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To: Amanda Doyle, Chief Clinical Officer,
Blackpool CCG / 28 July 2014
Dear Amanda,
Re:CCG Annual Assurance 2013-14
Thank you for meeting with us on 27 May 2014 to discuss the annual assessment of Blackpool CCG, and establish the development priorities for the coming year. This letter is a summary of the Quarterly Assurance meetings that we have held over the last year and provides a synopsis of the improvements and ambitions for future development laid out against the assurance domains.
Key Areas of Strength / Areas of Good Practice
Areas where evidence provided of strong delivery against assurance domains:
- Evidence of continuous monitoring of quality of commissioned services & clear action plans through reports provided to your management team and governing body as well as discussion at your monthly contract review meetings and fortnightly informal discussions with your provider
- Evidence of active participation in local Quality Surveillance Group and mortality review group identifying improvements in some specialties regarding mortality outcomes
- Demonstration of strong clinical input in services quoting examples of hypertension register update, stroke and end of life groups, clinical pathway involvement and dementia work in primary care
- There was clear evidence of joint working with providers, local council and public engagement groups eg. Altogether Now programme
- Evidence of programme of public engagement jointly delivered by Age Concern
- QIPP is part of all strategic and operational plans
- Evidence of clear vision with the development of the neighbourhood model and the planned implementation of Oliver Wyman models of care
- Shortlisted for the Accelerated Learning Programme
- Recognition of huge achievement on the CCG financial position
- Robust governance was described and substantiated by the 360 results.
NHS Constitution standards
Areas of good practice and system challenge in the delivery of the constitutional standards:
- Operational and non-delivery issues were raised with regard to 18 week RTT and 6 week Diagnostics for a number of specialties at acute provider. You described the additional investment for increased capacity and delivery of 18 weeks and the challenge posed to recovery plans for diagnostics
- Delivery of A&E 4 hour standard has been a challenge in Quarter 3 and 4 of 2013/14. You have accessed ECIST support and monitor recovery plan within your Urgent Care Working Group
- Mental health pathway management utilising public and 3rd sector involvement and the improvements identified
- Mixed Sex Accommodation improvements during the year but acknowledgement that there are still occasional breeches due to clinical need
NHS Statutory Duties
As part of our discussions we covered the following statutory responsibility areas and considered that as a CCG you demonstrated your ability to deliver as laid out in 14Z16 and 14Z8 of the NHS Act 2006 (as amended by the Health and Social Care Act 2012) sections:
- 14T – Each CCG whilst carrying out its functions must have a regard to the need to reduce inequalities between patients with respect to their ability to access health services, and reduce inequalities between patients with respect to the outcomes achieved for them.
- 14R - Duty as to continuous improvement in quality of services
- 14W - try to obtain appropriate advice in order to deliver functions
- 14Z2 - Public involvement and consultation by clinical commissioning groups
- 223H to 223J – Expenditure, finance and controls
- Consultation and engagement with HWB with regards development of joint and HWB strategy
- 14Z15Publication of a CCG annual report
Blackpool CCG has also:
- delivered a revenue surplus for the year against a planned deficit
- earmarked 2% of its budget on non-recurrent expenditure, in line with national guidance, however were required to use £2.86m to support the bottom line
- managed its running costs within target
- delivered QIPP savings of £6.79m
Key Areas of Challenge
Areas where challenges identified:
- A&E delivery due to the challenges facing CCGs and local health system
- Identification of delivery challenges for RT and diagnostics, recovery plan from acute trust remains unachievedand further work has been requested by your CCG in conjunction with Fylde and Wyre CCG, recognising that complete capacity and demand modelling would provide a better understanding of the challenges
- Cancer waiting times challenges in delivery – 2 week, 31 and 62 day pathways are being reviewed
- Review of quality challenges linked to CQC report at acute trust
- Mortality rate at acute trust remains a challenge, embedding actions to improve the clinical pathways requires ongoing scrutiny
- Identification of risk and mitigation for IAPT delivery issues
- The capacity and capability within the acute trust to enable the CCG ambitions to be achieved given the number of issues the trust is addressing.
Key Interdependencies and Associated Issues
Areas where issues and interdependencies are identified:
- Concerns were raised regarding the risk sharing process and governance elements of the delivery of the Better Care Fund; we are awaiting further national guidance relating to the performance payment element of BCF.
- The strategic plan submitted shows there are some gaps in knowledge with regards to the future direction of travel nationally for specialist commissioning and due to the delay in the national strategy for primary care being published by NHS England. Both these issues have been escalated and it is recognised that strategic plans are live documents that will continue to develop over time with the impact from Healthier Lancashire.
- Throughout 2013/14, the development of co-commissioning arrangements has increasingly been recognised as key to transforming primary care, this has been further underpinned by the recent national policy announcement, providing opportunities to formalise and broaden the scope of these co-commissioning arrangements. The CCG and the Area Team have been working jointly to identify and address issues relating to unwarranted variation in quality and safety and will continue to work jointly on the implementation of co-commissioning arrangements.
Development Needs and Agreed Actions
Areas where development required and actions agreed:
- A&E recovery plan to incorporate ECIST recommendations and to be forwarded to the Area Team.
- IAPT mental health within main provider – agreed IAPT IST to support a desktop review.
- The CCG Organisational Development plan identifies key areas for development to be taken forward.
Overall we would like to congratulate you on the progress you have made over the last year and the capability and capacity that you have worked hard to build and develop over the last year.
Thank you again to you and your team for meeting with us and for the open and constructive dialogue, I hope this letter provides an accurate summary of the discussions and clearly indicates the next steps. We look forward to working with you on progressing work against the domains outlined above.
Yours sincerely,
Jane HiggsRichard Jones
Director of Operations & Delivery Area Director
Lancashire Area TeamLancashire Area Team
Cc David Bonson – Blackpool CCG