19th January 2012 / AGENDA ITEM 4
NHS Blackpool Update
1.0 Matter for consideration
1.1 The Committee to consider an update report from NHS Blackpool covering;
a) Fylde Coast Health Services - Consultation Update
b) NHS Commissioning Update - NHS Blackpool Clinical Commissioning Group
c) NHS Commissioning Update - Lancashire PCT cluster arrangements
d) NHS Commissioning Update – National Developments NHS Outcome Framework
e) COPD Pathway Update
f) Any Qualified Provider (AQP)
2.0 Recommendation(s)
2.1 To scrutinise the report, asking questions and making recommendations that are considered appropriate.
3.0 Summary of key issues
3.1 Fylde Coast Health Services – Consultation Update
3.1.1 Health Committee Members will recall the consultation plan for the Fylde Coast Health Economy Consultation was subject to scrutiny and amendments at joint OSC Task Group. NHS Blackpool has reviewed, considered and implemented 11 of the 13 actions (all that can be implemented at this time).
3.1.2 The Clinical Case for Change has been finalised with Blackpool Clinical Commissioning Group and the new Fylde and Wyre Clinical Commissioning Group. Both groups have supported the principles of the Clinical Case for Change.
3.1.3 The consultation has been supported by the NHS Blackpool Trust Board on 20th December 2011 and Blackpool Teaching Hospitals Foundation Trust Board on 21st December 2011. Approval will be sought by NHS Lancashire Cluster Board in January 2012. Following anticipated approval at the NHS Lancashire Cluster Board, the Consultation Document, Clinical Case for Change, Consultation Plan and Business Case will be submitted to NHS North of England (NoE) as part of the Office of Government Commerce (OGC) gateway and National Commissioning Advisory Team (NCAT) review processes. This usually takes 6 weeks and involves interviews with key stakeholders and clinical leaders, relating to the Lansley 4 Tests.
3.1.4 It is anticipated that following conclusion of the NCAT review process, NHS NoE will approve, with recommendations, initiation of the consultation.
3.2 NHS Blackpool Clinical Commissioning Group Update
3.2.1 Blackpool Clinical Commissioning Group is developing plans to deliver the schemes of work to attain authorisation by October 2012. Following the submission of its assurance baseline to NHS NoE a series of plans are now in development, which are:
· Organisational Development Plan
· Communication and Engagement Plan
· Governance and Assurance Framework
· Constitution 2012/13
· Inter-Practice Agreement / CCG Memorandum of Understanding.
· Commissioning Strategic Plan
· Operational Plan
· Financial Plan
· Joint Strategic Needs Assessment
· Joint Health and Wellbeing Strategy
· Register of Interests
· Accountability Framework (subject to any collaborative/locality working
3.3 NHS Lancashire Cluster Arrangements Update
3.3.1 The NHS Lancashire Cluster Board continues to receive performance updates from each PCT locality.
Collaborative working is being actively promoted across the 5 locality PCT’s as part of next year’s planning for the commissioning cycle. This will include Quality Schedules and Commissioning for Quality and Innovation (CQUIN) schemes.
3.3.2 The NHS Lancashire Cluster is also overseeing the development of a commissioning support organisation (CSO). CSO’s are intended to provide back office support to Clinical Commissioning Groups. It is envisaged that key functions of the CSO will be:
a) Service Planning
b) Service Redesign
c) Contracting and Performance Support
d) Statutory Duties
A workforce strategy is expected early in 2012, outlining the process for transfer of staff for the CSO.
3.4 NHS Outcomes Framework
3.4.1 The 2012/13 NHS Outcomes Framework was published on 7th December 2011 by the Department of Health. In summary, the framework defines how the NHS will be accountable for outcomes. There are five domains articulating the responsibilities of the NHS, they are:
· Preventing people from dying prematurely
· Enhancing quality of life for people with long term conditions
· Helping people to recover from episodes of ill health or following injury
· Ensuring that people have a positive experience of care
· Treating and caring for people in a safe environment and protecting them from avoidable harm.
Twelve overarching indicators cover the broad aims of each domain. Twenty-seven improvement areas look in more detail at key areas within each domain and sixty indicators in total measure overarching and improvement area outcomes. A copy is attached for information and the web link below signposts to the full report.
The outcomes will be included in local performance reports to the CCG Board and to the NHS Lancashire Cluster Board.
3.5 Chronic Obstructive Pulmonary Disease (COPD) Pathway Update
3.5.1 Background to COPD
The term chronic obstructive pulmonary disease (COPD) is an umbrella term encompassing a range of chronic, disabling, often co-existing breathing disorders including chronic bronchitis, emphysema and airways disease. Characterised by airflow obstruction which is not fully reversible, it is a progressive and incurable condition. Whilst there are a number of recognised risk factors associated with COPD, including occupational exposures, genetic factors, air pollution and medical conditions such as recurrent lower respiratory tract infections, it is overwhelmingly dominated by current or former cigarette smoking, with over 80% of cases attributable to this.
Emergency hospital admissions due to COPD have been increasing by about five per cent per year, but many of these admissions are thought to be preventable with improved pathways involving diagnosis and treatments. COPD is one of the main reasons for non-elective admission in our local hospital. NHS Blackpool has been an active partner on a respiratory steering group consisting of Fylde Coast Acute, Primary Care and PCT representatives. NHS Blackpool has led on engagement with its patients about proposed service developments.
3.5.2 Background to COPD pathway
A report by Mr Ian Treasure to the 25th January 2011 Health Committee (then called Health Overview and Scrutiny Committee) outlined the proposed changes to the COPD Pathway in its stages, which are; Education and Prevention, Diagnosis, Assessment and Treatment, Crisis Management and Emergencies.
The report stated the 5 aims of the COPD pathway redesign, which are:
a) To increase the quality of life of COPD patients
b) To reduce the number of emergency hospital admissions for COPD
c) To Increase levels of identification of COPD, and identify it earlier
d) To increase levels of effective self management in COPD patients
e) To reduce inappropriate use of oxygen.
The pathway improvements were part of the local work undertaken with the British Lung Foundation Lung Improvement Programme that NHS Blackpool participated in.
3.5.3 Progress to date.
a) To increase the quality of life of COPD patients.
Quality of life has been increased by enabling patients to manage their own condition through:
· The development of ‘My Breathing Booklet’ – a guide for patients to recognise their own condition and when symptoms are worsening (Through a COPD Assessment Score – or CAT). A patient experience report on using the booklet will be available after April 2012.
· Better access to medication such as inhalers and emergency steroids.
· Self help groups and pulmonary rehabilitation (exercise and breathing programmes).
· For the over 65’s, signposting to agencies such as Age UK and Vitaline.
b) To reduce the number of emergency hospital admissions for COPD.
Due to a time delay in hospital admissions data, an accurate report on hospital admissions rates for a full 12 month period since the COPD pathway is currently unavailable. It is expected after 31st March 2012.
c) To Increase levels of identification of COPD, and identify it earlier.
Given the relationship between smoking and COPD, NHS Blackpool facilitate community based lung health checks (spirometry) on an ongoing basis. Since January 2009, there have been 1,054 smokers given lung health checks. A total of 953 of these were given brief advice on smoking cessation and 467 registered with the smoking cessation service. Tests also continue with spirometry by health professionals in clinical settings to assess lung function and volume, helping diagnose COPD and its severity.
d) To increase levels of effective self management in COPD patients.
Self Management is supported by the distribution of the ‘my breathing’ book.
A total of 1200 ‘my breathing’ books have been given to the multidisciplinary teams in the community for distribution to COPD patients in primary care.
Pulmonary rehabilitation, which is run in community venues, sports and primary care centres, helps with breathing exercises and social networks as part of self management. The scheme has increased in volume with 300 people per year completing the programme.
e) To reduce inappropriate use of oxygen therapy.
A total of 179 patients, previously unknown to the home oxygen assessment service, have been reviewed in 2011 and their oxygen usage adjusted according to clinical need. There are 93 patients out of 179 who are having oxygen prescription reduced, 56 stayed the same and 30 had their oxygen increased. GPs are now referring patients to the oxygen assessment service rather than prescribing home oxygen directly.
The number of patients now in receipt of a specialised Home Oxygen review/recall as recommended by National Institute of Clinical Excellence (NICE) has increased from 30% to 94% and exceeded the anticipated target of 80%. Capacity planning has been possible so future clinic sessions can allow current patients to be followed up, and initial assessment for patients new to the service.
3.5.4 Commissioning for Quality and Innovation (CQUIN) 2011/12
CQUIN is an incentive payment made upon the delivery of quality and innovation outcomes. Blackpool Teaching Hospitals Foundation Trust and Blackpool community health services were commissioned by NHS Blackpool to deliver a CQUIN indicator to implement the COPD Pathway during 2011/12. The indicators are; measuring oxygen assessments, staff training on distribution and advice relating to the ‘my breathing book’, A&E attendances for COPD, and Non-Elective Admissions for COPD. The outcomes of this scheme will be available after April 2012.
3.6 Any Qualified Provider (AQP)
3.6.1 Background to AQP
Since 2010, the Government has been committed to increased choice and personalisation in NHS-funded services. Choice for patients can be about the way care is provided, or the ability to control budgets and self-manage conditions. The government has specifically committed to extending patient choice of Any Qualified Provider for appropriate services. By choice of Any Qualified Provider (AQP) we mean that when patients are referred (usually by their GP) for a particular service, they should be able to choose from a list of qualified providers who meet NHS service quality requirements, prices and normal contractual obligations. Extending patient choice of provider is intended to empower patients and carers, improve their outcomes and experience, enable service innovation and free up clinicians to drive change and improve practice.
3.6.2 The Benefits of AQP
1. Broader range of providers
2. Improved quality – ‘in-the-market’ mentality
3. Benchmarking opportunities
4. More choice for patients
5. Open, honest, transparent & non-discriminatory
3.6.3 Local Developments
NHS Lancashire (Cluster) is co-ordinating the procurement process of the local priorities identified for extending choice of provider during 2012/13.
To date, the engagement process has involved asking patients, Clinical Commissioning Groups, Service providers and PCT’s to rank the proposed 8 services in order of preference for implementing AQP. NHS Lancashire has prioritised the top three by looking at which service was prioritised as 1st most often. The results were as follows:
1. Musculo-Skeletal services (MSK) for neck and back pain
2. Diagnostic tests (such as MRI Scanner)
3. Adult hearing services
An assessment of how MSK for neck and back pain and adult hearing services are currently provided in each of the PCT areas is now underway, which will help to assess the impact that AQP will have. Further engagement on which diagnostic tests to introduce AQP for is also underway.
National Implementation of AQP commissioning across these three types of services will begin from April 2012, which will involve a choice of provider to patients.
4.0 Witnesses / representatives
4.1 As requested by the Committee members, the following persons have been invited to attend the meeting to speak on the matter:
· Mr Ian Treasure, Deputy Director of Partnerships, NHS Blackpool
Relevant officer:
Mr Ian Treasure, Deputy Director of Partnerships, NHS Blackpool
E-mail:
Appendices attached:
Appendix 4 (a) NHS Outcomes Framework, at a glance
Background papers:
None
Websites and e-mail links for further information:
For the NHS Outcomes Framework;
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131700
For CQUIN;
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091443
Glossary:
CQUIN - Commissioning for Quality and Innovation – a quality incentive scheme where a range of quality schemes (Patient Safety, Effectiveness, Experience) are agreed with service providers on standard NHS contracts (NHS Blackpool Community Health Services (and other community providers) Blackpool Teaching Hospitals and North West Ambulance Service). These schemes have measurable targets that must be above normal contractual obligations and must improve quality. For the year 2011/12 CQUIN value was 1.5% of the contract value. Please see web link above for background information on CQUIN.
NHS NoE (NHS North of England) – The Strategic Health Authority