NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY. BOARDROOM ARTHOUSE SQUARE (lunch to be provided at 12.30pm) A G E N D A

Transcription

1 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY TUESDAY 9 th JULY 2013 AT 1PM BOARDROOM ARTHOUSE SQUARE (lunch to be provided at 12.30pm) A G E N D A Part 1: Introductions and Apologies 1.1 Declarations of Interest All 1.2 Minutes and action points from the last meeting Attached held on 11 th June 2013 All 1.3 Matters Arising All Part 2: Updates 2.1 Feedback from committees: Report no: GB: Primary Care: 25 th June 2013 Audit Risk & Scrutiny: 27 th June 2013 Service Improvement: 27 th June 2013 Nadim Fazlani Prof. Maureen Williams Jude Mahadanaarachchi 2.2 Merseyside CCG Network 3 rd July 2013: Report no: GB Nadim Fazlani / Katherine Sheerin 2.3 Health and Wellbeing Board Verbal Nadim Fazlani Cont Page 1 of 3

2 Part 3: Update on New Commissioning Arrangements 3.1 Authorisation Verbal Katherine Sheerin 3.2 NHS England Area Team Verbal Clare Duggan 3.3 Public Health Update Verbal Paula Grey Part 4: Strategy & Commissioning 4.1 Memorandum of Understanding for the provision Report no: GB of Public Health advice to Liverpool CCG Paula Grey 4.2 Integrated Commissioning/Section 75 Report no: GB Tony Woods Part 5: Governance 5.1 Safeguarding Adults and Children Update Report no: GB Jane Lunt 5.2 Aintree Hospital University Foundation Trust Report no: GB Katherine Sheerin Part 6: Performance 6.1 Performance Report Report no: GB Ian Davies 6.1 A&E 4 Hour Performance Report no: GB Fiona Lemmens/ Jim Cuthbert 7. Date and time of next meeting: Tuesday 13 th August 2013 at 1pm, to be held in the Boardroom at Arthouse Square Cont/ Page 2 of 3

3 For Noting: Minutes of Primary Care Committee 28 th May 2013 Minutes of Service Improvement Committee 23 rd May 2013 Minutes of Audit Risk & Scrutiny Committee 14 th May 2013 Exclusion of Press and Public: that in view of the confidential nature of the business to be transacted, members of the public, press and non voting members be excluded from the meeting at this point. A briefing from Cap Gemini will follow the formal Governing Body and we hope all members can attend to inform the design of the accelerated solutions event. Page 3 of 3

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5 Report no: GB NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY 9 TH JULY 2013 Title of Report Feedback from Committees Lead Governor Lead Manager Summary Recommendation Authorisation Evidence QIPP Impact Relevant Standards or targets Dr Jude Mahadanaarachchi Dr Nadim Fazlani Dr Simon Bowers Tony Woods, Head of Strategy & Outcomes Cheryl Mould, Head of Primary Care Quality & Improvement Tom Jackson, Chief Finance Officer Ian Davies, Head of Operations & Corporate Performance Jane Lunt, Head of Quality/Chief Nurse The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the following committees: Primary Care: 25 th June 2013 Audit Risk & Scrutiny: 27 th June 2013 Service Improvement: 27 th June 2013 This will ensure that the Governing Body is fully engaged with the work of committees, and reflects sound governance and decision making arrangements for the CCG. That Liverpool CCG Governing Body: Considers the report and recommendations from the committee Which domain(s) does this support? Please insert x that apply 1. Strong clinical and multi-professional focus 2. Engagement with patients/carers/communities 3. Clear and Credible Plans 4. Proper constitutional and governance arrangements x 5. Collaborative arrangements for commissioning 6. Great Leadership Authorisation of the CCG will enable clinical focus on the transformational requirements of QIPP. Standards of Good Governance NHS Operating Framework 2012/13 Page 1 of 8

6 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP PRIMARY CARE COMMITTEE TUESDAY 25 TH JUNE 2013 AT 1PM 3PM BOARDROOM ARTHOUSE SQUARE A G E N D A 1. Welcome & Introductions ALL 2. Declarations of Interest (form attached) ALL 3. Minutes of previous meeting, actions & matters arising: 3.1 IT Failure MA 3.1 Kate Warriner 4. Update from NHS England Verbal Tom Knight/ Rose Moran 5. Workstreams Update for June 2013: PCC a) Localities PCC 26a-13 North, Central & Matchworks b) Medicines Management Sub-Committee PCC 26b-13 Peter Johnstone c) Liverpool Quality Improvement Scheme PCC 26c-13 Sub-Committee Ed Gaynor 6. Prescribing Year End Report PCC Medicines Management Team 7. GP Specification Year End Presentation Presentation Ed Gaynor 8. Risk Register (standing item) Verbal ALL 9. Any Other Business ALL 10. Date and time of next meeting Tuesday 30 th July 2013, 1pm to 3pm, Boardroom, Arthouse Square Page 2 of 8

7 LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE COMMITTEE MINUTES Committee: Primary Care Committee Meeting Date: 25 th June 2013 Chair: Dr Nadim Fazlani Vice Chair: Dr Ed Gaynor Key issues: Risks Identified: Mitigating Actions: 1. IT Failure outage at Bevan. Don t understand full impact following report. Telephony Services Primary Care Group to be established to follow up on recommendations within report and undertake Risk Impact Assessment. Continuing to work with BT & Cisco to 2. CCG Practice Leads Event Lack of process for capturing issues and feedback plans and resolutions. resolve outstanding issues. Review of CCG Intranet. Feedback/queries form to be developed and stored on desktop. 3. Relationship with Liverpool Community Health Lack of opportunity for open forums for practice CCG leads Issues raised at Practice Leads event and at Locality meetings not being actioned/resolved. Current services specifications not being routinely reviewed Plans for at least twice yearly events for sharing of best practice and development of skills to facilitate change. To arrange Exec to Exec meeting. Issues to be formally raised at next CPQG. Quarterly attendance of Divisional Managers at Locality Meetings. Workstreams to be established Health Visiotrs, Adult Nursing, Diagnostics, Specialist Nursing. Recommendations to NHS Liverpool CCG Governing Body: 1. Note risks identified and actions in place. Page 3 of 8

8 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP AUDIT, RISK AND SCRUTINY COMMITTEE THURSDAY 27 TH JUNE 2013 AT 3PM 5PM ROOM 426 ARTHOUSE SQUARE Section 1 Standing Items AGENDA 1 Welcome and Introductions ALL 2 Declaration of Interest (form) & updated Register Report no: ARSC13-13 ALL 3 Minutes and Actions from the previous meeting held on 14 May 2013 Maureen Williams Section 2 Items for Decision 4 Fees letter Grant Thornton Report no: ARSC14-13 Robin Baker 5 Conflicts of Interest Letter Grant Thornton Report no: ARSC15-13 Robin Baker 6 Waiver Cap Gemini Healthy Liverpool Report no: ARSC16-13 Tom Jackson Section 3 Items for Discussion 7 MI / DALLAS update Verbal Tom Jackson 8 Transfer Scheme Update Report no: ARSC17-13 Keith Bowman 9 Risk Register Verbal Ian Davies Section 4 Items for Information 10 Organisation Set Up Project/plans update Report no: ARSCxx Dates for next meetings 24 September :00pm 5:30pm* *(includes private meeting) 17 December :30pm 5:30pm Page 4 of 8

9 LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE COMMITTEE MINUTES Committee: Audit, Risk and Scrutiny Committee Meeting Date: 27 JUNE 2013 Chair: Professor Maureen Williams Key issues: Risks Identified: Mitigating Actions: 1. Backlog of CHC Restitution claims identified. A year end provision made based on a consistent cluster wide calculation m payment to Clatterbridge Cancer Centre in 2012/13 regarding the cancer centre transfer has been treated as deferred income by the Trust. This is a different accounting treatment from the PCT. 3. Transfer scheme information submitted in accordance with the national requirements. A number of issues outstanding re IT and telephony. - Lack of capacity to review and process the outstanding claims - Potential that financial provision is insufficient to fund all claims - Impact of treatment of the funding if the transfer does not take place as planned - Assets may not transfer to the correct organisations - CSU proposal to process claims as an additional service - Reserve identified in the Financial Plan - Meeting between TJ and CCC DoF scheduled in July to discuss issues - ID liaising with LCH and Informatics Merseyside to agree next steps and future ownership Recommendations to NHS Liverpool CCG Governing Body: 1. Issues, risks and mitigations are noted. 2. Updates to be incorporated into the Corporate Risk Register until issues are resolved. Page 5 of 8

10 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP SERVICE IMPROVEMENT COMMITTEE THURSDAY 27 TH JUNE PM TO 2.30PM BOARDROOM ARTHOUSE SQUARE A G E N D A 1. Welcome & Introductions ALL 2. Declarations of Interest (form attached) ALL 3. Minutes of Previous meeting & Matters arising: ALL 4. Programme Report Diabetes: a. Impaired Glucose Regulation Pathway Report no: SIC 18a-13 - Options Paper Sue Renwick b. Diabetes Service Redesign - Review of Report no: SIC 18b-13 Diabetes Care Pathways Sue Renwick 5. Programme Report Integrated Care Report no: SIC 19-13/ Presentation Dani Jones 6. Primary Mental Healthcare Development in Report no: SIC Liverpool Clare Mahoney 7. Research & Development Sub-Committee - Report no: SIC Terms of Reference Kirsty Pine 8. Programmes Update Report Report no: SIC Sue Lavell 9. Risk Register (standing item) Verbal Tony Woods 10. Any Other Business ALL 11. Date and Time of Next meeting: Date Thursday 25 th July pm Boardroom Arthouse Square Page 6 of 8

11 LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE COMMITTEE MINUTES Committee: Service Improvement Committee Meeting Date: 27 th June 2013 Chair: Dr Jude Mahadanaarachchi Key issues: Risks Identified: Mitigating Actions: 1. Options for commissioning of Impaired Glucose Regulation (IGR) Pathway approval of recommendation to develop incentive scheme in line with GP Specification Failure to control increasing prevalence and associated costs of diabetes in line with increasing obesity Failure to implement a sustainable and effective delivery model Failure to agree inclusion within revised GP Specification Proposal for incorporation in GP Specification to be discussed by GP Specification Development Group Head of Primary Care Quality Improvement to champion priority status of IGR Pathway Outcome to be reviewed by SIC 2. Capacity issues within CCG programmes 3. Approval of plans for Primary Mental Health Services for Liverpool following agreement at Localities Failure to deliver implementation plans leading to non-delivery of QIPP financial plans Failure to meet expectations of Member Practices relating to priority areas Failure to ensure effective communication to Member Practices in an area identified as a priority Capacity plans, both clinical and nonclinical, to be reviewed alongside emerging priorities from Healthy Liverpool Programme Key risks to non-delivery of individual plans to be identified. Head of Strategy and Outcomes to work with Heads of Service to review capacity and allocation of resources Standard communication to be delivered to individual practices outlining plans and expected benefits of approach in early July by Locality Clinical Leads, in the form of a brief summary Presentation to Local Medical Committee in July/August Recommendations to NHS Liverpool CCG Governing Body: 1. Notes the key issues discussed at the Service Improvement Committee, risks identified and action plans Page 7 of 8

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13 Report no: GB NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY Title of Report Lead Governor Lead Manager Summary 9 TH JULY 2013 Feedback from Merseyside Clinical Commissioning Groups Network Dr Nadim Fazlani, Chair Dr Fiona Lemmens Katherine Sheerin, Chief Officer The purpose of this paper is to present the key issues discussed, risks identified and mitigating actions agreed at the Merseyside CCG Network on 3 rd July This will ensure that the Governing Body is fully engaged with the work of the Merseyside CCG Network and reflects sound governance and decision making arrangements for the CCG. That Liverpool CCG Governing Body: Considers the reports and recommendations from Merseyside CCG Network Authorisation Evidence Which domain(s) does this support? Please insert x that apply QIPP Impact Relevant Standards or targets 1. Strong clinical and multi-professional focus 2. Engagement with patients/carers/communities 3. Clear and Credible Plans 4. Proper constitutional and governance arrangements x 5. Collaborative arrangements for commissioning x 6. Great Leadership Authorisation of the CCG will enable clinical focus on the transformational requirements of QIPP. Standards of Good Governance NHS Operating Framework 2012/13 1

14 MERSEYSIDE CCG NETWORK MEETING WEDNESDAY, 3 JULY 2013 FROM PM BOARDROOM 1, REGATTA PLACE, BRUNSWICK BUSINESS PARK, SUMMERS ROAD, LIVERPOOL L3 4BL A G E N D A - PART 1 No. Item: Purpose Lead: 1 Welcome and Introductions Dr Nadim Fazlani 2 Apologies for absence: Dr Nadim Fazlani 3 Minutes of the previous meeting: 5 June 2013 To confirm Dr Nadim Fazlani 4 Matters arising not on agenda Meetings Structure (paper attached) Dr Nadim Fazlani 5 5a Collaborative Commissioning: NHS 111 Update and next steps Fiona Lemmens Ian Davies 5b Rehabilitation Pathway To ensure clarity of commissioning arrangements (letter attached) Katherine Sheerin 6 Operational Issues: 6a Procedures of Limited Clinical Priority Decision how policy is updated a) Proposal from C&MCSU b) Work undertaken by LCCG (papers attached) Katherine Sheerin 6b Urgent Care o Escalation Policy o Divert process o 4 Hour Target Discussion to ensure clarity of approach ALL 6c Commisioning Support To share current position and ideas CFOs 2

15 No. Item: Purpose Lead: Services for future arrangements 6d Pan Mersey Area Prescribing Committee Terms of Reference To review and debate if fit for purpose in light of CG responsibilities Sarah Johnson 6e Local Intelligence Network Discussion on CCG responsibilities and approach with NHSE(M) Steve Cox 7 CCG Development: Academic Health Science Network Presentation on role of AHSN so that we can consider fit within CCG responsibilities and how to maximise impact of all. Philip Dylak 8 Any Other Business: Dr Nadim Fazlani 9 Date and Time of Next Meeting Wednesday, 14 August pm Boardrooms 2 & 3, Regatta Place 3

16 LIVERPOOL CCG CORPORATE GOVERNANCE TEMPLATE Meeting: Merseyside CCG Network Meeting Date: Wednesday 3 rd July 2013 Chair: Dr Nadim Fazlani Key issues: Risks Identified: Mitigating Actions: 1. Establishment of a Joint Commissioning Forum for Cheshire & Merseyside to assess investment needs across the Rehabilitation model of care. Concern over the utilisation of existing capacity in local areas. Current lack of commissioner steering for the model which covers multiple commissioners. To include 2 representatives one covering North Mersey and a second covering Mid Mersey to represent Merseyside CCG Network on the commissioning forum. Martin McDowell sent Chief Finance Officer Sefton and Southport & Formby CCG to represent North Mersey. 2. Urgent Care Network. Robustness of current arrangements to manage escalation and divert processes currently in place. Escalation process to ensure CCG ownership of process to commence fully from with NHS England supporting in the interim. 3. Procedures for Controlled Drugs management for Merseyside Assurance for CCGs on current processes within NHS England to ensure effective management Review of divert arrangements to be undertaken to be led by Whiston. CCG Network Chairs to invite NHS England Medical Director to attend future meeting to clarify responsibilities and any risks. Recommendations to NHS Liverpool CCG Governing Body: 1. Note key issues and risks discussed and mitigating action plans. 4

17 Report no: GB NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY 9 TH JULY 2013 Title of Report Lead Governor Lead Manager Summary Recommendation Memorandum of Understanding for the provision of Public Health advice to Liverpool CCG Dr Nadim Fazlani, Chair of Liverpool CCG Dr Paula Grey, Director of Public Health Dr Paula Parvulescu, Consultant in Public Health Medicine,, Liverpool City Council The report sets out the strategic framework and mechanisms for the provision of public health advice to inform and support NHS commissioning. That Liverpool CCG Governing Body: Note the requirements of the Health and Social Care Act with respect to the provision of Public Health Advice to NHS Commissioners. Note the responsibilities of Liverpool City Council and Liverpool CCG set out in the Memorandum of Understanding and accompanying work plan in delivering the mandatory function. Authorisation Evidence Which domain(s) does this support? Please insert x that apply 1. Strong clinical and multi-professional focus X 2. Engagement with patients/carers/communities 3. Clear and Credible Plans X 4. Proper constitutional and governance arrangements X 5. Collaborative arrangements for commissioning X 6. Great Leadership X Page 1 of 4

18 QIPP Impact Relevant Standards or targets To support the delivery of QIPP requirements of Liverpool CCG. Standards of Good Governance NHS Operating Framework 2012/13 Public health advice service for clinical commissioning groups Public health advice service for clinical commissioning groups - Publications - Inside Government - GOV.UK Page 2 of 4

19 MEMORANDUM OF UNDERSTANDING FOR THE PROVISION OF PUBLIC HEALTH ADVICE TO LIVERPOOL CCG 1. PURPOSE The report sets out the strategic framework and mechanisms for the provision of public health advice to inform and support NHS commissioning. 2. RECOMMENDATIONS Liverpool CCG is asked to note the requirements of the Health and Social Care Act with respect to the provision of Public Health Advice to NHS Commissioners. The requirements and responsibilities of Liverpool City Council and Liverpool CCG are set out in a Memorandum of Understanding and accompanying work plan in delivering the mandatory function. 3. BACKGROUND Good population health outcomes, including reducing health inequalities, rely not just on health protection and health improvement, but on the quality and accessibility of healthcare services provided by the NHS. Following the implementation of the Health and Social Care Act 2012 primary responsibility for health improvement and health protection transferred at the national level from the NHS to Public Health England (PHE), and at local level from PCTs to Local Authorities and PHE, with Clinical Commissioning Groups (CCGs) playing an important role in this. Responsibility for strategic planning and commissioning of NHS services has transferred to Clinical Commissioning Groups and to the NHS Commissioning Board. Section 18 of the Health and Social Care Act gives the Secretary of State for Health powers to make regulations requiring local authorities to carry out public health functions with Section 22 further enabling them to delegate further public health functions. Within these sections it also sets out the provision of certain public health functions as mandatory. This includes the requirement of ensuring NHS commissioners receive public health advice on matters such as Health needs assessments for particular conditions or disease groups, evaluating evidence to support the process Page 3 of 4

20 of clinical prioritisation for populations and individuals and new drugs and technologies in development. 4. PROVISION OF PUBLIC HEALTH ADVICE TO THE NHS The healthcare public health advice service provided by the Liverpool City Council Public Health Directorate is intended to support this approach by advising on best methods to ensure the provision of high quality, costeffective services that meet the needs of the local population and take into account patient experience. The shape of the service will evolve over time reflecting the needs of Liverpool CCG and the resources available. The arrangement for the provision of this advice is the focus of this report which Liverpool CCG is asked to consider. Improving health and developing sustainable services are seen as being a key contribution to meeting the challenges of reduced public finances. The provision of public health advice to Liverpool CCG is to be delivered within the ring fenced budget and has been included within the agreed budget framework for Public Health. 5. MEMORANDUM OF UNDERSATNDING A Memorandum of Understanding has been developed between Liverpool City Council and Liverpool CCG that sets out the arrangement for the provision of this advice. The Memorandum of Understanding is supported by a work plan that reflects the transformational initiatives of the CCG. The work plan has been developed jointly between Public Health, Liverpool City Council and Liverpool CCG. Dr Paula Grey Director of Public Health Liverpool City Council Page 4 of 4

21 Liverpool City Council Public Health Directorate and Liverpool Clinical Commissioning Group Memorandum of Understanding 1. The purpose of this Memorandum of Understanding is to establish a framework for relationships between Liverpool City Council (LCC) and Liverpool Clinical Commissioning Group (Liverpool CCG) with regard to the Public Health Directorate. 2. Since 1974, specialist public health staff within the NHS, have assumed the lead for the three core public health responsibilities on behalf of the NHS and local communities: Health improvement e.g. lifestyle factors and the wider determinants of health. Health protection e.g. prevention and control of communicable diseases, public health input into incidents, emergencies and threats, and screening Population healthcare e.g. input to the commissioning of health services, evidence of effectiveness, care pathways. 3. Following the implementation of the Health and Social Care Act 2012 primary responsibility for health improvement and health protection transferred at the national level from the NHS to Public Health England (PHE), and at local level from PCTs to Local Authorities and to some extent PHE, although CCGs will still have an important role in this. Responsibility for strategic planning and commissioning of NHS services has transferred to Clinical Commissioning Groups and to the NHS England. 4. Public health professional staff formally transferred to their relevant Local Authorities on 1 st April There remains a requirement for them to provide public health (PH) expertise and support to their relevant CCGs. 5. There is a nominated PH consultant lead for Liverpool CCG staff to liaise with. Some support may be offered from a shared public health service working under the established governance of CHAMPs (Cheshire & Merseyside Public Health Collaborative Services). Some public health tasks are delivered most effectively and efficiently on a larger foot print e.g. screening, emergency planning and some specialised services, and as such will be delivered by teams that may work across existing boundaries. 6. Public Health support is aligned to specific commissioning priority areas. This includes PH support to joint commissioning arrangements with LCC and to the commissioning of Social care as needed. 1

22 Improving Health and Reducing Inequalities 7. With effect from 1 st April 2013 the Health and Social Care Act 2012 gave Local Authorities statutory duties to improve the health of the population. CCGs also have a duty to secure improvement in health and to reduce inequalities. This will require action along the entire care pathway from prevention to tertiary care. Therefore, LCC and Liverpool CCG recognise that they have a collective interest and individual and collective responsibility for health improvement. 8. This will give new opportunities to address the wider determinants of health. The Health and Wellbeing Board will hold the parties to account for their actions and impact on improving health. For 2013/14: LCC Public Health Directorate intends to: Refresh its delivery and lead role in current strategies and action plans to improve health and reduce health inequalities, with input from Liverpool CCG when required. Maintain, and refresh as necessary, metrics to allow the progress and outcomes of preventive measures to be monitored, particularly as they relate to delivery of key NHS and LA strategies. Work with other LCC departments to further embed ownership and leadership of health improvement through the Decade of Better Health Programme. Support Liverpool CCG with health improvement tasks appropriate to its provider healthcare responsibilities -for example by offering training opportunities for staff in relation to targeted behaviour health change programmes and services. Lead health improvement partnership working between Liverpool CCG, local partners and residents to integrate and optimise local efforts for health improvement and disease prevention. Provide advice to Liverpool CCG to align Liverpool CCG s investment and actions with Health and Wellbeing Board programme of health improvements and investment. Work with Liverpool CCG and providers to embed public health programmes around improving lifestyles into frontline services towards improving outcomes and reducing demand on treatment services. Liverpool CCG intends to: Contribute to strategies and action plans to improve health and reduce health inequalities. Ensure that constituent practices maximise their contribution to disease prevention for example by taking every opportunity to address smoking, alcohol, and obesity in their patients and by optimising management of long term conditions. 2

23 Ensure primary and secondary prevention is incorporated within commissioning practice. Commission to reduce health inequalities and inequity of access to services. Support and contribute to locally driven public health campaigns. Health Protection 9. The Health and Social Act 2012 and Regulations made under it give LCC and its Director of Public Health a series of responsibilities in respect of health protection, on behalf of Public Health England. These include preventing and responding to outbreaks of communicable disease, planning for and mitigating the effects of environmental hazards, and NHS resilience. 10. The Act also gives CCGs a duty to ensure that they are properly prepared to deal with relevant emergencies. The Secretary of State retains emergency powers to direct any NHS body to extend or cease functions, and will discharge these through the Director of Public Health, with advice from Public Health England. 11. Therefore, to ensure robust health protection arrangements for 2013/14: LCC Public Health Directorate aims to: Ensure that robust comprehensive agreed inter-agency plans are in place to protect the population from public health incidents, emergencies, outbreaks of infection and other threats Provide, or ensure access through Cheshire and Merseyside Public Health England Centre and others, to specialist health protection advice, information and expertise for the Liverpool CCG and clinical community. Provide local leadership and support, alongside the CMHPU, for key NHS health protection functions, including childhood vaccination, adult vaccination including influenza, blood borne virus prevention and control (Hepatitis and HIV), tuberculosis prevention and control and sexually transmitted infection prevention and control programmes. Liverpool CCG aims to: Familiarise themselves with strategic plans for responding to public health emergencies and outbreaks and arrangements for Health Emergency Preparedness, Resilience and Response from April 2013 as set out by the Department of Health at: Participate in exercises when requested by LCC to do so. Ensure that provider contracts include appropriate business continuity arrangements. Work with NHS England to ensure that constituent practices have business continuity plans in place to cover action in the event of the most likely public health emergencies. 3

24 Assist LCC with co-ordination of the response to public health emergencies, through local command and control arrangements. Ensure that resources are available to assist with the response to public health emergencies, by invoking provider business continuity arrangements and through action by constituent practices. Contribute to strategies and action plans and specifications to protect health and reduce inequalities. Ensure that constituent practices maximise their contribution to health protection for example by maximising vaccination uptake and reducing variation in uptake of childhood and adult vaccinations across practices; increasing access to HIV testing, increasing access to STI testing and treatment for those at risk. Support and contribute to locally driven health protection campaigns Commissioning NHS Services 12. The Health and Social Care Act 2012 established CCGs as the main local commissioners of NHS services and gave them a duty to continuously improve the effectiveness, safety and quality of services. The Liverpool Health and Well-being Board has been established as the primary mechanism of ensuring the responsibilities around health improvement and health and social care provision to identify the needs of the population and ensure that these are to be addressed through CCGs, public health and social care commissioning plans and activities. 13. Public health specialist staff currently provide a range of support for specific NHS commissioning functions. This support is also relevant for the commission of social services and integrated commissioning and it is obtained from an appropriately skilled local public health specialist team. For 2013/14: LCC Public Health Directorate developed a work plan (detailed in appendix 1) based on the following areas: Provide specialist public health advice to Liverpool CCG including working up a more defined specification for comprehensive public health support. For topics agreed with Liverpool CCG, assess the health needs of the local population, and how they can best be met using evidence-based interventions. Ensure the reduction of health inequalities are prioritised in the commissioning of services. Support the Liverpool CCG in developing evidence based care pathways, service specifications and quality indicators to improve patient outcomes. For topics agreed with Liverpool CCC, set out the contribution that interventions make to defined outcomes (modelling) and the relative return on investment across the portfolio of commissioned services. 4

25 Design monitoring and evaluation frameworks, collect and interpret results. Promote and facilitate joint working between LCC Liverpool CCG and wider partners to maximise health gain through integrated commissioning practice and service design. Support the clinical effectiveness and quality functions of the Liverpool CCG including input into assessing the evidence. Support the development of public health skills for Liverpool CCG staff. Lead the development of and professional support for, the Liverpool Health and Wellbeing Board. Through the Joint Strategic Needs Assessment (JSNA), refresh the needs assessment of the population and ensure that this is relevant to the city. The production of the JSNA will be complemented by a programme of targeted needs assessments. Liverpool CCG will be a co-participant in the production of the JSNA. Lead production of the Joint Health and Wellbeing Strategy and ensure that the CCG is fully involved in the production of this strategy. Lead the co-ordination of appropriate health commissioning work between the NHS, PHE and LCC at a local level. All work plans will be reviewed in the first year to establish appropriate delivery timelines beyond Liverpool CCG will: Consider how to incorporate specialist public health advice into decision making processes, in order that public health skills and expertise can inform key commissioning decisions. Support a process for defining public health support beyond 2013/2014. Utilise specialist public health skills to target services at greatest population need and towards a reduction of health inequalities. Contribute with intelligence and capacity to the production of the JSNA. LCC and Liverpool CCG recognise that these aims in conjunction with the new structures under the 2012 Act give fresh opportunities to address the whole range of health and wellbeing by strengthening partnerships across health, social services and the third sector. Liverpool CCG has an essential part to play and the LCC Public Health Directorate can help to facilitate this. Signed by Signed by Liverpool City Council Katherine Sheerin Liverpool CCG 5

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27 Liverpool City Council Public Health Work Plan for Liverpool Clinical Commissioning Group May 2013 and beyond

28 Long term conditions 1. Strategic Needs Assessment 2. Service redesign & Implementation 3. Insight 4. Social Marketing 5. Health Improvement 6. Health Protection 7. Consultant Support to CCG committees Cancer Liverpool CCG Transformational Change Initiatives PH Support Areas Specific activities and deliverables PH Leads CCG Leads End of Life CVD Respiratory Integrated care Children Urgent Care Planned Care *Early Detection and Screening *Pathway development and implementation *Timely access *Liverpool Cancer centre *Supporting Choice *Liverpool Care Pathway *Carers Support *Diabetes Model Implementation *Improved diagnostic *Pathway implementation *Reducing variation in General Practice *Pathway implementation *Reducing variation in General Practice *Community Respiratory team utilisation *Delivery of the Liverpool Integrated Care Model *Risk Stratification, Self care and Education *Multi-agency neighbourhood teams *Care home support *Enabling technologies (DALLAS, Feel Good factory) *Maternity Matters & Healthy Child Programmes *A&E attendance for primary care problems *Equipment services *Transition to Adult Services *Right care in the right place *Access, waiting times and discharge planning *Implementation of 111 programme *Same day emergency care in hospitals *Focus on access to services *Right care in the right place *Quality, safety and patient experience *Demand management Cancer intelligence reports Richard Jones Skin cancer economic impact Kerry Lloyd Evidence review of cancer pathways Emma Page Insight Outdoor Workers Insight - Sunbeds Insight Smoking cessation experience Social Marketing Sunbed campaign Social Marketing Outdoor workers intervention TBC Kate Scott Kerry Lloyd CVD retrospective mortality audit General Practice mortality rates CVD intelligence reports CVD pathway evidence review Insight - Medicines compliance Insight pre-diabetes pathway development COPD pathway evidence review Respiratory disease intelligence reports Insight Life enhancing technologies Developing outcomes to measure integrated care Linking council and CCG data (e.g. dementia records) Insight - Integrated care Insight build and deliver patient experience measurement Insight Profiling Insight Co-creation of care planning pathway Insight recruit and build patient and carer reference group Childhood accidents Breast Feeding Equity Audit Emotional Health & Wellbeing of C&YP HNA Work with NHSCB LAT to ensure universal Vitamin D coverage for all pregnant women and children ( 6 months to 5 years ) Insight - Children s Personal Health Record Insight Paediatrics use of all core services Developing of an improved integrated plan to reduce seasonal excess deaths. Support the development of the 5 year Urgent Care Strategy Insight Evaluation of adult core services Insight GP patient access Modelling the impact of implementing the NICE guidance on assessing risk of fragility fracture in adults Contribute to the pharmaceutical needs assessment Dr Paula Parvulescu Chris Williamson Sue Cumming Emma Page Dr Paula Parvulescu Richard Jones Dr Paula Parvulescu Richard Jones Sue Cumming Annette James Kate Scott Emma Page Sue Cumming Kerry Lloyd Chris Williamson Sue Cumming Dr Paula Parvulescu Kerry Lloyd Dr Ed Gaynor Hannah Hutchinson Dimitris Tsintzos Dr Donal O Donoghue Hannah Hutchinson Dr Janet Bliss Sue Renwick Richard Houghton Dr Janet Bliss Sue Renwick Richard Houghton Dr Maurice Smith Dani Jones Richard Houghton Dr Simon Bowers Alison Williams Avril Swan Lisa Nolan Susan Kilgallen Dr Jim Cuthbert Dr Fiona Lemmens Jane Keenan Jeanette Smart Dr Jude Mahadanaarachchi Cheryl Mould Susan Kilgallen Public Health Liverpool: Work plan for Liverpool CCG 2

29 Mental Health and Learning disabilities *Liverpool Model for Primary Mental Health Care *Rehabilitation Model of Care *Integrated Care Model *Physical Health Checks *Transition from Child Services Learning Disabilities HNA IAPT HNA NW Wellbeing Survey-Liverpool report Mental health social prescribing model Sandra Davies Gina Perigo Sue Neely Chris Williamson Sophie Kelly Dr Nadim Fazlani Clare Mahoney Michelle Urwin Antoinette Egan Dementia Alcohol *Implement hospital liaison service *Implement Dementia Care Navigators model *Memory clinics & improved diagnosis rates *Implement awareness and training programmes *Maximise LCAS Utilisation *Shared Care pathway for problem alcoholics *Increase awareness of impact of alcohol Dementia Health Profile Dementia HNA Audit of social care support &diagnosed patients Evidence review and modelling of various pathways to inform a dementia model for the city of Liverpool Alcohol intelligence reports Contribution to the joint alcohol strategy Commissioning of alcohol services Alcohol comprehensive needs assessment License application response Insight alcohol & pregnancy Dr Paula Parvulescu Sophie Kelly Kerry Lloyd Sue Neely Sandra Davies Ian Canning Sue O Looney Kerry Lloyd Sophie Kelly Emma Page Dr Moya Duffy Clare Mahoney Antoinette Egan Dr Shamin Rose Peter Johnstone Antoinette Egan Public Health Support Themes: 1. Strategic Needs Assessment i. JSNA ii. Health Needs Assessments iii. Health Impact Assessments iv. Analysis & Interpretation of Public Health data v. Prioritisation 2. Service Redesign & Implementation i. Evidence review, models of care and pathway modelling ii. 3. Insight 4. Social Marketing 5. Health Improvement 6. Health Protection 7. Consultant Support Programme budgeting analysis and resource allocation Public Health Liverpool: Work plan for Liverpool CCG 3

30 Programme: Cancer Governing Body Executive Sponsor: Dr Ed Gaynor Clinical Leads: Dr David O Hagan; Dr Steve Connolly; Dr Cathy Hubbard; Dr Jill Kirkham; Dr Katy Gardner CCG Programme Manager: Hannah Hutchinson Public Health Leads: Kerry Lloyd Why is change needed? CCG has high incidence and mortality across most Cancers, with the highest mortality rate in England for All Cancer Evidence of inequalities within the city Survival rates are good once detected Aim To reduce cancer incidence, morbidity and mortality, and to improve the experience and outcomes for Cancer patients and their carers. Objectives Improved and extended health prevention measures Earlier detection/ enhanced screening measures Clear pathways and adherence Improved access What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Improvement to pathways (Lung, X X - - Colorectal, Upper GI) General Practice education, public X X - - awareness & patient insight Implement Flexible Sigmoidoscopy X X Delivery of access targets X CQUIN - Smoking Prevention X - - Survivorship CQUIN X CQUIN - Audit of emergency admissions X - - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & Interpretation of PH data Tumour site intelligence reports Richard Jones 1. Analysis & Interpretation of PH data General Practice mortality rates Richard Jones 1. Analysis & Interpretation of PH data Economic impact of Skin Cancer Richard Jones 1. Analysis & Interpretation of PH data Understanding smoking prevalence Chris Williamson 2. Service Redesign & Implementation Cancer pathways evidence review Paula Parvulescu Kerry Lloyd 2. Service Redesign & Implementation Align work of health promotion team Kerry Lloyd to CCG planning and priorities 3. Insight Outdoor workers Emma Page 3. Insight Sun Beds Emma Page 3. Insight Smoking Cessation experience Sue Cumming 4. Social Marketing Sun beds campaign Emma Page 4. Social Marketing Outdoor workers interventions Emma Page Public Health Liverpool: Work plan for Liverpool CCG 4

31 What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Potential Years of Life Lost from causes considered amenable to healthcare Under 75 mortality from Cancer One and Five year survival rates Relevant Public Health Outcome Framework Indicators: Under 75 mortality from Cancer Under 75 mortality from Cancer considered preventable Smoking prevalence Adults NHS Constitutional Rights: Cancer waits (2weeks, 31days and 62days) Key Risks & Mitigating Actions Risks Delivery of 62 day access constitutional right due to complexity of pathways and the specialist nature of our providers Lack of consensus between Trusts around a Merseyside pathway for priority tumour groups Mitigating Actions - Joint work with Mersey & Cheshire Cancer Network including use of CQUIN - Continued focus on improvement in CQPMs - Proactive management by Clinical Commissioners and full engagement of Cancer Network Key Relationships for Delivery Health & Wellbeing Board Cheshire & Merseyside Cancer Network Collaborative CCGs NHSCB (Specialist Commissioning) Public Health Liverpool: Work plan for Liverpool CCG 5

32 Programme: Dementia Governing Body Executive Sponsor: Dr Nadim Fazlani Clinical Leads: Dr Moya Duffy, Dr Rajan Karthikeyan, Dr Jonathan Lock CCG Programme Manager: Michelle Urwin Public Health Leads: Dr Paula Parvulescu Why is change needed? Increasing need Need to increase identification Innovation opportunities Aim To improve earlier detection, diagnosis and post diagnosis support Objectives Integrated care pathway High quality secondary care services Adoption of Innovation What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Continued implementation of X X X X 2,000 - integrated pathway for the earlier detection, diagnosis and post diagnosis support Continued development of secondary X X X - - care services including memory services, inpatient facilities and liaison Carers advice and support X X X Focus on innovation (adoption and X X X X - - spread) BME dementia champions programme X X X - - Care Homes Integrated Care X X X X TBC - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis and interpretation of PH data Dementia Profile update Sophie Kelly 1. Needs Assessment Dementia Health Needs Kerry Lloyd Assessment 1. Analysis and interpretation of PH data Audit social care support for Sophie Kelly diagnosed patients 2. Service Redesign & Implementation Evidence review and modelling of various pathways to inform a dementia model for the city of Liverpool Paula Parvulescu Public Health Liverpool: Work plan for Liverpool CCG 6

33 2. Service Redesign & Implementation Return on investment analysis Paula Parvulescu What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Estimated diagnosis rate for people with dementia People with dementia prescribed anti-psychotic medication Relevant Public Health Outcome Framework Indicators: Health related quality of life for older people (placeholder) Dementia and its impact (placeholder) Key Risks & Mitigating Actions Risks - Lack of engagement in General Practice for targeted screening Mitigating Actions - Proactive clinical leadership - Potential for QOF revision to address - Review potential for LES Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Social Care Dementia is Mayoral Pledge) Innovate Dementia (Mersey Care & LJMU) Public Health Liverpool: Work plan for Liverpool CCG 7

34 Programme: Mental Health & Learning Disabilities Governing Body Executive Sponsor: Dr Nadim Fazlani Clinical Leads: Dr Moya Duffy, Dr Rajan Karthikeyan, Dr Jonathan Lock CCG Programme Manager: Clare Mahoney Public Health Leads: Consultant Lead Dr Sandra Davies; Officer Lead Gina Perigo Why is change needed? High incidence of mental illness Significant demand on General Practice Opportunity to improve outcomes and service model Aim To ensure effective services at all stages of the pathway and reduce inequalities Objectives Develop comprehensive primary mental health care service Focus on integrated care delivery for more proactive management of mild to moderate mental illness Ensure effective service models for Learning Disabilities What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Primary mental health care X X X X improvements and new model Development of rehabilitation model X X 50 - Integrated Care Model X X X X See LTC - Winterborne review implementation X Physical health checks for SMI and LD X X X CQUIN - 24hr staffing for s136 suites X X Transition from child and adolescent X X CQUIN - Reduce out of area treatments X X - - Section 117 aftercare X X 1,000 - Stakeholder engagement (MH X X X 38 - consortium) Waiting list reduction for specialist psychological therapies X Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Health Needs Assessment Learning Disabilities HNA Chris Williamson 1. Health Needs Assessment Support to HNA for IAPT Sophie Kelly / Chris Williamson 1. Health Needs Assessment North West Wellbeing Survey Chris Williamson 1. Analysis & Interpretation of PH data Analysis of wellbeing from Chris Williamson / Liverpool Lifestyle Survey 5. Health Improvement Work with CCG to develop social prescribing model Sophie Kelly Gina Perigo Public Health Liverpool: Work plan for Liverpool CCG 8

35 What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: People with severe mental illness who have received a list of physical checks Access to community mental health services by people from BME groups Access to psychological therapy services by people from BME groups Recovery from talking therapies Patient experience of community mental health services Reducing premature deaths in people with learning disabilities Relevant Public Health Outcome Framework Indicators: Adults with a learning disability who live in stable and appropriate accommodation Adults in contact with secondary mental health services who live in stable accommodation Excess under 75 mortality in adults with serious mental illness (placeholder) Mortality rate from suicide and injury of undetermined intend NHS Constitutional Rights: Care Programme Approach (CPA): Proportion of people under adult mental illness specialities on CPA who were followed up within 7 days of discharge from psychiatric in-patient care Key Risks & Mitigating Actions Risks Mitigating Actions - Impact of LCC funding cuts - Impact assessment of potential cuts - Proactive management with LCC - Lack of engagement by Mersey Care and IML in - Proactive clinical leadership Integrated Care - Use of contractual levers including CQUIN - Potential to pump prime engagement Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Social Care and Public Health) NHS Trusts (Mersey Care and Inclusion Matters) NHSCB Commissioning (Specialist) Mental Health Consortia Public Health Liverpool: Work plan for Liverpool CCG 9

36 Programme: Long Term Conditions (CVD, Respiratory) Governing Body Executive Sponsor: Dr Janet Bliss Clinical Leads: Dr Tristan Elkin; Dr Paula Finnerty; Dr Julie Woods; Dr Fiona Ogden-Forde; Dr Hitesh Kothari; Dr Rosie Kaur; Dave Webster CCG Programme Manager: Sue Renwick Public Health Leads: Dr Paula Parvulescu Why is change needed? High mortality rates and emergency admissions Significant variation in General Practice delivery Significant opportunity to improve outcomes and reduce costs Aim To improve the management of long term conditions and focus on proactive management of individuals at risk Objectives Focus on identifying populations at risk and delivery of personalised care Deliver effective pathways across primary and secondary care Reduce variation in General Practice Review service delivery What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Implement Liverpool Integrated Care X X X X 2,214 - Model Diabetes Pathway Implementation X X X - - CVD Pathways X X - - Address variation in General Practice X X X - - Service reviews (Heart failure, ECG, X X - - Anti-coagulation) Improve rehabilitation completion (cardiac, pulmonary) X - - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & interpretation of PH data CVD retrospective mortality audit Chris Williamson/ Richard Jones 2. Service Redesign & Implementation CVD pathway evidence review Paula Parvulescu 2. Service Redesign & Implementation COPD pathway evidence review Paula Parvulescu 3. Insight CVD Medicines Adherence Insight Sue Cumming Presentation 3. Insight Technology Assisted Care Sue Cumming 3. Insight Insight Pre-diabetes pathway Emma Page development 5. Health Improvement Ensure smooth transition of Health Sandra Davies Public Health Liverpool: Work plan for Liverpool CCG 10

37 Checks Programme to Public Health via CCG management of LES in first instance What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Potential years of life lost from causes considered amenable to healthcare U-75 mortality from cardiovascular disease Health related quality of life for people with LTC People feeling supported to manage their own condition Myocardial infarction, stroke and stage 5 kidney disease with diabetes People with diabetes who have had nine care processes People with diabetes diagnosed less than one year referred to structured education Unplanned hospitalisation for chronic ACS conditions Complications associated with diabetes including emergency admissions for diabetic ketoacidosis and lower limb amputation Patient experience of integrated care Relevant Public Health Outcome Framework Indicators: Under 75 mortality from all cardiovascular diseases (including heart disease and stroke) Take up of NHS Health Check Programme Health Check Offered Take up of NHS Health Check Programme Health Check Take Up Recorded Diabetes Mortality from respiratory diseases Key Risks & Mitigating Actions Risks Mitigating Actions - Lack of engagement by NHS Trusts in Integrated - Proactive Clinical Leadership Care - Utilise contract levers including CQUIN - Lack of engagement by member practices - Proactive Clinical Leadership - Neighbourhood focus - Facilitation support - Impact of LCC funding cuts - Risk analysis - CCG investment Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Social Care and Public Health) NHS Trusts (Acute, Mental Health and Community) Public Health Liverpool: Work plan for Liverpool CCG 11

38 Programme: Integrated Care Governing Body Executive Sponsor: Dr Maurice Smith Clinical Leads: Dr Tristan Elkin; Dr Paula Finnerty CCG Programme Manager: Dani Jones Public Health Leads: Dr Paula Parvulescu Why is change needed? High mortality rates and emergency admissions Demographic challenge; 30% of LTCs population account for 70% of the spend Poor outcomes & experience for people with LTCs Significant cuts to adult social care budget in Liverpool (52% over next 3 years) Significant opportunity to improve outcomes and reduce costs Aim To improve the management of long term conditions and focus on proactive management of individuals at risk To put people at the centre of their own holistic care plans; enabling them to take control, and have greater independence. Objectives Focus on identifying populations at risk and delivery of personalised care Implementation of multi-agency health care, social care, mental health and independent sector teams Standardised approach to self-care and education Best use of new technologies such as telehealth What are we doing about it? Transformational Change & Improvement Initiatives Implement Liverpool Integrated Care Model QIPP Financial Plan Q I P P Invest Savings X X X X 2,214 - Public Health Support Theme Sub-theme Outputs Public Health Lead 2. Service Redesign & Implementation Developing outcomes to measure Paula Parvulescu integrated care 3. Insight End user, carer and professional Sue Cumming insight to support development of integrated care pathway 3. Insight Development of patient experience Sue Cumming measurement 3. Insight Co-creation of care planning Sue Cumming pathway 3. Insight Insight Patient profile of those Sue Cumming identified at 70%+ risk 3. Insight Recruit and develop patient reference group Sue Cumming Public Health Liverpool: Work plan for Liverpool CCG 12

39 4. Social Marketing Dallas development of social marketing strategy based on insight work 4. Social Marketing Integrated care development of social marketing strategy based on insight work 5. Health Improvement Review implications of integrated care on role of Health Trainers Danielle Sharp Danielle Sharp Sandra Davies What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Potential years of life lost from causes considered amenable to healthcare U-75 mortality from cardiovascular disease Health related quality of life for people with LTC People feeling supported to manage their own condition Myocardial infarction, stroke and stage 5 kidney disease with diabetes People with diabetes who have had nine care processes People with diabetes diagnosed less than one year referred to structured education Unplanned hospitalisation for chronic ACS conditions Complications associated with diabetes including emergency admissions for diabetic ketoacidosis and lower limb amputation Patient experience of integrated care Relevant Public Health Outcome Framework Indicators: TBC Key Risks & Mitigating Actions Risks Mitigating Actions - Lack of engagement by NHS Trusts in Integrated - Proactive Clinical Leadership Care - Utilise contract levers including CQUIN - Lack of engagement by member practices - Proactive Clinical Leadership - Neighbourhood focus - Facilitation support - Impact of LCC funding cuts - Risk analysis - CCG investment Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Social Care and Public Health) NHS Trusts (Acute, Mental Health and Community) Public Health Liverpool: Work plan for Liverpool CCG 13

40 Programme: Children Governing Body Executive Sponsor: Dr Simon Bowers Clinical Leads: Dr Chris Peterson; Dr Paula Finnerty; Jane Lunt CCG Programme Manager: Avril Swan and Lisa Nolan Public Health Leads: Consultant Lead TBC. Officer Lead Annette James Why is change needed? High rates of emergency admissions Quality issues in transition to adult services Early Years affects life choices Aim To improve outcomes for children and young people and ensure financial resources are used to best effect. Objectives Reduce unplanned care admissions Deliver access targets Ensure effective transition to adult services Focus on early years What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Reduce unplanned care admissions X CQUIN - Review of ADHD Service X - - Transition Pathways for LTC including X X CQUIN - mental health & learning disabilities Review equipment services X X Improve breast feeding uptake X X X CQUIN - Integrated pathways for complex needs X X - - Reduction in maternal smoking X CQUIN - prevalence Implementation of best practice tariff for Diabetes X? - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & interpretation of PH data Analysis of childhood accidents Kate Scott 2. Service redesign & Implementation Children with complex needs pathway modelling Impaired glucose regulation pathway TBC Annette James 3. Insight Re-design children s Personal Health Emma Page Record 3. Insight QIPP Paediatrics Urgent Care: Sue Cumming Understanding across North Mersey of use of all paediatric core services. 4. Social Marketing Core Services: Paediatrics. Social marketing to reduce inappropriate Danielle Sharp Public Health Liverpool: Work plan for Liverpool CCG 14

41 A&E attendances 5. Health Improvement Provide a public health overview of maternal, children and young people s health and wellbeing Work with NHS England and other stakeholders to reduce the impact of poverty and the provision of the Healthy Child programme and child and family weight management. Universal vitamin D. Annette James What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Emergency admissions for children with lower respiratory tract infections Experience of healthcare for children and young people Women s experience of maternity services Antenatal assessment at 13weeks Breast Feeding at 6-8weeks Relevant Public Health Outcome Framework Indicators: Children in Poverty Breast Feeding Initiation Breast Feeding Continuation Smoking at time of delivery Excess weight in year olds Under 18 conceptions NHS Constitutional Rights: Cancer Waits (2weeks, 31days, 62days) RTT (18week, 52week) Key Risks & Mitigating Actions Risks Mitigating Actions - Lack of engagement by Alder Hey in plans to - Proactive Clinical Leadership reduce emergency admissions - Utilise contract levers including CQUIN - Impact of LCC funding cuts on respite care - Impact analysis of reduction in service - Integrated approach with LCC Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Children s Services and Public Health) NHS Trusts (Alder Hey, LWH and LCH) NHS England Public Health Liverpool: Work plan for Liverpool CCG 15

42 Programme: Alcohol Governing Body Executive Sponsor: Dr Shamin Rose Clinical Leads: Dr Moya Duffy; Dr Simon Abrams; Dr Jonathan Lock CCG Programme Manager: Peter Johnstone Public Health Leads: Consultant Lead Sandra Davies; Officer Lead Ian Canning/ Sue O Looney Why is change needed? High rates of emergency admissions High use of A&E Rising cause of mortality Evidence of variation in awareness Aim To maximise use of specialist services to improve management for people with alcohol problems leading to reduced hospital activity and mortality from liver disease Objectives To increase to the use of specialist alcohol services and reduce variation Improve services for problem alcoholics Improve awareness What are we doing about it? Transformational Change & Improvement Initiatives Focus on increasing referrals to Liverpool Community Alcohol Service Development of shared care pathway for problem alcoholics Review service impact and care model for Korsakoff syndrome Increased awareness of impact of alcohol within primary health teams and the public QIPP Financial Plan Q I P P Invest Savings X X X - - X X - - X X - - X X X - - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & interpretation of PH Data Quarterly alcohol dashboard Sophie Kelly 1. Health Needs Assessment Alcohol Health Needs Assessment Kerry Lloyd 3. Insight Alcohol & Pregnancy Sue Cumming 5. Health Improvement Licence application response Ian Canning 5. Health improvement Delivery of the medical and nonmedical Sue O Looney models of services 5. Health improvement Contribution to the joint alcohol strategy Ian Canning Public Health Liverpool: Work plan for Liverpool CCG 16

43 What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Potential years of life lost from causes considered amenable to healthcare U75 mortality from Liver Disease Emergency admissions for alcohol related liver disease Relevant Public Health Outcome Framework Indicators: Under 75 mortality from Liver Disease Alcohol related admissions to hospital Key Risks & Mitigating Actions Risks Mitigating Actions - Impact of LCC cuts on service provision - Risk assessment of potential cuts - Proactive engagement with LCC - Lack of engagement amongst General Practices - Proactive Clinical Leadership - Prioritise within Primary Care Clinical Quality Framework Key Relationships for Delivery Health & Wellbeing Board Liverpool City Council (Public Health) Mersey Care Aintree University Hospital NHS Foundation Trust Public Health Liverpool: Work plan for Liverpool CCG 17

44 Programme: Urgent Care Governing Body Executive Sponsor: Dr Jim Cuthbert & Dr Fiona Lemmens Clinical Leads: Dr Chris Peterson CCG Programme Manager: Jane Keenan Public Health Leads: Kerry Lloyd Why is change needed? High rates of emergency admissions High use of A&E Aim To reduce unnecessary admissions and urgent care services Objectives To ensure availability of high quality urgent care services To reduce variation across General Practice To deliver timely access to urgent care services To address unnecessary admissions What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Same day emergency care X X - - Implementation of 111 X Implementation of GP Out of Hours X X Focus on access and waiting times X X - - Reduce A&E in-hours attendances X X - - Review Aintree Clinical Decision Unit X X - - Walk-In Centres Review X X - - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & interpretation of PH Data Modelling population projections that are likely to have an impact on Kerry Lloyd Chris Williamson urgent care services 3. Insight QIPP Paediatrics Urgent Care: Sue Cumming Understanding across North Mersey of use of all paediatric core services. 3. Insight Patient Experience of GP access Sue Cumming 3. Insight Evaluation of adult core services Emma Page campaign 2. Service Redesign & Implementation Develop improved integrated plan Paula Parvulescu to reduce seasonal excess deaths 2. Service Redesign and Implementation Support development of 5 year urgent care strategy based upon current and future need/demand Kerry Lloyd Public Health Liverpool: Work plan for Liverpool CCG 18

45 What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Unplanned hospitalisation for chronic ACS conditions Emergency admissions for acute conditions that should not normally require hospital admission Patient experience of emergency care NHS Constitutional Rights: A&E Waits Ambulance Category A calls and handovers Relevant Public Health Outcome Framework Indicators: Excess winter deaths index Key Risks & Mitigating Actions Risks Mitigating Actions does not deliver expected reduction in use of A&E and emergency admissions - Scenarios modelled and factored into budgets - Delivery of provider performance targets - Robust focus on provider performance within clinical quality & performance meetings Key Relationships for Delivery NHS Trusts (Acute and Community) GP Out of Hours Service 111 Provider Public Health Liverpool: Work plan for Liverpool CCG 19

46 Programme: Planned Care Governing Body Executive Sponsor: Dr Jude Mahadanaarachchi Clinical Leads: Dr Janet Bliss; Dr Maurice Smith; Dr Denis O Brien CCG Programme Manager: Cheryl Mould Public Health Leads: Dr Paula Parvulescu Why is change needed? Opportunity to move services closer to home (Right Care, Right Place) Opportunity to improve quality standards and patient experience Aim To ensure services are delivered in the most appropriate setting and to high standards Objectives To review opportunities to shift services to primary/community settings To improve delivery of clinical quality standards To improve patient experience Ensure access standards are delivered What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Orthopaedics Improvements X X X - - ENT Pathways X X - - Rheumatology Assessment Service X Continued shift of urology service to X X - - primary care delivery Dermatology primary care X X 52 - management of benign lesions Better Care, Better Value X X - TBC Implementation Additional Locally Enhanced Service X X Choose & Book advice line X 10 - Ensure access target delivery X - - Focus on improvement of PROMs X - - Implement Friends & Family Test X - - Merseyside Trauma Service Model X X Merseyside Rehabilitation Service Model X X Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis & interpretation of PH Data Public health input to the Kerry Lloyd pharmaceutical needs assessment 2. Service Redesign & Implementation Modelling the impact of implementing the NICE guidance on assessing fragility fractures in Paula Parvulescu Public Health Liverpool: Work plan for Liverpool CCG 20

47 adults 2. Service Redesign & Implementation Evidence review of a ENT service in the community 2. Service Redesign & Implementation Understand the reason behind existing poor PROMS indicators in secondary care Understand and use PROMs data to benchmark practices and secondary care providers and work on reducing variation in the quality of care as perceived by patients. Paula Parvulescu Paula Parvulescu What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Improving recovery from fragility fractures Increased health gain as measured by patient reported outcome measures Patient experience of hospital services Patient safety incidents reported Incidence of VTE, MRSA and C-Difficile Incidence of Pressure Sores and Medication Errors NHS Constitutional Rights: RTT Waiting Times Diagnostic test waiting times Mixed sex accommodation breaches Cancelled operations Relevant Public Health Outcome Framework Indicators: Hip fractures in over 65 Key Risks & Mitigating Actions Risks Mitigating Actions - Failure to deliver NHS Constitutional Rights - Maintain focus through CQPM - Ensure planned activity reflects capacity requirements - Community wide focus on infection control Key Relationships for Delivery NHS Trusts NHS England Public Health Liverpool: Work plan for Liverpool CCG 21

48 Programme: End of Life Care Governing Body Executive Sponsor: Dr Donal O Donoghue Clinical Leads: Dr Cathy Hubbard; Dr Katy Gardner CCG Programme Manager: Hannah Hutchinson Public Health Leads: Kerry Lloyd Why is change needed? To maintain focus on delivery of high quality services To improve public understanding of care pathways for the dying Aim To enable all adults with life-limiting illness to live as good a life as possible until they die Objectives To deliver equitable services that provide care at the end of life To ensure that everyone at the end of their life is identified and their physical, psychological, social and spiritual needs are assessed and wherever possible met That everyone who is at the end of life is offered choice on where they would like to be cared for and /or die What are we doing about it? Transformational Change & QIPP Financial Plan Improvement Initiatives Q I P P Invest Savings Review current status of Liverpool End X - - of Life Care Strategy Understand needs of Liverpool Patients X - - and review current service model Implement and commission full STARS X X - - care programme Roll out DNACPR policy across Liverpool X X - - Public Health Support Theme Sub-theme Outputs Public Health Lead 1. Analysis and interpretation of Public Support developments in models Kerry Lloyd Health data of care and delivery through understanding current and projected need 2. Service Redesign & Implementation Evidence review, models of care and pathway modelling Kerry Lloyd What Key Performance Indicators will we use to monitor progress? Relevant NHS Outcome Framework Indicators: Enhancing quality of life for carers Improving the experience of care for people of at the end of their lives Public Health Liverpool: Work plan for Liverpool CCG 22

49 Key Risks & Mitigating Actions Risks - Negative public and media perception of LCP for the Dying Mitigating Actions - Consistent media messages - Open and responsive approach - Training for staff Key Relationships for Delivery Palliative Care Teams End of Life Care Steering Group Public Health Liverpool: Work plan for Liverpool CCG 23

50 1. Strategic and Business Planning Sub-theme Topic area PH Work to be done Output/deliverables Lead Needs assessment JSNA Overall lead for co-ordinating and producing JSNA on behalf JSNA Chris Williamson of Health & Wellbeing Board Dementia HNA Needs assessment Comparative and epidemiological Service use by people with dementia Report on Dementia needs Kerry Lloyd Sophie Kelly Chris Williamson Learning Merseyside & Cheshire learning disabilities needs Report Paula Parvulescu Disabilities HNA assessment IAPT HNA Support CCG in Rapid HNA around IAPT service Report Chris Williamson Sophie Kelly Pharmaceutical needs assessment Contribute to the delivery of the pharmaceutical needs assessment Kerry Lloyd Analysis & Interpretation of PH Data Health Impact Assessment Prioritisation Resource Allocation Analysis, synthesis and interpretation of PH data sets to inform needs and setting of priorities e.g. Cancer Programme Intelligence Reports, General Practice Mortality Rates, Taxonomy of General Practices, Lifestyle Survey, etc TBC Support prioritisation process by review of evidence and need Within the Transformational Change Initiatives agreed by the CCG, compare the current models of care with best available evidence and understand where the public health input is needed in order to ensure a population approach. Using epidemiology, evidence and health economics to work on resource allocation and areas of investment and disinvestment for the 5 years CCG strategy. Reports for CCG commissioners Health Impact Assessment reports Public Health Liverpool: Work plan for Liverpool CCG 24 Briefings for prioritisation process Short reports Technical tool, report, presentations, workshop and engagement with commissioners and stakeholders in order to improve the resource allocation between and within programme budgeting categories. Chris Williamson Richard Jones Sophie Kelly Paula Parvulescu Paula Parvulescu Kerry Lloyd Paula Parvulescu Kerry Lloyd Paula Parvulescu

51 Return on Investment Analysis 2. Service Redesign & Implementation Population health care Clinical effectiveness Data modelling To consider the most effective way to address a health problem and what are the priority interventions in order to ensure a greater impact. Individual Funding requests (IFR) To be agreed with CCG Health inequalities and addressing variation in primary care PROMS Use return on investment tools to understand the impact of a new service/investment (areas to be agreed with the CCG) Identify interventions to prevent a disease or diseases Provide evidence for models of care and specific intervention to inform commissioning of services Use data to benchmark services Consider impact on health inequality and missing (undiagnosed) patients Evidence reviews and public health input into the Merseyside IFR panel Using epidemiology and evidence to model the impact of interventions and programmes, as well as the impact of new or existing clinical pathways prior to their implementation (possible topics: implementing NICE guidance on assessing risk of fragility fracture in adults; Hypertension; COPD; Cancer (improvement of lung, colorectal and Upper GI pathways), CVD pathway, Dementia early detection, LTCrisk stratification). Evidence review and data modelling in order to understand what interventions need to be implemented in order to achieve the bigger impact on proposed quality premiums: Reduction in inequalities in primary care Diabetes 9 care processes Reduction in prevalence for maternal smoking Understand the reason behind poor PROMS indicators in secondary care Public Health Liverpool: Work plan for Liverpool CCG 25 Reports on agreed topics Timely response to IFRs Reports on agreed topics Report/briefing/ presentation Report/briefing/ presentation Paula Parvulescu Paula Parvulescu Kerry Lloyd Paula Parvulescu Paula Parvulescu Kerry Lloyd Paula Parvulescu Kerry Lloyd Paula Parvulescu

52 Health Outcomes 3. Insight To be agreed with CCG Public health Input into the Liverpool GP specification Medicine Adherence - CVD (awaiting for confirmation of funding) Integrated Care If involved in the PROMs primary care pilot, understand and use PROMs data to benchmark practices and work on reducing variation in the quality of care as perceived by patients. Support the use of health outcome measures in contacts TBC Gathering and analysis of data to inform for whom and why drug concordance is low Build and deliver Integrated care patient experience measure Outcome measures used in contract Qualitative end user Insight presentation to CCG Quantitative Pre and post measurement Paula Parvulescu Paula Parvulescu Sue Cumming Sue Cumming Integrated Care Co-creation of care planning pathway Qualitative report Sue Cumming Integrated Care Build profile of those identified as being 70%+ at risk Profile reports Sue Cumming Integrated Care Recruit and develop a patient and carer reference group Group established Sue Cumming Integrated Care Build and deliver Integrated care patient experience Quantitative Pre and post Sue Cumming measure measurement Patient Access Working with Dr Chris Peterson to build a diagnostic package to understand experience and attitudes towards patient access within 17 practices One overarching qualitative presentation plus 17 diagnostic reports, one per Sue Cumming DALLAS Insight to understand population attitudes etc towards Life Enhancing plans and Life Enhancing technologies participating practice 1 st wave of insight: Qualitative Delivered Jan 2013 Public Health Liverpool: Work plan for Liverpool CCG 26 Sue Cumming

53 QIPP Paediatrics Urgent Care Core Services Evaluation Skin Cancer - Sun Beds Skin Cancer Outdoor workers Smoking Cessation Patient Experience Children s Personal health Record Adults core services Alcohol in Pregnancy Further packages of insight and evaluation to be scoped and commissioned Understanding across North Merseyside use of all paediatric core services, awareness, attitudes, behaviours etc, to feed into marketing programme to promote appropriate use of services and reduce inappropriate use of paediatric A&E ( Alder Hey, Ormskirk and Whiston) Social Marketing Evaluation of adult core services to measure awareness, use and attitudes towards core services Understand attitudes, behaviours, motivations to under age use of sun beds Understand risk and avoidance of skin cancer amongst male outdoor workers Measure experience of patient experience services Quantitative and segmentation April 2013 Report to CCG Public Health Liverpool: Work plan for Liverpool CCG 27 Segmentation and qualitative presentation fed back. Collating all insight Secondary data, qualitative and segmentation to present back to all CCG s and PH departments from Liverpool, Sefton, Knowsley, Halton & St Helens Quantitative evaluation report Qualitative Report Qualitative Report Qualitative and Quantitative measures Sue Cumming Sue Cumming Emma Page Emma Page Sue Cumming Insight to understand ideal contents needed for record Qualitative Report Emma Page Evaluation of adults core services campaign Quantitative Report Emma Page Understand attitudes, behaviours, motivations and barriers to drinking alcohol in pregnancy Qualitative Report Sue Cumming

54 4. Social Marketing Core Services adults Core services paediatrics Dallas Social marketing strategy to reduce inappropriate A&E attendances Social marketing strategy to reduce inappropriate A&E attendances Develop a social marketing strategy based on the insight research currently being finalised. Social marketing campaigns Strategy /Social marketing campaigns Strategy/ campaigns Danielle Sharp Danielle Sharp Danielle Sharp Integrated Care 5. Health improvement Heath improvement work in the CCG Alcohol Insight currently being finalised do not know the scope of the work yet. To support the commissioners in the CCG on relevant PH services to procure both by the CGG and as part of integrated commissioning, and to work with the CCG as required to ensure the services deliver what is required Continue to support delivery of Training in brief intervention To be agreed with the CCG Provision of regular briefings for CCG and GPs; Sue O Looney Sandra Davies Ensure CCGs linked into and aware of all new developments around alcohol Alcohol lead GP sits on ASG achieved October Obtain CCG representation on Alcohol Strategy group and develop links through to CCG and GPs via this link Continue to support GP attendance Review CCG alcohol meetings and ASG to ensure no duplication, and promote groups that develop/remain post review Public Mental Work with CCG to develop social prescribing model and Booklets distributed to all Sandra Davies health encourage use of choosing health booklets. practices by November 2013 Model developed end of April 2013, and to be shared Ensure CCG linked into wellbeing initiatives through regular with CCG by May 2013 briefings and via GP newsletter Public health Agree a work programme for public health neighbourhood Work programme signed off John Marsden Public Health Liverpool: Work plan for Liverpool CCG 28

55 neighbourhood work managers to support CCG Localities Confirm working arrangements across neighbourhood configurations with Locality CCG Managers following meeting in April 2013 Health checks Confirm working arrangements across neighbourhood configuration Ensure smooth transition of commissioning of health checks to Public health via CCG management of LES in first instance Already agreed and in place. Monitor arrangements and workplan by October 2013 Arrangements in place by March Monitoring arrangements in place and performance Sandra Davies Smoking Ensure links with provider and GP practices are maintained Ensure links to other Public health contracts understood and maintained (e.g. Health Trainers) Continue to work with CCGs to develop stop smoking service inputs to Primary care, and to increase referral to service Develop action plan for linking with Practices by May 2013 Impacts assessed and taken into account within Service specification development from 1 st April 2013 Performance and issues relating to PC understood and remedied. Sandra Davies/ Susie Gardiner Performance issues reported to CCGs quarterly Exercise for Health To develop schools education programme with CCGs as part of Health and Wellbeing Strategy; Cancer strand Review referral process with CCGs and put in place process that works for all concerned Public Health Liverpool: Work plan for Liverpool CCG 29 Agree actions to be taken and to ensure no duplication March 2013 Agree additional funding from CCG to support work April 2013 New referral process in place Gain formal approval for Sandra Davies

56 changes via Service Quality Meetings with CCG Weight Management Better Lifestyles and health Improvement Continue to work with CCG and Primary Care to promote arrangements for weight management services commissioned by Public health, across life course Provide feedback to CCG on performance across all weight management programmes Involve CCG in commissioning of Children s weight management programme Support CCG to develop and deliver health improvement plans Provide on-going feedback on service performance to CCGs on-going CCG and PC linked into all services and interventions to reduce obesity and to improve healthy weight Monitoring system designed through Better Lifestyles Programme Review arrangements for Health Improvement Sandra Davies Sandra Davies Secure CCG representation onto Better Lifestyles sub group of the Health and Wellbeing Board Ensure CCG linked into all relevant service developments Work proactively with CCG to understand where integrated commissioning could support improved outcomes. CCGs in attendance at the October 2013 meeting and Ensure CCG involved in review of all Service Specifications for services transferring to Local Authority, to ensure future plans are taken into account where possible Discuss the implications of Integrated care on role of Health Trainers with CCG. Set up a small group to look at this with CCG Service specifications take into account specific needs of CCG Public Health Liverpool: Work plan for Liverpool CCG 30

57 Maternity Children and Young People Ensure CCG is involved in children and young people s agenda Ensure CCG priorities are taken into account on all service specifications as possible Link CCG to all aspects of the Child Poverty agenda as appropriate PH advice and support across the Healthy child programmes 0 4 and 5 16 Ensure joined up working across all stakeholders Service specifications take into account specific needs of CCG Regular updates with relevant GP leads and involvement with programmes Annette James 6. Health protection Oversight of health protection Emergency preparedness PH advice and support on transitions PH lead for the Liverpool Children s Safeguarding board Establish health protection forum to link to Health and Wellbeing Board Scrutiny and challenge of health protection plans and arrangements of whole health economy Provide public health advice and support to CCG plans to protect the health of the population Ensure CCG representation for all groups as appropriate Health protection forum established Briefings Agree work with CCG accountable officer for emergency preparedness Emer Coffey Emer Coffey Emergency response Infectious diseases Infection control Provide public heath leadership and advice to CCG, in collaboration with PHE, on their response to health protection incidents, outbreaks and emergencies Provide advice on commissioning plans for prevention and control of infectious disease, including TB, HIV, hepatitis C Oversight of infection control for Liverpool Improved integrated plan to reduce seasonal excess deaths Robust response Report/briefing/engagement with commissioners Revised community infection control service specification Emer Coffey Emer Coffey Emer Coffey/Jo Public Health Liverpool: Work plan for Liverpool CCG 31

58 Scrutiny and challenge of infection control plans Jointly commission community infection control service with CCG with clarity of commissioning responsibilities and agreed work-programme for 2013/14 Dillon Expert infection prevention and control advice and support from commissioning perspective Sexual health With CCG and NCB AT, establish strategic infection control forum Lead review panel on MRSA blood stream infections if required Develop service specification for recommissioning of service and work within Local Authority system to commission and procure new service Specifications and tendering processes finalised July 2012 Service tendering underway from April 2013 Sandra Davies/ Susie Gardiner Keep CCGs fully briefed of progress and ensure CCG representation on commissioning group Regular GP Bulletins produced ongoing Regular meetings of commissioning group with CCG representation ongoing from start of commissioning Public Health Liverpool: Work plan for Liverpool CCG 32

59 7. Consultant Support DPH advisor to governing body Consultant support to CCG committees 1. Quality, safety and outcomes 2. Primary Care 3. Service improvem ent 4. R&D Strategy Group Meeting PH advice and support PH advice and support 8. CHMPs Cheshire and Merseyside Public Health Collaborative Services PH support and specialist input Health care public health component Health intelligence component Health improvement component Paula Grey 1.Emer Coffey 2.Paula Parvulescu 3.Paula Parvulescu 4.Paula Parvulescu Paula Parvulescu Chris Williamson Sandra Davies Health protection component Emer Coffey All work plans will be reviewed in the first year to establish appropriate delivery timelines beyond Public Health Liverpool: Work plan for Liverpool CCG 33

60 Public Health Liverpool: Work plan for Liverpool CCG 34

61 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY 9 th JULY 2013 Title of Report Integrated Commissioning / Section 75 Report no: GB Lead Governor Lead Manager Summary Dr. Nadim Fazlani, Chair Tony Woods, Head of Strategy and Outcomes The purpose of this paper is to inform the Governing Body of proposals for a Partnership Agreement between Liverpool Clinical Commissioning Group and Liverpool City Council under Section 75 of the NHS Act 2006 re: Adult Health and Social Care and outlines the plans to develop the agreement through 2013/14. Recommendation Authorisation Evidence QIPP Impact That Liverpool CCG Governing Body: Approves the proposal for the continuation of the existing Section 75 Agreement with LCC Approves the proposal for development of new joint commissioning and working arrangements during 2013/14 in line with the new responsibilities of both LCCG and LCC Which domain(s) does this support? Please insert x that apply 1. Strong clinical and multi-professional focus X 2. Engagement with patients/carers/communities X 3. Clear and Credible Plans X 4. Proper constitutional and governance arrangements X 5. Collaborative arrangements for commissioning X 6. Great Leadership X Supports all areas of QIPP Page 1 of 4

62 Relevant Standards or targets Delivery of NHS Outcomes Framework CCG Assurance Framework INTEGRATED COMMISSIONING / SECTION PURPOSE The purpose of this paper is to inform the Governing Body of proposals for a Partnership Agreement between Liverpool Clinical Commissioning Group and Liverpool City Council under Section 75 of the NHS Act 2006 re: Adult Health and Social Care and outlines the plans to develop the agreement through 2013/ RECOMMENDATIONS That Liverpool CCG Governing Body: Approves the proposal for the continuation of the existing Section 75 Agreement with LCC Approves the proposal for development of new joint commissioning and working arrangements during 2013/14 in line with the new responsibilities of both LCCG and LCC 3. BACKGROUND Liverpool Clinical Commissioning Group (LCCG) and the Liverpool City Council (LCC) are proposing to further develop and enhance joint commissioning and working arrangements to support improvements to health and well-being outcomes and the delivery of more seamless health and social care provision for our population. Page 2 of 4

63 Effective integrated working and joint commissioning for LCCG and LCC will face a number of challenges and opportunities, which include: Population changes and growth The need to support the Liverpool Strategic Partnership in tackling deprivation, promoting public health and supporting communities Taking advantage of opportunities to integrate services, where that makes sense from a user perspective Developing the workforce and redesigning roles in order to reduce duplication and share skills and expertise Delivering on the personalisation agenda creating greater choice, personal control and responsibility Developing shared information protocols and/or systems to support planning and service delivery Supporting market development to respond to the needs of the local population, as needs and aspirations change over time, whilst ensuring stability and plurality of providers 4. THE SECTION 75 STATUTORY FRAMEWORK Section 75 partnership arrangements in the National Health Service Act 2006 were developed to give local authorities and NHS bodies the ability to respond effectively to improve services, either by joining up existing services or developing new, co-ordinated service: Section 75 agreements can be agreed for one or more of the following: Pooled Funds the ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services Lead Commissioning the partners can agree to delegate commissioning of a service to one lead organisation Integrated Provision the partners can join together their staff, resources and management structures to integrate the provision of a service 5. PROPOSAL FOR LIVERPOOL It is proposed that LCCG and LCC agree to develop an overarching umbrella agreement under Section 75 of the NHS Act This acknowledges that each of the partners has knowledge, skill and experience in delivering and Page 3 of 4

64 commissioning for health and well-being but that together they would be able to operate in a more effective and comprehensive manner with benefits to the organisations themselves and most importantly to the people of Liverpool. The Section 75 Agreement would be signed by LCCG and LCC, committing them to working together to a common vision of health and well-being. The intention is that the proposed new agreement would be in place from April During 2013/14 LCCG and LCC will review existing joint commissioning arrangements and develop further potential new arrangements in line with the Liverpool Health and Well-Being Strategy and commissioning plans. For 2013/14 the details of the previous Section 75 Agreement developed by LPCT and LCC will be left in place. Key to the development of joint working arrangements and the formalisation through the Section 75 Agreement, will be the Health and Well Being Board and the establish of working groups to ensure operational effectiveness and delivery. An interim Joint Commissioning Group will ensure oversight and co-ordination comprising key officers from LCCG and LCC. Governance arrangements will continue to be reviewed in line with development of join commissioning arrangements. Any proposed changes to the Section 75 Agreement will require an impact assessment and will need to be formally approved by both LCCG Governing Body and LCC. Tony Woods Head of Strategy and Outcomes 3 rd July 2013 ENDS Page 4 of 4

65 NHS LIVERPOOL CLINICAL COMMISSIONING GROUP GOVERNING BODY 9 TH JULY 2013 Report no: GB Title of Report Lead Governor Lead Manager Summary Recommendation Authorisation Evidence QIPP Impact Relevant Standards or targets Safeguarding Adults and Children Update Jane Lunt, Head of Quality/Chief Nurse Trish Drew, Designated Nurse Safeguarding Children Helen Smith, Head of Adult Safeguarding The purpose of this paper is to provide an update for Liverpool CCG Governing Body regarding key documents published recently relating to safeguarding adults and children, and to give an overview of the CCG s current position. That Liverpool CCG Governing Body: Note the contents of the report Note the guidance attached Which domain(s) does this support? Please insert x that apply 1. Strong clinical and multi-professional focus X 2. Engagement with patients/carers/communities X 3. Clear and Credible Plans 4. Proper constitutional and governance arrangements X 5. Collaborative arrangements for commissioning X 6. Great Leadership x 4. Ensuring that people have a positive experience of care 5. Treating and caring for people in a safe environment and protecting them from avoidable harm Page 1 of 8

66 Safeguarding Adults and Children Update 1. PURPOSE This paper provides an update for the Governing Body regarding key documents relating to safeguarding adults and children, which are relevant to Clinical Commissioning Groups and an overview of current progress. The key documents are: Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (March 2013) Working Together to Safeguard Children 2013 (April 2013) Safeguarding Adults: an aide memoire for clinical Commissioning Groups (March 2013) 2. RECOMMENDATIONS That Liverpool CCG Governing Body: Note the content of the report Note the guidance attached 3. BACKGROUND The documents have been produced in response to the NHS reforms, and in respect of a review (and subsequent report) commissioned by the coalition government; The Munro Report, A Child Centred System (2011). The Mandate from the Government to the NHS Commissioning Board (NHS CB) for April 2013 to March 2015 (published in November 2012) says: We expect to see the NHS, working together with schools and children's social services, supporting and safeguarding vulnerable, looked-after and adopted children, through a more joined-up approach to addressing their needs. The Mandate also sets the Board a specific objective of continuing to improve safeguarding practice in the NHS, reflecting also the commitment to prevent and reduce the risk of abuse and neglect of adults. This accountability and assurance framework was commissioned by the NHS Commissioning Board in order to set out clearly the responsibilities of each of the key players for safeguarding in the new architecture of the NHS. It has been Page 2 of 8

67 developed in partnership with colleagues from the Department of Health (DH), the Department for Education (DfE) and the wider NHS and social care system. The framework aims to: Promote partnership working to safeguard children, young people and adults at risk of abuse, at both strategic and operational levels Clarify NHS roles and responsibilities for safeguarding, including in relation to education and training Provide a shared understanding of how the new system will operate and, in particular, how it will be held to account both locally and nationally Ensure professional leadership and expertise are retained in the NHS, including the continuing key role of designated and named professionals for safeguarding children Outline a series of principles and ways of working that are equally applicable to the safeguarding of children and young people and of adults in vulnerable situations, recognising that safeguarding is everybody s business. Although this framework focuses on the statutory requirements to safeguard children, the same key principles will apply in relation to arrangements to safeguard adults. Legislation in this area is likely to be strengthened in the foreseeable future, following the publication of the draft Care and Support Bill in July 2012 and the ongoing development and consultation regarding this proposed legislation. 4. Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework This guidance came into effect from 1 st April 2013, and updates and replaces previous interim guidance issued in September Although the NHS has been fundamentally restructured, it remains the responsibility of every NHS funded organisation and healthcare professional to ensure that people in vulnerable circumstances are not only safe but also receive the highest possible standard of care. Section 3 of the guidance outlines the responsibilities for CCGs. The main responsibilities are as follows: CCGs are statutorily responsible for ensuring that the organisations from which they commission services provide a safe system that safeguards children and adults at risk of abuse or neglect CCGs have a statutory duty to be members of Local Safeguarding Children Boards (LSCBs) and are expected to be fully engaged with local Page 3 of 8

68 Safeguarding Adults Boards (SABs), working in partnership with local authorities to fulfil their safeguarding responsibilities. CCGs should ensure that robust processes are in place to learn lessons from cases where children or adults die or are seriously harmed and abuse or neglect is suspected NHS England provides oversight and assurance of CCGs safeguarding arrangements and supports CCGs in meeting their responsibilities, this includes working with the Care Quality Commission (CQC), professional regulatory bodies and other national partners In terms of the direct commissioning responsibility of NHS England, the above duties and requirements apply In order to have been authorised CCGs have also had to demonstrate that there are appropriate systems in place for discharging their responsibilities in respect of safeguarding, including: Plans to train their staff in recognising and reporting safeguarding issues A clear line of accountability for safeguarding, properly reflected in the CCG governance arrangements Appropriate arrangements to co-operate with local authorities in the operation of LSCBs, SABs and health and wellbeing boards Ensuring effective arrangements for information sharing Securing the expertise of designated doctors and nurses for safeguarding children and for looked after children and a designated paediatrician for unexpected deaths in childhood Having a safeguarding adults lead and a lead for the Mental Capacity Act, supported by the relevant policies and training. Current Position for Liverpool CCG Liverpool CCG has systems and processes in place to ensure that the organisations from which they commission services provide a safe system that safeguards children and adults at risk of abuse or neglect. Each contract contains safeguarding standards and key performance indicators (KPIs) which are reviewed regularly by the safeguarding Service and exception reported within the CCG governance structures. Recovery plans for any outstanding issues will be monitored via Clinical Performance and Quality Groups (CPQGs). Page 4 of 8

69 Liverpool CCG is represented on both the LSCB and the SAB through the Chief Nurse/ Head of Quality role, with the Designated Nurse for Safeguarding Children and the Adult Safeguarding Lead also members of the appropriate boards. In addition, the Chief Nurse/Head of Quality is co-chair of the SAB. The CCG is currently developing a system for the dissemination of learning from SCRs and other reviews to ensure that the learning is incorporated into the commissioning process. There are processes in place via the LSCB and the SAB to ensure that learning is shared with practitioners and managers so that practice is changed if necessary. There is a process in place via the Chief Nurses Forum chaired by the Director of Nursing within NHS England (Merseyside) for CCG s to provide assurance and this feeds into the regular assurance meetings between the CCG and NHS England (Merseyside). Merseyside CCGs have commissioned a safeguarding service to work across the CCGs which currently consists of the designated and deputy designated nurses for safeguarding children and the safeguarding adult lead and deputy nurses. These arrangements ensure that expertise with regard to looked after children and deprivation of Liberty (DoLs) standards and the Mental Capacity Act is available to CCGs. The service is hosted by Halton CCG. There are plans to review the arrangements for the designated doctors to ensure that the Service Level Agreement (SLA) reflects the new NHS responsibilities. Liverpool CCG was authorised with no conditions related to safeguarding. 5. Working Together to Safeguard Children 2013 The Department of Education (DfE) published revised guidance in April 2013, which replaces the version published in The guidance has been significantly reduced to 95 pages which is in keeping with the principle within the Munro report of reducing bureaucracy and enabling practitioner autonomy and use of professional judgement in terms of safeguarding. The key changes are: The independence of Local Safeguarding Children s Boards (LSCBs) will be strengthened; reinforcing their role in holding other bodies to account LSCBs will be required to publish a local document defining the thresholds for intervention Page 5 of 8

70 Initial and core assessments undertaken by children s social care will be merged into one continuous and comprehensive assessments and the timescale increased to 45 working days for completion CCGs are responsible for safeguarding quality assurance through contractual arrangements with all providers GP practices should have a named lead for safeguarding who should work closely with the named GP The guidance endorsed the Royal College of Paediatrics and Child Health (RCPCH) Intercollegiate document on roles and competences for health care staff which determines all levels of training LSCBs are required to ensure local learning from Serious Case Reviews (SCRs) and other reviews undertaken The process for SCRs is now more flexible to allow different approaches to be used, although the criteria remain unchanged In terms of Serious Case Reviews, a national panel of independent experts is to be established to provide advice to LSCBs with regard to publication of SCRs Current position for Liverpool CCG: Liverpool CCG is actively involved in the current work to review the work of the LSCB to ensure that the LSCB is effective in its role. This is critical as this will be a consideration of future inspections. There is work being undertaken locally to define thresholds for intervention. The task and finish group is co-chaired by the Chief Nurse/Head of Quality, and the Safeguarding Service has an identified lead for this work who is working closely with a lead officer from Liverpool City Council to review and produce revised documentation. The job descriptions for key roles within safeguarding reflect the Intercollegiate guidance, and any future review of roles will ensure this is maintained. Liverpool CCG contractual arrangements ensure that all contracts have the Northwest safeguarding policy as part of the core requirements, with standards and KPIs that are monitored according to an agreed schedule Liverpool CCG, as part of the commitment to ensuring the quality of primary care services, will work closely with key safeguarding leads to ensure that practices have access to training and support to ensure they are able to discharge their safeguarding responsibilities. Page 6 of 8

71 A thematic review of Liverpool s children s services approach to managing neglect in families was undertaken by Ofsted in June As this was not a formal inspection, there will not be a formal report. However verbal feedback was given to the Director of Children s Services and to the independent chair of the LSCB. There is now an action plan developed to address the areas for improvement and this will be overseen by the LSCB. 6. Safeguarding Adults: an aide memoire for Clinical Commissioning Groups. This document was prepared by Strategic Health Authority adult safeguarding leads, primarily to provide guidance in relation to commissioners duties to safeguard adults in all aspects of their commissioning and sets out how CCGs discharge their duties in accordance with the legislation, guidance and policy relating to safeguarding adults. The aide memoire serves as an interim to support the Accountability and Assurance Framework, and awaiting the outcome of the Care and Support Bill process. The key duties are: A responsibility to ensure high quality care is provided to patients CCGs must ensure that NHS funded services: Provide personalised care that supports patients in their choices about reducing risks of being abused and neglected within their homes and communities Provide services that deliver high quality personalised care supported by robust systems and processes in order to reduce the risks of neglect and abuse occurring within their service Identify and respond to neglect and abuse according to their local multiagency safeguarding adults procedures Further legislation is being developed (the draft Care and Support Bill) which puts adult safeguarding on a statutory footing. Although the NHS is changing, it remains the responsibility of every NHS funded organisation and healthcare professional to ensure that people in vulnerable circumstances are not only safe but also receive the highest possible standard of care. The Francis report highlights the need to end decades of complacency about poor care, by detecting and exposing unacceptable care quickly and ensuring Page 7 of 8

72 that the system takes real responsibility for fixing problems urgently and effectively. The Government and system wide response sets out actions to ensure consistently safe, effective and respectful care. The accountability and assurance framework is not intended to generate new policy or priorities for either the NHS or its partners. It merely seeks to articulate how the performance of the wider NHS with respect to the duties and priorities defined elsewhere will be assured. Current position for Liverpool CCG: This aide memoire forms the basis for ensuring that the CCG is compliant with current policy in terms of safeguarding adults. The position will be reviewed in light of the care and Support Bill becoming law. Jane Lunt Head of Quality/Chief Nurse 01/07/13 ENDS Page 8 of 8

73 Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework Page 1 of 28