Millbrow Care Home Body Meeting...Millbrow Care Home- The story • A purpose built two storey care home situated in Widnes, registered to provide both nursing and personal care for

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www.halton.gov.ukwww.halton.gov.uk

www.halton.gov.uk

Millbrow Care Home

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Sue Wallace-bonnerDASS

www.halton.gov.uk

Millbrow Care Home- The story

• A purpose built two storey care home situated in Widnes, registered toprovide both nursing and personal care for up to 44 people.

• The home is part of the Four Seasons Healthcare (FSHC).

• The home comprises of two units - upstairs accommodating EMI nursing,and downstairs accommodating residential, and general nursing beds.

• CQC have recently undertaken a series of urgent inspections duringAugust and September 2017 and rated the home as inadequate in allareas.

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www.halton.gov.uk

Millbrow Care Home- The story

• FSHC provided additional operational support to Millbrow to drive upquality and standards but this was neither satisfactory nor sustainable.

• FSHC advised the Council that Millbrow was no longer financially viabledue to the high use of agency nurses and associated quality issues.

• The Council offered various alternatives to closure, however, FSHCadvised the Council on the 1st November 2017, that they intend to closethe home on 10th December 2017.

• FSHC commenced formal consultation with both residents and staff toformalise closure of the home.

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www.halton.gov.uk

Challenges

Quality

• Inadequate

• CQC

• Residents- Homeless!!

• Families

• Staff

Finance

• FSHC do not own the property- leasefrom an American company at a cost of£300k per annum

• Taking into account the need forsubstantial remediation works toimprove the facilities and bring thehome up to standard which have beencosted in the region of £300k, thevaluation was considered to be£700,000.00

www.halton.gov.uk

Options for the Council

The home (Millbrow) is allowed to close

The Council to Purchase the home

The home would close on the 10th

December 2017 and the Council wouldattempt to secure alternativeaccommodation for the residents.

The current residents are a vulnerablegroup of people and any transfer wouldundoubtedly be very stressful andtraumatic for them and their families.

The alternative accommodation will bepredominantly out of area placements

Reduce the available care home beds inthe Borough by 44 beds.

Christmas

Purchase cost of £700k plus at least £300kworth of refurbishment- 8-12 weeks tocomplete

To prevent closure on 10th December 2017, aninterim business transfer agreement is required

CQC registration - needed to be completedwithin 5 weeks

Nursing provision is not core business for LAs

Quality improvement - at pace

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www.halton.gov.uk

Outcome

• Purchased the home, improvement plan in place

• Continue to deliver the service in partnership with CCG

• Improve Clinical Care- GP alignment, additional senior nurses

• Improve the quality- within 4 weeks of purchase- from inadequate to good

• Home now open and accepting admissions

www.halton.gov.uk

Outcome

• National interest- BBC radio 4 interview

http://www.bbc.co.uk/programmes/p05xj6ls

• International- Interview with New York Times

https://www.nytimes.com/2018/01/31/world/europe/britain-outsourcing-elderly-care.html?partner=rss&emc=rss

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www.halton.gov.uk

Next steps

• Centre Of Excellence

• Teaching Care Home

• Safer Staffing

• Finance model

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Governing Body

MINUTES OF THE PUBLIC MEETING

4 January 2018, 10am – 12.30pm Civic Suite, Runcorn Town Hall, Runcorn. WA7 5TD

Members in Attendance: Ann McIntyre (AM) Director of Children’s Services Halton Borough Council Dr Claire Forde (CF) GP Member / Medicines Management

Clinical Lead NHS Halton CCG

Dave Sweeney (DS) Interim Chief Officer NHS Halton CCG David Cooper (DC) Chief Finance Officer NHS Halton CCG Dr David Lyon (DL) CCG Chairman NHS Halton CCG David Merrill (DM) Lay Member NHS Halton CCG Eileen O’Meara (EO) Director of Public Health Halton Borough Council Dr Julie Langton (JL) Secondary Care Doctor NHS Halton CCG Dr Latha Meda (LM) Federation Representative – Widnes

Highfield NHS Halton CCG

Leigh Thompson (LT) Director of Commissioning NHS Halton CCG Michelle Creed (MC) Chief Nurse NHS Halton CCG Paul Cooke (PC) Halton Healthwatch Representative Halton Healthwatch Ruth Austen Vincent (RAV)

Lay Member NHS Halton CCG

Dr Gary O’Hare (GOH) GP Member & Clinical Lead Primary Care NHS Halton CCG

In Attendance by Invitation of the Chair: Louise Murtagh Senior Committee Administrator NHS Halton CCG Suzanne Barker (SB) Head of Corporate Governance NHS Halton CCG Anita Butterworth (AB) Volunteer Services Manager STHK NHS Trust Sue Costello (SC) Volunteer STHK NHS Trust

Apologies: Dr David Wilson (DW) Federation Representative – GP Health

Connect NHS Halton CCG

Diane Hanshaw Practice Manager Representative NHS Halton CCG Ingrid Fife Lay Member NHS Halton CCG Shazhad Tahir Lay Member NHS Halton CCG

1. Introductions, Declarations and Apologies DL welcomed all members and attendees to the meeting, introducing Anita Butterworth (AB) and Sue Costello (SC) from STHK Volunteer Service. Members introduced themselves. DL explained that it was taken that all reports were as read and that presenters would raise specific points for discussion.

Governing Body

GOH advised Governing Body that he was the Deputy Chair of GP Health Connect. In in DW’s absence during January 2018 he would be acting as Chair for the organisation. Apologies were received and noted as tabled earlier. 2. Public Minutes and Action Plan of the Governing Body held on 2 November

2017 (GB57-17) The minutes of the meeting held on the 2 November 2017 were agreed as a correct and accurate record of discussions. The action log from the previous meeting was discussed and the following actions reported and updated:

• 02/11/17 Item 3, Patient Story - MC confirmed that she would provide an update on Learning Disability Services to the March 2018 Governing Body meeting.

• 02/11/17 Item 3, Cancer - SJG to circulate information on mortality rates and provide follow up report on Cancer Actions during 2018. LT advised that this was scheduled for Governing Body in 2018/19 therefore the action could be closed

• 02/11/17 Item 8, Corporate Performance Report – LT advised that the work underway in respect of bed availability and urgent care services and Corporate Report to go to H&W board, was on the agenda therefore the action could be closed

• 02/11/17 Item 9, Financial Update – DC confirmed that the NHSE finance letter had been circulated and that discussions had taken place with NHSE regarding the CCG’s financial position. Therefore the action could be closed

Governing Body ratified the minutes.

3. Patient Story – Focus on Volunteering (Presentation) DL advised that this section of meeting related to the important work of volunteers. AB provided members with information relating to the Volunteering Service at St Helens and Knowsley Teaching Hospitals NHS Trust. Key details included: The service had 370 current volunteers; and 2 permanent and 2 bank members of staff. To assist with recruitment to the volunteering posts the service held various community events and volunteers were provided with regular training and newsletters. Social events such as coffee mornings were also held throughout the year and there was an annual awards ceremony. The service had a five-year strategy for 2016-2021 that aimed to increase volunteering opportunities and the workforce to 750. Managers would be involved in recruitment for their own areas and the impact of volunteers on patients was also being considered as part of the strategy. Information on the benefits that volunteers brought to the Trust was discussed as were the benefits for the volunteers themselves. There was a set criteria that volunteers had to commit to and an extensive list of roles open to people was provided.

Governing Body

Members watched a short video that showed clips from the latest Volunteer Award ceremony and interviews with a number of the winners and other volunteers. Questions and answers followed the presentation on how the Trust encouraged diversity in its volunteers and how the service fed back to the Board. All members thanked AB and SC for attending the Governing Body meeting.

4. Chairman’s Report (Verbal) DL provided a verbal update for the Governing Body on his CCG commitments over the past two months. This included work on Local Care Partnerships, integrating the commissioning offer with partners and a number of hospital meetings including quality meetings at both Whiston and Warrington Hospitals. Members noted the update.

5. Chief Officer’s Report (GB58-17) DS presented his Chief Officers Report providing an overview of key issues relating to the CCG as follows: Business updates • Jan Snoddon held the position of Independent Registered Nurse (IRN) up until December 2017.

The CCG had subsequently decided to incorporate the role into the portfolio of the Chief Nurse. • The Constitution had been submitted to NHSE for approval. Confirmation of final approval was

expected in January 2018. Reference to the IRN position would be removed in March 2018 • CCG arrangements for the Remuneration Framework for Clinical Commissioners/Contractors. This

was a complex area for review and that the CCG had submitted its evidence to MIAA. To commission services which continually improve the health and wellbeing of Halton residents • One Halton - Accountable Care System – local Provider Partnership. Work continued with Halton

Borough Council, Public Health, Specialist Commissioner and the two local GP federations in collaboration with NHS Bridgewater Community to investigate a place based out of hospital model and hospital and specialist provision. Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements • The inaugural meeting of the Alliance Healthier Together Joint Committee had taken place on 12

December 2017. A draft work plan will be developed which will include details of opportunities for maximum utilisation of services and further updates will be brought back to the Governing Body

To deliver our statutory duties in respect of commissioning, quality, equality, consultation, engagement and finance including QIPP

Governing Body

• Full details of the CCG’s finances would be presented in the Chief Officer’s report later in the meeting. QIPP remained a priority with opportunities to support financial recovery being explored at every opportunity.

To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders • The CCG has commissioned Desala Ltd to provide development support to the EMT and Heads of

Function during the next three months initially.

Relationships, partnerships, politics, health system updates • Aintree University Hospital NHS Foundation Trust and the Royal Liverpool and Broadgreen

University Hospitals NHS Trust had both approved the Outline Business Case for a merger. DS also asked for his thank you to all front line staff to be recorded. Members noted the content of the Report.

6. Chief Nurse’s Report (GB59-17) MC presented a detailed report to Governing Body that provided an update and assurance position in respect of quality, safety and experience of services commissioned. MC highlighted a number of issues contained within the report: • Bridgewater Collaborative Commissioning Forum. A meeting had been organised for 31 October

2017 with disappointing attendance. MC was asked to review and address this matter. A teleconference call was currently being scheduled for 18 January 2018 to discuss.

• Spinal services at Warrington & Halton Hospitals NHS Foundation Trust. The final report had been delayed. MC referred to the table within the report showing the number of patients on the Patient Transfer List.

• Local Flu Plan – the figures were better than had been expected. • Commencement of amendments to the Mental Health Act 1983 coming into force on 11 December

2017. Two of the significant changes for the CCG were - ‘it is unlawful to use a police station as a place of safety for anyone under the age of 18 in any circumstances’ and ‘a police station can only be used as a place of safety for adults in specific circumstances, which are set out in regulations’

• NHS Halton Enhanced Health in Care Homes in relation to the launch of the Red Bag scheme and the Lampard Report.

• Healthwatch’s general feedback regarding UCCs. • Millbrow Nursing Home purchase by the local authority had been completed on 11 December

2017. Family members had expressed their thanks for the support in ensuring continuity of care. Four residents who had left the home prior to the transfer had now requested to return. Members applauded this news as well as the GP alignment with Peel House and care home involvement with MDTs.

• NHS Halton CCG assessment outcome from the Engagement and Involvement IAF Assessment - Patient and Public Participation. The CCG had achieved good or outstanding in all areas other than Feedback and Engagement were a score equalling requiring improvement had been achieved. MC advised that the CCG evidence had not been visible to score higher. An action plan is under development and the Engagement and Involvement Group would monitor this.

Governing Body

• CCG Hosted Safeguarding Service Review. The consultation with staff closed on 31 December 2017. From 1 January 2018 the organisation would undertake discussions with receiving CCG to facilitate the transfer of staff. Governing Body noted the update. ACTION: MC to review and address the attendance levels the Bridgewater Collaborative Commissioning Forum. 7. Corporate Performance Report (GB60-17)

LT presented the Corporate Performance Report concentrating on Accident and Emergency. The report was taken as read by members. LT went on to say that figures confirmed that the service was under considerable pressure over the Christmas and New-Year period. LT had visited Whiston Hospital earlier in the week. From this visit LT advised that Whiston had been designed for a maximum of 250 people and there had been 384 in attendance at one point; ambulances had been queuing with a 70 minute turnaround, there had been no ICT beds at one point on 3 January 2018, consultants had been triaging patients and swabbing people for flu in A&E, non-clinical staff and volunteers had been signposting patients and helping out where possible, 50-70 extra beds had been opened, 15 patients had been identified medically fit for discharge but needed social care evaluation prior to discharge, urgent electives continued, patients were being nursed in ambulances. These were among the issues that had been brought to LT’s attention. DL advised that as non-elective surgery lists had been closed this should help to free up surgeries and surgery staff. Warrington had also sent some useful information to GPs recently. EO advised that following the CQC inspection that the local authority would add information relating to adult social care to the performance report. Governing Body noted the update. 8. Financial Update (GB61-17)

In addition to the detailed report received in the Governing Body Pack, Members received a one page summary in respect of the financial position from the Chief Finance Officer. DC provided a detailed overview of the CCG financial position and risks to the end of month 8. Financial risks and mitigations for months 9 to 12 were also listed. The financial position at the end of month 8 was an over spend of £4,129k against a plan of break-even after utilising the £1,066k contingency reserve in full. Adding in the expected spend and risk for the remainder of the year there would be an overspend of £10,497k. With mitigations this would be reduced to £8,506k. This however, would only be met if all risks and mitigations materialised in full. The worst case scenario would be an overspend of £14,626k. DC advised members that Trusts had been encouraged to review electives but that this may not

Governing Body

have a great impact. The CCG have informed NHSE adjusting of the actual outturn position and this was noted. DS highlighted that the CCG did not hold the contracts for the acutes and this is where the majority of the overspend sat. The CCG was also unable to use any contract levers against the acutes. DC confirmed that the CCG would continue with its work to address overspend by holding a third QIPP week, working collaboratively with Warrington and continuing conversations with Bridgewater. Governing Body noted the report. 9. Director of Commissioning Update (GB62-17)

The purpose of the paper presented by LT was to provide assurance with regard to the key strategic, operational issues and developments related to the delegated duties of the Director of Commissioning. LT highlighted a number of issues. Winter Pressures additional funding had been released in two tranches. The second allocation was for new initiatives to improve A&E performance over winter and was to be spent on pecific schemes identified within submitted bids. The report held a table that provided details of the successful resource allocation for the Mid Mersey A&E Board across Warrington, Halton, St Helens and Knowsley. Total resource allocation in both tranches 1 and 2 was £4,159,021. Recruitment to fill posts was already underway. The National Emergency Pressures Panel (NEPP) had met and issued guidance regarding reviewing elective activity to deal with non-elective pressures to ensure resources were directed to the most appropriate patients. The NEPP recommendations were listed in the report. Primary Care Streaming had gone live in both hospitals. The Warrington model was nurse led triage whereas Whiston was GP led but going forward it may move to a hybrid model. The assessment of the Urgent Treatment Centres had been completed and there were a number of actions identified following this regarding compliance mainly with IT. GOH was leading on this and it would probably be Summer 2018 before completed. On the 21 December 2017 the CCG received formal notification that our Better Care Fund Plan 2017-19 had been approved. The organisation was working with MIAA following this. The tender for the community respiratory service has been formally terminated to allow more time to develop a new clinical solution within a collaborative arrangement. In developing this the Clinical Advisory Group, Commissioning Oversight Group and Executive Management had supported the decision to terminate the procurement. The Governing Body noted and supported the termination of the Community Respiratory tender and requested that that Director of Commissioning to add this risk to the Corporate Risk Register. In late 2017 the Clinical Advisory Group, Primary Care Commissioning Committee, Executive

Governing Body

Management Team and Performance and Finance Committee agreed to the extension of the contract for the Referral Management System. This was to allow time for a move to the national E-referral system which was the preferred model. The Governing Body endorsed this decision. CF highlighted an issue relating to NWAS after 111 calls. LT advised that she would bring statistical information to the next Governing Body meeting in March 2018. Governing Body noted the report. ACTION: LT to add a risk to the Corporate Risk Register relating to the Community Respiratory Service. LT to bring statistical information regarding NWAs following 111 calls to the next Governing Body meeting in March 2018 10. Board Assurance Framework - GBAF (GB63-17)

MC presented the GBAF to Members advising that there were no changes to the document from the previous presentation. During discussions on the entries members noted that in relation to risk 1.1 the CCG had implemented a PMO process for commissioning, using the Committee system. Members requested that the risk listed at 3.1 required splitting into two. One risk relating to the failure to meet non-financial statutory duties (constitutional standards) and the second relating to financial statutory duties. The latter required an increased risk score to 25. MC advised that a strategy was being developed in relation to risk 4.1 The Governing Body noted these updates. ACTION: DC and DS to split risk 3.1 into two risks. The risk relating to finance requiring an increased risk score to 25. 11. Committee Key Issues (GB64-17)

DL confirmed that Key Issues Reports from respective Committees had been circulated with the papers for information and asked for questions from Members. No questions or comments were received by Members. Governing Body noted the reports. Date and time of next meeting: 1 March 2018, 10am – 12 noon Venue: TBC

Governing Body

Action Log

Reference

Meeting & Minute No:

Action Responsible

Officer

Date Due Status/Update

Item 3

Patient Story

MC to provide verbal update re Learning Disability Services to future GB Meeting

March 18 Meeting

Update to be included in Chief Nurse Report – 1st March 18

Item 5

Chief Nurse’s Report

Bridgewater Collaborative Commissioning Forum – a disappointing turnout for the meeting was noted. Members asked Michelle Creed to escalate this.

Michelle Creed

March 18 Meeting

Update regarding Bridgewater and outcomes of Collaborative Commissioning Forum (23rd Feb) to be included in the Private GB – 1st March 18

Item 9

Director of Commissioning Report

The tender for the community respiratory service has been formally terminated to allow development of a new solution. Members asked for a new, temporary risk to be added to the Risk Register.

NWAS and 111 calls – members asked for data relating to the interaction between the two services to be presented at the next Governing Body meeting

Leigh Thompson

Leigh Thompson

January 2018

March 2018

Risk Register updated to reflect this risk – for on-going review with Commissioning Manager

Focus on NWAS performance included as part of GB Agenda 1st March 18

Item 10

GBAF

Members requested that risk 3.1 relating to the CCGs statutory duties be split and the current risk scores for the two risks be raised to 25

David Cooper

January 2018

Action addresses as part of the updates to the GBAF – Agenda Item GB March 18

Governing Body Report

Date: March 2018

Report title: Report of the Clinical Chief Officer

Lead Executive

Dr Andrew Davies, Clinical Chief Officer

Purpose:

The purpose of the report is to provide members of the Governing Body with:

An update on any key national issues relevant to the CCG

An updated on any key corporate issues members need to be apprised of

A summary of key activities that support delivery of the CCGs strategic objectives

The Governing Body is asked

to:

Receive the report

This Report supports the following CCG Strategic Objectives

Objective one: To commission services which continually improve the health and wellbeing of Halton residents Objective two: Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements Objective three: To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP Objective four: To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders.

Commissioning Plan Implications

None

Financial Implications

None

Board Assurance Framework and Corporate Risk Register

The report provides updates on key areas of work relating to the strategic objectives of the CCG.

National Policy, Guidance, Standards, Targets or Legislation

N/A

Equality and Diversity and Human Rights

Throughout the development of this paper and the policies and processes cited NHS Halton CCG has: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

Report to Governing Body March 2018 Corporate updates

1. Interim Chief Officer Secondment

On 1st February 2018, the Interim Chief Officer, Dave Sweeney took up a 12 month secondment opportunity as Implementation Director within the NHS Cheshire and Merseyside Care Partnership. This is a key role in ensuring there is pace in terms of delivering the transformation agenda as described in the Five Year Forward View. Despite a significantly challenging year, he leaves a legacy of having supported the development of the Local Care Partnership setting the foundations for the evolution of an integrated model of care, delivery of the greatest proportion of QIPP than in any other year as well as a culture of developing positive partnerships and keeping the patients at the forefront of all that we do. We wish him every success in his new role.

2. NHS Halton CCG Constitution

On 2nd February, NHS England confirmed that the CCG’s application to amend its constitution had been approved. The Corporate Services Team will now arrange for circulation to the membership and for publication on the CCG’s website.

3. Annual Report and AGM

Work to support the development and production of the 2017/18 Annual Report is underway. Detailed guidance is provided to ensure that the CCG Annual Reports are completed in line with statutory requirements. Contributors to the various sections of the Annual Report are currently producing the respective content and we will then undertake a review exercise to ensure consistency, flow and tone of the document. A timeline for the production and review of the Annual Report is in place and this will include review by the EMT and Governing Body (update at the Development Day - 3

rd April) in addition to the final review by the Audit Committee in

April 18. Early discussions have taken place in respect of this year’s Annual General Meeting. In line with previous years, we will be holding our AGM in September 2018 (exact date to be confirmed). As a follow on from July’s NHS 70

th Birthday Celebrations we are proposing to

use an inter-generational theme and link with our Care Homes and Schools to support the event involving our staff fully in the development of this work. We will also be marking the NHS 70

th birthday in July with some celebratory events. Plans

will be shared in due course.

National updates

4. Planning Guidance – Refreshing NHS Plans for 2018/191

On 2nd February 2018, NHS England and NHS Improvement published planning guidance that requires commissioners and providers to refresh the existing two year operational plans. The CCG’s Executive Team and relevant leads are now working through the guidance to apply the activity and financial assumptions to facilitate the refresh. The draft plan will be submitted to NHS England (Cheshire and Merseyside) by 2nd March, with a final submission being made by 30th April following approval by the Governing Body. The key headlines for commissioners are as follows: • Resources available to CCGs will be increased reflecting realistic levels of emergency

activity, additional elective activity to tackle waiting lists, universal adherence to the Mental Health Investment Standard and a commitment to reaching standards set for cancer services and primary care.

• Creation of a new Commissioner Sustainability Fund (CSF) to enable CCGs to return to in year financial balance

• The two year tariff remains in place

• Improvements are expected in A&E performance, Delayed Transfers of Care (DTOC), Referral to Treatment (RTT) targets as well as ensuring compliance with the Mental Health Investment Standard (MHIS) and Cancer waiting time standards.

• Further guidance in respect of Commissioning for Quality and Innovation (CQUIN) and the Quality Premium is due to be published soon.

5. Items which should not be routinely prescribed in primary care

NHS England has partnered with NHS Clinical Commissioners (NHSCC) to support CCGs in ensuring they can use their prescribing resources effectively and deliver best patient outcomes from the medicines that their local population uses. National guidance on medicines which should no longer be routinely prescribed in primary care has been published to ensure people receive the safest and most effective treatment available, aiming to save the NHS up to £141m a year2.

The CCG’s Medicines Management Team is now considering how to implement the national guidance, with due regard to our local circumstances.

6. Personal Health Budgets

NHS England has commissioned Quality Health to run an online survey to gather feedback about people’s experiences of personal health budgets in England. Opening on 1 March 2018 and running until 30 April 2018. Commissioners are being encouraged to share details of the survey with all personal health budget holders in their area. The findings will be used to improve how personal health budgets are offered in England.

1 Available at https://www.england.nhs.uk/publication/refreshing-nhs-plans-for-2018-19/

2 Available at: https://www.england.nhs.uk/medicines/items-which-should-not-be-routinely-prescribed/

https://www.england.nhs.uk/publication/refreshing-nhs-plans-for-2018-19/

https://www.england.nhs.uk/medicines/items-which-should-not-be-routinely-prescribed/

7. Update to NHS RightCare Patient Decision Aids

As part of the Shared Decision Making and Person Centred Care work in NHS England, the current NHS RightCare Patient Decision Aids (PDAs) are to be removed from the and NICE Evidence Search by 31 March 2018. This decision has been taken as the format and information provided in the PDAs requires extensive review and updating to keep them as a high quality resource for use by clinicians, commissioners, patients and the public. Over the coming months, NHS RightCare will update the webpage with useful resources and links to PDAs that provide the most up-to-date advice and treatment options3.

8. Bradford healthy hearts publication

A new resource pack has been published which may help to cut the number of heart attacks and strokes. Based on Bradford Districts CCG’s pioneering Healthy Hearts programme. Bradford healthy hearts NHS RightCare resource pack offers a practical guide for health economies committed to reducing the incidence of heart attacks and strokes by improving the detection and management of high blood pressure, high cholesterol and atrial fibrillation (AF) within primary care. The pack outlines the actions taken, and the resources developed by Bradford Districts CCG, that resulted in the optimised treatment of 21,000 people and more than 200 fewer people suffering heart attacks or strokes4.

To commission services which continually improve the health and wellbeing of Halton residents. Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements

9. Kirkup Review of Liverpool Community Health

The Report of the Liverpool Community Health Independent Review undertaken by Dr. Bill Kirkup was published on 8

th February 2018. Although NHS Halton CCG is not referred to

in the report as they are not a main commissioner of services, the role of other local CCGs and regulators are reflected in the report. The CCG’s officers, under the leadership of the Chief Nurse are now in the process of reviewing the report and reflecting on the recommendations so that the Governing Body can consider key learning from the review and continue to ensure our community services offer exemplar standards of care for your patients. The link to the report is as follows: https://improvement.nhs.uk/news-alerts/independent-review-liverpool-community-health-nhs-trust-published/

10. Outpatient parenteral antimicrobial therapy (OPAT)

The CCG has recently approved a number of business cases for new services designed to significantly improve health outcomes for our patients. Outpatient parenteral antimicrobial therapy (OPAT) is a method for delivering intravenous antimicrobials in the community or outpatient setting, as an alternative to inpatient care. It is very effective as an intervention for patients who require parenteral therapy for moderate to severe infections but are otherwise well enough to be treated outside hospital. The new service will be implemented from April 2018 and the outcomes will be closely monitored by the Commissioning Oversight Group (COG).

3 Available at: https://www.england.nhs.uk/rightcare/shared-decision-making/

4 Available at: https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/11/casebook-

bradford-healthy-hearts.pdf

https://improvement.nhs.uk/news-alerts/independent-review-liverpool-community-health-nhs-trust-published/

https://improvement.nhs.uk/news-alerts/independent-review-liverpool-community-health-nhs-trust-published/

https://www.england.nhs.uk/rightcare/shared-decision-making/

https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/11/casebook-bradford-healthy-hearts.pdf

https://www.england.nhs.uk/rightcare/wp-content/uploads/sites/40/2016/11/casebook-bradford-healthy-hearts.pdf

11. Medicines Waste Campaign

In a 2010 report it was concluded that a robust estimate for gross annual cost of NHS primary and community care prescription medicines wastage in England is currently in the order of £300 million per year. It has been estimated that within that £300 million figure:

£90 million worth of unused prescription medicines that are retained in individuals’ homes at any one time.

£110 million returned to community pharmacies over the course of a year.

£50 million worth of NHS supplied medicines that are disposed of unused by care homes.

These figures don't take into account the cost to patients' health if medicines are not being correctly taken. If medicine is left unused, this could lead to worsening symptoms, extra treatments and hospital admissions that could have been avoided. Alongside this material waste it is estimated that about 50% of medicines prescribed are not taken as intended, to provide optimal health outcomes. In a bid to address this locally the CCG, working the Local Pharmaceutical Committee (LPC) has launched a “medicines waste campaign” aimed at raising awareness amongst clinicians and our public. The Director of Commissioning will provide further information about the services we commission and how the CCG performs against constitutional targets as part of the Integrated Performance Report.

To deliver our statutory duties in respect of commissioning, quality, equality, consultation, engagement and finance including QIPP

12. QIPP

The substantive financial report setting out the CCGs position, challenges and mitigations will be covered in the report of the Chief Finance Officer as detailed in the Corporate Performance Report. QIPP remains a key priority for the CCG and every effort continues to be made to identify additional QIPP opportunities to support financial recovery.

13. Quality, equality and diversity

As the CCG develops new schemes and services, the Quality Team continues to provide support in undertaking quality impact assessments ensuring our decisions do not adversely impact on the quality and safety of services. To further ensure that the CCG continues to meet its statutory duties the Commissioning Team attended an Equality and Diversity training session on 18th January.

To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders.

14. Leadership development

The CCG has now commenced the development programme focussed on developing leadership skills and will be key element of ensuring our staff have the relevant skills and capacity to meeting the CCGs strategic objectives.

Meetings

15. Meetings attended by the Clinical Chief Officer on behalf of the CCG

Since joining the CCG in February 2018 Dr Andrew Davies as Clinical Chief Officer for the

Clinical Commissioning Group has attended the following meetings:

01 February 2018 – Governing Body Development Session

02 February 2018 – Management Team Meeting

06 February 2018 – Joint meeting with Halton BC Management Team and David Parr

09 February 2018 – Cheshire and Mersey Accountable Officers Meeting

16 February 2018 – Management Team Meeting

20 February 2018 – Management Team Development Session

16. Recommendations

Members of the Governing Body are asked to:

a) Note the contents of this report Dr Andrew Davies Clinical Chief Officer NHS Halton CCG

Page 1 of 9

Governing Body

Date: 1st March 2018

Report title: Chief Nurses’ Report

Lead Clinician and/or Lead Manager: Michelle Creed

Purpose:

To give assurance to the Governing body with regard to Quality, Safety and Experience of commissioned services.

The Governing body is asked to: Note the contents of the Report and request further evidence for assurance if felt necessary.

This Report supports the following CCG Strategic Objectives

Objective one: To commission services which continually improve the health and wellbeing of Halton residents Objective two: Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements Objective three: To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP Objective four: To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders.

Commissioning Plan Implications

None

Financial Implications

Does this require financial support? No

Board Assurance Framework and Corporate Risk Register

GBAF 2 Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements

GBAF 3 To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP

National Policy, Guidance, Standards, Targets or Legislation

1. CCG Improvement and Assessment Framework (IAF) 2016/17 2. National Quality Board: How to make your quality surveillance effective. NHS England (2014)

Equality and Diversity and Human Rights

Throughout the development of this paper and the policies and processes cited NHS Halton CCG has: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

Page 2 of 9

1 PURPOSE The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and experience of the services commissioned by NHS Halton CCG.

2 NHS PROVIDERS

2.1 BRIDGEWATER COMMUNITY HEALTH NHS FOUNDATION TRUST (BCHFT)

Members will recall that an update has been given to Governing Body with regard to the CQC Action Plan progress since June 2017 which is being monitored through the Quality Committee via the Clinical Quality Performance Group (CPQG).

2.1.1 At Clinical Quality & Performance Group we have now undertaken 5 deep dives into the CQC action plan areas:

End of Life Services – July 2017

Community Services for Children, young People and Families - September 2017

Maternity Services – October 2017

Community Health Services for Adults – December 2017

Dental Services (commissioned by NHS England) – January 2018

Whilst progress is being made and evidenced against the CQC action plan concerns have been raised as to the pace of change for improvements. Coupled with this there have been concerns with regard to staff turnover, sickness, senior leadership and service delivery issues.

At the last Quality Committee in January 2018, members agreed to increase the risk score in regard to Bridgewater Community Trusts from 12 to 16 pending further quality surveillance investigation. In addition the Chief Nurse has undertaken an internal exercise to gain further intelligence with regard to issues/concerns/experience/performance with regard to this provider.

NHS Halton CCG has in place routine quality monitoring and governance arrangements, along with other mechanisms including Quality Surveillance Groups which enable identification of increasing quality concerns within a provider. Where there are increasing and/or persistent quality concerns identified the NHS England (NHSE) Quality Concerns Trigger/Quality Risk Profile Tool (Appendix 1) is used.

This guidance was developed to ensure a consistent approach when quality concerns have been identified with any provider during the provision of health services. It ensures a consistent approach to gathering of data and intelligence in a combined tool to enable all parts of the healthcare system to have the opportunity to share any information where persistent or increasing quality concerns have been identified. This ensures that all information in relation to Quality is shared so proportionate actions can be taken. It is a tool to enable providers to have an understanding of the commissioners and other stakeholders’ current view of the quality of care. The tool provides us with the ability to assess risk in a timely manner

NHS Halton CCG Quality Committee members subsequently discussed in light of the quality surveillance evidence decided to move the BCHFT from Regular to Enhanced Surveillance with regard to:

Leadership – significant changes in Leadership Team

Page 3 of 9

Workforce – staff vacancies

Resulting impact on service delivery with specific focus on Community Paediatric Service Delivery

This decision was discussed on Thursday 24th January 2018 at the Bridgewater Community Healthcare NHS Foundation Trust, Clinical Quality Performance Group (CQPG) and recorded via the contractual process and the Trust has been formally written to.

The Cheshire & Merseyside QSG was notified of the increase in surveillance at the meeting on 2nd February 2018. The intention in line with NHSE Quality Concerns guidance is to continue with the Enhanced surveillance for three months. However if there is limited or no assurance following these enhanced assurance processes then a Quality Risk Profile (QRP) will be triggered in line with the escalation tool.

2.1.2 Bridgewater Collaborative Commissioning Forum

A teleconference call was undertaken on 18th January 2018 to discuss and gain consensus of all to establish a collaborative commissioning forum and all partners (NHS Halton, ST Helens, Wigan, Warrington CCG’s, Wigan, Oldham, Halton LA’s, NHSE Northwest, Yorkshire & Humber and NHSE Cheshire & Merseyside) were in agreement. The first meeting is scheduled to take place on 23rd February 2018 with NHS Halton CCG chairing this forum.

2.2 WARRINGTON & HALTON HOSPITALS NHS FOUNDATION TRUST

2.2.1 Spinal Services Governing body members will recall the suspension of Spinal Services at Warrington & Halton Hospitals NHS Trust in September 2017. This was due to concerns raised by the Trust to the NHS Warrington CCG (WCCG) as lead commissioner and to NHSE for specialised commissioning, about the clinical governance and clinical decision making following a review of four serious incidents reported.

As reported previously a full suspension of all spinal surgery services delivered by Warrington and Halton Hospitals NHS Foundation Trust has been in place. This suspension notice means that the Trust can no longer provide spinal surgery services to all patients whether they are both inpatients, outpatients (new or follow up) or patients for spinal injections. All patients have been or are being transferred to alternative providers. All patients have been contacted, seen and either discharged or referred to new provider. WCCG and HCCG agreed with the trust and the new providers a staged process to transfer patients according to their scheduled appointment date and the new provider has offered a new consultation date as near to the original date as possible.

WCCG as co-ordinating commissioner has established monthly contract meetings with The Walton Centre, where the majority of non-complex cases and follow up patients have been transferred; this is enabling WCCG to work closely with them and HCCG to ensure patients receive timely consultations and to monitor patient outcomes. Salford Royal NHS Foundation Trust continues to accept ERS referrals and Pioneer Health Care continue to provide consultations for those patients requiring spinal injections.

Page 4 of 9

The Spinal Surgery Services Specification has been rewritten and it has been made clear those providers are to provide treatment in line with NICE guidance. NHSE, in collaboration with CCG commissioners, requested that the Royal College of Surgeons undertake a review of the spinal service, which commenced in November 2017. No decision will be taken with respect to lifting the suspension notice until the Royal College of Surgeons full report is published. The report is complete and with the Trust for factual accuracy. Regular monthly updates are presented to Quality Committee and a further update will be presented to Governing Body in May 2018.

2.2.2 Care Quality Commission Inspection

In January Governing Body an update with regard to the WHHT CQC inspection findings 2017 were discussed.

Requires Improvement o Safe o Effective o Responsive o Well Led

Good o Caring

A Quality Summit was expected early 2018. However, this has been delayed to incorporate the outcome of the Royal College of Surgeons review of Spinal Services. The Trust however, has established a ‘Getting to Good, Moving to Outstanding’ Steering Group (G2G, M2O) which held its first meeting on Thursday 8th February 2018. This is an executive oversight group and NHS Halton and NHS Warrington CCG’s Chief Nurses have been invited to join the group. There are 6 work streams which will report in:

Midwifery & Obstetric Improvement Workstream

Critical Care Improvement Workstream

Medical Care Improvement Workstream

Diagnostics & Outpatients Improvement Workstream

Well Led Workstream

Organisational Change Workstream

A full Action plan update will be reviewed at each meeting. Warrington CCG and NHS Halton CCG will be holding a joint meeting on 28th February 2018 with Quality Committee Members to receive a presentation from the Trust on their approach to the action plan implementation.

3 QUALITY, SAFETY AND EXPERIENCE

3.1 Kirkup Review of Liverpool Community Health

The Report of the Liverpool Community Health Independent Review undertaken by Dr Bill Kirkup was published on 8

th February 2018. Although NHS Halton CCG is not

Page 5 of 9

referred to in the report as they were not a commissioner of services from this trust, the role of other local CCGs and regulators are reflected in the report. The Governing Body members and CCG’s officers, under the leadership of the Chief Nurse have received and had the opportunity to review the report and enable reflection on the recommendations. The next Governing Body Development day scheduled for 5

th April

2018 will focus on the report and consider relevant lessons to enable us to ensure our commissioned services offer exemplar standards of care for your patients.

The link to the report is as follows: https://improvement.nhs.uk/newsalerts/independent-review-liverpool-community-health-nhs-trust-published/

A series of lunchtime Reflective Learning sessions will be held for all staff during April and May 2018 with information being cascaded via NHS Halton CCG Communications Bulletin.

3.2 Urgent Record Retention Notice for All Staff

On 11 July 2017 the Government announced an independent inquiry into contaminated blood – the events that led to people being infected with HIV or hepatitis C through NHS-supplied blood or blood products in the 1970s and 1980s. Many documents relating to blood safety, covering the period 1970-1995 have been published and are available in the National Archives.

There are further details about the inquiry here: https://www.gov.uk/government/news/pm-statement-on-contaminated-blood-inquiry-11-july-2017

NHS Improvement have informed all NHS Provider Trusts that they need to ensure they do not destroy any relevant documentation relating to the events that led to people being infected with HIV and/or hepatitis C through NHS-supplied blood or blood products. Document and records in relation to blood work may be held by the Medical and the Nursing Directorates in particular.

Trusts have been advised to retain all relevant documents and other records for the duration of the Inquiry. There may be further instructions once the Chair of the Inquiry is in place and the Trusts will be kept informed.

A central point of contact at NHS Improvement has been identified, Records Manager Sarah Graham on [email protected]

3.3 NHS Halton Enhanced Health in Care Homes

A Care Home Sector Meeting was held on 8th February 2018 with Care Home Owners and Managers to discuss developing a future commissioning and finance model. Partners were in favour of developing the model together with Halton Borough Council and NHS Halton CCG. Further meetings will now be planned to support. The Chief Nurse is working with Local Authority colleagues to establish clinical posts within the Care Home Quality Team to support enhanced healthcare in care homes and in addition a Quality Assurance Framework will be developed.

3.4 CCG Hosted Safeguarding Service

The Hosted Safeguarding Service was disband on 29th February 2018 and TUPE transfer undertakings to NHS Halton CCG, NHS Liverpool CCG, NHS South Sefton CCG and NHS Southport & Formby CCG are completed.

https://improvement.nhs.uk/newsalerts/independent-review-liverpool-community-health-nhs-trust-published/

https://improvement.nhs.uk/newsalerts/independent-review-liverpool-community-health-nhs-trust-published/

https://www.gov.uk/government/news/pm-statement-on-contaminated-blood-inquiry-11-july-2017

https://www.gov.uk/government/news/pm-statement-on-contaminated-blood-inquiry-11-july-2017

mailto:[email protected]

Page 6 of 9

NHS Halton CCG In House Safeguarding Team consists of:

Michelle Creed – Chief Nurse and Executive Safeguarding Lead

Denise Roberts – Deputy Chief Nurse and Clinical Lead for Children

Hayley McCulloch – Designated Nurse Safeguarding Children and Looked After Children.

Sam Atkinson – Designated Nurse Safeguarding Adults

Dr David Lyon – Named GP (Dr Joanne McCormack on sabbatical currently)

Recruitment underway - Designated Doctor Safeguarding Children 3.4.1 Designated Doctor Safeguarding

NHS Halton CCG is in discussion with a Designated Doctor for Safeguarding to deliver 2-3 sessions per week. All CCG’s should have a designated doctor to take a strategic and professional lead on all aspects of the health service contribution to safeguarding children across the area they serve, and should cover all providers.

The Designated Doctor will take a lead on Child Protection; sit on the Halton Children’s Safeguarding Board (HSCB) and the Child Death Overview Panel (CDOP) and will advise the Chief Nurse on questions of planning and strategy with regard to safeguarding children (including ensuring performance indicators are in place where child protection is concerned). Further discussion with Alder Hey Hospital is taking place regarding sessional time and the Consultants work plan.

3.4.2 Local Safeguarding Children Boards Changes to Multi-Agency

HM Government raised concerns about the effectiveness of LSCB’s to safeguard children, Child Death Overview Arrangements and Serious Case Reviews and commissioned Alan Wood to conduct a review, which concluded in the publication of the Wood Review (2016).

Wood was asked to conduct a fundamental review of the role and functions of Local Safeguarding Children Boards (LSCBs) within the context of local strategic multi-agency working. This was to include the child death review process, and consideration of how the intended centralisation of serious case reviews (SCRs) will work at local level and the report was published in March 2016.

Key recommendations

replace Local Safeguarding Children Boards with new flexible local safeguarding

arrangements led by three safeguarding partners (local authorities, chief officers of police, and clinical commissioning groups), and places a duty on those partners to make arrangements to work together and with any relevant agencies for the

purpose of safeguarding and promoting the welfare of children in their area

require safeguarding partners to identify and arrange for the review of serious child safeguarding cases which they think raise issues of importance in relation to their area

provide for the establishment of a national Child Safeguarding Practice Review Panel. The Panel will commission and publish reviews of serious child safeguarding cases which it thinks raise issues that are complex or of national importance

Page 7 of 9

give clinical commissioning groups and local authorities joint responsibility for child death reviews, and enable a wider geographical footprint for these partnerships in order for them to gain a better understanding of the causes of child deaths

There will be legislative changes to support implementation of the findings of the review. A meeting was held with partners from Cheshire Police, Local Authorities and CCG’s from Halton, Warrington, East Cheshire, South Cheshire, Vale Royal, Cheshire West and Chester on 4th January 2018 and a workplan for implementation agreed. There is a follow on meeting on 5th March 2018 in which partners will present a local picture of current arrangements. It is intended to discuss what should remain local, what can stop and what should be done at scale. Work will continue to full implementation by September 2018.

4 LOCAL AUTHORITY PROVIDERS 4.1 Millbrow Nursing Home now owned and managed by Halton Borough Council with

clinical support from the CCG completed on Monday 11th December 2017. This transfer has been subject to a robust transition plan with all patients being reviewed by the CCG CHC team and appropriate care plans in place. An action plan has been developed to address a number of training issues with the CCG Medicines Management team reviewing all patients’ medications and assessing staff training requirements. Support has been requested from NHSE to develop a safe staffing model. Currently family members have expressed their thanks and appreciation for all the support to date in ensuring continuity of care. There are 4 residents who left prior to the handover who are in the process of returning. The Director of Adult Social Care, The Chief Nurse and the Chair are meeting to discuss moving Millbrow to a Centre of Excellence and destination for Teaching in Care Homes, first meeting 1st March 2018.

4.2 St Lukes Nursing Home (owned by Community Integrated Care (CIC) is on enhanced

surveillance. CQC undertook an inspection and the report was published at the end of January 2018 with an inspection rating of Inadequate and a warning notice has been served.

MDT meetings have been undertaken scheduled on a weekly basis. There have been several changes of manager and a new manager commenced the role on Monday 22nd January. An action plan has been developed but satisfactory progress has not been achieved. The MDT has expressed a lack of confidence that risk is mitigated Risk profile undertaken escalated to Director of Adult Social Care. A meeting with CIC Regional Manager is in place. All residents have had a nursing assessment undertaken by the Continuing Healthcare Team and care plans reviewed.

5 CONCLUSION

The governing body should be assured that the system surveillance process is in place to identify best practise and sport early warning signs of system failure. However, this

Page 8 of 9

system and process will need to be reviewed in light of changing organisational forms, the financial recovery climate and engagement and involvement public requirements.

The Chief Nurse will submit a bi-monthly report to the Governing Body for consideration and challenge.

Ends

Page 9 of 9

Appendix 1 Quality Concerns Trigger Tool

Quality Concerns Trigger Tool

November 2016

CORPORATE PERFORMANCE REPORT

February 2018

Achieving target

Adverse variance to target

No target set

2a NHS HALTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2018

EXECUTIVE SUMMARY

WHAT’S IN THIS REPORT

Introduction This report provides the governing body with information on the key strategic and operational issues and developments related to the CCG's statutory requirements. Detailed reports can be seen at each relevant committee with corresponding actions, risks and mitigations. Achievement of recovery milestones for access standards remains a priority for 2017/18. Standards relating to A&E and ambulance waits, referral to treatment, 62-day cancer waits (including securing adequate diagnostic capacity) along with mental health access standards account for four of the nine National ‘must dos’ which every local system is expected to achieve for the financial year. Key performance exceptions Ambulance response performance as measured against the new national standards was low, particularly for category 2 calls (Urgent but not immediately life threatening) with responses times 10 minutes longer than the average standard (28min v 18 min) NWAS have identified several areas where performance can be improved, the full briefing will be made to Governing Body, but areas identified are highlighted on the following page. IAPT performance slipped considerably in December, this was due to many therapy sessions being suspended over the Christmas period . Dementia diagnosis rates have fallen for the third month in a row, the CCG is now at risk of missing its own locally set target but is not at risk of achieving the national target. Halton has not been immune to the pressures seen nationally around A&E waiting times. Both Whiston and Warrington A&E departments reported a worsening performance in December. Following rapid improvement in E-referral numbers earlier in 2017 no improvement has been seen since July 17 and the CCG is likely to miss the national target of 80%

Performance Highlights The CCG achieved all 9 cancer waiting time standards in December, including two weeks waits for initial appointment and 62 day waits to treatment . This is the first time this has been achieved . Halton was the only CCG in Merseyside where the ambulance response times for category 3 and 4 calls was achieved. No HCAI c-diff cases have been reported in the three months to January 2018. Key Activity Exceptions Type 1 A&E department activity continues to increase, particularly at Whiston. Both Warrington and Whiston reported greater numbers of Halton resident attending in December 17 than December 16. Non-elective admissions are above plan by around 500 admissions, however non-elective admissions at Warrington are slightly below plan while those at Whiston are significantly above plan. The reasons behind this are subject to a joint project being undertaken by local CCG's detailed on the following page. Activity Highlights The total number of referrals into secondary care continues to be under plan, with almost 1000 fewer referrals being made and over 1000 fewer outpatient appointments. Following instruction from NHSE to acute providers to suspend elective activity over December and January there has been a significant reduction in the number of outpatient appointments carried out during this period. However more Daycase activity was carried out than in previous years with no evidence of a reduction seen in either Daycase or overnight elective admissions in December.

Achieving target

Adverse variance to target

No target set

2b NHS HALTON CCG


EXECUTIVE SUMMARY

WHAT’S IN THIS REPORT

Actions Ambulance • Changes have been made to the contents and

sequencing of the initial questions the public will experience at the beginning of their call, with the aim of identifying and responding more quickly to the higher Category 1 & 2 calls.

• Alongside this additional staff have been recruited into the Emergency Operation Centre

• External consultancy has been commissioned to examine call processes, efficiency and model future demand.

• A significant retraining of control staff is underway, supported by enhanced clinical supervision, shared learning from other ambulance services and the introduction of what is referred to as auto dispatch, all of which are designed to achieve the ARP aims of getting the most clinically appropriate resources to patients in a timely manner.

• In the new financial year the fleet is to be expanded with 54 replacement ambulances and it is now planned to retain some of the outgoing fleet to boost the availability of ambulances. These ‘additional’ vehicles will be staffed from the planned reduction in the RRV fleet.

• As part of implementation, NWAS with clinical commissioners are undertaking a full review of all aspects of quality and safety, including serious incidents and complaints, in order to understand any impact to individual patients and to embed the learning within the organisation. This will form part of the agreed recovery plan going forwards.

A&E • Halton CCG worked with the Widnes Vikings to

raise awareness of the alternatives to A&E attendance, both through social media but also through a marketing event at the local derby game with Warrington with over 7000 fans reached with promotional marketing of alternatives to A&E.

• 'Beat the Scrum' was officially launched with high profile media interest including television. A presentation to the mid Mersey AED board was well received and further marketing will continue specifically around the use of the pharmacy and urgent care centres.

IAPT • IAPT access rates have exceeded national targets for

both October and November, however the initial figures for December show a significant reduction and the Q3 target is likely to be missed. This reduction is due to the closure of the service over the Christmas period. The provider is confident that the access target will be met in full for Q4.

Non-Elective Admissions • Halton, St Helens and Knowsley CCG's are working

together to examine the reasons behind the increase in Non-elective admissions at Whiston Hospital. This increase is limited to zero day admissions and is much greater than the increase in A&E attendances. The CCG's are investigating the appropriateness of these admissions, particularly the very short stay admissions (less than an hour is some instances) the CCG's wish to work with the Trust to ensure that those patients who can be treated in A&E are treated in A&E.

E-referral • Almost all paper referrals will no longer be accepted

by Trusts in early 2018 so all GP referrals must be completed electronically. The CCG has been raising awareness of this with GP practices.

Dementia • The CCG will be working with General Practices

regarding the identification of patients with Dementia as part of the practice visits.

Target 93.0% Target 99.0%

Target 85.0% Target 92.0%

Target 90.0% Target 439

LESS THAN 4-HOUR A&E WAITS DELAYED TRANSFERS OF CARE

511 DEC 1790.4% YTD

CANCER TWO WEEK WAITS

CANCER 62 DAY TREATMENT

6-WEEK DIAGNOSTIC WAIT

99.4%YTD

REFERRAL TO TREATMENT

92.8% YTD

94.2% YTD

79.9% YTD

3 NHS HALTON CCG


CONSTITUTIONAL STANDARDS

Urgent & Emergency Care - Ambulance Response Times

From October these standards have been replaced following the national Ambulance Response review. The initial data shows performance for category 1 and category 2 calls response times are significantly below expectations. NWAS have produced an action plan including additional ambulance resource and emergency control centre staff. . Referral To Treatment The percentage of patients being treated within 18 weeks has begun to improve following reductions over the previous months. The national standard of 92% continues to be achieved Diagnostics 99.4% of patients receive their first diagnostic test within 6 weeks of referral, achieving the target of 99%

Cancer The CCG continues to achieve the two-week to initial consultation standard, however 62-day cancer performance, although achieved in December it is unlikely that the CCG will achieve this standard for the full year. Most breaches are due to patients choosing to delay either the start of treatment or are delaying diagnostic tests thus pushing back their treatment times. The CCG has been working with primary care and local acute providers to promote the message about the importance of attending appointments

AT A GLANCE

Mental Health The CCG is performing well against the waiting time standards for mental health, both for those with anxiety and depression and those with psychosis and the number of people accessing services for anxiety and depression met the NHS standard for the first time in October following the introduction of group therapy by North West Boroughs. The CCG is working with North West Boroughs to ensure the use of voluntary sector provision by Wellbeing Enterprise is also captured where appropriate

NHS Halton CCG is committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report.

Dec-17

Dec-17

Dec-17

Dec-17

93.2%

97.4%

97.5%

88.0%

4 NHS HALTON CCG


CANCER

KPI 2017/18 PERFORMANCE ACTIONS

Overall two week wait appointment

performance remains above standard.

patient choice & patient cancellations

remain the biggest reasons for delay.

TWO WEEK WAITS The % patients seen within two weeks for an urgent GP referral for suspected cancer

93.0%

93.2%

93.9%

94.2%

Target

15/16

16/17

17/18 YTD

TWO WEEK WAITS

TWO WEEK WAIT - BREAST Two week wait standard for patients referred with breast symptoms not covered by two week wait for breast cancer

Due to very small numbers there is a

large degree of volatility in performance

reporting.

Although slightly below target at the end

of December if the performance seen in

November and December continues to

the end of the year the target will be met.

93.0%

93.3%

93.5%

92.8%

Target

15/16

16/17

17/18 YTD

TWO WEEK WAIT - BREAST SYMPTOMS

31 DAY TREATMENT The % of patients receiving their first definitive treatment within one month of diagnosis

Following the drop in performance seen in

October and November (breaches at

Clatterbridge relating to patient choice

delays at first seen trust) the CCG is

achieving the standard both in December

and YTD. 96.0%

98.6%

97.7%

96.7%

Target

15/16

16/17

17/18 YTD

31 DAY TREATMENT

62 DAY TREATMENT The % of patients receiving their first definitive treatment within two months of GP referral for suspected cancer

Although the standard was met in December,

previous underperformance means that the

CCG is not meeting the standard YTD. it is

unlikely that the CCG will achieve this

standard for the full year. Most breaches are

due to patients choosing to delay either the

start of treatment or are delaying diagnostic

tests thus pushing back their treatment times.

The CCG has been working with primary care

and local acute providers to promote the

message about the importance of attending

appointments.

85.0%

85.8%

84.97%

79.9%

Target

15/16

16/17

17/18 YTD

62 DAY TREATMENT


90%

100%

Apr-16 Apr 17 Dec-17

80%

90%

100%


90%

100%


60%

80%

100%


Dec-17

Dec-17

Dec-17

Dec-17

72.5%

3.8%

57.0%

66.7%

5 NHS HALTON CCG

CORPORATE PERFORMANCE REPORT FEBRUARY 2018

MENTAL HEALTH


The target for dementia diagnosis has increased from 67% to 72% and will rise again to 75% by the end of 2017/18. Although the CCG is achieving the target at the moment the current downward trajectory and increasing target suggests that the end of year position may not be met. The CCG are raising the issue of declining dementia diagnosis rates with practices during the practice visits.

DEMENTIA DIAGNOSIS Diagnosis rate for people with dementia, expressed as a percentage of estimated prevalence (aged 65+)

IAPT ACCESS People who receive psychological therapies as a percentage of people who have depression and/or anxiety disorders (rolling 3 month)

North West Boroughs introduced group therapy sessions in October as part of its action plan to improve access rates. This has already had an impact with October achieving the monthly access rate target. However the service closed for a 2 week period over the Christmas period which has impacted on the number of people beginning treatment. The provider is confident of achieving the target in Q4

IAPT RECOVERY The proportion of people who complete treatment who are moving to recovery.

North West Boroughs have now achieved the 50% recovery rate since May 17.

PSYCHOSIS 2WW The percentage of people experiencing a first episode of psychosis with a NICE approved care package within two weeks of referral.

The CCG performs well with respect to people receiving treatment promptly after a first episode of psychosis, although numbers are only small, two out of three people treated in two weeks. The CCG performs in line with both regional and national averages.

72.0%

72.0%

72.40%

72.5%

Target

15/16

16/17

17/18 YTD

DEMENTIA DIAGNOSIS

4.2%

3.6%

3.75%

3.8%

Target

15/16

16/17

17/18 YTD

IAPT ACCESS

50.0%

40.0%

45.00%

51.6%

Target

15/16

16/17

17/18 YTD

IAPT RECOVERY

53.8%

60.0%

74.00%

81.3%

Target

15/16

16/17

17/18 YTD

PSYCHOSIS 2 WEEK WAIT


60%

80%


3%

5%


20%

40%

60%


40%

100%


Dec-17

Dec-17

Dec-17

Dec-17

11:14

35:37

2604

90.4%

6 NHS HALTON CCG


URGENT & EMERGENCY CARE


From October this standard has been

replaced following the national Ambulance

Response review. The initial data shows

performance for category 1 calls

significantly below expectations. NWAS

have produced an action plan including

additional ambulance resource and

emergency control centre staff.

AMBULANCE Category 1 calls: Mean response time

AMBULANCE Category 2 calls: Mean response time

The initial data shows performance for category 2 calls significantly below expectations. NWAS have produced an action plan including additional ambulance resource and emergency control centre staff.

TYPE 1 A&E ATTENDANCES The number of Halton patients attending a type 1 AED (Acute hospital site)

4-HOUR A&E WAITS The percentage of patients who spent less than four hours in A&E

The Governments mandate to NHSE has

been reduced to 90% for the start of

17/18, which the CCG exceeds. The

increase in patients attending UCC’s

(average wait 57 minutes) means that

Halton CCG performs well

0400800

1,2001,6002,0002,4002,8003,200


90.0%

94.4%

93.10%

94.0%

Target

15/16

16/17

17/18 YTD

A&E 4-HOUR WAITS

2,584

2,528

2,604

Dec-15

Dec-16

Dec-17

TYPE 1 AED ATTENDANCES

85%

100%


Following below average attendances at the

beginning of the financial year the CCG has

begun to see type 1 attendances exceeding

last years activity. YTD performance has

consequently dropped from 3% below

16/17YTD to 2% above 16/17 YTD by

December. No increase has been reported at

Warrington Hospital however a 4% increase

has been reported at Whiston.


7.00

9.58

Target

17/18 YTD

AMBULANCE: CATEGORY 1: MEAN RESPONSE TIME

18.00

28.31

Target

17/18 YTD

AMBULANCE: CATEGORY 2: MEAN RESPONSE TIME

Target 22853 Target 35255

Target - Target 12981

Target 22476 Target 11578

A&E TYPE 1 ATTENDANCES ELECTIVE DAYCASE ADMISSIONS

23193YTD 12828YTD

URGENT CARE CENTRE ATTENDANCES NON-ELECTIVE ADMISSIONS

47466YTD 13402YTD

GP REFERRALS FIRST OUTPATIENTS

23471YTD 34382YTD

7 NHS HALTON CCG


Non elective admissions Non-elective activity is both above plan and above 16/17 levels. A&E conversion to admission rates are increasing at Whiston hospital signifying that those attending are appropriate, this also correlates with information from A&E departments that arriving patients have greater acuity. The CCG is looking at a number of schemes to reduce the impact of non-elective admissions including high intensity users and patients with very short admission stays (less than 1 hour) Elective activity Whilst some impact has been seen in the MSK QIPP programme other areas have seen increases or the impact of activity reduction schemes has not yet materialised. The CCG is working hard to prioritise which schemes can be implemented for an in-year impact.

Delayed Transfers of Care There has been a large increase in delayed transfers of care and Halton has exceeded the target over the last three months. Delays are mostly attributed to patients not willing to move to a transitional bed whilst waiting for a domiciliary care package. The LA has a dedicated resource in place tasked with reducing DTOC's. In early December the number of DTOC's at Whiston has fallen from 13 to 4.

Overview Significant increases in A&E and non-elective admissions have been seen at St Helens & Knowsley Hospitals NHS Trust. First outpatient activity is on plan, however a large increase in outpatient procedures has been recorded. A&E activity Type 1 A&E activity began the year significantly lower than 16/17, however the number of attendances in recent months has been higher than 16/17. Despite increases in attendances at the Urgent Care Centres, this increase has meant that from reporting 3% under 16/17 actuals activity is now 2% above 16/17. GP streaming at Whiston is currently still being recorded as an A&E attendance, GP streaming at Warrington came online in November. GP referrals Despite monthly variances, the CCG is currently around 3% above plan for GP referrals. Although a reduction was seen in December it is likely that these deferrals will be picked up in the new year

AT A GLANCE

KEY ACTIVITY

NHS Halton CCG monitors performance against key activity metrics continuously. Significant variations to plan are raised through contract review meetings . It should be noted that not all activity levels being monitored are reflected in the Corporate Performance Report.

Dec-17

Dec-17

Dec-17

Dec-17

2259

3197

92.4%

1432

8 NHS HALTON CCG


KEY ACTIVITY


The number of referrals seen in December

was in line with planned activity and a

significant reduction from November. The

NHSE instruction appears to have had a

impact on the number of outpatient

referrals seen, this may however by a

short lived reduction as outpatient referrals

deferred in December will be seen in early

2018

GP REFERRALS GP written referrals for a first outpatient appointment in G&A specialties

FIRST OUTPATIENTS All first outpatient activity G&A specialties

As with GP referrals the number of

outpatient appointments seen in

December fall significantly from

November. It is likely that outpatient

activity will increase in the new year as

those deferred appointments take place.

REFERRAL TO TREATMENT The percentage of patients waiting at the period end, who have been waiting less than 18 weeks from referral to treatment

The Referral to Treatment standard

continues to be achieved, with most

waiting list clearance times around 3

months.

The CCG has no immediate concerns

regarding RTT, however the long term

downward trend shows there is little

room for manoeuvre.

NON-ELECTIVE ADMISSIONS Total non-elective FFCEs in general and acute specialties

Non-elective activity has increased by

over 6% at St Helens, whilst admissions

at Warrington are down on both plan and

last years actuals. The increase in non-

elective admissions at Whiston is greater

than the increase seen in A&E

attendances and the admittance rate is

increasing. The CCG has written to the

trust for an explanation. and is working

with other local CCG's who have seen a

similar pattern of activity at St Helens

92.0%

96.1%

93.90%

92.8%

Target

15/16

16/17

17/18 YTD

REFERRAL TO TREATMENT - 18 WEEKS

2,000

3,500


3,000

5,000


90%

100%


1,000

2,000


KEY ACTIVITY

22,853

22,795

24,784

23,471

Target

15/16 YTD

16/17 YTD

17/18 YTD

GP REFERRALS

35,255

31,208

33,638

34,382

Target

15/16 YTD

16/17 YTD

17/18 YTD

FIRST OUTPATIENTS

12,981

12,549

13,339

13,402

Target

15/16 YTD

16/17 YTD

17/18 YTD

NON-ELECTIVE ADMISSIONS

Dec-17

Dec-17

Dec-17

Q2 2017/18

206

1324

511

77.2

9 NHS HALTON CCG


KEY ACTIVITY


ELECTIVE ADMISSIONS Total ordinary elective admissions in general and acute specialties

DAYCASE ADMISSIONS A Patient admitted electively during the course of a day who does not require the use of a bed overnight and who returns home as scheduled.

DELAYED TRANSFERS The number of delayed days from acute or non-acute (including community and mental health) care

CONTINUING HEALTH CARE Individuals eligible for NHS CHC (Standard NHS CHC and Fast Track) at quarter end per 50,000 GP patient list size - all types

The number of people assessed as eligible in

Halton is higher than both England and

regional averages. There are three elements

to this. 1) The % of referrals assessed as

eligible is higher than average at 43% against

an average of 31% 2) The number coming off

CHC in the quarter is very low at 7 per 50,000

against an average of 26. 3) The number

assessed for NHS funded nursing care is less

than half the average. The CCG is putting a

plan in place to improve reviewing rates for

people on CHC

180

300


1,000

2,000


0

800


61

85

102

79

77

England Ave

Q3 16/17

Q4 16/17

Q1 17/18

Q2 17/18

CONTINUING HEALTH CARE (Per 50,000)

KEY ACTIVITY

Halton have allocated dedicated resource to

reducing DTOC's with some success. The LA

have purchased a care home which have

previously had placements suspended, this will

add extra beds into the system. Focussed

work continues on increasing domiciliary

capacity .

Significant amounts of activity was taken out

provider contracts for 2017/18 . Around £3

million each year for 17/18 and 18/19.,

however QIPP schemes to achieve this

reduction have been delayed in their

implementation with only limited reductions

seen in some specialties. The CCG is

working to prioritise which QIPP schemes

can be taken forward quickly into 18/19

Although there has been some reduction

seen in Daycase elective activity it has not

been to the level taken out of provider

contracts. The CCG is currently in the

process of prioritising QIPP schemes which

can have an impact in year, however a

number may not be in place until 2018/19

2,043

2,311

2,261

2,318

Target

15/16 YTD

16/17 YTD

17/18 YTD

ORDINARY ELECTIVE ADMISSIONS

11,576

12,390

12,969

12,828

Target

15/16 YTD

16/17 YTD

17/18 YTD

DAY CASE ELECTIVE ADMISSIONS

450

347

628

511

Target

Dec-15

Dec-16

Dec-17

DELAYED TRANSFERS OF CARE

Target 0

16/17 1

Target 27

16/17 39

C-Diff

28Dec17 YTD

MRSA

3Dec17YTD

10 NHS HALTON CCG


Health Care Acquired Infections MRSA There have been 3 cases of MRSA reported against a zero tolerance . C Difficile There has been 28 cases of C Difficile reported year to date which is just 1 over plan Tthere were no C-Difficile cases reported in November or December. Most cases have been identified within the community. An appeals panel is in place to evidence those cases where there have been no lapses in care so that we have an accurate picture and this is also being reviewed as part of the Mid-Mersey HCAI network meeting. E-coli bacteraemia As part of the quality Premium the CCG has a target of reducing the number of E-coli bacteraemia by 50% by 2020. This is a challenging target however work is in train to address this. A crude audit has been conducted by St Helens and Knowsley Hospitals to elicit initial areas for development which include appropriate screening and appropriate antibiotic therapy. This work is ongoing within the network and the CCG Quality team with support from Medicines Management; and Infection, Prevention and Control have a work plan to address this.

Ensuring that people have a positive experience of care. Warrington and Halton Hospital has reported a further 14 Mixed Sex Accommodation breaches bringing a YTD total to 31. The CCG are working with the Trust to understand the detail behind this and ensure privacy and dignity is maintained at all times whilst appropriate solutions are determined. Serious Incidents (SI) A Serious Incident has been reported relating to a Halton CCG patient Within North West Boroughs Healthcare, which is a total of 4 YTD. Concern has been raised within the Quality Surveillance Group regarding the quality of investigation reports and thematic learning within a provider and the CCG are a key partner in the task and Finish Group seeking assurance. Whilst this may appear positive Trusts are encouraged to report SI’s to enable an open transparent culture with a focus on learning. The Quality Team have this area as a priority with a planned review of process, protocol and effective thematic learning as key areas. Four may appear low in terms of work load however we have the Lead Commissioner role for Bridgewater so whilst SI’s may not relate to Halton patients the same process applies for others. The SI panel is in development to ensure wider clinical engagement and review. A revised SI policy and panel protocol is in development and will be taken to the CCG Quality Committee for ratification. Mortality The CCG uses the Summary hospital Level Mortality indicator as the measure for mortality within our Provider organisations as recommended nationally. Both providers are currently above plan with Warrington & Halton Hospital scoring 1.10; and St Helens & Knowsley Hospital just over plan at 1.03. Mortality is an area of work progressing across Cheshire and Merseyside CCG’s and Providers being led by NHSE. The CCG are central to these discussions and this will be monitored via the Clinical Quality and Performance Group meetings (CQPG).

AT A GLANCE

QUALITY & SAFETY

Dec 17 YTD

Dec 17 YTD

Jul 17 YTD

Dec 17 YTD

3

28

4

31

11 NHS HALTON CCG


PATIENT SAFETY QUALITY MEASURES


There have been 3 cases of MRSA reported against a zero tolerance. all three cases are reported from non-acute settings.

MRSA All reported MRSA bacteraemia cases are attributed to a CCG

C-DIFF All reported C-DIFF bacteraemia cases are attributed to a CCG

Although above plan the CCG has had

no reported C-Diff cases in November

and December and is significantly below

last years number of cases.

SUI The number of Serious Untoward Incidents affecting Halton registered patients

The Quality Team have this area as a

priority with a planned review of

process, protocol and effective thematic

learning as key areas. The SI panel is in

development to ensure wider clinical

engagement and review. A revised SI

policy and panel protocol is in

development and will be taken to the

CCG Quality Committee for ratification.

MIXED SEX BREACHES The total occurrences of unjustified mixing in relation to sleeping accommodation.

Warrington and Halton Hospital has

reported further Mixed Sex

Accommodation breaches . It is

understood these breaches relate to

patients in critical care beds who are fit

enough to be moved to a ward but whose

move is delayed

0

0

1

3

Target

Dec 15 YTD

Dec16 YTD

Dec 17 YTD

MRSA

27

27

39

28

Target

Dec 15 YTD

Dec16 YTD

Dec 17 YTD

C-DIFF

0

4

Target

Jul 15 YTD

Jul 16 YTD

Jul 17 YTD

SUI

QUALITY & SAFETY

0

3

10

31

Target

Dec 15 YTD

Dec16 YTD

Dec 17 YTD

MIXED SEX BREACHES

16/17

16/17

16/17

16/17

0.050

0.347

0.304

0.055

12 NHS HALTON CCG


CLINICAL EFFECTIVENESS QUALITY MEASURES


PROMS - Groin Hernia Adjusted average health gain (EQ5D, EQ VAS)

PROMS - Hip Replacement Adjusted average health gain (EQ5D, EQ VAS)

PROMS - Knee Replacement Adjusted average health gain (EQ5D, EQ VAS)

PROMS - Varicose Vein Adjusted average health gain (EQ5D, EQ VAS)

QUALITY & SAFETY

0.088

0.059

0.061

0.035

0.050

Nat Ave

13/14

14/15

15/16

16/17

PROMS - Groin Hernia

0.442

0.381

0.451

0.515

0.347

Nat Ave

13/14

14/15

15/16

16/17

PROMS - Hip Replacement

0.325

0.325

0.330

0.302

0.304

Nat Ave

13/14

14/15

15/16

16/17

PROMS - Knee Replacement

0.093

0.204

0.055

Nat Ave

13/14

14/15

15/16

16/17

PROMS - Varicose Vein

Dec-17

Dec-17

Dec-17

Dec-17

97.0%

95.0%

89.0%

79.0%

13 NHS HALTON CCG


PATIENT EXPERIENCE QUALITY MEASURES


Friends & Family - Inpatient stays - STHK

Friends & Family - Inpatient stays - WHHFT

Friends & Family - A&E - STHK

Friends & Family - A&E - WHHFT

96.0%

95.0%

96.0%

97.0%

Nat Ave

Oct-15

Oct-16

Dec-17

Friends & Family - Inpatient Stays: STHK

96.0%

96.0%

95.0%

95.0%

Nat Ave

Oct-15

Oct-16

Dec-17

Friends & Family - Inpatient Stays: WHHFT

87.0%

93.0%

88.0%

89.0%

Nat Ave

Oct-15

Oct-16

Dec-17

Friends & Family A&E: STHK

87.0%

80.0%

92.0%

79.0%

Nat Ave

Oct-15

Oct-16

Dec-17

Friends & Family A&E: WHHFT

QUALITY & SAFETY

Target 92.0%

QP adj 0.0%

Target 90.0%

QP Adj 0.0%

Target 85.0%

QP Adj -33.3%

Target NO

QP adj -100%

Target NO

QP adj 0%

Target NO

QP adj 0%

Achieve 4 Target NO

Not Achieve 5 QP adj 0%

No Judgement 2

Target NO

QP adj 0%

Target 0.0%

Target £690,000

16/17 £0

£116,024

£352,976

£221,000

£0TOTAL QUALITY PREMIUM AWARD

Constitutional standard adjustments

Quality gateway adjustments

Total Quality Premium Adjustments

Total Quality Premium Award

TOTAL ADJUSTMENTS

-100%

BREACHES OF PROVIDER LICENCE

NO -NHSE ASSESSMENT - INADEQUATE CCG RESPONSE

NO -

CANCER 62 DAY TREATMENT

REFERRAL TO TREATMENT

92.8% -LESS THAN 4-HOUR A&E WAITS

94.0% -

NO -

79.9%

ADVERSE VARIANCE TO PLAN

YESQUALIFIED AUDIT REPORT

NO -CQC ENFORCEMENT

Financial gateway adjustments

14 NHS HALTON CCG


AT A GLANCE

Outline The 17/18 Quality Premium for Halton CCG is worth in the region of £690,000. The award is calculated by performance against a series of quality metrics, some of which are nationally mandated and others have a degree of local input with respect to the choice of metric and the level of ambition. The metrics for which an award can be made are detailed in the following pages, with the level of award detailed against each. In addition to the metrics for which a quality premium award can be made there are national metrics which can reduce the value of any award. These are detailed on the right. For 2017/18 there are a number of metrics for which baseline data has still not been made available nationally or has been supressed. Therefore no judgement has yet been made on the likelihood of receiving this portion of the quality premium. Of the metrics from which an award can be Made the CCG is currently forecasting the following.

QP ADJ - this is the adjustment to be made to any quality premium award due to the failure to meet the selected constitutional standards

The CCG is currently reporting it will achieve the financial plan, although it is acknowledged that this will be difficult. Should the financial plan not be achieved then it is likely the CCG will achieve no quality premium award. The CCG is prudently not including any award in its budget planning.

QUALITY PREMIUM

12m. to Jun 16

Value £110,500

Forecast £0

Jul-17

Value £110,500

Forecast n/a

Q2 17/18

Value £55,250

Forecast £0

Q2 17/18

Value £55,250

Forecast £55,250

52.8%

65.0%

47%

0%

15 NHS HALTON CCG


PERFORMANCE METRICS


The National Cancer Intelligence Network

(NCIN) have not yet updated any early stage

diagnosis figures since 2015 although they are

expected to publish figures quarterly. This has

been raised with them and we are awaiting a

response.

The Target for the quality premium award is

60% or a 4% improvement on 2016 actuals, so

the current target may yet change

EARLY STAGE DIAGNOSIS Cases of cancer diagnosed at stage 1 or 2 as a % of all new cases of cancer

GP Access and Experience Overall experience of making a GP appointment assessed through Q18 of the GP patient survey (those answering ‘very good’ or ‘fairly good’ as a % of the total

The target for the quality premium is for

3% improvement on the July 17 figure or

achieve 85%.

It is anticipated that the expansion of online consultations and improved telephone access via call queuing will improve patient experience when making an appointment.

Continuing Healthcare Full NHS CHC assessments are completed within 28 days

The CCG has recognised that CHC

assessments are not being completed

within the 28 timescales. A CHC

improvement plan has been

implemented and reported to NHS

England. Activity is monitored monthly

through CHC audit and improvements

are required to meet statutory

obligations. Q2 data analysis

demonstrates improvement.

Continuing Healthcare Full NHS CHC assessments take place in an acute setting

The CCG monitors this monthly and has

no concerns regarding performance.

53.8%

51.4%

49.8%

52.8%

Target

2014

2015

12m. to Jun 16

2017

EARLY STAGE CANCER DIAGNOSIS

68.0%

62.0%

63.0%

65.0%

Target

Jul-15

Jul-16

Jul-17

Jul-18

EXPERIENCE OF MAKING AN APPOINTMENT

80.0%

25.0%

25.0%

47.0%

Target

Q4 16/17

Q1 17/18

Q2 17/18

FULL CHC ASSESSMENT <28 DAYS

15.0%

0.4%

0%

0%

Target

Q4 16/17

Q1 17/18

Q2 17/18

FULL CHC ASSESSMENT IN ACUTE SETTING <15%

QUALITY PREMIUM

Jul-18

Value £110,500

Forecast n/a

Jan 17 - Dec 17

Value £38,675

Forecast £0

2017

Value £11,050

Forecast £11,050

12 month to Nov 17

Value £24,862

Forecast £24,862

n/a

116

Yes

0.906

16 NHS HALTON CCG


PERFORMANCE METRICS


NHS Digital has suppressed this data for

a large number of CCG's due to the small

numbers involved. The CCG is currently

working to find an alternative route to

obtain this information to calculate both

the baseline and the associated target

Mental Health OOA stays A reduction in the number of inappropriate adult OAPs for non-specialist adult acute care. Total number of bed days to have reduced by 33% of the baseline number as at 1st April 2017

Bloodstream Infections PART A) reducing gram negative blood stream infections across the whole health economy – I) reduction in e-coli infections

Bloodstream Infections PART A) reducing gram negative blood stream infections across the whole health economy – ii) collection of core data

Public Health England have published a

requirement for a core data set to be

collected in Primary Care regarding all

E-Coli BSI, occurring in Q2-Q4 2017/18.

Bloodstream Infections reducing inappropriate antibiotic prescribing for UTI’s in primary care – I) reduction in trimethoprim:Nitrofuantoin prescribing ratio

The Quality Premium is for a 10%

reduction in the

Trimethoprim:Nitrofuantoin prescribing

ratio based on CCG baseline (June 15-

May 16)

Target

Apr-17

Jul-18

MH OOA PLACEMENTS

81

95

90

116

Target

Sep 14 - Aug 15

Sep 15 - Aug 16

Jan 17 - Dec 17

E-COLI: Bloodstream infections

1.511

1.679

1.208 0.906

Target

2015/16

12 month to Apr 17

12 month to Nov 17

E-COLI: Bloodstream infections

QUALITY PREMIUM

Yes

No

Yes

Target

2016

2017

E-COLI: Primary Care data collection

12 month to Nov 17

Value £24,862

Forecast £24,862

Nov-17

Value £11,050

Forecast £0

Aug-17

Value £97,500

Forecast £0

2457

1.275

64.9%

17 NHS HALTON CCG


PERFORMANCE METRICS


Bloodstream Infections PART B) reducing inappropriate antibiotic prescribing for UTI’s in primary care – ii) reduction in trimethoprim prescribing in patients aged 70 or over

Bloodstream Infections PART C) sustained reduction of inappropriate antibiotic prescribing in Primary Care

Items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) must be equal to or below England 2013/14 mean performance of 1.161 Similar tests will apply for 2018/19

Dementia care plan review The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months.

The CCG collects data on a monthly

basis from General Practice however

there is no resource to increase the

number of care plan reviews carried out

beyond the QOF standard already being

achieved by the Practices.

3,380

3,756

2,878

2,457

Target

2015/16

12 month to Apr 17

12 month to Nov 17

Inappropriate antibiotic prescribing for UTI's

1.161

1.313

1.303

1.275

17/18 Target

Mar-16

Mar-17

Nov-17

Antibiotic Items per (STAR-PU)

78.9%

66.6%

76.0%

64.9%

17/18 Target

Oct-16

Mar-17

Aug-17

Dementia Care Plan Reviews

QUALITY PREMIUM

The CCG is on track to achieve this portion of the Quality Premium

130,860 Sep17 May 16 130,147 1,716

National 85% National 73%

Jul-16 85% Jul-16 63%

'GOOD' EXPERIENCE MAKING AN APPOINTMENT

65%July 17

'GOOD' OVERALL EXPERIENCE GP

85%July 17

PATIENTS PER WHOLE TIME EQUIVALENT GPPRACTICE POPULATION

18 NHS HALTON CCG


COPD prevalence: Ranges from 1.35% (Upton Rocks) to 5.14% Murdishaw. All practices exceeded the maximum payment threshold of 75% for record of FEV1 in the last 12 months. Exception reporting of this indicator ranges from 1.35% at Upton Rocks 40.49% at Peel House Medical Plaza, 41.13% at Hough Green and 49.3% at Tower House. Diabetes Prevalence: Ranges from 4.24% at Oaks Place Surgery to 7.67% at Castlefields and Murdishaw. All but three practices (The Beeches, Heath Road and Murdishaw) exceeded the maximum payment threshold of 75% for IFCC is 59mmol/mol in last 12 months. Exception reporting for this indicator ranges from 1.77% at Heath Road through to 31.41% at Peel House Medical Plaza. Atrial Fibrillation Prevalence: Ranges from 1.01% at Oaks Place to 3.12% at Appleton Village Surgery. All practice achieved the 70% maximum payment threshold for patients treated with an anticoagulation drug if a CHADS2-VASc score of 2 or more. Exception reporting ranges from 0% at Upton Rocks and Heath Road through to 22.86% at Weavervale. Quality & Contracting visit programme The Quality and Contracting visit has been developed and visits have commenced with practices. These visits are intended to be a conversation with practices and include a practice nominated GP Lead and Practice Manager along with the CCG GP Primary Care Lead and Primary Care team and will look at three areas of best practice and three areas for improvement. The content of the visits includes; Quality & Outcome Framework indicators with wide variation such as COPD, Diabetes, Heart Disease as well as cervical cytology; An opportunity for practices to raise issues with the CCG; A quality dashboard is shared with practices to allow consideration prior to the visit.

Patient Satisfaction Above average patient satisfaction continues in both 'making an appointment' and 'would recommend their GP' by patients from Hough Green, Oaks Place, Brookvale and Heath Road practices. Bowel Screening Data illustrates that uptake across practices ranges from 45% (Heath Road Medical Centre) to 63% (Upton Rocks), with a CCG average of 53%. This shows an increase from 51% Quarter 3 2014/15 (the last data available.) Flu Uptake in patients aged over 65 years illustrates that only Brookvale and Grove House met the national target of 75%. Practice uptake ranged from 63% (Newtown) to 75% (Brookvale.) Uptake is generally lower for the Widnes practices with four practices under 70% (Bevan Group Practice, The Beeches, Newtown Surgery and Upton Rocks.) Vaccinations Only three practices (Brookvale, Murdishaw and Bevan Group Practice) achieving the 95% national target for Pre School Booster uptake (range 84% to 98%.) Coronary Heart Disease: Prevalence rates vary from 2.21% at Upton Rocks to 4.73% at Castlefields, Grove House and Tower House Practices. All but three practices (Heath Road, The Beeches and Newtown) meet the 93% maximum payment threshold for BP in the last 12 months < 150/90. Exception reporting for this indicator ranges from 0.72% at Hough Green to 10.93% at Weaver Vale.

AT A GLANCE

PRIMARY CARE

General Practice Quality, Contract and Transformation visits continue which are supported by the General Practice Quality Dashboard. The Quality dashboard supports the CCGs statutory duty to improve the quality of its general practice services as well as the commissioning duties delegated from NHS England. The dashboard includes a range of indicators under the Patient Experience, Patient Safety and Clinical Effectiveness quality areas, whilst also including activity data.

Jun-16

16/17

Jul-17

Jul-17

53.5%

71.5%

85%

65%

19 NHS HALTON CCG


SCREENING, PATIENT EXPERIENCE


The Halton health improvement team

continue to work with the practices to

improve screening uptake. Whilst still

behind target it is encouraging to see an

increase since 2014

BOWEL SCREENING Proportion (%) of eligible 60-74 year old population screened for bowel cancer in last 2.5 years

FLU VACCINATION Proportion (%) of stated population who received vaccination

The Flu group continue to oversee

performance and areas for improvement.

It is anticipated that the Care Home

Alignment scheme will improve flu

vaccination rates amongst the over 65's

OVERALL EXPERIENCE OF GP The % of patients responding to the GP patient survey reporting 'very good' or 'fairly good' when asked to rate their Overall experience of GP surgery

It is positive to note that performance is

in line with the national average.

It is anticipated that transformation work,

in line with the GP forward View will

improve patient experience

OVERALL EXPERIENCE OF MAKING APPOINTMENT The % of patients responding to the GP patient survey reporting 'very good' or 'fairly good' when asked to rate their Overall experience making an appointment

Although below the national average,

improvement over the last two years has

been noted.

It is anticipated that the expansion of

online consultations and improved

telephone access via call queuing will

improve patient experience when making

an appointment.

60.0%

50.0%

51.0%

53.5%

Target

2014

Q3 14/15

Jun-16

BOWEL SCREENING

75.0%

73.8%

72.2%

71.5%

Target

14/15

15/16

16/17

FLU VACCINATION (65+)

85.0%

82.0%

85.0%

85.0%

National

Jul-15

Jul-16

Jul-17

OVERALL EXPERIENCE OF GP

73.0%

62.0%

63.00%

65.0%

National

Jul-15

Jul-16

Jul-17

OVERALL EXPERIENCE OF MAKING AN APPOINTMENT

PRIMARY CARE

16/17

16/17

16/17

16/17

82.4%

78.1%

68%

78%

20 NHS HALTON CCG


QOF


All but three practices (Heath Road, The

Beeches and Newtown) meet the 93%

maximum payment threshold.

Exception reporting ranges from 0.7% at

Hough Green to 10.9% at Weavervale

Prevalence rates vary from 2.2% at Upton

Rocks to 4.7% at Castlefields, Grove

House and Tower House

CORONARY HEART DISEASE CHD002The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less QoF Achievement threshold 53-93%

CHRONIC OBSTRUCTIVE PULMANORY DISEASE COPD004 The percentage of patients with COPD with a record of FEV1 in the preceding 12 months QoF Achievement Threshold 40-75%

All practices exceeded the maximum

payment threshold of 75%.

There are large variations in exception

reporting ranging from 1.3% at Upton

Rocks to 49.3% at Tower House

The content of the Quality and

Contracting visiting programme will

include the wide variation in exception

reporting

DIABETES DM007: The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months. QoF Achievement Threshold 35-75%

All but three practices (The Beeches,

Heath Road and Murdishaw) exceeded

the maximum payment threshold of 75%.

There are large variations in exception

reporting, from 1.7% at Heath Road to

31.4% at Peel House.

The Quality and contracting visiting

programme will look at the reasons

behind these variations

ATRIAL FIBRILATION AF007: In those patients with atrial fibrillation with a record of a CHA2DS2-VASc score of 2 or more, the percentage of patients who are currently treated with anti-coagulation drug therapy. QoF Achievement Threshold 40-70%

All practices achieved the maximum

payment threshold.

large variations in exception reporting

were apparent, with 0% at Upton Rocks

to 22.9% at Weavervale.

The large variations will be investigated

through the Quality & Contracting visiting

programme.

93.0%

89.1%

89.10%

82.4%

Threshold

14/15

15/16

16/17

CORONARY HEART DISEASE: BP last 12 months <=150/90

75.0%

67.7%

67.55%

78.1%

Threshold

14/15

15/16

16/17

COPD: FEV1 in last 12 months

75.0%

61.1%

57.20%

68.4%

Threshold

14/15

15/16

16/17

DIABETES: last IFCC is 59 mmol/mol in last 12 months

70.0%

0.0%

78.50%

78.4%

Threshold

14/15

15/16

16/17

ATRIAL FIBRILATION

PRIMARY CARE

21 NHS HALTON CCG


AT A GLANCE

MEDICINES MANAGEMENT

Prescribing Budget Performance Dashboard October 2017 Position The 2017/18 prescribing budget £23,850,271 (excluding QIPP)

1. Total actual prescribing cost by month in 17/18 against the same period in 16/17 and the monthly budget profile. 2. Halton CCG cumulative total prescribing actual cost in 17/18 against budget and 16/17 spend.

Halton CCG projected year-end over/underspend against budget (incl local adjustments):

£9,033 overspend (0.04%)

22 NHS HALTON CCG


Cost Pressures on Prescribing Budget 17/18

MEDICINES MANAGEMENT

Community Pharmacy Margin - 'Category M' As previously highlighted we have been notified by NHSE that the benefit from category M reductions from August 2017 that would otherwise flow to CCGs will be now be retained centrally and as such CCG finances will not benefit immediately from the price reductions. It is their intention that the benefit of the price reduction retained centrally should be available for investment by CCGs either in 2017/18 or in subsequent years subject to specific criteria. This money is clawed back every month and as such will have an impact on the overall forecast outturn. The impact for Halton is difficult to quantify but to date the has totalled £90,765 for the 3 months Aug-Oct 17. Based on this it is estimated to be approximately £242K for the year up to March 2018 but due to the difficulty in predicting monthly category M usage this figure may be an over or underestimate. Without this clawback, and taking into account other local adjustments, the budget is actually forecast to be £240,967 underspent (1%) but once the clawback is included this takes us to £9,033 overspend (0.04%). If the end of year estimated clawback figure is an under estimate this will further increase the pressure on the prescribing budget and outturn position. Medicines Supply Issues and Price Concessions There are still a number of issues affecting the medicine supply chain and causing a number of products to be subject to national 'No Cheaper Stock Obtainable' (NCSO) concessions . This continues to have a significant impact on prices we pay for commonly used drugs and as such an ongoing cost pressure on our prescribing budget. Some of the most commonly affected drugs are the atypical antipsychotics which within Halton are prescribed in the main by North West Boroughs Trust due to the limited uptake of shared care. Once we move to the amber initiated status during 18/19 more prescribing will move out to primary care and as such the impact of the NCSO or concessionary prices may increase significantly if these drugs are still affected by this long term. The cost pressure for Halton year to date is £456,869 and although things have improved slightly compared to what was anticipated it is estimated that this could be in excess of £750,000 by the year end. The category M savings retained centrally do not include drugs subject to NCSO status but the cost pressure remains. Outcome of NHSE Consultation on Items which should not be prescribed in primary care NHS England issued guidance to CCGs on Items which should not routinely be prescribed in primary care on 30 Nov 2017. The guidance is available via the following link: https://www.england.nhs.uk/publication/items-which-should-not-be-routinely-prescribed-in-primary-care-guidance-for-ccgs/ In terms of implications for Halton the main areas that we will need to focus on are: Co-proxamol - withdrawn from the market in 2007 due to safety concerns but still some unlicensed use within the area: 108 items prescribed over the previous 12 months at a cost of £15K. Lidocaine Plasters - licensed for symptomatic relief of neuropathic pain associated with post-herpetic neuralgia in adults. NICE CG173 does not recommend lidocaine plasters for treating neuropathic pain. This is a significant spend area for the CCG and we are one of the 10 highest prescribing CCGs nationally (209th out of 214). During the previous 12 months we prescribed 2573 items at a cost of £170,625. Changing practice regarding use of this product will be a challenge locally as both specialist clinics and GPs use it regularly for licensed and off-licence indications. Liothyronine - currently a RED drug on formulary so should remain with secondary care however a small amount of historic prescribing exists and is a significant cost in primary care: 246 items prescribed over the previous 12 months at a cost of £103,666. Work will commence without local trust to look at whether we can repatriate the small number of patients back to secondary care.

23 NHS HALTON CCG


The 3 phases of RightCare

Background NHS RightCare is a national NHS England supported programme committed to delivering the best care to patients, making the NHS’s money go as far as possible and improving patient outcomes. Ensuring people access the right care, in the right place at the right time means the NHS can treat more people effectively, now and in the future. NHS RightCare work is core to ensuring the best possible care is delivered everywhere. NHS RightCare advises local health economies to: Make the best use of resources – by tackling overuse and underuse of resources. Understand performance by identifying variation between demographically similar populations to enable the adoption and implementation of optimal care pathways more efficiently and effectively. Talk together about the same things – about population healthcare rather than organisations, and encouraging joint decision-making. Focus on areas of greatest opportunity by identifying priority programmes which offer the best opportunities to improve healthcare for people and ensuring taxpayer money goes as far as possible. Use tried and tested evidence based processes to make sustainable improvement to reduce unwarranted variation.

A BRIEF INTRODUCTION TO RIGHTCARE

RIGHTCARE

Neurology

Respiratory

Musculoskeletal

Gastro-Intestinal

24 NHS HALTON CCG


RIGHTCARE EMERGING OPPORTUNITIES

PROGRAMME AREA NARRATIVE PROJECTS

Spinal Surgery

Alliance multi-disciplinary Pain Management Programme Engage with Vanguard

Embed Parkinson's Nurse Pregabalin optimisation

COPD Service Review

Community Respiratory

Service Procurement

PointsPlus/GRASP tools

MyCOPD app

Inhaler Formulary and

guidance

Service re-design

Implementation of MSK Cats

Community Tri-age Service

MoM pathway review

Demand Management

Medicines Optimisation

Alcohol joint working with the LA

MoM pathway review - Scopes

Faecal Calprotectin test

availability

Lifestyle education sessions

PPI Formulary and guidance

NHS Halton is identified, through the RightCare programme, as an outlier in the level of expenditure on management of patient with neurological conditions, through acute hospital services and primary care prescribing. This review covers a number of neurological conditions but the management of pain is the highest element.

The aim of the Respiratory programme is to transform the management of COPD in the borough along the entire pathway; from diagnosis through to end of life. This will be delivered through the provision of Patient centred care which supports patients with COPD to become more independent, taking more responsibility for their own care

This programme has been informed by the growing evidence around outcome based commissioning and also the growing number of case study sites for outcome based commissioning within MSK services across the country with a number adopting the use of prime provider contracting processes to ensure the whole patient pathway

is being considered.

Gastro-intestinal has been identified as a key area for improvement by NHS RightCare. A paper went to the Service Development Committee (SDC) in Aug 2016 where high levels of activity and variation across towns and practices were discussed, and a mandate for further investigation was given.

The following areas have been chosen as the most promising areas to undertake a change programme, and have been developed into priority programmes , and submitted to NHSE as the emerging opportunities for NHS Halton.

RIGHTCARE

17/18Apr-16 May Jun Jul Aug Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17##### Apr 17 Dec-17

RAG G G G R G G G G R R G G R G G G G G G G G G

Actual 95.0% 94.7% 93.5% 91.8% 93.5% 96.4% 93.2% 94.4% 92.97% 91.8% 93.7% 95.0% 92.0% 93.1% 94.2% 95.8% 95.2% 95.3% 94.7% 94.0% 93.2% 94.2%

93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93%RAG G R G G G G R R G R G G R G G R R G G R G A

Actual 97.8% 88.1% 93.5% 96.9% 93.3% 98.1% 92.9% 92.0% 96.8% 86.0% 93.2% 96.9% 85.7% 97.1% 97.6% 86.5% 92.1% 93.6% 94.3% 90.0% 97.4% 92.8%

93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0% 93.0%RAG G R G G R G R G G G G G G G G G G G R R G G

Actual 97.9% 95.7% 96.5% 100.0% 94.7% 100.0% 94.2% 97.9% 98.3% 100.0% 97.6% 100.0% 96.4% 98.5% 98.2% 98.5% 98.7% 96.6% 92.5% 92.6% 97.5% 96.7%

96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0% 96.0%

RAG G G R G R G R G G R G G G G G G G R G G G G

Actual 100.0% 100.0% 71.4% 100.0% 85.7% 100.0% 75.0% 100.0% 100.0% 90.9% 100.0% 100.0% 100.0% 91.7% 100.0% 100.0% 100.0% 90.0% 100.0% 100.0% 100.0% 97.3%

94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0%

RAG G G G G R R R G R R G R G R R G R R G G G R

Actual 100.0% 100.0% 100.0% 100.0% 93.3% 92.9% 94.7% 100.0% 93.3% 89.5% 100.0% 90.0% 100.0% 95.2% 95.2% 100.0% 96.0% 88.2% 100.0% 100.0% 100.0% 97.4%

98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0% 98.0%

RAG R G R G G R G G G G G G G G G G G G G G G G

Actual 84.6% 100.0% 83.3% 100.0% 100.0% 80.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.7% 96.7% 100.0% 100.0% 99.0%

94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0% 94.0%

RAG R G G R G R R R R G R G R R G G R R G R G R

Actual 75.9% 88.4% 92.0% 83.9% 85.7% 84.0% 73.9% 84.0% 84.9% 95.7% 77.3% 90.6% 80.0% 68.0% 85.7% 89.7% 69.7% 73.1% 86.2% 79.3% 88.0% 79.9%

85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0%

RAG G G G G G R R G G G G G G G G G R G G G G

Actual 100% 100% 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 100% 100% 100% 100% 67% 100% 100% 100% 97.8%

90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%

RAG

Actual 100.0% 100.0% 66.7% 80.0% 50.0% 50.0% 100.0% 100.0% 100.0% 50.0% 100.0% 66.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.5%

539: % of patients receiving 1st definitive treatment for cancer

within 2 months (62 days) (MONTHLY)

The % of patients receiving their first definitive treatment for

cancer within two months (62 days) of GP or dentist urgent

referral for suspected cancer

Halton CCGTarget = 85%

540: % of patients receiving treatment for cancer within 62

days from an NHS Cancer Screening Service (MONTHLY)

Percentage of patients receiving first definitive treatment

following referral from an NHS Cancer Screening Service within

62 days.

Halton CCG Target = 90%

541: % of patients receiving treatment for cancer within 62

days upgrade their priority (MONTHLY)

% of patients treated for cancer who were not originally

referred for suspected cancer, but have been seen by a clinician

who suspects cancer, who has upgraded their status

Halton CCGNo national

target set

26: % of patients receiving subsequent treatment for cancer

within 31 days (Surgery) (MONTHLY)

31-Day Standard for Subsequent Cancer Treatments where the

treatment function is (Surgery)



within 31 days (Drug Treatments) (MONTHLY)

31-Day Standard for Subsequent Cancer Treatments (Drug

Treatments)Halton CCG Target = 98%


within 31 days (Radiotherapy Treatments) (MONTHLY)

31-Day Standard for Subsequent Cancer Treatments where the

treatment function is (Radiotherapy)Halton CCG Target = 94%

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

breast symptoms (MONTHLY)

Two week wait standard for patients referred with 'breast

symptoms' not currently covered by two week waits for

suspected breast cancer


535: % of patients receiving definitive treatment within 1

month of a cancer diagnosis (MONTHLY)

The percentage of patients receiving their first definitive

treatment within one month (31 days) of a decision to treat (as

a proxy for diagnosis) for cancer


Cancer

191: % Patients seen within two weeks for an urgent GP

referral for suspected cancer (MONTHLY)

The percentage of patients first seen by a specialist within two

weeks when urgently referred by their GP or dentist with

suspected cancer


December 2017Halton CCG - Performance Report

2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDPreventing People from Dying Prematurely

Q1 Q2 Q3

90%

100%


80%

90%

100%


90%

100%


80%

90%

100%


80%

90%

100%


90%

100%


60%

80%

100%


40%

60%

80%

100%


40%

60%

80%

100%


17/18Apr-16 May Jun Jul Aug Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17


2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R R

Actual 11:14 09:58

RAG R R

Actual 18:23 16:55

RAG R R

Actual 35:37 28:31

RAG R R

Actual 1:22:23 1:02:00

RAG R G

Actual 2:20:47 1:53:31

RAG A G

Actual 3:00:55 2:55:36

RAG

Actual 263 149 68 155 141 145 175 114 380 356 302 262 212 144 229 151 139 239 245 276 436 2,071

RAG

Actual 265 307 423 566 444 413 603 442 553 773 538 368 253 298 350 256 276 440 305 335 813 3,326

RAG

Actual 606 448 322 424 534 777 576 733 651 475 245 221 109 211 96 176 105 220 162 131 250 1,460

RAG

Actual 274 117 66 72 137 305 195 318 310 189 63 54 17 58 9 38 15 46 22 21 63 289

RAG

Actual 105 42 9 31 47 27 41 32 140 148 76 83 49 18 58 32 15 50 53 78 145 498

RAG

Actual 51 65 118 195 125 110 226 124 209 337 230 97 35 70 107 60 93 145 56 71 297 934WHISTON HOSPITAL

1933: Ambulance: 60 minute handover delays

Number of ambulance handover delays over 60 minutes

THE ROYAL

LIVERPOOL

UNIVERSITY

HOSPITAL

WARRINGTON

HOSPITAL

1932: Ambulance: 30 minute handover delays

Number of ambulance handover delays over 30 minutes WARRINGTON

HOSPITAL

WHISTON HOSPITAL

THE ROYAL

LIVERPOOL

UNIVERSITY

HOSPITAL

Ambulance

Target = 7 minHalton CCGAmbulance response programme: Category 1 calls: Mean

responses time

Ambulance response programme: Category 1 calls: 90th

Percentile time Halton CCG Target = 15 min

Ambulance response programme: Category 2 calls: Mean

response time Halton CCG Target = 18 min


Percetntile time Halton CCG Target = 40 min







2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R R R R R R R R G R G G G G G G G G G G A A

Actual 69.5% 68.8% 70.3% 69.3% 69.1% 69.2% 69.7% 70.9% 71.3% 70.9% 71.9% 72.4% 76.2% 75.1% 75.1% 75.2% 74.9% 75.2% 74.9% 72.9% 72.5% 72.5%

Target 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 71.2% 72.0% 72.0% 72.0% 72.0% 72.0% 72.0% 72.2% 72.8% 73.5%

RAG G G G R R R R R R R R G R R R R R R R A R R

Actual 3.9% 3.9% 3.9% 3.7% 3.7% 3.5% 3.5% 3.7% 3.4% 3.7% 3.6% 4.2% 3.7% 3.7% 3.7% 3.9% 3.8% 3.4% 3.8% 4.17% 3.8% 3.80%

Target 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 3.8% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2% 4.2%

RAG R R R R G R R R R R G G R G G G G G G G G G

Actual 39.1% 44.4% 41.6% 44.7% 50.0% 46.7% 30.4% 41.7% 47.8% 47.4% 50.8% 55.4% 48.7% 50.4% 53.3% 50.0% 52.1% 50.6% 50.7% 51.8% 57.0% 51.6%

50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0% 50.0%

RAG G G G G G G G G G G G G G G G G G G G G G G

Actual 86.9% 87.3% 91.8% 92.2% 98.0% 95.0% 96.0% 100.0% 98.6% 97.7% 99.2% 100.0% 98.3% 99.3% 99.1% 99.1% 100.0% 100.0% 99.2% 99.1% 100.0% 99.3%

Target 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0%


Actual 92.6% 92.7% 95.6% 95.3% 98.0% 97.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

RAG G

Actual 99.1%

RAG G G R G G G G G G G G G G G G G G G G G G G

Actual 50.0% 75.0% 0.0% 57.1% 85.7% 80.0% 100.0% 100.0% 80.0% 100.0% 75.0% 85.7% 66.7% 83.3% 85.7% 100.0% 83.3% 66.7% 100.0% 100.0% 66.7% 81.3%

50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 53.80% 53.80% 53.80% 53.80% 53.80% 53.80% 53.80% 53.80% 53.80%

G

2099: First episode of psychosis within two weeks of referral

The percentage of people experiencing a first episode of

psychosis with a NICE approved care package within two weeks

of referral. Halton CCG

Target 16/17 =

50% 17/18 =

53.8%

97.2% 95.0% 100.0% 100.0%

The proportion of people that wait 6 weeks or less from

referral to entering a course of IAPT treatment against the

number of people who finish a course of treatment in the

reporting period (EH1 - A1)

Halton CCG (LOCAL

DATA USED) -

Monthly

Target = 75%

G G R G

93.3% 96.6%

The proportion of people that wait 18 weeks or less from

referral to entering a course of IAPT treatment against the

number of people who finish a course of treatment in the

reporting period (EH2 - A2)

Halton CCG (LOCAL

DATA USED) -

Monthly

Target = 95%

138: Proportion of patients on (CPA) discharged from inpatient

care who are followed up within 7 days Halton CCG Target = 95%

G

97.6%

Estimated diagnosis rate for people with dementia (PHOF 4.16 /

NHS OF 2.6i) Halton CCG

Halton CCG (LOCAL

DATA USED)

Improving access to psychological therapies (QP2) Halton CCG -

Access Quarterly position (sum of current and previous 2

month's %, where available)Halton CCG (LOCAL

DATA USED) -

Monthly

Target 16/17=

3.75% 17/18 =

4.2%

Improving access to psychological therapies (QP2) Halton CCG -

Recovery Month ActualHalton CCG (LOCAL

DATA USED) -

Monthly

Target = 50%

Enhancing Quality of Life for People with Long Term Conditions

Mental Health

G

60%

80%


3%

5%


40%

100%


20%

40%

60%


60%

80%

100%


60%

80%

100%




2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R R R R R R G G R G R R R G R R R R R R R R

Actual 1 1 1 1 2 2 0 0 2 0 1 1 4 0 6 6 3 3 3 3 3 31

RAG G G G G G G G G R G G G G G G G G G G G G G

Actual 93.9% 94.2% 93.8% 93.6% 94.2% 93.2% 92.6% 92.7% 91.7% 92.7% 92.7% 93.4% 93.3% 93.7% 93.3% 92.5% 92.7% 92.0% 92.7% 92.6% 92.4% 92.8%

92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

RAG R R R G G G G G G G G G G G G G G R G G G R

Actual 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1


Actual 0.3% 0.2% 0.1% 0.2% 0.0% 0.1% 0.2% 0.1% 0.2% 0.2% 0.1% 0.2% 0.3% 0.2% 0.7% 0.5% 0.6% 0.6% 0.7% 0.7% 0.9% 0.6%

1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1% 1%

RAG R R R R R G G G G G G G G G G G R R G R G R

YTD 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 3

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0RAG G G G R R R R R R R R R G R G G R G G G G A

YTD 1 3 4 6 6 2 8 6 3 5 3 3 3 8 3 3 6 2 3 0 0 28

Target 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 27

24: Number of C.Difficile infections

Incidence of Clostridium Difficile (Commissioner) (in month)

Halton CCG

HCAI

497: Number of MRSA Bacteraemias

Incidence of MRSA bacteraemia (Commissioner) (in month)

Halton CCG

Target = 0

Treating and Caring for People in a Safe Environment and Protect them from

Avoidable Harm

1828: % of patients waiting 6 weeks or more for a diagnostic

test

The % of patients waiting 6 weeks or more for a diagnostic testHalton CCG

Target = 1%

1839: Referral to Treatment RTT - No of Incomplete Pathways

Waiting >52 weeks

The number of patients waiting at period end for incomplete

pathways >52 weeks

Halton CCGTarget = 0

Referral to Treatment (RTT) & Diagnostics

1067: Mixed sex accommodation breaches - All Providers

No. of MSA breaches for the reporting month in question for all

providers Halton CCG Target = 0

1291: Referral to Treatment RTT (Incomplete)

Percentage of patients waiting at period end (RTT) for

incomplete pathways (Commissioner) Halton CCGTarget = 92%

EMSA

Ensuring that People Have a Positive Experience of Care

90%

100%


0

5

10


-1%

0%

1%

2%


0

1

2


0

10




2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R A R R R A R R R R R R G G G G G G G G G G

Actual 93.9% 94.1% 93.5% 93.7% 93.9% 94.9% 93.5% 93.0% 91.4% 91.2% 91.3% 93.1% 94.9% 94.1% 94.1% 95.1% 95.5% 94.3% 93.6% 93.0% 90.4% 94.0%

95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0%RAG R R R R R R R R R R R R R R R R G R R R R R

Actual 88.4% 87.2% 83.2% 85.6% 85.4% 87.5% 84.0% 83.8% 83.9% 81.2% 83.9% 87.4% 88.9% 85.1% 86.6% 89.4% 90.5% 88.9% 88.1% 88.1% 85.5% 87.9%

95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 90% 90% 90% 90% 90% 90% 90% 90% 90%

RAG G G G G G G G G G G G G G G G G G G G G G

Actual 99.6% 99.5% 99.8% 99.6% 99.1% 98.9% 98.4% 99.7% 98.9% 99.6% 98.5% 97.2% 98.6% 97.3% 98.4% 99.4% 99.5% 98.4% 97.7% 98.4% 98.5%

95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0%

RAG R R R R R R R R R R R R G G G G G G R R R G

Actual 90.4% 92.2% 93.5% 92.7% 92.0% 94.8% 92.1% 91.6% 85.1% 85.9% 84.5% 90.7% 91.4% 92.8% 90.4% 92.8% 94.4% 90.9% 89.5% 87.5% 83.8% 90.3%

95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 95% 90% 90% 90% 90% 90% 90% 90% 90% 95%

RAG G G R R R R R R R R

Actual 1233 1384 1262 1343 1197 1283 1264 1342 1313 1260 1149 1316 1126 1269 1266 1389 1264 1349 1494 1407 1422 11,986

Target 1233 1384 1262 1343 1197 1283 1264 1342 1313 11621

RAG G G R R G G G R A G

Actual 1005 1002 917 1005 980 979 1000 890 953 949 876 1009 940 983 939 1028 967 948 977 969 954 8,705

Target 1005 1002 917 1005 980 979 1000 890 953 8731

RAG G G R R R R R R R R

Actual 2449 2653 2394 2601 2418 2473 2496 2464 2528 2447 2256 2539 2328 2524 2462 2700 2558 2600 2768 2649 2604 23,193

Target 2449 2653 2394 2601 2418 2473 2496 2464 2528 22476

RAG

Actual 1734 2029 1895 1949 1829 1941 2008 1832 1921 1982 1836 2048 2114 2312 2247 2192 1951 2075 2186 2065 2040 19,182

Target

RAG

Actual 2878 3189 2927 3134 2843 2969 3024 2986 3099 3133 2914 3135 2915 2975 3073 3359 3075 2970 3212 3032 3304 27,915

Target

RAG R R R R R R R R R R R R G R A R R G R R R R

Actual 7154 7942 7302 7785 7192 7474 7629 7482 7543 7553 6998 7722 7388 7851 7831 8297 7631 7685 8228 7800 7948 70659

Target 7135 7298 7161 7493 6819 7261 7262 7172 7291 6940 6488 7535 7651 7541 7634 7715 7006 7795 7393 7465 7334 67534

-3.4% 4.1% 2.6% 7.5% 8.9% -1.4% 11.3% 4.5% 8.4% 4.6%

Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

RAG R R R R R R R R R R

Actual 27.0% 28.8% 38.3% 41.5% 47.9% 49.6% 48.4% 49.7% 48.4% 48.7% 44.6%

Target 20.0% 20.0% 20.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0% 80.0%

RAG R R R G R R G R R R R R G A R R A G R R G R

YTD 2,657 2,880 2,760 2,755 2,841 3,034 2,555 2,925 2,377 2,871 2,809 3,255 2,124 2,563 2,833 2,720 2,733 2,503 2,872 2,864 2,259 23,471

Target 2600 2372 2626 2863 2425 2668 2627 2427 2322 2461 2577 2847 2188 2553 2674 2553 2674 2553 2674 2674 2310 22,853

-2.9% 0.4% 5.9% 6.5%

Activity

GP Written Referrals (MAR)

GP written referrals for a first outpatient appointment in G&A

specialtiesHalton CCG

E-Referrals

http://content.digital.nhs.uk/referrals/reports/weeklyutilisatio

nHalton CCG

Activity

A&E Attendances: All Types

Line 2: Number of attendances at all A&E depts.Halton CCG (LOCAL

DATA)

A&E Attendances: Type 3/4

Line 1: Number of attendances Type 3/4 Urgent Care Centres

(LOCAL DATA)

Halton CCG at

Runcorn Urgent care

Centre (LOCAL

DATA)

Halton CCG at

Widnes Urgent Care

Centre (LOCAL

DATA)

A&E Attendances: Type 1

Line 1: Number of attendances Type 1 A&E depts. Halton CCG at ST

HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST (LOCAL DATA)

Halton CCG at

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST (local data)

Halton CCG total

431: 4-Hour A&E Waiting Time Target (Monthly Aggregate for

Total Provider)

% of patients who spent less than four hours in A&E (Total

Acute position from Unify Weekly SitReps)

ST HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST

Target 90%

BRIDGEWATER

COMMUNITY

HEALTHCARE NHS

FOUNDATION TRUST

Target 95%

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST

Target 90%

Accident & Emergency

4-hour A&E waiting time, aggregate Halton CCG all types all

providersHalton CCG -Local

calculation

2016/17

Target 95%

2017/18

Target 90% 85%

100%


80%

90%

100%


90%

100%

Apr-16 Apr 17

80%

90%

100%


0

1,500


0

1,500


0

5,000


1,500

2,500


2,000

3,000

4,000


6,000

7,000

8,000

9,000


0%

100%


2,000

4,000




2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R R R R R R R R R R R R A A G G G G G G G G

YTD 2,027 1,932 1,932 2,061 1,771 1,716 1,653 1,653 1,523 1,712 1,804 1,904 1,753 2,048 1,842 1,872 1,784 1,651 1,889 1,918 1,499 16,256

Target 1444 1352 1573 1649 1418 1539 1431 1269 1342 1423 1357 1640 1705 1989 2084 1989 2084 1989 2084 2084 1800 17,808

2.8% 2.97% -11.6% -5.9%

RAG R R R R R R R R R R R R G A G A G G A A G G

YTD 4,684 4,812 4,692 4,816 4,612 4,753 4,208 4,578 3,900 4,583 4,613 5,159 3,877 4,611 4,675 4,592 4,517 4,154 4,761 4,782 3,758 39,727

Target 4044 3724 4199 4512 3843 4207 4058 3696 3664 3884 3934 4487 3893 4542 4758 4542 4758 4542 4758 4758 4110 40,661

-0.4% 1.5% -1.7% 1.1%

RAG G R R G G R G R R R R R R R R G R R R R R R

YTD 226 263 275 261 242 265 243 276 210 238 255 312 254 251 278 237 259 259 250 324 206 2,318

Target 249 258 250 272 248 248 276 248 204 207 198 256 224 231 242 255 213.45 239.85 227.55 228.6 181.95 2,043

13.3% 8.7% 15.1% -7.0%

RAG G R R G G R G R G R R R G G G G G G R R G G

YTD 100 122 117 113 103 113 87 115 84 99 118 134 81 104 95 97 102 110 110 133 81 913

Target 109 113 109 119 108 108 121 108 89 90 86 112 100 122 117 113 103 113 87 115 84 954

RAG G G R G R R G R G R R R R R R G G G G G R R

YTD 55 75 79 77 82 89 79 93 55 79 69 95 93 82 86 69 78 77 76 91 65 717

Target 73 75 73 79 72 72 80 72 59 60 58 75 55 75 79 77 82 89 79 93 55 684

RAG R R R R R R G R R R R R A R R G R A R R R R

YTD 1431 1317 1556 1530 1500 1509 1312 1580 1234 1465 1359 1571 1296 1430 1507 1334 1402 1394 1493 1648 1324 12,828

Target 1242 1226 1370 1420 1172 1347 1357 1339 1177 1361 1254 1421 1271 1308 1369 1444 1209.55 1359.15 1289.45 1295.4 1031.05 11,576

2.0% 9.3% 10.1% -7.6%

Elective - day cases (NHS AM2) Halton CCG (EC2)

Halton CCG

Elective - ordinary admissions (NHS AM1) Halton CCG (EC1)

(MAR)

Halton CCG

Elective - ordinary admissions (NHS AM1a) HCCG at WHHFT

(MAR) Halton CCG at

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST

Elective - ordinary admissions (NHS AM1b) HCCG at StH&K

(MAR) Halton CCG at ST

HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST

Other Referrals for First Outpatient Appointments (MAR)

Number of other referrals for a first outpatient appointment in

G&A specialtiesHalton CCG

1936: Total Referrals (MAR)

Total number of referrals (GP written referrals made & other

referrals - MAR)Halton CCG

1,000

3,000


3,000

6,000


100

400


0

200


0

100


0

2,000




2017-18

MetricReporting

LevelInformation

2016-17 2017-18

YTDQ1 TRENDQ1 Q2 Q3

RAG R G R R R R G R R R R R G R G G G G R G A G

YTD 755 653 840 813 768 796 643 869 649 790 711 844 704 720 740 685 707 751 753 850 660 6,570

Target 678 669 747 775 639 735 740 731 642 743 684 775 755 653 840 813 768 796 643 869 649 6,786

RAG R R R R R R R R R R R R G R R G G G R R A A

YTD 464 448 487 500 488 477 457 478 416 456 422 508 396 486 500 441 472 452 517 543 431 4,238

Target 391 386 432 447 369 424 427 427 371 429 395 448 464 448 487 500 488 477 457 478 416 4,215

RAG G R R R R R R R G G G R G R A R R R R R A R

YTD 1427 1548 1455 1524 1429 1454 1539 1517 1446 1468 1367 1577 1359 1527 1453 1579 1518 1500 1526 1508 1432 13,402

Target 1484 1458 1417 1509 1374 1453 1514 1460 1461 1522 1391 1470 1503 1459 1431 1497 1389 1398 1442 1438 1424 12,981

5.3% -5.7% -1.6% -1.8% -2.8% -3.9% -6.3% -5.2% -1.5%

RAG G R G R R G R G G G G G G G G G R R G R G G

YTD 632 686 620 674 636 602 683 614 593 613 565 635 600 634 585 607 651 623 589 601 547 5,437

Target 650 638 620 660 601 636 663 639 639 666 609 643 666 647 610 662 618 579 640 582 584 5,587

RAG G R R G R R R R R G R R G R R R R A R R A R

YTD 692 753 718 731 689 766 748 797 757 740 715 821 663 784 766 858 752 740 822 783 758 6,926

Target 730 718 697 743 676 715 745 719 719 749 685 723 729 710 706 718 670 736 701 755 745 6,471

RAG G G G G R G G R G G R R G G G G R G R R G G

YTD 3535 3531 3621 3786 3992 4016 3477 4279 3401 4045 3908 4646 3233 3956 4000 3985 3963 3861 3960 4227 3197 34,382

Target 4010 3784 4229 4356 3785 4412 4252 3922 3768 4092 3875 4617 4071 4049 4005 3996 3831 4044 3850 3903 3506 35,255

RAG R R R R R R R R G R

YTD 1407 1382 1414 1820 1804 1735 1309 1929 1561 1788 1748 2024 1533 1851 1899 1862 1889 1826 1845 1957 1458 16,120

Target 1407 1382 1414 1820 1804 1735 1309 1929 1561 14,361

RAG G R G R G G G G G G

YTD 1582 1569 1687 1479 1603 1661 1563 1707 1336 1650 1580 1992 1252 1581 1544 1545 1528 1488 1551 1635 1237 13,361

Target 1582 1569 1687 1479 1603 1661 1563 1707 1336 14,187

RAG G R R R R R R R R R R R R G G G R R R R R R

YTD 181 238 242 406 471 397 570 586 628 519 555 643 520 407 258 325 514 590 563 712 511 4400

236 236 236 236 236 236 236 236 236 236 236 236 450 450 450 450 450 450 450 450 450

Others

Delayed Transfers of care - days (BCF 11.3) in month figure

(Halton UA)Halton LA (LOCAL

DATA)

16/17 Target

=236: 17/18

Target = 450

All first outpatient attendances (NHS AM 4a) HCCG at WHHFT

G&A (MAR)Halton CCG at

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST

All first outpatient attendances (NHS AM 4b) HCCG at StH&K

(G&A (MAR) Halton CCG at ST

HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST

Non-elective admissions (NHS AM 3b) HCCG at StH&KHalton CCG at ST

HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST

All first outpatient attendances (NHS AM 4) Halton CCG (EC5)

G&A) NHS E Numbers

Halton CCG

Non-elective admissions (NHS AM 3) Halton CCG (EC4)

Halton CCG

Non-elective admissions (NHS AM 3a) HCCG at WHHFTHalton CCG at

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST

Elective - day cases (NHS AM2a) HCCG at WHHFT

Halton CCG at

WARRINGTON AND

HALTON HOSPITALS

NHS FOUNDATION

TRUST

Elective - day cases (NHS AM2) HCCG at StH&K

Halton CCG at ST

HELENS AND

KNOWSLEY

HOSPITALS NHS

TRUST

0

1,000


300

500

700


1,000

1,500

2,000


500

700


500

1,000


3,000

4,000

5,000


1,000

2,000


1,000

2,000


0

1,000


Governing Body

Date: 27th February 2018

Report title: NHS Halton CCG 2017/18 Finance Position

Lead Clinician and/or Lead Manager:

David Cooper – Chief Finance Officer

Purpose: This report updates the Governing Body on the current financial position and forecast outturn.

The Governing Body is asked to:

• Note the financial position at the end of January 2018; • Acknowledge the change in outturn position reported to NHS

England • Acknowledge the financial risks identified in the report; and • Discuss the additional actions required to reduce

expenditure and contribute towards longer term financial sustainability.

This Report supports the following CCG Strategic Objectives One: To commission services which continually improve the health and wellbeing of Halton residents.

Three: To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations.

Four: To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Commissioning Plan Implications The delivery of NHS Halton CCG’s Quality, Innovation, Productivity and Prevention (QIPP) plan is a fundamental part of the 2017/18 Commissioning Plan; this includes delivery against all appropriate national standards and priorities set out in the local joint Health & Wellbeing Strategy. This plan must be delivered, within allocated resources, to ensure that the CCG achieves its statutory duty to break even.

Financial Implications Does this require financial support? No

If Yes - Is there currently a budget for this? Not applicable

Board Assurance Framework and Corporate Risk Register Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? YES BAF 373

National Policy, Guidance, Standards, Targets or Legislation Delivering The Forward View: NHS planning guidance 2016/17 to 2020/21, NHSE, December 2015

Equality and Diversity and Human Rights None identified which specifically arise from this report although individual QIPP schemes would need to assess the impact on equality and diversity and human rights issues.

1. Introduction 1.1 This report provides a 2017/18 financial update to the CCG’s Governing Body for the

period up to and including January 2018.

2. Executive Summary Year to Date 2017/18 2.1 This financial position at the end of January 2018 (month 10) is an over spend of

£6.336m. The full year risk adjusted forecast outturn is deficit of £9.3m. This revised forecast has been agreed with NHS England.

2.2 Table 1 below provides an at-a-glance overview of the current performance against the

key financial duties of the CCG.

Green Amber Red

2.3Financial position before the application of

reserves

Forecast achievement of NHSE

business rules

Forecast Break-Even Position

Forecast Deficit Position

2.4 0.5% ContingencyContingency

available to offset f inancial pressures

Contingency deployed in equal

tw elths

Contingency deployed more

aggresively

2.5 Non recurrent headroomNR Headroom

supporting national risk reserve

N/ANR Headroom

supporting CCG financial position

2.6 Identification of QIPP on targetForecast delivery of annual QIPP target

N/AForecast under

delivery of annual QIPP target

2.7 Application of running cost targetForecast to operate w ithin running cost

allocation

N/AForecast to exceed

running cost allocation

2.8 Value & volume of invoices paid year to dateThe CCG is meeting the target for prompt

payment

N/AThe CCG is failing the

target for prompt payment

Guide to RAG RatingsReport Reference

Key Performance IndicatorRAG

Rating

2.3 Financial Position: NHS England (NHSE) Business Rules for commissioners require

that CCG’s achieve a minimum cumulative / historic surplus of 1% of the total revenue resource limit.

In 2017/18 NHS Halton CCG is monitored upon achievement of a break-even position in year with progress towards a 1% surplus over a 2-3 year period. For month 10 reporting, NHSE and the CCG have agreed a further revised control total (forecast outturn) position of £9.3m deficit which additional risks currently shown as being fully mitigated. As a consequence of both the deteriorating year to date financial position and the projected deficit, this indicator is assessed as red.

2.4 0.5% Contingency (Business Rules): The NHSE Business Rules for commissioners require that CCG’s set aside a minimum contingency of 0.5% which for NHS Halton CCG equates to £1.066m.

All reserves, including the contingency, have been utilised in full in-year. This leaves the CCG with no resilience to respond to any further financial pressures.

The CCG is forecasting to end the year with a deficit of £9.3m, therefore statutory duties and NHS England business rules will not be achieved. This indicator is therefore assessed as red.

2.5 QIPP Delivery: The CCG has a profiled quality, innovation, productivity and prevention

(QIPP) savings plan for 2017/18 of £9.951m. Total savings achieved year to date is £4.822m and projected savings for the year are £6.020m. This indicator is therefore assessed as red.

2.6 Running Costs: The CCG is reporting a balanced position against the running cost

allowance for both year-to-date and forecast outturn projection. This indicator is therefore assessed as green.

2.7 Better Payment Practice Code: The CCG continues to meet the targets for the prompt

payment of invoices.

3. Financial Position Year to Date 3.1 The financial position at the end of month 10 (January) is an over spend of £6.336m

against a plan of break-even after utilising the £1.066m contingency reserve in full. 3.2 The table below provides a summary of the financial performance to date.

AnnualBudget

BudgetTo Date

Spend To Date

Variance

£000 £000 £000 £000Mental Health 20,574 17,227 17,396 169Acutes 105,246 88,524 94,014 5,489Primary Care 6,415 5,346 5,339 (7)Primary Care Delegated Co-Commissioning 17,943 14,934 14,934 0Prescribing 23,850 19,875 19,753 (122)CHC 9,675 8,062 7,943 (119)Community 22,319 18,661 19,223 562Other Commissioning Areas 10,372 9,698 9,654 (44)Running Costs 2,731 2,275 2,275 0Reserves 368 (409) 0 409Total 219,493 184,194 190,531 6,336

Description

4. Revenue Resource Limit 4.1 NHS Halton CCG’s in-year revenue resource limit has increased in month by £0.250m

to £219.493m as detailed in the table below. This is ring-fenced funding specifically for the Cheshire & Merseyside Women’s & Children’s Vanguard project which the CCG hosts.

DETAIL ALLOCATION RECEIVED

CCG Initial Allocation @ M01 £217,108kMovements M02-M09 £2,135kNew Care Models: Maternity Vanguard Q4 250kTotal CCG Allocation @ M10 £219,493

In Month Allocation = £250K

5. Financial Headlines

5.1 Mental Health: • The year to date position at month 10 is £0.169m above budget which is as a

result of budget phasing and therefore forecast to present a balanced position at year end. Financial pressures regarding high cost placements are currently being managed and where possible savings are being made.

5.2 Acute sector:

• The acute sector is currently £5.489m above plan as illustrated in the table below. This is a combination of 2016/17 pressures (circa £0.6m), 2017/18 performance issues, and slippage on 2017/18 QIPP schemes assigned to the acute sector.

AnnualBudget

BudgetTo Date

ActualTo Date

Variance

£000 £000 £000 £000Alder Hey Childrens Hospital 1,024 853 1,003 149Aintree University Hospital 1,380 1,150 1,278 127Countess of Chester Hospital 1,240 1,033 855 (178)Liverpool Womens Hospital 1,444 1,203 1,103 (100)Royal Liverpool Hospital 4,485 3,738 3,635 (103)St Helens & Knowsley Hospital 40,044 33,370 35,480 2,110Warrington & Halton Hospital 46,083 38,402 40,346 1,944Other Contracts 9,545 8,774 10,314 1,540Sub-Total Acute 105,246 88,524 94,014 5,489

Description

• 2017/18 over performance is being driven by the CCGs two main providers, St Helens & Knowsley and Warrington & Halton Trusts. Even after contract challenges the in-year over performance at month 10 now totals £4.1m (£2.9m at month 9) across the two providers.

• The independent sector contracts are overspent by £0.288m (£0.233m at month 9) year to date; the bulk of this is with Spire Cheshire.

• As at month 9, total contract sanctions applied is £0.129m against a ‘possible’

value of £0.712m (excluding Warrington & Halton Hospitals for which updated information is awaited). However, as part of the Sustainability Fund, virtually all nationally available sanctions and penalties are suspended. The majority of the sanctions noted will be applied against the Royal Liverpool & Broadgreen Trust which is outside of STP control totals.

5.3 Primary Care including prescribing:

• Overall this budget area is underspent by £0.129m including £1m prescribing QIPP savings realised year to date.

5.4 Community Health:

• Currently overspent by £0.562m (£0.529m at month 9). The significant deterioration in month is primarily as a result of slippage in the delivery of expected efficiency savings.

5.5 Running Costs:

• Following a review of running costs (CCG Administration spend) both the year to date and forecast outturn positions are expected to be within the amount specified.

5.6 Other CCG Programme Spend – Better Care Pooled Budget:

• The pooled budget arrangement with Halton Borough Council is currently expected to overspend by between £2.2m and £2.5m depending upon the success of a number of recovery actions to reduce expenditure. This includes a review of the eligibility criteria for Continuing HealthCare (CHC), progressing patients from transitional placements to final outcomes sooner, reviews of the level of 1 to 1 nursing cover, and reviews of high cost placements to ascertain whether the packages represents the optimal level of care for the patients.

• Mitigations to offset the overspend are being pursued which if successful should reduce the level of overspend to circa £1m. Based on the CCG’s 40% contribution against the total budget, this would equate to a cost pressure at the end of year of £0.4m. In the event that the additional mitigations fail to materialise, the additional contribution required from the CCG could be circa £1m. This is not currently allowed for within the forecast £9.3m deficit.

5.7 Reserves:

• The current variance of £0.409m (£0.203m in M9) is slippage on QIPP delivery for primary care delegated co-commissioning budgets and the national adjustment in respect charges for overseas visitors.

• The 0.5% committed risk reserve (£0.976m) is set aside and assumed spent in accordance with NHSE Business Rules. This is expected to contribute to a national risk reserve. As with 2016/17, it is now likely this reserve will remain with the CCG at year end which will be reflected in the final accounts position. If this is the case, this would improve the deficit from the current £9.3m projection to £8.3m actual deficit (assuming all other factors are as per the forecast workings and assumptions). No residual reserves remain in 2017/18.

• Assuming the 0.5% national risk reserve of £1.0m is returned to the CCG to

support the accounts position, the cumulative deficit at the end of 2017/18 will be £11.4m (£3.1m from 16/17

5.8 Quality, Innovation, Productivity and Prevention (QIPP):

• The level of actual QIPP savings delivered year-to-date is calculated to be £4.882m against a plan of £6.159m.

• The forecast outturn position is that QIPP efficiency savings to be delivered will total £6.020m against an annual pan of £9.951m.

• Whilst the additional QIPP efficiency savings delivered over and above the

month 9 forecast is encouraging, there is an element of volatility in the QIPP figures as these are derived from provider activity monitoring schedules. However, whilst the level of QIPP savings delivered has increased, we are seeing additional pressures from the acute sector. In particular around winter planning and delivery initiatives, high levels of escalation (recently in excess of 100% capacity), and activity substitution, all of which lead to additional pressures to the CCG and therefore the additional QIPP savings are not resulting in a reduction in acute contract spend.

5.9 Forecast outturn:

• The CCG has agreed a further revised outturn position with NHSE of £9.3m deficit with a further £2.96m identified as risks and fully offset by mitigations. This position has been reported to NHSE at month 10. The further deterioration in forecast removes the unmitigated risks reported at month 9 as this has now crystallised into the forecast position.

• No allocation adjustments are expected in respect of No Cheaper Stock Obtainable (NCSO) drug cost pressures noted last month. The outturn position includes the latest assessment of £0.946m additional NCSO costs faced by the CCG.

• This is in addition to other cost pressures incurred by the CCG as a result of

national policy decisions, as previously reported to the Governing Body, including Category M drugs, Sepsis national re-coding, impact of HRG4+ on counting and coding and changes in the assignment of the relevant commissioner for specialised services (“IRs”).

Appendix A provides a more detailed analysis of the financial position by cost centre.

6. Risks & Mitigations

6.1 As a result of the change in forecast outturn position, unmitigated risks which the CCG have assessed as having definite / highly likely certainty, have now been moved from being flagged as risks to be included within the forecast outturn position. Resultantly, whilst £2.96m of risks remain in the forecast, these are now flagged against mitigating actions which providing they are successful will remove the risk from the assessment at year end.

7. Run Rate

The table below gives a brief summary of monthly spend levels to date:

£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

1,715 1,675 1,684 2,041 1,805 1,628 1,729 1,700 1,742 1,717

8,770 8,932 9,196 9,293 9,171 9,472 9,996 9,694 9,435 9,893

4,017 3,947 3,803 3,932 4,056 4,270 4,124 3,886 3,986 4,075

806 929 936 417 797 808 806 801 757 763

1,860 1,918 1,869 1,960 1,887 1,917 1,873 1,890 2,124 1,867

864 952 916 999 1,226 662 979 969 937 1,061

228 225 296 284 295 267 326 128 308 (79)

18,260 18,579 18,699 18,925 19,237 19,024 19,833 19,068 19,290 19,297

0 0 0 0 0 0 0 0 0 0

18,260 18,579 18,699 18,925 19,237 19,024 19,833 19,068 19,290 19,297

Sub-Total: Reserves

Grand Total I & E

1/12th M04Cost Centre Description

Sub-Total: Community Health

Sub-Total: Other Commissioning Areas

Sub-Total: Running Costs

Sub-Total Operating Budgets pre Reserves

Sub-Total: Acute

Sub-Total: Primary Care

Sub-Total: Continuing Care

Sub-Total: Mental Health

M02 M03 M05 M06 M07 M08 M09 M10

7.1 An analysis of the run rate i.e. a quick way of annualising data from a shorter period of time, gives an indication of the direction of travel with regards to expenditure and whether the overall trajectory is moving in the right direction. In order to deliver a balanced position at year end, a straight twelve-month average spend of £18.3m per month was required (this takes into account in year allocation adjustments). In month 2, the CCG spent £18.6m and this has risen to £18.7m in month 3, £18.9m in month 4, rising even further in month 5 to £19.2m, improving slightly to £19.0m in month 6, deteriorating to £19.8 in month 7, improving slightly to £19.1 in month 8 before deteriorating again in month 9 to £19.3m where it has remained constant into month 10.

7.2 Year to date spend totals £190.5m. The latest full year allocation totals £219.5m. In

addition, it has been agreed with NHSE that the CCG will report a deficit of £9.3m; therefore total expenditure is forecast to be £228.8m. Based on a straight line projection, this would suggest the M11 and M12 run rate will be £19.2m per month. Whilst this is a fractional improvement, a more significant step reduction in spend will be required to allow the CCG to achieve financial sustainability.

8. Better Public Sector Payment Code (BPPC)

8.1 The CCG continues to pay its invoices within the timescales set out in the BPPC.

9. Underlying Financial Position 9.1 The underlying position is a reflection of the CCG’s recurrent ongoing financial position.

This is calculated by comparing the recurrent expenditure to the recurrent allocation, adjusting for non-recurrent items and savings achieved and determines the CCG’s overall financial health on a going concern basis.

9.2 The underlying position of NHS Halton CCG at Month 10 after offsetting the non-

recurrent factors there is a deficit of £9.8m. Quickly summarised this represents the £9.3m operating deficit for the year plus £0.5m of other non-recurrent factors which have in effect supported the CCG’s in-year financial position.

10. Conclusion 10.1 The CCG has agreed a year end deficit control total of £9.3m with NHS England based

upon an analysis of expenditure, the level of QIPP savings expected, risks identified and the mitigations required to achieve this forecast.

10.2 The CCG has developed a financial recovery plan which continues to be refined and updated. The CCG will not be able to recover its financial position sufficiently in year to achieve statutory financial duties. This gives rise to a duty by our appointed auditor to report under section 30(b) of the Local Audit and Accountability Act 2014 to the Secretary of State for Health, this states that the auditor believes that the body or an officer of the body is about to take or has begun to take a course of action which, if followed to its conclusion, would be unlawful and likely to cause a loss or deficiency.

10.3 Further action must be taken to address the underlying financial position and to achieve

financial sustainability in 2018/19 and beyond. 10.3 Appendix A provides a detailed review of current spend by category. 11. Recommendations 11.1 The Governing Body is asked to:

• Note the financial position at the end of January 2018; • Acknowledge the change in outturn position reported to NHSE • Acknowledge the financial risks identified in the report; and • Discuss the additional actions required to reduce expenditure that contribute

towards longer term financial sustainability. David Cooper Chief Finance Officer February 2018

Appendix A: Year end financial position by cost centre

£000 £000 £000 £000 £000

MENTAL HEALTH CONTRACTS 14,071 11,759 12,024 265 277CHILD AND ADOLESCENT MENTAL HEALTH 723 602 411 (191) (353)IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES 1,434 1,195 1,190 (5) 0S117 1,557 1,298 1,298 0 0MENTAL HEALTH SERVICES - OTHER 2,789 2,373 2,473 100 0Sub-Total 20,574 17,227 17,396 169 (76)

ACUTE COMMISSIONING 95,049 80,025 85,002 4,976 6,571ACUTE CHILDRENS SERVICES 1,024 853 1,003 149 180AMBULANCE SERVICES 5,271 4,392 4,445 53 (60)CLINICAL ASSESSMENT AND TREATMENT CENTRES 1,086 907 1,195 288 321COLLABORATIVE COMMISSIONING - VANGUARD 1,577 1,314 1,314 (0) 0END OF LIFE 0 0 (7) (7) 0HIGH COST DRUGS 100 83 65 (18) (21)MATERNITY SERVICES 0 0 0 0 0NCAS/OATS 866 722 833 112 0PLANNED CARE 107 89 24 (65) 0WINTER RESILIENCE 166 138 139 1 0Sub-Total 105,246 88,524 94,014 5,489 6,991

CENTRAL DRUGS 721 601 601 (0) (28)COMMISSIONING SCHEMES 819 683 686 3 (2)LOCAL ENHANCED SERVICES 1,063 886 886 0 (100)MEDICINES MANAGEMENT - CLINICAL 1,007 839 823 (16) (23)OUT OF HOURS 1,141 951 954 2 (6)PCTF 858 715 715 0 0OXYGEN 255 212 216 4 7PRESCRIBING 23,850 19,875 19,753 (122) 0PRIMARY CARE IT 550 458 458 0 10PRC DELEGATED CO-COMMISSIONING 17,943 14,934 14,934 (0) 0Sub-Total 48,209 40,155 40,026 (129) (142)

CHC ADULT FULLY FUNDED 6,412 5,344 5,344 0 0ADULT JOINT FUNDED CONTINUING CARE 1,271 1,059 1,059 0 0CONTINUING HEALTHCARE ASSESSMENT & SUPPORT 456 380 369 (11) (5)CHC CHILDREN 550 458 350 (108) (130)FUNDED NURSING CARE 986 822 822 0 0Sub-Total 9,675 8,062 7,943 (119) (135)

COMMUNITY SERVICES 17,715 14,824 15,264 440 729CARERS 0 0 0 0 0HOSPICES 1,478 1,231 1,234 3 9INTERMEDIATE CARE 2,766 2,305 2,305 0 0LONG TERM CONDITIONS 360 300 420 120 140Sub-Total 22,319 18,661 19,223 562 878

COMMISSIONING - NON ACUTE - PMCF 71 59 59 0 (150)NON RECURRENT PROGRAMMES 167 273 295 22 59PROGRAMME PROJECTS 49 41 41 (0) (2)REABLEMENT - BCF 8,542 8,040 8,051 11 1,362RECHARGES NHS PROPERTY SERVICES LTD 439 366 97 (25) (60)SAFEGUARDING 389 324 269 (55) (68)NHS 111 349 290 293 3 2QUALITY PREMIUM 0 0 0 0 0CLINICAL LEADS 266 222 222 0 0Sub-Total 10,272 9,615 9,326 (44) 1,143

Sub-Total Programme Budgets 216,294 182,245 187,928 5,927 8,659

Forecast

MENTAL HEALTH

ACUTE

PRIMARY CARE

01F NHS Halton Clinical Commissioning Group Month 10 Financial Position 2017/18

AnnualBudget

BudgetTo Date

SpendTo Date

VarianceCost Centre Description

CONTINUING CARE

COMMUNITY HEALTH

COMMISSIONING - OTHER

Appendix A Cont: Year to date financial position by cost centre

£000 £000 £000 £000 £000

ADMINISTRATION & BUSINESS SUPPORT 279 232 230 (3) 6BUSINESS DEVELOPMENT 30 25 (0) (25) 0BUSINESS INFORMATICS 532 443 498 55 38CEO/ BOARD OFFICE 303 252 233 (20) (19)CHAIR AND NON EXECS 246 205 188 (17) (23)CLINICAL GOVERNANCE 0 0 0 0 0COMMISSIONING 151 126 127 1 3COMMUNICATIONS & PR 26 22 16 (5) 0CONTRACT MANAGEMENT 357 297 312 15 (8)CORPORATE COSTS & SERVICES 3 3 1 (1) 0EDUCATION AND TRAINING 111 92 130 38 34EMERGENCY PLANNING 0 0 0 0 0ESTATES AND FACILITIES 89 74 67 (8) (4)FINANCE 339 282 273 (10) (10)GENERAL RESERVE - ADMIN 0 0 0 0 0HUMAN RESOURCES 0 0 0 0 0IM&T 103 86 101 15 23PATIENT AND PUBLIC INVOLVEMENT 49 41 42 1 4PERFORMANCE 52 43 46 3 3PROCUREMENT 5 4 4 (0) 0RISK MANAGEMENT 56 46 8 (39) (50)Sub-Total 2,731 2,275 2,275 0 (3)

Sub-Total Running Cost Budgets 2,731 2,275 2,275 0 (3)

COMMISSIONING RESERVE (615) (615) 0 409 643

NON RECURRENT RESERVE 983 983 0 0 0Sub-Total 368 368 0 409 643

Grand Total I & E 219,393 184,520 190,203 6,336 9,299

Variance

RESERVES

01F NHS Halton Clinical Commissioning Group Month 10 Financial Position 2017/18

Cost Centre DescriptionAnnualBudget

BudgetTo Date

SpendTo Date

Variance

CORPORATE SERVICES - RUNNING COSTS

Governing Body

Page 1 of 4

Date: 1 March 2018

Report title: 2018/2019

CCG Lead Manager: Debbie Fairclough, QIPP lead

Director Lead: Leigh Thompson, Director of Commissioning

Purpose:

This guidance is an update to the NHS Operational and Contracting Planning Guidance for 2017/18 and 2018/19, published in September 2016, and Next Steps on the NHS Five Year Forward View, published in March 2017. The updates reflect progress made on the NHS’s core priorities and the additional revenue funding made available in the 2017 Autumn Budget.

The Group is asked to:

Note the content of the report and any associated improvement plans

Commissioning Implications Information in this report may determine where future areas of commissioning need to be focussed, especially where underperformance is evident. Background This report is brought on a bi-monthly basis to inform the Governing Body on the CCG’s current performance against national and local performance standards.

The NHS Outcomes Indicator Set of the NHS Outcomes Framework for 2015/16

The NHS Constitution operational standards

Quality Premium Indicators (both local and national)

Financial Implications Does this require financial support? No If Yes - Is there currently a budget for this?

Risks Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? YES If Yes - please state: BAF 36 – Significant assurance BAF 43 – Significant assurance BAF 41 – Limited assurance

Recommendations

That the Governing Body notes the content of the report and any associated action plans.

Governing Body

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1. INTRODUCTION

NHS England and NHS Improvement have published updated guidance for local providers and commissioners on priorities for the 2018/19 financial year, (https://www.england.nhs.uk/publication/refreshing-nhs-plans-for-2018-19/). This guidance is an update to the NHS Operational and Contracting Planning Guidance for 2017/18 and 2018/19, published in September 2016, and Next Steps on the NHS Five Year Forward View, published in March 2017. The updates reflect progress made on the NHS’s core priorities and the additional revenue funding made available in the 2017 Autumn Budget.

2. HEADLINE UPDATES INCLUDE:

£1.4bn increase in resources available to CCGs, including a £400m Commissioner Sustainability Fund (CSF);

An increase in the Provider Sustainability Fund (PSF) of £650m, taking the total to £2.45bn;

An expectation that these additional resources should allow local health systems to plan together for a more realistic level of emergency activity, significant increases in the volume of elective activity and the stabilisation of RTT waiting lists;

A continued focus on integrated working across health and social care commissioners and providers to improve services and outcomes for patients, including through STPs and the voluntary roll-out of ‘integrated care systems’. This new term covers different forms of local decision-making and responsibility, including devolved systems and those previously working as accountable care systems. The eight shadow Accountable Care System sites and two devolved health and care systems are now to be known as Integrated Care Systems (ICS). ICSs are expected to prepare a single system operating plan and to work within a system control total. They are expected to move to a more ‘autonomous’ regulatory relationship with NHS England and NHS Improvement over time;

A restatement of the importance of engaging with patients, the public and other individuals and groups when local services develop new ways of working;

The A&E performance recovery trajectory has been pushed back one year. Trusts will be expected to meet 90% by September 2018, and return to 95% by March 2019;

On the referral to treatment standard, the expectation is that the waiting list should not be any higher in March 2019 than in March 2018, alongside the

https://www.england.nhs.uk/publication/refreshing-nhs-plans-for-2018-19/

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expectation to halve the number of patients waiting 52 weeks in the same period;

The guidance states that there will be no additional winter funding in 2018/19. Systems are required to produce a winter demand and capacity plan with actions and proposed outcomes. Guidance on submitting these winter plans will be available by March 2018;

The two-year National Tariff Payment system is unchanged, with local systems encouraged to consider local payment reform in certain areas;

There is no new detail on how funding for the lifting of the pay cap will be administered. Trusts are urged, however, to ensure their workforce plans are robust as they will be used to inform pay modelling nationally.

3. COMMISSIONER FINANCES

An additional £1.4bn will be made available to CCGs next year:

£600m will be added to CCG allocations directly;

£370m will be released through lifting the requirement for commissioners to underspend 0.5% of their allocations;

£400m will be made available through a new Commissioner Sustainability Fund (CSF), through which commissioners will be expected to plan and deliver on their own control totals. Any CCG that overspends in 2017/18 will be expected to improve its in-year financial performance by at least 1% next year;

The 2018/19 allocation for general practice has been maintained to enable the expected cost uplifts as well as funding the commitments as set out in the General practice Forward View.

4. KEY DATES FROM THE CONTRACTING AND PLANNING TIMETABLE

Item Date

Draft 2018/19 Organisational Operating Plans submitted 8 March 2018

Draft 2018/19 STP triangulation template submitted 8 March 2018

National deadline for signing 2018/19 contract variations and contracts

23 March 2018

Final Board or Governing Body approved Organisation Operating Plans submitted

30 April 2018

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5. CCG ACTIONS AND NEXT STEPS

As part of the annual planning process the CCG officers in Finance, Performance and Planning are meeting weekly with the Director of Finance and Director of Commissioning to update the 2017/18 2018/19 plans, and will present revised versions to the CCG Executive Management Team (EMT) each Friday with a financial draft submission on the 2nd March 2018 to NHS England. Thereafter, the first revised draft will be submitted via unify to NHS England and further updates will be submitted as and when required, with Governing Body sign off 30th April 2018.

Governing Body

Page 1 of 8

Date: 1st March 2018

Report title: Director of Commissioning Governing Body Report

CCG Lead Manager: Leigh Thompson, Director of Commissioning

Clinical Lead:

Purpose:

To provide assurance from the Director of Commissioning to the Governing Body with regard to the key strategic and operational issues and developments related to the delegated duties of the Director of Commissioning. All constitutional performance standards are discussed and overseen at the Performance and Finance Committee and reported in detail in the Corporate Performance Report.

The Group is asked to: Note the content of the report.

Commissioning Implications Information in this report may determine where future areas of commissioning need to be focussed, especially where underperformance is evident. Background This report is brought on a bi-monthly basis to inform the Governing Body on the CCG’s current performance against national and local performance standards.

The NHS Outcomes Indicator Set of the NHS Outcomes Framework for 2015/16

The NHS Constitution operational standards

Quality Premium Indicators (both local and national)

Financial Implications Does this require financial support? No If Yes - Is there currently a budget for this?

Risks Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? YES If Yes - please state: BAF 36 – Significant assurance BAF 43 – Significant assurance BAF 41 – Limited assurance

Recommendations

That the Governing Body notes the content of the report and any associated action plans.

Governing Body

Page 2 of 8

1. PURPOSE The purpose of the paper is to provide assurance from the Director of Commissioning to the Governing Body with regard to the key strategic and operational issues and developments related to the delegated duties of the Director of Commissioning. All constitutional performance standards are discussed and overseen at the Performance and Finance Committee and reported in detail in the corporate performance report. Contract review meetings are held monthly with providers to review individual provider performance and ensure that necessary remedial action is taken in the event of provider underperformance through the contract. A&E standards are overseen through the A&E Delivery Board which holds the system to account for their role in achievement of the A&E 4 hour standard. The Urgent Care Operational Groups are tasked with delivering a specific 9 point plan set by NHSE and NHSI, to achieve the standard by March 2018. A Strategic RTT Improvement Group is to be established in 2018, to include members from the two acute care providers, 3 CCGs, NHS England, NHS Improvement and the national RTT Intensive Support Team, to ensure the recovery of the RTT 92% incomplete standard. The Clinical Advisory Group receives any impact assessments, clinical pathway amendments, makes recommendations and supports any commissioning decisions that are required during the contractual year. The Commissioning Oversight Group undertakes the review of all commissioning intentions, plans and developments and reports directly to the Finance and Performance Committee and to the Quality Committee, to ensure due process has been followed. The Executive Partnership Group is tasked with having a joint oversight role for any pooled arrangements and commissioning decisions. Commissioning Plan 2018/19 refresh is currently aligned with our Commissioning intentions refresh, QIPP delivery for 2018/19 and a placed based commissioning prospectus. Separate documents describing the refresh guidance and corporate performance are presented within this Governing Body paper, and will be presented by the relevant Director lead. 2. CORPORATE COMMISSIONING UPDATE Procedures of Low Clinical Priority – Tranche 1 and 2 policies have been completed and approved by Governing Body in January, once all of the Merseyside CCGs Governing Bodies have ratified the amendments these will form the basis of new Merseyside wide policy. The review of the tranche 3 policies, including infertility services has commenced and the draft revised narrative is near completion and will be circulated to NHS stakeholders for consideration before the public consultation is undertaken.

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3. REFERRAL MANAGEMENT Warrington Hospital commenced the soft launch, on 12th February, of the Paper Switch Off programme, which goes live on the 1st March. St Helens Hospital is scheduled for the 1st June. The Advice and Guidance programme is live with endocrinology, gastroenterology, allergies & neurology and gynaecology, cardiology, paediatrics, ENT, urology and dermatology are due to be available by the end of March. Warrington has maxillofacial, colorectal and general medicine scheduled to start in the first quarter of 18-19. We will keep the GB and the member practices appraised and will report back in June 2018. 4. URGENT & EMERGENCY CARE The last 6 weeks have seen sustained periods of pressure for the NHS, particularly as a result of the winter pressures, variations in the weather and ‘Flu’. Whilst we appreciate these were not unpredictable, there has been a marked increase in areas such as; attendances, admissions, respiratory diseases, different strains of ‘Flu’, ward closures due to norovirus and staffing challenges in a number of our community settings. St Helens Non-Elective Short Stay/Ambulatory Care has been an area of concern raised by our GP community and Dr Lyon wrote to the Trust expressing the CCGs concern regarding the growth in non-elective zero length of stay admissions that are being undertaken. A working group is reviewing this position with the intention to negotiate a local ambulatory care pathway tariff, similar to the one used at Warrington. This approach is supported by the 2018-19 Planning Guidance and further proposals are been discussed with a potential of a joint review of activity, process and pay. We are awaiting a formal response back from the trust in response to the letter and in the meantime we are discussing next steps in our Finance & Performance Committee. 4.1 A&E Counting The guidance is unchanged and must be adhered to. There are a number of issues currently causing concern. Firstly, there is some inconsistency between trusts and over time about the way in which some emergency presentations are being counted. This relates to assessment, ambulatory care activity, and things like attendances for emergency eye services and early pregnancy assessment units. There is also inconsistency around attribution of type three activity from urgent care centres, walk in facilities and minor injury units. There is not a clear line from the centre on this, but there are concerns that growth in activity is being overstated and that performance against the target is inconsistently measured. To address this, a template has been issued to providers which focus on type one activity and other types will be mapped in later on. 5. PLANNED CARE 5.1 Referral to Treatment (RTT) Currently both trusts are achieving their RTT standards, but have a few specialities that are breaching. Warrington did cancel their elective programme in line with the request from NHSE during the winter period, but will restart in February to ensure there are no

Governing Body

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breaches in the 52 week standard or the overall 18 week standard isn’t breached. St Helens continued with urgent and emergency surgery, cancers and some specialities and has resumed their entire elective care programme as of the first of February. 5.2 Respiratory The termination of the Community Respiratory tender has been formally communicated to all of the interested providers, and to date there has been one provider that has asked for further clarification. The revised commissioning plan for the transformation of respiratory services is in development with an end to end review and redesign of respiratory services for the borough. 6. GENERAL PRACTICE QUALITY, CONTRACT AND TRANSFORMATION VISITS The GP Clinical Lead and Primary Care Team have undertaken visits to half of the fourteen practices, and the remaining practices visits are diarised for February and March. The visits focus on key areas from a quality, contract and transformation perspective. Initial key themes identified so far include:

Celebrating success, sharing best practice and the identification of strategies to improve the provision of health checks for patients with a Learning Disability;

Discuss variation in exception reporting for the Quality & Outcomes Framework and exploration of local reporting and performance;

Identify and discuss any practice issues specifically re IT kit, contracting & estates;

Identify and discuss issues with referral process controls (referral management) Map of Medicine and any local pathway issues;

Confirmation that “NHS Choices” is up to date and used appropriately;

Identify that all practices are keen to reflect and learn from each other on individual issues to improve quality of care.

The visits have also provided practices with an opportunity to raise issues or areas for collaboration or improvement. Once all the visits have been completed, the outcomes will be collated and discussed with the Primary Care Group, Primary Care Commissioning Committee and Quality Committee in order to progress the improvement areas identified. An annual plan will be presented to the Primary Care Commissioning Committee aligned to the refreshed GP Forward view and GP strategy identifying priority areas. 6.1 Special Allocation Scheme (SAS) The SAS is a national scheme introduced in 2004 with the aim of providing a secure environment in which to accommodate patients who have exhibited challenging and sometimes violent behaviour when visiting their GP Practice. The scheme offers an alternative environment where patients can receive general medical services. As a delegated commissioner of primary medical services NHS Halton CCG is required to commission a SAS as part of its duty of ensuring all Halton residents can access primary medical care. The previous provider, Castlefields Health Centre, gave notice on the contract last year so a new provider had to be commissioned.

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The Governing Body is asked to note a formal thank you to Castlefields Health Centre for successfully providing the service since 2015. Discussions with local practices and an early engagement opportunity exercise demonstrated that there was no interest in bidding for this scheme. Therefore, in January, following discussions with a potential provider, the Primary Care Commissioning Committee approved PDS (Medical) Ltd as the new provider of the SAS. Established in 2004, PDS Medical is an independent healthcare provider, delivering a wide range of NHS services across the North of England. In 2017 they were awarded a five year, APMS contract with Lancashire and Greater Manchester NHSE to provide a SAS on behalf of six CCG’s across Lancashire and Cumbria. Mobilisation has commenced and it is anticipated the scheme will be up fully operational by end March/beginning April. 6.2 Community Dermatology Service As one of our priority areas for 17/18 we have been working with our partners in the North Mersey and Warrington CCG’s to procure an integrated Tier 3 and Tier 4 Dermatology service across the geographical footprint. The North Mersey Steering Group have agreed to follow a Light Touch Regime procurement process, and will be using the CSU Procurement team to support the process, with representatives from each CCG inputting into the steering group and subsequent working groups when necessary. Locally the CCG has been working with our two GP Federations to pilot a lesion triage service to support General Practice, and take some pressure away from the Acute Trust to support their Dermatology services. We are also working with our Acute Trust to roll out Dermatology advice and guidance, it has been advised that this should include Teledermatology, again supporting reduction in referrals into secondary care and reducing unnecessary hospital appointments for patients, ensuring they are cared for in the appropriate setting by the appropriate clinician and that they have choice of where best to receive their care. All of the above work is aligned to our QIPP and Commissioning Plan and will have a predicted go live date of April 2018. 6.3 EMIS Community The Phase 1 EMIS rollout plan for adult community services was approved via the EMIS Community Project Board. A Configuration lead is now in post within Bridgewater who is working with service leads to develop templates to support service delivery. A process has been agreed with the CCG Community Lead to ensure the delivery of the appropriate service reports to support the ongoing commissioning process. A scrutiny process is also being undertaken in relation to the EMIS mobile solution to ensure that it will deliver the requirements of the services which will be presented back to the Project Board in March. A local data sharing agreement has been developed which is currently awaiting approval. In addition, two business change posts, which will be hosted by the St Helen’s & Knowsley Health Informatics Service are currently being recruited too which will support the system optimisation and business change associated with the EMIS implementation including cross organisational tasks, managed referrals and document transfer.

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6.4 EMIS Urgent Care Centres A project plan and scoping document has been developed to capture detailed requirements of both Urgent Care Centre sites. A mapping exercise is being undertaken in conjunction with the UCC Clinical Pathways Group to ensure standardisation of documentation across both sites in the use of clinical templates. Scrutiny of Safeguarding alert process is being undertaken to ensure consistency and alignment across organisations in order to compliment the national Child Protection (CPIS) programme. The Project Lead is working with EMIS and the CCG Leads to ensure compliance with national data requirements (ECDS) ahead of the national deadline of October and we are working with both sites in order to streamline processes transitioning from paper to electronic processes where possible. A review of the urgent issues which have been identified as part of the scoping process are to be presented to the February Project Board along with discussion and agreement on the organisational setup of the system to support the strategic direction of the UCC’s and how this aligns to project timescales. 7. CHILDREN’S SERVICES Good progress has been made around the transformation of CAMHS services locally largely in conjunction with Warrington CCG which has resulted in a new service specification and performance framework. The new service offer is aimed at delivering the aspirations of Future in Mind a national document published Feb 2015 around seamless service without ‘tiers’ increased access to services – especially signposting and guidance through the development of Information Drop Ins/Hubs (to be delivered in partnership with Wellbeing Enterprises), additional support for schools to support young people and closer working with local authority children’s social care. A multi-agency launch of the new service offer and model is planned for April 2018. The new branding for CAMHS will be “Heads Up Halton” a name chosen by young people. 7.1 Community Consultant Paediatric Service Some concerns have been raised locally about the effectiveness and quality of the provision of service delivery. A Contract Performance Notice has been issued, a deep dive clinical audit will be undertaken, a remedial action plan around safeguarding concerns is in place and Health watch have been tasked to undertake a piece of work with local parents/carers to help provide a more holistic picture of service delivery. 8. MENTAL HEALTH Following on from the Tony Ryan Review work has been underway to support significant redesign of local mental health services into a town based model to provide an improved patient experience, and facilitate closer working relationships with local practices and third sector colleagues. The work will be further enhanced via the offer of support from an additional Resource Centre in Vine street which will allow co-location of statutory (health and social care) and third sector organisations . It is anticipated that the centre will also be part of the 24/7 offer for people in the borough experiencing crisis as an alternative to attending A&E.

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8.1 Mental Health Winter Funding 2018/19 North West Boroughs Healthcare NHS Foundation Trust was awarded £189,000 of funding in December 2018 to provide additional support to the Mid Mersey healthcare system throughout the winter of 2018 to support patients with mental health related illnesses. Five schemes were approved for implementation. Two of these schemes were to provide front line staff within the acute hospital trusts to support patient care delivery. A further two schemes were to support discharge delays and patient flow throughout Northwest Borough’s inpatient wards and to support the transfer of patients from acute hospital units to mental health facilities. The final scheme was to increase the frontline clinical support within the Knowsley Care Home Liaison service, in order to reduce any unnecessary admissions from care homes. The information below details the schemes and current key performance indicators used within the trust to demonstrate the potential impact of the schemes delivery. St Helens & Knowsley Schemes Two schemes have been implemented to support St Helens & Knowsley:

Scheme one relates to an additional post implemented in February to support the liaison teams and inpatient wards in improving patient flow across St Helens & Knowsley. The aim of the role is to ensure that adequate flow is maintained and to ensure there are minimal delays when admitting patients. In addition this post has been developed to ensure reporting and escalation procedures are in place across the St. Helens & Knowsley Patch

Scheme two relates to additional support; prior to core 24 services go live in April. The scheme has been developed to ensure sufficient assessment capacity is in place to support increase in demand in patients requiring mental health assessments.

The table below explains the schemes in detail and the returns sent to NHS England:

Mid Mersey Schemes (Warrington, Halton, St Helens & Knowsley) Two schemes are being implemented to support Mid Mersey flow:

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Scheme one has been implemented to support the trust in managing patients whose discharges are delayed. This trust wide role supports wards and boroughs in identifying patients who are experiencing difficulties in transferring to their preferred placed of care. The post holder is responsible for liaising with CCG’s and local authorities in identifying issues and implementing resolutions in order to reduce the delay in the patient journey. Prior to the support offered by NHS England the trust implemented this role in December 17.

The second scheme relates to increasing support worker capacity to the system in order to ensure patients who are in inpatient settings receive the appropriate 1-1 care. The monies released are to support both acute hospitals in the region. It has been agreed with STHK that requests for additional support would be made to the liaison service and support would be provided on a patient by patient basis. In addition if support was not required the additional support could be diverted to support the inpatient wards in managing and maintain patient flow. Currently NWBH is liaising with Warrington Hospitals in how to best apply this scheme.

The table below explains the schemes in detail and the returns sent to NHS England:

End Leigh Thompson Director of Commissioning

KEY ISSUES

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Clinical Advisory Group Date 14 February 2018

Agenda Item No:

Item Ref:

Key Issue:

Action:

CCG BAF/Risk Mitigation Level of assurance

3 & 4 CA08 &09-17 Two business cases were presented and members were asked to consider this as part of the Commissioning Oversight Group process

One scheme was recommended for approval with members asking for the other to be ‘worked-up’ before further consideration

5. CA10-17 Potential options following the withdrawal of Map of Medicine Sidebar and Map Referrals from the market were presented for comment

Members discussed the options and asked officers to worked towards the preferred one

6. CA11-17 Public Health (PH) provided information relating to the affordable warmth referral process

Members agreed to support the referral process in practice and asked PH to contact providers and other organisations to increase participation

8. CA12-17 Risk Register Risks were discussed and a request made to check if the Clinical Advisory Group was the appropriate group for a number of the entries

RISKS FOR THE COMMITTEE FOR WHICH NO INFORMATION HAS BEEN PRESENTED IN THIS MEETING RISK NUMBER ACTION REQUESTED BY COMMITTEE DATE FOR ACTION

Key Issues Report Date Prepared by: Louise Murtagh 21 February 2018 Verified by: NOTE: A copy of the approved Minutes from this Meeting or any papers referenced in this Key Issues Report will be made available to the Governing Body on request to the Committee Chair

KEY ISSUES

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Primary Care Commissioning Committee Date 11 January 2018

Agenda Item No:

Item Ref:

Key Issue:

Action:


PRIVATE 3. & 6.

PCC13-17 PCC16-17

List Closure Extension Applications The Committee agreed to 6 month list closures for both practices

PRIVATE 4. & 5.

PCC14-17 PCC15-17

Applications for Practice Relocations The Committee considered the advantages and disadvantages of the relocation applications. However, members were unable to make decisions on the applications and these were to be taken at an Urgent Issues Committee

3. Presentation Rob Foster and Mel Connell attended the meeting to present on Halton GP Federations Progress relating to project delivery

Discussions were around the federations’ links to secondary care and the ‘…ologies’; and the people using and working in the services. The report provided members with an insight into where funding was being spent

4. PCC38-17 Members considered the most appropriate way to procure the Special Allocation (previously known as the Zero Tolerance) Scheme (SAS) in Halton.

The Committee decided to recommend to Performance and Finance Committee that PDS (Medical) Ltd was appointed as the provider of the SAS scheme in Halton for a period of up to 5 years, in line with their current contract with NHS England.

5. PCC39-17 The Committee considered a report which outlined the plans for the 2018/19 Halton Enhanced Scheme (HES). The report included background information

The full report was to be brought to the next Committee. Comments received were around the removal of safeguarding meetings, a refresh of the Primary Care

KEY ISSUES

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Agenda Item No:

Item Ref:

Key Issue:

Action:


on the formation of the scheme and detailed the funding sources and amounts required

Strategy, the potential effects of the ACS, what the additional funding means for primary care and how withdrawal of funding would impact on MDTs etc. Discussions were around the overall CCG financial deficit and investment in primary care.

6. PCC40-17 This was an overview of complaints submitted to NHSE by patients, about GP practices between May 2015 and September 2017. They were grouped into themes prior to investigation by the NHSE complaints’ team and the outcome documented

The Committee noted the report

7. PCC41-17 The GP Extra Services was a pilot scheme and the CCG needed to consider whether to procure the GP Access service as a stand-alone contract or whether the contract should be procured to include other access services such as the UTCs.

Members noted the background report and that a full report would be brought to Committee in March 2018

8. PCC42-17 Information regarding the International GP Recruitment Scheme was considered by the Committee.

The Committee noted the joint application developed by Liverpool CCG in partnership with Cheshire and Merseyside CCGs

9. PCC43-17 Members were asked to note the decision to change Minor Ailment Web Platform. Three options had been presented

The Committee noted the decision reached was Option 2. to commission PharmOutcomes jointly with Halton Borough Council as this would reduce the cost by about 40%

KEY ISSUES

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Agenda Item No:

Item Ref:

Key Issue:

Action:


11. PCC44-17 LR presented a report to inform the committee of the proposal to run a local waste campaign. This included the proposed plan showing where savings were anticipated

The Committee noted the report

13. PCC46-17 Members noted the risks as listed in the report and that there was a need to update these

The Committee asked for risk handlers and manager to meet with the Risk and Governance Manager to update the report



KEY ISSUES

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QUALITY Committee Date 18 January 2018

Agenda Item No:

Item Ref:

Key Issue:

Action:


3b. QC82-17 HM presented a Quality Assurance Service Summary Report on Care Homes in the borough. The report listed each home with an associated CQC Rating HBC QAT Rating.

Members discussed the RAG rating of the care homes in the borough and the action that were being taken to improve each score. They also noted the GP Alignment project and its project

3c. QC83-17 MC presented the National Quality Board (third edition) Quality Surveillance Groups (QSG) National Guidance for members to note

MC confirmed that prior to taking to the subsequent QSG a copy of the report would be brought to Quality Committee in February 2018 for noting

4a QC86-17 JS presented a report to provide assurance via the early warning dashboard and CQPG feedback reports. The key issues were listed in the report

Members discussed individual providers and concerns. Following this amendments were to be made to the risk register

4b. QC87-17 MC introduced the IFR report for Quarter 2. The report provided details on applications. Members discussed exceptionality and the lack of understanding about this

Members noted the report

4c. QC89-17 DC presented the Engagement & Involvement Monthly Report

Members noted the report

4d. QC90-17 The Corporate Risk Register was discussed and it was noted that the CCG was transitioning to a new Datix

Members discussed the risks and a number of changes to entries were requested

KEY ISSUES

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Agenda Item No:

Item Ref:

Key Issue:

Action:


system for the recording and management of risks



KEY ISSUES

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QUALITY Committee Date 15 February 2018

Agenda Item No:

Item Ref:

Key Issue:

Action:


3a. QC93-17 117 After Care Project Plan. Members discussed 117 Aftercare procedures and policy in conjunction with the Council and North West Boroughs. They also reviewed how the CCG discharged its statutory functions for 117 aftercare and support the 117 aftercare project plan.

3b. QC94-17 NHSE Consultation OTC Medicines and Implications for Halton

The Committee considered the NHSE OTC consultation and its implications. Members agreed that key to success was a robust Communication and Engagement Plan

3d. QC96-17 Smoking in Pregnancy Update Members received an update on how the £75k funding from NHSE would be spent to help reduce the number of women who smoked in pregnancy and her family members

4b.& c QC99-17 QC100-17

CHC Update: MIAA action plan Interim Education, Health & Care (EHC) Plans (SEND) – Continuing Care Audit

Members received report on compliance relating to the MIAA action plan for CHC and the annual report for Children’s CHC. Regular updates reports would be presented

4d. QC101-17 Safe Management of Controlled Drugs The Committee considered a Q3 update on responsibilities under the Controlled Drugs Regulations 2013. Member referred to tight operational controls in care homes, drug seeking behaviour and opioid usage

4e, f & g QC102-17 Quality update from two local providers Members considered three reports relating

KEY ISSUES

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Agenda Item No:

Item Ref:

Key Issue:

Action:


QC103-17 QC104-17

CQC Local Area Review Action Pan QSG, Halton Borough Submission

to quality monitoring of providers and services by/or provided by the CCG. The Committee considered progress made against each plan, associated risks and next actions. Member requested regular updates

5a. QC105-17 Engagement & Involvement Monthly Report

The Committee received an update on past and future events and discussed the Primary Care Dashboard and feedback from Halton’s People Forum

6a. QC106-17 Quality issues with a local provider Members discussed quality and safety concerns with a local provider and authorised the audit of the service

6b. QC107-17 Risk Register The Committee looked at all risks and agreed that some of the actions agreed at the meeting would potentially reduce the risk scores once completed.



KEY ISSUES

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PERFORMANCE AND FINANCE COMMITTEE Date 23 January 2018

Agenda Item No:

Item Ref:

Key Issue:

Action:


3. Risk Register PC29-17 Members reviewed the risks associated with the Committee.

It was noted that a number of the risk descriptions, mitigations and scores required updating and FP was to meeting with the Risk and Governance Manager to review.

6.Commissioning Oversight Group Key Issues

PF32-17 As part of the new PMO process members were asked to consider three schemes

Members discussed the summaries presented to them and agreed support the recommendations

7.Combined Performance Report & 8.Recovery Plan

PF33-17 PF35-17

Members received the financial position at the end of December 2017 (month 9) and received a verbal update on progress made on the Recovery Plan

Members discussed the financial position and specifically referenced over performance in the acute sector

7.Corporate Performance Report

PF34-17 The report provided information on key strategic, operational issues and developments related to statutory requirements.

Members considered the report and noted performance highlights and the areas where the CCG was not hitting constitutional standards


Key Issues Report Date

KEY ISSUES

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Prepared by: Louise Murtagh 15 February 2018 Verified by: NOTE: A copy of the approved Minutes from this Meeting or any papers referenced in this Key Issues Report will be made available to the Governing Body on request to the Committee Chair

KEY ISSUES

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PERFORMANCE AND FINANCE COMMITTEE Date 27 February 2018 – As this meeting had not taken place the following entries were due for consideration

Agenda Item No: Item Ref:

Key Issue:

Action:


3. Risk Register PC38-17 Members would be asked to review For discussion

4. Contract Sanctions Application February 2018

PF39-17 To update and provide assurance that opportunities to apply contract sanctions are being optimised.

For noting

5. 2018/19 Halton Enhanced Scheme

PF40-17 To apprise the committee of work to date and plans for 2018/19, prior to a formal request for funding.

For approval

7. Pooled Budget incl, BCF–Q3 8. 2017/18 Finance Update

PF42-17 PF43-17

Members received updates on spend to date for 201/2018 on the pooled budget with the Council and CCG overall spend

For discussion and noting

9.Corporate Performance Report

PF44-17 The report provided details of the CCG’s performance against local, national and constitutional performance standards

Note the content of the report and any associated improvement plans

RISKS FOR THE COMMITTEE FOR WHICH NO INFORMATION HAS BEEN PRESENTED IN THIS MEETING RISK NUMBER ACTION REQUESTED BY COMMITTEE DATE FOR

ACTION


Documents

Millbrow Care Home Body Meeting...Millbrow Care Home- The story • A purpose built two storey care home situated in Widnes, registered to provide both nursing and personal care for