The next meeting of the NHS Stockport Clinical Commissioning Group Governing Body will be held at Regent House, Stockport at 10.00am on 29 November 2017.

Agenda item Report Action Indicative Timings Lead

1 Apologies Verbal To receive and note 10.00 J Crombleholme

2 Declarations of Interest Verbal To receive and note

3 Approval of the draft Minutes of the meeting held on 27 September 2017

Attached To receive and approve

J Crombleholme

4 Actions Arising Attached To comment and note

10.05 J Crombleholme

5 Notification of Items for Any Other Business

Verbal To note and consider

10.10 J Crombleholme

6 Patient Story Video 10.10 J Crombleholme

7 Corporate Performance Reports

a) Finance Report

Written Reports

To receive, assure and note.

10.20

M Chidgey

8 Stockport Together Highlight Report

Written Reports

To consider 10.35 T Ryley

9 Locality Chairs’ Update Written Report

To receive and note 10.50 Locality Chairs

10 Report of the Chair Verbal Report

To receive and note 11.05 J Crombleholme

11 Report of the Chief Operating Officer to include the following:

• Q2 Assurance Update• Primary Care CQC

Ratings

Written Report (To

Follow)

To discuss and approve

11.10 G Mullins

NHS Stockport Clinical Commissioning Group Governing Body Part 1

A G E N D A

Chair: Ms J Crombleholme Enquiries to: Laura Latham

07827 239332 Laura.latham1@nhs.net

001

• Winter Planning • Complaints Themes • Integrated

Commissioning MCP Procurement

12 Report of the Chief Clinical

Officer to include the following:

• Strategic Partnership Board Briefing

• Healthier Together Update

• EUR Ratifications

Written Report

To consider the information and ratify the EUR Policies as listed.

11.25 R Gill

13 CCG Commissioning Plans

• Commissioning a Specialist Stroke and Neurological Integrated Community Rehabilitation Service in Stockport

• Commissioning a Best Practice Pathway for Cardiac Imaging

• Procurement for a Spinal Assessment and Treatment Service

Written Report

To consider recommendations

11.40

M Chidgey

14 Reports from Committees

• Quality Committee (To follow)

• Finance and Performance Committee

Written reports

To note the content of the reports

12.10

A Rolfe P Carne

15 Any Other Business

Verbal 12.20

J Crombleholme

Date, Time and Venue of Next meeting The next NHS Stockport Clinical Commissioning Group Governing Body meeting will be held on 31 January 2018 at 10am at Regent House, Stockport. Potential agenda items should be notified to stoccg.gb@nhs.net by 3 January 2018

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NHS STOCKPORT CLINICAL COMMISSIONING GROUP MINUTES OF THE GOVERNING BODY

MEETING HELD AT REGENT HOUSE,

STOCKPORT ON WEDNESDAY 27 SEPTEMBER 2017

PART 1

PRESENT

Mrs J Crombleholme Lay Member (Chair) Mrs G Mullins Chief Operating Officer Mr M Chidgey Chief Finance Officer Mrs A Rolfe Executive Nurse Dr P Carne Locality Chair: Cheadle and Bramhall Dr J Higgins Locality Chair: Heatons and Tame Valley Dr D Kendall Secondary Care Consultant Ms C Morgan Lay Member for Primary Care Mr J Greenough Lay Member for Finance and Audit Dr V Owen Smith Clinical Director Public Health Dr R Gill Chief Clinical Officer Dr Lydia Hardern Locality Chair: Stepping Hill and Victoria Dr A Johnson Locality Chair: Dr C Briggs Clinical Director Quality and Provider Management

IN ATTENDANCE Mr T Ryley Director of Strategy and Performance Dr D Jones Director of Service Reform Mrs L Latham Associate Director Corporate Governance Mrs S Carroll Healthwatch Stockport 38/17 APOLOGIES Apologies were received from Dr P Carne, Councillor McGee and R Roberts 39/17 DECLARATIONS OF INTEREST Dr J Higgins, Dr L Hardern, Dr R Gill, Dr C Briggs and Dr A Johnson declared an interest in Item 15 Primary Care Commissioning Committee report. The nature of the interest being that a decision of the Committee being reported to the Governing Body related to approvals to Immunisation Schemes which would result in additional incentive monies being made available to General Practices in Stockport and therefore was a pecuniary interest. The Chair agreed that those who had declared pecuniary interest as GPs could remain in the meeting, and partake in the discussion as the item was for noting only. 40/17 APPROVAL OF THE DRAFT MINUTES OF THE GOVERNING BODY MEETING HELD ON 12 JULY 2017 The minutes of the meeting held on 12 July 2017 were approved as a correct record. 41/17 ACTIONS ARISING

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26 04 2017 – Actions Arising – Digital element of Stockport Together Programme update to be reported to Governing Body in Autumn. 26 04 2017 – Patient Story – Action can be removed from the log. 28 06 2017 – Pharmacy Review – This action was amended to note that discussion on local strategy development and commissioning for community pharmacy services would take place at the relevant meeting within the Greater Manchester context and not the Primary Care Commissioning Committee given it was not a CCG commissioning responsibility. 42/17 ANY OTHER BUSINESS There were no items of any other business on this occasion. 43/17 PATIENT STORY The Governing Body heard from a patient who had undergone 16 years of diagnostic tests and investigations following an episode where she had collapsed at work. She noted that she had experienced a constant cycle of tests, scans and referrals between different medical specialties to try and reach a diagnosis. She described a number of occasions where she had proactively chased her own results, had experienced delays and cancellations in terms of appointments and had felt a lack of respect from some of the clinicians she had seen. She noted that the root cause of her issues had still not been confirmed and she commented that lack of sharing of her information and case history over the episode of care had not assisted her to feel confident that her symptoms can be managed well and the embarrassment of continually falling over and hurting herself could be mitigated. She concluded by expressing sincere thanks to her GP, Dr J Higgins who had played a pivotal role in trying to manage and coordinate her care and assist her. In response to the Patient Story the Governing Body considered the following:

• The importance of the Outpatient Services Transformation being implemented as part of the Stockport Together Programme in particular the focus on managing patient care holistically, in particular for those with complex and long term conditions.

• The balance between clinicians seeking to confirm and diagnoses where possible, managing patient expectation where a diagnosis cannot be made and seeking to work collaboratively with wider health and care colleagues to put in place wider support including falls assessments, quality of life improvements and adaptations.

• The importance of health and care professionals communicating proactively with patients and the potential for IM&T to transform patient communication channels and increase effectiveness and efficiency.

• The focal role of GPs in coordinating patient care as part of the MCP Model and the resource impact on GPs of this role.

• The benefits which could be achieved for patients where they access medical records electronically and can use them to self-manage and understand medical conditions.

Resolved: That Governing Body:

1. Note the Patient Story and express thanks to the patient for sharing her experience. *Dr A Johnson joins the meeting. 44/17 CORPORATE PERFORMANCE REPORTS (a) Strategic Impact Report T Ryley provided an overview of the CCG’s performance against key indicators in the organisation’s Operational Plan for the period April to July 2017. He highlighted in particular increases in Accident and Emergency Admissions and the positive impact of the Ambulatory Ill Service. He explained that the impact of the neighbourhood model of care and intermediate care step-up services would, once implemented should reduce the numbers of individuals attending Accident and Emergency should the benefits be realised. He also highlighted, early indications on positive performance against plan for prescribing indicators and the impact of the reporting measures for non-elective admissions figures.

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In considering the CCG’s performance the following elements were highlighted:

• Emerging evidence that plans in place to increase assessment capacity within Stockport Foundation Trust would reduce the pressure on speciality beds and the need to capture and monitor the differentiation between long term and short term stays.

• The importance of ensuring performance information reported to Governing Body provided opportunity for trend analysis to provide assurance and the review of the CCG’s Performance Framework which was currently underway.

• The increase in patients attending Accident and Emergency and being treated and discharged the same day as linked to the comments of patients gathered through the Listening Exercise whereby patients would rather remain at home where possible to receive their care.

• The focus of the Stockport Together Programme in managing health and care closer to patient’s homes and within the community and the importance of the neighbourhood model of care in delivering this ambition.

• Examples where patients had experienced slower than anticipated discharge in order to avoid hospital admission.

• Impact of positive work being undertaken in Care Homes across Stockport on performance in a number of areas.

Resolved: That Governing Body: 1. Note the report 2. Request that the data relating to long term condition variance and prevalence be confirmed and

clarified by T Ryley. (b) Finance Report M Chidgey provided an overview of the CCGs financial position for Month 5. In particular he highlighted that the organisation’s year to date and forecast outturn positions were in line with plan, including the required surplus of £1.32m. He noted that a net risk of £2.60m remained which was not included in the forecast position which was based on the assumption, with risk that the CIP target of £17.4m would be achieved. He highlighted performance in particular against mental health investment target and drew Governing Body’s attention to Table 7 in the report which included net risks and mitigations. He confirmed that the CCG’s Leadership Team had been reviewing CIP delivery in detail and a plan was under development to achieve the requirements. The Procurement element of the report was considered by the Governing Body and M Chidgey noted the recommendation relating to the Supported Living for Adults with a Learning Disability Service. A discussion took place regarding the nature of the risks relating to CIP and in particular the impact of the upcoming wider period and potential increases to Emergency Department attendances and admissions, referral to treatment times and referral figures which could impact further on the CCGs and wider system’s financial position. M Chidgey clarified the national requirements for maintaining a surplus which whilst accounted for as part of the CCG’s ledger was not available for local investment but was part of a wider national system for managing Provider organisation deficits. A Johnson noted the importance of ensuring this requirement could be clearly articulated to the CCG’s GP Members. Resolved: That Governing Body: (i) Note the year-to-date position is in line with plan. (ii) Note that an outturn breakeven position is forecast to be delivered. (iii)Note that net risks totalling £2.60m are not reflected within the forecast position and that therefore improvement actions are highly likely required to deliver the plan (iv)Note that the position includes provision in full of the 0.5% non-recurrent uncommitted reserve as required by NHS England business rules. (v) Note that the Mental Health financial performance target is forecast to be achieved.

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(vi)Approve the recommendation to offer the incumbent provider of supported living for adults with a learning disability services a 3 year contract with an option to extend by another 2 years. (c) Resilience and Compliance The Governing Body considered the CCG’s performance against statutory duties and constitutional targets for Quarter 1, the period April to June 2017/18. G Mullins noted that indicators relating to Continuing and Complex Health Care had been included as part of the report in addition to performance shown as part of the Integrated Assurance Framework Assessment (IAF.) G Mullins noted the continued system focus on improving urgent care performance and the plans in place and implemented to manage the multiple and complex factors impacting on emergency department performance, hospital and system flow and capacity for rapid assessment both based within the community and acute settings where required. She confirmed that the short term recovery plan implementation was in its 6th week and CCG and Social Care Commissioners had been working collaboratively to ensure required system capacity across nursing, care and home care was in place. Other issues highlighted as part of planned improvements were triage systems (including GP streaming) implementation and embedding of SAFER within Stockport Foundation Trust, staffing and workforce plans (immediate and longer term.) Planning for Winter was noted to be underway system wide with the Plans being finalised ahead of the submission deadline. Key issues highlighted as part of the discussion included:

• CCG performance against the agreed trajectory to achieve 90% for the 4 Hour Emergency Department target in July 2017 as aligned to current performance.

• Importance of commissioning the 7 Day Service and ensuring effective embedded delivery. • Key risks in the delivery of required improvements in Urgent Care performance including workforce

availability and capacity, continued management of capacity with care home, residential care and home care market, embedding of SAFER.

• The national grading to Stockport Foundation Trust as Category 4 for Urgent Care performance. • High level of spend on urgent care as compared to other areas • Assurance regarding the anticipated achievement of Quarter 2 performance on the 62 day cancer

target and an explanation of the reasons for non-compliance in Quarter 1. • Performance and investment for children and young people’s mental health and the importance of

continuing to ensure that the ambitions and investment decisions of all Stockport Partners are aligned under a new Mental Health Strategy being developed collaboratively by Health and Care Commissioners.

Resolved: That Governing Body:

1. Notes the content of the report and the action being taken to address areas of poor performance or known challenges including the focus on Urgent Care performance.

45/17 STOCKPORT TOGETHER HIGHLIGHT REPORT T Ryley provided on overview of activity underway as part of the Stockport Together Programme including the proposed stakeholder consultation, development of the Provider Alliance Agreement, increased pace in implementation of the new models of care in neighbourhoods, including recruitment initiatives and recent attendance of representatives from the Greater Manchester Health and Social Care Partnership at the Stockport Together Programme Board. The implementation of revised Programme Governance was noted and key risks highlighted to the Governing Body. In particular the increased requirement for change capacity and expertise within the programme was noted and development of detailed workforce plans were noted to be a key risk to successful delivery. It was confirmed that Commissioner representation on the Provider Implementation Board would enable oversight and assurance regarding the delivery of programme milestones and associated benefits. A question was raised regarding the development of the new Provider Organisational Form and the re-

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aligned Senior Management Team which would support the delivery of the services changes. The role of the Alliance Agreement was noted. D Jones confirmed that a 2 year evaluation of the programme was due to commence imminently. It was noted that key to ensuring structural changes were embedded was a continued focus on organisational development and culture change and it was a priority area of focus across the Programme. The Board considered how the format of the report could be developed to ensure a Commissioner focus on the work across the Programme. Resolved: That Governing Body: Notes the update report. 46/17 LOCALITY CHAIR’S UPDATE It was noted that the report in future would be a written report following the re-alignment of the Locality Chair’s meeting. J Higgins confirmed that Locality Chairs had recently considered pneumococcal flu vaccinations and feedback to NHS Stockport Foundation Trust on contact compliance. A Johnson confirmed that discussions had also taken place regarding the overall management of out patient referrals and sharing of good practice. Resolved: That Governing Body: Notes the update report. 47/17 REPORT OF THE CHAIR J Crombleholme confirmed that there had been no Part 2 meeting prior to the Part 1 meeting. 48/17 REPORT OF THE CHIEF OPERATING OFFICER G Mullins provided an overview of the report including the recent Quarter 1 Assurance meeting with the Greater Manchester Health and Social Care Partnership and the continued focus on prioritising transformation and performance work. Full compliance on the EPRR (Emergency Preparedness Resilience and Response) was reported and the positive work in supporting nursing and care homes highlighted to the Governing Body. The alignment of local strategy with the recommendations of the Greater Manchester Commissioning Review was noted. V Owen Smith provided an overview of the smoking prevalence in Stockport within the context of the Strategy and highlighted the challenges in the less affluent areas and in particular for smoking during pregnancy. Resolved: That Governing Body: Notes the report of the Chief Operating Officer. 49/17 REPORT OF THE CHIEF CLINICAL OFFICER R Gill introduced the report and the following updates on the key elements were provided:

• Healthier Together – D Jones noted that recent activity had been focussed on the business and economic cases in particular on value for money and affordability. The Chief Finance Officers were noted to be working collectively to consider the overall financial challenges. Clinical pathway re-design was noted to be underway and the Public Voice element of the programme had been undertaking positive work, in particular focussing on the transport implications of the model.

• Healthier You: NHS Diabetes Prevention Programme (NDPP) - V Owen Smith provided an overview of the Programme and the impact prevention was having locally. She noted that patient engagement had been strong and support from Practices was required to enable.

• Stockport General Practice Performance Assessment 2016/17 – R Gill provided an overview of the assessment and noted the positive performance of General Practice in Stockport on a number of key areas including care planning for dementia, one year cancer survival rates and patient experience in general practice. Congratulations were noted to Bracondale Medical Centre which

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was in the top 10 nationally for overall patient satisfaction arising from the National Annual Patient Survey and all those Practices in Stockport which had received positive patient feedback. The Board noted the continued focus on mental health investment locally and in line with the Greater Manchester Investment Framework. The impact of Devolution was noted to be positive in beginning to standardise policies across health and care.

Resolved: That Governing Body: Notes the report of the Chief Clinical Officer. 50/17 CONSULTATION AND ENGAGEMENT T Ryley introduced the suite of reports which were being considered by Governing Body and formed the ongoing engagement work being undertaken in Stockport.

a) The Statement of Involvement

L Hayes provided an overview of the Statement of Involvement for 2016 / 2017 which outlined the CCG’s engagement activity in line with its statutory duties. She noted that 2670 people had engaged with the organisation across the year and a range of different methods had been used including local groups, public meetings, focus groups and online surveys. She noted that a different approach to the Patient Panel had been agreed and was being rolled out as part of the Citizen’s Panel in 2017/18. A discussion about the continued Governing Body oversight of complaints across the year and analysis of trends took place. G Mullins confirmed that 6 monthly updates were provided as part of the Chief Operating Officers Report. C Morgan expressed thanks on behalf of the Patient Panel to the Communications and Engagement Team for their support during the year.

b) The Listening Exercise

The Governing Body considered the key themes emerging from the clinically led Listening Exercise which was undertaken across Stockport and included 12 specific events. She noted that workforce pressures, including GP time pressures, mental health needs and investment, protecting the NHS from potential privitisation, tests to be applied to make decisions re future acute based bed capacity and concerns around presentation of messages to the public regarding receiving care in the best place as appropriate to need which may or may not be within a hospital setting were noted as key emerging themes.

The Governing Body considered the importance of ensuring views from the public were representative of all groups, including those with protected characteristics and were assured that the continued development and refinement of Equality Impact Assessments based on continued engagement. S Carroll commented that some of the daytime events had not proven as popular as some of the evening sessions. T Ryley noted that as part of the work there had been a variety of approaches undertaken, including sessions in health centres and other community venues and opportunities to further explore digital engagement methods were being considered as part of investments in digital technology. He noted that a strategic approach to IM&T would be considered by Governing Body later in the year. The development of the neighbourhood model as considered including the range of services to be included and the opportunity to shape service design through co-production between a range of professionals across health and care with the public. The role of Patient Participation Groups was noted as a key mechanism for local engagement.

c) The Consultation Mandate

T Ryley provided an overview of the mandate noting that it was a key principles based approach to stakeholder consultation but that views were sought from both targeted groups and the wider population. He drew Governing Body’s attention to the questions included within the consultation and the focus on providing further evidence which would be taken into account. He highlighted the areas

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which were open to influence as part of the consultation. He confirmed that the mandate had been considered by the Council’s Overview and Scrutiny Committee for Health and would be considered by Cabinet on 5 October 2017. The consultation was planned to run from 10 October until the end of November with final decision making on the output anticipated in January 2018. The dates for decision making would be confirmed and added to the mandate. Governing Body sought assurance about the continued development of the equality impact assessment element of the work. T Ryley confirmed that the consultation documents published would include an initial equalities statement which will remain under continual review and be used to further develop the Equality Impact Assessments linked to the individual Outline Business Cases. The list of stakeholders attached to the mandate was considered and it was noted that there had been specific focus on ensuring active and targeted engagement with groups with protected characteristics as defined by the Equality Act. The Stockport Together Programme Board would oversee the practical operation of the consultation on behalf of Commissioners. In response to questioning the following elements were noted:

• The consultation was open to all individuals, groups and stakeholders who wished to respond. • Clarity was required regarding the focus on adult stakeholders as aligned to the proposals for

changes to models of care within the Outline Business Cases. • It was acknowledged however that stakeholders representing children were welcome to

respond. • The focus on reducing health inequalities and improving health outcomes was noted to be

central to the approach and therefore proposed as a key message which should be clear throughout all consultation documentation.

Resolved: That Governing Body:

(a) Received the Statement of Involvement for 2016/17 noting that an overview of complaints would be provided in the Chief Operating Officer’s report at a future meeting.

(b) Considered the feedback from the Listening Phase Report as part of consideration of the Consultation Mandate.

(c) Noted the areas open to influence within the Consultation Mandate. (d) Approved the mandate and stakeholder consultation approach noting that the CCG Chief Operating

Officer and the SMBC Corporate Director, Services to People (as Programme Senior Responsible Officers) in consultation with appropriate CCG members have the delegated power to agree the final detail of the consultation on behalf of the respective organisations following approval of the mandate.

(e) Note that the Governing Body will consider the consultation results and make a formal decision on the approach to planning and funding services as its meeting scheduled for 31 January 2018.

51/17 BOARD ASSURANCE FRAMEWORK The Governing Body considered the CCG’s strategic position as at 18 September 2017, noting that the complex transformation environment in which the CCG was currently operating impacted significantly on the organisation’s overall risk profile and appetite. L Latham confirmed that the framework had been reviewed as part of a horizon scanning exercise for the 2017/18 year and that mitigations had been a significant part of the work. A discussion took place regarding a number of key strategic risks, in particular those new risks which had been added including General Practice Reform and delivery of the Healthier Together Programme. Risk 3 relating to membership engagement was noted to be a communications risk but within the wider corporate framework of the CCG. Future ownership and mitigation of the risk would be considered at the next review of the Framework. Resolved: That Governing Body:

1. Notes the revised Board Assurance Framework as updated on 18 September 2017.

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2. Notes the revised areas of likelihood and risk impact re-scoring and in particular, those strategic risks which are graded as extreme within the Framework.

52/17 REPORTS FROM COMMITTEES (a) Quality Committee

A Rolfe provided an overview of the work of the CCG’s Quality Committee in particular noting the focused piece of work in serious incident investigation at Stockport Foundation Trust. She highlighted the removal of Referral to Treatment Times (RTT) from the issues log and noted that issues relating to the Emergency Department issues. Governing Body noted that capacity within the CCG’s Safeguarding Team had been removed as an issue as new staff had been successfully recruited and were now in post. Resolved: That the report be noted.

(b) Finance and Performance Committee V Owen Smith provided an update on the work of the Committee providing assurance on the delivery of CIP, performance against the CCG’s plans and consideration of benchmarking on prescribing including high cost, low value drugs. Resolved: That the report be noted.

(c) Primary Care Commissioning Committee

C Morgan provided an overview of the work of the CCG’s Primary Care Commissioning Committee in particular noting the approval of a flu vaccination scheme for children aged 2 – 4 years, progression of a dispersal policy for the management of patients as part of a practice closure and a range of primary care quality matters.

Resolved: That the report be noted.

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Actions arising from Governing Body Part 1 Meetings

NUMBER ACTION MINUTE DUE DATE OWNER AND UPDATE

26 04 2017 Actions Arising An update on the digital element of the Stockport Together Programme would be provided to Governing Body in Autumn 2017.

04/17 July 2017 T Ryley

26 04 2017 Stockport Together Highlight Report C Briggs to provide a briefing to the Governing Body on the 100 Day Rapid Testing Phase 2 work.

10/17 May 2017 C Briggs

28 06 2017 Stockport Together Highlight Report Discussion regarding funding for the continuation of MDT’s to be considered by CCG Leadership Team and communicated to Locality Chairs.

24/17

July 2017

M Chidgey

28 06 2017 Scrutiny Review Pharmacy Local strategy development and commissioning for community pharmacy services be discussed by the relevant Committee at Greater Manchester.

29/17 September 2017

G Mullins

NHS Stockport Clinical Commissioning Group 27 September 2017

011

27 09 2017 Patient Story Note the Patient Story and express thanks to the patient for sharing her experience.

43/17

October 2017

L Latham

27 09 2017 Strategic Impact Report

1. Request that the data relating to long term condition variance and prevalence be confirmed and clarified by T Ryley.

44/17

November 2017

T Ryley

012

Finance Report for the period ending 31st October 2017 – Month 7

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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Executive Summary

What decisions do you require of the Governing Body?

(i) Note the year-to-date position is in line with plan. (ii) Note that an outturn breakeven position is forecast to be delivered. (iii) Note that net risks totalling £1.60m are not reflected within the forecast

and that a plan to mitigate the net risk has been developed and implemented.

(iv) Note that the position includes provision in full of the 0.5% non-recurrent uncommitted reserve as required by NHS England business rules.

(v) Note that the Mental Health financial performance target is forecast to be achieved.

(vi) Note that a recurrent deficit of £1.71m is currently forecast to be carried forward into 18/19 and the risks associated with this.

(vii) Note that CCG procurement policy decisions continue to be published on the CCG website.

Please detail the key points of this report The YTD and forecast outturn positions are in line with the planned in year surplus of £1.32m, however there remains net risk of £1.60m which is not included within the forecast position. As a result of activity levels being above planned levels, non-delivery of recurrent CIP and an increase in the number of CHC placements a £1.71m forecast recurrent deficit will be carried forward into 2018/19. What are the likely impacts and/or implications? Non-delivery of NHS England business rules and performance targets will result in increased scrutiny and will impact on the CCG’s assurance rating. How does this link to the Annual Business Plan? As per 2017/18 Financial Plan. What are the potential conflicts of interest? N/A Where has this report been previously discussed? All issues have been on the agenda of the Finance and Performance Committee, this specific report is being presented for the first time. Clinical Executive Sponsor: Ranjit Gill Presented by: Mark Chidgey Meeting Date: 29th November 2017 Agenda item: Reason for being in Part 2 (if applicable) N/A

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Report of the Chief Finance Officer

1.0 Introduction This report provides an overview of the CCG’s performance against

Statutory Financial Duties and Financial Performance Targets highlighting both the year to date and forecast positions for 2017/18.

This report provides an update on:-

• The financial position as at 31st October 2017 • The forecast outturn position for 2017/18

2.0 Statutory Financial Duties and Performance Targets As a CCG we are required to deliver statutory duties and financial

performance targets that we have approved as a Governing Body. Table 1 below RAG rates our financial performance on both a ‘Year to Date’ (YTD) and Forecast Outturn basis.

Table 1: Statutory Duty and Performance Targets

Area Statutory Duty Performance YTD

Performance Forecast

Revenue (Dashboard

Table 1)

Not to exceed revenue resource

allocation

Running Costs

(Dashboard Table 1)

Not to exceed running cost

allocation

Capital – (Note: The

CCG has not received a

capital allocation in

2017/18)

Not to exceed capital resource

allocation N/A N/A

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Area Performance Target

Performance YTD

Performance Forecast

Revenue

Underspend

revenue resource allocation by

£1.32m.

Cash (Appendix 1

Table 9)

Operate within the maximum

drawdown limit

Business Conduct

(Appendix 1 Table 8)

Comply with Better Payment Practices

Code

0.5% Uncommitted

Non-Recurrent Reserve

Create a uncommitted 0.5%

non-recurrent reserve

CIP (Appendix 1

Table 6)

Fully deliver planned CIP

saving

Mental Health Financial

Performance Target

Growth in Mental Health spend is at

least equal to programme

allocation growth

Net Risk (Appendix 1

Table 7)

All risk to be fully mitigated (NIL Net

Risk)

Integrated Assurance Framework

(IAF)

Finance Rating (Q2 Provisional)

From 2017/18, NHS England moved to performance managing CCGs financial performance on an in-year basis. Because NHS Stockport CCG’s 16/17 plan was below the national target level in 16/17 our financial performance in 2017/18 must compensate for this and we will be measured against delivering a £1.32m in-year surplus. The CCG’s statutory surplus forecast of £8.33m is reported in Appendix 1 Table 4 and is categorised between in-year surplus of £1.32m and prior year cumulative surpluses of £7.01m (this includes £4.26m surplus

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generated by releasing the 1% uncommitted risk reserve in 2016/17) carried forward from 2016/17. As required by the 2017/18 NHS Planning Guidance, the CCG has created a 0.5% (1.0% 2016/17) uncommitted reserve. In the event that the national NHS financial position deteriorates during the year the CCG will be required to release its 0.5% reserve, as a result surpluses will increase by £2.00m. The finance Quarter 2 Integrated Assurance Framework (IAF) rating has provisionally been assessed as AMBER. The AMBER rating is specifically related to the month 6 CIP delivery forecast being less than 90% of plan. It is forecast that the rating will move from AMBER to GREEN by the end of the financial year.

3.0 Financial Position as at 31st October 2017 – Month 7

The financial position as at month 7 is summarised in Table 2 below with further detail provided in Appendix 1 to this report.

Table 2: Summary of Financial Position at Month 7

Plan Actual (Favourable) / Adverse Variance

(Surplus) / Deficit

(Surplus) / Deficit

£000s £000s £000s Month 7 YTD (769) (769) 0 Year End Forecast (1,318) (1,318) 0

The CCG has reported a YTD surplus of £0.77m and a forecast outturn surplus of £1.32m in line with plan. The forecast outturn includes a CIP delivery shortfall of £0.51m after utilising contingency of £2.23m to offset the CCG CIP plan. However, members should note the net risk of £1.60m, which is not included within the forecast position. The net risk is predominately related to potential acute activity growth being above planned levels and a further impact of the increased number of Continuing Healthcare (CHC) placements.

4.0 Programme Expenditure

Acute Acute contract spend is £1.17m higher than year to date plan and forecast to overspend by £1.62m mainly due to non-elective over performance, due in part, to a change in clinical coding guidance whereby sepsis is used as the primary diagnostic code. There has also been a shift in outpatient first and follow-up activity to outpatient

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procedures. The full reason for this shift in outpatient activity is still under review.

Community Health The forecast overspend of £0.30m in Community Health is due to an increase in community neuro-rehabilitation placements. Continuing Care The forecast overspend of £0.64m is primarily due to an increase in the number of placements which aligns with changes to CHC process to reduce pressure on the acute system, in particular to reduce the number of Delayed Transfers of Care (DTOC). In addition, 4 high cost children’s packages have been agreed which have a total cost of £0.38m per annum. Mental Health The Mental Health YTD over spend of £0.16m and forecast outturn over spend of £0.40m reflects funding costs associated with older people mental health services. The CCG is committed to implement all planned Mental Health schemes and investments in line with our local investment strategy.

Prescribing

The latest information from the NHSBSA provides actual prescribing expenditure for the months April to August. As this information is published 2 months in arrears, an estimate for September and October has been made in arrive at a £0.09m under spend for the period.

The prescribing forecast of £49.46m has been derived by using the NHSBSA forecast adjusted for concessional pricing for drugs which are in short supply and Category M (generic drugs) price reduction benefits which, as part of a national financial risk reserve, are to be retained by NHS England. It is NHS England’s intention to make available any centrally retained benefit, estimated to be £0.48m, in subsequent years.

Primary Care The forecast underspend of £0.08m is mainly due to a reduction in the value of the Primary Care IM&T GMSS service level agreement and underspends within local enhanced services.

5.0 Running Costs (Corporate)

The YTD underspend of £0.23m and forecast outturn underspend of £0.34m mainly reflect pay underspend due to staff vacancies.

6.0 Cost Improvement Programme (CIP)

Including the utilisation of £2.2m contingency, £14.91m (85%) of the £17.45m CIP plan has been delivered year to date and £16.94m (97%) is forecast to be delivered by year end. Within the £14.91m of CIP delivered is acute demand QIPP of £6.82m which has been reported as delivered in full non-recurrently as a result of agreeing 17/18 contracts at 16/17 outturn and agreeing block

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8

contracts for A&E attendances, non-elective admissions and outpatient attendances with Stockport FT.

7.0 Recurrent (Underlying) Position

Due to the planned level of Stockport Together benefits not being realised (i.e. activity levels being above planned levels), non-delivery of recurrent CIP and an increase in the number of CHC placements a £1.71m (Appendix 1 Table 1) forecast recurrent deficit will be carried forward into 2018/19. If this recurrent deficit is not fully addressed through the CCGs plan for 2018/19 then the CCG will not be compliant with NHSE business rules. This would have a significant impact initially on the CCGs assessment rating but more fundamentally on the CCGs ability to implement the commissioning strategy, in particular where service change is dependent upon investment.

8.0 Reserves

Table 3 of Appendix 1 sets out the reserves held at month 7.

Investments – £7.54m includes in-year allocations, national “must do’s” and those agreed collaboratively at a local GM level i.e. GM Risk share.

Contingency – fully utilised by offsetting £2.23m contingency against the CCG CIP plan. Savings & Efficiency – the (£3.80m) reserve reflects the remaining value of CIP savings not yet embedded within expenditure budgets.

9.0 Financial Risks and Mitigations not in Forecast

The CCG has a net risk of £1.60m (Appendix 1 Table 7) which has not been incorporated into the forecast position as at month 7. The risks to the delivery of the financial plan are acute contract risks of £1.00m, increasing number of CHC placements £0.50m plus £0.10m of other income and expenditure risk. A plan to mitigate the net risk has been developed by the CCG Leadership Team and subsequently endorsed by the Finance and Performance Committee. As a result the NHSE provisional rating of AMBER is forecast to have moved to GREEN before the end of the year. Progress of the plan implementation will also be reported through the Finance and Performance Committee.

10.0 Procurement Plan The CCG procurement policy was approved in December 2014. Within this it states that the CCG will publish a schedule of planned procurements each year. It is confirmed to Governing Body that the policy is being followed, that Leadership team consider procurement decisions and that procurement decisions are published on the CCG website

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http://www.stockportccg.nhs.uk/about-us/procurement-contracts/

11.0 Recommendations These are set out on the front sheet of this report. Mark Chidgey Chief Finance Officer November 2017

Documentation Statutory and Local Policy Requirement

Cover sheet completed Y Change in Financial Spend: Finance Section below completed Y

Page numbers N Service Changes: Public Consultation Completed and Reported in Document n/a

Paragraph numbers in place Y Service Changes: Approved Equality Impact Assessment Included as Appendix n/a

2 Page Executive summary in place (Docs 6 pages or more in length) n/a Patient Level Data Impacted: Privacy Impact

Assessment included as Appendix n/a

All text single space Arial 12. Headings Arial Bold 12 or above, no underlining Y Change in Service Supplier: Procurement &

Tendering Rationale approved and Included n/a

Any form of change: Risk Assessment Completed and included n/a

Any impact on staff: Consultation and EIA undertaken and demonstrable in document n/a

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TABLE 1 TABLE 2

TABLE 3 TABLE 4 TABLE 5

TABLE 6

TABLE 7 TABLE 8

TABLE 9

Month 7 Financial Dashboard Appendix 1

Month 7 Financial Position - as at 31 October 2017

Budget Actual Var Var Budget Actual Var Var

£000s £000s £000s % £000s £000s £000s % £000s £000s £000s

Revenue Resource Limit (RRL)

Confirmed (260,234) (260,234) 0 0.0% (451,782) (451,782) 0 0.0% (444,236) (444,236) 0

Total RRL (260,234) (260,234) 0 0.0% (451,782) (451,782) 0 0.0% (444,236) (444,236) 0Net Expenditure

Acute 141,727 142,702 975 0.7% 242,868 244,483 1,615 0.7% 239,925 241,877 1,952Mental Health 19,440 19,600 160 0.8% 33,781 34,184 403 1.2% 33,282 33,798 516Community Health 22,392 22,572 180 0.8% 38,386 38,681 295 0.8% 38,386 38,695 309Continuing Care 8,933 9,262 329 3.7% 15,316 15,960 644 4.2% 15,316 16,024 708Primary Care 29,128 29,050 (78) (0.3%) 50,547 50,469 (78) (0.2%) 49,711 49,844 133Other 4,254 4,261 7 0.2% 10,273 10,350 77 0.7% 4,121 4,211 90

Sub Total Healthcare Contracts 225,874 227,447 1,573 0.7% 391,171 394,127 2,956 0.8% 380,741 384,449 3,708

Prescribing 28,851 28,760 (91) (0.3%) 49,459 49,459 0 0.0% 49,459 49,459 0Running Costs (Corporate) 3,484 3,258 (226) (6.5%) 6,090 5,751 (339) (5.6%) 6,090 6,090 0Reserves (Ref: Reserves Summary) 1,256 0 (1,256) 0.0% 3,744 1,127 (2,617) (69.9%) 2,912 5,951 3,039

Total Net Expenditure and Reserves 259,465 259,465 0 0.0% 450,464 450,464 0 0.0% 58,461 61,500 3,039

TOTAL (SURPLUS) / DEFICIT (769) (769) 0 0.0% (1,318) (1,318) 0 0.0% (5,034) 1,713 6,747

Recurrent Budget

Recurrent Commitment

Recurrent Variance

(Favourable) / Adverse

YTD (Mth 7) Forecast 17/18

RAG RATING

RAG Rating Key:

G Potential risk of overspend: less than or equal to £0

A Potential risk of overspend: between £0 and £250k

R Potential risk of overspend: Over £250k

Acute Contract Performance

Annual Budget

Budget ActualYTD Variance - Overspend /

(Underspend)

Forecast Outturn

Forecast Variance -

Overspend / (Underspend)

£'000 £'000 £'000 £'000 £'000 £'000Stockport Foundation Trust 151,416 88,323 88,411 88 151,579 163Manchester University NHS Foundation Trust 23,881 3,980 3,910 (70) 24,252 371University Hospitals of South Manchester FT 13,765 13,765 14,512 747 14,512 747Central Manchester University Hospitals FT 10,082 10,082 10,019 (63) 10,019 (63)Salford Royal FT 6,976 4,069 4,074 5 6,968 (8)The Christie NHS Foundation Trust 3,546 2,069 2,082 13 3,571 25East Cheshire NHS Trust 2,118 1,236 1,313 77 2,253 135Tameside & Glossop Integrated Care FT 1,275 744 672 (72) 1,152 (123)AQPs/IS 13,786 8,042 8,230 188 14,039 253Other 16,023 9,417 9,479 62 16,138 115Total Acute 242,868 141,727 142,702 975 244,483 1,615

Year to Date Forecast

Major Acute Commissioning contracts & AQP/IS

Month 7 - as at 31 October 2017

Forecast Reserves Summary

Reserves Commitments Forecast BalsHeld Mth 7 Year End

Amounts Held in CCG Reserves £000s £000s £000s Investments 7,146 4,197 (2,949) Contingency 0 0 0 In-Year Allocations 394 216 (178) Savings & Efficiency (3,796) (3,286) 510Total Reserves 3,744 1,127 (2,617)

Statutory Surplus Forecast £000s2017-18 Allocation (451,782)Less: 2017-18 Expenditure 450,464 In-Year Surplus (1,318)Add: Brought forward 2016-17 Surplus Allocation (7,010)Forecast Statutory (Surplus) / Deficit (8,328)

Public Sector Payment Policy (PSPP) - Measure of Compliance

Number £000s

Non-NHS PayablesTotal Non-NHS Trade Invoices Paid in the Year 7,779 60,480Total Non-NHS Trade Invoices Paid Within Target 7,491 59,822Percentage of Non-NHS Trade Invoices Paid Within Target 96.30 98.91NHS PayablesTotal NHS Trade Invoices Paid in the Year 1,747 165,714Total NHS Trade Invoices Paid Within Target 1,665 164,691Percentage of NHS Trade Invoices Paid Within Target 95.31 99.38Total NHS and Non NHS PayablesTotal NHS Trade Invoices Paid in the Year 9,526 226,194Total NHS Trade Invoices Paid Within Target 9,156 224,513Percentage of NHS Trade Invoices Paid Within Target 96.12 99.26

The Public Sector Payment Policy target requires CCG's to aim to pay 95% of all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

Ocotober YTD

We will continue to monitor our performance against the 95% 'Public Sector Payment Policy' (PSPP) target of invoices paid within 30 days of invoice. Performance is measured based on both numbers of invoices and £ value.

Cashflow Summary - Month 07 £000sCash Limit for the Year 449,683 Cash drawn down YTD 260,026 Remaining cash 189,657

Actual cash drawn down (%) 57.8%Expected cash drawn down (%) 58.3%

Sep 15 - Aug 16 (£000s)

Sep 16 - Aug 17 (£000s)

Change (£000s)Change in Spend (%)

Change in No. Items (%)

Cardiovascular System 6,577 6,854 277 4.2% -0.2%Appliances 1,498 1,596 99 6.6% 14.1%Stoma Appliances 1,640 1,723 82 5.0% 2.9%Other Drugs And Preparations 202 212 10 4.9% 4.1%Nutrition And Blood 2,934 2,943 9 0.3% 3.3%

Top Five Increases in Prescribing Spend by Drug Type

Financial Risks

Risk Risk Value (£m) Comment

Acute 1.0 In-year over performanceContinuing Healthcare 0.5 Increase in the number of CHC placementsOther I&E 0.1Total Risks 1.6

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022

Stockport Together Report

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to

live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS 023

Executive Summary

What decisions do you require of the Governing Body?

This report is to ensure the Governing Body are kept informed on progress in delivery of the Stockport Together (ST) Programme and the associated impact.

Please detail the key points of this report

We are now in a significant period for the programme:

o Consultation is underway o New care models are being tested at greater scale across the area o Procurement concluded and alliance arrangements operational

In areas which have been in place longer some evidence of benefits delivery, however too early yet to see significant benefits realisation. Programme is running c3-6mths behind. What are the likely impacts and/or implications?

There is an increased pressure on partners for next financial year given delays in implementation leading to delays in benefits realisation. Since major change is now underway it will be important to assess progress across Q3 before finalising plans for 2018-19.

How does this link to the Annual Business Plan?

Stockport Together and the creation of an MCP is our mechanism for delivering the 5 year forward view and a significant contributor to improving health outcomes a reducing financial challenge.

What are the potential conflicts of interest?

None related to this report.

Where has this report been previously discussed?

CCG Leadership Team on 22nd November.

Presented by: Tim Ryley

Meeting Date: 29th November 2017

Agenda item: 8

024

Stockport Together Report

1. Introduction The Stockport Health & Social Care system is currently in a critical and exciting phase following the endorsement of the outline business cases in July 2017. The integrated service solution is continuing to be developed and tested at scale and the CCG and SMBC are currently consulting formally with the public on the underlying policy approach. At the same time important decisions are being made concerning the new organisational landscape that is designed to deliver the new model of care.

This report will cover progress on: • The Integrated Service Solution • Local Care Organisation • Integrated Commissioning • Public Consultation • Impact and Risks • The next quarter

2. Integrated Service Solution Significant progress is being made on implementing a number of aspects of the new care model which takes the form of an integrated service solution across out-of-hospital and hospital interface services. Highlights include:

- Significant work on improving discharge arrangements generally in line with the Intermediate Care business case and in particular ensuring Transfer to Assess is rolled-out to all wards

- Also in line with Intermediate Care business case the Crisis Response pilot has now been transferred to mainstream service

- Based on the Neighbourhood business Case: o The Falls Service has started mobilisation o The Psychological Medicine in primary care service is being mobilised o Viaduct have provided detailed response to Commissioning Intentions

ahead of mobilising more widely the existing pilots for 7 day, acute visiting, medicines management, physiotherapy etc.

o Location of GP 7 day services has been identified; single successful pilot to date reviewed and IT tested

o Further work on strengthening and rolling-out enhanced case management is ongoing

- Over 200 community based staff recruited since April - The partnership continues to be involved in the NHS England 100 day rapid cycle

programme for outpatients. This next phase which is just launched will include: o Dermatology o Ophthalmology

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o Orthopaedics

3. Local Care Organisation Since the 1st of August the provider alliance (Viaduct, Stockport NHS Foundation Trust, Pennine Care NHS Foundation Trust and Stockport MBC) have been working under a single line management structure for all services in scope. From October there has been a formal alliance agreement and alliance board in place. The alliance has been called Stockport Neighbourhood Care. A permanent managing director has been appointed.

That MCP procurement process is now concluding and, at their November meeting, the Health and Care Commissioning Board will consider a recommendation that the focus should be on bringing the providers together through an alliance agreement as the most pragmatic and effective route to delivering the required new models of care.

4. Integrated Strategic Commissioner The Joint Commissioning Board and the Health & Care Integrated Commissioning Board have continued to meet. They have overseen the conclusion of the MCP procurement and also the development of a social care strategy. Work is progressing on the best approach to the next steps of developing a single integrated strategic commissioner function and the process for agreeing how tactical commissioning functions could be delivered by the provider alliance. The Joint Commissioning Board are also overseeing a joint approach to contracting and planning whilst respecting the existing statutory responsibilities of each partner.

5. Public Consultation The Public Consultation was launched on the 10th October. The public and interested stakeholders are being invited to influence the proposals on three specific issues of policy: the approach and range of integration; the structure and geography of neighbourhoods; and the criteria for decommissioning acute capacity.

There has been a media campaign including social, radio, TV and print media. We have written to over 300 interested local organisations asking for formal responses to our proposals and undertaken a number of meetings. Groups and individuals can respond on-line and in writing. We have procured a company to gather an additional 50 public responses from each of the 8 neighbourhoods (400 in total). Once the consultation is complete at the end of November an independent analyst has been secured to compile a report which will then go to Scrutiny Committee, Council Cabinet and the CCG Governing Body in January 2018 before final decisions are made.

We are also undertaking further work with the protected characteristic groups to ensure that the Equality Impact Assessments are updated with the views of local people.

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6. Impacts and Risks Since the Integrated Service Solution is still being mobilised and this has only started to move at pace in most areas in the last few months the visible impacts are unlikely to be significant at this stage. However, in areas where there has already been a specific focus, benefits have started to be demonstrated and as a whole growth in the system is broadly being managed. Some key areas to note are:

1: After a period of developing the intermediate model of care and aligning existing work to the new model, Delayed Transfers of Care (DTOC) have reduced from c40 to 16 per day.

2: Following the introduction of ambulatory care and other changes in assessment capability at the hospital the number of bed days has reduced by 1% overall and by 4% in our proxy for specialty beds (>= 2days).

3: After earlier work between GPs and Care Homes which has been built on with joint work led through the Joint Commissioning Board we are continuing to see sustained and significant reductions in Care Home admissions now over a two-year period. For the current 12 month period this is down a further 10.8%

4: GP 1st outpatient appointments (even though the outpatient programme bar the 100 day pilots is not yet underway) are down 4% this year.

However, given the scale and complexity of the change there remain significant risks to the programme:

• Workforce – despite some initial success and some excellent joint working there remain major challenges in all areas. These reflect the national picture compounded in Stockport for non-professional staff by the full employment position in the borough. This risk would exist independently of the changes underway. In addition to taking a creative approach to recruitment it is intended that the new model will improve retention with greater investment in general practice and community services and reduce demands for locum and agency staffing in the acute sector.

• Implementation – the scale of the service changes is stretching both implementation capacity and importantly leadership capability in the system. Leading change across cultures in complex systems requires significant leadership capability and this is in short supply.

• Benefit Delivery – whilst benefits are being delivered there have been delays in mobilisation and thus the programme is behind schedule. This will have an impact on delivery in 18/19 and impact on financial planning for organisations. The finance leaders of partner organisations remain committed to addressing the risks that arise collectively.

• IM&T Investment – As part of our transformation bid it was identified that we needed £3.1m of capital investment in digital technology. We have since identified a further £0.9m. We were assured this would come through the digital fund. Unfortunately Manchester has not received as much as was expected from national sources. As such we have been awarded £0.9m this year. We are working with the Greater Manchester

027

partnership to resolve as far as possible the issues but there will inevitably be delays further impacting on longer term benefits delivery.

7. Next Quarter It is anticipated that in the next three months:

- All aspects of the Intermediate Tier, Ambulatory Care and Neighbourhood model will either be fuller mobilised or being mobilised

- In particular Acute Visiting, GP 7 day services and enhanced case management will have significantly progressed in implementation

- Outpatients programme will have a mobilisation plan ready - The changes will be embedded in contracts for 2018-19 - The findings from the consultation will be built into the changes and inform a

decision by partners in January - The shape and form of the integrated strategic commissioner will be agreed and

work to mobilise will have commenced

028

Locality Chairs Report Report to November 2017 Governing Body

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

029

Executive Summary

What decisions do you require of the Governing Body?

This is a report for discussion and no decision is required

Please detail the key points of this report

There is a new format of meeting and a number of issues have been discussed

• GP connect • Hospital contract breaches • Referral Management

What are the likely impacts and/or implications? There is data to support contract management with Stockport FT There is discussion about the future of the referral management scheme How does this link to the Annual Business Plan? Primary care sustainability and the reduction of referrals are key to the delivery of the business plan What are the potential conflicts of interest? The GPs are commenting upon services that they deliver however the decisions are made at the primary care committee to alter the provision of service. This is therefore a consultation design process not a decision making process Where has this report been previously discussed? Nil Clinical Executive Sponsor: Dr Briggs Presented by: Dr Hardern Meeting Date: 29th November Agenda item: Locality Chairs Update Reason for being in Part 2 (if applicable)

Locality Chairs report to Governing Body 29th November 2017

030

1. Introduction 1.1. Locality Chairs meet on a monthly basis to discuss relevant issues for

General Practice. Themes discussed and the agenda for the next meeting are shared with member practices to encourage feedback on any issues. This has ensured that member feedback is incorporated into the meeting cycle.

1.2. Themes highlighted for discussion by Locality chairs have to date included

• GP connect • Hospital contract breaches • Referral Management

2. GP connect 2.1. GPs fed back that they were very happy to be available to speak with

consultants about patient care if consultants contact the practice. It was noted that this may involve GPs returning consultant calls between patients. Member practices felt that it was not appropriate for consultations to be interrupted.

3. Hospital Contract Breaches 3.1. The hospital contract was altered nationally for the year 2016/17 to reduce

the burden of paperwork on general practice and to improve communication. The week commencing 7th November was identified as the week for practices to log all hospital contract breaches in relation to these clauses. A link to the CCG website ‘citizen space’ was created for clinicians to log breaches to make it a quick and simple process and increase to report and not create a further burden.

3.2. 573 breaches have been recorded. 65% of recorded breaches related to

the Hospital Clinic Letter arriving more than 10 days after the appointment with a couple of practices reported that they had in excess of 100 breaches in this category so were unable to log them individually. Patient queries being passed inappropriately to the practice represented 4.71% whilst fit notes not being provided was reported as 3.84%. The Other category represents 15% of reported breaches and is to be reviewed in detail by the Locality Chairs as some clinical issues were raised.

3.3. Once a full analysis has been completed a report will be shared with the LMC and distributed from Locality Chairs to member practices. It is anticipated that this data can be used in contract negotiations with providers and may be repeated in 2018 to assess success in addressing the concerns reported.

4. Referral Management 4.1. Feedback on the current referral management scheme was discussed and

it was clear practices do this in very different ways and some find it more useful than others.

031

4.2. A survey has been circulated to practices to ask how they undertake referral management work currently. Whose referrals are reviewed and whether referral templates are used.

4.3. The scheme will continue but on receipt of the outcome of the audit above it will be reviewed and it may be that it would be recommended that it should not be specifically for a referral co-ordinator. The funding could be used by practices for training, peer review learning sessions or to continue with a referral co-ordinator, with the aim of effectively managing referrals.

5. Conclusion 5.1. Members are asked to note the report.

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1

Chief Clinical Officer’s update Chief Clinical Officer’s update to the November 2017 meeting of the Governing Body

NHS Stockport Clinical Commissioning Group will allow people to access health services that empower them to

live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900

Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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2

Executive Summary

What decisions do you require of the Governing Body? The Governing Body is requested to consider and discuss the information contained within the report and confirm ratification of the 3 EUR Policies listed below. Please detail the key points of this report This report provides an update on the following matters:

(a) Healthier Together (b) Strategic Partnership Board Briefing (attached) (c) EUR Ratifications

What are the likely impacts and/or implications? The implications and impact of is outlined within the body of the report. How does this link to the Annual Business Plan? Regional and sector based work forms a key part of the delivery of the Stockport Plan. What are the potential conflicts of interest? None Where has this report been previously discussed? The individual reports have been discussed at their development bodies. Clinical Executive Sponsor: Ranjit Gill Presented by: Ranjit Gill Meeting Date: 29 November 2017 Agenda item: 12

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3

Implementation of Healthier Together in the South East Sector: update on progress

November 17th 2017 Business Case and Financial Position Progress continues to be made with the business case in particular regarding the finalisation of the commercial case and accessing the capital funding agreed by the Treasury during the summer. As part of this process NHS Improvement, the regulatory body overseeing Foundation and NHS Trusts are leading a GM event on Monday 20th November to seek assurance regarding the proposed changes. Within South East Sector, the Chief Finance Officers continue to work on the local financial position in particular focussing on the recurrent revenue implications of the changes and the development of a sector approach to commissioning and contracting for the single service. Due diligence on the business case and financial position are essential to the success of the Healthier Together but the complexity of this continues to impact on the programme timescales. It is likely that the earliest changes related to the development of a single Multidisciplinary Team (MDT) assessment process will be in place in late spring/early summer. The movement of elective care is likely to be in autumn 2018, with the final phase of non-elective changes being undertaken in 2019. Clinical Pathway and Patient Journey Development Whilst detailed work on the new clinical pathways continues through the clinical subgroups, more work has been undertaken on the patient journey. An event focussing on the primary and community aspects of the patient journey was held in October and was extremely well attended by a range of people including members of Public Voice, the patient and public participation group for South East Sector Healthier Together, GPs, voluntary sector representatives, nursing and residential care staff and community health service leads. This event allowed a wide range of people to review the planned changes and highlight any further work that may be needed to ensure that people and their carers can move through the patient journey in the most appropriate way. Dr Steve Brown, consultant urologist and clinical lead of the urology single service based at Stepping Hill Hospital, provided a presentation highlighting the benefits of a single service based on his experience as well as a number of key lessons learned. A further stakeholder engagement event is being planned for the New Year to engage with a wide range of specialty leads to check and challenge the proposed changes and provide assurance to the Programme Board. Work on the paediatric pathway has also now commenced. At a Greater Manchester level North West Ambulance Service (NWAS) are developing the options for patient transfer and working with sectors to identify the optimal solution. This is a crucial piece of work to ensure that the number of transfers are minimised and that transfers occur in a timely manner dependent on the patient’s clinical needs.

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4

Public Voice Public Voice have now finalised the set of design characteristics they would like to see incorporated or avoided in the development of the new pathways. The Lay Chair of the Group, Lesley Surman is discussing these with the local clinical leaders for Healthier Together to ensure that they are part of the process of pathway development and to keep public and patient voices at the heart of these changes. A range of stakeholders, including members of Public Voice, have been involved in a key workstream related to transport. Transport for Greater Manchester (TfGM) have supported the group to analyse the transport links available between Stockport, Tameside and Glossop, North Derbyshire, East Cheshire and Stepping Hill Hospital including buses, trains and voluntary sector car transport schemes. This includes reviewing distances and travel times at various times of day to look at the potential impact on the public and whether any changes are needed. Over the next two months this work will develop to include travel to the Royal Oldham Hospital to take account of the flows of patients to Oldham from parts of Tameside. Stockport CCG will then lead the development of the approach across GM. Healthier Together Governance In order to align with Greater Manchester Health and Social Care Partnership governance and to utilise clinical and managerial time most effectively as the programme moves into the implementation phase, a number of changes in the governance of Healthier Together have been made. As Healthier Together is part of Theme 3 of the GM Strategic Plan from November 2017 the Delivery Board for Healthier Together has been stepped down and responsibility has transferred to the Theme 3 Delivery Board. To support implementation two groups have been established. The first of these is the General Surgery and Acute & Emergency Medicine Implementation Board which will focus on assurance regarding sector readiness to implement the changes and maintain oversight of the delivery of the implementation and equalities conditions. The second group is the Clinical and Operational implementation Group, a clinically led group that will support sectors with the clinical and operational requirements of the programme and assess sector operational readiness. The Implementation Group will report to the Implementation Board and link to the Theme 3 Clinical Reference Group. EUR Policy Ratification The following 3 new Greater Manchester Effective Use of Resources (EUR) Policies were approved by the Greater Manchester Association Governing Group (AGG) on the 2nd October 2017:-

• Surgical Correction of Trigger Finger • Carpal Tunnel Syndrome • Other Aesthetic Surgery

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5

Governing Body is requested to confirm that the policies have been ratified.

037

038

Greater Manchester Health and Social Care Partnership Briefing

Following the Strategic Partnership Board (SPB) meeting held at Oldham Civic Centre, on Friday 13th October, please find enclosed a briefing note for your information and which can be passed on to interested parties. Transformation Fund update: Funding for Bury, Rochdale, and Trafford has now been approved. Bury will receive £19.2m over four years to transform the health and care system and improve health and wellbeing in the borough. Rochdale has been allocated £23.5m over four years to help more people take charge of their own health and wellbeing and effectively manage long-term conditions. Trafford will be awarded £22m over three years to secure a sustainable health and social care system by 2021. Read more here.

In his Chief Officer’s Update, Jon Rouse noted that the new Manchester University Foundation Trust (MFT) has now been formed, following a merger of Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust. This will mean safer and more consistent care for patients. He highlighted coordinated efforts in Greater Manchester to ensure that our future nursing workforce continue to train here and then want to stay and work in our region. Looking ahead, the Partnership will be bringing reports to board on investment in population health, plans for the roll out of mental health transformation, and establishment of a new development framework for local care organisations. Read more here. Winter preparedness: Our health and social care systems come under increased pressure during the winter months. The Partnership has been working with partners, locally and nationally, to put plans in place to ensure we are prepared for this potentially difficult period. We are particularly focusing on Bolton, Stockport, and the North East Sector as these areas are judged to be most vulnerable in relation to A&E performance. From November, a new Greater Manchester Urgent and Emergency Care Operational Hub will collect, analyse, and report key performance information. This year we will be encouraging as many people as possible to have their flu vaccine by up weighting the national Stay Well This Winter campaign with our own Greater Manchester flu messages. Our local campaign includes advertisements on taxis and buses, and activity across traditional media and social media. This is the first time, we have embarked on a region wide campaign of this kind and we hope it will help relieve pressure on our health services. Read more here. Greater Manchester Model for Urgent Primary Care: The NHS has been set the task of simplifying the way people receive urgent medical care. In Greater Manchester we have done a review of the services that people use and this told us that services should work better together across Greater Manchester and be simpler to access. We want people to receive the right care, in the right place in a timely manner. This will help to reduce the pressure on our very busy A&E departments and GP practices. This is about standardising the care that people receive across Greater Manchester. There will need to be some technical changes to current systems however the only call to action for

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patients will be to ensure that they use their GP practice as their first port of call when they are ill (except for 999 emergencies). In A&E, patients will be seen and a decision made about whether they will be seen in a primary care urgent care treatment centre, often located within the hospital, or whether they will be seen in A&E. Some areas, for example, Bolton already operate this model and have seen significant improvement in the waiting times and patient experience. 16% of patients who arrive in A&E are seen alleviating pressure in the department and ensuring patients are been seen by the most appropriate clinician. GPs and A&E staff will eventually be able to refer patients to these urgent care treatment centres for same day, urgent appointments to help with managing their daily pressures. The urgent care treatment centres will be run by primary care clinicians (i.e. GPs, nurses and pharmacists) and open a minimum of 12 hours per day. There will be availability of diagnostic tests (i.e., blood tests) in each centre. In other areas work is ongoing to identify where each urgent care treatment centre will be. Some will be hosted in local hospitals or established centres in the community. By December 2017 there will be four urgent care treatment centres in place and we will know the locations of the rest. In areas where these are not set up patients who walk into A&E will be seen by a doctor or nurse who will advise them of the most appropriate service. An explanatory note will be circulated to elected members across Greater Manchester to outline how the revised system will work. Read more here. Manchester Arena Incident Response: We saw an amazing response from NHS staff in tragic circumstances when a terrorist attack took place at Manchester Arena on 22 May. Several months on, the Partnership continues to lead on coordinating the health response, working closely with CCGs and healthcare providers to ensure a high standard of care and support for those affected. The Greater Manchester Resilience Hub is coordinated by Pennine Care NHS Foundation Trust, supported with staff from other trusts across the region. The aim is to contact all those who purchased tickets. Those who were bereaved or suffered serious physical injuries have all been contacted. All health and care organisations involved in the response will be involved in an upcoming independent review. The lessons learnt from this process will inform our response to future incidents. Read more here. Health Innovation Manchester – Update on Progress: Health Innovation Manchester brings together research and clinical expertise with industry ‘know how’ and investment. It aims to speed up the discovery, development, and delivery of new ways to improve health. This organisation is currently focusing on a number of existing initiatives, that are already planned or underway, to accelerate their adoption across Greater Manchester. Since its launch in 2015, this organisation has built links across a range of sectors including life sciences, digital health, biotechnology, and pharmaceutical. Read more here. Health and homelessness: The Partnership is working with the Mayor of Greater Manchester, Andy Burnham, to tackle the problem of homelessness across the region. We have made four commitments to support the health and care contribution:

1. Ensure anyone without a fixed address can register with a GP practice if they wish to 2. Seek to ensure no one is discharged from hospital to sleep rough on the streets 3. Support the development of outreach teams in local areas to offer health screening,

advice, and support to homeless people

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4. Joined up commissioning and provision of specialist support service, such as mental health and substance misuse

Read more here. Presentation from NHS Oldham Clinical Commissioning Group: An update was given on progress made so far on the transformation of health and care in the borough. For more information on any of these items please contact Greater Manchester Health and Social Care Partnership Team via email – gm.hsccomms@nhs.net. For regular updates on our programme, visit our website www.gmhsc.org.uk where we have a useful resources page or follow us on Twitter where we post frequently @GM_HSC Who are we? Greater Manchester Health and Social Care (GMHSC) Partnership is the body made up of the NHS bodies, councils and voluntary, community and social enterprise organisations in the city region, which is overseeing devolution. In April 2016 we took responsibility for the £6 billion GM health and social care budget. In addition we have responsibility for a £450 million transformation fund (over five years) which we have the freedom to use flexibly in order to deliver clinical and financial sustainability by 2021. Governed by the Health and Social Care Partnership Board, which meets in public each month, the Partnership comprises the local authority and NHS organisations in Greater Manchester, representatives from primary care, NHS England, the voluntary, community and social enterprise sector, Healthwatch, Greater Manchester Police and Fire and Rescue Service. Vision To see the greatest and fastest improvement to the health, wealth and wellbeing of the 2.8 million people in the towns and cities of Greater Manchester Ends

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Business Case for a Specialist Stroke and Neurological Integrated Community Rehabilitation Service in Stockport

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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Executive Summary

What decisions do you require of the Governing Body?

(i) To review and approve the need for this service within Stockport. (ii) To confirm this as a priority service for inclusion within the CCG plan for

2018/19.

(iii) To note that final approval on investment will be part of the overall CCG plan for 2018/19.

Please detail the key points of this report The business cases sets out the need for an integrated community rehabilitation service for Stockport. What are the likely impacts and/or implications? Improvements in quality of patient care and improved rehabilitation outcomes for patients. How does this link to the Annual Business Plan? The case is consistent with the CCG strategy, the business plan for 18/19 is yet to be finalised.. What are the potential conflicts of interest? N/A Where has this report been previously discussed? CCG Leadership Team. Clinical Executive Sponsor: Ranjit Gill Presented by: Mark Chidgey Meeting Date: 29th November 2017 Agenda item: Reason for being in Part 2 (if applicable) N/A

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Endorsed by:

Name of Lead Clinician/Manager or Committee Chair

Position of Endorser or Name of Endorsing Committee

Date

V1: Dr P Carney Chair of Finance and Performance Committee 9th November 2016

V3: Dr Ranjit Gill Chief Clinical Officer 22nd November 2017

Commissioning a Specialist Stroke and Neurological Integrated Community Rehabilitation Service in Stockport

Classification: Business Case Version number: 3 Date: November 2017 Lead Author: V1 Wendy Webster, Interim Stroke Redesign Manager, NHS Stockport CCG V2 Cliff Wilson, Commissioning Support Officer, NHS Stockport CCG V3 Mark Chidgey, CFO, NHS Stockport CCG

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Index 1. Executive Summary: Business case for the development of an Integrated Community

Rehabilitation service 2. Introduction 3. Vision Statement 4. Proposal 5. Options 6. Developing an Integrated Service 7. Discharge Process 8. Pathway Structures 9. Benefits / Risks 10. Clinical Governance 11. Voluntary Services 12. Rationale 13. Benefits of the proposal: Research 14. Enabler Requirements / Impacts 15. Performance / Outcome Measures and evaluation 16. Finance Analysis 17. Service Utilisation

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This Business Case outlines the need for a commissioned Specialist Stroke and Neurological integrated Community Rehabilitation Service for the Stockport population. Limited community provision for stroke patients currently exists but does not meet the National Standards for Stroke set out by the National Institute for Health and Care Excellence (NICE) and the Royal College of Physicians (RCP) or the locally recommended Greater Manchester (GM) Specification for Stroke Rehabilitation. Neuro Rehab community provision in Stockport is also limited for more complex need. The Stockport hyper-acute stroke service has recently received an “A” rating (SSNAP) and Greater Manchester has the highest rated hospital stroke pathway in the country, yet Stockport is the only CCG in Greater Manchester with no specialist community Stroke rehabilitation service for our population.

Implementing the service will move Stockport from being the only GM locality without access to specialist rehabilitation to that of being the first Greater Manchester CCG to commission a service that meets the Greater Manchester specification. The service will cost £1.241m per annum in total of which £0.671m will be new investment. The sources of funding are shown in the table below alongside patient categorisation:-

Funding Source of Funding Impact / Benefit No of Patients

£0.216m Integration of the existing STAR team capacity.

Enhanced care is provided to existing community patients

250

£0.354m Reduced demand on bed based rehabilitation.

Patients will be enabled to return home earlier by moving some acute rehabilitation capacity into the community.

215

£0.671m NEW INVESTMENT Patients with needs that are not currently being met will receive the evidence based care that they need.

107

£1.241m 572

1. Executive Summary: Business case for the development of an Specialist Stroke and Neurological Integrated Community Rehabilitation service

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Current gaps in care were highlighted to the CCG Governing Body through a patient story at the Governing Body meeting in July 2016. https://www.youtube.com/watch?v=encfnpgDTpo

The new service will meet two key commissioning strategic aims through:- • the integration of pathways across acute and community provision and • taking care out of the acute sector and into the community, in this case directly into patient’s

homes.

The preferred option (option 3) is to fully commission the new Greater Manchester specification at an additional cost of £0.671m. The summary options appraisal is:-

Option Description Benefits Delivery

No of Patients

Additional Investment £m

Net additional cost / patient

£

1 Do Nothing None 0 £0 n/a

2 “Stand alone” Early Supported Discharge Medium 352 £0.43m £1,073

3 Specialist Stroke and Neurological Integrated Community Rehabilitation Service.

High 572 £0.67m £1,176

The approval of this Business Case will ensure:

• A commissioned Specialist Community Integrated Rehabilitation Service for patients who have experienced a stroke or have a Neurological condition that meets the National Standards and recommended GM Specifications

• An integrated service for stroke and neurology patients who require rehabilitation intervention in their home.

• An integrated specialist rehab service which is joined up with the Active Recovery service model.

• Stockport Stroke patients will be supported at home as soon as possible after their stroke with the same levels of intervention that they could expect in a hospital setting

• Stockport Neurology patients will be supported at home as soon as possible and receive the same levels of intervention that they could expect in a hospital setting

• A transfer of resources (staff and bed days) from hospital to the community

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2. Introduction

This Business Case outlines the need for a commissioned Specialist Stroke and Neurological Integrated Community Rehabilitation Service in Stockport bringing specialist community rehabilitation for stoke and neurology patients together within one team, working collaboratively with a private provider to continue to meet the needs of less complex patients in the community. Stroke has a devastating and lasting impact on people’s lives and on the nation’s health and economy. Strokes are a blood clot or bleed in the brain which can leave lasting damage, affecting mobility, cognition, sight and/or communication. The effects can include aphasia, physical disability, loss of cognitive and communication skills, depression and other mental health problems. Neurological disorders are diseases of the brain, spine and the nerves that connect them. There are more than 600 diseases of the nervous system, such as brain tumours, epilepsy, Parkinson's disease and stroke as well as less familiar ones such as frontotemporal dementia.

3. Vision Statement The vision for a Specialist Stroke and Neurological Integrated Community Rehabilitation Service is to create:

“a responsive and person centred specialist rehabilitation service that supports peoples recovery at home and provides a strong bridge to transition from hospital”

It is widely believed that care and treatment should be delivered in a person’s own home/place of residence or as close to home as possible. To achieve this the aim is to deliver a continuum of integrated, responsive, flexible, person-centred home services that collaborate with and bridge the transition between acute hospital and primary care settings.

This new integrated service will wrap care around a person at home to meet their physical, mental health and social care needs to facilitate early discharge and support recovery at home. They will promote faster recovery.

4. Proposal

NHS Stockport CCG, working with Stockport NHS Foundation Trust and a 3rd sector provider proposes to develop an integrated specialist community rehabilitation team incorporating the Early Supported Discharge model. This service will significantly enhance the services available to our population, further develop community rehabilitation services for people with Neurological conditions and most importantly will address gaps in care that currently exist.

Intensive rehabilitation immediately after stroke or acquired brain injury, operating across 6 days a

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week, can limit disability and improve recovery. The neurology pathway also offers Specialised rehabilitation needs to continue across the transition to home ensuring that health, social care and voluntary services together provide the long-term support people need, as well as access to advocacy, care navigation, practical and peer support. The pathway for neurology patient would be similar to that of stroke with the majority of neurology patients will complete their rehabilitation within 3-6 months of being accepted onto the service.

The requirement for patients with Neurological conditions to receive the service includes:

• Be aged 18 and above • Have a Neurological condition • Be registered with a Stockport GP • Require input from two or more of the disciplines (patients requiring physiotherapy only rehab

will be referred to Neurological Physiotherapy). • Be able to engage in and benefit from the rehabilitation services offered • Be willing to consent to assessment / intervention or, if not able to consent, it has been

established that the assessment is in the client’s best interests

At present the provision for Neurological physiotherapy in Stockport is provided by two main providers. The following are the services and criteria for our existing community rehab services in Stockport:

Service Age range Service Description Neurological Physiotherapy Ltd

16 plus A requirement for Neurological physiotherapy who are not housebound and can attend sessions within a clinic environment and need support from one discipline (physio)

Stockport Team for Adult Rehabilitation (STAR)

16 plus A requirement for Neurological conditions and take a IDT approach to rehabilitation involving OT, PT, SLT, neuro-psychology, medical and nursing who need support from two or more disciplines

A Specialist Stroke and Neurological Integrated Community Rehabilitation Service is a complete multidisciplinary team able to provide contact within 24 hours of discharge and a level of therapy similar to that which should be provided in an inpatient setting for a short term period. The proposed service will operate 6 days a week, therefore, will be able to offer a timely response and support discharges around weekends to enhance the patient flow from acute settings.

Rehabilitation services are commissioned to reduce limitation in activities, increase participation and improve quality of life for people with Neurological conditions, including stroke, using adaptive strategies. With stroke being the third largest cause of disability in the UK (Newton et al, 2015 (Ref ID 1023), providing effective rehabilitation is cost-effective in reducing long-term disability and the costs of domiciliary and institutional care. National evidence and GM policy is that integrated rehab services should be in place. The acute stroke service model in GM predominantly saves lives whereas the integrated rehab model not only saves lives but enables quality of life.

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The recommendation for rehabilitation for mild to moderate stroke patient input is 45 minutes of each active therapy that is required, for a minimum of five days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from therapy and are able to tolerate it (Cochrane review and NICE Guidance 2010). Stockport currently does not have any stroke specialist community based provision for this rehabilitation. The Greater Manchester Stroke and Neurological Rehabilitation Operational Delivery Network’s review of community rehabilitation teams in 2017 highlighted the significant variation and inequity of services across the conurbation. Stockport is one of only two areas that do not meet the national standards for stroke rehabilitation. The network report provided a clear recommendation that services be developed in Stockport to ensure the ongoing specialist rehabilitation needs of stroke (and neurology) patients are met when discharged from hospital, in line with NICE guidance and the Royal College of Physicians National Clinical Guideline for Stroke (2016). The Stroke Network wrote to the Directors of Stockport CCG to emphasise the importance of developing this service and the affect it is having on patients. Stockport CCG confirmed commitment to developing a community service. Whilst Stockport does have a community neuro-rehabilitation service, the service is not resourced to provide the intensity of therapy required by patients.

5. Options In reviewing the possibilities for improving community rehab services for local people as well as taking into consideration the cost effectiveness (current & future), three options were considered: Quality Compliance with

guidance GM/Nat

Additional Investment required.

Patient outcomes

Option 1 Do nothing

Poor – limited provision in the home setting

Poor – all national and local guidance suggest that rehabilitation for both stroke and Neurological patients should be available in the community.

None Average – patients are receiving a service but research suggests that receiving it in acute settings can make the recovery process longer and have psychological effects

Option 2 develop a standalone ESD service

Average – the service will provide more opportunity for stroke patients to receive rehab in

Average – the service would comply and meet the needs of the l national guidance, it

Average – After adjusting for reduced costs of bed based care, an investment of £0.4m would still

Good – an additional 215 ESD stroke patients would be given the opportunity to receive rehab at home and a further 107 stroke patients with higher needs

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the community but does not meet unmet need from underdeveloped specialist Neurological support. A separate team will have more operational challenges.

would also match the current GM “normal” standard of care across GM. It would not meet the new GM standard that all localities are expected to move to. In particular there would be a gap for non-stroke neurological patients.

be required. can access the service when their mobility improves

Option 3 Develop an integrated community rehabilitation service for stroke and neurology patients in the community working alongside the existing Neurological Physiotherapy private provider.

Very Good – This option would provide a fully staffed service to all Neurological and stroke patients who meet the eligibility criteria.

Very Good – this option would meet fully meet GM standards and exceed national guidance. It is fully consistent with the Stroke Network’s advice on the implementation of an integrated service.

High – the increased costs above an ESD are only partly mitigated through additional reductions in bed based neurorehabilitation demand. £0.671 additional investment would be required.

Very Good – this option allows all patients who meet the eligibility criteria to receive rehabilitation at home

It is the recommendation of the Greater Manchester Stroke and Neurological Rehabilitation Operational Delivery Networks that option 3 is preferable as the model allows the service to be more efficient and effective, providing greater flexibility and robustness in terms of staffing and continuity of service. This service design is more person-centred as the treatment of the patient is developed around their needs and the model allows integration with the current private provider and eliminates the need for procurement.

6. Developing an Integrated Service

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Initial discussions from Greater Manchester Stroke Operational Delivery Network recognised that provision for community based stroke rehabilitation service in Stockport required investment. The GM network has worked closely with each CCG to assist in the development of services as currently there is significant variation across the city. Stockport CCG developed a business case based on the Early Supported Discharge (ESD) model. The ESD model consists of intensive daily support over a short period of time for patients in their own home who are classed as having mild to moderate needs with some levels of independent functioning. A meeting was arranged with Greater Manchester Stroke Operational Delivery Network to discuss the proposed ESD service and plan a way forward. At this meeting it was advised by the network that an integrated service with neurology community services was a preferred option as the service would operate as a whole and would have the benefits of a larger team, one referral system, learning from colleagues and annual leave cover. Both the GM Neuro-Rehabilitation Operation Delivery Network and the Stroke Operational Delivery Network have developed service specifications in consultation with GM commissioners and GM clinicians in Stroke and Neuro-Rehabilitation services. Both networks have also consulted with patients and carers during the development of their respective service specifications. Neuro-Rehabilitation services in GM have been identified as a priority to transform through the GM Health & Social Care Partnership. It is understood that the transformation proposal for CCGs is to develop community neuro-rehabilitation services so that some inpatient neuro-rehabilitation beds can be made available by SFT towards excess demand across Greater Manchester. Further research was carried out to look at the options of service development. The Greater Manchester Stroke Operational Delivery Network provided a tool from The Sentinel Stroke National Audit Programme (SSNAP) which uses nation average data to calculate potential savings for NHS and Adult Social Care when the provision of rehabilitation services is moved from acute services into community. A further meeting with the Networks confirmed that by learning from the experience of other CCG’s in Greater Manchester, the suggested model of an integrated service would be recommended. Through discussions it was recommended that an expansion of the existing STAR team would enable the integrated service to grow and develop from one of Stockport’s existing services who have the expertise, skills and knowledge in this field of work.

7. Discharge Process It is intended that the discharge and referral pathway will be agreed collaboratively by all stakeholders and agreed and developed as part of the service specification of the new service. Close links with the Active Recovery Service will need to be established and early discussions with the SMC Lead have taken place.. We anticipate that the lead of the new service will be part of the Stockport Integrated Discharge Team and will ensure stroke and neuro patients follow the new pathway. If the patient requires additional

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support from Active Recovery referral should be made at the earliest convenience as failure to do so may result in a delayed discharge. A final discharge date should be agreed and first contact from the service should be made within 24 hours. Care planning for the patient should begin before discharge and continued in the community setting. Assessments will not be required in the community. The Specialist Stroke and Neurological Integrated Community Rehabilitation Team (SSNICRT) will be required to work alongside other support services that are available for patients in the community. GM service specifications for community rehabilitation for both stroke and neurology have suggested pathways for patients referred to community rehab services. The pathways include services from the Local Authority and voluntary sector to provide a holistic and coordinated service to patients. Pathway 2 highlights working with the local authority reablement services (Active Recovery) for patients who have higher needs. We anticipate that the two services would work together to jointly assess the patients and develop a joint management plan. The SSNICRT will provide treatment and lead on management plans which include therapy provided by Active Recovery support workers. The management plan will consist of up to 4 sessions per day provided by both SSNICRT and Active Recovery. SSNICRT will review goals weekly up to six weeks. When the six weeks of Active Recovery support ends support would be continued if necessary by SSNICRT as in pathway 1.

8. Specialist Stroke and Neurological Integrated Community Rehabilitation Service Pathway Structures

Hospital Phase

The Acute Stroke Unit / Neurology Unit will identify patients as potentially suitable for the Integrated Rehabilitation Service via daily ward round. The MDT will then discuss patients identified, reviewing them against the criteria to come to a joint decision on the patients suitability.

Stroke Pathway 1: Home with Integrated Community Rehab Team (SSNICRT) Discharged home with SSNICRT input over 6 days a week; daily visits by therapists and rehabilitation support workers as per clinical reasoning. The patient should be signposted to the GP for a 2 week post stroke assessment as part of their support. Stroke Pathway 2 - Home with SSNICRT and reablement service (Active Recovery) Support up to four times a day for six weeks to enable safe management and rehabilitation at home. Response times for assessment and treatment for these patients should be as per guidelines on pathway 1 for all ESD and non ESD patients. Stroke Pathway 3: Discharged to residential/nursing home

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People who have suffered a stroke who live in a care home should receive an assessment and treatment from stroke rehabilitation services in the same way as patients living in their own home. Stroke Pathway 4: One discipline support from Neurological Physiotherapy (private provider) Once referred a treatment plan will be established with goals identified in collaboration with patients, carers and family that can be achieved within 4 – 8 sessions. Neurology Pathway 1: as per the community neuro-rehabilitation model: Returning people home as early as possible with intensive support over 6 days is a key principle of the SSNICRT. Treatment:

• Intervention will commence between 1 and 7 days of discharge from inpatient services, as appropriate

Neurology Pathways 2 and 3 as per the community neuro-rehabilitation model:

The majority of patients will complete their rehabilitation within 3-6 months of being accepted onto the SSNICRT service. For the small number of individuals who require rehabilitation beyond 6 months, a review will take place prior to the 6 month mark, to ensure that remaining in the service beyond 6 months is the most appropriate treatment option for the patient.

Neurology Pathway 4: Discharged with support from Neurological Physiotherapy (private provider)

When a patient is referred a treatment plan will be established with goals identified in collaboration with patients, carers and family that can be achieved within 4 sessions.

Barthel Index Through discussions with existing teams it is anticipated that the use of the Barthel Index would be a starting point in identifying which patients would be appropriate for each of the identified pathways. The Barthel Index is a simple to administer tool for assessing self-care and mobility activities of daily living. It is widely used in geriatric assessment settings. Reliability, validity and overall utility are rated as good to excellent. Information is gained from observation, self-report or informant report. It takes approximately 5/10 minutes to complete if the observational method is used. Total possible scores from the tool range from 0 – 20, with lower scores indicating increased disability. If used to measure improvement after rehabilitation, changes of more than two points in the total score reflect a probable genuine change, and change on one item from fully dependent to independent is also likely to be reliable. Patients who require SALT/cognitive input would require services from pathways 1–3 depending on their needs. Patients who do not require SALT/cognitive input who have a score of above 14 would be referred to pathway 4 Neurological Physiotherapy.

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9. Benefits / Risks Service

Advantages/Benefits

Disadvantages/Risks

Do nothing To continue with the current acute and community service provision.

Less expensive than developing a new service Would not impact on workers time to develop and implement the service.

This option presents a greater risk around achieving national and strategic aims and will lead to continued gaps in community rehab services, especially for stroke patients. Will present a significant level of risk and will be unable to support reducing acute length of stay.

Develop a standalone ESD service To continue to provide services for neurology and stroke patients in the community through the current contracts and develop an ESD service for stroke patients to receive rehab in the community.

Quicker to set up as business case etc is already developed Would meet the needs of stroke patients

It is more expensive to have separate teams A separate service will create more operational obstacles. Less peer support when teams are separate Against the recommendations of the Stroke Network Would not address the lack of provision for Neurological patients in the community

Build upon current STAR Team to develop the Specialist Stroke and Neurological Integrated Community Rehabilitation Team (SSNICRT)

Operational Impact: Integrated Rehabilitation Service is predominantly provision of input to patients in their own homes and is closely aligned to the intermediate tier’s active recovery model Shared lone worker and other community systems Clearer definition of budget / activity

Operational Impact: Potential governance issue as would sit outside hospital stroke services although links into Stroke Clinical Governance

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plan aligned with existing community contract Options for cross cover for sickness etc. from within intermediate tier Reduces the FT footprint and is more in line with the Stockport Together programme of work to develop a fully integrated health and social care system in the area. Impact on Patients: Co-located with the longer term rehab part of the stroke pathway (intermediate tier / borough wide services and neighbourhood care and support model); improved communication and ability to achieve seamless transition at this point.

Impact on Patients: Risks to effective communication and seamless transfer on hospital discharge not co-located with acute inpatient team, however, Integrated Community Rehabilitation Team would in-reach into acute services to mitigate this

10. Clinical Governance

The proposed outline operating model will be used as a basis for developing a suite of protocols/pathways to ensure easy access, use and exit to and from intergraded community rehab services. These will be designed for in-house use to support training/development, awareness and help ensure new ways of working are embedded, as well as help develop key interfaces with other services.

Handover of clinical responsibility, what this entails and the points at which it occurs will be clearly identified within each aspect of the patient journey. A clinical governance protocol will be developed that ensures that the right specialist input and care pathway is available when needed.

The CCG Outcomes Indicator Set for 2014/15 sets out a requirement for all stroke survivors to receive a follow up assessment between 4 and 8 months after initial admission to hospital following a stroke. After consultations with CCG’s who have successfully commissioned Integrated Community Rehab services, it was felt that the use of third sector providers was beneficial to both patients and CCG’s.

11. Voluntary Services

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It is anticipated that as part of the service The Stroke Association would be contracted to complete 6 month reviews. Other CCG’s have been impressed with the quality of the review and patient feedback proved that their support was highly valued. Additional support for life after stroke by the voluntary sector will also be commissioned from the Stroke Association to improve patient experience and increase the efficiency of the community rehabilitation team.

12. Rationale When the summary of evidence above is reviewed, alongside Stockport’s current capacity and use of rehabilitation services, then the following conclusions are evident:

Too few patients/service users are provided with home-based services, with limited capacity and capabilities to provide enhanced sub-acute care at home

Research evidence has shown that specialist rehabilitation of stroke patients in the community can lead to improved recovery, with regaining of independence and improved abilities to perform activities of daily living.

to provide flexible and patient-tailored services while adhering to evidence-based service specifications that show value for money.

It is recommended that every CCG should commission a community rehabilitation service for stroke patients delivered by staff with stroke specialist skills

It is apparent from the above that focus and resource within Stockport is not afforded to specialist community rehabilitation services to the same degree as found in other areas of the country.

In light of this it is considered that significant improvements could be achieved by moving away from the current service provision within Stepping Hill Hospital to designing a fully integrated community rehab service which most effectively meets patient/service user needs and makes the most effective use of available resources.

13. BENEFITS OF PROPOSAL: Research A recent Cochrane Review of ESD Services for Stroke (Fearon & Langhorne 2102) which looked at 14 trials including 1957 patients concluded the following:

• The ESD group showed improvements in patients’ extended activities of daily living scores and satisfaction with services

• An additional 250 stroke patients and 100 Neurological patients would be able to receive treatment at home annually.

• There were no differences seen in carers’ subjective health status, mood or satisfaction with services

• The greatest benefits were seen in trials evaluating a co-ordinated ESD Team and in stroke patients with mild to moderate disability.

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• Economic analysis was included in 7 trials and all concluded that the opportunity savings from hospital bed days released tended to be greater than, or similar to, the cost of ESD. Realising such cost savings in practice can be difficult but ESD services appear to offer one way to manage increasing demand for a finite number of hospital beds

14. Enabler Requirements / Impacts

Workforce

The new model of care depends upon an integrated, multi-disciplinary and responsive team. This will in the immediacy require disparate teams, who are employed across a number of different organisations, to come together under one leadership structure, common governance systems and operate with an integrated support services function.

15. Performance / Outcome Measures and Evaluation

A clear performance framework will be developed that reflects national and local priorities. This will include clinical outcome measures, service user and carer feedback and the views of key partners / referrers to the service in addition to activity measures.

16. Finance Analysis Each option has been assessed from the perspective of both net additional cost and net additional cost per patient. Option No of

patients in service

Total Cost £m

Cost of existing services to be integrated £m

Cost of bed based deflection

£m

Net Cost (= Additional Investment required) £m

No of Patients

Net Cost / Additional patient

£

1 £n/a £n/a £n/a £n/a £0 n/a n/a

2 322 £0.519 (£n/a) (£0.140) £0.379 352 £1,076

3 572 £1.241 (£0.216) (£0.354) £0.671 572 £1,173

The table above shows that the preferred option 3 requires additional investment of £0.671m. This is significantly higher than option 2 (£0.379m). This difference is predominantly accounted for by the additional volume of patients as the net cost per additional patient are much more comparable (£1,173 for option 3 per patient compared to £1,076 for option 2).

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17. Service Utilisation The proposal is for an Integrated Service to be commissioned in Stockport that meets the requirements of relevant local and national guidelines. The Integrated service enables the accelerated discharge of stroke and neurology patients to their home (family home) providing specialist rehabilitation and social support in the community comparable to that of an in-patient stroke unit. Service provision would be focused around time specific patient goals and will embrace the needs and ability of patients and their carers. In order to ensure Stockport patients receive a quality service across the patient pathway which meets the GM Specification and the relevant clinical guidelines it is proposed that the required team structure should to be formally commissioned to manage a predicted caseload of 572 patients per year (Based on SFT figures, SSNAP, SUS and SLAM data, provider data and comparison with a similar populated CCG area). This estimation has also been considered by the GM Operational Development Network for Stroke and Neurology. The standards aim for 56% of stroke discharges to access an early discharge to the Integrated Rehabilitation Service into an ESD level of service, 25% of discharges are patients with higher needs but returning home with support from the team. Including the higher need neurology patients who will be referred we anticipate total usage of 572 patients annually. The lower need neurology patients that require support shall receive it from the neurology physiotherapy contract.

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Commissioning a best-practice pathway for

Cardiac Imaging

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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Executive Summary

What decisions do you require of the Governing Body? The Governing Body is asked to endorse enacting the contract notice given to Stockport Foundation Trust in 2014. Please detail the key points of this report Enacting the contract notice for Stockport patients means that care will transfer to compliant providers, most significantly UHSM. Therefore the current Angiography service delivered from the Cardiac Catheter Laboratory at Stepping Hill Hospital Stockport NHS FT service will be decommissioned. Stockport CCG is the lead commissioner for the contract with SFT on behalf of Stockport CCG, Tameside & Glossop CCG, Eastern Cheshire CCG and North Derbyshire CCG. 712 patients had angiography at SFT in the year ending June 2017. The breakdown of the activity is shown in the table below: Angiography Activity at

SFT year ending June 2017

Tameside & Glossop CCG

40%

Stockport CCG 25% Eastern Cheshire CCG 19% North Derbyshire CCG 8% Other 8%

What are the likely impacts and/or implications? The intended impact is that Stockport patients will receive Cardiac Imaging that is compliant with best practice as endorsed by the Greater Manchester Cardiac Network. The main implication is that the Stockport based service, which is not compliant with best practice, will be decommissioned. How does this link to the Annual Business Plan? This is a key element of the CCG’s commissioning activity. What are the potential conflicts of interest? None

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Where has this report been previously discussed? CCG Leadership Team and Executive to Executive Meeting with NHS Stockport Foundation Trust Clinical Executive Sponsor: Cath Briggs Presented by: Cath Briggs Meeting Date: 29 November 2017 Agenda item: 13

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Historical Context Stockport CCG issued a Variation Proposal to Stockport Foundation Trust in August 2014. This proposed, that access for Stockport patients was decommissioned to the Stockport Foundation Trust Angiography Service in accordance with the Cardiac Strategy 2012 – 2015. This strategy stated that the best clinical practice is to perform angiography where there is choice and capability to do this as a query proceed (ie to proceed to treatment) and where there is interventional capability on site. Stockport CCG’s variation proposed that for Stockport patients, the stand-alone angiography service was replaced with the provision supplied through the stable angina pathway at the three clinically accredited sites in Greater Manchester; University Hospital South Manchester, Central Manchester Foundation Trust and Pennine Acute Hospital Trust. This variation was not enacted following further advice from the Strategic Clinical Network in a letter of 18th June 2015. This advice confirmed the clinical position but recommended not to decommission because other angiography labs within Greater Manchester did not have the capacity to absorb the total work undertaken at Stockport at that time.

Recent Context Stockport CCG has re-stated its intention to decommission angiography through Commissioning Intentions in 2016/17 and in 2017/18. In 2016 Stockport CCG re-opened discussions with UHSM and SFT to progress our intentions. UHSM has confirmed in writing that with the recent completion of a 5th Cath Lab they have the capacity to absorb the angiography work undertaken by Stockport within the standards required for this service., A new cardiac day lounge which is a purpose built facility for patients before and after their angiogram procedure avoids the use of inpatient bed capacity. UHSM has also offered to support the development of new pathways from DGHs into UHSM and opportunities for working across localities. Discussions were also re-opened with SFT in 2016 including at their request, the cardiology consultants working at Stockport Foundation Trust. The clinical discussions centred on whether a pathway could be agreed such that no patient would have an outcome of query proceed. There was not a clinical consensus amongst the consultants. Stockport Foundation Trust has expressed concerns about the cost-effectiveness of the angiography service due to a required refurbishment of the Cath Lab in 2/3 years’ time requiring considerable financial investment. SFT accept the position with regards to decommissioning of angiography and are working with Stockport CCG to achieve this objective.

Engagement

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An Equality Impact Assessment has been undertaken and an Engagement Plan has been developed and used to guide this programme of work. Associate commissioners and Healthwatch have been involved in the engagement programme. An engagement with existing and potential new users of the service took place 11th August to Friday 8th September, using the Citizens Space portal and involving 10 face to face interviews. Stockport CCG led this engagement on behalf of all commissioners. A link to the survey was made available through CCG websites: https://stockport-haveyoursay.citizenspace.com/commissioning/stockport-angiogaphy-service-2017 Forty-four people took part in the survey. They were registered with a GP in Stockport (55%), Eastern Cheshire (25%), Tameside & Glossop (9%), North Derbyshire (9%) and Other (1%). Fifty-percent of the respondents were female, forty-three percent were male and seven percent declined to say. Eleven percent of the respondents advised that they were an NHS staff member. The patients’ who were interviewed were registered with GP’s in Eastern Cheshire and Tameside & Glossop. Respondents were asked the following question:

In response to the question ‘Do you agree with the proposal?’ 66% replied ‘No’ and 34% replied ‘Yes’. The concerns expressed fell into 3 broad categories:

1. Did not agree the case for change 2. Concerns with transport to UHSM 3. Concerns that waiting times would increase for angiography.

As part of the engagement the proposal to decommission was also taken to:

• Stockport’s Health & Scrutiny Committee on 25th July 2017 and supported.

• The Executive Committee of Theme 3 at the GM Health & Care Partnership on 24th August 2017. The committee considered Stockport’s proposal to be in line with the direction of travel for acute service in Greater Manchester and did not raise any concerns.

As with changes such as the centralisation of stroke services, this change is not universally endorsed and supported. This is reflected in the staff and patient engagement responses set out in this report.

Staff Engagement Stockport Foundation Trust has undertaken a staff engagement. A letter was sent from the cardiology consultants to Ann Barnes on 7th September raising significant concerns about the proposal to decommission and requesting that Stockport Foundation Trust object to and challenge the proposal from Stockport CCG. SFT are working with the consultants to develop a new service.

Associate Commissioners Tameside & Glossop CCG, Eastern Cheshire CCG and North Derbyshire CCG will consider their position on Stockport’s proposal at Governing Body meetings in October and November 2017.

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Procurement for a Spinal Assessment &

Treatment Service

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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Executive Summary

What decisions do you require of the Governing Body?

The Governing Body is requested to:-

1) Note that the CCG has followed a clear procurement process todetermine the preferred provider of this service.

2) Delegate the decision on the recommendation of the report to theCCG Chief Finance Officer.

Please detail the key points of this report

The report provides a summary of the procurement process. The purpose of the report is to provide the Governing Body with assurance and transparency as to how the procurement process has been undertaken.

The identity of the bidders is intentionally not included within the report.

It is confirmed that the Chief Finance Officer, to whom the decision is proposed to be delegated, has not been part of the assessment process.

What are the likely impacts and/or implications?

The implications and impact of is outlined within the body of the report.

How does this link to the Annual Business Plan?

This is a key element of the CCG’s commissioning activity.

What are the potential conflicts of interest?

None

Where has this report been previously discussed?

CCG Leadership Team.

Clinical Executive Sponsor: Cath Briggs

Presented by: Mark Chidgey

Meeting Date: 29 November 2017

Agenda item: 13

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PROCUREMENT OUTCOMES REPORT

A recommendation to the Governing Body

of NHS Stockport Clinical Commissioning Group

Following the completion of the evaluation of tenders received in regard to:

The procurement for the Provision

of a Spinal Assessment and Treatment Service

9th November 2017

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Table of Contents

1. Purpose 3

2. Background 3

3. Procurement Evaluation Panel 4

4. Bid Evaluation Process 4

5. Bid Evaluation Results 5

6. Financial Implications 7

7. Recommendation 7

8. Approval 8

9. Annexes 9

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1. Purpose 1.1. This report with recommendation has been compiled on behalf of the Procurement

Evaluation Panel for the Provision of a Spinal Assessment and Treatment Service (‘the Service’). The report is produced following the completion of the evaluation of bids received in response to the Invitation to Tender which was advertised through the Official Journal of the European Union (OJEU) and Contracts Finder on 27th July 2017.

1.2. The purpose of this report is to present a recommendation for consideration and approval of the Governing Body of NHS Stockport Clinical Commissioning Group (‘the CCG’).

1.3. The recommendation is based on the results of the evaluation carried out by the representatives appointed by the CCG to form the Procurement Evaluation Panel (the Panel), who evaluated the bids received in response to the Invitation to Tender.

2. Background 2.1. The aims and objectives of the Spinal Assessment and Treatment Service are to:

• Provide a high quality, cost effective specialist assessment and treatment service for MSK back conditions following evidence based practice.

• Achieve excellent patient outcomes and limit the physical and associated disabilities that are caused by musculoskeletal back conditions.

• Provide a convenient service to patients to ensure a balance of day, evening and weekend appointments to meet patient demand.

• Provide a service in a Stockport location that is easily accessible to all registered patients with good transport links and access to parking facilities.

• Provide patient education and shared decision making to empower the patient to self-manage and make decisions about their condition and potential treatment options and outcomes as clinically appropriate.

• Reduce pressure on secondary care services and enable the 18 week target to be met by the Service operating within the 18 week rules.

• Offer choice for secondary care referrals using the NHS e-Referral Service.

• Ensure integration and co-ordination with services across the MSK pathway, avoiding duplication of care.

• Ensure continuity of care including a clear ongoing management plan at discharge communicated to the referrer and to the patient.

2.2. The contract will run from 1st April 2018 to 31st March 2021 with an option to extend for 2 years.

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2.3. A competitive tender was deemed to be the most appropriate way to procure these Services due to the existence of more than one capable and interested provider in the market.

2.4. The Spinal Assessment and Treatment Service falls within Schedule 3 of the Public Contracts Regulations 2015 (the "Regulations"). As such, the procurement of the Service was run as a bespoke, single-stage application process akin to the Open Procedure.

2.5. The procurement process was managed by NHS Shared Business Services (NHS SBS) on behalf of the CCG using the NHS SBS EU-Supply electronic procurement system to administrate all communications with bidders and the receipt of completed tenders.

3. Procurement Evaluation Panel 3.1. Panel members were each required to complete a Statement of Confidentiality and

confirm a declaration in regard to potential Conflicts of Interest.

3.2. No Conflicts of Interest were identified as raising any concern in regard to this procurement.

4. Bid Evaluation Process 4.1. The procurement timetable for the Spinal Assessment and Treatment Service is set

out below:

Activity Dates

Issue Adverts and ITT Documentation 27th July 2017

Deadline for the receipt of clarification questions from Bidders

12th September 2017

ITT Bidder Response Submission Deadline 21st September 2017

ITT Bid Evaluation Stage 21st September to 18th October 2017

4.2. Tender receipt and opening took place by NHS SBS on 21st September and four bids were received.

4.3. The bids were evaluated in accordance with the evaluation process developed specifically for this procurement and published to bidders within the ITT documentation, designed to select the most economically advantageous tender, i.e. that which offers the optimum combination of service capability, quality and bid price (within affordability parameters).

4.4. Preliminary compliance checks were carried out by NHS SBS between 21st and 22nd September 2017 in order to confirm that all the correct information had been received.

4.5. Tender clarification queries were directed back to the bidders where appropriate.

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4.6. Compliance with the CCG’s published affordability threshold was checked for each bid submitted. The affordability threshold having been set in light of market forces and the intentions of the CCG to deliver best value. The scoring methodology published to potential bidders encouraged the submission of competitive prices.

4.7. All bidders met the affordability threshold as set out in the ITT.

4.8. Qualitative evaluation of the bid responses was undertaken by the Procurement Evaluation Panel.

4.9. The evaluation involved review of the bid by individual Panel members between 22nd September 2017 and 16th October 2017. The Panel subsequently met on 17th and 18th October to agree a consensus score for each element of the bid on behalf of the CCG.

5. Bid Evaluation Results 5.1. The maximum weighted marks available in the evaluation process were as follows:

Section Sub-Section Sub-Section Weighting

Total Section Weighting

Section 1 - Pre-requisites Pass/fail

Section 2 –Quality

Service Delivery 24.00%

75%

Clinical Quality and Governance 18.00%

Service Quality and Patient Experience 14.00%

Innovation 3.00% Workforce 8.00%

IM&T 8.00% Section 3 – Finance 25%

Overall Cost of Proposal 25% Total 100%

5.2. The overall, high-level results of evaluation, including the moderated scores are:

Sub - Section Bidder 1 Bidder 2 Bidder 3 Bidder 4 Service Delivery 18.50% 12.25% 17.50% 4.25% Clinical Quality and Governance 15.25% 13.00% 9.00% 5.50% Service Quality and Patient Experience

11.25% 11.25% 9.75% 7.00%

Innovation 2.25% 1.50% 2.25% 1.50%

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Workforce 6.00% 4.00% 4.00% 4.00% IM&T 3.25% 3.75% 3.25% 3.00% Overall Cost of Proposal 19.92% 21.69% 17.82% 25.00% Total Score 76.42% 67.44% 63.57% 50.25%

5.3. The Procurement Evaluation Panel concluded overall that the response from Bidder 1 provided a greater level of confidence and assurance in their ability to deliver the Service.

5.4. Whilst Bidder 1 achieved consistently higher scores in comparison to other Bidders, the advantage was particularly evident in the following areas:

Service Access Clinical Experience and Quality Outcomes

Patient Safety

Collaborative Working.

6. Financial Implications

6.1. The total affordability threshold set for the Service was £1,380,000 (for 3 years) or £2,300,000 (for 5 years) with an annual maximum value £460,000, inclusive of CQUIN.

7. Recommendation

7.1. The recommendation of the Procurement Evaluation Panel is that Bidder 1 will be confirmed as the Recommended Bidder and that engagement commences with this Recommended Bidder to progress toward contract signature, subject to any challenges during the allotted standstill period to enable service commencement by 1st April 2018.

7.2. Subject to approval, that a contract award letter covering the standstill period be issued to the Recommended Bidder and an unsuccessful letter covering standstill period be issued to the unsuccessful bidders.

7.3. The invitation to be extended to the Recommended Bidder to enter into a contract with the CCG, will be subject to the usual pre-contractual due diligence and the evidencing of associated assurances.

7.4. The unsuccessful bidders will be provided with detailed written feedback including comparative marks awarded to the Recommended Bidder. The Recommended Bidder will be provided with detailed feedback to assist understanding and learning from the bid evaluation process.

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8. Approval

8.1. The Governing Body of NHS Stockport CCG, 7th Floor, Regent House, Heaton Lane, Stockport, SK4 1BS is requested to approve the recommendations of this report, the appointment of Bidder 1 as the Recommended Bidder.

Author: Chris Gough, Senior Procurement Manager, NHS Shared Business Services

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9.

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Report of the Finance and Performance Committee

NHS Stockport Clinical Commissioning Group will allow

people to access health services that empower them to live healthier, longer and more independent lives.

Tel: 0161 426 9900 Fax: 0161 426 5999 Text Relay: 18001 + 0161 426 9900 Website: www.stockportccg.org

NHS Stockport Clinical Commissioning Group 7th Floor Regent House Heaton Lane Stockport SK4 1BS

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Executive Summary

What decisions do you require of the Governing Body? This report provides a summary of the meeting of the Finance and Performance Committees which took place on 11th October 2017 and 8th November 2017 No decisions are required of the Governing Body.

Please detail the key points of this report

The report provides an overview of the discussions which took place at the meeting relating to the following matters: • Risk regarding CIP delivery. CIP planning and an update on the CCG financial position • Performance of Activity compared to Plan. • Progress on our benchmark position regarding prescribing

What are the likely impacts and/or implications? Non delivery of CIP would impact significantly on the CCG’s financial plans and the delivery of required efficiencies (both non-financial and financial). Compliance with NHSE requirements are an important requirement of the CCG assurance framework. How does this link to the Annual Business Plan?

CIP is an integral part of the CCG’s Operational Plan.

What are the potential conflicts of interest?

None

Where has this report been previously discussed? The issues covered by this report were considered at the Finance and Performance Committee meeting on 11th October 2017 and 8th November 2017 Clinical Executive Sponsor: Ranjit Gill Presented by: Peter Carne Meeting Date: Agenda item: Reason for being in Part 2 (if applicable)

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Finance and Performance Committee Update for Governing Body

11th October

1.0 CIP and Financial Position

The committee received update reports confirming that whilst there would be very significant delivery of CIP in 17/18 (£14.3m) the full target of £17.4m was very unlikely to be achieved. This, along with higher than planned expenditure on acute activity and CHC cases, resulted in a significant net financial risk of £2.6m. The committee view was that net financial risk should have been addressed by this stage of the financial year and therefore required from the CFO:- • A clear mitigation plan setting out how the required surplus of

£1.32m would be achieved. • That from November the recurrent position that is being carried

forward into 2018/19 is clearly reported to the Governing Body. • An update on Stockport Together benefits delivery is brought to a

future meeting (date to be agreed). 2.0 Performance

The committee reviewed the IAF indicators and requested absolute clarity through the performance framework review, that is currently in progress, as to the IAF indicators that the committee were responsible for.

8th November 3.0 CIP and Financial Position

The CFO provided a report detailing financial over-performance and risks in 2017/18 with a net position of £2.4m. Alongside this he then presented to the committee a mitigation plan for the full £2.4m consisting:-

• Full recovery of all potential allocation income. • Further prescribing improvement • Contract management - Acute Contract Challenges • Non recurrent CIP / Technical

The risk adjusted position is currently £1.7m net risk and the CFO confirmed that he will bring a monthly update as to how likelihood of achievement is increasing and consequentially net risk is falling.

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