Appendix 8: CCG self-assessment
Outcome / CCG Self-AssessmentAchieving / CCG comments
1.1 Services are commissioned, procured, designed and delivered to meet the health needs of local communities / The Joint Strategic Needs Assessment (JSNA) for the resident population of Portsmouth City was updated in 2015. The JSNA is compiled by Portsmouth City Public Health Team. It analyses the health needs of the City’s population to inform and guide commissioning of health, well-being and social care services.
The JSNA informs the City’s Health and Wellbeing Strategy. The strategy has five strategic priorities, each supported by a set of work streams that specifically respond to health and wellbeing needs in Portsmouth that have been highlighted through the JSNA.
So that the CCG’s commissioning processes address the needs of everyone in the population each project and plan is screened in relation to equality and diversity, and where indicated a full equality analysis undertaken and actions identified and implemented.
Strategic leadership is provided through a lay member on the CCG’s Board who champions public involvement and works closely with the CCG’s Primary Care Engagement Team and member practices.
To support this work the health and social care Integrated Commissioning Unit’s Service User Involvement Officers lead engagement work with service users and the public. This includes those specifically from protected groups to include learning disabilities and mental health services clients and veterans. The Unit has established good links with local groups and good mechanisms for involving service users in service reviews.
The CCG also shares a Communications and Engagement Team with Fareham and Gosport and South Eastern CCGs who undertake a range of consultation exercises across the City on, for example, service re-design. Equality analysis is undertaken of that team’s strategy and engagement undertaken with the CCG’s population on a variety of health care issues to include provision of IVF and care of the elderly.
1.2 Individual people’s health needs are assessed and met in appropriate and effective ways / The Continuing Healthcare Team is responsible for assessing whether an individual is eligible for NHS Continuing Healthcare funding. This integrated health and social care team carries out assessments and reviews for all individuals in accordance with the national framework. Continuing healthcare is provided in the following circumstances;:
- Comprehensive assessment shows that the type, complexity, intensity and/or unpredictability of a person’s needs means that health care is most important. Referrals can be made by health or social care professionals.
- A person’s condition is rapidly worsening and may be in the terminal (end of life) stage. Referrals are made by experienced healthcare professionals.
The Portsmouth Blueprint was launched in 2016. It sets out how health and social care services will be transformed so that they meet the needs of the population and are co-ordinated. This will include a single point of access and community hubs of care teams. People will:
- Be able to access effectives services to manage their own health and stay well and independent
- Be able to plan ahead and keep control at times of crisis in their health and care
- Spend less time in hospital and institutional care
- Have access to effectives services when they have an urgent health care or welfare need.
1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed / Care pathways are in place to provide smooth transitions between services. These are set out in the service specifications agreed between the CCG and those NHS provider services from which we buy healthcare services for the people of Portsmouth.
Care pathways are monitored through formal contract monitoring between the CCG and provider services. Services covered include transition of children to adult services, acute to community care, particularly of older people.
As an outcome of the work of the Portsmouth Blueprint as detailed in 1.2 above, local people will find community services working more closely with hospital services to ensure smooth transfers of care.
GPs are involved in the development of care pathways and there are good mechanisms for sharing information including PIP (GP intranet) and regular GP commissioning events
Patients and the public are involved in the development of care pathways through our engagement mechanisms such as surveys and ongoing events as part of the Portsmouth Blueprint.
17 of the 20 Portsmouth General Practices (family doctors) now share the same clinical record system with Solent NHS Trust. Solent NHS Trust provides community and mental health services in the City. This means that the patient’s journey can be supported by improved information sharing. Adult Social Care has recently agreed to migrate onto this system. This will take a couple of years but it will be a significant step forward and improve care pathways.
1.4 When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse / The CCG’s Head of Safeguarding and Patient Safety has the role of working with clinical quality leads to ensure safety is considered as part of quality and robust processes are in place to monitor and act on patient safety.
The CCG is registered with the Government’s Sign up to Safety Campaign (SU2SC). This campaign was first launched in June 2014 in response to the findings and recommendations of a number of reports including the Mid-Staffordshire NHS Foundation Trust Inquiry. The aim is to deliver a single vision by aligning the safety initiatives or all NHS organisations.
SU2SC pledges to put safety first and lead on collaborative learning, being open and transport with people about safety issues and supporting staff in this process and supporting patients and their families when things go wrong and celebrate improvement.
Organisations providing NHS care can apply to the CCG eligible to work with us are: Solent NHS Trust, Portsmouth Hospitals NHS Trust, Portsmouth General Practices, Primary Care Alliance/Federations, Portsmouth Nursing Homes, Care UK (which runs the St Mary’s Treatment Centre) and South Central Ambulance Service.
Monitoring of quality schedules of provider contracts includes patient safety. Patient safety is covered under:
- Safe recruitment and retention practices to include appropriate supervision and mandatory training as appropriate to staff roles
- Safeguarding children
- Safeguarding vulnerable adults
- Incident and serious Incident Reporting (national and local)
- Organisational learning.
- Infection Prevention – health care acquired infections and environment.
The CCG’s Quality and Safeguarding Executive meets monthly and has an oversight role in the quality of all contracts with NHS provider organisations.
1.5 Screening, vaccination and other health promotion services reach and benefit all local communities / These services are the responsibility of Public Health, NHS England Local Area Teams and primary care, rather than being commissioned by the CCG.
However, stakeholders have raised concern with the CCG that people with disabilities, particularly learning disabilities miss out on accessing the annual influenza vaccination programme.
In response to that and other monitoring of influenza vaccination take up, the CCG’s primary care engagement team is reviewing its contact with general practices for this service and working with them to ensure all those people who are eligible are able to access this vaccination. To support access by people with learning disabilities, this will be included in a health check assessment.
2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds / The Portsmouth Blueprint includes a commitment to people to keep their independence through the range of services they can access to maintain their independence, whether this is in their community, at home or in the place they usually live and work.
Access to services is also reviewed as part of commissioning plans and projects. These reviews include engagement with local people whose experiences and views shape the final commissioning/re-commissioning of services. Reviews include accessibility of services so that they are “closer to home” and accessible when people need them. Pressure on delivery of constitutional standards means lengthening waiting times for people and access to treatment.
Monitoring of NHS services commissioned on behalf of the people of Portsmouth includes equity of access and non-discrimination. This includes the translation and communication support. Provider services’ patient experience reports are reviewed and assurances required for actions to be implemented.
The CCG has provided advice and support to member general practices so that they may review and ensure buildings and environments are accessible for people with sensory impairment or loss, and to provide communication support and information in accessible formats.
2.2 People are informed and supported to be as involved as they wish to be in decisions about their care / Personal Health Budgets are offered to adults who are eligible for Continuing Health Care and children who are eligible for Continuing Care. The Portsmouth Blueprint will use personal budgets routinely across health care so that people, their families and other carers will have more control, choice and flexibility over the support they receive. Portsmouth is in its third year as an early implementer for Integrated Personal Commissioning (IPC) which promotes and facilitates person centred care planning and the expansion of health and social care personal budgets.
Advocacy for adults in Portsmouth is delivered by Solent MIND and offers a wide range of free advocacy services in a person-centred way to make sure that the individual is at the centre of their decision process.
The CCG works closely with social care colleagues as part of the Integrated Commissioning Service. A range of advocacy services is commissioned by social care for children including services specifically for Looked After children through Advocacy and Independent Visitor, and Family Group Conferences.
Interpreting services are available for provider services, including GPs, to ensure those whose first language is not English or who have communication difficulties are supported and involved as they wish in decisions about their care. Each General Practices is being encouraged to implement an Accessible Communications Policy to include provision of information is alternative formats such as Easy Read.
The CCG’s Accessible Information Policy makes it the responsibility of individual staff members to understand and explore all options to provide information in accessible formats and communication support as identified and/or requested by patients and members of the public.
If, for any reason, a patient or member of the public has a complaint about their care, Healthwatch Portsmouth offers advice and can provide support throughout the complaints procedure.
2.3 People report positive experiences of the NHS / Patient views are monitored by the CCG through its contracts with provider organisations of NHS services. This includes the results of the NHS Friends and Family Test, comments and compliments received, patient surveys and consultations.
The CCG also encourages and receives reports of positive experience through a range of mechanisms to include:
- Telephone, letter or email
- Social media and the CCG’s website feedback form
- The CCG’s Community Engagement Committee
- Consultation and engagement events with patients and members of the public.
The CCG publishes an annual “Listening to Our Patients” report. This catalogues the engagement and consultation activities that have taken place over the previous year and highlights how patient feedback has changed. In 2016/17 specific work focused on dementia care and veterans’ health. In conjunction with partner CCGs and NHSE, the CCG encourage local people to engage in “Your Big Health Conversation” as part of publication and launch of the Hampshire and Isle of Wight Strategic Transformation Plan.
2.4 People’s complaints about services are handled respectfully and efficiently / All complaints are dealt with in line with NHS Regulations 2009. The CCG’s Complaints Concerns, Comments and Compliments Policy includes specific guidance in relation to equality and diversity and human rights. A copy of this policy is available on the CCG’s website and on request, including in alternative formats and languages.
The complaints procedure is underpinned by the Parliamentary Health Service Ombudsman’s “Principles for Remedy” which are:
- Getting it right
- Being customer focussed
- Being open and accountable
- Being fair and proportionate
- Putting things right
- Seeking continuous improvement
Recording and monitoring comments and compliments is integral to the CCG’s patient experience service which also handles complaints and concerns. This approach ensures a person centred approach and supports early resolution of concerns and complaints and improved utilisation of patient feedback.
Mandatory training for complaints staff includes safeguarding (children and adults). The service seeks to ensure it responds and listens to complainants appropriately and makes services better for everyone. An “About You –ensuring services are improved for everyone” form is included letters to complainants with a pre-paid reply envelope. It is anonymous and explanation acknowledges that the information, which covers the protected characteristics under the Equality Act 2010, is sensitive. Assurance is provided as to confidentiality.
3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels / The CCG advertises jobs and processes applications via NHS Jobs. All applicants are asked equalities monitoring questions covering 7 of the 9 protected characteristics. Equalities information for successful candidates is recorded on an Electronic Staff Record System. Applicants have the option not to disclose equalities information.
The CCG’s recruitment procedure as set out in its Recruitment Policy 2016 ensures compliance with the provisions of the Equality Act 2010 at all stages of recruitment and selection as well as employment legislation.
The CCG undertakes the NHS Workforce Race Equality Standard (WRES) each year.
3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations / CCG employee contracts are in accordance with NHS Agenda for Change. Agenda for Change was introduced in October 2004 to ensure that pay in the NHS is consistent with the requirements of equal pay law. This is a national job evaluation scheme and complies fully with anti-discrimination legislation.
Pay audits are not undertaken by PCCG.
3.3 Training and development opportunities are taken up and positively evaluated by all staff / All CCG staff are required to attend statutory and mandatory This is conducted mainly via the electronic Managed Learning Environment (MLE).
Specific training is also offered and taken up by clinical staff and staff identified by their line manager, for example, on infection control, adult basic life support and conflict resolution.
Staff will sometimes undertake training, research or have shadowing experiences which will count towards their Continual Professional Development (CPD).
Compliance with statutory and mandatory training is reviewed at each member of staff’s annual appraisal which also gives the individual an opportunity to feedback on training undertaken. Individual training opportunities are also discussed at annual appraisals and staff can be supported to undertake training through the Staff Learning Agreement which can include partial funding and/or study leave and may cover study leading to professional or vocational qualification relevant to business needs.
3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source / The CCG’s Grievance, Bullying and Harassment Policy sets out the CCG’s commitment to staff working in a safe environment in which they feel fully supported. The policy applies to all employees regardless of length of services. It does not apply to agency workers or self-employed contractors.
The CCG procures Occupational Health and Wellbeing services from Solent NHS Trust which accepts self-referrals and offers stress management advice and Stress Buster sessions.
CCG staff have access to Right Management Employee Assistance Programme which provides free confidential support, information, coaching and counselling and is available 24 hours a day, 365 days a year.
The CCG is implementing the Freedom to Speak Up guidance published by NHS England. A Freedom to Speak Up guardian is being nominated to support staff who wish to raise concerns and ensure they do not receive any detrimental treatment as a result.
3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives / The CCG’s Flexi-Time Working Hours Guidance is operated in conjunction with Agenda for Change terms of working hours for staff. It sets out guidance on flexi-time policy for staff wishing to exercise this option. An individual member of staff wishing to work flexible will need to discuss this with their line manager who will consisted the request against the business needs of the team and the CCG as a whole. All requests for flexi-time working should be made in writing and a copy kept in th individual’s personal record.
3.6 Staff report positive experiences of their membership of the workforce / A staff survey was conducted in February 2017 (Appendix 9) See Also Report Section 4.2
4.1 Boards and senior leaders routinely demonstrate their commitment to promoting equality within and beyond their organisations / The CCG’s governing Board and Primary Care Commissioning Committee meets in public bi-monthly. Details including papers for each meeting are accessible on request and on the CCG’s website. A patient story is periodically presented and discussed as part of review of services commissioned. Patients and members of the public are welcome to put questions to the Board and Commissioning Committee in email and in writing.
The CCG’s Constitution includes Good Governance, behaviours in accordance with the Nolan Principles of Public Life, one of the underpinning principles of which is the Equality Act 2010. In discharging its functions, the CCG makes the commitment to meet the public sector equality duty of the Equality Act 2010. This is through a range of mechanisms to include:
- Equality and Diversity Strategy
- Gathering information on how the CCG’s work affects different people
- An annual equality and diversity report
- Consultation with patients/service users, trade unions on commissioning and employment practices
- Equality impact assessment of policies, functions and commissioning decisions
- Setting and taking action to achieve Equality Objectives at least every four years.
in our Public Board meetings and Board development sessions the CCG's commitment to equality and fairness is demonstrated, from being an important part of our strategic aims (even if not directly stated)to Board patient stories. In our engagement there is a commitment and desire to reach out to all parts of Portsmouth hear theirvoices and be influenced by them eg homeless peoplefor Guildhall Square engagement. I think equality is important part of what we do and a driving force for us, the vulnerable as well as those with protected characteristics
4.2 Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed / Equality impact assessments (EIAs) are undertaken of commissioning projects and plans and of other policies and functions as identified. Work is ongoing to achieve excellence in completion of EIAs.
4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination / CCG aims to have policies and supporting procedures that are fair, equitable, transparent and in line with current employment legislation. Policies are subject to periodic review at agreed intervals or as informed by legislation or other changes. Policies and procedures are also aligned to the principles and requirements of the Equality Act 2010 and the Public Sector Equality Duty.
Equality objectives defined from the EDS2 assessment and reviewed on an annual basis will be informed by patient and public feedback and staff experience.
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