6,849 -550 -7%

Prescribing 27,356 28,462 1,105 4% 36,264 38,072 1,808 5%

Primary Care 5,052 5,024 -28 -1% 6,736 6,739 2 0%

Programme Reserves 6,092 4,447 -1,645 -27% 9,177 5,987 -3,190 -35%

Other 4,330 3,544 -786 -18% 5,773 4,736 -1,037 -18%

Total Programme Expenditure 197,794 197,904 109 263,725 263,875 150

RUNNING COST EXPENDITURE

Administration & Business Support 600 531 -69 -12% 675 575 -100 -15%

Business Informatics 591 591 0 0% 788 788 0 0%

CEO/ Board Office 399 399 0 0% 661 661 0 0%

Chair and Non Execs 187 180 -7 -4% 249 249 0 0%

Commissioning 39 39 0 0% 53 53 0 0%

Communications & PR 194 183 -11 -6% 259 259 0 0%

Contract Management 292 292 -1 0% 390 390 0 0%

Corporate Governance 378 343 -35 -9% 504 445 -59 -12%

Finance 499 488 -11 -2% 662 661 0 0%

Human Resources 50 44 -6 -11% 67 59 -8 -11%

Nursing Directorate 36 34 -2 -6% 48 48 0 0%

Performance 78 79 1 1% 104 107 3 3%

Procurement 100 100 0 0% 134 134 0 0%

Quality Assurance 143 157 14 10% 191 205 14 8%

Strategy & Development 573 590 17 3% 765 764 0 0%

Total Running Cost Expenditure 4,160 4,049 -111 5,548 5,398 -150

Summary Financial Position

1 April 2014 to 31 December 2014 Forecast Outturn


7

Programme Spend

2.1 This report reflects activity data for the first 7 months of the year, together with an estimate of activity for months 8 and 9.

2.2 On this basis, the CCG reports a year to date and a full year underspend associated with underperformance on its contract with ULHT. This underperformance amounts to 3.2% of the annual budget. This overall programme position is being closely monitored and is commensurate with the delivery of CCG QIPP schemes.

2.3 The CCG also reports an overspending on other acute and non-contract activity (NCA) amounting to

£2.1m to date and forecast to grow to £3.3m for the full year. This reflects patient activity at provider Trusts with whom the CCG does not have a contract in place. This position is closely monitored and all such activity and expenditure is fully validated on a monthly basis. The CCG will consider the benefits of entering into a formal contract with additional providers for 2015/16, where activity is considered material.

2.4 The CCG is forecasting achievement of its planned surplus for the year of £2.672m.

2.5 As previously reported, two Data Quality Summits have been held with ULHT to assess progress on

the resolution of outstanding data quality concerns. At a recent ULHT Project meeting it was reported that the number of major data quality issues has reduced and that remaining issues are being progressed within the Trust. ULHT has offered assurance that it will be back to historical levels of data quality by the end of the financial year.

3. Running Costs 3.1 The CCG continues to forecast the delivery of a £150,000 contribution to its planned surplus from

the CCG’s running costs allocation. 4. Quality, Innovation, Productivity and Prevention (QIPP) 4.1 The CCG’s full year QIPP target is to deliver £5.341m recurrent savings - equating to 2% of the

CCG’s total annual allocation – by 31 March 2015. The CCG is forecasting the delivery of planned QIPP savings for the year to date and the full year 2014/15.

5. Reserves 5.1 At 31 December 2014, the CCG’s only uncommitted reserve is a contingency reserve of £1.3m. 6. Transformation Funds 6.1 As nationally prescribed, the level of non-recurrent spending in 2014/15 has been increased, relative

to 2013/14 in order to create funds for service change and to prepare for the stepped increase in the Better Care Fund (BCF) in 2015-16. All CCGs have been directed to set aside 2.5% of total resources for non-recurrent spending in 2014-15 and for Lincolnshire West CCG this amounts to £6.46m. This sum has been fully committed in the CCG’s 2014/15 financial plan.


8

7. Better Payment Practice Code and Aged Creditors

7.1 The Better Payment Practice Code (BPPC) requires the CCG to pay at least 95% of all valid invoices within 30 days of receipt of the goods or a valid invoice, whichever is later. This target is measured by reference to (i) The volume of invoices received and paid, and (ii) The value of such invoices and payments.

7.2 Table 4 shows the number and values of bills paid in the year; the number and value of bills paid

within target period (i.e. within 30 days); and the percentage of bills paid within target. 7.3 Cumulatively all targets have been met for the nine months to 31 December 2014 except for the

payment of NHS invoices by volume at 89.5%. 7.4 Some credit notes that formed part of the payments in the month of May were not paid (credited)

within 30 days of receipt and as a result the value of NHS invoices paid within 30 days for the year to 31 December is higher than the total value of NHS invoices paid over the same period.

Table 4

Number £'000s Number £'000s

Payment of non-NHS Creditors

Total bills paid in the Month 1,041 3,661 9,319 33,435

Total bills paid within target (ie within 30 days) 1,013 3,372 8,973 32,226

Percentage of bills paid within target 97.3% 92.1% 96.3% 96.4%

Payment of NHS Creditors

Total bills paid in the Month 404 17,367 1,919 124,412

Total bills paid within target (ie within 30 days) 319 17,072 1,718 124,916


Payment of All Invoices

Total bills paid in the year 1,445 21,029 11,239 157,847

Total bills paid within target (ie within 30 days) 1,332 20,444 10,691 157,142


Better Payment Practice Code

Apr-Dec 2014Dec-14

7.5 Charts 1 & 2 below show creditor invoices and credit notes respectively, as registered on the ISFE

system at 31 December 2014 and their payment status. Some credit notes have been overdue for 90+ days as a result of invoices from the provider concerned being insufficient to match against the credit value.

Chart 1


9

Chart 2

8. Cash Management 8.1 From January 2015, NHS England guidance requires the CCG’s month-end cash balance to be no

greater that 1.25% of planned monthly cash spend. For Lincolnshire West CCG this will be in the region of £250,000. The CCG is working closely with GEM CSU to ensure that satisfactory cash management arrangements are in place to manage cash within this limit.

8.2 Chart 3 below shows the CCG’s year to date cash spend profile by month. Chart 3

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

£000's

Receipts 19,328 18,097 18,368 17,840 18,144 18,863 19,585 21,904 21,382

Expenditure 16,914 14,745 19,472 19,694 17,532 19,332 20,077 21,643 20,650

Balance 2,414 3,352 2,248 394 1,005 536 44 305 732

0

5,000

10,000

15,000

20,000

25,000

£0

00

's

Cash Spend Profile


10

9. Statement of Financial Position

9.1 The Statement of Financial Position, (see table 5 below), is a summary of the CCG's assets, liabilities and equity (ownership by taxpayers) as at 31 December 2014. It provides a snapshot of the CCG’s financial position at that date.

9.2 At 31 December, whilst the CCG had liabilities exceeding its assets, this does not, of itself, indicate

a weak financial position. NHS England provides cash to the CCG only when required to meet its current liabilities. As a consequence of liabilities exceeding assets, the CCG has negative taxpayers’ equity. This represents a common position for CCGs nationally.

9.3 The table below shows the actual position as at 31 December 2014 and the forecast year end

position. The forecast value of taxpayers’ equity at the end of the year is the sum of the 2014/15 surplus plus the previous year’s equity.

Table 5 – Statement of Financial Position as at 31 December 2014 and forecast to 31 March 2015

£'000 Actual Forecast

31 December 2014 31 March 2015

Non-Current Assets 0 0 Current Assets 6,037 937

Cash 732 280 Accounts Receivable 5,305 657

Total Assets 6,037 937

Current Liabilities 24,419 12,247

Accounts Payable 24,419 12,247 Long Term Liabilities 0 0 Total Taxpayers Equity -18,382 -11,310

Retained earnings -18,382 -11,310

Total Equity + Liabilities 6,037 937


1


28 January 2015

Better Care Fund Section 75 Agreement 2015/16

EXECUTIVE LEAD AND JOB TITLE Rob Croot, Chief Financial Officer

AUTHOR AND JOB TITLE Rob Croot, Chief Financial Officer

PURPOSE

To inform and update the Governing Body on the Better Care Fund Section 75 Agreement 2015/16 and the proposed contract structure and governance arrangements.


All four Lincolnshire CCGs and Lincolnshire County Council have been directly involved in developing the Better Care Fund plans. The plans are closely aligned to the Lincolnshire Health and Care Programme which has extensive stakeholder involvement, including HealthWatch.

RECOMMENDATIONS

The Governing Body are asked to consider the attached papers, approve the “pragmatic approach” proposed for construction of the pooled arrangements for 2015/16. The Governing Body to delegate authority to the Chief Clinical Officer, Chief Operating Officer and Chief Financial Officer in sign off of the Section 75 and approve the final budget for 2015/16. The Chief Financial Officer to seek independent legal advice where appropriate. Each Section 75 requires a host organisation which must be one of the five parties to the agreement who also appoints a pooled fund manager.

The Governing Body are asked to approve the current hosting arrangements for current Section 75 agreements.

The Governing Body to delegate the decision for hosting arrangements for the new Section 75s to the Chief Clinical Officer, Chief Operating Officer and Chief Financial Officer.


2

BACKGROUND

The Better Care Fund (BCF) was announced in June 2013. Its aim being to act as a catalyst to bring together health and social care commissioning and provision, creating a pooled fund with resources drawn from local government and CCGs. On 9 January 2015, the Lincolnshire Better Care Fund was re-submitted to NHS England as required. One of the key components within the submission is the intent to pool £197m of health and social care expenditure. This represents a step change in the way in which funding for health and care services are organised within the health and care community in Lincolnshire. The approach is in line with national policy and the level of local ambition as detailed in previous BCF reports and a variety of related reports within the Lincolnshire community. The level of pooling places Lincolnshire as one of only five health and care systems in the country with this level of ambition over and above the national BCF allocation. It also allowed two Secretaries of State to highlight this matter in the national media as a point of success in that the national sum for the BCF is £3.8bn but with local “top ups” is £5.3bn. However, notwithstanding the national imperative and the local ambition the pooling of such a substantial sum must be framed and that framework understood across the partners. This is the purpose of the attached papers (Appendix A and Appendix B) produced by the County Council’s legal adviser and a CCG senior finance officer. At this point it is important also to note that the proposed route does not change the current arrangements for decision making within the County Council or the CCGs. In other words executive authority within the CCG remains with Executives and Governing Body, and remains unchanged from those detailed within the Scheme of Delegation.


The attached papers propose two stages within a narrow timeframe in order to understand the approach taken to pool £197m in 2015/16, satisfy national prescriptions and begin to consider the likely scenarios beyond the national elections in May 2015 which will have a significant influence on the longevity of the BCF programme. This helps to emphasise the point that the BCF is only for 2015/16. A timeline has been produced (Appendix B) which shows in January a series of presentations using the attached papers to raise awareness of the approach being taken and address any issues arising in advance of the formal presentation in March to secure necessary support for a framework partnership agreement prior to the end of March 2015. The nationally prescribed requirement is that all health and social care systems will have in place contractual arrangements which, as a minimum, incorporates in one or more pooled funds the value of the national BCF allocation which in Lincolnshire is £53.2m made up of £48.4m recurring and £4.9m capital (of which the primary element is Disabled Facilities Grant for Districts and City Councils). The view in Lincolnshire is that we should seek to "pool" as much of the £197m as can be achieved. There are two approaches that can be taken to construct "pooled" arrangements for the maximum sum intended (£197m), these can be described as the principled or the pragmatic approach. The principled approach is to subsume all the £197m funding into one Section 75 agreement forming a single pooled fund with one set of governance, managerial, risk management and performance/monitoring arrangements.


3

The second approach called pragmatic is to create a framework agreement which broadly incorporates a number of separate existing pooled budgets, for example learning disabilities and integrated community equipment service; and adds a new Section 75 pooled fund for those elements coming to Lincolnshire from the BCF national allocation. Where for any reason it is inappropriate or impractical to bring any funding into a pooled fund the pragmatic approach nonetheless brings that funding within the framework approach under a single governance structure. Guidance obtained from the National Programme Office is clear that both options are relevant and would be acceptable. Further work is in progress to develop the risk and benefits framework Considerable discussions have taken place within the BCF Task Group and other fora involving all relevant senior officers within the four CCGs and the County Council (CMB) and a consensus view developed which is that the pragmatic approach will work best for Lincolnshire. In summary the pragmatic approach is preferred for two primary reasons: because it is the most likely arrangement to be secured across all partner agencies within the time allowed (31.3.15); and builds on existing agreements which have already been tested over time and where there are established governance, accountability and risk arrangements in place. Each Section (75) requires a host organisation which must be one of the five parties to the agreement who also appoints a pooled fund manager. For current Section (75) agreements it is pragmatic to retain the current hosting arrangements. For new Section (75)s to cover Proactive Care and Corporate the hosting arrangements will require agreement and it is suggested that for this CCG that Governing Body delegate this decision to the Chief Clinical Officer, Chief Operating Officer and Chief Financial Officer. Notwithstanding the work above the experience of progressing the BCF programme coupled with a perspective about how national policy will evolve indicates there will be value in the Governing Body considering whether its structure for governance and decision-making (notably with respect to the Health and Wellbeing Board and the Joint Commissioning Board structure) may need to evolve in 2015.


Locally the Better Care Fund is viewed as a means of increasing long term integration of health and social care services. However, nationally there is no clarity about the longevity of the BCF, or the financial envelope for 2016/17. The expectation is that following the national elections in May 2015 further guidance will be provided.


An inclusive process, taking account of the needs of all, including those of the protected characteristic groups will continue to be a requirement for BCF investment. Finances will be applied in accordance with the overall strategic plan of the CCG which has been subject to an Equality & Diversity Impact review.


The BCF is expected to have a positive impact on reducing inequalities. Finances will be applied in accordance with the overall strategic plan of the CCG which has been developed using information on health inequalities.


The BCF is expected to have a positive impact on service delivery. It is particularly focused on service integration, protection of social service provision and 7 day working.


4


The BCF in 2014/15 represented a re-categorisation of expenditure within the CCG’s financial plan. For 2015/16, whilst the CCG will receive an additional resource allocation of £5.035m for investment into the BCF, there remains a significant re-categorisation element of £9.46m resource into the BCF in 2015/16. This is reflected in the CCG’s financial plan.

HR IMPLICATIONS

Seven day working and increased integration will require significant changes to working patterns.


Not assessed


The risk of the CCG not being able to manage within its notified allocation is included within the risk register.

KEYWORDS

Better Care Fund

FURTHER INFORMATION

Rob Croot, Chief Financial Officer Lincolnshire West CCG 01522 513355


1


WEDNESDAY 28 JANUARY 2015

PMO & 2014-15 Projects

EXECUTIVE LEAD AND JOB TITLE Sarah Newton Chief Operating Officer

AUTHOR AND JOB TITLE Annette Lumb, Head of Planning & Corporate Governance Melissa Hall, Programme Support Officer

PURPOSE

To receive an update on the status and performance of 2014-15 projects.


Stakeholders are involved with, and consulted about, projects. Depending on the size of the project there is likely to be a project working group/project team and project advisers. Project managers will also have a Communication Plan as part of their project detailing how they will inform, engage and communicate with relevant parties. Feedback from the public, patients and stakeholders, from consultation and commissioning intentions events and engagement, is also used to inform programme and project development.

RECOMMENDATIONS

That Governing Body note progress to implement the PMO, and the status and performance of projects, and feedback any comments to the PMO, for programme and project managers.

BACKGROUND

The Governing Body is ultimately responsible for all programmes and projects within the CCG. Its role is to maintain a strategic oversight of all programmes (and all projects that sit within), seeking assurance that projects are appropriately commissioned and achieve their objectives through services that will deliver benefits; be these qualitative, innovative, performance or financially related.


There is now a PMO page on GPTN. Go to useful links, Topics Pages and click on PMO page. This is a work in progress. The page has links to the PMO framework and standard templates. A reporting section will be added shortly for the latest dashboards. Attached is a Governing Body dashboard summarising key information in relation to governance, assurance, project delivery and QIPP. Dashboard narrative – Governance: All current active projects have appropriate governance arrangements with the exception of a couple of projects in the Quality Programme. This will be resolved in the next few weeks following the appointment of new personnel in the Quality team. (There are 2 projects where the project and programme manager are the same person at present).

https://portal.gpteamnet.co.uk/lincwest/Topics/View/Details/24300691-0589-4a4e-8389-a3e300f147c8


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Assurance: Projects have been RAG rated against the new PMO standard. There are no projects that currently meet the standard. However, it should be noted that projects were initiated before the PMO was implemented so this is to be expected. Moving forward in 2015/16 there will be a requirement for all projects to follow PMO processes and have standard PMO documentation. The PMO Programme Support Officer will provide support and guidance to enable project managers to use PMO tools and complete all documentation. Implementation/Delivery: The RAG rating is an indicator as to whether the project is on track overall, as at 16 January 2015. QIPP: Further work needs to be undertaken with regard to QIPP. All projects are potentially QIPP projects and monitoring of activity and quality needs to be embedded into the process, as well as financial monitoring. More work is also required to align PMO and Finance reporting of QIPP.


Equality & Human Rights will be embedded into each project to ensure we meet the legal requirement for Equality Analysis and Due Regard.


See above.


The PMO will support project managers and ensure that projects across the organisation are co-ordinated and regularly reported.


The PMO is developing, with the Finance team, a more rigorous approach to QIPP and to developing & monitoring project budgets.

HR IMPLICATIONS

The PMO has 0.5 FTE staff. Programme and project management is delivered across the CCG via matrix working.


Nil


All projects shall have a risk log (on GP TeamNet) which project managers must review at each checkpoint.

KEYWORDS

PMO = Project Management Office


Annette Lumb Head of Planning & Corporate Governance Lincolnshire West CCG Cross O’Cliff Bracebridge Heath

Melissa Hall Programme Support Officer Lincolnshire West CCG Cross O’Cliff Bracebridge Heath


3

Lincoln LN4 2HN T : 01522 513355 ext 5507 M : 07769 300 806 E : [email protected]

Lincoln LN4 2HN T : 01522 513355 ext 5541 E : [email protected]

Governing Body

Reducing Inequalities

Care Homes

Diabetes

Implement agreed Dementia model of care

Improve access to end of life support

Neighbourhood Teams

Improving Outcomes for Cancer TBC

Complete Review of Mental Health Liaison Services (including HIPS)

Review and Tender: Crisis House

Re-specify and re-negotiate Contract(s) with LPFT - Review all Service Specs linking to PBR where appropriate

Develop: Peri- natal Services - Secure budget, Develop Specification and commission service

Complete Review of: PICU - Reduce Out-County Placements

Complete Review of IAPT

Integrated A&E and out of hours

Walk in Service

Dermatology Community Service

Teledermatology

Endoscopy Services Re-Design

ENT Community Service : Procurement

ENT Community Service: Pathway

Pain management

Stable Glaucoma

Urology

Inappropriate Paediatric Admissions TBC TBC

CAMHS Tier 3

DATIX

End of Life Care Quality TBC TBC

Improving Patient Engagement TBC TBC

Governance Assurance Implementation QIPP PlanningQIPP

ImplementationQIPP Impact

Governance (line

management) in

place

All project

documentation

completed

Project deliverables

on track or variance

of <10%

CompletedQIPP being

monitored monthly

Plans on course to

deliver finance,

activity & quality

Governance partially

in place

Most project

documentation

completed

Variance from plan

is 10-20%

in process of QIPP

planning

Variance from QIPP

is 10-20%

No Governance in

place

Little or no project

documentation

Project deliverables

off track or variance

of >20%

No QIPP planQIPP not being

monitored

QIPP targets unlikely

being met; .>20%

variation

Hosted In SWL CCG

Project Closing

N/A Until 2015/16

28 January 2015

Hosted In SWL CCG

TBC

Hosted In SWL CCG

Hosted In SWL CCG

TBC

N/A

Governance AssuranceImplementation/

DeliveryQIPP Planning

QIPP

ImplementationQIPP Impact

N/A Until 2015/16

N/A

N/A

Quality

Elective Care

Urgent Care

Mental Health & Learning

Disabilities

N/A

RAG Rating

Women & Children

Hosted In SWL CCG

Hosted In SWL CCG

Programme Current Active Projects

LTC and Frail Older People

N/A

Currently no active projects

Project Closing

Hosted in South Lincs CCG

Hosted In SWL CCG


1


28 January 2015

Co-Commissioning of Primary Care

EXECUTIVE LEAD AND JOB TITLE Sarah Newton, Chief Operating Officer

AUTHOR AND JOB TITLE Sarah Behan, Board Secretary

PURPOSE

• To inform Governing Body of the outcome of the member’s vote on Primary Care Commissioning and

consequential application for delegated commissioning responsibilities.

• To seek ratification of changes to the CCG’s constitution, including the establishment of a Primary Care Commissioning Committee.

• To approve changes to the CCG’s Conflicts of interest Policy


The proposals for changes the CCG’s responsibilities in respect of Primary Care Commissioning, have been discussed informally with the Chair of the Lincolnshire Health and Wellbeing Committee and other Lincolnshire County Council Officers. Options were also considered at the CCG’s Strategy Group meeting in December, and each member practice was given the opportunity to vote on the three options available. The options were also described on GPTeamNet.

RECOMMENDATIONS

Members are asked to: • Note the outcome of the members vote on Primary Care Commissioning.

• Ratify changes to the CCG’s constitution, including the establishment of a Primary Care Commissioning

Committee. • Approve changes to the CCG’s Conflicts of interest Policy.


2

BACKGROUND

In May 2014, NHS England invited clinical commissioning groups (CCGs) to come forward with expressions of interest to take on an increased role in the commissioning of primary care services. The intention was to empower and enable CCGs to improve primary care services locally for the benefit of patients and local communities. Following discussion with members and at the Governing body meeting on xxx, Lincolnshire West CCG submitted an expression of interest. In November 2014 the Department of Heath published Next steps towards primary care co-commissioning document. This document gave CCGs an opportunity to choose afresh the co-commissioning model they wish to assume. It clarified the opportunities and parameters of each model and set out the steps towards implementing co-commissioning arrangements. The Opportunities and risks associated with each of the three options outlined in the Next Steps publication were discussed at Governing Body Development session on 26 November and at the Governing Body meeting in December. It was noted that the results of the members vote would not be available until 23 December and the deadline for submission of interests in respect of option 3 delegated commissioning responsibilities was 9 January 2015. The Governing Body therefore agreed to delegate responsibility for determining which of the three options to choose and consequential changes to the CCG’s constitution, to the Chair, Accountable Officer and Chief Operating Officer.


Member’s Vote on Primary Care Commissioning Following the letter to all member practices on 5 December 2014 regarding the co-commissioning of primary care and the voting options for the three primary care models of which members were asked to vote on::- A total of 33 practices voted with the results as follows:-

Model 1 = 2

Model 2 = 9 (includes the 5 LCHS practices)

Model 3 = 22 As the great majority of member practices opted for Model 3 delegated commissioning arrangements, the CCG formally made an application for Model 3 delegated commissioning on Friday 9 January 2015 for the CCG to implement plans by 1 April 2015. Initial reviews of our proposals will be carried out by regional moderation panels in February 2015 and final sign off to be undertaken by the proposed new Commissioning Committee of NHS England’s Board. A copy of the CCG’s submission is attached as Appendix One. Once delegated commissioning proposals have been signed off by the Committee, the CCG will be required to sign a legally binding agreement to confirm the detail of how NHS England will delegate its general practice functions to CCG’s. A copy of the draft delegation agreement is attached as Appendix Two.

Model 1 - Greater involvement in

primary care decision-making

Model 2 – Joint commissioning

arrangements

Model 3 - Delegated commissioning

arrangements


3

Conflicts of Interest Policy Conflicts of interest need to be carefully managed within co-commissioning and the requirement for existing guidance to be strengthened in recognition that co-commissioning is likely to increase the range and frequency of real and perceived conflicts of interest, especially for delegated arrangements. National guidance has therefore also been issued requiring CCGs to amend their Conflicts of Interest policies. The application process for delegated commissioning required CCGs to submit a copy of their revised Conflict of Interest Policy. The CCG’s policy has therefore been amended and is attached as Appendix Three. Amendments to the CCG’s Constitution Furthermore for delegated commissioning arrangements this requires an amendment to the CCG’s Constitution. The changes that have been made to the Constitution and submitted with the application are detailed at Appendix Four. Primary Care Commissioning Committee The changes to the Constitution include the establishment of a Primary Care Commissioning Committee to exercise and oversee the delegated Primary Care commissioning functions. The minutes of these meetings will be presented to the Central Midlands Area Team of NHS England and the Governing Body of Lincolnshire West CCG. The Terms of Reference for the Committee are detailed at Appendix Five. The CCG is in the process of recruiting a Governing Body Lay Member (Primary Care Commissioning) to support the Committee and expand the oversight of CCG governance and with a particular interest in GP Primary Care Services. This role will ensure that the CCG exercises its functions effectively, efficiently and with good governance and in accordance with the terms of the CCG Constitution


Co-commissioning of primary care presents a real opportunity to improve service delivery and outcomes for our population. However, it is not without risks, particularly in relation to adequacy of resourcing and membership engagement.


None identified.


The proposal is expected to tackle health inequalities, in particular by improving quality of primary care in more deprived areas and for vulnerable or needy groups. It will also reduce health inequalities in access and outcomes of healthcare services and integrate services where this might reduce health inequalities.


4


Co-commissioning is expected to have a positive impact on service delivery by:-

Achieving greater integration of health and care services, in particular more cohesive systems of out-of-hospital care that brings together GP’s, Community Health services, Mental Health and Social Care).

Raising the standards of quality (clinical effectiveness, patient experience and patient safety) within general practice services, reduce unwarranted variations in quality and, where appropriate, providing targeted improvement support for practices.


These will need to be considered in detail once information on existing budgets and how they will be allocated is known.

HR IMPLICATIONS

It is anticipated that additional staff will be required to undertake the delegated commissioning duties. At this stage it is still not clear exactly how many staff (if any) will transfer. The working assumption is that staff needed for transitional/operational issues will be provided from existing staff via a pooled resource. However the CCG is likely to need to recruit at least 2wte to support development and integration of primary, and service the new committee.


Governance arrangement frameworks and terms of reference have been developed nationally to encourage CCG’s to utilise these resources when establishing their own governance arrangements.


Transferred resources (finances and staff).

KEYWORDS

Conflicts of Interest/Co-Commissioning/Delegation/PrimaryCare/Constitution/Governance


Sarah Newton Chief Operating Officer 01522 515381

Sarah Behan Board Secretary 01522 515381


5

Next steps towards primary care co-commissioning: Annex B

Submission proforma for delegated commissioning arrangements

November 2014


2

Introduction The following proforma should be completed by CCGs and area teams where a CCG wishes to implement a delegated commissioning arrangement.

Part one is for completion by the CCG. It requires CCGs to:

review and revise its conflicts of interest management policy in light of forthcoming new statutory guidance;

describe the intended benefits of co-commissioning arrangements;

detail the finance arrangements of the delegated budget; and

complete and sign a declaration.

Part two is for completion by the area team. It requires the area team to:

confirm that the CCG meets the required assurance thresholds;

confirm that the CCG meets the required conflicts of interest management thresholds;

confirm that the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements; and

complete and sign a declaration.

CCGs and area teams are encouraged to take note of the supporting annexes in the Next steps towards primary care co-commissioning document, specifically the model wording for constitutional changes (Annex C) and model terms of reference (incorporating the scheme of delegation) for delegated commissioning (Annex F) when completing this proforma. Please note: this annex is provided in draft form and will be finalised following publication of forthcoming NHS England statutory guidance on managing conflicts of interest in December.

CCGs and area teams should submit the following to

[email protected] by noon on Friday 9 January 2015

1. This form, with parts I and II completed 2. Conflicts of interest policy (draft or ratified version) 3. CCG governance structure, including any terms of reference and scheme of

delegation 4. Copy of the CCG(s) IG Toolkit 5. CCG constitution or proposed constitutional amendment submitted

Please note that any necessary constitutional amendments should also be sent to the relevant regional office.


PART I: TO BE COMPLETED BY THE CCG A Conflicts of interest

CCGs have a statutory requirement to:

Maintain one or more registers of interest of: the members of the group, members of its governing body, members of its committees or sub-committees of its governing body, and its employees.

Publish, or make arrangements to ensure that members of the public have access to these registers on request.

Make arrangements to ensure individuals declare any conflict or potential conflict in relation to a decision to be made by the group, and record them in the registers as soon as they become aware of it, and within 28 days.

Make arrangements, set out in their constitution, for managing conflicts of interest, and potential conflicts of interest in such a way as to ensure that they do not and do not appear to, affect the integrity of the group’s decision-making processes.

Conflicts of interest, actual and perceived, need to be carefully managed within co-commissioning. New statutory guidance for conflicts of interest management in primary care co-commissioning is being developed in partnership with NHS Clinical Commissioners and with formal engagement of Monitor, HealthWatch and the National Audit Office, and will be published in December 2014. The guidance will include a strengthened approach to:

the make-up of the decision-making committee;

national training for CCG lay members;

external involvement of local stakeholders;

register of interest; and

register of decisions.

Further detail is set out in of the conflicts of interest section in the Next steps towards primary care co-commissioning document. The CCG declaration (below) confirms that the CCG has reviewed and revised its conflicts of interest management processes and procedures in light of the forthcoming NHS England statutory guidance on managing conflicts of interest to ensure that it meets the requirements.

CCGs must attach a copy of its revised conflicts of interest policy.

Draft versions will be accepted, although confirmation that the CCG governing body has ratified the updated policy is required by 30 January 2015.


4

B CCG supporting statement to describe the intended benefits to patients through delegated co-commissioning arrangements

<maximum 400 words>

The Lincolnshire health and social care economy has developed a Strategic plan (LHAC) which outlines a shared vision to reform health and care services to improve outcomes for local people. The 37 member practices of the Lincolnshire West CCG are committed to this

plan and to facilitating the strategic development of local health and social

care services where :

Primary and community care are considered the critical component of

effective health care;

Hospital care is the exception, not the norm, and accessed only for

those interventions which require technical expertise and equipment;

The home not a hospital is the hub;

Primary care development is central to achieving these objectives and as such member GPs are engaged in developing a primary care strategy that will enable patients to be active partners in the management of their health. By actively involving the person in the co-design of treatment/care plans, individuals will be supported in self-management. This approach, facilitated by proactive and integrated care, is the core principle of the LHAC strategy which describes how staff will work together in neighbourhood teams to deliver integrated services with increasing quality and efficiency. This model of health care is the principle of our Frailty model which has successfully enabled an increased number of older people to remain at home. LWCCG understand that the long term sustainability of health and social care

is reliant on encouraging GPs to use their knowledge, experience and clinical

expertise to lead the development of community based services which reflect

best practice and encourages innovation. In a recent ballot, our members

voted to opt for delegated commissioning as they identified that co-

commissioning of primary care will act as an enabler to virtually integrate

services and will provide an added dimension to our existing BCF plans.

Through the co-commissioning framework we will use a quality dashboard to

inform contracting and promote the flexible use of QOF to incentivise local

service improvements. Over the last twelve months we have successfully

worked with colleagues to improve the detection rates of people with atrial

fibrillation symptoms, resulting in 500 extra people being identified and

treated. Based on our experience we have identified that with increased

contractual flexibility and through targeting QOF resources to facilitate

investment that reflects the needs of our diverse local communities and the

working practices of our primary care and community teams we could have


5

realised an even greater impact.

C Finance template for delegated budgets: to be completed by CCGs on or before noon on 9 January 2015

Notes for completing the finance template:

1. Double click into the table to complete the excel template. 2. Please enter the notified numbers for your CCG. 3. Please enter how you intend to spend the delegated budget in

2015/16. If your proposal is approved you will need to submit the detail of your planned spend as set out in the planning guidance.

4. Please include any additional investment the CCG is planning to make in primary care services from other areas of spend.

Premises cost reimbursements 2,966 2966

Other premises costs 0

Enhanced services 1,666 1666

QOF 2,937 2937

Other GP services -5 -5

Primary care NHS property services - GP 1,000 1,000

Sub Total GP services 27096 0 1000 28096

N/A + - +/-

Acute services -500 -500

Mental health services 0

Community health services 0

Primary care services 0

Continuing care services 0

Other care services -500 -500

Sub total CCG programme costs 0 -1000 -1000

Total 27096 0 0 27096

Check - total should equal zero 27096

Of the CCG's additional allocation (£2.8m from the national £1.98m) for 2015/16, the CCG plans to

allocate £1m to the commissioning of primary care services. This is shown in the analysis above. The

above analysis is based upon data provided by NHS England. The CCG is awaiting a detailed

reconciliation of the above baseline to the value of budgets initiallly notified as transferring to the

CCG (£27.927m). Subject to satisfactory receipt of this reconciliaion, the above reflects the CCGs

opening plan for 2015/16.

Please provide a description in the change in spend detailed above


6

D CCG declaration

I hereby confirm that NHS Lincolnshire West CCG membership and governing body have seen and agreed to all proposed arrangements in support of taking on delegated commissioning arrangements for primary medical services on behalf of NHS England for 2015/16.

Signed on behalf of NHS Lincolnshire West CCG governing body

Name: Richard Childs

Position: CCG Governing Body Lay Chair

Date: 6 January 2015

I hereby confirm that the CCG has in place robust conflicts of interest processes which and have been reviewed in light of the CCG’s statutory duties set out in the NHS Act 2006 (as amended by the Health and Social Care Act 2012), and the NHS England statutory guidance on managing conflicts of interest, prior to submission.

Signed by Lincolnshire West CCG Audit Committee Chair

Name: Roger Buttery

Position: CCG Audit Committee Chair


Signed by Lincolnshire West CCG Accountable Officer

Name: Dr Sunil Hindocha

Position: CCG Accountable Officer



7

PART II: TO BE COMPLETED BY AREA TEAM

Assurance domains

To be pre-populated by Area Team from 2014/15 Q2 data

Current Level

Domain 1: Are patients receiving clinically commissioned, high quality services?

Assured

Domain 2: Are patients and the public actively engaged and involved?

Assured

Domain 3: Are CCG plans delivering better outcomes for patients? Assured with support

Domain 4: Does the CCG have robust governance arrangements? Assured

Domain 5: Are CCGs working in partnership with others? Assured

Domain 6: Does the CCG have strong and robust leadership? Assured

Additional assurance

Area team confirms the CCG is capable of taking on delegated functions.

√

Area team confirms the CCG meets the required conflicts of interest management thresholds in line with the forthcoming statutory guidance.

√

Area team confirms the CCG demonstrates appropriate levels of sound financial control and meets all statutory and business planning requirements.

√

Any additional comments


8

Area team declaration

I hereby confirm, on behalf of NHS England, that NHS Lincolnshire West CCG meets the required conflicts of interest management, finance and assurance thresholds to proceed with delegated commissioning arrangements.

Signed on behalf of the NHS England Central Midlands Area Team

Name: Jim Heys

Position: Interim Director of Commissioning

Date:8th January 2015


9

PART III: FOR NHS ENGLAND OFFICE USE ONLY

NHS England Commissioning Committee

This serves as confirmation that, following a meeting of the NHS England Commissioning Committee on [insert date], NHS [insert name] CCG has been approved to proceed with delegated commissioning arrangements for 2015/16, having met the required conflicts of interest management, finance and assurance thresholds.

Name:

Position:

Date:

Confirmation of financial arrangements

Signed on behalf of the NHS England

Name:

Position:

Date:


10

Next steps towards primary care co-commissioning: Annex E

Draft delegation by NHS England

To Lincolnshire West CCG

January 2015 V6


2

Draft delegation by NHS England to Lincolnshire West CCG

Introduction

1. Simon Stevens, the Chief Executive of NHS England, announced on 1 May

2014 that NHS England was inviting Clinical Commissioning Groups (CCGs)

to expand their role in primary care commissioning and to submit

expressions of interest setting out the CCG’s preference for how it would

like to exercise expanded primary medical care commissioning functions.

One option available was that NHS England would delegate the exercise of

certain specified primary care commissioning functions to a CCG.

2. In accordance with its statutory powers under section 13Z of the National

Health Service Act 2006 (as amended, “NHS Act”), NHS England has

delegated the exercise of the functions specified in Schedule 1 to these

Terms of Reference to Lincolnshire West CCG.

3. Lincolnshire West CCG has established a Primary Care Commissioning Sub

Committee to exercise and oversee the exercise of delegated

commissioning functions.

4. The primary purpose of the delegation is to empower Lincolnshire West

CCG to commission primary medical services for the people of Lincolnshire

West Area

Statutory Framework

5. Under section 13Z of the NHS Act, NHS England may arrange for any

function exercisable by it under the NHS Act to be exercised by a CCG.

Arrangements may be on such terms and conditions (including terms as to

payment) as may be agreed between NHS England and the CCG

concerned.

6. Arrangements made under section 13Z do not affect the liability of NHS

England for the exercise of any of its functions. However, the CCG

acknowledges that in exercising its functions (including those delegated to

it), it must comply with the statutory duties set out in Chapter A2 of the NHS

Act and including:


3

a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and

economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section

14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

7. The CCG will also need to specifically, in respect of the delegated functions

from NHS England, exercise those set out below:

Duty to have regard to impact on services in certain areas (section 13O);

Duty as respects variation in provision of health services (section 13P).

8. The CCG remains subject to any directions made by NHS England or by the

Secretary of State.

Role of the CCG

9. The CCG will exercise the primary care commissioning functions according

to the delegation by NHS England and as set out Schedule 1 to this

document.

10. The delegation has been made in the context of a desire to promote

increased co-commissioning to increase quality, efficiency, productivity and

value for money and to remove administrative barriers.


4

11. The role of the CCG shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS

Act, except those relating to individual GP performance management, which

have been reserved to NHS England.

This includes the following activities:

GMS, PMS and APMS contracts (including the design of PMS and APMS

contracts, monitoring of contracts, taking contractual action such as

issuing branch/remedial notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and

“Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality

Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (e.g., returner/retainer

schemes);

12. The CCG will also carry out the following activities in relation to its delegated

primary care commissioning functions:

The activities described below are to be undertaken in the Lincolnshire West

CCG Area and are agreed with the NHS England Central Midlands Area

Team.

To plan, including needs assessment, primary medical care services.

To undertake reviews of primary medical care services;

To co-ordinate a common approach to the commissioning of primary

care services;

To manage the budget for commissioning of primary medical care

services;


5

To develop and implement integrated commissioning across acute,

community and social care services;

To develop and continuously improve the quality of commissioned

primary medical services;

To develop local incentives schemes (as an alternative to QoF) to

adapt the primary medical care ‘service offer’ to the needs of local

patients

To develop and support ‘vulnerable GP practices’ to ensure the

continuity of services to the local population;

To develop and implement primary care commissioning intentions

which address inequalities within the registered and non-registered

population;

To plan and develop the primary care workforce;

To develop and implement primary care commissioning intentions to

prepare primary care to deliver the NHS Five Year Forward View

Lincolnshire Health and Care programme


deliver the operational plans of the CCG and strategic plans of the

Lincolnshire ‘Unit of Planning’;

To develop federated/network/collaborative arrangements as required

to support the health needs of the population and the continuity of

primary medical services.


strengthen population-wide prevention, promote self-care and improve

access to healthy lifestyle services.

To develop and commission a wider range of community based multi-

specialty services which provide episodic care to the local population.

To work collaboratively with the Central Midland Area Team of NHS

England to maintain the stability of the AT Direct Commissioning

function during 2015-16


6

Geographical Coverage

13. The delegation relates to the geographical area of the Lincolnshire West

CCG.

Exercise of delegated authority

14. NHS England and the CCG have entered into an agreement that sets out

the detailed arrangements for how the CCG will exercise its delegated

authority. The CCG will exercise its delegated authority in accordance with

the terms of that agreement.

15. The CCG may determine the arrangements for the exercise of its delegated

authority, provided that they are in accordance with the statutory framework

(including Schedule 1A of the NHS Act) and with the CCG’s Constitution.

16. Lincolnshire West CCG has established a Primary Care Commissioning

Committee to exercise and oversee the exercise of delegated

commissioning functions.

Procurement of Agreed Services

17. The CCG will make procurement decisions as relevant to the exercise of its

delegated authority and in accordance with the detailed arrangements

regarding procurement set out in the delegation agreement.

Reporting and audit

18. The CCG will The CCG will provide reports to NHS England:

On a monthly basis covering the following:

Financial reporting of delegated budgets

On a quarterly basis covering the following:

Access to primary care services

Performance of enhanced services

Performance of incentive schemes

Referrals to the CCG Audit Committee concerning potential Conflicts

of Interest

On a six monthly basis covering the following:


7

Practice changes (mergers, list closures, new practices)

Uptake and impact of returner/retainer schemes

Public and Patient Participation.

19. The CCG’s Primary Care committee will present its minutes to Central

Midlands Area Team of NHS England and the governing body of

Lincolnshire West CCG

20. The CCG must also comply with any reporting requirements set out in its

Constitution.

21. Where relevant, NHS England may exercise its powers under sections

14Z17, 14Z18, 14Z19 and 14Z20 of the NHS Act to require information from

the CCG.

22. It is envisioned that this scheme of delegation will be reviewed initially on a

six monthly basis as co-commissioning develops during 2015-16 and

thereafter on an annual basis, for at least three years from April 2016.

Financial Accountability

23. The CCG must comply with its statutory financial duties, including those

under sections 223H and 223I of the NHS Act.

24. The CCG’s Primary Care Committee shall be accountable to the CCG’s

Governing Body and to NHS England in the exercise of its functions.

25. The CCG’s Primary Care Committee shall be responsible for the application

of resources formally delegated to it as part of the CCG’s agreed annual

financial plan, as approved by the CCG Governing Body. The committee

shall have no authority to commit expenditure in excess of the budget

delegated to it.

Decisions

26. The CCG will make decisions within the bounds of its remit.

27. The decisions of the CCG shall be binding on NHS England and

Lincolnshire West CCG.


8

Termination

28. This delegation may be revoked by NHS England and the circumstances

when this may be done are set out in the delegation agreement.

29. The parties may, by agreement, withdraw from delegated commissioning

arrangements but the party seeking to terminate must give six months’

notice to partners, with new arrangements starting from the beginning of the

next new financial year.

For and Behalf of Lincolnshire West CCG

For and on behalf of NHS England Central Midlands


9

Schedule 1 – Delegated functions

Appendix 1

The role of the CCG shall be to carry out the functions relating to the

commissioning of primary medical services under section 83 of the NHS Act,

except those relating to individual GP performance management, which have

been reserved to NHS England.

This includes the following activities:

GMS, PMS and APMS contracts (including the design of PMS and APMS

contracts, monitoring of contracts, taking contractual action such as

issuing branch/remedial notices, and removing a contract);

Newly designed enhanced services (“Local Enhanced Services” and

“Directed Enhanced Services”);

Design of local incentive schemes as an alternative to the Quality

Outcomes Framework (QOF);

Decision making on whether to establish new GP practices in an area;

Approving practice mergers; and

Making decisions on ‘discretionary’ payment (e.g., returner/retainer

schemes);

The CCG will also carry out the following activities in relation to its delegated

primary care commissioning functions:

The activities described below are to be undertaken in the Lincolnshire West

CCG Area and are agreed with the NHS England Central Midlands Area

Team.

To plan, including needs assessment, primary medical care services.

To undertake reviews of primary medical care services;

To co-ordinate a common approach to the commissioning of primary

care services;


10

To manage the budget for commissioning of primary medical care

services;

To develop and implement integrated commissioning across acute,

community and social care services;

To develop and continuously improve the quality of commissioned

primary medical services;

To develop local incentives schemes (as an alternative to QoF) to

adapt the primary medical care ‘service offer’ to the needs of local

patients

To develop and support ‘vulnerable GP practices’ to ensure the

continuity of services to the local population;

To develop and implement primary care commissioning intentions

which address inequalities within the registered and non-registered

population;

To plan and develop the primary care workforce;


prepare primary care to deliver the NHS Five Year Forward View

Lincolnshire Health and Care programme


deliver the operational plans of the CCG and strategic plans of the

Lincolnshire ‘Unit of Planning’;

To develop federated/network/collaborative arrangements as required

to support the health needs of the population and the continuity of

primary medical services.


strengthen population-wide prevention, promote self-care and improve

access to healthy lifestyle services.

To develop and commission a wider range of community based multi-

specialty services which provide episodic care to the local population.


11

To work collaboratively with the Central Midland Area Team of NHS

England to maintain the stability of the AT Direct Commissioning

function during 2015-16

CQRS Data entry summary (as at Dec 14).doc

1

Conflicts of Interest Policy and Standards

of Business Conduct

(including Hospitality, Gifts and

Sponsorship Policy)

Reference No:

Version: 5.0

Ratified by: Governing Body

Date ratified: 28.01.15

Name of originator/author: Sarah Newton, Chief Operating Officer

Name of responsible committee/individual:

Governing Body (Richard Childs – Lay Chair)

Richar

Date issued: January 2015

Review date: January 2016

Target audience: All members of the CCG, staff and office holders

Distributed via: Website

Intranet

3

Policy Statement

Conflicts of interest may arise where an individual’s personal interests or loyalties or those of a connected

person (a relative, close friend or business associate) conflict with those of the CCG. Such conflicts may

create problems such as inhibiting free discussions which could result in decisions or actions being taken

which are not in the interests of the CCG, and risk giving the impression that the CCG has acted improperly.

Background

The CCG is responsible for the stewardship of significant public resources when making decisions about the

commissioning of health and social care services. In order to ensure and be able to evidence that these

decisions secure the best possible services for the population it serves, NHS Lincolnshire West CCG will

demonstrate accountability to relevant stakeholders (particularly the public), probity and transparency in the

decision-making process. All members and all members, Office Holders and staff have a personal

responsibility to make sure that they are not placed in a position which risks, or appears to risk, a conflict

between their private interests and their NHS duties or allegations of their official position.

Statement

This policy informs members, and staff and officers about:

• guidelines to maintain the highest standards of probity and to provide assurance that any

relationships entered lead to clear benefit for the NHS

• the personal requirements they must observe before accepting any hospitality, gifts of inducement

Responsibilities

Compliance with the policy will be the responsibility of all members of the CCG, including Governing body

members, members of Committees, subcommittee and employees.

The policy is intended to help all members, Office Holders and staff to recognise and accept this

responsibility and to ensure a register of interests and a register of decisions are maintained.

A quarterly reminder of the existence and importance on the policy delivered via internal communication

methods. In addition to this, quarterly to update the Declaration of Interest forms sent to all Governing

Body members and any other committee, sub-committee or decision making group.

Training

The CCG maintains a responsibility to raise awareness of the process to all members, Office Holders and staff

. Particular attention should be paid to ensuring that the issues are raised to new members and all members,

Office Holders and staff through the induction process. A quarterly reminder of the existence and

importance of the policy delivered through internal communication methods, such as the Intranet.

Dissemination

This policy will be available via the CCG website, intranet (e.g. GP TeamNet) and a hard copy held by the CCG

Board Secretary.

4

Resource implication

This policy is intended to ensure:

• All members, Office Holders and staff are aware of the need to act impartially in all of their work

• Protect all members, Office Holders and staff against the possibility of accusations of corruptive

practice

• Uphold the established principles of business conduct within the NHS and the public sector

Uphold the Professional Standards Authority: Standards for Members of NHS Boards and Clinical

Commissioning Group Governing Bodies in England.

• Uphold the reputation of NHS Lincolnshire West CCG and its staff in the way it conducts its business

• Uphold the principles of openness

5

NHS Lincolnshire West CCG Conflicts of Interest Policy & Standards of Business Conduct and

Hospitality, gifts and sponsorship policy

Contents Page No

Introduction 5

Purpose of the Policy 5

Scope 6

What are conflicts of interest? 6

Accountability 7

National guidance and statutory provision 7

Management of Conflicts of Interest 8

CCG Constitution 9

Register of Interest 9

Declaration of interests 10

Responsibility for Managing Conflict of Interest 11

Failure to disclose 16

Transparency in Procuring Services 17

Hospitality, Gifts & Sponsorship 21

Additional Employment 21

Code of Conduct for Private Practice 21

Approval of Application 21

Monitoring compliance 24

Equality & Diversity Statement 24

Appendix 1 - Standards for Members of NHS Board and Clinical Commissioning Group 25

Governing Bodies in England

Appendix 2 - Register of Interests Template 29

Appendix 3 - Declaration of Conflict of Interest for Bidders/Contractors Update 31

Appendix 4a - Declaration of Interests for Employees Template 33

Appendix 4b - Declaration of Interests for Member Practices 36

Appendix 5 - Procurement Template 39

Appendix 6 - Personal Benefit Declaration Proforma 41

Appendix 7 - Commercial Sponsorship Approval Request Proforma 42

Appendix 8 - Seeking Sponsorship from the Commercial Sector 44

Appendix 9 - Commercial Sponsorship Agreement Proforma 46

7

1. Introduction

The National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) (“the Act”) sets

out clear requirements for CCGs to make arrangements for managing conflicts of interest and potential

conflicts of interest, to ensure they do not affect, or appear to affect, the integrity of the CCG’s decision

making processes. These requirements are supplemented by procurement-specific requirements in the

National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013.

NHS Lincolnshire West CCG is responsible for the stewardship of significant public resources when making

decisions about the commissioning of health and social care services. In order to ensure and be able to

evidence that these decisions secure the best possible services for the population it serves. NHS Lincolnshire

West CCG will demonstrate accountability to relevant stakeholders (particularly the public), probity and

transparency in the decision-making process.

This policy sets out clear and robust procedures for Lincolnshire West CCG to ensure that all members 1,

Office Holders and staff are aware of the Standards for membership of NHS Boards and Clinical

Commissioning Group Governing bodies published by the Professional Standards Authority see Appendix 1)

and the content of the organisation’s constitution and Standing Orders and Standing Financial Instructions in

relation to declaring conflicts of interest, hospitality, gifts and sponsorship.

2. Purpose of the policy

This policy is intended to:

Ensure all members, Office Holders and staff are aware of the need to act impartially in all of their work

Protect all members, Office Holders and staff against the possibility of accusations of corruptive practice

Uphold the established principles of business conduct within the NHS and the public sector

Uphold the reputation of NHS Lincolnshire West CCG and its all members, Office Holders and staff in the

way it conducts its business

Ensure all members, Office Holders and staff do not contravene the requirements of the Bribery Act

2010

Uphold the principles of openness

Uphold the Professional Standards Authority: Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England. (*See Appendix A).

Enable the CCG and clinicians in commissioning roles to demonstrate that processes are acted fairly and transparently and in the best interest of their patients and local populations.

Ensure that the CCG operates within the legal framework, but without being bound by over- prescriptive

rules that risk stifling innovation.

Safeguarding clinically led commissioning, whilst ensuring objective investment decisions.

Provide the public, providers, Parliament and regulators with confidence in the probity, integrity and

fairness of commissioners’ decisions; and

Uphold the confidence and trust between patients and GP’s, in the recognition that individual

commissioners may want to behave ethically but may need support and training to understand when

conflicts (whether actual or potential) may arise and how to manage them if they do.

1Throughout the document ‘members’ should be taken in the context to mean both GP practices and individual GPs.

8

To address the additional factors that the CCG needs to address when commissioning primary medical

care services, including factors the CCG needs to consider when drawing up plans for services that might

be provided by GP practices;

To provide assurance to the Audit Committee, Health and Wellbeing Board(s), NHS England and, where

necessary, the auditors, that services are appropriately commissioned from GP practices.

Identify the procedures for decision-making in cases where all the GPs (or other practice representatives)

sitting on a decision-making group have a potential financial interest in the decision.

This policy is not intended to:

• Restrict appropriate sponsorship of training and educational events • Develop unnecessary bureaucracy

If any hospitality, gift or sponsorship could cause embarrassment or be perceived as a significant conflict of

interest, it should be politely declined.

3. Scope

This policy applies to all members and employees of Lincolnshire West CCG, contracted third parties

(including agency staff) students/trainees, secondees and other staff on placement with the organisation and

staff of partner organisations with approved access. It applies to all areas in support of the organisation’s

business objectives both clinical and corporate.

NHS Lincolnshire West CCG will ensure that all employees and decision makers are aware of the existence of

this policy.

4. What are conflicts of interest?

A conflict of interest occurs where an individual’s ability to exercise judgement, or act in a role, is or could be

impaired or otherwise influenced by his or her involvement in another role or relationship. The individual

does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict

of interest to occur.

For the purposes of Regulation 6 [National Health Service (Procurement, Patient Choice and

Competition) (No.2) Regulations 20137], a conflict will arise where an individual’s ability to

exercise judgement or act in their role in the commissioning of services is impaired or influenced by

their interests in the provision of those services.”

Monitor - Substantive guidance on the Procurement, Patient Choice and Competition Regulations

(December 2013)

As well as direct financial interests, conflicts can arise from an indirect financial interest (e.g. payment to a

spouse) or a non-financial interest (e.g. reputation). Conflicts of loyalty may arise (e.g. in respect of an

organisation of which the individual is a member or with which they have an affiliation). Conflicts can arise

from personal or professional relationships with others, e.g. where the role or interest of a family member,

friend or acquaintance may influence an individual’s judgement or actions, or could be perceived to do so.

9

Depending upon the individual circumstances, these factors can all give rise to potential or actual conflicts of

interest.

For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could

be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider. In

the case of a GP involved in commissioning, an obvious example is the award of a new contract to a provider

in which the individual GP has a financial stake. However, the same considerations, and the approaches set

out in this policy, apply when deciding whether to extend a contract.

Pertinent issues to bear in mind:-

A perception of wrongdoing, impaired judgement or undue influence can be as detrimental as any of

them actually occurring.

If in doubt it is better to assume the existence of a conflict of interest and manage it appropriately

rather than ignore it, if a situation occurs that a conflict of interest could arise and advice is required,

please contact the Chief Operating Officer.

For a conflict of interest to exist, financial gain is not necessary.

5. Accountability

The intention of this policy is to maintain the highest standards of probity and to provide assurance that any

relationships entered lead to clear benefit for the NHS, and that they represent value for money. In order for

this to be achieved the process must be conducted in the context of openness and within the Code of

Conduct for NHS Managers.

The organisation requires all members of all members, Office Holders and staff to observe the Code of

Conduct for NHS Managers which is available on the Department of Health website and also the Nolan

Principles (the 7 principles of public life), and standards for members of NHS bodies and CCG governing

bodies in England.

6. National Guidance and Statutory Provision

The starting point for the CCG is section 14O of the Act. This sets out the minimum requirements in terms of

what both NHS England and the CCG will do in terms of managing conflicts of interest. For NHS Lincolnshire

West CCG this means that:-

An appropriate register of interests is maintained.

Publication of the register to allow the public to view this. The CCG’s register will be published on the

CCG’s website.

Making arrangements requiring the prompt declaration of interests by the persons specified (members

and employees) and ensuring that these interests are entered into the relevant register.

Making arrangements for managing conflicts of interest and potential conflicts of interest (e.g.

developing appropriate policies and procedures).

Section 14O is supplemented by the procurement specific requirements set out in the National Health

Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013. In particular, regulation 6

which requires the following:-

10

NHS Lincolnshire West CCG will not award a contract for the provision of NHS health care services where

conflicts, or potential conflicts, between the interests involved in providing the affect, or appear to

effect, the integrity of the award of that contract; and

The CCG will keep a record of how it managed any such conflict in relation to NHS commissioning

contracts it enters into.

An interest is defined for the purposes of regulation 6 as including an interest of the following:

A member of the CCG, either a GP practice as a whole or individual CCG GPs.

A member of the Governing Body.

A member of the committees or sub-committees of sub-committees of the Governing Body and

Employees of the CCG and Employees of CCG member practices.

As set out above a clear record of any conflicts of interest will be kept by the CCG in its register of interest.

NHS Lincolnshire West CCG will ensure that it records procurement decisions made, and details of how any

conflicts that arise in the context of the decision have been managed. These registers will be available for

public inspection.

NHS Lincolnshire West CCG will ensure that details of all contracts, including the contract value, are

published on the website within a month of a contract being are agreed. Where the CCG decides to

commission services through Any Qualified Provider (AQP), the CCG will publish on the website the type of

services that are being commissioned through an AQP approach.

Any relationships entered into must strictly comply with Department of Health and other national guidance.

7. Hospitality, gifts and sponsorship.

The Bribery Act 2010 replaces the fragmented and complex offences at common law, and in the Prevention

of Corruption Acts 1889-1916. The Act broadly defines the three types of offence:

• Two general offences of bribery – 1) Offering or giving a bribe to induce someone to behave, or to

reward someone for behaving, improperly and 2) requesting or accepting a bribe either in exchange

for acting improperly, or where the request or acceptance is itself improper;

• The new corporate offence of negligently failing by a company or limited liability partnership to

prevent bribery being given or offered by an employee or agent on behalf of that organisation.

Any suggestion or suspicion of corruption or fraudulent practice should be reported to the Local Counter

Fraud Specialist – as detailed in the Countering Fraud and Corruption Policy, Strategy and Guidance Notes.

NHS guidance requires that Lincolnshire West CCG maintains a register of hospitality, gifts and sponsorship.

Such a register should record any offer, receipt of provision of hospitality, gifts and will be subject to review

by the Audit Committee. The register is held by the Board Secretary to the Governing Body and

arrangements to view can be made by prior arrangement. It is also published on the CCG’s website.

8. CCG Constitution

NHS Lincolnshire West CCG has set out in the Constitution a statement of the conduct expected of

individuals involved in the CCG. E.g. members of the Governing Body, members of committee and

11

employees, which reflect the safeguards. This reflects the expectations set out in the Standards for

Members of NHS Board and Clinical Commissioning Groups.

Where there is any conflict with guidance contained in this document and the CCG Constitution the latter

will have precedence. All income received and expenditure incurred by the organisation is subject to

standing orders and standing financial instructions requirements covering safe custody of assets, contracting,

authorisation and approval.

9. Management of Conflicts of Interest

As required by section 140 of the 2006 Act, as inserted by section 25 of the 2012 Act, NHS Lincolnshire West

CCG will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions

made by NHS Lincolnshire West CCG will be taken without any possibility of the influence of external or

private interference.

Conflicts of interest can be managed by:-

Doing business appropriately. The CCG will ensure that its needs assessments, consultation

mechanisms, commissioning strategies and procurement procedures are right from the outset, then

conflicts of interest will become much easier to identify, avoid and/or manage, because the rationale for

all decision-making will be clear and transparent and should withstand scrutiny.

Being proactive, not reactive. The CCG will seek to identify and minimise the risk of conflicts of interest

at the earliest possible opportunity, for instance by:-

Considering potential conflicts of interest when electing or selecting individuals to join the Governing

Body or other decision-making bodies;

Ensuring individuals receive proper induction and training so that they understand their obligations

to declare conflicts of interest.

NHS Lincolnshire West CCG will establish and maintain registers of interests, and agree in advance how a

range of possible situations and scenarios will be handled, rather than waiting until they arise.

Assuming that individuals will seek to act ethically and professionally, but may not always be sensitive

to all conflicts of interest. Rules should assume people will volunteer information about conflicts and,

where necessary, exclude themselves from decision-making, but there should also be prompts and

checks to reinforce this.

Being balanced and proportionate. Rules should be clear and robust but not overly prescriptive or

restrictive. They should ensure that decision-making is transparent and fair, but not constrain people by

making it overly complex or cumbersome.

Openness. Ensuring early engagement with patients, the public, clinicians and other stakeholders,

including local HealthWatch and Health and Wellbeing Boards, in relation to proposed commissioning

plans.

Responsiveness and best practice. Ensuring that commissioning intentions are based on local health

needs and reflect evidence of best practice – securing “buy in” from local stakeholders to the clinical

case for change.

12

Transparency. Documenting clearly the approach taken at every stage in the commissioning cycle so

that a clear audit trail is evident.

Securing expert advice. Ensuring that plans take into account advice from appropriate health and social

care professionals, e.g. through clinical senates and networks and draw on commissioning support, for

instance around formal consultations and for procurement processes.

Engaging with providers. Early engagement with both incumbent and potential new providers over

potential changes to the services commissioned for a local population.

Creating clear and transparent commissioning specifications that reflect the depth of engagement and

set out the basis on which any contract will be awarded.

Following proper procurement processes and legal arrangements, including even-handed approaches

to providers.

Ensuring sound record-keeping, including up to date registers of interest; and

A clear, recognised and easily enacted system for dispute resolution.

These general processes and safeguards will apply at all stages of the commissioning process, but will be

particularly important at key decision points e.g. whether and how to go out to procurement of new or

additional services.

10. Declarations of Interest

Individuals will declare any interest that they have, in relation to the exercise of the commissioning functions

of NHS Lincolnshire West CCG, in writing to the Board Secretary as soon as they become aware of it and in

any event no later than 28 days after becoming aware.

Where an individual is unable to provide a declaration in writing (for example, if a conflict becomes apparent

in the course of a meeting), they will make an oral declaration before witnesses, and provide a written

declaration as soon as possible thereafter.

Where an individual, i.e. an employee, member of the Governing Body, or a member of a committee or a

sub-committee, of NHS Lincolnshire West CCG or its Governing body, or a CCG locality group, has an interest,

or becomes aware of an interest which could lead to a conflict of interests in the event of the group

considering an action or decision in relation to that interest, that must be considered as a potential conflict,

and is subject to the provisions of this policy.

These provisions also apply to relevant and material personal or business interests of the:

• spouse;

• civil partner;

• cohabitee;

• child or parent;

• sibling;

• business partners, employers, employees or officers where this role is in relation to a

Member Practice; or friend; of any of those named above, in which may influence or may be

perceived to influence their judgment.

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Such declarations should include, but are not limited to:

Directorships, including non-executive directorships held in private companies or PLCs (with the

exception of those of dormant companies).

Ownership or part-ownership of private companies, businesses or

Consultancies likely or potentially seeking to do business with the NHS.

Shareholdings in organisations likely or possibly seeking to do business with the NHS.

A position of authority in a charity/voluntary organisation in the field of health & social care.

Any connection with a voluntary or other organisation contracting for NHS services.

Research funding/grants that may be received by an individual or their department.

Interest in pooled funds that are under separate management, (any relevant company included

in this fund that has a potential relationship with NHS Lincolnshire West CCG must be declared).

Such interests may be:

A direct pecuniary interest

An indirect pecuniary interest

A non-pecuniary interest in an organisation that may benefit from a CCG decision

A non-pecuniary personal benefit

A close relationship with an individual or organisation with an interest

Loyalty (i.e. to professional bodies).

Examples of Interests that must be declared:-

Direct pecuniary interest - the individual is a GP with a Special Interest or has a partner working in a Care Home with whom the CCG might contract for beds

Indirect pecuniary interest

– A shareholder in a company that might bid for a CCG contract

Non-pecuniary interest in an organisation that may benefit from a NHS Lincolnshire West CCG decision

- trustee of a charity that might provide services for NHS Lincolnshire West CCG

A non-pecuniary personal benefit - living next door to a busy clinic that might lose a contract with NHS Lincolnshire West CCG thus resulting in less traffic

A close relationship with an individual or organisation with an interest

- a friend runs a company that seek a contract with the NHS Lincolnshire West CCG

Loyalty –includes loyalty to professional colleagues – e.g. partner, profession and professional bodies e.g. LMC.

If in doubt – declare! If a situation occurs that a conflict of interest could arise and advice is required,

please contact the Chief Operating Officer or Chief Finance Officer or in their absence their deputies.

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11. Registers of Interests

NHS Lincolnshire West CCG will ensure that, when members declare interests, this includes the interests of

all relevant individuals within their own organisation (e.g. partners in a GP practice), who have a relationship

with the CCG and who would potentially be in a position to benefit from the CCG’s decisions.

NHS Lincolnshire West CCG will create and maintain the following Registers of Interests:

For the Governing Body and Primary Care Commissioning Committee:

NHS Lincolnshire West CCG will consider whether conflicts of interest should exclude individuals

from being appointed to the Governing Body or to a committee, (such as the Primary Care

Commissioning Committee,) or sub-committee of the CCG or Governing Body. These will be

considered on a case-by-case basis but the CCG’s Constitution will reflect the CCG’s general

principles.

NHS Lincolnshire West CCG will assess the materiality of the interest, in particular whether the

individual (or a family member or business partner) could benefit from any decision the Governing

Body might take. This will be particularly relevant for any profit sharing member of any organisation

but would also be considered for all employees and especially those operating at senior or Governing

Body level.

NHS Lincolnshire West CCG will also determine the extent of the interest. If it is related to an area of

business significant enough that the individual would be unable to make a full and proper

contribution to the Governing Body, that individual should not become a member of the Governing

Body.

Any individual who has a material interest in an organisation which provides, or is likely to provide,

substantial services to the CCG (either as a provider of healthcare or commissioning support

services) should not be a member of the Governing Body or Primary Care Commissioning Committee,

if the nature of their interest is such that they are likely to need to exclude themselves from

decision-making on so regular a basis that it significantly limits their availability to effectively operate

as a Governing Body or Primary Care Commissioning Committee member .

The Executive Committee on behalf of the Governing Body shall create and maintain a Register of

Interests, which shall record all relevant personal or business interests or positions of influence of

each member of the Governing Body and Primary Care Commissioning Committee. Each member of

the Governing Body and Primary Care Commissioning Committee shall be under a duty to notify the

Governing Body through the Governing Body Board Secretary of any such interest. Any change to

these interests should be notified to the Chair prior to each meeting of the Governing Body or

Primary Care Commissioning Committee as well as to the Accountable Officer/ Chief Clinical Officer,

and Governing Body Board Secretary .

For Member Practices

The Executive Committee shall create and maintain a register of interests, which shall record all

relevant personal or business interests or positions of influence of each Member Practice (including

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individuals within those practices). Each Practice Representative shall be under a duty to notify the

Executive Committee of any such interest. Any change to these interests should be notified to the

Chair prior to each meeting of the Council of Members as well as to the Executive Committee.

Each Member Practice will be required to complete Appendix 4b Declaration of Interests for

Members. If in doubt it is better to assume the existence of a conflict of interest and manage it

appropriately rather than ignore it, if a situation occurs that a conflict of interest could arise and

advice is required, please contact the Chief Operating Officer or Chief Finance Officer or in their

absence their deputies

For Employees and Officers

The Executive Committee shall create and maintain a Register of Interests, which shall record all

relevant personal or business interests or positions of influence of any employee or officer of LWCGG

not included in the categories above. Each such individual shall be under a duty to notify the


Executive Committee and (if it becomes apparent at a meeting) to the Chair of the meeting.

For individuals seeking information in relation to procurement or participating in procurement,

potential provision of services or contracted to provide services or facilities.


relevant personal or business interests or positions of influence of any such individual. Each

individual shall be under a duty to notify the Executive Committee of any such interest. Any change

to these interests should be notified to the Executive Committee and (if it becomes apparent at a

meeting) to the Chair of the meeting.

For other individuals


relevant personal or business interests or positions of influence of any other individual, e.g. a

member of a committee or a sub-committee of NHS Lincolnshire West CCG or its Governing Body

who is not included in the above categories. Each individual shall be under a duty to notify the


Executive Committee and (if it becomes apparent at a meeting) to the Chair of the meeting.

The Register of Interest will be published on the CCG website to ensure that members of the public have

access to this.

NHS Lincolnshire West CCG will ensure that, as a matter of course, declarations of interest are made and

regularly confirmed or updated. This includes the following circumstances:-

On appointment:

Applicants for any appointment to the CCG or its Governing Body will be asked to declare any

relevant interests. When an appointment is made, a formal declaration of interests will again be

made and recorded.

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At meetings:

All attendees should be asked to declare any interest they have in any agenda item before it is

discussed or as soon as it becomes apparent. Even if an interest is declared in the register of

interests, it should be declared in meetings where matters relating to that interest are discussed.

Declarations of interest will be recorded in the minutes of meetings.

Quarterly:

The CCG will have systems in place to satisfy itself that on a quarterly basis that the register of

interests is accurate and up to date.

On changing role or responsibility:

Where an individual changes role or responsibility within a CCG or its Governing Body, any change to

the individuals interests should be declared.

On any other change of circumstances:

Wherever an individual’s circumstances change in a way that affects the individual’s interests (e.g.

where an individual takes on a new role outside the CCG or sets up a new business or relationship), a

further declaration should be made to reflect the change in circumstances. This could involve a

conflict of interest ceasing to exist or a new one materialising.

The CCG will set out the process to be followed if an individual fails to comply with its policies on

managing conflicts of interest as set out in its Constitution. This could include that individual being

removed from office.

12. Responsibility for Managing Conflicts of Interest

The Governing Body has overall responsibility for managing conflicts of interest and has delegated this to the

Executive Committee, and Governing Body Board Secretary, who will be responsible for:-

Creating and maintaining Registers of Interest

Ensuring that for every interest declared either in writing or by oral declaration, arrangements

are in place to manage any conflict or potential conflict of interest to ensure the integrity of NHS

Lincolnshire West CCG’s decision making process.

Recording in writing the means whereby such conflicts of interest will be managed within two

weeks of its notification.

Communicating these means to the individual concerned.

Ensuring that these means are available for inspection in the relevant Register of Interests.

The means of managing Conflicts of Interest includes:

The individual withdrawing from a specified activity on a temporary or permanent basis.

Monitoring of the specified activity undertaken by the individual either by a line manager,

colleague or other designated individual

Withdrawing from the meeting while the relevant matter is being discussed and voted on

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Taking such steps as are deemed appropriate including requesting information from individuals

to ensure that all actual and potential conflicts of interest are declared.

Where certain members of a decision-making body (be it the Governing Body, its committees or

sub-committees, or a committee or sub-committee of the CCG) have a material interest, they

will either be excluded from relevant parts of meetings, or join in the discussion but not

participate in the decision-making itself (i.e. not to have a vote).

The Chair of the meeting has responsibility for deciding whether there is a conflict of interest

and the appropriate course of corresponding action. In making such decisions, the Chair may

wish to consult the member of the Governing Body who has the responsibility for issues relating

to conflicts of interest. All decisions, and details of how any conflict of interest issue has been

managed, should be recorded in the minutes of the meeting and published in the registers.

NHS Lincolnshire West CCG will decide in advance of who will take the Chair’s role for

discussions and decision-making in the event that the Chair of a meeting is conflicted, or how

that will be decided at a meeting where that situation arises. This will normally be to the Vice

Chair.

Depending on the nature of the conflict, GPs or other practice representatives could be

permitted to join in discussions by the Governing Body, or such other decision-making body as

the CCG has created, about the proposed decision, but should not take part in any vote on the

decision.

In many cases, e.g. where a limited number of GPs have an interest, it will be straightforward for

relevant individuals to be excluded from decision making.

In some cases, all of the GPs or other practice representatives on a decision-making body could

have a material interest in a decision, e.g. where the CCG is proposing to commission services on

a direct award basis from all GP practices in the area, or where it is likely that all or most

practices would wish to be qualified providers for a service under AQP. Where such a situation

relates to primary medical services, the arrangements set out below provide a mechanism for

decision-making. (It could also be used for any other CCG responsibilities where decision-making

has been delegated to the committee responsible for primary medical care decision making and

where such a conflict of interest arises).

For decision making where such a conflict arises and which are not covered by the primary medical care

arrangements, NHS Lincolnshire West CCG will:-

Where the initial responsibility for the decision does not rest with the Governing Body, refer the

decision to the Governing Body and exclude all GP’s or other practice representatives with an

interest from the decision-making process, i.e. so that the decision is made only by the non-GP

members of the Governing Body including the lay and executive members and the registered

nurse and secondary care doctor.

Where the decision rests with the Governing Body:

All those with a conflict of potential conflict will be excluded and a decision made by

the remaining members. In the matter of a conflict of interest, the CCG has

arrangements in place for decision making maintaining five members with non-

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conflicted interests. Any decision of the Governing Body must be decided by

consensus or at least a majority decision.

In the event of a tied vote the Lay Chair of the meeting at that time shall have a

casting vote.

If decisions are made by majority vote and not consensus the Governing Body shall

record the decision making process and the outcome of any vote in the minutes of

the meeting.

This clause shall also apply to any resolutions made by a standing committee of the

Governing Body duly convened and held in accordance with the appropriate standing

orders set out below.

Any individual who has declared an interest either in writing or by oral declaration will ensure that

they have received confirmation of the arrangements to manage the actual or potential conflict of

interest from the Executive Committee or chair of the meeting before participating in any activity

connected with NHS Lincolnshire West CCG’s commissioning functions.

Decision making when a conflict of interest arises: primary medical care - decisions made by the Primary

Care Commissioning Committee

Procurement decisions relating to the commissioning of primary medical services will be made by the

Lincolnshire West CCG Primary Care Commissioning committee.

The membership of the committee is constituted so as to ensure that the majority is held by lay and

executive officers. An additional lay member (lay member – the Primary Care Commissioning) will be

appointed to ensure quoracy where all GP members are conflicted.

Any conflicts of interest issues will be considered on an individual basis. The chair and vice chair must always

be lay members of the Primary Care Commissioning committee.

The arrangements for primary medical care decision making do not preclude GP participation in strategic

discussions on primary care issues, subject to appropriate management of conflicts of interest. They apply to

decision making on procurement issues and the deliberations leading up to the decision.

13. Failure to disclose

Any breach of confidentiality or the CCG’s Conflicts of Interest policy will be treated very seriously. Potential

breaches will be investigated, normally within 10 days of a possible breach being identified, by a panel

chaired by the Chair or vice chair of CCG, a lay member and a chief CCG officer. The panel will produce a

report of its findings and make recommendations to the Governing Body on the appropriate action. This

could include, but is not limited to:

Disciplinary action in relation to any employee found to have breached

Removal from office

Governing Body Members and Primary Care Commissioning Committee members

Failure to disclose a relevant personal or business interest or position of influence by a Governing Body

Member or Primary Care Commissioning Committee members may result in suspension from the Governing

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Body in accordance with Standing Order 10.3 Any such failure should, on its discovery be promptly

communicated to NHS England.

Failure to disclose a relevant interest – others

• Failure to disclose any relevant personal or business interest or position of influence by a Member

Practice or other individual may result in suspension from active membership from any committees

or representative role held by the Member Practice or person while the matter is investigated.

• Such a failure must be reported to the Governing Body chair and vice chair as soon as reasonably

possible, once it is discovered and they should consider whether it should be reported to the NHS

England.

• In addition failure of declaration by a Member Practice, a Practice Representative, their proxy or

another GP participating in an Assembly Meeting, Locality meeting or a committee of NHS

Lincolnshire West CCG may result in suspension from the Assembly of Members by the other

Member Practices acting by Special Resolution at the Assembly meeting or subsequently.

• Failure to disclose a relevant personal or business interest or position of influence by a person

working on behalf of NHS Lincolnshire West CCG should be treated as a potential disciplinary offence

or a breach of contract (as appropriate) by NHS Lincolnshire West CCG or the relevant Member

Practice if they are not an NHS Lincolnshire West CCG employee.

• Failure to disclose by individuals seeking information in relation to procurement or participating in

procurement, potential provision of services or contracted to provide services or facilities should be

reported to the Governing Body to decide on appropriate further action which may include reporting

the matter to the NHS England.

Disclosure and Subsequent Procedure at meetings (including Conflicts of Interest involving the Chair of the

meeting) are addressed in Standing Order 19.

14. Transparency in Procuring Services

NHS Lincolnshire West CCG recognises the importance in making decisions about the services it procures in a

way that does not call into question the motives behind the procurement decision that has been made. The

group will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential

providers.

A register will be maintained on the procurement decisions taken including:-

The details of the decision.

Who was involved in making the decision (i.e. Governing Body or committee members and others

with decision making responsibility): and

A summary of any conflicts of interest in relation to the decision and how this was managed by the

CCG.

The Register will be updated whenever a procurement decision is taken. In the interests of transparency, the

register of interests and the register of decisions will be made publicly available and easily accessible to

patients and the public including ensuring that both registers are available in a prominent place and on the

CCG website.

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The registers will form part of the CCG’s annual accounts and thus will be signed off by the External Auditors.

NHS Lincolnshire West CCG will publish a Procurement Strategy approved by its governing body which will

ensure that:-

• That relevant clinicians (and not only those involved directly in NHS Lincolnshire West CCG)

and potential providers, together with local members of the public, are engaged in the

decision-making processes used to procure services;

• Service redesign and procurement processes are conducted in an open, transparent, non-

discriminatory and fair way.

The NHS Act, the Health and Social Care Act (“the HSCA”) and associated regulations sets out the statutory rules with which commissioners are required to comply when procuring and contracting for the provision of clinical services. They will be considered alongside the Public Contract Regulations and, where appropriate, EU procurement rules. The Procurement, Patient Choice and Competition Regulations place requirements on commissioners to ensure that they adhere to good practice in relation to procurement, do not engage in anti-competitive behaviour that is against the interest of patients, and protect the right of patients to make choices about their healthcare. The regulations set out that NHS Lincolnshire West CCG will:-

Manage conflicts and potential conflicts of interests when awarding a contract by prohibiting the award of a contract where the integrity of the award has been, or appears to have been, affected by a conflict; and

Keep appropriate records of how they have managed any conflicts in individual cases. The CCG recognises the importance of making decisions about the services it procures in a way that does not

call into question the motives behind the procurement decision that has been made. The CCG will procure

services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

Where a member, employee and person working for and or on behalf of the CCG, has the responsibility to

lead on commissioning or projects which may result in procurement, this person would be ineligible to apply

as a potential provider. Clinicians may be involved in supporting commissioning and projects but must

declare their interest if they may be a potential provider and will have no involvement in the procurement

phase.

All members and employees, who are in contact with suppliers and contractors, in particular those who are

authorised to sign purchase orders, or place contracts for goods or services, must ensure that they are

familiar with the CCG’s Standing Orders, Standing Financial Instructions.

The most obvious area in which conflicts could arise is where the CCG commissions (or continues to commission by contact extension) healthcare services, including GP services, in which a member of the CCG has a financial or other interest. They may most often arise in the context of co-commissioning of primary care, particularly with regard to delegated or joint arrangements, but it will also need to be considered in respect of any commissioning issue where GPs are current or possible providers. These factors are addressed in the procurement template at Appendix 5.

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NHS Lincolnshire West CCG will make evidence of the deliberations on conflicts publicly available. The procurement template is one way of the CCG evidencing this and will support the CCG in fulfilling its duty in relation to public involvement. It will further provide appropriate assurance:-

That the CCG is seeking and encouraging scrutiny of its decision-making process;

To Health and Wellbeing Boards, local HealthWatch and to local communities that the proposed service meets local needs and priorities, it will enable them to raise questions if they have concerns about the approach being taken;

To the Audit Committee and, where necessary, external auditors, that a robust process has been followed in deciding to commission the service, in selecting the appropriate procurement route, and in addressing potential conflicts; and

To NHS England in their role as assurers of the co-commissioning arrangements.

It is good practice to engage relevant providers, especially clinicians, in confirming that the design, of a service specification meet patient needs. Such engagement, done transparently and fairly, is entirely legal. However, conflicts of interest can occur if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. NHS Lincolnshire West CCG will seek as far as possible, to specify the outcomes that they wish to see delivered through a new service, rather than the process by which these outcomes are to be achieved. As well as supporting innovation, this helps prevent bias towards particular providers in the specification of services. Such engagement will follow the three main principles of procurement law, namely equal treatment, non-discrimination and transparency. This includes ensuring that the same information is given to all. Other steps include:-

Advertise the fact that a service design/re-design exercise is taking place widely and invite comments from any potential providers and other interested parties (ensuring a record is kept of all interactions);

As the service design develops, engage with a wide range of providers on an ongoing basis to seek comments on the proposed design, e.g. via the commissioners website or via workshops with interested parties;

Use engagement to help shape the requirement to meet patient need but take care not to gear the requirement in favour of any particular provider(s);

If appropriate, engage the advice of an independent clinical adviser on the design of the service;

Be transparent about procedures;

Ensure at all stages that potential providers are aware of how the service will be commissioned; and

Maintain commercial confidentiality of information received from providers. NHS Lincolnshire West CCG will also ensure that systems are in place for managing conflicts of interest on an ongoing basis, for instance, by monitoring a contract that has been awarded to a provider in which an individual commissioner has a vested interest.

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15. Hospitality, gifts and sponsorship

Some approaches may be at a personal level where an individual member, director, or employee receives

hospitality, a gift, or sponsorship from a company or an individual. All trust all members, Office Holders and

staff are required to record the receipt of hospitality, gifts or sponsorship, seeking prior approval where

required by this policy.

All hospitality, gifts and sponsorship accepted or declined should be declared to the Board Secretary to the

Governing Body using the forms supplied, as Appendix 6.

In cases of doubt, advice must be sought from your line manager and in no case must the value of the gift

exceed £25 limit without prior approval of the line manager (or Chief Operating Officer if the value exceeds

£200).

Hospitality

Hospitality provided it is normal and reasonable in the circumstances, may be accepted but must always

receive prior approval; retrospective recording in the register is not acceptable.

Modest incidental hospitality (e.g. refreshments) may be accepted without prior approval; modest incidental

meals in the course of working visits may also be accepted provided the value of the meals do not exceed

the cost that would otherwise be reimbursable by the NHS as an employer.

Casual gifts

The Register must be used for declaring all hospitality offered, but excluding small items such as pens and

calendars not exceeding £25 in value. However, gifts should be declared if several small gifts worth a total of

over £100 are received from the same or closely related source in a 12 month period.

It is also acceptable to receive other small value items, for example from a patient or relative in appreciation

of the treatment and care received, or seasonal items, if it is made clear to the offerer that it is accepted on

behalf of the Department or Service (and indeed is shared with colleagues), or is to be donated to the

organisation’s Charitable Fund.

Any other offers of personal gifts should be politely declined.

Cash

Under no circumstances must members or staff accept personal gifts of cash, even below the £25 threshold.

It is permissible for all members, Office Holders and staff to accept cash donations to the organisations

charitable funds, subject to a receipt being issued and the cash being banked through the organisations cash

office.

Sponsorship

Commercial sponsorship for all members, Office Holders and staff attendance at relevant conferences and

courses is acceptable, but only where permission is sought in advance from your line manager. Lincolnshire

West CCG must be satisfied that acceptance will not compromise purchasing decisions in any way.

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Organisational: incidental low value support (value less than £5,000)

The main characteristic of an “incidental” relationship is that the event, activity, etc. would be taking

place in any case and does not contribute to the shaping of Lincolnshire West CCG policy. Examples

might include assistance with publication costs, sponsoring educational events, loan of equipment,

etc. See Appendix 7 for form and guidance notes.

In addition the following may be relevant:

• an explicit written agreement must be drawn up detailing the duration, use and

responsibility for any loaned equipment (including responsibility in case of damage

of loss)

• sponsorship must be acknowledged in any published material

• details of all such arrangements will be entered in the hospitality register.

Organisational: all significant projects and those with a value greater than £5,000

A separate policy applies in respect of projects with a high money value (attached as Appendix 8).

The Chief Finance Officer must be notified of and must approve all such agreements entered into by

signing the appropriate form for this purpose.

Agreements with commercial organisations must not be in breach of article 85(1) of the EC Treaty

which prohibits agreements preventing, restricting or distorting competition, or section 21(1) of the

Competition Act 1980, which makes it unlawful to engage in practices preventing, restricting or

distorting competition in the supply or acquisition of goods.

Commercial sponsorship

Lincolnshire West CCG believes that the pharmaceutical and other health care industries have a

significant role to play in improving the health of the population, and that in principle, it is therefore

right to work in collaboration with the industry where there is a mutual benefit.

Lincolnshire West CCG believes that it is appropriate to seek opportunities for maximising the

availability of resources for the NHS from companies for core activities such as evaluation of services,

guideline development, education, audit and research, provided that this is within an agreed code of

conduct.

Limited financial and management resources make the potential availability of financial and other

support from commercial organisations highly attractive to NHS Trusts. The pharmaceutical industry

in particular has a strong desire to work in collaboration with the NHS. However, this must be

considered against the industry’s need to make profit which could potentially prejudice decision

making and independence.

There is no reason why such collaboration should not be to mutual advantage, but this can only

occur within the context of suitable controls.

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All approaches from commercial companies in respect of sponsorship should be notified to the

Board Secretary to the Governing Body who will act as co-ordinator and be responsible for ensuring

that the Chief Operating Officer is notified of all such circumstances.

Approval criteria

Proposals will not be approved where there is any direct or indirect conflict of interest with the role of

Lincolnshire West CCG or any individuals. However, where the benefit to the sponsoring organisation is

limited to general relationship building, sharing of information or profile raising this will not, in itself, be a

disqualifying factor. Where the sponsoring organisation has products or services which could benefit directly

from the project under consideration (even if there are also competing products available) then their

support should be declined.

Clinical aspects must always be under local control. Development of guidelines or advice will always be

overseen by the Lincolnshire West CCG clinical governance committee, and will not include a representative

of the company. However, the Clinical Governance and Risk Committee may agree that advice or guidelines

developed by the company are suitable for use locally.

Behaviour of drug companies

All drug companies entering into a relationship with Lincolnshire West CCG must undertake to comply with

the ABPI code of practice 28. The company should not be enabled to use Lincolnshire as a “loss-leader” site

by providing free or very cheap drugs, materials or equipment which it is not their intention to continue to

supply to the population on an ongoing basis except if this is done as a research/evaluation project. In such

cases a detailed proposal is to be provided for approval by the Lincolnshire Research Ethics Committee.

Value for money and accounting for NHS expenditure

Lincolnshire West CCG will assess all the costs and benefits of agreements, including any which fall on other

health bodies. Agreements will only proceed if the organisation is satisfied that there are likely to be new

overall gains to the NHS. No agreement entered into will provide for the purchase of any service or item for

which fees and allowances would already be paid to NHS practitioners.

Written agreements

Collaboration should be on the basis of a written agreement about the role of the company, resources they

intend to supply, e.g. personnel, materials, equipment, food, drink, meeting room, drugs etc. See Appendix 7

- Commercial Sponsorship Agreement Proforma. This proforma may need adopting to reflect the specific

nature of the support.

Clear written agreements will be established before any relationships are entered into. The potential

advantage of the proposal to the company and Lincolnshire West CCG should be made explicit and clearly

stated. Publication will be consistent with the Code of Practice on Openness in the NHS.

Register of relationships with commercial organisations

Lincolnshire West CCG will maintain a record of all support (direct or indirect financial or non-financial

benefit) received from companies in relation to the activities of Lincolnshire West CCG (excluding direct

25

suppliers). The Board Secretary to the Governing Body will maintain a register, which will be available for

inspection, by members of the organisation, all members, Office Holders and staff and public by prior

arrangement.

The agreement should also be explicit regarding the financial value of such support (e.g. be clear as to which

suppliers will be paid by the company and which by Lincolnshire West CCG). Any funding to be received by

Lincolnshire West CCG should be collected through the issue of an invoice from Lincolnshire West CCG

(contact the finance department for details) and payment received from the company in advance of

Lincolnshire West CCG incurring expenditure.

Acknowledgements

Financial support may be acknowledged on printed documents, educational meetings, and in reports of joint

work, if so requested by the sponsor.

Role of the Audit Committee

The Audit Committee will receive and review periodic reports of sponsorship and other similar relationships

entered into with companies, including the monetary value of the agreement. They may then wish to review

the policy and suggest amendments in due course.

Reporting arrangements

The total monetary value of arrangements entered into with companies will be reported on a regular basis to

the Audit Committee for consideration.

26

16. Additional Employment

A Policy has been developed in order to clarify the organisation’s position towards employees undertaking

additional employment with other organisations and to confirm the arrangements to be adopted. HR050

Additional Employment Policy sets out the principles to be adhered to.

17. Code of Conduct for Private Practice by All Employees of Lincolnshire West CCG

It is an established principle that NHS bodies must be impartial and honest in the conduct of their business

and, in order to ensure that strict ethical standards are maintained it is essential that conflict does not arise

between any private practice of all members, Office Holders and staff and their NHS duties. HR 051 Code of

Conduct for Private Practice by All Employees of Lincolnshire West CCG sets out the principles to be adhered

to.

18. Monitoring Compliance and Effectiveness of the Policy

This policy will be reviewed in annually. Staff and decision makers will be reminded of the policy and

Register on a quarterly basis with the Register being updated on a quarterly basis.

19. Equality & Diversity Statement NHS Lincolnshire West CCG is committed to ensuring that it treats its employees fairly, equitably and reasonably and that it does not discriminate against individuals or groups in the basis of their ethnic origin, physical or mental abilities, gender, age, religious beliefs or sexual orientation.

27

Appendix 1 – Standards for Members of NHS Board and Clinical Commissioning

Group Governing Bodies in England

31

Appendix 2 – Register of Interests Template

NHS Lincolnshire West CCG

The Register of Interests (Register) includes all interests declared by members, employees, Governing Body

members and members of committees or sub-committees, (including committees and sub-committees of

the Governing Body) of NHS Lincolnshire West CCG (the CCG).

In accordance with the CCG’s Constitution and section 14O of The National health Service Act 2006, the

CCG’s Chief Operating Officer must be informed of any interest which may lead to a conflict with the

interests of the CCG and the public for whom they commission services in relation to a decision to be made

by the CCG, that needs to be included in the Register within 28 days of the individual becoming aware of the

potential for a conflict. The Register will be updated regularly (at no more than three-monthly intervals).

Interests that must be declared (whether such interests are those of the individual themselves or of a family

member, business associate, close friend or other acquaintance of the individual include:-

Roles and responsibilities held within member practices.

Directorships, including non-executive directorships, held in private companies or PLC’s.

Ownership or part-ownership of private companies, businesses or consultancies likely or possibly

seeking to do business with the CCG and/or with NHS England.

Shareholdings (more than 5%) of companies in the field of health and social care.

A position of authority in an organisation (e.g. charity or voluntary organisation) in the field of health

and social care.

Any connection with a voluntary or other organisation (public or private) contracting for NHS

services.

Research funding/grants that may be received by the individual or any organisation in which they

have an interest or role.

Any other role or relationship which the public could perceive would impair or otherwise influence

the individual’s judgement or actions in their role within the CCG.

32

NHS Lincolnshire West CCG

Register of Interests

Name Date Position/Role Potential or actual area where conflict of interest could occur

Action taken to mitigate risk

Comments

33

Appendix 3 – Declaration of Conflict of Interest for Bidders/Contractors Update

DECLARATION OF CONFLICT OF INTERESTS FOR BIDDERS/CONTRACTORS FORM

NHS Lincolnshire West CCG Bidders/Potential Contractors/service providers declaration form: financial and other interests.

This form is required to be completed in accordance with the CCG’s Constitution, and s140 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) and the NHS (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and related guidance. For avoidance of doubt, it must be completed by CCG member practices who bid for any contracts.

Notes:

All potential bidders/contractors/service providers, including sub-contractors, members of a consortium, advisers of other associated parties (Relevant Organisation) are required to identify any potential conflicts of interest that could arise if the Relevant Organisation were to take part in any procurement process and/or provide services under, or otherwise enter into any contract with, the CCG, or with NHS England in circumstances where the CCG is jointly commissioning the service with, or acting under a delegation from, NHS England. If any assistance is required in order to complete this form, then the Relevant Organisation should contact the Chief Operating Officer.

The completed form should be sent to the Board Secretary. Any changes to interests declared either during the procurement process or during the term of any contract

subsequently entered into by the Relevant Organisation and the CCG must be notified to the CCG by completing a new declaration form and submitting it to the Board Secretary.

Relevant Organisations completing this declaration for must provide sufficient detail of each interest so that the CCG, NHS England and also a member of the public would be able to understand clearly the sort of financial or other interest the person concerned has and the circumstances in which a conflict of interest with the business or running of the CCG or NHS England (including the award of a contract) might arise.

If in doubt as to whether a conflict of interest could arise, a declaration of the interest should be made. Advice can be sought from the Chief Operating Officer.

Interests that must be declared (whether such interests are those of the Relevant person), include the following:-

The Relevant Organisation or any person employed or engaged by or otherwise connected with a Relevant Organisation (Relevant Person) has provided or it providing service or other work for the CCG or NHS England.

A Relevant Organisation or Relevant Person is providing service or other work for any other potential bidder in respect of this project or procurement process.

The Relevant Organisation or any Relevant Person has any other connection with the CCG or NHS England whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgments, decision or actions.

34

Declarations:

Name of Relevant Organisation:

Interests

Type of Interest Details

Provision of service or other work for the CCG or NHS England

Any other connection with the CCG or NHS England, whether personal or professional, which the public could perceive may impact or otherwise influence the CCG’s or any of its members’ or employees’ judgments, decisions or actions

Name of Relevant Person [complete for all Relevant Persons]

Interests

Type of Interest Details Personal interest or that of a family member, close friend or other acquaintance?

Provision of services or other work for any other potential bidder in respect of this project or procurement process the CCG or NHS England

Provision of services or other work for any other potential bidder in respect of this project or procurement process.

Any other connection with the CCG or NHS England, whether personal or professional, which the public could perceive may impair or otherwise influence the CCG’s or any of its members’ or employees’ judgments, decisions or actions.

To the best of my knowledge and belief, the above information is complete and correct. I undertake to update as necessary the information.

Signed:

On behalf of:

Date:

36

Appendix 4a – Declaration of Interests for Employees Template

NHS Lincolnshire West CCG member/employee /Governing Body member/committee or subcommittee

member (including committees and sub-committees of the Governing Body declaration form: financial and

other interests.

This form is required to be completed in accordance with the CCG’s Constitution and section 14O of The

National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition) regulations 2013

and the Substantive guidance on the Procurement, Patient Choice and Competition Regulations.

Notes:

NHS Lincolnshire West CCG will make arrangements to ensure that the persons mentioned above declare

any interest which may lead to a conflict with the interests of the CCG and/or NHS England and the public

for whom they commission services in relation to a decision to be made by the CCG and/or NHS England

or which may affect or appear to affect the integrity of the award of any contract by the CCG and/or NHS

England.

A declaration must be made of any interest likely to lead to a conflict or potential conflict as soon as the

individual becomes aware of it, and within 28 days.

If any assistance is required in order to complete this form, then the individual should contact the Board

Secretary. If a situation occurs that a conflict of interest could arise and advice is required, please contact

the Chief Operating Officer.

The completed form should be sent by both E Mail and signed hard copy to the Board Secretary.

Any changes to interests declared must also be registered within 28 days by completing and submitting a

new declaration form.

The register will be published on the CCG website and upon request addressed to the Board Secretary.

Any individual – and in particular members and employees of the CCG and/or NHS England – must provide

sufficient detail of the interest, and the potential for conflict with the interests of the CCG and/or NHS

England and the public for whom they commission services, to enable a lay person to understand the

implications and why the interest needs to be registered.

If there is any doubt as to whether or not a conflict of interest could arise, a declaration of the interest

must be made. If a situation occurs that a conflict of interest could arise and advice is required, please

contact the Chief Operating Officer


member, close friend or other acquaintance of the individual) include:-







and social care.

Any connection with a voluntary or other organisation (public or private) contracting for NHS services.



37

Any other role or relationship which the public could perceive would impair or otherwise influence the

individual’s judgement or actions in their role within the CCG.

If there is any doubt as to whether or not an interest is relevant, a declaration of the interest must be made.

If a situation occurs that a conflict of interest could arise and advice is required, please contact the Chief

Operating Officer

Declaration:

Name:

Position within or relationship with, the CCG or NHS England:

Interests

Type of Interest Details Personal interest or that of a family member, close friend or other acquaintance?

Roles and responsibilities held within member practices

Directorships, including non-executive directorships, held in private companies or PLCs

Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or with NHS England

Shareholdings (more than 5%) if companies in the field of health and social care

Positions of authority in an organisation 9e.g. charity or voluntary organisation) in the field of health and social care.

Any connection with a voluntary or other organisation contracting for NHS services

Research funding/grants that may be received by the individual or any organisation they have an interest or role in

[Other specific interests?]

38

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role within the CCG and/or with NHS England

To the best of my knowledge and belief, the above information is complete and correct. I undertake to

update as necessary the information provided and to review the accuracy of the information provided

regularly and no longer than annually. I give my consent for the information to be used for the purposes

described in the CCG’s Constitution and published accordingly.

Signed:

Date:

39

Appendix 4b - Declaration of Interests for Member Practices

NHS Lincolnshire West CCG member practices declaration form: financial and other interests.

This form is required to be completed in accordance with the CCG’s Constitution and section 14O of The

National Health Service Act 2006, the NHS (Procurement, Patient Choice and Competition) regulations 2013

and the Substantive guidance on the Procurement, Patient Choice and Competition Regulations.

Notes:

NHS Lincolnshire West CCG will make arrangements to ensure that the persons mentioned above declare

any interest which may lead to a conflict with the interests of the CCG and/or NHS England and the public

for whom they commission services in relation to a decision to be made by the CCG and/or NHS England

or which may affect or appear to affect the integrity of the award of any contract by the CCG and/or NHS

England.

A declaration must be made of any interest likely to lead to a conflict or potential conflict as soon as the

individual becomes aware of it, and within 28 days.

If any assistance is required in order to complete this form, then the individual should contact the Board

Secretary. If a situation occurs that a conflict of interest could arise and advice is required, please contact

the Chief Operating Officer.

The completed form should be sent by both E Mail and signed hard copy to the Board Secretary.

Any changes to interests declared must also be registered within 28 days by completing and submitting a

new declaration form.

The register will be published on the CCG website and upon request addressed to the Board Secretary.

Any individual – and in particular members and employees of the CCG and/or NHS England – must provide

sufficient detail of the interest, and the potential for conflict with the interests of the CCG and/or NHS

England and the public for whom they commission services, to enable a lay person to understand the

implications and why the interest needs to be registered.

If there is any doubt as to whether or not a conflict of interest could arise, a declaration of the interest

must be made. If a situation occurs that a conflict of interest could arise and advice is required, please

contact the Chief Operating Officer


member, close friend or other acquaintance of the individual) include:-







and social care.

Any connection with a voluntary or other organisation (public or private) contracting for NHS services.



Any other role or relationship which the public could perceive would impair or otherwise influence the

individual’s judgement or actions in their role within the CCG.

40

If there is any doubt as to whether or not an interest is relevant, a declaration of the interest must be made.

If a situation occurs that a conflict of interest could arise and advice is required, please contact the Chief

Operating Officer

Declaration:

Name:

Position within or relationship with, the CCG or NHS England:

Interests

Type of Interest e.g.:- Details Personal interest or that of a family member, close friend or other acquaintance?

Any Qualified Provider

Enhanced Services

Dispensing Practices

Roles and responsibilities held within member practices

Directorships, including non-executive directorships, held in private companies or PLCs

Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the CCG and/or with NHS England

Shareholdings (more than 5%) if companies in the field of health and social care

Positions of authority in an organisation 9e.g. charity or voluntary organisation) in the field of health and social care.

Any connection with a voluntary or other organisation contracting for NHS services

Research funding/grants that may be received by the individual or any organisation they have an interest or role in

[Other specific interests?]

Any other role or relationship which the public could perceive would impair or otherwise influence the individual’s judgement or actions in their role

41

within the CCG and/or with NHS England

To the best of my knowledge and belief, the above information is complete and correct. I undertake to

update as necessary the information provided and to review the accuracy of the information provided

regularly and no longer than annually. I give my consent for the information to be used for the purposes

described in the CCG’s Constitution and published accordingly.

Signed:

Date:

42

Appendix 5 – Procurement Template

[To be used when commissioning services from GP Practices, including provider consortia, or organisation in

which GPs have a financial interest]

NHS Lincolnshire West Clinical Commissioning Group

Service

Question Comment/Evidence

How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities? How does it comply with the CCG’s commissioning obligations?

How have you involved the public in the decision to commission this service?

What range of health professionals have been involved in designing the proposed service?

What range of potential providers have been involved in considering the proposals?

How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?

What are the proposals for monitoring the quality of the service?

What systems will there be to monitor and publish data on referral patterns?

Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available? Have you recorded how you have managed any conflict of potential conflict?

Why have you chosen this procurement route?

What additional external involvement will there be in scrutinising the proposed decisions?

How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process and award of any contract?

43

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) or direct award (for services where national tariffs do not apply)

How have you determined a fair price for the service?

Additional question when qualifying a provider on a list or framework or pre selection for tender (including but not limited to any qualified provider) where GP practices are likely to be qualified providers

How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for proposed direct awards to GP providers

What steps have been taken to demonstrate that the services to which the contract relates are capable of being provided by only one provider?

In what ways does the proposed service go above and beyond what GP practices should be expected to provider under the GP contract.

What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

44

Appendix 6

Personal Benefit Declaration

Any offers of hospitality, personal gifts (other than inexpensive items, such as pens/calendars etc.)

and sponsorship should be declared. Gifts of over £25 in value and offers of hospitality and

sponsorship should be authorised by your line manager and for gifts, personal hospitality or

sponsorship over the value of £200, authorisation from the Chief Operating Officer must be sought;

Authorisation must be PRIOR to acceptance.

Name: Job

Title:

Directorate: Tel No:

Details of the benefit

Name of organisation or individual providing benefit

Nature and purpose of benefit

Date

Estimated value

Other information

Decision of person offered benefit

Declined Accepted

If accepted, please have this form authorised by your line manager

Signed Dated

Authorisation by Line Manager (Limit is £200 – larger sums must be authorised by the Chief Operating Officer)

Yes No

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Appendix 7

Commercial sponsorship approval request

The following form must be completed by the manager entering into the arrangement. It must be submitted in ADVANCE to the Board Secretary to the Governing Body, Lincolnshire West CCG, Cross O’Cliff, Bracebridge Heath, Lincoln, LN4 2HN

Name of person organising the event

Directorate

Description of event/arrangements for which sponsorship is proposed

Date of event

Venue for event

Number of attendees

Costs

Hire of venue

Speakers

Catering per head

Other costs (specify)

Total Cost of event/publication

Name of sponsors Business of sponsors Value of sponsorship (£)

Role of sponsor/benefits to benefit

Would this event/publication go ahead Without sponsorship

Other supporting information (please attach separate sheet if necessary

46

Declaration of Director I believe the above sponsorship arrangements to fit within the guidance provided in the Lincolnshire Primary Care Trust commercial sponsorship policy.

Signed: Name:

Job title: Date:

Action

Signature: Secretary to the Governing Body

Signature: Chief Finance Officer (for significant projects and those with a value of over £5,000)

Date approval granted:

Date applicant informed of decision:

Date submitted to the Audit Committee:

Comments (if any)

Guidance Notes

1. Sponsorship may be used only if there are of benefit to the health community such as for “one- off” events, publications, all members, Office Holders and staff ing or education. For example:

It is designed to allow reasonable refreshments to be provided at a training event and

meet the reasonable expenses of an external speaker. To meet a proportion of the costs of producing publicity material on a subject not directly related to the sponsor’s business.

A prize for a health promotion competition.

2. Forms should normally be submitted in advance and only in very exceptional circumstances may be submitted retrospectively. Any retrospective submission must be accompanied by a full explanation as to why the submission has been made retrospectively.

3. Completed forms will be held and a register will be kept by the Board Secretary to the Governing Body for submission to the Audit Committee on a quarterly basis. One purpose of the monitoring will be to ensure that financial support is being shared amongst a variety of partners.

4. The Board Secretary to the Governing Body will inform applicants once approval for the sponsorship is granted or if there are any problems with the proposal.

5. For more substantial or ongoing arrangements, including those where the individual amounts are less than £5,000 but the total commitment may in the future exceed £5,000; the proforma should be accompanied by a detailed proposal for accepting the sponsorship. This should include the “value added” a sponsor would bring, the benefits to the sponsor and an option appraisal of any alternative(s). It should also include reference to the companies that will be invited to tender to be part of the project. Requests should be in the form of a letter to the Board Secretary to the Governing Body who will submit it to the next available meeting of either the Audit Committee or Governing Body, whichever is the sooner. This letter may not be submitted retrospectively.

47

Appendix 8 Seeking sponsorship from the commercial sector

Introduction

1. Most approvals under this policy have concerned funding to pay for the venue, refreshments and speaker fees for meetings organised by Lincolnshire West CCG; sponsorship has occasionally been sought for publications. Typically, sponsorship tends to have been offered by the company rather than having been sought by Lincolnshire West CCG, has been one-off, and the sums involved have been relatively small. Given the need to maximise the availability of resources for the NHS, and the apparent willingness of pharmaceutical companies to provide ongoing funding for large projects of mutual advantage, this policy provides a process for proactively seeking funding from selected companies, which would apply to all projects where the level of funding requested exceeded £5000.

Process

2.

Identification of projects potentially suitable for external sponsorship

Executive directors agree which projects are suitable and select suitable companies to approach (normally, a minimum of three companies to be approached for any one project)

Direct approach to selected companies asking them to provide sponsorship for the proposed project. Total funding could be sought from one company, or partial funding from a number of companies

On a case-by-case basis, approval sought from the Board, in the public session, to the proposal, prior to final signing with the company(ies) concerned

Monitoring of all projects approved under this process by the Audit Committee at its formal meeting.

Principles

3. All proposals would be required to conform to the following principles:

Compliance with the organisations corporate governance manual, particularly the hospitality and commercial sponsorship policy.

Compliance with the code of conduct of the Association of the British Pharmaceutical

Industry. Projects must not result in personal financial gain or benefit for Lincolnshire West CCG

employee. Projects must not favour the products of one company over any other, unless there is

clear and well documented impartial evidence of superior efficacy, and/or financial benefits to the health community

48

Clear legal advice will be taken in respect of any contractual terms offered by a

potential sponsor

In all cases Lincolnshire West CCG will ensure that the use of the organisation

name and intellectual material by a potential sponsor is explicitly forbidden (unless clearly agreed by the Board).

49

Appendix 9

Commercial Sponsorship Agreement

To: .............................................................................................................................. .

Of (Name of Company): ...............................................................................................

Date of Event:………………………………………………………………………….…………….

Thank you for agreeing to sponsor the above meeting to be held on (date): ........................... ..

At (venue): .............................................................................................................................. .

Terms and conditions of sponsorship

Sponsorship is accepted on the understanding that:

1. The course organiser retains overall control of the event outlined above.

2. The sponsor does not have a right to formally present teaching or research materials.

3. The sponsor does not use Lincolnshire West CCG or the all members, Office Holders and staff of Lincolnshire West CCG to promote products outside the meeting.

4. Any stand the sponsor uses to promote products is to be outside the main meeting room where practical.

5. The sponsor will remove all promotional materials and vacate the main meeting room prior to the main meeting commenced.

Details of sponsorship (e.g. room hire, food, speakers, including responsibility for payment to suppliers and other financial details):

Please confirm that the terms detailed above are accepted

Signed: ............................................... Print Name: .....................................................

Position held: ............................................................................................................

Company: .............................................................................................................

Meeting organiser should retain a copy of this form and a copy to be supplied to Sponsor