AGENDA
Black Country Alliance Programme Board, Public Agenda
Venue
Meeting Suite A, 3rd Floor MLCC, Walsall Healthcare
Date
12th October, 10:30 – 11:30
Chair for this Meeting – Jenni Ord
Members Attending
Danielle Oum
DO
WHC Chair
Jenni Ord
Richard Samuda
JO
RS
DGFT Chair
SWBH Chair
Richard Kirby
Paul Harrison
RK
PH
Toby Lewis
Apologies:
Kam Dhami
TL
WHC Chief Exec
DGFT Interim
Chief Exec
SWBH Chief Exec
KD
Governance Lead
Time
10:30
10:35
10:45
10:50
11:00
11:10
11:20
11:30
Item
1
2
3
In Attendance
Terry Whalley
Jayne Ilic
Daren
Fradgley
Secretriat
Sue Astley
TW
JI
DF
Black Country Alliance
Programme Director
Comms Lead
Stroke Exec Lead
SA
EA to Terry Whalley
Title
Enc
Action
Lead
Introductions / Check In
Verbal Chair
Apologies
Verbal Note
SA
Accept minutes of meeting held 31st July Enc 1
Note
Chair
(previously reviewed 31/8 but brought back
for the record)
4
Review Actions Due
Enc 2
Review
SA
5
Chair’s Business
Verbal Discuss
Chair
Matters for Discussion
6
Stroke
Enc 3* Note
DF
7
BCA Comms & Engagement Report
Enc 4
Note
JI
8
CRG Chair’s Report
Enc 5
Note
PH
9
Programme Director’s Update
Enc 6
Note
TW
10
Interventional Radiology
Enc 7
Endorse
TW
11
Back Office Phase 1
Enc 8
Discuss
TW
Estates & Facilities
Enc 8a
R&D Governance
Enc 8b
Legal Services
Enc 8c
Occupational Health
Enc 8d
Wrap Up & Close
12
Reflections on the meeting
Verbal Discuss
Chair
13
Any other business
Verbal Discuss
Chair
Details of next meeting:
Date – 9th November, 10:30 – 11:30
Venue – Ground Floor Committee Room, Management Block, Sandwell General
Chair – Danielle Oum
* Paper to follow
161012 BCA Public Board Agenda
ENC 1
MINUTES OF THE BLACK COUNTRY ALLIANCE PUBLIC BOARD MEETING
HELD AT 10:30AM ON WEDNESDAY 13TH JULY 2016
IN MEETING SUITE A, 3RD FLOOR, MLCC, WALSALL HEALTHCARE
Present:
Mrs J Ord (JO)
Mr R Kirby (RK)
Mrs D Oum (DO)
Mrs O Dutton (OD)
DGFT Chair
WHC CEO
WHC Chair
SWBH Vice-Chair
In Attendance
Mr T Whalley (TW)
Mrs K Dhami (KD)
Mrs J Ilic (JI)
Mrs A Baines (AB)
Mr M Sinclair (MS)
Mrs R Barlow (RB)
Miss S Astley (SA)
Black Country Alliance Programme Director
Governance Lead
Comms Lead
Director of Strategy
HRD WHC
Chief Operating Officer, SWBH
Minute Taker & EA to Mr T Whalley
Apologies:
Dr P Harrison (PH)
Ms P Clark (PC)
Mr T Lewis (TL)
Mr S Samuda (RS)
CRG Chair
DGFT CEO
SWBH CEO
SWBH Chair
BCA/16/73 INTRODUCTIONS / CHECK IN
ACTION
Mrs Ord welcomed members to the meeting, and welcomed Mrs Dutton,
vice-chair SWBH to the meeting.
There were no members of the public who attended the public session.
BCA/16/74 APOLOGIES
Apologies were noted from Dr P Harrison, Ms P Clark, Mr T Lewis and Mr
R Samuda. Mrs A Baines was in attendance for Ms Clark, and Mrs K
Dhami for Mr Lewis and Mrs Dutton for Mr Samuda.
It was confirmed that the meeting was quorate.
BCA/16/75 MINUTES OF LAST MEETING – 8TH JUNE 2016
The minutes of the public meeting held on the 8th June 2016 were
recorded as a true reflection of the meeting.
BCA/16/76 REVIEW ACTIONS DUE
The Board noted the actions log.
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BCA/16/77 CHAIRS BUSINESS
Chair noted item 9 (Histopathology) would be taken in the private
agenda.
There were no further items for discussion from the Chair of the
meeting.
BCA/16/78 PROGRAMME DIRECTOR’S UPDATE
Mr Whalley asked the BCA Board to note the Programme Director’s
report.
Rheumatology – the project continues to make progress, with 3 of the 4
advertised consultant posts now appointed to. A great example of the
BCA being able to attract interest and fill previously hard-to-fill posts. The
project remains on track for 3rd October provider led service launch.
Haemoglobinopathy – making good progress linking into broader West
Midlands Haemoglobinopathy Network for adults, this will enable
existing links between Walsall and Wolverhampton service to continue
but offer the opportunity to also link into SWBH as the main specialist
Haemoglobinopathy centre with Wolverhampton becoming accredited
local centre.
Procurement – Mr Whalley reported that Mr Dave Coley has been
appointed as joint BCA Director of Procurement and is expected to
commence his role in October. The first Clinical Procurement Group
meeting has taken place which was well attended with lots of
enthusiasm; work will be done over the Summer to prepare the terms of
reference and ways of working ahead of Mr Coley taking up his post. Mr
Whalley will request the Mr Coley to attend a couple of sessions, in
particular the Procurement Steering group, prior to his commencement.
Mr Kirby asked that Mr Coley attend a future BCA Board to discuss his
initial plans and thoughts.
ACTION:
 Mr Whalley to invite Mr Coley to BCA Board before end of TW
calendar year.
Atrial Fibrillation – Mr Whalley reported the context for bringing forward
a draft mandate for Atrial Fibrillation was recent conversations held with
the West Midlands Academic Health Science Network (WMAHSN) who
are nationally taking forward work on this topic and have access to
interested organisations with potential investment to take this forward.
At the same time there is an intention among the BCA R&D Steering
group to prioritise collaboration around cardiology. Finally there is
enthusiasm amongst cardiologists at SWBH to take forward work to
manage AF better together. They were keen to determine appetite to
ENC 1 160713 BCA Public Board Mins
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look at atrial fibrillation as a BCA collaboration.
Mrs Baines reported that she and Ms Clark have discussed this proposal.
Mrs Baines expressed some concern that the first time this opportunity
had been raised was in the Programme Director’s report. This makes it a
little difficult to determine the level of clinical and operational support
for the proposal, and therefore less straightforward to endorse.
Mr Kirby expressed a similar concern, although noted previous BCA
Board statement that there should be no gateways for matters on the
way to BCA Board, leading to a potential difficulty balancing pace &
perfection. Mr Kirby felt that the suggestion to invest a little time
exploring merit of the project seemed sensible, but was reluctant to
commit beyond that until some further 3 way dialog had taken place. Mr
Kirby commented that the Clinical Reference Group should be involved
with this. Mr Kirby also stated the next version of the draft mandate
should be a jointly written mandate to ensure it was more balanced and
inclusive.
Mrs Ord commented it was unclear as to whom the author is, and that it
felt the paper was a little rushed, coming to BCA Board perhaps a little
too early and without due consideration by others on the way.
Mrs Ord suggested we might slow down matters whilst appropriate
colleagues are being consulted, views need to be sufficiently understood
at that level so that when proposals are brought to BCA Board, Board
members know they have been discussed and what the
recommendations are. Mrs Ord commented that it was not clear what
the next steps were or what the timeline was, or whether the WMAHSN
were talking to others about this. Mr Whalley acknowledged this was not
clear, but that this was an early proposal to get direction from BCA Board
members as to whether there was interest enough to commit a little
time from the right people to take forward examination of merit.
Mr Whalley reminded Board Members that previously the BCA Board had
confirmed the governance model had no formal gateways, with a desire
to see more pace progressing matters. Mrs Baines commented that some
engagement with colleagues would be helpful even if there were no
formal governance requirement.
Members of the BCA Board all agreed the topic had merit on the face of
it, Mrs Ord commented this now needs appropriate conversation with
respective Trust cardiologists to explore merit. A revised Mandate should
then be taken to the Clinical Reference Group before coming back to BCA
Board in due course.
ACTION:
ENC 1 160713 BCA Public Board Mins
3
 Mr Whalley to form small team to produce next version of Project TW
AF Mandate, take to Clinical Reference Group and then bring back to
BCA Board.
Project ECHO – Mr Whalley reported that the ‘Extension of Community
Health Outcomes’ (ECHO) is an internationally renowned social
movement that uses video conferencing and learning management
platforms that enable specialist knowledge information to be made
available on a broader scale. There is an opportunity for BCA to be one of
10 early adopter hubs in England, and NHSE and our own CCIOs appear
to be keen to explore.
Mr Whalley reported there could be an opportunity to explore merits of
this in connection with AF work, through rheumatology or through the
work Neurologists are doing on complex headache services. Mr Whalley
said this could enable and support place based vertical collaboration as
well as horizontal provider collaboration.
Mr Kirby commented this appeared to be a really interesting opportunity
and that this was something he felt the BCA Board should ask people to
explore.
Mrs Ord commented this might have connection to primary care, and
stated it is a good idea to see what that audience feel about it before
embarking on any formal introduction of this process. Mrs Ord stated she
would feel uncomfortable about this being explored in isolation and
whoever takes it forward needs to reflect views of all 3 trusts. Mrs Ord
asked where this would fit with local digital roadmaps recently produced,
what funding we would require and how this could move forward.
Mr Whalley said Peter Davies CCIO at SWBH is happy to be lead on this
and write the mandate which would start to answer some of these
questions; Mr Davies has been an advocate to date and requested Mr
Whalley bring it to BCA Board. Mr Kirby said Mr Whalley would need to
ask Mr Davies to connect with colleagues in DGFT and Walsall so it is a 3
way proposition.
Board Members agreed to see this taken forward with a further proposal
being brought back in due course.
Mr Whalley reported that the WMAHSN had offered to reduce rates of
enhanced membership for BCA Trusts. The BCA are looking to trial use of
the Meridian portal, which may offer colleagues across the BCA
opportunity to connect and share innovations and link with commercial
and other stakeholders who may have solutions to some of the problems
we’re facing. Certain features of Meridian, the ability to create
campaigns for example, are only available to enhanced members.
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Mr Kirby said the Walsall view had been that they wouldn’t get enough
out of enhanced membership at this time; therefore they would not
want to sign up this year, although if the opportunity to get something of
value together was real this could change Walsall’s view. Mrs Baines said
DGFT views are the same as Walsall.
Mr Whalley said he would go back to the WMAHSN and see if they will
allow access to create campaigns to see how they would work as part of
a process of considering both the portal and the question of enhanced
membership.
ACTIONS:
 Mr Whalley to speak to WMAHSN about trialling Meridian TW
Campaigns feature and report back to BCA Board in October.
Interventional Radiology – Mrs Baines reported IR was proceeding well,
gastroenterologists have been asked about extending procedures under
the pilot. Mrs Baines reported issues around supporting project
management are still unresolved but they are in a better place than they
were. Mrs Baines will within the next 2 months come back to BCA Board
with a review of the pilot and assessment of options to continue, extend,
make enduring or stop.
ACTIONS:
 Mrs Baines to bring back IR paper in August / September with review AB
of pilot and options / proposals for next steps.
The BCA Board noted the report, asked for further work to be done on AF
Mandate before this could be endorsed, declined to take forward
enhanced membership of WMAHSN at this time and endorsed further
consideration of ECHO.
BCA/16/79 BCA COMMS AND ENGAGEMENT REPORT
Mrs Ilic presented the Comms and Engagement Report.
Mrs Ilic highlighted the BCA anniversary and said events were scheduled
to take place with the Chairs of each Trust attending an information
session with invited employees, an update will be provided at the next
BCA Board meeting. An update on the stakeholder reference group event
which has now been scheduled in September will be provided in the
Autumn.
Media opportunities are also being progressed with the regional, local
and trade media to highlight some of the tangible examples of the work
of the Black Country Alliance. In particular, interventional radiology,
rheumatology, some of the progress on back office services and potential
ENC 1 160713 BCA Public Board Mins
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future opportunities such as green light laser procedures. Mrs Ilic advised
they have had interest from Midlands Today on radiology and green light
laser. Mrs Wilkins from SWBH is the lead for media interest - Mrs Ilic to
request Mrs Wilkins ensure Board members are kept updated.
Mrs Ord requested dates of the stakeholder reference group – Mrs Ilic to
provide.
The Board noted the paper.
ACTIONS:
 Mrs Ilic to provide dates of stakeholder reference group
JI
BCA/16/80 CRG CHAIR’S REPORT
Mr Whalley presented the CRG Chairs report on behalf of Dr Harrison. Mr
Whalley commented that Dr Harrison was expecting to be able to attend
future BCA Boards; this being the last date where pre-existing
commitments could not be moved.
Resolution:
Board noted the report with no questions arising from it.
BCA/16/82 UROLOGY
Mr Whalley presented the Urology Report.
Mr Whalley advised the Urology Steering Group have met several times,
the group consists of clinical and operational leads from the three Trusts.
The group have drafted a detailed sub-specialist map which identified a
small number of areas that appear to an area of strength in each Trust
and that could be better used across the BCA; green light laser being one
example. Mr Whalley stated the green light laser at SWBH is a preferred
treatment method for certain prostate conditions, therefore providing an
opportunity to make more use of it for patients at Dudley and Walsall.
Mr Whalley referred to other examples such as penile implant and
reconstruction at DGFT, Infertility and Embryology at Walsall. Mr Whalley
said the group have started to define the proposed pathway changes
required to maximise these strengths and that those changes will be
considered through a CRG quality impact assessment and that each Trust
will consider their own governance arrangements before any pathway
changes are signed off.
Mrs Ord commented it was not only about impact on patients with
journey and travel costs, but also our operational impact in terms of
meeting performance metrics and not putting unnecessary strain on the
system. Mrs Baines said the Urology group need look at feasibility of
changes that may need to be put in place, ensuring volumes can be
catered for in receiving trust, that RTT performance is not impacted and
ENC 1 160713 BCA Public Board Mins
6
that detailed standard operating procedures are defined.
Mr Whalley stated the group are defining volumes and capacity in the
pathway proposals, together with considerations around money flow etc.
this will be done before pathways are changed.
Mrs Baines asked about the link between Wolverhampton and DGFT –
Mr Whalley said the steering group clinical leads are having
conversations with colleagues at Wolverhampton around their potential
involvement.
Mrs Oum stated this was a really welcome paper, being exactly the kind
of opportunity the BCA should be taking forward. Mrs Oum asked if this
will this go through some sort of challenge process. Mr Whalley stated
the CRG will do quality impact assessment so they are assured it clinically
makes sense, thereafter the clinical lead and operational lead from each
Trust will ensure governance is in place.
Mr Kirby asked that it our thanks be noted to those doing the work, it
was great to see tangible and specific examples of collaboration coming
forward and the teams should be encouraged to keep going.
The BCA Board noted the report and endorsed the direction of travel.
BCA/16/84 HR UPDATE
Mr Sinclair presented the HR update report.
Mr Sinclair stated the three ESR leads meet monthly to discuss
streamlining projects and how they can work together more efficiently.
The three leads have carried out a process mapping exercise with the
intention of identifying where there are operational system differences
and determine whether there would be time, people or process
efficiencies by working more effectively together. The three trusts have
also agreed to work jointly on implementing the ESR updates and
changes expected later this year, to ensure consistency and that learning
is shared.
Mr Sinclair reported they are also currently defining opportunities for
shared development of HR policies, which will include a secondment
policy and a Maintaining High Professional Standards (MHPS) policy, both
of which are expected to be complete in August. Work on the Junior
Doctors revised contract will be further considered in the light of the
rejection of this by Junior Doctors and the anticipated imposition by the
government. Colleagues in HR are looking at sharing visibility of
vacancies across the three Trusts for those staff who could be at risk
during any current / future consultation.
Occupational Health Services – WHC currently working with SWBH to be
ENC 1 160713 BCA Public Board Mins
7
potential hub for occupational health services, Mr Sinclair reported due
to a shortage of occupational health nurses the hub may not be in place
until Summer next year.
Mr Sinclair responded to a question asked by the BCA Board in June
about the implications of changing contracts of employment for new
Consultant grade appointments such that there is a provision within
contracts for some flexibility of location to support future potential
collaborative working. The view in summary is that making the change
for new consultant appointments would be more straight forward than
changing existing contracts.
Mrs Oum commented that this could be seen as an attraction, the
potential of working across three Trusts. Mr Kirby felt it would be an
attraction for new appointments and that we should get on and make
the change for new contracts.
Mrs Dhami agreed we should make the change for new contracts, and
that the JD would have to be carefully worded around how working
across three Trusts would be implemented and how staff would be
supported and looked after. Mrs Ord commented we need to avoid
rushing, and make sure we get the words right to avoid this being offputting to potential candidates.
Mr Kirby reconfirmed his desire to make the change quickly, stated the
JD could simply be updated to state the Trust was a part of the BCA and
therefore there was some possibility of the need to work at alternate
locations.
Mr Whalley suggested the HRDs be requested to draft something specific
and take through CRG to gain clinical endorsement and report back to
BCA Board.
ACTION:
 Mr Whalley to request HRD draft something specific around future TW
clinical JDs and report through CRG for clinical approval.
BCA/16/85 INFORMATION GOVERNANCE, CLOSE DOWN REPORT
Mrs Dhami presented the paper as written, noting the steps being taken
to assure resilience and peer support. The BCA Board thanked Mrs Dhami
for the report, the team for their work and agreed the project could be
closed down.
BCA/16/86 REFLECTIONS ON THE MEETING
There were no reflections to note.
BCA/16/87 ANY OTHER BUSINESS
No other business was discussed.
ENC 1 160713 BCA Public Board Mins
8
BCA/16/88 DATE AND TIME OF NEXT METING
31st August @ 10am
CEC, 1st Floor, South Block, Russell’s Hall Hospital, Dudley
Chair: Mrs. Ord.
ENC 1 160713 BCA Public Board Mins
9
ENC 2
BLACK COUNTRY ALLIANCE BOARD
(PUBLIC BOARD) ACTION LOG
Ref:
Meeting
Date
Minute
Number
1
13.04.16
BCA/16/41
8
13.04.16
10
Who
Date
Consider extending IR Pilot to include additional procedures.
Anne Baines as exec sponsor to lead
TW (AB)
Oct 16
Complete, item on October
agenda
BCA/16/41
Discuss Complex TB Lab facility at DGFT and how this may
affect the participation of DGFT in the Complex TB initiative
TW
Sep 16
Waiting to meet with Liz Rees to
discuss
11.05.16
BCA/16/54
Bring back outline public value case for Children’s services by
January 2017
TW
Jan 17
Update provided in October
Board, further paper to come back
by Jan ’17.
12
11.05.16
BCA/16/55
Share lessons learned on Kiosk implementation with PC
TL
Aug 16
23
08.06.16
BCA/16/70
Stroke report to be brought to October BCA Board
RK
Oct 16
ENC 2 161012 BCA Public Board Action Log
Action
Progress/Comments
Complete, item on October
agenda
1
Ref:
Meeting
Date
Minute
Number
24
13.07.16
BCA/16/78
25
13.07.16
26
27
Who
Date
Mr Whalley to invite Mr Coley (Director of Procurement) to
future BCA Board before end of calendar year.
TW
Dec 16
Complete, Dave will attend
November’s BCA Board.
BCA/16/78
Mr Whalley to form small team to produce next version of AF
Project Mandate to take to CRG and bring back to BCA Board.
TW
Oct 16
COMPLETE Team formed,
meetings scheduled Oct and Nov.
Update in Prog Director’s report.
13.07.16
BCA/16/78
Mr Whalley to speak to WMAHSN about trialling Meridian
campaigns feature, and report back to BCA Board in October
TW
Oct 16
13.07.15
BCA/16/78
Mrs Baines to bring back IR paper in October with
review of pilot and options for next steps
AB
Oct 16
ENC 2 161012 BCA Public Board Action Log
Action
Progress/Comments
Complete, on October agenda
2
ENC 4
Black Country Alliance Programme Board
On October 12th 2016
TITLE:
Stakeholder Engagement
Proposals and Communications
Update
EXEC SPONSOR:
Ruth Wilkin, Director of
Communications, SWBHNHST
AUTHOR:
Liz Abbiss, Head of
communications and Patient
Experience, DGNHSFT
Ruth Wilkin, Director of
Communications, SWBHNHST
Jayne Ilic, Head of
Communications, Engagement
and Marketing WHNHST
PRESENTER
Jayne Ilic, Head of
Communications, Engagement
and Marketing, WHNHST
OBJECTIVE:
To update the BCA Board on communications and engagement activity.
KEY ISSUES:
To note the proposed stakeholder engagement meeting.
IMPLICATIONS OF PAPER:
Y
Detail: Ensure staff and stakeholders are informed
about the work of the Black Country Alliance
RISK
Risk Register:
COMMS,
COMPLIANCE
and/or
LEGAL
REQUIREMENTS
CQC
Patient / Citizen
Engagement
NHSI
Equality Assured
N
Y
Y
Y/N
Competition
& N
Mergers
Comms Lead OK
Y
Governance Lead OK N
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
Detail:
Detail: patients to be involved and engaged in service
changes and developments
Detail: As workstreams develop
Detail: Equality impacts to be assessed for each
workstream
Detail:
Detail: Developed by comms leads
Detail: ToRs to be agreed by governance leads
Discussion
Other
x
x
RECOMMENDATIONS FOR THE BCA BOARD:
To receive a communications and engagement update on progress and plans every quarter.
ENC 4 161012 BCA Board Communications Update
Black Country Alliance Stakeholder Engagement Proposals and Communications Update: 12th
October 2016
1
Executive summary
This paper updates the BCA Board of the communications and engagement activity relating to the
BCA in line with the agreement to receive a quarterly update.
2
Stakeholder engagement
The Stakeholder Reference Group (SRG) meeting was unfortunately postponed due to a competing
event taking involving Walsall stakeholders. The first meeting of the SRG has now been scheduled
for Wednesday 9th November. It is intended that we spend some time sharing with the SRG our
thoughts on the role of the SRG; the purpose, ethos and principles of the BCA; what we’ve achieved
in the first 12 months or so; our plans for next 12 months and the links between BCA and STP. We
then hope to encourage a more open conversation about what matters to the SRG Members before
going on to agree a Terms of Reference for the SRG. There will finally be time for informal
networking and conversation over light refreshments. The three Healthwatch organisations have
been involved in regular meetings with Terry Whalley, Programme Director.
3
Celebrating the Black Country Alliance Anniversary – 14th July 2016
On Black Country Day (14th July) the BCA celebrated its first anniversary. The Chair of each Trust met
with invited employees to discuss the BCA and hear about its progress. Local media coverage
highlighted the three Trust’s working together with a patient story about interventional radiology.
4
Fundraising activities
The three partners have been working together on a number of fundraising activities to raise funds
for each organisation’s charity including a sponsored run by Programme Director, Terry Whalley on
13th August between the four main hospital sites. All 3 trusts are fielding 3 5-a-side football teams
for the first BCA Charity Football tournament, which kicks-off on 8th October with a family fun-day
and qualifying matches. The winning Trust will then play in a match in November or December
against Walsall FC’s Community Team, with special appearances from Walsall FC Legends. Proceeds
will be shared among the 3 Trust’s Dementia Care funds. Further discussions will be held by Charity
Teams early in the New Year regarding plans for collaborative fund raising in 2017. Sandwell and
West Birmingham are planning an event for the New Year.
5
Recommendations
The BCA Board is asked to:
 Note the communications and engagement activity that has taken place and is planned
ENC 4 161012 BCA Board Communications Update
Appendix 1: Progress against communications action plan
Responsible
By when
Completed
Notes
Actions & tactics
Black Country Alliance
branding and templates
Comms
leads
July 2015
Complete
Establish Black Country
Alliance website
RW/ comms
leads
July 2015
Complete
Black Country Alliance
CAN update
Comms
leads
Ongoing
BCA link from each trust
website
Comms
leads
Monthly
following
each
Board
November
2015
Review logo/ branding when
national NHS identity
guidance published in April
2016
Board papers to be
published when meetings in
public. Project team info to
be uploaded Jan.
Share with stakeholder
reference group following
first meeting
BCA twitter account
Comms
leads/ TW
Ongoing
BCA item on all trust
communications
Comms
leads
November
2015
All leads
and TW
have access
to account
Complete
Email signatures/
stationary/ templates to
include ‘partner of the
Black Country Alliance’
Comms
leads
April 2016
Updated
Black country Alliance
page on each intranet
with links to twitter and
BCA website
Comms
leads
31/01/16
Complete
All Trust intranets have BCA
page
BCA 2016/17 phase two
projects – ideas
generation
Comms
leads
31/01/16
Complete
Ideas generation campaign
completed
Media training for
spokespeople
Comms
leads
December
2016
Membership/ stakeholder
updates
Comms
leads
Ongoing
Proactive media strategy
Comms
leads
Terry
Whalley
Ongoing
05/02/16
Complete
Comms
leads
July 2016
Updated
Clinical conference
Patient, carer, public and
members involvement
ENC 4 161012 BCA Board Communications Update
Complete
Updated
Planning a twitter chat event
in Autumn 2016
Shared in Trusts’
communications channels.
BCA presence at AGMs
Added to recruitment
documentation
To be scoped depending on
likely media interest in
workstreams
Meetings with Healthwatch
leads have taken place
Stakeholder reference group
to take place in November
2016.
Coverage on BCA
anniversary – patient story
Consider future events for
2017 including clinical
networks
Second meeting with
Healthwatch taken place in
summer 2016
ENC 5
The Black Country Alliance Programme Board
Clinical Reference Group Chair’s Report
TITLE:
Clinical Reference Group Chair’s EXEC SPONSOR:
Report
BCA Board
AUTHORS:
Terry Whalley
Paul Harrison
PRESENTER
CONTRIBUTORS:
Clinical Reference Group
OBJECTIVE:
This report gives a brief update on the clinical reference group meeting held on Monday, 19th September
2016.
KEY ISSUES:
None, other than contained within the document
IMPLICATIONS OF PAPER:
RISK
Risk Register:
CQC
Patient / Citizen
Engagement
Monitor / TDA
Equality Assured
Competition &
Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
Not applicable
N
N
Not applicable
Not applicable
N
N
N
Not applicable
Not applicable
Not applicable
Y
Y
Approved
Approved
Discussion
Other
X
RECOMMENDATIONS FOR THE BCA BOARD:
The BCA Board is asked to note this report, debate the areas requested and support the proposal for
 a collaborative substantive Nursing workforce project to be initiated
 a singular clinical conference to be organised in spring 2017
ENC 5 161012 BCA CRG Chairs Report September 2016
The Black Country Alliance
Black Country Alliance Clinical Reference Group
1.
Purpose of Report
The Black Country Alliance Clinical Reference Group (CRG) was established to provide clinical
input to the work of the Black Country Alliance (BCA). This report gives a brief update on the
meeting held on Monday, 19th September 2016.
2.
Update
There was reasonable attendance, and with all three Trusts and both Medical Directors and
Chief Nurse Groups being represented the meeting was quorate.
The Chair confirmed that he would be taking on the role as Acting CEO at DGFT following
Paula Clark’s departure to UHNM as from 1st October, that Matt Banks will be Acting Medical
Director from the same date and would so attend future CRG meetings for DGFT. This requires
that alternate arrangements would need to be made regarding CRG Chair, and the Chair
stated he would ask the BCA Programme Director to support the process for selecting a new
Chair.
The CRG were joined by Human Resource Directors (HRDs) and together they discussed a
number of workforce development matters. The proposed amendment to future Consultant
contracts will make it clear that Consultants may be required to deliver services for more than
one Trust within the Black Country Alliance. This was again supported by the CRG but it was
noted that perhaps this could be broadened out to other employee groups in due course. It
was agreed that HRDs would now take forward and implement this change to contracts.
The Group discussed with HRDs the subject of Wolverhampton University’s PGAIM proposal.
Aimed at providing post graduate ‘Masters’ qualification for junior and mid-grade doctors at a
low cost, it was felt there was merit in linking this with the emerging BCA MTI initiative, as the
offering of such an academic qualification would likely significantly increase the calibre of
Fellows seeking to come and work in the Black Country. The Group will further explore this
with attendance from Prof Singh. The Medical Training Initiative (MTI) initiative was discussed
and the progress made by SWBH, WHC and DGFT was noted.
The Group discussed with HRDs Temporary Staffing, and heard that SWBH had had some
success attracting staff from agency to bank as a result of increasing bank rates. HRDs
confirmed the Temp Staffing Project is considering a move toward creating BCA Bank as a
means to reduce dependency on Agency spend. The Group discussed that while this was a
worthwhile step, it was also important to consider collaboration on substantive recruitment
initiatives. Regardless of the success or otherwise of the collaborative bid for Associate Nurse
Role, it was felt a parallel project to advance this would be desirable and would not distract
ENC 5 161012 BCA CRG Chairs Report September 2016
2
from the Temp Staffing work in progress.
The Group reviewed the Urology Quality Impact Assessments presented by Mrs Wardell, exec
sponsor for Urology project. Acknowledging these were the first efforts at using the new QIA
process, and accepting that on the basis of these and previously reviewed pathway
documents the CRG had no concerns regarding quality or safety, the Group did ask Mrs
Wardell to develop the QIAs further with the Urology Steering Group. In particular, specific
measures were required, and narrative around quality impact beyond the Trust receiving
patients.
The Group heard from the Chair the feedback from August 31st BCA Board suggesting a series
of mini conferences may be preferable to a single Clinical Conference in the style of the 2016
conference. The Group felt though that as there was likely a number of individuals who may
be required to attend multiple smaller events, it was unlikely to more efficient to run smaller
events. Offering a chance for all to network, hear about emergent STP and BCA priorities in a
consistent way, and share good practice beyond silos, there was a strong preference among
CRG to organise a single event.
Mr Khan had asked for several other areas of clinical urgency to be discussed under AOB
which included out of hours emergency endoscopy cover, out of hours radiological reporting,
microbiology out of hours and bariatric surgery. The BCA Programme Director was given the
contact names from each Trust for the first three of these issues to facilitate clinician to
clinician discussion on a possible way forward. It was felt that the bariatric surgery issue was
somewhat more complex and that this should be discussed at a future BCA meeting when Mr
Khan was present.
The next meeting of the CRG is on the 19th September 2016 at Walsall and as noted above will
be a joint meeting with HRDs.
ENC 5 161012 BCA CRG Chairs Report September 2016
3
ENC 6
The Black Country Alliance
Programme Director’s Update – October 2016
TITLE:
BCA Programme Director’s
Report
EXEC SPONSOR:
BCA Board
AUTHOR:
Terry Whalley
PRESENTER
Terry Whalley
OBJECTIVE:
The purpose of this paper is to provide a brief update from the Programme Director on the projects
within the scope of the Black Country Alliance, together with other matters of interest to the Black
Country Alliance Board
KEY ISSUES:
None other than those covered in the paper
IMPLICATIONS OF PAPER:
RISK
Risk Register:
None
CQC
Patient / Citizen
Engagement
COMMS,
Monitor / TDA
COMPLIANCE
Equality Assured
and/or
Competition
&
LEGAL
REQUIREMENTS Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
N
N
Not required
Not required
N
N
N
Not required
Not required
Not required
N
Y
Not required
Not required
Discussion
X
Other
X
RECOMMENDATIONS FOR THE BCA BOARD:
The Black Country Alliance Board is invited to;
1. Receive and comment on the above update.
2. Endorse the Mortality Review Network Terms of Reference.
ENC 6 161012 Programme Directors Update
1
Purpose
The purpose of this paper is to provide a brief update from the Programme Director on the projects
within the scope of the Black Country Alliance, together with other matters of interest to the Black
Country Alliance Board.
2
Project updates
2.1
Urology
Further to recent updates, the team have now produced first draft Quality Impact
Assessment using the Clinical Reference Group’s newly defined QIA Process. These QIAs
went to the last Clinical Reference Group and while there is a little more detail the CRG have
asked to see included, there were no concerns raised about the revised proposed pathways
and positive endorsement of the patient benefits associated with these changes.
Good progress is being made with establishing the virtual BCA Urology MDT. Focussing
initially on Complex Stones cases, the intention is to broaden the scope of this as demand
from Urologists determines.
Planning is now under way for our first Black Country Alliance Urology Network conference,
likely to be held toward the end of November 2016. In addition to sharing and celebrating
the progress we’ve made, the purpose of this conference will be to get as many Urology
colleagues as possible involved in determining opportunities to go further faster together
within our BCA Urology Network. Further details of this conference will be shared in
subsequent updates to the BCA Board.
2.2
Medical Training Initiative
The Department of Health in association with the Academy of Medical Royal Colleges
established in 2009 a national Medical Training Initiative (MTI) Scheme. In the BCA, a small
task and finish group has been established to explore how a collaborative MTI may be of
benefit to all Trusts.
The 3 BCA Trusts have made varying degrees of progress in establishing MTIs and some
benefits are expected to be realised in the current financial year within each Trust as a result
of this:
 SWBH recruited an MTI Fellow who started with the Trust in May, This will realise a
financial saving of approximately £51,000 based on reduced need for Locum cover;
 At WHC, the first group of MTI placements have been recruited from Pakistan across
Medicine, Paediatrics and Orthopaedics and will join the Trust in October 16. Detailed
numbers haven’t been provided, but based on SWBH numbers we can expect a financial
benefit of around £34k per Fellow in 16/17. Assuming 1 trainee per area, this would
mean around £102k in total in 16/17.
 DGFT has received trainees from Sri Lanka in Rheumatology, vascular surgery and Urology.
Detailed numbers haven’t been provided, but based on SWBH numbers we can expect a
financial benefit of around £34k per Fellow in 16/17. Assuming 1 trainee per area, this
would mean around £102k in total in 16/17
It is believed that greater benefits could be realised through the creation of a collaborative
MTI for the Black Country. The proposal will include the availability of rotational posts across
the BCA Trusts and the group is also exploring options to combine with a post-graduate
qualification from the University of Wolverhampton’s Academic Institute of Medicine (AIM).
This approach will make the BCA particularly attractive thereby securing regular supply and
ENC 6 161012 Programme Directors Update
2
high quality candidates. The group continue to aim to identify and recruit a further round of
Fellows before the end of 16/17.
Benefits will be realised through reduced reliance on locum and agency doctors, joint
recruitment processes across the Black Country, and improved quality of care provision.
2.3
Rheumatology
The BCA rheumatology project is now at operational implementation stage.
Medical - All of the 4 consultant rheumatologists posts have now been appointed to by
SWBH. Additionally, they also have a ‘retire and return’ consultant rheumatologist in place.
The appointments of the new consultants are phased (linked to start dates) and so the cover
for the BCA service will be defined accordingly. This is reflected in the job plans for the team.
The first 2 consultants are job planned to deliver clinics at WHC from the 3rd October 2016
this will increase to provide optimum cover over 5 days and be completed by March 2017
when the 4th consultant is in post. WHC operational team are confident that the phased
approach will match the service demand and will also allow for key milestone reviews to
assess the service model.
As the current situation is that there will be no locum cover at WHC from the end of
September 2016, Dr Situnayake and Dr Elamanchi have developed a contingency with the
operational team at WHC to provide rheumatology cover. The medical team will receive a
group induction at WHC, which is now being arranged. DGFT consultant recruitment drive to
recruit 2 rheumatologists has at time of report been unsuccessful and the clinical and
operational team are in the process of reviewing options.
Nursing - The nursing model mirrors the team based approach of the consultant model. The
job plans for the Clinical Nurse Specialists (CNS) have been drafted and are ready to be
implemented on request from WHC. The current Band 7 CNS from SWBH and B6 from WHC
are meeting the demand. Additional 4 sessions of nursing cover is on standby and will be put
in place once WHC have confirmed need. The current B7 cover at WHC is a ‘retire and
return’ CNS contracted until 2017.
IT - SWBH are leading on IT plans with support from WHC. All the SWBH consultants and
nurses who are job-planned to provide clinics at Walsall will be provided with a laptop which
is compatible with WiFi access at WHC. This will be sufficient to meet the immediate
requirements of accessing relevant patient information portals from different sites.
Other Matters – work continues on drafting detailed Service Level Agreements, overall
principles have been agreed and detailed draft has been submitted to and reviewed by
colleagues at WHC, who have raised some queries around the assumptions which are being
addressed by the SWBH operational team. A document defining the clinical governance
model has been drafted by Dr Situnayake and is out for comment before being finalised in
the coming month. A comprehensive Standard Operational Model is in the process of being
drafted by the 3 Operational teams and is expected to be completed by the mid October.
2.4
Children’s Acute & Community Services
It has continued to be challenging to get designated Stakeholders from across all 3 Trusts
together to determine priorities and specific opportunities for collaboration. In part due to
summer holidays and in part due to the realities of services delivery. That said, progress has
been made, and a draft speciality map has been produced and was reviewed at the Steering
Group in September. In addition to mapping services, this will also contain a view by service
ENC 6 161012 Programme Directors Update
3
on the level of challenge associated with Geography (hand over from one locale to another),
Transition from Child to Adult, Out of Hours (24 hours 7 days a week) and overall
Sustainability. The Group have committed to finalising this map by the end of the calendar
year, following which it is expected some priorities will emerge for work in 2017. In the
meantime, the group have identified some immediate opportunity to explore how we tackle
the risk associated with CAMHS better together, reinforcing the discussion from last month’s
risk discussion at the BCA Board. Out of Hours Sexual Abuse, Home IVs, 24/7 Palliative Care
and MRI/CT scans were all areas felt to be quick wins where immediate discussion to
progress would be useful. Further updates will be brought back to BCA Board in due course.
2.5
Interventional Radiology
This is covered in a separate paper on the agenda.
2.6
FINCH
Collaboration between SWBH and DGFT colleagues continues to progress well. As reported
at the August Board, the next stage of the project is to explore opportunities for
collaboration between WHC and SWBH for the small number of services identified at the
workshop in July. The project group is due to meet again in October and a further update
will be available to the BCA Board in November.
2.7
Atrial Fibrillation / Stroke Prevention
In August, the group reported on a grant application being made to Pfizer for proposals that
will improve the care of AF patients in order to reduce the risk of stroke. Despite the very
tight turnaround, a credible and collaborative application was submitted on behalf of the 3
BCA Trusts with endorsement from the West Midlands Academic Health Sciences Network
(WMAHSN) and clinical commissioners. The proposal is based on an integrated model of
care developed originally in Maastricht, Netherlands. It incorporates technological
innovation, using an app to educate non-specialist clinicians and patients, and to increase
the uptake of proven treatments across primary and secondary care. Additional aspects of
the bid include:
•
Education and upskilling of GPs via ECHO (Extension for Community Healthcare
Outcomes), a multimedia information sharing platform aimed at moving knowledge and
information from specialists to generalists;
•
AF screening in general practices using innovative mobile technology to identify
abnormal ECG readings (subsequently undergo a 12-lead ECG to confirm new AF
diagnoses).
The outcome of the application is expected toward the end of October. In the interim, the
project group is looking to prioritise and mobilise the key elements of the proposal that can
be implemented within existing resources. There are meetings scheduled throughout
October and early November with clinical colleagues across the BCA Trusts as well as
external partners including clinical commissioners and, most recently, Cerner. Cerner are
confirmed providers of SWBH EPR and are one of 2 shortlisted within DGFT’s selection
process. Cerner are a provider of population health management through their health
information exchange, which operate agnostic to the EPR or system being used and is
already at the heart of a Vanguard PACS model elsewhere in the country. At this stage, we
are holding exploratory discussions to understand how this approach might help achieve our
triple aim.
In terms of benefits, the proposal has the potential to reduce outpatient appointments and
delays to treatment in the short to medium term. In the long term, it has the potential to
ENC 6 161012 Programme Directors Update
4
identify, diagnose and improve the management of more patients with AF. This will reduce
the risk of stroke, which has multiple long term benefits to the health sector and wider
economy.
2.8
Community Services
It has continued to be challenging to get designated Community Stakeholders from across all
3 Trusts together to determine priorities and specific opportunities for collaboration. In part
due to summer holidays and in part due to the realities of community service delivery. That
said, progress has been made, and a detailed assessment of Strengths, Weaknesses,
Opportunities & Threats (SWOT) has been produced by each Trust, see appendix B. This was
reviewed at the Steering Group in September. From this, some emerging themes have been
identified where the group feel there may be opportunity for collaboration. These include
Workforce development, Single Point of Access, Patient Transport Services and Mobile
Technology. Additionally, the group agreed that to stimulate more organic collaboration, a
joint BCA Community Services Conference might be really valuable. The Group have
committed to reflecting further on this analysis ahead of the next Steering Group in
October/November. Following which it is expected some priorities will emerge for work in
2017. Wheelchair Services, Podiatry and Rapid Response Teams were all areas felt to be
quick wins where immediate discussion to progress would be useful. Further updates will be
brought back to BCA Board in due course.
2.9
Upper Limb Trauma Centre
As reported at the August BCA Board, the Upper Limb Trauma group is focussed on 3
emerging work streams:
1.
Define and agree a comprehensive service map, including sub specialties where
appropriate, covering the BCA and which can be used to identify strengths, weaknesses,
opportunities and threats and so inform future opportunities for collaboration;
2.
Establish a virtual MDT for upper limb that would support diagnosis and prevent some
patients from being referred out of the area;
3.
Consider the specialist hand care that is currently referred out of the area in terms of
clinic assessment, surgery and rehab (starting initially with a review of hand fractures
and flexor tendons/ hand lacerations).
Mobilisation of these work streams has been particularly challenging due to the large
number of stakeholders involved from each Trust. This includes T&O Consultants, Therapies
Leads and Operational Managers. There are also continued difficulties experienced in
obtaining the relevant inter-hospital referral data. This poses a risk to the aspirational
timeline and our ability to realise any benefits of collaboration within the 16/17 financial
year.
Since the last report, some progress has been made:
•
•
•
WHC has provided service mapping information;
WHC and SWBH information leads have supported discussions to overcome the
challenges relating to inter-hospital referral data;
Therapies and operational leads for all 3 Trusts have now been identified.
Further progress is expected to be made during October and an update will be provided to
the BCA Board in November.
ENC 6 161012 Programme Directors Update
5
2.10
Procurement
The Steering Group met for the first time with the newly appointed Director of Procurement.
BCA members have received from NHSi the Local Procurement Transformation templates
and the Steering Group agreed a timetable for completion and ratification in each Trust and
across the BCA.
•
•
•
Baseline and gap analysis reported within each Trust
Working draft of plans internal and BCA reports
Final plans at Trust and BCA level
Oct 16
Nov 16
Feb 17
These plans will in turn inform a BCA wide Procurement Strategy for endorsement in the
Spring of 2017.
Carter rightly majors on e-enablement and the modernisation of NHS supply chains which
will take investment and time to deliver.
Earlier in the year the DH ran a competition for Trusts to bid for monies to deliver fully GS1
compliant hospitals. The process concluded with 6 ‘demonstrator’ sites chosen who would
develop templates and ‘how to’ guides for the NHS – the ultimate object is to deliver
business cases with clear ROIs. We believe there is a very high chance that a further bid
process will be announced in November with award of monies confirmed in February 2017.
We plan to develop a multi-trust application & understand DH initial reaction is extremely
favourable to this approach. Royal Wolverhampton who came 8th in the first bid round has
agreed in principle to join the BCA in a joint bid.
A key strand in Carter and our potential GS1 bid is the BCA commencing a journey towards
e-enablement. The most fundamental thing we can do quickly and at a low cost is adopt one
catalogue solution that will manage improvements in the following areas:
•
•
•
•
•
Reduced PO and Invoice matching issues.
Lack of control over the items available to requisitioners.
Integration into existing IT infrastructure.
Savings through access & visibility of contracts and price comparison.
Contracts and compliance reporting functionality.
A full cost model will be developed for the November Procurement Steering Group meeting.
Other areas that will be developed during the autumn include some opportunities identified
with Chief Pharmacists around procurement of biologics, outpatient dispensing, capital
purchases and other stock reduction initiatives. The group will also consider the case for
more focussed Clinical Nurse Procurement model, similar to the one at Nottingham that
have delivered multi £m benefit.
2.11
BCA Mortality Review Network
The BCA Clinical Reference Group (CRG) commissioned the establishment of a BCA Mortality
Review Network. Mortality Leads across all 3 Trusts were identified and met for the first
time on 26th September. Each Trust shared their current processes for identifying and
undertaking Mortality Reviews, identifying and learning lessons and for providing assurances
through to Trust Boards. The MRN identified a number of key themes where collaboration is
highly desirable across the Black Country Alliance;
1.
Identifying and reducing undesirable variation in process, rates of return and mortality /
quality of care indicators
ENC 6 161012 Programme Directors Update
6
2.
Improving distribution of lessons learned locally (within Trust) and across the BCA
where quality of care could/should have been better and Local Health Economies in
cases where deaths were predictable and patients perhaps shouldn’t have been
admitted for acute care.
3.
Improving logistics to enable timely, consistent process and provision of robust
assurances
4.
Improving ability to perform Common Cause Analysis / spot trends over time
5.
Embedding culture of continuous improvement / learning across the patch
The MRN have now approved a terms of reference, see appendix A, and will meet quarterly
to drive this Black Country Alliance Mortality Review Network forward. Focus in final quarter
of 2016 will be a comprehensive definition of our starting position, processes, metrics and
performance to enable identification of variation and enable a better definition of granular
opportunity for improvement in each of the 5 key themes identified above. The December
2016 MRN will then set out a proposed programme of interventions for 2017. A further
report on this proposed programme of work will be taken back to the Clinical Reference
Group and BCA Board in January / February 2017.
3.
Other News
BCA Team; we have successfully completed the recruitment of our second project Manager
for the core Black Country Alliance team. Grace Hodgetts joins us on 31st October from
Health Education England where she was managing a number of accreditation programmes
with national institutions. Prior to HEE, Grace has had spells working as Project Manager
with NHS Property Services, PCTs and Providers in an NHS career spanning more than 20
years. This will enable more support to be provided to the growing scope of work for BCA.
WMAHSN Meridian Portal; a small SWBH team has been formed to explore how WMAHSN’s
Meridian innovation portal may be of benefit to Trusts in the BCA. WMAHSN are prepared to
support us create and run a ‘campaign’ so we may test & learn. This feature is normally only
available to enhanced members of the AHSN. It is likely that the topic we will develop in this
campaign will be centred on ‘developing the resilience of Midwives’.
4.
The Ask of the Black Country Alliance Board
The Black Country Alliance Board is invited to;
1. Receive and comment on the above update.
2. Endorse the Mortality Review Network Terms of Reference.
ENC 6 161012 Programme Directors Update
7
Appendices
A – BCA Mortality Review Network Terms of Reference
B – BCA Trust Community Services SWOT.
ENC 6 161012 Programme Directors Update
8
Appendix A – Urology Patient Story
Kidney stone op gets Walsall man back on his feet
A Walsall HGV driver has thanked a Dudley specialist surgeon for getting him back on his feet after
innovative keyhole kidney surgery.
Donald Witton, 58, from Bloxwich was referred to Russells Hall Hospital by surgeons at Walsall
Manor Hospital to have the large kidney stone removed by Consultant Urologist Mr Asad Abedin.
“The kidney stone was large and very painful. I was in pain for 12 months, said Donald. “It was so
bad that it knocked me off my feet.”
The referral was made because Walsall Healthcare Trust and The Dudley Group NHS Foundation
Trust, along with Sandwell and West Birmingham Hospitals Trust, are working in a partnership called
the Black Country Alliance (BCA).
Speaking on the first anniversary of the alliance, Donald said he was pleased he did not have to
travel to London to have specialist surgery.
“When I was told Mr Abedin could remove the stone, I was really pleased. I didn’t mind travelling to
Dudley; I just wanted the pain to be over,” said Donald. “Mr Abedin looked at my X-ray and said he
was confident he could remove it.”
The procedure carried out by Mr Abedin, called a mini-PCNL, puts patients on their backs during
surgery with a small incision made in the side. The stone is broken up using a drill and Mr Abedin
removes the pieces using forceps.
“Kidney stone surgery usually requires patients to lie on their front. However, this can put too much
pressure on the eyes if a patient is lying in that position for three or four hours during the procedure,”
said Mr Abedin.
“This new technique is suitable for patients with a stone of 2cm or larger. It’s a simpler operation
than traditional keyhole surgery and means patients spend less time in hospital and recover more
quickly,” he added.
ENC 6 161012 Programme Directors Update
9
ENC 6A
DGFT SWOT Analysis – Community Services
Strengths



New management structure from November 2015, 5
District Nurse teams.
Clinical leadership from Clinical Director who can
influence other services.
Strategic leadership from 3 x Clinical Locality
Managers.
Dedicated Community Matron to support governance,
training, quality.
Dedicated AHP lead.
Block contract for 2016/17.
Established Outpatient Parenteral Antimicrobial
Treatment (OPAT) service.
Access to hospital multidisciplinary teams to support
patients needs e.g. Consultant group, hospital social
team, specialty nurses, therapy.
SPA (Single Point of Access).
Good patient feedback.

Transformation board meeting.







Weaknesses











Opportunities











Vanguard monies for Multispecialty Community
Provider for 2017.
Community rehab pathways e.g. Falls, Elderly Care.
7 day working.
Integration with Local Authority and CCG, Trusted
Assessor Role, Therapy pathways.
Nurse led prescribing and AHP lead prescribing.
Care Co-ordinators roles for practice based MDT
Case load weighting tool to ensure effective resource
management.
OPAT, increase pathways to reduce length of stay in
acute and keep patients closer to home.
Escalation development for each.
Shared IT system.
Podiatry services could expand and support other
pathways e.g. orthopaedics.
ENC 6a BCA Community Services SWOT Analysis
Vacancy factor in speech and language and ANP areas.
Skill set.
SPA, not integrated.
Estates.
IT, wifi technology, Real Time Data.
Communication.
New structure is in development.
Out of hours support/access
Surge management
Lack of information analysis v information overload.
Performance management structure
Threats








IT
Integration/duplication.
The ability to recruit and retain clinical staff.
Increasing elderly population.
The CCG wanting to procure other services.
Demand for services is unmanageable, particularly at
peak times during the year.
The ability to flex resources whilst managing at peak
times.
The ability to move at pace for immediate change in
services.
SWBH SWOT Analysis – Community & Therapies Clinical Group
Strengths























Integrated clinical group including therapies, bed bases &
community specialist nursing (DN, Resp, HF, End of life,
Matrons)
Strong AHP and Nursing Clinical leadership from Clinical
Directors who influence Trust decision making.
Strong, positive working relationships within Group
Strategic leadership from 3 x Clinical Directorate Leads
Dedicated Service Leads to support integrated service
delivery, governance structure, training, quality
All clinical leaders lead multi-professional integrated
teams and pathways
Work across Directorates and Group to deliver Group
business and pathways including 9 transformation
projects in preparation for MMH. Constant horizon
scanning, review and improvement cycle across services
and pathways
Established relationships with CCG clinical leads and
commissioning managers
GP partners instrumental in developing services
collaboratively
Established relationships with social services and
voluntary sector across a range of pathways
The Group is an enabler for other clinical Groups within
Trust (e.g. RCRH, bed closure programme)
SPA (Single Point of Access) for all community services;
includes all administrative functions delivered centrally
via Hubs.
Admin function meets clinical service requirements 50
hours a week
Electronic patient notes linked to 90% Sandwell GPs
Good patient feedback with robust data collection
High performing E&D rating by service user expert group
Nationally recognised services (Kings Fund, Nursing
Times, AHA Awards, National Rehab Commissioning
Guidance) and open to learning from others and sharing
our practices - the good and the bad
Trust commitment to L&D with access to advanced
training for registered and non-registered staff
Apprentices a core component of clinical & admin teams
7 day working
Services can respond (e.g.rehab, diabetic foot, RRTS) can
respond same day in community and ED
Nurse and AHP Independent Prescribers across a range
of pathways
As a group we have permission to be solution focussed
and adapt model to meet new threats. Leads work
flexibly, outside of traditional roles and barriers, with
staff to deliver solutions at short notice
ENC 6a BCA Community Services SWOT Analysis
Weaknesses

















Vacancy factor in band 6 posts across all services and
professional groups
Vacancy factor in bed based band 5 nursing
Current workforce reviews impacting on recruitment
Access to electronic record in non-Trust premises
Poor linkage of IT across acute & community (but WIP
with new system commissioned)
Estates; some buildings not fit for purpose,
community venues via propco, charging for
established clinics,
Community IT infrastructure needs upgrading
Devices not compatible to new ways of working
Staff feedback re communication
Surge management
Acute capacity management and impact on LOS in
acute, community bed flow, community access,
readmissions
Agency and bank spend increasing due to delays in
recruitment
Short term winter projects that increase agency
spend, lack of lead in time for preparation, weak
evaluation from commissioners
Protracted tendering processes locally
Transformation pace affecting how schemes are
embedded into new ways of working
Mat leave backfill not received unlike ward nursing
teams
Different provider for West Bham patch and so
different discharge pathways, outcomes and patient
satisfaction. Acute teams managing flow with
different service providers
2
Opportunities













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
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
Vanguard (Modality) for Multispecialty Community
Provider as part of SWBH footprint.
Trusted referrer and accelerated referral in to
community beds
New roles being developed as part of the transformation
plans
Case load weighting tool to ensure effective resource
management.
Extend range of hospital at home pathways building on
existing pathways and teams e.g. OPAT
Discharge to Assess
Technological solutions to delivering care – telemedicine,
virtual visiting
End of Life Hub 24/7 to link in with 24/7 community
services, social care, housing
Development of sponsored student programmes across
whole of training course
Development of new solutions in providing clinical hours
Extend R&D capability and capacity
Extend role and number of apprentices
Community career framework in development includes
comprehensive competency framework integrated
across professional groups
Further integration with social care and voluntary sector
around rapid response and referral management
Expansion of clinical based activity for traditionally
home-based services
MMH as a driver for transformation
CCG wanting to procure other services
Successful delivery internally has enabled Group to have
more autonomy and so develop a brand and
recruitment campaign
Different provider for West Bham patch and opportunity
to be future sole provider
ENC 6a BCA Community Services SWOT Analysis
Threats









Financial programmes
Political instability
STP and Vanguard recommending MSCP as an option
contrary to RCRH philosophy
Estates hindering service integration and delivery
The ability to recruit and retain clinical staff
(registered and non-registered)
IT
Capping of cost and volume contracts and penalties
for over performance
Band 5 turnover rate as they are promoted or seek
new opportunities
Different provider for West Bham patch and
uncertainty over future provider
3
WHC SWOT Analysis – Community Services
Strengths















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


Integrated acute/community organisation
Newly developing Adult Community Nursing Care
Group aligned to Division Medicine/Long Term
Conditions. Range of services included in Care Group
i.e. District Nursing, Community matrons, Wound
clinics , Rapid Response, Intermediate Care (not
therapies), in-reach matrons, Community neuro-rehab
team, Specialist falls/Osteoporosis, Nursing and
Residential home case management, Podiatry and
Clinical Intervention.
Clinical leadership at Exec level – Director Nursing,
Director of Strategy and CEO with strong vision for care
closer to home.
Dedicated AHP lead.
Block contract for 2016/17.
Established Outpatient Parenteral Antimicrobial
Treatment (OPAT) service.
SPA (Single Point of Access) in each locality team
Good patient feedback.
CQC rating GOOD for community nursing and
community end of life care
Specialist links to locality teams good for Diabetes, End
of Life and Infection Control
Frailty team
Community equipment provision
Wound healing
Nurse led prescribing and AHP lead prescribing.
Capacity and demand modelling
Excellent pro-active clinical recruitment
24/7 nursing service
Locality teams driving integration
Visible structures for integrated locality teams
Telehealth – availability
Admission avoidance work – credibility
Dashboards for care closer to home initiatives and
clinical quality
Discharge to assess availability
Specialist Falls , joint tender award with Walsall Leisure
providing exercise and balance programmes
Relationships with GP – Primary Care
Staff Retention
ENC 6a BCA Community Services SWOT Analysis
Weaknesses

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Loss of some essential links with some services across
Divisions e.g. SALT, Continence. COPD.
SPA, not One but in each locality, not integrated with
other providers
Estates.
Lorenzo
SAP documentation not fit for purpose
IT, wifi technology, Real Time Data.
No recognised PDU support for community
Lack of time to embed services, new initiatives
Therapies not aligned to place based teams
Lone working processes
Lack of bank staff
Telehealth – poor uptake
Specialist links to locality for Respiratory, Cardiology
and Continence
Community nursing maternity backfill not provided
within budget
Discharge to assess provision , some patients length of
stay longer than anticipated
4
Opportunities
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Mobile working , progressing with business case
Frailty screening to be used across pathways
enhancing step down, step up care
Community rehab pathways e.g. Falls, Frailty Care.
Redesign of Locality model into place based teams
Analysis of frequent hospital admission patients by
place based teams, length of stay and co-morbidities
Development of pathways based on above analysis
Resilient communities
Prevention strategies
Strengthen intermediate care
Integration with Social Care, DWMH,
Walsall together collaboration
Improving nurse to patient ratio and named nurse
concept
Place based MDT
Identify therapy leads for place based teams
Rapid Response joining localities
Clinical lead , Head of Nursing , Care Group Manager
appointments
In house career pathways
Development of associate nurse
ENC 6a BCA Community Services SWOT Analysis
Threats







IT – need time to embed
The ability to recruit clinical staff.
Increasing elderly population.
CCG instability , potential service tenders
Increasing demand for services, care closer to home,
particularly at peak times during the year.
The ability to flex resources whilst managing at peak
times.
Financial versus performance challenges
5
ENC 6B
Black Country Alliance – Mortality Review Network
Terms of Reference
Introduction
The Black Country Alliance Clinical Reference Group commissioned the establishment of a
BCA Mortality Review Network (MRN).
Terms of Reference
Work Mortality Leads at all Trusts in the Black Country Alliance (Dudley Group NHS FT,
Sandwell & West Birmingham Hospitals NHST and Walsall Healthcare NHST) to;
-
Take stock of the strengths and weaknesses of current mortality review processes;
-
Assess opportunities for working together to improve the quality and/or effectiveness
of the mortality review process, reduce variation and improve quality of care metrics;
-
Assess opportunities to create culture of learning & continuous improvement, and to
more rapidly and effectively spread lessons learned;
-
Consider options for improving quality of care standards and for providing full
assurance to Trust Boards on the efficacy of mortality review process;
-
Provide connection on behalf of all 3 Trusts to emerging National Mortality Review
process and requirements via regional HQUIP;
-
Consider options beyond initial priorities for further improvement based on regional,
national and international practice.
Governance
The MRN will be chaired by a member of the BCA Clinical Reference Group, initially Medical
Director at Sandwell & West Birmingham for a period of 6 months.
The MRN will be attended by nominated Mortality Review Leads across all 3 Trusts, initially;
Roger Stedman
Roger Callender
Chris Newson
Carol Cobb
Teekai Beech
Simon Parker
Philip Brammer
Terry Whalley
Richard Tipper
Mumtaz Goolam
ENC 6b BCA MRN Terms of Reference
Mortality Review Network Members
RS
SWBH, Medical Director and MRN Chair
RC DGFT, Deputy Medical Director
CN WHC, Mortality Lead
CC
SWBH, Mortality Lead
TB
DGFT, Directorate Manager / Mortality Lead
SP
SWBH, Head of Clinical Effectiveness
PB
DGFT, Associate Medical Director
TW BCA Programme Director
RT
WHC
MG SWBH
The MRN will meet at least quarterly, and will undertake agreed business during the period
between meetings.
The MRN will provide a quarterly report to the BCA Clinical Reference Group and the BCA
Board.
The MRN in no way, shape or form is intended to replace extant Trust mechanisms for
undertaking mortality reviews, learning lessons or providing assurance required to Trust
Board via Quality Committees. Rather, it is intended to provide a forum to share bets
practice and enable changes and improvements to be recommended for consideration by
each Trusts’ governance mechanism.
ENC 6b BCA MRN Terms of Reference
2
ENC 7
The Black Country Alliance Programme Board
Non-Vascular Interventional Radiology Weekend On-call Pilot review
TITLE:
Non-Vascular Interventional Radiology
Weekend On-call Pilot review
EXEC
SPONSOR:
PRESENTER
Dawn Wardell (For Anne
Baines)
Terry Whalley
AUTHORS: Lisa Peaty
CONTRIBUTORS:
Clinical and Operational members of the IR Steering Group
OBJECTIVE:
To provide a review of the 6 month pilot of non-vascular IR on call pilot, and to seek endorsement of the
recommendations coming from the Steering Group.
KEY ISSUES:
None other than reported in the paper
IMPLICATIONS OF PAPER:
RISK
Risk Register:
Not required
CQC
Patient Engagement
NHSI
N
N
N
Equality Assured
Y
Competition &
Mergers
N
Comms Lead OK
Governance Lead OK
Y
Y
Not required
There is no need to consult with NHSI as we are responding to
Royal College requirement to offer services out of hours
There is no equality impact as extant services will be offered at
extended hours in the week.
There are no concerns in respect of competition & mergers as we
are establishing a shared rota, not reconfiguring or merging
services.
No concerns
No concerns
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
Discussion
X
ENC 7 IR Report
Other
X
3
RECOMMENDATIONS FOR THE BCA BOARD:
1)
2)
3)
4)
5)
ENC 7 IR Report
The 9:00 – 17:00 weekend/bank holiday Interventional Radiology (IR) nephrostomy pilot
becomes an on-going arrangement between participating trusts in its current format and
BCA pathway and QIA documents are completed;
individual organisations and the IR Steering Group continue to resolve the issues with
current pilot (Section Three);
the current model of delivery is extended to other relevant Urology and Gastroenterology
procedures for a pilot period of six months from April 2017, subject to the resources
required being approved by individual Trusts (Section Five);
a qualitative survey of patients and their relatives/carers takes place to capture their
feedback;
Trusts involved in the pilot work together to continue to explore how to close the gap
between the national requirement for 24/7 access to Interventional Radiology and the
service offered as part of the IR pilot and proposed extension to it.
2
The Black Country Alliance
Non-Vascular Interventional Radiology
Weekend On-call Pilot –
The Interventional Radiology Steering Group recommends that:
1)
2)
3)
4)
5)
1.
the 9:00 – 17:00 weekend/bank holiday Interventional Radiology (IR) nephrostomy
pilot becomes an on-going arrangement between participating trusts in its current
format and that BCA pathway and QIA documents are completed;
individual organisations and the IR Steering Group continue to resolve the issues with
current pilot (Section Three);
the current model of delivery is extended to other relevant Urology and
Gastroenterology procedures for a pilot period of six months from April 2017, subject
to the resources required being approved by individual Trusts (Section Five);
a qualitative survey of patients and their relatives/carers takes place to capture their
feedback;
Trusts involved in the pilot work together to continue to explore how to close the gap
between the national requirement for 24/7 access to Interventional Radiology and the
service offered as part of the IR pilot and proposed extension to it.
Context and overview
During 2014/15, the Royal College of Radiologists, British Society of Interventional Radiology
and National Imaging Board produced standards and guidance on the service delivery of
Interventional Radiology (IR), whilst NHS England stated a requirement that all acute
hospitals provide access to IR services 24 hours a day, 7 days a week to provide
haemorrhage control and nephrostomy drainage. In response, the Black Country Alliance, in
conjunction with the Royal Wolverhampton Hospital Trust, implemented a six month long
pilot which commenced in April 2016. The focus of the pilot is the provision of seven day
access between 09:00 and 17:00 for Percutaneous Nephrostomy and / or stenting (for acute
or progressive renal failure/sepsis). This is in the form of a 9:00am – 5:00pm on-call service
alternating between Russell’s Hall Hospital, New Cross Hospital and City Hospital on a two
weekly basis, for which a revised clinical pathway was agreed by the BCA clinical leads for
Urology and Interventional Radiology. The on-call team is activated only following the
agreement of the on-call Consultant Interventional Radiologist. For the purposes of the
pilot, all staff have the competence to undertake nephrostomies. West Midlands Ambulance
Service (WMAS) transfers patients to and from the referring and on-call sites.
This approach enables all four trusts to close the gap on required standards of care, but
without incurring the cost associated with doing this independently on four separate
hospital sites. This enables better use of resources whilst improving health outcomes and
patient experience. Whilst the aspiration is to meet the national standard of a 24/7 service,
this has not been possible due to the cost of providing such a service and associated
implications for workforce recruitment and retention.
2.
Activity data
In the period during which the pilot has been operational, the following activity has taken
place up to the weekend of 24th and 25th September 2016.
ENC 7 IR Report
3
Total number of nephrostomy cases referred into system
Total number of Nephrostomy cases performed
30
26
Total number of non-urological cases discussed with IR
Total number of “other1” procedures performed
27
10
The figures indicate that not every potential nephrostomy case that was referred resulted in
a nephrostomy being undertaken. As anticipated, the numbers of nephrostomies have
increased since the pilot has been operational – having the service available has increased
demand.
A range of procedures other than nephrostomy have also been undertaken. On call teams
have made themselves available to undertake such procedures where there has been a
clear clinical need identified.
All of the procedures that were performed were recorded as being successful with no
clinical complications noted.
A total of 11 cases were transferred from a referring hospital to a host site hospital.
Direction of transfer
DGFT
WHCT
RWHT
WHCT
WHCT
SWBH
Total
SWBH
DGFT
DGFT
SWBH
RWHT
RWHT
Number of patients
(02/04/2016 – 25/09/2016)
3
2
2
2
1
1
11
The time patients spent in recovery at the on-call site is recorded as being between 5 and
60 minutes (n=7 patients).
3.
Evaluation of the pilot
Feedback from clinicians involved in the pilot has been very positive and there have been
clear benefits to the Trusts and patients involved. These include:
i)
improved patient outcomes because the procedure has been carried out more quickly
and recovery has started sooner;
ii)
improved patient outcomes because of better treatment options which are less
invasive and thus reduce the risk of trauma and infection risk leading to swifter
recovery;
iii) improved patient outcomes as the procedure has been performed in the appropriate
environment by appropriate staff;
iv) improved outcomes for the patient and their family/carers because follow up and
after care has taken place at their local hospital;
1
Other includes 1 x PTC; 1 x GI Bleed embolization; 7 x drainage of renal abscess, IP abscess,
pleural effusion, ascitic liver, suspected urinoma; 1 x biopsy
ENC 7 IR Report
4
v)
the avoidance of adverse event for patients who would not have been able to have
accessed appropriated procedures in a timely manner;
vi) improved compliance for the Trusts involved with requirements of NHS England and
with recommendations from and standards introduced by the Royal College of
Radiologists, British Society of Interventional Radiology and National Imaging Board;
vii) a standardised pathway across the Black Country staffed by clinicians working to a
Standard Operating Procedure who are efficient with use of their own IR suites;
viii) mitigation of risk for the trusts and patients in implementing alternative pathways for
dealing with such patients (e.g. transporting patients further afield);
ix) financial benefits for the Trusts involved, estimated to be approximately £260,000 per
trust (Appendix One) through cost avoidance of having to provide a 24/7 IR service
individually. This figure has been based on calculations from one trust which were
considered by the Interventional Radiology Steering Group to be applicable to the
other trusts involved in the pilot;
x)
benefits for the workforce who are part of a rota system rather than providing an on
call IR service every weekend if each Trust had to provide this service individually.
Thus, the service is provided at one location rather than at all four sites;
xi) a 9:00-17:00 service rather than 8:00-20:00 or 24/7 services is of benefit to the
workforce and maximises use of resources (i.e. reduces cost of provision), whilst, at
the same time, closes the gap between the national standards required and actual
provision.
There have been no complaints (formal or informal) about the on call service and no
incidents have occurred. Feedback from a patient is that they were very grateful for the
service provided as this allowed a swift discharge to be made and a quicker return to caring
for her husband at home. It has been difficult to obtain any detailed feedback from patients
and their relatives following their discharge as NHS numbers have not routinely been
recorded on the monitoring system. A system for obtaining systematic patient feedback will
be discussed by the IR Steering Group if the pilot becomes an on-going arrangement.
None of the procedures been escalated beyond the capabilities of the on-call team.
It has not been possible to calculate any decreased length of stay; bed days saved and
reduced theatre utilisation as a result of the pilot. This is because it is difficult to quantify
outcomes for each patient if the pilot had not been in place.
However, the following issues have arisen and been/are being addressed:
i)
Transfer times
The standard WMAS response time for urgent transfer which applies to patients being
transferred between sites in the pilot is between 2 and 4 hours, although there is a quicker
response time for patients requiring an emergency transfer. However, some concerns have
been raised by clinicians regarding transfer times from the referring site to the host site.
Where recorded (n=8 patients), the time between referral and arrival at the host site was
between 2 and 8 hours. The eight hour delay in transfer occurred for one patient due to
reluctance of WMAS to transfer a patient from Walsall to the host site without the patient’s
ENC 7 IR Report
5
notes and drug chart. These had to be faxed through causing further delay whilst the
clinical team were waiting to undertake the procedure. This issue has been addressed by
confirming response times required with WMAS and reinforcing with clinicians the Standard
Operating Procedure for transferring patients. Transfer times continue to be monitored.
ii)
Case notes and image availability
Drugs charts and case notes were available for 8 of the 11 patients that were transferred,
but images were transferred with just three patients. Discussion with clinicians participating
in the pilot indicates that the images were available at the referring site but were not
transferred with the patient. Despite clinicians having access to images via IEP, they have
indicated that they prefer images to be transferred with the patient. The Standard
Operating Procedure (SOP) for the pilot states that images should be transferred with the
patient. However, this has been strengthened and the SOP has been re-circulated and
reinforced with staff involved in the pilot. Transfer of images has improved since doing this
and following further discussion by the IR Steering Group.
iii)
Repatriation of patients
Repatriation of patients to the referring site has generally taken place smoothly, but
repatriation was delayed for one patient from Walsall which resulted in a three day
inpatient stay at the host site (DGFT). There was no clinical reason preventing the patient
from transferring back to the referring hospital. However, the bed that had been vacated at
the time of transfer had been used to accommodate another patient. Capacity issues at the
time meant that another bed was not available for three days to transfer the patient back to
Walsall. The SOP is being strengthened to include a requirement that transfer back to the
referring hospital should take place as soon as the patient has recovered enough to travel
and that a bed should be kept available. Most patients should be well enough to transfer
within four hours of the procedure.
4.
Proposed continuation of the nephrostomy pilot as an on-going arrangement
As outlined in Section Three, feedback from clinicians has been positive; there are clear
benefits associated with the pilot and the issues that have arisen have been or are being
addressed. Following discussion and evaluation of the pilot at the IR Steering Group, it is
proposed that the current model of delivery (i.e. an on-call service for Black Country and
Wolverhampton patients alternating between Russell’s Hall, New Cross and City Hospitals
on a two weekly basis with patients being transferred between sites) should be continued as
an on-going arrangement beyond the period of the six month pilot (April – September
2016).
Each Trust participating in the pilot has confirmed that they have sufficient workforce with
the required competencies in place to be able to continue with the current 9:00 – 17:00
arrangement and that there would be no additional costs over and above those of the
existing pilot. The costs in the initial business case for the services were:


Indicative cost per procedure2 - £1,023
Basic income per procedure - £1,200
2
Excludes costs associated with setting up the pilot, but includes cost of workforce, consumables and
bed.
ENC 7 IR Report
6
These costs are currently absorbed within each Trust:

At Wolverhampton and Dudley, non-vascular IR on call is supported by existing
Wolverhampton and Dudley staff. The nurses and radiographers from Dudley and
Radiologists from Dudley and Wolverhampton also support the vascular on call
service;

At SWBH the pilot is resourced through an extra shift by a radiographer and on call
nurses at a cost of £205 per day, A Walsall radiologist also provides support;

the cost of consumables is similar for each of the trusts (estimated to be c. £10,000
per annum)
Therefore, if the initial set up costs are excluded (Appendix Two), the 30 nephrostomies that
took place cost £30, 690 and generated an income of £36,000.
The IR Steering Group considered the option of extending the hours of the on call service
from 9:00 – 17:00 to 8:00 – 20:003. This would incur the following additional costs over and
above the costs of the existing pilot (Section 4):
Pay costs: Dudley
Resource
No of WTE
Consultant
Radiographer 1.78
Nurse
1.14
Total: £102,659
Cost
£67,526
£35,133
Pay costs: Wolverhampton
Total: £29,014
Resource
No of WTE
Consultant
Radiographer 0.3
Cost
Nurse
£16 712
0.5
£12 302
Pay costs: SWBH
Resource
Consultant
Radiographer
Nurse
No of WTE
0.05
0.05
Total staff costs
The additional radiographers and nurses
would need to be recruited to provide an
8:00 – 20:00 service.
The additional radiographers and nurses
would need to be recruited to provide an
8:00 – 20:00 service.
Total: £4,230
Cost
To cover the extra hours worked.
£2307
£1923
£135,903
The additional staff costs associated with extending the pilot to 08:00 – 20:00 would not
increase the cost per nephrostomy as the same number and type of staff would be required
per procedure. The costs increase as more nephrostomies would take place during the
periods between 8:00 and 9:00 and between 17:00 and 20:00 and because more staff would
be required to maintain this working pattern. The staff would also be on call and available
to cover other procedures when not undertaking a nephrostomy. As with the 9 to 5 pilot,
the costs of extending to an 8 to 8 service would be incurred where the procedure is
undertaken.
3
Indicative costs for a 24/7 service can be found in Appendix One.
ENC 7 IR Report
7
However, discussions with radiographers and nurses involved in the pilot have indicated
that staff would be reluctant to participate in an on call rota covering the hours from 8:00 –
20:00 given their other on call duties (e.g. vascular rota) and because it would constitute a
change to their current contracted working pattern. Given recruitment and retention
difficulties of staff with relevant skill sets, the IR Steering Group proposes that an on-going
weekend on call service should operate as a 9:00 – 17:00 service.
If the arrangements ceased after the pilot finished, there would be a deficit in the quality of
service provided by the trusts as none would be able to offer an on call weekend service
alone without significant investment in staff. This would mean that the trusts would not be
compliant with relevant standards and NHS England requirements. Any patients requiring a
nephrostomy at the weekend would either have to wait until Monday, have an alternative
more invasive procedure or transfer to University Hospital Birmingham.
5.
Proposed extension to other procedures
The standards and guidance produced by the Royal College of Radiologists, British Society of
Interventional Radiology and National Imaging Board on the service delivery of
Interventional Radiology; as well as the NHS England requirement for access to IR 24/7
services, include haemorrhage control (e.g. GI bleeds) and Urological procedures other than
Nephrostomy.
Feedback from clinicians at the four Trusts involved in the pilot, including Gastroenterology
and Urology leads, indicates that they are positive about extending the remit of the existing
service to other relevant IR procedures. A meeting for Urologists, Gastroenterologists and
Radiologists to discuss potential extension of the pilot and to enable shared learning from
the pilot was scheduled for early September, but did not take place due to annual leave
arrangements and the planned Junior Doctors’ strike. IR leads have discussed the
development of the pilot with Gastroenterology and Urology leads within their trusts that
have been keen to develop an on call service for these procedures. In addition, a conference
call is being arranged during a BCA Urology Meeting on 20 th October to enable shared
learning to take place between IR, Urology and Gastroenterology leads.
The core requirements for an extended IR service are the same as for nephrostomy:
i)
Workforce:
All team members must have the following members:





Consultant Interventional Radiologist
Radiographer
Nurse
Circulating person – required to provide support within in the treatment room when
the procedure is underway (can be either a nurse or radiographer)
a Gastroenterologist to be on call at the host trust to accept the patient.
ii)
Facilities:


Interventional Radiology Suite
Appropriate ward based beds post procedure; this may be HDU, depending on the
individual requirements of the patient.
ENC 7 IR Report
8
Consequently, each Trust has scoped the costs of resourcing an extended weekend service
to extend the pilot to other relevant procedures based on the current model of delivery.
However, two options have been proposed and costed:


i.
Option One Weekend service operational between 9:00 and 17:00
Option Two Weekend service operational between 8:00 and 20:00
Option One: 9:00 - 17:00
Pay costs: Dudley
Total: Additional £34,377
Resource
No of WTE
Consultant
Radiographer 0.5
Cost
Nurse
£15,409
0.5
£18,968
Pay costs: Wolverhampton
Total: Additional £33,346
Resource
No of WTE
Consultant
Radiographer -
Cost
Nurse
33,346
1.0
Pay costs: SWBH
Cost
£20,000
£40,000
Nurse
£40,000
Total staff costs
ii.
SWBH have the greatest gap to be filled to
make this work. Consultant PAs are required
to backfill for other clinical commitments
undertaken whilst on-call.
Radiographers and nurses required to make
the rest of the routine rotas work
£147,723
Option Two: 8:00 - 20:00
Pay costs: Dudley
Total: Additional £102,659
Resource
No of WTE
Consultant
Radiographer 1.78
Cost
Nurse
£35,133
1.14
£67,526
Pay costs: Wolverhampton
Resource
Consultant
Radiographer
Nurse
ENC 7 IR Report
Consultants and radiographers are already
working on an on-call rota and can cover the
extension of the pilot but an additional
nurse would be required as the workload
would increase.
Total: Additional £80,000
Resource
No of WTE
Consultant
2PA
Radiographer 1.0
1.0
Although existing staff will provide cover, an
additional 0.5 Band 6 radiographer and
additional 0.5 Band 5 nurse would be
required to sustain the rota as the
probability of the team being required would
increase.
No of WTE
1.3
1.5
Based upon an additional 0.64 of Band 6
radiographer x 2 and 0.64 of Band 5 nurse,
providing a shift cover for the extended
service assuming a substantial increase in
work.
Total: Additional £103,314
Cost
£53,295
£50,019
9
Pay costs: SWBH
Total: Additional £120,000
Resource
No of WTE
Consultant
2PA
Radiographer 1.5
Cost
£20,000
£60,000
Nurse
£40,000
1.0
Total staff costs
PAs required to backfill for other clinical
commitments undertaken whilst on-call.
This reflects the total requirement. i.e. 0.5
WTE radiographer in addition to the 9:00 17:00 option
£325,973
It has been difficult to estimate the cost of consumables that would be required to extend
the pilot to other procedures because a wide range of procedures could be undertaken
which have very different consumable costs. The IR Steering Group propose to monitor the
expenditure on consumables to ascertain whether the costs even out between Trusts and if
demand (and therefore cost) increases due to availability of a pilot service.
However, discussions with radiographers and nurses involved in the pilot have indicated
that staff would be reluctant to participate in an on call rota covering the hours from 8:00 –
20:00 given their other on call duties (e.g. vascular rota) and because it would constitute a
change to their current contracted working pattern. Given recruitment and retention
difficulties of staff with relevant skill sets, the IR Steering Group propose that an on-going
weekend on call service should operate as a 9:00 – 17:00 service. Formal consultation
would take place with relevant staff at each Trust.
In summary, the costs associated with all models of delivery are:
Option
Model of delivery
1
2
3
4
Stop the service
Continue with Nephrostomy only 9-5
Extend Nephrostomy only to cover 8-8
sustain Nephrostomy service on 9-5 basis and
add other procedures, initially on a 6 month
pilot
sustain Nephrostomy service on 8-8 basis and add
other procedures, initially on a 6 month pilot
Independent 24/7 out of hours provision at all
four trusts
5
6
Total staffing
costs (£)
0
25,3804
131,673
144,723
314,973
1,040,000
The IR Steering Group recommends option 4, the implementation of an extended 9am –
5pm weekend and Bank Holiday service for relevant GI and Urology procedures as a pilot for
six months, during which time patient outcomes, activity levels and cost of the service
(especially for consumables) will be monitored.
In order to commence the pilot in a sustainable way and to minimise impact on the existing
workforce, the start date for the pilot is influenced by the following:
4
Calculated as indicative staff cost per procedure x actual number of procedures undertaken during 6
month pilot x 2 to give annual staffing cost. This cost is lower as additional staff have not been
appointed and most work is absorbed by existing on call vascular cover at Wolverhampton and
Dudley and through the current establishment at SWBH.
ENC 7 IR Report
10

business cases being written and approved by each individual trust to secure funding
for the additional posts;
recruitment of the additional posts and the employment of successful candidates
commenced;
recently recruited consultants at SWBH commencing employment (early 2017);
staff training taking place;
a SOP and patient pathway being developed by the IR Steering Group and agreed by
the trusts involved;
avoid introducing new service during a period when winter pressures are still being
experienced.





Therefore, the IR Steering Group proposes that the pilot commences in April 2017.
The following risks of implementing an extended on call service have been identified:
Risk
Mitigation
Ability to fulfil the workforce
requirements of an extended service
Business cases developed by each Trust to
seek approval for funding for additional
staff required for the extended service
Potential BCA joint recruitment campaign
to any vacant posts with open day
Head hunting of suitable candidates
Retention of existing staff who feel
extension to additional procedures
would increase on call frequency beyond
that which they are willing to commit to.
Additional staff in place to minimise impact
on existing staff
Delay due to time taken to train new
staff
Skills analysis of existing staff to identify
gaps
Ensure training needs of new and existing
staff are identified early enough and
training is planned in a timely way.
Gastroenterology bed availability
SOP to be developed to address bed
availability for patients that transfer.
The referring trust would need to give
priority to repatriate the patient back
Resilience of the rota due to limited
workforce
Clinical teams would have to provide cover
in the case of sickness
Compliance of the ambulance service to
transport patients to and from the
designated site
Development and agreement of the SOP
ENC 7 IR Report
11
Bed availability at the receiving site
The SOP will outline the requirement to
confirm a bed is available at the receiving
trust before the decision to transfer the
patient is made
Availability of porters and other support
staff if future activity increased slowing
down the movement of patients to and
from radiology within the host hospital
Earlier notification to portering team of
need to move patient
Clarity in SOP of requirements for hospital
porters
The IR Steering Group recommends that:
1)
2)
3)
4)
5)
ENC 7 IR Report
the 9:00 – 17:00 weekend/bank holiday Interventional Radiology (IR) nephrostomy
pilot becomes an on-going arrangement between participating trusts in its current
format and that BCA pathway and QIA documents are completed;
individual organisations and the IR Steering Group continue to resolve the issues with
current pilot (Section Three);
the current model of delivery is extended to other relevant Urology and
Gastroenterology procedures for a pilot period of six months from April 2017, subject
to the resources required being approved by individual Trusts (Section Five);
a qualitative survey of patients and their relatives/carers takes place to capture their
feedback;
Trusts involved in the pilot work together to continue to explore how to close the gap
between the national requirement for 24/7 access to Interventional Radiology and the
service offered as part of the IR pilot and proposed extension to it.
12
Appendix One: Indicative cost of additional staff required to implement a 24/7 on IR
service at one hospital site
Pay costs
Radiographer (band 6)
Nurse (band 5)
HCA (band 2)
Stand by weekday x 5 days/week less bank
holidays
Stand by weekend x 2 days x 52 weeks
Stand by Bank Holiday x 8 (24 hour shift)
Call outs based on 2 per week x 5hours per call
out plus travel time
Cost per
WTE
40,995
33,346
21,445
WTE
3.6
2
1
147,582
66,692
21,445
5,449
5,207
455
10,090
TOTAL
ENC 7 IR Report
Annual cost
256,920
13
Appendix Two: Initial estimate of costs of IR Nephrostomy pilot
1)
Annual activity / income
a.
b.
c.
2)
Costs of set up and recurring costs
a.
i.
ii.
b.
i.
ii.
iii.
iv.
c.
i.
ii.
iii.
3)
ENC 7 IR Report
7 nephrostomies in 2014/15 across Dudley, Sandwell and Walsall
Estimated c. 3 per trust across the year (Dudley, Sandwell and Wolverhampton)
Income is approximately £1,200 depending on the complexity
3 x 1,200 = 3,600 per trust
3 x 3,600 = 10,800 total income annually
Basic staffing stand-by costs
Based on 52 weekends per year + 8 bank holiday
= c. 39 days per trust per year
Stand-by costs for radiographer, nurse, and circulating person
= £59 per day including on costs
39 x 59 = 2,301 per trust for the basic running of the service
Running costs for procedures
Pay costs
= 364
Non pay costs
= 600
Total cost
= 964
3 procedures
= 2,892 per trust
Set up costs
SWBH
1.
have held a vacancy for a second Radiologist. These associated costs will
therefore be restricted to recruitment costs, as the post will not be solely
to provide this service, we propose that the costs are absorbed by SWBH
2.
Training costs for additional radiographers to be skilled in IR techniques –
amount to be confirmed
WHCT
1.
requires time to provide refresher IR training for the Radiologist for the 7
day service. This role will also need to backfilled – amount to be
confirmed. This is not essential for the duration of the pilot
DGFT
1.
additional training of radiographers to provide “scrub” hours – amount to
be confirmed
Split of contribution for each organisation
a.
Costs
i.
Based on the assumptions of basic stand-by costs, costs per procedure and
an average of 3 procedures per trust the individual trusts running costs
would be
14
ii.
2,301 + 2,892 = 5,193 annually
NB. This excludes the unknown set up costs
The average cost per trust for the pilot for 6 months running would be
5,193 / 2 = 2,596.50 for 6 months
b. Income
i.
Based on a standard income figure of 1,200 per procedure the individual
trusts income would be
3 x 1,200 = 3,600 annually
ii.
The average income per trust for the pilot for 6 months would be
3,600 / 2 = 1,800 for 6 months
c. The net cost per trust would therefore be
i.
Annually
5,193 – 3,600 = 1,593
ii.
Pilot
2,596.50 – 1,800 = 796.50
ENC 7 IR Report
15
ENC 8
The Black Country Alliance
Back Office Services Phase 1
TITLE:
Back Office Services Phase 1
EXEC SPONSOR:
BCA Board
AUTHOR:
Terry Whalley
PRESENTER
Terry Whalley
OBJECTIVE:
The purpose of this paper is to provide a summary of the progress made in the first wave of Back Office
Service reviews commissioned by the BCA Board that began in April 2016, and to provide visibility on
next steps / plans for remainder of 16/17.
KEY ISSUES:
None other than those covered in the paper
IMPLICATIONS OF PAPER:
RISK
Risk Register:
CQC
Patient / Citizen
Engagement
COMMS,
Monitor / TDA
COMPLIANCE
Equality Assured
and/or
Competition
&
LEGAL
REQUIREMENTS Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
None
N
N
Not required
Not required
N
N
N
Not required
Not required
Not required
Y
Y
Discussion
Other
X
RECOMMENDATIONS FOR THE BCA BOARD:
The Black Country Alliance Board is invited to receive and comment on the report, provide any further
guidance on next steps for the projects and endorse the specific recommendations made;
Temp Staffing



Endorse the emerging proposals in relation to harmonisation of rates and specifically the
appetite for individual Trusts to move away (either up or down) from current rates to a BCAwide rate;
Approve the phased approach to implementation of any harmonisation of rates, starting
with the ‘deep dive’ into Radiology;
Approve recommendation to continue on disparate e-rostering systems on the basis that the
costs of consolidating outweigh any potential benefits.
ENC 8 161012 Back Office Services Phase 1
Clinical Coding




endorse the anticipated timelines in respect of the following areas of collaborative working:
BCA Network for Data Quality and Best Practice (sharing good practice / technical advice),
with a view to establishing a schedule of meetings by the end of 2016
BCA Academy for Coders (Apprenticeship and Training Programme) to develop our own, with
a view to having apprentices in post by April 17 at the latest;
Home Coding opportunities to be exploited, with learning shared across BCA Trusts and a
subsequent timeline agreed for implementation (a further update in respect of savings and
timelines to be provided at the November Board).
ENC 8 161012 Back Office Services Phase 1
2
1
Purpose
The purpose of this paper is to provide a summary of the progress made in the first wave of
Back Office Service reviews commissioned by the BCA Board that began in April 2016.
Contract management in
estates and facilities
Research governance
Information governance
Legal services
Temp staffing
admin/rates
ESR admin
Coding
Procurement
Occupational health
All three Trusts operate PFIs. There is an extensive team at
SWBH and changes in the team at Walsall. There is
considerable collective knowledge of contract management.
This review will examine both KPIs, processes for monitoring,
and opportunities to operate similar review structures.
All 3 Trusts operate offices which examine, price, and approve
studies. These 3 operate to common regional and national
standards. The duplication may have value, but all three face
periodic capacity pressures. We ought to be able to develop
rapidly a virtual, single process with common charging
standards.
All 3 Trusts operate small teams to advise Caldicott guardians
and staff on issues of legal compliance. There may be merit in
pooling that expertise to create good coverage across the
three organisations, as well as peer support in isolating roles.
SWBH employs its own solicitor. All 3 Trusts use firms under
contract, and wish to reduce cost. The review will explore
whether a shared function, containing two solicitors, has the
prospect of doing that.
We will explore immediately rates and terms being put in
common. This will report back by July. Beyond that we will
explore whether a single bank and bank system would add
bandwidth and value.
We operate different ESR systems. We want to collaboratively
map our processes associated with using these systems. This
may illustrate opportunities to lean approaches, and will
provide a knowledge base in examining the future of all 3 ESR
systems.
All three Trusts operate separate teams. We want to explore
banding structures, and best practice including virtual ‘home’
coding. We can examine leadership and training structures.
Strategic and tactical advancement of our collective
procurement capability to enable significant improve value for
money, balancing quality & value.
This is a bilateral piece of work (DGH not involved) to create
the right OH service for Walsall, building from the award
winning unit at SWBH
2
Project updates
2.1
Contract Management in Estates & Facilities
Covered in some detail in appendix A, An initial review of each of Trusts current PFI
arrangement has been completed. This has confirmed extant arrangements and highlighted
some variation, for example length of concession, age of contract, and scope of services
provided. Such differences need to be acknowledged as they will complicate negotiations,
and impact on securing improvements and benefits across each of the Trusts. A meeting is
ENC 8 161012 Back Office Services Phase 1
3
planned for early November to enable lessons learnt from the review to be captured and
shared across the 3 Trusts.
In addition to the review of the 3 Trusts PFI Contract Management arrangements, a range of
other Non PFI potential opportunities have also been identified and progressed to varying
degrees in Q2, including Trusts developing Service Level Agreements (SLAs) for estates or
facilities services enabling the sharing of resources and or the delivery of a service by one
Trust to another.
In Q3 and Q4 of FY16/17 other services which are also intended to be considered include:
2.2
•
Trust PFI Contract Management and Administration costs and Trust retained advisor
costs,
•
EBME services,
•
Potential discussions with SPV partners to identify other services and opportunities
(operational and strategic), which could be provided for mutual benefit.
Research Governance
Teams will act in an increasingly coordinated manner facilitated by the implementation
across all BCA partners of the EDGE clinical research software, which will provide a real-time
view of clinical research activity across the BCA. By providing a single, innovative, cloudbased clinical management system, EDGE supports collaboration and information sharing
between the key research stakeholders across the BCA, from project registration through to
closure. R&D teams across the BCA are now working in collaboration to train their staff on
the new system.
Colleagues at SWBH will be trialling a system to facilitate the mobility of patient facing R&D
staff by equipping them with laptops to allow them to access study related documents (e.g.
study protocols) at locations remote from the physical site files to enhance efficiency.
Outcomes will be shared with R&D teams at Walsall and Dudley.
In-house Good Clinical Practice (GCP) updates are provided locally to SWBH, Walsall and
DGH staff by members of the respective R&D departments. Local training opportunities will
be advertised and made available to all members of the BCA to increasing the range of
training opportunities available.
Details of open research trials across the BCA are now routinely shared within each Trust,
with the EDGE being used as the resource to capture and share details. Additionally, SWBH
follow up via their monthly QIHD sessions.
Coordinated Research activity is initially focussing around the following four exemplar
specialities: Cardiology, Rheumatology, Dermatology and Haematology.
More detail is provided in appendix B of this report.
2.3
Information Governance
Information Governance plays an important role within each Trust and the function provides
assurance required under legislation, in particular Data Protection Act 1998 and also has
responsibility to ensure national DoH and NHS standards are met. Each Trust employs
between 2 and 3 IG staff and this highlighted a need and opportunity to improve resilience
across the organisations in terms of access to advice and support. The teams are responsible
for assessing IG incidents to confirm whether serious incident (SI) severity criteria is met and
these are subject to 24 hour reporting deadlines to Information Commissioner’s Office and
48 hours to NHS England through STEIS. Other work is affected by statutory deadlines such
ENC 8 161012 Back Office Services Phase 1
4
as Data Protection subject access requests and Freedom of Information requests (though
not all IG teams process FOI requests). The teams have agreed and implemented proposed
way of working to ensure resilience, cover for planned and unplanned absence and
established a forum for knowledge sharing and collaboration on matters such as BCA
Information Sharing Protocols.
While this falls short of consolidation and doesn’t lead to sustained reduction in spend, it
does make better use of our collective resources by improving resilience which will mitigate
pressure to take on temporary staff in the event of unplanned absence and at the same time,
allows us to maintain service levels during planned absence.
2.4
Legal Services
The review of Trust Legal Services has confirmed that all 3 Trusts are already seeing a
downward trajectory on legal services expenditure, and has identified that there would be
negligible financial benefit from having a combined legal service across BCA without further
resources, which would not necessarily give value for the additional investment required.
However, there are opportunities which need to be explored further which may help to
further reduce the financial commitment for external legal advice by sharing
advice/information.
Numbers of claims are not high in any given year so analysing cases for any trends or themes
by Trust often does not provide meaningful information to learn from. By working together
BCA Trusts will share lessons to minimise the likelihood of a similar claim being brought
across the three Trusts.
The mechanisms for this need to be developed, not just across legal service provisions, but
by HR Directors (for example) in respect of employment advice and cases.
An option remains for HR Directors to consolidate employment legal advice and support
from a joint post holder to further reduce costs for each Trust. This will be further explored.
There may also be opportunity to consider tendering for one firm of solicitors to act on
behalf of BCA to further generate shared learning. This will require further discussion to
identify timing of current contracts and variables in current procurement.
See appendix 8c for more detail.
2.5
Temp Staffing Admin / Rates
Phase 1 of the temporary staffing project sought to undertake an options appraisal for a
collaborative temporary staffing working arrangement across the 3 BCA Trusts. The overall
direction of travel is towards the creation of a central bank or bank system and the project
includes the following key components.
Workstream
Harmonisation of bank
rates
Specialist Nurses
ENC 8 161012 Back Office Services Phase 1
Detail/ Rationale
Financial modelling to present the options, risks and investment
decisions associated with moving all 3 BCA Trusts onto the
same bank rates.
More detailed financial modelling and exploratory work is being
undertaken to consider options for this specific workforce, with
leadership from Rachel Overfield, Chief Nurse at WHC. Agency
usage for this staff group is particularly expensive. Within scope
are ED and paediatric nurses, and some AHPs e.g. sonographers
and radiographers.
5
Interpretation Services
Administration
Limited Company
Workers
IT (enabler)
Procurement of Agency
Workers
A separate task and finish (T&F) group has been established as
these services are not managed by the temporary workforce
leads in all 3 Trusts. The T&F group is exploring options for WHC
and DGFT to implement learning from the SWBH model.
This workstream considers all operational and practical
considerations associated with operating a central bank or bank
system e.g. policies, car parking, IT access, etc.
There are two main aims of this workstream:
 Ensure appropriate and consistent application of the new
IR35 guidelines, which come into effect on 1st April 17;
 Eradicate use of Limited Company workers across the BCA
Trusts.
Explore options for consolidation of IT systems e.g. for erostering including the benefits, risks and investment decisions.
Explore options for joint procurement of agency workers across
BCA Trusts.
Finance Leads from all 3 BCA Trusts have started to share information on bank rates, fill
rates and agency spend. Currently, there is significant variation in the rates offered across
the BCA. As such, the group has committed to modelling the investment required and risks
associated with following 2 options:
1.
2.
3.
Moving to / toward the highest rates currently offered;
Moving to / toward the current BCA average rates;
Moving to / toward a rate somewhere between 1 and 2.
The initial financial modelling has highlighted the significant financial impact for Trusts that
might be required to increase rates. The next step is to model, at a more granular level, the
options that demonstrate how decreases in agency spend may enable a bank rate that is
attractive enough to encourage increased uptake. In other words, financial benefits are
associated with reduced agency spend if agency workers can be attracted onto the bank. If
successful, the savings here could outweigh any cost-pressures as a result of increased bank
rates and support Trusts to achieve their agency ceiling targets. However, there are
significant risks; the increased uptake must be sufficient such that the increased pay rates
for existing bank staff are also covered off by a reduction in agency spend.
Production of this more detailed data is underway (for all staff groups) and the data
requirements are discussed on a weekly basis by the project group to both analyse and
consider additional requirements. This exercise will be completed by the end of 2016.
The group recommends a risk-based approach to implementation of any BCA-wide,
harmonisation of bank rates. It is difficult to be certain of all influencing factors in terms of
uptake and there remains a need to test some of the assumptions made to date. Therefore,
the proposal from the group is to undertake a deep dive of certain, specialist areas as a
starting point with a view to rolling out across other specialist areas and potentially to more
general nursing over time. The Specialist Nurse workstream is desirable because this
workforce accounts for a significant amount of agency spend and particularly off-framework
spend with each shift attracting a high tariff.
The project group is exploring options to attract this particular workforce back into bank
employment. The group has commenced a ‘deep dive’ of agency spend and substantive fill
rates within Radiography as this is a staff group for which SWBH has seen particular success
in terms of attracting individuals from agency to bank employment.
ENC 8 161012 Back Office Services Phase 1
6
For Interpretation Services, SWBH has adopted an in-house model, which has resulted in
significant savings for this temporary workforce. Both DGFT and WHC have expressed an
interest in adopting the same or a similar model, which also includes the potential to utilise a
mobile workforce across the 3 Trusts in future. There is consensus that many of this
workforce are already mobile across the BCA patch due to the nature of the current service
at SWBH (covering community services and GP practices).
DGFT and WHC are at different stages in terms of existing contractual arrangements with
external interpreting services. At the time of writing, the T&F group is newly established and
is yet to meet for the first time. However, there is agreement in principle from all 3 Trust
Leads to explore options for future collaboration.
The group have produced a long list of administration considerations that are required
should a decision be taken to move towards a central bank or bank system. This includes
recruitment, advertising, payroll support, training, disciplinary issues, car parking, ID and
access, exchequer services, communication, IT, and call centre processes.
Limited Company workers exist predominantly within the medical workforce although there
are increasing numbers from other staff groups. From 1st April 17, new HMRC IR35
guidelines will restrict the circumstances within which the use of this form of employment
will be appropriate and legal. Helpfully, PWC has produced guidance to support Trusts with
interpreting the new guidelines, which has been shared across the Temporary Staffing
Project Group. To date, Finance Leads have agreed to produce consistent communication to
existing limited company workers advising them of the change and to confirm that, where
appropriate, Trusts will start to collect tax and NI at source from 1st April. This collaborative
approach ensures more robust mitigation of the risks associated with non-compliance.
The project group has explored options for consolidation of IT systems used for e-rostering
and temporary resource management. Following review of the investment required and the
level of functionality offered by each system, there is consensus amongst the group that
whilst a move to a single e-rostering system may be beneficial, it not essential to the
creation of a central bank or bank system.
It was originally thought that there were risks with staying on the SMART software (utilised
by WHC and SWBH) as there was no assurance that the software would be supported longterm. As such, the group was exploring whether Allocate (DGFT provider) could offer any
discount if it was procured jointly across the 3 Trusts. However, a detailed ‘road map’ of
performance upgrades for 2016 and 2017 has now been provided along with assurance of
continued support beyond 2017. In summary, the recommendation is for each Trust to
remain on their current software and for the remaining project workstreams to continue on
the basis that there will be multiple systems.
For medical staff, procurement of agency workers is either via direct employment, a
managed service, or the individual’s limited company. The 3 Trusts have committed to
sharing a breakdown of spend according to these categories and it is expected that this
information will be available by the end of October.
For Nursing and AHP staff, all 3 trusts are working within the HTE Framework and all 3 Trusts
are a member of the Birmingham Cluster Group, which helps to streamline rates, share best
practices and work collaboratively to encourage agency compliance with the national wage
and price caps. Going forward, the recent merger announced between HEFT and UHB poses
a risk to the future stability of this group; UHB are no longer members and there are
concerns that HEFT will follow suit. This further reinforces the recommendation for both a
Black Country STP and regional level collaboration on tackling the issue of agency spend.
ENC 8 161012 Back Office Services Phase 1
7
Summary of Benefits
The workstreams identified will have a combined impact on the following public value
benefits. These may well be realised to a certain extent by individual Trusts irrespective of
the project. However, collaboration across the BCA Trusts and potentially wider via the STP
and regional footprints will increase the likelihood of realising larger benefits within a short
period of time.
1.
Improving Health Outcomes
A reduction in agency workers will provide more consistency in care provision, and a better
understanding of local pathways and policies associated with care provision, thereby
improving health outcomes. It is also believed that a substantive workforce is more
committed to improving the long-term health outcomes of individuals and the wider local
population.
2.
Improving Healthcare Experience
Reducing the reliance on agency workers will improve the experience of healthcare for
patients and staff. For patients, a more committed workforce, with better understanding of
local pathways will help to minimise delays to treatment pathways. For staff, tension as a
result of high turnover and disparities in rates of pay is reduced and previously stretched
areas become better positioned to meet demand.
3.
Making Better Use of resources.
There are direct financial benefits associated with increasing the uptake of bank
employment. The associated reduction in agency spend is potentially significant. Additionally,
the collaborative approach will provide benefits, for example, through joint recruitment and
administration processes.
Recommendations; The BCA Board is asked to:
2.6
•
Discuss the emerging proposals in relation to harmonisation of rates and specifically the
appetite for individual Trusts to move away (either up or down) from current rates to a
BCA-wide rate;
•
Approve the phased approach to implementation of any harmonisation of rates,
starting with the ‘deep dive’ into Radiology;
•
Approve recommendation to continue on disparate e-rostering systems on the basis
that the costs of consolidating outweigh any potential benefits.
Electronic Staff Records (ESR)
The intention for this project was to identify variance in systems and processes across the 3
BCA Trusts where standardisation would be of benefit, specifically in terms of making the
best use of resources.
To date, the project group has shared information on the operational system processes
associated with ESR in the individual organisations. They have identified areas of variation
for example, the extent to which manager self-service functionality is utilised. As per earlier
reports to the BCA Board, the ESR Leads continue to meet on a regular basis to share
learning and to identify how they could work more effectively together. This includes a
commitment to work jointly on implementation of ESR updates (delayed from summer 2016
and now expected in April 17).
Additionally, the project group has produced a high level overview of all organisational
ENC 8 161012 Back Office Services Phase 1
8
functions that interface with ESR. There is consensus across the group that these present
multiple opportunities to potentially reduce variation. However, the implication of change to
these systems and processes is both complex and far-reaching in terms of the number of
staff and other business processes / IT systems involved. For this reason, greater focus has
been given to the other HR projects where the route to value is less complex.
Going forward, HRDs have provided a direct steer in terms of aspirations for the project and
the areas for which they expect to be able to realise benefits through collaboration. As such,
the project group will focus on undertaking a detailed process mapping exercise of the
following ESR-related areas with a view to presenting a clear options appraisal to the BCA
Board in early 2017. This will include how each organisation can make better use of ESR and
share best practice across the BCA:
•
Manager & Employee self-service; building on exemplars of where this has been
implemented and collectively going further
•
Appraisals, Attendance and Mandatory Training; making better use of ESR to support
and make more consistent our approaches with the aim of improving experience of
working in the Black Country and making better use of the workforce we have.
A further update on the above will be brought back to BCA Board in January or February
2017.
2.7
Coding
The Project Mandate for Clinical Coding describes a case for change based on difficulties
experienced across all three Trusts in appointing qualified clinical coders. There is a national
shortage of clinical coders and locally there are significant vacancies, with varying pay
structures in force across the three Trusts.
The BCA Board received at its August 31st meeting an overview of progress made in exploring
banding structures and best practice including virtual ‘home’ coding as well as leadership
and training structures. This paper provides an update in terms of progress made with:

Creating a local data quality network;

Developing a robust apprenticeship, training and retention programme;

The enablement of ‘home’ coding.
Data Quality Network
All 3 BCA Trusts are committed to establishing a BCA Network for Data Quality. In addition to
the existing West Midlands Academy Network, this would involve quarterly meetings with
Coding and Information Managers to review data quality across the patch. This process
would involve learning and sharing of best practice. The project group is due to meet in
October and will define a meeting schedule to ensure this is up and running by the end of
2016.
Improved quality of coding supports more accurate completion of other qualitative
measures such as mortality indicators, through the improved quality of diagnosis and
treatment coding. This gives Trusts a better understanding of the acuity and disease
prevalence across the population and therefore provides an improved opportunity to take
action that will improve health outcomes and experience of healthcare.
There are wider benefits in terms of improving the use of resources. For example, it will have
a positive impact on the accuracy of reference cost information, which impacts on Trusts’
financial forecasting as well as influencing the national tariff. Additionally, HRG4+ is
ENC 8 161012 Back Office Services Phase 1
9
expected to be released in the next financial year. Improved data quality across the patch
will better enable BCA Trusts to code accurately against an increased number of HRGs
(increased breakdown of comorbidities alongside the primary diagnosis).
Apprenticeship Programme
The project group continues to work on developing a training and apprenticeship scheme,
which will help to rebuild this workforce in the medium term and lead to a sustainable
workforce over the next 2-3 years. Since the previous report, there has been an initial
meeting with Dudley College, who have confirmed their support for the scheme. Colleagues
at DGFT are working on the scheme documentation covering the terms and conditions,
academic training and support and costs. They are also developing a JD and person
specification. The group expects to be able to secure the first round of apprentices in Q4 of
2016/17 but by no later than April 17 (e.g. if the funding is not available to commence in
2016/17).
The benefits associated with this scheme are predicated on our ability to ‘grow our own’
coders. It responds to the specific problem of there being a local and national shortage of
qualified coders. Indirectly, health outcomes will be improved through improved coding
accuracy. Reduced vacancies will improve the experience of staff working within the existing
coding teams as they will be better able to meet demand. It will also help to relieve any
tensions caused as a result of agency staff being paid higher rates of pay in comparison to
the substantive workforce.
The ability of Trusts’ to train individuals and convert a number into qualified coders will have
a direct impact on agency spend as well as ensuring the volume and quality of coding in
individual Trusts is sustained into the future. It is hoped that the introduction of an
apprenticeship programme will enable Trusts’ to identify potential coders before investing
the significant time and resources required to support trainee coders through to being
qualified.
Finally, the scheme includes the addition of contractual clauses that insist individuals remain
in the host organisation (or BCA Trust) for a period of time (e.g. 2-5 years to be agreed and
dependent on the cost of qualification), otherwise the individual would be required to payback the cost of the course on a pro-rata basis. This minimises existing risks that resources
are deployed to training individuals that subsequently leave to work in other Trusts.
Virtual ‘Home’ Coding
Since the previous report, the group has made contact with the Coding Lead at UHNM. They
have shared details of their processes and a ‘Home Coding Policy’, which can be adapted for
use by BCA Trusts. This includes the ‘rules’ agreed that guide coders whilst working off-site.
It is recommended that individuals are asked explicitly to sign-up to these as part of the
hiring process and that compliance is monitored.
As previously discussed, from an IG perspective, ‘home coding’ would only be possible
within an electronic system. Paper-based notes or discharge letters cannot be transported
off-site as the risks in terms of an IG breach are too high. As such, each Trust will need to
have a fully operational EPR system and, whilst all 3 Trusts share this aspiration, they are
currently at different stages of implementation. It is therefore likely that this element of the
project will be implemented in each individual Trust at different times.
The facilitation of ‘home’ coding offers potential benefits in the medium to long term as part
of the wider workforce strategy for Coders in the BCA: health outcomes are improved
through improved coding accuracy and quality, which is improved with a consistent and
ENC 8 161012 Back Office Services Phase 1
10
substantive workforce; and the flexibility of ‘home’ coding significantly improves the
experience of staff, particularly for those with childcare and other dependency-based
considerations.
Financial benefits could be realised within the current financial year. Based on early
negotiations (to be confirmed), a ‘home’ coder offers a potential saving of approximately
£16k per annum per Coder for posts currently filled by agency workers. It is hoped that these
benefits will incentivise BCA Trusts to consider the pace at which they can implement ‘home’
coding.
Longer term, it is expected that home coding will support attraction to and retention within
the substantive workforce, thereby further reducing the reliance on agency workers and
presenting additional opportunities to consider a collaborative approach to supporting
vacancies.
Recommendations
The Board is asked to note the progress made and endorse the anticipated timelines in
respect of the following areas of collaborative working:
2.8

BCA Network for Data Quality and Best Practice (sharing good practice / technical
advice), with a view to establishing a schedule of meetings by the end of 2016;

BCA Academy for Coders (Apprenticeship and Training Programme) to develop our own,
with a view to having apprentices in post by April 17 at the latest;

Home Coding opportunities to be exploited, with learning shared across BCA Trusts and
a subsequent timeline agreed for implementation (a further update in respect of
savings and timelines to be provided at the November Board).
Procurement
A high level review of extant procurement functions was commissioned by the BCA
Procurement Steering Group and completed with support from NHS Business Services
Authority, which concluded that the 3 trusts lacked the strategic capacity and capability to
drive at pace and scale the kind of transformation required with respect to procurement.
This was presented back to BCA Board in April and a decision was taken to recruit a joint
director of procurement and establish a clinical procurement group.
At the same time, a small number of tactical procurement projects were initiated to enable
collaboration among the existing heads of procurement, and current view is that these will
generate savings in excess of £140k in current FY 2016/17, with recurring annual value in
excess of £300k per annum.
We have subsequently appointed Dave Coley, formerly Procurement Director at HeFT, who
starts formally in post on 1st October. We have also formed a Clinical Procurement Group to
provide a more effective link between BCA procurement function and clinical colleagues
across the 3 Trusts. We have also taken steps to implement effective analytics capability to
support improved assessment and identification of opportunity.
The initial commitment made by all 3 Trusts is to transition over 12 months to a new model
of procurement with the expectation that this will lead to significantly improved response to
Carter and realisation of non-pay spend reductions through collaboration.
During the autumn and winter we expect under Dave’s leadership to develop BCA wide
procurement strategy for endorsement in the spring of 2017 which will cover among other
things how we e-enable and modernise our supply chain, for example introducing a single
ENC 8 161012 Back Office Services Phase 1
11
BCA catalogue solution, how we maximise and leverage our collective buying power, how we
make the most of extant knowledge and strengths within each Trust on behalf of all Trusts,
how we collaborate effectively with neighbours to achieve greater synergy and of course,
how we compare & save through better analytics and benchmarking. We will also consider
the case for more focussed Clinical Nurse Procurement model to complement our Clinical
Procurement Group.
2.9
Occupational Health
Covered in some more detail in appendix D, Occupational Health review has progressed
between SWBH and WHC. The plans in place will enable WHC OH outcomes to improve
because the collaboration with SWBH will allow them to meet national minimum quality
audit standards (SEQOHS) and then develop in terms of clinical governance. Accreditation
will potentially enable WHC to be better placed to win tenders for external business too.
SWBH will benefit from the extra expertise offered by the nurse in charge at WHC when
developing further clinical initiatives and policy. There will be a consistent standard of
service at both units.
In addition the collaboration opens the opportunity for all staff to be seen more quickly, and
more local to their home, by utilising both sites as need arises. The staff fast-tracking
treatment service at Sandwell could also be easily rolled out at Walsall with this
collaboration, so that all staff can be treated and investigated more quickly and locally too.
SWBH has an award winning health and wellbeing service so the resources can be shared
cost effectively. OH staff can rotate to gain more experience and there is good evidence that
larger OH units recruit more easily.
Investing in a joint consultant post and potentially sharing counselling services will be
cheaper for WHC and allow us to attract another specialist trainee to work in both services.
Joint training in development nursing posts which are already established at SWBH can be
used, preventing the need for agency workers which have been the mainstay at WHC. SWBH
will benefit from the extra consultant post which it would not have been able to fund alone
but provides some more depth of service.
3.
The Ask of the Black Country Alliance Board
The Black Country Alliance Board is invited to receive and comment on the report, provide
any further guidance on next steps for the projects and endorse the specific
recommendations made;
Temp Staffing



Endorse the emerging proposals in relation to harmonisation of rates and specifically the
appetite for individual Trusts to move away (either up or down) from current rates to a
BCA-wide rate;
Approve the phased approach to implementation of any harmonisation of rates, starting
with the ‘deep dive’ into Radiology;
Approve recommendation to continue on disparate e-rostering systems on the basis
that the costs of consolidating outweigh any potential benefits.
Clinical Coding


endorse the anticipated timelines in respect of the following areas of collaborative
working:
BCA Network for Data Quality and Best Practice (sharing good practice / technical
advice), with a view to establishing a schedule of meetings by the end of 2016
ENC 8 161012 Back Office Services Phase 1
12


BCA Academy for Coders (Apprenticeship and Training Programme) to develop our own,
with a view to having apprentices in post by April 17 at the latest;
Home Coding opportunities to be exploited, with learning shared across BCA Trusts and
a subsequent timeline agreed for implementation (a further update in respect of savings
and timelines to be provided at the November Board).
ENC 8 161012 Back Office Services Phase 1
13
Appendices
A - Estates & Facilities Report
B - RM&G Report
C – Legal Services Report
D – Occupational Health Report
ENC 8 161012 Back Office Services Phase 1
14
ENC 8a
The Black Country Alliance Programme Board
Review of PFI Hard & Soft FM Contract Management Arrangements - Estates and Facilities
(Back Office Functions)
TITLE:
AUTHORS:
Black Country Alliance
Alan Kenny
Director of Estates /New Hospital
CONTRIBUTORS:
EXEC SPONSOR:
PRESENTER
Alan Kenny
N/A
Purpose of Paper
This paper summaries; the progress made during Q2 - 16/17 in response to the BCA Boards
request for a review of the current PFI hard and soft Contract Management arrangements
across each of the 3 Trusts. The paper also provides a summary of the other potential
opportunities being explored in terms of Estates and Facilities back office functions.
Objective:
The objective behind the review being to examine the arrangements, structures, processes,
resources and KPIs, against which the each Trust manages its PFI contract, identify and secure,
(financial and non-financial), improvements.
An initial review of each of Trusts current PFI’s confirmed that each Trust;





ENC 8a Estates
Reviews their PFI contracts as part of annual planning business planning processes.
Operational meetings are held monthly by each Trust with its SPV partner.
Inspections are undertaken to monitor the performance and quality of services jointly
and independently by the Trust and SPV.
Variances exist between how each Trust resources its PFI contract management team
this reflects the scale of the PFI, scope of services provided performance of and
relationship with the SPV partner.
Key performance indicators (KPIs) are used by each Trust to measure and monitor
service performance, the calculation of service failure points and levying of financial
deductions. The KPIs’ are consistent with DH and HMT Treasury guidance and include;
o Help desk services,
o Response and rectification times for urgent, emergency and routine works.
o Compliance with statutory standards.
o Life-cycle programmes.
o Energy
The review also identified material differences between each Trusts PFI contracts, e.g. length of
concession, age of contract, scope of services provided,






Dudley’s PFI was part of the 1st wave of health care PFI projects. The contract / project
agreement is not of a standard form. As a consequence contractual terms, conditions,
risk allocation, performance & monitoring criteria are inconsistent with “standard form”
contracts used on both Walsall’s and S&WB’s PFIs contracts.
Each Trust’s PFI was designed, constructed and is operated by a different SPV, each
project has different funders / stakeholders. The operational contract period for the PFIs
range between 30 and 40 years.
The scope of FM services provided in each PFI is different. At Dudley the SPV provides
hard & soft FM services to the PFI estate. At Walsall the SPV provides only hard FM
services, to the PFI and the Trusts retained estate. At S&WB the SPV provides hard FM
services only to the Birmingham Treatment Centre.
Financial models which underpin each PFI have differences reflecting when financial
close was achieved, contracts signed and market conditions.
Advisors, (e.g. Legal and Financial at each Trust are different).
In addition differences exist with regard to the level of commercial management applied
by each of the 3 Trust’s confirming that there are opportunities for each Trust to learn
from each other and engage more proactively with their respective SPV partners.
Such differences need to be acknowledged as they will complicate negotiations, and impact on
securing improvements and benefits across each of the Trusts.
A meeting is planned for early November to enable lessons learnt from the review to be
captured and shared across the 3 Trusts. This timescale reflects work being undertaken by the
Dudley Group in response to the development of their local STP.
Other Potential Opportunities.
In addition to the review of the 3 Trusts PFI Contract Management arrangements, a range of
other Non PFI potential opportunities have also been identified and progressed to varying
degrees in Q2, these include;

A review of 15/16 PFI and Non-PFI performance benchmarking data published by DH for
each Trust. The objective being to identify and learn from the performance of the best
performing Trusts in the same category as each of the 3 individual Trusts.
This data has been used to inform the Lord Carter – Productivity and Efficiency work
programme. Both the Dudley Group and Sandwell & West Birmingham Trusts have been
visited by DH Estates staff and were encouraged to share aspects of the work they were
undertaking, e.g. the mock ups used to inform the design of MMH.

ENC 8a Estates
Trusts developing Service Level Agreements (SLAs) for estates or facilities services
2
enabling the sharing of resources and or the delivery of a service by one Trust to
another.
E.g. Sandwell & West Birmingham’s, and Walsall Healthcare’s Estates functions are
working together to provide a single estates service to both Trusts.
In Q3 and Q4 of FY16/17 other services which are also intended to be considered include:




Trust PFI Contract Management and Administration costs and Trust retained advisor
costs.
EBME services,
Potential discussions with SPV partners to identify other services and opportunities
(operational and strategic), which could be provided for mutual benefit.
An individual response to Recommendation 6 in the Lord Carter - Productivity and
Efficiency Programme. This suggests that:
All Trusts estates and facilities departments should operate at, or above the benchmarks
for the operational management of their estates and facilities functions by April 2017 (as
set by NHS Improvement by April 2016); with all trusts (where appropriate) having a plan
to operate with a maximum of 35% of non-clinical floor space and 2.5% of unoccupied or
under-used space by April 2017 and delivering this benchmark by April 2020, so that
estates and facilities resources are used in a cost effective manner.


Identify and respond to contract management teams training and development needs.
Review capital programmes of each Trust to identify and respond to opportunities, e.g. ,
shared project management, healthcare planning, design resources.
KEY ISSUES:
The option of project management support being made available is being progressed with the
BCA Programme Director, this may enable further opportunities for joint working on Estates and
Facilities services to be identified and pursued.
ENC 8a Estates
3
IMPLICATIONS OF PAPER:
RISK
Risk Register:
CQC
Patient / Citizen
Engagement
NHSI
Equality Assured
Competition &
Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
NO impact
N
N
N/A
N/A
N
N
N
N/A
No immediate equality considerations
N/A
Y
Y
Discussion
Other
X
RECOMMENDATIONS FOR THE BCA BOARD:
It is recommended that the BCA board discuss the paper and note the progress being made in reviewing
the PFI Contract Management arrangements of each Trust and the other potential opportunities being
explored by each Trust.
ENC 8a Estates
4
ENC 8B
The Black Country Alliance Programme Board
Research Management & Governance (RM&G) Update
TITLE:
Research Management &
EXEC SPONSOR:
Toby Lewis
Governance Report
AUTHORS: Karim Raza (SWBH),
PRESENTER
Terry Whalley
James Halpern (WHC)
Jeff Neilson (DGFT)
CONTRIBUTORS:
Jocelyn Bell, SWBH
OBJECTIVE:
This paper serves to provide the BCA Board with an update following the first phase review of
opportunity for collaboration across BCA Research Management & Governance
KEY ISSUES:
None
IMPLICATIONS OF PAPER:
RISK
Risk Register:
CQC
Patient / Citizen
Engagement
NHSI
Equality Assured
Competition &
Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
No impact at this stage
N
N
Not required at this stage
Not required at this stage
N
N
N
Not required at this stage
Not required at this stage
Not required at this stage
Y
Y
Discussion
Other
X
RECOMMENDATIONS FOR THE BCA BOARD:
The BCA Board is asked to note this paper, discuss the content and provide any further direction required
for focus in remainder of FY16/17.
ENC 8b BCA RMG Project
The Black Country Alliance
Research Management & Governance (RM&G) Update
A. RM&G
Coordinated working:
RM&G functions operate at all three BCA partners.
Until early 2016, study-wide (global) governance review of a research study application was
undertaken by the RM&G team of the lead NHS site. Now, all study wide governance
reviews are carried out by the Health Research Authority (HRA). These HRA reviews are
generic to the study and are undertaken once through a UK permissions coordinating
function on behalf of all organisations being asked to host the research study. The resulting
Governance Report assembles evidence to aid the host NHS organisation in making their
decision whether to grant NHS R&D approval or not based on an assessment of local
capacity and capability.
Since local issues (e.g. researcher capacity, pharmacy capacity, space) are local to each
organisation, and need to be assessed on a study by study basis via face to face meetings
with RM&G staff and other members of the study team (e.g. research nurses, principal
investigators, support staff), the assessment of local permissions will remain with local R&D
teams at each site for the present time. However teams will act in an increasingly
coordinated manner facilitated by the implementation across all BCA partners of the EDGE
clinical research software (http://www.edgeclinical.com/).
Historically BCA Trust R&D departments have used in house IT systems to aid the data
management of all research undertaken in their organisation. In 2015, through mutual
agreement, it was agreed that EDGE would be introduced to replace all previous
databases used within the BCA and provide a real-time view of clinical research activity
across the BCA. By providing a single, innovative, cloud-based clinical management system,
EDGE supports collaboration and information sharing between the key
research stakeholders across the BCA, from project registration through to closure.
Since the commissioning of EDGE, the last of the data migration from old systems to the
EDGE database was completed in July 2016 and R&D teams across the BCA are now
working in collaboration to train their staff on the new system. Once this process is
complete, EDGE will support a wide range of research management functions which will
enable RM&G staff, research managers, data analysts, research nurses and clinicians to
make the most of their information. For example, it will allow a straightforward mechanism
for identifying which studies are open at which site and will facilitate the sharing of standard
operating procedures.
The group considered more effective enrolment of patients for clinical trials using
technology, consent process and patient information, with the aim to reduce initial
interaction hit rate (aka time wasted interviewing candidates for studies who do not go
forward). SWBH will be trialling a system to facilitate the mobility of its patient facing R&D
staff by equipping them with laptops to allow them to access study related documents (e.g.
study protocols) at locations remote from the physical site files to enhance efficiency.
Outcomes will be shared with R&D teams at Walsall and Dudley. Prof Raza has had
discussions re optimising participant identification with R&D leads at UHB. Further
ENC 8b BCA RMG Project
2
developments in this area are dependent on searchable clinical information held in
electronic format / an electronic patient record – once the infrastructure is in place the
groups will explore further developing such systems. In the meantime, each trust will
continue to look for opportunity to improve within current constraints.
Coordinated training:
In-house Good Clinical Practice (GCP) updates are provided locally to SWBH, Walsall and
DGH staff by members of the respective R&D departments. Local training opportunities will
be advertised and made available to all members of the BCA to increasing the range of
training opportunities available.
Capacity Pressures:
All three Trusts face Trusts face capacity pressures. Headcount at BCA Trusts is low
compared to others, with higher recruitment volumes and intent to increase those volumes.
Consequently, there is no immediate capacity for sharing that resource until and unless
there is a clear direction that recruitment is to be targeted at a BCA level rather than at each
Trust.
B. Coordinated research activity
Details of open research trials across the BCA are now routinely shared within each Trust,
with the EDGE being used as the resource to capture and share details. Additionally, SWBH
follow up via their monthly QIHD sessions.
Coordinated Research activity is initially focussing around the following four exemplar
specialities: Cardiology, Rheumatology, Dermatology and Haematology. Examples of
activities to date include:
1. Cardiology. An agreement has been reached regarding (i) recruitment into the same
AF research projects (NOAH, EORP); (ii) coordinating a joint grant application on
integrated AF management, also involving the AHSN and based on implementation
of the 2016 ESC AF guidelines.
2. Rheumatology. Following the appointment of new consultants to work between
SWBH and Walsall, studies including “predicting outcomes in early arthritis” will be
extended from SWBH to Walsall.
3. Dermatology. Walsall is acting as a PIC site for a commercial rosacea study being
undertaken at SWBH.
C. To further enhance joint working we have agreed that the following are needed
1. R&D plans from DGH and Walsall to understand how R&D vision for all three BCA
partners aligns. A plan has been developed for SWBH.
2. An agreed BCA R&D income distribution and usage document. An SWBH draft is
currently under review by the SWBH R&D committee ahead of further consideration
at DGFT and WHC ahead of bringing back to BCA Board by the end of the year.
The BCA Board is asked to note this paper, discuss the content and provide any further direction
required for focus in remainder of FY16/17.
ENC 8b BCA RMG Project
3
ENC 8C
The Black Country Alliance Programme Board
Legal Services Project Update
TITLE:
AUTHORS:
Black Country Alliance
EXEC SPONSOR:
Allison Binns
PRESENTER
Assistant Director of Governance
CONTRIBUTORS: Kam Dhami, Glen Palethorpe and Linda Storey
Kam Dhami
TBC
OBJECTIVE: To consider the provision of one legal team for BCA to provide the clinical and claims
elements of the service and whether this would be value for money.
KEY ISSUES:
None other than those noted in the paper
IMPLICATIONS OF PAPER:
RISK
Risk Register:
CQC
Patient / Citizen
Engagement
NHSI
Equality Assured
Competition &
Mergers
Comms Lead OK
Governance Lead OK
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
No risks
N
N
Not required at this stage
Not necessary
N
N
N
Not necessary
No equality or diversity impact
Not necessary
Y
Y
Discussion
Other

RECOMMENDATIONS FOR THE BCA BOARD:
The Board is asked to note the update provided, ask any questions and endorse the direction of travel
outlined within the paper.
ENC 8c 161012 Legal Services Update
The Black Country Alliance
Legal Services Project Update
All three Trusts use legal firms under contract and wish to reduce cost as part of the response to Lord
Carter’s report as part of an ongoing drive to deliver better value for money. Equally, all three Trust’s
wish to improve the quality and timeliness of legal advice.
As all three Trusts have a single person providing this role, there would be merit in providing some
resilience for periods of planned and unplanned leave.
SWBH employs a Head of Legal Services as well as using an external legal firm to provide specialist
advice. DGFT and WCH do not have a dedicated legal service but have staff who as part of their role
provide aspects of a legal service, together with advice and assistance from their contracted legal
firms.
The legal provision and use of external legal advice has been reviewed by each Trust which has
included the past and current financial outgoings for that external legal provision. The group have
reviewed what is currently in place within SWBH to determine any merit or financial benefit from
replicating this to provide a BCA wide legal service or whether the current provision is value for
money.
Current Situation
Following the review it has been identified that SWBH have reduced their overall spending on external
legal provision by bringing in house expertise within a dedicated Legal team, primarily providing
support for the claims which are brought against the Trust and for Inquests. However, there are still
requirements for external legal advice and involvement and this spend has been constant for 14/15
and 15/16 at £155K. The amount this year may be more as there have been a number of cases heard
before the Court of Protection.
The financial commitment for legal advice at DGFT has decreased year on year over the past three
years from £344K (14/15), £180K (15/16) to the current year spend which is £55k with the majority of
this spending being on clinical negligence claims and employment issues.
WCH had spending of £56K in 15/16 and are on a similar spending trajectory this year with the same
two areas of highest spend as DGFT.
ENC 8c 161012 Legal Services Update
2
Outcomes & Opportunities
The review has identified that there would be no financial benefit from having a combined legal
service across BCA without further resources, which would not necessarily give value for the
additional investment required.
However, there are opportunities which need to be explored further which may help to further
reduce the financial commitment for external legal advice by sharing advice/information.
Numbers of claims are not high in any given year so analysing cases for any trends or themes by
Trust often does not provide meaningful information to learn from. By working together BCA can
share lessons to minimise the likelihood of a similar claim being brought across the three Trusts.
Mechanisms for this need to be developed not just across legal service provisions but by HR
Directors (for example) with employment advice and cases.
An option remains for HR Directors to consolidate employment legal advice and support from a
joint post holder to further reduce costs for each Trust. This will be further explored.
There may also be opportunity to consider tendering for one firm of solicitors to act on behalf of
BCA to further generate shared learning. This will require further discussion to identify timing of
current contracts and variables in current procurement.
In Scope
 Legal services [clinical negligence, employer and public liability, employment and inquests]
RECOMMENDATIONS FOR THE BCA BOARD:
The Board is asked to note the update provided, ask any questions and endorse the direction of
travel outlined within the paper.
ENC 8c 161012 Legal Services Update
3
ENC 8D
The Black Country Alliance Programme Board
Occupational Health Update
TITLE:
Occupational Health Update
EXEC SPONSOR:
AUTHORS:
Dr Tamsin Radford, Head of PRESENTER
Occupational
Health
and
Wellbeing services, SWBH
CONTRIBUTORS:
Raffaela Goodby and Mark
Sinclair, OD directors
Terry Whalley
OBJECTIVE:
To update the BCA Board about the progress so far in the realignment of Occupational Health services
between SWBH and Walsall Healthcare Trusts, and provide a projected plan for 2016/7 and beyond.
KEY ISSUES: Walsall and SWBH are moving towards a combined Occupational Health service with plans
to achieve this in the next 12 months. Equality of care for staff and financial benefits are predicted.
Dudley is not currently involved but there is potential to extend that. The project is dependent on
accreditation work currently ongoing at Walsall.
IMPLICATIONS OF PAPER:
RISK
Risk Register:
Not required
CQC
Patient / Citizen
Engagement
Monitor / TDA
Equality Assured
Competition &
Mergers
Comms Lead OK
N
N
Not required
Not required
N
N
N
Not required
Not required
Not required
N
Not required
Governance Lead OK
N
Not required
ACTION REQUIRED OF BCA BOARD:
Decision
Approval
RECOMMENDATIONS FOR THE BCA BOARD:
The BCA Board is asked to note this update.
ENC 8d 161012 OH Update
Discussion
Other
X for information
1. Introduction and background





Occupational health (OH) has a national quality accreditation scheme called SEQOHS
(safe, effective, quality OH services) which is a rigorous scheme involving domains of
business probity, information governance, Staff, Facilities and Equipment,
Relationships with clients and Relationships with others.
Occupational Health (OH) is currently provided by three separate units over the
three Trusts. Dudley has a SEQOHS accredited nurse led service, Sandwell has a
consultant led SEQOHS accredited service and Walsall has an unaccredited nurse led
service.
Work to investigate an alliance between Occupational Health services at the three
Trusts began in late 2015. Discussion between OD/Workforce leads identified that at
that time Dudley were happy with their service and level of investment. This was left
open to be revisited.
Work continued between SWBH and Walsall Acute as there was deemed to be most
need to establish equality of service across those two Trusts and obtain accreditation
at Walsall, so that the services were “starting from a level playing field” to enable
further collaboration. SWBH’s own quality accreditation requirements effectively
prevent close collaboration otherwise, other than on a tender basis.
It was recognised that while this project was primarily about care quality for Trust
staff, there could be cost savings made from economies of scale and potential
increased income generation opportunities from a combined unit.
2. Progress to Date
2015
 At the request of Mark Sinclair the SWBH senior OH team visited Walsall OH for a
week in November 2015. The aims were to identify shared areas of practice, quick
wins and easy changes which would allow the services to work more closely together
and ensure that peer accepted good practice was being uniformly practiced.
 The results of this work in the form of a gap analysis were presented to a group of
senior executives at Walsall acute, including the CEO.
 It was agreed in principle in late 2015 by the Walsall Board that the direction of
travel was towards SWBH and Walsall OH forming some kind of merger / partnership
over a 12-18 months period. The CEO and OD director at SWBH are also supportive
of this in principle.
2016 to date
 A number of changes were agreed for Walsall OH and have since been actioned, to
bring the service more into line with modern requirements. Significantly these have
included the appointment of a new, experience, nurse manager.
 She has been working to meet SEQOHS requirements, with some advice and sharing
of policies and procedures from SWBH which will ease future harmonisation of the
services as well as helping care quality at Walsall OH.
 Walsall and SWBH have been looking at provision of consultant care and also
counselling services to Walsall OH as the current provision is external and expensive.
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
Meeting SEQOHS requirements at Walsall is the rate limiting step of further
collaboration hence is being given priority, by both services. Once work is
complete and application submitted, full accreditation can take 6-9 months.
3. Current agreed project aims
I. To achieve an integrated consultant led service providing equal, quality assured
care across Walsall and SWBH OH
II. For both Trusts to retain their own OH staff but for SWBH OH to lead on clinical
governance, policy, process and planning, training requirements and tendering for
external contracts.
III. To provide a model where Trust staff and external contract staff could be seen
flexibly on either site to aid swift appointments and convenience
4. Timeline
By end of2016/7 Q3
 Future provisional model of service to be drafted by the author and circulated for
approval by key stakeholders
 SWBH to initiate and receive Royal College of Physicians’ approval for a joint
consultant post, using 50% funding from both Trusts
 Walsall to complete work on SEQOHS, supported by SWBH, and apply for
accreditation process
2016/17 Q4
 Consultant post appointed providing sessional consultant support to Walsall Acute
OH
 Harmonisation process to commence including policy and procedure standardisation
(with local adjustment) communications plan, HR / staffing management issues,
training needs matrix, risk register
2017/18 Q1
 SEQOHS accreditation to be achieved by Walsall OH
2017/18 Q2
 Harmonised service to begin across Walsall and Sandwell
5. Extended project aims
I.
II.
III.
IV.
To revisit discussion with Dudley regarding building this model all across the BCA
To extend the provisionally agreed “easy access” to diagnosis and treatment for
staff of SWBH, across the new service
To standardise counselling provision across the new service
To share wellbeing resources and initiatives across the new service
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6. Conclusion
Meeting SEQOHS requirements at Walsall is the rate limiting step of further
collaboration and is being given high priority and support by Walsall Acute Trust and
SWBH as required. It is predicted that this project will achieve OH care equality for
Trust staff and potential financial benefits too.
While it is recognised that there is a lot still to be done, agreement on direction of
travel is strong between Walsall and SWBH. Both Trusts would welcome
reconsideration by Dudley about how the model could be extended to their OH
service, at any point.
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