NHS England London Southside 4th Floor 105 Victoria Street London SW1E 6QT. 24 th July Dear Daniel, Nicola and Sue, Re: CCG Annual Assurance

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1 NHS England London Southside 4th Floor 105 Victoria Street London SW1E 6QT 24 th July 2014 Dear Daniel, Nicola and Sue, Re: CCG Annual Assurance Many thanks for meeting with us on 6 th June 2014 to discuss the annual assessment of Hounslow CCG and to review the development priorities for the coming year. This letter is a summary of the Quarterly Assurance meetings that we have held over the last year and provides a synopsis of the improvements and ambitions for future developments laid out against the assurance domains. Key area of strengths / Areas of good practice Implementation of a new Urgent Care Centre at West Middlesex University Hospital NHS Trust working closely with the hospital and Hounslow & Richmond Community Healthcare NHS Trust Strong performance at West Middlesex University Hospital NHS Trust (A&E and waiting times for in-patient treatment) over winter supported by effective leadership of the Hounslow Urgent Care Working Group Work with member practices to maximise benefits of SystemOne Development of embargo policy for Care Homes now adopted across the Collaboration Development of a primary care system to support mental health patients in primary care Development of role of navigators to work with localities North West London CCGs - To note that Hounslow CCG have been party to a number of pilot schemes being implemented across NWL. These include: Being successful as a Whole Systems Integration Pioneer Seven Day Working Prime Ministers Challenge Fund NHS Constitution Standards To note that the CCG has a statutory duty to report on services defined in the NHS Constitution. For 2013/14, Hounslow CCG met the following NHS Performance Standards: 18 weeks referral to treatment (RTT) admitted performance within 18 weeks 18 weeks RTT non-admitted performance within 18 weeks 18 weeks RTT - incomplete pathways performance within 18 weeks Patients waiting more than 6 weeks for a diagnostic test Mixed Sex Accommodation (MSA) breaches Mixed Sex Accommodation (MSA) breach rate Total time spent in A & E < 4 hours (all activity types) 1

2 Patients who have waited over 12 hours in A&E from decision to admit to admission Cancer 2 week waits: Percentage of patients seen within two weeks of an urgent GP referral for suspected cancer Cancer 2 week waits: Percentage of patients seen within two weeks of an urgent referral for breast symptoms where cancer is not initially suspected Cancer 31 day waits: Percentage of patients receiving first definitive treatment within one month of a cancer diagnosis cancer within 31-days where that treatment is surgery cancer within 31-days where that treatment is an Anti-Cancer Drug Regime cancer within 31-days where that treatment is a Radiotherapy Treatment Course Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of a consultant decision to upgrade their priority status Mental health care programme approach seven day follow up: The proportion of patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days The standards which were not met include: Number of 52 week RTT pathways - admitted Number of 52 week RTT pathways - non-admitted Number of 52 week RTT pathways - incomplete pathways The number of hospital and community acquired infections for MRSA The number of hospital and community acquired infections for clostridium difficile Number of LAS arrival to handover greater than 30mins Number of LAS arrival to handover greater than 60mins Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of an urgent GP referral for suspected cancer Cancer 62 day waits: Percentage of patients receiving first definitive treatment for cancer within 62-days of referral from an NHS Cancer Screening Service NHS Statutory Duties This section covers details of discussions regarding the CCGs ability to deliver their functions as laid out in the 14Z16 or 14ZA of the NHS Act 2006 as amended by The Health and Social Care Act The CCG has published its annual report on its website. 14T Each CCG whilst carrying out its functions must have regards to the need to reduce inequalities between patients with respect to their ability to access health services and reduce inequalities between patients which affect the outcomes achieved for them. It should be noted that discussion has taken place in terms of the CCGs commitment to the quality of opportunity and the promotion of the equality and diversity agenda and it can be confirmed that the CCG is actively pursuing these three policies and its commissioning decisions. The CCG published its Equality and Diversity objectives for 2013/16 and these were discussed at an assurance meeting. These include: Supporting the physical health needs and emotional wellbeing of carers by considering differences in provision for different protected characteristic groups Improve service provision for people with Learning Disabilities by considering the different barriers faced by different protected characteristic groups Improve outcomes for mental health patients by shifting settings of care and considering the potential negative impact for different protected characteristic groups Improve Children and Adolescent Mental Health Services (CAMHS) by understanding how different protected characteristic groups interact with services 2

3 Improve cancer screening uptake for hard to reach community groups Work with providers through the Clinical Quality Groups meetings to agree actions for improving patient experience data collection and analysis on Ethnicity, Religion, Sexual Orientation and Disability Hold providers to account on their patient experience strategy by inviting them to present the impact of the patient experience improvement work conducted at the Patient and Public 14R Duty as to continuous improvement to services You have described processes whereby you monitor the quality of care commissioned on behalf of Hounslow patients. Clinicians from the CCG chair the Clinical Quality Group at the West Middlesex University Hospital NHS Trust and with Hounslow and Richmond Community Healthcare NHS Trust and there is strong clinical and managerial involvement and support of the West London Mental Health NHS Trust Clinical Quality Group. The Quality and Safety Committee, a sub-committee of the Board, receives intelligence regarding safety, clinical effectiveness and patient experience. Your Board has also been briefed by the Director of Quality and Safety about the recommendations contained within the Francis Enquiry and the Berwick Review and the actions required. You have also worked effectively with the Director of Quality and Safety to ensure active oversight of action plans etc. arising from for example the Care Quality Commission s review of the Limes, Part of West London Mental Health NHS Trust Services. We have also discussed the need to continue to strive to meet the Winterbourne target, including having confidence in current data and working with the national team to ensure data is validated. It is very important that the CCG continues its focus on increasing the number of patients that have been assessed and have a proposed discharge date. We will continue to highlight this area as part of our ongoing assurance discussions 14W Try to obtain appropriate advice in order to deliver functions Although noting that the composition of the Collaboration changed within the year, when Ealing CCG decided to move from the BEHH Federation to join the CWHH Collaboration, the CCG is still well served by its Senior Clinical and Management Leadership Team. The Management Team consists of experienced Directors of Quality, Finance, and Performance who work in conjunction with the Clinical members, the Chief Officer, the Managing Director and the Accountable Officer. Your Board comprises the required range of clinicians in both primary and secondary care and we are assured therefore that you are able to access appropriate advice to allow the CCG to discharge its functions. 14Z Public involvement and consultation by Clinical Group During our assurance meetings you have described the mechanisms you use to involve the local community in your work. It should be noted that Hounslow CCG along with the 7 other NWL CCGs are involved in the Whole Systems Integration work which has strongly involved lay partners and is being seen as a model of good practice in terms of lay involvement. We have talked about the implementation of personal health budgets and you have noted that the preparation in the run up to April has mostly been on known complex children which has raised a number of issues in terms of Governance and Clinical Safety, however, you are assured that the mechanisms in place for involvement and discussion on personal health budgets is robust. 223H-223J Expenditure, Finance and Controls All clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended) regarding the use of resources to ensure that their capital and revenue resource use in a financial year does not exceed the amount specified by the NHS Commissioning Board Hounslow CCG achieved all its financial duties and performance is summarised below: 3

4 Expenditure not to exceed its income: In 2013/14 Hounslow CCG recorded a surplus of 1.9m; Revenue resource use not to exceed the amount specified in directions: In 2013/14 Hounslow CCG s net revenue expenditure totalled 288.1m, against a revenue resource limit of 290.1m; Capital resource use not to exceed the amount specified in directions: In 2013/14 Hounslow CCG did not have a capital allocation. The 2013/14 plan was for breakeven (which did not meet business rules) but the CCG actually achieved a FCOT surplus of 1.9m (0.7%). Health and Well-being Board You have worked with the Hounslow Health and Well-being Board with regards to the development of the Health and Well-being strategy, noting the CCG has been an active member of the Health and Well-being Board. A range of issues have been discussed including the development of the Better Care Fund, Health and Well-Being Strategy and Adult Safeguarding. It has been noted that there has been some change of officers at Hounslow Council which has required additional engagement to maintain the momentum on Whole Health Economy working. However I believe the Board is now well placed to provide some effective leadership to tackling a number of key challenges in Hounslow. Strategic Plan All CCGs are involved in the development of the NWL Strategic Five Year Plan. This builds on the content of Shaping a Healthier Future and develops this in a number of key areas arising from local Joint Strategic Needs Assessments as well as national priorities. The results are a solid plan which is aligned to local strategies such as improving out of hospital care. The focus for this year must now be on the delivery of these plans. Key areas of challenge: Over the year all CCGs in North West London have expressed concerns around the performance of the North West London Commissioning Support Unit (CSU), as a result a decision has been taken by all CCGs to de-commission the NWL CSU. The challenge for the first 6 months of 2014/15, now the decision is made the focus of 14/15 will be to ensure the safe transition of services. In 2013/14 the CCG achieved QIPP of 9m, 87% of the planned 10.3m. The areas of slippage were in acute unscheduled care and locally based non elective schemes. The move of Ealing CCG to CWHHE already noted was particularly challenging in terms of the additional workload that it brought You have been working with West Middlesex University Hospital NHS Trust, the National Trust Development Authority and Chelsea and Westminster NHS Foundation Trust on plans for the acquisition by Chelsea & Westminster NHS Foundation Trust of West Middlesex University Hospital NHS Trust. It should be noted that there have been no changes to the CCGs leadership team at the end of the financial year and there are substantial appointments in place for all staff. Authorisation Hounslow CCG was authorised by NHS Commissioning Board in March 2013 with 2 conditions places upon it. This has required additional work by the CCG to meet and sign off these conditions. These were as follows: Systems and processes for monitoring and acting on patient feedback, and particularly in identifying quality including safety issues. 4

5 CCG has a clear and credible integrated plan, which includes an operating plan for 2012/13, draft commissioning intentions for 2013/14 and a high-level strategic plan until 2014/15. Following the submission of further evidence and considerable work by Your Board has also been briefed by the Director of Quality and Safety about the recommendations contained within the Francis Enquiry and the Berwick Review and the actions required. You have also worked effectively with the Director of Quality and Safety to ensure active oversight of action plans etc. arising from for example the Care Quality Commission s review of the Limes, Part of West London Mental Health NHS Trust Services. These conditions were removed in June Summary The CCG continues to face a number of challenges relating to its inherited financial position and it has made good strides as part of the CWHHE collaboration of finding ways to address the CCG s funding position. We would also want to recognise the leadership the CCG has shown in terms of its focus on using SystmOne and its development of a cell/locality based approach to working with its member practices. Despite the change of personnel at the Local Authority good relationships have been made and the ongoing senior commitment to joint working and integration. I hope this provides a helpful summary of the CCG s work and notes the progress made by the CCG during the course of its first year as a statutory body. I consider the CCG has a strong base to go forward and to continue to tackle a number of long standing problems facing the Ealing health economy. I would suggest as part of our assurance process we continue to focus on the following areas; Areas of Development for Discussion; Focus on delivery of national constitution standards Focus on work to improve the quality and safety of commissioned care Delivery of CCGs QIPP and financial plans including deficit reduction Delivery of CCGs out of hospital ambitions Delivery of CCGs engagement (public and patient) strategy Continuation of work with Hounslow Council Work as part of 8 NWL CCGs on integration, and on delivering the Shaping a Healthier Future plans I would encourage you to publish this letter on your website and to share it with member practices and stakeholders. Yours sincerely Joanne Murfitt Acting Area Director, North West London, NHS England 5

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