Gloucestershire Health and Care Overview
and Scrutiny Committee (HCOSC)
15 July 2013
NHS Gloucestershire Clinical Commissioning Group (GCCG) Clinical
Chair and Accountable Officer’s Report
1 Department of Health Consultations
Information regarding Department of Health consultations is now available via the GOV.UK website
https://www.gov.uk/government/publications?publication_filter_option=consultat ions
This website also includes Government responses to closed consultations. 1.1 Consultation: Migrant access to the NHS
Organisation: Department of Health Published: 3 July 2013
Closing date: 28 August 2013
Policy: Making the NHS more efficient and less bureaucratic Applies to: England
This consultation is about migrants’ access and financial contribution to the NHS.
2. Update - Your NHS – Right Care, Right Time, Right Place 2013 - Maintaining high quality, specialist services.
2.1 Your NHS updates to HCOSC
At its meeting on 4 June 2013 HCOSC agreed to support all the service changes but with qualification(s) relating to the emergency and urgent care service change proposal.
2.1.1 The qualifications were:
a) that performance information must be provided to the committee on a monthly basis (including ambulance handover times, patient numbers etc) b) that there are formal reviews after 6 and 12 months to ascertain whether expected outcomes are being achieved
c) that the reviews included looking at mortality figures
2.1.2 Performance information relating to the emergency and urgent care service changes will be included in the performance reports coming to scheduled HCOSC meetings, with information broken down by month.
2.1.3 The outcome of reviews will be reported to future HCOSC meetings, schedule to be agreed at HCOSC Agenda Planning Meetings.
2.2 NHS Gloucestershire Clinical Commissioning Group Governing Body 18 July 2013
At its meeting on 18 July 2013, NHS Gloucestershire Clinical Commissioning Group Governing Body will consider the outcome of consultation and
implementation plans and actions developed by Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) in response to public and staff feedback from the recent three month public consultation. Subject to the outcome of this meeting we will ensure appropriate publicity supports the implementation of these changes.
2.3 National Clinical Advisory Team (NCAT) Report
2.3.1 Since the meeting of the HCOSC on 4 June 2013, the NCAT report has been received.
2.3.2 On 15 May 2013, NCAT representatives visited GHNHSFT. NCAT provides a pool of clinical experts to support, advise and guide the NHS on local service reconfiguration proposals to ensure safe effective and accessible services for patients. GCCG and GHNHSFT jointly commissioned the review, to provide external clinical assurance of the proposals. The NCAT final report was received on 10 June 2013.
2.3.3 The majority of the report focusses on the proposal relating to emergency and urgent care services. The NCAT report makes it clear that in their view: “the present arrangements for Emergency Care are unsustainable”. In particular the NCAT report recognises the concerns regarding possible increased mortality with extra distance for ambulance travel, concluding that the: “benefits of the change greatly outweigh any risks”. The full NCAT report available on both GHT and CCG websites
2.3.4 The NCAT report makes a recommendation to commissioners regarding the “synergy” between services when considering the configuration of primary care out of hours services.
2.3.5 In conclusion the NCAT report supports all of the Your NHS Phase 3 proposals and makes useful recommendations, which are reflected in the GHNHSFT implementation plan. NCAT have requested a brief report from GHNHSFT updating on progress made by 1 September 2013.
3. Unscheduled Care Performance
3.1 In common with other parts of the South West (and the rest of the country) Gloucestershire has experienced significant pressures on the unscheduled care system. In response to these pressures, GCCG has been working with partners to lead the development of a community wide unscheduled care plan.
3.2 The plan has been designed to address immediate pressures on the system and to make sure the county is well prepared for next Winter. As well as
providing an analysis of the increased demands on the system, the plan identifies a series of short, medium and longer term actions. The leadership of these programmes of work is shared across commissioners and providers. The plan also includes significant commissioner investment to support improved performance.
3.3 The need for this local plan was confirmed by a letter from NHS England in May 2013, which emphasised the need to deliver sustained performance against the A&E four hour operational standard. This letter sets out the national
requirement for local recovery and improvement plans to be established alongside reinvigorated Urgent Care Boards.
4. NHS 111 Local Update
4.1 NHS 111 is a national initiative with procurement of the service for
Gloucestershire carried out by the former NHS Gloucestershire and NHS Swindon PCT Cluster during 2012.
4.2 Soft launch of NHS 111 happened in Gloucestershire at the end of February 2013. Soft launch refers to the provider, Harmoni, taking on responsibility for out of hours call handling only - providing health advice and signposting patients to the most appropriate service where necessary.
4.3 With any new service there can be teething problems, but GCCG has been working closely with the provider, GP and practice colleagues, the ambulance service and other out of hours staff to ensure that any feedback is acted upon promptly.
4.4 A number of steps have been taken by the provider to strengthen resource and improve quality of service. This includes increasing the pool of clinical advisors and call advisors and further targeted training which will continue.
4.5 Paramedics are also working closely with call advisors to make sure that ambulances are dispatched appropriately. In addition to this, call advice is being regularly reviewed and audited to ensure continuous learning.
4.6 These actions are part of a wider performance plan, which includes a series of key performance indicators. This has demonstrated significant improvement in performance particularly at weekends. However, there continues to be further work required on clinical advisor recruitment. GCCG continues to monitor performance on a daily basis.
4.7 Gloucestershire has still not yet moved to public launch (otherwise referred to as hard launch). At this point, NHS 111 will become fully operational and will provide a 24/7 telephone advice service. Gloucestershire will not proceed to full public launch until a sustained period of high performance has been delivered. 4.8 Patient safety and the quality of service that people in Gloucestershire receive
is of paramount importance to GCCG and we want to be fully satisfied that every aspect of the NHS 111 service is working to the high standards expected. 4.9 There are comprehensive plans in place to promote the service at the time of
public launch and there are also plans in place for a sustained public ‘Choose Well’ service campaign.
5. Out of Hours Medical Services Procurement
5.1 NHS Gloucestershire Clinical Commissioning Group (GCCG) has decided to cancel the current Out of Hours Medical Services procurement process. 5.2 This decision has been taken so that GCCG can fully evaluate the impact of
NHS 111 on the Out of Hours service, including the number of telephone referrals in to the service, face-to-face patient appointments at out of hours centres and patient visits.
5.3 GCCG has also considered the benefits of not completing this process in late Autumn as we work with our health and social care partners to address urgent care pressures and plan for the Winter period.
5.4 Furthermore, as commissioners, this step offers us additional time to give greater consideration to the contribution of out of hours services alongside other emergency and urgent care services in Gloucestershire.
5.5 GCCG agreed that a future procurement process will begin during 2014. 5.6 GCCG is currently in discussion with the current providers of out of hours
services, Gloucestershire Care Services NHS Trust and South Western Ambulance Service NHS Foundation Trust to ensure service continuity during the interim period.
6. Cross-Border Patients
6.1 Concerns have been raised by members of the public regarding the provision of access to elective health care for Gloucestershire residents registered with Welsh GP practices. It has come to the notice of the CCG, that Aneurin Bevan Health Board (ABHB) introduced a policy last September which restricts patient access to some elective and outpatient services from English providers. This specifically affects approximately 6000 patients who live in Gloucestershire and receive GP services from branch surgeries of Welsh practices, which are
located in Gloucestershire.
6.2 ABHB under the current agreement with the Department of Health and the Welsh Assembly, receive the funding for these patients’ health care services. These resources are not contained within the GCCG allocation.
6.3 This policy change has affected these residents in many ways, including difficulties in accessing local English services, additional travel costs, waiting significantly longer for outpatient appointments and elective treatments. These residents consider that it has limited their right to ‘choice’ in respect of NHS services.
6.4 GCCG is sympathetic to these residents’ concerns and has raised this matter with both senior management in the ABHB and the Welsh Government.
7. GP Practice Visits
7.1 Weekly practice visits are on-going with either the Clinical Chair and Deputy Accountable Officer or the Deputy Clinical Chair and Accountable Officer meeting with individual practice teams in localities.
7.2 The purpose in organising these visits is to share the GCCG vision to be a member driven organisation which will effect real transformational change in the coming year and to get regular feedback from member practices.
7.3 Feedback from practices so far visited has been positive with 22 out of 85 practice visits having taken place and a further 26 already pre-arranged. 8. Academic Health Science Network
8.1 Innovation, Health & Wealth: Accelerating Adoption and Diffusion in the NHS (2011) proposed that a more systematic delivery mechanism for the spreading of innovation was established within the NHS by building strong cross boundary networks. Part of the solution is the designation of new Academic Health
Science Network (AHSN) to accelerate adoption of diffusion. This will align education, clinical research, informatics, innovation, training and education & healthcare delivery.
8.2 Partners across the West of England have spent recent months working intensively together to explore the potential offered by an AHSN, identifying strengths, challenges, common interests and building our collective leadership. A submission has been made and the approval process is still underway but it is expected that the West of England AHSN will be authorised,
9. The Independent Inquiry Into Care Provided By Mid-Staffordshire NHS Foundation Trust (The Francis Report 2013)
9.1 The Mid Staffordshire NHS Foundation Trust Public Inquiry was announced in June 2010 by the Secretary of State for Health. This inquiry was set up to examine the commissioning, supervisory and regulatory organisations in relation to their monitoring role at Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009. It considered why the serious problems at the Trust were not identified and acted on sooner, identifying important lessons learnt for the future of patient care.
9.2 The Inquiry, chaired by Robert Francis QC, made 290 recommendations to the Secretary of State based on the lessons learnt from Mid Staffordshire. The recommendations impact on all NHS organisations.
9.3 A key message from the events at Mid Staffordshire NHS Foundation Trust is that organisations have a duty to consider how they might take decisive action to improve quality, safety and patient experience.
9.4 Key Recommendations for Local Commissioners:
• Commissioners are accountable for ensuring that services they pay for are well provided and are provided safely.
• Contracts with providers need to set out redress for non-compliance with contracted standards.
• Commissioners, working with providers, need to devise developmental standards which set longer term goals.
• Commissioners need to be adequately resourced to enable proper scrutiny of providers. This should include the capacity to undertake audits,
inspections and investigations of individual complaints and of groups of complaints.
• Commissioners must have access to quality accounts and to all quality and risk profiles available to the CQC.
• The commissioner should be able to stop the provision of the service being supplied in breach of the standards or require the provision of the service in a different way or by different personnel. The commissioners should have contingency plans in place in the event of needing to exercise these powers. • Commissioners, not the providers, should decide what needs to be
provided. The views of clinicians should influence commissioning needs where appropriate.
• Commissioners should in their contracts require the Boards of providers to obtain and record the views of clinical staff at the Board meetings
particularly in respect of major service change, nurse staffing levels and the provision of facilities for patients.
• Commissioners need to involve the public in commissioning and enable their views to be taken into account. Commissioners need to raise their public profile.
• All commissioners must have at least one nurse on their Governing Body. 9.5 Patients First and Foremost – The initial Government
Response to the Report of The Mid Staffordshire NHS Foundation Trust Public Inquiry
9.5.1 The initial response to the Francis recommendations from the Government was published in March 2013. This document starts from a ‘Statement of Common Purpose’ a simple premise and a simple goal “that the NHS is there to serve patients and must therefore put the needs, the voice and the choices of patients ahead of all other considerations”. The response sets out a five point plan to revolutionise the care people receive from the NHS, putting an end to failure and issuing a call for excellence.
A. Preventing Problems- includes a review by the NHS Confederation on how to reduce the bureaucratic burden on frontline staff and NHS providers by a third. Putting in place a culture of zero-harm and compassionate care. B. Detecting problems quickly – includes a new regulatory model under a strong, independent Chief Inspector of Hospitals. The appointment of a new Chief Inspector of Social Care will ensure that same rigour is applied across the health and care system. The merits of having a Chief Inspector of Primary Care are also being explored. The CQC will move to a new specialist model based on rigorous and challenging peer-review. It is also intended to review best practice in complaints handling with an emphasis on the constructive nature of complaints i.e. lessons learned.
C. Taking action promptly - penalties for disinformation and introducing a statutory duty of candour.
D. Ensuring robust accountability – includes Health and social care professionals will be held more accountable
E. Ensuring staff are trained and motivated – includes NHS funded student nurses will spend up to a year working on the frontline as healthcare assistants, as a prerequisite for receiving funding for their degree
9.6 Current quality surveillance in GCCG
9.6.1 There are existing robust arrangements to monitor quality assurance of
commissioned services. All quality related performance is reviewed at provider-specific Clinical Quality Review Group (CQRG) meetings, which report to the provider-specific Contract Boards. CQRGs are led by GCCG GP leads and attended by GCCG Quality and Risk managers. Provider representatives include heads of nursing, safety and experience leads plus medical director representation.
9.6.3 Output from the CQRGs is reported to the GCCG Integrated Governance Committee, which from May 2013 now has two distinct halves: Quality and Governance, to enable quality and governance to be discussed fully whilst maintaining a strong link between the two. IGC is a formal sub-committee of the full GCCG Governing Body, and as such all minutes from IGC are reported through to the Governing Body.
9.7 GCCG planned actions
9.7.1 The following actions have been identified:
• Development of more robust mechanism(s) to ensure that the messages coming from listening to thousands of individual primary care patient
interactions happening every day are captured and acted upon. GCCG, as membership organisation, made up of GP practices has direct access to the voice of many patients. We must find effective ways of listening to these voices and acting on what we hear. This will require effective partnership working with the NHS England Area Team, which has responsibility for commissioning primary care services.
• Reinforcing that listening to patients is the responsibility of every member of staff in the organisation, including GP practice staff across GCCG.
• Creating a partnership between the public and clinicians, where public and patient representatives have a real voice.
• Making it easier for staff, patients, carers to ‘whistle-blow’.
• Continuing to build on existing work to understand and tackle variation in quality. Clinicians to clinician conversations contribute to the real
understanding of what is really going on and what the data is telling us. This will aid the drive to change behaviours.
• Holding commissioned service providers more effectively to account. This will be done using effective real-time information on the performance of all provider services against agreed quality standards and supported by the new national quality dashboard, which contains benchmarked data for each provider organisation. To aspire to include effective real-time information on
the performance of each consultant and specialist teams. It is essential to have agreed quality metrics to identify outliers and deteriorating
performance.
• Build on the 4C’s (compliments, comments, concerns and complaints) approach, requiring development of better mechanisms for collating multiple sources of ‘soft’ intelligence, to provide trends e.g. including review of local media and setting up systems to listen to our staff member’s patient stories and establishing constructive working relationships with the newly
established HealthWatch Gloucestershire (replaced Gloucestershire Local Involvement Network / LINk from 1 April 2013) and the Voluntary Sector Alliance (replaced Gloucestershire Assembly from 1 April 2013).
10 Non-emergency patient transport services
10.1 Arriva Transport Solutions Ltd has been selected to provide non-emergency patient transport services in Gloucestershire.
10.2 During 2012, the former primary care trusts in Gloucestershire, Bath and North East Somerset, Swindon and Wiltshire, invited qualified organisations to tender for a five year contract to co-ordinate all non-emergency patient transport services.
10.3 The procurement process, which included patient representation, involved the evaluation of a number of key areas such as patient safety and experience, quality of service, staff training, and respect and dignity.
10.4 As part of the contract specification, the service will now run 24 hours, 7 days a week, which is an extension of existing services with some currently only
running Monday to Friday, 9am – 5pm.
10.5 Subject to contract, the service will run a single access centre, which will provide a convenient booking and enquiries service.
10.6 Through the use of modern technology and systems, the service will be able to manage demand for patient transport efficiently and will co-ordinate and
provide journeys in and out of county. The service will offer flexibility to respond to changing needs e.g. new healthcare locations, on the day requests and flexible times for pick up and return home including evenings and weekends. 10.7 The single access centre will also provide information and advice for those
patients who do not meet the current Department of Health eligibility criteria. This will include signposting to alternative transport options, including voluntary and community providers.
10.8 Subject to the contract award, those staff currently providing non-emergency patient transport services and working for South Western Ambulance Service NHS Foundation Trust and certain other local providers will be offered TUPE (Transfer of Undertakings Protection of Employment) transfer to the provider of the new contract.
10.9 GCCG will work closely with current providers to ensure a smooth transition. The priority is to ensure that patients who are eligible can access the very best service which can meet their specific medical and mobility needs.
11. 2gether NHSFT Volunteering Strategy
11.1 2gether NHSFT Board has agreed a new Volunteering Strategy. It seeks to provide a clear, shared vision of volunteering activity within the Trust and recognises the broad range of experience and support volunteers provide. Engaged and supported volunteers bring talent, compassion, commitment and enthusiasm to their activities. The strategy includes eight objectives to assist in the development of an active volunteering programme starting with internal and external promotion of the benefits of volunteering to achieve a broader range of volunteering placements.
12. Severn and Wye Recovery Colleges
12.1 2gether has secured a grant from the Health Foundation to set up and pilot Recovery Colleges for our service users, carers and staff. A recovery college provides courses and educational workshops that teach people to become experts in their own recovery and self-care. Through developing knowledge and life skills, students are able to learn more about their condition and treatments to gain the power and resilience to recover and stay well. The colleges offer a new method of recovery for Gloucestershire and will run from the beginning of September 2013
13. Baby-Friendly GHNHSFT
13.1 GHNHSFT has been reaccredited with Baby Friendly Status across the county. Maternity services at Gloucestershire Royal, Cheltenham General, Stroud Maternity Unit and the Forest of Dean Community have gained international recognition from UNICEF (United Nation’s Children’s Fund) for the third year. 13.2 The Baby Friendly Initiative, set up by UNICEF and the World Health
Organisation, is a global programme. In the UK, the initiative works with health professionals to ensure that mothers and babies receive high-quality support to facilitate successful breastfeeding. The Award is given to maternity services after a rigorous assessment by a UNICEF team showed that recognised best practice standards were in place.
14. SmartCare
14.1 GHNHSFT have been awarded Government funding to enable realisation of SmartCare – a new digital system which will improve patient care.
14.2 The Government has approved central funding to help GHNHSFT to introduce an Electronic Patient Record, which will underpin the safety and quality of services. Once in place, the new SmartCare system will provide modern information technology to teams of doctors, nurses, therapists and support staff. SmartCare is a clinical solution, shaped by staff. Key GHNHSFT staff have already been directly involved, working up a detailed specification and seeing what different suppliers have to offer at demonstration days.
14.3 GHNHSFT aim to choose a preferred supplier by January 2014. The decision will be based on extensive testing by groups of key staff, from ward clerks to consultants. GHNHSFT has a legal responsibility to inform patients about these
changes and will therefore be asking staff to help patients understand changes to their care records.
Helen Miller Mary Hutton
Clinical Chair Accountable Officer
NHS Gloucestershire CCG NHS Gloucestershire CCG
