CCG Governing Body meetings and papers

Questions and answers

Anyone may ask questions about Governing Body agenda items in advance of each meeting. The questions and answers are posted here within 20 working days of the meeting.

Questions from the public at Governing Body meetings

Date of Meeting: 22 February 2017

Question: Regarding the Nottingham Pain Service:

At what stage are you anticipating any direct consultation with the staff concerned from the Nottingham Back and Pain Team, who to date have no certainty regarding their futures and that of the service provision?

What is the date of the meeting that has been scheduled with the service to discuss this new way of working?

Response: The CCG has met with representatives of NUH (Nottingham University Hospitals NHS Trust) and with the Back Pain Team. HR (Human Resources) teams from both organisations are liaising with each other and discussions are ongoing.

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Date of Meeting: 25 January 2017

Question: The Nottingham Back and Pain Team and the Traumatic Brain Injury Team have both been informed that they are to be "decommissioned" under STP plans This appears to be a recurrent theme for many teams.  Much more than this, they do not know and each time the CCG have been contacted to provide some clarity, non has been forthcoming. Some staff have found out through the HSJ that their services are to be "decommissioned", or are they to be tendered out - it remains unclear.  This has led to staff being very uncertain over their futures, the future for their patients and is having a direct detrimental effect on the planning of patient care as they are unable to book assessed patients in for required treatments later in the year.  Will the CCG stop this current decommissioning of services and start afresh by actively consulting, negotiating and engaging both appropriately and effectively with service users, the staff in the services and their respective unions in line with the agreed national consultation processes over future planning and organisation these services?

Response: The changes to these services are planned under a review of hospital contracts that aims to provide patients with the same level of support closer to home with better value for the NHS.  We have made our commissioning intentions clear to the Trust and are working closely with the new providers to ensure they involve Nottingham University Hospitals (NUH) staff in plans for the transfer of services into the community.  Although it is the responsibility of providers to manage the transition process, we will ensure that the new providers do not advertise any posts until proper negotiations take place with affected staff around their individual circumstances.

Nottingham Pain Service
The CCG has for a number of years held a community pain contract with two providers (NUH, Pain Management Solutions [PMS]) who deliver pain services within the community. The CCG is redefining these contracts to ensure appropriate utilisation of these services. This will require moving a small element of the pain service (back pain) within NUH to our community providers. We are in discussions with NUH and PMS as this will be a small variation to their community contract. A meeting has been scheduled with the service to discuss this new way of working. Where TUPE applies, NUH staff will transfer to the community service provider.

Traumatic Brain Injury
We plan to expand the Community Neurological Service which delivers the same interventions and outcomes as NUH in locations closer to patient’s homes. We are facilitating provider to provider meetings to discuss hand over of patients. Where TUPE applies, NUH staff will transfer to the community service provider.

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Date of Meeting: 25 March 2015

Question 1: What percentage of the CCG’s commissioned budget is currently delivered by Black and Minority Ethnic (BME) organisations?

Question 2: Which contracts are currently held by BME organisations in Nottingham City?

Response: None of the CCG's budget is currently delivered by BME organisations in Nottingham City.

Question: What percentage of the CCG’s commissioned budget is currently allocated to BME groups irrespective of who delivers it?

Response: The CCG as an NHS commissioner is responsible for planning and buying healthcare services that meet the needs of local people and address health inequalities. To do this effectively we need to fully understand the health needs and problems of people living in Nottingham City and plan and buy services that will help people the most and making sure that they are high quality and deliver value for money.

In order to understand the needs of our population we have produced a Joint Strategic Needs Assessment (JSNA) in conjunction with Nottingham City Council. The JSNA provides a picture of Nottingham City in relation to health and wellbeing and describes the local profile of our population (children, young people, families, and adults) including information on, for example age, ethnicity, and deprivation. The CCG uses the JSNA to inform all of our commissioning decisions and plans by assessing the current and future health and care needs of the local population and identifying areas and opportunities where we could reduce health inequalities. A standard template is used for all JSNA chapters and comprehensive guidance has been produced for chapter authors, which requires that consideration be given to all protected characteristics in line with the Equality Act 2010.In addition, the CCG also directly funds and commissions local research and evaluation activities, to inform the evidence base which further support the commissioning of health services to reduce health inequalities.

We use other sources of information, feedback and data to inform our commissioning decisions including what local people tell us about their experiences of using services and what they would expect or is important to them about services, national and local research, best practice, targets and measures, for example the NHS Outcomes Framework and the indicators within our six strategic priorities which we use to make sure our actions are making the right difference to people’s health and health outcomes to inform our commissioning decisions. We also work with partners, including Nottingham City Council to ensure that we understand all of the groups that we have within our population and their needs.

As a CCG we commission services that we expect to meet the needs of our entire population. However where data and information shows that particular groups and communities experience inequalities compared to the general population and would benefit from specific focus to improve these, the CCG would target services appropriately.

The services below are examples of how the CCG has commissioned to meet identified needs within Nottingham City’s population.

  • A counselling service was commissioned due to an increase in presentations of self- harm and an increase in suicides in young people. This service provides vulnerable young people from 10 to 24 with advice and support for emotional or mental health problems. It is aimed at those who may be at risk of self-harm and provides targeted early intervention work, offering confidential online and face to face counselling and small group-therapy sessions. In 2014/15 30% of service users who accessed the service were from BME backgrounds.
  • The CCG strategy focuses on improving access to psychological therapies for specific service users including those from BME backgrounds. Up to the end of February 2015 25% of patients who completed an IAPT treatment were from a BME background, this is a 2% increase from 2013/14. In addition the CCG has commissioned research into the factors relating to the effectiveness and equity of Primary Care Psychological Therapies Services.
  • The CCG is participating in a pilot for personal health budgets for people with mental illness, this helps to support people make choices about the services that would most benefit them and meet their needs.
  • Increasing the uptake of primary and community long term conditions services in BME communities in Nottingham – this is an exploratory research study

The CCG also commissions research to inform decision making, an example of this is:

  • Increasing the uptake of primary and community long term conditions services in BME communities in Nottingham – this is an exploratory research study

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Date of Meeting: 28 January 2015

Question: Please could you provide me with information regarding Nottingham CCG's emergency readmission policy, specifically regarding the thresholds that have been set for readmissions above which NUH (or QMC specifically) is not reimbursed. If there are separate proportions that have been set for readmissions following elective admission and readmissions following non-elective admission please could this be highlighted.

Response: Nottingham City CGG follows national guidance in relation to Emergency readmissions:

The thresholds have been calculated in line with this national guidance. The local thresholds have been determined by a clinically lead review team (Dr Ian Bowns). The resultant proportion of readmissions deemed to be avoidable i.e. the threshold rate was agreed at 20.9%. The adjustment is for all readmissions – there is not a separate proportion agreed for elective and non elective.

Question: Please could you let me know the value of the emergency readmissions payments withheld from NUH (or QMC specifically) as a result of the Payment by Results policy since 2011 (either broken down by year or a total since 2011)

Response: The values from 2011 – 2013/14 relate to the predecessor organisation Nottingham City PCT and we do not have access to this information.

As a CCG:

Emergency readmissions adjustment - NUH contract 

  2013/14 2014/15 Comment
Readmissions credit -£1,816 -£1,816 As per NUH contract monitoring
Readmissions reinvestment £884   Community schemes
NUH reinvestment £932 £1,816 NUH schemes
Net 'witheld' -£884 0  

NB - data supplied in relation to Nottingham City CCG and therefore no figures disclsed relating to 2011/12 and 2012/13

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Date of Meeting: 26 February 2014

Question: Can the CCG explain why they do not fund culturally specific Mental Health Services when there is evidence that such services are needed?

Response: The CCG required all of its commissioned services to be culturally sensitive and Public Health colleague were currently doing some work in this area to review the available evidence base to determine whether dedicated services for specific communities should be commissioned.  

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Date of Meeting: 29 January 2014

Question: Can the Board assure the public that the Better Care Fund will be used by the Local Authority for health and social care services and that safeguards are in place to this effect?

Response: Assurance was given at the meeting that the use of the Better Care Fund would be closely monitored by the Commissioning Executive Committee of the Health and Wellbeing Board who would ensure delivery.

Question:    

To what extent has Any Qualified Provider been successful in its aim of extending patient choice?

To what extent has Any Qualified Provider been successful in raising service quality and efficiency?

Is the additional work required in the Any Qualified Provider qualification process and monitoring multiple contracts (for both commissioners and providers) justified by the outcomes?

A recent study on commissioning psychological therapies using Any Qualified Provider carried out by the University of Chester raises concerns that the payment system (Payment by results/zero contract)  has resulted in:

    • Cherry picking of those patients most likely to ‘recover’
    • Employment of less skilled, lower paid therapists
    • Financial incentives to misuse measurement scales to improve outcomes and trigger payment

Has the CCG any data on these issues in relation to the Nottingham Primary Care Psychological Therapies?

Does the CCG intend to roll out Any Qualified Provider to other services?

Response: The responses to all the questions were covered in the presentation of the Offering Patient Choice: Any Qualified Provider item and is detailed within the Minutes of the meeting which are available to view in the Governing Body Papers for 26 February 2014.

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Date of Meeting: 24 April 2013

Question: What are the plans for public involvement in the process to pre-procure Primary Medical Out of Hours Services? Specifically how will the lay member(s) of the Joint Procurement Delivery Group be chosen and how will lay people be involved in the tendering process?”

Response/action taken: Dawn Smith responded to say the lay members of the Joint Procurement Delivery Group would be existing Governing Body lay members, who were equivalent to Non-Executive Directors in other NHS trusts. Their role would be to provide independent scrutiny and challenge to the process. Dawn went on to explain that members of the public, patients and carers would also be involved in the re-procurement process and that a questionnaire had already been sent out and this had been followed up by specific focus groups. Dawn gave assurance that there would be an on-going process that would be led by the Joint Procurement Delivery Group to ensure continued public engagement.

Question: Our members (Nottingham Patients Action Group) are reporting concerns right across the City that older people are having difficulties in getting local surgery appointments, sometimes waiting 10 days or more. Some report that morning emergency slots are taken over night by patients with access to computer booking. How will the Board address this problem?”

Response/action taken: Dr Hugh Porter responded by stating that the Nottinghamshire / Derbyshire Area Team of NHS England was responsible for contracting with GP practices. However, it was recognised that access to GP appointments was critical to the CCG’s role in assisting improvements in primary care quality. Following discussion, the Governing Body agreed that ten days was an unacceptable timeframe to wait for an appointment and it was agreed that Maria Principe would investigate this further and discuss with Maxine Davis how this could be addressed through the work of the People’s Council.

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Date of Meeting: 27 March 2013

Question: In light of recent coverage of financial conflicts of interest in CCGs and the Governing Body Members’ Registered Interests submitted as a paper for this meeting, how can Nottingham City CCG ensure that all decisions will be made entirely in patient's best interests?

Response/action taken: Lucy Branson responded by highlighting the CCG’s vision, which was to ensure the interests of patients were at the heart of everything the organisation does. This was further demonstrated by the Engagement and Quality Improvement Frameworks that had been discussed earlier. Safeguards had been established to ensure there was a robust challenge into decision making processes, which included the independent members of the Governing Body and its committees. Lucy went on to state that she felt that the Standards of Business Conduct Policy demonstrated clear and transparent decision-making arrangements, which would be further supported by the Procurement Framework once finalised. Maxine Davis also gave assurance that this would be integrated into the way the People’s Council would work.

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Date of Meeting: 27 February 2013

Question: Could the Board please provide its response to the letter from Keep Our NHS Public dated 4 December 2012 and make clear why the new constitution was not submitted to the Health Scrutiny Panels.

Response/action taken: Dr Hugh Porter responded by confirming that a copy of the CCG’s Constitution had been sent to the requestor and that an invitation to meet with the requestor in order to discuss any concerns that he may have had been extended. Hugh explained that the CCG’s Constitution was the legal document that established the CCG as a membership organisation, and as such, it had been developed and agreed in consultation with the CCG’s GP member practices. Dawn Smith highlighted that there had not been any requirement for the CCG’s Constitution to be presented to the Health Scrutiny Panel. However, she had attended meetings to keep the Panel updated on the CCG authorisation process, and that this had included discussion regarding the development of the CCG’s Constitution.

Question: Further, in light of the proposed secondary legislation published on 13 February 2013, will the Board give a clear commitment to convene public meetings as a matter of urgency to make clear the likely impact of these regulations on procurement policy and the consequences for local future NHS service provision in Nottingham.

Response/action taken: Dawn Smith responded by explaining that the Regulations outlined what the organisation had to do in order to comply with EU legislation, and as such, would not normally be subject to public engagement. Dawn highlighted that the CCG’s Procurement Framework and Choice Policy were due to be presented to the Governing Body for endorsement during early 2013/14.