Date / 7September 2016
Title / CCG Update
Responsible Officer / Amanda Hume – Chief Accountable Officer, South Tees CCG
Purpose of Item / Thepurpose ofthis briefingnoteis to updatetheHealthandWell-beingBoardonthe progress being madeinanumberofkeyareas bySouthTees Clinical Commissioning Group(theCCG),workingin partnershipwithMiddlesbroughBoroughCouncil andmembers oftheNHS Provider community.
Summary of Recommendations
That Middlesbrough Health and Wellbeing Board are asked to:
- Notethe progress of the work of the Crisis Care Concordat
- Note the recommendations from the urgent care consultation and the timeline for implementation.
- Note and support the CCG Annual General Meeting and Health and Wellbeing Fair
- Notethe process and timeframes for the CCG 2017/18 commissioning intentions
- Note the activities and progress within the Support to Care Homes Project
- Note the progress with development of a Single Point of Access
- Notethe progress of the work of the Health Inequalities Steering Group
- Notetheformation of the Carers Strategic Partnership
- Notetheupcoming joint event with the CCG and the Voluntary Sector to explore joint working
- Notetheupcoming event to develop innovative contracting practices to deliver new models of care
- Notethe requirement to implement a Local A&E Delivery Board.
1.0 PURPOSE OF THE REPORT
Thepurpose ofthis reportis to updatetheHealthandWell-beingBoardonthe progress being madeinanumberofkeyareas bySouthTees Clinical Commissioning Group(STCCG),workingin partnershipwithMiddlesbroughBoroughCouncil andmembers oftheNHS Provider community.
2.0 CRISIS CARE CONCORDAT FOR MENTAL HEALTH
Partners of the Tees-wide Crisis Care Concordat undertook astrategy refresh in April 2016 to refine the group’s purpose, individual organisational drivers and refocus objectives of the concordat.
Currently the concordant is working on a range of initiatives which are summarised below:
- We identified the30 most frequent users of urgent and emergency services (Cohort 30). These individuals were further classified as belonging to one of five groups with a range of recommendations. Implementation of the recommendations are currently being overseen by the concordat group.
- The crisis assessment suite (CAS) continues to receive around 200 referrals per month, via the police, ambulance service and self- referrals, and funding has been agreed to enable the CAS to be relocated within Roseberry Park Hospital allowing for improved facilities for patient assessment and co-location of the Middlesbrough Crisis Team.
- Concordat partners have designed a two-week pilot study to station a mental health nurse in the police control room from 9th September to provide mental health advice to individuals calling in crisis and,if necessary, refer to the street triage team, who will conduct a 7- day follow up with the patient to assess the intervention.
- Use of the commissioned private ambulance service for mental health conveyance across Tees has been a success; however there are increasing pressures on the service as utilisation from more CCG’s/local authorities increases. Discussions are taking place to determine the contract arrangements going forwards to maintain waiting times and ensure a sustainable service.
It is recommended that the H&WBB:
- Notetheprogress of the work of the Crisis Care Concordat
3.0 URGENT CARE CONSULTATION
MAKING HEALTH SIMPLE; RIGHT PLACE FIRST TIME
Following feedback from stakeholders and a public consultation from 11 January to 1 April 2016, a recommendation report on the options for future services was presented to the CCG Governing Body in July 2016. The following recommendations were approved:
- the CCG implements a four extended hours GP centre model, open seven days a week from 6.30 pm to 9.30pm, at the One Life Centre, Middlesbrough; Redcar Primary Care Hospital; East Cleveland Hospital and North Ormesby Health Village;
- the minor injuries unit at Redcar Primary Care Hospital, including diagnostics, should be open from 8am to 9.30pm seven days a week;
- the CCG commissions a revised out of hours service, in line with the new arrangements for extended hours GP centres, including improved specifications around home visiting;
- the CCG continues to refine and develop its proposal to enhance A&E with GP services, in particular, through the development of a GP led frailty unit;
- the CCG develops and implements a robust communications and engagement plan which takes into consideration feedback received during the engagement and consultation activities to ensure that ‘making health simple’ becomes a reality and people living across South Tees receive the information they need to go to the right place first time;
- the CCG continues its constructive working relationship with South Tees Health Scrutiny Joint Committee, to reassure members on the issues outlined, including exploring opportunities for screening services to be available in the extended hours GP centres;
- the CCG continues to work with colleagues from across the North East on regional projects to accelerate delivery of the national model for urgent care services.
The CCG has now moved into the implementation phaseof the recommendations with mobilisation commencing in December 2016 with a view to go-live of the new services on 1 April 2017.
It is recommended that the H&WBB:- Notethe recommendations from the urgent care consultation and the timeline for implementation.
4.0 ANNUAL GENERAL MEETING (AGM) AND HEALTH AND WELLBEING FAIR
NHS South Tees CCG Annual General Meeting (AGM) and Health and Wellbeing Fair will be held on 14th September 2016 at Middlesbrough College from 11am-2pm.
The CCG has usedstudent health needs assessment information, shared by the college, to ensure information, market stalls and signposting at the Health and Wellbeing Fairis tailored to students’ needs.
The CCG will also be hosting a careers workshop between 12.30-13.30, which will see roundtable discussions with health professions from Psychologists to Paramedics, enabling students from the college to get a feel for the real life experiences of people in these professions.
It is recommended that the H&WBB:- Note and support the CCG Annual General Meeting and Health and Wellbeing Fair
5.0 NHS SOUTH TEES CCG COMMISIONNING INTENTIONS 2017/2018
The CCG commissioning intentions for 2017/18 are currently being developed within our clinically led work-streams, in line with the CCG aims and objectives.
Our work-streams have been using local intelligence and data from the Joint Strategic Needs Assessment (JSNA) and Commissioning for Value- Right Care packs to inform the intentions, alongside a clear evidence base. All the CCG draft commissioning intentions will support the CCG QIPP agenda; which focuses on improved quality (Q), innovation (I), productivity (P) and preventative (P) activities.
There will be an opportunity for public and stakeholders to review and comment on the draft commissioning intentions in early September and the CCG Governing Body will be asked to ratify the commissioning intentions in November 2016.
It is recommended that the H&WBB:- Notetheprocess and timeframes for the CCG 2017/18 commissioning intentions
6.0 SUPPORT TO CARE HOMES PROJECT
The Support to Care Homesproject forms part of the work of the Better Care Fund (BCF) programme, linking in with both the Middlesbrough and Redcar & Cleveland Care Home Forums.
A ‘medicines management’ task and finish group has been established within the care home project to develop a specification for additional targeted medication support in care homes. In addition, a ‘discharge’ task and finish group has been established to improve processes for patients being transferred to/from care homes and reduce the number of delayed transfers of care.
The project is also exploring GP/nursing input into care homes and working in partnership with South Tees NHS Hospitals Foundation Trust on their care home pilot to provide an advanced nurse practitioner via rapid response.
Other activities include; falls training in care homes in August,a telecare pilot in September and future plans to deliver nutrition training and support.
It is recommended that the H&WBB:- Notethe activities and progress within the Support to Care Homes Project
7.0 SUSTAINABILITY AND TRANSFORMATION PLAN (STP) and BETTER HEALTH PROGRAMME (BHP)
A verbal update to be provided by the Chief Officer, South Tees CCG at the Health and Wellbeing Board on 7th September 2016.
8.0 SINGLE POINT OF ACCESS (SPA)
Good progress is being made with implementation of the SPA and a revised delivery plan has been developed to reflect its new location with an anticipated ‘go-live’ date of December 2016.
The SPA will host staff from the two Local Authorities, South Tees Foundation Trust and Tees, Esk and Wear Valley (TEWV) Mental Health Trust. It will provide access to social care access teams, social care reablement, including Integrated Occupational Therapy team (IOT’s), social care rapid response, community nursing, community matrons, nursing rapid response, integrated community therapists, hospital discharge to community and a TEWV mental health nurse.
First point of contact staff within the SPA will undertake the initial screening and there will also be registered social workers, nursing staff, occupational therapists and physiotherapists who will be able to provide clinical triage and assessments where appropriate.
It is recommended that the H&WBB:- Note the progress with development of a Single Point of Access
9.0 HEALTH INEQUALITIES PROGRESS
The Health Inequalities Steering Group, with membership including the Directors of Public Health and CCG Executive GPs, continues to meet on a monthly basis to tackle the Health Inequalities agenda.
The objectives of the group are to:
- Set the strategic context within the CCG and across the partnership to influence wider policy and support delivery of a reduction in health inequalities for the South Tees population.
- Contribute to the design and delivery of new ways of working such as Sustainability and Transformational plans, health and social care integration and local strategies eg. the Mayor’s vision.
- Support the implementation of the five-year forward view in respect of the radical upgrade of prevention and reduction in deep-rooted health inequalities.
- Identify key priorities for action with due regard for the entire patient pathway including prevention, diagnosis, treatment and after care.
- Establish a clear direction for the Commissioning Group to ensure delivery of the health inequalities agenda through its work programme.
- Inform the work ofthe CCG clinical work-streams and leads with regards to health inequalities.
- Identify opportunities for collaboration and a reduction in duplication within CCG, and across wider partnership work-streams and work programmes and commission services that will deliver a reduction in health inequalities.
- Review health inequalities data to inform the work of the Steering Group and partner organisations.
- Advocate for reductions in health inequalities in all aspects of business.
Current work of the steering group is focused around addressing health inequalities in diabetes and lung cancer and addressing an identified unmet need of smoking cessation whilst receiving inpatient hospital care.
In addition, poverty remains an important area for the group, plus working together to explore opportunities to commission collaboratively with regards to the provision of health specific welfare advice services.
The steering group have recently undertaken a workshop to shape the work programme for the next 12 months.
It is recommended that the H&WBB:- Notethe progress of the work of the Health Inequalities Steering Group
10.0 CARERS STRATEGIC PARTNERSHIP
The Carers Strategic Partnership is a new partnership to deliver the ‘Strategy to support and value carers in Middlesbrough 2015 – 2019’, the development of which was led collaboratively by Middlesbrough Voluntary Development Agency (MVDA), the local authority and the CCG.
There is good representation from organisations supporting carers with an ‘insight’ session scheduled at each meeting to develop the partnership’s understanding of a wide range of issues affecting different groups of carers and provide real life case studies.
Two initial task and finish groups have been established to focus on identifying and supporting hidden carers, and how we better engage with carers to ensure their views and experiences inform the services commissioned locally.
It is recommended that the H&WBB:- Notetheformation of the Carers Strategic Partnership
11.0 WORKING WITH THE VOLUNTARY SECTOR
Chief Executives from the two local Voluntary Development Agencies (VDAs) in Redcar and Cleveland and Middlesbrough, working alongside the Chair from NHS South Tees CCG, have agreed to host a joint event to bring members of the sector together with the CCG to explore how organisations can work together more meaningfully and effectively to deliver benefits to local people and achieve best value for the ‘South Tees pound’.
The session will take place on 9th September and is intended to mark the beginning of ongoing dialogue regarding joint working.
It is recommended that the H&WBB:- Notetheupcoming joint event with the CCG and the Voluntary Sector to explore joint working
12.0 STRATEGIC ALIGNMENT FOR COMMISSIONING TRANSFORMATION
South Tees CCG are hosting a bespoke facilitated workshop for members of our local health and social care system on 15th September to consider and develop innovative contracting practices to deliver new models of care to realise the benefits of integrated working, by showcasing case studies and learning from national models.
The event is designed for system leaders and all staff involved in shaping new models of care and developing local solutions, particularly those involved in commissioning and contracting.
It is recommended that the H&WBB:- Notetheupcoming event to develop innovative contracting practices to deliver new models of care
13.0 LOCAL A&E DELIVERY BOARD
Following discussions at a national and regional level, the Association of Directors of Social Services (ADASS), NHS Improvement (NHSI) and NHS England (NHSE) have developed a plan for the improvement of A&E waiting time performance, aimed at recovering the national position to target (ie the percentage of patients who spent 4 hours or less in an A&E department from arrival to transfer; admission or discharge should remain above 95%)by March 2017.
At a national level this standard has been failed for 21 consecutive months dating back to September 2014. Locally performance has exceeded the national position (Figure 1) with in excess of 95% of patients being seen within the 4hour standard on a consistent basis.
A recent tri-partite letter from ADASS, NHSI and NHSE has requested that local System Resilience Groups (SRGs) be transformed intolocal A&E Delivery Boards, with a sole focus on Urgent and Emergency Care, with the mandate tooversee the implementation and delivery of:
- A&E streaming at the ‘front-door’ to ambulatory and primary care
- Improving the effectiveness of NHS 111 by increasing the number of calls transferred for clinical advice
- Ensuring that Ambulance Service providers undertake Dispatch on Disposition (DoD) and code review pilots enabling increased time to assess the response needs of callers to 111, while continuing to progress work with Health Education England (HEE) to increase the relevant workforce
- Improve patient flow within all hospital Trusts
- Mandating ‘discharge to assess’ and ‘trusted assessor’ models to reduce delays in discharge and support home as the first port of call where clinically appropriate.
The local A&E Delivery Board will comprise of executive level staff within member organisations ie South Tees CCG (STCCG) , Hambleton and Richmondshire (HRW) CCG, North East Ambulance Services (NEAS), South Tees Foundation Trust (STFT), Tees Esk and Wear Valley (TEWV) Mental Health Trust and Yorkshire Ambulance Service (YAS).Local authority executives from Middlesbrough and Redcar and Cleveland willalso be invited to be full members of the Board. The Board will operate tri-chair arrangements; ie Chief Officer STCCG, Chief Executive STFT and the Chief Officer of HRW CCG.
It is recommended that the H&WBB:- Notetherequirement to implement a local A&E Delivery Board.
Report prepared by: Alex Sinclair, Head of Programmes and Delivery
South Tees CCG
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