Meeting
Middlesbrough Health and Wellbeing Board
Date
Title
Responsible Officer
14 December 2016
CCG Update
Amanda Hume – Chief Accountable Officer, South Tees CCG
Purpose of Item
The purpose of this briefing note is to update the Health and
Well-being Board on the progress being made in a number of key
areas by South Tees Clinical Commissioning Group (the CCG),
working in partnership with Middlesbrough Borough Council and
members of the NHS Provider community.
Summary of Recommendations
That Middlesbrough Health and Wellbeing Board are asked to:
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Note the work underway with regards to commissioning health services for care
leavers
Note the progress with delivery of Making Health Simple; Right Place First Time
Note the CCG Annual General Meeting and Health and Wellbeing Fair
Note the CCG 2017/18 commissioning intentions
Note the activities and progress within the Support to Care Homes Project
Note the early outcomes from partnership investment in welfare advice services
delivered within a heath care setting.
Note the progress with development of a Single Point of Access
Note the development of the CCG Operational Plan in line with the requirements of
the NHS shared planning guidance 2017-19
Note the progress of the Carers Strategic Partnership
Note the implementation and planned evaluation of the ‘Shelf Help Scheme’ in
local libraries and GP practices.
Note the next steps with regards to CCG and Voluntary Sector joint working
Note the application for participation in a programme led by ‘NHS Improvement’, to
support partnership working across South Tees to undertake transformational
change via system leadership.
Note the progress of the local A&E Delivery Board.
Note the CCG QIPP plans.
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1.0 PURPOSE OF THE REPORT
The purpose of this report is to update the Health and Well-being Board on the progress
being made in a number of key areas by South Tees Clinical Commissioning Group
(STCCG), working in partnership with Middlesbrough Borough Council and members of
the NHS Provider community.
2.0 MEETING THE HEALTH NEEDS OF CARE LEAVERS
South Tees is one of a small number of areas across the country to be participating in a
national Department of Health funded programme led by the Care Leavers Association to
commission services to better meet the needs of people who have been in care; as we
know that the health of people who have been in care is often worse than that of peers
who have not.
The national director of the Care Leavers Association, spent a day at South Tees CCG
during November where he met with commissioning managers for mental health and
health inequalities to discuss the health needs of people who have been in care, and to
highlight some of the challenges faced by care leavers with regards to their mental health.
Work continues with the care leavers partnership group to develop a needs assessment
for care leavers, building on work already undertaken in relation to identifying the health
needs of looked after children.
It is recommended that the H&WBB:
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Note the work underway with regards to commissioning health services for care
leavers
3.0 URGENT CARE CONSULTATION
MAKING HEALTH SIMPLE; RIGHT PLACE FIRST TIME
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Procurement of GP extended hubs and out of hours services – The CCG has
completed a procurement process for both these services, which was ratified by the
CCG Governing Body on the 30th November 2016. We have now entered a legally
required ‘stand-still’ period until formal announcement of the successful bidders on
the 13th December 2016. The CCG are on track to implement the new services on
the 1st of April 2017 which will co-incide with the walk-in centres closing. A robust
communication plan will be aligned to this timetable.
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Joint projects with South Tees Foundation Trust - The CCG are working
collaboratively on two projects, which will not only improve pathways for patients
attending A&E but also free up time for the doctors working in A&E so that they can
focus on emergency cases. In particular, the CCG will be introducing a new nurse
navigator role at the front of A&E to assess and signpost patients to other more
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appropriate services if required and plan to commence a ‘proof of concept’ project
in February 2017 to better support frail, elderly patients presenting at A&E. The
plan is to deliver GP led multi-disciplinary frailty assessments at the front of A&E
utilising existing therapy and social care teams to enable more patients to be
supported in the community and at home, reducing the numbers of unnecessary or
prolonged admissions.
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Enhancements to NHS 111 – The CCG now have 35 practices in South Tees
offering direct booking from NHS 111 and we are supporting plans to implement a
NHS 111 clinical hub in 2017.
The CCG will be further reporting on progress to South Tees Health Scrutiny Joint
Committee in January next year.
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CIPR Pride Awards
The North of England Commissioning Support Unit’s communications team working
collaboratively with South Tees CCG were award winners at the North East
Chartered Institute of Press Relations Pride Awards in December.
The CIPR PRide Awards is the UK’s most prestigious nation-wide awards scheme,
recognising excellence in public relations and communications across Scotland,
Wales, Northern Ireland and six English regions. Now in its 13th year, the PRide
Awards attracted more than 1,000 entries from public relations teams,
consultancies and individuals across the UK. The team received a silver award in
the category ‘Health Care Champion’ for our ‘Making Health Simple, Right Place,
First Time’ public consultation.
It is recommended that the H&WBB:
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Note the progress with delivery of Making Health Simple; Right Place First Time
4.0 ANNUAL GENERAL MEETING (AGM) AND HEALTH AND WELLBEING FAIR
Our Annual General Meeting (AGM) and Health and Wellbeing Fair was held on 14th
September 2016 at Middlesbrough College, where we promoted the work of the CCG and
signposted students and local people to local health and care services.
As part of the formal AGM, the CCG hosted a careers workshop, which involved
roundtable discussions with health professions from psychologists to paramedics to
nurses. This session was extremely well received and enabled students from the college
to get a feel for the real life experiences of people in these professions.
Dr Janet Walker and Mrs Amanda Hume, Chair and Chief Officer respectively of South
Tees CCG; presented the annual report and annual accounts at the AGM followed by a
question and answer session with members of the audience.
The health fair was an opportunity for local people to find out more about local services
including mental health services, money advice and sexual health. Holding the AGM at
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Middlesbrough College was an excellent way of engaging with young people and the
support we received from the college was outstanding. We continue to work with the
college to tackle health inequalities and to meet the student’s needs, with one of our
Directors, Mrs Alex Sinclair, being a member Middlesbrough College Safeguarding and
Welfare Committee.
It is recommended that the H&WBB:
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Note the CCG Annual General Meeting and Health and Wellbeing Fair
5.0 NHS SOUTH TEES CCG COMMISIONNING INTENTIONS 2017/2018
The CCG commissioning intentions for 2017/18 were approved, subject to financial
allocations, at the Governing body on 30th November. The commissioning intentions were
developed within our clinically led work-streams, in line with the CCG aims and objectives
using local intelligence and data from the Joint Strategic Needs Assessment (JSNA) and
Commissioning for Value- Right Care packs to inform the intentions, alongside a clear
evidence base. All the CCG commissioning intentions will support the CCG QIPP agenda;
which focuses on improved quality (Q), innovation (I), productivity (P) and preventative (P)
activities.
Commissioning intentions include:
 Integrated crisis, liaison and intensive home treatment for children and young
people
 Collaborative commissioning of welfare rights services
 Inpatient smoking cessation within South Tees NHS Foundation Trust Hospitals
 Supervised exercise programmes for people with intermittent claudication ( the pain
that develops in the muscles of the legs when taking exercise, such as walking)
 Complex crisis support service
 Review of health funded respite care for adults with a learning disability and
complex needs in relation to the wider ‘Transforming Care’ agenda.
 Primary care chronic disease management programme
 Prescribing QIPP plan 17/18
 Early intervention in psychosis
It is recommended that the H&WBB:
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Note the CCG 2017/18 commissioning intentions
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6.0 SUPPORT TO CARE HOMES PROJECT
The ‘Support to Care Homes Project’ forms part of the work of the Better Care Fund (BCF)
programme, linking in with both the Middlesbrough and Redcar & Cleveland Care Home
Forums.
A medicines optimisation proposal (12 month pilot) has been developed to provide
additional medication support in care homes. In addition, a patient passport has been
developed and piloted to improve processes for patients being transferred to/from care
homes and reduce the number of delayed transfers of care.
The project is also exploring GP/nursing input into care homes and working in partnership
with South Tees NHS Hospitals Foundation Trust on their care home pilot to provide an
advanced nurse practitioner via rapid response. A business case has also been
developed to provide reactive nursing/paramedic support to any patient at risk of being
admitted which includes education and training for care home staff.
It is recommended that the H&WBB:
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Note the activities and progress within the Support to Care Homes Project
7.0 WELARE ADVICE IN HEALTHCARE SETTINGS
The CCG recognises the relationship between wellbeing and social factors such as
financial hardship and the CCG invests £160k in welfare advice services delivered from
GP practices. Along with our two local authorities, the CCG also invests in specialist
advice for people with cancer and their families and in addition, we invest in specialist
advice for people with a mental health condition with Middlesbrough Council.
Alongside the benefits these services can bring to wellbeing, CCG clinicians also note that
the welfare system is increasing in complexity and patients with an entitlement to this
support are finding it increasing difficult to navigate the system. From a review of
investment and outcomes in quarter one of 2016/17, figures suggest that around 22 times
the financial resource invested is being released, and so far over £1M of entitlement has
been made available to local people and the economy. Entitlements include Personal
Independence Payments along with employment support allowance, income support and
carers allowance.
It is recommended that the H&WBB:
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Note the early outcomes from partnership investment in welfare advice services
delivered within a heath care setting.
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8.0 SINGLE POINT OF ACCESS (SPA)
South Tees Single Point of Access (SPA) for adult health and social care is planned to ‘golive’ week commencing 30th January 2017. The SPA will host staff from the two local
authorities, South Tees Foundation Trust (STFT) and Tees Esk and Wear Valley (TEWV)
Mental Health Trust. The SPA will provide access to social care access teams, social care
reablement, social care rapid response, community nursing, community matrons, nursing
rapid response, integrated community therapists, hospital discharge to community and a
TEWV mental health nurse.
Call handlers/first point of contact staff will undertake the initial screening via a number of
methods i.e. telephone, e-mail, written and via electronic referral systems. As well as initial
call handlers/first point of contact staff there will also be registered social workers, nursing
staff, occupational therapists and physiotherapists that will be able to provide clinical triage
and assessments where appropriate.
All internal refurbishments are now complete at the site on Daisy Lane and furniture is in
situ. The information sharing agreement has also been finalised; testing of the systems
(including the new telephony system) will begin early January.
It is recommended that the H&WBB:
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Note the progress with development of a Single Point of Access
9.0 CCG OPERATIONAL PLAN
The CCG has been working to develop its Operational Plan for the period 2017-19, in line
with the requirements of the NHS shared planning guidance 2017-19. The Operational
Plan is expected to outline how the CCG will address the three gaps identified in the
shared planning guidance referred to as the ‘Triple Aims’, these being; the Health and Well
Being gap, the Care and Quality gap and the Financial gap. The plan builds on the theme
areas developed in the Sustainability and Transformation Plan (STP) and indicates the key
actions the CCG is planning to undertake over the period to support ‘early intervention and
prevention’, develop our neighbourhood and community health, support the reconfiguration
of acute hospitals and progress the use of digital care and technologies. The plan also
details technical narratives relating to how we will deliver the NHS Constitutional standards
and manage various activity flows.
A draft version of the plan was submitted to NHS England on the 24th November and initial
feedback is anticipated on the 9th December with a final submission due on the 23rd
December accompanied by signed provider contracts.
It is recommended that the H&WBB:
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Note the development of the CCG Operational Plan in line with the requirements of
the NHS shared planning guidance 2017-19
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10.0 CARERS STRATEGIC PARTNERSHIP
The Carers Strategic Partnership is a new partnership to deliver the ‘Strategy to support
and value carers in Middlesbrough 2015 – 2019’, the development of which was led
collaboratively by Middlesbrough Voluntary Development Agency (MVDA), the local
authority and the CCG. The CCG, through its Partnership and Innovations Manager now
chairs the Carers Strategic Partnership.
Colleagues may soon be approached to join a time limited task and finish group aimed at
supporting Middlesbrough to better identifying hidden carers. The work of this subgroup
will be fundamental to the delivery of the 12 strategic outcomes that form the strategy.
It is recommended that the H&WBB:
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Note the progress of the Carers Strategic Partnership
11.0 SHELF HELP - BOOKS ON PRESCRIPTION FOR CHILDREN AND YOUNG
PEOPLE
Working in partnership, Middlesbrough Library Services and the CCG are implementing
books on prescription for children and young people as part of the national Reading
Agency’s ‘Shelf Help’ scheme. The project is led by the Library Service with funding from
the CCG’s Community Innovation Fund. Books are available in libraries, GP practices and
Middlesbrough College.
This reading initiative will provide young people with high-quality information, support and
advice on a wide-range of mental health issues such as anxiety, depression, eating
disorders, self-harm and difficult life pressures, like bullying and exams.
The books, whether fiction or those that take a more structured approach to explaining
why people may be feeling the way they do, can help young people realise they are not
alone and importantly that there are strategies they may be able use to help manage and
improve their wellbeing. The books also help GPs and carers to have conversations with
children and young people about their wellbeing. The scheme which is being piloted in
eight GP practices across South Tees will be evaluated and the South Tees approach is
attracting some national interest.
It is recommended that the H&WBB:
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Note the implementation and planned evaluation of the ‘Shelf Help Scheme’ in
local libraries and GP practices.
12.0 WORKING WITH THE VOLUNTARY SECTOR
On 9th September, the CCG and members of the Voluntary & Community Services (VCS)
came together to explore how we can work collaboratively in the future to benefit the
people of South Tees. The nature of the event was to be open and share honest,
constructive criticism and feedback about current partnership working to improve future
collaboration and services for local people. It was a productive session with lots of
enthusiasm and some valuable networking.
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There was a large degree of consensus about common priorities, challenges and potential
solutions for addressing these and for radically improving collaboration and outcomes for
local people. There was a clear willingness to commit to working differently for the benefit
of local people and to explore working better together over the coming months and years.
The CCG and VCS working group which developed the event are now reviewing the
outcomes and identifying actions for taking forward participants’ recommendations.
It is recommended that the H&WBB:
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Note the next steps with regards to CCG and Voluntary Sector joint working
13.0 TRANSFORMATIONAL CHANGE THROUGH SYSTEM LEADERSHIP
South Tees CCG in partnership with South Tees Foundation Trust, Tees Esk and Wear
Valley Mental Health Trust, Middlesbrough Local Authority and Redcar and Cleveland
Local Authority have applied to participate in a programme led by ‘NHS Improvement’, to
support partnership working across South Tees to undertake transformational change via
system leadership.
If the application is successful the multidisciplinary director level team will focus on a
system-wide project to design and implement a new model of care which will provide more
joined up care, closer to people’s homes, which will reduce pressure on hospital-based
services and the need for residential care placements. The model will build on existing
strengths of general practice to link services together to provide intensive support for
patients with complex conditions, with services integrated around patients.
It is recommended that the H&WBB:
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Note the application for participation in a programme led by ‘NHS Improvement’, to
support partnership working across South Tees to undertake transformational
change via system leadership.
14.0 LOCAL A&E DELIVERY BOARD
The Hambleton, Richmondshire, Whitby and South Tees local A&E delivery board
(LA&EDB) have met to agree the terms of reference and governance structures and
finalise the submission of the winter operational plans.
The LA&EBD is chaired by Siobhan McArdle, CEO of South Tees Hospitals NHS
Foundation Trust with the co-vice chairs being Amanda Hume, Chief Officer of South Tees
CCG (STCCG) and Janet Probert, Chief Officer of Hambleton, Richmondshire and Whitby
(HRW CCG). The LA&EBD will be supported operationally by a system resilience group
(SRG) in STCCG and a SRG in HRWCCG and a range of system wide groups to focus on
achievements such as ‘discharge to assess’ and ‘delayed transfers of care’ (DTOC).
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These groups will report on a monthly basis to the local A&E delivery board, which has
aligned their existing systems to the escalation triggers and terminology as outlined in the
‘national operational pressures escalation levels framework’.
It is recommended that the H&WBB:
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Note the progress of the local A&E Delivery Board.
15.0 SOUTH TEES CCG QIPP PLANS
South Tees CCG has an ongoing range of QIPP plans which support quality (Q),
innovation (I), productivity (P) plus prevention (P) of waste. A focused QIPP
implementation plan between December 2016 and 31st March 2017 to support CCG
financial stability and sustainability and will include reduction in medicines waste, review of
continuing healthcare packages and supporting patients and GPs to ensure access to the
right services.
These plans, plus additional QIPP plans, will continue beyond 31st March 2017
It is recommended that the H&WBB:
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Note the CCG QIPP plans.
Report prepared by:
Alex Sinclair, Director of Programmes and Primary Care Development, South Tees CCG
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