NHS LIVERPOOL CLINICAL COMMISSIONING GROUP … · 2016-01-12 · Page 3 of 11 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP SERVICE IMPROVEMENT COMMITTEE THURSDAY 5TH DECEMBER 2013 12.45PM

Page 1 of 2

NHS LIVERPOOL CLINICAL COMMISSIONING GROUP

GOVERNING BODY

TUESDAY 14TH JANUARY 2014 AT 1PM

BOARDROOM ARTHOUSE SQUARE (lunch to be provided at 12.30pm)

A G E N D A

Part 1: Introductions and Apologies 1.1 Declarations of Interest All 1.2 Minutes and action points from the last meeting Attached

held on 10th December 2013 All 1.3 Matters Arising All 1.4 Questions from the Public Part 2: Updates 2.1 Feedback from committees: Report no: GB 01-14

Service Improvement: 5th December 2013 Jim Cuthbert Approvals Panel: 17th December 2013 Prof. Maureen Williams Primary Care: 31st December 2013 Nadim Fazlani Finance Procurement & Contracting: 7th January 2014 Nadim Fazlani

2.2 Joint Commissioning Group 16th December 2013 Report no: GB 02-14 Tony Woods 2.3 Chief Officer’s Update Verbal Katherine Sheerin 2.4 NHS England Area Team Verbal Clare Duggan

Page 2 of 2

2.5 Public Health Update Verbal Paula Grey Part 3: Strategy & Commissioning 3.1 Everyone Counts – Report no: GB 03-14

Planning for Patients 2014/15 – 2018/19 Tony Woods Part 4: Governance 4.1 Care Quality Commission Inspections and the Report no: GB 04-14 Changing Methodology Jane Lunt Part 5: Performance 5.1 CCG Performance Report Report no: GB 05-14 Ian Davies

6. Date and time of next meeting:

Tuesday 11th February 2014 at 1pm, to be held in the Boardroom at Arthouse Square

For Noting:

Minutes of Service Improvement Committee - 24th October 2013 Minutes of Primary Care Committee - 26th November 2013 Minutes of Finance Procurement & Contracting Committee - 26th November

2013

Exclusion of Press and Public: that in view of the confidential nature of the business to be transacted, members of the public, press and non voting

members be excluded from the meeting at this point.

Page 1 of 11

Report no: GB 01-14 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP

GOVERNING BODY TUESDAY 14TH JANUARY 2014

Title of Report Feedback from Committees

Lead Governor Dr Jude Mahadanaarachchi Dr Nadim Fazlani Dr Simon Bowers

Senior Management Team Lead

Tony Woods, Head of Strategy & Outcomes Cheryl Mould, Head of Primary Care Quality & Improvement Tom Jackson, Chief Finance Officer Ian Davies, Head of Operations & Corporate Performance Jane Lunt, Head of Quality/Chief Nurse

Report Author(s)

Tony Woods, Head of Strategy & Outcomes Cheryl Mould, Head of Primary Care Quality & Improvement Tom Jackson, Chief Finance Officer Ian Davies, Head of Operations & Corporate Performance Jane Lunt, Head of Quality/Chief Nurse

Summary The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the following committees:

Service Improvement: 5th December 2013 Approvals Panel: 17th December 2013 Primary Care: 31st December 2013 Finance Procurement & Contracting: 7th

January 2014

This will ensure that the Governing Body is fully engaged with the work of committees, and reflects sound governance and decision making arrangements for the CCG.

Recommendation That Liverpool CCG Governing Body: Considers the report and recommendations from

the committee

Page 2 of 11

Impact on improving health outcomes, reducing inequalities and promoting financial sustainability

As per each Committee’s Terms of Reference

Relevant Standards or targets

Standards of Good Governance NHS Operating Framework 2012/13

Page 3 of 11


SERVICE IMPROVEMENT COMMITTEE THURSDAY 5TH DECEMBER 2013 12.45PM TO 2.45PM MEETING ROOM 2 4TH FLOOR – ARTHOUSE SQUARE

A G E N D A

1. Welcome & Introductions ALL 2. Declarations of Interest (form attached) ALL

3. Minutes of Previous meeting & Matters arising: ALL 4. Programme report – Children Presentation

Alison Williams

5. Programme Update Highlight Report Report No: SIC 34-13 Sue Lavell

6. Investment Prioritisation Papers: Report No: SIC 35-13

a) Asthma in Pharmacy Peter Johnstone b) Proposal to develop a sustainable model of delivery

for Care Aims Alison Williams c) Options for Macmillan GPs working with CCG Hannah Hutchinson d) Smoking Behaviours and Disease Development Hannah Hutchinson e) Transforming Choices Peter Johnstone

Tony Woods

7. Investment Process Tracking Report No: SIC 36-13

Sue Lavell

8. Any Other Business ALL 9. Date and Time of Next meeting: Thursday 23rd January 2014 12.45pm –

Boardroom Arthouse Square

Page 4 of 11

LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Service Improvement Committee

Meeting Date: 5th December 2013 Chair: Dr Jude Mahadanaarachchi

Key issues:

Risks Identified: Mitigating Actions:

1. The Committee received a presentation on the key workstreams of the Chilidren’s and Maternity Pprogramme

The Committee noted the scale and breadth of the programme, its understanding of the challenges and the close working with the City Council.

Committee to continue to monitor progress via routine reporting.

2. The Committee reviewed and approved in principle a number of investment proposals relating to

i. Improved Inhaler Technique ii. Delivery of Care Aims. iii. Options for Continuation of

Macmillan GPs Model iv. Insight into Smoking Behaviours v. Alcohol – Transforming Choices.

As the committee was not quorate decision were to be ratified at the next meeting.

Model for Macmillan GPs and Alcohol

Transforming Choices to be referred to Finance, Contracting & Procurement Committee as investment levels exceeded delegated approvals limit for Service Improvement Committee.

Decisions to be ratified at January 2014 meeting.

Recommendations to NHS Liverpool CCG Governing Body: 1. Note the issues discussed and actions taken by the Service Improvement Committee.

Page 5 of 11

Approvals Panel Tuesday, 17 December 2013 – 1.00 – 2.00 pm K Sheerin Office, 2nd Floor, Arthouse Square

1. Minutes of the previous meeting held on 3 December 2013

2. General Practice Winter Proposals for consideration and approval

3. SSP Practice Bids

4. Any other business 5. Date of next meeting: Friday, 10 January 2014 12.00 – 1.00 pm Room 2, 4th Floor, Arthouse

Page 6 of 11

LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Approvals Panel

Meeting Date: 17th December 2013 (Virtual Meeting)

Chair: Maureen Williams

Key issues:


1. Proposals agreed for 1 practice totalling £4,800

14 bids still rejected at this stage – awaiting amended submission

Further contact made with practices and support offered if required.

Recommendations to NHS Liverpool CCG Governing Body: 1. To note the approval to fund 1 bid total £4,800 to support additional capacity during the winter period

Page 7 of 11

NHS LIVERPOOL CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMITTEE

TUESDAY 31ST DECEMBER 2013 AT 1PM – 2.30PM BOARDROOM – ARTHOUSE SQUARE

A G E N D A

1. Welcome & Introductions ALL 2. Declarations of Interest (form attached) ALL

3. Minutes of previous meeting, actions & matters arising:

4. Update from NHS England Verbal – Tom Knight/

Rose Gorman

5. Workstreams Update for December 2013: PCC 49-13

a) Localities PCC 49a-13 North, Central & Matchworks

b) Medicines Management Sub-Committee PCC 49b-13 Peter Johnstone

c) Innovations PCC 49c-13 Ed Gaynor

d) Neighbourhood Working Group PCC 49d-13

Jude Mahadanaarachchi/ Paula Finnerty

6. Role of Neighbourhoods PCC 50-13

ALL

7. Any Other Business ALL 8. Date and time of next meeting

28th January 2014, 1pm to 3pm, Boardroom, Arthouse Square

Page 8 of 11

LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Primary Care Committee

Meeting Date: 31st December 2013 Chair: Dr Nadim Fazlani Vice Chair: Ed Gaynor

Key issues:


1. Innovation Fund.

Applications being presented are for continuation of services not “innovation”.

Current process is delaying

submission of bids.

Unclear on term “innovation”.

Suspend Fund and review definition and process, working with Trustech.

Contacted all Neighbourhood leads to

explain decision to suspend Fund and other organisations who have bids in the system.

2. Role of Neighbourhood.

Member practices unaware of

potential changes to Primary Care delivery & impact.

Not having the structures in place to deliver at scale .

Summary of key documents to be drawn up and shared with members.

Engagement event to be arranged for

February to begin discussions.

Localities to discuss at their leadership team and then for Neighbourhood Leads to add onto Neighbourhood agenda

Recommendations to NHS Liverpool CCG Governing Body: 1. To note the issues and actions agreed.

Page 9 of 11

FINANCE, PROCUREMENT AND CONTRACTING COMMITTEE TUESDAY 7th JANUARY 2014 AT 10:30AM – 12:30PM

ROOM 2 – ARTHOUSE SQUARE

AGENDA

1. Welcome and Introductions All 2. Declaration of Interests (form attached) All

3. Minutes and action notes of previous meeting

held on 26 November 2013 Chair 4. Dates of other sub committees (for information only)

a. Financial Monitoring and Contracting 19 December 2013 b. QIPP Board 3 October 2013

AGENDA ITEMS

9. Month 8 Finance Report Report no:FPCC01-14 Alison Ormrod 10. Specialised Commissioning (Standing Item) Verbal Tom Jackson 11. Investment Prioritisation Process amendments Report no: FPCC02-14 Kim McNaught 12. Investments for Approval Report no: FPCC03-14 a: Local Quality Improvement Schemes Cheryl Mould 13. Risk Register Report no:FPCC04-14 Including “reds and ambers” Alison Ormrod

14. Financial Planning/Contracting update Report no:FPCC05-14 Tom Jackson

Page 10 of 11

15. Waiver Tender Report no:FPCC06-14 Derek Rothwell 16. Any Other Business All

17. Date of the next meeting(s) Tuesday 28 January 2014 10am – 12 noon Room 2

2014 dates of meetings (all Room 2 Arthouse) DATES FOR FINAL PAPERS AND AGENDA ITEMS (7 WORKING DAYS)

DATE PAPERS SENT OUT TO THE COMMITTEE MEMBERS (5 WORKING DAYS)

DATE OF MEETINGS (10am – 12 noon unless otherwise stated)

FRIDAY 27 DECEMBER 2013 TUESDAY 31 DECEMBER 2013

Tuesday 7 January 2014 (extra meeting)

FRIDAY 17 JANUARY 2014 TUESDAY 21 JANUARY 2014

Tuesday 28 January 2014

FRIDAY 14TH MARCH 2014 TUESDAY 28TH MARCH 2014

Tuesday 25 March 2014

FRIDAY 16TH MAY 2014 TUESDAY 20TH MAY 2014 Tuesday 27 May 2014 FRIDAY 18TH JULY 2014 TUESDAY 22 JULY 2014 Tuesday 29 July 2014 FRIDAY 12TH SEPTEMBER 2014

TUESDAY 16TH SEPTEMBER 2014

Tuesday 23 September 2014

FRIDAY 14TH NOVEMBER 2014

TUESDAY 18TH NOVEMBER 2014

Tuesday 25 November 2014

FRIDAY 16TH JANUARY 2015 TUESDAY 20TH JANUARY 2015

Tuesday 27 January 2015

FRIDAY 13TH MARCH 2015 TUESDAY 17TH MARCH 2015

Tuesday 24 March 2015

PLEASE NOTE: PAPERS NOT ON THE AGENDA WILL NOT BE TABLED/DISCUSSED

Page 11 of 11

LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Finance, Procurement & Contracting Committee

Meeting Date: 7 January 2014 Chair: Dr Nadim Fazlani

Key issues:


1. Transfer of current LES to CCG Local Quality Improvement Schemes

Potential conflict of Interest Engage Approvals Panel

2. Approval given to extend ‘Transforming Choices’ pilot.

Impact on patient care/outcomes In year decision made under delegated authority

Recommendations to NHS Liverpool CCG Governing Body: 1.Governing Body asked to note the approval of the transfer of current Local Enhanced Services (LES) to CCG Local Quality Improvement Schemes.

Report no: GB 02-14

NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY

TUESDAY 14TH JANUARY 2014

Title of Report Feedback from the Joint Commissioning

Group of the Health & Wellbeing Board/Liverpool CCG

Lead Governor Dr Nadim Fazlani, Chair


Tony Woods, Head of Strategy and Outcomes

Report Author


Summary The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the Joint Commissioning Group on 16th December 2013. This will ensure that the Governing Body is fully engaged with the work of the Joint Commissioning Group and reflects sound governance and decision making arrangements for the CCG.

Recommendation That Liverpool CCG Governing Body: Considers the reports and

recommendations from Joint Commissioning Group


Reduction of health inequalities in the city

Improve the physical and mental health and well-being of the population of residents in Liverpool


Preventing people from dying prematurely Helping people to recover from episodes of ill-health or following injury Ensuring that people have a positive experience of care

JOINT COMMISSIONING GROUP (INTERIM) OF THE HEALTH AND WELLBEING BOARD

Monday, 16 December 2013

3.00 P.M.

AGENDA

1. Welcome / Apologies

To welcome all attendees to the meeting; and To receive any notices of apologies for absence.

Chair to lead.

LAST MEETING - 18TH NOVEMBER 2013 2. Notes of the Last Meeting

To receive and consider the notes of the last meeting of the Joint Commissioning Group, held on 18th November 2013.

Chair to lead.

(Pages 1 - 6)

3. Matters Arising

To provide an opportunity for members to raise any matters from the notes of the last meeting, that are not covered elsewhere on the agenda.

Chair to lead.

DEVELOPMENT ACTIVITY 4. Partnership Arrangement between LCC and LCCG

(Pages 7 - 11)

5. Integration Transformation Fund Development Proposals

To receive and consider information updating on the Liverpool bid for the Integrated Transformation Fund.

(Pages 12 - 25)

LIVERPOOL HEALTH AND WELLBEING BOARD MEETING - 16TH JANUARY 2014

6. Draft Agenda

The draft agenda of the next meeting of the Liverpool Health and Wellbeing Board (16th January 2014) will be available at the meeting as a separate document.

OTHER RELEVANT ITEMS 7. Time to Change Pledge Launch

To receive information on a launch of the Time to Change Pledge undertaken by the Liverpool Health and Wellbeing Board.

(Pages 26 - 28)

Page 4 of 5

LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE – COMMITTEE MINUTES Committee: Joint Commissioning Group

Meeting Date: 16 December 2013 Chair: Samih Kalakeche Director Adult Services and Health Co-Chair: Katherine Sheerin, Accountable Officer Liverpool Clinical Commissioning Group

Key issues:


1. Development of Joint Commissioning Plans through the use of the Better Care Fund (previously Integration Transformation Fund)

Use of Better Care Fund achieves the national requirements of the fund and supports the transformation agenda for Liverpool health and social care integration

Focus of commissioning intentions aligned to the priorities as set out in the Health and Wellbeing Strategy and Healthy Liverpool Programme.

Session for CCG Governing Body

members to understand the ramifications of the Better Care Fund and ensure the Fund is focused as an enabler for transformation and integration of health and social care delivery to support key programmes

2. Development of Partnership

Agreement between Liverpool Clinical Commissioning Group and Liverpool City Council

Partnership Agreement in place in line with commitment made by the Governing Body and Liverpool City Council.

Partnership Agreement in place to meet

the requirements of the Better Care Fund.

Continued development of the Partnership agreement for completion and finalisation in March 2014

Presentation to Informal Governing

Body in January 2014 and Formal Governing Body in February 2014

Recommendations to NHS Liverpool CCG Governing Body: 1. To note the issues, risks and actions from the Joint Commissioning Group

Page 5 of 5

Page 1 of 13

Report no: GB 03-14


TUESDAY 14th JANUARY 2014

Title of Report Everyone Counts – Planning for Patients 2014/15 –

2018/19

Lead Governor Dr Nadim Fazlani, Chair



Report Author


Summary The purpose of this paper is to inform the Governing Body of the requirements of the planning guidance ‘Everyone Counts – Planning for Patients 2014/15-2018/19 for the CCG to deliver a five year strategic plan, with associated detailed two year operational plans and the proposed local approach for production of the plan.

Recommendation That Liverpool CCG Governing Body: Notes the requirements for planning for the CCG Notes the proposed approach to production of the

plan


The Strategic Planning process will set out the approach to health outcome improvement, reduction in health inequalities and delivering financial stability for the next five years.


Delivery of statutory responsibilities of the CCG

Page 2 of 13

EVERYONE COUNTS – PLANNING FOR PATIENTS 2014/15-2018/19

1. PURPOSE The purpose of this paper is to inform the Governing Body of the requirements of the planning guidance ‘Everyone Counts – Planning for Patients 2014/15-2018/19 for the CCG to deliver a five year strategic plan, with associated detailed two year operational plans and the proposed local approach for production of the plan. 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Notes the requirements for planning for the CCG Notes the proposed approach to production of the plan

3. BACKGROUND Everyone Counts: Planning for Patients 2014/15 to 2018/19 (appendix one) sets out the requirement for NHS Commissioners to develop bold and ambitious five year strategic plans to secure the sustainability of high quality care, aimed at improving outcomes through the delivery of transformational service models. A key change within the planning process is a shift to longer term five year planning, with operational level detail for the first two years, to enable health systems to meet the financial and demographic challenges facing the NHS whilst delivering the transformational changes required to improve outcomes for patients and to address inequalities. CCGs are required to develop and submit a number of individual plans, providing different levels of detail, but aggregate to a coherent aligned plan. These individual plans cover:

Strategic Plan Operational Plan Financial Plan Better Care Fund

Page 3 of 13

In addition NHS England is required to produce a Direct Commissioning Plan that will form a key element of our strategic planning process, including primary care and specialist commissioning plans. 4. STRATEGIC PLAN The CCG is required to produce a strategic plan which sets out what the local health system plans to achieve over the next five years, its vision and key plans. Plans are required to be set out at a Unit of Planning level. This approach enables neighbouring CCGs to associate to form larger units to aggregate plans, ensure strategies align in a holistic way and maximise value for money from planning resources and support. A number of principles apply for CCGs to consider in their decision making on forming a Unit of Planning including:

A CCG can only belong to one unit only; The unit has clear clinical ownership and leadership; It is based on existing health economies that reflect patient flows across

Health and Well Being Board areas and local provider footprints with no CCG to be split across boundaries.

Liverpool CCG has determined that it will operate as a single Unit of Planning, reflecting our strategic fit with the Health and Well Being Board, public health and social care; scale of the CCG to deliver the improvements required and strategic fit with transformational developments within the provider landscape within the city. Our Unit of Planning needs to reflect the whole system of health commissioners and NHS providers within Liverpool, including Liverpool City Council; NHS England Area Team (Direct Commissioning); and NHS Trusts. Our Healthy Liverpool Programme provides this level of planning footprint, stakeholder engagement and governance. The strategic plan needs to include the following elements:

A long term strategic vision An assessment of the current state and current opportunities and

challenges facing the system A clear set of objectives, that include the locally set outcome ambition

metrics

Page 4 of 13

A series of interventions that when implemented move the health system from its current position to achieving the objectives and implementing the vision

The structure of the plan has two core sections:

A system wide description of what the health economy should look like in five years, described on a Plan on a Page, clearly describing the ambition for improvement of key outcomes and the transformational initiatives designed to achieve our ambition,

A narrative describing how we will reach this desired state. The narrative takes the form of a key lines of enquiry submission.

The fundamental elements of what need to be included in the strategic plan, either through the key lines of enquiry narrative or within the templates are described on pages 29-33 of the planning guidance. 5. OPERATIONAL PLAN The Operational Plan is a metrics based submission to support the assurance of, and measure performance against, the strategic plan. The Operational Plan is structured around four headings:

Outcomes; NHS Constitution; Activity; Better Care Fund.

5.1 Outcomes The measure of improvement of the health service at both national and local level is through the five domains of the NHS Outcomes Framework (see table below). The NHS Outcomes Framework has a derivation set of indicators that relate directly to areas where CCGs are viewed to have the ability to directly impact on improvement, recognising that whole system health outcome improvement is affected by determinants that are outside the direct influence and control of clinical commissioners. This is known as the CCG Outcome Indicator Set (OIS), the OIS includes quality indicators that have an evidence base that delivery will directly impact on health outcome e.g., Diabetes 9 Care Processes (see appendix two).

Page 5 of 13

The CCG is expected, in collaboration with the Health and Well Being Board, to understand its position in relation to the OIS, identify priorities for improvement in line with the health needs of the population, aligned with the Joint Strategic Needs Assessment (JSNA) and to set the initiatives aimed at improving the current position. Whilst the prioritisation of outcome indicators is seen as a local decision, reflecting health needs of individual CCG/HWB populations the planning guidance sets out a requirement to ensure progress is made against seven key indicators, which are spread across the five outcome domains. NHS Outcome Framework Domains 7 Outcome Ambitions Domain 1 – Preventing people from dying prematurely

1. Securing additional years of life for people with treatable mental and physical health conditions

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

2. Improving the health related quality of life for people with one or more long term condition, including mental health conditions3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital

Domain 3 – Helping people to recover from episodes of ill health or following injury

4. Increasing the proportion of older people living independently at home following discharge from hospital

Domain 4 – Ensuring that people have a positive experience of care

5. Increasing the number of people having a positive experience of hospital care 6. Increasing the number of people with mental and physical health conditions having a positive experience of care outside of hospital, in general practice and in the community

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

7. Making significant progress towards eliminating avoidable deaths in hospitals caused by problems in care

The CCG is required to set levels of ambition and trajectories for the next five years against each indicator.

Page 6 of 13

The key element of this process is for the CCG to describe clearly the transformational initiatives we will be implementing over the next five years and to quantify the expected impact in relation to outcome improvement. Both public health and analytical support is essential and strong support has been identified to support our clinical leads and management support in this process. To support CCGs in setting levels of ambition a suite of support tools is available providing extensive trend and benchmarking data. Additional modelling tools are expected in January 2014 to support the process, which will include expected impact of proven high impact interventions on local populations. Health outcomes for the Liverpool population are well understood within the CCG and has been a key feature of the prioritisation and establishment of our clinical programme areas and prioritisation within individual programmes to identify and focus on the key outcome drivers. This is evidenced in areas such as Cancer that has a strong understanding of the key tumour groups and health inequalities within the city. Our work on the Healthy Liverpool Programme throughout the year has established a clear understanding and position, with key stakeholders, of the priorities facing the local health economy and transformation initiatives have been identified and are being developed. Our priorities for improvement are consistent with the seven national priority outcome indicators and on the majority of indicators the local health economy can demonstrate major improvement over the past 3 years, through current initiatives such as the GP Specification and prevention programmes. 5.2 NHS Constitution The CCG is required to submit its current baseline and trajectories for meeting the NHS Constitutional requirements. The constitutional measures are described in Annex B of the Planning Guidance and will be a key feature of contracts with NHS providers.

Page 7 of 13

5.3 Activity The CCG is required to set out its current baseline and trajectories for NHS activity levels over the next five years covering:

Elective Non-elective Outpatients A&E Referrals

This activity will be the basis for provider income and as such will be reflected within the CCG Financial Plans and should also align with NHS Provider organisations plans for the next five years. Activity plans should reflect and tie back to transformational initiatives aimed at improving health outcomes, with impact reflected in terms of expected activity levels. 5.4 Better Care Fund Described in Section 7. 6. FINANCIAL PLAN The Financial Plan is again a metrics based submission providing the detailed financial breakdown of each plan and providing the financial metrics to support the assurance of, and measure performance against, the strategic plan. The full details of the content of the financial plan template are included in Appendix J of the planning guidance. The Financial Plan underpins the delivery of transformational initiatives, activity assumptions and impact of outcome improvement plans. The Financial and Operational Plans are a key test of system planning alignment.

Page 8 of 13

7. BETTER CARE FUND The Better Care Fund (BCF) plan requires the CCG to formulate a joint plan, with the local authority, for integrated health and social care and to establish a single pooled BCF budget to facilitate this joint working. Joint plans are required to be approved through the Health and Well Being Board and will need to be agreed between the CCG and City Council. The aim of the BCF is to support a shift in health spend from hospital contracts to more community based services, self-care and prevention programmes. The BCF becomes a requirement from 2015/16 with the financial budget determined in line with CCG allocations. For Liverpool this figure is £39.8m plus two capital grants of £4m. It is however expected that local areas make progress on joint commissioning and pooled budget arrangements in 2014/15. The CCG already has a Section 75 agreement with the local authority. Access to the BCF is not automatic and is subject to meeting a number of conditions, including detailed understanding of the expected benefits and outcome improvements. Access is also performance related with funds withheld centrally if local areas do not deliver on expected outcome improvements. National Conditions Outcome Measures Plans to be jointly agreed between

CCGs and Health and Well Being Boards

Protection for social care services

(not spending) Agreed plans for 7 day services in

health and social care to support patients being discharged and prevent unnecessary admissions at weekends

Better data sharing between health

and social care, based on the NHS number

Ensure a joint approach to

assessments and care planning and

National Metrics: Admissions to residential and care

homes Effectiveness of reablement Delayed transfers of care Avoidable emergency admissions Patient/Service user involvement In addition to delivery of compulsory national metrics local areas are also required to choose a local indicator that reflects their specific plans. The local indicator must be able to establish a baseline in 2014/15 and is expected to be a metric contained within either the: NHS Outcomes Framework; Adult Social Care Outcomes

Page 9 of 13

ensure that, where funding is used for integrated packages of care, there will be an accountable professional

Agreement on the consequential

impact of changes on the acute sector

Framework; or Public Health Outcomes Framework

The engagement of health and social care provider organisations is key as it is expected that funding for the BCF is realised through reallocation of resources currently spent on NHS Trusts reflecting current activity flows. Providers will need to be actively engaged in developing transformation programmes, expected impact on outcome and activity levels and risk assessment of organisational finances and capacity levels. The key aspect of the BCF is to be clear on the vision that the CCG and local authority have for integrated health and social care delivery and how this translates for local priorities. A key focus of our work will reflect the transformational areas identified within the Healthy Liverpool Programme including services for older people, mental health and transition arrangements from child to adulthood. 8. NHS ENGLAND DIRECT COMMISSIONING PLANS NHS England has responsibility for commissioning of services for patients across five areas:

Primary, medical, dental, pharmacy and optical services and secondary care dental services;

Specialist services; Public health section 7A services; Services for members of the Armed Forces and their families; Services for people in the justice system.

NHS England Area Teams need to develop strategic plans for these services and ensure they are aligned with CCG commissioning plans. NHS England Direct Commissioning Plans for Liverpool need to be clearly visible within the overall Liverpool Strategic Plan, which will be co-ordinated by the CCG.

Page 10 of 13

Timescales for the availability of plans will need to be agreed with NHS England Area Team including the arrangements for plans led by other Area Teams including Specialist Commissioning. 9. STAKEHOLDER ENGAGEMENT 9.1 Public/Citizens There is a clear expectation that strategic plans are driven by active participation with local citizens and that local plans demonstrate how citizens will be fully included in all aspects of service design and change, and how patients will be fully empowered in their own care. A series of local public engagement events took place in the Spring 2013 focused on the key health issues affecting our system, testing out our intentions for improvement and the emerging new Healthy Liverpool programme and approach. Outputs from these events informed our programme priorities and improvement initiatives. Programme level engagement initiatives have taken place throughout the year as part of service redesign including mental health and diabetes and a significant amount of ‘Insight’ has been undertaken to ensure service design is focused on a deeper understanding of our population, tailoring approaches to reflect population segmentation including lifestyle choices and drivers. Evidence from National Voices has informed our approach to integrated care delivery. A further series of three public engagement events are planned for the end of January 2014 to be delivered jointly with the local authority as part of engagement on the Health and Well Being Strategy. 9.2 Member Practices As a members based organisation the active engagement and agreement on plans is a key element of our Constitution. A number of member practice engagement events were held in the Summer 2013, sharing plans for Healthy Liverpool and identifying priority areas. In addition to routine communication via localities, neighbourhoods and email a member practice engagement event is planned for February 2014. Details on the approach are being developed via Locality Chairs.

Page 11 of 13

9.3 Health and Well Being Board and Local Authority Engagement In addition to responsibility for approving the plans for use of the Better Care Fund (described in Section 7) the Health and Well Being Board has a key function in reviewing the CCG plans and ensuring that appropriate cohesion of plans between local authority health, social care and public health commissioning through the Health and Well Being Strategy. There is strong engagement with the Health and Well Being Board on the Healthy Liverpool Programme, with strong support for the programme plans and active engagement from the local authority in the design and delivery of plans. In addition joint arrangements for strategy development and governance are in place and in development including Childrens Trust Board and Health Improvement. 9.4 NHS Providers NHS Providers has played an active role in the development of the Healthy Liverpool Programme and governance arrangements are in place to ensure on-going participation through the Healthy Liverpool Programme Advisory Board. NHS Trust clinicians play an active role in the development of transformational initiatives e.g., Older People with Frailty, Diabetes. An active programme of engagement is in place in line with contract planning and performance arrangements. An engagement event focused on the requirements of the planning guidance and the Better Care Fund is scheduled for the 16th January 2014 that will also include the local authority and NHS England Direct Commissioning. 9.5 Mersey CCGs Although it has been agreed that our Unit of Planning for development of the strategic plan will be on a Liverpool footprint it is essential, given the flow of patients across our borders that there is active collaboration on plans. In addition to on-going collaboration via the CCG Network and Collaborative Commissioning arrangements a joint planning event is planned for January 8th 2014.

Page 12 of 13

9.6 NHS England Area Teams (Direct Commissioning) As described in Section 8, NHS England are expected to produce plans for their direct commissioning responsible areas and ensure that their plans are clear at CCG Unit of Planning level and form part of the overall strategic plan. The CCG will be actively engaging with NHSE, with planned sessions in January on Specialist Commissioning. 10. ASSURANCE OF PLANS Plan assurance will address the scale of ambition and plans for implementation of the planning fundamentals, over the two and five year timescales. For the five year strategic plan assurance will be undertaken by NHS England Regional Team, whilst the two year operational plan and financial plan will be undertaken by NHS England Area Team. There is a clear emphasis on the alignment and reconciliation of provider plans with Monitor and the NHS Trust Development Authority working closely with NHS England. Local assurance of Better Care Fund Plans is via Health and Well Being Boards and NHS England Area Teams with intervention from Ministers and the Local Governance Association if local areas are unable to agree plans. Full details of the assurance process is detailed on pages 38-39 of the planning guidance. 11. TIMESCALES FOR SUBMISSION A first draft submission of the Operational (Financial and Operational) and Better Care Fund Plans is required to be submitted to NHS England Area Team by 14th February 2014. The submission of the final two year Operational Plans and draft five year strategic plan to be approved by Boards by 31st March and submitted by 4th April 2014. The submission of the final five year strategic plan by 20th June 2014.

Page 13 of 13

Details of key submission and planning development dates are included on the gant chart in appendix three. Tony Woods Head of Strategy and Outcomes 8th January 2014 ENDS

England

BETTER OUTCOMES

FOR PATIENTS

NHS SERVICES

7 DAYS AWEEK

TRANSPARENCY AND

FINANCIALCONTROL

PUTTING PATIENTS

AND

TRANSFORMATIVE

IDEASCONTROL

CITIZENS IN

PARTICIPATION

EVERYONE COUNTS:PLANNING FOR PATIENTS 2014/15 TO 2018/19

jonesp1

Typewritten Text

GB 03-14 Appendix 1

ii 1!

NHS England INFORMATION READER BOX

DirectorateMedical Operations Patients and InformationNursing Policy Commissioning DevelopmentFinance Human Resources

Publications Gateway Reference: 01000

Document Purpose

Document Name

Author

Publication DateTarget Audience

Additional Circulation List

Description

Cross Reference

Action Required

Timing / Deadlines(if applicable)

Everyone Counts: Planning for Patients 2014/15 - 2018/19

Superseded Docs(if applicable)

Contact Details for further information

Document Status

0

This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet

Guidance

Leeds LS2 7UE0

Dame Barbara Hakin/Paul Baumann

Chief Operating Officer/Chief Finance Officer

NHS England

Quarry House

This guidance sets out the need for bold and ambitious five year strategic plans from NHS commissioners. It describes an approach to deliver transformational change with the first critical steps over the next two years, to achieve the continued ambition to secure sustainable high quality care for all, now and for future generations.

n/a

NHS England

20 December 2013

CCG Clinical Leaders, CCG Accountable Officers, Care Trusts CEs, NHS Trust CEs, Foundation Trusts CEs, Local Authority CEs, NHS England Regional Directors, NHS England Area Directors, NHS Trust Board Chairs, Directors of Finance, Communications Leads, Directors of Operations and Delivery

Voluntary organisations

n/a

n/a

n/a

ii

England

1

CONTENTS

FOREWORD 3

Part 1: Our ambition 6High quality care for all, now and for future generations 6Delivering Transformational Change 9

• Citizen participation and empowerment 10• Wider primary care, provided at scale 13• A modern model of integrated care 14• Access to the highest quality urgent and emergency care 16• A step-change in the productivity of elective care 17• Specialised services concentrated in centres of excellence 17• Implementation choices determined locally 17

Maintaining the focus on essentials 18• Quality 18• Access to services – Convenient for Everyone 22• Driving Change through Innovation 23• Value for money, effectiveness and efficiency 23

Leading the Way through Commissioning 24

Part 2: How we are going to achieve these ambitions 26The Strategic and Operational Planning Process 26

A new approach to planning 26Planning fundamentals 28Improving outcomes 28Joint working and involvement 28Aligned planning across health economies 34Balancing plans 35Planning timetable 36

322

EnglandPlan submission 36Assurance of Plans 37On-going assurance 40Overview of Planning Support 40Universal support package 41Tailored local support to meet local challenges 42Any town health system 43

1. Strategic, Operational and Financial Planning 44Strategic Plan Overview 44Operational Plan Overview 44Financial Plan Overview 44Financial allocations and the efficiency challenge 45Programme and administrative costs 46Financial Planning assumptions 47Strategic Enablers 48

• The NHS standard contract 48• Pricing and incentives 49• The Quality Premium: rewarding commissioners 49• Commissioning for Quality and Innovation (CQUIN) 49• Non recurrent funds 50

2. NHS England Direct Commissioning 51Direct Commissioning Overview 51Content of Plans 51Financial Planning assumptions 52

3. Better Care Fund Planning 53Better Care Fund Overview 53Funding for integrated care 53

Glossary 55

Annexes 57Annex A: Outcomes measures 57Annex B: NHS Constitution measures 60Annex C: Activity measures 62Annex D: Primary care measures 63Annex E: Specialised services measures 64Annex F: Public health section 7A services measures 65Annex G: Health and Justice measures 67Annex H: Direct Commissioning Supporting Information 68Annex I: Better Care Fund measures and information 73Annex J: Template contents 87

England

322

FOREWORD

Sir David Nicholson KCB, CBE Chief Executive

NHS England is a new organisation. We were established in 2011 but only took on our full powers in April 2013. Put simply, our role is to invest the £96 billion we receive from the government each year to deliver great outcomes for our patients.

We have been established as an independent organisation, at arms-length from government. Each year the government gives us a mandate1 setting out its ambitions for the NHS. This details the outcomes that the government wants us to achieve for patients, but gives us the flexibility to determine how to deliver the mandate through our own direct commissioning and through Clinical Commissioning Groups. Delivering the mandate is central to our work but we also are determined to go further.

Our vision and purpose flow from the single idea that we exist to ensure high quality care for all, now and for future generations. We want everyone to have greater control over their health and wellbeing, supported to live longer, healthier lives by high quality health and care services that are compassionate, inclusive and constantly improving.

Our work is underpinned by the following values:●● We prioritise patients in every decision we take.●● We listen and learn.●● We are evidence-based.●● We are open and transparent.●● We are inclusive.●● We strive for improvement.

Significant advances have already been made as a consequence of last year’s planning guidance. Now for the next phase.

1 https://www.gov.uk/government/publications/nhs-mandate-2014-to-2015

https://www.gov.uk/government/publications/nhs-mandate-2014-to-2015

4

EnglandThis planning guidance sets out how we propose that the NHS budget is invested so as to drive continuous improvement and to make high quality care for all, now and for future generations into a reality:

High quality care. We will be driven by quality in all we do. No longer can we accept minimum standards as good enough – our patients rightly expect the best possible service.

High quality care for all. We need to ensure that access to all services is on an equal footing whether the patient’s need is for mental or physical help and support. We must put the greatest effort in providing care for the most vulnerable and excluded in society.

High quality care for all, now. But high quality is not just an aspiration. The NHS provides high quality care, often to the highest standards of anywhere in the world, but we need to spread excellence more widely. We have to learn from the best and get better at sharing good practice rapidly across the NHS.

High quality care for all, now and for future generations. We are investing not just for today but for the future. We have a responsibility to ensure that the NHS is on as strong a footing as possible, capable of remaining focused on quality through the significant economic challenges ahead. There is great urgency to plan strategically to start making the changes that are required to deliver models of care that will be sustainable in the longer term.

That is why this planning guidance is bold in asking commissioners to work with providers and partners in local government to develop strong, robust and ambitious five year plans to secure the continuity of sustainable high quality care for all, now and for future generations.

Sir David Nicholson Chief Executive

54

Eng

land

Vision: High quality care for all, now and for future generations

Outcome ambitions 5 Domains - 7 outcome measures

+ Improving health Reducing health inequalities

Parity of esteem

Access Quality Innovation Value

Commissioning for transformation (with clinical leadership)

•  Francis/Berwick/ Winterbourne View

•  Patient safety •  Patient experience •  Compassion in practice •  Staff satisfaction •  Seven day services •  Safeguarding

•  Value for money •  Effectiveness •  Efficiency •  Procurement

•  Convenient for everyone •  NHS Constitution

•  Research and innovation

Delivering transformational service models

•  New approach to ensuring that citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care

•  Wider primary care, provided at scale •  A modern model of integrated care •  Access to the highest quality urgent and emergency care •  A step-change in the productivity of elective care •  Specialised services concentrated in centres of excellence.

66

England

PART 1: OUR AMBITION

HIGH QUALITY CARE FOR ALL, NOW AND

FOR FUTURE GENERATIONS

1. People consistently tell us that what they want from the NHS and the wider care system is great outcomes. This requires a relentless focus on the provision of high quality care – care that is safe, clinically effective and provides as good an experience for the patient as possible. They also tell us that they want services to be available when they need them, offered in a way which is convenient for them and that their needs must be met. They want to be helped to stay well and get the best treatment when they are ill. That is why NHS England wants the delivery of high quality care and the achievement of excellent outcomes for patients to be the central focus of our work.

2. Put simply, the outcome of care or a treatment is the impact it has on a patient – on their symptoms and on their ability to live the life they want to live. An outcomes-based approach means focusing less on what is

done for patients, and more on the results of what is done. It means focusing on how well patients feel after treatment and helping them to stay well, whether suffering from physical or mental ill-health.

3. Our aspiration is to develop an NHS that delivers great outcomes, now and for future generations. That means reflecting the government’s objectives for the NHS set out in their mandate to us, adding our own stretching ambitions for improving health and delivering better services and supporting local leaders to go even further to tailor care to their citizens’ needs.

4. This document builds on the great work done last year in response to Everyone Counts: Planning for Patients 2013/14 2. Part 1 focuses on the outcomes we want for patients and describes our bold ambitions to deliver them. It describes the emerging findings from our strategy, which lead us to six new models of care which together will deliver the transformational change needed if the NHS is to deliver improving outcomes

2 http://www.england.nhs.uk/wp-content/uploads/2012/12/everyonecounts-planning.pdf

http://www.england.nhs.uk/wp-content/uploads/2012/12/everyonecounts-planning.pdf

76

England

6

at a time of increasing need, unprecedented new treatment options and economic restraint. In our role as leaders of the commissioning system we emphasise where our focus will lie – delivering the government’s mandate to us and going beyond that to secure even better care. It concludes by reaffirming our commitment to a clinically led commissioning system with CCGs as local leaders. NHS England is also a local commissioner and throughout we recognise our dual role – a local commissioning partner as well as the coordinator and leader of a commissioning system on which better health and better care depend.

5. Part 2 of this document outlines the planning process and details of the plan which needs to be produced. The first chapter provides an overview of the fundamental planning considerations for all plans, outlines the strategic enablers, describes how plans will be submitted and assured and provides an overview of the support available for the process. Subsequent chapters describe in more detail the content of plans and the core financial allocations and assumptions which must underpin them.

6. Last year we made five offers:●● NHS services, seven days a week●● More transparency, more choice●● Listening to patients and increasing their

participation●● Better data, informed commissioning,

driving improved outcomes●● Higher standards, safer care

7. These offers represented what we then saw as the key enablers of change. They were identified early in NHS England’s life when we had not begun the work on our emerging strategy. We consider that these early choices have stood the test of time; they remain central to the next stage of development and can now be accommodated in the broader context of our strategic thinking. High standards of quality are still at the heart of everything we do, and 7 day services, a key driver of quality, now are moving from aspiration to reality. This year’s guidance describes the further progress we want to see on these as well as describing in the next level of detail how transparency and more widely available information empower citizens and patients and help them make the best choices for their services and their care.

8. Much of the basis for the government’s mandate to us is the NHS Outcomes Framework which describes the five main categories of better outcomes we want to see:

●● We want to prevent people from dying prematurely, with an increase in life expectancy for all sections of society.

●● We want to make sure that those people with long-term conditions, including those with mental illnesses, get the best possible quality of life.

●● We want to ensure patients are able to recover quickly and successfully from episodes of ill-health or following an injury.

●● We want to ensure patients have a great experience of all their care.

8

England●● We want to ensure that patients in our

care are kept safe and protected from all avoidable harm.

9. Our ambitions will always be focused on delivering the outcomes in these five domains.

10. However, it is vital that we translate these outcomes into specific measurable ambitions which we believe are critical indicators of success and against which we can track our progress. Working with clinicians and staff in NHS England, in CCGs and with key stakeholders we have defined seven specific ambitions:

●● Securing additional years of life for the people of England with treatable mental and physical health conditions.

●● Improving the health related quality of life of the 15 million+ people with one or more long-term condition, including mental health conditions.

●● Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital.

●● Increasing the proportion of older people living independently at home following discharge from hospital.

●● Increasing the number of people with mental and physical health conditions having a positive experience of hospital care.

●● Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community.

●● Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in care.

11. Additionally, there are three more key measures that are vitally important and on which we expect to see significant focus and rapid improvements.

12. The first is improving health, which must have just as much focus as treating illness. At national level we will work closely with Public Health England to create the best environment for all localities. At a local level all stakeholders will address these issues through Health and Wellbeing Boards. We need to ensure that the key elements of Commissioning for Prevention are delivered and that every contact really does count in taking the opportunity to promote a healthy environment and healthy lifestyles. Everyone must make sure they work with all partners so that all those things which affect the broader determinants of health are addressed.

13. And as we strive to improve outcomes, we must place special emphasis on reducing health inequalities. We need to ensure that the most vulnerable in our society get better care and better services, often through integration, in order to bring an acceleration in improvement in their health outcomes.

14. We are absolutely committed to moving towards parity of esteem, making sure that we are just as focused on improving mental as physical health and that patients with mental health problems don’t suffer inequalities, either because of the mental health problem itself or because they then

98

Englanddon’t get the best care for their physical health problems.

15. This is our ambition for the NHS and the wider care system – not only delivering the key elements in the government’s mandate but also going beyond those ambitions in our national thinking and unleashing the power of local systems to deliver the ambitions of their population. This will not be a task for the NHS alone. CCGs, as the local leaders of the NHS supported by Commissioning Support Units, NHS England, and all NHS providers, will need to work closely with all the key partners on the Health and Wellbeing Boards. It will be vital that NHS commissioners work closely with Local Authorities, who have such an important part to play in securing the broader determinants of health as well as delivering high quality social care services, and Healthwatch who will ensure the patient perspective is paramount.

16. Working together we can make the biggest difference, ensuring great outcomes for everyone delivered through convenient services, under strong financial discipline, with enthusiastic and committed staff, adopting the 6Cs in Compassion in Practice 3, truly empowering patients and citizens and making everyone’s lives better, both now and for future generations.

DELIVERING TRANSFORMATIONAL CHANGE

17. Fulfilling our long-term ambitions will require a change in the way health services are

delivered. People are living longer, and our ability to treat and help to manage conditions that were previously life-threatening is improving all the time. With this has come a change in what can be delivered safely, effectively and efficiently in different settings. For example, patients can be cared for in their own homes, supported by experienced clinicians and technology which enables them to monitor their condition and get expert help to manage it. The result is that patients who would previously have needed hospital treatment can now stay at home.

18. That is why in July 2013, NHS England along with our national partners launched A Call to Action 4 which set out the challenges and opportunities faced by the health and care systems across the country over the next five to ten years. Put starkly, we need to find ways to raise the quality of care for all in our communities to the best international standards while closing a potential funding gap of around £30 billion by 2020/21. This was a call for creativity, innovation and transformation. It will require a significant shift in activity and resource from the hospital sector to the community. The funding and implementation of the Better Care Fund has the potential to improve sustainability and raise quality, including by reducing emergency admissions; hospital emergency activity will have to reduce by around 15 per cent. CCGs will need to make significant progress towards this during 2014/15.

3 http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf4 http://www.england.nhs.uk/wp-content/uploads/2013/07/nhs_belongs.pdf

http://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/07/nhs_belongs.pdf

10

England19. The response to this Call to Action has been

impressive. Over 250 local events involving clinicians, patients and public have been held to debate the future shape of services. Nationally, we have opened up discussion on the future of those services NHS England commissions with Calls to Action on general practice, community pharmacy and specialised services. And we have brought together patients, public and clinical and managerial experts in a series of events to share the best analysis and thinking on prevention, mental health and parity of esteem, and future landscape for providers, learning from the best in class in the world. In parallel, the development of integration pioneers and the ministerial focus on vulnerable older people have been strong influences on the Call to Action.

20. There is a good degree of consistency in the themes emerging. The strongest message is that citizens must be at the centre of all our planning; their interests and aspirations must be the organising principles for the future of health and care.

21. Taking this principle as our starting point, we know that different, identifiable groups within our population have different needs, and that the way services organise themselves to respond has a direct impact on outcomes and best use of resources. For many years, local health systems in this country and overseas have tested and developed new approaches for some groups covering some services. NHS England believes it is now time to draw out the lessons and propose a direction of service development, based on meeting the needs of whole populations, to be applied consistently across the country.

22. That means identifying the models of care that will apply in five years’ time and determining the steps needed to realise that vision. NHS England has identified that any high quality, sustainable health and care system in England will have the following six characteristics in five years:

●● A completely new approach to ensuring that citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care.

●● Wider primary care, provided at scale.●● A modern model of integrated care.●● Access to the highest quality urgent and

emergency care.●● A step-change in the productivity of

elective care.●● Specialised services concentrated in

centres of excellence.

Citizen participation and empowerment

23. We know that citizens want to be fully engaged in making positive choices about their own health and lifestyles; participating in the shaping and development of health and care services; well served by access to transparent and accessible data and advice about health and services; and able to choose which health services they can use and how to access them. We know that the public want a much greater say in how health services are organised, and we know that patients and their carers want much more say in how their personal care is delivered. We also know that patients and the public want much more and better information about how they can stay well or help to manage their own illness and to have

1110

Englandinformation that is of high quality and readily accessible about different services and different treatments so that they can make informed choices about what will be the best for them. Empowered in this way, citizens and patients become co-providers of and active participants in health care.

i) Listening to patients’ views

24. We need to make sure that public, patient and carer voices are at the centre of our healthcare services from planning to delivery. We also want commissioners to be informed by insightful methods of listening to those who use and care about services. The extension of the Friends and Family Test to maternity services in October 2013, to community and mental health services by December 2014, to GP Practices from the end of December 2014 and to the rest of NHS services by the end of March 2015, will enhance the information that patients can use to make choices, such as for their maternity care. The Friends and Family Test provides real time feedback on the quality of services and gives front line staff a powerful incentive to make practical and timely improvements to the services they provide. There are two duties for NHS commissioners to support better patient and public participation. The first requires commissioners to ensure patients and carers are able to participate in planning, managing and making decisions about their care and treatment through the services they commission. The second requires the effective participation of the public in the commissioning process itself, so that

services reflect the needs of local people. We have set out our approach to supporting CCGs with these important duties in Transforming Participation in Health and Care 5. The stronger role for user voice within services will also be strengthened through the roll-out of Personal Health Budgets from April 2014. CCGs will be able to offer Personal Health Budgets, including as a Direct Payment, to all patients who may benefit, and NHS Continuing Healthcare patients will have a right to have a Personal Health Budget from October 2014. In addition, we will expand existing programmes of patient reported outcome measurement to give patients and carers the greatest ability to manage and share data on their own care.

ii) Delivering better care through the digital revolution

25. Changes in technology and the way we communicate have made vast differences to everyone’s lives. We need to ensure that the NHS harnesses the use of this to deliver better care and to make it more convenient for patients. For example, we expect all people with a long-term condition to have a personalised care plan which is accessible, available electronically and linked to their GP health record, and that conforms to the best-practice standards that we will be developing. That will mean they receive safer care and don’t need to repeat their details at every new contact. Greater access to web tools like NHS Choices and the creation of a digital ‘front door’ will help transform the way patients, their families and

5 http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/09/trans-part-hc-guid1.pdf

12

Englandcarers access information about NHS services and will provide self-management materials and information to further empower them to manage their own condition. Greater use of telehealth and telecare will also be important in supporting people with long-term conditions to manage their own health and care. We are committed to ensuring that nobody is left behind as we give patients and citizens greater control. For this reason, we have launched a major health literacy programme with the Tinder Foundation, which will help 100,000 people each year learn how to use the Internet for health benefit, and Care Connect, an initiative to test how telephone and social media channels can improve public participation.

iii) Transparency and Sharing Data

26. For too long the NHS has been unable to share the information patients need to understand their condition and make choices about the best treatment for them; including where and how they receive it. We are determined to make apparent the different clinical outcomes that different treatments, organisations and individual specialists achieve. Consultant level activity and clinical outcomes data for ten surgical specialties have now been published. This gives patients and citizens, as well as their commissioners and clinicians, enhanced access to data and information. We plan to extend this so that data from all appropriate NHS funded national clinical audits is made available before 2020. This will continue to provide vital insight for both patients and healthcare professionals about the care

that is provided and lead to improvements in quality.

27. We also know that effectively collecting, sharing and interpreting data is fundamental to the transformation we need to deliver. The steps we have already taken include the promotion of a single set of data and data transmission standards to facilitate a nationwide exchange of health information. Called care.data this will safely join up existing clinical data sets, held securely within the Health and Social Care Information Centre, and extend and expand them so that they provide the data that commissioners need to support the delivery of high quality care and improved outcomes. Offering the opportunity for patients to access their own health information also forms part of this ground breaking work. These opportunities need to be factored into commissioner plans. By the summer of 2014 we anticipate that data in at least 5 per cent of GP practices will be linked to hospital data. By the end of March 2015 this will have increased to 90 per cent. We expect strategic plans to set out when 100 per cent coverage will be completed.

28. Everyone Counts: Planning for Patients 2013/14 set out the expectation of universal adoption of the NHS number as the primary identifier by all providers. However, a significant number of providers are still not compliant. Such behaviour can have a detrimental impact on patient outcomes, as it hinders the effective flow of information between primary and secondary care. Working with EHI Intelligence we have developed the Clinical Digital Maturity Index (CDMI) which will allow us to identify the

1312

Englandscale of digitisation in each provider, including use of the NHS number. As a first step, we shall work with CCGs to secure immediate improvement from those providers who are in the bottom quartile of digitisation. Following that, our intention is to consider the possibility of introducing a range of increasingly stringent sanctions on poorly performing providers, from contractual fines through to the withdrawal of contracts.

29. The 2014/15 GMS contract will help empower patients by enabling practices to register patients from outside traditional catchment areas, thereby creating greater patient choice. It introduces a new requirement for practices to promote and offer to all patients the ability to book appointments, order repeat prescriptions and access their medical notes online. NHS England will develop metrics to identify the number of practices with access to online services.

30. The 2014/15 GMS contract introduces a new requirement for GP practices to upload information about medicines, allergies and adverse reactions onto the Summary Care Record. Commissioners should encourage out-of-hours, NHS111 and A&E providers to access this information to improve quality and outcomes. The contract also requires that practices use the NHS number as the primary identifier for all clinical correspondence from April 2014 and use electronic systems to transfer patient records between practices.

Wider primary care, provided at scale

31. For those patients with a moderate mental or physical long-term condition (about 20 per cent of the population) we need to secure access to all the support and care they need from wider primary care, provided at scale. This will mean access to a broader range of services in primary care, in their own homes and in their communities, centred on a much more pivotal and expanded role for general practice to co-ordinate and deliver comprehensive care in collaboration with community services and expert clinicians.

i) Transforming primary care services

32. Our strategic framework for commissioning of general practice services, to be published in 2014, will set out the action we are taking at national level to support commissioners in developing joint strategies for primary care as part of their five year strategic plans. One of our key aims is to enable general practice, community pharmacy and other primary care services to play a much stronger role, at the heart of a more integrated system of community-based services, in improving health outcomes. It is clear from the Call to Action that there is a widespread appetite for developing new models of primary care that provide more proactive, holistic and responsive services for local communities, particularly for frail older people and those with complex health needs; play a stronger role in preventing ill-health; involve patients and carers more fully in managing their health; and ensure consistently high quality of care. NHS England and CCGs have a joint responsibility to drive up all aspects of quality in primary care services.

14

England33. There is a growing consensus that this will

mean enabling general practice to work at greater scale and in closer collaboration with other health and care organisations, whilst retaining personal continuity of care and strong links with local communities. NHS England will create the strategic framework for this approach and work with CCGs to stimulate new models of care and in developing innovative forms of commissioning and contracting to support these new models.

A modern model of integrated care

34. For the 5 per cent of patients with multiple, often complex, mental or physical long-term conditions, often compounded by being elderly and perhaps frail, we need a modern model of integrated care with a senior clinician taking responsibility (through a personal relationship) for active co-ordination of the full range of support from lifestyle help to acute care.

i) Ensuring tailored care for vulnerable and older people

35. The government has determined that there will be a specific focus during 2014/15 on those patients aged 75 and over and those with complex needs. The new GP contract secures specific arrangements for all patients aged 75 and over to have an accountable GP and for those who need it to have a comprehensive and co-ordinated package of care. Our expectation is that similar arrangements will apply to increasing numbers of people with long-term conditions in future years.

36. CCGs will be expected to support practices in transforming the care of patients aged 75 or older and reducing avoidable admissions by providing funding for practice plans to do so. They will be expected to provide additional funding to commission additional services which practices, individually or collectively, have identified will further support the accountable GP in improving quality of care for older people. This funding should be at around £5 per head of population for each practice, which broadly equates to £50 for patients aged 75 and over. Practice plans should be complementary to initiatives through the Better Care Fund.

37. In some instances, practices may propose that this new funding be used to commission new general practice services that go beyond what is required in the GP contract and the new enhanced service. We will make arrangements for NHS England to be involved under these circumstances in order to help identify the contractual arrangements and help provide appropriate oversight and governance. In other instances, practices may propose that this money be invested in other community services to secure integration with primary care provision. Practices should have the confidence that, where these initial investment plans successfully reduce emergency admissions, it will be possible to maintain and potentially increase this investment on a recurrent basis.

38. In addition, CCGs will need to demonstrate how individual practices can have as much influence as they need over the commissioning of associated community

1514

Englandservices, community nursing, especially district nursing, and end of life care, so that their accountable GPs can discharge their responsibilities and so as to ensure that these services are co-ordinated with the services provided by the practice itself and provide integrated care for patients.

39. The 2014/15 General Medical Services (GMS) contract will support more proactive, integrated and personalised care, through:

●● ensuring that all people aged 75 and over have a named, accountable GP who is responsible for overseeing their care;

●● introducing more systematic arrangements for risk profiling and proactive care management, under the supervision of a named GP, for patients with the most complex health and care needs; and

●● giving GP practices more specific responsibilities for helping monitor the quality of out-of-hours services for their patients and supporting more integrated working with out-of-hours services.

ii) Care integrated around the patient

40. Delivering care in a way which is integrated around the individual patient is essential to a new way of working which truly puts the patient at the heart of what we do. Our early focus will be the integration of care around the most frail, often elderly patients but it will be important for all those who receive complex care. This may mean integration across health and social care and across different elements of NHS care. It may mean integrating specific services or integrated

provider organisations. It may mean integrated commissioning between CCGs and NHS England and Local Authorities. But what matters is that patients experience holistic care which is joined up and is a single tailored package for them. Each integrated care model will look different depending on the community served but is likely to include the following features:

●● senior clinicians (within a team) taking full responsibility for people with multiple long-term conditions;

●● full responsibility lasting from presentation to episodic care, including personalised care planning for those who would benefit; and

●● co-ordination of care including lifestyle support and advice, social care, general practice care and hospital episode co-management.

41. With CCGs assuming responsibility for Special Educational Needs commissioning from September 2014, they will need to work closely with Local Authorities and schools to meet the wider pledge for better health outcomes for children and young people.

42. We have also begun to shift our focus from treating the consequences of poor care to the causes of preventing poor care. The £3.8 billion Better Care Fund that comes into operation in 2015/16 is aimed at supporting the integration of health and social care. The fund is an opportunity for local services to transform and improve the lives of the people that need it most. The fund will be available in 2015 but the planning has already started across the country. We expect commissioners to include in their

16

Englandplans their vision for how health and social care services work together to provide better support at home and earlier treatment in the community to prevent people needing emergency care in hospital or care homes. All CCGs must include in their plans the actions they will take in 2014/15 to create the funding required to make the Better Care Fund affordable when it is introduced in 2015/16 in order to fulfil their duty to commission sustainable services for patients.

Access to the highest quality urgent and emergency care

43. All citizens deserve access to the highest quality urgent and emergency care. The report on the first phase Urgent and Emergency Care review 6 sets out an exciting vision for how we deliver NHS services in a way that complements modern day lifestyles and preferences. It suggests that the quality of urgent and emergency care would be enhanced if patients were treated as close to home as possible and if networks were established, with major specialised services offered in between 40 and 70 major emergency centres, supported by other emergency centres and urgent care facilities.

44. The review will take some time to implement. Meanwhile, there are immediate issues around planning for seasonal variation, emergency situations and times of varying demand.

45. NHS 111 services will be a key component of the urgent care service. NHS 111 services will be rolled out to cover the whole of England. In addition, NHS England and CCGs will produce a new service specification for 111 to support the future commissioning of a comprehensive and high quality service.

46. We expect local resilience planning, led through Urgent Care Working Groups (UCWGs), to be a continuous process, with preparations simply continuing on from this winter to lead us into next winter. UCWGs should refresh their membership and ensure that all relevant stakeholders are involved at an appropriately senior level when the full group convenes. We recognise that a smaller core group will be needed to support day to day activities. It is essential that GP practices and out-of-hours providers, as well as all those who deliver other community and mental health services, are fully involved. UCWGs must also engage effectively with local independent and voluntary sector providers, and we are developing a framework to support UCWGs in doing this. UCWGs should agree an appropriate mechanism for providers such as ambulance trusts, who will relate to many UCWGs, to engage with them all effectively, e.g. through lead commissioning arrangements. It is similarly equally important that all local CCGs whose patients use the acute trust at the centre of urgent care plans have a mechanism for full engagement through the lead CCG.

6 http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf

http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf

1716

England47. We expect UCWGs will build on their plans

for 2013/14 in the spring and will have a fully refreshed set of plans before summer 2014. NHS England, working with NHS Trust Development Authority (TDA), Monitor and partners in local government, will assess the effectiveness of each UCWG and, for those where there are concerns, will oversee the necessary changes required to ensure that these groups are well led and can play a comprehensive and effective role in the management of urgent care in 2014/15 especially during the winter. In particular, we expect UCWGs to be the vehicle for reaching agreement on the investment plans to be funded by the retained 70 per cent from the application of the marginal rate rule. Prior to any contracts being in place there must be absolute transparency about the use of this money to reduce pressures on A&E departments over the winter, and the acute trust must be satisfied that the plans for the use of that money addresses their needs.

A step-change in the productivity of elective care

48. For people who need episodic, elective care, access to services must be designed and managed from start to finish to remove error, maximise quality, and achieve a major step – change in productivity. We expect to see centres that can deliver high quality treatment, treating adequate numbers to be expert, and with the most modern equipment available. If we are going to transform out of hospital care and look to concentrate specialised services in fewer sites then we need to review how we deliver routine planned admissions for patients for less complex treatments. International

comparisons suggest that, as well as quality improvements, there are significant productivity gains to be made if we can change our model of delivering elective care – giving us the opportunity to treat even more patients at the same or lower cost.

Specialised services concentrated in centres of excellence

49. For those who need them, specialised services for less common disorders need to be concentrated in centres of excellence where we know that the highest quality can be delivered. Maximising quality, effectiveness and efficiency means working at volume and connecting actively to research and teaching. Specialised services are currently being delivered out of too many sites, with too much variety in quality and at too high a cost in some places. Through NHS England’s direct commissioning we shall be looking to reduce significantly the number of centres providing NHS specialised services, require standards of care to be applied consistently across England and maximise synergy from research and learning. Our strategy for specialised services is still in the early stages of development, but we can foresee a concentration of expertise in some 15 to 30 centres for most aspects of specialised care. Academic Health Science Networks will play an important role as the focus for many of these.

Implementation choices determined locally

50. These characteristics of a high-performing health system will not need to be delivered in the same way everywhere. Local communities need to come together to

18

Englanddetermine the best way to deliver services for patients. For example, integrated care models for the 5 per cent of our population with greatest need could be developed out of existing NHS Trusts or NHS Foundation Trusts, out of extended primary care built on general practice, or through new offers. The outcome is what matters rather than the process or organisational form. NHS England wants local partners to determine the delivery vehicle which best suits local geographies and capabilities.

MAINTAINING THE FOCUS ON ESSENTIALS

51. There are a number of essential elements that will apply to all of the characteristics of every successful and sustainable health economy:

●● quality;●● access;●● innovation; and●● value for money.

52. We expect to see how a specific focus will be maintained on each of these in local plans in a way which clearly demonstrates how they will be implemented to drive up outcomes for patients and local communities.

Quality

53. In everything we do, quality – covering effectiveness, experience and safety – must be the central theme. All NHS commissioners must put quality at the centre of all their discussions with providers. Where

feasible, NHS England will work with the Care Quality Commission (CQC) to agree the quality standards that apply to NHS services, with the CQC making the definitive judgements on quality in providers. The lessons from the Francis Report, Winterbourne View and the Berwick Report are that quality is as much about our behaviours and attitudes to patients as human beings as it is about the transactions we need to make to ensure services improve. There are three non-negotiable items that we expect to be part of every relationship between a commissioner and provider:

●● The Francis Report 7 into the systemic failings at the Mid Staffordshire NHS Foundation Trust provides us all with important learning to ensure we expect and deliver the best possible care for our patients. NHS England supports the government’s response set out in Hard Truths 8. The National Quality Board’s How to ensure the right people, with the right skills, are in the right place at the right time 9 sets out an approach to improving nursing, midwifery and care staffing for the benefit of patients. Getting the right staff with the right skills to care for our patients all the time is not something that can be mandated or secured nationally. Providers and commissioners, working together in partnership, listening to their staff and patients, are responsible for making these expectations a reality.

7 http://www.midstaffspublicinquiry.com8 https://www.gov.uk/government/publications/mid-staffordshire-nhs-ft-public-inquiry-government-response9 http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf

http://www.midstaffspublicinquiry.com

https://www.gov.uk/government/publications/mid-staffordshire-nhs-ft-public-inquiry-government-response

http://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf

1918

England●● Transforming Care: A national response

to Winterbourne View Hospital10 set out the basis on which CCGs, Local Authorities and specialised commissioners should work together to implement the core specification. This describes the core principles that must be present in all education, health and social care services for children, young people, adults and older people with learning disabilities and/or autism who either display, or are at risk of displaying, behaviour that challenges.

●● Further to the government’s response to the Berwick review into patient safety 11, CCGs are expected to take an active part in their local patient safety improvement collaborative and address how their commissioning can support local improvement. Commissioners should ensure they have systems in place to satisfy themselves that the providers they commission services from are effectively reporting and learning from safety incidents and implementing patient safety alert actions in a timely manner.

54. To ensure local autonomy and flexibility in how NHS organisations plan and deliver service re-designs, plans need to demonstrate robust evidence against four tests, which are that there should be:

●● support from clinical commissioners;●● clarity on the clinical evidence base;●● robust patient and public engagement;

and

●● support for patient choice.

55. A number of vital aspects of quality need to be considered:

i) Patient safety

56. Knowing that they will be safe in our care is of paramount importance to patients. We are introducing a number of approaches to improve patient safety and reduce avoidable harm:

●● Regional and Area Team Quality Surveillance Groups to provide a wealth of evidence and intelligence to support early intervention when issues develop;

●● a new Patient Safety Alerting System to support organisations to understand and take rapid action in relation to patient safety risks;

●● continued zero tolerance of MRSA bloodstream infections and ongoing focus on reducing Clostridium difficile infections;

●● we will set up and support the Patient Safety Collaborative Programme to create a comprehensive, effective and sustainable collaborative improvement system that underpins a culture of continual learning and patient safety improvement; and

●● we will create new NHS Safety Thermometers for mental health care, medicines safety and maternity that can be used by organisations to support local improvement activity.

10 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213215/final-report.pdf11 https://www.gov.uk/government/publications/berwick-review-into-patient-safety

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213215/final-report.pdf

https://www.gov.uk/government/publications/berwick-review-into-patient-safety

20

England57. From January 2014 the CQC will provide

definitive quality ratings on all providers of NHS services. Commissioners are expected to take prompt action with all providers that are judged by the CQC as “require improvement” or “inadequate”. The CQC has committed to sharing information with commissioners through its Intelligent Monitoring, and we expect commissioners to inform the CQC if they believe a provider might have quality or risk issues.

58. We also need commissioners to be more proactive in responding to complaints and concerns expressed by patients, the public and NHS staff, whether expressed through whistleblowing or other means. CCGs should have a strong and collaborative working relationship with their local Healthwatch so that issues of concern can be dealt with early.

ii) Patient Experience

59. Plans are expected to demonstrate measurable improvement in patient experience as well as continued investment in generating feedback. Improvement will be supported through:

●● tools to help establish who is receiving poor care and where poor care is to be found;

●● proven methods to enhance feedback and insight from vulnerable patient groups;

●● tools to measure and improve the experience of carers;

●● independent evaluation of improvement methodologies and easier access to proven techniques and support for their

implementation, including train the trainer and master classes;

●● recommended methodologies to strengthen forms of staff engagement which can support improvements in patient experience through better staff experience;

●● support for the collaborative sharing of learning and good practice; and

●● a strategy to learn from complaints and improve the experience of making a complaint.

iii) Compassion in Practice

60. Compassion in Practice, the national nursing, midwifery and care giving vision and strategy, provides a challenge for commissioners to support providers through the adoption of the 6Cs: care, compassion, competence, communication, courage and commitment. The 6Cs now have wide acceptance and reach throughout the nursing, midwifery and care staff workforce in the NHS across England in order to address six areas of action.

●● help people to stay independent, maximising well-being and improving health outcomes;

●● work with people to provide a positive experience of care;

●● deliver high quality care and measure impact;

●● build and strengthen leadership;●● ensure the right staff, with the right skills

in the right place; and●● support a positive staff experience.

2120

England61. Each area of action has an implementation

plan with national, local and individual actions. This is a nursing, midwifery and care staff strategy which is being delivered by the NHS healthcare system, with national bodies and regulators leading on a range of initiatives. CCGs are asked to ensure that the local areas of action within the Compassion in Practice implementation plans are reflected in the services they commission.

iv) Staff satisfaction

62. Staff satisfaction is an important indicator of quality. There is good evidence that happy, well-motivated staff deliver better care and that their patients have better outcomes. NHS staff work very hard, often under great pressure; and we must ensure that we work with all providers of NHS services to make it possible for them to do the best job they can. We must ensure that clinical leadership in front line teams flourishes and drives innovation and better care. The results of the staff survey and, as it comes on stream, the staff Friends and Family Test should be used when considering the quality of services being provided.

v) Seven Day Services

63. The NHS Services, Seven Days a Week Forum, chaired by the National Medical Director, has reported to NHS England on how NHS services can be improved to provide a more responsive and patient centred service across the seven day week 12. The Forum was asked to focus, as a first stage, on urgent and emergency care

services and their supporting diagnostic services. The Forum’s review points to significant variation in outcomes for patients admitted to hospital at the weekend across the NHS. This variation is seen in mortality rates, patient experience, length of stay and re-admission rates.

64. There is no ‘one size fits all’ answer to introducing seven day urgent and emergency care services. Local solutions will need to be found. We shall work with Health Education England on the workforce implications of transforming services. The Forum has developed a set of clinical standards describing the standard of urgent and emergency care that all patients should expect to receive seven days a week. The standards have been developed through extensive engagement with stakeholders and include a comprehensive supporting evidence base. Local contracts for 2014/15 should include an Action Plan to deliver the clinical standards within the Service Development and Improvement Plan Section, and a local CQUIN should be considered, based on the clinical standard for time from arrival to initial consultant assessment.

65. Consideration is being given to how data and information on the extent to which the clinical standards are being delivered, and the provision of seven day services, can be published in an accessible format that lends itself to comparisons. There is work to be undertaken both nationally and locally to determine how these standards can be delivered affordably.

12 http://www.england.nhs.uk/ourwork/qual-clin-lead/7-day-week/

http://www.england.nhs.uk/ourwork/qual-clin-lead/7-day-week/

22

Englandvi) Safeguarding

66. The safeguarding of all those who are vulnerable is an enormous obligation for all of us who work in the NHS and partner agencies. There is still much to do to ensure this happens. In March 2013, NHS England published the Safeguarding Vulnerable People in the Reformed NHS; Accountability and Assurance Framework 13. The Framework provides a clear set of principles and guidance to ensure the new system delivers improved outcomes for children and vulnerable adults. A strategic national steering group has been established to ensure the framework is embedded, and it provides a national forum to enable safeguarding leaders in NHS England to implement cross governmental policy. A number of key priorities are emerging which include policies to prevent child sexual exploitation, female genital mutilation, sexual violence and domestic abuse, and which will ensure effective implementation of national legislation and policies relating to vulnerable children and adults.

67. Demonstrating how safeguarding duties will be discharged needs to be reflected in all local plans and NHS England will seek continuous assurance on this important issue.

Access to services – Convenient for Everyone

68. Our patients have consistently told us how important it is that they don’t have to wait for treatment. They tell us that waiting can be the most distressing part of their illness. And we know that waiting can make clinical

outcomes worse and can even make services unsafe. We also know that our services can only improve outcomes for patients if they are available to them, and they receive those services quickly, when they need them, and in a way which is convenient for them and fits with their daily lives.

69. Disadvantaged and minority groups need specifically tailored services which suit their circumstances or they will simply not be accessible to them. There are many minority groups who will struggle to get the care they need if they are expected simply to fit in with what works for the majority.

70. During 2014/15, we will also oversee pilots designed to extend access to general practice services and stimulate innovative ways of providing primary care services, supported by the Prime Minister’s £50 million challenge fund. There will be at least nine pilots covering around half a million patients and testing new ways of providing evening and weekend access, making greater use of email and phone consultations, joining up urgent care and out-of-hours care, and providing a range of other flexibilities in how citizens access services.

71. The NHS Constitution identifies a range of standards to which patients are entitled and which NHS England has committed to deliver. Every local plan will need to identify both how they will make services generally accessible but also how they will specifically deliver the standards in the constitution.

13 http://www.england.nhs.uk/wp-content/uploads/2013/03/safeguarding-vulnerable-people.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/03/safeguarding-vulnerable-people.pdf

2322

EnglandDriving Change through Innovation

i) Supporting our staff to innovate

72. NHS England is committed to innovation to deliver significant improvements in quality and efficiency in the NHS. In 2013/14 we introduced a Regional Innovation Fund to support and promote the adoption of innovation and the spread of best practice across the NHS. We will be looking to facilitate fresh perspectives or partnerships, bringing in different types of expertise or capacity to support the adoption of current innovations or the development of new ideas.

ii) Research

73. Research and evaluation across the whole patient pathway including with partners in local government and Public Health England will contribute to improving outcomes and spreading innovation and economic growth. A marker of quality within NHS organisations is those with research activity able to demonstrate evidence of improved patient outcomes and health service delivery. Commissioners should actively seek out research opportunities, understand where research is taking place within the providers with whom they contract and support that activity wherever possible, through their commissioning decisions.

Value for money, effectiveness and efficiency

74. Of course, all of this must be delivered against the backdrop of ensuring that patients and citizens get the very best out of every pound that is spent and that all parts

of the system play their part in delivering better care within their allocated resource.

75. We have already set out that there is a potential funding gap of around £30 billion by 2020/21. Plans need to be explicit on how they will close this gap in a local context whilst maintaining or enhancing the quality of services provided to patients. NHS England does not underestimate the scale of this task and will do all in our power to support local health communities to take the bold decisions they need to transform services. We shall review our funding mechanisms so that they are truly supportive of improving outcomes.

76. In helping to deliver value for money for the taxpayer, commissioners and providers should support the implementation of Better Procurement, Better Value, Better Care14. This is a procurement development programme which includes an ambitious package of measures to help the NHS save £1.5 billion to £2 billion through improved procurement whilst supporting economic growth by improving access of opportunity for small and medium enterprises and ensuring the NHS is transparent in all its commercial relationships and procurement information.

77. It is absolutely critical that all commissioners can demonstrate a systematic approach to securing value for money, so that our patients can be assured that the best possible quality of care is secured for every pound spent on their behalf.

14 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226835/procurement_development_programme_for_NHS.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226835/procurement_development_programme_for_NHS.pdf

24

England

LEADING THE WAY THROUGH

COMMISSIONING

78. Last year’s guidance identified stronger commissioning as a key theme for driving change. This section has set out those things which local commissioners need to include in their plans which will deliver the change they want to see. CCGs and NHS England, supported by CSUs, must work as a coordinated whole and with other non-NHS commissioners of care.

79. Our commitment to clinical commissioning remains strong, ensuring that commissioning decisions are firmly based on clinicians’ close relationships with their patients and their understanding of clinical processes.

80. In this first section of the document we have:●● reiterated the five domains of the

outcomes we want to deliver for our patients;

●● translated those into a set of practical measurable ambitions which describe the progress we want to see in delivering the outcomes;

●● identified a further three measures which it is vital that we deliver;

●● signalled six patterns of service, emerging from our early Call to Action work, which we believe will be necessary to deliver the transformation we need; and

●● identified four essential elements for the delivery of services.

81. It is now for local communities and all those who commission or deliver care to them to create the robust plans which will be their roadmap to better outcomes for their citizens. CCGs as the local leaders of health commissioning will take the lead in working with all key stakeholders, especially Local Authorities, to develop those plans. NHS England will be alongside them in this planning as co-commissioners and in providing support and oversight. Health and Wellbeing Boards will be a key forum for agreeing plans with all stakeholders and accounting to the local community that these plans meet their needs and are delivered. In some instances, CCGs will work together to create a bigger footprint as their unit of planning. In all instances, CCGs will need to work with their neighbours to ensure that each plan demonstrates how services delivered across a broader geography, such as ambulance services or specialised services, are commissioned and delivered consistently and cohesively. They will need to demonstrate how they deliver all the aspects of the government’s mandate to the commissioning system. They will need to take account of NHS England’s ambitions and steers on strategic approach. They will need to include their own ambitions for the things their citizens tell them will meet their needs.

82. This approach will allow us to articulate and quantify what we are aiming to achieve for the patients and communities we serve, both locally and nationally. The scale of our ambitions will be determined by how bold we, and the communities we serve, are prepared to be and by how well we collaborate with partner organisations, particularly local government and the

2524

Englandvoluntary and community sector. Outcomes based commissioning is now fundamental to our approach and will maximise health gain for the citizens of England and value for money for taxpayers.

83. Plans must be owned locally and driven by local needs. Unlike previous years, this document is not prescriptive in how CCGs achieve this ambition, nor does it attempt to apportion to individual CCGs specific targets across a host of areas where our collective action will need to deliver and exceed the government’s mandate. It makes the assumption that individual patches will want to go even further in delivering the best for their citizens. NHS England does, however, have a key role in assuring that all plans are sufficiently robust, that they will collectively deliver our commitments and that all citizens across England are supported by equally high quality services. We also need to make sure the commissioning system is effective and efficient and that local flexibility does not translate into inefficiency or duplicated effort.

84. Part 2 of this guidance sets out in greater detail our expectations of these plans, but most importantly it creates the framework for planning which will help everyone to deliver. We expect each local system to use this framework and the associated tools to make the right changes happen. The five year strategic plans are the starting point for the whole planning process. Each strategic plan needs to be tested against the six characteristics of a sustainable health and care system, ensuring that it reflects the needs of local citizens, the conclusions of local Call to Action conversations and insights from modelling tools such as Any

town (see section 2 paragraph 41). The two year operational plans and the local approach to the Better Care Fund will need to demonstrate how they are driven by the strategic plan.

85. Part 2 also identifies the comprehensive range of support which is on offer.

86. Nationally, NHS England will organise and prioritise our work to support a move in this strategic direction. There is an important set of changes in day to day practice which will support these patterns of care, as well as a set of enablers we need to develop nationally to give local systems the freedom to innovate. As the Call to Action work draws to a conclusion in the spring/early summer 2014, we shall be working with national health and local government partners to identify the further financial, regulatory, leadership and workforce development enablers which will accelerate the move towards high quality, sustainable health and care systems across the country.

87. We expect the strategic vision work locally to be open and inclusive, involving patients, citizens and providers as well as commissioning partners on Health and Wellbeing Boards. We will harness the very best of what new technologies and new ways of working now offer to the changing needs of local populations and groups, relentlessly focusing on improving outcomes. In every part of the country this will be brought together into a compelling description of the local care delivery system that local health and social care communities want to build, underpinned by a clear and credible local plan to get there.

26

England

26

PART 2: HOW WE ARE GOING TO ACHIEVE THESE AMBITIONS

1. Part 2 of this guidance is structured to provide an overview of the planning process and details of the plans which need to be produced. It comprises four sections:

●● The Strategic and Operational Planning process – provides an overview of the fundamental planning considerations for all plans, describes how plans will be submitted and assured and provides an overview of the support available for the process.

●● Strategic, Operational and Financial Planning – provides a high level overview of the structure and requirements of the 3 plans, sets out the financial allocations and core financial planning assumptions and outlines the related strategic enablers.

●● Direct Commissioning – provides an overview of planning for direct commissioning and the associated financial planning assumptions.

●● Better Care Fund – provides an overview of Better Care Fund planning and the funding for integrated care.

THE STRATEGIC AND OPERATIONAL PLANNING PROCESS

A NEW APPROACH TO PLANNING

2. NHS planning has in the past been successful in supporting the delivery of annual incremental improvement. However, the NHS is facing an unprecedented challenge. We are committed to transforming outcomes for patients and to playing our role in minimising inequalities within and between communities. A Call to Action forecasts a financial gap of around £30 billion by 2020/21, and the affordability challenges in 2014/15 and 2015/16 are real and urgent.

3. Therefore, we now need to take a longer term view of the planning of services to reflect the step changes required to tackle these unprecedented challenges.

2726

England

26

The planning process has changed to address this:

●● Stretching local ambitions for outcomes should be developed against each of the outcomes ambitions set out in Part 1 paragraph 10 of this guidance, along with credible and costed plans to deliver them.

●● Through this guidance we are setting out a challenge for commissioners to plan for the transformation of services on a five year basis. Each commissioner’s five year plan must drive its decisions to ensure its providers are best placed to deliver high quality and sustainable services for patients, and in particular we would expect to see alignment with the six service models outlined in Part 1.

●● Each five year plan should include the first two years of operational delivery in detail so that patients, their carers and other key stakeholders can be satisfied

that progress is being made against the longer term goals and the service transformation needed to realise them.

●● As set out in Part 1 paragraph 18, plans must be explicit in dealing with the financial gap and contain appropriate risk and mitigation strategies.

●● The planning process and timeline have been aligned with our national partners, including NHS commissioners, Monitor, the NHS Trust Development Authority, the Local Government Association and Health Education England.

●● In addition to completing a complete set of plans for their own organisation, CCGs have been asked to choose their own footprint for strategic health and social care planning. This may involve working as part of a larger ‘Unit of Planning’ to enable wider issues which affect more than one commissioner to be dealt with at scale.

Requirement for the planning round was one year.

Strategic plans covering a five year period with first two years at operating plan

level of detail

Cooperation encouraged between providers and commissioners.

Cooperation will be encouraged formally through guidance issued and aligned

process with Monitor/TDA

Local cooperation with Local Authorities to inform planning round.

Widest possible scope of integration. Cooperation with Local Authorities for

BCF planning

Published guidance

Support extended to include benchmarking data, a comprehensive universal support

offer and additional on-site support for challenged commissioners

Period of time covered by plans

Integration between providers and commissioners

Integration with social care

Extent of support to commissioners preparing plans

How could this planning process look different?

2013/14 planning round 2014/19

1

28

England●● a stratified support programme has been

put in place to support the new planning process.

4. Both short-term transactional change and long-term transformation need to be guided by an explicit model of change and to be supported by a strong research and evidence base. The NHS Change Model15

has been created to support the NHS to adopt a shared approach to leading change and transformation. Developed with hundreds of our senior leaders, clinicians, commissioners, providers and improvement activists and supported by a robust evidence base, the NHS Change Model brings together collective improvement knowledge and experience from across the NHS. Application of the eight components of change brings together improvement in a systematic and sustainable way, and we would expect to see this approach reflected in local strategic and operational plans.

PLANNING FUNDAMENTALS

5. Strategic and operational plans must be explicit in dealing with local ambitions for outcomes within funding available. They should also be developed based on some fundamental planning principles. Plans should be:

●● bold and ambitious;●● developed in partnership with providers

and Local Authorities; and●● locally led.

6. Either through submission of the planning templates or separately, each strategic and operational plan must explicitly set out in detail the approach to delivering the fundamentals set out in the table opposite, the five year ambition and the plans for the first two years to move towards the long-term ambition.

IMPROVING OUTCOMES

7. Part 1 paragraph 10 of this guidance sets out our seven ambitions which the NHS is striving to achieve for the people of England.

8. The seven outcomes ambitions are set out in Annex A of this document, together with the measures that CCGs should use in planning. NHS England Area Teams should use the same measures, where relevant to their commissioning responsibilities, with further measures also included in Annexes D-G of this guidance.

JOINT WORKING AND INVOLVEMENT

9. NHS England is working closely with Monitor and the NHS Trust Development Authority to ensure plans are sustainable and deliverable across commissioning and provision in local health economies. For plans to be deliverable, we are committed to ensuring that one organisation’s plan does not put another’s at risk or generate behaviours that work against patients’ interests.

15 http://www.changemodel.nhs.uk

http://www.changemodel.nhs.uk

2928

EnglandFundamental elements of commissioner plans

Fundamental Key features to be demonstrated in plans

1

Outcomes

Delivery across the five domains and seven outcome

measures

●● your understanding of your current position on outcomes as set out in the NHS Outcomes Framework

●● the actions you need to take to improve outcomes

2 Improving health

●● working with H&WB partners, your planned outcomes from taking the 5 steps recommended in the “commissioning for prevention” report

3 Reducing health inequalities

●● identification of the groups of people in your area that have a worse outcomes and experience of care and your plans to close the gap

●● implementation of the 5 most cost effective high impact interventions recommended by the NAO report on health inequalities

●● implementing EDS2

4 Parity of esteem

●● the resources you are allocating to mental health to achieve parity of esteem

●● identification and support for young people with mental health problems

●● plans to reduce the 20 year gap in life expectancy for people with severe mental illness

5 Patient services

New approach to ensuring that citizens are fully included

in all aspects of service design and change and that patients are fully empowered

in their own care

●● how you will commission services so that patients and citizens have the opportunity to take control

●● how you will put real time patient and citizen voice at the heart of decision making

●● how you will include authentic citizen participation in the design of your plans

●● how you will promote transparency in local health services

30

England


6

Patient services

(continued)

Wider primary care, provided at scale

●● your understanding of the potential contribution of primary care to delivery of your ambition

●● working with partners and the public to develop an integrated approach to primary and community services, with joint commissioning as appropriate

●● how you will enable primary care to operate at greater scale to improve access and continuity of care and to enable your urgent and emergency care network to function effectively

7 A modern model of integrated care

●● what you are doing to ensure people with multiple long-term conditions and clinical risk factors are offered a fully integrated experience of support and care

8 Access to the highest quality urgent and emergency care

●● how your strategic plan is in line with the vision set out in the Urgent and Emergency Care Review Phase One Report http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf

●● how you will you be ready to determine the footprint of your urgent and emergency care network during 2014/15, working with key partners and informed by a detailed understanding for your area of:

a) patient flows;

b) the number and location of emergency and urgent care facilities;

c) the services they provide; and

d) the most pressing needs for your population

●● how you will be ready in 2015/16 to begin the process of designation for all facilities within your network

9 A step-change in the productivity of elective care

●● how you have considered your model of elective care for your local providers to achieve a 20% productivity improvement within 5 years, so that existing activity levels can be delivered with better outcomes and 20% less resource

http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf

3130

England


10Patient services

(continued)

Specialised services concentrated in centres of

excellence.

●● how your strategic plans address whether your providers are seeing and treating a sufficiently high enough volume of patients to meet specified clinical standards, in line with the need to concentrate specialised services in 15-30 centres of excellence, linked to Academic Health Science Networks

●● how your plans are ensuring that specialised services in your area are connecting actively to and maximising the opportunities of working with research and teaching

11

Access

Convenient access for everyone

●● how you will deliver good access to the full range of services, including general practice and community services, especially mental health services in a way which is timely, convenient and specifically tailored to minority groups

12 Meeting the NHS Constitution standards

●● that your plans include commissioning sufficient services to deliver the NHS Constitution rights and pledges for patients on access to treatment as set out in Annex B and how they will be maintained during busy periods

13

Quality

Response to Francis, Berwick and Winterbourne View

●● how your plans will reflect the key findings of the Francis, Berwick and Winterbourne View Reports

14 Patient safety

●● how you will address the need to understand and measure the harm that can occur in healthcare services, to support the development of capacity and capability in patient safety improvement

●● how you will increase the reporting of harm to patients, particularly in primary care and focused on learning and improvement

32

England


15

Quality (continued)

Patient experience

●● how you will set measureable ambitions to reduce poor experience of inpatient care and poor experience in general practice

●● how you will assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for those patients

●● how you will demonstrate improvements from FFT complaints and other feedback

16 Compassion in practice

●● how your plans will ensure that local provider plans are delivering against the six action areas of the Compassion in Practice implementation plans

●● how the 6Cs are being rolled out across all staff

17 Staff satisfaction

●● an in-depth understanding of the factors affecting staff satisfaction in the local health economy and how staff satisfaction locally benchmarks against others

●● how your plans will ensure measureable improvements in staff experience in order to improve patient experience

18 Seven day services

●● that the action plans submitted by your providers (a requirement within the Service Development and Improvement Plan section of the NHS Standard Contract) give you confidence that they will be able to comply with all ten of the Seven Day Service Clinical Standards by 2016/17

●● if not, how your strategic and operational plans are going to ensure these standards are being met for patients

●● how your strategic plans are addressing the need to provide consistently high quality urgent and emergency care services outside of hospital across the seven day week

3332

England


19 Safeguarding

●● how your plans will meet the requirements of the accountability and assurance framework for protecting vulnerable people

●● the support for quality improvement in application of the Mental Capacity Act

●● how you will measure the requirements set out in your plans in order to meet the standards in the prevent agenda

20 Innovation Research and innovation

●● how your plans fulfil your statutory responsibilities to support research

●● how you will use Academic Health Science Networks to promote research

●● how you will adopt innovative approaches using the delivery agenda set out in Innovation Health and Wealth: accelerating adoption and diffusion in the NHS

21 Delivering value

Financial resilience; delivering value for money for taxpayers and patients and procurement

●● meeting the business rules on financial plans including surplus, contingency and non-recurrent expenditure.

●● clear and credible plans for QIPP that meet the efficiency challenge and are evidence based, including reference to benchmarks

●● the clear link between service plans, financial and activity plans

34

England10. Plans need to reflect local priorities, as

determined by each Health and Wellbeing Strategy, with the assumption that local discussions will resolve any differences. We expect commissioners and providers to cooperate in planning, and to be able to explain any differences in their assumptions. The assurance processes described later in this section will have a particular focus on localities where there are significant differences in plans.

11. A Call to Action has reinforced the need for active and on-going participation with local communities and the people within them. These participation activities need to be extensive, rigorous and demonstrably central to every five year strategic plan.

ALIGNED PLANNING ACROSS HEALTH

ECONOMIES

12. Each CCG is accountable for developing a Strategic, Operational and Financial plan. To enable wider and more strategic health economy planning, all CCGs will work in close collaboration with relevant Area Teams, providers and Local Authorities and where appropriate they may also choose to join with neighbouring CCGs in a larger ‘Unit of Planning’ to aggregate plans, ensure that the strategies align in a holistic way and maximise the value for money from the planning resources and support at their disposal.

13. Where CCGs choose to associate to form a ‘Unit of Planning’ they should consider the following principles:

●● each CCG to belong to one unit only;●● the Unit has been locally agreed and

has clear clinical ownership and leadership;

●● it is based on existing health economies that reflect patient flows across Health and Wellbeing Board areas and local provider footprints with no CCG to be split across boundaries;

●● it has sufficient scale to deliver geography wide clinical improvements;

●● it enables the pooling of resources to reduce the risk associated with large investments;

●● it does not cut across existing locally agreed collaboration agreements;

●● engagement has been secured from Local Authorities; and

●● engagement has been secured from the Local Education and Training Board (LETB).

14. The diagram below demonstrates the potential components of a Unit of Planning.

15. Commissioner plans need to be submitted on the templates issued alongside this guidance. There are five templates:

●● Strategic plan; ●● Operational plan;

Illustrative Unit of Planning team

Area team

Acute provider Community provider

CCGCCG CCG

Acute provider

HWB LA

Community provider

3534

England●● Financial plan;●● Direct Commissioning plan; and●● Better Care Fund.

16. Broader strategic plans constructed by Units of Planning will be a consolidation of individual organisations’ strategic plans.

17. The Better Care Fund plan is developed at Health and Wellbeing Board level. This will mean that in some cases more than one CCG will be involved in the development of this plan.

18. Further details on plans for the Better Care Fund are included in Annex I of this guidance.

19. NHS England’s plans for directly commissioned services may not always fit neatly to a single Unit of Planning, so Area Teams will ensure their plans dovetail into all relevant Units of Planning. Similarly, on some occasions a provider’s plan may need to be reflected in more than one Unit of Planning, and when that happens, commissioners need to be satisfied that they are sighted on the totality of the Trust’s plan.

BALANCING PLANS

20. It is important that plans are balanced and aligned across the respective strategic, operational and financial elements illustrated below.

Outcome measures

Finances

Activity Measures

NHS Constitution Measures

Strategic Plan

CCG OIS

21. The CCG Outcomes Indicators Set16 (CCG OIS) should be used by CCGs as a tool to understand trends in outcomes and to help them identify potential priorities for improvement and for inclusion in plans. Not all outcomes will be relevant for every plan. CCGs and NHS England may wish to refer to indicators in the CCG OIS to help them gain a rounded picture of local outcomes as part of the assurance process.

22. NHS England will look to ensure that plans are consistent across primary, secondary and specialist care (i.e. that CCG and Area Team plans are aligned). We will work with Monitor and the NHS Trust Development Authority to develop a shared view about the recovery action that might be required where health economies are demonstrating pressure to such an extent that the quality of services provided to patients may be at risk of deterioration.

16 http://www.england.nhs.uk/ccg-ois/

http://www.england.nhs.uk/ccg-ois/

36

England23. The operational plans must demonstrate that

the strategic plan is the driving force behind transformational change. The operational plans should contain outcomes and relevant local metrics which show the journey towards the tangible achievement of the overarching strategy.

PLANNING TIMETABLE

24. This guidance is issued at the same time as our allocations to commissioners. The planning timetable is detailed in the table opposite. It will be challenging for everyone; but it is important that we lay strong foundations for delivery during what will be a testing time for all NHS organisations.

25. We will work closely with Monitor, NHS Trust Development Authority and Health Education England throughout this process to provide feedback to CCGs and providers and to ensure alignment and deliverability. This will be an iterative process as providers respond to commissioner plans.

Activity Deadline

First submission of plans 14 February 2014

Contracts signed 28 February 2014

Refresh of plan post contract sign off 5 March 2014

Reconciliation process with NHS TDA and Monitor From 5 March 2014

Plans approved by Boards 31 March 2014

Submission of final 2 year operational plans and draft

5 year strategic plan4 April 2014

Submission of final 5 year strategic plans

Years 1 & 2 of the 5 year plan will be fixed per the final plan submitted on 4

April 2014

20 June 2014

PLAN SUBMISSION

26. The diagram below illustrates the submission process.

Submission process

Operational plans

Financial plans

Strategic plans

UNIFY

Sent via email (in text or xls form) to central email

address

UNIFY (previous

years)

Assurers Submitters

Better Care Fund

All templates to be emailed to same central NHS England address for consistency and integration and then shared

with Area Teams

Some key items to be centrally loaded into UNIFY

3736

England27. The central email address for strategic and

financial plan submission is: [email protected]

ASSURANCE OF PLANS

28. Plan assurance will address the scale of ambition and plans for implementation of the planning fundamentals set out in paragraph 6 of Part 2 of this guidance, in the two and five year time horizons.

29. To maximise opportunities for mutual assurance across all health and social care services and minimise complexity, we will adopt the following principles for the assurance process:

●● Assurance of the overall strategic plan will be at Unit of Planning level, including engagement with patients and public in the local community;

●● Operational plans will be assured at CCG and at Health and Wellbeing Board level, and at Area Team level for NHS England’s directly commissioned services;

●● Area Teams to lead the assurance of CCG plans;

●● Regional Teams manage the assurance of Direct Commissioning plans;

●● Area Teams to assure the overall consolidated commissioning position and strength of local partnerships;

●● Area Teams and CCGs to ensure mutual assurance of Direct Commissioning plans, with escalation by exception; and

●● Boards and governing bodies should satisfy themselves that the outcomes or recommendations of the plan assurance process have been appropriately addressed prior to plan sign off.

30. The lead responsibilities for plan production and assurance are shown in the following table.

31. The NHS England national support centre will support regions and areas throughout the process, providing challenge and advice through a series of risk-based checkpoint meetings.

32. The review and triangulation of plans will include:

●● the finances to secure delivery of the output objectives and adherence to the requirements outlined in the planning guidance;

●● ensuring the finance and activity projections are supported by reasonable and deliverable planning assumptions including level of assumed QIPP delivery and underlying activity growth;

●● triangulation of finance and activity; ●● coherence with the other planning and

output assumptions; and ●● testing the strength of local relationships,

which are key to ensuring delivery.

[email protected]

38

Eng

land

Assurance and production of plans

Plan Produced by… Engaged Triangulation Formal assurance

Responsible for driving

development, completing &

submitting plan

Contribute to plan developmentResponsible for ensuring

that their work triangulates with plan

Responsible for providing formal assurance of plan

Strategic Unit of Planning

●● Patients & carers●● Healthwatch●● CCG●● Provider●● HWB●● Local Authority●● NHS England Area Team●● Health Education England ●● Local Education and Training

Board (LETB)

●● CCG●● Provider●● HWB●● Local Authority●● Area Teams

NHS England Regional Team

Operational CCG

●● Provider●● Local Authority (contracts with

community/social care providers)

●● Provider●● HWB●● Local Authority●● Unit of Planning

NHS England Area Team

Financial CCG

●● Provider●● Local Authority (contracts with

community/social care providers)

●● Provider●● HWB●● Local Authority●● Unit of Planning


3938

Eng

land

Plan Produced by… Engaged Triangulation Formal assurance

Responsible for driving

development, completing &

submitting plan

Contribute to plan developmentResponsible for ensuring

that their work triangulates with plan

Responsible for providing formal assurance of plan

Provider Provider

●● CCG●● Local Authority (depending on

provider type)

●● CCG●● HWB●● Local Authority●● NHS England Area Teams ●● Unit of Planning

Monitor

NHS Trust Development Authority

Better Care Fund HWB

●● Patients and carers●● Healthwatch●● Local Authority●● NHS England Area Teams●● PHE●● Monitor●● NTDA

●● CCGs●● Provider●● Units of Planning

Ministers

HWB


LGA

Direct Commissioning


●● NHS England Regional Team●● Provider

●● Provider●● CCG

NHS England Regional Team

40

England

ON-GOING ASSURANCE

33. NHS England has published assurance frameworks for both CCGs17 and our direct commissioning18 functions. These are integral to our approach to assurance of plans. In line with the principles set out in the assurance frameworks, discussions will take place on the basis of six consistent assurance domains.

34. Assurance will be informed by robust and diverse sources of evidence, underpinned by a developmental and supportive approach. Where delivery concerns are identified, improvement actions will be agreed. NHS England has broad powers available through legislation to ensure that these improvements are made. This guidance sets out the expectations for NHS commissioners, and the assurance process will be an important way of ensuring that both NHS England and CCGs are mutually accountable for delivering the improvements we want to see delivered.

OVERVIEW OF PLANNING SUPPORT

35. The support package that we will provide puts these requirements at the centre of the development and delivery of five year strategic plans. It has been developed in consultation with commissioners in CCGs and Area Teams and will be made available for commissioners to draw on where needed. A detailed communication on support will be published by the end of December.

36. The support programme includes:●● universal, nationally developed tools,

including information packs, exemplars and Strategic Planning Workshops that will bring together local partners to support them in agreeing their approach and priorities in developing and delivering aligned strategic plans;

●● bespoke support based around ten key specifications;

●● an intensive support package for economies with deep financial and/or quality issues, developed and owned jointly by NHS England, NHS Trust Development Authority, Monitor and the Local Government Association; and

●● support to a number of Health and Wellbeing Boards aligned and interwoven across both the universal and bespoke elements of support.

37. The diagram that follows shows the support package which will be made available to support the planning process.

17 http://www.england.nhs.uk/wp-content/uploads/2013/11/ccg-ass-frmwrk.pdf18 http://www.england.nhs.uk/wp-content/uploads/2013/11/dc-ass-frmwrk.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/11/ccg-ass-frmwrk.pdf

http://www.england.nhs.uk/wp-content/uploads/2013/11/dc-ass-frmwrk.pdf

4140

England

UNIVERSAL SUPPORT PACKAGE

38. The universal support package, available to all commissioners, will include:

●● Practical support on participation – Our interactive web based Transforming Participation in Health and Care tool already provides advice, good practice, evidence and case studies on approaches to good public participation. This will be supplemented by resources that will be made available through Commissioning Support Units (CSU) aimed at engaging local communities in developing and commissioning services that meet their needs, and using insight and market research techniques to better understand those needs. The expectation is that local and regional voluntary sector organisations will work

to make certain that public participation reaches all parts of local communities. There should be particular focus on seeking and achieving input from communities which have traditionally not provided sufficient input into NHS decision-making.

●● Any town health system and Better Care Fund models – To support CCGs in preparing plans, the Any town health system model will be published in January. The Better Care Fund modelling tool enables HWBs to model high level integration interventions.

●● Data packages – data and analysis packs showing the local opportunities for improvement and relative performance e.g. Commissioning for Value packs released in October.

What support will be made available?

Guidance / exemplars

Information Packs

Learning collaborative

Local support

Incr

easi

ngly

bes

poke

sup

port

Bespoke support commissioned by CCGs, ATs and Units of Planning based on local priorities

Universal offer available for all commissioners,

Strategic planning workshops

Intensive Support

42

England●● Strategic planning workshops – Local

workshops designed to kick-start the planning process and build local relationships to create a joint vision and prepare for planning submissions. They will provide practical and technical advice about translating a strategy into a financial and operating plan and will support joint ways of working through advice on creating local governance arrangements aimed at galvanising action and initiating stakeholder discussions.

●● Learning collaborative – This will support the spread and adoption of learning, best practice and technical expertise. We are planning to create a programme of webinars and learning events on key topics across three broad areas; best practice sharing; thought leadership; and support for the technical aspects of planning and delivery.

TAILORED LOCAL SUPPORT TO MEET LOCAL

CHALLENGES

39. The local support offer will be available to CCGs, Area Teams and Units of Planning that would benefit from additional more bespoke support in key areas.

40. Ten different specifications have been identified, which relate to the three main areas of planning activity: building a shared vision for health and social care across multiple partners in the Unit of Planning; development of plans which deliver that vision; and implementation of plans. These are shown in the following diagram.

9. Direct Commissioning

6. Service Redesign

7. Integrated Health & Social CareDeveloping Plans

Support materials

4. Patient &Public Involvement

2. Leadership & Partnership working

Building a shared vision

8. Modelling & Analytics

3. Case studies & Evidence for change

1. Creating a vision

5. Strategy Development

10. Programme & Change ManagementImplementation

4342

England

ANY TOWN HEALTH SYSTEM

41. The Any town health system model is a resource designed to help local areas identify potential improvements to service delivery, and enable them to understand what the quality and financial impacts of those improvements may be. The tool provides case studies and analysis of a number of interventions that could be applied in a local health economy to achieve improved clinical outcomes and financial performance. It shows how a typical CCG could achieve financial balance over the strategic period covered.

42. A number of ‘High Impact Interventions’ have been fully impact assessed and included in the report. Twelve ‘Early Adopter Interventions’ are also included; these have not been impact assessed to the same specification as the ‘High Impact Interventions’, but are innovative, cutting edge ideas which may be promising.

43. To help understand the impact different interventions will have in different settings, three scenarios have been created: Urban CCG, Suburban CCG and Rural CCG. There is a version of Any town for each scenario CCG. Local areas are, therefore, able to understand how each intervention might affect performance in an area that is demographically similar to their own.

Any town

1

Younger demographic

Lower average prevalence of LTCs

Higher levels of deprivation

Urban CCG Rural CCG


Older demographic

Lower average prevalence of most LTCs


Same age demographic

Higher average prevalence of LTCs

Suburban CCG

44

England

1 STRATEGIC, OPERATIONAL AND FINANCIAL PLANNING

STRATEGIC PLAN OVERVIEW

44. Each strategic plan needs to have the ownership and buy-in of the whole local health economy and reflect a joint vision for the area, including the road map required to attain this. All organisations should be satisfied that the plan will support the delivery of improvements for patients and service users. The plan should be short and focused, and it should describe to those outside the system what the system plans to achieve in a way that informs and engages.

45. It is essential for these plans to be at the forefront of the planning process; they set the vision, ambitions and framework against which operational and financial planning will be determined.

46. Plans should be clear on proposed future activity levels, referenced to historical trends and future service proposals. The plans must demonstrate a clear link between activity and finances.

47. The strategic plan will require the creation of a:

●● System narrative ‘plan on a page’; and●● Organisation specific key highlights.

48. Details regarding the content of the Strategic Plan template can be found in Annex J.

OPERATIONAL PLAN OVERVIEW

49. The operational plan will include the key operational metrics needed to support the assurance of, and measure performance against, strategic plans. The plan will be structured around the four headings:

●● Outcomes;●● NHS Constitution;●● Activity; and●● Better Care Fund.

50. Details regarding the content of the Operational Plan template can be found in Annex J.

FINANCIAL PLAN OVERVIEW

51. The financial plan will provide the detailed financial breakdown of each plan. It will include the key financial metrics to support the assurance of, and measure performance against, strategic plans. It will require information under the following headings:

●● Revenue resource limit;●● Planning assumptions;●● Financial plan detail 14/15-18/19;●● QIPP 14/15-18/19;●● Risk;●● Investment;●● Statement of financial position;●● Cash;●● Capital; and●● Contract value 14/15-18/19.

4544

England52. Details regarding the content of the Financial

Plan template can be found in Annex J.

FINANCIAL ALLOCATIONS AND THE

EFFICIENCY CHALLENGE

53. The 2014/15 and 2015/16 income allocated to CCGs and direct commissioning has been published alongside this guidance.

54. The funding objectives contained within the mandate require NHS England to run a transparent allocation process to ensure “equal access for equal need”. The 2012 Health & Social Care Act also requires NHS England to have regard to reducing inequalities in access to and outcomes from healthcare. Consequently, the intention is to implement an approach to allocation of funding that has regard for population on a per capita basis and takes into account both inequalities and the impact of an ageing population on demand for healthcare.

55. For CCGs, NHS England has adopted a revised funding formula recommended by the Advisory Committee on Resource Allocation. For direct commissioners of primary care, NHS England is adopting a new funding formula which aims to allocate primary care funding based on need. Adjustments are made to both formulae to reflect the need to address unmet or inappropriately met need, particularly relating to our most deprived communities. Funds for specialised commissioning, health and justice and armed forces in 2014/15 and 2015/16 will continue to be allocated on a national basis and the investment made by

NHS England in public health will be budgeted on a programme basis.

56. The implication of the distribution of resources is a differing level of efficiency challenge in 2014/15 and 2015/16 by commissioner. In 2014/15, specialised commissioning remains the area with the most challenging efficiency requirement. In 2015/16, with the introduction of the Better Care Fund, CCGs face a more significant efficiency challenge. Over the two years the efficiency challenge for both CCGs and specialised commissioning is similar at approximately 9 per cent, including the provider efficiency deflator.

57. To support commissioners to manage this challenge over the two year period we propose to prioritise access to drawdown of surpluses from prior years for specialist commissioning in the first year and CCGs in the second year.

58. For 2016/17 to 2018/19 commissioners as a whole should assume a continuity of the current allocations policy, although no decisions on allocations beyond 2015/16 have yet been taken. For subsequent years, commissioners should assume that income growth increases in line with the GDP deflator.

2016/17 2017/18 2018/19

1.8% 1.7% 1.7%

59. Continuity of the current policy would mean that CCGs and primary care commissioners would continue to move towards target on

46

Englandthe basis of the trajectory set in 2014/15 and 2015/16.

60. From 2014/15 commissioners will be required to count the use of provisions as a utilisation of their allocated resource, in line with HM Treasury accounting rules.

PROGRAMME AND ADMINISTRATIVE COSTS

61. Income is allocated separately for programme and administrative costs. Expenditure against these allocations will be monitored separately. Commissioners are asked to ensure that plans are in place to ensure administrative costs are not overspent. Underspends on administrative costs may be spent on programme costs.

62. Overall running cost assumptions for the commissioning sector were set out in the allocations paper to the NHS England Board

on 17 December 2013. The assumption that the planned 10 per cent reduction in overall health sector administration costs in 2015/16 will be applied to CCGs and NHS England will be confirmed in due course. For planning purposes, commissioners should assume that the overall running cost envelope will remain flat in cash terms for 2014/15 and reduce by 10 per cent in 2015/16. Individual CCG running cost allocations will be adjusted to take into account population change. Commissioners should assume for years 3 to 5 of the planning period that the overall running cost envelope remains flat in cash terms. As in 2014/15 and 2015/16, at individual CCG level running costs in years 3 to 5 will be adjusted to take into account population change. These will be based on the latest available ONS population projections. Running cost projections for the five year period for each CCG will be made shortly available.

CCGs

Demographic growth Local determination using age profiled population projections.

Non-demographic growth Local determination based on historic analysis and evidence.

Tariff changes See below.

Price inflation – prescribing Local determination – expected to be in a range of 4% to 7% per annum increase.

Price inflation – continuing health care

Local determination – expected to be in a range of 2% to 5% per annum increase.

Business rules

2014/15●● Minimum 0.5% contingency ●● 1% cumulative surplus carry

forward●● 2.5% non-recurrent spend

(including 1% for transformation).

2015/16-2018/19●● Minimum 0.5% contingency ●● 1% cumulative surplus carry

forward●● 1% non-recurrent spend●● Better Care Fund spend as

notified separately.

4746

England

FINANCIAL PLANNING ASSUMPTIONS

63. Published alongside this planning guidance is the Call to Action technical paper. This sets out the key financial and activity assumptions that underpin the £30bn challenge which was published in July. This guidance is based on additional work which has been undertaken to develop these assumptions further.

64. The core financial planning assumptions for CCGs to use are shown in the table on the previous page. More detail is included in subsequent paragraphs.

65. Surpluses and deficits accumulated at 31 March 2014 and subsequent years will be carried forward into the following financial years. Commissioners are asked to include proposals for access to historical surpluses, if required, in their plans. The plans will be assessed with reference to the impact on outcomes and subject to the maximum drawdown available. The maximum expected level of the national surplus drawdown will be finalised with the Department of Health and HM Treasury.

66. The National Tariff for 2014/15 was published jointly by NHS England and Monitor on 17th December. The tariff prices are generally the 2013/14 prices rolled forward and adjusted for inflation and efficiency. The cost uplift for 2014/15 is 2.5 per cent and the efficiency requirement is 4 per cent, giving an overall adjustment to tariff prices of (1.5) per cent. This should be also the starting point for adjustments to the price for services without a national price.

67. For emergency admissions, commissioners should budget for all admissions at 100 per cent of the tariff. They should only pay 30 per cent for emergency admissions over the 2008/9 baseline with the 70 per cent to be invested in relevant demand management schemes. Full details of the operation of these rules are set out in the 2014/15 National Tariff Payment System which can be found at: http://www.england.nhs.uk/resources/pay-syst/national-tariff/. Commissioners need to engage with relevant providers with input from Urgent Care Working Groups when developing plans for the investment of the 70 per cent balance. These plans should be published on the commissioner’s website and shared with all relevant stakeholders. The tariff document also contains details of the specific circumstances in which baselines should be adjusted, e.g. for service change.

68. NHS England and Monitor are currently developing a medium term pricing strategy for 2015/16 and beyond. As set out in our joint consultation in May, we will be considering how best to develop an approach to pricing that supports improved outcomes and in particular more integrated services for patients. As part of our work we will consider the case for implementing new currencies and contracting models, and whether a more segmented approach to pricing is more appropriate. However, for the purposes of planning, commissioners should assume continuity of current pricing policy. Where appropriate, they should also consider the scope to use the local flexibilities introduced in 2014/15, specifically regarding local pricing variations where they are in the best interests of patients.

http://www.england.nhs.uk/resources/pay-syst/national-tariff/

http://www.england.nhs.uk/resources/pay-syst/national-tariff/

48

England

69. Commissioners should plan on the basis that the underlying level of provider efficiency remains in the 2 to 2.5 per cent range over the five year period. To support delivery of this range, for planning purposes, commissioners should assume that the efficiency factor in tariff remains at 4 per cent. The difference is currently referred to as “leakage” which we believe is the result of some providers and commissioners working together to balance budgets without delivering the full headline level of real efficiency improvement. NHS England and Monitor are however committed to introducing greater transparency into pricing and therefore expect that over time, the difference between underlying efficiency and the efficiency factor will converge. As evidence of greater transparency emerges

over time, we project that the headline efficiency factor could begin to move towards the second row in the table below.

STRATEGIC ENABLERS

The NHS standard contract

70. The NHS standard contract remains the form of contract which commissioners must use for all contracts for clinical services, other than primary care.

71. After a significant re-drafting for 2013/14, the 2014/15 contract will retain the same structure and much of the same detailed content, allowing commissioners and providers to become familiar with using it in practice.

Tariff assumptions

FY 14/15 FY 15/16 FY 16/17 FY 17/18 FY 18/19

Secondary Care health cost inflation 2.3% 2.2% 3.0% 3.4% 3.4%

Provider sector efficiency 4.0% 4.0% 4.0% 4.0% 4.0%

Tariff uplift -1.7% -1.8% -1.0% -0.6% -0.6%

Tariff assumptions

2014/15 2015/16 2016/17 2017/18 2018/19

Projected underlying provider efficiency 2% 2.5% 2% 2% 2%

Efficiency factor assuming reduced leakage 4% 4% 3.1% 2.8% 2.6%

Efficiency factor assuming constant leakage 4% 4% 4% 4% 4%

4948

England72. There will be significantly greater flexibility

for commissioners to determine the duration of the contract they wish to offer, within the framework of national guidelines and regulations on procurement, choice and competition. The standard contract enables innovative contracting models such as the prime provider approach; with increased flexibility on contract duration, together with new tariff flexibilities (Local Payment Variations). Commissioners will be equipped with the tools to enable longer-term, transformational, outcomes-based commissioning approaches.

73. The framework of sanctions within the standard contract has been reviewed in depth, with significant input from stakeholders. The contract for 2014/15 will contain a more consistent and proportionate set of sanctions. We expect commissioners to enforce the standard terms of the contract, including the application of sanctions.

74. An online system for completing the NHS standard contract (the eContract) was made available in February 2013 and an improved, more robust system will be available for use for 2014/15. The eContract approach has significant benefits, for instance in enabling the tailoring of contract content to reflect the specific range of services being commissioned. We strongly encourage CCGs and CSUs to use the eContract during the 2014/15 contracting round. NHS England anticipates that use of the eContract approach will become the norm for directly commissioned services in 2014/15.

75. We expect commissioners to ensure that robust, good value contracts are signed by 28 February 2014.

Pricing and incentives

76. A strategic review of pricing and incentives is underway as part of the Call to Action work. It has the aim of developing a fully integrated set of arrangements which support the emerging strategic priorities and provide the flexibility to implement the new service models which will be required. Arrangements for 2014/15, described below, aim to preserve stability in the short term while providing sufficient local flexibility to enable innovation to flourish.

The Quality Premium: rewarding commissioners

77. The measures to be used to determine the Quality Premium paid to CCGs in 2015/16 on the basis of performance during 2014/15 align with our outcomes ambitions and reflect local decision-making with Health and Wellbeing Boards. NHS England will publish the full methodology to be used for calculation of the Quality Premium in December 2013.

Commissioning for Quality and Innovation (CQUIN)

78. A CQUIN scheme will be in place for 2014/15. The key aim is to secure improvements in the quality of services and better outcomes for patients. Providers will be able to earn up to 2.5 per cent of their annual contract outturn, excluding any income for high cost drugs and devices excluded from national prices.

50

England79. One fifth of the CQUIN scheme will be for

achievement of national improvement goals, as follows:

●● Friends and Family Test – where commissioners will be encouraged to incentivise high performing providers;

●● Improvement against the NHS Safety Thermometer, particularly pressure sores;

●● Improving dementia and delirium care, including sustained improvement in Finding people with dementia, Assessing and Investigating their symptoms and Referring for support (FAIR); and

●● Improving diagnosis in mental health – providers will be rewarded for better assessing and treating the mental and physical needs of their service users.

80. Following three years of funding through the national CQUIN scheme, the VTE CQUIN scheme will not be in place for 2014/15. Providers will be expected to continue to improve their management of VTE risk, and any deterioration in risk assessment from current performance will result in a contract sanction being applied.

81. NHS England will publish separate guidance on the 2014/15 CQUIN scheme in December 2013, including detailed descriptions of the mandated national indicators and guidance on developing local CQUIN indicators and setting improvement trajectories, along with a list of quality assured indicators for optional use.

Non recurrent funds

82. As in previous years, commissioning organisations are required to set aside some of their funding for non-recurrent expenditure. Recognising the need to accelerate efficiencies in 2014/15 both to prepare for the challenges in 2015/16 and to create funding for service change, we have increased the level of resource reserved for non-recurrent expenditure in 2014/15 to 2.5 per cent. Of the total 2.5 per cent, commissioners are asked to plan for 1 per cent of this spend to be applied to transformation of local services. This transformation fund is intended to be used at a local health economy level by commissioners working together to develop and implement plans for change, focusing in particular on any actions required to prepare for the introduction of the Better Care Fund.

5150

England

2 NHS ENGLAND DIRECT COMMISSIONING

DIRECT COMMISSIONING OVERVIEW

83. NHS England has statutory responsibilities to commission services for patients across five areas:

●● primary, medical, dental, pharmacy and optical services and secondary care dental services;

●● specialised services;●● public health section 7A services;●● services for members of the Armed

Forces and their families; and●● services for people in the justice system.

84. In planning for the delivery for those services, NHS England’s Area Teams will ensure they are aligned with CCG commissioning plans. The approach we will adopt is that each Area Team with responsibility for one or more of the above areas will:

●● develop a strategic plan for that service within which there will be greater granularity on the first two years;

●● ensure that each of those strategic plans is visible within relevant Units of Planning;

●● work with CCGs and other local partners to ensure a consistent and coordinated approach across the commissioning of all NHS services and related social care provision; and

●● ensure services are planned on the basis of affordability and securing the best possible outcome for patients.

85. The approach will be nationally consistent to deliver quantifiable improvements for patients within principles of:

●● equity of offer;●● equity of access; and●● equity of outcome.

CONTENT OF PLANS

86. NHS England’s Area Teams will produce strategic and operational plans for the services they commission on the same basis as CCGs. For each of the five areas of NHS England’s commissioning responsibilities, Area Teams will:

●● set out a five year strategic plan for how that service will improve within available resources, including dealing with any structural deficit;

●● include more granular detail for the first two years; and

●● use the measures in the Annexes D-G to identify improvement.

87. For each aspect of our commissioning, the objectives we expect to be achieved are set out below and should be read alongside the measures to be included in plans as set out in Annexes A to G of this guidance, with supporting information in Annex H.

88. Details regarding the content of the Direct Commissioning Plan template can be found in Annex J.

52

England

FINANCIAL PLANNING ASSUMPTIONS

89. The core financial planning assumptions for direct commissioning are set out below.

Direct commissioning excluding public health

Demographic growth

Primary care: Local determination based on resident population in line with crude population projections.

Other: Local determination using age profiled population projections for population covered by Area Teams.

Non-demographic growth Local determination based on historic analysis and evidence.

Tariff changes See above.

Primary care cost increase To be confirmed.

Business rules

2014/15●● Minimum 0.5% contingency ●● 1% cumulative surplus carry

forward●● 2.5% non-recurrent spend.

2015/16-2018/19●● Minimum 0.5% contingency ●● 1% cumulative surplus carry

forward●● 2% non-recurrent spend.

Public health

Demographic growth Local determination using age profiled population projections for population covered by Area Teams.

Business rules

●● Minimum 0.5% contingency ●● 0% cumulative surplus carry forward●● 0% underlying surplus●● 0% non-recurrent spend.

5352

England

3 BETTER CARE FUND PLANNING

BETTER CARE FUND OVERVIEW

90. The Better Care Fund plan requires local areas to formulate a joint plan for integrated health and social care and to set out how their single pooled Better Care Fund budget will be implemented to facilitate closer working between health and social care services. Joint plans should be approved through the relevant local Health and Wellbeing Board and be agreed between all local CCGs and the Upper Tier Local Authority. Health and social care providers should also be closely involved in plan development.

91. The plan should demonstrate clearly how it meets all of the national Better Care Fund conditions, include details of the expected outcomes and benefits of the schemes involved, and confirm how the associated risks to existing NHS services will be managed. The measures we expect CCGs to use in considering the quality of the impact of the Better Care Fund are in Annex I, along with additional supporting information on developing Better Care Fund plans.

92. It is essential that CCGs and Local Authorities engage from the outset with all providers likely to be affected by the use of the Better Care Fund so that plans are developed in a way that achieves the best outcomes for local people. Commissioner and provider plans should have a shared view of the future shape of services. This

should include an assessment of future capacity requirements across the system. CCGs and Local Authorities should also work with providers to help manage the transition to new patterns of provision including, for example, the use of non-recurrent funding to support service change.

FUNDING FOR INTEGRATED CARE

93. In 2014/15, a total of £1,100 million (increased from £859 million) will transfer to Local Authorities for social care to benefit health, using the same formula as 2013/14. This will become transacted through a central Section 256 transfer. In 2015/16, this funding will be part of the pooled Better Care Fund; while it will continue to be allocated to areas on the same basis as in previous years, the funding will be added to CCG allocations. For example, if a Local Authority consists of two equal sized CCGs and it received £10 million from the Section 256 transfer in 2014/15, in 2015/16 the area will still receive £10 million of the £1,100 million, but it will be divided between the two CCGs’ allocations. CCGs will be required to pass this funding to the Better Care Fund pooled budget along with the funding from core CCG allocations, discussed below.

94. From 2015/16, the Better Care Fund will also include a £1.9 billion contribution from core CCG funding, over and above the existing £300 million reablement funding and £130 million carers’ breaks which will also be

5454

Englandpooled in the Better Care Fund. Core CCG funding going to the pooled Better Care Fund will be allocated based upon the CCG allocation formula. Additional contributions to the Better Care Fund from Local Authorities, in the form of social care capital grants and disabled facilities grants, will continue to be allocated to them by central government on the same basis as for 2014/15.

England

555454

GLOSSARY

A Call to Action NHS England document and programme of action focused on the challenge to staff, the public and politicians to help the NHS meet future demands and tackle the funding gap through honest and realistic debate.

Armed Forces Covenant Commitment The armed forces covenant sets out the relationship between the nation, the state and the armed forces. It recognises that the whole nation has a moral obligation to members of the armed forces and their families and it establishes how they should expect to be treated.

Better Care Fund (BCF) A single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities.

Care.data A modern information system which will make increased use of information from medical records with the intention of improving health services. The system is being delivered by the Health and Social Care Information Centre (HSCIC) and NHS England on behalf of the NHS.

CCG Outcomes Indicator Set (CCG OIS) The CCG Outcomes Indicator Set is part of the NHS England’s systematic approach to promoting quality improvement. Its aim is to support clinical commissioning groups and health and wellbeing partners in improving health outcomes by providing comparative information on the quality of health services commissioned by CCGs and the associated health outcomes – and to support transparency and accountability by making this information available to patients and the public.

Clinical Digital Maturity Index (CDMI) The Clinical Digital Maturity Index has been developed by EHI Intelligence in partnership with NHS England. It is a unique benchmarking tool that enables NHS Trusts to better understand how investing and effectively using, information technology can achieve better patient outcomes, reduce bureaucracy, improve patient safety and deliver efficiencies.

Compassion in Practice Compassion in Practice is the three year vision and strategy for nursing, midwifery and care staff drawn up by NHS England and the Department of Health.

575656

EnglandCommissioning for Quality and Innovation (CQUIN) The system introduced in 2009 to make a proportion of healthcare providers’ income conditional on demonstrating improvements in quality and innovation in specified areas of care.

Everyone Counts: Planning for Patients 2013/14 outlines the priorities, incentives and levers that were used to improve services from April 2013, the first year of the new NHS, where improvement was driven by clinical commissioners.

Find, Assess and Investigate, and Refer (FAIR) Improving dementia care, including sustained improvement in finding people with dementia, assessing and investigating their symptoms and referring for support.

Friends and Family Test The Friends and Family Test (FFT) aims to provide a simple headline metric which, when combined with follow-up questions, can drive a culture change of continuous recognition of good practice and potential improvements in the quality of the care received by NHS patients and service users.

Liaison and Diversion Programme The Government’s commitment to having diversion services in place (for children and for adults) in all local areas by 2014. These services are fundamental to the identification and assessment of offenders with health needs and other vulnerabilities to give offenders the right health and social care services.

National Quality Board The National Quality Board (NQB) is a multi-stakeholder board established to champion quality and ensure alignment in quality throughout the NHS. The NQB is a key aspect of the work to deliver high quality care for patients.

NHS Choices NHS Choices is the online ‘front door’ to the NHS. It is the country’s biggest health website and gives all the information citizens need to make choices about their health.

NHS Outcomes Framework The NHS Outcomes Framework sets out the outcomes and corresponding indicators used to hold NHS England to account for improvements in health outcomes.

NHS Safety Thermometer The NHS Safety Thermometer provides a quick and simple method for surveying patient harms and analysing results so that we can measure and monitor local improvement and harm-free care over time.

Personalised Care Plan Personalised care planning goes beyond the normal clinical and medical conditions. It extends into other areas of the individual’s life and recognises that many different issues can impact on their health and well-being.

Quality Premium The Quality Premium rewards CCGs for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities.

Unit of Planning A number of CCGs who have joined together with relevant Area Teams, providers, Local Authorities and Health and Wellbeing Boards to create a footprint of a size large enough to enable effective strategic planning.

England

575656

ANNEXES

ANNEX A: OUTCOMES MEASURES

58

England

Outcome ambition Measure to be used Quality Premium measure Support measure(s)

1. Securing additional years of life for the people of England with treatable mental and physical health conditions.

Potential years of life lost from conditions

considered amenable to healthcare – a rate

generated by number of amenable deaths

divided by the population of the area.

Improvement to be locally set and no less

than 3.2%. CCGs should focus on

improving in areas of deprivation in

developing their plans for reducing mortality.

None

2. Improving the health related quality of life of the 15 million+ people with one or more long-term condition, including mental health conditions.

Health related quality of life for people with

long-term conditions (measured using the EQ5D tool in the GP

Patient Survey).

IAPT roll-out:

i. achieve 15% for CCGs below that level

ii Additional locally set improvement for those over 15% or near 15%.

●● Increase dementia diagnosis rate to 67 per cent by March 2015.

●● Achieve the IAPT recovery rate of 50%.

3. Reducing the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital.

A rate comprised of:●● Unplanned

hospitalisation for chronic ambulatory care sensitive conditions.

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

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

●● Emergency admissions for children with lower respiratory tract infections.

As per outcome measure None

5958

England

Outcome ambition Measure to be used Quality Premium measure Support measure(s)

4. Increasing the proportion of older people living independently at home following discharge from hospital.

No indicator available at CCG level.

CCGs and Area Teams will not be expected to set a quantitative level

of ambition for this outcome. However, they will be expected to set

out how they will improve outcomes on

this ambition in their five year strategic plans.

None

A level of ambition needs to be established at Health and Wellbeing

Board level on the Proportion of older

people (65 and over) who were still at home 91 days after discharge

from hospital into re-ablement/rehabilitation

services.

5. Increasing the number of people having a positive experience of hospital care.

Patient experience of inpatient care.

Friends and Family Test: specific actions to

improve low scores.None

6. Increasing the number of people with mental and physical health conditions having a positive experience of care outside hospital, in general practice and in the community.

Composite indicator comprised of (i) GP

services, (ii) GP Out of Hours.

None None

7. Making significant progress towards eliminating avoidable deaths in our hospitals caused by problems in care.

Hospital deaths attributable to problems in care. This indicator is

in development.

Improving the reporting of medication errors.

●● MRSA zero tolerance●● Clostridium difficile

reduction

All CCG OIS measures are available for planning: http://www.england.nhs.uk/ccg-ois/


60

England

ANNEX B: NHS CONSTITUTION MEASURES

Referral To Treatment waiting times for non-urgent consultant-led treatment

Admitted patients to start treatment within a maximum of 18 weeks from referral – 90%

Non-admitted patients to start treatment within a maximum of 18 weeks from referral – 95%

Patients on incomplete non-emergency pathways (yet to start treatment) should have been waiting no more than 18 weeks from referral – 92%

Diagnostic test waiting times

Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral – 99%

A&E waits

Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E department – 95%

Cancer waits – 2 week wait

Maximum two-week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP – 93%

Maximum two-week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected) – 93%

Cancer waits – 31 days

Maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers – 96%

Maximum 31-day wait for subsequent treatment where that treatment is surgery – 94%

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

Maximum 31-day wait for subsequent treatment where the treatment is a course of radiotherapy – 94%

Cancer waits – 62 days

Maximum two month (62-day) wait from urgent GP referral to first definitive treatment for cancer – 85%

Maximum 62-day wait from referral from an NHS screening service to first definitive treatment for all cancers – 90%

Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority of the patient (all cancers) – no operational standard set

6160

England

Category A ambulance calls

Category A calls resulting in an emergency response arriving within 8 minutes – 75% (standard to be met for both Red 1 and Red 2 calls separately)

Category A calls resulting in an ambulance arriving at the scene within 19 minutes – 95%

NHS Constitution support measures

Mixed Sex Accommodation Breaches

Minimise breaches

Cancelled Operations

All patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the patient’s

treatment to be funded at the time and hospital of the patient’s choice.

Mental health

Care Programme Approach (CPA): The proportion of people under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care during the period – 95%

Referral To Treatment waiting times for non-urgent consultant-led treatment

Zero tolerance of over 52 week waiters

A&E waits

No waits from decision to admit to admission (trolley waits) over 12 hours

Cancelled Operations

No urgent operation to be cancelled for a 2nd time

Ambulance Handovers

All handovers between ambulance and A & E must take place within 15 minutes and crews should be ready to accept new calls within a further 15 minutes. Financial penalties, in both cases, for delays over

30 minutes and over an hour.

62

England

ANNEX C: ACTIVITY MEASURES

Elective

Elective – ordinary admissions FFCEs

Elective – day cases FFCEs

Non elective

Non Elective admissions FFCEs

Outpatients

All first outpatient attendances in general and acute specialties

All subsequent outpatient attendances in general and acute specialties

A&E

A&E attendances – Type 1

A&E attendances – Total all types

Referrals

GP written referrals from GPs for a first outpatient appointment in general and acute specialties

Other referrals for a first outpatient appointment in general and acute specialties

First outpatient attendances following GP referral in general and acute specialties

6362

England

ANNEX D: PRIMARY CARE MEASURES

Medical

Patient satisfaction

Satisfaction with the quality of consultation at the GP practice

Satisfaction with the overall care received at the surgery

Satisfaction with accessing primary care

Referrals

Proportion of new cancer cases referred using 2 week wait pathway

Vaccinations

Flu vaccinations – at risk coverage

Mental health

Identifying the prevalence of depression compared to estimated model

Dental

Access

% Patients seen – 24 month measure

Activity

Number of course of treatments per 100,000 population

Patient experience

GPPS % Positive experience

General Ophthalmic Services

Activity

Total number of sight tests/per 100,000 population

Quality and Innovation

%of tints per voucher

% of repairs per voucher and % of replacements per voucher

% of prisms per voucher

64

England

ANNEX E: SPECIALISED SERVICES MEASURES

Referrals

% of all NHS England patients receiving treatment within 18 wks of referral

Diagnostics

% of NHS England patients waiting 6 weeks or more for diagnostic tests

6564

England

ANNEX F: PUBLIC HEALTH SECTION 7A SERVICES MEASURES

Vaccinations

Population vaccination coverage – Dtap/IPV/Hib (1 year old)

Population vaccination coverage – MenC

Population vaccination coverage – PCV

Population vaccination coverage – Dtap/IPV/Hib (2 years old)

Population vaccination coverage – PCV booster

Population vaccination coverage – Hib/MenC booster (2 years old)

Population vaccination coverage – MMR for one dose (2 years old)

Population vaccination coverage – MMR for one dose (5 years old)

Population vaccination coverage – MMR for two doses (5 years old)

Population vaccination coverage – Hib/Men C booster (5 years)

Population vaccination coverage – Hepatitis B (1 year old)

Population vaccination coverage – Hepatitis B (2 years old)

Population vaccination coverage – HPV

Population vaccination coverage – PPV

Population vaccination coverage – Flu (aged 65+)

Population vaccination coverage – Flu (at risk individuals)

66

England

Screening

% of pregnant women eligible for infectious disease screening who are tested for HIV, leading to a conclusive result

% of women booked for antenatal care, as reported by maternity services, who have a screening test for syphilis, hepatitis B and susceptibility to rubella leading to a conclusive result

% of pregnant women eligible for antenatal sickle cell and thalassaemia screening for whom a conclusive screening result is available at the day of report

% of babies registered within the local authority area both at birth and at the time of report who are eligible for newborn blood spot screening and have a conclusive result recorded on the Child Health

Information System within an effective timeframe

% of babies eligible for newborn hearing screening for whom the screening process is complete within 4 weeks corrected age (hospital programmes – well babies, all programmes – NICU babies) or 5 weeks

corrected age (community programmes – well babies)

% of babies eligible for the newborn physical examination who were tested within 72 hours of birth

% of those offered screening for diabetic eye screening who attend a digital screening event

Abdominal Aortic Aneurysm (AAA) KPI

Breast cancer screening coverage % of eligible women screened adequately within the previous 3 years on 31st March

Cervical cancer screening coverage % of eligible women screened adequately within the previous 3.5 or 5.5 years (according to age) on 31st March

Bowel Cancer screening – uptake and coverage over 2.5 years

Family health services

No. of FTE Health Visitors

6766

England

ANNEX G: HEALTH AND JUSTICE MEASURES

Health commissioned services

Deliver chronic disease care to the same standard of process and outcomes as is required by the National Service Frameworks for: Diabetes, CHD and Long Term Conditions and Mental Health and a

QOF score is available

Access and waiting time

Access and waiting time

Learning disabilities

% of identified patients with a learning disability have an annual health check

Mental health

% of all prisoners returning to prison from any other Mental Health facility following treatment under the Mental Health Act (including section 3, 47, 48) are accompanied by a 117 aftercare programme

68

England

ANNEX H: DIRECT COMMISSIONING SUPPORTING INFORMATION

PRIMARY, MEDICAL, DENTAL, PHARMACY AND OPTICAL SERVICES AND SECONDARY CARE

DENTAL SERVICES

1. There are two central objectives to our commissioning:●● to develop more integrated out-of-hospital services that help people stay healthy and provide

proactive, coordinated support, particularly for people with long-term conditions; and●● for our Area Teams, CCGs and Local Professional Networks to work collaboratively with local

communities to develop joint strategies for commissioning primary care and wider community services, based on patient and public insight. These should be part of an integrated strategy for out-of-hospital care.

2. Local strategic plans should include specific actions to support development of general practice services in ways that reflect the six key characteristics of high-quality care set out in our general practice A Call to Action as follows:

●● proactive coordination of care, particularly for people with long-term conditions and more complex health and care problems;

●● holistic care: addressing people’s physical health needs, mental health needs and social care needs in the round;

●● ensuring fast, responsive access to care and preventing avoidable emergency admissions and A&E attendances;

●● preventing ill-health, ensuring more timely diagnosis of ill-health, and supporting wider action to improve community health and wellbeing;

●● involving patients and carers more fully in managing their own health and care; and●● ensuring consistently high quality of care: effectiveness, safety and patient experience.

3. Area Teams should also work with their Local Professional Networks and, where appropriate, CCGs to develop equivalent commissioning strategies for dental care, community pharmacy care and eye care services, again as part of an integrated out-of-hospital strategy.

PRIMARY CARE SUPPORT SERVICES

4. NHS England is responsible for primary care support (PCS) services (also known as family health services or FHS). NHS England wants all practitioners to have access to a standard range of modern, efficient and effective PCS/FHS services which meet their needs.

6968

England5. The range of PCS/FHS services provided to primary care providers currently varies from area to

area. Figures from November 2012 indicated that their costs also varied from around 80p to £2.70 per head of population. NHS England wants to reduce the PCS/FHS budget from £100 million in 2013/14 to £60 million in 2014/15, although any cost reduction must be in the context of delivering safe, high quality and effective services at all times.

6. NHS England will progress work through 2013 into 2014 to achieve a safe transition in PCS services. Efficiencies will be created by:

●● having a standard specification for core PCS/FHS services that will be funded by NHS England;●● achieving ‘best practice’ levels of quality and cost across all services;●● providing services from fewer sites; ●● making more and better use of technology; and●● changing some of the ways services are delivered.

SPECIALISED SERVICES

7. As part of A Call to Action, NHS England is developing a five year strategy for specialised services. This will address the service specific objectives for the next five years, overarching strategic objectives for the provision of a system of specialised health care as a whole and the impact of co-dependency between service areas.

8. The published commissioning intentions for 2014-2016 commit NHS England to a six strand strategic commissioning approach:

i. Ensuring consistent access to the effective treatments for patients in line with evidence based clinical policies, underpinned by clinical practice audit.

ii. A clinical sustainability programme with all providers focused on quality and value through:●● achieving and maintaining compliance with full service specifications, and making changes to

service provision where there is no realistic prospect of standards being met;●● refreshing and focusing Commissioning for Quality and Innovation (CQUIN) schemes to

directly contribute to improving outcomes with challenging, but achievable goals; and●● providing transparency in service quality through the continued development of service level

quality dashboards and improvements in data flows.

iii. An associated financial sustainability programme with all providers, focused on better value through a two year programme of productivity and efficiency improvement.

iv. A systematic market review for all services to ensure the right capacity is available, consolidating services where appropriate, to address clinical or financial sustainability issues.

70

Englandv. Adopting new approaches to commissioning care where it promotes integrated care and clinical

oversight for patients, in particular services and care pathways to include a prime contractor model and co-commissioning with CCGs.

vi. A systematic rules-based approach to in-year management of contractual service delivery.

9. In their plans we expect NHS England’s Area Teams to address any structural deficit from 2013/14. Cost growth will need to be constrained, greater consistency of provision secured and the quality of services maintained or improved.

PUBLIC HEALTH SECTION 7A SERVICES

10. It is our objective to ensure the effective commissioning of certain public health services: immunisation and screening programmes, children’s public health services from pregnancy to age five, child health information systems, public health for people in places of detention, and sexual assault services.

11. We will continue the effective implementation of the section 7A agreement, of which there are two overarching ambitions:

●● to increase the pace of change for the full implementation of the national service specifications; and

●● to set performance ‘floors’ to address unacceptably low performance by local providers.

12. NHS England’s Area Teams will implement the specific changes from 2014/15, in line with these ambitions:

●● new trajectories for roll out of the Family Nurse Partnership and the Health Visitor Programmes;●● a revised specification for Pneumococcal Vaccination;●● introduction of HPV testing in women with mild/borderline changes in their cervical screening;●● revised performance baselines for bowel and diabetic eye screening;●● extension of the bowel screening programme for men and women up to 75;●● a minor change to the service specification for seasonal flu;●● a meningitis C catch up programme for university entrants;●● continuation of a time limited MMR campaign for people over 16 and a catch-up campaign for

teenagers;●● continuation of the temporary programme for pertussis for pregnant women;●● implementation of DNA testing for sickle cell and thalassemia screening;●● a shingles catch up programme planned for 71-79 year olds, starting with 78 and 79 year olds;

and

7170

England●● a number of developments for Sexual Assault Referral Centres to develop the service and make

it more equitable.

13. We intend to extend flu vaccinations to all children over time. When fully implemented this will be the largest single immunisation programme that has yet been introduced. The extent to which the programme can be rolled out in 2014/15 and the expected uptake rates have not yet been agreed. They remain subject to an assessment of NHS England’s commissioning capacity, and the development of robust workforce models for delivery of the programme, which will be completed in early 2014. These will be confirmed through a variation to the section 7A agreement. Prior to this planned variation, the proposed section 7A agreement for 2014/15 confirms that NHS England shares the ambition to offer vaccines to all children between 2 and 4 years old and as many secondary school aged children as possible in 2014/15.

SERVICES FOR MEMBERS OF THE ARMED FORCES AND THEIR FAMILIES

14. We want to see the following achieved:●● that the commissioning of services is organised in such a way as to provide the best possible

patient outcomes and avoid any geographical or organisational variation;●● to continue to embed the single operating model as described in Securing Excellence for Armed

Forces and their Families;●● full implementation of the Armed Forces Covenant Commitment;●● to work in partnership with the Ministry of Defence (DMS Personnel and Recovery)

commissioning healthcare in line with the Armed Forces National Partnership Agreement; and●● to collaborate with CCGs to ensure services are locally integrated and to develop strong Armed

Forces networks across England.

SERVICES FOR PEOPLE IN THE JUSTICE SYSTEM

15. We will continue the implementation of the single operating framework and commissioning intentions (developed jointly with National Offender Management Service, Public Health England, Youth Justice Board, Home Office Immigration Enforcement and Police Custody Healthcare) in a range of Justice services settings:

●● Prisons;●● Young Offender Institutes;●● Secure Children’s Homes;●● Immigration and Removal Centres;●● Police Custody Suites; and●● Court Liaison Services.

72

England16. Specifically our priorities from 2014/15 are:

●● to ensure that commissioning is informed by an up-to-date health needs assessment, taking account of the reconfiguration of the custodial estate, including the creation of Resettlement Prisons;

●● to support sustainable recovery from addiction to drugs and alcohol and improved mental health services;

●● promotion of continuity of care from custody to community and between establishments, working closely with Probation Services, Local Authorities and CCGs;

●● development of a full understanding of the healthcare needs of children and young people accommodated in the secure estate and work collaboratively to commission services to meet these needs;

●● continued close collaboration with our partners in the successful implementation of the Liaison and Diversion Programme; and

●● to ensure timely and effective transition of commissioning responsibility for healthcare in immigration and removal centres.

7372

England

ANNEX I: BETTER CARE FUND MEASURES AND INFORMATION

BETTER CARE FUND MEASURES

Transfers

Delayed transfers of care

Admissions

Emergency admissions

Admissions to residential and nursing care

Reablement

Effectiveness of reablement

Patient/service user experience

Patient/service user experience

WHAT IS INCLUDED IN THE BETTER CARE FUND AND WHAT DOES IT COVER?

1. The Better Care Fund (previously referred to as the Integration Transformation Fund) was announced in June as part of the 2013 Spending Round. It provides an opportunity to transform local services so that people are provided with better integrated care and support. It encompasses a substantial level of funding to help local areas manage pressures and improve long term sustainability. The Fund will be an important enabler to take the integration agenda forward at scale and pace, acting as a significant catalyst for change.

2. The Better Care Fund provides an opportunity to improve the lives of some of the most vulnerable people in our society, giving them control, placing them at the centre of their own care and support, and, in doing so, providing them with a better service and better quality of life.

3. The Fund will support the aim of providing people with the right care, in the right place, at the right time, including through a significant expansion of care in community settings. This will build on the work Clinical Commissioning Groups (CCGs) and councils are already doing, for example, as part of the integrated care “pioneers” initiative, through Community Budgets, through work with the Public Service Transformation Network, and on understanding the patient/service user experience.

74

England

WHAT IS INCLUDED IN THE BETTER CARE FUND AND WHAT DOES IT COVER?

4. The Fund provides for £3.8 billion worth of funding in 2015/16 to be spent locally on health and care to drive closer integration and improve outcomes for patients and service users and carers. In 2014/15, in addition to the £859m transfer already planned from the NHS to adult social care, a further £241m will transfer to enable localities to prepare for the Better Care Fund in 2015/16.

5. The tables below summarise the elements of the Spending Round announcement on the Fund:

The June 2013 Spending Round set out the following:

2014/15 2015/16

A further £241m transfer from the NHS to adult social care, in addition to the £859m

transfer already planned

£3.8bn to be deployed locally on health and social care through pooled budget arrangements

In 2015/16 the Fund will be created from:

£1.9bn of NHS funding

£1.9bn based on existing funding in 2014/15 that is allocated across the health and wider care system. This will comprise:

£130m Carers’ Break funding

£300m CCG reablement funding

£354m capital funding (including £220m Disabled Facilities Grant)

£1.1bn existing transfer from health to adult social care.

6. For 2014/15 there are no additional conditions attached to the £859m transfer already announced, but NHS England will only pay out the additional £241m to councils that have jointly agreed and signed off two-year plans for the Better Care Fund.

7. In 2014/15 there are no new requirements for pooling of budgets. The requirements for the use of the funds transferred from the NHS to Local Authorities in 2014/15 remain consistent with the guidance19 from the Department of Health (DH) to NHS England on 19 December 2012 on the funding transfer from NHS to social care in 2013/14. In line with this:

●● “The funding must be used to support adult social care services in each local authority, which also has a health benefit. However, beyond this broad condition we want to provide flexibility for local areas to determine how this investment in social care services is best used.

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

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

7574

England●● A condition of the transfer is that the local authority agrees with its local health partners how the

funding is best used within social care, and the outcomes expected from this investment. Health and wellbeing boards will be the natural place for discussions between NHS England, clinical commissioning groups and councils on how the funding should be spent, as part of their wider discussions on the use of their total health and care resources.

●● In line with our responsibilities under the Health and Social Care Act, an additional condition of the transfer is that councils and clinical commissioning groups have regard to the Joint Strategic Needs Assessment for their local population, and existing commissioning plans for both health and social care, in how the funding is used.

●● A further condition of the transfer is that Local Authorities councils and clinical commissioning groups demonstrate how the funding transfer will make a positive difference to social care services, and outcomes for service users, compared to service plans in the absence of the funding transfer”

8. Councils should use the additional £241m to prepare for the implementation of pooled budgets in April 2015 and to make early progress against the national conditions and the performance measures set out in the locally agreed plan. This is important, since some of the performance-related money is linked to performance in 2014/15.

9. The £3.8bn Fund includes £130m of NHS funding for carers’ breaks. Local plans should set out the level of resource that will be dedicated to carer-specific support, including carers’ breaks, and identify how the chosen methods for supporting carers will help to meet key outcomes (e.g. reducing delayed transfers of care). The Fund also includes £300m of NHS funding for reablement services. Local plans will therefore need to demonstrate a continued focus on reablement

10. It was announced as part of the Spending Round that the Better Care Fund would include funding for costs to councils resulting from care and support reform. This money is not ring-fenced, but local plans should show how the new duties are being met.

i. £50m of the capital funding has been earmarked for the capital costs (including IT) associated with transition to the capped cost system, which will be implemented in April 2016.

ii. £135m of revenue funding is linked to a range of new duties that come in from April 2015 as a result of the Care Bill. Most of the cost results from new entitlements for carers and the introduction of a national minimum eligibility threshold, but there is also funding for better information and advice, advocacy, safeguarding and other measures in the Care Bill.

76

England

WHAT WILL BE THE STATUTORY FRAMEWORK FOR THE FUND?

11. In 2015/16 the Fund will be allocated to local areas, where it will be put into pooled budgets under Section 75 20 joint governance arrangements between CCGs and councils. A condition of accessing the money in the Fund is that CCGs and councils must jointly agree plans for how the money will be spent, and these plans must meet certain requirements.

12. Funding will be routed through NHS England to protect the overall level of health spending and ensure a process that works coherently with wider NHS funding arrangements.

13. DH will use the Mandate for 2015/16 to instruct NHS England to ring-fence its contribution to the Fund and to ensure this is deployed in specified amounts at local level for use in pooled budgets by CCGs and Local Authorities.

14. Legislation is needed to ring-fence NHS contributions to the Fund at national and local levels, to give NHS England powers to assure local plans and performance, and to ensure that Local Authorities not party to the pooled budget can be paid from it, through additional conditions in Section 31 of the Local Government Act 2003. This will ensure that the Disabled Facilities Grant (DFG) can be included in the Fund

15. The DFG has been included in the Fund so that the provision of adaptations can be incorporated in the strategic consideration and planning of investment to improve outcomes for service users. DFG will be paid to upper-tier authorities in 2015/16. However, the statutory duty on local housing authorities to provide DFG to those who qualify for it will remain. Therefore each area will have to allocate this funding to their respective housing authorities (district councils in two-tier areas) from the pooled budget to enable them to continue to meet their statutory duty to provide adaptations to the homes of disabled people, including in relation to young people aged 17 and under.

16. Special conditions will be added to the DFG Conditions of Grant Usage (under Section 31 of the Local Government Act 2003) which stipulate that, where relevant, upper-tier Local Authorities or CCGs must ensure they cascade the DFG allocation to district council level in a timely manner such that it can be spent within year. Further indicative minimum allocations for DFG have been provided for all upper-tier authorities, with further breakdowns for allocations at district council level as the holders of the Fund may decide that additional funding is appropriate to top up the minimum DFG funding levels.

17. DH and the Department for Communities and Local Government (DCLG) will also use Section 31 of the Local Government Act 2003 to ensure that DH Adult Social Care capital grants (£134m) will reach

20 Sec 75 of the NHS Act, 2006, provides for CCGs and Local Authorities to pool budgets.

7776

Englandlocal areas as part of the Fund. Relevant conditions will be attached to these grants so that they are used in pooled budgets for the purposes of the Fund. DH, DCLG and the Treasury will work together in early 2014 to develop the terms and conditions of these grants.

HOW WILL LOCAL FUND ALLOCATIONS BE DETERMINED?

18. Councils will receive their detailed funding allocations in the normal way. NHS allocations will be two-year allocations for 2014/15 and 2015/16 to enable more effective planning.

19. In 2014/15 the existing £859m s.256 transfer to councils for adult social care to benefit health, and the additional £241m, will continue to be distributed using the social care relative needs formula (RNF).

20. The formula for distribution of the full £3.8bn fund in 2015/16 will be based on a financial framework agreed by ministers. The current social care transfer of £1.1bn and the £134m of adult social care capital funding included in the Fund in 2015/16 will be allocated in the same way as in 2014/15. DFG will be allocated based on the same formula as 2014/15. The remainder of the Fund will be allocated on the basis of the CCG allocations formula. It will be for local areas to decide how to spend their allocations on health and social care services through their joint plan.

21. The announcement of the two-year CCG allocations, communicated to CCGs and councils alongside this planning guidance, includes the Fund allocations in 2015/16. In 2014/15, the additional £241m will be transferred directly from NHS England to councils along with the rest of the adult social care transfer. The local authority and CCGs in each Health and Wellbeing Board area will receive a notification of their share of the pooled fund for 2014/15 and 2015/16 based on the aggregate of the allocation mechanisms. The allocation letter also specifies the amount that is included in the payment-for-performance element, and is therefore contingent in part on planning and performance in 2014/15 and in part on achieving specified goals in 2015/16.

22. Allocation letters will specify only the minimum amount of funds to be included in pooled budgets. CCGs and councils are free to extend the scope of their pooled budget to support better integration in line with their Joint Health and Wellbeing Strategy.

23. The wider powers to use Health Act flexibilities to pool funds, share information and staff are unaffected by the new Better Care Fund requirements, and will be helpful in taking this work forward.

78

England

HOW SHOULD COUNCILS AND CCGs DEVELOP AND AGREE A JOINT PLAN FOR THE FUND?

24. Each statutory Health and Wellbeing Board will sign off the plan for its constituent councils and CCGs. The Fund plan must be developed as a fully integral part of a CCG’s wider strategic and operational plan, but the Better Care Fund elements must be capable of being extracted to be seen as a stand-alone plan.

25. Where a unit of planning chosen by a CCG for its strategic and operational plan is not consistent with the boundaries of the Health and Wellbeing Board, or Boards, with which it works, it will be necessary for the CCG to reconcile the Better Care Fund element of its plan to the Health and Wellbeing Board level. NHS England will support CCGs in this position to ensure that plans are properly aligned.

26. The specific priorities and performance goals in the plan are clearly a matter for each locality but it will be valuable to be able to:

●● aggregate the ambitions set for the Fund across all Health and Wellbeing Boards; ●● assure that the national conditions have been achieved; and●● understand the performance goals and payment regimes that have been agreed in each area.

27. To assist Health and Wellbeing Boards we have developed a template which we expect everyone to use in developing, agreeing and publishing their Better Care Plan. This is published alongside this guidance as a separate Word document and Excel spread sheet. The template sets out the key information and metrics that all Health and Wellbeing Boards will need to assure themselves that the plan addresses the conditions of the Fund.

28. As part of this template, local areas should provide an agreed shared risk register. This should include an agreed approach to risk sharing and mitigation covering, as a minimum, the impact on existing NHS and social care delivery and the steps that will be taken if activity volumes do not change as planned (for example, if emergency admissions or nursing home admissions increase).

29. CCGs and councils must engage from the outset with all providers, both NHS and social care (and also providers of housing and other related services), likely to be affected by the use of the fund in order to achieve the best outcomes for local people. The plans must clearly set out how this engagement has taken place. Providers, CCGs and councils must develop a shared view of the future shape of services, the impact of the Fund on existing models of service delivery, and how the transition from these models to the future shape of services will be made. This should include an assessment of future capacity and workforce requirements across the system. It will be important to work closely with Local Education and Training Boards and the market shaping functions of councils, as well as with providers themselves, on the workforce implications to ensure that there is a consistent approach to workforce planning for both providers and commissioners.

7978

England30. CCGs and councils should also work with providers to help manage the transition to new patterns of

provision including, for example, the use of non-recurrent funding to support disinvestment from services. It is also essential that the implications for all local providers are set out clearly for Health and Wellbeing Boards and that their agreement for the deployment of the Fund includes agreement to all the service change consequences.

WHAT ARE THE NATIONAL CONDITIONS?

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

National Condition Definition

Plans to be jointly agreed

The Better Care Fund Plan, covering a minimum of the pooled fund specified in the Spending Round, and potentially extending to the totality

of the health and care spend in the Health and Wellbeing Board area, should be signed off by the Health and Well Being Board itself, and by the

constituent Councils and Clinical Commissioning Groups.

In agreeing the plan, CCGs and councils should engage with all providers likely to be affected by the use of the fund in order to achieve the best outcomes for local people. They should develop a shared view of the future shape of services. This should include an assessment of future

capacity and workforce requirements across the system. The implications for local providers should be set out clearly for Health and Wellbeing

Boards so that their agreement for the deployment of the fund includes recognition of the service change consequences.

Protection for social care services (not spending)

Local areas must include an explanation of how local adult social care services will be protected within their plans. The definition of protecting services is to be agreed locally. It should be consistent with the 2012

Department of Health guidance referred to in paragraphs 8 to 11, above.

As part of agreed local plans, 7-day

services in health and social care to support

patients being discharged and

prevent unnecessary admissions at

weekends

Local areas are asked to confirm how their plans will provide 7-day services to support patients being discharged and prevent unnecessary admissions at weekends. If they are not able to provide such plans, they

must explain why. There will not be a nationally defined level of 7-day services to be provided. This will be for local determination and

agreement.

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

within existing resources.

80

England

National Condition Definition

Better data sharing between health and

social care, based on the NHS number

The safe, secure sharing of data in the best interests of people who use care and support is essential to the provision of safe, seamless care.

The use of the NHS number as a primary identifier is an important element of this, as is progress towards systems and processes that allow

the safe and timely sharing of information. It is also vital that the right cultures, behaviours and leadership are demonstrated locally, fostering a

culture of secure, lawful and appropriate sharing of data to support better care.

Local areas should: ●● confirm that they are using the NHS Number as the primary identifier

for health and care services, and if they are not, when they plan to; ●● confirm that they are pursuing open APIs (ie. systems that speak to

each other); and●● ensure they have the appropriate Information Governance controls in

place for information sharing in line with Caldicott 2, and if not, when they plan for it to be in place.

NHS England has already produced guidance that relates to both of these areas. (It is recognised that progress on this issue will require the

resolution of some Information Governance issues by DH).

Ensure a joint approach to

assessments and care planning and ensure that, where funding is used for

integrated packages of care, there will be

an accountable professional

Local areas should identify which proportion of their population will be receiving case management and a lead accountable professional, and

which proportions will be receiving self-management help – following the principles of person-centred care planning. Dementia services will be a particularly important priority for better integrated health and social care

services, supported by accountable professionals.

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

those with complex needs.

Agreement on the consequential impact

of changes in the acute sector

Local areas should identify, provider-by-provider, what the impact will be in their local area. Assurance will also be sought on public and patient

and service user engagement in this planning, as well as plans for political buy-in.

Ministers have indicated that, in line with the Mandate requirements on achieving parity of esteem for mental health, plans should not have a

negative impact on the level and quality of mental health services.

8180

England

HOW WILL COUNCILS AND CCGs BE REWARDED FOR MEETING GOALS?

32. The Spending Round indicated that £1bn of the £3.8bn would be linked to achieving outcomes. Ministers have agreed the basis on which this payment-for-performance element of the Fund will operate.

33. Half of the £1bn will be released in April 2015. £250m of this will depend on progress against four of the six national conditions and the other £250m will relate to performance against a number of national and locally determined metrics during 2014/15. The remainder (£500m) will be released in October 2015 and will relate to further progress against the national and locally determined metrics.

34. The performance payment arrangements are summarised in the table below:

WhenPayment for performance

amountPaid for

April 2015

£250m

Progress against four of the national conditions:●● protection for adult social care services ●● providing 7-day services to support patients being discharged

and prevent unnecessary admissions at weekends ●● agreement on the consequential impact of changes in the

acute sector; ●● ensuring that where funding is used for integrated packages

of care there will be an accountable lead professional

£250m

Progress against the local metric and two of the national metrics:●● delayed transfers of care; and●● avoidable emergency admissions.

October 2015 £500m Further progress against all of the national and local metrics.

82

England

NATIONAL AND LOCAL METRICS

35. Only a limited number of national measures can be used to demonstrate progress towards better integrated health and social care services in 2015/16, because of the need to establish a baseline of performance in 2014/15. National metrics for the Fund have therefore been based on a number of criteria, in particular the need for data to be available with sufficient regularity and rigour.

36. The national metrics underpinning the Fund will be:●● admissions to residential and care homes;●● effectiveness of reablement;●● delayed transfers of care;●● avoidable emergency admissions; and●● patient/service user experience.

37. The measures are the best available but do have shortcomings. Local plans will need to ensure that they are applied sensitively and do not adversely affect decisions on the care of individual patients and service users.

38. Further technical guidance will be provided on the national metrics, including the detailed definition, the source of the data underpinning the metric, the reporting schedule and advice on the statistical significance of ambitions for improvement.

39. Due to the varying time lags for the metrics, different time periods will underpin the two payments for the Fund as set out in the table below. Data for the first two of these metrics, on admissions to residential and care homes and the effectiveness of reablement, are currently only available annually and so will not be available to be included in the first payment in April 2015.

MetricApril 2015 payment

based on performance in

October 2015 payment based on performance

in

Admissions to residential and care homes N/A Apr 2014 – Mar 2015

Effectiveness of reablement N/A Apr 2014 – Mar 2015

Delayed transfers of care Apr – Dec 2014 Jan – Jun 2015

Avoidable emergency admissions Apr – Sept 2014 Oct 2014 – Mar 2015

Patient/service user experience N/A Details TBC

8382

England40. For the metric on patient/service user experience, no single measure of the experience of integrated

care is currently available, as opposed to quality of health care or social care alone. A new national measure is being developed, but will not be in place in time to measure improvements in 2015/16. In the meantime, further details will be provided shortly on how patient/service user experience should be measured specifically for the purpose of the Fund.

41. In addition to the five national metrics, local areas should choose one additional indicator that will contribute to the payment-for-performance element of the Fund. In choosing this indicator, it must be possible to establish a baseline of performance in 2014/15.

42. A menu of possible local metrics selected from the NHS, Adult Social Care and Public Health Outcomes Frameworks is set out in the table below:

NHS Outcomes Framework

2.1 Proportion of people feeling supported to manage their (long term) condition

2.6i Estimated diagnosis rate for people with dementia

3.5 Proportion of patients with fragility fractures recovering to their previous levels of mobility/walking ability at 30/120 days

Adult Social Care Outcomes Framework

1A Social care-related quality of life

1H Proportion of adults in contact with secondary mental health services living independently with or without support

1D Carer-reported quality of life

Public Health Outcomes Framework

1.18i Proportion of adult social care users who have as much social contact as they would like

2.13ii Proportion of adults classified as “inactive”

2.24i Injuries due to falls in people aged 65 and over

43. Local areas must either select one of the metrics from this menu, or agree a local alternative. Any alternative chosen must meet the following criteria:

●● it has a clear, demonstrable link with the Joint Health and Wellbeing Strategy;●● data is robust and reliable with no major data quality issues (e.g. not subject to small numbers);●● it comes from an established, reliable (ideally published) source;●● timely data is available, in line with requirements for pay for performance;●● the achievement of the locally set level of ambition is suitably challenging; and●● it creates the right incentives.

84

England44. Each metric will be of equal value for the payment for performance element of the Fund.

45. Local areas should set an appropriate level of ambition for improvement against each of the national indicators, and the locally determined indicator. In signing off local plans, Health and Wellbeing Boards should be mindful of the link to the levels of ambition on outcomes that CCGs have been asked to set as part of their wider strategic and operational plans. Both the effectiveness of reablement and avoidable emergency admissions outcomes metrics are consistent with national metrics for the Fund, and so Health and Wellbeing Boards will need to ensure consistency between the CCG levels of ambitions and the Fund plans.

46. In agreeing specific levels of ambition for the metrics, Health and Wellbeing Boards should be mindful of a number of factors, such as:

●● having a clear baseline against which to compare future performance;●● understanding the long-run trend to ensure that the target does not purely reward improved

performance consistent with trend increase;●● ensuring that any seasonality in the performance is taken in to account; and●● ensuring that the target is achievable, yet challenging enough to incentivise an improvement in

integration and improved outcomes for users.

47. In agreeing levels of ambition, Health and Wellbeing Boards should also consider the level required for a statistically significant improvement. It would not be appropriate for the level of ambition to be set such that it rewards a small improvement that is purely an artefact of variation in the underlying dataset.

HOW WILL PLANS BE ASSURED?

48. Ministers, stakeholder organisations and people in local areas will wish to be assured that the Fund is being used for the intended purpose, and that the local plans credibly set out how improved outcomes and wellbeing for people will be achieved, with effective protection of social care and integrated activity to reduce emergency and urgent health demand.

49. To maximise our collective capacity to achieve these outcomes and deliver sustainable services the NHS and local government will have a shared approach to supporting local areas and assuring plans.

50. The most important element of assurance for plans will be the requirement for them to be signed-off by the Health and Wellbeing Board. The Health and Wellbeing Board is best placed to decide whether the plans are the best for the locality, engaging with local people and bringing a sector-led approach to the process.

8584

England51. The plans will also go through an assurance process involving NHS England and the LGA to assure

Ministers. The key elements of the overall assurance process are as follows:●● Plans are presented to the Health and Wellbeing Board, which considers whether the plans are

sufficiently challenging and will deliver tangible benefits for the local population (linked to the Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy).

●● If the Health and Wellbeing Board is not satisfied, and the plan is still lacking after a process of progressive iteration, an element of local government and NHS peer challenge will be facilitated by NHS England and the LGA.

●● NHS England’s process for assuring CCG strategic and operational plans will include a specific focus on the element of the plan developed for the Fund. This will allow us to summarise, aggregate and rate all plans, against criteria agreed with government departments and the LGA, to provide an overview of Fund plans at national, regional and local level.

●● This overview will be reviewed by a Departmental-led senior group comprised of DH, DCLG, HMT, NHS England and LGA officials, supported by external expertise from the NHS and local government. Where issues of serious concern are highlighted the group will consider how issues may be resolved, either through provision of additional support or escalation to Ministers.

●● Where necessary, Ministers (supported by the senior group) will meet representatives from the relevant LAs and CCGs to account for why they have not been able to produce an acceptable plan and agree next steps to formulate such a plan.

●● Ministers will give the final sign-off to plans and the release of performance related funds.

WHAT WILL BE THE CONSEQUENCES OF FAILURE TO ACHIEVE IMPROVEMENT?

52. Ministers have considered whether local areas which fail to achieve the levels of ambition set out in their plan should have their performance-related funding withdrawn, to be reallocated elsewhere. However, given the scale and complexity of the challenge of developing plans for the first time, they have agreed that such a sanction will not be applied in 2015/16. Further consideration will be given to whether it should be introduced in subsequent years.

53. If a local area achieves 70% or more of the levels of ambition set out in each of the indicators in its plan, it will be allowed to use the held-back portion of the performance pool to fund its agreed contingency plan, as necessary.

54. If an area fails to deliver 70% of the levels of ambition set out in its plan, it may be required to produce a recovery plan. This will be developed with the support of a peer review process involving colleagues from NHS and local government organisations in neighbouring areas. The peer review process will be co-ordinated by NHS England, with the support of the LGA.

86

England55. If the recovery plan is agreed by the Health and Wellbeing Board, NHS England and the local

government peer reviewer, the held-back portion of the performance payment from the Fund will be made available to fund the recovery plan.

56. If a recovery plan cannot be agreed locally, and signed-off by the peer reviewers, NHS England will direct how the held-back performance related portion of the Fund should be used by the local organisations, subject to the money being used for the benefit of the health and care system in line with the aims and conditions of the Fund.

57. Ministers will have the opportunity to give the final sign-off to peer-reviewed recovery plans and to any directions given by NHS England on the use of funds in cases where it has not been possible to agree a recovery plan.

WHEN SHOULD PLANS BE SUBMITTED?

58. Health and Wellbeing Boards should provide the first cut of their completed Better Care Plan template, as an integral part of the constituent CCGs’ Strategic and Operational Plans by 14 February 2014, so that we can aggregate them to provide a composite report, and identify any areas where it has proved challenging to agree plans for the Fund.

59. The revised version of the Better Care Plan should be submitted to NHS England, as an integral part of the constituent CCGs’ Strategic and Operational Plans by 4 April 2014.

8786

England

ANNEX J: TEMPLATE CONTENTS

Content of the Strategic Plan

Segment Covering: Supported by:

System vision

A statement describing what the desired state would be for the health economy in 2018/19 – this should ideally describe the health and care system rather than an

individual organisation view.

Stakeholder sign up

Individual organisation visions

Improving quality and outcomes

Looking at the seven improving outcome ambitions identified in Everyone counts: planning for patients, how

does the health economy plan to improve these and, where appropriate, what level of improvement does it

expect?

Detailed metrics will be provided in the

operational template for years 3 – 5

What other local quality improvement plans are in place and how do these align with the local strategic needs

assessments?

Sign up from key stakeholders such as

Health and Well-being Boards

Sustainability

In five years, what are the health economy goals for sustainability including reference to financial position, other resources and points of service delivery? This work should reference the do nothing gap calculated for the system by 2018/19 that aligns to the challenges identified in A Call to

Action21.

Detailed metrics supplied in the

financial templates for each component

organisation

Improvement interventions

To achieve the desired end state what are the key improvement interventions planned at an organisational

level and how will these deliver the quality and sustainability outcomes required?

Contract expectations

included in the financial template

Governance overview

A summary of the governance processes in place to oversee the delivery of the plans, including high level

description of what success looks like and who is responsible for measuring it.

Key values and principles

A summary of the agreed values and principles that underpin the system wide working required to deliver the

vision.

21 http://www.england.nhs.uk/2013/07/11/call-to-action/

http://www.england.nhs.uk/2013/07/11/call-to-action/

88

EnglandContent of Operational Plan

Segment Covering: Further detail:

Outcomes

Improvement against the measures to support the seven outcome ambitions:

●● Trajectory for Clostridium difficile reduction.●● Trajectory for dementia diagnosis.●● Trajectory for IAPT coverage and recovery.●● Trajectory for seven outcome ambition measures.●● Trajectory for Quality Premium measures (where different

from seven outcome ambitions).

Measures set out in Annex A.

NHS Constitution Self-certification of the delivery of all NHS Constitution rights and pledges.

Measures set out in Annex B.

Activity

Trajectories for:●● Elective FFCEs.●● Non elective FFCEs.●● Outpatient attendances.●● A&E attendances.●● Referrals

Measures set out in Annex C.

Better Care Fund Improvement against the agreed BCF measures. Measures set out in Annex I.

8988

EnglandContent of Financial Plan

Segment Covering:

Financial plan summary An overview of the financial plan.

Revenue resource limit Detail of recurrent and non-recurrent allocations expected to be received.

Planning assumptions Provider efficiency, inflation, activity growth (demographic and non-demographic), contingency, recurrent headroom.

Financial plan detail 14/15-18/19

Financial plan for each of the next five years (2014/15 and 2015/16 at a higher level of detail). Planned income and expenditure for each service type.

QIPP 14/15-18/19

Detail of financial impact of QIPP schemes for each of the next five years with profile for the first two years.

RiskDetails and valuation of identified risks over each of the next five years (2014/15 and 2015/16 at a higher level of detail). Details of mitigation

strategies.

Investment Details of planned investment over each of the next five years including use of headroom.

Statement of financial position Detail of assets, liabilities and taxpayers’ equity for each of the next two years.

Cash Breakdown of receipts and payments over each of the next two years.

Capital Planned capital expenditure by scheme for each of the next five years.

Contract value 14/15-18/19

Details of forecast spend on current contracts for 13/14 and anticipated contract value for each of the next five years.

90

EnglandContent of Direct Commissioning Financial Plan

Segment Covering:

Area Team Summary Summary of the financial plan for all directly commissioned services for Area Team.

For e

ach

Dire

ctly

Com

mis

sion

ed s

ervi

ce

Financial plan summary An overview of the financial plan for each area of direct commissioning.

Resource allocations Details of allocation for service for each of the next five years.

Assumptions Provider efficiency, inflation, activity growth (demographic and non-demographic) – assumptions for each of the next five years.

Financial Plan Detail Financial plan for each of the next five years (2014/15 and 2015/16 at a higher level of detail).

QIPPDetail of financial impact of QIPP schemes for each of the next five

years and saving profile for each of the next two years (2014/15 and 2015/16 at a higher level of detail).

Investment Details of planned investment over each of the next five years (2014/15 and 2015/16 at a higher level of detail).

NR proposals Proposals for non-recurrent funding over each of the next five years.

RiskDetails and valuation of identified risks over each of the next five

years. Details of mitigation strategies and funding required (2014/15 and 2015/16 at a higher level of detail).

Contract value 14/15-18/19

Details of forecast spend on current contracts for 13/14 and anticipated contract value for each of the next five years.

Content of Direct Commissioning Operational Plan: NHS England commissioning improvement

measures

Segment Covering: Supported by:

Improvement Measures

Improvement against the measures identified for area of Direct commissioning.

Measures set out in Annexes D-G

NHS Constitution Self-certification of the delivery of all relevant NHS Constitution rights and pledges.

Measures set out in Annex B.

Activity Trajectories for relevant activity measures for direct commissioning area

Measures set out in Annex C.

CCG Outcomes Indicator Set 2014/15-at a glance

jonesp1

Typewritten Text

GB 03-14 Appendix 2

CCG Outcomes Indicator Set 2014/15-at a glance

First published: December 2013

Insert heading depending on line length; please delete other cover options once you have chosen one. 14pt

Introduction This at-a-glance guide sets out the 2014/15 CCG Outcomes Indicator Set, grouped under the five domains of the NHS Outcomes Framework.

The CCG outcomes indicators have been selected on the basis that they help contribute to better outcomes across the five domains of the NHS Outcomes Framework. The 2014/15 CCG Outcomes Indicator Set has a range of new measures including ones in relation to: • Cancer: early detection, diagnosis via emergency routes and, record of stage at

diagnosis • Lung cancer; record of stage at diagnosis • Breast cancer: mortality • Heart failure: 12 month all-cause mortality • People who have had a stroke who spend 90% of more of their hospital stay on an

acute stroke unit • Hip fracture: incidence, formal hip fracture programme, timely surgery, multifactorial

risk assessment and the proportion of patients recovering to their previous level of mobility or walking ability

• Alcohol admissions and readmissions • Mental health readmissions within 30 days of discharge • Smoking rates in people with severe mental illness • Proportion of adults in contact with secondary mental health services in paid

employment.

A small number of indicators that were set out in the 2013/14 Outcomes Indicator Set as being ‘in development’ are not included for 2014/15. This is because it has been identified from the development work that it was not possible to develop a statistically robust measure at CCG level. NHS England will be carrying out work with partners to consider alternative approaches to such measures. CCG Outcomes Indicator Set measures are developed from NHS Outcomes Framework indicators that can be measured at CCG level together with additional indicators developed by NICE and the Health and Social Care Information Centre. These provide clear, comparative information for CCGs, Health and Wellbeing Boards, local authorities and patients and the public about the quality of health services commissioned by CCGs and the associated health outcomes. They are useful for CCGs and Health and Wellbeing Boards in identifying local priorities for quality improvement and to demonstrate progress that local health systems are making on outcomes. Technical guidance for the 2014/15 CCG Outcomes Indicator Set can be found at: http://www.england.nhs.uk/ccg-ois/


3 Overarching indicators

Improvement areas

Helping people to recover from episodes of ill health or following injury

• Emergency admissions for acute conditions that should not usually require hospital admission (NHS OF 3a) ^

• Emergency readmissions within 30 days of discharge from hospital (NHS OF 3b) *

Improving outcomes from planned treatments

• Increased health gain as assessed by patients for elective procedures a) hip replacement b) knee replacement c) groin hernia d) varicose veins (NHS OF 3.1 i - iv)

Preventing lower respiratory tract infections in children from becoming serious

• Emergency admissions for children with lower respiratory tract infections (NHS OF 3.2) ^

Improving recovery from injuries and trauma NHS OF indicator in development. No CCG measure at present

Improving recovery from stroke People who have had a stroke who • are admitted to an acute stroke unit within four hours of arrival to hospital • receive thrombolysis following an acute stroke • are discharged from hospital with a joint health and social care plan • receive a follow-up assessment between 4-8 months after initial admission • spend 90% of more of their stay on an acute stroke unit Improving recovery from fragility fractures

• Proportion of patients recovering to their previous level of mobility or walking ability (NHS OF 3.5 i and ii)

• Hip fracture: formal hip fracture programme, timely surgery, and multifactorial risk assessment

Helping older people to recover their independence after illness or injury No CCG measure at present Improving recovery from mental illness

• Alcohol admissions and readmissions • Mental health readmissions within 30 days of discharge • Proportion of adults in contact with secondary mental health services in paid

employment

Enhancing quality of life for people with long-term conditions

Overarching indicator

• Health-related quality of life for people with long-term conditions (NHS OF 2) ^ **

Improvement areas

Ensuring people feel supported to manage their condition

• People feeling supported to manage their condition (NHS OF 2.1) ^ * **

Improving functional ability in people with long-term conditions

• People with COPD & Medical Research Council Dyspnoea scale ≤3 referred to pulmonary rehabilitation programme • People with diabetes who have received nine care processes • People with diabetes diagnosed less than one year referred to structured education Reducing time spent in hospital by people with long-term conditions

• Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) (NHS OF 2.3.i) ^ • Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s (NHS OF 2.3.ii) ^ • Complications associated with diabetes inc emergency admission for diabetic ketoacidosis and lower limb amputation

Enhancing quality of life for people with mental illness

• Access to community mental health services by people from BME groups • Access to psychological therapy services by people from BME groups • Recovery following talking therapies (all ages and older than 65) • Health-related quality of life for people with a long-term mental health condition Enhancing quality of life for people with dementia • Estimated diagnosis rate for people with dementia NHS OF measure in development. No CCG measure at

present

• People with dementia prescribed anti-psychotic medication -

Preventing people from dying prematurely 1 Overarching indicator • Potential years of life lost from causes considered amenable to healthcare:

adults, children and young people (NHS OF 1a i & ii) ^

Improvement areas

Reducing premature death in people with severe mental illness

• People with severe mental illness who have received a list of physical checks

• Severe mental illness: smoking rates

Reducing deaths in babies and young children

• Antenatal assessment < 13 weeks • Maternal smoking at delivery • Breastfeeding prevalence at 6-8 weeks

Reducing premature mortality from the major causes of death

• Under 75 mortality from cardiovascular disease (NHS OF 1.1) ^ * • Cardiac rehabilitation completion • Myocardial infarction, stroke & stage 5 kidney disease in people with diabetes • Mortality within 30 days of hospital admission for stroke • Under 75 mortality from respiratory disease (NHS OF 1.2) ^ * • Under 75 mortality from liver disease (NHS OF 1.3) ^ • Emergency admissions for alcohol related liver disease • Under 75 mortality from cancer (NHS OF 1.4) ^ *

• One year survival from all cancers (NHS OF 1.4i) ^ • One year survival from breast, lung & colorectal cancers

(NHS OF 1.4 iii) ^ • Cancer: diagnosis via emergency routes • Cancer: record of stage at diagnosis • Cancer: early detection • Lung cancer; record of stage at diagnosis • Breast cancer: mortality • Heart failure: 12 month all cause mortality • Hip fracture: incidence

Reducing premature deaths in people with learning disabilities NHS OF indicator in development. No CCG measure at present

4 Overarching indicators

Ensuring that people have a positive experience of care

Patient experience of primary and hospital care

• Patient experience of GP out of hours services (NHS OF 4a ii) ^ • Patient experience of hospital care (NHS OF 4 b) • Friends and family test for acute inpatient care and A&E (NHS OF 4c)

Improvement areas

Improving people’s experience of outpatient care

• Patient experience of outpatient services (NHS OF 4.1)

Improving hospitals’ responsiveness to personal needs

• Responsiveness to in-patients’ personal needs (NHS OF 4.2)

Improving women and their families’ experience of maternity services

• Women’s experience of maternity services (NHS OF 4.5) Improving the experience of care for people at the end of their lives

• Bereaved carers views on the quality of care in the last 3 months of life NHS OF 4.6)

Improving experience of healthcare for people with mental illness

• Patient experience of community mental health services (NHS OF 4.7)

Improving children and young people’s experience of healthcare NHS OF indicator in development. .No CCG measure at present

Improving people’s experience of accident and emergency services

• Patient experience of A&E services (NHS OF 4.3)

Improving people’s experience of integrated care NHS OF indicator in development. No CCG measure at present

Reducing the incidence of avoidable harm

• Incidence of healthcare associated infection: MRSA (NHS OF 5.2.i) • Incidence of healthcare associated infection: C difficile (NHS OF 5.2.ii) No CCG measures at present for category 2, 3 and 4 pressure ulcers and incidence of medication errors causing serious harm

Improving the safety of maternity services

No CCG measure at present

Delivering safe care to children in acute settings No CCG measure at present

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

5


• Patient safety incidents reported (NHS OF 5a)

Improvement areas

NOTES & LEGEND

NHS OF: indicator derived from NHS Outcomes Framework ^ NHS OF indicator that is also measurable at local authority level * NHS OF indicator shared with Public Health Outcomes Framework ** NHS OF indicator complementary with Adult Social Care Outcomes Framework Other indicators are developed from NICE quality standards or other existing data collections.

2

Enhancing quality of life for carers

• Health-related quality of life for carers (NHS OF 1.4)


CCG Outcomes Indicator Set 2014/15

GB 03-14 Appendix 3

Healthy Liverpool Strategic Plan Development Plan

Milestone 6 13 20 27 3 10 17 24 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30

Development

1.0 Development of two year operational plans

2.0 Development of five year strategic plans

3.0Engagment event with NHS England

Specialist Commissioning

4.0

Healthy Liverpool Programme Board -

review of transformational plans and

outcomes

5.0Engagment event with NHS Providers and

Collaborative Commissioners

6.0Informal Governing Body - review and

development of plans

7.0Health & Wellbeing Board

Principles and approach for BCF

8.0

Governing Body Time Out - Outcome

Ambition, Trainsformation Initiatives and

BCF

9.0Joint Commissioning Group -

development of BCF plans

10.0 Public Engagement Events

11.0Healthy Liverpool Programme Advisory

Board

12.0 Member Practice Engagement Eventtbc

13.0Reconcilliation of plans between NHSE,

Monitor and NHS TDA

Approval and Submission

14.0Governing Body approval of draft

operational plans

15.0Governing Body approval of final two year

plan and draft strategic plan

16.0 Submission of draft operational plans

17.0 Submission of draft BCF

18.0 Provider Contracts signed

19.0 Refresh of plans post contract sign off

20.0 Governing Body approval of BCF Plan

21.0Health and Well Being Board approval of

BCF Plan

22.0Submission of Final 2 Year Operational

Plan and Draft 5 Year Strategic Plan

23.0Governing Body approval of final five year

strategy

24.0 Submission of final 5 Year Strategic Plan

May JuneAprilJanuary Febuary March

Page 1 of 7

Report no: GB 04-14


TUESDAY 14TH JANUARY 2014

Title of Report CARE QUALITY COMMISSION (CQC) INSPECTIONS

AND THE CHANGING METHODOLOGY

Lead Governor Jane Lunt , Head of Quality/Chief Nurse


Jane Lunt , Head of Quality/Chief Nurse

Report Author

Jane Lunt , Head of Quality/Chief Nurse

Summary The purpose of this paper is to update the Governing Body regarding the changing CQC methodology and activity regarding Liverpool providers since April 2013.

Recommendation That Liverpool CCG Governing Body: Notes the contents of the report Notes the engagement of the CCG in the work to

pool intelligence and data to form comprehensive understanding of provider performance.


To ensure patients receive a consistently high standard of treatment and care form NHS Commissioned services.


Preventing people from dying prematurely Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting them from harm

Page 2 of 7

CARE QUALITY COMMISSION (CQC) INSPECTIONS AND THE CHANGING

METHODOLOGY

1. PURPOSE The purpose of this report is to update the Governing Body regarding the changing CQC methodology, and activity regarding Liverpool providers since April 2013. 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Notes the contents of the report Notes the engagement of the CCG in the work to pool intelligence and

data to form comprehensive understanding of provider performance. 3. ROLE OF CQC/CHANGING METHODOLOGY The Care Quality Commission (CQC) is the independent regulator of health and adult social care services in England. Their role is to ensure that the care provided by hospitals, dentists, ambulances, care homes and home-care agencies meets government standards of quality and safety. The CQC is also responsible for protecting the interests of vulnerable people, including those whose rights are restricted under the Mental Health Act, and aim to include the views, experiences, health and wellbeing of people who use services at the centre of their work. Providers, including GP practices since April 2013, are required to register with CQC, and CQC inspect providers to ensure that standards are being met. The inspection methodology ensures that information from a variety of sources is used to form a view of a provider; this includes feedback from patients and the public, and also any whistleblowers. During the inspection process this information is triangulated through knowledge from previous inspections, talking to staff and also to patients, and talking to other organisations, such as commissioners or Healthwatch. The outcome of an inspection is published on the CQC website and is accessible to both professionals and the public. Appendix 1 shows the 28 CQC outcomes which are used to check providers’ compliance.

Page 3 of 7

There are three types of inspections: Scheduled –these are carried out regularly, and providers are given 48

hours notice before the visit. Responsive –these are carried out if concerns are raised over whether the

practice meets the essential standards or where CQC are following up non-compliance from a previous inspection. Often, no notice of our inspection is given in responsive reviews.

Themed –These inspections look at particular themes in health and social care. They look at what happens to people across different services or at issues in a particular type of organisation.

The majority of inspections taking place are unannounced and therefore “responsive” inspections. Following an inspection visit, CQC will judge a provider or manager to be either compliant or non-compliant with one or more of the regulations. Where a provider or manager is judged to be non-compliant with a regulation, an assessment of the impact of this on people who use the service (and others, where appropriate) will be made and judge it to be either minor, moderate or major. The CQC possesses a range of powers to use to take action if people are judged to be getting poor care; in summary, CQC can:

Issue a warning notice, asking for improvements within a short period of time

Restrict the services that the care provider can offer Restrict admissions to the service Issue a fixed penalty notice Suspend the care provider’s registration Cancel the care provider’s registration Prosecute the care provider

The CQC has been criticised regarding the quality and rigour of its inspection process in light of poor quality and performance being found in trusts where recent CQC inspections have demonstrated compliance and failed to highlight cause for concern. The CQC is strengthening the methodology used to inspect providers to improve the quality of inspections. 4. ACTIVITY IN LIVERPOOL

Page 4 of 7

Primary Care There have been a number of inspections of GP providers since April 2013. The practices are Bousefield Surgery; (Doctors Shah and Doctors Roberts & Longford); Fairfield Medical Centre; Priory Medical Centre, and Mather Avenue Surgery where all relevant standards were met. However, one practice, Walton Village Medical Centre failed to meet the standard for Outcome 7 (people should be protected from abuse and staff should respect their human rights) and improvement is required within a defined timescale to meet this standard. In addition, Urgent Care 24 Limited (the out of hours provider for both Liverpool and Knowsley) has been inspected in July 2013, and all relevant standards were met. Liverpool Women’s Hospital An unannounced inspection took place in July in response to concerns that standards were not being met. The inspection team focused the following 3 standards; care and welfare of people who use services, staffing and supporting workers and found that action was needed in respect of all 3. The report was published on the CQC website and there is an action plan to ensure that the standards are met. The action plan has been shared with the CCGs via the Clinical Performance and Quality Group (CPQG). The Trust accepted the findings, but felt that they should be seen in the context of an improvement journey, as the Trust had secured an increase in the number of midwives who were coming into post during July and August 2013, and the increased numbers would ensure the Trust meet the standards. The CQC inspection did not highlight any areas of concern to the CCG that had not been identified within the quality monitoring processes that the Trust had been subject to. Aintree An unannounced inspection took place late September/early October. The report was published in December 2013. A number of standards were not met and the Trust has been issued with a warning notice regarding 2 standards (namely care and welfare of people who use services; and complaints) and an enforcement notice with regard to assessing and monitoring the quality of service provision. The trust has a timescale in which to make the required improvements. The inspection report appears to have highlighted issues that the CCGs had considered of concern and contributing to the slow pace of change since increased monitoring of the Trust began in April 2013. The CCG has review the implications of the report within the Collaborative Commissioning Forum (CCF) and within the Risk Summit process instigated by NHS North in November 2013.

Page 5 of 7

Royal Liverpool and Broadgreen University Hospital Trust. This trust was inspected at the end of November 2013. Early informal feedback from the trust indicates that CQC found some examples of very good practice, (end of life care was highlighted) and also some areas for improvement. The inspection report will be published in January 2014. Care homes There are a number of Care Homes in Liverpool that are currently subject to CQC action or enforcement. They are: Abbeydale Nursing Home The Orchard Care Home 10 Glenside In order to facilitate closer working between Liverpool City Council and the CCG in terms if information and intelligence sharing with regard to care homes, there is work to align the processes of quality monitoring and contract monitoring. The ambition is to create a system which enables more ‘early warning’ of issues and the ability to check individuals in terms of their safety and also a more systemic review of the Home. To ensure effective information sharing between agencies, a monthly meeting between the CQC area managers Liverpool City Council, the CCG Safeguarding Service and the Police. This meeting, though relatively new in its purpose, has already proved helpful in the determination of the judgements and subsequent action with regard to the care homes referenced above. This meeting also offers the CQC an opportunity to give feedback regarding the homes progress in terms of addressing the CQC concerns. 5. INTELLIGENT MONITORING As stated earlier, CQC are changing and adapting the methodology used to inspect and regulate providers. One key component of this is the change to the inspection and regulation of acute hospitals in the form of ‘Intelligent Monitoring’. This is a method of bringing together 150 indicators creating a profile of a hospital which enables the CQC to direct resources to inspect hospitals where there are more potential issues first. The ‘Intelligent Monitoring’ profiles were published on 24th October, in conjunction with an announcement regarding the CQC’s new hospital inspection programme. The methodology for these inspections has changed and the hospitals will be inspected using larger expert teams that include professional and clinical staff and trained members of the public.

Page 6 of 7

The Intelligent Monitoring profiles have taken the results of the intelligent monitoring work and grouped the 161 acute NHS trusts into six bands based on the risk that people may not be receiving safe, effective, high quality care - with band 1 being the highest risk and band 6 the lowest. The banding for the Liverpool providers is: Aintree – band 1 Alder Hey- band 1 Liverpool Women’s Hospital – band 3 Royal Liverpool & Broadgreen University Hospital- band 6 Liverpool Heart & Chest- band 6 The Walton Centre –band 6 Alder Hey, and the other children’s hospital Trusts nationally have directly challenged the CQC methodology as many of the indicators do not apply to children’s trusts, and so the allocation of risk is based on a much reduced number of indicators. CQC and the children’s Trusts are in discussion with a view to potentially improving or amending the indicators used potential assess risk in children’s hospitals. The first phase of hospital inspections began in September 2013 and the second phase begins in January 2014, with every acute trust having been inspected by December 2015. The next phase of inspections includes Aintree, even though it has recently been subject to an unannounced inspection. Royal Liverpool & Broadgreen University Hospital Trust was inspected at the end of November 2013. 6. FUTURE WORKING Increasingly the CQC are working closely with CCGs in order to gain information and intelligence regarding providers of care services. They are members of the Merseyside Quality Surveillance Group (QSG) and participate in the Quality Review and Risk Summit processes when there are additional concerns regarding a provider. There are also local mechanisms for information sharing such as the meeting for sharing information regarding care homes. The first few months of the new NHS have seen the development of closer working relationships between the regulators (CQC and Monitor) and the commissioners, i.e. CCGs, NHS England and local authorities. This enables early warnings to be detected, where possible, and action to mitigate the associated risks, with work to improve quality and performance. However, the roles and accountabilities of CCGs and NHS England in terms of quality are still evolving.

Page 7 of 7

Action plans are in place with all providers that have not met the standards required during inspections, with NHS Liverpool CCG playing an active role in supporting providers to improve through the Clinical Performance and Quality Groups (CPQGs), and associated quality improvement processes, and also within the Merseyside Quality Surveillance Group. The Quality, Safety and Outcomes Committee will formally consider CQC reports and gain assurance via the CPQGs that any required improvements are undertaken. Jane Lunt Chief Nurse/Head of Quality 31st December 2013 Ins Name Ins Title Ins Date ENDS

Page 1 of 17

Report no: GB 05-14


TUESDAY 14th JANUARY 2014

Title of Report CCG Performance report

Lead Governor Dr Nadim Fazlani


Ian Davies, Head of Operations & Corporate Performance

Report Author

Ian Davies, Head of Operations & Corporate Performance

Summary The purpose of this paper is to report to the Governing Body key aspects of the CCG’s performance in delivery of quality, performance and financial targets for 2013/14.

Recommendation That Liverpool CCG Governing Body: Notes the performance of the CCG in delivery

of key national performance indicators and the recovery actions taken to improve performance


The report provides evidence of the progress being made across the organisation at both an organisational and individual service provider level.


Everyone Counts: Planning for Patients 2013/14

Page 2 of 17

LIVERPOOL CCG PERFORMANCE REPORT

1. PURPOSE The purpose of this paper is to report to the Governing Body key aspects of the CCG’s performance in delivery of quality, performance and financial targets for the year 2013/14. 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Notes the performance of the CCG in delivery of key national performance

indicators and the recovery actions taken to improve performance, if required.

3. BACKGROUND From April 2013 the CCG is held to account by the NHS England on its performance in delivery of key indicators within the CCG Outcome Indicator Set of the NHS Outcomes Framework 2013/14 and operational standards expected from the NHS Constitution. In addition the CCG needs to be assured that the services we commission are delivering the required quality standards and any risks and issues relating to service quality and patient safety are identified and positive action taken to rectify. The CCG has established governance processes to monitor performance and provide assurance to the Governing Body that key risks to the organisation are identified and effectively managed. The Quality, Safety and Outcomes Committee are responsible for quality and performance issues within its commissioned services. The Finance, Procurement and Contracting Committee are responsible for financial monitoring. Concerns remain as to the quality and accuracy of some of the data used and this continues to be investigated and worked upon by the CCG and the Cheshire & Merseyside Commissioning Support Unit. As a consequence of the timing of reporting and data schedules, this report updates the Governing Body mainly with a mix of data up to the end of October and/or November.

Page 3 of 17

4. NATIONAL PERFORMANCE MEASURES These measures relate to Quality (Safety, Effectiveness and Patient Experience) and also Resources (Finance, Capability and Capacity) and reflect the key priority areas from Everyone Counts: Planning for Patients 2013/14. Specific commentary is provided on the following areas of performance. Health Care Acquired Infection

C-Diff: Overall there have now been a further 18 incidences of C-Diff reported for Liverpool patients in November, bringing the total year to date to 125, significantly higher than the tolerance level of 73. Of these additional cases, 9 were community acquired and 9 hospital acquired infections.

MRSA: during the month of November there were no new cases of

MRSA reported. The continuing monthly increases in C-diff remain a matter of significant concern and a high priority for continuing investigation, action and review by commissioners working collaboratively on an individual Trust by Trust basis. Mersey Antibiotics Guidance was published in January 2014 and the Medicine Management Team is working closely to offer further support to practices with high antibiotic prescribing through audits and education. The Royal Liverpool & Broadgreen Hospital has requested an external review of HCAI processes and systems from the TDA and this is to be urgently arranged. Cancer This month shows that the improving picture seen for cancer waiting times overall has been maintained, with a reduction in Trust specific issues. In all cases the commissioners are working with the providers to understand the positions and where required seek recovery plans/assurances as to future service delivery and performance. 62 days wait for first definitive treatment (wait from urgent GP referral to first definitive treatment) – here we see little change in the Liverpool Heart & Chest performance which stands at 76.14% against their revised Monitor threshold of

Page 4 of 17

79%. The small numbers of patients referred to this specialist Trust for treatment remains a challenge. 62 days wait for first definitive treatment (following Consultant’s decision to upgrade the priority of the patient) – here performance at the Liverpool Heart & Chest Hospital remains at ‘Red’. There is no change here from last months data, as no referrals in this category were made. RTT. Data for October 2013 continues to show ‘Red’ performance at Alder Hey for those waiting over 52 weeks for complex spinal surgery, the responsibility of Specialist Commissioning. Alder Hey continues to experience problems in meeting the 18 week target for referral to treatment, although some improvement has been seen in Octobers performance at 85.8%. Here the principal problem lies in ENT, with a backlog of patients having built up due to some increases in demand. The Trust have employed an additional Consultant to manage this demand and overall waiting times have improved as a consequence. Stroke As previously reported in September there was improvement seen in the performance at Aintree Hospital with performance at 79%, unfortunately this has since fallen to 73.7% in October. In the month 49 patients were admitted with a stroke and 13 breached the target, mainly as a consequence of medical outliers occupying beds in the Stroke Unit. The CCG with Sefton colleagues continue to monitor this important area and the actions planned by the Trust to achieve a sustainable improvement in performance. • 4 Hour AED Performance One of the key and high profile NHS constitutional rights measures is the percentage of patients who spend 4 hours or less in AED (95% target) Cumulatively up to the end of November the CCG met this target at 96%, with respective performance of 95.10% at Aintree Hospital; 98.10% at Alder Hey; 99.90% at Liverpool Women’s; and finally slight under performance of 94.9% at the Royal Liverpool Hospital. As previously reported, despite reasonable performance in the first half of the year both Aintree and the Royal have experienced significant difficulties in maintaining this performance into the second half of the year and particularly as we enter the winter period. This is within a context locally of falling AED attendances year to date (Aintree: -6%,

Page 5 of 17

Royal Liverpool: -1%) and similarly falling numbers of non-elective or emergency admissions. Performance against the 4 hour target is monitored daily, with the weekly data summarised below showing Trust performance, CCG position and predicted performance through to year end. The latter predictions are informed by performance to date, historical/seasonal trends and actions underway.

Week EndingTotal A&E

AttendancesNo. Pats >4 Hours

% < 4 Hours

Total A&E Attendances

No. Pats >4 Hours

% < 4 Hours


No. Pats >4 Hours

% < 4 Hours


No. Pats >4 Hours

% < 4 Hours

07/04/2013 2,044 201 90.2% 1646 88 94.7% 1045 26 97.5% 3595 233 93.5%14/04/2013 1,984 197 90.1% 1624 319 80.4% 1117 50 95.5% 3559 335 90.6%21/04/2013 2,119 181 91.5% 1679 227 86.5% 1145 45 96.1% 3748 271 92.8%28/04/2013 2,069 102 95.1% 1565 118 92.5% 1193 66 94.5% 3694 181 95.1%05/05/2013 2,101 83 96.0% 1589 125 92.1% 1183 31 97.4% 3702 139 96.2%12/05/2013 2,012 49 97.6% 1685 46 97.3% 1175 19 98.4% 3676 75 98.0%19/05/2013 1,975 97 95.1% 1537 44 97.1% 1199 40 96.7% 3588 127 96.5%26/05/2013 2,023 132 93.5% 1591 28 98.2% 1101 41 96.3% 3580 148 95.9%02/06/2013 1,982 130 93.4% 1606 117 92.7% 920 6 99.3% 3428 157 95.4%09/06/2013 1,933 55 97.2% 1519 61 96.0% 1077 3 99.7% 3433 75 97.8%16/06/2013 1,944 42 97.8% 1603 42 97.4% 1077 12 98.9% 3503 62 98.2%23/06/2013 1,849 5 99.7% 1549 2 99.9% 1103 9 99.2% 3471 15 99.6%30/06/2013 2,062 26 98.7% 1576 15 99.0% 1072 9 99.2% 3584 43 98.8%07/07/2013 1,993 23 98.8% 1452 20 98.6% 1067 1 99.9% 3487 36 99.0%14/07/2013 2,078 102 95.1% 1557 13 99.2% 1234 12 99.0% 3753 100 97.3%21/07/2013 2,000 60 97.0% 1560 158 89.9% 1177 10 99.2% 3647 123 96.6%28/07/2013 2,024 60 97.0% 1557 100 93.6% 1066 4 99.6% 3614 100 97.2%04/08/2013 1,975 52 97.4% 1507 41 97.3% 903 6 99.3% 3384 67 98.0%11/08/2013 1,901 73 96.2% 1560 21 98.7% 844 7 99.2% 3302 79 97.6%18/08/2013 1,894 49 97.4% 1493 33 97.8% 772 1 99.9% 3195 57 98.2%25/08/2013 1,940 39 98.0% 1557 62 96.0% 828 5 99.4% 3335 62 98.1%01/09/2013 2,016 104 94.8% 1479 28 98.1% 879 1 99.9% 3375 99 97.1%08/09/2013 1,969 98 95.0% 1533 5 99.7% 909 8 99.1% 3378 89 97.4%15/09/2013 1,844 154 91.6% 1409 6 99.6% 938 45 95.2% 3234 155 95.2%22/09/2013 2,007 192 90.4% 1506 10 99.3% 1047 46 95.6% 3488 195 94.4%29/09/2013 2,137 207 90.3% 1513 20 98.7% 1134 14 98.8% 3676 188 94.9%06/10/2013 2,060 191 90.7% 1503 103 93.1% 1086 8 99.3% 3591 204 94.3%13/10/2013 1,999 133 93.3% 1562 119 92.4% 1102 72 93.5% 3536 206 94.2%20/10/2013 1,954 97 95.0% 1467 48 96.7% 1029 7 99.3% 3407 111 96.7%27/10/2013 2,001 121 94.0% 1537 99 93.6% 932 7 99.2% 3405 146 95.7%03/11/2013 2,001 174 91.3% 1514 89 94.1% 1007 3 99.7% 3435 185 94.6%10/11/2013 1,981 164 91.7% 1479 104 93.0% 1038 7 99.3% 3400 188 94.5%17/11/2013 1,973 225 88.6% 1509 161 89.3% 1126 25 97.8% 3509 270 92.3%24/11/2013 1,966 154 92.2% 1482 132 91.1% 1191 27 97.7% 3517 200 94.3%01/12/2013 1,905 157 91.8% 1428 45 96.8% 1299 27 97.9% 3538 169 95.2%08/12/2013 1,945 185 90.5% 1441 72 95.0% 1239 58 95.3% 3500 227 93.5%15/12/2013 1,969 209 89.4% 1454 84 94.2% 1288 69 94.6% 3599 259 92.8%22/12/2013 1,895 71 96.3% 2011 7 99.7% 1193 22 98.2% 3601 90 97.5%29/12/2013 1,736 69 96.0% 1902 6 99.7% 919 6 99.3% 3179 71 97.8%05/01/2014 1,816 186 89.8% 1606 187 88.4% 983 20 97.9% 3476 237 93.2%12/01/2014 1,990 144 92.8% 1586 113 92.8% 998 21 97.9% 3393 177 94.8%19/01/2014 1,894 64 96.6% 1501 34 97.7% 1051 36 96.5% 3310 123 96.3%26/01/2014 1,832 71 96.1% 1521 72 95.3% 1130 17 98.5% 3539 115 96.8%02/02/2014 1,968 100 94.9% 1608 137 91.5% 1253 26 97.9% 3722 173 95.3%09/02/2014 2,011 121 94.0% 1575 119 92.5% 1247 18 98.5% 3703 163 95.6%16/02/2014 2,000 216 89.2% 1545 215 86.1% 1170 18 98.4% 3658 254 93.0%23/02/2014 2,041 236 88.4% 1577 90 94.3% 1192 31 97.4% 3706 245 93.4%02/03/2014 2,071 238 88.5% 1594 178 88.8% 1259 29 97.7% 3823 278 92.7%09/03/2014 2,125 124 94.1% 1587 114 92.8% 1313 31 97.7% 3841 182 95.3%16/03/2014 2,094 109 94.8% 1519 70 95.4% 1218 21 98.3% 3690 136 96.3%23/03/2014 2,056 160 92.2% 1531 85 94.4% 1359 57 95.8% 3826 221 94.2%30/03/2014 2,069 172 91.7% 1535 43 97.2% 1268 34 97.3% 3642 191 94.8%

Current YTD Position

77,260 4,463 94.2% 60,741 2,818 95.4% 41,654 855 97.9% 136,645 5,541 95.9%

Estimated Year End Position

103,227 6,404 93.8% 81,027 4,275 94.7% 57,094 1,215 97.9% 183,975 8,036 95.6%

Min. Weekly Perf. to Achieve at Year End

25967 698 97.3% 20286 1233 93.9% 15440 2000 87.0% 47330 3658 92.3%

TRUST CATCHMENT EVERYONE COUNTS MAPPINGSRoyal Liverpool & Broadgreen

University Hospitals TrustAintree University Hospitals NHS FT Liverpool CCGAlder Hey Children's NHS FT

Page 6 of 17

Governing Body members should note that the CCG continues to be predicted to achieve the 4 hour target for its population for the year. However, as can be seen from the table performance at both the Royal Liverpool and Aintree continues to give significant cause for concern. The impact of the additional ‘winter monies’ investment and subsequent schemes continue to be monitored closely and adjustments made to schemes where the predicted impact is not being seen or achieved. The CCGs Urgent Care Team, jointly led by Dr James Cuthbert and Dr Fiona Lemmens, continues to take a whole health and social care system approach, not looking at AED performance in isolation. A wide range of actions and interventions continue in both Trusts and the wider health economies to improve performance against the 4 hour target, based on evidence of good practice. In addition the CCG continues to play a wider leadership role across the health economy, both in chairing the North Mersey Urgent Care Network and in its role in leading the commissioning of NWAS and 111 across Merseyside. The CCG will continue to monitor Trust performance against the 4 hour target closely and work with the Trusts and other partners to see how performance through winter can be improved to maintain patient safety, improve experience and outcomes. • Diagnostic Waiting times Performance in November remained disappointing with a further increase in delays for diagnostic tests. At the end of the month 7.58% of patients were waiting over 6 weeks for diagnostic tests, against the 1% target. Analysis shows that the principal problems continue at the Royal Liverpool and Broadgreen Hospitals with some further pressures seen in Liverpool Community Health. At the Royal 363 patients waited over 6 weeks with the pressures seen in CT 28 patients; MRI 79 patients; and in non obstetric ultrasound 256 patients. In some cases delays extended to 9 weeks. To compensate for the particular issues surrounding the long term sickness of a Senior Sonographer, additional sessions have been arranged through December and the Trust expects to see an improvement in waiting times. Lesser problems in Liverpool Community Health also continue with some 27 patients breaching the 6 week target for a non-obstetric ultrasound. A full dashboard is included at Appendix 1 including Merseyside benchmarks.

Page 7 of 17

5. CCG QUALITY PREMIUMS The quality premium, introduced from April 2013 is intended to reward CCGs for improvements in the quality of the services they commission and for associated improvements in health outcomes and reducing inequalities. The quality premium potentially available to CCGs in 2014/15, will reflect 2013/14 quality and will be based upon four national measures and three local measures. Currently the poor performance against the HCAI targets (MRSA/C-Diff) continues to present the major challenge in this area. Appendix 2 provides a summary of this performance dashboard There is an overlap in a number of the items shown in this dashboard and those in the CCG Corporate and Provider Performance tables. 6. NHS TRUST CLINICAL QUALITY AND NHS CONSTITUTIONAL

RIGHTS In line with the recommendations of the National Quality Board (NQB) and as previously agreed the Quality, Safety and Outcomes Committee have implemented a new Quality Early Warning Dashboard. This dashboard is designed to provide the CCG with a system to identify any issues and risks relating to patient quality and safety for areas identified by the NQB as potential indicators of quality and safety issues. The dashboard covers all NHS Trusts within the Merseyside area and includes Risk Profiles for each organisation issued by the Care Quality Commission (CQC) and Monitor Risk and Financial Ratings. Where risks have been identified these will be actively managed through the CCG governance arrangements overseen by the Quality, Safety and Outcomes Committee, Trust Clinical Quality and Performance Meetings and collaborative commissioning arrangements with Merseyside CCGs. 6.1 Care Quality Commission and Monitor Warning or Issue Notices Aintree Hospital The latest report published by CQC on the 6th December 2013 identified that action was needed in respect of the standards Care and Welfare of People who use services and also Complaints. However enforcement action was specifically being taken by CQC for the areas of non-compliance identified in the standard

Page 8 of 17

Assessing and Monitoring the Quality of Service Provision. The Trust was required by CQC to provide a response to them by the 14th December 2013. Enforcement action was required to protect the health, safety and welfare of people using this service. Assessing and Monitoring the Quality of Service Provision - Overall the Trust

had systems and processes in place for governance and risk management. However, the implementation and quality of these was found to be variable. Risk Management was a particularly poor area highlighted at all levels of the organisation, as was the timeliness to put in place risk reduction measures to prevent serious incidents reoccurring. CQC judged that this has a major impact on people who use the service and have therefore taken enforcement action.

Care and Welfare of People who use services - Care and treatment was

found not always to be planned and delivered in a way that was intended to ensure people's safety and welfare. CQC judged that this has a minor impact on people who use the service, and have told the provider to take action.

Complaints - The Trust was found not to have an effective complaints system

in place. CQC found that complaints people made were not handled and responded to appropriately. CQC judged that this has a moderate impact on people who use the service, and have told the provider to take action.

A co-ordinated approach has been taken with partner CCGs and with NHS England (Merseyside) to manage these areas of risk. Collaborative working is evident through the recent Risk Summit, Clinical Quality and Performance Meetings and Collaborative Commissioning Forums. It should be noted that the Trust did however demonstrate full compliance in both the Medicine Management and Records standards which had previously been reported as non-compliant. Liverpool Women’s Hospital Trust As previously reported the last report published by CQC on the 18th September 2013 identified that the standard of care was not being fully met for the standards of Providing Care, Treatment and Support that meets people’s needs and also the standard for Staffing. The Trust has an action plan in place which is discussed and monitored at regular Clinical Quality and Performance Meetings. A number of actions have been completed and the Trust is awaiting a follow-up visit by the CQC to review compliance. Performance continues to be closely monitored through the Clinical Quality and Performance Meetings.

Page 9 of 17

Liverpool Heart and Chest Hospital The latest report published by CQC on 4th December 2013 identified the standard of care in Management of Medicines required action. The CQC identified that patients were not protected against the risks associated with medicines because the trust did not have appropriate arrangements in place to safely manage them. This was judged as a moderate impact on people who use the service, and the trust was required to act. An action plan was required by 10th December 2013 and this was also shared with the CCG. Support has been provided by the CCG Medicine Management team and compliance will be monitored through the Clinical Quality and Performance meetings. 6.2 Quality Risk Profiles The Quality Risk Profile for November demonstrated that Mersey Care had remained the same as October against Outcome 6 Co-operating with other providers. The Trust risk estimate for this outcome has remained as a high yellow rating. The Trust continues to be involved in a task and finish group along with the Local Authority. Performance and progress to embed robust systems and processes will continue to be monitored through the Clinical Quality and Performance forum. 6.3 Patient Safety The CCG monitors closely the incidence of patient safety incidents across providers and during the month of November there were 15 patient safety incidents reported which are all subject to a thorough investigation and review under the quality and patient safety processes. A further ‘never’ event involving “wrong site surgery” was also reported at the Royal Liverpool involving dental surgery and the removal of the wrong tooth, this is a service commissioned by NHS England.

7. CCG FINANCIAL POSITION

The reported position as at 30th November 2013 showed an overspend of £1.17m against planned expenditure, however, the year-end forecast remains indicative of achievement of the planned surplus of £14.3m at 31st March 2014.

Where performance is at variance against plan action is underway with providers to review and deliver corrective action.

Reserves have been set aside as part of the 2013/14 financial plan to mitigate identified pressures and to fund investments.

Page 10 of 17

NHS England notified a change of approach to the accounting treatment of

legacy balances in 2013/14 in December 2013. CCGs will now account for fixed assets, associated financial liabilities and revaluation reserves in 2013/ 14.

All other legacy balances identified in legal transfer schemes as relating to

NHS England and CCGs will be accounted for in the 2013/14 NHS England financial statements. These balances will now be transferred to CCGs with effect from 1st April 2014. NHS England will require information from CCGs in month 9 and at year end regarding movements on provisions and in respect of partially completed spells where appropriate.

The CCG will need to liaise with NHS England around the process for

recovery of costs incurred by the CCG in 2013/14.

NHS England require CCGs to take part in a national accounts preparation and consolidation exercise at 31st December 2013. This will enable NHS England and CCGs to act upon any emerging issues in the consolidation process in advance of preparation of final accounts.

Area Commentary Rating

- Year to Date

Rating– 31 March 2014

Balanced Position On track

Surplus No significant issues

2% Non-recurrent Investment

On track

Running Cost Allowance Running Costs expected to be fully utilised in 2013-14, current year to date position shows an underspend to month 8.

Page 11 of 17

8. SUMMARY

Where performance is at variance to plan action is underway with Trusts to deliver corrective action to improve performance as we move towards the second half of 2013/14 with contractual levers utilised to support improvements. These improvements are actively led by CCG Clinicians.

Ian Davies Head of Operations & Corporate Performance

7th January 2014

Page 12 of 17

Appendix 1: CCG and Provider Dashboards

Page 13 of 17

Page 14 of 17

Page 15 of 17

Page 16 of 17

Page 17 of 17

Appendix 2: Quality Premiums

Page 1 of 5


SERVICE IMPROVEMENT COMMITTEE Minutes of meeting held on Thursday 24TH OCTOBER 2013 at

12.45pm Boardroom Arthouse Square

PRESENT: Jude Mahadanaarachchi (JM) GP – Governing Body

Member/Chair CO-OPTED MEMBERS: IN ATTENDANCE: John Roberts (JR) Healthwatch Volunteer Tony Woods (TW) Head of Strategy &

Outcomes Phil Saha (PS) Head of Programme

Finance Jacqui Waterhouse (JW) Locality Development

Manager Paula Parvulescu (PP) Consultant in Public Health

Medicine Dani Jones (DJ) Senior Programme Manager

– Integrated Care Paula Jones Minutes

APOLOGIES: Moira Cain (MC) Practice Nurse – Governing

Body Member Janet Bliss (JB) GP – Governing Body

Member Jim Cuthbert (JC) GP – Governing Body

Member Peter Johnstone (PJ) Prescribing Lead Cheryl Mould (CM) Head of Primary Care

Quality & Improvement Kim McNaught (KMc) Deputy Director of Finance Laura Buckels (LB) Principal Analyst Sue Lavell (SL) Programme Office Manager

Page 2 of 5

1. WELCOME AND INTRODUCTIONS

The Chair welcomed everyone to the meeting and noted that due to the apologies received the meeting was not quorate.

2. DECLARATION OF INTEREST

None.

MINUTES OF PREVIOUS MEETING & MATTERS ARISING

The minutes from the previous meeting on 26th September 2013 were approved as an accurate record of the discussions which had taken place. It was noted however by JR that his title should be amended to Healthwatch Volunteer.

3.1 Action Point One Treatments for macular Oedema – PS

updated the Service Improvement Committee that he had met with the Commissioning Support Unit looking at provider pricing and that this would be brought back to the Service Improvement Committee at some point.

3.2 Action Points Two, Three and Four were for the November

2013 meeting.

3.3 Action Point Five Toxteth Library Project investment proposal – TW updated the Service Improvement Committee that the issue of co-ordinated decision making on investment/disinvestment was being picked up with Liverpool City Council. He noted that Third Sector organisations were lacking clarity on where their funding would come from and a singular approach needed to be agreed with Liverpool City Council re the voluntary sector. JW noted that the Compact was about to be launched and agreed to send TW a copy.

3.4 Action Point Six JW updated the Service Improvement

Committee that practices were still waiting to hear about 24 Hour Blood Pressure, it was noted that this would be dealt with on the update re Action Point Eleven.

3.5 Action Point Eight: it was noted that the Insight work on

Pulmonary Rehabilitation, Cardiac Rehabilitation and Integrated Care had been sent to the Finance Procurement

Page 3 of 5

and Contracting Committee and that PS would pick this up re the decision of the Committee. PP stressed the urgency of progressing with this.

3.6 Action Point Nine: it was noted that the investment proposal

for Benefits Advice in Health Setting would be sent to the Governing Body in November for approval as recommended by the Service Improvement Committee.

3.7 Action Point Ten: it was noted that the Winter Plans

additional funding had been approved by the Governing Body in October.

3.8 Action Point Eleven: JM noted that the updates on progress

requested by practices on Blood Pressure, ECG etc (part of CVD therefore Long Term Conditions) would be picked up at the Localities Away Day the following week and that the Programme Teams needed to listen to practices and their requests. JW added that eight of the Innovation Bids were around 24 Hour Blood Pressure. TW reminded the Service Improvement Committee that it had been discussed the previous year that these issues would be picked up by the CVD Group, he would ask the Integrated Care Programme Manager to pick these issues up with the Group. JM commented that it was vital to be mindful of what the practices and public communicated to the CCG.

4. PROGRAMME REPORT – INTEGRATED CARE – PRESENTATION

This item was deferred to the November 2013 meeting as the meeting was not quorate and it would be more beneficial for all members to hear the update.

5. HEALTHY LIVERPOOL UPDATE -VERBAL

TW gave a verbal update to the Service Improvement Committee on the Health Liverpool Programme:

Second Accelerated Solutions Two Day Event held at Aintree Racecourse – 60 attendees from all Liverpool Trusts and North West Ambulance Service.

Page 4 of 5

A clear model for the city had emerged and the CCG had a mandate to deliver the changes required.

Prevention and Self Care were at the heart of the changes –

services should be designed to keep individuals out of hospital.

This would be discussed at the Governing Body Awayday on

31st October 2013 – it was vital to focus on a smaller number of areas.

JM stressed the need to agree clinical outcomes and commission to a set standard to ensure the co-operation of providers. TW noted that Healthy Liverpool would be the Liverpool CCG Five Year Strategy and it was the first time that prevention and self-care had been so high on the agenda with resources used for health and social care. It was therefore important to have clinical leadership behind the areas and then develop contractual mechanisms. JW stressed again the importance of communicating with all practices on what was being undertaken.

The Service Improvement Committee: Noted the verbal update.

6. COMMISSIONING INTENTIONS - VERBAL

TW gave a verbal update to the Service Improvement Committee on Commissioning Intentions. The priorities identified by the Programmes were strongly aligned with the Healthy Liverpool Programme but there was a definite need to focus on a solution for the Elderly. A meeting was taking place with Liverpool City Council the following day to look at commissioning intentions and ensure alignment of the CCG and the Council’s intentions. The CCG also needed to get Specialist Commissioning’s intentions as well as those of NHS England for General Practice. PP noted that the CCG should also obtain the commissioning intentions for Public

Page 5 of 5

Health England Local Area Team. She clarified for the Service Improvement Committee the difference between Public Health Local Authority and Public Health England Local Area Team, noting that Public Health England were responsible for immunisations and vaccinations and she advised the Service Improvement Committee that Public Health Local Authority was also working to keep aware of the different areas of responsibility. JW added that Public Health England did provide practices with the health protection data applicable to each individual practice. The Service Improvement Committee: Noted the verbal update.

7. ANY OTHER BUSINESS

None

8. DATE & TIME OF NEXT MEETING Thursday 28th November 2013 12.45pm, Boardroom, Arthouse Square

Page 1 of 12


PRIMARY CARE COMMITTEE Minutes of meeting held on Tuesday 26th November 2013 at 1pm

Boardroom Arthouse Square

Present: Nadim Fazlani (NF) Chair Edward Gaynor (EG) GP Governing Body Member/Vice Chair Jude Mahadanaarachchi GP Governing Body member /Liverpool (JM) Central Locality Chair Dave Antrobus (DA) Governing Body Lay Member – Patient

Engagement Moira Cain (MC) Practice Nurse Governing Body Member James Cuthbert (JC) GP Governing Body Member/Matchworks

Locality Chair Paula Finnerty (PF) GP – North Locality Chair In attendance: Cheryl Mould (CM) Head of Primary Care Quality and

Improvement Colette Morris (CMo) Locality Development Manager – Liverpool

Central Jenny Levy (JL) Locality Development Manager – North Jacqui Waterhouse (JW) Locality Development Manager – Matchworks Scott Aldridge (SA) Neighbourhood Support Manager – North Rob Barnett (RB) LMC Secretary Peter Johnstone (PJ) Transformation Change Manager –

Prescribing Laura Buckels (LB) Senior Intelligence Analyst Tom Knight (TK) Head of Primary Care - Direct

Commissioning, NHS England Merseyside Area Team

Kate Warriner (KW) Deputy Director, Informatics Merseyside Steve Appleton (SAp) Head of Clinical Informatics, Informatics

Merseyside Paula Jones Minute Taker Apologies: Maria Cann (MCa) Primary Care IM&T Manager Paula Parvulescu (PP) Public Health Dr Simon Bowers (SB) GP, Governing Body Clinical Vice Chair Ray Guy (RG) Governing Body Practice Manager co-opted

member

Page 2 of 12

Rose Gorman (RG) Contract Manager, Commissioning Directorate - NHS England

Dyane Aspinall (DA) Assistant Director Adult Services - Liverpool City Council

1. WELCOME & INTRODUCTIONS

The Chair welcomed everyone to the meeting.

2. DECLARATIONS OF INTEREST

None specific were made.

3. MINUTES OF PREVIOUS MEETING, ACTIONS AND MATTERS ARISING

The minutes of the previous meeting on 29th October 2013 were accepted as an accurate note of the discussions which had taken place. Matters Arising and Action Points not already on the agenda:

3.1 Action Point One: EG noted that he had discussed the Do

Not Attempt CPR Policy with Hannah Hutchinson and that this had been discussed further at the Local Medical Committee with regards to the concerns that the GP signing the form should be the patient’s usual clinician rather than a Locum. It was noted that this might cause difficulties as many practices relied heavily on regular locums and a small change had therefore been suggested to add the phrase “where possible” to this clause. It was agreed by the Primary Care Committee that this was acceptable.

3.2 Action Point Three re NHS England Primary Care

Development Day 12September 2013: TK updated the Primary Care Committee that nothing specific had been discussed re access and there was certainly no issue with Liverpool practices – the notes from the meeting would be circulated to the Primary Care Committee in due course.

3.3 Action Point Four re Dingle Park Community Nursing Bid: it

was noted that this action was ongoing.

Page 3 of 12

3.4 Action Point Five re NHS England and Healthwatch: TK

updated the Primary Care Committee that his intention was to attend a Healthwatch meeting when he was available in order to observe the nature of patient feedback being received. CM referred to the Task & Finish Group on GP Access which she and other key Primary Care Committee members/attendees were involved with including the RB.

3.5 Action Points Six, Seven and Eight re Local Improvement

Scheme: CM updated the Primary Care Committee the Quality Schemes had been approved at the last meeting and would not go to the Local Medical Committee for consideration. The next step would then be to look at the procurement for each Scheme and an update would go to the Finance Procurement & Contracting Committee in December 2013. Then the Local Improvement Scheme would need to be approved by NHS England Merseyside Area Team. TK noted that this would need to be done by the Operations & Delivery Director as it would come under Assurance rather than Commissioning.

3.6 Action Point Nine re NICE Quality Standard for Asthma – it

was noted that rather than come back to the Primary Care Committee which had looked at the general overview, the detail of this would need to be approved at each Locality and Dr Tristan Elkin would be contacting each Locality Chair.

4. DISCUSSION ON GP CONTRACT 2014/15, BMA & GP ALLIANCE GUIDANCE FOR GPS - REPORT NO: PCC 46-13

NF presented a paper to the Primary Care Committee to facilitate a discussion following the recent publication of the outcome of the 2014/15 GMS Contract Negotiations, the BMA’s “Developing General Practice today” and General Practitioners Committee guidance for GPs on Collaborative GP Alliances and Federations. He noted that RB was available to enable the discussion and that the role of the Primary Care Committee was to look at how to support practices in collaboration with NHS England Merseyside Area Team and the Local Medical Committee around the changes. RB noted that the changes meant that funding was transferring from the Quality Outcomes Framework or elsewhere to the Global

Page 4 of 12

Sum and the changes made the Liverpool CCG Quality Improvement Scheme much safer as no one could say that practices were being paid twice for the delivery of certain services. As regards Information Technology the changes made sense and did not interfere with the CCG IM&T programme, rather they enhanced it. An open meeting was being held by the Local Medical Committee in January 2014 to explain the changes and they affected GPs and practices. NF noted that some of the changes were very clinical and the CCG needed assurance around the shifting of funding out of Quality Outcomes Framework to core funding and assurance that work continued in areas such as Long Term Conditions Management would continue. EG responded that the Primary Care Quality Framework would continue to show areas were performance levels were not achieved and what went from Quality Outcomes Framework would be included in this. NF noted that there was extensive supporting information to the letter on the BMA website. RB noted that looking at the detail would be key and the Business Rules were still to be received. Some elements had been removed, others reinstated, disease registers for example did not appear but were so embedded in general practice behaviour as to not be a problem. Generally Quality Outcomes Framework became safer rather than easier. He highlighted the Friends & Family Test as an area of potential difficulty. SA referred to two North Liverpool SSP practices and the concerns from the managers around not being able to have the upper limited and therefore lose potentially 239 points. TK noted that NHS England were looking at the potential difficulties for all providers and the need to identify key risks. This could be done now with an Action Plan prepared for the Primary Care Committee to be implemented over the next few months to support practices. It was agreed to go through the letter from the NHS England National Director for Commissioning Development point by point:

Named, accountable GP for people over 75: patients were currently registered with a practice rather than a GP, and would not be able to access the same named GP during all the hours the practice was open. The computer systems would need to be changed to allow for assignment to a name GP.

Page 5 of 12

Out of Hours Services: there would be a new contractual obligation to report on an monitor quality of out of hours services – Liverpool was already doing this and had regular monthly meetings with the citywide provider UC24.

Reducing Unplanned Admissions: JC noted that Liverpool

CCG was already focussing on some of the issues – improving practice availability would need to be supported through the GP Specification.

o A&E clinicians/ambulance services being able to contact the GP practice by telephone – this did happen now but work was ongoing to have it set in the patient pathway.

o Risk Profiling – it was noted that the Long Term Conditions Group would link in to this to support practices to make this happen. PF noted that the difficulty was in obtaining a suitable care plan to cover all patients but as the Programmes Work was joined up Liverpool was well placed to deliver this.

o Discharge process – it was noted that effective discharge had an effect on A&E and four hour waits which was being picked up already by Liverpool CCG.

Choice of GP Practice: EG highlighted the problem of

Liverpool patients registered with practices outside of Liverpool and the issue around home visits for those patients. RB was concerned about the de-stabilising of practices and the effect on the Global Sum. GPs would not be obligated to visit out of area patients but were responsible for their care and practices needed to consider the implication of their choice in this area. NHS England would need to enter into a contract with a provider to carry out home visits for these patients.

Friends & Family Test: this would be a contractual

requirement from December 2014 for practices, RB stressed the importance of ensuring, as well as 100% response, that patients received “guidance” as the responses needed to be positive.

Patient Online Services: KW noted that 69 GP practices

were signed up to the online booking of appointments project, 5 practices had signed up to the access of records online pilot. SA noted that non EMIS practices might incur a

Page 6 of 12

charge for the software to facilitate this. EG raised a concern about repeat prescribing being online. RB noted that £24m was being transferred to the Global Sum to support patient online access so this would be a contractual obligation, however with regard to patient records, patients would have access to less detail than first anticipated i.e. the Summary Care Record and measures would be in place to protect vulnerable patients. KW gave assurance that the technology was there now to achieve this.

Extended Opening: there would be more flexibility in this so

it would be possible to consider it at Locality/Neighbourhood level along the lines of Winter Planning. NF noted that there would be no additional funding but reserves could be pooled.

Patient Participation: NF felt that Liverpool was performing

well in this area, JW confirmed that this featured in the Primary Care Quality Framework for most practices with action plans in place.

Transparency of GP earnings: RB felt that these needed to

be based on the format as consultants’ earnings i.e. on a 37.5 hour week which would portray a more accurate position.

Seniority Pay: this would disappear in its current form over

the next 6 years by 15% a year which would transfer to the Global Sum on an annual basis until absorbed. Some GPs in their fifties and early sixties might be dis-incentivised to remain in General Practice.

Diagnosis and Care for People with Dementia: NF noted that

there was no evidence that universal screening was more effective than selective screening. There would be small changes to the Learning Difficulties Health Checks, the changes proposed around Alcohol and Depression were what Liverpool was going to do anyway.

Information Sharing: KW noted the issue that not all systems

could support the requirements. RB noted the timescale for achievement by March 2015 therefore the systems suppliers would need to ensure that this was available. PF queried the number of practices that could use GP2GP and that the matter needed to be revisited. It was noted that SA and

Page 7 of 12

Lynn Jones were to meet with the maternity leave cover for MCa to look at this issue and how to support practices.

PMS Contracts: RB noted that the changes did not apply

formally to Personal Medical Services agreements but there needed to be alignment.

NF asked what the Primary Care Committee needed to do in preparation for the Local Medical Committee Open Meeting in January 2014. CM noted that Action Plans for the support to practices for implementation of the changes needed to be developed by the Locality Development Managers and Locality Chairs to define their roles. TK noted that this was a great opportunity for NHS England to collaborate with the CCG to identify the risks to practices. NF noted that the CCG needed to be supportive and did not have the responsibility of managing the contract. It was noted that the various Strategy/Congress meetings of the Localities to raise awareness. NF noted that this was a great opportunity to work with Member practices to deliver the Healthy Liverpool Programme. KW suggested using the Market place Events to promote awareness. However RB stressed the need not to worry practices unnecessarily and that this was generally good news for General Practice, it was better to work up a plan over the next 6-8 weeks ready for the Open Meeting in January. TK added that NHS England would need to circulate some information but would work in conjunction with the Local Medical Committee and the CCG.

The Primary Care Committee:

Discussed the attached documents. Considered a development plan to support practices with

the emerging change to General Practice.

5. UPDATE FROM NHS ENGLAND – VERBAL

TK gave a brief update to the Primary Care Committee:

Direct Commissioning Assurance Framework – this would be rolled out in Quarter Three – he would arrange for a paper to be circulated providing the timelines.

Page 8 of 12

Commissioning Intentions and Planning 2014/15: the commissioning intentions for Primary Care were being drawn up. David Scannell was dealing with Primary Care Medical APMS and would bring to the Primary Care Leads in December. Leigh Thompson-Greatrex would be co-ordinating.

Noted the verbal update.

6. WORKSTREAMs UPDATE – REPORT NO: PCC 47-13

5.a Localities – Report No PCC 47a-13:

North - PF

The meeting was not quorate and therefore was an informal discussion with no decisions made.

Two GPs were to be invited to attend each Locality

Leadership Team meeting starting with the CCG Practice Leads – this would facilitate filling vacancies and would manage for succession. It was confirmed for DA that the issue of a patient representative had been resolved.

Liverpool Central – JM

Dr Janet Bliss had attended re Dermatology and the problems around commissioning services due to the overuse of the two week rule. A review of the ICATs service at Broadgreen was being carried out and ideas from the Localities were welcomed.

There had been a robust exchange of views around

Integrated Care although Liverpool Central had the most difficulties. Dr Maurice Smith had attended to champion Integrated Care and it was noted that Anfield Neighbourhood did feel that Integrated Care was working well. The Neighbourhoods were to come up with their own approach to Integrated Care and feedback for further discussion. No one actually queried the concept of Integrated Care, the issue was purely around implementation.

Page 9 of 12

Practice variation across the city and the ways to reduce it were discussed. The Locality needed to agree how to best use the data to inform priorities and practice needs.

Health Visiting: consultation had been undertaken with

practices by Tina Atkins and Fiona Ogden-Forde which had identified a need for better communication between Health Visitors and Practices.

Innovation Bids – two proposals had been discussed and

would be referred on to the Innovation Panel once amendments had been made rather than having to come back to the Locality. The issue had been raised about having the right criteria to assess innovation bids.

Matchworks – JC

Locality Development Plan – this needed to be right and would be looked at over the next month and would hopefully be ready for January/February 2014.

Communication in general: the response from asking

practice staff what the CCG was had been mixed.

Re Chilidwall Neighbourhood Saturday morning opening proposal re winter pressures – a request had been made for a specific telephone number but the Head of Operations and Corporate Performance had advised that in order to avoid confusion and to main continuity with the rest of the year, the UC24 number should continue to be used but UC24 would forward the calls to the practice via a mobile number. This was agreed by the Primary Care Committee to be the safest option.

Health Improvement Steering Group meetings.

MCAS Pilot: Dr Denis O’Brien had attended to discuss the

issues raised, in particular re requests for a second opinion not within MCAS – this would need to be referred back to MCAS with more information.

Page 10 of 12

5.b Medicines Management Sub-Committee Report No PCC 47b-13 - PJ:

Prescribing KPI – practices were required to achieve 2%

reduction but given the extreme rise in costs of 5 major commonly prescribed and difficult to substitute drugs, these would be excluded from the baseline costs and practices would need to achieve a 2% reduction on the remaining drugs. It was noted that Liverpool Central and Matchworks had seen a reduction in prescribing costs but there had been growth in North Locality.

The Primary Care Committee agreed with the approach and felt that it was sensible.

5.c Innovations Panel - Verbal:– JW

A review of the innovations process was noted as being required.

The Innovation Panel was due to meet on 20th December

2013 and was due consider three to four bids. The Primary Care Committee:

Noted the reporting templates.

7. PRIMARY CARE IM&T UPDATE- REPORT NO PCC 48-13

The Deputy Director of Informatics Merseyside presented a paper to the Primary Care Committee to give the quarterly update on IM&T progress and developments, giving a flavour of some of the ongoing projects, a dashboard re the communications CQUIN, 6 monthly summary of the IT Service to GPs Key Performance Indicators and a look at how to move forward with any new initiatives.

GP Practice Clinical Systems and migration to EMIS Web: 68 practices to migrate by August 2014.

Electronic Clinical Correspondence – 8 Trusts had been

enabled, there were issues around the process at the Primary Care end, this should be sorted in December by and EMIS “patch”.

Page 11 of 12

Electronic Prescribing – the first practice was going live in

December which was a significant milestone. EG raised concerns about EPS2 and was keen to get the report back from the pilot first, given the issues over inappropriate dispensing from pharmacies on repeat prescriptions. PJ noted that this had been requested as an agenda item for the Local Medical Committee the following week. KW agreed to work with PJ in bringing something back to the Primary Care Committee.

Gold Standard IM&T – this had been approved by the

Liverpool CCG Governing Body Approvals Panel.

Roll out of WiFi to practices – SAp noted that there were 2 options to consider: Option 1 roll out Wifi across 18 large sites and 24 small sites using the kit already purchased or Option 2 roll out WiFi across all GP practices. There was an opportunity for capital funding from NHS England for the full amount for Option 2 but feedback on this would be available in 8 weeks’ time Given the substantial capital cost involved in Option 2 of £120k it was agreed to delay making a decision until the results of the bid were known.

Communication CQUIN – 2 providers were green, 4 were

amber, scores were awaited for 2 for Quarter 1 submissions. A query was raised by PF on why Aintree was showing as green but KW noted that the CQUIN Dashboard was based on the results submitted by the Trusts. CM noted that a member of the CHOICE Team has been tasked with the role of challenging information received from general practice. PF commented that Discharge Summaries were part of the Communications CQUIN but there would be an Effective Discharge CQUIN in addition to this as they were two separate issues. KW noted that this was a re-iterative process and that all feedback was greatly appreciated. It was noted that there were problems with St Paul’s re discharge and communication. It was noted that KW met on a monthly basis with CM looking at the delivery of IT performance and targets. A group of Practice Managers were looking at quality improvement re performance and service.

.

Page 12 of 12

The Primary Care Committee:

Reviewed the document for information. Fedback any comments. Delayed making a decision on which option to proceed

with regarding GP Practice WiFi Roll Out until the results of the bid for capital funding from NHS England were known.

8. ANY OTHER BUSINESS None

9. DATE AND TIME OF NEXT MEETING

Tuesday 31st December 2013 – 1pm to 3pm – even though this was New Year’s Eve it was normal working day and the meeting would be going ahead.

1

FINANCE, PROCUREMENT AND CONTRACTING COMMITTEE 26 NOVEMBER 2013 10AM – 12NOON

ROOM 2 - ARTHOUSE SQUARE In attendance Nadim Fazlani (NF) Chair Dave Antrobus (DA) Lay Member Maureen Williams (MW) Lay Member Tom Jackson (TJ) Chief Finance Officer Katherine Sheerin(KS) Chief Officer Maurice Smith (MS) GP – Governing Body Member Kim McNaught (KM) Deputy Chief Finance Officer Derek Rothwell (DR) Head of Contracts and Procurement Alison Ormrod (AO) Chief Accountant Tony Woods (TW) Head of Strategy and Outcomes Shan Holford (SH) Intelligence Manager Matthew Greene (MG) Assistant Planning Accountant Sue Renwick (SR) Long Term Conditions Programme Manager (for Item FPCC40-13b only) Lynne Hill (LH) PA/Minute Taker Apologies Ray Guy (RG) Practice Manager Jane Lunt (JL) Head of Quality/Chief Nurse 1 Welcome and Introductions The Chair welcomed all to the Committee meeting and agreed that items would be taken out of order from the agenda to allow colleagues to go to other meetings. The agenda items are listed in the order they were taken. 2 Declaration of Interest No declarations were made. 3 Minutes from the last meeting held on 24 September 2013 The minutes were agreed as a correct record with the minor amendments as follows:

Page 3 line 3 - remove “we” Page 6 last paragraph replace should with would Page 1 apologies received from Maurice Smith

3a Actions from the last meeting held on 24 September 2013 SPIRE DR tabled a Spire update paper re increased activity and highlighted the key issues:

2

Attendances, overall increase in Orthopaedic attendances of 20% month on month for 2012/13. For Spire there was an increase of 24% and for Aintree an increase of 30%.

Page 2 (conversion rate) Spire showing 50% conversion rate, but note that this is not comparing like for like. Whereas RLBUHT had a conversion rate of 36% and Aintree a conversion rate of 26%

There is a noticeable difference in ages of patient attending Spire compared to other Acute providers. The other Acute providers deal with considerably more patients aged 65+

Referrals from 8 local practices have 30% or more of their orthopaedic patients choosing Spire)

Overall growth driven by choice, and the age profile at Spire is markedly different to that at Aintree and RLBUHT

MS made an observation that T&O has always been an issue for Liverpool, and all decisions will be going via MCAS. DA queried if these figures are to the end of the treatment. SH confirmed that this is only where the referral is coming from and no double counting is taking place. TJ reported that Spire is a major provider in hip and knee replacements. NF commented that Spire is a major provider for Liverpool and especially in hip and knee surgery then some possible “cherry picking” may be taking place. TJ acknowledged that under the tariff based system there is a potential to increase revenue. KS stated that diabetes outcomes model was discussed at the Informal Governing Body and it included how we can try and incentivise providers to encourage patients to consider the potential of not having the procedures when considered with the potential negative consequences of some treatments. MS stated that we should include a method in the process for the contracting of the provision. TW referred to the Outcomes Commissioning for Value packs and the potential opportunities we may have in areas such as musculoskeletal, as it is a high use area. Outcomes are poor and we need to undertake some quick work and review this area. MW commented that we probably need to do something over and above this, however MS questioned whether we have anything that is robust enough to provide an alternative to surgery (ie support rather than surgery). MW agreed on the search for shared decision making but we need to ensure that it is meaningful.

3

NF stated that there are possibly three (3) aspects to review; Referral criteria Decision making (place that they are choosing) Alternative treatment/support

MS stated that NHS Oldham CCG have a prime provider model for shared decision making. Donal O’Donaghue has the contact details. Action: Maurice Smith and Tony Woods to make contact with NHS

Oldham CCG. 3b Draft Contract Timeline 2014/15 DR tabled the Contract Timeline 2014/15. MW queried if this timeline allowed the CCG to fit in all our commissioning intentions. DR commented that TW is working on this via the Healthy Liverpool Programme (HLP) work and that this timetable does not stop us achieving this and there is a wide work programme with providers to be completed in January /February 2014. TW gave examples of the frail elderly work that is on-going. MW queried does this work in January/February 2014 to allow us to have the appropriate discussions and negotiations. DR stated that we can build in flexibility and fit in a monitoring regime. MW queried if we are considering 2 year contracts. TJ confirmed that we are and that he has had discussions with providers on the option of 2 year contracts which would include CQUIN and they have been very responsive to this. This will emerge over the next 2 months. MW commented that given that the new emphasis is on outputs and outcomes, will we be including social value and are providers expected to take this into consideration. TJ acknowledged that the Social Value Strategy is being presented at the January 2014 Governing Body and will need to work through and link this with a detailed specification and an incentives pilot. DA queried whether the providers were aware of what we want to achieve or are they only going to discover this in January 2014. TJ stated that the diabetes model work has included providers in the discussions. Provider Directors of Finance have been in discussion with TJ and have been aware of the intentions for some time. DR stated that all providers have been involved in discussions and have received information. Action: Timetables to be circulated electronically (LH)

4

Continuing Health Care (CHC) KM has met with the CMCSU regarding the CHC and work is on-going. Item deferred to the next meeting. Action: Agenda item Continuing Health Care update (KM)

Inclusion Matters (IM) TW stated that a more detailed paper is ready and available to be presented to the Governing Body. TW is in regular contact with Merseycare in relation to Single Point of Access (SPoA) and hoping to make a decision by the end of January 2014. It was agreed that the Informal Governing Body and Finance Procurement and Contracting Committee (FPCC) to have sight of the paper. Action: TW to prepare paper for January 2014 Informal Governing Body

and FPCC. Information Governance TW gave a verbal update on Information Governance, Safe Haven rules and identifiable patient information. LCCG are currently working with Mersey Internal Audit Agency (MIAA) to meet the national level 2 requirements. A number of policies and strategies will be presented to the January 2014 FPCC. Action: Agenda item for January 2014 FPCC Action: TW to prepare policies and strategies for the late January 2014

FPCC Anticoagulation Service DR updated the Committee on the contract duration and it is confirmed that LCCG has the final decision and can be 3 years with a suitable review time. NF confirmed that the decision made was 3 years plus 2 year review. 4 Dates of other Sub Committees The Committee noted the dates of the Sub committees QIPP Financial Monitoring and Contracting

Agenda Items 5 Month 7 Finance Report (FPCC38-13) AO talked through the Month 7 Finance report; Key issues

Operating Statement: amber flagged – working through these areas, CCG will still achieve the forecast stated at the beginning of the year.

Better Payments Practice code – this is the first time the CCG have been presented with the information. The reporting of the target will transfer from

5

CMCSU to CCG wef January and will be reported regularly within the Finance updates.

KS commented that it is a well presented report, and that it would be useful for a breakdown of primary care to provide more details. Action: AO to include a breakdown of primary care in the next report.

6 Specialised Commissioning TJ updated the Committee that specialised commissioning has also been discussed at previous FPCC and Audit, Risk and Scrutiny Committee and both had given permission for TJ to go back to Specialised Commissioning to negotiate the £6.7m reduction. However, since the last meeting further requests have come through on additional monies to be deducted. TJ has spoken with KS and NF and it has not been accepted to go forward with this. Since then a number of other adjustment requests have come through. NHSE(M) have written to KS with the adjustments that the CCG had not agreed stating that they have been actioned. NF highlighted that there was a lack of process or fairness as there seems to be no process, even though the CCG have signed up to an agreement in March 2013. The letter describes 3 actions which offset each other. However, there is a risk with regard to Clatterbridge Cancer Centre (CCC). The previous PCT had provided funding to support the transfer of the Cancer Centre to Liverpool and the CCG are unclear what the funding will be used for if the transfer does not take place. Further funding requests are being received and although not large individual amounts they are building up. A meeting on 17 December 2013 is taking place to discuss allocations. MW stated that we need to ensure we are not railroaded into the position and we should not accept the position. MW stated that this Committee should refer this issue to the Audit, Risk and Scrutiny Committee as a risk. Action: It should also be put on to the Finance Risk Register and the

Corporate Risk Register (Action KM/AO/ID) KS confirmed that she is in agreement with NF and MW and that transparency of process is absent. It was agreed that the Finance, Procurement and Contracting Committee

support the approach. Action: KS and NF will provide a formal response to NHSE(M) Action: Item for Private Section of the Governing Body on 12 December

2013 (NF/KS)

6

7 Investment Prioritisation Process Progress (IPP) (FPCC39-13) KM outlined the changes to the IPP. 3 areas:

Decision cut off point - 75% Make up of the panel membership with relevant expert knowledge. Inclusion of additional scoring criteria - Social Value and Value for Money

MW acknowledged that it is excellent that we have a process and is happy with the process and principles behind it. We have now got more streamlined with the Approvals Panel. Therefore, some changes to words i.e. The principles of the Approvals Panel go to the Governing Body. Approvals Panel will make the decision and not a recommendation to the

Governing Body. Approvals Panel will consider if there is a conflict of interest and able to make the

decision. Governing Body will make decision if value is above £250k and must approve the

strategic investment, but if underneath that the dispersals of the investment brings a conflict of interest then that should go to the Approval Panel.

MS suggested that we produce a worked up case model to show how this works to avoid any confusion. Action: worked up case to be devised KM/AO/DR

Steps KS stated that the IPP has included the “Programme Lead” which is the SMT Programme Lead and it should be the Governing Body member, therefore need to review this step. Scoring MW suggested that health outcomes should be included in the Investment Prioritisation Process (IPP). Membership DA is available. MW agreed that this is an important point on the membership and quoracy. Value for Money Value for Money/Social value this needs to be changed to “how is it taken into consideration”. TJ stated that there are 3 sets of outcomes; the Nicholson 7 set, National outcomes plus our own outcomes. MW stated that the prioritisation process is value judgement and also is an audit trail, but it represents a starting point.

7

NF stated that this is a starting point for what we want to achieve, some changes are required and it needs to be clear if we are challenged. Some worked examples need to be produced so that it can help those that are completing the process. Some discussion can happen “virtually” via email and the changes presented to the next Finance Procurement and Contracting Committee. Action: Amendments to be made to the IPP (KM/SL) Action: IPP - Agenda Item for next FPCC (LH)

7 Investments for Approval (FPCC40-13) 7a: Parent Infant Psychological Services (PIP) Across the city DR stated that the initial query on the PIP service was on who provides the funding. This is dependent on the provider to get the funding and not the CCG therefore it is not a risk to the CCG. NF/MW raised concern on what could be our historic commitment to investments and we would need to be vigilant on this. Concern was highlighted on the PIP and if it will actually deliver the outcomes expected. KS stated that she does not fully understand the paper and why it has been presented to the FPC. KM confirmed that PIP has been approved at Service Improvement Committee and has been presented to the FPCC due to the value of the bid. MS also raised the issue of what is being agreed and what papers are being presented and MW was concerned that the paper refers to a contract held by the CCG however too many unknowns and therefore was not comfortable in approving the PIP investment. NF acknowledged that the PIP paper requires a clear process, rationale and why the decision was made. The paper appears unclear and therefore the Finance Procurement and Contracting Committee have not approved the PIP. TJ suggested that bids need to be put forward annually to review and decisions to be made on the affordability and duration of each. DA queried whose money is it that we are trying to match. NF gave the background to the bid and that the pilot has come to an end but there is money available but only if this is matched. MW suggested that the PIP may be a good example to run through as a worked up model and be re-presented later next year.

8

Finance Procurement and Contracting Committee have not approved the Introduction of a Liverpool Parent Infant Psychological (PIP) Service

7b: Insight – for Pulmonary, Rehab, Cardiac Rehab and Integrated Care

MS talked through the paper and highlighted the key areas: Groups of people – 4 groups Active resistors – map across to Unconfident Fatalists Target interventions more accurately as and when we find them. Focus

services on those people. Clear benefit and a bespoke intervention for those individuals.

SR - Reduces admissions, mortality and quality of life. Tailored to the group. KS suggested that going forward for next year, as resources may transfer to the Local Authority, rather than having individual Insight proposals a CCG wide plan should be developed to identify all areas that require Insight input. KM said that this has been discussed at Service Improvement Committee and Tony Woods was taking this up. SR confirmed that the Local Authority co-ordinate the Insight work, however will “buy in” resources to do some of the work (i.e relevant expertise). MS queried the process for making incentive payments directly to patients. KM highlighted the potential issues resulting from making cash payments to patients including the implications for tax and benefits payments and the knock on effect to other workstreams that do not make payments to patients. The CCG does not have a policy for payments to patients. MW stated that she does not feel that there is justification to approve as there is no indication of when it will start or numbers of people and it appears to only include MI/DALLAS. MS acknowledged that this was written for when the integrated care process was in place. This paper is presented to the Finance Procurement and Contracting Committee as a new process and is an innovative bid and advocates that the bid is useful and beneficial for the service user/patients. MS clarified that will this be an SLA and not a contract or grant KS agreed that it is different to the previous PIP paper and supports MS discussion and the case for the Insight bid. NF confirmed that we have to demonstrate as a CCG that there is due process and governance and the process needs to be clear enough to enable that. This Insight paper has met that requirement.

9

The FPC Committee approved “Insight” as a one off SLA for £62,500k. It was also agreed that future “Insight type bids” will come in as part of

an overall Insight Strategy in future (TW). 9 Spire Update DR updated the Committee on Spire. A contract query has been issued and the concerns are now being dealt with via the contractual route. 10 Section 64 (S64) KM gave an overview of Section 64 and that CCS will be undertaking this until March 2014 and will result in a total spend of £20k - £25k. Action: A progress report will be presented at the FPCC March 2014

(KM) 11 Risk Register (Tabled) (FPCC41-13) TJ talked through only those RAG ratings which were red and amber and highlighted the following: Legacy Issues KM outlined the information presented at a recent NHSE seminar and the background on the Legacy issues. Draft figures are expected at Month 09, however these will not be the final figures and also may not be available until the end of December 2013 Working with the Local Authority TJ continues to work with the Local Authority, spending cuts will be significant, however we will not be fully aware of the line-by-line reductions until next year. Working with Providers on Cost Improvement Programmes (CIP) TJ informed the Committee that many of our providers are stating they are under considerable financial pressures and this will not be any easier next year. TJ outlined the CIP and the tariff process. Providers have been utilising income generation schemes rather than CIP and therefore the impact will be greater. PFI TJ stated that is on-going on a recurrent basis.

NHS Property Services TJ confirmed that the CCG have received invoices from the NHS Property Services on the basis of occupancy/usage of NHS buildings. There are on-going discussions

10

with Liverpool Community Health on the funding of property. Discussions involve the changes since new buildings have come in to place and the new process of occupancy charges. CMCSU work On going work until March 2014. F015 TUPE KM outlined the discussions regarding the potential TUPE of staff from CMCSU to the CCG. 12 Any Other Business 12a Financial Planning/Contracting TJ stated that in January 2014 we will need to discuss financial planning, budgets and allocations. Commissioning for Outcomes - Contracting for Outcomes and work needs to be undertaken on this. Action: Financial Planning/Contracting agenda item for January 2014

(TJ) TJ stated that there has been an announcement of £150m AED monies for those providers that did not receive funding in the first tranche. 12b Movement around the provider systems in TDA (Trust Development Authority) TJ outlined the Trusts that are covered by the TDA, including: St Helen’s & Knowsley Hospitals, Royal Liverpool & Broadgreen University Hospitals and Liverpool Community Health MW stated that the Integrated Care Steering Group discussed the Commissioning for Outcomes. TW or TJ agreed to attend the next Integrated Steering group. Action : TJ or TW to attend the January Integrated Care Steering Group

12c Committee meetings and tabled papers It was agreed that papers not presented on the agenda will not be discussed at the meeting. 12d Bring to Market Anticoagulation Service DR updated the Committee on the Bids for the Anti Coagulation Service and specifically the PQQ stage. 13 Committee Dates for 2014 Committee dates agreed and be circulated with deadline dates for final papers. Action: Dates to be circulated (LH)

11

13a Date of Next Meeting An additional meeting to take place on Tuesday 7 January 2014 at 10:30am – 12:30pm.