Leading the CWHH Clinical Commissioning Groups

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1 Chief Officer s Report June 2013 Purpose This paper provides a summary of the key areas of business as led by the Chief Officer for this and the other three Clinical Commissioning Groups (CCGs) in the collaborative. It includes a brief summary of the main areas of work during May. The CWHH collaborative comprises NHS Central London, West London, Hammersmith and Fulham, and Hounslow CCGs. It has been written as a standard report across all four CCGs. The areas covered are: Quality Seminar Prospectus A&E Performance Improvement Plans The Board Assurance Framework and Internal Audit Contracts Whole systems integrated care and pioneer application CCG Constitution changes Appraisals Staff Engagement Ealing Clinical Commissioning Group Quality Seminar On 30 th May, The Director of Patient and Safety and Quality hosted a quality seminar for staff across the collaborative. It was attended by clinicians, managers and lay members. The main item was a presentation from Yvonne Sawbridge who had been the Director of Quality and Nursing at South Staffordshire Primary Care Trust at the time patient safety issues were identified at Mid Staffordshire NHS Foundation Trust. The powerful seminar led to discussion and debate on how we can practically respond to the recommendations from the Francis Report. The debate focussed on: What do we need to do? What are the practical steps? What will assurance look like? How will we make patients (people) central to our work? The work will be followed up through the Quality and Patient Safety Committee. Prospectus On 29 th April Dame Barbara Hakin, Chief Operating Officer of NHS England, wrote to CCGs clarifying the arrangements to prepare and publish a prospectus The intention of the prospectus is to be a very short guide which explains to the local community what the CCG is, and the ambitions we have for our local population s health services. Each CCG s prospectus should be locally determined to reflect the needs of the people we serve. Our prospectus s: 1

2 reflect the local health and wellbeing strategy; set out the key health priorities for our population; include a high level description of how the budget for these services will be spent; demonstrate how we and our key partners will address health inequalities; and include how our population s views are heard. The prospectus for each CCG in the collaborative will be completed by the end of May. Initially it will be published on our website. We also have plans to produce some hard copies to widen our distribution options. A&E Performance Improvement Plans You will have noticed recent coverage in the press about pressure on accident and emergency services. In order to address local issues, each CCG has produced a detailed plan setting out how we intend to ease pressures on A&E departments through such work as: improving access to GP out-of-hours services, improved communications to patients on the options available to them, working with social care and hospitals to improve hospital discharge arrangements. In order to make sure there is a coordinated approach to addressing these issues, we are creating two Urgent Care Boards across CWHH CCGs: one for Hounslow; and another joint board across the boroughs of Hammersmith and Fulham, Kensington and Chelsea, and Westminster. These Boards will ensure that the local recovery and improvement plans are in place and being delivered. The Urgent Care Boards will report their progress to CCGs as well as NHS England. Board Assurance Framework Workshops have taken place with each CCG in the collaborative to identify the key risks to delivering the organisation s objectives. Risks have been mapped to the four priority areas as described on our plan-ona-page. These are: improving patient safety and quality; performance improvement; establishing and developing clinical commissioning; and integrating health and social care. There is broad alignment across the four CCGs on the main risk areas and these were circulated to chairs and managing directors for comments prior to a discussion with the chairs on 30 th May. This process has identified 20 key risks. The next steps are for these risks to be refined, scored and BAF entries to be worked up. This will include setting risk appetites i.e. the level of risk we are prepared to tolerate. It is also important to ensure that all strategic risks identified at workshops are captured either in the BAF entries or on local risk registers. Internal Audit will focus their work on providing independent assurances that we are managing our strategic risks appropriately. Contracts Good progress has been made with each of the contracts: Community (Central London Healthcare NHS Trust and Hounslow and Richmond Community Healthcare NHS Trust) the final contracts are with the lawyers for final review prior to signing. Mental Health (West London Mental Health Trust, and Central North west London Mental Health Trust) the contracts are being finalised and is due to be sent to the lawyers for final review in the week commencing 3 rd June; 2

3 Chelsea & Westminster amendments are being made to the contract following a review by the lawyers; West Middlesex Heads of Terms not yet signed, this is being held up by an NHS England issue relating to transitional relief which has yet to be resolved. Imperial agreement has been reached on financial issues but letters are being exchanged on other matters. The Director of Contracts and Information Development, Cerith Lewis, has been seconded to the Commissioning Support Unit (CSU) as Account Director for Imperial and is developing an action plan to address the issues arising from this. His role has now been filled by Anne Dray on an interim basis. Whole systems integrated care and pioneer application The Whole Systems Integrated Care project is addressing the systemic barriers that commissioners across health and social care face in delivering their local integration initiatives and integrated care elements of their Out of Hospital strategies. After discussions with commissioners and providers from health and social care, the Strategy and Transformation team have planned a dual-phase programme: an initial co-design phase to create solutions, tools and products for boroughs to implement locally an implementation phase with flexible timescales for each locality. Norman Lamb, Minister for Care and Support, has announced his intention to launch a new wave of largescale, locally led pioneer sites in integrated care across the country. We believe that NWL as a collaboration of health and social care organisations is well positioned to be a pioneer site and that our Whole systems integrated care programme could develop a strong application. The patient voice will sit at the heart of the programme s progression, and we will work to align all programme stakeholders around a common set of patient-centric values or principles which are core to delivering integrated care at scale and pace across NWL. CCG Constitution changes Underpinning our governance arrangements is our constitution. This document describes how we are set up and how decisions are made. All CCGs across the collaborative produced constitutions which passed authorisation requirements. NHS England acknowledges that these documents will require refinement and amendment as we develop as organisations and, on 30 th May, set out the process to be followed. The key points that NHS England have asked us to note are: Date for submission of constitutional changes - before Jun 14th The national guidance suggests a submission date of June 1 st. Given the very recent publication of the guidance we are suggesting that London CCGs who wish to make constitutional changes submit information to patch delivery teams before the 14th June. Process for submitting information on constitutional changes - CCG to submit a formal application to Patch Delivery Team. There is not a standard template for submissions on constitutional changes. CCGs are encouraged to submit an application that reflects their local needs and meets the requirements set out in the national guidance. A checklist has been issued to help ensure that CCGs have covered all the requirements in making an application. 3

4 All constitutional changes need to be submitted for approval - No matter how minor. Unfortunately the guidance doesn t include any minimum thresholds for changes, and therefore all changes, however minor, have to be submitted for approval. Process for reviewing applications for constitutional changes - A template has been developed to support Patch Delivery teams review all applications for constitutional changes and develop a narrative to justify recommended decision. This will be used to support the recommendation for approval. The Director of Compliance is working with each CCG to ensure that we comply with this direction. Appraisals A new appraisal system for staff across the CCG has been launched. Each member of staff will have an annual appraisal with their line manager at which performance will be reviewed and objectives set for the year. Objectives will be linked to those of the CCG. Staff engagement On 23 rd May we held our second staff engagement event. The event was well attended and covered: Plans and objectives for 2013/14 Staff appraisal system What is working well and what can be improved Safeguarding Children Understanding the new NHS organisational landscape We also send monthly newsletters to staff with updates on progress, reminding staff of the key areas of focus. Severance Payments David Nicholson has written to all Accountable Officers with advice for CCGs on the process for approval of severance payments and wording in constitutions on whistleblowing. The letter emphasises the importance of every NHS organisation supporting NHS staff seeking to raise concerns in the public interest. He re-iterates the various guidance that has been issued in this area and confirms that HM Treasury approval is required for any non-contractual payments made by an NHS body, including those arising as part of a settlement of employment issues. The letter also covers the perception of gagging clauses in constitutions that prevent members or employees from speaking out about the work of the CCG without the written approval of its governing body. It suggests that CCGs adopt the following statement: The group recognises and confirms that nothing in or referred to in this constitution (including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the group, any member of its governing body, any member of any of its committees or sub-committees or the committees 4

5 or sub-committees of its governing body, or any employee of the group or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act. Ealing Clinical Commissioning Group Ealing CCG has submitted a proposal to NHS England to move from the federation of CCGs in outer North West London to the CWHH collaborative of CCGs. NHS England has responded with an assurance process to be followed before a decision can be made. An Ealing Options Programme Board has been established to steer and oversee the programme of work arising from the proposal. Jeff Zitron, the chair of the 8 NW London PCTs up until their dissolution on 31 st March 2013, has been appointed as an independent chair of the programme board. The programme board will be accountable to Ealing CCG governing body and will provide updates to this governing body on progress. Recommendation The governing body is asked to: note this report; and agree to the commitment on severance payments. Daniel Elkeles Chief Officer, CWHH CCGs 30 th May