NHS Kernow Disclosure Log Freedom of Information Requests November 2014

NHS Kernow Disclosure Log Freedom of Information Requests November 2014

Contents FOI 45160 - Information governance - OOH Complaints / Serious Incident Reports. 3 FOI 45150 Contracts - OOH services... 5 FOI 45140 Contracts - Mitie... 6 FOI 45130 - Continuing healthcare - CHC Co-ordinators... 8 FOI 45110 - Finance & budgets - Remuneration... 8 FOI 45060 - Clinical management - Bowel cancer... 9 FOI 45050 Organisation Governing Body... 10 FOI 45020 Contracts GP services... 10 FOI 44980 - Referral management - Orthopaedic surgery... 10 FOI 44970 - Prescribing & pharmacies - Incontinence pads... 11 FOI 44950 - Referral management - Commissioning Treatment... 11 The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988. You are free to use it for your own purposes, including any non-commercial research you are doing and for the purposes of news reporting. Any other re-use, for example commercial publication, would require the permission of the copyright holder. Most documents supplied by NHS Kernow Clinical Commissioning Group will have been produced by local officials and will be our copyright. Information you receive which is not subject to our copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. You must ensure that you gain their permission before reproducing any third party information. 2

FOI 45160 - Information governance - OOH Complaints / Serious Incident Reports Date received: 28/11/2014 1. The total number of complaints, to both the CCG and the providers commissioned by your CCG, relating to Urgent Care Centres, GP Out of Hours services, minor injuries units and walk in centres. This request is for all complaints that meet these criteria and were submitted from 1 June 2014 to 28 November 2014. A. To identify the providers and services mentioned in the request, we have searched our files under the search terms of Camborne Redruth Community Hospital; West Cornwall Hospital; Serco; MIUs, and Cardrew Health Centre. From 1 June to 28 November 2014, NHS Kernow received five complaints about these services, one which was investigated by NHS Kernow as a complaint. The other four complaints were sent to the appropriate body/ies for investigation under the NHS Complaints Procedure. We do not hold information on complaints made directly to providers, to the level of detail which will enable us to answer your question. To gain this information, you will need to contact the relevant provider. 2. If the CCG has an arrangement with any service providers whereby all complaints that meet the above criteria are not forwarded to the CCG then we request the clause/s of the contract between your CCG and the providers commissioned by it to provide urgent care, GP Out of Hours services and minor injuries units relating to this aspect of the relationship between your CCG and these providers, as well as all information about what other public body/bodies this complaint information is forwarded to, if any. A. Minor Injury Units: NHS Kernow adopts the national contract template for its contract with Peninsula Community Health to provide a minor injury unit service. This contract contains a standard clause which specifies how the provider must deal with complaints. The following sections have been taken from the contract: SC3 Service Standards: 3.4 The Provider must continually review and evaluate the Services, must implement Lessons Learned from those reviews and evaluations, from complaints, Patient Safety Incidents, Never Events, and Service User and Staff involvement (including the outcomes of Surveys), and must demonstrate at Review Meetings the extent to which Service improvements have been made as a result. SC17 Complaints: 17.1 The Commissioners and the Provider must each: 17.1.1 publish, maintain and operate a Complaints Procedure which complies with the Law and Guidance; and 3

17.1.2 ensure that Service Users are made aware of that Complaints Procedure and how to use it effectively. NHS Kernow does not require providers to supply details of individual complaints, but they must provide a summary of any complaints through the quality management processes. This must include the number of complaints, a summary including a timeline of response and confirmation if the complaint was upheld, not upheld or partially upheld. The summary must also include any themes and any learning or actions that arose. Out of hours service: The out of hours service is commissioned under an APMS contract, which states the following must procedure must be followed when dealing with complaints: Schedule 10: Complaints procedures: The Provider shall have systems in place to ensure that Patients, their relatives and carers have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of the Services. The Provider shall handle complaints in line with The Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 (SI 2009/309) and Good Industry Practice. http://www.legislation.gov.uk/uksi/2009/309/contents/made The Provider shall have systems in place to ensure that Patients, their relatives and carers are not discriminated against when complaints are made. The Provider shall endeavour to use concerns and complaints from Patients, relatives and carers to improve service delivery where appropriate. The Provider shall submit quarterly and annual reports regarding complaints in accordance with Annex 1 of Schedule 10. The Provider shall allow the PCT to inspect individual complaints records on request by the PCT. In addition, as part of the out of hours national quality requirements, which must be achieved by all out of hours providers, they must adhere to the following procedure: Providers must operate a complaints procedure that is consistent with the principles of the NHS complaints procedure. They will report anonymised details of each complaint, and the manner in which it has been dealt with, to the contracting PCT. All complaints must be audited in relation to individual staff so that, where necessary, appropriate action can be taken. NHS 111: The NHS 111 contract states that complaints must be dealt with in the following way: 4

Complaints: In relation to any complaint which the Commissioner is required by Law or otherwise to handle itself, the Contractor acknowledges and accepts that in attempting local resolution of any complaint it is acting as the agent of the Commissioner as well as on its own behalf. The Contractor shall comply with the terms of the Complaints Procedure; and record all complaints received in relation to the Services, setting out the reason for each complaint and the outcome of each complaint. The Contractor shall comply with all regulations, codes of practice, guidance notes and other requirements issued by the Commissioner, the relevant Strategic Health Authority, the Secretary of State and the Department of Health on complaints handling. The Contractor shall implement Lessons Learned from complaints and demonstrate at Contract Meetings the extent to which Services improvements have been made as a result. The Contractor shall issue a complaints, litigation, incidents and patients advice and liaison ( CLIP ) report in the frequency, manner and containing all the relevant information required pursuant to the terms of this Contract or as reasonably required by the Commissioner. 3. The total number of Serious Incidents Requiring Investigation reported to you by any and all members of staff (or any other person) relating to Urgent Care Centres, GP Out of Hours Services and minor injuries units. This request is for all Serious Incident Reports that meet these criteria and were submitted from 1st June 2014-28th November 2014. A. There was one reported Serious Incident Requiring Investigation related to GP out of hours services from 1 June to 28 November 2014. FOI 45150 Contracts - OOH services Date received: 28/11/2014 1. A list of all the providers your CCG has commissioned to provide urgent or unscheduled care, including GP Out of Hours services, minor injuries units, Urgent care services and any other service excluding A&E and Ambulance services. A. NHS Kernow commissions Peninsula Community Health to provide minor injury units from its community hospitals. The GP out of hours service is provided by Serco. 5

NHS 111 is provided by SWASFT. 2. Please also inform me if these services are due for retendering and if so when that tender may be issued. A. Community services: This contract is due to end on 1 March 2016. The CCG is working with Monitor and NHS England on its options relating to the contract in order to inform our decision to extend the contact; to procure a new service or undertake a redesign as part of our Living Well programme. No decision has been made when the tender may be issued. Out of hours: This contract ends 31 May 2015. It was decided in September 2014 to put the service out to open tender to ensure a service is in place when the contract ends next year. NHS 111: This contract ends on 3 February 2019, with a potential break clause on 31 March 2016. The Official Journal of the European Union (OJEU) was issued on 1 October 2014 and the expression of interest deadline was 31 October 2014. The tender documents were issued on 7 November and the tender response deadline is 18 December 2014. We are involving local clinicians and patient representatives in our process, and will announce the new provider early next year. 3. Please also send me the value/cost of the contracts for these services. The total costs will suffice I am not requesting copies of the contracts. A. The community services contract is worth 74.4 million per annum. The out of hours contract is worth 6.3 million per annum. The NHS 111 contract value is worth 1.5 million per annum. FOI 45140 Contracts - Mitie Date received: 25/11/2014 1. Did the CCG have any involvement in the appointment of Mitie? A. No. 2. Are you aware that this company has a criminal record? Why was this company chosen when it has been fined many times for health and safety breaches? A. NHS Kernow was not involved in the decision to award this contract. Please redirect your enquiry to Royal Cornwall Hospital Trust - foi.rcht@cornwall.nhs.uk. 3. What other contracts does Mitie already hold within the Kernow CCG region? A. NHS Kernow would only have details of services it has commissioned. NHS Kernow does not have any contracts with Mitie. Please contact Mitie direct to find out this answer. 6

4. Which other possible outsourcing contracts are you currently working on for the NHS in Cornwall? A. NHS Kernow is undertaking a number of procurements. Both NHS and non-nhs providers are eligible to take part in this process. These contracts are: Improving Access to Psychological Therapies (IAPT services): The contract is worth 4.1 million and is due to expire on 1 November, 2015. The CCG is working with local clinicians and users to determine if it will extend the contract for another year, redesign or procure a new service. Children s community services: A range of children s health and wellbeing services in Cornwall and the Isles of Scilly were put out to tender in October 2014. The commissioners NHS Kernow, Cornwall Council, NHS England and the Council of the Isles of Scilly - have put the 23 services into a procurement process. The services include school nursing; speech and language therapy; Health Visiting; Family Nurse Partnership and child and adolescent specialist mental health services. The new contracts have a combined value of 22 million per year and must be in place for 1 April 2016. The contract values for each commissioner are: NHS Kernow: 13.20 million. NHS England: 6.117 million. Cornwall Council: 1.808 million. No decision has been made as to who will provide these services and both NHS and non-nhs organisations, voluntary groups and charities are able to respond to the tender process. Out of hours/ urgent care: The value of the contact is 6.3 million per annum and it ends on 31 May 2015. It was decided in September to put the service out to open tender to ensure a service is in place when the contract ends next year. We are involving local clinicians and patient representatives in our process, and will announce the new provider early next year. Community services: The contract is worth 74.4 million and is due to end on 1 March, 2016. The CCG is working with Monitor and NHS England on its options relating to the contract in order to inform our decision to extend the contact; to procure a new service or undertake a redesign as part of our Living Well programme. Musculoskeletal services: The musculoskeletal service (MSK) is provided under a commissioning arrangement called Any Qualified Provider that is worth 2 million per annum. The contract expires on 31 March, 2016 and NHS Kernow is working with stakeholders to determine whether to extend the contact for another year; to procure a new service or undertake a redesign. Audiology AQP: The adult hearing (audiology) service is provided under the Any Qualified Provider arrangement. The contract costs 1 million per annum. 7

The contract expires on 31 March, 2016 and NHS Kernow is deciding whether to extend the contact for another year; to procure a new service or undertake a redesign. Wheelchair services - equipment and maintenance: This contract, which is worth 1.2 million, is due to end on 1 November 2015. NHS Kernow is working with stakeholders to inform whether to extend the contact for another year; to procure a new service, including looking at different rehabilitation models, or to undertake a redesign. 5. Do any of them involve Mitie, Serco or G4S as potential bidders? A. NHS Kernow cannot confirm or deny the names of potential bidders until the procurement has ended and the contract has been awarded. We therefore exempt this information under Section 43 of the Freedom of Information Act, commercial interests. FOI 45130 - Continuing healthcare - CHC Co-ordinators Date received: 25/11/2014 1. How many staff does the CCG (including its Support Unit) currently have, whose job title, or part-title, is: NHS Continuing Healthcare assessment Coordinator? A. NHS Kernow employs 26 people to assess CHC eligibility claims. FOI 45110 - Finance & budgets - Remuneration Date received: 24/11/2014 1. The total number of non-clinical staff who received remuneration equal to, or in excess of, 100,000 in 2013-14. A. The details of NHS Kernow s senior managers salaries and allowances that are equal to, or in excess of 100,000, are contained within our Annual Report, which is published online: www.kernowccg.nhs.uk/media/460372/nhs_kernow_annual_report_and_account s_2013-14.pdf We therefore exempt this information under section 21 of the Freedom of Information Act, information accessible by other means. In addition, NHS Kernow employed one other person whose remuneration (defined as salary plus employer s superannuation costs) exceeded 100,000 during 2013/14. Employer s pension contributions are paid in-line with the NHS Pension Scheme requirements. The statutory disclosure does not expect this to be quantified for individual employees. The statutory requirements are published in line with national guidance and are available on page 93 of the annual report: www.kernowccg.nhs.uk/media/460372/nhs_kernow_annual_report_and_account s_2013-14.pdf 8

2. For those non clinical staff who received remuneration in excess of 150,000: i. The employee s name ii. The employee s job title iii. The remuneration received by the employee iv. An itemised list of expenses claims made by the employee. If an itemised list is not available, please provide the amount the employee claimed in expenses in 2013-14 A. As supplied to the previous FOI request, NHS Kernow did not pay any non clinical staff member in excess of 150,000 during 2013/14. FOI 45060 - Clinical management - Bowel cancer Date received: 20/11/2014 1. Are patients diagnosed with bowel cancer under 50 years within your clinical commissioning group tested for Lynch Syndrome at diagnosis? 2. Is Lynch syndrome testing carried out using MMR immunohistochemistry? If not, which method is being used to test for Lynch syndrome? 3. If testing for Lynch syndrome is not carried out, are you intending to implement the recommendation for Lynch syndrome testing? A. NHS Kernow does not commission bowel cancer screening, this is the responsibility of NHS England. Please contact NHS England for further details: england.contactus@nhs.net. NHS Kernow is, however, responsible for the pathway to diagnose and manage colorectal cancer. Our service specification for colorectal cancer requires compliance with Royal College of Pathologists guidelines for surgical sections and states that pathology services must be available to the multidisciplinary team in-line with the network agreed guidelines for these services. The pathology services should operate as per Royal College of Pathologists guidelines and standards. Laboratories should comply with Clinical Pathology Accreditation (UK) Ltd (CPA) and participate in appropriate NEQAS modules. Pathologists should complete the Royal College of Pathologists minimum dataset for colorectal cancer for discussion at the colorectal cancer multidisciplinary team. We have checked with our two providers about its testing procedures and can confirm that at Derriford Hospital in Plymouth, patients who are younger than 50 and diagnosed with bowel are discussed during a weekly colorectal multidisciplinary team meeting and samples are sent to Birmingham for MMR testing. We understand they employ both immunohistochemitry IHC) and the Bethesda MSI analysis panel with DHPLC in Birmingham. The Royal Cornwall Hospital NHS Trust tests all Duke B carcinoma with MSI testing, which can be used as a surrogate for Lynch syndrome but not diagnostic. To do this it has to do genetic testing, which if implemented on site would need to be discussed as to the best platform. 9

Please contact both providers if you would like more details: Derriford Hospital at plh-tr.foi-requests@nhs.net and Royal Cornwall Hospital NHS Trust at foi.rcht@cornwall.nhs.uk FOI 45050 Organisation Governing Body Date received: 20/11/2014 1. How many times, since April 2013 to September 2014, have more than 50% of the members of the CCG governing body meeting have been required to withdraw from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests? A. None. 2. In addition, when this has happened what process, of the potential options available in the constitution, has specifically been put in place by the CCG? A. Not applicable, see previous answer. FOI 45020 Contracts GP services Date received: 17/11/2014 1. How many a) GPs are employed in the entire CCG area and b) per 100,000 people; 2. What is the average waiting time for a GP appointment in the CCG area? 3. How many vacancies are there for GPs at practices across the CCG area? A. NHS Kernow does not commission GP services and is unable to answer your questions. Please re-direct your questions to NHS England, which commissions GPs. Please email england.contactus@nhs.net. FOI 44980 - Referral management - Orthopaedic surgery Date received: 17/11/2014 1. Does the CCG have a triage process for patients with orthopaedic symptoms, or does the CCG allow unrestricted GP referrals? A. Yes, NHS Kernow does have a triage process for patients. 2. If the CCG does have a triage process, how is it organised? A. Referrals in Cornwall and the Isles of Scilly are managed through two referral management centres. The Referral Management Service in Truro and Devon Referral Support Services in Newton Abbott that covers the GP practices in east Cornwall. The RMS and DRSS employ GPs/consultants who look at the referrals and ensure that they comply with current agreed referral guidelines that have been developed in conjunction with general practitioners and secondary care clinicians. 3. How are patients given a choice of provider for orthopaedic surgery in the area the CCG covers? 10

A. The referral management centres provide patients choice under the Choose and Book service. A number of providers will be offered to the patient based on their clinical need. 4. Does the CCG have any plans to tender orthopaedic triage services in the next year? A. The CCG will undertake an Orthopaedic Services Review in 2015/16. The review will look at the whole pathway including triage options. FOI 44970 - Prescribing & pharmacies - Incontinence pads Date received: 14/11/2014 1. Please could you tell me how much the Kernow CCG spent on Incontinence Pads for the financial year 2103/14. If you do not have a figure for that period, the last available data will suffice. A. NHS Kernow spent 523,256 on incontinence pads during 2013/14. 2. Who within the CCG has clinical responsibility for Urology in terms of commissioning? A. NHS Kernow does not have a clinical lead for urology. FOI 44950 - Referral management - Commissioning Treatment Date received: 03/11/2014 1. The names of the CCGs you represent A. NHS Kernow. 2. How many commissioning policies are in operation for treatment or referral to treatment (either drawn up by the CCG or inherited from previous organisations) A. We exempt this information under section 21 of the Freedom of Information Act, information which is accessible by other means, as it is published on our website at www.kernowccg.nhs.uk/get-info/individual-funding-requests/treatment-policies/ 3. How many of those policies include additional threshold criteria when compared to NICE criteria for patient eligibility. A. We exempt this information under section 21 of the Freedom of Information Act, information which is accessible by other means, as it is published on our website at www.kernowccg.nhs.uk/get-info/individual-funding-requests/treatment-policies/ 4. How many of the CCG policies which state additional threshold criteria include prohibitions or restrictions on commissioning of treatments based on: a) BMI b) Degree of weight loss c) Smoking Status d) Alcohol consumption e) A maximum age 11

f) A minimum time period of "watchful waiting" before the start of treatment g) Financial cost If a full breakdown is not available please give as full an answer as possible. A. Details of criteria is published alongside each policy, which are available online at www.kernowccg.nhs.uk/get-info/individual-funding-requests/treatment-policies/ We exempt this information under section 21 of the Freedom of Information Act, information which is accessible by other means. 5. How many policies (for treatment or referral of treatment) have been changed by the CCG since its inception to include additional threshold criteria when compared to NICE eligibility criteria. A. There are two NHS Kernow policies that are different to NICE guidance. These are the varicose vein policy and the assisted conception policy. The varicose vein policy states that, despite the NICE clinical guidance 168 recommending that patients with mild symptoms should be offered intervention, KCCG has decided that, in view of the high prevalence of varicose veins and the difficulty predicting who will benefit the most and from what treatment, Cornwall will continue to apply local referral criteria for varicose vein intervention. The assisted conception policy has limitations on age, BMI and smoking. 12