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Agenda Item No: 6.1

REPORT TO: GOVERNING BODY

MEETING DATE: 27 July 2015

REPORT TITLE:

Chief Clinical Officer’s Report

SUMMARY OF REPORT:

This report provides an update on issues of interest pertinent to Governing Body members which have taken place since my last

update in June 2015.

REPORT RECOMMENDATIONS:

Members are requested to note the updates within this report.

FINANCIAL IMPLICATIONS:

None.

REPORT CATEGORY: Formally Receipt

Tick

√

Action the recommendations outlined in the report.

Debate the content of the report

Receive the report for information

AUTHOR:

Debra Atkinson Corporate Business Manager

Report supported & approved by your Senior Lead Yes

PRESENTED BY:

Mike Ions Chief Clinical Officer

OTHER COMMITTEES/ GROUPS CONSULTED:

N/A

EQUALITY IMPACT ASSESSMENT (EIA) :

Has an EIA been completed in respect of this report? N

RISKS: None N

PATIENT ENGAGEMENT: Has there been any patient engagement associated with this report.

Y

CONFLICT OF INTEREST: None N

PRIVACY STATUS OF THE REPORT: Can the document be shared? Y

Which Strategic Objective does the report relate to

Tick

1 Commission the right services for patients to be seen at the right time, in the right place, by the right professional.

√

2 Optimise appropriate use of resources and remove inefficiencies. √

3 Improve access, quality and choice of service provision within Primary Care √

4 Work with colleagues from Secondary Care and Local Authorities to develop seamless care pathways

√

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Agenda Item No: 6.1

NHS East Lancashire CCG Governing Body 27 July 2015

Chief Clinical Officer’s Report

1 Introduction This report provides an update on both strategic and operational issues of interest to Governing Body members which have taken place since my last update in June 2015. 2 Department of Health 2.1 Financial Controls The Secretary of State has announced a package of measures that will help to cut costs whilst improving frontline care. Tacking staff agencies is part of the package which will help the NHS bring down agency staff bills which cost the NHS £3.3 billion last year. Other controls include limiting the use of expensive management consultants. A series of new rules will:

• set a maximum hourly rate for agency doctors and nurses • ban the use of agencies that are not on approved frameworks • put a cap on total agency staff spending for each NHS trust in financial difficulty • require approval for any consultancy contracts over £50,000

The agency staff cap will firstly apply to nursing staff but will be extended to other clinical, medical and management and administrative staff. Capped rates will be reduced from the initial set level over time. 2.2 New Deal for General Practice In a speech on the 19 June, the Secretary of State announced a ‘new deal for General Practitioners (GPs)’ where he outlined plans to invest in new GPs and surgeries, in return for seven day appointments for patients. Part of his announcement included a new piece of work to develop a programme of support for failing practices, details of which are still to be worked through. The which has been produced by Royal College of General Practitioners has published a blueprint which sets out a comprehensive plan for the future of General Practice. The document, “A blueprint for building the new deal for General Practice in England” was shared with the Government immediately following the outcome of the General Election and had been discussed with the Secretary of State for Health and the Chief Executive of NHS England. The Blueprint sets out five overarching actions which the RCGP suggests should be taken by the new Government to strengthen General Practice for the future. The actions set out are:

• Invest 11% of the NHS budget in General Practice • Grow the GP workforce by 8,000 • Give GPs time to focus on patient care • Allow GPs time to innovate

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• Improve GP premises

Further information via: http://www.rcgp.org.uk/newdeal 3 NHS England 3.1 Transforming Services for People with Learning Disability Following the publication of the Winterbourne report the Department of Health published a report and action plan titled ‘Transforming Care’. The Winterbourne report highlighted the very high number of recorded physical interventions, evidence of poor quality healthcare, routine healthcare needs not being met and families and other visitors not allowed access to the wards or patients’ bedrooms. Individuals also had limited access to advocacy and the review found widespread failings in service design, failure of commissioning and a failure to transform services in line with established good practice. The subsequent Bubb Report published in November 2014 reinforced and escalated requirements in relation to how people with learning disability are supported and it emphasised a lack of progress within the national and local plans on Winterbourne/Transforming Care. The report is directive about how commissioners need to respond to the agenda, specifying the need for ‘one shared plan’, ‘one lead commissioner’ and ultimately, ‘one pooled budget’.

NHS England has established five fast track sites that will test new approaches to re-shaping services for people with learning disabilities and / or autism, to ensure more services are provided in the community and closer to home. The sites will bring together organisations across health and care that will benefit from additional technical support from NHS England and have access to a £10 million transformation fund, to kick-start implementation from Autumn 2015.

The sites are:

Greater Manchester and Lancashire;

Cumbria and the North East; Arden;

Herefordshire and Worcestershire;

Nottinghamshire;

Hertfordshire.

Lancashire’s inclusion in this programme will drive the transformation required and take forward the following areas, agreed prior to the fast track sites being established:

for Programme Office Support from LCC to develop a new strategic action plan

for higher level support for Adult Social Care LCC – an Area Operations Manager and a Principle Social Worker will be identified to lead on the Transforming Care agenda from a Social Work perspective

for support with capacity and develop the action plan for Lancashire from CSU Service Redesign

for agreement from the LD Commissioners Network to develop a Pan Lancashire Shared Vison & Action Plan.

Jan Ledward, Chief Operating Officer for Chorely & South Ribble and Greater Preston CCG has been identified as the Senior Responsible Officer to lead the process for Lancashire and has outlined 7 priority areas in a letter to NHS England detailing Lancashire’s requirements for a bespoke package of support from the Fast Track programme. These areas are:

project management

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clinical leadership

social work leadership

carer and user involvement and engagement

legal advice

market management

Personal Health Budget advice and support

A governance framework for the transformation programme for Lancashire has been developed and Project Boards have been established with representation from each of the commissioning organisations in both Lancashire and Manchester with the first meeting of the Lancashire Board took place on Friday 17 July. The group will plan and develop the trajectory to produce the Joint Transformation Plan with timescales for submission in September. The Governing Body is asked to note the progress being made in developing the Transforming Care agenda in Lancashire and a further update will be given at the Governing Body’s Informal meeting in August.

3.2 New £15m Scheme to Give Patients Pharmacist Support in GP Surgeries

A new £15m scheme to fund, recruit and employ clinical pharmacists in GP surgeries was launched on 7 July by NHS England Chief Executive Simon Stevens.

The three year initiative, which will go live this year, will give patients the additional support of an expert pharmacist in their GP surgery. Examples of the benefits patients can expect include extra help to manage long-term conditions, specific advice for those with multiple medications and better access to health checks.

The pharmacists will be employed directly by the general practice to help patients, while also easing GP workload and improving communication between general practice, hospitals and community pharmacists. The scheme will focus on areas of greatest need where GPs are under greatest pressure, and aims to build on the success of GP practices already employing pharmacists in patient-facing roles.

The announcement is an important part of the New Deal for General Practice outlined by the NHS Five Year Forward View, and is the result of close collaborative work with Royal College of General Practice, the BMA’s General Practice Committee, the Royal Pharmaceutical Society and Health Education England.

Simon Stevens, NHS England Chief Executive said: “This has the potential to be a win-win-win for patients, their GPs and for pharmacists.

“Tapping into the skills of clinical pharmacists should help expand care and relieve some of the pressure that GPs are clearly under. This isn’t a silver bullet but it is a practical and constructive contribution to the wider challenge.”

The model of each pilot site will be based on one senior clinical pharmacist and five clinical pharmacists. The senior clinical pharmacist will provide mentoring to the other pharmacists, including training support where needed to take on prescribing responsibilities during the programme. The clinical pharmacists will undertake a tailored education programme throughout the first year. Around 250 pharmacists are expected to be employed in the first wave of the programme. NHS England will co-fund the new pharmacists alongside practices.

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NHS England will part fund the pharmacists pay costs for 36 months

o 60% for the first 12 months of employment

o 40% for the second 12 months of employment

o 20% for the third 12 months of employment

o 0% after the first 36 months of support (or fewer months if recruited after 31 March 2016)

Applications by general practices to participate in the pilot will be assessed against a set of criteria and will be considered by NHS England regions and Health Education England who can apply their local knowledge in support of applications. The final determination will be made by the national moderation panel consisting of all partner organisations. More information can be accessed at the Clinical Pharmacists in General Practice Pilot webpage.

3.3 Annual Investment Decisions for Certain Specialised Services

NHS England has set out its planned investment decisions for certain specialised services as part of its annual commissioning round.

The decision follows a three-month public consultation on the principles and processes NHS England will follow when making investment decisions. Feedback from the consultation has helped inform the way these decisions have been made. NHS England has listened to the views of patients and service users and also taken advice from clinical experts and the independently chaired Clinical Priorities Advisory Group (CPAG).

Thirty nine proposed new investments have been carefully considered against the principles NHS England follows when making investment decisions. The principles can be found in Appendix A of NHS England’s response to consultation on investing in specialised services.

The following treatments and services will be routinely commissioned:

Duodopa as a treatment to control the symptoms of patients with advanced Parkinson’s Disease

A programme of BRCA1/2 gene testing, helping women to discover if they have harmful genetic mutations which can increase the likelihood of developing breast or ovarian cancer

A raft of new genetic tests to be provided by the UK Genetic Test Network

Widening access to Proton Beam Therapy for certain types of cancer, for both children and adults

New treatments – bedaquiline and delamanid – for drug-resistant tuberculosis

Robotic-assisted surgery for early stage prostate cancer

Cervical disc replacement to address spinal degeneration

Extending treatment with Ivacaftor for Cystic Fibrosis with the G551D mutation

Riociguat for use in chronic thromboembolic pulmonary hypertension

Sildenafil and Bosentan for digital ulceration in systemic sclerosis

Intrathecal drug delivery for cancer pain

Occipital nerve stimulation for intractable headaches & migraine

Rituximab for steroid sensitive nephrotic syndrome in children

Rituximab for steroid resistant nephrotic syndrome in children

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Rituximab for acquired haemophilia

Biologics for Juvenile Idiophatic Arthritis in children and adults

Sacral nerve stimulation for urinary incontinence and retention

Management of fetal anaemia secondary to red cell alloimmunisation (Fetal transfusion)

A new service for hand transplants, giving those with amputated forearms an alternative to prosthetics

New guidelines on the use of Positron emission tomography–computed tomography (PET-CT)

Elvitegravir/cobicistat/emtricitabine/tenofovir for treatment of human immunodeficiency virus (HIV) Type 1 infection in adults

Cobicistat for booster in treatment of HIV positive adults and adolescents

A Treatment as Prevention programme for patients with HIV, to both reduce mortality and illness for the patients themselves and the risk of transmission by reducing viral load

The following treatments and services will not be routinely commissioned:

Two separate policies on Deep Brain Stimulation for chronic pain and refractory epilepsy

Three separate policies on new types of prosthetic limbs

The use of Sapropterin to treat the rare genetic condition Phenylketonuria (PKU) in children.

Eculizumab and Bortezomib for prevention of organ rejection post kidney transplantation

Cytoreductive surgery with HIPEC for peritoneal mesothelioma

Intrathecal Drug Delivery for chronic non-cancer pain

Infliximab (Remicade) and Adalimumab (Humira) Anti-TNF treatment options for adults and children with severe refractory uveitis

NHS England has agreed with the recommendations from CPAG that final funding decisions on the following two treatments should be made after NICE has concluded its Highly Specialised Technology Appraisal process:

Elosulfase alfa (Vimizim) for Morquio A Syndrome.

Ataluren (Translarna) for Duchenne muscular dystrophy.

The NICE appraisal of elosulfase alfa (Vimizim) should conclude in 12 – 16 weeks’ time and is expected to produce draft guidance on ataluren (Translarna) in October, with final guidance to follow shortly after. The European medicines regulator has also asked the manufacturer to undertake further studies of the treatment for completion in October.

Three further clinical policies – one on new service standards for Gender Dysphoria treatment options and two policies on the use of Rituximab – that were due to be considered as part of this round of prioritisation are now expected to be considered later in the year once more evidence has been gathered and there has been further public engagement and consultation.

The clinical commissioning policies considered as part of this process are now available on the NHS England website

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Routes remain open to clinicians for patients with exceptional or critically clinically urgent need, to access a certain treatment or service, even where a clinical commissioning policy has not been approved through this process.

3.4. GP Patient Survey Results

The latest GP Patient Survey which seeks the views of over two and a half million people every year about their experience of GP services and NHS dentistry, has been published on 2 July.

The data included in this publication was collected in two waves during July to September 2014 and January to March 2015.

Dr. David Geddes, Head of Primary Care Commissioning for NHS England, said: “The GP Patient Survey provides invaluable feedback and insight on the services we provide. It is encouraging to see the vast majority of patients rate their experience of general practice as good but there are also areas where we can focus efforts to improve services across the country.

“We are working on ambitious plans, set out in the Five Year Forward View, to strengthen primary care including £350 million of investment in new schemes to improve access to general practice and improve premises and technology. We are also working with Health Education, The Royal College of General Practitioners and the British Medical Association’s GP Committee, to expand the primary care workforce and further benefit patients.”

The full survey results can be viewed at:

http://www.england.nhs.uk/statistics/2015/07/02/gp-patient-survey-2014-15/

3.5 Children and Young People Give Their Views in Unique Health Survey

The first ever survey seeking the views of children and young people on the health services they receive has been published on 1 July.

Children and young people aged eight to 15 years have been asked to give their views as part of the survey conducted by the Care Quality Commission.

Children aged nought to seven years are also included in the first National Children’s Inpatient and Day Case Survey 20124 – although their parents only were asked for their views.

The experiences of almost 19,000 children and young people, who stayed in hospital or were seen as day patients, were included in the survey. They show that 87% of children and young people and 88% of parents or carers rated their overall experience as seven or above out of ten.

Nationally, 137 acute NHS trusts took part in the survey which was broken down into three age-appropriate questionnaires, specially developed to give children and young people a voice on health care. These were divided into nought to seven years – parents’ survey; the eight to 11 years child and parent survey, and the 12 to 15 years young person and parent survey.

There are a number of surveys within the NHS patient survey programme which gather the views of adult patients about the care they have recently received. However, the views of children and young people have not previously been sought.

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The surveys are expected to inform local improvement activity. They will be an important source of information for people to help them choose between providers, and for informing commissioners of services.

As well as supplying NHS England and the Department of Health with data to assess performance against national targets on patient experience, the survey programme provides an important source of data for CQC’s assessments.

For the full details of the survey go to the CQC website: http://www.cqc.org.uk/content/children-

and-young-peoples-survey-2014

3.6 New NHS safe staffing framework for mental health wards published

NHS England has launched a new practical guide to help ensure the right people with the right skills are recruited into the right inpatient mental health settings.

The Mental Health Staffing Framework, which focuses on inpatient care, was commissioned as part of the NHS England’s ‘Compassion in Practice programme’. It was developed by an independent group of directors of nursing who undertook a rigorous review of the available evidence and drew on their extensive experience.

Amongst its objectives is to equip mental health leaders with the skills and knowledge to plan and deliver safe staffing, it will also provide a means of assessing their services against agreed best practice.

The focus of the framework is on inpatient staffing, but work is underway on a similar guide for community mental health services. It will feed into the work of the Mental Health Taskforce on establishing the right balance of staff in the many settings treating those with mental illness which is expected to publish at the end of the year.

4 East Lancashire CCG 4.1 Partnership Representation at Governing Body Meetings

Further to my update in June in relation to a reduction in LCC representation at Governing Body meetings, and our commitment to ensuring effective partnership working, stakeholder representation and input, I would like to propose that Mike Wedgeworth, Chair of Third Sector Lancashire, a Canon at Blackburn Cathedral and formerly Chief Executive of Hyndburn Borough Council attend future Governing Body meetings. Mike is also a member of the East Lancashire Health and Wellbeing Partnership, and brings strong partnership links with his role.

In line with our constitution and composition of the Governing Body, this would be a non-voting role. 4.2 Awards I am delighted to announce that the CCG has been able to submit 5 good submissions for Health Service Journal of the Year awards this year. For Innovation in Mental Health we teamed up with the Women’s Centre to showcase their work which we have commissioned and which is already benefiting patients. For primary care innovation we submitted the work we have done to invest in and promote social prescribing. For compassionate patient care we have submitted the work we have done to promote #HMNI and of course compassion in practice. We felt we had an opportunity to submit a summary of the

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achievements and endeavours of the CCG for the CCG of the Year award and we also submitted a strong nomination for the Commissioning for Carers award. Most of the submissions included testimonials from patients, carers or partner organisations, and I am grateful for their collaboration in this process. We can expect to hear if we have been shortlisted in the autumn. If this is the case we will need to conduct a further presentation in London to the HSJ. The final judging takes place on the 18th November. The CCG was also recently shortlisted for the National Patient Safety Awards for changing culture with the NHS Leadership Academy. The Patient Safety Awards continue to recognise and reward outstanding practice within the NHS and independent healthcare organisations. In my last report in June I shared that the CCG had been nominated for The Diverse Company Award at this year’s National Diversity Awards. This nomination was made as a result of the work being undertaken around the Equality and Inclusion agenda and based on the CCG having a diverse workforce and being an organisation which is better able to understand the demographics of our local communities, and whose goals are to reassure and encourage people from the most deprived areas to further their careers. Unfortunately following the shortlisting process the CCG was unsuccessful however the fact that we were nominated, and received numerous votes from our staff, should be seen as highly positive. I am grateful to CCG staff and members whose hard work as commissioners has resulted in us being able to submit these nominations. The process of submitting nominations for awards such as these is itself a useful one as it serves to remind us just how much we as an organisation have achieved, often in partnership with other organisations. The driver for us is our passion to improve patient care and the services that we commission for patients. However such awards are also helpful in providing external validation of the work we are doing.

4.3 Healthier Together – Greater Manchester Service Developments On the 15th July, clinical commissioners in Greater Manchester agreed new standards of care for emergency medicine and general surgery (surgery on the abdomen and bowels) in all hospitals across the Greater Manchester area. Under the Healthier Together proposals, ‘single services’ will be formed – creating networks of linked hospitals working in partnership. This means that care will be provided by a team of medical staff who will work together across a number of hospital sites within the single service. All hospitals will improve to ensure they meet the quality and safety standards. The new standards will mean an additional 35 hospital consultants recruited across A&E and general surgery, a minimum of 12 hours of consultant cover in A&E seven days a week, and a consultant surgeon and anaesthetist present for all high risk general surgical operations. All hospitals will keep their existing specialisms and will continue to provide care to their local populations as they do now. The clinical leaders in Greater Manchester decided unanimously that Stepping Hill hospital in Stockport will be the fourth hospital in Greater Manchester to provide emergency medicine and specialist abdominal surgery as part of a single service with Tameside General Hospital, under the Healthier Together proposals to drive up quality and standards. The other three hospitals will work in partnership to provide shared single services:

Manchester Royal Infirmary, Wythenshawe Hospital and Trafford General Hospital

Royal Oldham Hospital, North Manchester General Hospital, Fairfield General Hospital in Bury, and Rochdale Infirmary

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Salford Royal Hospital, Royal Bolton Hospital and Royal Albert Edward Infirmary in Wigan. Members will be keen to learn of the impact of this change on our resident population. Members will recall that emergency / high risk general surgery (surgery on the abdomen and the bowels) will not be provided from the Fairfield site in the future, it will be provided from the aforementioned four hospitals. A&E services remain at Fairfield, and residents in the Rossendale area in the main will continue to use Royal Blackburn Hospital for surgery. In broad terms, we welcome the service developments in Greater Manchester and believe that they will have limited impact on patients and residents in the East Lancashire area. As clinical commissioners for East Lancashire we will continue to keep a close eye on the arrangements and at all times ensure that services are configured in the best interests of our residents. 4.4 Urgent Care The 95% target of patients being seen and treated within 4 hours at A&E was failed for East Lancashire Hospital Trust in Q1 of 2015-16. The target achieved was 93.61% at the end of Quarter 1:

1

An average of 95.45% on a daily basis now needs to be achieved in order to achieve the 95% target by year end. Weekly and monthly performance through the year has been improving steadily however, following the difficulties in performance around the Easter period. Monthly performance:

April 2015 - 92.52%

May 2015 – 93.41%

June 2015 – 94.79%

Latest weekly performance:

25th- 31st May 2015 – 92.8%

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1st - 7th June 2015 – 93.3%

8th - 14th June 2015 – 95.8%

15th - 21st June 2015 – 94.9%

22nd- 28th June 2015 – 95.8%

Positively, there has still been no incidence of 12 hour breaches at the Trust.

Intense scrutiny and management of the Urgent care system is continuing with regular reporting on performance to the monthly System Resilience Group, although performance itself is monitored and scrutinised on a daily basis. Teleconferences across the health system continue twice weekly and specific planning for business continuity within the Urgent care system has taken place over Ramadan, Eid and the Summer holiday period. Planning for specific flexing of the system over the winter period has also been started. Continued tracking of Delayed Transfers of care takes place weekly and there has been a slight rise in the numbers over the last month though the overall figure continues to be at 50-60% of the peak from the new year period of 2015. This has been a result of some staffing constraints within the complex discharge team that has resulted in greater difficulty in supporting the Community Hospital sites. This is being addressed through the development of the Integrated Discharge team which will commence in September 2015. The level of delays on the acute site itself has reduced significantly over the period that the measure has been tracked.

Sustainable performance of the 95% target for completion of treatment within 4 hours at A&E still continues to be a key goal for the CCG and there are a number of actions underway to support the consistent delivery of the target:

- The Emergency Care Intensive Support Team (ECIST) are undertaking a further system

diagnostic of the ED and Frailty pathway at ELHT. They formerly supported the ‘Perfect

week’ process at ELHT in 2013 and have undertaken a further review and will specifically

look at the ED and frailty pathways at the end of July. Feedback from the team on initial

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steps has taken place and the team has fed back that there are significant and tangible

improvements already since their visit in 2013.

- The main focus of the improvement plan is the delivery of the SAFER bundle, which is

currently being utilised to update the Right care, right time plan at the Trust. This

concentrates on some key actions within the Trust to create better flow to their internal

systems. A 2 weekly meeting to progress these key internal actions is taking place and the

CCG are supporting this workstream at the Trust.

- Within the Pennine Lancashire Urgent Care Group (PLUCG), a system wide recovery plan is

being developed, this will focus on the key areas of change required over a 90 day period to

drive sustainable impacts on A&E performance.

NWAS performance After 2 years of underperformance of the key emergency response to Category A (Red1) ambulance calls within 8 minutes, it is pleasing to report that May 2015 saw the first achievement of this performance metric.

4.5 Better Care Fund Update Work continues to progress on delivery of the 4 schemes identified in East Lancashire, and all 21 schemes across Lancashire. The Lancashire Health and Wellbeing Board agreed the first quarterly report on the progress of delivery of the Lancashire Better Care Fund Plan and acknowledged that some performance measures have risen significantly in the last quarter of 2014/15 but this was the case across the country. The Board also agreed to explore an offer of support and critical review of Lancashire's Better Care Fund Plan through NHSE. Regular updates on progress against the plan will also be presented to the EL Health and Wellbeing Partnership. The Lancashire BCF Steering Group (chaired by Mark

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Youlton) and Programme Managers Group meet regularly on a fortnightly basis to review delivery and progress against schemes. 5 Policies and Procedures The following policies have been updated, approved and disseminated in line with the policy ‘An Organisation wide Policy for the Development and Management of Policy and Procedural Documents’:

Title New Policy or Replace Existing ELCCG_Corp11_V2_Intellectual Property Replaces 49_Management of Intellectual

Property in Research

6 Stakeholder Engagement As part of the CCG’s proactive programme of engagement with our key stakeholders, the following meetings have taken place since my last update:

28 May – Lancashire CCG Network Meeting

2 June – East Lancs Health and Wellbeing Partnership

3 June – Pennine Lancashire Transformation Board

5 June – Health and Wellbeing Board

9 June – Collaborative Commissioning Board

16 June – Blackburn with Darwen CG Chief Clinical Officer

23 June – Head of Health Equity and Partnership for LCC

25 June– NHS England Quarter 4 Assurance Meeting

25 June – East Lancs Hospitals Trust Chief Executive

14 July – Collaborative Commissioning Board

14 July – ELHT Stakeholder Listening Event

16 July - East Lancs Hospitals Trust Chief Executive

Weekly Healthier Lancashire meetings

Actions from these meetings will be handled through the embedded CCG business processes.

7 Recommendations

Members are asked to:

Support the proposal to invite Mike Wedgeworth to attend future Governing Body

Meetings;

Note the progress being made in developing the Transforming Care agenda in

Lancashire;

Note the updates within this report

Dr Mike Ions Chief Clinical Officer