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High Weald Lewes Haven Clinical Commissioning Group Governing Body

Agenda

Date: 28 February 2018

Time: 13:00 – 17:00

Location: Boardroom, HWLH CCG 36-38 Friars Walk, Lewes

Item ref Item description Action Lead Paper Time

Questions from the public (submitted in writing within the specified time frame) will be taken prior to the formal opening of the Governing Body meeting. A record of the discussions will be appended to the formal minutes.

EG

001/18 Welcome and apologies for absence

Note EG Verbal 1.00

002/18

Declaration of interests: A conflict of interest is defined as: A set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold.

Note EG Yes 1.00

003/18 Minutes of the last meeting: 24 January 2018

Approve EG Yes 1.05

004/18 Matters arising/Action log Note EG Yes 1.15

005/18 Chair’s Report Note EG Verbal 1.20

006/18 Accountable Officer’s report Note AD Verbal 1.30

Quality, Performance & Delivery

007/18 Quality report Review and discuss

SR Yes 1.40

008/18 Finance and Contract report (including QIPP)

Review and discuss

MB Yes 1.55

009/18 Performance Report Review and discuss

SS Yes 2.10

10/18 Kent and Medway Stroke review

Note DR/PB Yes 2.25

Items to note - to discuss by request only

011/18 Development Urgent Treatment Centres

Note PB Yes 2.35

Any other business and future meetings

012/18 Any other business (To be notified to Chair at least 2 working days in advance)

Note EG 2.50

Dates of future meetings: Wednesday 28 March 2018 – Boardroom, 36-38 Friars Walk, Lewes BN7 2PB Wednesday 25 April 2018 - Boardroom, 36-38 Friars Walk, Lewes BN7 2PB

EG

Close EG 3.00

Freedom of Information Act: Those present at the meeting should be aware that their names and designation will be listed in the minutes of this Meeting which may be released to members of the public on request.

Conduct of meetings in relation to attendance by members of the public: Members of the public are asked to note that Governing Body meetings are meetings of the Governing Body held in public. They are not ‘public meetings’ where members of the public can speak at any point.

The Agenda above identifies when the Chair will receive questions and comments from the public. For all other agenda items speaking rights are reserved to Governing Body members and agreed representatives sitting at the table; members of the public should not speak or intervene in proceedings unless invited to do so. In all matters the Chair’s decision is final.

The introduction by the public or press representatives of recording, transmitting, video or similar apparatus into meetings of High Weald Lewes Havens Commissioning Group is not permitted.

Written questions from the public:

Members of the public attending Governing Body meetings are welcome to ask questions at the beginning of the meeting. Please submit your questions at least three working days before the meeting to [email protected] ensuring you include a contact name, telephone number or email address.

Governing Body papers:

Papers are held on the Clinical Commissioning Group website and can be accessed through the following web page link:

http://www.highwealdleweshavensccg.nhs.uk/about-us/our-governing-body/meetings-in-public/?categoryesctl9967092=18153

mailto:[email protected]



HIGH WEALD LEWES HAVENS CCG

CONFLICTS OF INTEREST REGISTER

Name Job Title/Role Interest Type of Interest DescriptionDate Interest Relates

From & ToActions

Consent to

publish

Date DOI

received

Date added

to register

Date for

review

Adam Doyle Accountable Officer, Central Sussex

Commissioning Alliance (B&H CCG)

NO N/A N/A N/A N/A Yes 11/07/17 23/01/17 14/07/18

Alan Beasley Chief Finance Officer for HWLH & B&H CCGs No N/A N/A N/A N/A Yes 02/02/18 02/02/18 05/02/19

Alan Keys Lay Member (Patient and Public Engagement),

Member of the Audit Committee, Auditor

Panel, Procurement Governance Committee,

PCCC, RemCom, and Equality & Diversity

Working Group

Yes Non-Financial Professional President, Cardiovascular Care

Partnership (UK) - patient arm of

British Cardiovascular Society

(BCS) with financial support from

British Heart Foundation -

expenses only.

Pre 2010 and ongoing Non-participation in decisions at

meetings where interest is discussed.

Yes 01/07/17 04/07/18





Working Group

Yes Non-Financial Professional Council Member, BCS. Finance

Committee member, BCS (2015-

Now). Member British

Cardiovascular Intervention

Society Standards Committee

2013 ongoing Non-participation in decisions at


Yes 01/07/17 04/07/18





Working Group

Yes Non financial professional

interest

Board Member National

Cardiovascular Information

Network (NCVIN)

2014 ongoing Non-participation in decisions at


Yes 01/07/17 04/07/18

Ashley Scarff Director of Commissioning & Deputy CO No N/A N/A N/A N/A Yes 01/05/17 04/05/18

David Roche GP Governing Body Member

GP Locality Lead for High Weald

Yes Financial GP Locum in Kent and Sussex Ongoing GPs should be aware of BMA

guidance on conflicts of interest for

GPs in their role as commissioners.

Yes 01/03/17 04/03/18

Denise Matthams Governing Body Registered Nurse Member Yes Professional Specialist advisor for the Care

Quality Commission

2012 - ongoing Non-participation in decisions at


Yes 01/03/17 04/03/18

Elizabeth Gill CCG Clinical Chair, GP Partner at Buxted

Medical Centre and Manor Oak Surgery

Yes Financial James Gill (spouse), dementia

practitioner, does occasional

work for CCG. Director of BEH

Ltd.

2016 ongoing Not involved in decisions about

commissioning dementia

practitioners

Yes 01/06/17 04/06/18



Yes Financial GP Partner at Buxted & East

Hoathly practices

Ongoing GPs should be aware of BMA



Yes 01/06/17 04/06/18



Yes Indirect Interest Richard Wade (brother), Partner

at Blake Morgan Commercial

Property

2005 ongoing Is not routinely involved in

appointing legal advisers

Yes 01/06/17 04/06/18



Yes Indirect Interest Kate Gill (sister-in-law),

Consultant Orthopaedic Surgeon,

Guildford Hospital

2013 ongoing Will not be involved in decisions

about commissioning from Guildford

Hospital

Yes 01/06/17 04/06/18

Frank Powell Governing Body Locality Practice

Management Lead

Yes Financial Employee of Beacon Surgery Ongoing Although not a GP, Actions should

be consistent with BMA guidance on

conflicts of interest for GPs in their

role as commissioners.

Yes 22/01/18 25/01/19

Governing Body Conflicts of Interest Register for February 2018

Page 1 of 3




From & ToActions

Consent to

publish

Date DOI

received

Date added

to register

Date for

review

Hugo Luck Associate Director of Operations Yes Non-Financial Personal

Interest

Volunteer with Wave Project

Brighton, who receive occasional

referrals from CCG member

practices, but no funding.

Sept 16 - Ongoing Non participation in decisions at

meetings where interest may be

discussed.

Yes 12/12/17 15/12/18

Hugo Luck Associate Director of Operations Yes Non-Financial Personal

Interest

Trustee for the Substance Misue

Management in General Practice,

a national charity which receives

no CCG funding, but from whom

CCG members may receive

Continuing Professional

Development.

Dec 17 - ongoing Non participation in decisions at

meetings where interest may be

discussed.

Yes 12/12/17 15/12/18

Joanne Bernhaut Consultant Public Health, East Sussex County

Council

No N/A N/A N/A N/A Yes 01/04/17 04/04/18

Karen Ford Governing Body Practice Management Lead Yes Financial Business Partner at Quayside

Medical Practice.

1 November 2012 - ongoing Although not a GP, Actions should

be consistent with BMA guidance on

conflicts of interest for GPs in their

role as commissioners.

Yes 01/04/17 04/04/18

Mark Baker Strategic Finance Director, Central Sussex


No TBC N/A N/A N/A 02/01/01

Martin Smits Lay Member (Primary Care Governance) Yes Non-Financial Personal

Interest

Lay Member for South Kent

Coast CCG.

1 May 2017 - ongoing N/A Yes 01/03/17 04/03/18

Mary Stoneham Board Services Officer, Corporate Services No N/A N/A N/A N/A Yes 30/01/18 30/01/18 02/02/19

Naomi Forder Secondary Care Clinican, Governing Body

member

Neil Myers GP Governing Body Member

GP Locality Lead for Lewes Havens

GP Partner at Rowe Avenue Surgery

Yes Financial GP - Rowe Avenue Surgery Ongoing GPs should be aware of BMA



Yes 01/03/17 04/03/18

Neil Myers GP Governing Body Member

GP Locality Lead for Lewes Havens

GP Partner at Rowe Avenue Surgery

Yes Financial Company Director of a small

company which owns student

accommodation

April 2016 - ongoing NNCR Ltd is not involved in any

health service work

Yes 01/10/17 04/10/18

Peter Birtles GP Governing Body Member

Clinical Programme Lead Primary and Urgent

Care

Yes Financial Salaried GP at Quayside Medical

Practice

August 2015 - ongoing N/A Yes 01/05/17 04/05/18

Peter Douglas Governing Body Member and Vice Chair.

Chair of Audit Committee, Remuneration

Committee and Governance Committee.

No N/A N/A N/A N/A Yes 01/11/17 04/11/18

Ragu Rajan GP Partner at Mid Downs Medical Practice,

Clinical Programme Lead for Planned Care,

Governing Body member.

Yes Financial GP partner at Mid Downs

Medical Practice.

N/A N/A Yes 01/05/17 04/05/18

Rebecca Walker GP Partner at School Hill Medical Practice No N/A N/A N/A N/A Yes 12/12/17 15/12/18

Sally Smith Director of Primary Care & Integration No N/A N/A N/A N/A Yes 12/12/17 15/12/18

Sarah Richards Chief of Clinical Quality and Performance Yes Financial Salaried GP at Buxted Surgery 01/04/16 - ongoing Not a GP partner Yes 07/02/18 07/02/18 10/02/19

Terry Willows Director of Corporate Affairs, Central Sussex


TBC Seconded by NHS England 02/01/01

Page 2 of 3




From & ToActions

Consent to

publish

Date DOI

received

Date added

to register

Date for

review

Wendy Carberry Managing Director (South), Central Sussex

Commissioning Alliance (HWLH CCG)

No N/A N/A N/A N/A Yes 01/04/17 04/04/18

Page 3 of 3

Governing Body (part 1)

DRAFT Minutes

Date: Wednesday 24 January 2018

Time: 1 – 3pm

Location: Boardroom, 36-38 Friars Walk, Lewes, BN7 2PB.

Summary of resolutions taken at meeting

Chair Dr Elizabeth Gill, Clinical Chair (EG)

Present

Joanne Bernhaut (JB) Consultant in Public Health (non-voting) Wendy Carberry (WC) Managing Director South Peter Douglas (PD) Lay Member (Governance) and Vice

Chair Karen Ford (KF) Lewes Havens Locality Practice

Management Lead Denise Matthams (DM) Registered Nurse Member Dr Neil Myers (NM) Lewes Havens Locality Chair Frank Powell (FP) High Weald Locality Practice

Management Lead Dr Ragu Rajan (RR) Planned Care Clinical Programme Lead Dr Sarah Richards (SR) Chief of Clinical Quality and Performance Dr David Roche (DR) High Weald Locality Chair Martin Smits (MS) Lay Member Primary Care Governance

In attendance

Mark Baker (MB) Strategic Director of Finance Hugo Luck (HL) Associate Director of Operations Jan Robberds (JR) Interim Board Services Officer (minutes) Ashley Scarff (AS) Director of Commissioning & Deputy

Chief Officer Sally Smith (SS) Director of Primary Care & Integration Terry Willows (TW) Director of Corporate Affairs

Apologies Dr Peter Birtles (PB) Urgent Care Clinical Programme Lead Adam Doyle (AD) Accountable Officer

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Alan Keys (AK) Lay Member Patient and Public Involvement

Agenda item

Discussion Action

Questions from the public

The Chair reported that one question had been received in advance of the meeting from Cait Fleet, concerning the de-prescribing of Liothyronine. The Chair invited Ms Fleet, who was present, to ask her question and then read out the CCG’s prepared answer. Question and answer are appended to these minutes and will be uploaded to the website. The two members of the public left at this point.

174/18

Welcome and apologies for absence: The Chair welcomed everyone to the meeting and noted the apologies as recorded above.

175/18

Declarations of Interest: The Chair reminded Governing Body members of their obligation to declare any interests they may have on any issues arising at Governing Body and committee meetings which might conflict with the business of High Weald Lewes Havens CCG. Declarations declared by members of the Governing Body are listed in the CCG’s Register of Interests, which is available on the CCG website at: http://www.highwealdleweshavensccg.nhs.uk/about-us/our-governing-body/ There were no declarations of interest considered prejudicial to any agenda items at this particular meeting from members of the Governing Body.

176/18

Minutes of the last meeting on 22 November 2017 – accuracy and matters arising:

Page 2, 146/17: typo ‘…it has been a privilege and joy to work with her’.

The minutes were agreed as an accurate record with the above correction.

177/18 Matters arising / Action Log: The Governing Body reviewed the Actions Log:

http://www.highwealdleweshavensccg.nhs.uk/about-us/our-governing-body/

http://www.highwealdleweshavensccg.nhs.uk/about-us/our-governing-body/

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Item 149/17 i) Anticoagulation and Wafarin LCSs: reviewed for clinical sign off and will be on the agenda of the next Primary Care Commissioning Committee – action closed.

Item 149/17 ii) Community rapid response service: we have increased this service aiming to increase discharges and avoid admissions. The existing discharge scheme has been expanded – action closed.

Item 153/17 training of 111 Service staff: the issue has been raised with the service – action closed.

New action: HL has details of the training that has been provided to staff and will circulate after the meeting.

There were no other matters arising.

HL

178/18

Chair’s report: The Chair reflected on some of the key issues since the last Governing Body meeting in public: The CCG is now part of the Central Sussex Commissioning Alliance and there is a new executive team in post. AD (Accountable Officer) sends his apologies as he had a long-standing commitment. All GB members have been offered 1:1 meetings with AD. The financial position is deteriorating, but membership the Alliance, offers some protection from legal directions being placed on the CCG. The CCG did not win the HSJ Award, but did win a GP Award sponsored by NHS England (part of the GP Forward View Innovations Category) for the Golden Ticket. The Alliance is now rolling out the Golden Ticket. News from the enhancing nursing homes project is very positive. GPs like the new way of working in nursing homes.

179/18

Accountable Officer’s report: In the absence of AD, the Managing Director South (WC) updated the GB on key issues since the last meeting in public: There is increased pressure on the system across the board; it’s a challenging situation for all our providers and it is important to thank everyone for their hard work, including the local authority. The average wait for discharge has dropped significantly from 25 to 3 days, but it is taking intense capacity to maintain this. In addition there has been an increase in influenza cases, which has needed further amendments to support.

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WC is Managing Director for South and has attended the Brighton and Hove CCG Governing Body meeting. She found it reassuring that GB meetings are similar. There are now a weekly senior managers meeting and a fortnightly heads of department meeting across the South. WC has seen a good paper on infection control that she will take to a future Quality Committee meeting.

Section 1 Quality, Performance and Delivery

180/18

SR presented the Quality Report. She confirmed this is a highlight report of a more in-depth report that is discussed at the monthly Quality Committee. The following areas were brought to the attention of the Governing Body. Re SECAmb: at the Governing Body meeting two months ago, the CCG did not feel fully assured and concerns were raised, and are ongoing, regarding the level of visibility of patient safety issues. Since then, there has been a big increase in Datix reports and the backlog of Serious Incidents should be completed by end February 2018. The Trust is still in special measures with weekly meetings and regular reporting via a steering group. There was an issue with a lack of reporting of near misses, which are essential for learning. A number of staff have now been trained in Root Cause Analysis and this is being disseminated down to operational level. It is recognised however, that there is a need for a cultural change, which can be challenging for staff. A query was also raised regarding SECAmb use of the Summary Care Record. Action: SR will check with the Head of Quality There is good news that Sussex Partnership Foundation Trust (SPFT) has received a ‘Good’ CQC report after their recent visit. This replaces the previous ‘Requires Improvement’. There was a discussion regarding the process of CQC inspection, with concerns raised by one member that it is just a ‘tick box’ exercise and data driven, rather than looking at actual processes. This was felt not to be the case – the CQC process is felt to be robust and involves discussions with patients and in-depth review. Action: It was agreed that the Quality Team would look into the CQC process to provide assurance regarding this. The wheelchair service numbers were queried as the contract has been in place for 18 months. It was noted that they are prioritising

SR SR

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patients, e.g. some may already have a wheelchair, but need a specialised version. There is an issue with patients not being seen as part of the backlog. Action: Quality team to investigate. DM was able to assure the Governing Body that the Quality Committee has time to go into more detail of the report, particularly areas of concern.

SR

181/18

Finance and Contract report including QIPP MB presented the report noting that currently the most likely out-turn position is expected to be a deficit of just under £6 million. We need to demonstrate how we plan to mitigate this. It is likely the position will get worse rather than better and it could be as much as £8 million. Due to the Alliance this will not trigger legal directions for the CCG. Position for next year: An estimated £16 million savings requirement, amounting to 7-10%. While there is no requirement to have a recovery plan, the Alliance plans to put one in place as the appropriate action going forward. The first meeting of the new Finance and Performance Committee is meeting following this meeting. MB wanted to assure the Governing Body that the CCG is handling the situation and taking it forward in a positive way. A question was asked about how some of the figures add up to the totals given. Action: MB will check and report back. It was noted that the figures for next year seem very high and asked whether the CCG should have anticipated this; some elements feel out of our control. MB explained that the CCG is dealing with the demand and the projections are what we could realistically achieve in one year. AS noted there was a deep dive in December and that non-recurrent funds were used last year to bring us to our current position, but the situation is more difficult this year. Concerns were expressed that the CCG is being over-optimistic and has difficulties in holding acute providers to account, e.g. the large number of delayed discharges. It was explained that there is work in primary care and other contracts, but it is sometimes hard

MB

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to quantify the savings. WC noted that working as an Alliance gives the CCG a lot more power to address issues with Brighton and Sussex University Hospitals Trust (BSUH). Concerns were expressed that the current programmes of work will need several years to realise sufficient savings and that there is pressure on the whole pathway: Acute, Community and Primary Care. WC noted that the programme ‘Get it Right First Time (GIRFT), looking at variances across the system, offers significant savings.

182/18

Performance Report HL presented the report that was taken as read. The former Quality & Performance Committee has now been separated into a Quality Committee and a Finance & Performance Committee. In summary, there is marginal improvement although continued challenges around acuity. During the first week of January there was a 6-10% increase, more than expected, but SECAmb had its best performance in 12 years over the same period. The number of delayed transfers of care were lower, the enhanced nursing home programme is successful and the ‘Help my NHS’ campaign has been rolled out. Minor Injury Units (MIUs) put more staff on after the Bank Holidays, to cope with their busiest times. Extra beds were commissioned locally. In answer to a question whether MIUs made a difference this year, HL clarified that the tendency is not to have high attendance on Christmas Day, but on the two days following. Currently cannot guarantee to beat the four hour target. Elective and A&E costs over 5 years and the increase in outpatient procedures were queried. HL explained we not are seeing an increase overall as we are getting more admissions via the non-elective group. It was noted that the Musculoskeletal (MSK) service would account for some of that cost, which would not appear as elective. It was noted that real savings can be achieved through MSK.

Public Health and Engagement

183/18

Patient and Public Involvement (PPI) update: An update had been provided by AK in his absence. The two PPG Forums continue to be involved in all aspects of the CCG’s work,

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receiving regular updates on progress, e.g. Dementia Golden Ticket and contributing actively in consultation and engagement, e.g. the Forums are keen to play an active role in consultations about the 111 Service Re-procurement. The Governing Body noted the update.

184/18

Reports from sub-committee Chairs and Leads: High Weald Locality – DR: The group has had presentations on Care for the Carers and Occupational Health. The Fire and Rescue service has offered to visit some vulnerable patients at home. The GPs have expressed concerns around treatment of minor injuries, but this is the strategic direction. Action: AS agreed to report back on eye services. Lewes Havens Locality – NM: There have been fewer referrals in the locality and there has been more support in terms of rapid response. The mental health strategy needs GPs to identify those patients who are not coming to reviews and plan how to address this issue. There has been expansion in Improving Access to Psychological Therapies (IAPT) service. Quality Committee – DM: The new committee format gave more focus, but the full agenda is being reviewed. In the past, the committee struggled to be assured about services and there are still some issues with the big Trusts. Review of the meeting by AD noted it was a good meeting and well chaired. Clinical Executive Committee – SR End of Life Care is being reviewed on behalf of the CCG and the committee looked at Tranche 2 of Low Priority Procedures. The Hospice in the Weald training scheme was approved. The Governing Body noted the reports.

AS

Governance

185/18

Assurance Framework: HL presented the report. Two new risks have been added to the AF: UTC004 – lack of financial support for the project – HL noted that there has been an injection of funds and the risk score should come down soon.

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H0011 – financial and operational challenges, score increased to 25, issues already discussed. The assurance framework was approved.

186/18

Psychological Wellbeing at Work Policy: HL presented the policy for ratification. The policy has been adapted for the CCG from Brighton and Hove CCG, so there is consistency across the South. It enables the CCG to remain complaint with relevant Health and Safety legislation. The policy was ratified.

187/18

Risk Management Policy and Procedure: The policy has been updated to reflect the current responsibilities of the Corporate Services Officer. The policy has been approved by the Governance Committee. The policy was ratified.

188/18

Risk Management Strategy: The strategy has been updated to reflect the current responsibilities of the Corporate Services Officer and Risk Appetite. The strategy has been approved by the Governance Committee. The strategy was ratified.

189/18

Remuneration and Nominations Committee Terms of Reference: The ToR have been updated following receipt of a letter from the Secretary of State. A line has been inserted about the process for approval of VSM appointments. The updated terms of reference were ratified.

Items to note – to discuss by request only

190/18

Public Health Update: JB noted that Public Health England has issued some key messages on flu and relaunched the ‘Catch it, Bin it, Kill it’ campaign. The outbreak has now reached Kent and Medway. It is not too late to be vaccinated although the message is not getting through to the public and there are misconceptions around the vaccine. Additional clinics have been put on, but no uptake. Some practices are hitting the targets, others far lower uptake, nationally

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it’s 55%. In our area the target for children has been hit, but pregnant women are below target. There is no clear solution to this issue.

191/18 The item was noted.








Any other business

199/18 Due to timing of meetings, Cyber Security Training was postponed to a later date.

Date of next meeting

Wednesday 28 February 2018 – Boardroom, 36-38 Friars Walk, Lewes

Quality

Meeting Date

Minute

ReferenceItem Action Required Due Date

Executive

Lead Comment/ Update Progress

24/01/2018 177/18 Training of 111 Service

staff

Details of training provided to be

circulated to GB members.

21/02/2018 Hugo Luck 21/02/2018: Emailed to members 01/02/2018 Completed

24/01/2018 180/18 i SECAmb use of

Summary Care Record

SR to d/w Adrian Bryan and update GB

members

21/02/2018 Sarah Richards 21/02/2018: SR to give verbal update at 28/02 GB In progress

24/01/2018 180/18 ii CQC inspection

process - reassurance

for GB

Quality team to look into the CQC

process and provide assurance.

28/03/2018 Sarah Richards 28/03/2018: In progress

24/01/2018 180/18 iii Query about

wheelchair service

numbers.

Quality team to investigate and report

back to GB.

21/02/2018 Sarah Richards 21/02/2018: SR to give verbal update at 28/02 GB In progress

24/01/2018 181/18 Finance report figures,

need to check totals

MB to check and report back to GB. 21/02/2018 Mark Baker 21/02/2018: MB sent email to PD 14/02/2018 Completed

24/01/2018 184/18 GP concerns about

eye services.

AS to report back to GB on eye services 21/02/2018 Ashley Scarff 21/02/2018:A report on changes to eye services will be

considered at the March meeting of the Clinical Executive

Committee (CEC)

In progress

Progress Key

Off track

In hand and on

schedule

Complete

Meeting: Governing Body 28 February 2018

Report to Governing Body (Public)

Title: Chair’s Report

Item number: 05/18

Date: 16/02/18

Author: Dr Elizabeth Gill

Accountable Executive Director: -

Clinical Lead: -

Purpose of the report:

The Governing Body is recommended to note the report.

Summary of key issues:

The Chair will reflect on the CCG’s key issues and look forward to the next two months.

Corporate aims this paper relates to:

To provide an update to the Governing Body.

Recommendation / decision required:

None

Chair’s Report 05/18

Page 2 of 2

Implications

Quality and Safety None

Financial None

Patient and Public Involvement

None

Equality and Diversity An assessment is not required for this report.

Workforce and Educational

None

Risk None

Legal None

Committees / meetings where this item has been considered:

Governing Body standing committee Date

Governing Body meeting 28/02/18


Title: Accountable Officer's report

Item number: 06/18

Date: 16/02/18

Author: Adam Doyle

Accountable Executive Director: -

Clinical Lead: -


The Governing Body is asked to note the Accountable Officer’s report.


The Accountable Officer will reflect on the key issues that he has needed to address, update on the key meetings attended, and look forward to the next two months.


Provide an update to the Governing Body on key issues.


None

Chief Officers Report 06/18

Page 2 of 2

Implications

Quality and Safety None

Financial None


None

Equality and Diversity An assessment is not required for this report.


None

Risk None

Legal None



Governing Body meeting 28/02/18


Name of Meeting: Integrated Quality and Safeguarding report

Date of Meeting: 28th February 2018

Item Number: 07/18

Recommendation:

The Committee is asked to:

Review the report and identify gaps in assurance not highlighted;

Recommend further action or further scrutiny where necessary; and

Identify any further action required by the Governing Body.

Reviewed at:

Not applicable

Summary

This report provides an overview of quality information detailing key issues on organisations providing community and acute care to patients within the HWLH Clinical Commissioning Group. The summary section highlights key issues potentially affecting Surrey and Sussex patients, and the proposed or actual actions required to improve quality.

Lead Director: Ashley Scarff

Clinical Lead Dr Sarah Richards

Author Adrian Bryan

Date of Report: 13th February 2018

Financial Implications

Where residents do not achieve optimal health outcomes and quality from the commissioned services there are inherent additional costs to the health system. These

Sussex CCG Integrated Quality and Safeguarding Report 07/18

Page 2 of 8

can be related to on-going health needs and/ or as a consequence of residents suffering avoidable harm associated with healthcare.

Legal or Compliance Implications

Care Quality Commission (CQC) compliance included within the report.

Point 2

Link to key objective and/or assurance framework risk

Risks associated with the duty to provide quality and improve health outcomes for residents within the Surrey and Sussex geographical area.

Point 2

Patient, carer and public engagement

Patient experience is included within the report on each provider, such as Family and Friends Test (FFT) and Complaints process.

Equality Impact Assessment

Not applicable


Page 2 of 8

Sussex CCG Integrated Quality and Safeguarding report

Contents

1. INTRODUCTION 4

2. SUMMARY OF QUALITY ISSUES 5

3. ACUTE PROVIDERS ERROR! BOOKMARK NOT DEFINED.

3.1. Brighton and Sussex University Hospitals Trust (BSUH) Error! Bookmark not defined.

3.2. Maidstone and Tunbridge Wells NHS Trust (MTW) Error! Bookmark not defined.

3.3. East Sussex Healthcare NHS Trust (ESHT) Error! Bookmark not defined.

3.4. Sussex Partnership NHS Foundation Trust (SPFT) Error! Bookmark not defined.

3.5. South East Coast Ambulance Service NHS Foundation Trust (SECAmb) -999 Error! Bookmark not defined.

3.6. South East Coast Ambulance Service NHS Foundation Trust (SECAmb) – KMSS 111 service Error! Bookmark not defined.

4. COMMUNITY PROVIDERS ERROR! BOOKMARK NOT DEFINED.

4.1. Sussex Community NHS Foundation Trust (SCFT) Error! Bookmark not defined.

4.2. Sussex Muscle-Skeletal Partnership East (SMSKPE) Error! Bookmark not defined.

4.3. Integrated Care 24 (IC24) - Out of hours service Error! Bookmark not defined.

4.4. Millbrook Healthcare - Children & Adults Wheelchair Service (CAWS) Error! Bookmark not defined.

4.5. South Central Ambulance Service (SCAS) Error! Bookmark not defined.

5. PRIMARY CARE QUALITY MONITORING ERROR! BOOKMARK NOT DEFINED.

6. INFECTION CONTROL (ACQUIRED INFECTIONS FOR HWLH PATIENTS) ERROR! BOOKMARK NOT DEFINED.

7. APPENDICES ERROR! BOOKMARK NOT DEFINED.


Page 2 of 8

1. Introduction

This report provides an overview of quality information detailing key issues on acute and community organisations providing care to patients across Surrey and Sussex Clinical Commissioning CCGs.

This report gives an update of providers up to November 2017.

Information within this report is obtained through regular attendance at quality review meetings, communication with providers, quality leads, and relevant commissioning support units (CSU) and national agencies, as well as individual provider or CCG quality reports; the data represents the latest available for this reporting period at the time of writing; in some instance verifiable soft intelligence data and anecdotal narrative is used to support this to provide a balanced overview of the providers services.

The report summary details the main concerns in quality of care that have been identified by the CCG quality team for discussion by the quality and performance (Q&P) committee; any RAG rated performance is presented either verbatim, as per the individual organisations rating, or within the agreed targets, although this may vary between individual providers.

Glossary

A full alphabetical glossary of abbreviations commonly used within the quality reports is included in

Appendix 1 of this report.


Page 2 of 8

2. Summary of Quality issues The following table details the key issues effecting Surrey and Sussex CCG patients and the proposed or actual action taken.

Quality Concern / Risk Action Taken / Required Timeline

Brighton University Hospital Trust

RTT - Delay to treatment:

Quality concerns exist around levels of consequential harm.

Administration validation and clinical review of people waiting over 52 weeks and who have not yet received their end treatment or procedure.

Current position is 47 patients without a date for treatment; trust plan to date patients

April 2018

ED: Emergency access standard performance:

Trust action plan overseen by NHSI is in process addressing the issues raised by the CQC around ED performance overseen Quality oversight committee

Monthly

The trust is completing root cause analysis to establish cause of readmission type (Elective / Non Elective) and speciality.

To implement remedial action plan to improve performance.

Q4 2018

Maidstone and Tunbridge Wells NHS Trust

Serious Incident rate: The rate has doubled from the previous year and month on month

o Request review into increase in count month on month and yr. on yr.

o Identify root causes and process o Share paper to Quality committee

March 2018

East Sussex NHS Trust

Maternity: Meconium. The Trust reported one episodes of meconium aspiration in November

Medications: Increase in medication errors

The Trust agreed to review and present these cases at the next QRM.

Whilst themes had been identified internally and discussed at the QRM through the Trust assurance report further work was required to define actions to improve performance.

March 2018


Page 2 of 8

Sussex Community NHS Foundation Trust (SCFT)

DTOC rate of 12.82% - impacting patient flow

Lack of capacity in ASC and lack of packages of care within JCR

Daily review at ward level and SMT to expedite blockages in discharge in partnership with ASC.

Partnership working with acute colleagues to ensure appropriate referral to re-enablement beds.

MDT event was held in July 2017 to support review of DTOC.

Weekly

Workforce Trust adopt local recruitment and retention strategy – includes milestones for recovery

Apprenticeship programme started

Monthly through QRM

SECamb 999

Red 1 and R2 response times:

HWLH significantly below national, CCG & Sussex wide target levels

This being addressed via the unified recovery action plan in place overseen by NHSI, NHSE and lead commissioner.

New revised response targets implemented. Await outcome of new indicators and impact.

Weekly operations call

December report

Serious Incidents Improve the handling, recording, investigation of and learning from all incidents based on a human factors approach.

Monthly action group

Safeguarding Consolidating and continuing to improve safeguarding capability, response and processes.

Through QRM

Health Records: The safe and secure handling of patient records - both paper and electronic has been identified as an area requiring improvement. In summary the areas of focus are as follow:

Improvement of safe and secure storage

Reduction of loss records between completion and scanning by the records department

QRM


Page 2 of 8

Improvement in the consistency of records completion and quality of clinical entries

Clear audit and compliance plan

Development and move to electronic patient records

CQC compliance:

Overall rating – ‘Inadequate’ (Special Measures)

SECAmb unified recovery action plan in place being overseen by the lead commissioner, NHSI and NHSE, following publication of CQC report rating of ‘Inadequate’

Integrated Care 24 (IC24) - Out of hours service

No action

SMSK

No action

Millbrook Healthcare - Children & Adults Wheelchair Service (CAWS)

Long waiting list for patients Quality involvement at contract meetings. Data suggests the service is meeting demand and reducing waiting list backlog.

Full QIA assurance visit performed by the CCG CQM.

The provider will prioritise treating patients waiting the longest.

Monitor waiting time data and months progress.

Monthly through QRM

South-coast Ambulance Service (SCAS)

No action


Title: Month 10 Finance Report

Item number: 08/18

Date: 28th February, 2018

Author: Chris Tait, Head of Finance

Accountable Executive Director: Alan Beasley, Chief Finance Officer

Clinical Lead: n/a


The Governing Body is asked to note the ongoing financial pressures faced by the CCG and future action necessary to return to a balanced position.


Following discussions with NHSE, the CCG is now reporting that it will not achieve its control total. At month 10, the CCG is reporting a deficit of £(7.6)m to date and a £(9.2)m forecast outturn.

Plans currently show a £19.0m QIPP target for the CCG to achieve its statutory duties for next year, which equates to 7% of the CCG’s total allocation. QIPP delivery in 2018/19 is currently forecast at £6.9m meaning there is currently a gap of £12.1m. A Strategic Plan is being developed to demonstrate how the CCG will return to a financially balanced position. A Plan for 2018/19 and the Strategic Plan will be included within the Month 11 Finance Report.


Actions to be taken to deliver the statutory financial duty.


The Committee is recommended to note the ongoing financial pressures faced by the CCG and future action necessary to return to a balanced position.

Implications

Quality and Safety n/a

Financial Contained in the report.

Month 10 Finance Report 08/18

Page 2 of 2


Not applicable.

Equality and Diversity No Impact


n/a

Risk Contained in the report.

Legal Actions to be taken to deliver the statutory financial duty.



Finance and Performance Committee 20/02/18

Finance Report Month 10

1. Executive Summary

At month 10, the CCG is reporting a deficit of £(7.6)m to date and £(9.2)m forecast outturn. Despite substantial work to mitigate the risk of overspend against plan (see section 3), the CCG is now reporting to NHSE that it will not achieve its control total in-year. This recognises the level of risk reported through the year, which the CCG has been unable to mitigate against.

In 2018/19, Plans are showing a requirement for a £19m QIPP target were the CCG to achieve its statutory duties next year. This equates to 7% of the CCG’s total allocation and represents a significant challenge. To put this into context, QIPP delivery in 2018/19 is forecast to be circa £6.9m. A Strategic Plan is being developed to demonstrate how the CCG will return to a financially balanced position and the timeframe over which this will be achieved.

2. Month 10 2017/18

The Summary Operating Cost Statement (OCS) below shows the position at month 10 and FOT reported to NHSE. A detailed OCS for the year is shown in appendix 1. The Statement shows a variance against Plan to date of £(8.3)m and forecast outturn variance of £(10.0)m.

Summary OPERATING COST STATEMENT

For the Period Ended 31 JANUARY 2018

Full Yr

Commissioning Plan Plan Actual Variance

Reported

Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000

Acute 115,805 96,504 100,964 (4,460) 118,736 (2,931)

Community 21,367 17,806 15,514 2,291 20,068 1,299

Better Care Fund 10,772 8,977 8,977 (0) 10,772 0

Mental Health 17,778 14,815 14,677 138 17,138 640

Continuing Healthcare 13,877 11,564 11,489 75 13,640 237

Primary Care 57,302 47,751 46,430 1,320 55,045 2,257

Other Commissioning* (14,139) (10,899) (3,250) (7,648) (447) (13,692)

Total Commissioning 222,761 186,517 194,801 (8,284) 234,952 (12,191)

Corporate (Running Costs) 3,711 3,092 3,087 5 3,711 0

Reserves 1,018 11 0 11 0 1,018

Contingency 1,175 2 0 2 0 1,175

Total Non-Commissioning 5,904 3,105 3,087 18 3,711 2,193

Total Operating Costs 228,665 189,622 197,888 (8,265) 238,663 (9,998)

Revenue Resource Limit 229,463 190,287 190,287 0 229,463 0

Surplus / (Deficit) 798 665 (7,600) 8,265 (9,200) 9,998* For a breakdown of Other Commissioning Services, see appendix 1

CCG Operating Costs

Year to date Forecast

Finance Report Month 10 2

FOTs against the CCG’s main acute provider Trusts are as follows:

The FOTs reflect in-year 17/18 expenditure against SLA and do not include 16/17 prior year adjustments. The Brighton and Sussex University Hospitals (BSUH) forecast outturn reflects an agreed Aligned Incentive Scheme (AIS) between the Sussex CCGs and the Trust. NHS High Weald Lewes Havens CCG’s (HWLH’s) share of the AIC for 2017/18 is £45.5m. The balance has been adjusted to include the expectation of funding for Identification Rules following an NHSE recalibration exercise of £(0.8)m. In addition, an adjustment has been made for maternity pathways of £(0.3)m. There are further non-contract items included totalling £0.1m. The forecast Maidstone and Tunbridge Wells (MTW) balance reflects an agreement to cap and collar the 2017/18 outturn. The cap and collar has been set at £23.8m and £23.3m respectively. The CCG will therefore pay up to a maximum of £23.8m and a minimum of £23.3m. An adjustment has been made to the outturn in the table for a maternity pathways accrual at year-end. An AIS has not been agreed for East Sussex Healthcare (ESH) and the forecast outturn has been calculated based upon activity data provided by the CSU up to month 9. An adjustment has also been made in respect of a maternity pathways accrual.

The variances on the main acute SLAs, other acute Trusts and London Contracts are being partially offset by savings in respect of the MSK Contract. At month 9, the CCG reported an underspend for South East Coast Ambulance Service NHS Foundation Trust (SECAMB) in relation to the 999 contract. Following a Sussex-wide CCG reconciliation process with the Trust, this budget is now reported to break-even.

The underspend on community contracts relates to a favourable community contract variation for the East Sussex Healthcare (ESHT) relating to podiatry services where activity transferred over to a new service provided by Sussex Community NHS Foundation Trust.

Mental Health is forecast to underspend due to Learning Disability costs that are currently under dispute with both NHS Eastbourne and Seaford CCG (EHS) and East Sussex County Council. Costs are being invoiced relating to patients which do not fall under the liability of High Weald Lewes Havens (HWLH).

A small forecast underspend is reported on continuing healthcare based upon activity reports received from Hastings and Rother CCG (H&R) who host the service on behalf of HWLH.

Full Yr

Commissioning Plan Plan Actual Variance

Reported

Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000

Brighton & Sussex University Hospitals 42,888 35,740 36,405 (665) 44,512 (1,624)

Maidstone& Tunbridge Wells 22,600 18,833 20,722 (1,889) 23,300 (700)

East Sussex Healthcare 10,086 8,405 9,879 (1,474) 11,613 (1,527)



The forecast underspend on Primary Care is mainly due to work carried out by Medicines Management to reduce prescribing costs. This is through a number of QIPP schemes that have affected costs including the department’s work at medicines optimisation.

The CCG continues to report that it will meet its running costs target for the year

although it also recognises this is challenging.

The Plan includes 50% of the 1 percent non-recurrent reserve which the CCG is allowed to commit in the current year. The remaining 50% must remain uncommitted.

3. Work to mitigate the Potential Overspend against Plan

The CCG recognised the significant challenge in 17/18 at planning stage and

implemented an ambitious QIPP Plan. Appendix 2 shows a Waterfall that summarises the pressures upon the CCG in 2017/18 and work carried out to mitigate against the risk.

The Waterfall shows that the CCG faced a “do-nothing” position at the beginning

of the year of £16.8m. Additional pressures were imposed on the CCG in relation to HRG4+ (£1.4m), being the difference between allocation deductions and calculated impact, IR pressures (£1.5m), reduced funding for category M drugs (£0.3m) and additional costs for non-stock drug items (£1.0m). Consequently, the total pressure faced by the CCG was £21.0m.

The total forecast QIPP savings, before additional schemes identified in the latter

part of the year, are forecast to be £8.6m. There is substantial evidence to show the impact of the QIPP schemes implemented which include:

20% increase in MIU attendances

GP Referrals 3.3% lower compared to 2016/17

Elective admissions - 1.5% higher than 2016/17 but lower in September

Outpatient First Attendances – 3.3% lower than 2016/17

Outpatient Follow-Ups – 7.1% lower than 2016/17

Governance arrangements around projects were strengthened early in the

financial year by establishing a Remedial Action Group led by Executive Leads. The terms of reference of the group was to identify additional in year measures across primary, community, and secondary care to mitigate the overall level of risk in the system. This included identifying schemes supporting the Carnell Farrar 11 interventions and the Five Year Forward View.

The new schemes targeted frailty, enhanced care in nursing homes, additional

medicines management schemes and low priority procedures. Medicines Management schemes are forecast to deliver further savings through the latter part of the year of £0.2m. However, all the schemes are expected to have a major impact on future years to support the CCG’s return to financial balance. A


newly established Finance and Performance Committee has been set up to oversee delivery of these schemes.

In addition to the pressures highlighted above, the CCG also carries a pressure in

relation to CQUIN. CCGs were required to hold back 0.5% CQUIN from the Trusts. Dependent upon delivery of the QIPP schemes, the 0.5% will either be paid over to the Trusts or added to the CCGs’ control totals. HWLH takes account of this pressure within the reported deficit.

Despite the work carried out by the CCG and evidence of QIPP delivery, together

with anticipated funding in respect of BSUH IR rules (see paragraph 2.1) the CCG is still forecasting a likely deficit of £9.2m.

4. M10 QIPP Update

HWLH CCG has identified £6.9m in net QIPP savings for 18/19, against a gap of £19.0m. HWLH is working closely with its fellow Alliance CCGs to identify further QIPP opportunities and economies of scale through wider working. Appendix 3 shows a summary of the QIPP Savings Plan for 17/18.

The Plan shows the programmes that are currently in place. The planned savings for each project and programme are adjusted each month to take into account the following:

Whether robust plans are in place to deliver the project

Whether similar projects have successfully realised full benefits in the past

Likelihood of delivery in-year

Risk of overlap / double-counting with other projects

Current slippage or known risks / issues

No new initiatives were registered with the PMO in Month 10. The CSU is reviewing the prevalence and impact of additional counting and coding, with specific concerns at MTW regarding:

Increased NEL Zero LOS admissions

Increased average cost of A&E attendances

High New:Follow up ratio

Higher levels of coding including Sepsis

Diagnostics coding

Double payment for maternity episodes


The CSU has incorporated these issues within the monthly challenge letter, and

audits are to be organised from January.


Appendix 1 - DETAILED OPERATING COST STATEMENT

For the Period Ended 31 JANUARY 2018

Full Yr

CommissioningPlan Plan Actual Variance

Reported

Forecast Variance

£'000 £'000 £'000 £'000 £'000 £'000

Brighton & Sussex University Hospitals * 42,888 35,740 36,405 (665) 44,512 (1,624)

Maidstone& Tunbridge Wells * 22,600 18,833 20,722 (1,889) 23,300 (700)

MSK 16,722 13,935 13,495 440 16,194 528

East Sussex Healthcare * 10,086 8,405 9,879 (1,474) 11,613 (1,527)

South East Coast Ambulance Service (999) 5,714 4,762 4,762 0 5,714 0

South East Coast Ambulance Service (111) 744 620 620 (0) 744 0

Non Contract Activity 3,900 3,250 3,250 0 3,900 0

Queen Victoria SLA 3,796 3,163 3,240 (77) 3,888 (92)

London Contracts 3,037 2,531 2,566 (35) 3,079 (42)

Other acute ** 3,055 2,546 3,038 (492) 3,199 (144)

Other SACS Acute SLA ** 1,094 912 1,282 (370) 1,500 (406)

Winter Pressures 2,159 1,799 1,706 93 1,083 1,076

Horder Centre 10 8 (0) 8 10 0

Total ACUTE 115,805 96,504 100,964 (4,460) 118,736 (2,931)

Sussex Community Trust 15,815 13,179 12,167 1,012 15,291 524

East Sussex Healthcare Community 2,485 2,071 1,447 624 1,800 685

Kent Community Health NHST 1,535 1,279 742 537 1,525 10

ESCC Reablement underspend returned to CCG 264 220 264 (44) 264 0

Wheelchair Service 524 437 471 (35) 444 80

Hospices 444 370 414 (44) 444 0

Other Community Services 300 250 9 241 300 0

Total COMMUNITY SERVICES 21,367 17,806 15,514 2,291 20,068 1,299

Sussex Partnership NHS Foundation Trust 14,525 12,104 11,821 283 14,600 (75)

Health in Mind 1,448 1,207 1,207 0 1,448 0

Other Mental Health 151 126 536 (411) 151 0

Learning Disabilities Expenditure 1,430 1,192 990 202 715 715

Dementia 224 186 123 63 224 0

Total MENTAL HEALTH 17,778 14,815 14,677 138 17,138 640

Adults Continuing Healthcare 8,170 6,808 6,577 231 7,834 336

Funded Nursing Care 3,736 3,114 3,187 (73) 3,850 (114)

Continuing Healthcare Assessment & Support 1,112 926 872 55 1,046 66

Childrens Continuing Healthcare 860 716 854 (137) 910 (50)

Total CONTINUING HEALTHCARE 13,877 11,564 11,489 75 13,640 237

Better Care Fund 10,772 8,977 8,977 (0) 10,772 0

Patient Transport 1,170 975 1,352 (377) 1,620 (450)

Integrated Community Equipment Store 773 644 683 (39) 809 (36)

Collaborative Fees 112 93 90 3 112 0

Childrens Services 29 24 647 (623) 29 0

Programme Projects 1,405 1,171 853 318 1,329 76

Programme Support Costs 767 639 1,088 (449) 1,430 (664)

Programme Property Charges 2,715 2,262 1,208 1,054 1,450 1,265

Other Non Acute 123 103 284 (181) 123 0

Counselling 25 21 16 5 25 0

NHS Commissioned Schemes (HWLH) paid (9,375) (6,928) (9,471) 2,543 (7,375) (2,000)

QIPP (11,883) (9,902) 0 (9,902) (11,883)

Total OTHER COMMISSIONING * (3,367) (1,922) 5,726 (7,648) 10,325 (13,692)

TOTAL COMMISSIONING 165,459 138,766 148,370 (9,604) 179,907 (14,448)

Prescribing 30,438 25,365 24,017 1,348 28,821 1,617

Primary Care Commissioning 21,431 17,858 17,858 1 20,797 634

Enhanced Services 3,002 2,501 2,283 219 2,953 49

Medicines Management - Clinical 452 376 410 (34) 452 0

Primary Care IT 556 463 464 (0) 556 0

Out Of Hours 1,087 906 1,066 (160) 1,087 0

Primary Care Other 337 280 331 (50) 331 6

Practice-based Commissioning Schemes 0 (0) 2 (2) 49 (49)

Total PRIMARY CARE 57,302 47,751 46,430 1,320 55,045 2,257

Running Costs 3,711 3,092 3,087 5 3,711 0

Total CORPORATE & CLINICAL EXPENSES 3,711 3,092 3,087 5 3,711 0

Earmarked Reserves 1,018 11 0 11 0 1,018

Contingency 1,175 2 0 2 0 1,175

Total RESERVES AND CONTINGENCY 2,193 13 0 13 0 2,193

Total OPERATING COSTS 228,665 189,622 197,888 (8,265) 238,663 (9,998)

Revenue Resource Limit 229,463 190,287 190,287 0 229,463 0

Surplus / (Deficit) 798 665 (7,600) 8,265 (9,200) 9,998

* With effect from Month 8, 16/17 prior year adjustents have been moved to "Other Acute" so that the main SLA acutes only show 17/18 expenfiture.

** Other acute contracts include Surrey and Sussex Healthcare NHS Trust, Royal Surrey County NHS Foundation Trust and Western Sussex

Hospitals NHS Foundation Trust. It also includes private providers including Spire Healthcare Ltd, BMI Healthcare Ltd and Nuffield Health.

Also, see note above in respect of prior year adjustments.

CCG Operating Costs



Appendix 2

-25.0

-20.0

-15.0

-10.0

-5.0

0.0

5.0

Do Nothing HRG4+ Pressure IR Rules Pressure Cat M Drugs Non-Stock Drugs QIPP Risk Adjusted

Forecast Outturn

Contingency 1% Non-Recurrent

reserve (0.5%

committed)

BCF Additional Funding BSUH 0.5% CQUIN held

back

MTW 0.5% CQUIN held

back

Additional Meds

Management QIPP

Return of BSUH IR

High Weald Lewes Havens CCG - BSUH - Waterfall 2017/18

£(9.2)m deficit


Appendix 3

CCG Improvement and

Assessment Framework

28 February 2018

Number of personal health budgets in place per 100,000 CCG population

17-18

Q1 Q2 Q3 Q4 Q1

Actual 0 0 0 0 10

Inequality in unplanned hospitalisation for chronic and urgent ambulatory care sensitive conditions

15-16

Q4 Q1 Q2 Q3 Q4

Absolute gradient 1660 1696 1458 1314 1329

Appropriate prescribing of antibiotics in primary care (number of antibiotics prescribed in primary care per STAR-PU)

Target Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

National 1.2 1.07 1.07 1.07 1.07 1.07 1.07 1.07 1.08 1.07 1.06 1.05 1.05 1.05

HWLH 1.2 1.04 1.04 1.05 1.04 1.04 1.05 1.05 1.06 1.05 1.04 1.03 1.03 1.02

12 monthly rolling data

103b

104a

Type 1 Diabetes:

% if diabetes patients that have achieved all the NICE

recommended treatment targets

2015-

16

2014/1

573.3

Percentage of children aged 10-11 classif ied as

overw eight or obese

2017-18

TrendPeriod Value MeanMeasure

Better Health

Chart

2013-14 - 2015-

16

18.3

Type 2 and other Diabetes:



2013-14 - 2015-

16

2015-

16

21.0

39.3

2013-

14 to

2015-

16

27.8 33.5

2010-11 to 2012-

13 to 2013-14 to

2015-16

102a

103a

40.4

105b

2016-17

106a HWLH

2016-17

107a

2015-16 Q4 -

2016-17 Q4

2011/12 - 2014/15

HWLH

2016-17

Rolling 12 months to end

1841.4 1906.0

77.4

2016-

17 Q4

People w ith diabetes diagnosed less than a year w ho

attend a structured education course

Age-sex standardised rate of emergency hospital

admissions for injuries due to falls in persons aged 65+

per 100,000 population

Commentary from published NHS England data show s that the current HWLH gradient is amongst the CCGs w ith the

least inequality.

Absolute gradient:Show s how much higher the rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions is in the most deprived areas of a CCG compared to the least deprived.

A higher value indicates a higher difference between more and less deprived areas

Appropriate prescribing of broad spectrum antibiotics in primary care (No. of co-amoxiclav, cephalosporins and quinolones as a percentage of total number of selected antibiotics prescribed in primary care).

Target Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17

National 11% 9.4% 9.3% 9.2% 9.1% 9.1% 9.0% 8.9% 8.9% 8.9% 8.9% 8.9% 8.9% 8.9%

HWLH 11% 11.9% 11.9% 11.9% 12.0% 12.0% 12.0% 11.8% 11.8% 11.8% 11.9% 11.9% 12.0% 12.0%

12 monthly rolling data

Chart

2016-17 2017-18

Trend

107b

Measure Period Value Mean

Better Care

CQC ratings: Use of high quality providers

Date of last CQC report

Safe

Effective

Caring

Responsive

Well-led

Overall

Percentage of patients w aiting no more than tw o months (62 days) from urgent GP referral to f irst definitive treatment for cancer

Provider % <62 dys All BSUH ESHT MTW Target

Q1 16/17 80.3% 98 122 79.0% 73.7% 71.5% 85%

Q2 16/17 79.5% 124 156 78.5% 76.1% 75.7% 85%

Q3 16/17 76.0% 111 146 74.3% 81.5% 71.4% 85%

Q4 16/17 77.5% 131 169 75.0% 75.1% 70.2% 85%

Q1 17/18 79.2% 118 149 80.7% 74.0% 67.3% 85%

Q2 17/18 74.3% 104 140 76.4% 78.6% 75.5% 85%

Q3 17/18 85%

Q4 17/18 85%

YTD 76.8% 222 289 78.5% 76.5% 71.3% 85%

Variation -8.2% -6% -9% -14%

Provider

121a

Requires improvement

MTW

03-Feb-15


Inadequate

17-Aug-16 27-Jan-17

54.4


Good





Provision of high quality care - Adult Social Care

Overall score indicative of the quality of care in a CCG

area as determined by CQC inspection ratings.

2017-

18 Q1


Good

Inadequate

Inadequate


Requires improvementInadequate


ESHTBSUH

Inadequate

2016-17 Q4 -

2017-18 Q1

121b

121c

2012 - 2015

122a

2016-17 Q3 -

2017-18 Q159.3

Provision of high quality care - Hospitals



2017-

18 Q1

2017-

18 Q167.3

61.0 61.1

2015 51.1

HWLH

122b

65.5

Percentage of cancers detected at stage 1 and 2

2016-17 Q4 -

2017-18 Q1

Provision of high quality care - GP



52.4

70%

75%

80%

85%

90%

95%

Q116/17

Q216/17

Q316/17

Q416/17

Q117/18

Q217/18

Q317/18

Q417/18

HWLH

BSUH

ESHT

MTW

Target

Access to IAPT services: People entering IAPT services as a % of those estimated to have anxiety/depression

Q3 Q4 Y/E Q1 Q2 Q3 YTD

HWLH Actual 3.9% 4.5% 16.6% 4.4% 4.3% 1.7% 10.4%

Target 3.8% 3.8% 15.0% 3.8% 3.8% 3.8% 11.3%

People w ith f irst episode of psychosis starting treatment w ith a NICE-recommended package of care treated w ithin 2 w eeks of referral

Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 YTD Var

HWLH 50% 100% 100% 100% 100% 75% 50% 100% 100% - - 100% 100% - 92% 42%

SPFT 50% 91% 79% 80% 93% 79% 82% 93% 92% 91% 80% 89% 84% 96% 89% 39%

Reliance on specialist inpatient care for people w ith a learning disability and/or autism

17-18

Q1 Q2 Q3 Q4 Q1

43 43 44 43 42

125a

125b

124a

HWLH

124b Proportion of people w ith a learning disability on the GP

register receiving an annual health check

2015-

1644.6 37.1

79.7Women's experience of maternity services

2015 - 2016

123b

8.56

69.9

Jun-17

2016-17

123c

One-year survival from all cancers 2014

122c

123a

122d 2016

Measure Period Value Trend

No trend data

available

2013 - 2015Neonatal mortality and stillbirths 7.0

Maternal smoking at delivery

Quarter

1

2017/18

2015 83.1

2015

2016-17

Choices in maternity services

2016-17 2017-18

2017-18

2015 5.4

No trend data

available

No trend data

available

Mean Chart

Jul-15 - Jun-17

1999 - 2014

Cancer patient experience

Average score "Overall, how w ould you rate your care?"

(from 0-10 w here 10 is the best)

51.9 50.6

Percentage of referrals to Improving Access to

Psychological Therapies (IAPT) services w hich indicated

a reliable recovery follow ing completion of treatment

8.72

70.4

125c

6.2 11.2

Quarter 1 2013/14

- Quarter 1

2017/18

125d

68.7 65.4

The number of inpatients for each CCG in the Transforming Care Partnership, based on CCG of origin, per million GP registered adult population in the Partnership.

Estimated diagnosis rate for people w ith dementia

Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 YTD

National Actual 67.8% 67.4% 67.3% 67.6% 67.9% 67.8% 68.0% 68.0% 68.2% 68.2% 68.6% 68.7% 68.3% 68%

HWLH Actual 61.7% 61.5% 61.9% 63.6% 66.0% 65.3% 64.6% 64.2% 64.2% 63.9% 63.8% 64.3% 64.3% 65%

Percentage of patients on incomplete non-emergency pathw ays (yet to start treatment) w aiting no more than 18 w eeks from referral

Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 YTD Var

92% 90.5% 89.7% 89.9% 90.0% 90.3% 89.9% 90.4% 90.3% 89.9% 89.4% 89.1% 89.3% 89.5% 89.7% -2.3%

92% 85.5% 84.6% 85.7% 86.1% 88.0% 88.0% 88.9% 88.4% 88.1% 88.4% 86.9% 86.9% 87.0% 87.8% -4.2%

92% 80.1% 79.6% 81.4% 82.1% 84.2% 85.2% 86.1% 86.9% 87.0% 86.8% 86.0% 86.1% 86.3% 86.3% -5.7%

92% 85.6% 85.6% 88.9% 89.3% 90.8% 90.8% 92.3% 92.2% 92.0% 92.0% 91.3% 91.4% 91.5% 91.7% -0.3%

92% 90.6% 90.4% 90.3% 89.3% 88.3% 87.7% 87.6% 87.0% 85.6% 85.9% 84.6% 85.0% 85.0% 86.0% -6.0%

92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92% 92%

2016-17 2017-18

78.4%

127e

2016-17

Mar-17 1.1 Sep-15 - Mar-17

2014-15 - 2015-

16

Delayed transfers of care attributable to the NHS per

100,000 population

127f Population use of hospital beds follow ing emergency

admission

2016-

17 Q4470.4

128d

129a

National

128b

MTW

BSUH

ESHT

2017 88.2%

Primary care w orkforce

(FTE per 1000 w eighted patients)

HWLH

2010/11 - July

2016 to June

2017 (Provisional)

Emergency admissions for acute conditions that should

not usually require hospital admission DSR per 100,000

July 2016

to June

2017

(Provisio

nal)

844.9 1330.6

Patient experience of GP services

2015-

1675.1%

TrendPeriodMeasure

126a

17.4

2013 - 2017

2017-18

Value

84.8%

1.0

Chart

127b

Dementia care planning and post-diagnostic support

% of patients diagnosed w hose care plan has been

review ed in face-to-face review in preceding 12 months

Sep-15 - Aug-17

505.02015-16 Q4 -

2016-17 Q4

126b

Aug-17 13.0

Mean

70%75%80%85%90%95%

100%

Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17

National

HWLH

BSUH

ESHT

MTW

Target

Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting

17-18

Q1 Q2 Q3 Q4 Q1

Actual 26.7%

Actual 26.3%

3

% of referrals for a f irst outpatient appointment that are made using the NHS e-referral service

Target Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17

80% 54% 54% 55% 55% 56% 57% 56% 58% 58% 59% 60% 60% 62%

HWLH 80% 4% 4% 4% 4% 4% 3% 4% 3% 3% 4% 4% 4% 4%

144a

National

National

2016-17

HWLH

131a

2016-17 2017-18

Measure Period Value Mean Chart Trend

Outcome Indicators Report

28 February 2018

Contents

Page

Preventing people from dying prematurely 3

Enhancing quality of life for people with long-term conditions 5

Helping people to recover from episodes of ill health or following injury 7

Ensuring that people have a positive experience of care 9

Commentary

Preventing people from dying prematurely

2009 - 2015

2001 - 03 to 2014

- 16

2001 - 03 to 2014

- 16

13.1

Potential years of life lost (PYLL) from causes considered

amenable to healthcare DSR per 100,000

2014

(cal yr)

2001-03 - 2013-

15

Under 75 mortality rate from respiratory disease DSR per

100,000

2015

(cal yr)16.3 29.4 2009 - 2015

Under 75 mortality rate from cardiovascular disease DSR

per 100,000

2015

(cal yr)40.1 64.0

12.2 11.4

2009 - 2015

Life expectancy at 75 for Females

Currently only available at local

authority district level

2064.51496.2

2001-03 - 2013-

15

2009 - 2014

2013-

1514.9

2009 - 2015Under 75 mortality rate from cancer DSR per 100,0002015

(cal yr)94.7 119.5

Wealden2014 -

16

182.8

Measure Period Value Eng/Ave Chart

2001-03 - 2013-

15

Wealden2013-

1512.0 11.4

2001-03 - 2013-

15

Life expectancy at 75 for Males



Lew es2013-

15

Wealden2013-

1513.9 13.1

Trend

Lew es

Age standardised rate of mortality from

causes considered preventable per

100,000)



Lew es2014 -

16139.8

Under 75 mortality rate from liver disease DSR per

100,0002015 8.7 16.1

132.5 182.8

1999 to 2015

2015 0.8 3.7 1999 to 2015

One-year survival from breast, lung and colorectal

cancers2011 69.35 69.3 1996 - 2011

1999 - 2014

Quarter 1

2013/14 -

Quarter 1

2017/18

2016/1

726.0

2006/07 to

2016/1734.2

2006/07 to

2016/17

HWLH CCG

2013-

14 to

2015-

16

27.8 33.5

Lew es

Wealden2016/1

727.3 34.2

5.4 7.0

2015 3.4 3.7

11.2

Trend

2013 - 2015Neonatal mortality and stillbirths 2015

Wealden

27.7

2010/11 to July

2016 to June

2017

(Provisional)

One-year survival from all cancers 2014 69.9 70.4

Percentage of cancers detected at stage 1 and 2

Emergency admissions for alcohol related liver disease

DSR per 100,000

July 2016

to June

2017

(Provisi

onal)

20.9

2015 51.1 52.4

370.0

Excess under 75 mortality rate in adults w ith serious

mental illness

Currently only available at local authority level (East Sussex)

2014/1

5328.3

2009/10 -

2014/15

2012 - 2015

Infant Mortality



Lew es

Measure Period Value Eng/Ave Chart

Maternal smoking at delivery

Quarter

1

2017/18

Percentage of children aged 10-11

classif ied as overw eight or obese

6.2

2010-11 to 2012-

13 to 2013-14 to

2015-16

Enhancing quality of life for people with long-term

conditions

People w ith diabetes diagnosed less than a year w ho

attend a structured education course2014/15 73.3

2013/14 -

2016/17

1/7/2006 to

30/9/2006 -

1/4/2017 to

30/6/2017

July 2016

to June

2017

(Provisi

onal)

2011/12 -

2014/15

2016/17

2015-16

301.3

Percentage of referrals to Improving Access to

Psychological Therapies (IAPT) services w hich indicated

a reliable recovery follow ing completion of treatment

Jun-17

Unplanned hospitalisation for asthma, diabetes and

epilepsy in under 19s DSR per 100,000

51.9 50.6

39.3 40.4

2011/12 to

2016/17

ChartMeasure Period Value Eng/Ave

0.83

Health related quality of life for people w ith long term

conditions (Directly standardised average health status

(EQ-5DTM) score for those aged 18 and over)

2016/17 0.8 0.7

2016/17

1/4/2017

to

30/6/201

7

People w ith a long-term condition feeling supported to

manage their condition(s)

126.5

Employment of people w ith mental illness

Currently only available at local authority level (East

Sussex)

Trend

2010/11 - July

2016 to June

2017

(Provisional)

Unplanned hospitalisation for chronic ambulatory care

sensitive conditions (adults) DSR per 100,000

Type 2 and other Diabetes:



2013-14 - 2015-

16

2010/11 - July

2016 to June

2017

(Provisional)

2016/17 64.7 64.0

77.4

0.80Health related quality of life for carers, aged 18 and above

1/4/2017

to

30/6/201

7

22.1 31.3

Health related quality of life for people w ith a long-term

mental health condition0.62 0.52

July 2016

to June

2017

(Provisi

onal)

506.6 811.5

Type 1 Diabetes:



2015-16 21.0 18.32013-14 - 2015-

16

2011/12 to

2016/17

6.9 12.1

1/7/2006 to

30/9/2006 -

1/4/2017 to

30/6/2017

2011/12 -

2016/17

Jul-15 - Jun-17

Employment of people w ith long-term conditions

Currently only available at local authority level (East

Sussex)

806.9

2015-16 0.75 0.78

503.3

2014-15 - 2015-

16

Dementia care planning and post-diagnostic support

% of patients diagnosed w hose care plan has been

review ed in a face-to-face review in the preceding 12

months

Management of long term conditions

(proxy measure: unplanned hospitalisation for chronic

ambulatory sensitive conditions)

12

month

ro lling

data to 4

Q15/16

No trend data

available

Measure Period Value Eng/Ave Chart Trend

No trend data

available

Proportion of people w ith a learning disability on the GP

register receiving an annual health check2015-16 44.6 37.1

Helping people to recover from episodes of ill health

or following injury

1841.4

Lew es2015/1

6

HWLH CCG

2010/11 to

2015/16

Wealden2015/1

6109.5 134.1

2010/11 to

2015/16

2015/1

6146.2 134.1

2010/11 to

2015/16

Lew es2015/1

696.7

Patient reported outcome measures for elective

procedures: hip replacement (primary only)

2015/1

60.46

2010/11 to

2015/162026.5 2169.4

Measure Period Value Eng/Ave

1906.0

Age-sex standardised rate of emergency

hospital admissions for injuries due to

falls in persons aged 65+ per 100,000

population

2015-16 Q4 -

2016-17 Q4

2012/13 -

2013/14

2169.4

Rate of hospital admissions caused by

unintentional and deliberate injuries in

children aged 15-24 years per 10,000

resident population



Lew es

Chart Trend

Wealden

July 2016

to June

2017

(Provisi

onal)

0.44

Emergency readmissions w ithin 30 days of discharge

from hospital indirectly standardised percentage

2154.1

844.9 1330.6

2011/1

210.7 11.8

Wealden2015/1

6

104.2

2010/11 -

2011/12

2010/11 - July

2016 to June

2017

(Provisional)

2010/11 to

2015/16

Emergency admissions for children w ith low er respiratory

tract infections DSR per 100,000

April

2016 to

M arch

2017

(Provisi

445.4 459.0

2010/11 - April

2016 to March

2017

(Provisional)

Rate of hospital admissions caused by

unintentional and deliberate injuries in

children aged 0-14 years per 10,000

resident population



2010/11 to

2015/16

2015/1

696.3 104.2

2015-16

Q4 -

2016-17

Q4

Emergency admissions for acute conditions that should

not usually require hospital admission DSR per 100,000

Tooth extractions due to decay for

children admitted as inpatients to hospital,

aged 10 years and under



Lew es

Wealden

Aug-17 17.4 13.0

Proportion of older people (65 and over) w ho w ere

offered rehabilitation follow ing discharge from acute or

community hospital

Currently only available at local authority level (East Sussex)

2015/16 1.5 2.9

54.9 425.0

Sep-15 - Aug-17

2015/1

692.2

0.09

470.4

Delayed transfers of care attributable to the NHS per

100,000 population

2012/13 - 2015/16Patient reported outcome measures for elective

procedures: knee replacement (primary only)

2015/1

6

2011/12 to

2015/16

425.0

Measure Period Value

2015/1

6

0.32 0.32

Eng/Ave Chart

2011/12 -

2015/16

0.042010/11 -

2015/16

Trend

2011/12 to

2015/16

2015/1

6

Patient reported outcome measures for elective

procedures: groin hernia

505.02015-16 Q4 -

2016-17 Q4

Population use of hospital beds follow ing emergency

admission

2016-17

Q4

Ensuring that people have a positive experience of

care

2013 - 2017

Patient experience of GP services

Primary care w orkforce

(FTE per 1000 w eighted patients)

July 2011 to

March 2012 -

January 2017 to

March 2017

July 2011 to

March 2012 -

January 2017 to

March 2017

Wealden

January

2017 to

M arch

2017

73.3 72.7

July 2011 to

March 2012 -

January 2017 to

March 2017

Access to GP services



84.8

January

2017 to

M arch

2017

75.9 72.7

July 2011 to

March 2012 -

January 2017 to

March 2017

Patient experience of hospital care2013/1

475.1 76.5

Mar-17 1.1 1.0

2013/1

4

January

2017 to

M arch

2017

July 2011 to

March 2012 -

January 2017 to

March 2017

85.2Wealden

January

2017 to

M arch

2017

Ensuring that people have a positive experience of care

Patient experience of GP out-of-hours services (w eighted

percentage)

Please note that in Aug 16, HSCIC advised that this indicator can no

longer be generated

July

2014 to

March

2015

70.7 68.6

July 2011 to

March 2012 -

July 2014 to

March 2015

Lew es

January

2017 to

M arch

2017

89.2 84.8

HWLH CCG

Lew es

Patient experience of Dental services



Lew es

Period

2017 88.2 84.8

85.286.4

65.5 68.4No trend data

available

July 2011 to

March 2012 -

January 2017 to

March 2017

Wealden

January

2017 to

M arch

2017

88.1

No trend data

available

Responsiveness to Inpatient's personal needs

Chart Trend

Sep-15 - Mar-17

Eng/AveMeasure

84.3

Value

Percentage of deaths w hich take place in hospital

2016/1

7 Q1 -

2016/1

7 Q4

40.4 46.9

2010/11 Q4 to

2011/12 Q3 -

2016/17 Q1 -

2016/17 Q4

July 2011 to

March 2012 -

January 2017 to

March 2017

Wealden

January

2017 to

M arch

2017

95.5 94.6

July 2011 to

March 2012 -

January 2017 to

March 2017

94.6

Proportion of deaths in usual place of residence

(Rolling 12 months)

2016/1

7 Q1 -

2016/1

7 Q4

51.7 46.1

2010/11 Q4 to

2011/12 Q3 -

2016/17 Q1 -

2016/17 Q4

Access to NHS dental services



Lew es

January

2017 to

M arch

2017

95.0

Cancer patient experience

Average score "Overall, how w ould you rate your care?"

(from 0-10 w here 10 is the best)

2016 8.56 8.72 2015 - 2016

Women's experience of maternity services 2015 83.1 79.7No trend data

available

Choices in maternity services 2015 68.7 65.4No trend data

available

Measure Period Value Eng/Ave Chart Trend


Title: HWLH CCG Outcomes and IAF Metrics

Item number: 09/18

Date: 28th February, 2018

Author: Stephen Clarke

Accountable Executive Director: Hugo Luck

Clinical Lead:


To inform the Governing Body with regards to the overarching Outcomes and Improvement & Assessment Framework (IAF) Metrics, that contribute towards CCG evaluation.


Outcomes Measures, metrics in bold type are also IAF metrics

Preventing people from dying prematurely The CCG is better than the national average in all indicators, except

o Percentage of Cancers detected at Stage 1 & 2 The gap between the CCG and the national average has narrowed from 8% to just over 1%. The CCG expects this to continue and improve further.

o One-year survival from all cancers Historically the CCG trend has matched exactly the national trend where a significant improvement has been delivered since 2000; but slightly below the national average. This is potentially due to the CCGs older population.

Enhancing quality of life for people with long-term conditions The CCG is better than the national average in all indicators, except

o People with diabetes diagnosed less than a year who attend a structured education course.

o Percentage of diabetes patients that have achieved all the NICE recommended treatment targets. The data used relates to 2014/15. The CCG commissioned a new integrated diabetes service in 2016 which has significantly improved the take up of structured education classes, and increased adherence to the

HWLH CCG Outcomes and IAF Metrics 09/18

Page 2 of 3

NICE recommendations. This has subsequently contributed towards our ‘Good’ rating for diabetes services.

o Percentage of patients diagnosed whose care plan has been reviewed in face to face reviews in the preceding 12 months. The new Dementia ‘Golden Ticket’ service will ensure that patients with dementia will receive the best possible care.

Helping people to recover from episodes of ill health or following injury The CCG is better than the national average in all indicators, except

o Patient reported outcome measures for elective procedures – Groin hernia This is a sudden and recent drop in performance and requires further investigation. However, recently released final data for 2016/17 indicates an adjusted health gain in line with peer CCGs, and better than the national average.

o Proportion of older people who were offered rehabilitation following discharge from an acute or community hospital.

o Delayed transfers of care attributable to the NHS per 100,000 Since the Autumn, schemes have been in place to reduce the volume of DTOCs. These have been shown to have been successful

Ensuring that people have a positive experience of care The CCG is better than the national average in all indicators, except

o Patient experience of hospital care

o Responsiveness to Inpatient’s personal needs

o Cancer Patient Experience Data from the National Cancer Patient Experience Survey indicates a number of questions where the CCG could improve:

Patient found it easy to contact their Clinical Nurse Specialist

Hospital staff gave information on getting financial help

Hospital staff told patient they could get free prescriptions

Patient was able to discuss worries of fears with staff during visit

GP given enough information about patient’s condition and treatment

Overall the administration of the care was very good/good. The survey will be reviewed by our Cancer lead.

HWLH CCG Outcomes and IAF Metrics 09/18

Page 3 of 3


Ensuring high quality care for the CCG’s population.


Implications

Quality and Safety Metrics used relate to the quality of care provided.

Financial

Individual performance risks may have potential financial impact with respect to penalties applicable and usage of the RTT monies


Not applicable

Equality and Diversity Not applicable


Not applicable

Risk Quality domains and financial balance

Legal Individual performance risks may have potential legal impact




Title: Kent and Medway Stroke Review

Item number: 10/18

Date: 21 February 2018

Author: Ashley Scarff

Accountable Executive Director: Ashley Scarff

Clinical Lead: Dr David Roche Dr Peter Birtles


This report is to inform the Governing Body of the outcome of the meeting of the Kent and Medway Stroke Review Joint Committee of CCGs (JCCCG), of which HWLH CCG is a member.

The Governing Body will be reminded that the CCG made provisions, including necessary amendments to the constitution to enable HWLH CCG’s direct involvement in the joint committee. The CCG’s nominated representatives on the committee were agreed to be Dr David Roche, High Weald Locality Chair and Dr Peter Birtles, Clinical Lead for Urgent and Primary Care.


On the 31st January 2018 the JCCCG met in public at Maidstone Kent to consider recommendations to proceed to a formal public consultation on changes to the provision of stroke services across Kent and Medway hospitals. This has the potential to affect patients in the High Weald area of HWLH who are currently served by the Tunbridge Wells Hospital in Pembury. This meeting was the latest of a series that have considered the evidence and analysis in detail to arrive at a recommended shortlist of configuration options that would secure improved outcomes for people suffering strokes. At all stages of the process so far the relevant population that has been included is the whole population served by Kent and Medway hospitals, not just Kent and Medway. The populations of High Weald, some of Rother, Mid Sussex and Bexley have all been factored in.

The accompanying report was presented to the JCCCG and serves as a summary of the case for change, options appraisal and business case that underpin the recommendation to consider reconfiguration options to improve stroke care.

Kent and Medway Stroke Review 10/18

Page 2 of 5

The conclusion of the JCCCG was unanimous agreement to proceed to formal consultation for a period of 10 weeks.

Key points to note are:

1. There are 5 shortlisted configuration options being consulted on – 2 involve no change for HWLH population, 3 see stroke services move away Tunbridge Wells Hospital, Pembury meaning some High Weald activity would flow south to Eastbourne.

2. The case for change is compelling and well-established – The clinical case for change is consistent with that for the BSUH reconfiguration agreed last year, ESHT stroke services prior to that and elsewhere nationally.

3. The public consultation is to run for 10 weeks and for our purposes will be targeted to the Tunbridge Wells (Pembury Hospital) catchment area in the High Weald.

4. The East Sussex Health Overview and Scrutiny Committee (HOSC) have been involved as part of pre-consultation engagement and have endorsed the consultation approach and methodology and they are part of a joint HOSC being formed together with Kent and Medway and Bexley area HOSCs.

5. There are roughly 100 strokes a year from the High Weald area treated in Tunbridge Wells

6. Post consultation analysis will be complete by June, a final decision making business case will be prepared for mid-September

7. Implementation of any agreed reconfiguration would be managed over an 18-24 month period

8. Particular slides recommended to the Governing Body to note are:

Slide 6&7 – Case for change and benefits Slide 11 – Configuration options

Slide 14 – Evaluation matrix of long list of options that shows relative assessment against shortlisting criteria.

Slide 15 – Comparison of shortlisted options Slide 23 – Engagement plan

Full details and the underpinning pre-consultation business case can be found on the following link:

https://kentandmedway.nhs.uk/latest-news/jccgpapers_31_jan_18/

It is recommended that further updates will be reported to the Clinical Executive Committee (CEC) ahead of the expected decision making point in September 2018.


Page 3 of 5


1. Commission safe, patient centred, high quality, effective and affordable care from birth to end of life.

2. More timely diagnosis and risk management.


1. To note the report and the presentation made to the JCCCG Committee. 2. To note the commencement of a 10 week consultation period targeted to the High

Weald 3. To note that future updates will be reported to the Clinical Executive Committee (CEC)


Page 4 of 5

Implications

Quality and Safety Review addresses inconsistencies in quality in care across Kent and Medway compared to national quality standards and deliver best practice.

Financial

Providers meeting all stroke care standards may be eligible for increased ‘best practice tariff’ for stroke activity. It is expected that the Kent configuration would enable this. This would bring Kent providers into line with other providers including BSUH. The additional net cost of Best Practice Tariff is off-set by savings achieved through reduced on going care as a result of improved outcomes for stroke survivors. There are also capital investment considerations for providers that are set out in the pre-consultation business case.


Public consultation is required for the changes shortlisted for consideration. The East Sussex HOSC has provided oversight on proposals for engagement within East Sussex. An engagement plan was considered by the JCCCG Committee.

Equality and Diversity

A full integrated impact assessment has been completed and formed part of the papers informing the JCCCG decision to proceed to consultation. This impact assessment this will be updated and represented post consultation and engagement for the decision making business case stage.


Additional workforce requirements are summarised in the report attached, presented in terms of additional stroke consultants. At this stage the relative measure of the number of (additional) stroke consultants required is a proxy measure for all associated workforce in order to compare configuration potions.

Risk Risks outlined in the report (Slide 20)

Legal Legal requirement for public consultation.



None.


Page 5 of 5

Previous GB, CEC and Q&P committees have been advised of the process and progress, working with Kent and Medway CCGs, to get to this point.

Transforming health and social care in Kent and Medway is a partnership of all the NHS

organisations in Kent and Medway, Kent County Council and Medway Council. We are working

together to develop and deliver the Sustainability and Transformation Plan for our area.

Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Kent and Medway Sustainability

and Transformation Partnership Kent and Medway Stroke Review Joint Committee of CCGs

Discussion Document

31 January 2018

Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018 Kent and Medway Stroke Review Joint Committee of CCGs – 31 January 2018

Stroke is a serious life-threatening condition caused by a blood clot or bleed in

a blood vessel in the brain.

How well people recover is affected by speed and quality of treatment.

• Around 3,000 people a year who have a stroke live nearest to a Kent and

Medway hospital

• Around 250 patients currently treated for stroke in Kent and Medway

hospitals are from outside of Kent and Medway

Stroke and current services in Kent and Medway

Six of our seven* hospitals

currently provide some urgent

stroke care across Kent and

Medway.

But we are not consistently

meeting national quality

standards or delivering best

practice care.

*Services not currently provided at Kent and Canterbury Hospital

Our proposal Setting the scene (Patricia Davies)


Hospital staff in Kent and Medway provide the best urgent stroke service they

can. But the way urgent stroke services are set up currently, along with staff

shortages, mean local hospitals do not consistently meet national

standards for clinical quality.

We want anybody who has a stroke, day or night, anywhere across Kent and

Medway, and our border areas, to have the best chances of survival and

recovery. To do this we must reorganise our stroke services.

Our proposal

We want to develop 24/7 urgent stroke services

• Hyper acute stroke units

• Acute stroke units

• Transient ischaemic attack (‘mini stroke’) clinics

Investing up to £40m in hospitals and recruiting more staff


3


Significant service change requires public consultation

Kent and

Medway Case

for Change

Development of

Kent and

Medway service

delivery models

Development of

hurdle criteria

Identify full

evaluation

criteria

Identify long list

of options

Application of

hurdle criteria to

produce a

shortlist of

options

Evaluation of

shortlist of

options (using

evaluation

criteria) to

identify a

preferred

option(s)

Development of

a Pre-

Consultation-

Business Case

(PCBC)

Submission of

PCBC to NHS

England

National

Investment

Committee

Public

Consultation

Evaluation of

consultation

discussions and

responses

Decision by

Joint Committee

of CCGs

Current position


Timeline

2018

Jan February March April May June July August September

Consultation

31/01

Formal

JCCCG Consultation

analysis

Formal

JCCCG

(date TBC)

Mid-late Sep

(date TBC)

Formal JCCG

Decision making

meeting

Decision Making Business Case (DMBC) development

Ongoing communications and engagement

01/02

Consultation

launch (TBC)


We only have 1/3 of the

stroke consultants needed

to deliver a best practice

service in all hospitals

Specialist stroke resources are spread too thinly and most hospitals do not

meet national standards and best practice ways of working.

24/7 access is not

consistently available

for consultants, brain scans

and clot busting drugs

Over 1/3 of stroke patients are

not getting brain scans

in recommended time

Half of appropriate patients

not getting clot busting

drugs in recommended time

Only one unit seeing enough stroke patients

for staff to maintain and develop expertise

(recommended minimum of 500 stroke patients per year)

Case for change (Patricia Davies)


• Run 24 hours a day, 7 days a week

• Always have access to a stroke consultant with seven

day/week consultant ward rounds

• Able to do brain scans and give clot-busting drugs within 2

hours of calling an ambulance, round the clock

• Staffed by teams of stroke specialist doctors, nurses and

therapists

• Inpatient care for first 72 hours is on the hyper acute unit,

follow up care is also on specialist acute stroke unit

Hyper acute stroke units in action

Service model and benefits (David Hargroves)


Seven day TIA (or “mini stroke”) clinics will be provided at the

Hyper Acute Stroke Units / Acute Stroke Units

Under the future TIA pathway:

• Very high risk TIA patients will be admitted to the HASU/ASU

• Probable TIA patients require urgent assessment. This will take place at the

seven day TIA clinics run at the HASU/ASU sites

• Less likely suspected TIAs require less urgent assessment, and this can be

provided locally

• In addition, the Clinical Reference Group will explore the requirement for

provision of local TIA clinics for probable TIA patients


TIA (“mini stroke”) pathway

Very high risk

TIA requires

admission

Probable TIA

35%

Unlikely TIA but

needs urgent

assessment

20%

Other

neuro/specialit

y

30%

Clear

diagnosis

15%

Diagnosis and

prescription

Triage

24/7

Alert

Outpatient

pathway

Home

Immediate

admission

24/7

<24H 7 day

>1W 5 day

>1W 5 day

Immediate

7 day

Outpatient

pathway

HASU/ASU

(Local DGH)

(Local District General

Hospital)

Speed of response

Approx. 10% of

confirmed strokes


Consolidating urgent stroke services would help deliver consistently

high-quality care regardless of where people live or when a stroke/TIA

occurs

• more patients getting brain scans and, if needed, clot busting drugs within

the recommended time

• a reduction in deaths from stroke

• fewer people living with long-term disability following a stroke

• fewer people losing their independence and being admitted to nursing/care

homes following a stroke

• shorter stays in hospital

• fewer vacancies within the stroke services and less turnover of staff

• improved experiences for patients and staff through best practice care

delivered in specialist units 24 hours a day, seven days a week.

Benefits of change


We are consulting on

• The proposed move to a new way of delivering urgent stroke care

• The development of three sites into new stroke units

• A shortlist of deliverable three-site options

Options for consultation

Option Hospitals

A Darent Valley | Medway Maritime | William Harvey

B Darent Valley | Maidstone | William Harvey

C Maidstone | Medway Maritime | William Harvey

D Tunbridge Wells | Medway Maritime | William Harvey

E Darent Valley | Tunbridge Wells | William Harvey

• Options are not ranked in order of preference.

• A preferred option will be agreed after consultation.

• Urgent stroke services would not be available at other

hospitals in Kent and Medway.

Options and evaluation (David Hargroves, Nick Dawe)


The 13 options on the medium list were evaluated against the following five

domains: Quality, Access, Workforce, Ability to Deliver and Affordability

Ability to

deliver

Quality

of care

for all

Access

to care

for all

Criteria

1

2

3

4

Workforce

• Expected time to deliver

• Scale of impact

• Clinical effectiveness and

responsiveness

• Time to access services

Sub-criteria

• Sustainability

• Trust ability to deliver

Affordability

and value for

money

5 • Net present

value


The following process was undertaken to reach a shortlist of options

Clinical and other non-financial evaluation analysis

Clinical Board + Stroke CRG chair

Review draft analysis 24/08

Stroke CRG + Stroke Prog. Board

Review output of initial eval. w/s 05/09, 06/09

Financial analysis

Finance Group 25/08

Finance evaluation workshop

Finance Group + Stroke Assoc. 08/09

CCG JC makes

final decision

whether to go to

consultation

31 January 2018

Review by

South East

Coast Clinical

Senate

16/11

Full evaluation workshop 20/09

STP Programme Board 11/09

Stroke CRG 03/10

Finance Group 06/10

STP Programme Board 09/10

1:1s with Estate Directors, Finance Directors and Dep. Chief Execs w/c 02/10

Submission to South East Coast Clinical Senate 26/10

CCG Chairs and AOs 11/10

Initial evaluation workshop 30/08


1) DVH,

WHH,

QEQM

2) MGH,

MMH,

QEQM

3) DVH,

MMH,

WHH

4) DVH,

MMH,

QEQM

5) DVH,

MGH,

WHH

6) DVH,

MGH,

QEQM

7) DVH,

TWH,

QEQM

8) MGH,

MMH,

WHH

9) TWH,

MMH,

QEQM

10) TWH,

MMH,

WHH

11) DVH,

TWH,

WHH

12) DVH,

MGH

MMH,

13) MGH,

WHH,

QEQM

1

2

3

4

5

Qu

ali

ty

Ac

ce

ss

W

ork

forc

e

Fin

an

ce

A

bil

ity t

o d

eli

ve

r

• SEC co-adjacencies

• Co-adjacencies

for mech.

thrombectomy

• Req. for MEC

• Blue light, proxy

• Private car, off

peak

• Gap in workforce

requirements

• Vacancies

• Turnover

• Expected time to

deliver

• Trust ability to

deliver

Full evaluation matrix

• Net Present Value

(NPV at 10 yrs, £m)

/

++

++

++

-

++

- -

- -

-

/

/

/

+

++

-

- -

+

++

-

/

+

++

/

/

- -

++

+

+

/

+

/

+

+

+

/

-

- -

++

-

/

+

+

+

+

/

+

/

++

/

+

-

/

+

++

/

/

/

++

-

-

/

+

+

+

-

++

-

++

-

/

+

+

++

+

-

- -

+

++

+

/

+

++

++

-

- -

+

++

-

/

++

++

++

++

-

-

+

++

-

++

+

++

++

++

/

++

-

++

-

+

+

/

- -

- -

++

/

-

- -

/

+

/

+

++

++

- -

-

/

+

/

+ + ++ + - + + + + ++ -

+ - -

- - /


A Darent Valley,

Medway,

William Harvey

B Darent Valley,

Maidstone,

William Harvey

C Maidstone,

Medway,

William Harvey

D Tunbridge

Wells, Medway,

William Harvey

E Darent Valley,

Tunbridge

Wells,

William Harvey

Hospital site

locations

Population within

30 mins by

ambulance 73.4% 74.2% 76.2% 82.2% 76.9%

Population within

45 mins by

ambulance 91.0% 91.3% 91.3% 92% 91.9%

Capital investment

required £30.82m £36.29m £37.86m £35.95m £30.63m

More

stroke

doctors

needed

In K&M

8 8 8 8 8

Outside

K&M 0 0 2 2 0

Comparison of options


Why are some sites not proposed as a future Hyper Acute Stroke Unit/Acute

Stroke Unit?

Kent and

Canterbury

Hospital

Queen Elizabeth

the Queen Mother

Hospital

• East Kent University Hospitals Foundation Trust felt that it would

be very difficult to deliver stroke services on two sites (William

Harvey Hospital and Queen Elizabeth the Queen Mother Hospital)

due to recruitment issues and the risks around staff re-location

• Therefore, all options with a HASU/ASU at both of these sites

were evaluated more poorly in the trust ability to deliver

• Kent and Canterbury Hospital does not currently meet the co-

dependency requirement for a HASU as it is lacking acute medicine

and critical care

• This is due to the withdrawal of training doctors by Health Education

England in March 2017

• Options with Kent and Canterbury Hospital have not been shortlisted

for consultation.


• Thousands of people have engaged in stroke review since late 2014

including: stroke survivors/ their families and carers/ members of the

public/ clinicians/ key stakeholders including CCGs, providers from Kent,

Medway, and across the borders in Sussex, Surrey and south London

• They have provided a valuable challenge and helpful insight throughout

the review

• Views have been fed into the decision-making process

• Variety of engagement channels have been used including surveys, focus

groups, listening events, roadshows, face to face meetings

• We have used a variety of channels to communicate including e

newsletters, printed magazines, emails, media, social media, websites

• All engagement work has been logged and evidenced

Overview of stroke engagement

Stakeholder engagement (Patricia Davies)


Since starting the stroke review we have been talking to staff, patients, the public

and wider stakeholders to develop the future care model. Key advantages of the

new model that people identified included:

Potential advantages and benefits

Separate specialist centres

7 day service/longer

hours

More collaborative

working

Better delivery of

care

Seven days a week specialist

service is good. Ashford

I understand or know that stroke

services like this have better

outcomes. It is a sad compromise

that [increased] travel may be

necessary. Deal


Since starting the stroke review we have been talking to staff, patients, the public

and wider stakeholders. Issues already raised include:

Potential disadvantages and concerns

Why not have a

hyper acute stroke

unit at every hospital?

Why not centralise everything

on one site?

Is three the right number?

Will sites that lose

stroke services suffer?

Are hospitals outside

Kent and Medway affected?

Impact on other hospitals

Can we recruit enough

staff for the proposed

changes?

Will staff be willing to move to

new locations?

Recruitment & retention

Can ambulances get

people to a hyper acute

stroke unit fast enough?

Can relatives and carers

visit easily?

Travel times


Mitigations against potential disadvantages have been developed

Travel and access

for carers and

relatives

Workforce

• Training offered for staff at non HASU/ASU sites to ensure no loss of

expertise at these sites

• Protocol in development for patients who have a stroke in a non

HASU/ASU

Transition

Risk Mitigation

Travel and access

for patients

• Increased travel time will be off-set by the improved diagnostic and

treatment efficiencies in the model of care at the HASU.

• Ambition of the new model of care is to provide thrombolysis treatment

within 30 minutes of arrival – this allows for 90 minutes for call to door

• Liaise with voluntary transport services in transporting carers and

relatives

• Explore options for carers and relatives to stay overnight

• Maximise public transport accessibility through engagement with local

transport providers

• Review cost/availability of car parking spaces for carers and relatives

• Incentives to encourage staff to relocate.

• Develop a system wide approach to encourage and support the

movement of staff

• Promotion of stroke roles through the use of targeted recruitment

campaigns


Assurance (Michael Ridgwell)

• South East Coast Clinical Senate

• Integrated Impact Assessment

• Joint Health Overview and Scrutiny Committee

• NHS England


Integrated Impact Assessment

• An independent integrated impact assessment of the proposed options

was commissioned

• Looked at potential impact of the options in terms of health, travel and

access, sustainability and populations with protected characteristics

• The difference between the options for consultation was found to be

minimal

• Report gave recommendations for mitigations – these have been further

developed by the stroke review governance groups


It is proposed to launch the public consultation on 1 February 2018 to run for ten weeks.

During the consultation period we will:

• Have online information, materials and questionnaire as well as hard copies

• Hold proactive listening events x 10 CCG areas

• Discuss the consultation and encourage responses at existing meetings and

opportunities, at both county and CCG level

• Respond to meeting requests where we can

• Provide materials and support for meetings run by others (eg animation, consultation

documents, FAQs)

• Conduct outreach to seldom heard groups (building on pre-consultation engagement)

• Conduct targeted focus groups i) IIA ii) those particularly at risk of stroke iii) staff

• Gather feedback from a representative sample population – telephone survey

• Continue 1-1 stakeholder engagement for targeted responses

• Run a digital and social media campaign

• Continue working with local media

• Take every opportunity to build in ‘FAST’ and other prevention messages to our

communications.

Meeting dates will be published at www.kentandmedway.nhs.uk/stroke and on individual

CCG websites, as well as cascaded through networks and publicised locally.

Consultation process Consultation plan (Steph Hood)

http://www.kentandmedway.nhs.uk/stroke


Consultation activity overview

Briefing stroke teams

Dissemination of

consultation doc

Stakeholder launch event

Media launch

Roadshow in local towns

Adverts in local media

Webchat with clinician

EIA target focus

groups

At risk of stroke focus

groups

Roadshow continues

3x listening events in

CCG areas


Staff focus groups


CCG areas


EIA target focus groups


groups


CCG areas


Telephone survey begins

Staff focus groups

Mid-point media push

3x listening events in CCG

areas


Telephone survey

continues



groups


areas


Telephone survey

continues

Staff focus groups


areas





groups


areas


Staff focus group

Deadline media push

Final call for responses across all channels

Press release/ media on close of

consultation

1 2 3 4 5 6 7 8 9 10 -2

We

ek

nu

mb

er


Consultation activity overview

Activity taking place throughout consultation period

• Supporting materials and survey on STP website and signposted from CCG and

provider sites

• Weekly topic-specific content shared via STP, CCG and provider communications

channels (e.g. website, social media, bulletins/newsletters, staff briefings etc)

• Promotion of consultation to and in 3rd party stakeholder organisations

communications channels

• Presentations to/attendance at key stakeholder meetings/groups

• Information displayed in provider organisations (including staff areas), GP

practices, libraries, community centres and other public spaces

• Providing support materials for 3rd party meetings (e.g. animation, consultation

documents, FAQs)

• Proactive outreach to seldom heard groups

• Targeted1-1 stakeholder engagement to generate responses


Once our consultation has launched:

• You will be able to read more about the proposed changes

Visit www.kentandmedway.nhs.uk/stroke

for the consultation document and questionnaire (these will also available in

printed format), and find more information on our website including:

pre-consultation business case

travel time modelling

options evaluation process

integrated impact assessment and more

• And when you are ready to respond

- Complete the consultation questionnaire online, by post or by telephone.

Giving your views

http://www.kentandmedway.nhs.uk/stroke


Q&A

Consultation process Public Q&A


Title: Development of Urgent Treatment Centres

Item number: 11/18

Date: 20.02.2018

Author: Leila Hughes, Urgent Care Project Manager

Accountable Executive Director: Sally Smith, Director of Integration and Primary Care

Clinical Lead: Dr Peter Birtles, Clinical Lead for Urgent Care and Primary Care


This development plan details the proposed enhancement of HWLH Minor Injury Units to meet Urgent Treatment Centre standards, as set out by NHS England.


Within High Weald Lewes Havens (HWLH) there is no Emergency Department (ED). Currently members of the public travel to either Brighton, Eastbourne, Haywards Heath, Tunbridge Wells or East Surrey to attend an ED. The majority of urgent care needs are met locally by GP contractual, extended hours and out of hour’s services along with three Community Hospitals containing three Minor Injury Units (MIU) at Lewes, Uckfield and Crowborough. The “Next Steps on the NHS Five Year Forward View” document highlighted urgent and emergency care as one of the NHS’ main national improvement priorities with a need to improve ED performance and streamline access to services. One element of these improvements is the development of standardised Urgent Treatment Centres (UTC). NHS England (NHSE) has mandated all Clinical Commissioning Groups (CCG) to review current urgent care provision and where appropriate transform current sites into the new UTC model. Discussions are taking place across the Sustainability and Transformation Partnership (STP) to ensure a system wide approach to the provision of UTC within Sussex and East Surrey. Conversations will continue to take place in parallel to the NHSE project plan submission on the 31 March 2018. The UTC is part of integrated urgent care service which aligns with NHS111, GP out of hours and face to face urgent care. The UTC operates as a networked model of care providing referral pathways to ED and specialist services. Each is a GP led service with a multidisciplinary clinical workforce, offering services for a minimum of 12 hours per day 7 days a week 365 days a year. Patients access services directly through NHS111, General Practice and ambulance services, or by walk-in attendance. The UTC has access to

Development of Urgent Treatment Centres 11/18

Page 2 of 53

simple diagnostics (e.g. urinalysis, ECG, bloods and X-ray etc.) as well as access to the Directory of Services. An expansion of services offered by the MIU was always planned as part of the service development improvement plan. This proposed development delivered these aspirations, but also offers opportunities to link effectively with existing programmes such as 7-day access to step up / step down beds; and extended access to Primary Care, to deliver a high quality, value for money service for patients. This project looks to develop two of the three MIU’s within HWLH CCG boundaries. The facilities at both sites will require some upgrade; Uckfield MIU based at Uckfield Community Hospital will be upgraded to meet the NHSE UTC standards, and Lewes MIU based at Lewes Victoria Hospital will be designated an UTC with exceptions. The remaining MIU at Crowborough War Memorial Hospital will continue to function in its current form. Developments at the Lewes site are due to take place within the first wave “fast follower’s” of NHSE recommended timeframes; completion by March 2018. Subject to affordability and other urgent care developments in the CSCA footprint, development of the Uckfield site are set to take place in the second wave of NHSE recommended timeframes, which requires the submission of final project plans by 31 March 2018; and completion of upgrades by 1 December 2019. The UTC model has already been reviewed by the Clinical Executive Committee. The Governing Body is asked to approve the attached development plan and agree the next steps needed as follows. Next Steps:

Clarify the financial for presentation to the Finance and Performance Committee

Engagement with General Practice, each Community Hospital League of Friends, Patient Participation Groups, other CCG’s across the sustainability and transformation partnership area of Sussex and East Surrey; and Kent to ensure coherent and consistent planning and delivery of urgent care.

Re-procurement of NHS111 service and implementation of direct booking facility Project plans to be submitted to NHSE by 31 March 2018


The primary project outcome is to streamline urgent care services for easier patient and public access, providing better alignment with primary care and other urgent care services. The secondary project outcome is to reduce attendance and convergence to emergency departments which will reduce emergency department waiting times.

The key project benefits are to improve patient and staff experience of urgent and emergency care through:

A more integrated approach to urgent care

Reductions in patient and public confusion over the mixture of urgent care services


Page 3 of 53

providing a clearer route to access services

Co-location of services offering patient and staff convenience

Patients being treated as close to home as possible

Reductions in minor attendance at Emergency Departments

Improved Emergency Department performance by reduction in waiting times for treatment

An alternative to convergence to Emergency Departments for ambulance services

Urgent Primary Care needs being managed by Primary Care clinicians

Increased Primary Care resilience by freeing up General Practitioners


The Governing Body is recommended to approve the development plan; and to delegate discussion and approval of the subsequent financials to the Finance and Performance Committee.


Page 4 of 53

Implications:

Quality and Safety

The potential implications of the project have been identified within the reports mentioned below and within the Privacy Impact Assessment completed on 19.12.2017 (full version attached in report appendix). Quality Impact Assessment completed on 24.10.2017 (full version attached in report appendix) Summary: The project aligns with the national and local quality themes; patient safety, clinical effectiveness (including timeliness and efficiency of treatment), patient experience (including person centred care and equality). Patient safety will be achieved through; more immediate access to urgent care services, better communication between services, risk sharing and responsibility. Clinical effectiveness will be achieved through; a networked approach to urgent and emergency care, on site access to diagnostics, electronic access to patient records, diagnostics and prescribing, compliance with national guidance. Patient experience will be achieved through; increase in patient satisfaction with access to urgent care services, and reduced waiting time in emergency departments.

Financial

NHSE have provided some funding to support the developments at Lewes – as it part of the fast follower cohort of UTCs in the South East.

Sussex Community NHS Foundation Trust have entered into discussions with providers re. the clinical model and the financial details.

The overall service cost will be discussed at the next financial and performance meeting.


The project is an expansion of the current service. UTC plans have been developed nationally by NHSE in response to patient feedback on difficulties navigating through current urgent care services. Extensive public and patient engagement has taken place in relation to the three community hospitals and MIU’s as part of the re-procurement of the community services contract. The Connecting 4 You Shaping Health and Care event held on 6th September asked patients and the public to feedback


Page 5 of 53

on planned developments within the CCG; including Urgent Treatment Centres. A full communication and engagement plan has been developed as part of the development plan.

Equality and Diversity

Equality Impact Assessment completed on 22.11.2017 (full version attached in report appendix)

Summary:

Age, disability, pregnancy and those of low socio-economic status may need to be considered in terms of access to the service. This is because the service is located in an area with poor public transport links. Parking is currently an issue at the Lewes site and will be considered. It is crucial for the project to proactively engage with key groups that may be less likely to be in contact with the CCG and those that may be more likely to experience potential challenges in accessing the service. Feedback on service developments, and plans from harder to reach groups will be taken into account to ensure that all considerations and adjustments are made to ensure the service is fully accessible to all groups.


The service will be GP led and supported by a multidisciplinary team including; enhanced nurse practitioners, health care assistants, care navigators and radiology staff. Current MIU staff have been given additional training to manage minor illnesses and paediatric resuscitation. In addition, some staff may require additional training, for example, in high vaginal swab taking and prescribing.

Risk

Workforce requirements

Digital capability

Estate resources

Financial support

NHSE timeframe

Alignment with Primary Care

Public and staff promotion and engagement

Multiple provider relationships

Clinical governance

Gap in delivery of out of hours Primary Care

Legal NHSE mandated service development. A clear plan and rationale to be submitted to NHSE for service developments or reasons why development will not be


Page 6 of 53

taking place. Current service is commissioned by HWLH and provided by Sussex Community Foundation Trust (SCFT) who will continue to be responsible for overseeing information governance within the service.



Initial Proposal reviewed by the CCGs Programme Management Office 05.09.2017

Initial Proposal reviewed by CEC 13.09.2017

Options Appraisal reviewed by CEC 11.10.2017

Development plan reviewed by the CCGs Programme Management Office

12.12.2017


Page 7 of 53

Proposed Development

Urgent Treatment Centres

Version: V2.0. 20.02.2018

CONFIDENTIAL DRAFT


Page 8 of 53

Document Management

Author Leila Hughes

Date 20.02.2018

Version V2.0

Status Draft

Project Code

Clarity Code

Template Version

V20170609

Document Sign-Off

Project Sponsor(s): Must include Finance, PMO, Clinical, IM&T

Role Name Signature Sign-off Date

PMO Deirdre Kelly

Quality Adrian Bryan

Finance Tracy Strickland

IM&T Neil Kelly

Medicines Management Paul Wilson

Urgent Care Hugo Luck

Primary Care Sally Smith

Clinical Dr Peter Birtles

Document Control

Version History

Date Version Status Prepared by Comments

10.11.2017 V1.0 Draft Leila Hughes Initial draft sent to Sally Smith and Gemma Clayton

14.11.2017 V1.1 Draft Leila Hughes Changes made based on Gemma Clayton’s feedback


Page 9 of 53

17.11.2017 V1.2 Draft Leila Hughes Changes made based on Maggie Keating, Adrian Bryan, and Steve Clarke’s feedback

27.11.2017 V1.3 Draft Leila Hughes Changes made based on Sally Smith and Gemma Clayton’s feedback

01.12.2017 V1.4 Draft Leila Hughes Changes made following UTC working group meeting

08.12.2017 V1.5 Draft Leila Hughes Costing and financial model from Tracy Strickland added and changes made following feedback from Colin Simmons

19.12.2017 V1.6 Draft Leila Hughes Changed made from PMO feedback and updated financial modelling and costing from Tracy Strickland

03.01.2018 V1.7 Draft Leila Hughes Updated finances from Tracy Strickland

26.01.2018 V1.8 Draft Leila Hughes Changes made based on working group discussions with SCFT

31.01.2018 V1.9 Draft Leila Hughes Changes made based on feedback from Sally Smith and Gemma Clayton

20.02.2018 V2.0 Draft Leila Hughes Changes made based on feedback from Hugo Luck

Distribution List

Role Name E-mail Telephone

Programme Manager – Urgent Care

Gemma Clayton [email protected] 01273 403713

Associate Director of Operations

Hugo Luck [email protected] 01273 403562

Director of Integration & Primary Care

Sally Smith [email protected] 07825934815

Clinical Lead for Urgent Care & Primary Care

Dr Peter Birtles [email protected]

Senior Programme Manager – Sussex &

Maggie Keating [email protected] 07889 704893







Page 10 of 53

Role Name E-mail Telephone

East Surrey STP

Sussex Community NHS Foundation Trust

Chloe Rogers [email protected]


Nadia White [email protected]


Karen Hawes [email protected]

References

This document refers to the following documents:

Doc Ref: Path / Location Title Version

Appendix 1

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Guidance

Next Steps on the NHS Five Year Forward View

N/A

Appendix 2


Integrated Urgent Care Service Specification

N/A

Appendix 3


Urgent Treatment Centre - Principles Standards

N/A

Appendix 4

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Comms

Patient Flow Diagrams

N/A

Appendix 5

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Project Plans

STP UTC Site Designations

N/A

Appendix 6

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\NHSE Documentation

HWLH CCG UTC Pro-forma August SOUTH EAST

V1.3

Appendix 7

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Project Approval Documentation

UTC Options Appraisal

V1.8

Appendix 8

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Reports & Data\Outcome Measures

PROMs & PREMs Outcomes Measures

N/A





Page 11 of 53

Appendix 9


Integrated Urgent Care Minimum Data Set Specification

N/A

Appendix 10


NHSE Integrated Urgent Care Key Performance Indicators

N/A

Appendix 11

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Project Plans

UTC Project Plan N/A

Appendix 12

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Governance & Risk

UTC Risk Log 31.01.18

N/A

Appendix 13


UTC Quality Impact Assessment

V1.2

Appendix 14


Communication and Engagement Plan

V1.3

Appendix 15


UTC Equality Impact Assessment

V1.3

Appendix 16


UTC Privacy Impact Assessment

V1.2

Appendix 17


HWLH UTC Service Specification

V1

Appendix 18

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Reports & Data

Activity modelling: Lewes UTC

V1

Appendix 19

V:\USF\East\HWLH\Restricted\Operations\Urgent Care\Projects\Urgent Treatment Centres\Reports & Data

Activity modelling: Uckfield UTC

V1


Page 12 of 53

TABLE OF CONTENTS

1.0 Executive Summary ......................................................................................................... 15

1.1 General Information ............................................................................................. 15

1.2 Key changes ........................................................................................................ 15

1.3 Internal and external drivers ................................................................................ 15

1.4 Key Success Metrics ........................................................................................... 16

1.5 Financials ............................................................................................................ 16

2.0 Project Overview .............................................................................................................. 18

2.1 Context ................................................................................................................ 18

2.2 Scope .................................................................................................................. 19

2.3 Benefits and Strategic Alignment ......................................................................... 22

Strategic Alignment ............................................................................................. 23

3.0 Service Options Appraisal ............................................................................................... 24

3.1 Optimised without Investment .............................................................................. 25

3.2 Overview of Service Alternatives ......................................................................... 26

Financial Summary of Service Alternatives .......................................................... 26

4.0 Commissioning Intentions .............................................................................................. 27

4.1 Key commissioning considerations ...................................................................... 27

4.2 Commissioning (and commercial) option evaluation process ............................... 28

5.0 Delivery capability and capacity ..................................................................................... 29

5.1 Resource Expectations ........................................................................................ 29

5.2 Project Interdependencies ................................................................................... 30

5.3 Integrated Urgent Care System Dependencies .................................................... 32

5.4 Project Milestones ............................................................................................... 33

5.5 Change Management .......................................................................................... 34

5.6 Stakeholder Consultation and Communications ................................................... 35

6.0 Funding Arrangements .................................................................................................... 37

7.0 Financials ......................................................................................................................... 38

7.1 Financial Summary .............................................................................................. 38

7.2 Summary of Capital Costs – Assumptions ........................................................... 38

7.3 Summary of Operational Costs – Assumptions .................................................... 38

8.0 Project risks ..................................................................................................................... 39

8.1 Project Delivery Risks .......................................................................................... 39

8.2 Post Implementation Risks .................................................................................. 40

9.0 Project Quality .................................................................................................................. 42


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9.1 Quality considerations ......................................................................................... 42

10.0 Project Governance ......................................................................................................... 45

10.1 Governance Structure .......................................................................................... 45

11.0 Communication Plan and Strategy ................................................................................. 46

12.0 Appendix .......................................................................................................................... 48

1. Next Steps on the NHS Five Year Forward View ............................................................ 48

2. Integrated Urgent Care Service Specification ................................................................ 48

3. Urgent Treatment Centre - Principles Standards ........................................................... 48

4. Patient Flow Diagrams ..................................................................................................... 48

5. STP UTC Site Designations ............................................................................................. 48

6. HWLH CCG UTC Pro-forma August SOUTH EAST ........................................................ 48

7. UTC Options Appraisal .................................................................................................... 48

8. PREMs & PROMs Outcome Measures ............................................................................ 48

9. Integrated Urgent Care Minimum Data Set Specification .............................................. 48

10. NHSE Integrated Urgent Care Key Performance Indicators .......................................... 48

11. UTC Project Plan .............................................................................................................. 48

12. UTC Risk Log 31.01.18 ..................................................................................................... 48

13. UTC Quality Impact Assessment .................................................................................... 48

14. Communication and Engagement Plan .......................................................................... 48

15. UTC Equality Impact Assessment .................................................................................. 48

16. UTC Privacy Impact Assessment .................................................................................... 48

17. HWLH UTC Service Specification ................................................................................... 48

18. Activity Modelling: Lewes UTC ....................................................................................... 48

19. Activity Modelling: Uckfield UTC .................................................................................... 48

Appendix 1: Next Steps on the NHS Five Year Forward View ............................. 49

Appendix 2: Integrated Urgent Care Service Specification ................................... 49

Appendix 3: Urgent Treatment Centre - Principles Standards .............................. 49

Appendix 4: Patient Flow Diagrams ..................................................................... 49

............................................................................................................................ 50

Appendix 5: STP UTC Site Designations ............................................................. 50

Appendix 6: HWLH CCG UTC Pro-forma August SOUTH EAST ......................... 51

Appendix 7: UTC Options Appraisal .................................................................... 51

Appendix 8: PROMs & PREMs Outcome Measures ............................................ 51

Appendix 9: Integrated Urgent Care Minimum Data Set Specification ................. 52

Appendix 10: NHSE Integrated Urgent Care Key Performance Indicators ........... 52


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Appendix 11: UTC Project Plan ........................................................................... 52

Appendix 12: UTC Risk Log 31.01.18 .................................................................. 52

Appendix 13: UTC Quality Impact Assessment .................................................... 52

Appendix 14: Communication and Engagement Plan .......................................... 53

Appendix 15: UTC Equality Impact Assessment .................................................. 53

Appendix 16: UTC Privacy Impact Assessment ................................................... 53

Appendix 17: HWLH UTC Service Specification .................................................. 53

Appendix 18: Activity Modelling: Lewes UTC ....................................................... 53

Appendix 19: Activity Modelling: Uckfield UTC..................................................... 53


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1.0 Executive Summary

1.1 General Information

The project looks to enhance two of the Minor Injury Units within High Weald Lewes Havens to meet Urgent Treatment Centre standards. The project looks to expand community services provided by Sussex Community NHS Foundation Trust with Primary Care to create an integrated urgent care service. This will also support the service development and improvement plan as per the community service contract. The service will provide same day rapid assessment, interface and discharge ensuring appropriate medical advice, diagnosis and/or treatment for illness and injuries which require urgent care but which are non-life threatening and do not require the full service of an Emergency Department.

The primary project outcome is to streamline urgent care services for easier patient and public access providing better alignment with primary care and other urgent care services. The secondary project outcome is to reduce attendance and conveyance to Emergency Departments which will reduce Emergency Department waiting times.

The project will benefit the population of High Weald Lewes Havens by providing a viable alternative to Emergency Departments within surrounding Clinical Commissioning Group boundaries. This will allow patients to get the right level of care in the right place, at the right time. In addition, it will allow patients with long term chronic conditions to be seen by local Primary Care clinicians for urgent needs.

The key project risks are around workforce, digital capability, estate resources, financial support, project timeframes, alignment with Primary Care, and public engagement.

The project is currently at gateway three and is awaiting approval of the proposed development case by the Governing Body 28th February 2018.

1.2 Key changes

The initial project proposal and option appraisal submitted to the Project Management Office (5th September 2017) and the Clinical Executive Committee (13th September 2017 and 11th November 2017) and following early discussions with Sussex Community Foundation Trust (15th August 2017), proposed the development of one Minor Injury Unit (Uckfield). Following submission of the pro-forma to NHS England, there has been an update to the Urgent Treatment Centre standards and an option to designate sites as Urgent Treatment Centre with exceptions. NHS England has encouraged the development of further sites within a fast tracked timeline in order to increase resilience and support urgent care system flow. In response to this the options appraisal has been revised to consider sites that could be designated with exception status. As a result of this subsequent options appraisal it has been decided that one Minor Injury Unit could be developed to meet full Urgent Treatment Centre criteria (Uckfield) and one other Minor Injury Unit could be developed to meet Urgent Treatment Centre criteria with exceptions (Lewes).

1.3 Internal and external drivers


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The urgent care system is experiencing significant demands on patient flow across services; in particular, Emergency Departments have been under increased pressure. In addition, the current urgent care system is fragmented and challenging for patient and the public to navigate effectively. As a result it is crucial to offer a viable alternative to Emergency Departments to patients which offer care that is close to the individual’s home. There is a national drive towards an integrated urgent care system that aligns community service, emergency departments and ambulance services. This project forms part of High Weald Lewes Havens Clinical Commissioning Groups strategic vision for the provision of urgent care and further development of the service development and improvement plan in the community service contract. Integrated urgent care services are essential to the population of High Weald Lewes Havens as patients needing acute hospital care are required to travel outside of the Clinical Commission Group boundary. Integration between acute hospital services, community services and Primary Care are crucial to support the areas geographical patient flows and optimise patient care.

Driver 1: Increase the efficiency and effectiveness of urgent care to manage increased demand due to demographic pressures

Driver 2: To reduce demand on Emergency Departments

Driver 3: Improve information and advice, to enable people to plan for the future and to self-care

Driver 4: Improve the patient journey by improving consistency and access

Driver 5: Develop urgent care that is fit for the future

1.4 Key Success Metrics

The project will measure the success of the service changes through evaluation of the services key performance indicators, audit of patient outcomes, and patient satisfaction with the service.

In addition, the project will look to measure the effect the service changes have on key performance indicators in local Emergency Departments.

1.5 Financials

A significant amount of funding for the UTC already exists in the contract with SCFT to provide Minor Injuries Units. Some additional funding is required, primarily additional medical cover and some diagnostics. As this will be contracted by SCFT, this is currently commercially sensitive. Additional capital funding will be sought from the League of Friends.

In addition, the Lewes GPs are currently considering locating urgent primary care at the UTC, and as such there are potential duplication of service opportunities which can be maximised.

Final costings will be presented to the Finance and Performance Committee for approval. It is not anticipated at the current time that these will include any savings to be realised by


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diversion of otherwise Emergency Department attendances. Though these may materialise over time, these cannot be assumed or quantified currently.


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2.0 Project Overview

2.1 Context

Urgent care needs are currently met by either attendance at Emergency Departments, GP contractual, extended hours, and out of hour’s services, Walk-in Centres, Minor Injury Units, contacting 111, or Urgent Care Centres. Navigating the urgent care system in order to receive the best quality care in a timely way is often challenging for patients using this current system. In addition, there is an increase in demand on Emergency Departments. The “Next Steps on the NHS Five Year Forward View” document highlighted Urgent and Emergency Care as one of the NHS’ main national improvement priorities with a need to improve Emergency Department performance and streamline access to services. One element of these improvements will be the development of standardised Urgent Treatment Centres.

The project aims to provide an integrated urgent care service which aligns NHS111, GP extended access (currently out of hours) and face to face urgent care. The project looks to enhance two of the three Minor Injury Units within High Weald Lewes Havens Clinical Commissioning Group boundaries. The facilities at both sites will require some upgrade; Uckfield Minor Injury Unit based at Uckfield Community Hospital will be upgraded to meet the NHS England Urgent Treatment Centre standards, and Lewes Minor Injury Unit based at Lewes Victoria Hospital will be designated an Urgent Treatment Centre with exceptions. The remaining Minor Injury Unit at Crowborough War Memorial Hospital will continue to function as it currently does with a view to potentially enhance this service in the future. Developments at the Lewes site are due to take place within the first wave “fast follower’s” of NHS England recommended timeframes; completion by March 2018. Developments at the Uckfield site are set to take place in the second wave of NHS England recommended timeframes; submission of final project plans by 31st March 2018 and completion of upgrades by 1st December 2019.

Urgent Treatment Centres will be a GP lead service with a multidisciplinary clinical workforce, offering services for a minimum of 12 hours per day 7 days a week 365 days a year. Patients will access services directly through NHS 111, General Practice and Ambulance Services, with an additional walk-in element. The Urgent Treatment Centres will have access to simple diagnostics (e.g. urinalysis, ECG, bloods and X-ray etc.) as well as access to the Directory of Services. The Urgent Treatment Centres will operate as a networked model of care providing referral pathways to Emergency Departments and specialist services. It is anticipated that the development of these two sites will benefit the population (166, 288 individuals) within High Weald Lewes Havens but also those of neighbouring Clinical Commissioning Group’s (for example, Brighton and Hove, Horsham and Mid Sussex).

This project forms part of High Weald Lewes Havens Clinical Commissioning Groups strategic vision for the provision of urgent care and supports the service development and improvement plan as per the community services contract. Integrated urgent care services are essential to the population of High Weald Lewes Havens where patients needing acute hospital care are required to travel outside of the Clinical Commission Group boundary. Integration between acute hospital services, community services and Primary Care are crucial to support the areas geographical patient flows and optimise patient care. The Clinical Commissioning Groups looks to bring services closer to home and deliver integrated


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packages of care to achieve the best outcomes for patients and keep them out of hospital. The Clinical Commissioning Group is working with other Clinical Commissioning Groups across the Sussex and East Surrey Sustainability and Transformation Partnership to develop and implement an integrated urgent care strategy, which the Urgent Treatment Centre project forms part of.

High Weald Lewes Havens Clinical Commissioning Group held a Shaping Health and Care Event as part of its Connecting 4 You programme on 6th September 2017 where members of

the public and patient participation group representatives were invited to give feedback on planned developments; including the Urgent Treatment Centre work. Similar events are planned six monthly going forward and the Clinical Commissioning Group intends to continue to engage with patients and public throughout this project.

The Initial Project Proposal was discussed on 15th August 2017 as part of an initial provider meeting, reviewed by the Project Management Office on 5th September 2017 and was subsequently reviewed by the Clinical Executive Committee on the 13th September 2017. NHS England’s Urgent Treatment Centre pro-forma was returned on 25th September 2017. An Options Appraisal for the project was reviewed by the Clinical Executive Committee on 11th October 2017. The proposed development was reviewed by the Project Management Office on 12th December 2017. The project is currently at gateway three and is awaiting approval of the proposed development by the Governing Body on 28th February 2018.

2.2 Scope

Two Minor Injury Units have been chosen to be developed rather than three to maximise access, operation and delivery in terms of workforce and affordability.

Between 80-90% of acute care given to High Weald Lewes Havens residents takes place outside of East Sussex. 34% of patients attend the Royal Sussex County Hospital (Brighton), 22% Medway and Tunbridge Wells Hospital, 18% Princess Royal Hospital (Haywards Heath), 9% Eastbourne District General Hospital (Eastbourne), 5% Royal Alexandra Children’s Hospital (Brighton), 3% Conquest Hospital (Hastings), 1% Maidstone Hospital (Maidstone), 1% Queen Victoria Hospital (East Grinstead). As the majority of urgent care takes place within the Brighton system it makes sense to focus on supporting patient flow away from these acute hospitals which are often under pressure (See Appendix 4).

The Lewes site would be well placed to support the needs of the Havens and Lewes local population and support patient flow away from the Royal Sussex County Hospital at Brighton. This will be particularly crucial to a) support the Royal Sussex County Hospital Emergency Department reconfiguration building works and b) if Brighton and Hove Clinical Commissioning Group make the decision to place their Urgent Treatment Centre at the Hove Polyclinic site. In addition, planned developments within the Burgess Hill area will be supported by the Lewes site and help direct patient flow away from the Princess Royal Hospital at Haywards Heath. Developments within Primary Care are currently taking place in the Lewes practices to transform their service into a Primary Care Home. Community service providers and General Practitioners are engaged in developments with the Clinical


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Commissioning Group around how these could be maximised and linked with the provision of acute general practice care at the community hospital.

The Uckfield site is well situated to support the High Weald area and support patient flow away from the Princess Royal Hospital at Haywards Heath. The GP out of hour’s service (provided by Integrated Care 24) is co-located at the Uckfield site and will be well placed to facilitate engagement with General Practitioners.

There are current challenges in the workforce provision at the Crowborough site and there is not sufficient footfall to support the development of this site currently. Plans to develop an Urgent Treatment Centre at both Tunbridge Wells and East Grinstead will provide support to the Crowborough and northern area of the Clinical Commissioning Group, whilst patients will also have the option to travel south to the Uckfield site (See Appendix 5).

Uckfield Minor Injuries Unit will be developed to meet the full set of NHS England criteria for an Urgent Treatment Centre this will include:

Open for 12 hours per day 7 days a week [Opening hours to be confirmed, currently being discussed with provider and clinicians]

Assessment and treatment for minor injuries and illness in adults and children of any age, including adult and paediatric resuscitation and safeguarding

GP presence, advice and guidance on a daily basis, 7 days a week, via telephone or face to face. The service will be linked with the GP extended access (currently out of hours) service which will provide additional GP oversight

On-site diagnostics including X-Ray (Monday to Friday 9:00-17:00 including weekend cover across sites), electrocardiograms, swabs, pregnancy testing, urine dipstick, glucose and d-dimer blood testing

Courier service for full bloods (haemoglobin and electrolytes) and urine culture

Ability to issue prescriptions (repeat prescriptions and e-prescriptions) and provide emergency contraception

Have access to electronic patient care records

Direct booked appointments, through 111, with an additional walk-in element

Ability to refer patients to Ambulance Services or Emergency Departments

Have access to local mental health advice and services

Offer self-care management and patient education including sign-posting and advice to local community and social care services


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Lewes Minor Injuries Unit will be developed and will be designated an Urgent Treatment Centre with exceptions. The Lewes site will link with the Uckfield site to provide services not offered at the Lewes site. The service provision will include:

Open for 12 hours per day 7 days a week

Assessment and treatment for minor injuries and illness in adults and children of any age, including adult paediatric resuscitation and safeguarding

GP presence, advice and guidance via telephone or face to face. The service will be linked with the GP extended hours’ service and medical support to subacute beds within the community hospital allowing GPs to be available to see patients where necessary.

On-site diagnostics including X-Ray (Monday to Friday 9:00-17:00), electrocardiograms, swabs, pregnancy testing, urine dipstick, and glucose blood testing

Courier service for full bloods (haemoglobin and electrolytes) and urine culture

The ability to issue prescriptions via GP surgery or nurse prescribers

Have access to electronic patient care records


Ability to refer patients to Ambulance Services or Emergency Departments

Crowborough Minor Injuries unit will continue to function as it currently does with the opportunity to develop in future to a Primary Care Access Hub. The Crowborough site will link with the Uckfield site to provide services not offered at the Crowborough site. Crowborough currently offers the following service provision:

Open 12 hours per day 7 days per week

Assessment and treatment of minor injuries only in adults and children above 1 years of age

The service is nurse led

On-site diagnostics including X-Ray (by bookable appointment Monday to Friday 9:00-16:15), electrocardiograms, swabs, pregnancy testing, urine dipstick, and glucose blood testing

The ability to issue prescriptions via GP surgery or nurse prescribers



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2.3 Benefits and Strategic Alignment

The primary project outcome is to streamline urgent care services for easier patient and public access providing better alignment with primary care and other urgent care services. The secondary project outcome is to reduce attendance and convergence to Emergency Departments which will reduce Emergency Department waiting times and improve system flow. The project will benefit the population of High Weald Lewes Havens by providing a viable alternative to Emergency Departments within surrounding Clinical Commissioning Group boundaries. This will allow patients to get access to urgent care closer to home and in

a more timely way. In addition, it will allow patients with long term chronic conditions to be seen by local Primary Care clinicians for urgent needs.

In order to achieve this the project will need to implement the following changes to upgrade the current facilities to meet the standards of Urgent Treatment Centres; GP led with appropriate GP cover and access to blood testing and urine culture, standardise the access to Urgent Treatment Centres via bookable appointments through NHS111, implement alternative referral pathways via ambulance and GP services, and ensure appropriate access to patient notes and prescribing on site.

The key project benefits are to improve patient and staff experience of urgent and emergency care through:

A more integrated approach to urgent care

Reductions in patient and public confusion over the mixture of urgent care services providing a clearer route to access services

Co-location of services offering patient and staff convenience

Patients being treated as close to home as possible

Reductions in minor attendance at Emergency Departments

Improved Emergency Department performance by reduction in waiting times for treatment

An alternative to convergence to Emergency Departments for ambulance services

Urgent Primary Care needs being managed by Primary Care clinicians

Increased Primary Care resilience by freeing up General Practitioners

It is anticipated that the project benefits will begin to be realised by Gateway 5, three months after the service has gone live. For the Lewes site this will be June 2018 and for the Uckfield site this will be by 1st March 2020.

It is anticipated that [% activity assumptions to be discussed] of Emergency Department attendances could be seen at an Urgent Treatment Centre. Although this will not initially translate into financial savings the long term benefits of the project will consist of; care in the right place at the right time, support to acute trust providers, facilitate patient flow across the urgent care system, and reduce pressures on Primary Care.


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Strategic Alignment

This project looks to address some of the challenges faced by Emergency Departments highlighted in the Next Steps on the NHS Five Year Forward View where an increase is estimated in the number of people attending Emergency Departments who could have their needs met in other parts of the urgent care system. Rising numbers of elective and non-elective care combined with increasing financial challenges means that acute providers may struggle to continue to meet the levels of demand and highlights the need for change.

This project forms part of High Weald Lewes Havens Clinical Commissioning Groups

strategic vision for the provision of urgent care by aligning the fragmented nature of out of hospital services and offering patients an adequate alternative to Emergency Departments. It also supports the service development and improvement plan as per the community services contract. An integrated urgent care service is essential to the population of High Weald Lewes Havens as patients requiring acute hospital care have to travel outside of the Clinical Commission Group boundary. High Weald Lewes Havens has a large population of older people and those with long term conditions, this combined with its largely rural setting with poor transport links means that hospital based urgent care is not suitable to meet the needs of the whole population. The Clinical Commissioning Groups vision looks to bring services closer to home and deliver integrated packages of care to achieve the best outcomes for patients and to keep them out of hospital.

In line with the Integrated Urgent Care Strategy, the service will help to move towards an integrated 24/7 urgent care model that incorporates NHS 111 and GP extended access (currently out of hours) services, and looks to improve interconnectivity between the community services, emergency departments and ambulance services. Integration between urgent care services is crucial to support the areas geographical patient flows and to optimise patient care. The Clinical Commissioning Group is working with other Clinical Commissioning Groups across the Sussex and East Surrey Sustainability and Transformation Partnership to develop and implement an integrated urgent care strategy, which the Urgent Treatment Centre project forms part of. The service specification and standards for Urgent Treatment Centres have been directed by NHSE England to ensure service alignment across the country.


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3.0 Service Options Appraisal

See Appendix 7 for full Options Appraisal.

High Weald Lewes Havens Clinical Commissioning Group’s Urgent Care programme team, including Clinical Lead, has met to discuss all viable options that could be implemented to meet the expected project outcomes. Discussions have also taken place with surrounding Clinical Commissioning Groups within the Sussex and East Surrey Sustainability and Transformation Partnership. An appraisal criterion has been identified to assess the shortlisted options based on the desired project benefits, project deliverability, and fit with the strategic direction of High Weald Lewes Havens Clinical Commissioning Group and wider Sustainability Transformation Partnership. The appraisal criteria and subsequent scoring of options was completed by members of the Urgent Care Programme team with the Clinical Lead and a member of the Executive Management Team. The Clinical Executive Committee approved the Options Appraisal presented on 11 October 2017 with the recommendation that the Uckfield Minor Injury Site be developed to meet Urgent Treatment Centre standard with a view to developing a subsequent site if needed depending on NHS England feedback on the initial proposal. NHS England have subsequently revised the Urgent Treatment Centre criteria and supported the option of Urgent Treatment Centre with exception designation to some sites. NHS England has encouraged the development of further sites and within a fast tracked timeline. In response to this the options appraisal has been revised to consider sites that could be designated with exception status.

Proposed Option

Based on the outcome from the comparison of options the recommendation would be for the development of the Uckfield Minor Injury Unit to meet Urgent Treatment Centre criteria. This option has the highest potential project benefits and meets the most critical success factors in comparison to the other possible options.

The Uckfield site is well situated geographically (centrally) to support the population of High Weald Lewes Havens Clinical Commissioning Group. The site will be able to support patient flow away from the Emergency Department at the Royal Sussex County Hospital (Brighton), Princess Royal Hospital (Haywards Heath) and Medway and Tunbridge Wells Hospital (Tunbridge Wells’ site); where the majority of patients in High Weald Lewes Havens receive urgent care. The GP out of hour’s service (provided by Integrated Care 24) is co-located at the Uckfield site and will be well placed to facilitate engagement with General Practitioners. In terms of cost, the Uckfield Minor Injury Unit site will not require much in the way of upgrade and there is underutilised estate space within the Minor Injury Unit and community hospital outpatient department which could be used (for full costings see Section 7). The site has good recruitment of staff and is co-located with the community hospital, GP surgery and the GP out of hour’s service.

The scoring for both the Lewes and Uckfield option and Lewes only option were close to the preferred option above. Considering this close scoring in combination with the revised NHS England criteria and the favourable opinion of developing both the Uckfield site and another site by the Clinical Executive Committee; it is proposed that the Lewes site be developed to meet Urgent Treatment Centre with exception criteria alongside the development of a full


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Urgent Treatment Centre at Uckfield.

The Lewes site is well situated as it is one of the larger towns within the Clinical Commissioning Group’s area, it is closely located to the Havens which is a densely populated part of the region and would be well situated to offer additional support to the Royal Sussex County Hospital Emergency Department which is under increased pressure and where the majority of residents receive urgent care. This will be particularly crucial if Brighton and Hove Clinical Commissioning Group make the decision to place their Urgent Treatment Centre at the Hove Polyclinic site. In addition, planned developments within the Burgess Hill area will be supported by the Lewes site and help direct patient flow away from the Princess Royal Hospital at Haywards Heath. There are synergies and opportunities of co-location of the General Practice at the Lewes site. Due to the timelines associated with the Lewes practice developments and the site being in a good position to offer most Urgent Treatment Standards it is to be adopted onto NHS England’s first wave “fast follower’s” for completion by March 2018 as an Urgent Treatment Centre with exceptions. This option allows the maximisation of both operation and delivery in terms of workforce and access as well as affordability.

It is anticipated that the development of these two sites will benefit the population of High Weald Lewes Havens but also those of neighbouring Clinical Commissioning Groups. A full break down of costs and risks for the preferred option can be found in Sections 7 and 8.

The Crowborough site would therefore maintain its current provision with a view to developing this in future to meet NHS England’s criteria for a Primary Care Access Hub. Low footfall indicates that there would not be sufficient need from the local population of High Weald Lewes Havens to support the development of all three sites into Urgent Treatment Centres. In addition, the site is situated in a rural location and is close in proximity to the Uckfield site. The planned developments of Urgent Treatment Centres at both Tunbridge Wells and East Grinstead will provide support to individuals living in the north of the area and the Uckfield site will be able to support those living within the Crowborough area.

The other shortlisted options have been discounted based on the greater cost of developing the sites, challenges around workforce recruitment to certain sites, insufficient time and estates availability to upgrade sites.

3.1 Optimised without Investment

See Appendix 7 for full Option Appraisal.

Option 2 within the Option Appraisal offers an optimised without investment option; for the three Minor Injury Units to extend their provision to become Primary Care Access Hubs. This option would not require any additional investment as staff based at the Minor Injury Unit have already received additional training to be able to offer assessment and treatment to those presenting with minor illnesses as well as minor injuries. However, additional training may be required for staff to be able to assess and treat children under the age of 1 year old and to have paediatric resuscitation training. There is the possibility that General Practitioners may be able to offer some support to a Primary Care Access Hub, however, this would be dependant to the developments being made within Primary Care.


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The optimised without investment option was not selected as the preferred option because although it would offer minimal investment it would likely provide the least cost savings through reductions in Emergency Department attendances. It would also be unlikely to make a significant impact on improving access to urgent care systems for patients and the public. It would offer insufficient strategic alignment both in terms of the Clinical Commissioning Groups direction and also that of NHS England. Lastly, this option would carry increased risks around workforce, estates, engagement and time.

3.2 Overview of Service Alternatives

See Appendix 7 for full Option Appraisal.

The proposed option looks to develop two existing sites. Both the Minor Injury Unit at Uckfield and Lewes are provided by Sussex Community NHS Foundation Trust. The current provider will be asked to work with the Clinical Commissioning Group to develop a new service model. This forms part of the service development and improvement plan as per the community services contract.

Financial Summary of Service Alternatives

[To be discussed at the next financial and performance meeting]


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4.0 Commissioning Intentions

4.1 Key commissioning considerations

The primary project outcome is to streamline urgent care services for easier patient and public access, providing better alignment with primary care and other urgent care services. The secondary project outcome is to reduce attendance and convergence to Emergency Departments which will reduce Emergency Department waiting times.

It will be crucial to ensure that key performance indicators are clear and that the project team works closely with other Clinical Commissioning Groups and our providers. It will be important to establish links to the current data collected on the Urgent Care and A&E dashboards. Data will be captured monthly via the Commissioning Support Unit and will be reviewed by project commissioners within High Weald Lewes Havens Clinical Commissioning Group and shared with service providers (Sussex Community NHS Foundation Trust, Brighton and Sussex University Hospitals, and Primary Care).

See Section 9.1 for quality and patient safety measures.

The data below is currently being collected for the service and will continue to be collected as part of the new developments.

Patient reported experience measures:

Friends and Family Test scores; % of staff who would recommend the hospital for care, % of staff who would recommend the hospital as a place to work, % of patients who would recommend the hospital.

Patient reported outcome measures:

The primary complaint, injury or illness patient presents with

Follow-up patient outcome data

Service key performance indicators:

Number of monthly contacts per site

Number of contacts per CCG

The number of Emergency Department attendances from High Weald Lewes Havens

Percentage of 4 hour wait target met by Emergency Department

Number of Emergency Department attendances that lead to an admission

Average length of hospital stay

The number of conveyances to Emergency Department from High Weald Lewes Havens

The following additional data will be collected for the new service in line with the integrated urgent care minimum data set specification and key performance indicators (see appendix 9


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& 10).

Patient reported experience measures:

Patient and carer online survey; satisfaction with service and change in condition after contact with the service.

Service key performance indicators:

Number of unscheduled attendances (walk-in)

Total time to clinical encounter

Number of referrals from NHS 111

The number of GP contacts

4.2 Commissioning (and commercial) option evaluation process

NHS England has recommended the development of urgent care services and the standardisation of the provision of Urgent Treatment Centres based on patient feedback. High Weald Lewes Havens Clinical Commissioning Group has previously extensively engaged with the public in plans to develop the Minor Injury Units as part of the re-procurement of the community services contract. A Shaping Health and Care Event was held on 6th September 2017 where members of the public, patient participation groups, General Practitioners and local providers were invited to give feedback on planned developments including the Urgent Treatment Centre work. The Clinical Commissioning Group plans to hold another Shaping Health and Care Event in the New Year and these events are planned to be held six monthly going forward. The Clinical Commissioning Group will continue to engage with patients, public and service providers throughout the development of the project utilising links with local patient participation groups and friends of community hospital groups.

See Communication and Engagement plans in Section 10.3.


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5.0 Delivery capability and capacity

5.1 Resource Expectations

Resource Provider Resource Detail Potential Challenges

Leads

High Weald Lewes Havens CCG

Project Manager Competing project demands

Gemma Clayton


Project Management Office

Competing project demands

Deirdre Kelly


Finance Team Financial position of Clinical Commissioning Group

Alan Beasley (TBC)


Quality Team Competing project demands

Adrian Bryan


Clinical Lead Competing clinical and project demands, declaration of interests

Peter Birtles


Urgent Care Team Competing programme demands

Hugo Luck / Gemma Clayton


Communication and Engagement

Competing project demands and capacity

Tom Gurney / Jan Leslie

High Weald Lewes Havens IM&T Competing

programme demands

Maggie Keating

(Neil Kelly)


Service Provision Competing clinical demands, financial and workforce challenges

Nadia White / Chloe Rogers

Commissioning Support Unit

Analytical Team Availability of resource due to workforce size

Janette Hoole


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and demand

NHS South of England Procurement Service

Procurement Capacity and competing demands

Kevin Green

NHS England Sussex & East Surrey STP

Availability of key members

Maggie Keating

NHS England Estates Team Communication

with national teams

Gaynor Baker

NHS Digital Digital Communication with national teams

Georgie Cole

5.2 Project Interdependencies

Interdependent Programme / Project

Potential Challenges Responsible Manager

Management of Interdependencies

Information Management & Technology

The project is dependent on digital interoperability capabilities in order to offer direct booking via NHS111, e-prescribing and access to patient records.

Maggie Keating

(Neil Kelly)

Link with 111 Transformation team, 111 Digital Project Manager, NHS111 Online team and NHS Digital.

Communication & Engagement

The project is dependent on successful engagement with patients and the public. Poor engagement could result in patients not utilising the new service and reputational damage to the Clinical Commissioning Group.

Tom Gurney / Jan Leslie

Development of full communication and engagement plan.

Link to developments of a health application for public and patients.

Primary Care (including GP extended hours)

The project is dependent on the engagement of General Practitioners to provide the medical support needed in the Urgent Treatment Centre.

Sally Smith Joint working across Primary Care and Urgent Care teams. Clinical Lead and Director already work across the two teams.


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The service needs to align with developments taking place within Primary Care and extended Primary Care hours.

Project Manager for Urgent Care to link with Project Manager for Lewes General Practice developments.

NHS111 (including OOH & CAS)

The project is dependent on NHS111 directing

appropriate cases to the Urgent Treatment Centre and the ability to book appointments directly. NHS111 Clinical Assessment Service and GP extended access (currently out of hours) Service will also need to be able to direct patients to the service and book appointments directly.

Colin Simmons

Urgent Care Programme Manager

currently works across the Urgent Treatment Centre and NHS111 projects and works closely with the NHS111 transformation team.

Directory of Services The service will need to be appropriately profiled on the Directory of Services to ensure NHS111 and 999 call handlers can utilise the service. The profile will need to detail the correct service information, symptom groups, disposition codes as well as be ranked high enough on the ranking

strategy to appear to call handlers at the appropriate time.

Vinny Hanley Urgent Care Project Manager currently holds joint responsibility for the Directory of Services for High Weald Lewes Havens Clinical Commissioning Group and works closely with the Directory of Service Lead.

Primary Care Streaming

The service will need to be linked with the developments at Emergency Departments so that GPs based there can identify inappropriate attendances and direct patient flow to Urgent

Gemma Clayton

Urgent Care Programme Manager currently works across the Urgent Treatment Centre and Primary Care Streaming project.


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Treatment Centres as required.

South East Coast Ambulance Service

[When service fully operational]

The project is dependent on the Ambulance Service being able to refer or directly convey appropriate

patients to the Urgent Treatment Centre rather than the Emergency Department. Patients will need to be fully assessed to ensure that only patients that can be safely managed at the Urgent Treatment Centre are referred there. The staff at the Urgent Treatment Centre will need to be available to receive patients by ambulance and able to refer patients to South East Coast Ambulance Service if their condition deteriorates.

Helen Wilshaw / James Pavey

Urgent Care Project Manager and Quality Lead for High Weald Lewes Havens are currently engaged in working with South

East Coast Ambulance Service to improve performance.

Mental Health [When service fully operational]

The service will need to be linked to local mental health services including crisis services. Staff based at the Urgent Treatment Centre will be able to get appropriate advice to specialist mental health services and refer where appropriate.

Michele Armstrong

Link with the Mental Health Commissioner and Sussex Partnership NHS Foundation Trust.

5.3 Integrated Urgent Care System Dependencies

NHS England has specified that in order to deliver a fully networked model for urgent care,


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systems will need to:

Provide a facility to support out of hours face to face GP led consultations at a static base that NHS 111 can book direct appointments into (or ensure that alternative protocols are in place)

Ensure that these provisions are available 18:30 to 08:00 and at weekends (outside of GP in hours services)

Provide a base or facilities for out of hours home visiting service providers where required

5.4 Project Milestones

Gateway/Milestone Proposed Date

Gateway 1: Idea conceived and registered with PMO

Identification of initial cohort

Registered with PMO

05/09/2017

15/08/2017

05/09/2017

Gateway 2: IPF is approved by PMO & CEC

Initial Proposal Form to PMO

Initial Proposal Form to CEC

Pro-forma submission to NHSE

Options Appraisal to CEC

11/10/2017

05/09/2017

13/09/2017

25/09/2017

11/10/2017

Gateway 3: Approved by PMO & GB

Submitted to PMO

Submitted to GB

Clinical model & care pathway design

Workforce model development

Finance model

IT model development

Engagement with Estates team

Engagement with Comms team

Public engagement plan development

Final project plans submitted to NHSE

31/03/2018

12/12/2017

28/02/2018

31/03/2018

31/03/2018

31/03/2018

31/03/2018

31/03/2018

31/03/2018

31/03/2018

31/03/2018

Gateway/Milestone Lewes Site Uckfield Site

Gateway 4: Service GOES LIVE 31/03/2018 01/12/2019


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5.5 Change Management

Change Management Activities

Maintenance & Support Potential Challenges

Set up of an Urgent Treatment Centre working group

Feeds into Urgent Care Strategy Group. Link to Connecting 4 You Planning Board and Local A&E Delivery Boards

Representation from all providers and potential for patient representation

Integrate service into the Urgent Care Pathway

Link with Emergency Department, Ambulance Services, Primary Care, and NHS111 at CUCORG meetings

Agreement from all parties on how new pathway may look and function

Integration of Primary Care General Practitioners with Minor Injury Unit staff team

Working closely with General Practitioners and Sussex Community NHS Foundation Trust via Community Care Delivery

Potential challenges around clinical governance, responsibilities, structure and funding.

Sign off model

Sign off specification

Staff, patient & public engagement

Room Renovation

Purchase of equipment

Staff training

Rota fill

31/03/2018

31/03/2018

31/02/2018

31/02/2018

31/02/2018

30/01/2018

31/02/2018

01/06/2018

01/06/2018

01/07/2018

01/12/2018

01/03/2019

01/09/2019

01/10/2019

Gateway 5: Benefits begin to be realised

Initial data collection & analysis

Project sustainability assessed

31/06/2018

31/06/2018

31/06/2018

01/03/2020

01/03/2020

01/03/2020

Gateway 6: Project Closure

Final data collection & analysis

Project sustainability plans in place

Project closure agreed by PMO

Project closure agreed by CEC

31/09/2018

31/09/2018

31/09/2018

31/09/2018

31/09/2018

01/06/2020

01/06/2020

01/06/2020

01/06/2020

01/06/2020


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Board and CUCORG meetings

Workforce recruitment.

Reallocation of rooms within Minor Injury Units and Community Hospitals

Support required from NHS England Estates team. Communication between Sussex Community NHS Foundation Trust and General Practice

Competing demands for clinical and office space, lack of clarity around estates ownership

Meeting to discuss Lewes site estates on 17th

January 2018

Access processes for haematology & microbiology samples to be sent from Urgent Treatment Centre

Communication between Sussex Community NHS Foundation Trust and acute service providers

Timeliness, procedures, agreed courier service, equipment and funding

Access to summary care records from Urgent Treatment Centre

Communication between Sussex Community NHS Foundation Trust and General Practice

Information governance responsibilities and digital interoperability

Data recording and collection Liaison with Commissioning Support Unit and Sussex Community NHS Foundation Trust

Agreed measures, appropriate recording, and regular review

5.6 Stakeholder Consultation and Communications

Key Stakeholder Management of Relationships

Patients and public Engagement with patient and public forums

General Practice Via the proposed Urgent Treatment Centre working group


Via the proposed Urgent Treatment Centre working group

Brighton and Sussex University Hospitals Via Local A&E Delivery Board

South East Coast Ambulance Via Local A&E Delivery Board

Sussex Partnership NHS Foundation Trust

Via Local A&E Delivery Board

Care and Nursing Homes Via newsletter and service promotion

Third Sector Services Via newsletter and service promotion

Clinical Commissioning Groups Urgent Treatment Centre forum for Sussex


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and East Surrey Sustainability and Transformation Partnership, Urgent Care Strategy meetings, and Local A&E Delivery Board


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6.0 Funding Arrangements

High Weald Lewes Havens Clinical Commissioning Group have been successful in an application to NHS England for revenue costs towards the Lewes UTC site in order for the service to go live within their “fast followers” timescale (March 2018). Additional project revenue costs will be absorbed by the Clinical Commissioning Groups business as usual activity this includes the implementation and project management role as well as a Directory of Services champion.

The Clinical Commissioning Group will make applications for capital funding from NHS England as they become available. Project capital costs will be met through mainstream funding requests as well as potential funding from the hospital league of friends. It is anticipated that by maximising resources across the Sussex and East Surrey Sustainability and Transformation Partnership and by facilitating good patient flow across the system savings will be made. In addition, improvements that support providers to achieve their targets will result in financial benefits.


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7.0 Financials

7.1 Financial Summary

[To be presented to the Finance and Performance committee]

7.2 Summary of Capital Costs – Assumptions

[As above]

7.3 Summary of Operational Costs – Assumptions

[As above]


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8.0 Project risks

See Appendix 12 for full risk register

8.1 Project Delivery Risks

Risk Description Consequence Likelihood

Rating Risk Level

If workforce requirements are not met, then there is a risk that the service will run with minimal staffing levels resulting in unsafe working or the closure of the service

3 (Moderate) 3 (Possible)

9 High Risk

If digital capability is not viable, then there is a risk that patients will not be able to book direct appointments and clinicians will not be able to electronically prescribe resulting in the service not meeting NHS England specifications and duplication of work

3 (Moderate) 2 (Unlikely)

6 Moderate Risk

If appropriate estate resources are not identified, then there is a risk that staff will be expected to work in unsuitable clinical spaces resulting in a reduction in their abilities to complete all necessary clinical duties


6 Moderate Risk

If there is a lack of parking and options for patient access to the sites, then there is a risk that patients and the public may default to other services resulting in inappropriate attendances elsewhere


9 High Risk

If there is a lack of financial support for the project, then there is a risk that appropriate equipment and workforce will not be able to be met resulting in unsafe working and reduced clinical effectiveness and impact on the CCG’s financial security

4 (Major) 4 (Likely) 16 Extreme Risk

If the changes needed are not met within the specified timeframe, then there is a risk that the service will not meet the NHS England Urgent Treatment Centre standards resulting the service not being ready for winter

2 (Minor) 2 (Unlikely)

4 Moderate Risk


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planning

If there is a lack of alignment with Primary Care Access Hubs, then there is a risk of duplication of work and a disengaged workforce resulting in an ineffective service


9 High Risk

If there is a lack of public and staff promotion or engagement, then there is a risk that the public will not use the service resulting in a lack of reduction in minor Emergency Department attendance

3 (Moderate) 1 (Rare) 3 Low Risk

If there is a break down in the relationships between the multiple providers for the project, then there is a risk that communication between organisations will be effected resulting in the service failing to provide good quality care.


9 High Risk

If the service is managed by multiple providers there is a risk that clinical governance may vary between providers and responsibility for monitoring and reporting may not be clear resulting in an unsafe service model


9 High Risk

If the Urgent Treatment Centre service goes live on 01/12/2019, there is a risk that there will be a gap between April 2019 and Dec 2019 due to the change in GP out of hours contract resulting in a reduction in GP service provision


9 High Risk

8.2 Post Implementation Risks

Risk Description Consequence Likelihood Rating Risk Level

If there is insufficient General Practice workforce, then there is a risk that the service will run without sufficient medical cover and could impact negatively on Primary Care resources


9 High Risk


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If there is a sudden influx in patient demand at Urgent Treatment Centres, then there is a risk that the workforce and provision put in place will not be able to keep up with the demand


6 Moderate Risk

If there is an increase in capacity created at Emergency Departments as a result of the project, then there is

a risk that this additional capacity gets filled by demands from a different part of the health care system


9 High Risk

If the project fails to become business as usual, then there is a risk that additional resources will be required to mitigate this

2 (Minor) 3 (Possible)

6 Moderate Risk

If there is a lack of financial support for the project, then there is a risk that revenue costs for the service will not be met resulting in an insufficient service provision and impact on the CCG’s financial security

4 (Major) 3 (Possible)

12 High Risk

If digital capability is not viable, then there is a risk that patients will not be able to book direct appointments and clinicians will not be able to electronically prescribe resulting in the service not meeting NHS England specifications and duplication of work


6 Moderate Risk

If there is a break down in the relationships between the multiple providers for the project, then there is a risk that communication between organisations will be effected resulting in the service failing to provide good quality care.


9 High Risk


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9.0 Project Quality

See Appendix 13 for Quality Impact Assessment

9.1 Quality considerations

See Section 4.1 for details of patient outcomes and performance indicators.

The project looks to address the following domains within the NHS Outcomes Framework Indicators:

Domain 1 – Preventing people from dying prematurely:

Providing an alternative to individuals who may be unlikely to present to an Emergency Department or who are unable to get an appointment with their GP, which may result in an emergency condition or illness being identified earlier

Domain 2 – Enhancing quality of life for people with long term conditions:

The ability to provide care to those with a long term condition who are experiencing an urgent illness or injury alongside providing support via General Practitioners for the person’s long term condition

Domain 3 – Helping people to recover from episodes of ill health or injury:

Providing a service tailored to minor injury and minor illness combined with advice around condition management and education

Domain four – Ensuring that people have a positive experience of care:

Providing a service that is easy to navigate, timely, convenient and close to home

Domain 5 – Treating and caring for people in a safe environment and protecting them from avoidable harm:

Providing care in a more appropriate and accessible setting and avoiding unnecessary

admissions to hospital where there is an increased risk of acquired infections and deterioration of physical condition

The project aligns with the following national and local quality themes; patient safety, clinical effectiveness (including timeliness and efficiency of treatment), patient experience (including person centred care and equality).

Patient safety will be achieved through; more immediate access to urgent care services, better communication between services, risk sharing and responsibility:

Procedures and pathways are already in place for shared risk within the existing Minor Injury Unit sites. NHS111 will play a key role by streaming patients prior to attendance at Urgent Treatment Centres.


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Providers will use existing established safeguarding systems, although it is likely that additional staffing with appropriate expertise in paediatric care and safeguarding for children under 1 years of age will be required.

Patients will be seen by an appropriate clinician earlier as a result of the service change. Providers will use existing established patient safety, governance and incident reporting systems.

NHS111 and the Urgent Treatment Centre staff will be able to make immediate referrals to 999 where needed. GP's to be engaged in discussions around

appropriate patient record sharing and risk sharing for out of area patients.

It is hoped that the project will result in a reduction in attendances at Emergency Departments and therefore reduce the number of admissions to acute hospitals, and the risk of acquired infections.

Serious incidents, never events and complaints will be reported and investigated using the provider’s current system; local serious incident policy and procedure, and the national reporting and learning system.

Clinical effectiveness will be achieved through; a networked approach to urgent and emergency care, on site access to diagnostics, electronic access to patient records, diagnostics and prescribing, compliance with national guidance:

The project supports the implementation of evidence based practice by working towards an integrated model of urgent care services and ensures the patient is seen in the most clinically relevant setting (e.g. in an Urgent Treatment Centre for urgent non-emergency medical needs rather than an Emergency Department).

Improvement in urgent care pathways by way of streamlining access for all patients including those self-caring with long term conditions. Patients will be offered advice around illness management & prevention.

Patients attending a local Urgent Treatment Centre will be seen by an appropriate clinician in a more timely way, this also supports the efficient running of Emergency Departments by reducing demand created through minor attendances, this is likely to be cost saving to acute trust providers.

The project provides effective utilisation of current Minor Injury Units, GP extended access (currently out of hours), and Primary Care Access Hubs, staff and resources.

The project streamlines access for all suitable patients ensuring they are seen and treated by appropriate clinicians in the most relevant setting.

Additional appropriately trained and skilled workforce may be required.

Patient experience will be achieved through; increase in patient satisfaction with access to urgent care services, and reduced waiting times in Emergency Departments:

Urgent Treatment Centres can utilise the current provider Friend and Family


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Test mechanisms for both patients and staff to feedback on the service as well as display the results to patients and the public. Healthwatch, NHS Choices, Patient Advisory Liaison Service, and the provider’s complaint services are already in place.

Privacy and dignity issues would be identified and addressed through CQC compliance, PLACE audit, Friends and Family Test, and complaint feedback.

Urgent Treatment Centre plans have been developed nationally by NHS England based on patient feedback on difficulties with navigating through

current urgent care services.


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10.0 Project Governance

10.1 Governance Structure

The following structures will be used within the Clinical Commissioning Group to manage the governance and reporting of the project:

Urgent Treatment Centre Working Group

Urgent Care Strategy Meeting

Sussex and East Surrey Sustainability and Transformation Partnership Urgent Treatment Centre Forum

Local A&E Delivery Board

Connecting 4 You Planning Board

Quality Team

Programme Management Office

Senior Executive Team

Clinical Executive Committee

Governing Body

NHS England

The following providers will be engaged in conversations that look to identify the roles and responsibilities that apply to each stakeholder group:

General Practice


Brighton and Sussex University Hospitals

South East Coast Ambulance

Sussex Partnership NHS Foundation Trust

Care and Nursing Homes

Third Sector Services

Clinical Commissioning Groups


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11.0 Communication Plan and Strategy

See Appendix 14 for full Communication and Engagement plan.

Patients and public:

The intended communication will inform both patients and members of the public about the development of the Urgent Treatment Centre service, what the new service will cover, provide key service information (e.g. opening times, location etc.), and advise them of when it is

appropriate to attend instead of attending an Emergency Department. In addition, it will be crucial to communicate with patients and the public about the service at Crowborough, ensuring that it is clear the service will remain as it is and providing a rationale for why the service has not been developed.

Communications will be made via social media, articles within local newspapers, and via direct communication to patient participation groups and key community forums. Communications will be made ahead of the services going live and updates will be made on a regular basis throughout the 6 months following the service going live. In addition, patients and the public will be engaged in discussions about the service changes through the Shaping Health and Care Events held by the Clinical Commissioning Groups and through online survey.

Service providers:

The intended communication will be to liaise with and engage service providers directly involved or affected by the service change to ensure a smooth transition and that all staff concerns are addressed. In addition, it will be crucial to work closely with providers to develop plans and referral pathways. Crucial to this will be engagement with General Practitioners, Community Providers, Acute Trusts, and Ambulance Services. NHS111 and the Clinical Assessment Service will need to be updated as developments take place so that they are fully informed to be able to direct patients to the service accordingly. It will also be key to liaise well with other Third Sector and Voluntary Organisations including care and nursing homes to ensure good understanding of the new service provision, coverage, access and referral information so that these services will also be in a position to utilise this resource rather than Emergency Departments.

Communications will be made to key stakeholders via the Urgent Treatment Centre Working Group meetings which will be held on a regular basis between commissioners and providers throughout the development and implementation of the project. NHS111 and the Clinical Assessment Service will be update via communication and training updates facilitated by the call centre Directory of Services Champion. The project manager will also work closely with the Directory of Services Lead to ensure that the new service is correctly profiled and active on the Directory of Services. Third Sector and Voluntary Services that will be able to refer patients to the service will be kept informed via Newsletter updates and through the Connecting 4 You Programme and Communities of Practices.


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Clinical Commissioning Groups:

The intended communication will be to align project plans with the developments of Urgent Treatment Centres within other Clinical Commissioning Groups to ensure an appropriate provision of urgent care services across the Sussex and East Surrey Sustainability and Transformation Partnership to meet the regional population health needs. In addition, it will be beneficial to work closely as many of the providers of local services are established across the region this will help to ensure consistency in communication and to avoid duplication of work. Neighbouring Clinical Commissioning Groups will need to work together to ensure that urgent care pathways work effectively.

Communications will be made via the Urgent and Emergency Care Strategic Meetings, Combined Urgent Care Operational Resilience Group, and Local A&E Delivery Boards. Additional meetings have been arranged by the Sussex and East Surrey Sustainability and Transformation Partnership Urgent and Emergency Care Senior Programme Manager to facilitate cross working between the Clinical Commissioning Groups.


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12.0 Appendix

1. Next Steps on the NHS Five Year Forward View

2. Integrated Urgent Care Service Specification

3. Urgent Treatment Centre - Principles Standards

4. Patient Flow Diagrams

5. STP UTC Site Designations

6. HWLH CCG UTC Pro-forma August SOUTH EAST

7. UTC Options Appraisal

8. PREMs & PROMs Outcome Measures

9. Integrated Urgent Care Minimum Data Set Specification

10. NHSE Integrated Urgent Care Key Performance Indicators

11. UTC Project Plan

12. UTC Risk Log 31.01.18

13. UTC Quality Impact Assessment

14. Communication and Engagement Plan

15. UTC Equality Impact Assessment

16. UTC Privacy Impact Assessment

17. HWLH UTC Service Specification

18. Activity Modelling: Lewes UTC

19. Activity Modelling: Uckfield UTC


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Appendix 1: Next Steps on the NHS Five Year Forward View

[Available on request]

Appendix 2: Integrated Urgent Care Service Specification


Appendix 3: Urgent Treatment Centre - Principles Standards


Appendix 4: Patient Flow Diagrams


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Appendix 5: STP UTC Site Designations


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Appendix 6: HWLH CCG UTC Pro-forma August SOUTH EAST


Appendix 7: UTC Options Appraisal


Appendix 8: PROMs & PREMs Outcome Measures

Outcome Measure Metric Evidence

Outcome Measure 1: Patient reported outcome measures (PROMS) - The setting and achievement of patient directed goals. Purpose: To determine the quality of the service through measuring patient directed goals. The patient identifies their problem and what they would like to achieve on admission to the service through discussion with the clinician to ensure realistic target. These goals are reviewed at the end of treatment (or following an agreed timescale for long term service user) to determine if achieved.

Patient goals agreed at admission to the service that are confirmed as achievable and realistic with the clinician. These are assessed at discharge from the service to determine the number of goals achieved. An overall score of goals achieved and percentage will be provided. Patients on long term care will be assessed annually to determine new goals and confirmation of existing goals met. All new patients admitted to the service will have these in place from 1st January. Reporting will be for all patients on a quarterly basis however for 2015/16 Quarter 4 the data will be from an audit of cases (10% of caseload) and not all patients. From April 2016 all patients will be have Goals agreed however in year one the minimum number of patients with data collected/reported will be 25% and year 2 75% as described in column H-L. The following information will be provided:

Number of patients

Total Number of Goals set

Total number and percentage of goals achieved

Health Records Audit: Quarterly audit established Resp Service: Respiratory Outcome Case studies *To be tabled Respiratory Pulmonary Rehab Outcomes Oct-Dec 2016

Outcome Measure 2:

Patient reported experience measures (PREMS) - Patient

Patient experience questionnaire have standard set of questions with 4 specific questions designed for each specialty.

Service specific Surveys in place July 2016


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feedback to include experience and satisfaction of the service, carer experience, communication and information provided throughout the care episode and assurance the patient directed goals were agreed between patient and clinician. Family and Friends test can be included within this.

Purpose: To determine if patients and carers have a good experience of using the service and identify any areas of good practice or improvement to share with staff and commissioners on a timely basis.

This will be able to provide breakdown of score for each question and an overall patient satisfaction score for the whole questionnaire. This will be for all patients and will commence from 1st January 2016. There will be a baseline audit in Q4 2015/16 and then from April 2016 the response rates and overall scores will be as per columns H-L. Please note we will require the overall satisfaction score for all the questionnaire as we will see the breakdown within your patient experience reports. It would be useful to have this information (overall score) by locality.

Service specific questions summary Oct – Dec 2016 Doc 3 FFT Oct – Dec 2016 (see next slides)

Appendix 9: Integrated Urgent Care Minimum Data Set Specification


Appendix 10: NHSE Integrated Urgent Care Key Performance Indicators


Appendix 11: UTC Project Plan

Please note this is a working document and therefore the dates on the timeline are subject to change and may differ from previous documents.


Appendix 12: UTC Risk Log 31.01.18


Appendix 13: UTC Quality Impact Assessment


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Appendix 14: Communication and Engagement Plan


Appendix 15: UTC Equality Impact Assessment


Appendix 16: UTC Privacy Impact Assessment


Appendix 17: HWLH UTC Service Specification

[In progress]

Appendix 18: Activity Modelling: Lewes UTC

[In progress]

Appendix 19: Activity Modelling: Uckfield UTC

[In progress]

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