Jan 28, 2015 - We will build on the commitments given by NHS England to promote and work towards parity ...... HTML emai
A Meeting of the NHS South Tees Clinical Commissioning Group
Governing Body will take place on Wednesday, 28 January 2015 at 2.00pm At Acklam Green Centre, Stainsby Road, Middlesbrough AGENDA Time
Item No.
Item
Attached or Verbal
Presented by
Page No.
Section 1 14:00 1.1
Apologies for Absence
Verbal
Chair
14:02 1.2
Declaration of Interest
Attached
Chair
3
14:05 1.3
Draft Minutes of previous meeting held 26 November 2014
Attached
Chair
5
14:10 1.4
Matters Arising & Action Log
Attached
Chair
19
14:20 1.5
Chair & Chief Officer’s Report
Attached
Chair/Amanda Hume
23
14:30 1.6
Locality Reports: - Middlesbrough - Langbaurgh - Eston
Verbal
14:45 1.7
Patient Story
Verbal
15.00
2.1
15:10
2.2
Section 2 – Items for Decision Redcar and Cleveland Carers’ Strategic Attached Framework Communication and Engagement Strategy Attached
15.20
2.3
15.30 3.1 15.40 3.2 15:50 3.3 15.55 16:05 16:15 16.25
3.4 3.5 3.6 3.7
16:35 5.1 5.1.1 5.1.2 5.1.3
Dr Vaishali Nanda Dr Ali Tahmassebi Dr J Walker Lawrence McAnelly
Sue Renvoize
31
Paul Parsons Simon Gregory
71
Draft Financial Plans 2015/16 (including Attached Commissioning Intentions) Section 3 – Items of Discussion Quality and Safety Report Attached Jean Fruend Finance Report Attached Simon Gregory Report from Quality, Performance and Attached Dr Ali Tahmassebi Finance Committee Chair Winter planning and resilience Verbal Dr Mike Milner Corporate Objectives Update Report Attached Craig Blair Assurance Framework Attached Simon Gregory HealthWatch Reports re improving access Attached Craig to confirm to psychological therapies and Cancer with Mark Burdon Section 4 – Items for Information No items for information Section 5 – Confirmed Minutes and Reports from Committees Confirmed Minutes of; Governance and Risk Committee meeting Attached Simon Gregory held on 8 October 2014 Audit Committee held on 1 October 2014 Attached Peter Race Redcar and Cleveland Health and Attached Amanda Hume Page 1 of 225
107
113 125 135
141 151 161
203 205 211 215
Wellbeing Board held on 14 May 2014 Redcar and Cleveland Health and Attached Amanda Hume 221 Wellbeing Board held on 3 September 2014 Questions from the Public – Members of the public may raise issues of general interest which relate to the Agenda Section 6 – Any Other Business 16:45 6.4 Date and time of next meeting is scheduled to take place on Wednesday, 25 March 2015 2014 at 2.00pm at Redcar and Cleveland College, Trunk Road, Corporation Road, Redcar TS10 1EZ 5.1.4
“Representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity in which would be prejudicial to the public interest (Section 1(2) of the Public Bodies Admissions to Meetings Act 1960)”
Page 2 of 225
SOUTH TEES CLINICAL COMMISSIONING GROUP GOVERNING BODY MEMBERS' REGISTER OF INTERESTS
NAME
TITLE
as at 21.01.15
NAME OF ORGANISATION AND NATURE OF ITS BUSINESS
POSITION HELD / NATURE OF INTEREST
PERSONAL INTEREST
DATE DECLARED
DATE UPDATED
Nil
06/12/2013
10/01/2014
Bentley Medical Practice Park Avenue Surgery Slater's Bridge Urgent Care Lead, Governing Northern Doctors, Out Body Member of Hours GP Service Huntcliff Surgery South Tees FT
Partner : Dr Royal & Partners Manor House Surgery, Normanby Partner
Nil
05/11/2013
10/01/2014
Partner Director Partner, Out of hours GP GP Neurology consultant
Nil Nil
05/11/2013 18/03/2014 04/12/2013
10/01/2014 19/03/2014 10/01/2014
Nil Nil
17/04/2014 17/04/2014
17/04/2014 17/04/2014
Mr David Brunskill Dr John Drury
PPI Lay Member Secondary Care Consultant
Nil Nil
Nil Nil
31/10/2013 06/12/2013
10/01/2014 10/01/2014
Mrs Jean Fruend
Executive Nurse
Executive Nurse (job Nil share South Tees and Hartlepool & Stocktonon-Tees CCG's)
20/11/2013
01/06/2014
GOVERNING BODY MEMBERS Dr Janet Walker
Chair
Dr Ali Tahmassebi
Governing Body Member, Locality Lead (Langbaugh)
Dr Mike Milner
Eston Locality Lead
Hartlepool & Stocktonon-Tees CCG
Page 3 of 225
Mr Simon Gregory
Chief Finance Officer
Mrs Amanda Hume Mr Peter Race Mr Nigel Rowell
Chief Officer Lay Member, Governance Governing Body Member
Nil Nil Endeavour Practice Ltd Director North of England Cardio Primary Care Lead Vascular Network
Partner works for Tees, Esk and Wear Valley NHS FT Finance Team Nil Nil Nil
22/11/2013
03/02/2014
11/11/2013 04/11/2013 27/11/2013
10/01/2014 10/01/2014 10/01/2014
Husband owns Nanda 16/01/2014 Medical Services for private orthopaedic work Husband is a 02/04/2014 Consultant in orthopaedics at NTHFT
20/01/2014
Nil
STAT JCUH Heart CPSI in Heart Failure Nil Failure Service Servier Laboratories Ltd Live : Life Study Nil Principle Investigator Dr Vaishali Nanda
Governing Body GP
The Discovery Practice GP at The Discovery Practice
Page 4 of 225
02/04/2014
Draft Minutes of the NHS South Tees Clinical Commissioning Group Governing Body Meeting Held on Wednesday, 26 November 2014 at 1.45pm At Eston City Learning Centre, Normanby Road, Middlesbrough Present Dr Henry Waters Mrs Amanda Hume Mr Simon Gregory Dr John Drury Dr Vaishali Nanda Dr Mike Milner Mr Peter Race MBE Dr Ali Tahmassebi Dr Janet Walker Ms Jean Fruend Mr David Brunskill In Attendance Mr Craig Blair Mrs Sue Perkin Mr Mark Adams Mrs Liane Cotterill Mr Patrick Rice Mrs Jacqui Keane Mrs Julie Bailey Mrs Jo Chakal Mr Iain Sim Mrs Chris Smith
Chair Chief Officer Chief Finance Officer Secondary Care Doctor GP Locality Lead (Middlesbrough) GP Deputy Locality Lead (Langbaurgh) (Caldicott Guardian) Lay Member (Audit /Governance) GP Locality Lead (Langbaurgh) GP Locality Lead (Eston) Executive Nurse Lay Member (PPI)
Associate Director Commissioning, Delivery and Operations on behalf of Mr Kunonga, Director of Public Health, Middlesbrough Council Acting Director of Public Health, Redcar and Cleveland Council Senior Governance Manager, North of England Commissioning Support Assistant Director Commissioning and Adults, Redcar and Cleveland Council Corporate Governance and Risk Officer Partnership & Innovation Manager PA, North of England Commissioning Support (Minute Taker) Chief Executive, Coast & Country Housing (for item GB/165/14) Director of Business Development, Thirteen Group (for item GB/165/14)
Members of public in attendance Mrs R Farmer Business Development Manager, Care Visions at Home GB/153/14
Apologies for Absence Apologies for absence were received from Mr Edward Kunonga, Director of Public Health, Middlesbrough Council and Dr Nigel Rowell.
GB/154/14
Declaration of Interests There were no interests declared in relation to items on the agenda.
GB/155/14
Minutes of previous meeting
155.1
The minutes of the previous meeting held on 24 September 2014 were accepted as a true record subject to the following amendments:
155.1.1
133.1, final line to read “….GPs in Redcar & Cleveland and Middlesbrough…”
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133.3 – final line to read “ …. Made up of six Practices …” 155.1.2
137.9 – Paragraph to be amended to state that the Better Care Fund (BCF) schemes were being implemented, not ‘had been implemented’.
155.2
The minutes of the previous meeting held on 15 October 2014 were accepted as a true record subject to the following amendments;
155.2.1
150.13.1 - Dr Walker highlighted that this should include reference to the comments raised by Councillors in relation to the Patient Transport Service access and criteria. It was agreed to amend the minute accordingly. ACTION GB/30/14 (Mrs Kerry McLean)
GB/156/14
Matters arising and Action Log
156.1
Matters Arising Minutes of 24 September 2014. (GB/145/14.1) Mrs Hume informed the Governing Body that the Communications and Engagement Team were in direct contact with ‘Love Middlesbrough’ magazine to help promote the work the CCG is doing with Middlesbrough residents. Minutes of 15 October 2014. There were no matters arising from the Minutes that were not covered on the action log.
156.2
Action Log The Governing Body reviewed the action log and discussed each action in turn:
156.2.1
Action GB/25/14 Langbaurgh Locality Report - Mrs Hume informed the Governing Body that further discussions with NHS England had taken place and specific work was being progressed regarding Primary Care Workforce. Mrs Hume added that as work emerges, she would update the Governing Body. It was agreed the action could be closed.
156.2.2
Action GB/26/14 Information Governance Strategy – Mr Kunonga advised that this action had been completed. It was agreed the action could be closed.
156.2.3
Action GB/27/14 The Better Care Fund Submission - Mr Blair advised work was ongoing with NHS England; an update would be provided at the January Governing Body. It was agreed the action could be closed.
156.2.4
Action GB/29/14 Discussion and Questions (IMProVE) – It was noted that Mrs Stevens was progressing discussions with other agencies around public transport.
156.2.5 A robust project management structure, including a separate risk log, had been established to take forward the IMProVE programme. It was agreed that the Governing Body would receive regular updates on progress. Mr Gregory added that contract negotiations with the Foundation Trust would include issues relating to the successful delivery of the IMProVE programme.
Page 6 of 225
GB/157/14
Chair & Chief Officer’s report
157.1
Mrs Hume advised the Governing Body that the CCG had received positive feedback on the Better Care Fund submission and had been commended on the work done to ensure a high level of partnership working.
157.2
Two public engagement events to discuss commissioning intentions had taken place in August and November and both events had been very positive and well attended. Dr Walker added that the events had encouraged some valuable feedback that the CCG could consider as part of its commissioning approach, eg. how to support young people and the homeless.
157.3
Mrs Hume provided updates on six bids submitted to NHS England aimed at improving mental health resilience. She advised that as the total number of bids received exceeded the funding available it had been necessary for the CCG to review its submission and prioritise the bid for a Crisis Assessment Suite. The outcome of this bid was awaited.
157.4
Ms Fruend updated the Governing Body regarding arrangements to protect against child sexual exploitation and it was noted that the comprehensive multi-agency work programme underway across Teesside was continuing, details of which had been shared and further updates of its work would be provided on an ongoing basis. .
157.4
The Governing Body was informed that the Community Innovations and Mental Health Innovations Funds were progressing, with applications currently being considered; information on final decisions were due soon and would be shared.
157.5
Mrs Hume explained that the Integration Programme Board was continuing to meet and aimed to ensure there was a more effective approach to multi-agency working. A key area of focus was around the support of the frail elderly population. She added that Ms Kathryn Warnock had been appointed as Integration Manager to support this work. Ms Warnock would take up her post in early 2015.
157.6
Practice visits were continuing and were proving to be very valuable to enhance communication with Practices. The Governing Body NOTED the Chair and Chief Officer’s Report
GB/158/14
Locality Reports
158.1
Middlesbrough The Middlesbrough locality met in November, Dr Nanda explained that the key areas of discussion were: -
-
-
the Governing Body’s agreement to the IMProVE proposals and it had been stressed that if there were any concerns relating to quality or performance then Practices should highlight these. the new contractual requirement for practices to implement the Friends and Family Test and the CCG had invited the Area Team to come and speak to practices on the subject. the engagement with Practices in relation to Commissioning intentions. implementation of a new Physiotherapy phone advice line. Mental health strategy.
Page 7 of 225
158.2
Langbaurgh Dr Tahmassebi highlighted that there had been a similar agenda to Middlesbrough Locality, but in addition there had been a discussion regarding Learning Disabilities. It was agreed that more annual checks for learning disabilities were required in some practices, however it was acknowledged that more training was required and it was suggested an educational session could enhance this.
158.3
Eston Dr Walker advised that, in addition to the items identified by the other localities, Eston had also discussed how to encourage more patients to attend for Healthy Heart and Lung checks. She added that four Eston practices had been involved in the Deep End project which was addressing health inequalities In addition; there had been discussions on the preservation of the Eston Locality. The Governing Body NOTED the locality reports
GB/159/14
Commissioning Intentions
159.1
Mr Blair provided an overview of the process used to develop the Commissioning Intentions and the communications and engagement activity undertaken. The process had been two-tiered with the Executive Group reviewing the content created by the workstreams. Mr Blair sought support from the Governing Body to approve the next steps. Mrs Hume queried how the intentions had changed as a result of involvement with the public; in response to this Mr Blair gave assurance that the public’s view had informed and supported the detail provided within the report. Dr Walker noted that a recent issue highlighted as part of the engagement exercise had been around the autism spectrum disorder pathway and she was pleased to see that this had been included within the Commissioning Intentions. He added that access, prevention and quality were the three areas picked up strongly from the public’s feedback. The Chair acknowledged that progress was being made on promoting prevention via the Health Inequalities Workstream.
159.2
Mr Brunskill reiterated the CCG’s commitment to ensuring public and patient involvement (PPI) and explained that the CCG had commissioned an internal audit study of its PPI activity. Mr Gregory explained that an engagement map was being developed which would identify the CCG’s level of engagement related to expenditure and activity; this would enable the CCG to address any gaps in engagement and to also identify where greater emphasis should be placed. Mrs Hume added Healthwatch had reported some recommendations in relation to cancer and improving access to psychological therapies (IAPT). It was agreed that a report would be brought to the January Governing Body on these. ACTION GB/31/14 (Mrs Kerry McLean)
159.3
It was noted that the clinical workstreams involvement in the development and prioritisation of the commissioning intentions had strengthened and ensured a high level of clinical engagement.
159.4
Mr Gregory highlighted that the commissioning intentions outlined in the report were subject to affordability and the report did not include any detailed costings as the national publication of the final tariff was awaited. The Governing Body would be updated on the financial implications at the January meeting. The Governing Body AGREED the Commissioning Intentions Report, subject to affordability. Page 8 of 225
GB/160/14
Research & Innovation Strategy
160.1
Dr Nanda presented the strategy and noted that Ms Bailey had played a key role in developing the strategy. Ms Bailey explained that the strategy was intended to show how the CGG would deliver better services, empower commissioning decisions, and how ideas and innovation should be supported and promoted. She added that it would enhance the reputation of the organisation and would be supported by a full implementation plan, if approved.
160.2
The Chair noted that AHSN and other partners were already engaged with the CCG and Dr Nanda added that this collaboration was highlighted in the report. Dr Tahmassebi noted that funding was only for member practices and queried if there were any potential conflicts of interests; in response to this Mr Gregory confirmed that there were no conflicts as it was the strategy that was requiring approval and not the financial aspect.
160.3
Dr Drury highlighted that funds were finite and suggested the CCG should consider looking for partners to support projects, such as universities. Members were keen to ensure that the bulk of any funding for research and innovation was not spent on salaries and that alternative approaches should be explored. Dr Drury emphasised the importance of ensuring that research ethics was a prime consideration; for which guidance would be provided by North of England Commissioning Support Unit.
160.4
Mrs Perkin referred to FUSE, a collaboration between five universities which may have resource to provide support. Mr Gregory supported Ms Bailey’s comments and added that project investment would illustrate commitment to research and should encourage further buy-in.
160.5
Dr Tahmassebi stressed the importance of the innovation element of the strategy. It was noted that an innovation event had been planned for 28 November 2014 which had unfortunately had to be cancelled; it was being deliberated as to whether to change the format and reschedule.
160.6
The Chair acknowledged that other innovations across the region had been beneficial to the north east in general and may have a useful impact, and the CCG would wish to contribute. Dr Tahmassebi informed the Governing Body of the first meeting of a research alliance in Langbaurgh involving 16 practices looking at how best to work together to do more research. The Chair suggested the foundation trust may welcome an alliance with Primary Care.
160.7
Mrs Hume believed that innovation was a key component in developing the CCG’s approach to engagement with Practices. There was the potential to explore whether the the CCG could access frontline professionals in a different way to promote the projects. It was noted that an Innovations event across primary and secondary care and attendance of approximately 140 clinicians was expected. This event would provide a good learning opportunity and for joint actions and reflections to be developed and shared.
160.8
Ms Fruend highlighted that the CCG already commissioned for quality and innovation via CQUIN. It was the intention that there would be more focus on the ‘innovation’ element in order that patient care can continue to be improved. The Governing Body APPROVED the Research & Innovation Strategy
Page 9 of 225
GB/163/14
Schedule of dates 2015/16
163.1
The Governing Body reviewed the draft schedule of dates for 2015/16. It was acknowledged that venues had not been booked and would be done so following the Governing Body’s approval of the dates and times.
163.2
The Governing Body AGREED that an Annual General Meeting (AGM) was to be scheduled for September 2015. The Governing Body APPROVED the Schedule of dates for 2015/16
GB/164/14
Alternative Provider Medical Services (APMS) Contracts
164.1
Dr Milner and Mr Blair provided an overview of the APMS contract arrangements throughout Middlesbrough and Redcar. It was clarified that there were three contracts that had unregistered (walk-in) elements and that this element of service provision was the responsibility of the CCG. The ‘registered’ elements were the responsibility of the Area Team. The APMS arrangements related to: -
Resolution Practice, North Ormesby Health Village, Middlesbrough Eston Grange NHS Healthcare Centre, Middlesbrough Langbaurgh NHS Medical Centre, Redcar.
The report presented to the Governing Body described the process being undertaken by the Area Team on public and stakeholder engagement on the review of the registered elements of these contracts, and the work carried out in parallel by the CCG and commissioning support unit to review the unregistered elements. The following key points were noted by the Governing Body: -
-
Resolution Practice: o unregistered attendance was 42,636 during 2013/14. o Governing Body previously extended the unregistered element to 31 March 2016 which would allow consideration of services in line with national guidance and the CCG’s emerging Urgent Care Strategy. o Area Team consultation on procuring a new practice within the area and that, if this was progressed, then ‘registered’ patients could be transferred to that Practice. In the meantime, the Area Team were negotiating to extend the registered element of the contract to 31 March 2016. Eston Grange: o Unregistered attendance was 27,658 during 2013/14. o The ‘registered’ element managed by the Area Team was a weighted list of 1,363 at March 2014. o In view of the small list size, service quality and performance and the close availability of alternative service provision, the Area Team was consulting on decommissioning the ‘registered’ element of the contract. In the meantime, the Area Team had extended this element of the contract to 31 March 2016. o The Area Team had advised the CCG that should registered Practice be dispersed to other Practices then a new national contract for the unregistered element needed to be drafted and agreed for the period 1/4/14 to 31/3/16. A Prior Information Notice would need to be issued.
Page 10 of 225
-
Langbaurgh NHS Medical Centre: o Unregistered activity in 2013/14 was 1,699 attendances against an annual attendance target of 12,000. o The CCG had carried out periods of engagement on alternative service provision and the closure of the walk-in element of the contract that was due to expire on 31 December 2014. If approved, it was the intention of the CCG not to seek to either extend this contract or procure an alternative similar service. o Patients would still be able to attend the walk in service in Eston Grange until, at least, March 2016. o The Area Team were carrying out further consultation on the ‘registered’ element of the contract and were, therefore, in discussions to extend that part of the contract to 30 September 2015.
The Governing Body discussed the above in detail and acknowledged that there was a stark contrast in attendance numbers and recognised that there was nearby, easily accessible alternative facilities for patients. However, the importance of ensuring the public were aware of the different types of services was paramount to ensure that the right care was provided in appropriate settings and that any changes to service provision would not result in increased attendances at A&E. The Governing Body AGREED: -
GB/165/14
To extend the APMS contract for unregistered patients at the Eston Grange NHS Healthcare Centre to 31 March 2016; To approve the issue of Prior Information Notice to inform the market of its intention to reprocure a service for Eston Grange. To allowing the unregistered element of the contract at Langbaurgh NHS Medical Centre to expire on 14 December 2014 without procuring a further non-bookable appointment service.
Strategic Links between Health & Housing
165.1
Mrs Hume introduced Mr Sim and Mrs Smith to the Governing Body in order to discuss the impact housing provision had on the population’s health and to explore opportunities for the CCG to work with Housing areas that could have a beneficial impact in terms of health. Mr Sim and Mrs Smith gave a presentation on the services provided by Coast and Country Housing and the Thirteen Group, which worked with the public and partners on prevention and intervention. Their overriding ethos was to help to keep individuals in their own homes with a strong focus on social inclusion. Some examples of services that had a potential positive impact on health in terms of prevention and intervention included: assistive technology and telecare; adaptations and alterations to enable those with long term conditions and physical disabilities to stay at home; community drug and alcohol recovery services; step up and step down accommodation to prevent hospital admissions and to provide support following discharge and support for vulnerable persons. Mrs Smith described their housing function, including specialist accommodation. It was noted that there was a focus on dementia models currently in the Tees Valley, however not a lot of provision.
165.2
The Support to Stay project provided intensive support for vulnerable people about to give up tenancies who may have complex needs. Social Inclusion supported people into work, providing skills and training and worked with schools and further education. The group supported digital skills and helping to get people online. Work was ongoing to provide homes beyond the “decent homes” standard, with fuel switching, insulation and energy support and advice to help people heat their homes at a safe and healthy temperature.
Page 11 of 225
165.3
Mrs Smith provided detail of the Gateway project based in Middlehaven, Middlesbrough. This was a 40 bed/12 transitional development aimed at providing a pathway to independence through intensive support and reablement.
165.4
Mr Sim explained the Coast and Country Housing Independent Living Service which was TSA accredited and included a rapid response Social Care Service, easy access for referrers (including GPs) and Telecare facilities. He gave details of some of the potential benefits based on the previous year’s figures for falls, the independent living service and residential care.
165.6.1
Mrs Fruend referred to her roles within the Safeguarding Boards, and acknowledged the work both housing organisations were doing to help with this agenda to improve outcomes.
165.6.2
The Governing Body recognised the potential benefit of exploring further partnership opportunities for a range of health related agendas, including: learning disabilities support; community care; supporting maintaining independence at home and the Deep End project. It was agreed that Mr Blair would progress these discussions. Mr Sim and Mrs Smith left the meeting
GB/166/14
Financial Report
166.1
Mr Gregory presented the Finance report for the period to 31 October 2014 to the Governing Body and highlighted the following points: -
The CCG was on target to deliver the required 1% surplus; There were performance issues on the main contract, including the delivery of QIPP savings particularly with regard to emergency activity. It was anticipated that there should be an improvement on this towards the end of the financial year. Although some of the CCG’s reserves had been committed, there was still the required contingency fund of 0.5
There was the potential that national risk share funding related to national CHC provisions may revert to the CCG from NHS England.. 166.3
Mr Gregory highlighted the work undertaken in the clinically led workstreams to identify key projects primarily from the CCG’s commissioning intentions. It was acknowledged that additional work was ongoing to further develop these schemes and cost estimates.
166.4
The Governing Body discussed the financial position, including a tranche of funds from the strategic resilience monies. Mr Gregory noted underspends may assist where there may be winter pressures.
Page 12 of 225
The Governing Body NOTED the Finance Report and, in particular: -
The current forecast outturn for 2014-15 The CCG’s reserves and pipeline of current and expected projects; The strategic issues that will have a financial effect in future years, and The opportunities for reviewing efficiencies identified in benchmarking data.
GB/167/14
Annual Audit Letter from Deloitte
167.1
Mr Gregory informed the Governing Body that the CCG had received a positive Audit Letter from Deliotte and confirmed that no concerns had been raised. He advised that Deloitte would expect the CCG to demonstrate robust validation of data for South Tees Hospitals NHS Foundation Trust, particularly in light of the Trust’s financial position. Mrs Hume acknowledged that the South Tees Hospitals Foundation Trust financial position remained a concern and confirmed that the CCG was in continuing dialogue with the Trust regarding the robustness of their financial recovery plan, with a particular emphasis on ensuring there were mitigations in place to reduce any adverse impact on the quality of patient care.
167.2
In light of the differences between the 2013/14 to 2014/15 figures, Dr Tahmassebi sought assurances that the commissioning support unit had processes in place to validate activity and potential coding issues. Mr Gregory confirmed that checks were in place and Mr Blair affirmed that any anomalies were investigated and addressed. The Governing Body NOTED the Audit Letter report
GB/168/14
Quality & Safeguarding Report
168.1
Ms Fruend presented the Quality and Safeguarding report for the period to end September 2014 and drew the Governing Body’s attention to some key areas for consideration.
168.2
South Tees Hospitals Foundation Trust (STHFT) -
Serious Incidents: slight increase in grade 3 pressure ulcers; Mortality; the Trust is no longer considered on outlier; HCAI; 3 reported MRSA cases in the year to-date and just within the annual trajectory for C.Diff.
In addition, Ms Fruend advised that the CCG was awaiting the Cost Improvement Plan (CIP) which would be quality impact assured as soon as it become available. 168.3
Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) -
progress was being made on the recommendations for improvements following an assurance visit to Park House and Roseberry House. the Trust had given assurances regarding their action plans to address issues raised from the Care Quality Commission (CQC) visit.
Page 13 of 225
North East Ambulance Service Foundation Trust -
168.4
The NEAS CQUIN schemes had been agreed and were underway although further work was required to agree metrics; At the end of Q2, the Trust had not achieved the 75% performance target for 8 minute response, however, they were achieving it for the overall year-to-date The potential impact upon patient care was being closely monitored by the CCG. .
Safeguarding Ms Fruend explained that the restructuring of the Adult Safeguarding team was continuing to work well; resulting in improved reporting of more granular data which would be of benefit across agencies and, ultimately, prevent deterioration of safeguarding incidences.
168.5
Ms Fruend advised that work was ongoing to seek feedback on the format and content of the paper to ensure that it provided the Governing Body with a robust level of assurance. The Chair thanked Ms Fruend and the Quality Team for the work in developing the report which enabled the Governing Body to focus on the key quality issues. The Governing Body NOTED the Quality & Safeguarding Report
GB/169/14
System Resilience Group and Schemes Update Report
169.1
Dr Milner and Mr Blair presented the System Resilience Group and Schemes Update Report. Mr Blair informed the Governing Body of the CCG’s approach to responding to NHS England’s 13 requirements for winter planning. He advised that the majority of schemes were underway and that all funded schemes were closely monitored and tracked via the Systems Resilience Group to support their delivery and ensuring quality, performance and financial balance.
169.2
Mr Blair asked whether the Governing Body felt additional information was needed or clarity in any areas was required in order to gain assurances for winter planning. Mrs Hume highlighted that the Executive Group had discussed issues around frail elderly, housing and supporting other non-traditional areas of surge. She felt there should be further discussion within the SRG on delirium and housing and asked Mr Blair to progress. ACTION GB/33/14 (Mr Craig Blair)
169.3
Dr Nanda queried what engagement had been carried out with Primary Care to help with surge pressures; in response to this Mr Blair confirmed the Area Team was represented on the SRG and that there were 3 GPs on the Group. He advised that the urgent care pilot scheme would allow the development of practice based responses. Dr Nanda was keen to encourage greater involvement of practices. Mr Blair agreed to take this forward. ACTION GB/34/14 (Mr Craig Blair) The Governing Body NOTED the System Resilience Group and Schemes Update Report
Page 14 of 225
GB/170/14
Stand-down of Chair
170.1
The Chair confirmed to the Governing Body that this was his final session as Chair and he thanked members for their support and stated he had enjoyed his time as Chair.
170.2
Dr Waters formally stood down as Chair of the Governing Body due to his impending retirement from the CCG and as a GP. The Governing Body thanked Dr Waters for his service and contribution to the CCG and wished him well for his retirement.
170.3
To complete the meeting Mr Brunskill took the role of Chair of this meeting.
GB/171/14
Assurance Framework
171.1
Mr Gregory provided an update on the Assurance Framework and explained there would be some changes to the Framework for next year. He provided the Governing Body with an overview of the risks detailed in the report which had been discussed by the Executive Group that morning. With regard to specific risks in the report, he assured the Governing Body that monies allocated for winter pressures would be spent appropriately and that improved links would be created with NHS Property Services. He highlighted that although the level of the Better Care Fund risk had been reduced, it remained a risk. The risk relating to surge remained and the CCG would ensure monies were again targeted to the correct areas.
171.2
The Governing Body noted that a new risk had been added to the risk register regarding public engagement work which the CCG was committed to developing across all relevant pieces of work.
171.3
Ms Fruend added that an unannounced commissioner visit by six CCG colleagues last week to STHFT had confirmed that staffing improvements were evident and were seen in A&E particular which assured members regarding pressures. The Governing Body NOTED the Assurance Framework Update.
GB/172/14
Primary Care Co-Commissioning
172.1
Mr Blair reminded the Governing Body of the recent request for CCGs to identify the areas they wished to consider for future commissioning arrangements, however NHS England had provided a new proposal with options including greater involvement in decision making and revised commissioning arrangements.
172.2
Mr Blair explained that the new proposals gave the ability to establish new GP practices, or the approval of GP mergers in the area, in order to pursue revised arrangements, CCGs would be required to implement revised governance requirements, in terms of supporting CCGs, although there was no additional financial resource available. He added there were some individuals in NHS England who managed Primary Care contracts; access to those people could be available but minimal.
172.3
Mr Blair highlighted the following options and timescale implications; Option 1 - Remain as current with greater involvement in primary care decision making; which had no implications.
Page 15 of 225
Option 2 - Joint Commissioning Arrangements (JCA) with formal application due for submission by end of January 2015 Option 3 - Delegated Commissioning Arrangements (DCA); the CCG must inform NHS England now and submit a plan by 9 January 2015. 172.4
Mr Blair highlighted that there were risk to all the options, such as reputational concern and a gap in skills and expertise which required the CCG to recruit.
172.5
Mr Blair sought approval for a preferred option; he added that, following detailed consideration of the options, the Executive Group’s recommendation would be to pursue option 2, the Joint Commissioning model, although it was recognised that more detailed consideration would be required. Mr Blair advised that the joint commissioning option increased the ability to inform contractual requirements and outcomes. A joint committee would be a sub-committee of the Governing Body which would need to be chaired by a lay member.
172.6
Dr Nanda queried the implications for the CCG to continue as they were; Mr Blair advised that there would be changes, regardless of which option was taken by the CCG and it was important for the CCG to demonstrate its commitment to moving forward as a commissioning organisation.,
172.7
Mrs Hume clarified that the proposals being considered were in the early stages and it was important for the Governing Body to give the Executive Group a mandate to further pursue the options available in order to discuss further with Clinical Council of Members (CCOM). It was noted that if the CCOM wished to pursue the ‘full delegation’ option an Extraordinary Governing Body meeting would need to be convened before the deadline of 9 January 2015. Mr Gregory highlighted that detailed discussions were required with the commissioning support unit to understand the level of support they were able to give to the CCG. ACTION GB/37/14 (Mr Craig Blair)
172.8
It was agreed that, in light of the national timescales, the Executive Group should pursue the development of the options and discussions with the Clinical Council of Members. The Governing Body were to be kept updated on these discussions in order that appropriate governance arrangements for approvals could be organised. ACTION GB/38/14 (Executive Group) The Governing Body NOTED the options and AGREED that the Executive Group would further develop the options; discuss with the Clinical Council of members and seek formal approval by the Governing Body in line with the national timetable.
GB/173/14
Appointment of New Chair Mr Brunskill, as Chair informed the Governing Body that following Dr Waters’ resignation for retirement, the CCG had followed an internal process to elect a new Chair of the CCG. Through this process the CCG had received a nomination for Dr Janet Walker to be appointed as Chair. This had also been discussed with the Clinical Council of Members. The Chair asked all Governing Body Members to vote on electing Dr Walker as Chair; there were no abstentions or dissent. All members voted for Dr Walker to become Chair and welcomed her in her new role on the Governing Body. The Governing Body ELECTED Dr Walker as Chair of the CCG.
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GB/174/14
Report from Quality, Performance and Finance Committee held 5 November 2014 Dr Tahmassebi informed the Governing Body that the majority of the QPF Committee discussion had focused on issues with the North East Ambulance Service (NEAS); the main concern being ambulance response and handover times. Work was planned to look at this more closely and consider options for the CCG to help improve this. Dr Milner queried if there were any specific areas of concern in the waiting time figures; in response to this Dr Tahmassebi confirmed there were trends which would be examined. The Governing Body NOTED the Report from the Quality, Performance and Finance Committee held on 5 November 2014
GB/175/14
Confirmed Minutes
175.1
Confirmed Minutes of the Governance and Risk Committee held on 13 August 2014 The Governing Body NOTED the confirmed Minutes of the Governance and Risk Committee held on 13 August 2014
175.2
Confirmed Minutes of the Audit Committee held on 2 June 2014 The Governing Body NOTED the confirmed Minutes of the Audit Committee held on 2 June 2014
GB/176/14
Appointment of New GP member The Governing Body was informed that following the retirement of Dr Waters, there was a vacancy for a Governing Body GP member and advised that the LMC had managed the election and selection process. The Clinical Council of Members had been involved throughout and had confirmed their general acceptance to the approach taken. The CCG had received an expression of interest from Dr Raj Khapra and a subsequent Nominations Panel had been held in addition to all Practices being contacted to ask for any concerns to be raised. It was confirmed that there had been no objections raised by Practices to Dr Khapra’s appointment and that Dr Khapra met all the criteria required of a Governing Body GP. Mrs Hume sought the approval from the Governing Body to appoint Dr Khapra as a Governing Body GP member. The Governing Body APPROVED the appointment of Dr Raj Khapra as a Governing Body GP Member.
GB/177/14
Any Other Business There was no other business discussed.
GB/178/14
Date, Time, Venue of next meeting The next meeting was scheduled for Wednesday, 28 January 2015 at 2.00pm at The Acklam Green Centre, Stainsby Road, Middlesbrough.
Signed: ……………………………………………….. Chair of the Governing Body Page 17 of 225
Date: ………………………………
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South Tees CCG Governing Body Meeting Action Log Action number
Date of meeting
Subject
GB/24/14
24.09.14
Matters Arising
GB/30/14
26.11.14
GB/31/14
26.11.14
GB/32/14
26.11.14
Action
The governing Body was informed that the Overview and Scrutiny Committee had asked the CCG to consider quality of access under Equality agenda, therefore the CCG needed to ensure it was informed in their Equality action plan. Minutes of previous Dr Walker highlighted comments meeting raised by Councillors in relation to the Patient Transport Service access and criteria. It was agreed to amend the minute accordingly. Commissioning Mrs Hume suggested this report be Intentions presented to the Governing Body in January 2015. Mrs Bailey highlighted that there was also a Cancer report that should come to the Governing Body in January 2015. APMS Contract Report Mrs Hume informed the Governing Body of recent publicity in the press that had not seemed straightforward; Eston Grange never achieved the registered list size expected and the actual list was lower than the weighted list. It was suggested that the report needed to be clear in relation to patients in Redcar being able to attend a walk-in centre at Eston Grange until at least March 2016 and this transition needed further clarity. Mr Brunskill sought clarity on the difference between an Urgent Care centre and a walk-in centre from the patient perspective; in response to this it was clarified that an Urgent Care Centre could be mainly nurse-led with more GP presence. Mrs Hume requested this point be clearly made within the report to avoid confusion for the public. Mr Brunskill felt there were other elements of the report which the public may not understand for example, decommissioning. Mr Race added that recent local and national publicity had shown patients did still attend A&E and felt more could be done to illustrate the benefits of the strategy to inform
Responsible officer
Due date
Mr. Ben Murphy
17.11.14
Mrs McLean
21.01.15
Mrs McLean
21.01.15
Dr Milner
21.01.15
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Comments
Date reviewed
Status
26.11.14
Open
Minutes amended
28.01.15
Complete
06.01.15 - Scheduled on draft agenda for approval. 13.01.15 - item removed from final agenda by Chair.
28.01.15
Complete
28.01.15
Open
GB/33/14
26.11.14
System Resilience Group and Schemes Update Report
Mr Blair asked whether the Governing Mr Blair Body felt additional information was needed or clarity in any areas in order to gain assurances for winter planning. Mrs Hume highlighted that the Executive Team had discussed Frail Elderly, Housing and supporting other non-traditional areas of surge. She felt there should be further discussion with the SRG on Housing and asked Mr Blair to progress.
21.01.15
28.01.15
Open
GB/34/14
26.11.14
System Resilience Group and Schemes Update Report
Dr Nanda queried what efforts had Mr Blair been made to engage with Primary Care for Winter Pressures issues; in response to this Mr Blair confirmed the Area Team was represented within the SRG and the Urgent Care pilot scheme would develop practice based schemes to address this. Dr Nanda was keen to check the proportion of GPs involved with this; Mr Blair confirmed the involvement of three GPs from the South Tees locality. She felt there were ways to involve the practices further and asked if the Local Medical Committee (LMC) were communicating back to practices and members and should be encouraged to do so. Dr Tahmassebi felt members as providers were actively engaging. Mr Blair suggested perhaps he could discuss this with them.
21.01.15
28.01.15
Open
GB/35/14
26.11.14
Primary Care CoCommissioning
Mr Blair sought approval for a preferred Mr Blair option; he added that the Executive Team’s preference had been option 2, the Joint model. The Governing Body requested further discussion at Executive Team which was to be brought back to the Governing Body for discussion and to approve the next steps.
21.01.15
28.01.15
Open
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GB/36/14
26.11.14
Primary Care CoCommissioning
Dr Tahmassebi acknowledged that a Mrs Keane lot of work had already been done regarding the options and queried responsibility for APMS practices in terms of the funds withdrawn last year; in response this Mrs Hume clarified that this was in the early stages of the decision and the first step was a mandate to pursue the status agreement. To agree full delegation an Extraordinary Governing Body meeting would need to be convened before the deadline of 9 January 2015.
21.01.15
28.01.15
Open
GB/37/14
26.11.14
Primary Care CoCommissioning
21.01.15
28.01.15
Open
GB/38/14
26.11.14
Primary Care CoCommissioning
Mr Gregory highlighted that detailed Mr Blair discussions were required with NECS to progress. The Chair suggested the Executive Executive Team Team look at the option in more detail and advise the Governing Body in due course.
21.01.15
28.01.15
Open
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REPORT CLASSIFICATION – please refer to Report Classification Guidance and check appropriate box below
NHS Confidential NHS Protect x Public
NHS South Tees Clinical Commissioning Group Governing Body Agenda Item: 1.5 Wednesday 28 January 2015
Purpose of Paper
For information
Title Responsible Author of the Report Recommendation(s)
Report of the Chair and Chief Officer Dr Janet Walker, CCG Chair and Mrs Amanda Hume, Chief Officer Mrs Jacqui Keane, Corporate Governance and Risk Officer The Governing Body is asked to note the content and receive the Report.
Summary
The report provides the Governing Body with a short summary of business since the Governing Body meeting in November 2014. There are no financial implications relating to this report. There are no legal or regulatory implications relating directly to this report. There are no Risk Register or Assurance Framework implications relating directly to this report.
Financial Implications Legal/Regulatory Implications Assurance Framework/Risk Register Implications Details of relationship to the NHS Constitution Details of Patient and Public Involvement and/or Implications Has an Equality Analysis been completed? Attachments Please detail any Committees or Forums at which this paper has previously been tabled
A number of areas highlighted in the report reflect the CCG’s compliance with the principles of the NHS Constitution, eg. partnership working, engagement and continuing to work to improve the quality of services. Although the content of this report was not subject to patient and public involvement, it outlines some of the areas the CCG is pursuing to enhance involvement and engagement with patients, stakeholders and member practices. Not applicable to this report
Report of the Chair and Chief Officer – January 2015 None.
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REPORT OF THE CHAIR AND CHIEF OFFICER GOVERNING BODY MEETING – 28 JANUARY 2015 1.
Introduction This report provides the Governing Body with a short summary of some of the business undertaken since the Governing Body meeting in November 2014. The Governing Body is asked to receive the report, note the update and consider the issues highlighted.
2.
Public involvement and engagement As a CCG we are committed to involving the public in our work so that we can further understand the needs of our population and, thus, inform and influence our decision making. The following summarises some of the involvement activity undertaken over the last two months:
a.
Call to Action Primary Care Co-Commissioning event We held a public engagement meeting on the 8th January 2014 to raise awareness of the options available to the CCG in relation to the national Primary Care CoCommissioning agenda. This was attended by members of the public as well as local voluntary and community sector organisations, including Healthwatch and the Cleveland Local Medical Committee (LMC). We wanted to ensure that this complex area of health policy was understood by attendees so that they could give us their informed view of how they felt the CCG should progress. This was a valuable exercise and has reinforced the CCG’s desire to move forward with joint commissioning arrangements which will give the CCG more influence locally and nationally.
b.
Patient Participation Groups (PPG)/ CCG Meetings In December, Dr Ali Tahmassebi and Dr Janet Walker attended the third Langbaurgh and Eston PPG meeting to progress how the CCG can engage with the PPG members from the local area. The meeting was an opportunity to give an update on IMProVE (Integrated management and proactive care for the vulnerable and elderly) as well as a general update on the work of the CCG to keep members updated, involved and informed. Dr Walker also attended the first Middlesbrough PPG/CCG meeting in December; unfortunately due to adverse weather conditions the meeting wasn’t well represented but we will look to hold another meeting very soon.
c.
Equality and Diversity The CCG’s equality objectives were discussed at a public engagement meeting in November so that local people were able to hear about our commitment to equality and diversity and for them to share their views on the CCG’s approach and how we graded ourselves on our performance. We received a lot of helpful comments and as a result of their feedback we amended some of the gradings. The CCG’s
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progress on meeting the revised equality objectives will be monitored by the CCG’s Governance and Risk Committee. d.
Twitter We know that it isn’t always possible for people to come along to meetings to get involved in what we do and that sometimes public invitations to events can easily be missed. We are keen, therefore, to use other communications methods, including social media. The CCG’s twitter site is another way of hearing about events and finding out about the work done by ourselves and some of our partners and we would encourage members of the public to follow us on twitter using at @SouthTeesCCG.
3.
Partnership working The north east is recognised as an area with specific health and social care challenges and high levels of health inequalities. The best way for us to tackle this and work to improve our population’s health is by working together with other agencies; the following gives a flavour of some of the areas we are pursuing:
a.
Integration event The first South Tees integration event organised by two of our GPs (Dr Bye and Dr Weatherall) was held on 28 November and was extremely well attended by consultants from South Tees Hospitals NHS Foundation Trust (STHFT) and South Tees GPs. There has been interest shown in developing the work from this event to improve communications between primary and secondary care which will ultimately lead to improvement of patient care pathways.
b.
Exploring new models of care The Chair, Chief Officer and Governing Body GP, Dr Tahmessebi, together with senior colleagues from STHFT, attended a national meeting to explore how we could work together to explore new models of care as proposed in the 5 year forward view. There was strong support from all the South Tees attendees to work together in order to design a new system approach for urgent care and community nursing, involving all partners and stakeholders. There is an opportunity to access support and possible funding to progress this, and we have agreed that an expression of interest will be developed and submitted to help us achieve our vision.
c.
Northern CCG Forum The CCG Forum met earlier this month and focussed on system leadership and how to ensure better co-ordination and collaboration across the whole north east health economy in order that the 13 CCGs can work together on large scale transformation. The intention is that the focus for this work would be improving the approach to learning disability services and the handling of complex cases.
d.
Primary Care Co-Commissioning We held an extraordinary CCOM meeting on 7th January 2014 for our member practices to discuss the options available to the CCG in relation to Primary Care CoCommissioning. We had good attendance at the meeting which allowed for an interesting and stimulating debate about the options available to the CCG. This was supplemented by a Practice survey which has resulted in the agreement of the
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proposed approach for a joint commissioning arrangement with NHS England. In addition, as previously mentioned, events have been held to encourage public involvement on this decision. The CCG is now developing its submission to NHS England to undertake joint commissioning beginning 1 April 2015. The CCG is committed to ensuring the transparency of decisions made by this Committee and will invite our local HealthWatch and Health and Wellbeing Boards to join the committee, in line with national guidance. e.
Visits to Member Practices We are continuing to meet with our Member Practices on a rolling programme throughout the year. These are extremely valuable to us and provide an excellent opportunity to build relationships and discuss key issues.
4.
A focus on mental health
a.
Mental Health Crisis Care Concordat A large amount of work has been undertaken to develop the local response to the Mental Health Crisis Care Concordat with partners including the Police, both Local Authorities and local health providers. All partners have now formally expressed their commitment to this work and are now developing a joint action plan. The Chief Officer chairs a task group with partners from across Tees to take forward this important agenda. This work, as well as the awarding of national funding to implement a Crisis Assessment Suite at Roseberry Park, has highlighted the need to examine the pathway for people experiencing mental health crisis and the services we place around it. A piece of work is starting to examine patient journeys through services which will inform discussion of mental health crisis provision over the next few months.
b.
Improving Access to Psychological Therapies A promotional marketing campaign highlighting talking therapy services was launched earlier this month with the public and GP Practices. The CCG is keen to encourage early referrals into this service as research suggests this has improved outcomes for patients. Further details are available via the CCG website. http://www.southteesccg.nhs.uk/
5.
Supporting our community
a.
Seasonal ailment scheme pilot in Community Pharmacy The winter period often results in a rise in attendances at GP practices and we are keen to promote alternatives for people who may have minor ailments that could be treated without a visit to their GP. Local pharmacies are an excellent source of advice for people and to supplement this, a pilot scheme has been launched across 10 pharmacies across South Tees to also provide a level of free treatment for eligible patients, which includes free paracetamol or ibuprofen
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b.
Community Innovations Fund and Mental Health Innovations Fund Following the success of our Community Innovations Fund last year, we decided that this year we would expand this to also have a specific Mental Health Innovations Fund. Over 50 applications were submitted to the CCG for funding for some very worthwhile projects to improve health in the community. The shortlisting process included a review of bids by: clinicians, local authority partners, Healthwatch and patients. The successful local community projects this year were: Sporting Memories Network, North Riding County Football Association, Carers Together, Living Sober, Mommy’s Little Helper, Friends of Skelton Library, Trinity Holistic Centre, Middlesbrough Library Services (books on prescription dementia); ME North East and Cleveland Alzheimer’s Residential Care. Successful projects in the mental health category were: MFC Foundation; Middlesbrough and Stockton MIND; Wellbeing for All the Well Being Recovery College; Garth Surgery, Garth Health and Wellbeing Service; Victim Support Mental Health Innovation Project; The Junction Foundation; The LINK (Redcar) CIC and EVA Women’s Aid. For further information about individual projects please see the Community Innovations Fund section on the CCG website at www.southteesccg.nhs.uk
c.
The Gazette Community Champion Awards 2014 Once again, together with NHS Hartlepool and Stockton on Tees CCG, we sponsored the Evening Gazette’s Community Champion Carers Category. As part of the judging panel for this award, we were humbled to read the stories of carers and everyone who was nominated for the award deserves recognition. Ultimately, the panel presented the award to Naomi Wise; a selfless individual whose dedication to others makes her stand out from the crowd. We welcome the opportunity to attend and support such events which recognise the contributions made by local people.
d.
South Tees Volunteering Excellence Awards The South Tees Volunteering Excellence Award was organised by Middlesbrough and Redcar & Cleveland Voluntary Development Agencies to recognise the outstanding contributions of local people to their communities. These volunteers can make a huge difference to the lives of others and we were pleased to sponsor the Health and Wellbeing Champion’s 2014 award. Dr Henry Waters (past-Chair of the CCG) and Mr David Brunskill (CCG Lay Member) attended the awards ceremony and presented the award to Glynis Rodgerson.
e.
Fundraising Event at Redcar Primary Care Hospital The CCG Chair, Janet Walker, opened the Redcar and Cleveland Christmas fundraising event which was raising funds for the Salvation Army and Footsteps in the Community which is a local food bank.
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f.
Charity bike ride We were delighted to support a member of the CCG staff, Hannah Boulton, who did a charity bike ride around all 47 of the CCG’s GP Practices over two very cold and wet December days. Her sterling efforts took Hannah all around Middlesbrough and Redcar & Cleveland area covering 70 miles. The generosity and kindness showed to Hannah by the GP Practice staff, patients and members of the public who she passed along her route has helped her raise over £300 for the WomenVCancer charity. Her ride was also good training for the Cycle Africa event she is doing later this year for the benefit of the same charity.
Dr Janet Walker CCG Chair
Amanda Hume Chief Officer
January 2015
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REPORT CLASSIFICATION – please refer to Report Classification Guidance and check appropriate box below
NHS Confidential NHS Protect X Public
NHS South Tees Clinical Commissioning Group Governing Body Agenda Item: 2.1 Wednesday, 28 January 2015
Purpose of Paper
For Decision
Title Responsible Lead Author of the Report
Redcar & Cleveland Joint Carers Strategic Plan 2014 – 19 Associate Director of Commissioning and Delivery Sue Renvoize, Commissioning Lead for Services for Older People & Carers The Governing Body is asked to approve the plans and confirm the organisation’s commitment to delivery.
Recommendation(s)
Summary
Financial Implications Legal/Regulatory Implications Assurance Framework/Risk Register Implications
Details of relationship to the NHS Constitution
Details of Patient and Public Involvement and/or Implications Has an Equality Analysis been completed? Attachments Please detail any Committees or Forums at which this paper has previously been tabled
This strategic plan identifies the current provision of services and support for carers and the views that a range of carers of all ages have made during consultation exercises held in 2013 – 14. The aim of the carers strategic plan is to improve the quality of life of carers and to ensure that they are respected for the invaluable role that they undertake. The plan will be taken forward by partners through the development of an action plan which will highlight the projects / services to be developed during the current year (and refreshed in each successive year). Financial commitments for carers support and services are outlined within the Better Care Fund. None identified. The plan will support the delivery of corporate objective 1 To continue to demonstrate a measurable improvement in the quality and safety of the services we commission and the experiences of those who use them, encouraging transparency and openness; and 3 To build on existing relationships with member practices, the public and patients, ensuring greater engagement in commissioning decisions. Relates to constitutional principle number 4: “The NHS aspires to put patients at the heart of everything it does”; 5: “The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.”; and principle 7: “The NHS is accountable to the public, communities and patients that it serves”. Carers have been involved in the development of the plan. Their views have been sought and have influenced the content of the plan. Consideration has been given to an equality analysis and it is considered that such analysis not required for this document. Redcar & Cleveland Joint Carers Strategic Plan 2014 – 19 The plan is recommended to the Governing Body by the Health Inequalities Workstream and the Executive Team.
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Redcar & Cleveland Joint Carers Strategic Plan 2014 – 19 Introduction This carers strategic plan has been developed by the Redcar & Cleveland Carers Strategy Steering Group which has been responsible for implementing the previous joint carers strategy 2009-14. Members of the steering group represent: carers; Carers Together; The Junction; South Tees Clinical Commissioning Group; Coast & Country Housing; Tees, Esk & Wear Valleys Mental Health Foundation Trust; South Tees Acute Hospitals NHS Foundation Trust; and Redcar & Cleveland Local Authority Adult and Childrens’ Social Care department. This strategic plan identifies the current provision of services and support for carers; the comments that a range of carers of all ages have made during consultation exercises held in 2013 – 14 and the response from partner agencies to the priorities that have been identified for the coming 5 years. The aim of the carers strategic plan is to improve the quality of life of carers and to ensure that they are respected for the invaluable role that they undertake. The strategic plan will be taken forward by partners through the development of an action plan which will highlight the projects / services to be developed during the current year (and refreshed in each successive year). Progress on the priorities in the strategic plan will be reported to the Redcar & Cleveland Carers Partnership which meets quarterly. The South Tees CCG and Redcar & Cleveland Adult and Childrens’ Social Care department will collaborate to develop a joint commissioning plan for carers services using core funding and resources from the Better Care Fund. The joint commissioning plan will reflect the priorities identified in the service strategy. 4 key schemes have been identified for 2014-15, funded from the Better Care Fund. 1 Who are carers? A carer is someone who spends a significant proportion of their life providing unpaid support to family or friends. This could be caring for a relative, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems. (Carers at the heart of 21st century families and communities HM Government 2008.) The Department of Health report Commitment to Carers
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2014 corroborates this – ‘a carer is anybody who looks after a family member, partner or friend who needs help because of their illness, frailty or disability. All the care they give is unpaid’. A young carer is a child or young person under the age of 18 carrying out significant caring tasks and assuming a level of responsibility for another person which would normally be taken by an adult. (Princess Royal Trust for Carers). Parent carers are also included in this strategic plan. A parent carer is a parent or guardian who is likely to provide more support because their child is unwell or has a disability. Parents will often see themselves only as a parent rather than a carer, but if their child has additional care needs they may be entitled to additional support. 2 2.1
• • • •
National Guidance about carers In 2008, the Department of Health published ‘Carers at the heart of 21st century families and communities: A caring system on your side. A life of your own’. This was followed by ‘Recognised, valued and supported: Next steps for the Carers Strategy’ in 2010, produced by the coalition government. Both documents highlighted the government’s commitment to supporting unpaid carers. There are 4 key themes to the national carers strategy: Identification and recognition of carers - “Supporting those with caring responsibilities to identify themselves as carers at an early stage, recognising the value of their contribution and involving them from the outset in designing local care provision and in planning individual care packages” Realising and releasing potential - “Enabling those with caring responsibilities to fulfil their education and employment potential” A life alongside caring - “Personalised support both for carers and those they support, enabling them to have a family and community life” Supporting carers to stay healthy - “Supporting carers to remain mentally and physically well” This refreshed joint Carers Strategic Plan for 2014 - 19 follows a similar structure using these themes. The previous joint Carers Strategy for 2009 – 14 was also written around these 4 themes.
2.2
In 2014 the Department of Health published their Commitment to Carers. They reported that the engagement process with carers, had highlighted a number of themes that NHS England has worked through to establish a set of commitments:
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• • • • • • • • • • • • • • •
Recognise me as a carer (this may not always be as ‘carers’ but simply as parents, children, partners, friends and members of our local communities); Information is shared with me and other professionals; Signpost information for me and help link professionals together; Care is flexible and is available when it suits me and the person I care for; Recognise that I also may need help both in my caring role and in maintaining my own health and well-being; Respect, involve and treat me as an expert in care; and Treat me with dignity and compassion. In response NHS England will develop 37 commitments to carers which they can implement, around the following priorities: Raising the profile of carers; Education, training and information; Service development; Person-centred, well-coordinated care; Primary care; Commissioning support; Partnership links; and NHS England as an employer.
Further details are set out in appendix 1. 2.3
In 2013 the Department of Health developed the Better Care Fund – a transfer of funding from the NHS to Social Care to achieve their shared objectives of keeping people out of hospital and long term care, and sustaining their independence in the community. This includes a specific element for carers breaks and the development of carers services. The NHS Outcomes Framework 2014-15 Every One Counts includes a duty for commissioners to ensure patients and carers are able to participate in planning, managing and making decisions about their care and treatment through the services that are commissioned.
2.4
The government has now passed the Care Act 2014. It aims to improve the quality of care and support offered by Social Care including the right of carers to have an assessment of their needs, irrespective of whether they meet the Fair Access to
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Care criteria, in order to establish how the provision of support would enable a carer to achieve their day to day outcomes. The local authority will have a duty to meet the carer’s need for support. This includes assessing the ongoing needs of young carers when they reach 18, if the Local Authority is asked to do this. 2.5
The Department of Health has recently published its Second Action Plan for 2014 -16 for continuing the implementation of the national Carers Strategy. This is based on the 4 key themes of the national strategy as defined in section 2.1 above. • • • • • • • • • •
The actions proposed by the Department of Health include: Working with Local Authorities and other partners to help them prepare for the implementation of the Care Act and Children and Families Act. Continuing to fund programmes to help health care professionals identify carers; research the lives of young carers and to fund the Next Steps programme which develops a whole family approach to meet the needs of young carers. Supporting NHS England to help primary care identify carers and recognise their contributions. Updating the e learning programme for staff of schools to help identify and support young carers Training 150 more school nurses to be champions for young carers. Continuing to explore ways of increasing flexible working opportunities following the introduction of the right of employees to request flexible working arrangements from June 2014. Initiate a pilot to explore ways in which Local Authorities and local partners can support carers to remain in paid employment. Supporting local partners to make use of the opportunity presented by the Better Care fund to develop shared approaches to identifying and supporting carers including the importance of maintaining a focus on breaks from caring through the delivery of the Better Care Fund in 2015 – 16 Working with NHS England to include an offer of a health check for carers in the revised GP Enhanced Service for dementia. Repeat the survey of bereaved people to measure quality of care provided at end of life to the person, families and carers.
2.6 The national context for both the NHS and Social Care services for the coming years is a focus on increasing health promotion and supporting people to take greater care of their own health and well-being; reducing emergency hospital admissions and carrying out more health care in community settings; and supporting people to retain their independence for longer underpinned by increased support for unpaid carers. The NHS Five Year Forward View published in October 2014 published by NHS England, identifies some of the ways in which the NHS will operate in future to achieve this.
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3 Carers in the UK; Young carers in the UK Carers UK has analysed the data on carers from the 2011 census, which was published in December 2012. The headline figures show that nationally there are 6.5 million carers in the UK (1 in 8 of the population). There are around 5.4 million people in England who provide unpaid care for a friend or family member. The key changes since 2001 are: • 35% increase in the number of carers over 65 - the fastest growing age group. • 24% increase in the number of carers under the age of 24 - currently 430,000 • 58% of carers are women and 42% are men in England and Wales; a similar gender ratio to 2001, • 1 in 4 women and 1 in 6 men aged 50-64 has caring responsibilities for older or disabled loved ones. • 20% increase in the number of Black, Asian and minority ethnic (BAME) carers to almost 600,000. • 11% increase in the number of carers juggling work and care - over 3 million people in England and Wales are working alongside caring. However 1 in 5 carers are forced to give up work altogether. • 13.2% of carers who are caring for over 50 hours a week, were in 'bad' or 'very bad' health. This compares to 5.3% of people without caring responsibilities. Full-time carers are two and a half times more likely to be in bad health. Additionally • Every day another 6,000 people take on a caring responsibility - that equates to over 2 million people each year. • Over 1 million people care for more than one person • Carers save the economy £119 billion per year, an average of £18,473 per carer. The main carer's benefit is £59.75 for a minimum of 35 hours, equivalent to £1.71 per hour - far short of the national minimum wage of £6.19 per hour. In their Commitment to Carers 2014, NHS England cites the following key facts: •
Between 2001 and 2011, the number of unpaid carers has grown by 600,000 (11%) with the largest increase being in the unpaid care category, fifty or more hours per week. This equates to 1.4 million people providing fifty or more hours of unpaid care per week.
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• •
• • • • • •
4 4.1
Unpaid care has increased at a faster pace than population growth between 2001 and 2011 and an ageing population and improved life expectancy for people with long term conditions or complex disabilities means more high level care is provided for longer. Increasing hours of care result in the general health of carers deteriorating incrementally. Unpaid carers who provide high levels of care for sick, or disabled relatives and friends, are more than twice as likely to suffer from poor health compared to people without caring responsibilities, with nearly 21% of carers providing over 50 hours of care, in poor health compared to nearly 11% of the non-carer population. Caring responsibilities can have an adverse impact on the physical and mental health, education and employment potential of those who care, which can result in significantly poorer health and quality of life outcomes. These in turn can affect a carer’s effectiveness and lead to the admission of the cared for person to hospital or residential care. 84% of carers surveyed for the 2013 State of Caring Survey said that caring has had a negative impact on their health, up from 74% in 2011-12. Carers attribute their health risk to a lack of support, with 64% citing a lack of practical support. Carers make a major contribution to society. Estimates show that the care provided by friends and family members to ill, frail or disabled relatives is equivalent to £119 billion every year. 70% of carers come into contact with health professionals yet health professionals only identify one in ten carers with GPs, more specifically, only identifying 7%. 66% of carers feel that healthcare staff do not help to signpost them to relevant information or support, and when information is given, it comes from charities and support groups. Context of the strategy in Redcar &Cleveland Borough Council and South Tees Clinical Commissioning Group Redcar and Cleveland Borough Council is committed to supporting carers so that they can continue to undertake their caring responsibilities for as long as they wish, and to working with community and voluntary sector organisations to provide a wide range of community based low level interventions that will maintain the independence, health and well being of all our residents. This Golden Thread runs throughout the councils documentation from Our Plan to the newly emerging Service Improvement Plan 2014 – 17 for Adult Social Care. Our Plan includes an objective to help local carers get the support they need; the Adult Social Care department commissioning strategy for 2012 -17 recognised the value of early intervention for carers and cared for people who need low
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level support with daily living. The department will work with the voluntary sector and local neighbourhood communities to provide befriending and social support. The council’s Market Position Statement 2013/14 highlights the fact that there is a higher proportion of carers in Redcar & Cleveland than in neighbouring boroughs and they are providing more hours of care per week than elsewhere. There is specific need for new befriending and volunteering services to support carers and the cared for person, so that they can both access community activities. Finally the Adult Social Care Service Improvement Plan 2014 – 17 makes specific reference to the need to increase the range of services for carers from Social Services. 4.2 • • • • • • • • • • • • •
The South Tees CCG Clear and Credible plan covering 2012 to 2017 includes the following vision for health services: Engage with our member practices as the voice of the patient Ensure our health professionals are involved in planning care Ensure our health professionals provide a sound evidence base for service changes Listen to clinical views and professionals across the health and social care sector Work in partnership with our local councils, social care departments, public health, police and fire authorities Work in partnership with our provider services Work in partnership with our patients Work in partnership with our staff Work together with the NHS Commissioning Board Engage with patients who receive services Engage with carers who look after our patients Engage with representatives of groups of patients who have particular needs Engage with the voluntary community
The CCG is developing strategies to address the health needs of Carers and Patients with Long term conditions, Children and young people, Patients with learning disabilities, Military personnel and veterans. The CCG recognises that each carer has an individual experience and their roles are each unique. They may differ depending on the health of the person they are caring for. For example people caring for individuals with physical health needs may have a different experience from people caring for people trying to maintain good mental health. And some carers may be providing care to those experiencing both.
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The CCG also acknowledges that there is a high level of deprivation in some wards in Redcar & Cleveland and there is a need to work hard to engage with and support all of the community. The South Tees Commissioning Intentions for 2014-15 are currently being refreshed for 2015-16. They set out the main areas of development on an annual basis. Within the Health & Wellbeing work stream there is a commitment to carers “ To improve the physical and mental health of local carers, improve provision provided to carers so that they are aware of the support for them in order to increase their confidence to manage their ward/ patient/ relative” by:• reviewing current numbers of carers on practice registers and ensuring the information is accurate • Improving the processes to identify carers and how they are recorded on GP systems. • Agreeing the processes to ensure that the physical and mental health needs of carers are identified. These will vary depending upon a number of factors such as the number of people they care for, the condition of that individual, whether there is support for others with the care, their own as well as their family, health, social and work commitments. • Agreeing local processes to support the physical and mental health needs of carers. • Working with stakeholders to promote carers health needs so they are aware that health support is available to them This will be extended in 2015-16 to include a commitment to:• Support carers who support a person with Mental Health needs • Support carers to get statutory needs assessments as required which may include a personal budget and direct payment. • Continue to jointly commission carer services with the Local Authority as part of the Better Care fund. 5 How we consulted to develop this strategy 5.1 Think Local Act Personal questionnaire Carers were consulted by Carers Together between July and December 2013 on the development of the Carers Strategic Plan to ensure it is both relevant and ‘fit for purpose’ for 2014 and beyond. The consultation was undertaken using a tool developed by ‘Think Local, Act Personal (previously the personalisation agenda).This focussed on how well carers thought the Local Authority was meeting their needs under defined headings. A similar consultation
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exercise was carried out in all 11 other Local Authorities in the North East. The results from Redcar and Cleveland were similar to the regional findings and will be used to develop common approaches and support programmes for addressing unmet needs. In Redcar and Cleveland surveys were carried out with carers at a number of groups and events, including the Carers Partnership, East Cleveland Focus Group, Eston Carers Support Group and the New Marske Carers Group Carers completed surveys individually and in groups, with a total of 30 carers sharing their views. The responses were then collated by Carers Together to reflect the priorities for development and an assessment of current services from carers’ perspectives. Users of the FACES service – Families and Carers Engagement Service, who are carers for people with drug and alcohol problems, held a focus group to identify their priorities for service improvement. 5.2 IMProVE survey Carers Together also undertook a consultation exercise with 348 residents of Middlesbrough and Redcar & Cleveland on behalf of the South Tees Clinical Commissioning Group and the South Tees NHS Foundation Trust, between September – November 2013. The results were to inform the work of the IMProVE group (Integrated Management & Proactive Care for the Vulnerable Elderly). This survey questionnaire was made available through the S Tees CCG website; stakeholder organisations; to members of My NHS and at 5 public consultation events. All respondents were aged over 66. 16% were aged 66 – 69; 49% were aged between 70 – 79 and 36% were aged over 80. 58% of the respondents were carers. The responses have been collated by Carers Together to give additional views on NHS services for carers. 5.3 The Junction The Junction Young Carers service organised a variety of feedback mechanisms from young carers who are supported by the service. They held a “Vision” day during the October Half Term 2013 for a mixed gender group of young carers aged between 10 and 15 which focused on key themes of “Making life better for young carers”, “Making me feel better about my caring role”, “Making life better for me at School”, “The Young Carers service raises awareness of young carers” and “The Young carers service supports Families to make life better for all of us”. This model enabled young carers themselves to individually and then collectively score each element of the service out of 10 and then prompted discussion to identify “what’s good?” / “what’s not so good?” / “what could be better?” As a result, 3 priority areas were identified: • Resource and provide a model of support for young carers and their families based on early intervention and prevention
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• •
Planning for the future. Resource, develop and deliver opportunities for young carers to learn and develop. Build skills in confidence, self belief and positive plans for the future. Raise awareness, increase understanding and support in all schools.
The Junction held a focus group led by a Peer Mentor, with a number of young adult carers aged 18 - 25. This identified that young adult carers were an important transitional group with differing, though related, needs to those of Young Carers (aged 5 to 18 year old) and adult carers. Transition to adulthood is a critical time in a young person’s life. 5.4 East Cleveland group for parents of children with autism Members of the East Cleveland group for parents of children with autism held a focus group to identify the priority needs of parent carers of children with disabilities. 6 Vision for carers in Redcar and Cleveland Our vision is to deliver the national Carers Strategy 2010 ‘Recognised, Valued and Supported: Next steps for the Carers Strategy’. Our aim is that ‘All carers should have full opportunities, choices and support to
improve their quality of life, be respected and included as equal members of society.’ This is in line with the Commitment to Carers given by NHS England: ‘we want to improve the quality of life for carers and the people for whom they care’. 7 Carers in Redcar and Cleveland – data from 2011 census Information gained from the 2011 census shows that in Redcar & Cleveland there are now • 16034 carers - a reduction of 71 from 2001 census (0% change over 10 years) • Of the 16034 carers, 1221 are aged under 24 (8%); 5313 are aged 25 – 49 (33%); 5810 are aged 50 – 64 (36%) and 3688 are aged over 65 (23%). Since 2001, there has been an increase of 18.7% in young carers (aged under 25) and of 73% in the
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• • • •
number of carers aged over 65. The number of carers aged 25 – 49 has dropped by 18.7%.This is consistent with many council areas in the north east. Of the 16034 carers, 9004 provide up to 19 hours care per week (56%); 2450 provide 20 to 49 hours of care per week (15%) and 4580 provide over 50 hours of care per week (29%). Consistent with England and the north east, there has been an increase in the number of people providing over 20 and over 50 hours of care per week. Of the 4580 carers providing over 50 hours care per week, 696 – 15.2% say they are in bad or very bad health themselves. The figure for England is 13% and for the north east 15.5%. 45.8% of carers are in employment (full time; part time & self employment). This compares to a rate of 50% in the north east and 53.1% in England. Of the 16034 carers, 15880 are white British (99%); 50 are of mixed race; 81 Asian; 15 are black and 8 other ethnic race. In England 89% of carers are white British and in the north east 97% are white British.
8 8.1 • • • • • • • • • 8.2
Services already in place for carers (as at 2014) The Local Authority provides and commissions services specifically for carers: The opportunity for carers needs to be assessed primarily through completing a self assessment questionnaire. Support is provided by Carers Together and Social Workers to complete the assessments. Personal budgets and direct payments to carers who meet the Fair Access to Care (FACs) criteria so that they can commission services that will support them in their caring role. Access to respite sitting services for the carer and respite stays in a care home for the cared for person. Funding for the carers emergency card and emergency card plus schemes to provide support in the event of an emergency * Financial contributions to the revenue costs of Carers Together to provide support to carers. Commissions services from other agencies for carers * Telecare & assistive technology A peer support group for those affected by substance misuse (FACES) accessed via the commissioned substance misuse recovery service provider * Funding for short breaks for carers South Tees CCG provides funding to the Local Authority, via the Better Care Fund, to support the commissioning of carers services identified above with *.
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8.3 • • • • • • • • • • • • • •
Carers Together provides: Friendly and confidential services that aim to ease the pressure of caring, including information and support with benefits and finances, health problems, housing, training, employment, taking a break from caring or concerns about the person being cared for. Flexible support that can change as carers’ needs change. Individual or group support at home, in local community venues, by telephone or email Carers assessments and support plans to address the physical and mental / emotional support needs of carers. A Welfare Rights service A Counselling service A Dementia Advisory service Information and support for working carers and employers Activities and events A carers’ newsletter Carers Emergency card Training for carers and professionals Involvement opportunities eg in a Carers Partnership and local carers groups Volunteering roles with Friends of Carers Together
8.4 The Junction provides: • Accessible, specialist, child and young person centred services which are confidential, age appropriate, friendly and welcoming for children and young people aged up to 25 with the specific aim of making life better for young carers, young adult carers and their families. • The work focus is on promoting the positive impacts of their caring responsibilities, removing barriers which might prevent them achieving their potential and supporting them to lead healthy and fulfilling lives. The Junction aims to reduce the negative impact of their caring role and reduce the risk of harm. • Services include: support and information services for young carers, young adult carers and their families. • Safe space and Whole family working – 2 pilot schemes funded by the CCG in 14-15.
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This is achieved through: • Comprehensive whole family assessment • Outcomes focused Action planning and pathways to relevant support • Whole family support where there is a significant negative impact on young carers and young adult carers • One to one support for young carers to develop positive coping strategies and achieve positive outcomes • * One to one support for young adult carers to enable positive transitions and achieve positive outcomes • Advocacy and voice • Specialist children and young person’s Counselling to address long term and deep rooted issues, providing confidential space to facilitate positive change • * Young carer and young adult carers led sustainable peer support networks • Focused and themed group work, e.g. emotional well being, confidence building, • Leisure and social activities and opportunities to have fun, build relationships and share experiences with other young carers and young adult carers • Learning and development opportunities, e.g. understanding issues, peer mentoring, First aid, safety etc. • Providing access to complementary young person centred services provided by The Junction and its partners. i.e. Mental health and emotional well being, information and support, education and employment support • Raising awareness of young carers and young adult carers 8.5
FACES provides • Specialist advice and support for family and carers of drug and alcohol users in the Redcar and Cleveland area. • FACES offers; one to one support; advice and information; home visits; crisis intervention; workshops; advocacy; respite; signposting; and a peer support group. The workshops cover; • Alcohol Awareness, • Drug Awareness, • Kinship caring, legal and financial support, • Relationship Management, • Building recovery capital
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• • • • •
Safety management Health and Wellbeing Sleep management Stress management Social functioning
Carers will be able to receive a package of support tailored to their individual needs. To receive this support the person they are caring for does not have to be in treatment. 8.6 •
• •
Tees, Esk & Wear Valley Foundation Trust The Foundation Trust has its own carers support strategy for 2014 -17 in place. This strategy applies the Trust’s values and behaviours to their contact with carers and provides a framework for staff as part of the Quality and Assurance Strategy to improve, monitor and evaluate carer experience alongside patient experience measures. The strategy recognises carer expertise and outlines the priorities that the carers of users of trust services have identified are important to them, via feedback from consultations and previous surveys, The Psychosis Team are implementing the CQUIN relating to Carer involvement. The Trust is implementing the ‘Triangle of Care’ (TOC) guidance which was launched in 2010 by the Carers Trust as a guide to best practice in mental health care in England. A second edition was published in 2013 to extend the work into all areas of the mental health care pathway. The aim of the guidance is to ”provide a therapeutic alliance between service user, staff member and carer that promotes safety, support, recovery and sustains wellbeing.” It includes standards and resources to support Trusts to ensure carers are fully included and supported when the person they care for, has an acute mental health episode. The Triangle of Care guidance has 6 key elements to achieving a better collaboration and partnership with carers in the service user and carer’s journey through mental health services as follows:• Carers and the essential role they play are identified at first contact or as soon as possible thereafter. • Staff are ‘carer aware’ and trained in carer engagement strategies • Policy and practice protocols re: confidentiality and sharing information, are in place • Defined post(s) responsible for carers are in place • A carer introduction to the service and staff is available, with a relevant range of information across the care pathway
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• •
• • •
A range of carer support services is available
The Older People’s Mental Health / psychosis team is developing links with Carers’ Together and plans to provide, in conjunction with the Mental Health Carers’ Group, a number of ‘awareness’ sessions for carers, family members and service users to assist with understanding the symptoms of dementia. These sessions are being developed following feedback from the Mental Health Carers’ Group as to their specific requirements. An information pack for carers is being compiled and will be made available in the reception at Foxrush House and as a resource for Care-Co-ordinators. As an employer the Trust has carer friendly employment policies in place, to support staff who have caring responsibilities. Carers Champions are in place for the whole Trust and for individual departments eg CAMHS and Older Peoples Mental Health services.
9 Consultation – what did adult carers tell us; what will we do in the next 3 – 5 years 9.1 Information & Advice Carers said: Carers have told us that they value face-to-face contact and emotional support more than anything else, with all carers rating these high in terms of their importance. The majority of carers indicated that this support is currently provided for them through the workers at Carers Together, although carers are involved with other services that also provide support. “Face-to-face contact is very important to help you out in times of need.” Carers would like support in emergencies and out of hours to be able to get advice. They want advice on benefits and on carers rights and more information about services and activities that are available for them. Carers have identified that the main area for improvement is for Local Authority and NHS staff to “know the system 100%.” Carers rated this as 5 out of 5 for importance but only rated this on average of 2 out of 5 in relation the current position.
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Carers also told us that they felt confidentiality for the cared for person, was a barrier to successful communication between them, as carers, and professionals. Carers would like to see a significant improvement in this in future. Carers want to be treated as partners in care. They feel they should be involved more fully in the hospital discharge process. What we are going to do • We will increase the opening hours of our services, as funding allows, so that carers can get face to face support for longer in the week. • We will promote the Carers Emergency Card and the Carers Emergency Card Plus scheme. • We will maintain the Carers Information and Support service at James Cook University Hospital to support carers through the discharge process. • We will maintain and if possible extend the dedicated and specialist welfare benefits service provided through Carers Together, in addition to the services commissioned from Citizens Advice Bureau. • We will develop easily accessible information about services and activities that are available in the Redcar & Cleveland area both for carers and the cared for person. • We are contracting with Carers Together to undertake all initial assessments with carers who approach the council for support and advice, in addition to undertaking assessments with carers who approach CT themselves or are referred to CT by another professional. Carers Together will help carers identify existing services and activities that could form a useful part of their support plan. • We will work with NHS and social care professionals to raise their awareness of the needs of carers. • We will identify a Carers Champion within the CCG Board How we will measure success • Uptake of the carers emergency card increased by 50% in year 1 (from baseline of 914 at August 2014 to 1371 at Aug 2015). • Carers Information and Support Service in place in JCUH & impact on the number of readmissions assessed. • More carers who are entitled to benefits, are supported to claim their benefits • Increase the number of carers who are accessing information and advice at Carers Together • Carers reporting that they feel informed and supported, in surveys circulated by Carers Together
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9.2 Active & Supportive Communities The overwhelming message is that the provision of support - and the freedom to tailor that support to carers’ own needs - is a key issue for carers. Carers want more appropriate support. This includes the need to have flexible support, available on evenings and at weekends; time for group activities and 1:1 activities. Some carers want the time (and support) to manage their own health needs, while others are keen to find time to pursue their own hobbies or simply feel they are in need of the space to be someone other than a carer. Many carers reported on how helpful they found the Breaks for Carers Fund in 2012/13 because it was very flexible, carers could use the funding as they wished and the application process was simple. “The Breaks for Carers Fund gave me the space to be someone other than a carer.” Carers expressed a need to understand clearly how the cared for persons personal budget is allocated and in particular how much time is paid for from care at home services both for care and travel time for the paid for carer. What are we going to do: • •
We will work with carers to complete their self assessment and support plans so that services can be designed to meet their particular needs. We will maintain the carers breaks project and promote the scheme widely to encourage new carers to come forward.
How we will measure success • Carers report that the short breaks scheme has been beneficial in helping them to continue caring. • New carers identify themselves as carers as a result of the short breaks for carers scheme • Carers assessments completed and support plans in place for all carers who approach the council for support from April 2015.
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9.3
Personal Budgets & Self-Funding
Carers would like more involvement in and influence over the planning of the cared for person’s support plan within their personal budget / direct payment, so that they can ensure value for money with regards to local activities. One example would be that transport costs should be included in all activities for the cared for person. Carer’s responses also made it clear that they would like to be given more choice in how they receive support to help manage direct payments, with an emphasis on receiving “the right support with direct payments”. What we are going to do: • We will review the help that is available to people who take direct payments to help them manage their arrangements. • We will work with social workers to ensure that the support plans for cared for people are clear, and are shared with the carer with the cared for person’s consent. • We will use the information from carers support plans to identify how best to promote the health and well-being of carers. • We will keep carers informed about the use of personal budgets How we will measure success: • Carers report felling more involved in support planning for the cared for person • Increased uptake of carers personal budgets 9.4
Flexible & Integrated Care & Support
Two of the key elements for carers are communication and support. Carers value very highly the need for good communication both between organisations and across borough boundaries, so that those who are “living out of borough” are not disadvantaged in any way.
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Carers indicated that the kind of support they want is through a named, non-judgemental social worker or a “champion” who will know their story, so that it will not have to be repeated over and over; and someone who can support both “the person and the family in all areas”. What we are going to do: • We will continue to improve the ways in which we communicate with carers and between organisations. • We will continue to support the Carers Partnership meetings and Carers Together to ensure that the views of carers are heard by statutory organisations. • We will continue to involve carers in the development of carers services and the process of assessment and support planning. • We will explore the benefits of the key worker / champion role to provide consistent support for carers. • We will make information readily available about all the services and facilities that carers can access. How we will measure success • Carers report that the information about carers services and facilities is easy to access and use • Carers are involved in the development of carers services • Carers views are listened to by statutory organisation eg at local carers partnership meetings. 9.5
Workforce
Two factors are high priorities for carers – respect for carers knowledge & contribution to care and being able to trust paid carers. Carers feel that professionals do not value their expertise and knowledge as carers. This came through strongly in the Department of Health consultations which led to the Commitment to Carers. Carers feel unsure about whether the people who deliver care and support are “reliable, knowledgeable and trustworthy”. Carers were also concerned that if they report poor care the cared for person may suffer some repercussions. Carers need to feel confident that any complaint they make will not have a negative impact on the person they care for.
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Carers would also like to be sure that they and the cared for person receive the amount of care and support they have paid a provider to deliver. Travel time should not be taken out of the allocated support time. What we are going to do: • • • • • • • •
We will continue to work with health and social care professionals through ongoing training and contact, to encourage them to respect and to seek out the views of carers. We will work with care at home providers to maintain and improve the quality of care provided to the cared for person and to develop an effective and non judgemental feedback arrangement which carers can use. We will build on the commitments given by NHS England to promote and work towards parity of esteem for carers so that mental health and wellbeing is considered and supported alongside physical health needs (Commitments 20 – 23). We will review the implementation of the Triangle of Care tool by Tees, Esk & Wear Valley Trust and see whether it would be beneficial to role the use of the tool out to other organisations. We will encourage primary care providers to get involved in the Carers Rights Annual event We will encourage GPs to increase their rate of identification of carers through primary care systems and by providing training to health professionals when required. We will review the benefits of the carers overnight stay facilities and pagers, provided by James Cook University hospital for parents to see if this could be implemented elsewhere. We will encourage more organisations to apply for Carer Friendly accreditation from Carers Together and work with the Workplace Health team to encourage more businesses to adopt the healthy workplace standards.
How we will measure success • The triangle of care has been evaluated as helpful to carers and it has been rolled out to other providers • The number of health and social care professionals who have been involved in training about the needs of carers • Carers report that they feel that their views are respected by professionals and that they can work constructively with Care at Home providers to improve the package of care for the cared for person. • Increase the number of carer friendly employers accredited by Carers Together. 9.6
Risk Enablement
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Carers rate very highly the opportunity to work with staff who have good listening skills because they feel that they get the desired outcome quickly and efficiently, and this reduces the likelihood of a breakdown in care. Carers had mixed views as to how well agencies are currently performing in this respect. However, carers’ responses indicate the importance of ensuring that staff are available to listen and respond quickly to carers’ needs, and this should be reflected in the Carers Strategy. Support for carers in an emergency or crisis is also important, with groups and individuals alike indicating the need for a “safety net” of support for carers. What we are going to do • We will work with training providers eg Universities of Teesside and Durham at Stockton to promote the needs of carers and the importance of treating them as equal partners in caring for the cared for person. • We will maintain the advocacy service so that carers and cared for people can have independent support to explain their needs. • We will promote the uptake of the Carers Emergency Card and carers Emergency card plus. How we will measure success • Carers who use the advocacy service report that it has been beneficial to their needs. • Carers are involved in training to current health and social care staff and trainees. 9.7 Specific needs of carers aged 85+ The NHS has identified a specific focus on the needs of elderly carers in 2015-16. Carers Together has worked with elderly carers and identified the following issues which affect this group of carers: • Not being able to plan for or enjoy their life. • Feeling exhausted and constantly anxious. • The physical demands of caring. • The change to a relationship with a partner, which can be hard to adjust to. • A feeling of loss of a relationship or of precious time.
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• • • • • • • • • •
Feel frustrated when health professionals don’t involve them as a full partner in care. Concerns about the future ie what will happen to the cared for person if they aren’t able to care eg if they are ill/ admitted to hospital. Anxiety about what will happen to their relative in an emergency A general loss of confidence eg about going out A lack of information about care and support services that are available and that services are for them An unwillingness to acknowledge that that they might need help and a reluctance to accept help Not considering day care or residential care as possible options for respite or for longer term care Becoming isolated Not heating their homes adequately Poor general health, including not having a healthy, balanced diet
The needs of elderly carers are similar to all carers, but their caring role eg for someone with a learning disability, dementia or an enduring condition, has often been long term, which can lead to them needing: • • • • • • • • •
Opportunities to discuss their caring role with someone who understands and will take the time to listen. Information about the support available to enable them to continue their caring role. Knowledge about what will happen to their relative in an emergency, especially if that emergency occurs ‘out of office’ hours Support to plan for the future with their relative and others, who can provide informed and consistent support, including information about accommodation options, wills, power of attorney, trusts etc, when the time is right for them and their relative Regular health checks, including mental health screening, as least annually by their GP Information and support in dealing with difficult behaviour, which may be new to them. The offer of GP home visits, if necessary, to fit around caring. Social care and health services which work together with the carer to develop an acceptable plan for how alternative care will be provided, where carers need time to recover from treatment. Opportunity to share & enjoy a social presence within the community
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• • • • • • • • •
Flexible and creative options for breaks from caring, including overnight breaks in a setting which might possibly become a realistic long-term placement for the person they care for eg a shared care arrangement. Opportunities to build up positive relationships with individuals and services likely to have a role in supporting their relative in the future. Workers who understand their experience of caring and not to feel judged about the way they have cared for and supported their relative. Peace of mind that their relative will be well looked after when they are no longer able to care. Opportunity to share the expertise and knowledge they have built up as carers, so that it will be available when they are no longer able to care. Services which recognise and value mutually dependent relationships between older family carers and their relatives, especially those with learning disabilities. Opportunity to remain involved and valued in their relative’s life, even if that person is no longer living with them in the family home Appointments, including primary care and hospital, which are flexible to meet the needs of older carers.
What we are going to do • Extend the availability of a carers assessment and support planning to all carers (in line with the Care Act 2014) and consider how to make these particularly relevant and supportive for older carers. Carers assessments will be undertaken by Carers Together. • Continue to raise awareness of the Carers Emergency Card plus scheme which can support the cared for person in an emergency whilst longer term plans are put in place. • Development and promoting the Rapid Response service in Adult Social Care which supports people to remain at home if the carer is incapacitated. • Expansion of the breaks for carers scheme to provide flexible short term respite options. • Social and peer support through links to Carers Together. How we will measure success • Older carers who are in contact with Carers Together, report that they feel more supported and have plans in place to support the person they care for, if they become unable to care themselves.
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• •
Greater uptake of the breaks for carers scheme by older carers, with positive feedback on the benefits of the scheme. More older carers participating in activities at Carers Together and sharing their expertise with other carers.
9.8 Findings about Carers views on health services from the IMProVE survey. Respondents asked for • Improved communication with carers from all professionals; • A more holistic view of the family situation so that staff who are involved with the family have up to date information about the family circumstances. • Recognition that carers first port of call for any problems would be the GP and they suggested that appointment systems should be easier to use and understand; • GPs should be more willing to visit patients at home and there should be greater continuity of care with the same GP. • Carers and families should be given more information about the patients condition and how to manage it. Staff should check that carers have fully understood the information they are given. • Carers need help to understand what to do if the persons condition worsens. • Unpaid carers need more support including on call support at weekends and in the evenings. • More respite care is needed. • Better information for carers of people who have dementia, with a wider range of support services in place. • Special support for elderly carers whose own health may be deteriorating. • It was very important that professionals listened to what carers know about the cared for person • Both carers and professionals need to be kept informed about changes in the cared for persons health, with information about how to manage this. What we are going to do: • We will promote the importance of carer identification in primary care • We will explore the potential of social prescribing so that GPs could refer carers to other relevant services. We will evaluate the findings and introduce the service as appropriate. • We will provide information and training to all GP practice staff about the needs of carers. • We will consider how to provide information for carers about the condition / diagnosis that the cared for person has been given eg pilot with Tees Esk & Wear Valley Foundation Trust for carers of people with dementia. If successfully evaluated by
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• • • • • •
carers, the scheme will be rolled out further. We will sustain the range of information and support provided by the Dementia Adviser service including provision of advice about dementia, for carers of those who have been newly diagnosed. We will increase the availability of planned respite care beds. We will identify a Carers Champion from the CCG Board We will include a commitment for the Foundation Trusts “service improvement plans” to include requirements under the SEND reforms and Children’s & Families Act to support young carers. We will include carers in consultations on major health pathway developments and strategies such as the Dementia Strategy and the Mental Health Strategy. We will continue to encourage carers onto the Learning Disability Partnership Boards and to be involved in developing hospital services. We will review how to ensure that the carers NHS number is included on each carers assessment so that information could be shared with health members of the primary care multi disciplinary team. We will consider whether the carers assessment could also include reference to those cared for people who have a named GP to manage their care because of their high levels of needs.
How we will measure success • There will be 100% increase in the number of planned respite care beds (baseline 4 beds available at Nov 2014). • There will be an increase in the number of referrals from GPs to Carers Together (baseline 2013-14 12 referrals) if social prescribing is implemented. • Each GP practice will have received support and input about the needs of carers and how the practice could support carers. • Number of carers who have participated in sessions designed to increase their knowledge of dementia following a diagnosis of dementia for their cared for person. • Quantifiable Increase in commitment from health services to consider carers in pathway and service redesign • Carers Champion in place on CCG Board • Foundation Trust service improvement plans include development to meet the needs of carers and young carers. • Increase the number of carers on the Learning Disability Partnership Board 9.9 Young carers and family support– Young carers have told staff at the Junction that they need resources and support for themselves and their families including one to one support, counselling, therapeutic group work, activities and whole family support
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to reduce the negative impacts of their caring responsibilities on themselves and to maintain early intervention and prevention of break down in their home situation.
What we are going to do • • •
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We will involve young carers in identifying their own personal outcomes and goals. We will undertake assessments of the whole family and have action plans and support for the family We will increase the resources available to support families, in addition to the work we are already doing with families affected by mental health problems. We will review the success of the Safe Places and Whole Family Assessment pilots funded by the CCG in 2014-15 to determine the future of these schemes.
How we will measure success • All young carers known to the young carers services will have a statement of personal outcomes and goals • Increased number of family assessments completed • Increase the number of young carers accessing information and support from the young carers service • Young carers report that they feel informed and supported. 9.10 Young carers increase in self confidence – Young carers have told us that they want help to increase their skills and to develop their self confidence and help to make positive plans for their future. What we are going to do • We will provide access to information about illnesses; disabilities & addictions so that young carers are aware of these issues. • We will provide access to First Aid courses; financial skills and confidence building courses. How we will measure success • Number of young carers who have taken part in courses. • Number of young carers reporting that their self confidence has increased
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9.11 Increased awareness of young carers needs by schools. Young carers have said that they want us to work with all local secondary schools to increase the awareness of staff and teachers about the needs of young carers so that they can provide more support to young carers throughout their school careers. What we are going to do • We will support young carers to provide awareness training in secondary schools • We will encourage all schools to appoint a Young Carers champion who can promote awareness of their needs, and increase understanding and support in schools. How we will measure success • Number of schools with young carers champions in place. • Number of schools which have been involved in awareness raising sessions about young carers. 9.12 Make life better for young Adult Carers For some young carers, (often sibling carers with strong, family based support networks) their late teens is a time when they have less caring responsibility and are able to develop their own paths in life. Sometimes the emotional strain of this changing relationship provides a degree of uncertainty. What was appreciated was the opportunity to access information and support to help them navigate through their options, re-assurance about managing the impact on the cared for person(s) and their family, and access to peer support networks. This approach provides the confidence for Young Adult Carers to successfully move forward with their own lives and aspirations. For young adult carers who are the main carer, with limited support networks and who are affected by a multiplicity of issues, including; mental ill health, substance misuse, poverty and unemployment, it presents a time where they are actually taking on more responsibility with an ongoing negative impact on their own lives. There were concerns about being further isolated from their peers, increased levels of responsibility; increase in stress, anxiety and the negative impacts on their own emotional well being, a real or perceived inability to focus on their own independence, aspirations, futures and career choices, and a lack of access to information and support. They identified the need, in some cases, to provide whole family support to minimise the ongoing and increasing negative impacts on themselves as young adult carers.
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What we are going to do: • We will support early identification of young adult carers through work with colleges; training establishments and employment organisations to help to identify hidden young carers • We will provide whole family support to reduce the negative impacts of caring, and to provide help with some practical issues eg Benefits checks, Housing, Advice and information, advocacy,& building sustainable emotional support networks. • We will provide 1 to 1 outreach to set up a support plan, and signpost to relevant services. • We will maintain access to social/peer support networks for young adult carers. • We will provide access to training for personal development eg Volunteering, Mentoring, etc. • We will work together to provide support during transition to adult carers services How we will measure success • Number of new young adult carers identified through work with colleges, training establishments & employment organisations • Increase in the number of young adult carers with a support plan • Number of young adult carers transitioned from the young carers to adult carers services. 9.13 Parents of children with disabilities Parents of children with autism have highlighted the following priorities to support them in their caring roles: • Honest transparent information for parent /carers • Dedicated service for parent carers (as most parents think Carers Together is for carers of the elderly) • Support for the health and wellbeing of the parents and siblings • More support for specific areas of interest ie education personal budgets, transitions, housing, domestic violence, diagnosis • General local support ie where are disabled toilets, where do you get a radar key, how can you find local funding for holidays, availability of special schools. What we are going to do
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Our Local Offer website intends to provide clear transparent information for parents and carers of children and young people with Special Educational Needs and Disabilities, through advice and information pages, as well as a searchable directory of services. Carers Together has been commissioned to provide an Independent Parent Support Service via the National Children’s Bureau funding, for those going through the process of receiving an Education, Health and Care plan. This will be delivered in partnership with the Special Educational Needs and Disabilities Support Service (formerly known as the Parent Partnership Service). This will raise the profile of Carers Together with parents of children with disabilities and will ensure that they develop a focus on the special needs of these parents. Information about the support available should be publicised through the local offer website and Carers Together. The local offer should outline what is available and who is eligible for support. The broader People’s Information Network website (PIN) will include info on issues such as Domestic Violence. The Local Offer area of the People’s Information Network will be developed to include information on accessible toilets/changing places and radar keys, and already contains information about grant schemes such as the Family Fund.
How we will measure success • Carers reporting that they feel better informed and supported • Parent carers are involved and consulted about service developments. • Parent carers report feeling represented by a support group 9.14 Carers for people with alcohol and drugs problems Problematic drug use affects many people besides the person using the drugs. Family members and close friends, for example, can experience significant stress and health problems as a result of being close to and concerned about the person with the drug problem. The impact can also spread more widely, for example affecting family members’ employment, their social lives and relationships, and family finances. 1.5 million people in the UK are affected by a relative’s drug use not including those affected by alcohol misuse whose figures are much harder to quantify. The cost of the harms they experience is believed to be about £1.8 billion per year. What we are going to do:
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Carers affected by substance misuse told us they want a carer’s assessment to identify their needs so that the right support can be provided. We will work with Carers Together to embed a process to ensure family members and carers receive an assessment of their personal, social and mental health needs. Currently, the FACES peer support group is run from Redcar High Street. Now that the commissioned substance misuse recovery service provider has premises in central Redcar, South Bank and Loftus we will investigate if peer support groups can be delivered from these additional premises to increase accessibly to support.
How we will measure success • Number of carers of people with drug and alcohol problems who have a carers assessment and support plan with support from Carers Together. • Increase in the number and distribution of peer support groups 10
Next steps
The finalised joint Carers Strategic Plan will be adopted by all of the partner agencies. It will ultimately be presented to the Redcar & Cleveland Health and Wellbeing Board highlighting how the Carers Strategic Plan links into the key themes of the Health & Wellbeing Strategy. The carers component of the Better Care Fund will be used to help achieve the priorities identified in this joint Carers Strategy, over the coming years. Each year the CCG and Social Care Services will develop and refine their joint commissioning strategy to decide how best to allocate the funds in the Better Care Fund and core expenditure on carers services to ensure that it is achieving the best possible outcomes for carers in line with the priorities they have identified in the strategy. Progress on implementing the agreed strategic Plan and associated actions will be monitored by the Carers Strategy Steering Group and will be reported on a quarterly basis to the Carers Partnership which is run by Carers Together. This will include an annual assessment of the outcomes of the pilot projects that we have set up, in order to determine whether to continue their remit. The Junction will review progress at regular intervals for individual young carers, their families and review their own organisational performance. The service is committed to making a positive difference and reducing the negative impact of caring roles on young
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carers. This approach will capture the views of progress from the user and carer perspective, putting young carers and their families central to the service.
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Glossary Adult Social Care / People services This is the new title for what was adult social services. The peoples directorate now has responsibility for some parts of public health. Carer Champion A person within an organisation who takes on the role of promoting the recognition and needs of carers within that organisation. Carers Emergency card A service provided to carers in R&C to offer emergency support to the cared for person if the carer were to be unexpectedly unavailable due to an emergency eg involved in an accident. Carers Register A list of those who are identified as carers held by some GPs to enable the practice to provide more appropriate support. Carers Together This is the charitable foundation which provides a range of services including information, advice and support, to adult carers in Redcar & Cleveland. Clinical Commissioning Groups Local Health commissioning organisations led by local GPs. Commissioners People in statutory organisations responsible for planning & buying services. Direct Payment Money paid directly to the individual in lieu of services. This means the person organises their own support or services. Focus groups
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Groups of people including carers who came together to look at questions in the consultation exercise. Health & Wellbeing Board A board with representation from the health and social care agencies responsible for the well being of residents of Redcar & Cleveland. Personal Budget The amount of money that is identified to meet a person’s assessed needs. Personalisation The way in which care and support services are delivered to best meet the individual’s needs and give personal choice and control. Primary and Community Health Care Health services delivered in or near to a person’s home to which the person has direct access. These services include those provided in GP surgeries, health centres & community hospitals or in the persons own home by a team of professionals including for example GPs; practice nurses and community nurses. Respite care Respite care is the provision of short term temporary relief for those who are caring for family members who might otherwise require a permanent placement in a facility outside the home. Secondary Health Care If a persons needs are too complex to be managed in primary care, they are referred for more specialist services in secondary care, including hospitals and treatment given away from a hospital setting, such as mental health services, learning disability services and help for older people. SEND Special educational needs and disability department within the Local Authority. Statutory services
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These are services set up by law eg a Local Authority or NHS organisations Sitting services Short term 2 – 4 hours respite care provided within the home. Strategy A plan designed to achieve a specific goal. The Junction Foundation This is the charitable foundation which provides a range of services including information, advice and support, to young carers and young adult carers aged
