a - front cover · items to note / receipt of minutes 11. receipt of minutes from committees •...

Governing Body

To be held on Thursday 19

th June 2014

from 12.30pm until 4.30pm

in the Boardroom, Sovereign House, Heavens Walk, Doncaster DN4 5HZ

Governing Body To be held on Thursday 19th June 2014

Commencing at 12.30pm – 4:30pm In the Boardroom, Sovereign House, Heavens Walk, Doncaster, DN4 5HZ

PUBLIC AGENDA

Presenter Enc

1. Welcome and Introductions

Dr Tupper

2. Apologies

Dr Tupper

3. Declarations of Interest

Dr Tupper

4. Patient Stories / Questions from Members of the Public

Dr Tupper

5. Minutes of the previous meeting held on 15th May 2014

Dr Tupper Enc A

6. Matters Arising

Dr Tupper

Assurance

7. Integrated Quality & Performance Report including a spotlight report on Annual Update on Mortality

Mrs Shepherd & Mrs Leighton Mr Ray Cuschieri, DBHFT

Enc B

8. Finance Report

Mrs Tingle Enc C

Strategy

9. Talking Points - Strategy Launch

Mr Carpenter Verbal

Standing Items

10. Chair & Chief Officer Report

Mr Stainforth Enc D

Items to Note / Receipt of Minutes

11. Receipt of Minutes from Committees

• Audit Committee – Draft minutes from the meeting held on

5th June 2014 will be received by the Governing Body in July.

• Quality & Safety Committee – Draft minutes from the meeting held 1

st May 2014

• Engagement & Experience Committee – Draft minutes

from the meeting held on 5th June 2014 will be received by the

Governing Body in July.

• Delivery & Performance Committee – Minutes from the

meeting held on 8th May 2014

Dr Tupper Enc E

12. Any Other Business

Dr Tupper

13. Date and Time of Next Meeting Thursday 17th July 2014 at 12:30pm

Dr Tupper

14. To resolve that representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

Dr Tupper

Enc A

Minutes of the previous meeting

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Minutes of the Governing Body Held on Thursday 15 May 2014 commencing at 12.30pm

In the Boardroom, Sovereign House Present:

Dr Nick Tupper – NHS Doncaster CCG Chairman Dr Marco Pieri – Locality Lead, North West Locality Dr Niki Seddon – Locality Lead, North West Locality Dr Jeremy Bradley – Locality Lead, North East Locality Dr Andy Oakford – Locality Lead, North East Locality Dr Pat Barbour – Locality Lead, South East Locality Dr Ayesha Zafar – Locality Lead, South East Locality Dr Karen Wagstaff – Locality Lead, South West Locality Dr Lindsey Britten – Locality Lead, South West locality Dr Anna Kirkman – Locality Lead, Central Locality Dr Emyr Wyn Jones – Secondary Care Doctor Member Miss Anthea Morris – Lay Member Mr Chris Stainforth – Chief Officer Mrs Hayley Tingle – Chief Finance Officer Mrs Mary Shepherd – Chief Nurse Mrs Jackie Pederson – Chief of Strategy & Delivery Mrs Sarah Atkins Whatley – Chief of Corporate Services Mrs Joan Beck – DMBC Representative Dr Tony Baxter – Director of Public Health Mrs Sheila Barnes – Healthwatch Doncaster Representative (attending on behalf of Mrs Ann Gilbert)

In attendance:

Mrs Jayne Satterthwaite – PA (Taking Minutes) Mrs Ailsa Leighton – Head of Performance

ACTION

1. Welcome and Introductions Dr Tupper welcomed everyone to the Governing Body meeting and announced that this would be Mrs Joan Beck’s last attendance at the Governing Body meeting due to her impending retirement. Dr Tupper thanked Mrs Beck for her valuable contribution. There were 10 members of the public in attendance at the meeting.

2. Apologies Apologies were received from:

• Mr Albert Schofield – Lay Member and Vice Chair of the Governing Body

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• Dr Sam Feeney – Locality Lead, Central Locality

• Mrs Ann Gilbert – Healthwatch Doncaster Representative

3. Declarations of Interest Declarations of Interest were made at the commencement of Item 12, Unplanned Care.

4. Questions from Members of the Public/ Patient Stories Patient Story Dr Tupper introduced Mrs Barton to the Governing Body meeting and explained that he had known Mrs Barton and her family for 12 years in his capacity as their GP and that she had kindly agreed to attend the meeting to give her personal account of living with her eldest son’s diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and the impact of this on the family. Mrs Barton informed the Governing Body that her son was a bright baby however as he grew older he began to display challenging behaviour and a lack of understanding of boundaries. He attended a small primary school where he was described as very intelligent and easily bored and Mrs Barton was regularly asked to attend to discuss her son’s behaviour. It became more problematic when her son attended secondary school as he was unable to cope with the changeover of lessons/teachers and possessed no techniques for planning. He began to abscond from home, initially overnight, then progressively for longer periods of time, the longest being 5 days at the age of 14 years. Her son was subsequently excluded from school and was later enrolled in the Joint Agency Support programme (JAS). Mrs Barton requested that Dr Tupper refer her son to the Child and Adolescent Mental Health Service (CAMHS) and, after a period of 6 weeks, he was seen by an Occupational Therapist and a nurse who described him as bright and required counselling and was subsequently discharged. Mrs Barton was informed of a questionnaire available on the internet which she completed with her son and gave to CAMHS. He was then seen by a paediatrician at 15 years of age who prescribed Ritalin on a trial basis. Within 2 months her son had passed 5 GCSE examinations. He expressed a desire to complete his A level studies and was accepted into school where he performed well. At 16 years of age he was discharged from the Paediatric team after which there was a gap in service until he was 18 when he was seen by a psychiatrist.

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Mrs Barton reported that her son is now 23 and has channelled his energy into extreme sports and is employed as a snowboarding instructor. Mrs Barton gave her recommendations to the Governing Body as follows:

• There is a gap in service after being discharged from the Paediatric Team at 16 years of age to being seen by a Psychiatrist at 18

• More education of ADHD is required for the police, teachers and social workers etc

Dr Barbour introduced herself to Mrs Barton as the Governing Body Clinical lead on Children’s services and informed her of the new re-design of the Paediatric pathway and that she would welcome her comments and advice on the pathway. Mrs Barton stated that she would be willing to do so. Dr Tupper thanked Mrs Barton for her valuable contribution. Question to the Governing Body Care UK attended the meeting and informed the Governing Body that they are currently taking industrial action on behalf of their patients and queried funding for Supported Living Services in Doncaster. Dr Tupper reported that NHS Doncaster CCG does not have a contract with Care UK. He assured Care UK that the CCG follows a rigorous procurement process with detailed criteria which is considered by professionals and which also includes criteria on patient involvement. Dr Tupper thanked Care UK for their query.

5. Minutes of the Previous Meeting held 17th April 2014 The minutes of the meeting held on 17th April 2014 were agreed as an accurate record subject to the following amendment: Patient Story Page 2, Paragraph 3, Line 4/5 ‘The surgery finally took place in Bassetlaw Hospital 12 days later’.

6. Matters Arising QIPP Programme Mrs Tingle informed the Governing Body that the action would be

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covered in Item 9, Draft Annual Accounts.

7. Quality & Performance Report Mrs Shepherd and Mrs Leighton presented the Quality and Performance Report to the Governing Body. Provider Performance Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT)

• Stroke – The Stroke Action Plan is now underway. Stroke Specialist Nurses now operate 24/7 and are able admit patients directly and order scans as required. Improvement is indicated in patient flows. There has been a change is the process of SALT assessments and all new referrals are seen immediately. Dr Seddon queried the routine timeframe for SALT assessments. Mrs Shepherd and Mrs Leighton agreed to query this with the Trust.

• Ophthalmology - An External Ophthalmology Review has been completed and the report provided to NHS Doncaster CCG. The report clarifies and confirms the issues that were already identified through DBHFTs internal investigations. An action plan is in place and this will be monitored through the contractual meeting structure. No new Serious Incidents (SIs) have been identified and all previous SIs have been closed.

• Pressure Ulcers - The number of ungradeable pressure ulcers has not improved in line with expectations following the implementation of the new strategy at DBHFT however it is hoped that results will be measureable from July. In addition there has been a high level of staff training in this area and significant improvements are expected during 2014/15.

• Falls - There have been a number of reported injuries following falls at DBHFT. The number appears to be higher than in previous months. This will be explored through the contractual meetings. Improving care for those at risk of falling remains a priority within DBHFT.

• 18 Week Waits – DBHFT achieved 90.5% in the 18 week wait target.

Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH )

• Quarter 4 Commissioning for Quality & Innovation (CQUIN) targets were achieved.

Other Commissioned Services

• Winterbourne Statement - NHS Doncaster CCG has not identified any significant risk in relation to meeting its responsibilities.

• NHS Doncaster CCG are working with the Local Authority to ensure that there is a coordinated response to the judgement with the aim of supporting local providers and the Local Authority to meet their statutory responsibilities and provide safe effective care

Mrs Shepherd

/ Mrs Leighton

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in line with the Mental Capacity Act and Deprivation of Liberty Safeguards.

• A drop in performance in the Yorkshire Ambulance Service (YAS) Category A 8 minute response times was noted in Doncaster and across the YAS patch which is under review and potentially due to delayed implementation of operational changes / changes not delivering expected outcomes.

The Governing Body noted the report. Spotlight Report on Dementia Services by Rotherham Doncaster & South Humber NHS Foundation Trust (RDaSH) Dr John Bottomley attended the Governing Body and gave a presentation on the services commissioned from RDaSH in anticipation of the Dementia Awareness week held from 18 – 24 May 2014.

• There is a high proportion of Dementia identified in Doncaster.

• There are robust assessment procedures at RDaSH which are compliant with NICE guidelines, rapid access into services, a Multidisciplinary team (MDT) including a Consultant Psychiatrist, input into all assessments and care planning and high quality inpatient care.

• Outside of the Old Age Psychiatry services RDaSH also has Community services, Learning Difficulty services, Forensic services, General Adult services and Drug and Alcohol services.

• In-patient services include 20 in-patient beds with 50% occupancy (prior to Continuing Healthcare changes), a challenging behaviour patient population, assessment and management of dementia.

• The Community Mental Health Team provide planned assessment/care, crisis management, carer support, Mental Health Social Worker input, Community Memory Therapy services, care home and hospital liaison service.

The Governing Body held a detailed discussion and identified a potential lack of integration, co-ordination and navigation between the various providers and agreed further work in this area. Dr Tupper thanked Dr Bottomley for his valuable contribution.

8. Corporate Assurance Report Quarter 4 Mrs Atkins Whatley presented the Corporate Assurance Report Quarter 4 which covers the period 1st January to 31st March 2014 and provides a summary for the key internal corporate assurance and governance activities within NHS Doncaster CCG during this period. Assurance Framework - There have been no new risks added to the Framework during the last Quarter, with the total remaining at 21. Of these risks, 2 were scored above the CCG’s risk toleration threshold (a

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reduction of 1 from the last Quarter which related to personal confidential data in commissioning), and both of these were being treated. 2 additional risks below the risk toleration threshold were also being treated to further strengthen existing controls / assurances (a reduction of 1 from the last Quarter which related to in-year changes in financial allocations). The risk added in Quarter 2 regarding the effective commissioning of Continuing Healthcare Services remains at a score of 16 and the Governing Body’s attention has particularly been brought to the updates against this risk. The action plan is progressing with Chief Officer oversight and the risk likelihood is expected to reduce in Quarter 1 following Governing Body receipt of written assurance on action plan progress. External Assessments - Internal Audits have been received relating to a) collaborative commissioning contract negotiations, b) budgetary control & financial reporting, c) key financial systems & payroll, d) Information Governance, and e) Governance Structure, all with significant assurance. Committee Activity –

• Audit Committee considered a Counter Fraud Progress Report and 2014/15 work plan, reviewed the Assurance Framework, considered a pre-Service Auditor report from the Commissioning Support Unit, reviewed the CCG’s banking arrangements, reviewed the Risk Register and Probity Register and approved a range of governance policies.

• Remuneration Committee reviewed salaries, terms & conditions and made recommendations to Governing Body, and approved a range of Human Resources policies.

• Quality & Safety Committee considered the usual full range of quality reports, including a detailed Medicines Management Report covering controlled drugs, medicines safety, shared care, finance, antibiotic stewardship, use of Information Technology and planning / strategy.

• Engagement & Experience Committee explored options for strategic partnering to improve patient experience and considered strategic planning of engagement activity linked to the CCG planning cycle. From this, a Talking Points strategy emerged and was approved. The Committee also oversaw the development of a Practice Participation Group (PPG) Network, with the first meeting held in January 2014.

• Delivery & Performance Committee considered a range of pathway redesigns, business cases and options, reviewed the Directory of Services assurance report and considered a report on business intelligence.

Procedural Document Management - 2013/14 has seen a significant programme of review and refresh of inherited procedural documents, and a wide range have been approved during the last Quarter and published on our website with an update provided for staff on key

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changes. Sustainability - The CCG Sustainability Strategy was refreshed during Quarter 4 and approved by the Governing Body. The Strategy includes an action plan based on the Good Corporate Citizenship Assessment Model including travel, procurement, facilities management, workforce, community engagement and buildings. A year-end review of progress against due actions in the sustainability action plan has been completed. All actions are on track excepting the action regarding building sustainability. NHS Property Services have advised and agreed with NHS England that they cannot provide CCGs with building sustainability data for 2013/14. There has been limited engagement possible with NHS Property Services on other sustainability matters. The CCG is therefore planning sustainable investments separately e.g. covered bike racks. Information Governance - The CCG has achieved Controlled Environment for Finance (CEfF) status, enabling the processing of personal confidential data for invoice validation. Financial Governance - The Standing Financial Instructions, Standing Orders and Scheme of Delegation are under refresh and a final draft is due to be received by Audit Committee in May 2014. Organisational Development - The Organisational Development Strategy and action plan continue to be implemented. Actions due for completion in 2013/14 are performance monitored and brief updates are provided in this section. The majority of actions are on track, and plans are in place for any outstanding actions. Staffing Governance - A programme of mandatory and statutory training was re-launched in Quarter 4 via e-learning and employees were supported to achieve full compliance. Following an excellent response from staff, the target compliance rate of 95% of eligible staff was achieved across all performance monitored areas. The Governing Body noted the report.

9. Draft Annual Accounts

• Draft Annual Accounts

• Draft Annual Governance Statement

• Draft Annual Report Mrs Tingle and Mrs Atkins Whatley presented the Draft Annual Accounts, Draft Annual Governance Statement and Draft Annual Report respectively and explained that the draft documents are due to be finalised and submitted in final format on 6th June 2014. The accounts are now subject to audit and will not be signed off until the

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auditors complete their work, which could be up to 5th June 2014. The documents are therefore presented to the Governing Body in draft for review with an expectation that the finalised accounts will be signed off on 5th June 2014 for submission on 6th June 2014. These documents were considered at the Audit Committee on 8th May 2014 and no significant issues were raised. At the Audit Committee on 8th May 2014 External Audit expressed the opinion that there may be a few presentational changes but nothing of significant concern was raised. An extraordinary Governing Body meeting will be convened on the afternoon of 5th June for the purpose of signing off the final submission. Draft Annual Accounts – The direct costs for Specialised Services and the main Primary Care Contracts, Public Health, PCT-owned property, LIFT buildings and Legacy balances including Continuing Healthcare no longer feature in the CCG’s accounts. The exclusion of the above areas has had a significant effect on the Notes to the Accounts, in particular those relating to purchase of healthcare services from NHS organisations, Assets, Borrowing, Finance and Operating Leases, Provisions, Contingencies and Employee Benefits. A new financial ledger system, the Integrated Single Financial Environment (ISFE) was implemented on 1st April 2013 and this is the first set of Accounts prepared using the new ledger. ISFE facilitates the national consolidation of all sets of Accounts within the NHS England resource boundary. The Draft Accounts for the CCG for 2013/14 were completed and submitted on 22nd April 2014, which was one day in advance of the national deadline. The Draft Accounts demonstrated the achievement of all financial targets, in particular a Surplus of £7,182,000 against a resource Allocation of £420,878,000. The Statement of Comprehensive Net Expenditure (SOCNE) shows the gross expenditure incurred and gross income received, which is attributable to the financial year 1st April 2013 to 31st March 2014. The net expenditure for the CCG was £413,697,000 compared with £587,347,000 by the PCT in 2012/13. Mrs Tingle informed the Governing Body that comparative figures will be available next year as this is the first year as a CCG. Dr Jones re-iterated that the Draft Annual Accounts had been rigorously examined through the Audit Committee and congratulated Mrs Tingle and her team for their preparation. The Governing Body noted the draft Annual Accounts. Draft Annual Governance Statement – The Draft Annual Governance Statement follows the format as required by NHS England and focusses on the Assurance Framework and Risk Management. The Statement notes that our governance meeting structure is headed

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by the Governing Body. The Governing Body has responsibility to undertake the roles and responsibilities as delegated through the Constitution signed by the 43 Member Practices which constitute the CCG. Mrs Atkins Whatley drew attention to page 23 which reflected the Continuing Healthcare audit which had been given a limited assurance conclusion. The Governing Body noted the actions in place to address the highlighted issues and agreed the draft Annual Governance Statement. Draft Annual Report – The Draft Annual Report follows the format as required by NHS England and focusses on the technical and business forward assurance. We produce an Annual Patient Prospectus which is a more patient focussed document. The refreshed Annual Reporting format requires a new Membership Statement in Section 1, which for our CCG is composed by the Chair, and also a Sustainability Report and an Equality Report which are included within the annual report. The report explained about the merger of two practices resulting in the 44 formal Members Practices reducing to 43. Mrs Atkins Whatley also referred the Governing Body to the Remuneration Report in section 4 of the annual report. Mrs Atkins Whatley informed the Governing Body that further additional information will be incorporated to reflect the year-end financial position. The Governing Body agreed the draft Annual Governance Report.

10. Standing Orders, Scheme of Delegation & Standing Financial Instructions Mrs Atkins Whatley presented the Standing Orders (SOs), Scheme of Delegation (SoD) and Standing Financial Instructions (SFIs) to the Governing Body for approval of the changes to the documents. The Standing Orders, together with the Scheme of Delegation and Standing Financial Instructions, regulate the proceedings of the CCG so that it can fulfil its obligations. The CCG inherited the documents from the legacy body Doncaster Primary Care Trust (PCT), with only minor updates to reflect the establishment of the CCG. The document has been under review by the Audit Committee to ensure that it reflects the CCG’s current position and the Committee considered the updates in details at its meeting on 8th May 2014. Standing Orders - The Standing Orders have been fundamentally reviewed and refreshed to ensure that they match our Constitution, our structure, and to clarify the respective roles within the organisation of Officers, Non-Officers (Lay Members), and Locality Leads and include the following:

• The arrangements for conducting the business of the CCG

• The appointment of Member Practice representatives

• The procedure to be followed at meetings of the CCG, the Governing Body and any committees or sub-committees

• The process to delegate powers

• The requirements relating to declaration of interests and

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standards of conduct The Standing Orders also reflect the assurance role of each of the Committees reporting directly to the Governing Body. Scheme of Delegation - The Scheme of Delegation has been updated to include, for completeness, the overarching Scheme of Delegation already approved within the CCG Constitution. The underpinning operational scheme of delegation has been refreshed to better align with the CCG Constitution, the statutory duties of the Governing Body, and the statutory duties of individuals who are members of the Governing Body. The Scheme of Delegation also confirms the financial delegation as regards decisions to procure and confirm the award of contracts. In approving the Financial Plan and the resulting annual budgets, the Governing Body thereby delegates the enactment and the management of the budgets in line with the budgetary scheme of delegation. The budgetary scheme of delegation confirms the thresholds for tendering/contracting, the thresholds for authorisation of requisitions, the thresholds for authorisation of invoice payments, and the thresholds for signing Service Level Agreements. Standing Financial Instructions - The Standing Financial Instructions have been refreshed with minor updates only. Miss Morris re-iterated that the documents had been rigorously examined through the Audit Committee. The Governing Body noted and approved the changes to the documents.

11. Procurement Strategy Mrs Tingle presented the refreshed Procurement Strategy and explained that it was last presented to the Governing Body in February 2014 where it was recommended that the Strategy needed to fully align with the Standing Orders, Scheme of Delegation and Standing Financial Instructions of the organisation which were themselves under review. For completeness, the amendments to the Procurement Strategy previously recommended to the Governing Body and which are linked to changes in policy and legislation were noted as follows:

• Reference to revision of European Procurement Directive with indication of anticipated changes

• Updates to legislation o Health and Social Care Act (2012) o Procurement, Patient Choice and Competition

Regulations o Public Services (Social Value) Act 2012 (UK)

• Monitor’s Role

• Timescales for process

• Governance, Delegation and sign off

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• Use of Pilots

• Sustainable Procurement

• Updated appendices: o Conflicts of interest in procurement o Viability / Sourcing assessment o Single Quote Waiver

Expertise within the organisation or externally will be utilised during the procurement process with the support of Mrs Claire Burns. Mrs Atkins Whatley noted the importance of patient and public involvement within the commissioning cycle including procurement, and highlighted that this requirement was captured within the refreshed Procurement Strategy. The Governing Body agreed the importance of meaningful engagement with patients and the public and agreed that this should be agreed at the beginning of each planned procurement. The Governing Body approved the refreshed Procurement Strategy.

12. Unplanned Care At the commencement of this item Mr Stainforth and Mrs Atkins Whatley explained that any Governing Body member who is a Director, Shareholder, or employed by one of the services or whose Associates may be involved must declare an interest. Clinical input in the decision making will be sought from those who do not have a pecuniary interest. The following Governing Body members declared an interest in this item:

• Dr Tupper – GP Out of Hours Service and Co-Clinical Director of 8 to 8 Centre (pecuniary)

• Dr Wagstaff – GP Out of Hours Service (pecuniary)

• Dr Britten – GP Out of Hours Service (pecuniary)

• Dr Zafar – GP Out of Hours Service (pecuniary)

• Dr Oakford – GP Out of Hours Service (pecuniary)

• Dr Barbour – GP Out of Hours (pecuniary)

• Dr Seddon – GP

• Dr Pieri – GP

• Dr Bradley – GP

• Dr Kirkman – GP Those individuals declaring a pecuniary interest were excluded from this item. As Dr Tupper was excluded from the discussions and decisions, the role of Vice Chair was handed to Miss Morris for the duration of the item. Mr Stainforth reported that the Strategy Development Forum discussed the overall unplanned care system at its March 2014 meeting and agreed an incremental approach to service improvements. This was supported by the contents of the Emergency Care Intensive Support Team (ECIST) review.

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The Strategy Development Forum met on the 3 April 2014 and had a wide ranging discussion on 3 service contracts that expire on the 31 March 2015. The 3 services are:

a. GP Out of Hours service b. Unregistered Patient element of the 8 to 8 Centre c. Emergency Care Practitioner service

In summary, it was agreed that all 3 services were of value and should be continued. In order to secure the continuation of these services market procurement is the required way forward. The price for the current services is £4.2m. New contracts for the services would be activity driven and local tariffs will be negotiated. There may be further costs identified as the procurement progresses in respect of new models i.e. diagnostics and pathology. There may also be some non-recurrent costs associated with the transition of activity as patients become adjusted to the new service model. It was proposed that a financial envelope of £4.2m be applied to the procurement process with an expectation that this may increase if Bidders demonstrate additionality or the proposed model demonstrates a cost shift from other services, e.g. A&E. There may also be additional non-recurrent resources required to support transition. Mr Stainforth proposed that the following criteria and weighting be applied to the procurement of the 3 unplanned care services:

• Clinical/Quality. Weighting 30

• Cost and price. Weighting 28

• Integration. Weighting 22

• Contract management and service mobilisation. Weighting 10

• Stakeholder management. Weighting 10 The Governing Body held a detailed discussion and raised the following points:

• Dr Pieri queried whether activity data should be assessed. Mrs Pederson reported that this had taken place.

• Miss Morris queried how patient experience would be demonstrated. It was reported that this is established through contract management.

• Dr Jones stated that reports should be presented to the Governing Body at regular intervals.

Dr Seddon offered her clinical professional advice in the process as her interest is non-pecuniary.

The Governing Body agreed the procurement, the broad financial parameters and agreed the criteria and weightings.

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13. Chair and Chief Officer Report Dr Tupper and Mr Stainforth gave a joint report and highlighted the following points:

• Simon Stevens recently announced that CCGs will be given the opportunity to co-commission primary care in partnership with NHS England. Specific initiatives relate to Over 75s Named GPs, Risk Stratification and Vulnerable Adults care. The draft proposals are currently being consulted upon within Localities and Local Medical Committee (LMC) discussions are planned.

• The Department of Health has released proposals to amend current legislation to remove administrative burdens on CCG’s and NHS England. The Department of Health is proposing to amend the NHS Act 2006 to enable 2 or more CCG’s to form a joint committee when carrying out their functions and enable NHS England and CCG’s to jointly exercise CCG functions and form a joint committee when doing so.

• The North Yorkshire and Humber CSU and West and South Yorkshire and Bassetlaw CSU recently announced a strategic partnership in order to bid to secure a place on the Lead Provider Framework. As this work progressed it has become clear that both organisations have much in common and a decision has now been taken by both boards of directors that it is in the best interests of staff and customers for the organisations to work more closely together with the aim of merging into one organisation by 1st October 2014.

• The restructure of DBHFT continues with the Trust recently announcing appointments of the Care Group Directors.

• Mr Paul Moffat, former Director of Children’s Services for Northumberland, has been recruited to the post of Chief Executive of Doncaster Children’s Trust. Mr Moffat has worked in local government for over 20 years and had also worked for the National Society for the Protection of Cruelty to Children. He will take up his role in June and the Trust is expected to become operational 1st October 2014.

• The Health and Wellbeing Board is in the process of reviewing the current Health and Wellbeing Strategy. A stakeholder event is taking place 12th June 2014 to start the process and progress will be reported to the Governing Body in due course.

The Governing Body noted the report.

14. Receipt of Minutes from Sub Committees There were no minutes to be received by the Governing Body.

• Audit Committee – draft minutes of the meeting held in May will be received by the Governing Body in June.

• Quality & Safety Committee – draft minutes of the meeting held in May will be received by the Governing Body in June.

• Engagement & Experience Committee – no meeting held since last minutes received.

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• Delivery & Performance Committee – draft minutes of the meeting in May will be received by the Governing Body in June.

15. Any Other Business Governing Body Member Resignation Dr Tupper announced that Dr Zafar had tendered her resignation from the Governing Body and that her last day is 9th June 2014. Dr Tupper thanked Dr Zafar for her valuable contribution. Dr Zafar thanked the Governing Body for its continued support. Patient Stories Dr Barbour raised the patient stories at the commencement of the meetings and how we gain assurance that follow up actions are being taken. It was agreed that Dr Barbour and Mr Carpenter work together on an IBook to build on the stories, which could include both pictures and narratives and with the involvement, when necessary, of the Engagement & Experience Committee. A resume could be produced every 6 months. Governing Body Agenda Dr Seddon queried the length of time taken on the agendas and that the Dementia presentation had not been included on the agenda. Mrs Shepherd stated that the presentation followed on from the Integrated Quality & Performance Report as the inclusive spotlight report. Mrs Pederson stated that topics are planned ahead but will only be brought to the meeting if relevant. Director Adults and Communities Mrs Beck announced that Mr David Hamilton had been successfully appointed as her replacement. Dementia Awareness Week Mr Carpenter showed a short video which had been filmed at the Cantley Memory Clinic ahead of Dementia Week 18 May – 24 May 2014.

Dr Barbour / Mr

Carpenter

16. Date and Time of Next Meeting 12:30pm on Thursday 19th June 2014.

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17. It was resolved that representatives of the press and other

members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1(2) Public Bodies (Admission to Meetings) Act 1960.

Enc B

Quality & Performance Report

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Meeting name Governing Body

Meeting date 19th June 2014

Title of paper

Quality & Performance Report

Executive / Clinical Lead(s)

Mrs Mary Shepherd, Chief Nurse

Author(s) Mrs Mary Shepherd, Chief Nurse Mrs Ailsa Leighton, Head of Performance

Purpose of Paper - Executive Summary This report sets out the key quality and performance issues to be noted by the NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG) Governing Body. The format of the report covers 3 main sections this month:

• Provider Performance - main local providers

• Other services commissioned by NHS Doncaster CCG

• Items for escalation regarding Local Delivery Plan in year delivery

Whilst a new contractual year commenced in April 2014, the historic information has been retained in the report in order to enable trends to be identified. However, the performance rating, indicated by Red Amber or Green status, denotes the current month performance and does not reflect the historic trends. The report is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators. The key changes to note since the last report are: Doncaster & Bassetlaw Hospitals NHS Foundation Trust (DBHFT)

• MRSA

• Pressure Ulcers

• Referral to treatment times

Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH)

• IAPT Recovery Rate Other Commissioned Services

• Winterbourne Assurance

• Supreme Court Judgement

• YAS Category A 8 minute response times

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Local Delivery Plan

• Initial Health Assessments for Looked After Children

• Ambulance Handover time

Recommendation(s) The DCCG Governing Body is asked to:

• Note the key quality performance areas for attention

Impact analysis

Assurance Framework

2.1, 2.2, 2.4

Risk analysis

Risks are captured in the Executive Summary

Equality impact

Neutral

Sustainability impact

Nil

Financial implications

As identified in the report

Legal implications

Nil

Consultation / Engagement

N/A

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INTRODUCTION This report sets out the key quality and performance issues to be noted by the Governing Body. The format of the report covers 3 main sections this month:

• Provider Performance - main local providers

• Other services commissioned by NHS Doncaster Clinical Commissioning Group (NHS Doncaster CCG)

• Items for escalation regarding Local Delivery Plan in year delivery

Whilst a new contractual year commenced in April 2014, the historic information has been retained in the report in order to enable trends to be identified. However, the performance rating, indicated by Red Amber or Green status, denotes the current month performance and does not reflect the historic trends. The report is supported by a detailed appendix (Appendix 1) which highlights performance for NHS Doncaster CCG and all local providers with regards to the main performance indicators. The key changes to note since the last report are: DBHFT

• MRSA – There were no breaches during April.

• Pressure Ulcers – There were 12 pressure ulcers recorded in April 2014 against a monthly trajectory of 12 or less. The Hospital Acquired Pressure Ulcer Strategy is continuing monthly and Clinical Service Unit Reports have commenced which include the monitoring of the delivery of root cause analysis actions.

• Referral to Treatment Times – All three referral to treatment targets were met

by DBHFT in April 2014 for the 1st time in 13 months. Capacity and demand and data validation work have been signed off by the NHS England Elective Intensive Support Team and DBHFT have been asked to contribute to NHS England’s document on data validation.

RDASH

• IAPT Recovery Rate – Although performance fell below the 50% target during April 2014 it is expected that this will recover quickly. NHS England monitors both access to the service and recovery on a quarterly basis.

Other Commissioned Services

• Winterbourne Assurance - NHS Doncaster CCG has not identified any significant risk in relation to meeting its responsibilities

4

• Supreme Court Judgement - NHS Doncaster CCG continue to work with the Local Authority to ensure that there is a coordinated response to the judgement. There has been the expected rise in the number or requests for assessments and authorisations under the safeguards.

• Ambulance Response Times - The ambulance response time for the 8 minute Red 1 target in Doncaster fell for the 4th consecutive month during May 2014. The Red 2 response time recovered slightly to 67.18% but remained below target. Red 1 and Red 2 Category A 8 min performance also remains just below 70% year to date across all CCGs.

A number of actions are therefore being taken by the three lead CCGs for the YAS 999 contract alongside the West, South Yorkshire & Bassetlaw Commissioning Support Unit (WSYB CSU). Actions include the issue of contract queries for April 2014 and May 2014 performance.

• Current position of independent care/nursing home providers - New embargoes placed in April

Total Providers with embargoes in Place

Embargoes lifted in April

Total Providers with restrictions in Place

Restrictions lifted in April

0 1 0 0 0

Local Delivery Plan

• Initial Health Assessments (IHA) for Looked After Children- The GP Clinical Lead for Children completed an audit on 16 patients in January 2014 which highlighted issues in the timeliness of processes involved in the health assessments. The new community paediatric model should remedy the IHA issue, however DBHFT are currently unable to provide this due to difficulties in recruitment. As a result alternatives are under consideration.

• Ambulance Handover time- there continue to be a number of delays in handover time at DBHFT. Whilst similar patterns are seen across South Yorkshire an action plan is in place around the procedures employed by ambulance crews and Emergency Department staff at DRI and is monitored and performance managed by DBHFT to ensure that the numbers of delays reduce.

5

SECTION 1: PROVIDER PERFORMANCE REPORT Introduction The following section of the report details performance for each main local provider, namely Doncaster & Bassetlaw Hospitals NHS Foundation Trust (DBHFT) and Rotherham, Doncaster & South Humber NHS Foundation Trust (RDASH). Performance is across a range of quality and more traditional “performance” measures. As such the report includes performance for each Trust as a whole, and does not simply relate to the service provided to NHS Doncaster CCG.

1.1 Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Governance

Time Period

Q2 2013/14 Q3 2013/14 Q4 2013/14 April 2014 May 2014

Changes to the board

Interim Director of Finance

Substantive Director of Finance

None applicable

None applicable

None applicable

Mortality identified as a risk to quality

Amber Red Amber Red Amber Amber Amber

Rolling 12 month HSMR for non-elective admissions at the DRI site shows sustained improvement. The timing of this improvement coincides with implementation of the revised acute medical pathway. Overall HSMR, HSMR by admission and by site are within the expected range. It should also be noted that a pilot of independent review of mortality commenced in April 2014. Currently crude mortality is 102.47.

Monitor Governance Rating

Amber Red Green Green Green

No evident concerns

(new rating scale)

Monitor Continuity of Services Rating

3 3 4 4 4

The continuity of services rating has replaced the financial rating from April 2014. The rating indicates Monitor’s view of the risk that the trust will fail to carry on as a going concern. A rating of 1 indicates the most serious risk and 4 the least risk

Contractual actions

2014/15 Contract Queries: no queries issued during May 2014. Performance Notices: zero

Number of serious incidents reported

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14

21 33 33 47

Key themes from April & May are:

• Hospital Acquired Pressure Ulcer (Category 3)

• Fall resulting in fractured neck of femur (#NOF)

6

Patient Experience

Time Period

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 April 14

Complaints Opened 140 122 94 115 96

Good progress has been made following the implementation of the Complaints, Concerns, Compliments Resolution and Learning Policy. From April 2014 a new committee has begun to review this detailed work and any learning fed back to the appropriate people.

Friends & Family Test

Inpatient score Eng. Average (inc. indep.sector) Inpatient response rate

Eng. Average (inc. indep.sector) A&E score Eng. Average A&E response rate

Eng. Average

Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14

73 73 83 81 79 79 76 74

72 72 73 72 73 73 73 73

21.9% 23.0% 20.0% 17.3% 21.6% 25.2% 27.5% 28.7%

29.4% 30.5% 31.3% 28.8% 31.0% 34..2% 34.8% 34.8%

46 39 50 44 53 41 45 54

53 56 56 57 57 55 54 55

6% 6% 7.4% 3.1% 13.7% 23.7% 25.1% 16.5%

13.2% 13.9% 15.2% 15.3% 17.4% 18.6% 18.5% 18.6%

During April 2014 the response rate for A&E fell to below the England average while the score did rise by 13 points. The response rates for inpatients rose by 3.5%.

Friends & Family Test

36 weeks gestation score response rate Birth score response rate Postnatal score response rate Community provision score response rate

Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14

29 65 75 64 74 76

4.6% 5.7% 8.4% 14.8% 21.3% 13.7%

65 64 83 82 85 88

28.0% 41.7% 16.9% 18.1% 17.0% 14.7%

100 50 58 62 59 55

2.1% 1.0% 21.9% 43% 57.1% 47.4%

57 74 80 89 79 79

7.0% 14.6% 11.0% 16% 21.1%

DBHFT’s score was higher than the England average for birth and 36 weeks gestation.

7

Workforce

Time Period 2013/14 WTE nurses per bed day

The number of wards with gaps between the funded and available establishments of more than the planned 24% has increased by one since March 2014 to 2013.

• Vacancy rates have increased from 7.9% to 8.08% as a result of a reduction in available candidates. Confirmed appointments would reduce the vacancy rate by 1.29% to 6.79%

• Two CSU’s are over recruited due to a reduction in the establishment associated to the winter plans

• Seven CSU’s have vacancy rates higher than 5% which is adding to the demand on temporary staffing

• The bank and agency use in March was equivalent to 202 wte (14% of the funded establishments). This has contributed to an overspend of £74.4k in month 1

“Hard Truths” action plan on target. Francis action plan on target.

Spells per WTE staff

Vacancies – medical

Agency spend

Safety

Time Period May 13

Jun 13

July 13

Aug 13 Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

Number of Never Events

(cumulative)

0 0 1 1 1 1 2 3 3 3 3 0

2013/14: Q1 – 1 never event de-logged. July – wrong site surgery (Ophthalmology) November – wrong site surgery (Theatre) December – retained swab (Women’s and Theatre). 2014/15: No Never Events to date

MRSA (cum.)

0 0 0 1 1 1 2 2 2 2 2 0

2013/14: There were 2 cases of MRSA YTD attributed to DBHFT against a target of 0. 2014/15: No cases of MRSA to date

C-diff Actual

C-diff

Trajectory (NHSE cum.)

4 9 14 17 20 21 26 37 39 40 41 4

6 9 12 15 18 21 24 27 30 33 37 4

2014/15: Performance was at trajectory during April 2014. Some variance to the C Difficile plans related to slippage on the deep cleaning programme in general and acute medicine but will return to plan in May 2014. Revised operational arrangements have been agreed to ensure that any variation from the planned cleaning schedules is agreed with Executive Directors.

8

All medical wards are deep cleaned at 6 monthly intervals.

Pressure Ulcers (total)

Q1 - 322 Q2 - 346 Q3 - 378 Q4 - 387 Apr 14 - 12

All category 3, 4 and ungradeable pressure ulcers are reviewed at the Root Cause Analysis overview panel. There were 12 pressure ulcers recorded in April against a monthly trajectory of 12 or less. Hospital Acquired Pressure Ulcer Strategy is continuing monthly and Clinical Service Unit Reports have commenced which includes the monitoring of the delivery of root cause analysis actions.

Falls

Q1 430 all falls 8 serious falls



Q4 433 all falls, 5 serious falls

Apr 14 6 serious falls

There have been a number of reported injuries following falls at DBHFT. The number appears to be higher than in previous months. This will be explored through the contractual quality meetings. Improving care for those at risk of falling remains a priority within DBHFT and this is also supported through the CQUIN scheme.

Operational Effectiveness

Time Period

July 13

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

Percentage of admitted pathways within 18 weeks for admitted patients

whose clocks stopped during the

period on an adjusted basis (90%

target)

84.0 86.3 87.9 86.3 86.4 85.4 83.9 84.6

86.7

90.5

All three Referral to Treatment targets were met by DBHFT for the 1st time in 13

months. Capacity and demand and data validation work have been signed off by the Elective Intensive Support Team and DBHFT have been asked to contribute to NHS England’s document on data validation.

52 Week Waits

Aug 13

Sep 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

DCCG 8 3 0 0 0 0 1 0 0

Other 2 1 0 0 0 0 0 0 0

NHSE 4 3 1 1 0 0 0 1 1

DBHFT 14 7 1 1 0 0 1 1 1

62.0%

72.0%

82.0%

92.0%

Apr-13

May-13

Jun-13

Jul-13

Aug-13

Sep-13

Oct-13

Nov-13

Dec-13

Jan-14

Feb-14

Mar-14

Apr-14

Admitted

Target

R

9

The breach in April related to a prisoner; DBHFT has engaged with both NHS England and the prison to develop both improved communication and pathways for prisoners.

4 Hour access - total time in the A&E

department (target 95%)

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

95.4% 94.0% 94.5% 96.1% 95.6% 96.6% 95.2% 96.5% 95.7%

During April 2014 performance against the 4 hour target at DBHFT was achieved for the 6

th month in a row.

Cancelled Operations (target

<0.8%)

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

0.84% 0.89% 0.86% 1.41% 2.91% 1.30% 1.43% 1.09% 0.7%

The target for cancelled operations met target for the first time since May 2013.

All cancer two week wait (target 93%)

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

93.3% 93.0% 95.3% 94.4% 93.7% 91.4% 94.5% 94.6% 94.4%

Outliers (Daily averages)

Medicine to Orthopaedics Medicine to S12 Medicine to surgery Medicine to gynaecology

January 14

February 14 March 14 April 2014

8 5 4 Data not available



8

6 4 Data not available

Due to a change in reporting for 2014/15 at DBHFT, the data regarding outliers is not available at the time of reporting.

CQUINs

Time Period

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14

Family and Friends Test

Not achieved Not achieved Due Q4 Achieved

Experience Adults

Part achieved

Part achieved

Part Achieved

Almost Full Achievement

Experience Children’s

Available from Q2

Part achieved

Part Achieved

Part Achieved

Experience Maternity

Achieved Achieved Part

Achieved Almost Full

Achievement

10

Local Family and Friends Test A&E

Not achieved Part

Achieved

Not Achieved

Part Achieved

Local Family and Friends Test

Orthopaedic surgery

Part Achieved

Achieved Q4 payment Part

Achieved

VTE: Risk assessment

VTE: Root cause analysis

Achieved Achieved Achieved Achieved


Dementia


Pressure Ulcer: Incidence

Pressure Ulcer: Root cause analysis

Not achieved

Not achieved

Not Achieved

Not Achieved

Achieved Part

Achieved Part

achieved Part

Achieved

Falls: Incidence

Root cause analysis

payment Q4

Q4 payment On track to full payment

q4

Part Achieved

Not achieved Part

achieved

Part achieved

Achieved

Safe discharge and Safe and Well check

Achieved Achieved Achieved

Achieved

Dementia/vulnerable patients


Achieved

Dementia - Safe discharge and Well

Check


End of Life

Achieved Achieved Part

achieved Not

Achieved

Accountability Framework Wards

Achieved


Accountability Framework A&E

Achieved


2ww feedback


11

Local Intelligence Issues

Time Period Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 April 14

Stroke : direct admission within 4

hours Target 90%

64.2% 77.7% 67.5% 60.2% 60%

Also off track in April 2014:

• Patients spending 90% of their time on stroke unit (68.9% against a target of 80%)

Stroke performance continued to fail for direct admission; this was partly due to lack of bed availability on Ward 16 (6 patients were affected), a GP referral to the Medical Assessment Unit and 6 patients that were treated on other wards initially as their symptoms at first were not of stroke. 1 patient was slept out after their acute treatment. The proportion of stroke patients scanned within 1 hour has seen an improvement to 46.7%% against a target of 50% in April 2014. The 24 hour Stroke Specialist Service is now in operation and 1 additional stroke bed is available on the unit for assessment. NHS Doncaster CCG is meeting again with DBHFT at the end of June 2014 to assess the impact of the actions. A more detailed update will be provided at the July 2014 Governing Body meeting.

Fractured Neck of Femur

% achieving all best practice tariff criteria

Q1 51% Q2 58% Q3 63.2% Q4 62.7% YTD 72.3%

Performance in April 2014 has improved against Q4 2013/14.

Ophthalmology: number of SIs and

management of review lists

The CCG has now received the external peer review of the Ophthalmology service. The report and the summary produced by DBHFT were recently discussed at the Delivery & Performance committee on 10 April 2014 and the Strategy Development Forum on 1 May 2014. Both meetings approved the approach recommended to continue to work with DBHFT with the aim of rebuilding a robust acute Ophthalmology service. A review and update will be given to the governing body in October 2014. 1 new Serious Incident has been reported within the Ophthalmology department. This incident is under investigation and the root cause is yet unknown.

12

1.2 Rotherham, Doncaster & South Humber NHS Foundation Trust

Governance

Time Period

Q1 2013/14

Q2 2013/14

Q3 2013/14

Q4 2013/14

April 2014

May 2014

Number of serious incidents reported

4 16 24 16 3 9

There were 8 serious incidents reported in May relating to category 3 and 4 pressure ulcers and 1 due to an unexpected death. The rise in the figures during the first quarter to 2014/15 in comparison to 2013/14 is due to category 3 pressure ulcers now being recognised as serious incidents.

Monitor Governance

Rating

Green Green Green Green Green No

evident concerns

Monitor Continuity of Services Rating

4 3 3 4 4 4

The continuity of services rating has replaced the financial rating from April. Monitor’s view of the risk that the trust will fail to carry on as a going concern. A rating of 1 indicates the most serious risk and 4 the least risk

Contractual Actions

No contractual actions undertaken during May 2014.

Patient Experience

Time Period

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 April 2014

Complaints 21 14 20 13 4

Currently only the complaints in relation to the Mental Health Services provided by RDASH are available for April 2014. Data relating to the Community Services has been requested but is awaited.

Workforce- in development

Time Period

2014/15

Over view Work is progressing in relation to the Community Services provided by RDASH to establish a monitoring and recording process for capacity and demand. Two main tools are being used for this to assess the amount of units (time units for caseload completion) and complexity of patients (possibility of more complex patients being moved to the community as services offer more varied treatment) which will allow both RDASH and commissioners better understanding of the services provided and the need of the general population.

13

Safety

Operational Effectiveness – in development

Time Period

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

Adult Mental Health 18 week Non admitted

98.6% 100% 100% 98.6% 100% 100% 100% 100% 100%

Older People Mental Health 18 week Non

admitted

100% 100% 100% 100% 100% 100% 100% 100% 100%

Improved access to psychological services - the

proportion of people who complete

treatment who are moving to recovery

(Target – 50%)

44.4% 44.2% 49.8% 44.2% 59.0% 50.0% 53.1% 53.4% 49.5%

Although performance fell just below the 50% target during April 2014 it is expected that this will recover quickly. Meetings regarding performance continue. NHS England monitors both access to the service and recovery on a quarterly basis and it is expected that for the quarter the target will be met.

Improved access to psychological services - the

proportion of people that enter treatment against the level of need in the general

population

Q1 target 3.75%

4.8% 6.7% 7.9% 9% 9.7% 10.7% 11.5% 12.6% 1.1%

Time Period

July 13

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

Number of Never Events

0 0 0 0 0 0 0 0 0 0

MRSA (cumulative)

0 0 0 0 0 0 0 0 0 0

C-diff Actual

C-diff Trajectory (cumulative)

1 1 1 1 1 1 1 1 1 0

0 0 0 0 0 0 0 0 0 0

14

CQUINs

CQUINs Quarter One progress to be provided in the August 2014 report.

Local Intelligence Issues- in development

Time Period

July 13

Aug 13

Sept 13

Oct 13

Nov 13

Dec 13

Jan 14

Feb 14

Mar 14

Apr 14

CAMHS -Percentage of patients with agreed care

pathways and treatment

plans (100% target)

100% 97.6% 97.5% 100% 99.9% 99.7% 100% 100% 100% 100%

CAMHS - Percentage of

urgent referrals assessed within 24

hours

100% 100% 100% 33.3% 50% 100% 100% 100% 100% 100%

CAMHS - Percentage of

non-urgent referrals assessed

within 4 weeks (95%)

92.6% 100% 100% 98.6% 100% 56.9% 100% 90.9% 82.8% 82.6%

Data is reported on a monthly basis to enable timely understanding of performance as a whole. However the monthly data includes a number of potential exceptions, which if excluded would improve the performance. There is therefore a second stage in the process - a quarterly reconciliation whereby all exceptions are reviewed between NHS Doncaster CCG and RDASH. Once this process has been undertaken and exceptions agreed a final position is confirmed. Should the exceptions be agreed for April this would result in performance of 95.7% against the target of 95%.

Neurology – The

percentage of routine

referrals that are

seen/assessed within 6 weeks

(95%)

Q1 2013/14 Q2 2013/14 Q3 2013/14 Q4 2013/14 April 14

97.6% 92.9% 95.2% 74.2% 81.5%

This relates in the main to referrals to the Epilepsy Nurse Specialist, Multiple Sclerosis team and Neurological Rehabilitation Outreach Team. There has been an improvement in the data capture for April which is reflected in the performance and it is expected that this level of improvement will continue. It has also been recognised, that the process of recording visits on System One which have been undertaken by the social worker is to be reviewed as social workers are not currently able access the system and record when they have actually seen the patient.

15

SECTION 2: OTHER COMMISSIONED SERVICES Nursing / Care Homes / Domiciliary Care Providers The information provided within this section is taken up to the 31st May 2014. Since the last Governing body meeting there have been no new embargoes against admissions/new care packages. There is currently one embargo against admissions within one care home within Doncaster. There is on-going work within across the Doncaster Partnership to support the necessary improvements within this home. It is envisaged that this embargo will be lifted in June 2014. New embargoes placed in May

Total Providers with embargoes in Place

Embargoes lifted in May

Total Providers with restrictions in Place

Restrictions lifted in May

0 1 0 0 0

Winterbourne The events at Winterbourne view and the range of subsequent investigations have been discussed at a previous Governing Body meeting. NHS England requires all CCGs to provide assurance on a quarterly basis in relation to the actions that are being undertaken in response to the recommendations made. A further return was requested in relation to timescales to complete some of the actions required by the Winterbourne concordat. The request acknowledged that the original timescales have been a challenge to many areas. The return was completed and returned by the required date. Quarter 2 of the planned assurance returns will be due for completion in July 2014. Supreme Court Judgement The Governing Body has previously received information about the Supreme Court Judgement made in relation to the Deprivation of Liberty Safeguards. As expected there has been a significant increase in the number of requests for assessments and authorisations under the Safeguards. NHS Doncaster CCG are working with the Local Authority to ensure that there is a coordinated response to the judgement with the aim of supporting local providers and the Local Authority to meet their statutory responsibilities and provide safe effective care in line with the Mental Capacity Act and Deprivation of Liberty Safeguards. An action plan has been developed and Doncaster CCG are supporting this where appropriate.

16

Doncaster Safeguarding Adults Partnership Board As previously reported, the Serious Case Review being undertaken by the Doncaster Safeguarding Adults Partnership Board (DSAPB) in relation to the Solar Centre continues. The second draft has been developed and was considered by the Doncaster Safeguarding Adults Board in May 2014. A final draft is being produced and plans are being developed for publication and communication of the final report. 2 further lessons learnt reviews have been commissioned by the DSAPB. The first of these has been presented to the DSAPB. Recommendations were accepted and action plan are now being monitored by the DSAPB Safeguarding Adults Review Subgroup. The second lessons learnt review is underway. A workshop was to be held on the 6 June 2014. The report will be presented to the July Safeguarding Adults Review Panel in July 2014. These reviews will be monitored by the Safeguarding Adults Review Group which sits within the DSAPB Substructure Further reporting in relation to these Lessons Learnt Reviews will be through the Quality and Patient Safety Committee under the Safeguarding section. Safeguarding Children Serious Case Reviews / Lesson Learnt Reviews There have been no new Serious Case Reviews or Lessons Learnt Reviews commissioned by the Doncaster Safeguarding Children Board (DSCB) or the DSAPB. Yorkshire Ambulance Service (YAS) The ambulance response time for the 8 minute Red 1 target in Doncaster fell for the 4th consecutive month during May 2014. The Red 2 response time recovered slightly to 68.18% but remained below target. Red 1 and Red 2 8 min performance also remains just below 70% year to date across all CCGs. A number of actions are therefore being taken by the three lead CCGs for the YAS 999 contract alongside the West, South Yorkshire & Bassetlaw Commissioning Support Unit (WSYB CSU). The actions being taken are:

1. Contract queries have been raised for April 2014 and May 2014 performance. YAS have responded with a remedial action plan but this has yet to be agreed by commissioners due to a number of issues

2. CCG contract leads are due to meet with the YAS Director of Operations on 20 June 2014 to resolve the outstanding issues regarding the remedial action plan and recovery trajectory.

3. It is expected that the remedial action plan and recovery trajectory will be adopted at the YAS Contract Management Board meeting on 24 June 2014.

17

4. Further assurance is being sought by the CCG contract leads regarding delivery for the remainder of the year. This will be the focus of a further meeting with YAS Directors in early July 2014.

Doncaster CCG YAS Performance: December January February March April May

R1 MTD 73.28% 78.26% 73.26% 67.05% 62.28% 61.40% R1 YTD 80.53% 80.32% 79.84% 79.03% 62.28% 62.01% R2 MTD 73.06% 76.28% 70.58% 71.11% 66.64% 68.18% R2 YTD 75.06% 75.21% 74.81% 74.47% 66.64% 67.39%

18

SECTION 3: NHS Doncaster CCG Local Delivery Plans- Items for Escalation

Children: Timeliness of Looked After Children Initial Health Assessments (IHA) The GP Clinical Lead for Children completed an audit on 16 patients in January 2014 which highlighted issues in the processes involved in the health assessments. The new community paediatric model should remedy the IHA issue, however DBHFT are currently unable to provide this due to difficulties in recruitment. As a result alternatives are under consideration. With regard to Social Care this is being raised with the Local Authority. Unplanned Care: Ambulance Handover Time There were 333 ambulance delays over 30 minutes during Quarter 4 at DBHFT against a target of 0. An action plan is in place around the procedures employed by ambulance crews and Emergency Department staff at DRI and is monitored and performance managed by DBHFT to ensure that the numbers of delays reduce.

LOC Indicator Pass Condition Fail Condition Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14

A&E Attendances (Type1) DBHFT 11440 11440 11440 11440 11440 11440 11440 11440 11440 11440 11440 11440

A&E Attendances (Type1) DBHFT 11440 12012 11415 11629 11501 12273 11669 11410 11562 10755 11365 10961 10499 12142 14746

A&E Attendances (All) DBHFT 14375 14375 14375 14375 14375 14375 14375 14375 14375 14375 14375 14375

A&E Attendances (All) DBHFT 14375 15094 14380 14651 14578 15528 14261 14205 14336 13557 14392 13601 13061 15292 11663

T Total Longest Wait in A&E department (hh:mm) 4 Hours > 4.2 Hours 18:52:00 15:10:00 15:34:00 15:16:00 15:47:00 16:51:00 14:29:00 15:12:00 20:34:00 15:25:00 14:14:00 13:38:00 13:37:00

All first outpatient attendances 7853 8256 7235 8637 6869 7965 9103 7726 6969 8061 7145 7640

All first outpatient attendances 7640 8022 7979 8158 8330 8946 7359 8287 8569 7932 7546 8598 7396 8527

T

Number of 52 week Referral to Treatment Pathways - the number of

incomplete pathways greater than 52 weeks for patients on incomplete

pathways at the end of the period

0 >10 10 22 18 13 14 7 1 1 0 0 1 1 1

Elective finished first consultant episodes (FFCEs) 3141 3205 3049 3494 2910 3049 3522 3308 2815 3255 3107 3203

Elective finished first consultant episodes (FFCEs) 3107 3262 3510 3650 3604 3905 3648 3706 4130 3801 3306 3863 3658 3976

TImplementation of Stroke Strategy - Patients spending 90% Time on a Stroke

Unit80% <80% 68.9%

TPeople who have had a stroke and are admitted to an acute stroke unit with

four hours of arrival to hospital90% 85.50% 70.5% 55.3% 67.4% 66.7% 83.3% 84.8% 59.3% 73.5% 71.4% 61.4% 62.2% 57.4% 60.0%

C Ambulance clinical quality – Category A (Red 1) 8 minute response time YAS >75% <71.25% 75.28% 76.83% 75.61% 80.70% 83.15% 81.68% 79.14% 76.15% 72.66% 76.28% 73.31% 71.71% 69.78%

C Ambulance clinical quality – Category A (Red 2) 8 minute response time DONC >=75% <71.25% 77.31% 77.27% 77.13% 73.83% 74.68% 76.71% 72.47% 73.26% 73.06% 76.28% 73.26% 67.05% 66.64%

C

Ambulance clinical quality – Category A (Red 2) 8 minute response time YAS

>=75% <71.25% 78.04% 78.69% 78.64% 74.58% 74.21% 74.39% 73.97% 73..97% 71.80% 76.04% 72.50% 73.68% 70.65%

C Ambulance clinical quality – Category A (Red 1) 8 minute response time DONC >=75% <71.25% 74.49% 74.03% 82.02% 79.84% 89.66% 86.71% 79.43% 77.17% 73.28% 78.26% 73.26% 67.05% 66.64%

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 30 minutes0 >1 106 96 129 96 102 138 138 61 81 52 73 199

TAll handovers between ambulance and A&E must take place within 15 minutes -

those over 60 minutes0 >1 6 27 22 7 8 17 7 4 7 4 0 5

76.64%

C

Q1 Q2 Q3

Accident & Emergency

Indicators Currently reported as RED or OFF TRACK

Doncaster CCG 2013/14 Performance Report

Waiting Times

TBaseline

TBaseline

Baseline

Cancer

CBaseline

Stroke & TIA

Ambulance

Q4

75.0%85.10% 82.20%

Doncaster CCG 2013/14 Performance ReportCCG

DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets

C = CCG related Targets


Q1 Q2 Q3Doncaster CCG 2013/14 Performance Report Q4


DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


T

Cancelled Operations - All patients who operations cancelled for non clinical

reasons to be offered another binding date within 28 days0 >0 2 0 0 0 6 4 0 0 2 1 1 4 3

T Maternal smoking at delivery <=21% >21% 19% 24% 19% 22% 23% 21% 20% 16% 21% 23% 19% 26% 21.1%

T Antenatal assessments <13 weeks >=85% <85% 89.5% 93.0% 90.0% 88.5% 89.6% 91.9% 89.2% 90.0% 87.3% 80.3% 84.7% 85.4% 83.7%

T

Percentage of patients receiving first definitive treatment for cancer within 62-

days of a consultant decision to upgrade their priority status. DBHFT >=90% <85% 76.9% 91.3% 95.8% 96.0% 94.1% 100.0% 95.2% 87.50% 92.90% 100.00% 90.00% 100.00% 88.00%

CPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer. CCG>=85% <80% 87.10% 89.58% 86.27% 88.68% 85.42% 84.44% 94.8% 94.81% 86.80% 78.00% 95.74% 92.75% 84.62%

Non-elective FFCEs (First Finished Consultant Episode) 3150 3359 3082 3201 2985 2827 3156 3164 3056 3006 3031 3220

Non-elective FFCEs (First Finished Consultant Episode) 3031 3183 3148 3185 3094 3290 3177 3129 3239 3150 3251 3308 3043 3375

T

The percentage of admitted pathways within 18 weeks for admitted patients

whose clocks stopped during the period on an adjusted basis>=90% <85% 78.0% 82.4% 85.5% 84.0% 86.3% 87.9% 86.3% 86.4% 85.4% 73.9% 84.6% 86.7%

C

Percentage of admitted pathways within 18 weeks for admitted patients whose

clocks stopped during the period on an adjusted basis >=90% <85% 80.26% 85.21% 87.51% 85.03% 87.07% 88.01% 88.64% 88.49% 95.39% 86.28% 84.86% 87.77%

T

Mental Health Measure- Improved access to psychological services - The

proportion of people who complete treatment who are moving to recovery

(Target)

>=50% <47.50% 49.5%

C A&E waiting time - total time in the A&E department >=95% <95% 91.90% 96.60% 96.90% 95.91% 94.60% 93.28% 93.79% 95.15% 94.79% 95.59% 95.90% 96.44% 95.71%

T A&E waiting time - total time in the A&E department >=95% <95% 91.22% 96.86% 97.15% 96.39% 95.42% 93.97% 94.46% 96.12% 95.60% 96.56% 95.17% 96.46% 95.70%

C Trolley waits in A&E <=12 Hours > 12 Hours 0 0 0 0 0 0 0 0 0 0 0 0 0

T Trolley waits in A&E <=12 Hours > 12 Hours 0 0 0 0 0 0 0 0 0 0 0 0 0

T

Unplanned re-attendance rate - Unplanned re-attendance at A&E within 7 days

of original attendance (including if referred back by another health professional) 5.00% 5.25% 0.4% 0.3% 0.3% 0.3% 0.6% 0.6% 0.6% 0.4% 0.3% 0.5% 0.5% 0.3% 0.6%

T A & E - Left department without being seen rate 5% >5.25% 2.60% 1.30% 1.30% 1.70% 2.00% 2.10% 2.70% 1.50% 2.00% 1.30% 1.60% 1.80% 1.90%

T Time to initial assessment (95th percentile) hh:mm 15 Mins > 15 Mins 00:15 00:14 00:15 00:15 00:13 00:14 00:13 00:12 00:12 00:10 00:12 00:14 00:15

T Time to treatment in department (median) hh:mm 1 Hour >1 Hour 5 Mins 00:27 00:21 00:25 00:28 00:26 00:29 00:26 00:26 00:26 00:24 00:34 00:42 00:44

A&E Attendances (Type1) CCG 7227 7227 7227 7227 7227 7227 7227 7227 7227 7227 7227 7227

A&E Attendances (Type1) CCG 7227 7588 7277 7287 7281 7589 7265 7250 7431 6832 7177 7039 7222

A&E Attendances (All) CCG 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168

A&E Attendances (All) CCG 8168 8576 8264 8346 8356 8751 8366 8255 8342 7720 8026 7812

Incidence of healthcare associated infection: MRSA bacteraemia <= > 0 0 0 0 0 0 0 0 0 0 0 0 0

Incidence of healthcare associated infection: MRSA bacteraemia Act 0 0 0 1 1 1 1 2 2 4 4 4 4 4 0

Other

Maternity

C

CBaseline

CBaseline

Cancer

50.6% 45.9% 50.1%

Indicators Currently reported as AMBER or AT RISK

Waiting Times

CBaseline

Infection Control

52.1%

Accident & Emergency

Indicators Currently reported as GREEN or ON TRACK

Other




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


Incidence of healthcare associated infection: C. difficile <= > 7 13 18 22 26 30 35 40 45 51 57 62 4

Incidence of healthcare associated infection: C. difficile Actual 35 36 5 9 21 27 33 41 51 59 69 75 80 83 4







C 31-day standard for subsequent cancer treatments-surgery CCG >=94% <89% 100.00% 100.00% 92.86% 92.86% 100.00% 100.00% 100.00% 100.00% 96.00% 93.10% 90.91% 96.77% 96.55%

CPercentage of patients receiving first definitive treatment within one month of

a cancer diagnosis CCG>=96% <91% 97.18% 98.51% 97.89% 98.79% 98.51% 98.45% 99.4% 99.35% 97.90% 95.80% 100.00% 98.06% 98.64%

CPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service. CCG>=90% <85% 88.89% 85.71% 87.50% 92.86% 92.86% 100.00% 100.00% 100.00% 90.90% 83.33% 100.00% 100.00% 100.00%

C31-day standard for subsequent cancer treatments-anti cancer drug regimens

CCG>=98% <87% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

C 31-day standard for subsequent cancer treatments-radiotherapy CCG >=94% <89% 98.15% 100.00% 97.73% 100.00% 97.62% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.08%

C All cancer two week wait. CCG >=93% <88% 95.78% 95.95% 94.48% 94.36% 94.87% 94.5% 96.0% 96.00% 95.50% 94.74% 95.57% 95.55% 95.70%

CTwo week wait for breast symptoms (where cancer was not initially suspected).

CCG>=93% <88% 98.82% 96.30% 91.21% 95.54% 94.12% 93.55% 97.3% 97.32% 93.80% 95.16% 92.25% 90.98% 97.41%

CNumber of emergency admissions as a result of cancer (Primary diagnosis) 877 Per Year

219 Per QuarterHigher


days of a consultant decision to upgrade their priority status. CCG>=90% <85% 77.78% 86.67% 100.00% 95.24% 91.67% 100.00% 90.00% 90.00% 80.00% 94.74% 80.00% 88.24% 94.74%

TPercentage of patients receiving first definitive treatment within one month of

a cancer diagnosis DBHFT>=96% <91% 99.3% 100.0% 98.4% 97.5% 100.0% 99.1% 98.7% 98.60% 100.00% 98.30% 100.00% 100.00% 100.00%

T 31-day standard for subsequent cancer treatments-surgery DBHFT >=94% <89% 100.0% 95.2% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00% 100.00% 100.00% 100.00% 100.00% 95.00%

T31-day standard for subsequent cancer treatments-anti cancer drug regimens

DBHFT>=98% <87% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

TPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer. DBHFT>=85% <80% 91.4% 87.5% 87.6% 89.8% 87.2% 88.6% 92.1% 89.40% 87.10% 86.20% 92.10% 89.60% 87.40%

TPercentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service. DBHFT>=90% <85% 91.7% 93.1% 91.9% 90.0% 94.7% 100.0% 100.0% 90.70% 100.00% 90.90% 100.00% 100.00% 100.00%

TTwo week wait for breast symptoms (where cancer was not initially suspected).

DBHFT>=93% <88% 93.9% 91.7% 88.2% 96.2% 93.6% 93.7% 97.1% 94.00% 94.00% 95.70% 92.80% 92.60% 96.30%

TAll cancer two week wait. DBHFT

>=93% <88% 93.9% 93.3% 93.0% 93.9% 93.6% 93.0% 95.3% 94.40% 93.70% 91.40% 94.50% 94.30% 94.40%

T

Cancer

T

C

T

187 196 162 127




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


C

Number of 52 week Referral to Treatment Pathways - the number of

incomplete pathways greater than 52 weeks for patients on incomplete

pathways at the end of the period

0 >10 9 16 12 9 9 3 0 0 0 0 1 0 0

CPercentage of non-admitted pathways within 18 weeks for non-admitted

patients whose clocks stopped during the period>=95% <90% 95.44% 97.07% 96.91% 96.29% 95.86% 95.96% 95.52% 95.46% 95.76% 95.37% 95.65% 95.74%

TThe percentage of non-admitted pathways within 18 weeks for non-admitted

patients whose clocks stopped during the period>=95% <90% 95.02% 96.60% 96.70% 96.13% 95.91% 95.50% 95.00% 95.16%

CPercentage of incomplete pathways within 18 weeks for patients on incomplete

pathways at the end of the period>=92% <87% 92.61% 93.23% 92.62% 93.10% 92.81% 92.72% 92.81% 93.10% 93.01% 92.43% 92.66% 92.50%

TThe percentage of incomplete pathways within 18 weeks for patients on

incomplete pathways at the end of the period>=92% <87% 92.69% 93.60% 93.20% 93.35% 93.03% 92.60% 93.00% 93.21% 93.0% 93.0% 93.0% 92.8%

C Diagnostic test waiting times >99% <99% 99.14% 99.7% 99.45% 99.59% 99.3% 98.7% 99.7% 99.60% 98.50% 99.00% 99.72% 96.33%

T Diagnostic test waiting times >99% <99% 99.30% 99.73% 99.60% 99.70% 99.10% 98.90% 99.70% 99.70% 98.90% 99.00% 99.92% 96.16%



C Mixed Sex Accommodation (MSA) Breaches CCG 0 >0 0 0 0 0 0 0 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (DBHFT) 0 >0 0 0 0 0 0 0 0 0 0 0 0 0 0

T Mixed Sex Accommodation (MSA) Breaches (RDSAH) 0 >0 0 0 0 0 0 0 0 0 0 0 0 0 0

C Ambulance clinical quality - Category A 19 minute transportation time DONC >=95% <95% 97.70% 98.26% 97.80% 97.40% 98.01% 98.50% 98.59% 98.00% 97.18% 97.34% 96.90% 96.60% 96.66%

C Ambulance clinical quality - Category A 19 minute transportation time YAS >=95% <95% 97.62% 97.79% 97.61% 97.29% 97.25% 97.22% 97.49% 97.19% 96.57% 97.57% 96.83% 97.04% 96.19%

CImplementation of Stroke Strategy - Patients spending 90% Time on a Stroke

Unit (CCG)80% <80%

CImplementation of Stroke Strategy - TIA Patients Assessed and Treated within

24 Hours (CCG)60% <60%

TImplementation of Stroke Strategy - TIA Patients Assessed and Treated within

24 Hours60% <60% 82.9%

C Antenatal assessments <13 weeks >=85% <85% 89.0% 94.2% 89.6% 87.5% 87.5% 91.7% 89.5% 89.5% 90.0% 79.1% 84.9% 85.2% 86.7%

CEmergency admissions for children with lower respiratory tract infections

(LRTIs)

<114 at Q4, <423

per annumMore than

T

Mental Health Measure – Care Programme Approach (CPA) - The proportion of

those patients on Care Programme Approach (CPA) discharged from inpatient

care who are followed up within 7 days (stretch local target)

95% <90.25% 100% 87.5% 100% 97% 96% 96% 100% 95.80% 94.70% 100% 100% 100% 98%

All Other

Stroke & TIA

72.73%

64.89%

82.70% 81.90%

T

Waiting Times

Infection Control

Yorkshire Ambulance Service

88.20% 75.60%

Mixed Sex Accomodation

42 17 165 76

73.2%

71.7%

76.5%

58.57% 85.50% 75.40%




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


=> <

9.5% 9.00% 1.01%

C Friends and Family Test (Inpatients) 77 78 77 79 72 73 73 83 81 79 79 76 74

C Friends and Family Test (A&E) 75 52 59 53 44 46 39 50 44 53 41 45 54

TPatient Reported Outcome Measures (PROMS) for elective procedures – Live:

Unilateral Hip Replacements (Primary and Revisions),No Target No Target


Unilateral Knee Replacements (Primary and Revisions)No Target No Target


Groin Hernia Surgery,No Target No Target


Varicose Vein SurgeryNo Target No Target

CPercentage of Call backs within 20 Minutes (Triage of urgent calls)

>=95% <90% 90.82% 96.70% 97.17% 95.40% 94.78% 93.76% 94.60% 91.22% 86.47% 97.08% 98.03% 98.49% 89.05%

CPercentage of Call backs within 60 Minutes (Triage of all other calls)

>=95% <90% 99.66% 99.98% 99.79% 99.90% 99.36% 99.87% 99.83% 99.57% 98.55% 100% 99.22% 99.89% 96.88%

C Percentage of Home visits made within 2 Hours (urgent) >=95% <90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%

C Percentage of Home visits made within 6 Hours (less urgent) >=95% <90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 98.84% 100% 100% 100% 100%

C Percentage of Consultations Made within 2 Hours (UCC) - Urgent >=95% <90% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 97.62% 100.00%

CPercentage of Consultations Made within 6 Hours (UCC) - Less Urgent

>=95% <90% 99.66% 99.74% 99.91% 99.91% 99.60% 99.78% 99.81% 99.68% 97.78% 100% 100% 100% 100%

C Total Number of calls made to service 5572 5566 5472 5233 5435 4978 5119 5504 6811 5319 5095 5738 6290

No Data Available

37.00% (Apr 12 - Dec 12) Partici[ation Rate 0.272 (Apr 12 - Dec 12)

6.5% 9.5%

(Apr 12 - Dec 12) Partici[ation Rate 0.081

(Apr 12 - Dec 12) Partici[ation Rate

(Apr 12 - Dec 12)

3.5%

Indicators Currently reported with no RAG rating

6.00%

73.00%

3.31%

T

Out Of Hours

(Apr 12 - Dec 12)

Out Of Hours


proportion of people that enter treatment against the level of need in the

general population (the level of prevalence addressed or ‘captured’ by referral

routes)9.65%6.74%

(Apr 12 - Dec 12)76.00% (Apr 12 - Dec 12) Partici[ation Rate

12.5%

12.60%

0.426




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


C improve 39% treatment from 2ww 39% <37.05%

Zero growth in A&E attendance against 12/13 outturn 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168 8168

Doncaster Patients < = 8168 > 8576 8173 8311 8316 8703 8303 8223 8306 7678 7975 7766 7501 8840

C No Ambulance delays over 30 minutes at ED 0 >0 112 123 151 103 110 155 145 65 68 56

Average length of stay (DRI)

Against 12/13 outturn

C 100% completion IHA within 60 working days all LAC 31/03/14 100 Less Than 100% 94% 95% 89% 82% 88% 87% 75%

C5% Reduction in emergency admissions for upper respiratory tract infections by

April 2014 (Cum)

5% Reduction or

MoreLess Than

C


proportion of people who complete treatment who are moving to recovery

(Target)

>=50% <47.50% 49.5%

Readmissions to DRI


Zero growth in emergency admissions for ACSC against 12/13 252 252 252 252 252 252 252 252 252 252 252 252

outtun < = 252 > 265 248 220 249 217 207 224 239 217 281 267 229 244

CPercentage of patients receiving first definitive treatment for cancer within two

months (62 days) of an urgent GP referral for suspected cancer. CCG>=85% <80% 87.10% 89.58% 86.27% 88.68% 85.42% 84.40% 100.00% 86.80% 95.25% 78.00% 95.74% 92.75% 84.62%

CPercentage of patients receiving first definitive treatment within one month of

a cancer diagnosis CCG>=96% <91% 97.18% 98.51% 97.89% 98.79% 98.51% 98.50% 99.40% 97.90% 100.00% 95.80% 100.00% 98.06% 98.64%

Zero growth in conversion rate of ED attendances to admissions

from 12/13baseline

C Achievement of 95% A&E 4 hour access target >=95% <95% 91.90% 96.60% 96.90% 95.91% 94.60% 93.28% 93.79% 95.15% 94.79% 95.59% 95.90% 96.44%

Zero growth In Emergency Hospital admissions against 12/13 3199 3199 3199 3199 3199 3199 3199 3199 3199 3199 3199 3199

outtun < = 3199 > 3356 3036 3077 3018 3158 3055 3059 3105 3124 3166 3198 2942 3248

C15% of people with anxiety and depression will access psychological therapies

by 2014/15 6.50% Q2 1.1%

PLANS ON A PAGE

38.50% 35.40%

Up 16.67% Up 22.56%

8.31

Unplanned Care Plan On Page

C

3.32%

Up 20.73%

Dementia Plan On Page

Mental Health Plan On Page


10.40

9.69

Up 7.21%

23.27% 23.27% 23.27%

9.65%

C12/13 Baseline

C12/13 Baseline

Indicators Currently reported as GREEN or ON TRACK

6.74%

12/13 Baseline

Mental Health Plan On Page

Cancer Plan On Page


Indicators Currently reported as RED or OFF TRACK

43.96%

C

Cancer Plan On Page

C12/13 Baseline

10.13 11.05 10.27

Greater Than

Indicators Currently reported as AMBER or AT RISK

Childrens Plan On Page

Greater Than8.259.09

50.60% 45.89% 50.10%

79 89

86C 124

95 128

93

19.41% 20.61% 22.29% 21.17%


9.09

52.1%

12.6%

99

101

23.27%




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


People with dementia who had an episode of crisis


Hospital admissions to DRI within 30 days


C

Percentage of patients receiving first definitive treatment for cancer within 62-

days of referral from an NHS Cancer Screening Service. CCG >=90% <85% 88.89% 85.71% 87.50% 92.86% 92.86% 100.00% 100.00% 90.90% 100.00% 83.33% 100.00% 100.00% 100.00%


days of a consultant decision to upgrade their priority status. CCG>=90% <85% 77.78% 86.67% 100.00% 95.24% 91.67% 100.00% 90.00% 80.00% 94.12% 94.74% 80.00% 88.24% 0.00%

C 88% patients having curative treatments 88% <83.6%

C31-day standard for subsequent cancer treatments-surgery CCG

>=94% <89% 100.00% 100.00% 92.86% 92.56% 100.00% 100.00% 100.00% 96.00% 100.00% 93.10% 90.91% 96.77% 0.00%

CTwo week wait for breast symptoms (where cancer was not initially suspected).

CCG>=93% <88% 98.82% 96.30% 91.21% 95.54% 94.12% 93.60% 97.30% 93.80% 95.60% 95.16% 92.25% 90.98% 0.00%

C31-day standard for subsequent cancer treatments-anti cancer drug regimens

CCG>=98% <87% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 0.00%

C

31-day standard for subsequent cancer treatments-radiotherapy CCG

>=94% <89% 98.15% 100.00% 97.73% 100.00% 97.62% 100.00% 100.00% 100.00% 97.83% 100.00% 97.83% 100.00% 0.00%

C All cancer two week wait. CCG >=93% <88% 95.78% 95.95% 94.48% 94.36% 94.87% 94.50% 96.00% 95.50% 95.31% 94.74% 95.57% 95.55% 0.00%

C 66% one or two GP attendances prior to referral 66% Less Than

C Reduction in Emergency admissions as a result of cancer 220 per Quarter Higher Than

C90% Initial Health Assesments (in area) completed within 28 working days by

31/03/1440% Less Than 50% 25% 16% 67% 18% 44% 33% 58%

C5% reduction in emergency admissions - LRTI (Cum) 5% Reduction or

moreMore Than 33.87% 39.36%

Childrens Plan On Page

79%

31.07%

Greater Than


Greater Than

543 644

466 525

68%

Cancer Plan On Page

506C

87.70% 91.30% 88.68%

1 0C

0 00

3

517< 601

< 3

67%N/A

187 196 162 127

32.58%

0

524

0

511




DBHFT

RDaSH

Misc Delivery Plans

Key:

T = Trust Targets


Reduction in re-admission rates 12/13 outturn

reduction to bring in line with SY average 13.02% 13.82% 13.87% 13.08% 11.84% 14.51% 11.11% 12.66% 13.40%

CReduce national benchmarking ranking by quarter 4 submitted results (Activity)

C Reduce national benchmarking ranking by quarter 4 submitted results (Cost)

CDevelop mechanisms to ensure that total spend against budget is full

understood and reported against on a monthly basis

C

Develop robust and detailed understanding of patient flow at aggregate and

individual level, with appropriate targets being agreed by 31 March 2014 for

14/15

C

Quarterly review of % of Fast Tracks over 90 days, leading to the development

and agreement of an appropriate target for 14/15 (Cum)

1st

5th 1st 1st

Under Development

6.00% 10.64% 12.83% 11.81%

12/13 Baseline

2nd2nd

Continuing Health Care

Under Development

C

Indicators Currently reported with no RAG rating


Enc C

Finance Report



Title of paper

Budget Book


Mrs Hayley Tingle, Chief Finance Officer

Author(s) Mrs Hayley Tingle, Chief Finance Officer

Purpose of Paper - Executive Summary The purpose of this paper is to set out the proposed Budgets for the CCG for 2013/14. It outlines the Budget setting process and the next steps to allocate to budget managers.

Recommendation(s) The Governing Body is asked to approve the High Level budget Summary for 2014/15.

Impact analysis

Assurance Framework

3.2, 5.1, 5.2

Risk analysis

The financial risks and mitigation to these budgets remain the same as highlighted in the Financial Plan 2014/15.

Equality impact

Neutral


Nil


Nil

Legal implications

Nil


Budget Book 2014/15 Introduction This report sets out the proposed Budget Book for 2014/15. The financial plan for 2014/15 was agreed at the April 2014 Governing Body meeting and forms the basis for the budget setting process. This has provided the ‘financial envelope ‘within which budgets can be set. The Budget Book outlines the total revenue resources available for 2014/15, including recurrent growth for investment, non recurrent allocations anticipated by the CCG, together with details as to how these resources are allocated across commissioned services and infrastructure support across all programmes. Budget Setting Process 2014/15 Budget books are being prepared on the basis of the Doncaster CCG allocation of £429.5m for 2014/15 which includes growth, the running costs allocation and return of surplus. This has provided the ‘financial envelope ‘within which budgets can be set. A CCG under its constitution is required to set a budget that meets its statutory financial duties, detailed CCG budgets have been calculated ready for CCG approval. The planning assumptions identified in the financial plan, efficiency savings and investment priorities have been incorporated into a high level Budget Book, which in turn is supported by detailed financial budgets constructed primarily around provider contract agreements, investment priorities to support the delivery of business plans. The budget setting process now looks to define and allocate out respective budgets on a more detailed basis including the mapping and transfer of allocations into cost centres. The detailed budget setting process is consistent with the Doncaster CCG 2014/15 Moving Forward, getting better commissioning strategy and underpins the delivery of its strategic objectives. Summary The Summary Budgets are attached at Appendix 1 for review and approval. The Draft CCG Budgets will be presented to the relevant Budget Holders / Budget Managers for formal sign off. Detailed financial risks, mitigations and risk sharing were highlighted in the financial plan commentary and not repeated here. These will be incorporated and monitored as part of monthly financial reporting. The Governing Body is requested to approve the Budgets outlined for 2014/15.

High Level Budget Book Summary 2014/15 - Appendix 1

Recurrent Non Recurrent Total

£000's £000's £000's

Baseline Allocation 406,100 406,100

70% Marginal Rate Collection 0 0

Running Cost Allowance 7,639 7,639

Initial Allocation 413,739 0 413,739

2.14% Inflation 8,674 8,674

Return of Surplus 7,130 7,130

Total Allocation 422,413 7,130 429,543

Acute Contracts - Doncaster & Bassetlaw NHS FT inc Offender Health 175,988 0 175,988

Acute Contracts - Other NHS 32,163 0 32,163

Aucte Contracts - Other Providers Non NHS 3,803 0 3,803

Acute - Non Contract Activity 2,771 0 2,771

Total Acute Services 214,725 0 214,725

Mental Health Contracts - Rotherham , Doncaster & South Humber NHS FT 35,696 0 35,696

Mental Health Contracts - Other NHS 309 309

Mental Health Contracts - Other Providers 11,985 11,985

Mental Health - Non Contract Activity 177 177

Total Mental Health Services 48,167 0 48,167

Community Contracts - Rotherham , Doncaster & South Humber NHS FT 28,197 0 28,197

Mental Health Contracts - Other NHS 377 377

Mental Health Contracts - Other Providers 3,173 3,173Total Mental Health Services 31,746 0 31,746

Prescribing 57,460 57,460

Oxygen Services 511 511

Other Primary Care Services 3,068 3,068

Primary Care Services 61,039 0 61,039

Continuing Healthcare 38,154 38,154

Continuing Healthcare Services 38,154 0 38,154

Corporate Costs including Property Costs 11,081 11,081

Total Corporate Costs 11,081 0 11,081

Non Recurrent Headroom Reserve 10870 10,870

Contingency Reserve 0.5% 2,148 2,148

Investments 5,000 5,000

Total Reserves 7,148 10,870 18,018

Total Application of Funds 412,061 10,870 422,931

Surplus 1% 6,612

Enc D

Chair & Chief Officer Report



Title of paper

Chair and Chief Officer Report


Dr Nick Tupper, Clinical Chair Mr Chris Stainforth, Chief Officer

Author(s) Mrs Jackie Pederson, Chief of Strategy and Delivery

Purpose of Paper - Executive Summary The purpose of this report is to update the DCCG Governing Body on issues relating to the activity of the Doncaster Clinical Commissioning Group of which the Governing Body needs to be aware, but which do not themselves warrant a full Governing Body paper. This month the paper includes progress on the following areas:

− South East Locality Election

− DCCG Quarter 4 Assurance meeting

− National 360o National Survey

− Estates Utilisation Report

Recommendation(s) The DCCG Governing Body is asked to

- Note the report

Impact analysis

Assurance Framework

3.2, 5.1, 6.2

Risk analysis

None

Equality impact

Neutral


Nil


Nil

Legal implications

Nil


N/A

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1. South East Locality Election Due to the resignation of Dr Ayesha Zafar, Governing Body Lead elections are currently taking place in the South East Locality. The closing date for applications was 16th June 2014. If more than one application is received, an election will be held with votes counted 7th July 2014. 2. DCCG Quarter 4 Assurance Meeting The DCCG quarter 4 assurance meeting took place Tuesday 27th May 2014. Feedback from Area Team colleagues was positive in relation to the achievement of the 18 week position and A&E 4 hour wait target. There was further discussion relating to primary care commissioning opportunities and the successes achieved by the DCCG in the last 12 months. Formal feedback from Area Team colleagues will be presented to the Governing Body in due course. This will also be made available to the general public via the DCCG website. 3. National 360o National Survey The national CCG 360o stakeholder survey was conducted recently. It is the second time the process has been undertaken as the survey also took place during the authorisation process. The survey, conducted by NHS England, allows stakeholders to provide feedback on working relationships with CCGs. The results from the survey aim to serve two purposes:

− To provide a wealth of data for CCGs to help with their ongoing organisational development, enabling them to continue to build strong and productive relationships with stakeholders. The findings can provide a valuable tool for all CCGs to be able to evaluate their progress and inform their organisational decisions.

− To feed into assurance conversations between NHS England Area Teams and CCGs. The survey will form part of the evidence used to assess whether the stakeholder relationships, forged during the transition through authorisation, continue to be central to the effective commissioning of services by CCGs, and in doing so, improve quality and outcomes for patients.

A list of core respondents was set nationally, with local contact details being populated by the CCG. Within the survey, stakeholders were asked a series of questions about their working relationship with the CCG. In addition, to reflect each core stakeholder group’s different area of expertise and knowledge, they were presented with a

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short section of questions which was specific to the stakeholder group they were representing. 2.1 Response Rate 38 of the DCCG’s stakeholders completed the survey. The overall response rate was 64% which varied across the stakeholder groups shown in the table below.

Stakeholder Group Invited to take part in survey

Completed survey

Response rate

GP Member Practices 40 23 58%

Health and Wellbeing Board

1 1 100%

Local Healthwatch / Patient Groups

2 2 100%

NHS Providers 4 3 75%

Other CCGs 4 3 75%

Local Authorities 4 3 75%

Wider stakeholders 4 3 75%

2.2 Summary conclusions The results from the 360 stakeholder survey are generally positive and correlate with the national picture of CCG results. Our results demonstrate a particularly positive relationship with the Health & Wellbeing Board, the Local Authority and with NHS Providers. Our Member Practices have a wide range of perceptions, demonstrating differential feelings of engagement and involvement with the DCCG from different Member Practices. In the following areas the survey results highlight areas for further focus:

− Just under half of our stakeholders feel that the DCCG takes on board their comments on our plans and priorities and this is lower than the average finding for CCGs overall. The Governing Body may need to consider further strengthening a “You Said, We Did” approach, potentially via our Talking Points strategy which is launching soon, and also closing the feedback loop to stakeholders who have taken the time to share their views with us.

− Around half of our stakeholders agree that the leadership of the DCCG has the necessary blend of skills and experience and this is lower than the finding for CCGs overall. However the majority of our stakeholders do agree that there is clear and visible leadership and the majority also have confidence in the leadership of the DCCG to deliver its plans and priorities and agree that the leadership is delivering continued quality improvements – and this last finding is

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higher than the finding for CCGs overall. The Governing Body may need to consider developing a more visible leadership profile which more explicitly brings out the range of skills and experience contained within the team.

4. Estates Utilisation Report The DCCG recently appointed Doncaster Community Solutions to undertake a review of estate utilisation following the transfer of some estate responsibilities from Doncaster PCT. The review highlighted the following findings:

− Leases on properties that are underutilised and have break clauses in the near future

− DCCG is currently charged directly for bookable and void space across the estate

− Bookable space is concentrated in the 9 LIFT buildings

− There is not a robust room booking and tracking system in use across the estate.

− Bookable space is heavily underutilised being used only circa 28% of the time

A number of recommendations were received and are currently being considered by the DCCG. 5. Recommendation The DCCG Governing Body is asked to:

- Note the remainder of the report

Enc E

Receipt of Minutes from Committees

1

Minutes of the Quality & Safety Committee Held on Thursday 1st May 2014 at 9.30am in the

Board Room, Sovereign House

Present: Dr Emyr Jones Secondary Care Doctor Member (Chair) Mrs Mary Shepherd Chief Nurse DCCG Dr Jeremy Bradley Locality Lead, DCCG Dr Lindsey Britten GP Lead for Quality, DCCG Mrs Suzannah Cookson Head of Quality for Children and Designated Nurse, DCCG Ms Wendy Feirn Head of Infection & Control Mr Victor Joseph Consultant in Public Health, DMBC Mrs Christina Quinn Public & Patient Experience Manager, DCCG Mr Mark Randerson Head of Medicines Management, DCCG Mr Andrew Russell Head of Quality for Vulnerable Adults, DCCG Mr Ian Boldy Named Nurse for Safeguarding, DCCG Miss Emma Smith Senior Officer for Primary Care

In attendance Miss Lauren Camplin Safeguarding Support Officer, DCCG Mrs Jenny Rainer Senior Officer for Quality, DCCG Ms Glenis Nicholson Corporate Services Officer, DCCG (Minutes)

ACTION

1. Welcome and Apologies

2. Minutes of the last meeting held on 5th September 2013 The minutes of the last meeting held on 7th November 2013 were marked as an accurate record. The following updates were noted: P2 – Clostridium difficile - Mrs Feirn confirmed that the trajectory figure for 204/15 was 91. P3 – Serious Incidents - Mr Russell confirmed this is a long term piece of work and will keep updating the group on progress. P3 – Assurance Visits - Mr Russell confirmed that these have been undertaken and written up and he will bring highlights to next meeting.

Mr Russell

Mr Russell

3. Matters arising not on the agenda Cost Improvement Plan – Mr Russell asked the group to note that this has been through a quality improvement plan with the support of both DBHfT and RDaSH with the high risk areas going through the CQRGs. Mrs Shepherd agreed to bring

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to the report to the next meeting to ensure high risk areas have been identified and addressed. Mr Russell asked that this become a standing agenda item.

Mrs Shepherd

Ms

Nicholson

4. QUALITY a) DBHFT Quality Dashboard and Risk Profile

The purpose of this paper is to provide an overview of the Quality and Patient Safety Issues in relation to DBHFT. In addition to the paper there is an attached Business Intelligence Report which is submitted to each Clinical and Quality Review Group Meeting. The report covers

• A monthly reduction in SIs with Pressure Ulcers remaining the most frequent category.

• Receipt of the Ophthalmology External Review.

• Improvement in the NHFD performance.

• Number of Clostridium difficile cases reduced and maintained within the Monitor Target of 47.

• Completion of the quality assessment in relation to Cost Improvement plans (CIP)

The Committee is asked to:

• Receive and note the on-going DBHfT Quality Report.

• Consider the format of the report and any additional assurances that may be required

• Serious Incidents The number of SIs reported through February dropped. This is the first drop since October. The significance of this is yet to be analysed and may just be a fluctuation. DBHFT also appear to have a higher reporting rate than other organisations within the South Yorkshire area.

• Pressure Ulcers The incidence of Pressure Ulcers continues to be a challenge within DBHFT and the wider community. The Trust is in the process of implementing the new strategy and this includes ‘de-escalation’ policy. It was envisaged that all the necessary resources would be in place in April 2014. The impact of these strategies will continue to be monitored through CQRG meetings.

• Ophthalmology The Independent Ophthalmology Review was completed and presented to the CQRG meeting in April. A formal action plan is to be agreed with the Trust and progress against this will be monitored through CQRG.

• FNOF Best Practice Pathway As previously reported, there had been a drop in performance against the best practice guidance. In addition to this, performance is lower at the DRI site in relation to Bassetlaw site. January had seen a slight increase in mortality rates for this patient group; this mirrored the data from last year. February data saw an improving performance and reduction in mortality rates. The position continues to be monitored by CQRG

• Clostridium difficile The committee are aware that the Trust breached the national trajectory for Clostridium difficile (37). The current number is 38. The Trust continued work to maintain levels below the Monitor target of 47 cases for the year and the final position at the end of the year was a total of 41 cases This is well inside the monitor target.

• Cost Improvement – DBHfT have developed their cost improvement plans and the quality assurance process includes senior team members from Doncaster

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CCG. Dr Jones asked if we are satisfied with their level of awareness in light of incidents at Staffordshire, Mr Russell confirmed that the quality team were happy and will continue to monitor.

c) CQUINS for RDASH CQUINS attainment for 13/14 Commissioning for Quality and Innovations (CQUIN) framework is to secure improvements in quality of services for better outcomes for patients, whilst also maintaining strong financial management. Negotiation forms part of the contract negotiations and is embedded within the provider contracts and has a value of 2.5% of the contract value for each provider. CQUIN monies are non-recurrent and commissioners must clearly set out the proportion of payment associated with each indicator. Monies should be used to incentivise providers to deliver quality and innovation improvements above the baseline requirements set out in the standard contract. Topics for inclusion in CQUINS are derived from • Nationally mandated CQUINS • Local strategic direction and CCG current and planned priorities • Quality priorities identified via PROMS/PREMS and serious incident (SI) reporting RDASH attainment for 2013/14

Mental Health Experience

All trajectories were met for experience measures for patients but not all were met for carer surveys. The main elements of dissatisfaction were in relation to involvement in care planning and information provision. Adult mental health inpatients also appears to show lower satisfaction and will be rolled into 14/15 CQUIN scheme Dementia I statements, CAMHS and roll out of local FFT (in preparation for this becoming mandatory in 14/15) met all the improvement trajectories set and positive experiences were noted. The GP survey was based around Primary Cares experience of RDASH Learning Disability services and although there was only a small return of questionnaires the trust have devised an action plan to address comments and areas highlighted as a concern.

Partial achievement (only a small financial penalty incurred) over the financial year.

Safety Thermometer

As part of the nationally mandated scheme point prevalence data has been collected on a monthly basis within Mental Health Inpatient services. Additionally due to the numbers being very low in this area the CCG negotiated a further stretch with the

Full payment achieved

4

introduction of the fall safe scheme which should have a positive effect on reducing the number of falls. During quarter 4 the trust Falls Leads and Business Division Falls Co-ordinators have continued to use falls per 1000 bed days data to monitor and work with each ward. This work includes analysing falls where numbers have peaked during a month developing action plans and sharing lesson learnt. This continues to be included into the 14/15 CQUIN scheme and training is currently being rolled out across older people’s mental health In patient areas. The evidence based scheme has been shown to reduce falls by 25%. Monitoring against this will take place on a regular basis and will form part of the quality framework for Mental Health services during 14/15.

Transition planning

Transition planning is an important part the recovery process. The CQUIN concentrated on improvement in patient and carer experience and actual outcomes with regard to transition between services for CAMHS to AMH, LD transitions and LD joint worked with AMH and OPMHS and finally OPMHS discharges of S117 from in patient wards. The elements included

• Involvement in care planning and transition plans

• Having an identified care co coordinator/named worker

• Information about current team providing services and the new service to be transition towards

• Planned transition date

• Communication with the patient and the patients GP in relation to transition.

All trajectories were met by the end of the CQUIN year and additionally as part of this process it was identified that there were no transitions from Adult Mental Health Services to Older Peoples Mental Health Services which provides consistency for patients as they approach older age.


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Due to the above it was negotiated that the trust would review the IAPT to secondary care transitions and provides a baseline position. Results were varied and there was some lower attainment around patients having a clear team responsible for the continuation of care up until the point of transition and that the patient had been informed of the transition. Additionally it identified that some patients were waiting more than 28 days between last IAPT contact and referral to secondary care. This is being picked up via the contracting route via the lead commissioner. The action plan will be monitored during Q2 of 14/15 and will be measured against the re-audit result’s also due at this time.

Recovery Discharge and planning

The trust, as part of this indicator, has worked to develop a culture of recovery that begins at the start of all agreed clinical pathways which also includes in patient and community services. This in turn results in patients following an appropriate recovery pathway and not being unnecessarily retained in services. It also included themed reports on ‘aids and blocks’ to recovery. The findings were that there has been good coverage of use of recovery tools at start of treatment and during the course of the year. There has also been a marked improvement to tools being used at discharge and thus providing a quality outcome measure. This is going to be included in next year’s CQUINS to enable further embedding and stretch and also to get outcomes at review periods in line with clustering expectations.


Community Experience

As with mental health patients community patients and carers experience has been measured. Across the board all improvement trajectories have been met. Experience on the whole is positive both for patients and their carers and includes the following

• Privacy and dignity

• Involvement in care planning

• Information provision

• Giving feedback

• FFT across the trust

Full payment agreed

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This will again be included in the 14/15 CQUINS and the trust will work with teams to pick out lower levels of satisfaction to further improve patients and carers experience of care and service provision. They will also ensure satisfaction levels do not drop and if this should occur teams and services will address via action planning and sharing of lessons learnt.

Community Safety Thermometer

At the beginning of the year data collection processes were phased across teams and services in 13/14 after the process was implemented in 12/13 for inpatient areas. Mid-year it was established that there had been low levels of reporting onto the safety thermometer system and there was not the expected 80% coverage needed to meet the data collection requirements. As such the CCG negotiated with the trust to work on cascading though teams the importance of undertaking the safety thermometer requirements on one day per month and to also establish how other assurances could be provided to the CCG particularly in relation to pressure ulcer prevalence, management and care. Data collection improved in the 2nd half of the year and continued to sustain above an 80% target coverage rate. Additionally it was agreed that an audit of pressure ulcer assessment and care planning would be undertaken and some stretching trajectories were agreed from baseline figures. The audit focussed on the following key areas

• Risk assessment

• Care planning

• Assessment of pressure relieving equipment needs and patient refusal

• Recording of site classification and origin of wound

• Wound treatment plan and effectiveness of dressing

The re-audit against the improvement trajectories showed varying attainment. Particularly concerning was at re-audit only a quarter of patients in the audit co-hort

Partial payment achieved

7

were being risk assessed. There was also poor compliance to care planning elements and assessment of pressure relieving equipment requirements. In total the trust only met 5 of the 12 elements needed to achieve full payment against the CQUIN. The trust as a result of this are reviewing the pressure ulcer protocol and pathway as in areas it was identified as not being fit for purpose. Additionally an action plan has been developed to address areas of poor compliance. The Quality Manager has requested that this action plan is monitored at the Clinical Quality Review Group and that once changes have had chance to take effect the re-audit is submitted to this group to gain assurance of quality improvement. The safety thermometer will again be incorporated in the 14/15 scheme as mandated nationally. There is the expectation that there will be a 50% reduction in the number of pressure ulcers across all providers. Additionally other quality performance measures will be devised with performance and IP&C colleagues to enable full and accurate reporting of pressure ulcer prevalence and reduction of harm.

Community Information data set

The trust, during the year has worked closely with contracting colleagues to develop community information data systems. This includes reporting and recording to improve underlying data quality and visibility. This has supported effective service monitoring, efficient use of resource and has informed community service development. Community information and data sets have been shared with the CCG and an issue log has been developed and progressed throughout the year. Monthly analysis of Warrington units and complexity levels has been provided for District Nursing and Community Matrons. This has enabled an understanding of the proportion of contacts and the complexity of patients on caseloads and will inform the implementation of the community nursing specification.


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The issues log has been divided into Information team issues and service issues and is monitored as part of the information sub group with the CCG and will continue into 2014/15 along with data provision but not specifically as a CQUIN but part of the on-going business development and adopts itself, to an extent to the Community Nursing redesign process with forms part of 14/15 CQUIN scheme.

Community One Team Working

The trust has continued to work towards the integration of Adults and Children’s services with DMBC. The roll out programme has focused on co-locating staff, embedding MDT meetings developing working processes, sharing information and improving access for service users. The CQUIN focussed on a two year evaluation of the process which will continue into 14/15 in collaboration with the community nursing service specification implementation. A mid programme evaluation report has identified that in adult services the benefits of the changes to date are well recognised and reported by staff members. Benefits to service users have been seen resulting in efficient, joined up seamless care; in particular the ability to co-ordinate visits to patient’s homes resulting in joint visits or reducing the need for certain visits to collect information held by another party. There has been some varying feedback from GP’s with some having more understanding than others on the OTW within their locality and also that GP’s expressed a wish to revert back to having District Nurses embedded within their practice. GP’s have been attending the OTW MDT meetings and moving forward these meetings will help collaboration to develop relationships collectively and share knowledge and best ways to communicate with GP practices. Children’s and families’ services in DMBC have seen significant organisational changes and implementing the substantial changes required for OTW has been challenging. Due to the shift in children’s


9

services to the local authority the trust have shared lesson learnt and evaluation to date with them to help inform the children’s review process currently underway.

Mr Russell informed the group that the last meeting of the RDaSH CQRG was not quorate, however assurances had been received from RDaSH that these would be covered in future. Mr Russell further confirmed there are no concerns around quality of care and work is on-going on to develop a more meaningful quality framework. Dr Jones asked for assurance that this group will receive the framework, Mr Russell confirmed this and provided a brief insight into the reporting mechanism which goes to the Board on a quarterly basis. CQUIN year-end attainment – Dr Jones commented that it was an excellent narrative by Mrs Stothard. Mr Russell highlighted areas to be improved around pressure ulcer. There then followed a brief discussion around KPIs and the need to ensure these are embedded and monitored and fed into the quality framework to ensure they are measured correctly. Dr Jones said that some walk rounds should have had targeted questions asked – report for DBHfT will be in this week. Dr Jones asked that as almost all CQUIN payments have been achieved it be recorded in the minutes. Mrs Shepherd said that the CQUINs for 2014/15 is a much better and more aligned scheme this time and are more about outcomes. Mr Russell agreed to provide headlines to the next meeting. d) Care Homes Mr Russell said the first goal of getting NHS contract in place for NHS commissioned services has been achieved and the contracts have been received very well, managing the contracts is the next step. One of the processes is to quality assure and monitor, the overarching plan just needs to be put in place. The first meeting will take place next week with the Local Authority Contracts Team. Part of work is to plan around how we elicit low level concerns and how they are managed and to ensure there is a shared purpose and vision and that systems are in place and are pro-active and robust. Mr Russell to bring report to the next meeting. e) Primary Care

Miss Smith confirmed that Primary Care is actively engaging with all of our local contractors and committees to continue to improve the working relationship between the CCG and our communities. She further confirmed that all 43 GP standard contracts for services in 2014/15 are now finalised and Primary Care are working towards an allocation of contracts for all Ophthalmic and Pharmacy contractors in the coming months. Local Winter Funding Schemes have been successful in visiting the vulnerable elderly, providing information on preventing falls and assisting with Inhaler techniques across Pharmacies and GP practices. The Primary Care team in collaboration with the LPC have been recognised in the 2014 Chemist and Druggist awards for Clinical service of the year, and the multi-disciplinary innovation award which will take place in London in June. The CCG are actively meeting with the area team on a monthly basis which at times has proved challenging to discuss the national and local agendas. There followed a brief discussion around communication with providers and regular discussion with LMC, Dr Britten said there are issues around cross providers and the local area team and asked for some clarification. Mr Russell said that some issues can be aired through the area team and quality leads meetings and can be fed back via Miss Smith.

Mr Russell

Mr Russell

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Dr Jones said that around 100 GP practice could go to the wall according to news and could we keep an eye on the situation, Mrs Smith confirmed she has a good relationship with practices and they would highlight any problems as they occur. It was agreed to leave on as standing agenda item f) CHC Mrs Shepherd said that there would be a full presentation at Strategy & Development Forum this afternoon and she will send out presentation to members. After a brief discussion it was agreed that this committee would sign it off the revised set of policies. Post Meeting Note: The CHC Policies have been approved

g) Winterbourne There group had a discussion around the national programme for implementing Winterbourne and work around CHC quality framework and recommendations and actions.

The following were discussed in brief:

• National programme for implementing Winterbourne’s have shown an interest in coming to Doncaster. Mrs Kitchen agreed to provide an update if they do decide to visit.

• Long term day to day business

• Focusing on Concordat which is to be delivered by June 2014

• Criteria around patients in hospital and whether they are being moved to care home on due dates and only patients moving patients who are inappropriately placed.

Dr Jones commented that we need to be assured that the action plans have received sufficient scrutiny and that we have sufficient assurance both internally and also if we are subjected to outside scrutiny. Mr Russell agreed to provide a written paper for future meetings.

Mrs Shepherd/

Ms Nicholson

Mr Russell

5. PATIENT SAFETY a) Medicines Management Report The purpose of this paper is to inform the Committee of the key Medicines Management headlines relating to:

1.Controlled Drugs 2. Medicines Safety 3. Shared care/managed entry of new drugs 4. Finance 5. Antibiotic Stewardship 6. IT 7. Local Authority

The Committee is asked to receive and note the contents of this paper. The following issues were discussed in further detail:

• 1g – Outstanding issue of wording on the old system.

• 1h – The need for an alert mechanism for reporting of incidents by care homes.

• 2a, iii – NHSE requirement to have Medicines Safety Officer – Mr Randerson to feedback resolution at next meeting.

• 3a, iii – Transfer of stable patients with a history of psychotic illness. Dr

Mr Randerson

11

Jones said NICE guidance is that patients should be transferred to facilitate that commission and involve GPs and LMC.

• 3d –Discussion are on-going with DBHfT around the ‘homecare medicines services. Dr Britten asked for clarification around the drugs supplied. Dr Jones asked if there were any concerns about our providers and commented that there needs to be a robust contingency plan built in to ensure that if the company ceases to exist someone picks up the patients medication. It was agreed that this should be added to the CQRG agenda.

• 6a - The Electronic Prescription Service is making good progress.

• 7b – There are issues around with access to healthy start vitamins, who is eligible for free vitamins and who is means tested. Mr Joseph agreed to look into and feed back at the next meeting.

Mrs Shepherd said that cellulitis needs tidying up and that it is a commissioner responsibility, however there are issues around the pathway and she would look at the ECP pathway with Ms Smith & Mrs Forestall. b) Infection Prevention & Control / C-difficile Plan To provide the committee with the data relating to the mandatory surveillance of:

• MRSA bacteraemia

• Clostridium difficile infection

• Category 3 & 4 Pressure Ulcer – Root Cause Analysis

• SY&B related work streams

• Report the outcomes of the Post Infection Review overview Panel

• Report on outbreaks of Infection Recommendation: The meeting to receive and approve the paper. Analysis of Key Issues: To describe actions taken to promote the reduction in healthcare Associated Infection, including new national, regional and local guidance documents. Mrs Feirn gave a comprehensive update on the CDI Improvement Plan highlighting the following:

• C-difficile Trajectories - allowed 41 cases for Doncaster CCG and 45 for DBHfT – which are a subset breached trajectory and continue.

• GP Letter - A letter is sent to GPs to advise outcomes, letters are sometimes returned unopened, almost as if nothing to do with them. issues.

• Outbreaks of Infection - There was an outbreak in the Nepalese community of latent pulmonary TB and during process of being treated some have developed open pulmonary TB, this is a specific strain and highly contagious. This was charged to DCCG at 440 per patient/case issues have been resolved and worked though.

• Pressure Ulcer Panel – DBHfT data for 2013/14 had identified 442 inherited pressure ulcers and 172 hospital acquired cases. Drop down box to be put on database so information on care homes can also be recorded.

The Committee received and approved the report. Policy of Surveillance – Mrs Eyre asked the committee to note that the updated timescales on the front of sheet.

Mr Joseph

Mrs Shepherd/ Ms Smith/

Mrs Forestall

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The Committee received and approved the report. c) Serious Incident (SI) Report

Mr Russell told the group that information on the reviews which have been introduced will be provided at the next meeting.

• Increase in falls - Mr Russell asked the group to note the rate of falls which result in harm is monitored via the IMF and also CQUINS.

d) Thematic Review - Mr Russell confirmed this is a quarterly review and he will summarise and bring to the next meeting.

Safeguarding Annual Report Mrs Cookson presented the report advising that this is the first draft and the committee are asked for comments. She further confirmed that this is the first performance data for the next quarter. The following items were then discussed:

• Quality Support Role - At the last Quality Meeting approval was granted for this role. This was sent out to Locality areas and presented at TARGET.

• Level 4 safeguarding - This has been recognised as good practice by NHS England and the CCG has been asked to roll it out nationally by 18 September 2014, focusing on key areas of sexual exploitation.

• CQC Unannounced Inspection – Local Authority are to be inspected later this year.

Mrs Shepherd said it is important to note that we are system leader for safeguarding and held responsible for CQC, Dr Jones commented that we can also use this work well with other organisations. Mr Russell said there are significant updates and progress on the Adults and he will provide an update on the work plan for the next meeting Solar Centre – There was a specific issue on a serious incident in 2007 of institutional abuse which the Safeguarding Board decided not to prosecute. An independent author has been assigned to produce a significant piece of work to be done before the final report goes to the Safeguarding Board. It was noted that this will be high profile plan when published. Dr Jones asked what we are doing as commissioner and provider, Mr Russell responded that this was subject to an SI at the time and huge amount of learning and lessons have been learned and action plans put in place with the liaison of CPS and Police. Mrs Shepherd confirmed that a media plan is in place Lessons Learned Review – Mr Russell said there is a delay in the review due to lack of attendance by other providers and has now escalated the issue to the Safeguarding Board Members. Post Meeting Note: The date for this has been agreed and it is hoped that this will be presented to the next DSAPB Board. CQC Inspection – Mrs Cookson told the group that we have developed a similar process and prepared a mock inspection for ourselves.

Mr Russell Mr Russell

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Mrs Shepherd asked that the full Safeguarding Annual Report is presented at the Governing Body and Children’s Safeguarding Board. Mrs Cookson and Mr Russell agreed to action. Dr Jones said that if it could be done by late June, the report could come to this committee and then be present at the Governing Body as spotlight for presentation in July. 360 Assurance – After a brief discussion Mrs Shepherd confirmed that it was appropriate for this to be included at this meeting. Safeguarding Assurance - Mrs Shepherd agreed to provide some information around the leadership role to the next meeting.

Mrs Cookson/ Mr Russell Mrs Shepherd

6. PATIENT EXPERIENCE Caldicott Plan 2013/14 Mrs Mary Shepherd confirmed that there are no issues this month to report.

7. MINUTES FOR INFORMATION Medicines Management Committee The minutes of the Medicines Management Committee held on 13 March 2014 were received and noted. Safeguarding Assurance Forum The minutes of the Safeguarding Assurance Forum are unavailable at present. Incident Management Forum The minutes of the Incident Management Forums held on 18 February 2014, 04 March 2014 and 18 March 2014 were received and noted. Area Prescribing Committee The minutes of the Area Prescribing Committee held on 27 March 2014 were received and noted. District Infection Prevention Control The District Infection Prevention Control meeting minutes held on 5 December 2013 were received and noted.

8. Any Other Business There was no other business

9. DATE AND TIME OF NEXT MEETING Thursday 3 July 2014 at 9:30am in the Board Room, Sovereign House

Schedule of future meetings

Thursday 11th September 9.30 – 11.30 Board Room, Sovereign House

Thursday 6th November 9.30 – 11.30 Board Room, Sovereign House

1

Delivery and Performance Committee

Held on Thursday 8 May 2014 Board Room, Sovereign House

Present: Mr Stainforth, Chief Officer (Chair)

Dr Oakford, North East Locality Lead Mrs Pederson, Head of Strategy and Delivery Mrs Shepherd, Chief Nurse Mrs Leighton, Head of Performance

In attendance: Mrs Satterthwaite, PA (Minutes)

Mr Carpenter, Communications Manager Dr Seddon, North West Locality Lead, (attending on behalf of Dr Barbour) Mr Goddard (Item 5) Mr Metcalfe (Items 6, 7 and 8) Mr Roberts (Item 8) Mr Randerson (Item 9) Dr Pieri, North West Locality Lead Dr Wagstaff, South West Locality Lead Dr Britten, South West Locality Lead

ACTION

1. Apologies

Apologies were received from:

• Dr Tupper, CCG Chairman

• Dr Barbour, South East Locality Lead

• Mrs Tingle, Chief Finance Officer

Declarations of Interest Declarations of Interest were received for Items 5, 6, 7, and 8

however none were pecuniary.

2. Minutes of the last meeting

The minutes of the last meeting were agreed as a true record.

3. Matters Arising

Ophthalmology

Mr Stainforth confirmed that a letter had been sent to Mr Pinkerton, Chief Executive, Doncaster and Bassetlaw Hospitals NHS Foundation Trust (DBHFT) on 7 May 2014.

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Any other Business The issue regarding the decision whether GPs take patients off Warfarin is almost resolved.

4. Improving Dementia Diagnosis

Mr Goddard attended the meeting to present the Business Case

regarding Improving Dementia Diagnosis and explained that it was originally presented at the meeting on 13 March 2014 but a decision was deferred pending obtaining further information. A pilot of the CANTABmobile screening tool was introduced in February 2014 and was used in two local practices. The test identifies a potential cognitive impairment, lasts approximately ten minutes and no longer than twenty and can be performed by practice nurses. The results are presented using a traffic light system – Red is investigative, Amber is monitor and Green no further action. On evaluation there has been sufficient success to propose the extension of the pilot with the ambition to improve diagnosis and a further 4 practices have expressed an interest to use. Funding to support this extension will be from a £20k research allocation to the CCG from NHS England. The Committee held a detailed discussion and approved the Business Case.

5. Delivering our aspirations within the Cancer Plan (non-

recurrent)

Mr Metcalfe attended the meeting to present the Business Case. Cancer has been identified as one of the five CCG priorities in the Strategic Plan and we have been making significant progress by increasing the number of patients urgently referred under the 2 week wait by 9% and the number of patients having their first treatment by 8%. In order to maintain the progress made, a non-recurrent investment package has been developed which includes the following:

• An opportunity for practices to undertake a ‘Deep Dive’ has been offered twice. The feedback received has been positive with a good deal of insight gained in to their patient’s cancer journey. To date 20 of the 43 member practices have participated however some were unable to partake due to timescales

• Cancer survivors in Doncaster have informed us that, though their clinical treatment is generally good, there are other challenges in living their lives with and beyond cancer with wider issues such as money, employment,

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information, support, health and wellbeing, hospital discharge, carer wellbeing and communication between professionals therefore 2 MacMillan funded GP facilitators have been sourced who will visit practices and engage with pharmacists, dentists and optometrists

• In working with colleagues from Public Health we are able to prioritise the areas for focus such as tumour site and gender and identify which localities are at risk of poorer outcomes. There has been considerable success in raising awareness, referral and treatment of Prostate cancer through a campaign with Doncaster Rovers Football Club who have once again approached the CCG to work in partnership with MacMillan and key partners to build on future campaigns such as Lung cancer in women and Colorectal and Prostate in men

• NHS England Pharmacy contractors have been commissioned to deliver awareness campaigns on 6 topics each year 3 of which are national and 3 local.

The non-recurrent cost for 2014 has been estimated at between £73k and £89k, made up of the following:

• Doncaster GP practice Cancer Deep Dive - £15k

• GP practice engagement with Cancer Survivorship - £34k

• Targeted public awareness campaigns - £10k

• Awareness and Early identification - £15k The Committee discussed and approved the Business Case, requesting verbal updates be given to the DCCG Delivery and Performance Committee at regular intervals.

6. End of Life Care – Hospice at Home

Mr Metcalfe informed the Committee that Doncaster has a significantly high proportion of deaths in hospital with low death rates in care homes and hospices. More people attend A&E in the last stages of life than in other areas and more patients are admitted into secondary care when their preferred place of death is at home, this could be prevented by an extended responsive and flexible Community Nursing service which includes Domiciliary Care. The purpose of the paper is to detail the options of service delivery for End of Life Care covering the last 12 months, 3 months and finally the last 72 hours of care operating 24/7 365 days a year. The options are as follows:

• To do nothing and continue with a team of Community Nurses who case manage and commission our Domiciliary Care from existing providers

• To continue with the existing Community Nursing service but add additional domiciliary/care support capacity to

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form a more integrated Community Nursing service model which will support packages of care in the last 3month/72 hours of life. The Community Nurses will case manage the patients to permit continuation of care of the patient

• An independent End of Life care team managed by a separate provider with experienced nurses and domiciliary/care support workers. The Community Nursing service will continue to case manage patients and support packages of care in the last 3months/72 hours of life with specialist input

The Committee held a detailed discussion regarding the proposal and highlighted the following points:

• It would be essential that the nursing staff have the focus and capacity required

• Practice nurses can be instrumental in providing palliative care

• The service would have to be co-ordinated specific to the patient needs at any time

• Confidence is necessary that they have the responsibility to deliver the service and the flexibility to adjust to the patient care as necessary

The Committee agreed Option 2 and to work with Rotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) regarding the specifications.

7. Telederm Evaluation

Mr Metcalfe attended the meeting to present the Telederm Evaluation.

The original business Case was agreed by the DCCG Delivery & Performance meeting on 14 March 2013. The pilot was initiated in the South East locality in September 2013 and out of the 9 practices within the locality, 4 have consistently used the pilot. The other practices have identified issues with using the equipment which mainly relate to the signal on the mobile device and the ability to forward images to the mole clinic. This is mainly due to the practices being located on Doncaster’s perimeter with limited signal therefore these practices have been issued with a Wi-Fi signal booster device from EE with positive results. There is a potential cost for this of £30-£50 per device and then £16 a month on a 30 day rolling contract. At present the practices are allowed to claim £10 per month for top up charges so this would result in an extra £6 recurring monthly cost. Feedback from users of the pilot has been positive, with clinicians commenting on the easy use of the equipment and the speed in which images are captured, sent and results received back. Dr Oakford queried if there was any potential for wider use, for

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example, in non-specific rashes and Mr Metcalfe confirmed this would be possible. The Committee approved the extension of the pilot for a further 6 months until the end of December 2014.

8. Premature Ejaculation

Mr Randerson attended the meeting to outline the current situation and recent developments in medication for Premature Ejaculation (PE). Dapoxetine is a controlled drug and is the first oral treatment for PE to be licensed in the UK and has been discussed through the Medicines Management Group. The total (assumed) combined cost is £50,115.84pa. There are 3 potential options as follows:

• It stays within Primary Care

• All referrals for PE go to the Leger Clinic for assessment of need and prescribing

• All referrals for PE go to the Leger Clinic for assessment of need and prescribing is done in Primary Care

Mr Randerson informed the Committee that the Medicines Management Group recommends Option 3 as this would give the CCG some control over numbers without making the pathway too onerous and suggested a dosage of between 4-6 tablets/ month. The Committee held a discussion and raised the issue of potential for re-sale ‘on the street’ therefore deferred a decision pending further investigations.

9. Receipt of Minutes

The minutes of the Unplanned Care Board dated 24 April 2014 were noted by the Committee.

10. Any Other Business

There was no other business discussed.

11. Date and Time of Next Meeting

Thursday 12 June 2014 at 12.30pm, Board Room, Sovereign House.

a - front cover · items to note / receipt of minutes 11. receipt of minutes from committees •...

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