chief officer’s report lead director: chris … body papers...chris edwards lead officer: n/a job...
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NHS Rotherham CCG Governing Body – May 2015
CHIEF OFFICER’S REPORT
Lead Director: Chris Edwards Lead Officer: n/a
Job Title: CCG Chief Officer Job Title: n/a
Purpose
This report informs the Governing Body about national/local developments in the past month.
Formal Handover of Primary Care Commissioning
With effect from 1 April 2015 the CCG took on delegated authority for primary medical contracts. The attached letter was signed as part of the formal handover arrangements. Appendix 1
Rotherham Health & Wellbeing Board
The Chairman of the Rotherham Health & Wellbeing Board is Cllr David Roach. At the meeting held on 22nd April 2015 it was agreed that our Chair, Dr Julie Kitlowski, will become Vice Chair of the Rotherham Health & Wellbeing Board.
New Assurance Framework for CCGs
The new Clinical Commissioning Group (CCG) assurance framework for 2015/16 has been published. The new framework describes the assurance process which supports CCGs to commission safe, high quality and cost effective services for patients. It includes a strengthened focus on a CCG’s performance in delivering improvements for patients, as well as assessment of its capability to deliver core and additional delegated responsibilities. Appendix 2
CCG’s Working Together – Annual Report
Last year we agreed a significant commissioner led programme of work to review and re-design a number of services across a wider geography served by eight CCGs. This was our commissioner “Working Together” programme which worked with our hospitals own “Working Together” programme, covering the same geographical area. The two programmes are closely aligned and represent the South Yorkshire, North Derbyshire and Wakefield Health systems working closely to improve services and increase the effectiveness of every pound spent on Healthcare.
The attached report details work to date. Appendix 3
Rotherham Moving Forward Together Newsletter
This is the inaugural partnership newsletter which incorporates an update on partners’ response to Child Sexual Exploitation (CSE). Appendix 4
Healthy Balance Event Invitation – Wednesday 3rd June 2015
This year we are taking a new approach to our Annual General Meeting. Working with Rotherham Healthwatch we have combined a market place event with our Annual General Meeting to showcase our key projects and current big issues. We want people to tell us what they think about our work and about health services in general.
The event and the CCG’s Annual General Meeting will take place on Wednesday 3rd June 2015 commencing at 11am. This will be followed at 1pm by our Annual General Meeting with the Public Governing Body at 2pm. It would be helpful if you could let us know if you wish to attend by contacting 01709 302114 or [email protected].
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Communications Update
BBC Radio Sheffield covered a story on the decision to implement clinical restrictions in
Rotherham on Thursday 9th April. Dr Robin Carlisle was interviewed live on the Toby Foster
show about the restrictions and what it means for our patients. The interview can be heard at
1:23:55 on www.bbc.co.uk/programmes/p02n5225 until Thursday 7th May 2015.
The CCG has undertaken training of volunteer, during April, in partnership with Voluntary Action
Rotherham as part of the next phase of our ‘Right Care, First Time’ campaign. Volunteers will
work in targeted areas of Rotherham to encourage appropriate use of health services, focusing
primarily on Pharmacy First.
There have been numerous positive articles and case studies highlighting the excellent work of
social prescribing, both in regional and national publications. The articles highlight the ongoing
success of the programme in helping our vulnerable patients, with long-term conditions, to stay
out of hospital and live independently.
Healthwatch Newsletter for March/April 2015 is attached as Appendix 5
Recommendation The Governing Body is asked to note the Chief Officer’s Report.
Appendix 1
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Appendix 2
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NHS England INFORMATION READER BOX
DirectorateMedical Commissioning Operations Patients and InformationNursing Trans. & Corp. Ops. Commissioning StrategyFinance
Publications Gateway Reference: 03283
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Publication Date
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Guidance
Planning and Assurance
NHS England
This document outlines the approach to CCG assurance for 2015/16. It is the product of the engagement efforts and reflects views gathered from across the stakeholder community.
By 00 January 1900
NHS England: Commissioning Operations, Planning and Assurance
26 March 2015
CCG Clinical Leaders, CCG Accountable Officers, NHS England Regional Directors, NHS England Directors of Commissioning Operations
#VALUE!
Five Year Forward View
The CCG Assurance Framework (published Nov 13)
0
CCG Assurance Framework 2015/16
Superseded Docs(if applicable)
Contact Details for further information
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This is a controlled document. Whilst this document may be printed, the electronic version posted on the intranet is the controlled copy. Any printed copies of this document are not controlled. As a controlled document, this document should not be saved onto local or network drives but should always be accessed from the intranet. NB: The NHS Commissioning Board (NHS CB) was established on 1 October 2012 as an executive non-departmental public body. Since 1 April 2013, the NHS Commissioning Board has used the name NHS England for operational purposes.
Contents
Introduction ................................................................................................................. 1
Background ................................................................................................................. 1
Principles ..................................................................................................................... 2
Components of the new assurance framework ........................................................... 3
The assurance process ............................................................................................... 6
Key sources of information .......................................................................................... 7
National Insight ....................................................................................................... 7 Local insight ............................................................................................................ 7 Outputs of assurance .............................................................................................. 8 Special Measures ................................................................................................. 10
Governance of the CCG assurance process ............................................................. 11
Annex: Assurance Categories ................................................................................... 12
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Introduction
1. This document describes NHS England’s approach to Clinical CommissioningGroup (CCG) assurance for 2015/16. It provides an overview of:
the principles and behaviours which will underpin the approach toassurance;
the contents of the assurance framework; how the assurance process will operate; and, NHS England’s potential responses to the assurance process.
2. The framework will be supported by an operational manual which will set outfurther details of the assurance process and its alignment with The Forward Viewinto Action: Planning for 2015/16.1 This manual will be issued in late springfollowing further engagement with CCGs.
Background
3. The Health and Social Care Act 2012 created CCGs as membershiporganisations of GP practices, to promote clinical leadership and local ownershipof the way health services are delivered. Under the provisions of s.14Z16 of theNHS Act 2006 (as amended), NHS England has a statutory duty to conduct aperformance assessment of each CCG and it does this through the assuranceprocess. Underpinning CCG assurance are the statutory duties that each CCGhas to meet and the need for NHS England to comply with guidance issued bythe Secretary of State for Health under s.14Z16 or s.14Z8 of the 2006 Act.
4. NHS England’s first assurance framework was based on the CCG authorisationprocess and was structured around six domains:
i. are patients receiving clinically commissioned, high quality services?ii. are patients and the public actively engaged and involved?iii. are CCG plans delivering better outcomes for patients?iv. does the CCG have robust governance arrangements?v. are CCGs working in partnership with others?vi. does the CCG have strong and robust leadership?
5. This process successfully provided assurance about CCG capability (CCGs notfully ready were subject to conditions) but also added significant value to CCGsas part of their development. However, the process was inevitably limited to anassessment of capability and potential to deliver, recognising that CCGs had norecord of performance on which to draw. They have now been in existence foralmost two years, and their record of performance and improvements for patientsis really material.
6. Much has changed since the authorisation process was undertaken, giving rise tothe need for a refreshed approach to assurance. The NHS has had to respond tomore challenging performance and financial positions, as well as changes within
1 http://www.england.nhs.uk/wp-content/uploads/2014/12/forward-view-plning.pdf
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the commissioning landscape. The publication of the NHS Five Year Forward View2 in October 2014 set out a new strategic direction, describing how the health service needs to change and, linked to that, NHS England has worked with Monitor and the NHS Trust Development Authority to develop a more joined up approach to planning and supporting local health economies.
7. The National Information Board framework for action Personalised Health andCare 20203, published alongside the Forward View, outlined the increasingimportance of technology and information in the delivery of safe, efficient andeffective care. As commissioners of secondary care, and with responsibility forthe GP IT budget, CCGs are uniquely placed to achieve safe, digital recordkeeping and the digital transfer of patient information across care settings withintheir health economies. They will need to understand and can fulfil theirobligations for digital interoperability.
8. CCGs are already responsible for commissioning out-of-hours Primary MedicalCare Services in accordance with the direction from NHS England to do so on itsbehalf. Another change in the scope of commissioning responsibilities is thatNHS England has determined that CCGs should have a much greater role incommissioning some of the services for which NHS England has statutoryresponsibility. Specific additional assurance will be required for such delegatedfunctions which, from April 2015, will include primary care.
9. A new assurance framework is therefore required to address these changes.This will strengthen the focus on a CCG’s track record and ongoing performancein delivering improvements for patients. It will continue to assess a CCG’scapability as well as ensuring its fitness to take on additional roles andresponsibilities.
10. This new framework also acknowledges that CCGs have different startingpositions, with different populations and challenges, requiring different leadershipresponses. Some are operating in an extremely difficult environment, withinchallenged health economies or with legacy financial issues. Assurance coversthe overall delivery of a CCG, and will take place continuously throughout theyear, rather than as a one-off inspection.
11. This framework describes a continuous assurance process that aims to provideconfidence to internal and external stakeholders and the wider public that CCGsare operating effectively to commission safe, high-quality and sustainableservices within their resources, delivering on their statutory duties and drivingcontinuous improvement in the quality of services and outcomes achieved forpatients.
Principles
12. A set of broad principles has been identified, which should underpin how CCGassurance is undertaken.
2 http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf 3 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/384650/NIB_Report.pdf
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Assurance should be transparent and demonstrate to internal and externalstakeholders and the wider public the effective use of public funds tocommission safe and sustainable services.
Assurance is primarily about providing confidence. Assurance should build on what CCGs are already doing to hold themselves
accountable locally to their communities, members and stakeholders, for bothstatutory requirements and for national and local priorities.
Assurance should minimise bureaucracy and additional reportingrequirements by drawing on available data and aligning with other regulatoryand planning processes – there should be minimal additional paperwork.
Assurance should be proportionate and respect the time and priorities ofCCGs and NHS England teams.
Assurance should be summative and take place over the year as on-goingconversations.
The tone, process and outcomes need to focus on development as well asperformance.
Accountability, learning and development between CCGs and NHS Englandwill be integral to the process.
The framework will be based on a nationally consistent methodology andformat whilst allowing room for local context and variation.
Whilst uncompromising on the facts which describe the quality of servicespatients are receiving, we will be open minded in understanding the reasonsfor variation and, where a problem is found, clear on the consequences andactions which the CCG and NHS England will need to take.
Components of the new assurance framework
13. The new assurance framework recognises that assurance is a continuousprocess that considers the breadth of a CCG’s responsibilities. It will consist ofthe following components:
i. Well-led organisation: this will assess the extent to which a CCG: has strong and robust leadership; has robust governance arrangements; involves and engages patients and the public actively; works in partnership with others, including other CCGs; secures the range of skills and capabilities it requires to deliver all of its
commissioning functions, using support functions effectively, and gettingthe best value for money; and
has effective systems in place to ensure compliance with its statutoryfunctions.
This element of the framework builds on several of the domains of the original assurance framework. Given the level of organisational maturity that CCGs have now attained, NHS England will need to re-assess this element in details when there has been a significant organisational change, such as to the leadership arrangements, or where particular problems have arisen.
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From February 2015, CCGs have been able to take advantage of the commissioning support Lead Provider Framework.4 Those using the framework will be offered the choice of the best and most affordable support services that will deliver efficiencies and improve the quality of services and patient outcomes.
In light of this development, NHS England will assess the extent to which CCGs have the right range of support services in place to enable them to improve patient services and achieve financial balance, and the extent to which these services are sustainable, are able to adapt to future challenges and are of high quality and represent good value for money.
NHS England will also assess whether a CCG’s decision-making processes about the configuration of commissioning support arrangements are transparent and robust. This assessment will take place only when material changes occur or there is cause to question the effectiveness of current arrangements.
The systems that a CCG has set up to ensure that it can effectively meet all statutory requirements placed on it will be reviewed periodically in response to any questions around their effectiveness or as part of the more detailed focus on those statutory functions that require dedicated discussion.
These include key statutory responsibilities for CCGs to reduce health inequalities as set out in the Health and Social Care Act 2012, and to meet the Public Sector Equality Duty of the Equality Act 2010. These will continue to be critical components of the assurance conversations with a CCG.
ii. Performance: delivery of commitments and improved outcomes: a keyfocus of assurance will be how well CCGs deliver improved services, maintainand improve quality, and ensure better outcomes for patients. This includestheir progress in delivering key Mandate requirements and NHS Constitutionstandards, and ensuring that they are meeting standards for all aspects ofquality, including safeguarding, and digital record keeping and transfers ofcare. This focus on quality, performance and outcomes will be continuousthroughout the year, and will be underpinned by a set of delivery metricswhich will constitute the CCG scorecard, which is also intended for publicationas part of MyNHS on the NHS Choices website.
iii. Financial management: the monitoring of a CCG’s financial managementcapability and performance will be continuous throughout the year, includingan assessment of data quality and contractual enforcement. Immediateremedial action will be required when financial problems become evident.Such action could include the use of special measures and NHS England’sstatutory powers of direction, described later in the framework.
iv. Planning: the assurance of a CCG’s plans will be a continuous process,covering not only annual operational plans, and related plans such as thoserelating to System Resilience Groups and the Better Care Fund, but alsolonger term strategic plans, including progress with the implementation of the
4 http://www.england.nhs.uk/lpf/
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Forward View. Progress towards moving secondary care providers from paper-based to digital processes and the extent to which NHS Number and discharge summaries are being transferred digitally across care settings will be specific measures during 2015/16, towards the ambition for a paperless NHS.
v. Delegated functions: specific additional assurances will be required fromCCGs which have taken responsibility for delegated functions. From April2015 it will include primary care and may, in time, include other services. Anannual review of the assurance of delegated functions will be required prior tothe NHS England business planning process for 2016/17. This is in additionto the assurances needed for out-of-hours Primary Medical Services, giventhis is a directed rather than delegated function.
14. In addition, there are particular statutory functions for which NHS England willrequire more detailed focus as part of the assurance process in a particular year.They will be a small number of areas that, because of their complexity or profile,require particular attention. In 2015/16 these will include safeguarding ofvulnerable patients and NHS Continuing Healthcare.
15. The figure below illustrates the components of the assurance framework.
16. It is our intention to publish the CCG scorecard which will inform several of thesecomponents on MyNHS, through the NHS Choices website. Our performanceand delivery commitments will be described in relation to five population groups:the generally well, people with long term conditions, people with mental healthproblems or learning disabilities, children and young people, and the frail elderly,
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with an additional focus on planning. The outcome measures in the scorecard will be derived from, and assessed in line with, the NHS Outcomes Framework.
17. We will also publish a more detailed operational manual as well as technicalguidance on the metrics used in the scorecard. Key sources of information forassurance will be thoroughly scrutinised so that everyone has full confidence inthe facts.
The assurance process
18. CCGs are statutory organisations responsible to their governing body for thedelivery of both their statutory and constitutional duties, and improvements in thehealth outcomes of their population. NHS England will therefore approachassurance from the assumption that CCGs will deliver against theserequirements. This will underpin the approach to assurance, and the agreedimprovement plan and support that is made available.
19. The information and metrics used as the basis for the assurance process will besubject to discussion between the CCG and NHS England. It will be important totake into account the variety of circumstances which may explain the reasons forvariation between CCGs.
20. The new assurance process introduces a more risk-based approach whichdifferentiates high performing CCGs, those whose performance gives cause forconcern, and those in between. It will provide a robust, supportive and structuredframework for those in more challenged circumstances, with a lighter touchapproach for the best performers. A continuous assurance approach will help toidentify emerging patterns of poor performance or any areas of potential risk, withless reliance on fixed points. The process will use information derived from avariety of sources including, where necessary, face-to-face visits. The nature ofthe oversight, including the expected frequency of assurance meetings, will beagreed between NHS England and individual CCGs, depending on theircircumstances, the range of risks identified, and on the leadership response.
21. We will work with CCGs to identify how peer review can be incorporated into thisprocess.
22. CCGs operating within a distressed health economy, in challengedcircumstances, or with performance issues, will have more frequent assessmentsincluding of those areas described above that will be continuously reviewed.
23. At the end of the year all information will be consolidated into a statutoryassurance report by NHS England.
24. For co-commissioning functions and for out-of-hours services, CCGs will berequired to prepare a quarterly self-certification of compliance against five keyareas: governance and the management of potential conflicts of interest,procurement, expiry of contracts, availability of services, and outcomes. Fordelegated arrangements and out-of-hours services, the self-certification will berequired to be signed off by the CCG governing body. For joint commissioningarrangements the self–certification will be signed off by the joint committee of the
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CCGs or of the CCG and NHS England. The process will reflect the flexibility of NHS England to respond differently in different circumstances.
25. A national moderation process will take place to provide confidence that theframework has been applied consistently across all CCGs, and that issues arebeing handled and escalated using the same approach.
26. At the end of the year all this information will be consolidated into a statutoryassurance report to be published by NHS England. CCGs will also be expectedto publish their individual assurance reports.
Key sources of information
National Insight
27. A number of sources of evidence will inform the assurance process. The newCCG scorecard, which is intended for publication as part of MyNHS, will providea clear, common information source, including indicators covering coreperformance standards, finance, digital maturity and quality and outcomes.
28. In addition to the scorecard, NHS England will consider other information on acontinuous basis to provide ongoing assurance that CCGs are delivering theirstatutory duties. This will include information on financial performance.Consideration will also be given to the adequacy of operational and longer termstrategic plans, including the Forward View, to respond to performancepressures.
29. NHS England will continue to conduct the nationally commissioned 360 degreestakeholder survey on an annual basis to enable CCGs to continue to improvequality and outcomes for patients, while building stronger relationships with theirstakeholders. The scope and content of the survey is shaped to track year-on-year progress.
30. The overarching principles of the survey will provide broad comparisons of therelative maturity of the relationships built with CCGs in England; provideassurance of continuing organisational development; provide triangulation ofevidence of stakeholder and partnership working across the health economythrough the assurance process, and provide value to NHS England and CCGs asa national insight tool.
31. CCGs will publish the results of their survey to share with their local healtheconomy to aid decision making and support public and patient engagement.NHS England is committed to publishing an overall summary of the results.
Local insight
32. ‘Areas for discussion’ will also be agreed based on performance against theareas of assurance. They can also be generated from the information whichCCGs produce and make available locally to patients and the public such asCCG board papers and the CCG constitution - including internal and external
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audits and financial and strategic plans. Each of these documents demonstrates CCG accountability and contains additional supporting information which provides insight into CCG governance.
33. Another key source of insight will be intelligence received from local partners andother organisations, such as the Care Quality Commission, the NHS TrustDevelopment Authority and Monitor reviews and reports, plus relevant local JointStrategic Needs Assessments, Joint Health and Wellbeing Strategies andinsights from quality surveillance groups. Local HealthWatch organisations alsoplay a crucial role in highlighting issues of local concern and opportunities forimproving services. In addition, CCGs can also demonstrate how they haveworked in partnership with neighbouring CCGs, including inviting a peerassessment of their ways of working.
34. This intelligence will also give insight into concerns about delivery and outcomes,and an opportunity to provide constructive challenge to ensure that CCGs aremeeting their statutory responsibilities. Key local partners, including localauthority and Health and Wellbeing Board members, will also be importantcontributors to the 360 degree stakeholder survey.
35. CCGs have a statutory duty to prepare an annual report for each financial yearon how they have discharged their functions. The annual report will be animportant source of local insight to inform the annual assessment of CCGs,particularly regarding compliance with statutory duties including the publication offinancial information. CCGs are therefore expected to include a section onstatutory compliance within their annual report, which makes a self-certificationabout continued delivery of statutory duties.
Outputs of assurance
36. NHS England will make a periodic assessment under each component of theassurance framework on the basis of the evidence presented. Theseassessments will take into account any information which NHS England hasreceived as a result of a request for further information or improvementtrajectories.
37. CCGs will be assessed as being in one of four assurance categories, which havebeen named to make them consistent with those used elsewhere in the NHS,such as the Care Quality Commission, and in other sectors, and to make themmore meaningful to patients and the public. The categories are:
assured as outstanding; assured as good; limited assurance, requires improvement; and, not assured.
38. Clear principles have been developed to underpin these assurance categories,providing consistent ‘rules’ to be followed by NHS England’s teams when makingassessments. They will be clear on the trigger points for each category, but willallow for judgements to be made on the basis of local intelligence. We willensure that CCGs are clear about the consequences of the different levels of
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assurance and the subsequent actions. A summary explanation of the categories is attached at annex A.
39. Where NHS England is fully assured by a CCG’s performance across all five ofthe individual areas, the assessment will be ‘assured as outstanding’. For CCGsthat are 'assured as outstanding', the ongoing assurance process will berelatively light touch. Provided key performance indicators are maintained, NHSEngland's support would only be at the request of the CCG.
40. Where there are minor concerns with the performance of the CCG, but overall theCCG is well led and demonstrates good organisational capability, or if a CCG hasa higher level of risk but it is managing it effectively, the headline assessment willbe ‘assured as good’. NHS England would expect these CCGs to produce theirown improvement plan, and to report to NHS England on their progress.However, support would be at the request of the CCG.
41. A CCG that has more serious performance or financial challenges and a highlevel of risk will be assessed as ‘limited assurance, requires improvement.’ TheseCCGs would be required to develop an improvement plan which will be approvedand monitored by NHS England. This plan would also include a clear indicationfrom NHS England as to the consequences at each step if the plan fails todeliver, and NHS England may take action to intervene if delivery is below plan atany point.
42. The improvement plan would also include the additional help and support theCCG should access to ensure delivery, for example support from well-performingCCGs in a ‘buddying’ arrangement.
43. In some circumstances, as laid out in s.14Z21 of the NHS Act 2006 (asamended), NHS England has the ability to exercise statutory powers of directionwhere it is satisfied that (a) a CCG is failing or (b) is at risk of failing to dischargeits functions.5 In these circumstances, the assessment should be that the CCG is‘not assured’.
44. For CCGs that are assessed as 'not assured', NHS England will conduct athorough assessment, working with the CCG, to identify the underlying causes.NHS England will then specify the remedial actions required in the improvementplan. Where a CCG is ‘not assured’ due to a lack of confidence in the leadershipof the CCG, NHS England will work with the CCG to identify how new leadershipcan be put in place. Where there is confidence in the leadership, NHS Englandwill define a prescriptive set of parameters within which the CCG will operate, andwill maintain direct oversight of the organisation until the 'not assured' status islifted.
45. NHS England could, of course, take action to intervene with a CCG which hasbeen assessed as being in any of the four assurance categories at any time,should an urgent problem arise, including issuing formal directions. However, it
5 NB: NHS England has additional specific powers of direction in relation to the Better Care Fund. S.223GA of the NHS Act 2006 (amended by the Care Act 2014) enables NHS England to direct a CCG as to the use of the designated amount for purposes relating to service integration or for making payment under s.256 of the 2006 Act, where a condition set under s.223G or s.223GA has not been met.
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is most likely to take such action in relation to those CCGs in the ‘limited assurance’ and ‘not assured’ categories.
46. Interventions will be tailored to the circumstances of the individual CCG, butcould include:
requirement to have plans signed off by NHS England; NHS England attendance at meetings and joint decision-making; placement of an improvement director into the CCG; direction over how a CCG conducts its functions; removal of functions to NHS England or another CCG; removal of the Accountable Officer; and, in extreme cases, dissolution of the CCG.
47. At the end of the year the outputs of the assurance process will be consolidatedinto a statutory assurance report to be published by NHS England. CCGs willalso be expected to publish their individual assurance reports.
Special Measures
48. Alongside the four assurance categories NHS England may apply a new specialmeasures regime designed to address persistent and chronic performancechallenges, financial challenges and / or governance difficulties due to the CCG’slack of capability and capacity to provide leadership to deliver sustainedimprovement. The application of special measures will usually result from issuesthat have persisted over a period of two quarters, unless action is requiredsooner, such as when financial problems are identified. It is most likely to beapplied to those CCGs in the ‘limited assurance’ and ‘not assured’ categories.
49. A CCG placed in special measures will be required to agree with NHS England,and to deliver, a sustainable improvement plan, with the assistance of a range ofintensive support options. This could include, for example, support from a well-performing CCG, which could act as a ‘buddy’ for the CCG in special measures.The CCG should have made significant progress in its recovery plan in amaximum of 12 months and, following a review, should exit special measures atthis point, if not sooner, even though there may be ongoing deliverables to beachieved as part of the improvement plan.
50. Not all CCGs with the same set of issues are likely to be in special measures, asthe trigger is the CCG’s grip of its situation. If the CCG has not clearly identified,and is not managing the risks arising from its challenges, a decision will be madeon whether special measures should be applied.
51. In exceptional circumstances NHS England may need to exercise its statutorypowers of direction immediately, without a CCG having previously been placed inspecial measures, or during the special measures process, if the CCG’s situationdeteriorates.
52. For any CCG that is in special measures or under direction, the self-certificationprocess for delegated functions will only be of limited reliance and therefore thedischarge of any delegated functions by the CCG in this category will be subject
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to continuous assurance. For these CCGs, NHS England will also consider reversing the delegation of functions.
53. The Forward View into Action: Planning for 2015/16 described how NHSEngland, Monitor and the NHS Trust Development Authority will, together,develop a new success regime to support challenged local health economies.NHS England is working with Monitor and the NHS Trust Development Authorityto ensure this regime is complementary with ‘special measures’.
Governance of the CCG assurance process
54. NHS England’s Commissioning Committee will oversee this assurance on behalfof the Board. The Committee will need to be assured that the process for CCGassurance is robust, fair and consistent, and will receive the annual report for2015/16 at the end of the year. This report will outline headline assurance ratingsfor all CCGs and any areas of interest or concern.
55. The Committee will be underpinned by management’s CCG Assurance OversightGroup. This group will undertake an active role in the assurance processthroughout the year, taking responsibility for:
operational oversight of the assurance process, ensuring that it is robustlyand consistently delivered;
approving any changes to the status of any CCG including interventions,taking powers of direction, lifting existing conditions and placing a CCGinto special measures; and,
identifying emerging risks or issues.
Summary
56. In summary, the process is:
tough on the facts: key sources of information for assurance will bethoroughly scrutinised;
open-minded on reasons for performance: as a consequence of thedifferent challenges CCGs face; and,
clear on the consequences for CCGs.
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Annex: Assurance Categories
Assured as outstanding
Assured as good
Limited assurance, requires improvement
Not assured
Explanation of assurance category
CCG can demonstrate that it is continuing to perform well across the five components of assurance. It may have some identified challenges but is proactively managing them.
There are minor concerns with the performance of the CCG, but overall the CCG is well led and in good organisational health, or if a CCG has a higher level of risk but it is managing it effectively.
CCG has serious / persistent / chronic performance or finance challenges and it may not demonstrate the capability or capacity to manage the associated risks to make sustained improvement on its own.
NHS England is satisfied that a CCG is failing or is at risk of failing to discharge its functions
Support level None Some support may be required for specific issues
Extensive, from a range of provider options
Formal direction by NHS England
Number / level of issues and unmitigated risks
LOW MEDIUM HIGH VERY HIGH
Action plan – time to recover
None 3-6 months Up to 12 months
As appropriate
Funding for support and ownership of improvement
n/a CCG CCG CCG / NHS England
Working Together – Annual Report Insert
April 2015
Towards the end of 2013, as CCGs approached the end of their first year of establishment, we agreed a significant commissioner led programme of work to review and re-design a number of services across a wider geography served by eight CCGs. This was our commissioner “Working Together” programme which worked with our hospitals own “Working Together” programme, covering the same geographical area. The two programmes are closely aligned and represent the South Yorkshire, North Derbyshire and Wakefield Health systems working closely to improve services and increase the effectiveness of every pound we spend on Healthcare.
Our work across our four initial agreed areas, children’s services, cardiovascular, smaller surgical and medical specialties and urgent and emergency care has been in partnership with our hospitals and our clinicians and made good progress. We are, in a unique position to build on our collaboration so far to make the changes required of the National Health Service that are set out in the Five Year Forward View with the support of our clinicians and our patients. This programme is a major commitment for all our CCGs but one that is necessary to realise the significant changes that will deliver both improved outcomes and respond to the national requirement to find £30 billion of efficiencies in the way we deliver healthcare.
The scope of the Working Together collaboration extends and includes eight Clinical Commissioning Groups and NHS England, covering a population of approximately 2.3 million.
The establishment of the Working Together Programme took place at a time when the NHS had recently undergone a period of fundamental change and Clinical Commissioning Groups (CCGs) and NHS England (NHSE) were relatively new organisations. It was also at a time when there was an increased emphasis on the need to improve quality and outcomes of care and when we are seeing rising demand for services, due to an ageing population, an increasing burden of chronic diseases and increasing patient expectations and a requirement to fundamentally review how we commission and deliver services to improve quality and deliver efficiency.
In this first phase of commissioners working together, the focus has been on a small number of services areas. In these areas there was agreement from all commissioners that these would benefit from collective action and by working together we could make a demonstrable difference to improve the quality and efficiency of these services.
Appendix 3
The priorities in phase one have been children’s services, cardiovascular, smaller surgical and medical specialties and urgent and emergency care this work has been progressed in partnership with our hospitals, clinicians and managers and key stakeholders.
Good progress has been made and as a result of our work in phase one we have been able to make changes to services which will have a direct impact on the quality and experience of patient care. In 2015/16 a new model of service for patients who have had a particular type of heart attack will be implemented. In addition, we have been able to develop a detailed understanding of the challenges facing some of our specialist services, for example hyper acute stroke and children’s surgery to inform our case for change in these areas to improve the quality of care.
We have established a programme office and approach and have been able to test a range of methodologies to help guide our working. Through clinical workshops and stakeholder events we have engaged with key stakeholders in these service areas and wider.
In October 2014 our programme was reviewed by the Department of Health Gateway Team. The review provided some significant insights which have guided a number of changes to the programme and approach. In addition there has been significant learning from our initial work, which we constantly reviewing and applying.
The publication of the Five Year Forward View has reinforced the confidence we stated in 2013/14. We are on track and one of the approaches will enable us to deliver the significant change outlined in the Forward View, particularly across a wider geographical footprint and where pathways of care cross both provider and commissioner boundaries. In addition the Dalton Review has offered new opportunities for providers and the approaches in the two programmes align well to those advocated in these two key documents.
Phase two of the Working Together programme will continue to deliver on the commitments started in phase one, including improving the provision of children’s services and stroke services. There is also a commitment to increase the ambition of the programme and this will be underpinned with a strategic review across the Working Together footprint. In addition we will be working with the King’s Fund to develop our thinking and ambitions for new models of care and the opportunities of taking a collaborative approach to commissioning.
1ROTHERHAM MOVING FORWARD TOGETHER
A new service co-ordinator is ensuring people a� ected by child sexual exploitation get the right help and support.
Jo Smith, Chief Executive of Rush House, has been seconded to the new role with Rotherham Borough Council and is responsible for the co-ordination
of agencies involved in supporting individuals and families wishing to access services.
Jo is also working closely with the NSPCC which provides Rotherham’s Sexual Exploitation Helpline – set up in December as single point of support (more information below).
The new role is part of a package of support which has been put in place to help people across the borough.
Jo said: “Where a person has su� ered abuse they can get help in a number of ways. They may choose to phone helpline sta� initially, who would provide a listening ear and discuss their worries or concerns.
“After talking things through, if the individual felt they may like further support they would be referred to me and I will work closely with them to identify their needs, talk through the range of options open to them, identify what support they may require and organise the � rst contact with the support service for them.
“Alternatively, they may wish to access the services directly. We are aiming to meet their speci� c needs and recognise that we cannot take a ‘one size � ts all’ approach.
“I would also like to hear from people who have been a� ected by child sexual exploitation to ensure that we can shape future services to meet their needs.”
A range of local organisations are providing support including Rotherham Women’s Counselling Service and Pit Stop for Men (RWCS), GROW, the Sexual Assault Referral Centre (SARC), Victim Support, Rotherham Women’s Refuge (RWR) and Youth Start.
ROTHERHAM:MOVING FORWARD TOGETHER
Victims and survivors of sexual exploitation in Rotherham can seek support following the launch of a con� dential helpline.
The 24-hour support service is a single point of contact for people who have su� ered abuse in the past, or those who may be being exploited now.
The Rotherham sexual exploitation
helpline is being run by national charity, the NSPCC, on behalf of Rotherham Borough Council, and provides support to people of all ages.
David McWilliams, Rotherham Council’s Interim Director for Commissioning & Performance, said: “It takes an incredible amount of courage for someone who has su� ered abuse to take that � rst step and seek help.“
“In talking to groups and organisations we know how important it is that when people feel the time is right for them to ask for support, it is crucial that we make sure help is as easy to � nd as possible.“
“This con� dential helpline provides a single point of contact for people of all ages who want to speak to someone about their experiences, and seek further help and support.”
The helpline forms part of the council’s strategic response to provide more support for victims and survivors of sexual exploitation.
The con� dential helpline and email address is sta� ed 24 hours-a-day, seven days a week. It can be accessed as below:
0800 [email protected]
For more information and contact details visit:
www.rotherhamstandingtogether.org.uk/help
*Please see page four for furtherinformation about local support.
HELPLINE LAUNCHED FOR SEXUAL EXPLOITATION
NEW LEAD TO CO-ORDINATE SUPPORT FOR VICTIMS AND SURVIVORS
MOVING FORWARD TOGETHER
ISSUE 1Appendix 4
2 3ROTHERHAM MOVING FORWARD TOGETHER ROTHERHAM MOVING FORWARD TOGETHER
ROTHERHAM STANDS TOGETHER
Organisations across the borough are pledging to stand together to keep Rotherham’s children safe.
Over 80 businesses, voluntary groups and public bodies have so far made a commitment to back the Rotherham Standing Together against Child Sexual Exploitation campaign.
Community representatives stood side-by-side at the o� cial launch of the pledge in November 2014 – demonstrating a public commitment to understand the signs of child sexual exploitation, and to act as the ‘eyes and ears’ of the community.
Speaking following the launch Andrew Denni� of the Chamber of Commerce said:
“It has been a very di� cult few months for our town. Now is the time for us to move forward together to ensure that what has happened can never be repeated, demonstrating the strength of our community and our determination to keep Rotherham’s children safe.”
Voluntary Action Rotherham’s Sha� q Hussain added:
“In Rotherham we must continue to be vigilant, and together, we all have a responsibility to protect our young people from such harm.”
By joining the campaign organisations will:
• Take a stand against child sexual exploitation
• Show public support for the pledge by displaying the pledge sticker, including details of how anyone can report concerns
• Make sure sta� or volunteers understand how child sexual exploitation can happen - and know how to report it.
Individuals are also invited to sign the pledge to take a personal stand, as part of the next phase of the campaign.
For more information and resources visit rotherhamstandingtogether.org.uk
TO KEEP CHILDREN SAFE
INITIATIVE SET UP TO TACKLE CHILD SEXUAL EXPLOITATION IN HOTELS PROVES SUCCESSFULSta� at 14 Rotherham hotels have been trained to spot the signs of child sexual exploitation as part of a South Yorkshire Police initiative
The project, Operation Makesafe, involves police working with sta� at hotels to encourage vigilance to this type of crime.
O� cers have trained sta� members to help them identify the warning signs of exploitation, how to spot potential perpetrators and victims and how to report suspicions to police.
Sta� at 60 hotels across the county have now been trained.
To date, 21 incidents have been reported to police and these have led to six arrests and several young people being removed from harm.
The National Working Group has highlighted the operation as good practice and it is now part of their national campaign in tackling child sexual exploitation.
MOVING ROTHERHAM COUNCIL FORWARD Rotherham Borough Council is now managed by a team of � ve Commissioners, appointed by the Government in February 2015 after the Jay and Casey reports highlighted serious failings across the authority.
They have been appointed for a period of up to four years and could be in charge of the council until March 2019. Government intervention on this level is unprecedented in England, and it has had a signi� cant impact on the democratic process.
In summary the Commissioners’ remit includes all Executive functions of the council. This means there is no longer a decision-making Cabinet. The Commissioners make all key decisions about what services are provided, how these are delivered and how the council’s budget is spent. They are also in charge of the licensing function.
The Commissioners are:
• Sir Derek Myers Lead Commissioner
• Commissioner Stella Manzie CBEManaging Director Commissioner
• Commissioner Malcolm Newsam Children’s Social Care Commissioner
• Commissioner Mary Ney and Commissioner Julie Kenny CBEsupporting Commissioners
For more information about their individual roles, and how they will work to deliver services to local people visit the website at www.rotherham.gov.uk/commissioners
A countywide campaign to raise awareness of child sexual exploitation has received positive feedback from the public.
The ‘Spot the Signs’ campaign, a partnership between South Yorkshire Police, all four local councils, Crimestoppers, the National Working Group (NWG) and the Crown Prosecution Service (CPS), was launched in November last year.
The campaign includes a series of posters with 14 di� erent signs that a young person is a victim of sexual exploitation. These are currently displayed in prominent public locations including on buses, in shopping centres and doctor’s surgeries.
There is also an online marketing campaign to help raise awareness of young people and how they can report any concerns and where they can get help and advice. Follow the campaign on Twitter using #spotthesigns and #saysomething.
This has received positive feedback on social media and has generated to several online discussions, which is helping to increase awareness of the subject.
Assistant Chief Constable Ingrid Lee said: “This campaign is just one of a number of ways we are working to increase awareness of this shocking crime, its tell-tale signs and where people can go to get help if they have concerns.”
TITLE GOES HERE
The campaign includes a series of posters with 14 di� erent signs that a young person is a victim of sexual exploitation. These are currently displayed in prominent public locations including on buses, in shopping
There is also an online marketing campaign to help raise awareness of young people and how they can report any concerns and where
Follow the campaign on Twitter
has generated to several online discussions, which is helping to
For more information about the campaign visit southyorks.police.uk/spotthesigns
SPOT THE SIGNS CAMPAIGN RAISES AWARENESS ACROSS THE COUNTY
SYFR STAFF RECEIVE EXPLOITATION TRAINING
South Yorkshire Fire & Rescue has extensive safeguarding processes, policies and procedures in place, all of which were reviewed and updated in 2014.
Key frontline sta� have recently received updated child sexual exploitation training, with an emphasis on national and local issues and case studies. We are additionally training our business inspection sta� to raise awareness of
speci� c risks in industries such as hotels and hospitality.
We recognise we play a supporting role to partners, which have more regular interaction with child protection issues. We take our responsibilities in this respect seriously and stand ready to provide appropriate assistance to improve child sexual exploitation outcomes throughout South Yorkshire.
EXTRA INVESTMENT TO SUPPORT VICTIMS An extra £800,000 will be invested in council services to support victims and survivors of child sexual exploitation, and to protect those at risk of harm.
In this year’s budget, spending on Rotherham Council’s Children’s Safeguarding budget will be ring-fenced and an additional £824,000 will be allocated to:
£234,000 for the development of outreach youth work based provision to engage with young people at risk of child sexual exploitation
£390,000 for additional social workers to make sure children at risk are seen by Children’s Services as quickly as possible
£200,000 additional support for child sexual exploitation victims and survivors
4 ROTHERHAM MOVING FORWARD TOGETHER
The health community in Rotherham has made it a top priority to ensure that victims have post abuse support services they need.
In early 2014, NHS Rotherham Clinical Commissioning Group (CCG) recognised a need to enhance health support services for victims and have invested in improving access throughout the last year. In addition, since the Alexis Jay report was published NHS organisations, including the CCG, Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH) and the Rotherham NHS Foundation Trust (TRFT), have spent a
lot of time increasing awareness of child sexual exploitation (CSE), identifying potential victims of abuse and ensuring the appropriate support services they need are available when they need them.
TRAINING FOR FRONTLINE STAFF
People’s � rst contact with health in Rotherham is normally their local GP, therefore a priority has been to train over 650 GP practice sta� in recognising signs of sexual exploitation.
At TRFT, ‘Stop the Shift’ child sexual exploitation sessions have taken place with frontline sta� and to date 495 colleagues have taken part. This resource was also distributed to all areas in order for all sta� to have access to the presentation. Additionally the trust has provided training to 36 senior managers from the child sexual exploitation specialist nurse and safeguarding team.
At RDaSH, all sta� have received level one awareness training after the named nurses developed a bulletin in relation to child sexual exploitation. The bulletin is on the safeguarding webpage, which is available to all sta� who work across the trust.
INCREASING ACCESS TO SERVICES
The CCG has worked closely with RDaSH, to improve Child and Adolescent Mental Health Services, employing another consultant to increase clinical leadership for child sexual exploitation cases and increasing opportunities for victims to access help. The capacity of our talking therapy services for children and adults has increased, concentrating on supporting new and existing child sexual exploitation victims.
UPDATE FROM THE NHS IN ROTHERHAM
South Yorkshire Police has investigated and continues to investigate a large number of child sexual exploitation-related crimes.
In Rotherham, between April 2014 and February 2015 there have been 68 reported crimes with a child sexual exploitation link.
Of those, a number of crimes are alleged to have been committed outside prior to April 2014.
This shows victims have the con� dence to come forward and report what happened to them to police, regardless of how long ago o� ences took place, knowing they will be treated sensitively and we will investigate thoroughly.
During that period there were 14 people prosecuted in connection with child sexual exploitation o� ences in Rotherham. Eleven people were charged and one was summoned to
court and are at various stages of the criminal justice process. Two people received a caution.
As at the end of February, specialist o� cers were investigating 46 child sexual exploitation-related crimes in Rotherham. Further prosecutions are anticipated.
Investigations of this nature can take many months to complete particularly when the o� ences occurred a long time ago.
A team of 32 dedicated o� cers are also investigating non-recent reports of child sexual exploitation. They are dealing with a number of investigations some of which are large scale and involve a large number of potential victims and potential o� enders.
Arrests have been made in connection with these investigations.
SYP CONTINUES TO INVESTIGATE A LARGE NUMBER OF OFFENCES
TO SUBMIT CONTENT FOR FUTURE NEWSLETTERS CONTACT JOANNE WRIGHT ON [email protected]
NCA TWO-STAGE INVESTIGATION UNDERWAY O� cers from the National Crime Agency (NCA) are now operating in South Yorkshire to deliver the � rst stage of an independent investigation into non-familial child sexual exploitation in Rotherham.
The investigation, called Operation Stovewood, is being conducted at the request of South Yorkshire Police and follows publication of the Alexis Jay Report.
The NCA has appointed Steve Baldwin, former NCA Head of Investigations for Northern England, as Senior Investigating O� cer (SIO).
He will directly manage o� cers and sta� on the investigation and report to the o� cer in overall command, NCA Director Trevor Pearce.
The NCA is currently establishing a major incident room, having been given management and control of secure accommodation in a South Yorkshire Police building.
The operation has two initial stages.
The � rst stage will identify and examine relevant material held by South Yorkshire Police and other bodies in order to scope the nature, scale and requirements of the investigation.
NCA o� cers will also oversee a review of all current relevant investigations being carried out by South Yorkshire Police into non-familial child sexual exploitation in Rotherham.
A summary of Operation Stovewood’s Terms of Reference are published on the NCA’s website nationalcrimeagency.gov.uk
Foundation Trust (TRFT), have spent a
TRAINING FOR FRONTLINE STAFF
People’s � rst contact with health in Rotherham is normally their local GP, therefore a priority has been to train over 650 GP practice sta� in recognising signs of sexual exploitation.
appointed Steve Baldwin, former
manage o� cers and sta�
Welcome to the Healthwatch Rotherham Newsletter March/April 2015
Successes This Month
Work with RDASH CAMHS:
Healthwatch Rotherham now has a single point of contact for RDASH CAMHS for all
current issues raised to us.
Bi-monthly meetings arranged between Healthwatch Rotherham and the Assistant Director of RDASH CAMHS to keep an open dialogue.
Healthwatch Rotherham to facilitate a meeting for parents and young people who have expressed concern with RDASH CAMHS.
Training to be arranged for RDASH CAMHS Rotherham staff on the complaints procedure and how Healthwatch Rotherham works. This training will include a talk from a service user sharing their experience. th Young Healthwatch are now attending the RDASH CAMHS Strategy and Partnership meeting. This is enabling the voices of young people to be heard.
Other Successes include:
Rotherham Hospital has now recruited Learning Disability Champions. All the
champions have had training and there are now resource packs and
communication tools in place. The Hospital has also created a new Learning
Disability Lead Nurse, who will be the main point of contact for people with
learning disabilities and their families as well as keeping in contact with the
champions.
Following a complaint raised with The Rotherham NHS Foundation Trust a positive
outcome has been achieved. The person who made the complaint has volunteered
at the Hospital requests to attend training sessions to share their own experiences
to staff within the Trust.
The hospital have introduced new bed boards which make dietary requirements
much clearer and which should be updated every day by the nurse in charge of
patient.
Appendix 5
33 High Street, Rotherham, S60 1PT [email protected]
01709 717130 www.healthwatchrotherham.org.uk
From The CEO
Naveen has had some
health problems, so is
taking a rest. Naveen
is recovering well, so
hopefully it will not be
too long before we see
him again. Many
thanks to Gary Kent
who has stepped into
the role.
I am pleased to hear that Rebecca Parkin our (Healthwatch Young Ambassador) has been nominated in the National Diversity Awards Celebrating Unity in Society. Well done Rebecca.
Tony
01709 71 71 30
@hwrotherham
www.facebook.com/hwrotherham
www.healthwatchrotherham.org.uk
Working with CQC
Healthwatch Rotherham have provided the CQC with a lot of information in the past
few months, as the CQC have performed a number of inspections in the area:
Yorkshire Ambulance Trust Rotherham NHS Foundation Trust Review of safeguarding children and services for looked after children in Rotherham Rotherham GP services
We have heard that the CQC will be
including at least one of the Healthwatch
Rotherham recommendations from our
CAMHS report published last year into their
report into the review of safeguarding
children and services for looked after
children in Rotherham. Watch this space.
Rotherham Young Healthwatch
So far 60 members have signed up to become members of Rotherham Young Healthwatch. A Special mention must go to Healthwatch Rotherham’s first Youth Ambassador, Rebecca Parkin. Rebecca has managed so far to sign up all 60 members.
The Young Healthwatch team will be also
working with the National Children’s Bureau
on the work around the NHS Constitution for
young people. This work will be taking place
within schools and youth centres across
Rotherham. 3 Healthwatch volunteers went
on training provided by the National
Children’s Bureau and are now ready to roll
out the programme. The first workshop will
be held at Wales High School.
Rotherham Young Healthwatch was
represented at NHS Youth Forum. The Forum
works with NHS England, Department of
Health and Public Health England to improve
healthcare for young people.
News in Brief
A debate on child and adolescent mental health services (CAMHS) was held on Tuesday 3rd March in the House of Commons.
Healthwatch Rotherham provided all 3 local MPs with a briefing prior to the debate to assist them.
Support has been given to a new organisation called Ebb & Flow. The aim of Ebb & Flow is to support families to maintain family life and parenting following the diagnosis of a serious or life limiting illness. www.ebbflow.org for more details.