Annual Report and Accounts
2016/2017
Annual Report 2016/17 Mid Essex CCG
Contents
1. Performance Report ......................................................................................................... 2
1.1 Performance Overview .................................................................................................... 3
1.1.1 What Mid Essex CCG does ..................................................................................... 3
1.1.2 Key issues and challenges ...................................................................................... 10
1.1.3 Performance Summary ............................................................................................ 12
1.1.4 Financial Overview .................................................................................................. 15
1.2 Performance Analysis ...................................................................................................... 18
1.2.1 Improve quality ........................................................................................................ 18
1.2.2 Health and wellbeing strategy ................................................................................. 22
1.2.3 Patient and public involvement ................................................................................ 23
1.2.4 Reducing health inequality ...................................................................................... 27
1.2.5 Detailed review of the CCG’s development and performance ................................. 29
1.2.6 Sustainable development ........................................................................................ 37
2. Accountability Report ...................................................................................................... 41
2.1 Corporate Governance Report ........................................................................................ 42
2.1.1 Members Report – member practices ..................................................................... 42
2.1.2 Composition of Governing Body .............................................................................. 43
2.1.3 Board Members and Other Elected GPs ................................................................. 43
2.1.4 Personal-data-related incidents ............................................................................... 51
2.1.5 Statement as to disclosure to auditors .................................................................... 51
2.1.6 Donations to political parties and charitable organisations ...................................... 51
2.1.7 Modern Slavery Act ................................................................................................. 52
2.1.8 Statement of Accountable Officer’s Responsibilities ............................................... 52
2.2 Governance Statement .................................................................................................... 55
2.2.1 Introduction and context .......................................................................................... 55
2.2.2 Governance arrangements and effectiveness ......................................................... 56
2.2.3 Risk management arrangements and effectiveness ............................................... 62
2.2.4 Other sources of assurance .................................................................................... 66
2.2.5 Control Issues .......................................................................................................... 69
2.2.6 Review of economy, efficiency and effectiveness of the use of resources .............. 69
2.2.7 Review of the effectiveness of governance, risk management and internal control .... 73
2.3 Remuneration and Staff Report ...................................................................................... 74
2.3.1 Remuneration Committee Report ............................................................................ 74
2.3.2 CCG staff ................................................................................................................. 83
2.3.3 Off-payroll engagements ......................................................................................... 87
2.3.4 Expenditure on consultancy .................................................................................... 88
2.3.5 Pension liabilities ..................................................................................................... 88
2.4 Parliamentary Accountability and Audit Report (subject to audit) .................................... 89
3. Independent Auditor’s Report to the Members of the Governing Body ..................... 90
4. Financial Statements ....................................................................................................... 93
Appendix A: Glossary of non-financial terms
Appendix B: Glossary of financial terms
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Annual Report 2016/17 Mid Essex CCG
1. Performance Report
The landscape of NHS services and how care is
offered nationally, and locally, are in the process
of major change and transformation.
Since Mid Essex CCG formed in 2013, our year leading meetings to begin much wider
conversation with local people has been about pieces of work and develop plans.
how we can provide the best care, when
needed, and how we can plan for the future to One of the key strands to STP work going
ensure services continue. This conversation forwards will be how we can help people to
has been tough at times – especially given the ‘Live Well’ – an idea developed by partners at
overall NHS financial picture and continuing Braintree District Council and us here at the
financial pressures locally – and has in past CCG to start a conversation locally about self-
years focused on what money is available and care, lifestyles and changing health behaviours.
how services may need to change. You can find out more about Live Well and
public involvement in this report.
Yet over the past year, our conversation about
health and good care has continued to expand, There is no doubt that in this coming year we
involve and inspire. Having solid and robust need to continue making every effort to engage
support from local people on the future of their people in our conversation about health. The
NHS is crucial and we have worked hard to NHS and the services within it are changing
begin a different discussion with mid Essex all the time so we need your involvement
residents. and support to help us make the best use of
resources – both people and money.
The NHS, local and county councils, providers
and users of services, community and voluntary You should be at the heart of how we can
organisations are coming together in 44 areas innovate and ensure that local NHS services
across the country to develop proposals for are here for years to come. Please continue to
health in the future. These proposals are called stay involved – follow us @MidEssexCCG on
Sustainability and Transformation Plans (STPs) Twitter or via our website for ways you can do
and are being developed so that services can this – and help us push on with our journey to
support and meet the needs of local people. improve.
The STP in our area covers not only mid but Caroline Rassell
south Essex too – a population of 1.2 million Accountable Officer
people. It has evolved from the work started
by the Mid and South Essex Success Regime, 30 May 2017
one of three programmes established nationally
under the NHS Five Year Forward View to
address deep-rooted pressures on particularly
challenged health and care systems.
Mid Essex CCG has played a lead role in
reviewing how care is delivered outside of
hospital across this bigger geographical patch.
I, as the CCG’s Accountable Officer, along with
our Medical Director and Director of Clinical
Commissioning have spent a large part of this
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Annual Report 2016/17 Mid Essex CCG
1.1 Performance Overview
This section offers a snapshot of the CCG’s
core work in 2016/17, along with how and
why we bring health and care services to
the residents and patients of mid Essex. The
overview also shows our performance against
key NHS targets, the way we work with our
many partner organisations and where our
funding goes.
1.1.1 What Mid Essex CCG does
NHS Mid Essex CCG is a clinically-led
organisation responsible, since April 2013, for
the planning, buying and monitoring – a process
called commissioning – of most NHS care in
Braintree District, Chelmsford City and Maldon
District. These three “localities” cover an area
of about 520 square miles and are collectively
known as mid Essex.
We were set up by the Health and Social Care
Act 2012, which introduced a number of major
changes to the way the NHS works, locally and
nationally. One of the most significant changes
was putting GPs at the heart of planning care
for their communities, so the CCG is made
up of all the general practices in mid Essex.
They elect GPs to represent local views on our
governing Board. Our Chair, Clinical Vice Chair
and others on the Board are experienced mid
Essex GPs.
You can find out more about CCGs on the NHS
Clinical Commissioners website, but we like to
explain our principal goal in one sentence:
We want everyone in mid
Essex to Live Well
This means making sure that you, your
family and loved ones have high-quality
health services that support you to stay well
throughout your life within the resources we
have available. To do that, we buy your NHS
hospital care, medicines and prescribing,
mental health services, urgent care, community
care and ambulance services.
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Annual Report 2016/17 Mid Essex CCG
Our Live Well vision and values are informed by fully engaged member
practices
Our vision for local healthcare reflects our legal
obligation and commitment as an organisation • giving people in mid Essex confidence in the
to follow the NHS Constitution, alongside services we commission
national NHS priorities and emerging needs in
our own communities. Our Five Year Strategy • making sure the CCG has the right
2014-19 establishes our main objectives in governance, capacity and capability to
meeting that vision as: deliver all our duties and responsibilities.
• improving quality and outcomes for all and To achieve these objectives, we have adopted
keeping patients safe an approach to local healthcare begun by
Braintree District Council, called Live Well.
• meeting our financial challenge through Led by our clinical members’ knowledge of
responsible use of resources local health needs, we are hoping to identify
people early on in their health and care journey
• bringing about transformation, innovation and offer them support. Together with partner
and integration of services organisations we hope to help people look after
themselves at different stages of life.
• making sure our commissioning decisions
Start Well gives children in mid Essex the best possible start in life. It seeks
to support families before birth, throughout childhood, adolescence and into
adulthood.
Be Well helps adults make healthy lifestyle choices and ensures people
know how to look after themselves, using health and social care services
appropriately.
Stay Well supports adults with long-term illness, poor mental health or social
care concerns to maintain fulfilling, productive and healthy lives. It does
this while making sure plans and services are in place if a person’s health
deteriorates.
Age Well acknowledges that as we age, we are more likely to need the
support of others. By helping people to understand and control their own care
needs, Age Well helps to build a strong network of support – including family
members and voluntary groups – in appropriate settings for older, more frail
individuals.
Die Well tackles the difficult topic of death head-on, giving people nearing the
end of their lives more choice about how they receive end-of-life care, to have
a dignified death.
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Annual Report 2016/17 Mid Essex CCG
All these “Wells” aim to give patients better There are more details of our values in section
health outcomes at lower cost, which in turn 2.3.2, but an example of how we are applying
makes health and social care in mid Essex them can be seen in a recent campaign
sustainable in the years to come. Reducing celebrating each individual member of staff for
people’s need for clinical care through being a Live Well ‘Ambassador of the Day’ –
early intervention is part of that, alongside you can find out more by reading about them on
strengthening links with non-NHS community our Twitter feed @MidEssexCCG.
and voluntary groups and resources.
Other organisations we work with
Our social prescribing scheme, Connect Well
offers a good way to signpost people to a wide We work closely with partner organisations that
variety of community-based help and support. have similar goals. For example, the Health
For those people who have greater difficulties and Social Care Act 2012 also created NHS
in managing their own health and wellbeing England, a national organisation that allocates
Connect Well also offers one-to-one support to resources across the NHS, supports CCGs and
develop non-medical, personalised solutions to checks NHS performance.
improving health and well-being.
We share responsibility with NHS England
Connect Well self-referral will be launched in for buying GP services through a process
the summer of 2017 to improve its reach and called “co-commissioning” while NHS England
connect people more simply and quickly to leads on buying other sorts of “primary care” –
local, help and support. optician, dental and pharmacy services, along
with a variety of specialist services (which are
high-cost, low-number services provided in
relatively few hospitals for large areas, including
certain types of heart, kidney, cancer, and
genetic services).
The 2012 Act also moved responsibility
for Public Health from the NHS to local
authorities. Essex County Council’s Director of
Public Health works with us to reduce health
inequalities – in other words making sure
everyone has access to the healthcare they
need and receives the same outcomes.
Making Live Well work is a major change and to The county council’s Public Health team provide
support this we need to ensure our organisation health intelligence, advice and support to Essex
leads by example. Every Board member and CCGs through a dedicated Consultant in Public
employee of the CCG is now adopting our Live Health under a local agreement. This consultant
Well values. is a non-voting member of our Board, and the
Director of Public Health supports a Joint Health
and Wellbeing Strategy for Essex under the
guidance of the Essex Health and Wellbeing
Board (see section 1.2.2).
These are: understanding the Live Well agenda, Overall, the mid Essex health and social
positively promoting it inside and outside the care system is made up of NHS Mid Essex
NHS, taking steps to Be Well ourselves, and CCG, Essex County Council, Chelmsford City
taking part in initiatives that help us make a Council, Maldon District Council and Braintree
personal difference to helping people Live Well. District Council plus key providers Mid Essex
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Annual Report 2016/17 Mid Essex CCG
Hospital Services NHS Trust, North Essex and South Essex Success Regime, we are
Partnership NHS Foundation Trust (Essex particularly impressed with two initiatives from
Partnership University NHS Foundation Trust the CCG over the past year. We have heard
since 1 April 2017 following a merger with a very positive feedback about the childhood
neighbouring trust), Provide Community Interest illness workshops the CCG has been running
Company, East of England Ambulance Service in recent months, which we know have proved
NHS Trust and a range of smaller providers popular with mid Essex parents and carers.
working together.
“Another important achievement for the CCG is
Both NHS England and NHS Improvement, its programme of re-directing A&E patients who
the watchdog organisation for the quality and can receive more appropriate NHS care from
provision of care in all health trusts, work with other services. It featured a strong element of
us and four other local CCGs – Southend, explanation to patients on the options open to
Thurrock, Basildon and Brentwood and Castle them and how they can access the alternatives,
Point and Rochford CCGs – in the Mid and which reflects the good lines of communication
South Essex Success Regime (see section the CCG works to maintain with the public.”
1.1.2). We also regularly work with national and
local charities, community organisations and What we have achieved together
voluntary groups on a variety of projects that
bring health benefits to local people. We pride ourselves on the innovation, high
The CCG is in regular contact with Healthwatch quality and good value we bring to local NHS
Essex, an independent organisation that care. Working with our partners, providers
and patient representatives, we have taken
“We feel they have a the Live Well agenda forward in a number of
good understanding of important ways during 2016/17. Several of
how important this is, these achievements have received national
and are pleased to have recognition.
had their support across
a number of Healthwatch • We have changed the way we make our
Essex projects” decisions, focusing our main committees
around the Live Well agenda and
streamlining them so they need to meet
less often. That leaves us more time to put
decisions they make into practice.
represents local people’s views about health • Using funding freed up from a national
and care to help improve services. Dr David review of GP contracts, we created a
Sollis, the organisation’s Engagement Manager, Primary Care Sustainability, Transformation
said: “Healthwatch Essex has a strong and Development Fund to support great
working relationship with Mid Essex CCG and ideas from our member practices about
appreciates their hard work to include patient new ways of working. This has been hugely
voice and lived experience in commissioning successful, creating as many as 90,000
decisions. We feel they have a good extra appointments in primary care across
understanding of how important this is, and mid Essex from a range of primary care
are pleased to have had their support across a professionals.
number of Healthwatch Essex projects.
• We are proud of our record of eliminating
Dr Sollis added: “Along with the very positive inpatient ‘grade 4’ pressure ulcers (the
way the CCG has engaged with the Mid most serious sort associated with breaches
in key policy) from acute and community
wards in mid Essex. As well as the welfare
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Annual Report 2016/17 Mid Essex CCG
issues such ulcers can cause, they have the Alongside national award short-listings for
potential to limit patients’ clinical outcomes individual achievements, we were proud to be
as well as causing a significant cost to the named one of the finalists for CCG of the Year
healthcare system, directly and through the at the HSJ Awards 2016 and to win a 2016
additional length of stay. HSJ Value Award in recognition of how our
Continuing Health Care (CHC) team supports
• We have created an award-winning fast vulnerable people who need care quickly.
track Continuing Health Care (CHC) service
that means patients at the end of life are
receiving coordinated care to help them
Die Well.
• We have significantly improved the positive
engagement we have with our partners, as
measured by an independent Ipsos MORI
survey. This makes it easier for us to explain
how Live Well works across the system and
support others in making it happen. See
section 1.2.3 for more details of how we
involve patients and the public in our plans.
• We have seen more than 400 social
prescribing champions trained under our
Connect Well scheme. Mostly in public-
facing jobs, these champions can now
identify whether the person they are talking
to might benefit from support at a local
voluntary or community group and give them
appropriate advice.
• Working with our member GP practices and
primary care providers, we became one of
the first healthcare systems in the country
to redirect patients coming to A&E without a
serious or life-threatening condition back to
primary care for more appropriate services.
• We have worked with patients to create and
launch a “waste medicine toolkit” that our
member practices can use to help people
make better use of medication and reduce
waste. The co-design approach has allowed
the toolkits to be fully adaptable to individual
communities’ needs, so each GP patient
group can take what it needs to support their
own populations to Stay Well.
• Part of making our Live Well values real for
CCG staff has seen many colleagues make
personal pledges on ways they can Live
Well.
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Annual Report 2016/17 Mid Essex CCG
NHS Mid Essex CCG – facts and figures
Headquarters Wren House
Hedgerows Business Park, Colchester Road
Chelmsford, Essex
CM2 5PF
Population (registered with a GP) Total mid Essex GP-registered population is
387,422 (January 2017)
Expenditure (for 2016/17) Healthcare expenditure £442.7m
Running costs £7.4m
Number of GP practices on 31 March 2017 Total £450.1m
Number of employees
46 (with about 250 GPs between them)
Providers of commissioning support services
132.33 Whole Time Equivalents permanently
employed on 31 March 2017
IT and some business information services are
purchased from North East London CSU. Arden
and Greater East Midlands CSU provide reviews
of Continuing Health Care in cases where
patients request it
Local Essex CCGs lead on delivering a number
of support services across the Essex footprint
such as the information governance function.
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Annual Report 2016/17 Mid Essex CCG
NHS Mid Essex CCG – facts and figures
Type of healthcare Where we buy it from on your behalf
Community services: Provide Community Interest Company
This includes district nursing, speech and
language therapy, podiatry, community Service agreements with 30+ other providers
hospitals, community stroke and rehabilitation including voluntary sector and smaller
services organisations
Hospital services: Mid Essex Hospital Services NHS Trust – mainly
This includes outpatient clinics, planned from Broomfield Hospital
inpatient treatment and emergency care
Colchester Hospital University NHS
Foundation Trust
Ramsay Healthcare Springfield Hospital
Basildon and Thurrock University Hospitals NHS
Foundation Trust
The Princess Alexandra Hospital NHS Trust
(Harlow)
Southend University Hospital NHS
Foundation Trust
Mental health services: Hospitals outside Essex such as Addenbrooke’s
This includes psychological therapies, Hospital in Cambridge and St Bartholomew’s
community mental health teams and learning Hospital in central London – referrals to such
disability services hospitals are made due to particular specialisms
there (Addenbrooke’s takes complex emergency
trauma cases for example) or patient choice
Improving Access to Psychological Therapies
(IAPT) provided by Hertfordshire Partnership
University NHS Foundation Trust
Secondary Care Mental Health services provided
by North Essex Partnership University NHS
Foundation Trust (Essex Partnership University
NHS Foundation Trust since 1 April 2017 after a
merger with a neighbouring trust)
“Locally enhanced” GP services Emotional Wellbeing and Mental Health Service
for children and young people provided by North
Emergency transport service East London NHS Foundation Trust
Non-emergency transport service We hold contracts with member GP practices
for the provision of particular services for some
areas of mid Essex
East of England Ambulance Service NHS Trust
ERS Medical Ltd
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Annual Report 2016/17 Mid Essex CCG
NHS 111 (commissioned on our behalf by Intergrated Care 24
West Essex CCG) Prime Care
Out-of-hours GP services
One CCG may lead the buying of shared
services on behalf of several local CCGs:
Emotional Wellbeing and Mental Health West Essex CCG leads on behalf of the seven
Service for children and young people (see Essex CCGs and three local Essex Tier 1 local
above) authorities (since 1 November 2015)
Adult Mental Health Services (see above) North East Essex CCG leads on behalf of the
three north Essex CCGs
Services for people with learning disabilities
(see above) West Essex CCG leads on behalf of the three
north Essex CCGs in partnership with Essex
Emergency Health Services and Transport County Council
(see above)
All CCGs across the east of England region buy
Children’s continuing care for Essex as a consortium, which is led by NHS Ipswich
and East Suffolk CCG
Mid Essex CCG is the “host commissioner” for
this service, which means buying it on behalf of
the Essex area
1.1.2 Key issues and challenges
We think our Live Well plan is the right way for
health and social care in mid Essex to develop,
but it is essential that we make it work not only
to make sure patients have the right outcomes
from their care, but because we face huge
challenges as a CCG and a healthcare system.
You may have seen in the news over the Our population is
winter of 2016/17 how many hospitals were expected to rise
struggling to cope with unprecedented numbers around 3% by 2020
of patients. Not only was that evident in mid
Essex, but there are also ongoing pressures
on NHS finances and staff numbers across our
health and social care system and the wider
Essex area.
By 2020, the mid Essex population (currently
less than 390,000) is expected to grow to
more than 400,000, with the number of frail
elderly and chronically ill people also rising
faster than the national average. This is placing
enormous pressure on services at a time
the NHS has faced a sustained slowdown in
spending growth, and substantial cuts in local
government spending continue. Mid Essex
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Annual Report 2016/17 Mid Essex CCG
CCG has to find significant savings each year Live Well services that draw on several or all of
in order to balance our budget and in 2016/17 those areas. With our partners’ and providers’
we have also been asked to begin repaying a help, we are overcoming that barrier.
historical deficit resulting from less funding than
national calculations say we should have.
Recruiting suitably skilled and experienced
clinical staff is also difficult for local health and
care organisations. Both health and social care
providers in mid Essex have large numbers of
unfilled vacancies. Concern over long-term NHS
staffing in the county has led to the creation of
a programme specifically to attract and retain
GPs, practice nurses and primary care staff, the
Essex Primary Care Inter-professional Centre
(EPIC) for Workforce Development.
There are two ways we are tackling these
challenges – leading the mid Essex health and
social care system on Live Well, and working
with our healthcare partners in south Essex on
a Sustainability and Transformation Plan (STP).
How Live Well can help The Mid and South Essex
Sustainability and Transformation
Two key elements of Live Well are helping Plan
people with long-term, life-limiting illnesses to
manage their condition better, requiring less The STP continues to develop the work of the
clinical intervention and changing people’s Mid and South Essex Success Regime. This is
behaviour in the longer term to improve not a national initiative first announced in 2015 to
just their health but quality of life – which also support three NHS areas with deep-rooted and
reduces the need for clinical services. persistent pressures where financial deficits and
service shortfalls create serious challenges for
We are working to create a series of “Live Well health and care in the future.
hubs” throughout mid Essex to encourage these
changes. The hubs will offer places where GPs By encouraging the five CCGs in the STP area
will work alongside traditional health services, to work together and more closely with other
social care and voluntary organisations to organisations, unblocking barriers to change
create the right package of support for the and offering a small amount of extra resources,
people who need it most. Working together the Mid and South Essex Success Regime has
will allow health, social care and voluntary allowed us to begin work early on our joint plan.
organisations to reduce duplication while
improving care quality – something two district There is strong evidence that some types of
councils have already seen value in, working care are best delivered to larger populations
in close partnership with us on hubs in Witham than our individual CCGs areas serve. So
and Maldon. the Department of Health has brought the
NHS and local councils together in 44 areas,
Delivering our Live Well vision will need a major or “footprints” of more than 1m people each.
change in the way the CCG and others buy The Mid and South Essex STP covers a 1.2m
services. The traditional divide between primary population. The STP helps us to innovate and
care, community services, social care and make changes to close gaps in the local NHS
hospitals is becoming a barrier to personalised budget.
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Annual Report 2016/17 Mid Essex CCG
Mid Essex CCG actively supports the plans and 1.1.3 Performance Summary
intentions set out in our STP and will play its
role in helping to bring these about. The CCG has plans in place to contribute to
delivery of the nine national NHS “must do’s”
A number of our executive officers have leading as set out in Delivering the Forward View: NHS
roles in the STP’s development and the CCG’s Planning Guidance 2016/17 – 2020/21.
operational plans are written to match and
support the direction of travel set out in the STP. The nine national “must dos” are to:
These include:
• develop a high-quality and agreed STP with
• building stronger localities to deliver a progress toward the “triple aim” of improved
broader range of primary and community health and wellbeing, transformed quality of
services care delivery and sustainable finances
• changing the way our acute hospital trusts • return the healthcare system to overall
work together and reviewing the services financial balance
they provide, including reducing the number
of urgent, unplanned admissions • develop and implement a local plan for
general practice sustainability and quality
• redesigning clinical pathways and services
including Frailty and End of Life. • meet access standards for A&E and
ambulance waits
• meet a 92% target for the national 18 week
Referral to Treatment (RTT) target
• deliver cancer standards targets
• meet mental health access standards and
dementia diagnosis target
• transform care for people with learning
disabilities
• have an affordable plan to make
improvements in quality.
The two tables over the page show how Mid
Essex CCG and our main acute services
provider have performed against NHS
Constitution benchmarks.
The development of appropriate seven-days-a- The tables highlight the unprecedented urgent
week healthcare services is also a government care pressures in A&E departments across
and NHS priority, so another important objective Essex and the challenge of meeting the Cancer
is making sure that the CCG and our partners 62 day pathway.
can provide seven-day services to the public.
In the table, performance figures without
Plans are being made to move towards this as percentage signs against them are numerical –
resources allow. in other words, they relate to the actual number
of patients.
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Annual Report 2016/17 Mid Essex CCG
CCG performance against national indicators
Our key performance measures are the 18 within 18 weeks of referral, unless they choose
week pathway, 4 hour target for A&E wait times to wait longer or it is necessary for better health
and two cancer care standards, the 31 day and outcomes. Mid Essex Hospital Services NHS
62 day pathways. These may be of particular Trust (MEHT) has been meeting the 92%
importance to local people using services. National Standard for this 18 week pathway
during 2016/17.
18 weeks pathway
We regularly review this performance through
NHS patients have a legal right to start the contractual process with MEHT. A sub-
non-emergency NHS consultant-led treatment group meets monthly to look at 18 week
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Annual Report 2016/17 Mid Essex CCG
pathway performance in more detail and pick Cancer standards – 31 day and
up detailed actions to make sure performance 62 day standards
is maintained, as well as addressing known
specialty underperformance. These are the principal measures of good
cancer care performance in the NHS. The first
Accident and Emergency – 4 hour is a target of no more than 31 days between
wait times clinical staff making a decision to treat any
patient for cancer and the patient receiving
The year has again seen increasing demand their first treatment. The second is a target of
on NHS services and particularly A&E. The no more than 62 days between a GP’s 2 week
pressure of unprecedented numbers of patients wait referral for urgent cancer care and the first
attending A&E at Broomfield Hospital has definitive treatment for the patient who was
resulted in MEHT not meeting the standard of referred.
95 per cent of patients being seen and treated
in A&E within four hours. It has also affected the MEHT has not met these national cancer
18 week pathway, with operations cancelled as standards over the past year. There are a
a result of beds being needed for emergency number of reasons for this, including capacity
admissions. (both workforce and surgical theatre), high
demand, transfers into and out of the hospital
The Mid Essex Urgent Care Board made up by other NHS trusts and process management.
of key local organisations involved in health During 2016 MEHT revised their remedial action
and social care continues to work together plan with support from NHS Improvement as
in implementing the immediate care strategy their position in meeting these targets changed.
involving all the members to tackle these
pressures. The strategy put into effect in The main features of the plan are:
2015/16 covers NHS111, 999, GP access,
A&E, GP Out of Hours, social care services, • tumour-site-specific work to improve
mental health crisis services, rapid community performance, taking into account the varying
services and other urgent care services. Partner degrees of complexities across sites
organisations offer support to MEHT when their
help can reduce the number of people going to • improved access to diagnostics and tracking
or being admitted to hospital. improvements to “inter-provider transfer”
across the Mid and South Essex STP.
Details of specific actions taken to alleviate
A&E pressure at MEHT can be found in section MEHT has launched one of three pilot
1.2.5. schemes across the East of England for a
Multi-Disciplinary Centre to improve early
diagnosis of cancer. A Cancer Nurse Specialist
has been employed to liaise with GP practices,
supporting patients and referrals regarding
vague symptoms. The first Multi-Disciplinary
Team meeting has taken place, with work
continuing in the coming year before a review
of outcomes. It is expected the scheme will
improve early diagnosis by offering GPs an
alternative to 2 week wait referrals if there is
concern for a patient not showing symptoms.
Work is also underway for an STP-wide
programme backed by Cancer Research UK
and Macmillan Cancer Support.
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Annual Report 2016/17 Mid Essex CCG
1.1.4 Financial Overview surplus towards paying off the deficit. While we
set and delivered a surplus budget in 2016/17
Our full statutory financial accounts are included of £3m, that meant we still had a “carried-
in part three. This section provides a summary forward” deficit into 2017/18 of £21.9m. We
of our current financial position. delivered a savings programme of £11.9m
(2.8% of our healthcare services funding) to
CCG funding achieve the surplus.
Mid Essex CCG receives funding according How your money was spent
to a national formula designed to calculate
healthcare needs based on the makeup of the In 2016/17 we spent £441.0m on healthcare
local patient population. Mid Essex’s population services, £1.7m on behalf of the Mid and South
is considered to have a relatively low need for Essex Sustainability and Transformation Plan
healthcare spend under the formula so our Out of Hospital project – see section 1.1.2,
funding per head of population is the lowest in and £7.4m on running costs. We have met HM
Essex. Treasury’s guidelines on cost allocation.
We received £441m baseline funding for The pie chart over the page shows the major
healthcare in 2016/17 which was 1.6% (£7.3m) areas of spend for healthcare in mid Essex. See
below target funding. In addition to that baseline section 1.2.5 for more details of the Better Care
funding, we received a number of extra one-off Fund – Protection of Social Care segment.
allocations for spending on specific areas of
care and some project planning costs on behalf
of the Mid and South Essex STP (see section
1.1.2).
In 2016/17 that brought our total healthcare
funding to £445m. The funding for running the
CCG (called “running cost expenditure” funding)
for 2016/17 was £21.62 per mid Essex resident,
or £8.3m.
We have a number of financial duties at the
CCG.
• To contain revenue expenditure within
allocated financial resources and any
specified Directions
• To contain capital expenditure within
allocated financial resources and any
specified Directions
• Running cost expenditure must not exceed
the £21.62 per head figure
As of 1 April 2016 the CCG had an accumulated
deficit from previous years of £24.9m. We
were required by NHS England to underspend
against funding in order to generate a £3m
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Annual Report 2016/17 Mid Essex CCG
Capital spending pay at least 95% of invoices within 30 days
of receipt, or within agreed contract terms.
We did not receive a capital allocation for In 2016/17 we met all four targets (based on
2016/17, but the Mid and South Essex STP invoice numbers and value of expenditure) for
footprint was awarded Estates and Technology both NHS and non-NHS invoices – see Note 6
Transformation Funding (ETTF) including a sum of the Financial Statements for details.
for minor developments on some GP premises
and a share of funding to develop primary care We are also an approved signatory of the
mobile working. ETTF expenditure is accounted Prompt Payment Code. The government
for by NHS England. designed this initiative with the Institute of
Credit Management to tackle the crucial issue
Since 31 March 2013, premises previously of late payment and to help small businesses.
owned or leased by Mid Essex Primary Care Suppliers can have confidence in any
Trust have belonged to NHS Property Services organisation signed up to the code that they will
(NHSPS) or other local NHS providers, but be paid within clearly defined terms and that
getting the best use from these resources proper processes are in place to deal with any
and keeping buildings fit for purpose are still disputed payments. Approved signatories have
important roles for the CCG. committed to:
Paying our suppliers and providers • paying suppliers on time
The national Better Payment Practice Code • giving clear guidance to suppliers and
means we must aim to pay all valid invoices resolving disputes as quickly as possible
by the due date or within 30 days of receiving
them, whichever is later. The NHS aims to • encouraging suppliers and customers to
sign up to the code.
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Annual Report 2016/17 Mid Essex CCG
The national measures for payment individual CCG plans for 2017/18 have been
performance do not identify the delays in linked to system-wide plans. Our major clinical
payment during the time that an invoice is on and service transformation plans will be
hold. delivered and monitored partly at a local level
and partly across the STP. In 2017/18 we must
Commissioning support continue to transform services in a way that
relieves pressure on expensive hospital care
We buy a limited number of services and reduces cost.
from Commissioning Support Units, with
Corporate IT, GP IT and the Data Service for We will also be continuing our patient education
Commissioners (DSCRO) coming from North programme to help patients deal with minor
East London CSU and Continuing Healthcare issues and ensure that they know which
Retrospective claim management from Arden & healthcare professionals and services to
GEM CSU. contact if symptoms worsen.
We also buy procurement support from Attain We will continue to jointly commission primary
and HR transactional services from Anglian care with NHS England over the next 12
Community Enterprises Community Interest months and work closely with them to develop
Company. Basildon and Brentwood CCG primary care and community-based plans
provides our information governance services. where patients could benefit from care closer to
home.
2017/18 financial plans and looking to
the future Although the CCG had a cumulative deficit of
£21.9m as of 31 March 2017, for accounting
We have received £452m for local healthcare, and risk management purposes the CCG is
taking us closer to our target funding – we will assumed to be a ‘Going Concern’ as it has an
be 1.3%, or £5.8m, below where we should agreed deficit repayment plan which has been
be. The increase in funding for 2017/18 is approved by NHS England.
£11.1m. However, NHS England requires that
we underspend our allocated resource by £9m The scale of the challenge is immense if we are
(2%) in 2017/18 in order to repay a further £9m to meet our financial targets in the coming year.
of the accumulated deficit. Expenditure will
therefore need to be capped at £14.8m (3.2%)
below target funding.
In the context of typical cost pressures and
the requirement to generate a £9m surplus as
well as the impact of the new rates for the way
NHS hospitals charge CCGs for some services,
2017/18 will be a very difficult year financially.
Staying on track with our financial recovery
presents us with a substantial challenge. Based
upon our estimates of service demand and cost
pressures, we forecast that the CCG will need
to deliver £23.5m of savings in 2017/18.
As explained in section 1.1.2, we are part of
the Mid and South Essex STP which means
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Annual Report 2016/17 Mid Essex CCG
1.2 Performance Analysis its statutory functions regarding quality, which
are:
1.2.1 Improve quality • securing continuous improvement in the
quality of services for patients and in
The CCG has a legal duty under section 14R of outcomes, with particular regard to clinical
the National Health Service Act 2006 to improve effectiveness, safety and patient experience
the quality of services.
• assisting and supporting NHS England in
Alongside our commitment to measuring our securing continuous improvement in quality.
performance against the NHS Constitution and
core national measures (see sections 1.1.3 All main contracts that we issue to healthcare
and 1.2.5), we assess the quality of the care providers contain clear quality requirements,
we plan and buy in three ways: effectiveness, measures and incentives where relevant to
patient experience and patient safety. ensure that services meet the expectations of
both mid Essex patients and the CCG.
To deliver high-quality care, CCGs work to
the NHS Outcomes Framework to ensure This process allows us to develop and meet
improvements in the areas of: local and national quality standards and to
remain focused on getting the best outcomes
• preventing people from dying prematurely for the people who live in mid Essex.
• enhancing quality of life for people with long Our Nursing and Quality team seeks assurance
term conditions of quality from a number of sources, including
provider reports, feedback from patients
• helping people to recover from episodes of using services we commission and our own
ill health or following injury assurance visits to providers. Quality assurance
processes cover acute care, community care,
• ensuring that people have a positive nursing homes, mental health and learning
experience of care disabilities.
• offering care in a safe environment, The CCG’s Nursing and Quality team is
protecting patients from avoidable harm. responsible for:
The CCG is committed to working with all • ensuring the CCG meets statutory and
organisations that provide mid Essex health mandatory patient quality and safety
services to make sure patients receive the requirements
best possible care, have a positive experience
of healthcare and are treated safely and with • monitoring performance in quality, safety
compassion. and patient experience for commissioned
services’ contracts through formal Clinical
Our Quality and Governance Committee is Quality Review meetings, announced
at the centre of this work, as it is responsible and unannounced site visits and patient
for giving our governing Board assurance experience feedback. Performance
that appropriate and effective governance monitoring includes triangulation of available
mechanisms are in place for all aspects of intelligence
quality.
• making sure quality is incorporated into the
The committee also supports the Board to fulfil commissioning and procurement processes.
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Annual Report 2016/17 Mid Essex CCG
Our quality monitoring processes are based The Quality and Governance Committee
around principles and recommendations for receives a ‘dashboard’ at each of its quarterly
best practice following a number of high-profile meeting that details key performance measures
national reviews and reports such as Francis, for all providers. Quality Assurance ‘deep dives’
Berwick, Keogh, Hart and Cavendish, as well as – a thorough review of a service that focus on
Safer Staffing guidance. all aspects of quality, patient experience and
safety for both NHS and independent providers
We also have governance arrangements to – take place across commissioned services.
provide assurance on and support decisions
relating to contracts and providers. These
arrangements involve working with statutory
organisations, partners, patients, carers and
providers to give us access to a range of
intelligence that can support decisions affected
by the quality of services we buy.
National indicators (targets) in the NHS
Outcomes Framework cover Clinical
Effectiveness, Patient Experience and
Patient Safety. These indicators allow us to
seek assurance of the quality of services
being delivered by our providers and, when
necessary, to challenge and intervene.
The Care Quality Commission’s regulations Clinical effectiveness
for providers include a requirement to be open
and transparent about care and treatment We follow national guidance, including the
with people receiving the services and with NHS Outcomes Framework 2016 to 2017,
those properly acting on their behalf. The and draw on clinical advice from national
requirements also include specific rules on what bodies alongside local priorities to make sure
providers must do when care and treatment go that providers are delivering services that
wrong. In those cases, we check that providers meet the latest best practice guidance and
are exercising their duty of candour and being protocols. Examples of this relate to accessing
open with patients and their representatives. psychological therapies and improving quality of
life for people with dementia.
To ensure that we meet the recommendations
for CCGs arising from national reviews such as Checking that provider policies consider NICE
the Francis report, our Board has been through guidance through Quality Review meetings
an assurance process. We also regularly report is another key element of CCG monitoring.
on progress against the recommendations We also review data to measure local
of the Winterbourne View report. Actions providers’ performance. Regional and national
we are taking to achieve Winterbourne comparisons can be drawn against this data to
recommendations include: understand where and why we see differences
in performance, such as in caesarean section
• setting key safety, experience and rates.
effectiveness measures monitored robustly
through Quality Review meetings, quality Our Designated Adult Safeguarding Manager
assurance visits and contract review and Clinical Quality Nurse also work closely
meetings with the local authority to monitor services in
• providing an integrated performance and
quality report for the governing body.
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Annual Report 2016/17 Mid Essex CCG
care homes. Work is underway to include in formal complaints from patients or carers (plus
this assurance process the Care Agencies that 1 complaint relating to Continuing Health Care
deliver personal care to people in their own which under CCG procedure is not investigated
homes. as a complaint prior to PHSO consideration).
We also received 18 compliments. The CCG
Patient experience also received 73 enquiries from MPs making
contact on behalf of a constituent.
This element of the CCG’s performance
analysis focuses on: We have since 1 January 2017 been logging
enquiries from local councillors following a
• CCG Patient Advice and Liaison Service question from the floor at a CCG Board meeting
(PALS) for compliments and complaints in public. We have so far recorded 7 enquiries
and tracking will continue in 2017/18.
• Friends and Family Test
Of the 75 complaints noted above two cases
Our Patient Experience Team (PET) were accepted by the PHSO for investigation
encompasses PALS and complaints. The team during 2016/17. One complaint was partially
responds to patient complaints about decisions upheld (50%) and the PHSO made one
the CCG has made, but the NHS Complaints recommendation with which we are complying
Regulations also give patients and the public in full. The other case is still under review.
the opportunity to complain to the CCG as a
commissioner if they do not wish to complain During 2016/17 we have reviewed a variety of
directly to a provider. patient experience reports from all providers.
Through the renewal of contracts, we have
The CCG Complaints Policy reflects best standardised what information we want reported
practice principles for complaints handling to us so that we get more than a traditional
according to the Parliamentary and Health complaints report and are able to triangulate the
Service Ombudsman (PHSO), as noted in the full spectrum of patient experience across the
documents Principles for Remedy, Principles entire area we serve.
of Good Complaint Handling and Principles of
Good Administration. To meet the Principles for Relevant mid Essex providers have participated
Remedy, the CCG places a strong emphasis in the Friends and Family Test initiative, asking
on putting things right, ensuring continuous a simple question: “Would you recommend
improvement and learning from complaints. hospital wards / accident and emergency /
maternity units to a friend or relative based on
PALS provides help, information and advice your treatment?”
to patients and the public in relation to local
health services. During 2016/17, PALS handled The most recently available scores are shown
a total of 513 contacts, and we received 74 below.
Friend and Family Test Score for December MEHT Ramsay Provide
2016 (most recent figure) Springfield 100%
Inpatient 94% 98%
A&E 81% N/A N/A
Maternity 100% N/A N/A
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Annual Report 2016/17 Mid Essex CCG
Over the past year we have produced a series We also analyse Hospital Standardised
of ‘patient stories’ about the Live Well cycle. Mortality Ratios (HSMR) and Summary
These have encompassed experiences of Hospital-level Mortality Indicator (SHMI) data to
services relating to Start Well, Be Well, Stay support the mid Essex health economy’s strong
Well, Age Well and Die Well and been well focus on reducing mortality rates. The CCG
received. attends MEHT’s Mortality Review meetings.
The stories are available for viewing as videos During 2016/17 we have been supporting the
on our website, and you can view them by trust in the undertaking of harm reviews for
following the link above. We plan to continue patients whose care breached the 52 week
to produce such patient story videos and are RTT standard. These reviews ensure that
currently working on the themes we wish to each patient has an individual assessment
pursue in the coming year. to determine if harm has occurred in direct
correlation to the NHS not meeting their
treatment timeframes.
The outcomes of the review enable us to
wrap individualised plans around patients to
ensure they receive appropriate care, but also
enable our commissioning teams to understand
why the breaches occurred and how we can
commission effectively to prevent recurrence.
Dignity and respect: Quality
assurance visits
Patient safety We run a programme of Quality Assurance
Visits across providers throughout the year,
We implement the national serious incident both “announced” (with the provider aware) or
reporting process where all identified actions unannounced. The visits, conducted in line with
are closely monitored by a review panel to Care Quality Commission (CQC) guidance, are
make sure they are fully implemented before linked to information gathered from incidents or
the incident is closed. complaints. During visits, we obtain feedback
from patients who are using the service.
The CCG also uses a data reporting tool to
analyse performance against the five key areas Recommendations from the visits are shared
listed in the NHS Outcomes Framework. with the provider, which is then expected to
produce an action plan to address any concerns
The NHS Safety Thermometer Harm raised. This plan is checked at the provider’s
Measurement Instrument provides information quality contract review.
on all NHS-provided care organisations
including acute, mental health, community Dignity and respect:
wards and district nurse caseloads. All relevant Same-sex accommodation
providers are actively involved in submitting
performance information they collect. The CCG receives monitoring reports from
providers with inpatient facilities covering Mixed
Sex Accommodation Breaches. These are
monitored and reported at the Clinical Quality
Review Group on a monthly basis. Providers
are commissioned to deliver care in line with the
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Annual Report 2016/17 Mid Essex CCG
“Delivering Same Sex Accommodation” policy system-wide leadership to improve both health
from NHS England (East of England). and care services. In particular, they have a
duty to promote integrated working and drive
Through the first six months of 2016/17 improvements in health and wellbeing.
there were a noted number of mixed sex
accommodation breaches in the MEHT Health and Wellbeing Boards (established on 1
Intensive Care Unit (ITU). We worked with April 2013) are responsible for:
MEHT to look at solutions to the breaches
and how we could move to a zero-tolerance • leading on the production and regular
approach. MEHT showed a considerable updates of the Joint Strategic Needs
reduction in mixed sex occurrence since Assessment (JSNA) as an assessment of
October 2016 and where a breach has since local health and wellbeing needs across
occurred, we now are clear it is due to capacity healthcare, social care and public health
in the rest of the trust to enable a step down
from the critical care environment. • producing and annually reviewing a Joint
Health and Wellbeing Strategy in response
This is a concern that we continue to work to the JSNA, which will provide a strategic
with MEHT in addressing through demand and framework for local commissioning plans.
capacity management into 2017/18.
• the Essex Health and Wellbeing Board
External reviews brings together locally elected councillors
and key commissioners, including
The CCG plays an active part in the Essex representatives of CCGs, Directors of
Quality Surveillance Group that highlights and Public Health, Children’s Services and
enables the sharing of soft intelligence with Adult Social Services and a representative
CCGs, local authorities, NHS England, NHS of Healthwatch Essex, which provides an
Improvement, Healthwatch and the CQC. We independent voice on healthcare for people
also monitor reports from the CQC in relation to in our county.
commissioned providers.
The board has produced a five-year strategy
Whenever concerns about a provider are raised that sets out how partners will work together on
by the CQC, we work with the provider and improvements up to 2018.
support their production and implementation of
an improvement plan. The development of this strategy is informed
by the JSNA, the national District Health
Following inspection by the CQC, Colchester Profiles, a number of needs assessments and
Hospitals NHS Foundation Trust and North a programme of ‘deep dive’ analyses of key
Essex Partnership University NHS Foundation issues for Essex. This work has been overseen
Trust were receiving further support and by a Performance Sub-Group of the board.
monitoring during 2016/17 from Oversight
Groups led by NHS Improvement. The board is chaired by the county council
Cabinet Member for Health, Councillor Graham
1.2.2 Health and wellbeing Butland. The nominated Vice Chair is Dr Gary
strategy Sweeney, Chair of North East Essex CCG.
There are 23 voting members including clinical
A key outcome of the Health and Social Care representation from CCGs and a member from
Act 2012 was to establish a statutory Health the NHS England Area Team.
and Wellbeing Board in every local authority
area. These Boards offer the opportunity for Dr Caroline Dollery has been a member of the
Health and Wellbeing Board since she became
Chair of Mid Essex CCG in September 2014.
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Annual Report 2016/17 Mid Essex CCG
There are two non-voting members: the Police communities in line with our legal duties under
and Crime Commissioner and the independent section 14Z2 of the Health and Social Care Act
chair of the Essex safeguarding boards. 2012 to ensure there is public involvement and
consultation in commissioning processes and
Throughout 2016/17, the board oversaw decisions.
a further update of the JSNA with updated
locality profiles and a review of the Joint Health Our reports to Board every two months,
and Wellbeing Strategy. It also oversees the published in the Board report papers, provide
implementation of CCGs’ five-year plans as a detailed record of how we have engaged and
well as the development of Better Care plans involved patients and the public in core CCG
promoting integrated commissioning between business over the past 12 months.
health and social care.
The board is currently reviewing its role, with a
particular focus on:
• how its work programme can be integrated
with those of other Essex partnerships
• recognising and enhancing the role of
district-level health and wellbeing boards
• its role in developing and monitoring NHS
Sustainability and Transformation Plans.
Each year, our annual report is offered to board During 2016/17, the CCG continued to develop
members at an early stage of drafting so they imaginative ways to reach out and involve
have the opportunity to offer feedback. The people, from creating targeted social media
Health and Wellbeing Board responded with campaigns to having a presence at both large-
confirmation that they had no further comments. scale and localised community events. We have
a virtual network of more than 500 subscribers
Any residents wishing to attend Essex Health informed by regular e-newsletters and
and Wellbeing meetings are welcome to do individuals have shared their lived experience
so. Minutes of previous meetings are also of NHS care at public Board meetings. The year
available. See http://bit.ly/2ogyfEE for further has been enriched with public involvement.
details or email health.andwellbeing@essex. The landscape of health and care continues
gov.uk. to change at pace in mid Essex and so our
growing stakeholder networks have become
1.2.3 Patient and public invaluable for ensuring we have strong patient
involvement voice, challenge and support for emerging
plans.
We have an ongoing ambition to be as
inclusive as possible with our patient and public During the annual reporting period the
involvement, actively seeking input to help us CCG has worked hand-in-hand with our GP
make sure the services we commission are practices’ patient groups, our member practices
tailored to the needs of people in mid Essex. themselves, district and city councils, the
local community and voluntary sector and
Our published Communications and
Engagement Strategy describes how our
CCG has laid foundations to engage with local
23
Annual Report 2016/17 Mid Essex CCG
Healthwatch Essex in particular to maximise services and given the CCG calls to action
engagement locally. regarding improvements.
Throughout this report, you will see examples In particular, the PRG has been instrumental
of where public involvement has influenced this year in the development, design and most
commissioning, improvement to services and importantly the use of practice promotional
made real differences to health and care in our toolkits aimed at reducing medicine waste at the
area. Some areas are particularly significant for level of individual communities. The innovative
us, as detailed later in this section. project, which combined the expert local
knowledge of patients with input from Medicine
Patient Reference Group (PRG) Waste UK, is continuing to roll out across our
area and leading behaviour change.
Over the past 12 months, we have worked
hard to develop a robust and accountable PRG We have also supported patient representatives
made up of representatives from local GP to engage further in specific commissioning
practice patient groups, Healthwatch Essex and projects including developing plans for a health
community and voluntary groups. hub; reconfiguration of hospital services;
collaboration in primary care localities;
The PRG, chaired by our Lay Board Member promotion of GP online services; and better
for Patient and Public Involvement, is attended recognition of and provision for carers.
by senior CCG staff who present plans and
take actions as a result of direct feedback from Stakeholder relationships
the group. Agendas, minutes and actions are
recorded and shared publicly on our website. Our last public consultation, which finished in
early 2016, achieved almost 1,300 responses
In 2016/17, the PRG has: and was cited by Essex County Council’s
Health and Overview Scrutiny Committee,
• discussed and influenced ongoing savings or HOSC, as a genuine example of health
plans engagement.
• organised and supported localised events The 2016 MORI 360 stakeholder survey
to discuss emerging STP proposals for mid – an independent review of how our key
and south Essex partners rate the CCG – showed substantial
improvement in our engagement. Results and
• shared invaluable lived experience of local some anecdotal quotes are highlighted below.
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Annual Report 2016/17 Mid Essex CCG
“Mid Essex CCG is one of the best in Essex for us. They seem to be proactively
engaging with partners, are visible in the community based forums and have bright
and enthusiastic leadership. I wish them well for the future.”
“There has been a sea change in attitude and our relationship has really developed”
We have continued during 2016/17 to organise
opportunities for regular engagement with our
GPs through the development of twice-yearly
summits to discuss commissioning plans
and, through the emergence of locality-based
meetings, to share plans, ideas and feedback
on changes to care.
Our most recent Annual General Meeting
was held in September 2016 and gave our
stakeholders the opportunity to find out more
about the CCG’s priorities and performance as
well as ask questions of senior staff. For the first
time, we combined our AGM with a community
awards event celebrating the achievements
of partners, providers and the community
and voluntary sector in a bid to broaden local Live Well events and became ambassadors
knowledge of health and care. The event for the campaign
received great feedback and an overview was
presented to our Board in November. • More than 20 patient groups getting involved
Live Well in helping support local promotion and
publicity of events – a ‘free’ network of
2016 saw the launch of Live Well – our promotion
campaign to involve local people in discussions • Targeted events to include harder-to-reach
about plans for health and care, and to start groups such as pitches at Chelmsford
conversations about the importance of self-care PRIDE, a stall at a men’s health charity
for their long-term wellbeing. roadshow and events aimed at parents and
Key outcomes of the campaign were: grandparents.
• More than 500 direct conversations about Social media
what Live Well means with local people
during more than 30 events and road shows During the annual reporting period, we have
designed and launched a new website and
• About 30% of those conversations led to re-launched accounts for Twitter, Facebook,
signposting people to local services that can Instagram and YouTube.
help keep them active and healthy – with
around 25% of these people taking up an Over the past year we have gained a steady
intervention like smoking cessation, weight increase in visitors to our website – averaging
management or social prescribing around 7,000 visitors per month. We’ve
significantly increased Twitter impressions
• More than 50 staff across 24 partner (how many times tweets are seen), from 2,000
organisations joined in with supporting our to 136,000 over the past year and steadily
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Annual Report 2016/17 Mid Essex CCG
increased our reach across all social media
platforms.
More importantly, we’ve significantly increased
the use of online feedback by encouraging the
use of Twitter polls and have responded to all
queries posted within 24 hours to ensure we
can engage in a timely way with this audience.
The CCG has also taken on management of
social media for partnership projects including
Maternity Voices (a support network to engage
parents, grandparents and carers); Connect
Well (our social prescribing programme) and
the Mid and South Essex STP.
Childhood illness workshops
As part of a wider strategy designed to reduce
demand on A&E services during the winter
of 2016/17 and support people to make the
best choices for NHS help, we developed a
childhood illness booklet with help from local
clinicians and parents. We then ran a series of
free public workshops based around it.
The workshops, which took place at a variety Comments from parents include:
of venues including schools and children’s
centres in November 2016, attracted more than “Interactive and relaxed, opportunity to ask
130 local parents, grandparents and carers. questions to a range of professionals”
Supported by local GPs, pharmacists and the
NHS 111 service, attendees were given top tips “It was great that the workshop was interactive.
on how to recognise some of the most common The professionals were very human”
childhood illnesses and how to treat them.
“Excellent opportunity to hear from a GP,
Using questionnaires prepared by the CCG, Pharmacist and 111 staff about services they
attendees shared their experiences and provide and the scenarios that could trigger
learning from the first wave of workshops their support”
helped us to design a second phase of events
held in March 2017. “A great understand of what my pharmacist
should be able to offer as I would now be more
To date, more than 20,000 booklets have been likely to call in to see them than book a GP
given to parents across mid Essex and more appointment”
than 1,700 people have downloaded the booklet
in electronic form from the CCG website. “The workshop was organised really well – the
best thing was the chance to ask questions”
We continue to share tips and signpost people
to local health and care services using our
social media channels and use national
awareness days to engage audiences and start
conversations.
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Annual Report 2016/17 Mid Essex CCG
1.2.4 Reducing health inequality Goal 3 – a representative, supported workforce
Working towards an NHS that is Goal 4 – inclusive leadership.
personal, fair and diverse
The CCG shared its EDS2 self-assessment
We are committed to working within the against Goals 1, 2 and 4 with public and patient
framework of the Equality Act 2010, which representatives on 3 May 2017. No objections
replaced previous anti-discrimination laws to the self-assessed ratings were received.
and aims to protect people from unfavourable
treatment. Nine different characteristics are On 26 April 2017 the CCG shared its EDS2 self-
protected under the Act, some of which apply to assessment against Goal 3 with our Work Well
everyone and some only to specific groups of Group, whose members are representatives
people. The nine characteristics are: from each Directorate. No objections to the self-
assessed ratings were received. The CCG was
• Age therefore rated as follows:
• Disability
• Gender reassignment Goal No of Final Rating
• Marriage and civil partnership
• Race (including nationality and ethnicity) Better Health “Outcomes”
• Pregnancy and maternity Outcomes
• Religion or belief Developing – 2
• Sexuality
• Sexual orientation 5 Achieving – 3
The public sector general Equality Duty Improved 4 Developing – 0
applies to all public authorities including CCGs patient access 6 Achieving – 4
who must, as they carry out their work, take and exerience 3
appropriate actions to: Developing – 1
A Achieving – 5
• eliminate unlawful discrimination, representative
harassment and victimisation, and other and supported Developing – 1
conduct prohibited under the Act workforce Achieving – 2
• advance equality of opportunity between Inclusive
people who share a relevant protected leadership
characteristic and people who do not
The overall score of 4 x Developing and 14 x
• foster good relations between people who Achieving is an improved position compared to
share a relevant protected characteristic and 2015/16 (5 x Developing and 13 x Achieving).
people who do not. There were no perceptions that the CCG was
either ‘Underdeveloped’ or ‘Excelling’ against
The CCG regularly reviews its local Equality any of the four goals. The CCG will continue to
and Diversity objectives and monitors its improve its EDS2 ratings during 2017/18.
achievement against both these and the NHS
Equality and Delivery System (EDS2) goals, The CCG’s local Equality and Diversity
which are: objectives are:
Goal 1 – better health outcomes Objective 1 – ensuring there is local
engagement from vulnerable and ethnic groups
Goal 2 – improved patient access and in assessing health needs, service redesign and
experience measuring the impact of commissioned services
Objective 2 – improving the individual
experiences of the protected groups in
accessing and using NHS Services
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Annual Report 2016/17 Mid Essex CCG
Objective 3 – improving overall staff health and • Further Equality and Diversity training
wellbeing within the CCG arranged for Board members (to be
delivered in April 2017)
Objective 4 – the CCG has a representative
workforce that suffers no inequality in The CCG’s Annual Equality and Diversity report
remuneration, bullying and harassment at will be presented to the Board at its meeting in
work or during the recruitment process and is public on 29 June 2017, and will include a copy
empowered to promote equality at work of the CCG’s EDS2 assessment.
Objective 5 – embedding equality and diversity Duty to reduce inequality
at Board level and at every level in the CCG.
The CCG has a duty under Section 149 of the
Progress against these objectives was Health and Social Care Act 2012 to reduce
monitored during the year by the Equality and inequalities. There have been no serious
Diversity Sub-Committee and a number of key lapses in the CCG’s fulfilment of that duty,
actions were completed during 2016/17. demonstrated by our EDS2 outcomes for
2016/17 noted above.
• The Nursing and Quality Team have
been asked to advise the Head of When commissioning, the CCG uses the NHS
Communications and Engagement where Standard Contract, which sets out to avoid
they have identified that a patient with discrimination through its terms and conditions.
a protected characteristic has reported There are five provisions to protect equality
positive or negative experiences in under Service Condition 13 (“Equity of Access,
accessing services Equality and Non-Discrimination”), the full
text of which is available on the NHS England
• The database used to record complaints and website.
Patient Advice and Liaison Service (PALS)
enquiries has been modified to record any The CCG requires contracted healthcare
issues relating to discrimination experienced providers to demonstrate compliance with
by a patient with a protected characteristic all relevant provisions as part of the contract
monitoring process.
• The CCG’s equality impact assessment
(EIA) screening document was reviewed There was an update to the Essex JSNA in
2016 (see section 1.2.2 for more details) that
• Work was undertaken to ensure that took a similar life course approach to the CCG’s
the CCG complied with the Accessible Live Well approach, with some in-depth analysis
Information Standard (AIS) on topics pertinent to the inequalities agenda
such as premature mortality, mental health.
• Workforce Race Equality Standard, or
WRES – see below for more details Two new specialist topics needing assessments
– mental health and sensory impairment – were
• Agreeing new arrangements to review the introduced under the JSNA banner in 2016 and
CCG’s main providers compliance with the the annual district reports identifying variation in
AIS, WRES and WDES during 2016/17 once needs across the CCG.
the results are available
In addition to these local analyses, we have
• Introduction of Staff Awards scheme begun using the RightCare approach, which
highlights local variations in care, compared
• Training of staff ‘Health Champions’ to data obtained from demographically similar
CCGs. This is another example of intelligence-
• Achievement of ‘Mindful Employer’ status driven commissioning and transformation.
28
Annual Report 2016/17 Mid Essex CCG
Our Board had a development session the CCG) and both the Accountable Officer and
on understanding data and an extended Managing Director are female. One of the three
programme will be rolled out to key CCG staff lay Board roles and four of the seven Executive
to support using local intelligence. Director posts are held by women. The CCG
also has eight Clinical Leads, four of whom are
NHS Workforce Race and Equality female.
Standard (WRES)
1.2.5 Detailed review of the
WRES is the mandatory standard to ensure CCG’s development and
race equality and fair treatment for the black performance
and minority ethnic (BME) NHS workforce. Its
goal is improved workplace experience for BME Many of our performance indicators can be
staff, and that they have representation at all found on the MyNHS section of the national
levels within an organisation. NHS website, alongside those of other CCGs
and NHS providers. Mid Essex residents can
The standards are built around nine indicators find these by searching for the local postcode
that need to be compared to the measures for on the site.
white and BME staff. The first four indicators
are workforce related and are provided through While some performance measures for the
the workforce reporting the CCG already does CCG compare favourably with neighbouring
through gathering data from NHS jobs and our CCGs and national targets, there are a number
own Electronic Staff Record (ESR) system, of areas where the CCG is rated as needing
which holds records of all employees. improvement.
Information for the next four indicators has Steps to address cancer care, where diagnosis
been gathered from our own Staff Survey, at an early stage is currently rated at 57.9%,
which ran between September and December are noted in section 1.1.3. All figures in this
2016. Each of these indicators is compared section are the most current available, but not
to measurements for the responses for white necessarily for 2016/17.
and BME staff across each relevant survey
question. In dementia care, where our estimated
diagnosis rate is 57.3% and we have the
Following publication of its first WRES report on greatest need for improvement, we have
1 July 2016, the CCG will be producing a new implemented a comprehensive and accountable
report by 1 July 2017. action plan, a review of GP registers, a review
of the care pathway, a model to support
Gender diagnosis of patients living in care homes and a
task-and-finish group to develop a system-wide
NHS Workforce data shows that the proportion approach.
of females to males within the overall healthcare
workforce is around 77% to 23%, while just over In terms of care for people with learning
42% of NHS chief executives are women. The disabilities (LD), 51 patients with autism and/or
CCG has Whole Time Equivalent (WTE) 109.91 LD per 1m population are reliant on specialist
female staff, which is 83% of the workforce, inpatient care. To improve care, the CCG
while 22.42 WTE (17%) of the workforce are has made proacative use of the Community
male. See section 2.3.2 for more details of our Learning Nursing Disabilities Team and nurses
staffing numbers. from Herts Partnership Foundation Trust (see
section 1.1.1) to better support LD patients
At senior level in Mid Essex CCG two of the in the community and reduce the number of
four elected GP Board members (one chairing inpatients, particularly those attending hospital
29
Annual Report 2016/17 Mid Essex CCG
regularly. There has been more support for GP Value for Money
Practices to provide access to annual health
checks and reviews, with the use of tailored We strive to get best value for money in the way
information for all LD patients and their carers. we use public funds. In 2016/17 we contained
our expenditure within our allocated resources
A wide variety of measures have been taken and generated a £3m surplus which has
to improve mid Essex maternity care, including reduced our cumulative deficit to £21.9m. Our
the experience mothers and families have expenditure per head of population is the lowest
of it. The score for women’s experience was in Essex. Previous national reviews confirmed
80.6 at year-end. We have worked with MEHT that we compare well against similar CCGs for
to ensure care is centred on women, their the way we use resources.
babies and family based around their needs
and decisions. We aim to give them genuine Even so, our Financial Recovery Plan means
choice about their maternity care, informed we must identify more ways to improve
by unbiased information. Alongside aiming to efficiency and reduce our spending as part
reduce smoking during pregnancy: of the challenge to stay within our limited
resources. Preparatory work has shown that a
• each woman is provided with a named number of the savings identified for Success
midwife and continuity of carer Regime CCGs have already been made in mid
Essex, so finding further savings will be a major
• all expecting mothers receive individualised challenge.
care planning
Appropriate procedures for procurement are
• we offer choice of location of delivery in place, including tendering for goods and
services and making sure suppliers’ quotes are
• young parents also receive a named midwife competitive.
• services are available from a perinatal During 2017/18 we will continue to work closely
mental health midwife. with Essex County Council and other partners
to identify further ways services can link
In diabetes care, 36.2% patients in mid Essex together and improve their efficiency.
have achieved all the NICE-recommended
treatment targets. To improve care, the CCG The Better Care Fund – Protection of Social
has developed a comprehensive diabetes Care expenditure shown on the chart in section
action plan which is now being monitored to 1.1.4 reflects money passed from the NHS
ensure delivery. This includes all GP practices to pay for adult social care, which the NHS
participating in the national audit, with a recognises as playing an important part in
reminder that it is a contractual requirement for reducing demand on healthcare services.
them from July 2017.
In 2016/17 we and Essex County Council ran a
Mental health has a number of important Mid Essex Better Care Fund totalling £22.7m,
measures, including the Crisis Care and Liaison of which £8.3m related to protection of social
Mental Health Services – Transformation score care. The remaining £14.4m related to health
of 62.5%. Substantial improvement plans are in services which are included in the relevant
place around mid Essex mental health services healthcare expenditure categories of spend in
for adults, and the principal provider trust the same chart.
has now merged with a neighbouring trust to
consolidate services as noted in section 1.1.1. Our overall financial management
arrangements were subject to review by our
Work continues in all these areas to make the external auditors, Ernst & Young LLP, as part of
required improvements in health and care. their annual review of our accounts.
30
Annual Report 2016/17 Mid Essex CCG
In 2013/14 and 2014/15 we incurred in-year
deficits totalling £24.9m. As a result, we
automatically received “qualified value for
money opinions” from the auditor for those
years. We achieved in-year break-even in
2015/16 and a £3m surplus in 2016/17 but
have again received a qualified value for money
opinion in 2016/17 because of the accumulated
deficit and the scale of the challenge we face in
repaying it.
QIPP and the Health and Social Care
Act (2012)
QIPP (Quality, Innovation, Productivity and attend A&E inappropriately, so that staff there
Prevention) is the umbrella term used to can better prioritise patients who do require
describe the approach the NHS is taking locally, emergency treatment.
regionally and nationally to reform and redesign
services in the light of financial challenge.
The Health and Social Care Act 2012 outlined Some QIPP schemes for 2017/18 have been
the Government’s commitment to ensuring that developed across the organisations in the
QIPP supports the NHS to make efficiency STP while others are specific to the CCG. This
savings, which can be reinvested back into the means that some will be implemented only in
service to continually improve the quality of mid Essex while others are developed across
care. mid and south Essex and monitored on a
system-wide basis.
In 2016/17 we were required to set a £3m
surplus budget and achieving this required Urgent Care activity at MEHT
cost savings of £18m. The CCG delivered
£11.9m of the planned £18m of savings with A&E attendances have been variable
the remaining £6.1m of the challenge being throughout the year but higher than previously
covered by slippage against some areas of seen in 2014/15 and 2015/16. Some of this
expected expenditure including not committing pressure was alleviated by the “GP in ED”
expenditure against the 1% transformation fund, scheme set up by the CCG in the previous
and a number of non-recurrent benefits. financial year to avoid some A&E care costs,
but MEHT has not met the target of 95% of A&E
The focus for transformational change in patients being seen, treated and admitted or
2016/17 has been the way that the health discharged in under four hours.
system looks after the frail elderly, including
those with long-term conditions. To help To help address these systemic pressures, the
manage the demand in the A&E department Emergency Care Improvement Programme (a
at MEHT we continue to operate the “GP in National Emergency Support Team) continues
ED” scheme so that patients who do not need to work across mid Essex and specifically with
an emergency specialist doctor can be seen MEHT to help improve the following areas:
quickly.
• A&E
We have been working with GP practices to
increase their capacity and resilience and • “patient flow” through the hospital – the
we continue to work on increasing patient process for transferring patients to the areas
awareness in order to reduce the number who of care they need
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Annual Report 2016/17 Mid Essex CCG
• discharge – to their home or another care The CCG is working with other organisations
setting. to support EEAST as it moves to a more
sustainable position enabling it to deliver
A system-wide recovery and improvement national targets. Key issues of focus are around
plan has been developed with all partners. It capacity, recruitment and ambulance service
is reviewed continuously and further changes transformation, as they were in 2015/16.
have been suggested to support A&E and
the delivery of the 95% standard. The main Serious Incidents and Never Events
elements of the plan are:
The CCG receives Serious Incident reports
• demand management – services to support from all commissioned services and closely
the demand at A&E such as the GP in ED monitors the investigation and learning from
scheme mentioned above these incidents. In 2016/17 there were 169
Serious Incidents (including pressure ulcers,
• admission avoidance – services to prevent the majority of which were identified as
unplanned admissions into the hospital avoidable or due to non-compliance with policy)
reported and investigated across the different
• NHS 111 – increasing awareness of NHS commissioned organisations. All Serious
111 and the services to which it can signpost Incidents are investigated using Root Cause
patients in preference to A&E Analysis and robust learning plans are put in
place with a view to improving patient safety.
• ambulance – reviewing services that support
ambulances to take patients elsewhere ‘Never Events’ are Serious Incidents that
rather than A&E. are preventable. National guidance or safety
recommendations are available to all healthcare
Re-direction of patients from A&E began this providers that should protect patients from such
year. Based on the presenting symptoms of incidents taking place. Each Never Event has
the patient, they may be re-directed to a more the potential to cause serious patient harm or
appropriate service such as their GP practice. death. However, serious harm or death is not
required to have happened as a result of a
This year has also seen a number of partners specific incident occurrence for that incident to
coming together to support discharge further, be categorised as a Never Event.
through an Integrated Discharge Team
programme. Partners have formed one team Never Events include incidents such as:
based at MEHT to support and expedite
discharges by working in an integrated way and • “wrong site” surgery (when an operation is
worked on a “Home to Assess” model. Both performed on the wrong part of the patient’s
will need further development during 2017/18 body)
through support from improvement measures
such as the SAFER Patient Flow Bundle, • retained instrument post operation (when a
which reduces delays for adult non-maternity piece of medical equipment is left inside a
inpatients. patient after an operation)
Emergency Ambulance Service • wrong route administration of chemotherapy
(when chemotherapy drugs are administered
The East of England Ambulance Service to a patient incorrectly).
NHS Trust (EEAST), which we commission
to provide emergency patient transport in mid In 2016/17, four Never Events were reported
Essex, is experiencing ongoing performance to Mid Essex CCG by MEHT, three of which
issues and is currently rated by the Care Quality related to services we commission. As with all
Commission as “Requires Improvement”. Serious Incidents, investigations take place into
32
Annual Report 2016/17 Mid Essex CCG
each Never Event and robust learning plans and determines for case assignment
are put in place with a view to improving patient (contractual)
safety and learning across the organisation and
system. • supports Antimicrobial Stewardship
programmes within providers and
Pressure Ulcers encourages sharing of policies and actions
on this topic
Reporting of all acquired grade 2, 3 and 4
pressure ulcers continues through the Serious • leads the North Essex IPC Committee, a
Incident reporting route, in line with contractual group that designs and delivers a Health
requirements. Care Associated Infection Reduction Annual
Plan that uses surveillance data to inform
All incidents require a Root Cause Analysis risk mitigation
(RCA) and an outcome from the providers’
harm free panels on whether the ulcer was • provides ongoing quarterly and annual
associated with a breach in policy. Only those analysis of Clostridium difficile and MRSA
ulcers associated with policy breach are raised bacteraemia root causes and identified risks
as Serious Incidents.
All incidents reported as a Serious Incident
are recorded against the originating provider
organisation and this information is held within
the Quality Team.
There has continued to be a reduction in the
number of grade 4 provider-acquired pressure
ulcers this year (with no avoidable grade 4
ulcers at all in MEHT, as noted in section 1.1.1).
More importantly, there has been an • ensures and demonstrates organisational
improvement in the quality of Investigations of accountability
Pressure Ulcers, in particular within care homes
where the CCG Adult Safeguarding manager
and Clinical Quality Nurse continue to support
the process.
Infection Prevention and Control (IPC) provides services using the national
framework for Infection Prevention and
The Mid Essex Infection Prevention and Control
team provides specialist support to all three • Control commissioning (Infection Prevention
north Essex CCGs. The team: Society with Royal College of Nursing)
• monitors, investigates and reports • has a specific role in monitoring and
Clostridium difficile and MRSA bacteraemia following up all Serious Incidents (see
performance against nationally set reduction above) related to HCAI, and can respond
targets with required amount of expert knowledge to
situations such as outbreaks and incidents
• leads the North Essex Health Care as they occur
Associated Infection (HCAI) Scrutiny panel,
which reviews all investigation findings • has performance monitoring responsibilities
33
Annual Report 2016/17 Mid Essex CCG
for all healthcare providers, to monitor Panel recommendations are then reported to
compliance with the code of practice for the North Essex Serious Incident and Never
infection prevention and control Event Panel (SINE) for further scrutiny and final
approval. To the end of January 2017, MEHT
• has leadership and developmental had successfully sought trajectory appeal
responsibilities for all healthcare providers’ decisions on 22 cases.
specialist teams and nominated infection
prevention and control leads, to ensure Zero tolerance to MRSA bloodstream infections
efficiency and effectiveness of strategies remains the national ambition. In some quarters
and actions this is interpreted as zero cases. The CCG
and North Essex Specialist view is that zero
• provides infection prevention and control tolerance means all possible efforts are made
support to those providers without across the system to prevent these infections.
specialists within their organisation
Where infections happen, Root Cause Analysis
• monitors commissioned provider premises (RCA) techniques are undertaken to identify
and their suitability for the range of clinical any possible learning, as well as assessing
activities planned, including advice on compliance with current policy. The national
planned build and refurbishment works Post Infection Review process is followed with
the addition of taking the opportunity to identify
• produces quarterly and annual reports of all possible learning, whether relevant to the
PC activity and outcomes for the three case under consideration or not.
CCGs of north Essex
MRSA cases at the end of March 2017
Clostridium difficile cases at the end of against a zero-tolerance ambition:
March 2017:
Cases: Cases:
Cases: 2016/17 Cases: 2015/16 2016/17
2015/16 ceiling 2016/17
Mid Essex 7 8
CCG
Mid Essex
CCG 57 71 85 MEHT 3 3
MEHT 20 13 34
The previously implemented trajectory appeals Freedom of Information (FoI) requests
process has been continued and remains in line
with national guidance. Therefore, all whole- We received 299 FoI requests during 2016/17,
economy investigations are reviewed by North the highest number of any Essex CCG. There
Essex HCAI Scrutiny Panel, which recommends was a 100% response rate within the statutory
cases are taken off the Acute Trust trajectory timeline.
(for purposes of contract sanctions) if one or
more of the following apply: Continuing Health Care (CHC) and
Funded Nursing Care (FNC)
• the case was deemed colonisation and not Continuing Health Care (CHC) is the name
infection given to the assessed package of care that is
arranged and funded exclusively by the NHS
• there is clear evidence of infection prior to for people who are not in hospital but have a
the admission to hospital complex, ongoing primary healthcare need.
Funded Nursing Care (FNC) is funding provided
• the infection occurred despite all policy and by the NHS to patients who are cared for in
best practice being followed. a placement setting as opposed to their own
34
Annual Report 2016/17 Mid Essex CCG
home. FNC is awarded to the individual who All current and new patients receiving CHC-
requires some care provision to be delivered by funded care are informed of the opportunity
a Registered Nurse. to request a personal health budget. NHS
organisations in Essex are working in
Since 2007, NHS-funded nursing care has partnership with Purple (formerly the Essex
been based on a single rate. In all cases, Coalition of Disabled People, an organisation
an individual’s eligibility for CHC should be run by and for disabled people) to help
considered before a decision is reached introduce the new approach.
about the need for NHS-funded nursing care.
Eligibility for NHS CHC and FNC is based on an Purple has a pioneering track record in
individual’s assessed needs and is not disease- supporting disabled people at local, regional
specific, nor determined by either the setting and national levels and has worked with a
where the care is provided or who provides it. number of local authorities to help people to
manage direct payments.
FNC is payable only when an individual is
being cared for in a care home that provides More information about personal health budgets
registered nursing care. can be found on the NHS Choices website.
The CCG is committed to ongoing improvement Safeguarding Vulnerable People
of the CHC service in a challenging
financial climate and ensuring that patients Safeguarding means protecting people’s health,
are individually assessed and reviewed. wellbeing and human rights, and enabling them
Implemented improvement plans have already to live free from harm, abuse and neglect.
allowed the CCG to continue building robust
processes and systems for the management of People who may need safeguarding include
CHC in 2016/17. children and those who are elderly and frail,
living on their own in the community, or without
Personal Health Budgets for CHC much family support in care homes. They are
often people with physical or learning disabilities
People currently eligible, or who are found to and people with mental health needs at risk of
be eligible, for CHC have the right to a Personal suffering harm in the community or in care.
Health Budget (PHB). PHBs became available
in October 2014 for everyone who meets CHC The CCG has accountability and governance
eligibility criteria. PHBs give patients the option arrangements that include regular reports to
of asking for direct payments to be made to the Board through the Quality and Governance
them, or someone who looks after them. Committee, and CCG representation at the
Essex Safeguarding Adults and Safeguarding
People requesting such payments then work Children Boards.
with local NHS professionals to create an
individual care plan. Each person with a PHB The CCG’s governing Board has delegated
can choose how to use their allocated budget operational responsibility to the Designated
for a tailored package of care to meet their Nurse Safeguarding Adults and the Designated
needs. Nurse Safeguarding Children. Both are
members of the Quality Team and Quality
People can use PHBs to pay for a range of help Committee, with a level of responsibility aimed
appropriate for them and their condition, such at making sure safeguarding strategy, policy
as therapies, personal care and some types of and procedures are in place, implemented and
equipment from private and voluntary sector understood throughout the organisation.
providers. PHBs can also carry on funding
NHS care and support if patients do not want to The CCG’s Designated Nurses are members of
make changes. various CCG sub groups reporting to the Board.
35
Annual Report 2016/17 Mid Essex CCG
They also manage a programme of quality included within training as necessary. However,
assurance that takes place with all providers in quarter 4 the Essex Safeguarding Board
in relation to key performance indicators and commissioned a Partnership Learning Review
participation in self-assessment audits to meet and the CCG will participate as required.
the requirements of the Safeguarding Boards.
In addition to these key roles, the CCG’s The CCG continues with its responsibility to
Clinical Vice Chair is our Named GP for support the Child Death Overview Process
Safeguarding Adults and Children. in securing the expertise of a Designated
Paediatrician for Unexpected Deaths in
Ongoing quality assurance work with mid Essex Childhood. The Child Death Overview Panel
healthcare providers includes performance is chaired by a public health consultant who
monitoring in relation to key performance is not involved in directly providing services to
indicators (KPIs), serious case review action children and families in the area.
plans, participation in multi-agency audits and
completion of self-assessments as required During 2016/17, there were 13 child deaths in
under the relevant legislation. mid Essex, of which six were unexpected.
Safeguarding Adults at Risk Looked After Children (LAC)
The Care Act 2014 gives a clear legal The term “Looked After Children” applies to all
framework for how local authorities, CCGs under-18s for whom the local authority provides
and other parts of the health and care system accommodation, either through a court order
should safeguard adults at risk of abuse or or with the child’s parental consent or, if aged
neglect. During the year, the CCG worked 16 or 17 years old, their own consent. A child
with providers and partners to develop policy may become Looked After (also called “in care”)
and practice that met the requirements of the for a variety of reasons, but most frequently as
Care Act, ensuring that safeguarding adults is a result of temporary or permanent problems
everyone’s business. facing their parents, or as a result of abuse or
neglect.
The Care Act gives the Safeguarding
Adults Board (SAB) a clear basis in law and An Essex-wide LAC strategy is in place and
also stipulates that SAB must arrange a work continues in line with local need and
Safeguarding Adults Review (SAR) after an national guidance. The ‘voice of the child’
adult has died as a result of abuse or neglect, is sought on a regular basis to check young
or is still alive and has experienced abuse or people’s views and opinions are reflected in
neglect. There were no SARs initiated in this services provided for them.
financial year.
As of 31 March 2017, Mid Essex CCG was
The Safeguarding Adults agenda continues to responsible for approximately 550 looked after
expand, particularly in relation to changes in children and care leavers.
law. The rate of change remains challenging for
both commissioners and providers, but helps to Child Protection Plan (CPP)
embed processes so that adults at risk can stay
safe. A CPP is made when a child is judged to be at
risk of significant harm – that is, a level of harm
Safeguarding Children that affects the health, welfare and development
of a child. The plan will say what the specific
There have been no Serious Case Reviews risks are to the child and the actions needed to
(SCRs) requiring health input from Mid Essex keep the child safe.
CCG in 2016/17. The learning from other local
and national SCRs has been disseminated and The CPP is made following a meeting called
36
Annual Report 2016/17 Mid Essex CCG
a child protection conference to which all of an improvement on 2015/16 thanks to
the people who are involved with the child substantial work undertaken since then in the
including the parents are invited. It is the task following areas:
of the conference to decide whether there are
significant risks to a child, what those risks are, • business continuity planning
and what is needed to be done to reduce or
remove those risks. • training and exercising
In mid Essex as of 31 March 2017, there are • pandemic flu preparedness.
196 children who are the subject of a child
protection plan. All CCGs in Essex share a generic Incident
Response and Incident Coordination Centre
Following assessment, if a child is deemed not Plan, which details establishing an Incident
to be at risk of significant harm, but it is thought Coordination Centre and an Incident Response
that the child or family may need extra help or Team within the local CCG. These plans have
support to ensure that the child has the chance been updated during 2016 to include the
to achieve or maintain a reasonable standard of increasing expectations placed upon CCGs by
health or development, the child is deemed to NHS England in the event of an incident.
be a Child in Need (CIN)
Business Continuity Management (BCM) is
In mid Essex there are currently 456 children a statutory requirement for all Essex CCGs.
who have a CIN plan (as of 31 March 2017). Suitable plans aligned to the international
Business Continuity Standard ISO22301 have
Planning for Emergencies been established to enable us to respond to an
internal incident or disruption.
Within the Civil Contingencies Act, CCGs
have a duty to be prepared for incidents and The BCM process is supported by a CCG
emergencies. CCGs are classed as a “category Business Continuity Management System
two” responder and are seen as a “co-operating and Policy and the CCG’s individual Business
body”. This means we are less likely to be Continuity Plan (BCP).
involved at the heart of the planning, but we will
be heavily involved in incidents that affect the Our BCP outlines response and recovery
health sector through co-operation in response arrangements and how we would mitigate
and sharing of information. the impact of a business disruption on the
operations and reputation of the CCG. We are
The Essex CCGs have an Emergency reviewing the Policy and Plan as part of our
Preparedness, Resilience and Response annual BCM review process.
(EPRR) and Business Continuity Strategy to
ensure that we can respond in accordance The CCG Emergency Planning team has
with the Civil Contingencies Act 2004, Health strengthened partnership working with NHS
and Social Care Act 2012 and NHS England England Midlands and East (East) and with
national policy and guidance, including the New local providers and has also ensured the CCG
NHS England EPRR Framework 2015 and NHS is a key partner in the Essex Resilience Forum.
England EPRR core standards.
1.2.6 Sustainable development
In July 2016, our Emergency Planning team
undertook a self-assessment against the Environmental sustainability is recognised
NHS England EPRR Core Standards. There nationally as an essential part of delivering
were four levels of compliance that could be high-quality healthcare efficiently, so it needs
achieved: full, substantial, partial and non- to be part of the everyday work of the CCG, its
compliant. The CCG achieved “full” compliance, partner organisations and the wider NHS.
37
Annual Report 2016/17 Mid Essex CCG
Sustainability is not just about the CCG using provide a healthier and more comfortable
its limited financial resources carefully. It is environment for staff
also about ensuring the CCG makes the most
of existing social and community resources • made further progress in changing working
(such as community buildings and local practices to reduce our paper and fuel
groups) and minimising the impact on the local consumption and continued to promote
environment by considering sustainability during sustainable travel
commissioning and procurement processes.
• explored schemes to reduce employee
The CCG is committed to improving the travel through video and teleconferencing
sustainability of services. In 2016/17, we have:
• reviewed the CCG’s confidential waste
• continued to improve our business continuity disposal arrangements
preparedness both internally and with health
and social care partners across Essex to • decreased the frequency of meetings of
ensure services are sustainable and resilient our Board and committees and explored
in the event of adverse weather conditions, ways of reducing the amount of paperwork
power failure or other major interruptions generated by these meetings.
• commissioned work to the building Figures from NHS Property Services for the
maintenance system at the CCG’s premises environmental footprint of Mid Essex CCG’s
to ensure it is working efficiently and to offices are shown in the tables below.
CCG total Units 2016/17
£ 25,401
Financial data (spend):
Total energy cost (all energy supplies)
Electricity cost £ 23,730
Gas cost £ 144
Resource use: Water cost £ 1,527
Electricity Consumed Units 2016/17
kWh 195,388
Gas Consumed kWh 5,379
Water/Sewerage Consumed m3 937
2016/17 building breakdown – costs
Building name Tenant Total tenant Electricity cost Gas cost Water cost
occupancy % area (m2) 2016/17 2016/17 2016/17
Collingwood Road 1.78% 63.32 766.93 143.53 83.42
Wren House 69.03% 904.92 22963.56 0.00 1444.06
Grand Total N/A 968.24 23730.49 143.53 1527.47
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Annual Report 2016/17 Mid Essex CCG
2016/17 building breakdown – consumption
Building name Tenant Total tenant Electricity Gas Water
Collingwood Road consumption
occupancy % area (m2) 2016/17 consumption consumption
7368.22 2016/17 2016/17
1.78% 63.32 5378.74 28.09
Wren House 69.03% 904.92 188019.37 0.00 928.43
Grand Total N/A 968.24 195387.59 5378.74 956.52
The above figures are based on actual receive high quality services both now and into
consumption of Electricity, Gas and Water at the future.
Wren House and Collingwood Road as at the
following dates: The CCG is part of the Mid and South Essex
Sustainability and Transformation Plan (STP)
• 31 January 2017 for electricity system, and we continue to work with other
stakeholders within the local health and social
• 1 December 2016 for gas care STP footprint to ensure that our services
remain sustainable in the medium to long term
• 31 October 2016 for water. while still providing high quality healthcare
services to our population.
Based on actual consumption, an estimate for
the remainder of the year was calculated to One of the key benefits of system working
give the total consumption figures. The CCG within the STP footprint will be to ensure that
occupancy percentage of each building was demand is managed consistently across the
then applied to the total consumption to arrive local system and that the commissioning of
at a total for the CCG. healthcare services is undertaken at scale,
ensuring that our resources are focused on
Planning for new premises healthcare delivery.
The CCG has a commitment to the The acute hospital reconfiguration proposals
sustainability agenda in the healthcare forming part of the STP will also include a
developments planned for Maldon, Witham consideration of their environmental impact.
and Heybridge and will be reflecting this in
the required adherence to Building Research In addition to its responsibilities as a
Establishment Environmental Assessment commissioner, the CCG also has duties as a
Method (BREEAM) excellent design and build corporate body and works closely with its staff
quality standards. and GP member practices to use resources
wisely and minimise waste in its day-to-day
Sustainability is built into procurement work.
processes as standard to ensure that the
providers that the CCG contracts with are Sustainability information will be included within
environmentally responsible. the annual reports of NHS organisations that we
commission services from.
This is especially important where the CCG
is commissioning a service which has an During 2017/18 our focus will be to:
increased logistics requirement.
• continue to work with our partner
The CCG is committed to working with all its organisations within the Mid and South
partners to commission sustainable healthcare Essex STP footprint to ensure sustainability
and help ensure that the people of Mid Essex of services
39
Annual Report 2016/17 Mid Essex CCG
• ensuring that our emergency planning the opportunities afforded by implementing
arrangements continue to develop greater new technology.
resilience to the increased risk of
climate-related impacts such as flooding This concludes the 2016/17 Mid Essex CCG
Performance Report.
• undertake a review of staff travel
arrangements with a view to encouraging Caroline Rassell
emissions reductions Accountable Officer
• further reduce our carbon footprint by 30 May 2017
continually reviewing the way we work and
40
Annual Report 2016/17 Mid Essex CCG
2. Accountability Report
The second part of Mid Essex Clinical (section 2.3) sets out the CCG’s policy for
Commissioning Group’s Annual Report and paying directors and senior managers, and
Accounts 2016/17, the Accountability Report, explains the payments made under that
has several elements. policy during 2016/17.
• The Corporate Governance Report CCG Board members’ details, staffing
(section 2.1 below) explains how the CCG is numbers, policies relating to staff and
managed and run (its governance structure) equality and diversity are also included in
and how that helps meet CCG objectives. this element of the Accountability Report.
• The Statement of Accountable Officer’s Ernst & Young LLP are the CCG’s external
Responsibilities (section 2.1.8) sets out auditors, appointed by the Audit Commission.
who is answerable for the CCG’s finances The total planned fee for the 2016/17 audit was
£74,160 including VAT.
and functions, with outlines of their duties.
• The Governance Statement (section 2.2) Caroline Rassell
explains how the CCG’s internal controls Accountable Officer
work.
• The Remuneration and Staff Report 30 May 2017
41
Annual Report 2016/17 Mid Essex CCG
2.1 Corporate Governance Report
2.1.1 Members Report – member practices
CCGs are clinically-led membership organisations made up of general practices. The following
NHS practices are in mid Essex.
Practice Area served Little Waltham and Great Little Waltham
Notley Surgeries Maldon
Baddow Village Surgery Great Baddow
Longfield Medical Centre
Danbury and
The Beacon Health Group Chelmsford Melbourne House Surgery Chelmsford
Beauchamp House Surgery Chelmsford Moulsham Lodge Surgery Chelmsford
Blackwater Medical Centre Maldon Mount Chambers Surgery Braintree
South Woodham
Blandford Medical Centre Braintree The New Surgery Ferrers
Chelmsford
Blyth’s Meadow Surgery Braintree North Chelmsford NHS Earls Colne
Brickfields Surgery Healthcare Centre Chelmsford
Brimpton House Surgery South Woodham Witham
Burnham Surgery Ferrers The Pump House Surgery
Chelmer Village Surgery Braintree
Kelvedon Rivermead Gate Medical
Centre Boreham and
Burnham on Hatfield Peverel
Crouch Silver End Surgery Stock
Chelmsford St Lawrence Medical
Practice (renamed Church
Coggeshall Surgery Coggeshall Lane Surgery on 20 March
2017)
Collingwood Surgery Witham Sidney House and The
Laurels Surgeries
Dengie Medical Partnership Tillingham and
Maylandsea Stock Surgery
Dickens Place Surgery Chelmsford
Douglas Grove Surgery Witham Sutherland Lodge Surgery Chelmsford
Halstead
The Elizabeth Courtauld Witham Tennyson House Surgery Chelmsford
Surgery The Castle Surgery
Tollesbury Surgery Castle
Fern House Surgery Hedingham
The Freshford Practice Finchingfield Tollesbury
South Woodham
Greenwood Surgery Ferrers Trinity Medical Practice Mayland
Sible
Hilton House Surgery Hedingham Whitley House Surgery Chelmsford
Chelmsford Southminster
Humber Road Surgery William Fisher Medical Witham
Kelvedon and Feering Kelvedon Centre
Health Centre
Kingsway Surgery South Woodham Witham Health Centre
Ferrers
Writtle Surgery Writtle
Wyncroft Surgery Bicknacre
42
Annual Report 2016/17 Mid Essex CCG
2.1.2. Composition of Governing 2.1.3 Board Members and Other
Body Elected GPs
The CCG’s Board is the accountable body for Carol Anderson
the performance of the CCG.
Acting Managing Director
It has four GP members elected by their fellow
GPs to lead the organisation alongside the Carol is a Registered Nurse and her substantive
Executive membership. One of these elected post is Director of Nursing and Quality. Carol
GPs chairs the Board. was appointed as Managing Director in August
2016 having previously held the position of
The Board also has three lay members. Their Acting Accountable Officer from 25 March 2016.
roles include ensuring views and suggestions
from patients and the public are properly Carol has over 20 years’ clinical experience
considered by the CCG, providing independent as a nurse within the NHS and private sector.
judgment and sound commercial knowledge, Having worked predominantly in cardiology,
and helping to ensure the CCG is well run and Carol participated in the development of the
uses public funds properly. National Cardioloy Framework.
As at 31 March 2017, the Board consisted of
17 members. Of these, 10 are female and 7 are
male.
The secondary care Board position is currently
vacant.
Membership of the Board, together with
information on which of the main CCG
committees each Board member attends, is set
out below and in the Governance Statement in
section 223.
Until December 2016, full Board meetings were
held in public every two months. Since then
Board meetings are held on a quarterly basis.
Board papers are published on the CCG
website in advance of each meeting.
At all formal meetings of the Board and its • Clinical Board member
Committees, members must declare if they • Caldicott Guardian for Mid Essex CCG
have an interest in any agenda items under • Member of Finance and Performance,
discussion.
Live Well, Primary Care Commissioning
The CCG maintains a register of interests Committees and Primary Care Forum
declared by Board members, a copy of which is • Chair of Savings Programme Board
provided at all Board meetings. • Cancer Lead for the Mid and South Essex
Sustainability and Transformation Plan
The full register of Board members’ interests is
available on the CCG’s website.
43
Annual Report 2016/17 Mid Essex CCG
Dr Michael Bailey
Elected GP
A GP partner for 35 years, Mike Bailey retired
from the Writtle Surgery in 2015. In 2003 he
received the Queen’s Jubilee Medal for services
to Immediate Care.
Throughout his career Mike has been an active
member of a number of forums and groups
operating within the mid Essex area. He also
served as Senior Medical Officer at the V
Festival held at Hylands Park, Chelmsford, for
more than 15 years.
• Clinical Board member
• Clinical Lead (Immediate Care)
• Vice Chair of Finance and Performance
Committee
• Member of Audit and Live Well Committees
• Exceptional Cases Panel member
• Primary Care Forum member
Keith Andrew
Lay Board Member (Governance)
Keith spent over 30 years in banking and was
the Regional Manager for the Co-operative
Bank in the Anglian region.
He now runs his own business providing
management and business advice to clients
across the region.
• Deputy Chair of CCG and Lay Board
member
• Audit Committee Chair and Conflicts of
Interest Guardian
• Remuneration and Terms of Service
Committee Chair
• Non-Executive Lead for Emergency
Planning, Resilience and Response
44
Annual Report 2016/17 Mid Essex CCG
Vivienne Barnes
Director of Corporate Services
Viv joined the CCG in August 2014 as Director
of Corporate Services, following a secondment
from NHS England where she was Assistant
Director of Clinical Strategy for the Essex Area
Team. She has a background in Corporate
Governance and has worked at Board level
within a number of Primary Care Trusts in south
Essex and a London health authority.
Viv began her career in the NHS supporting the
development of primary care in the Southend
area.
• Board member
• Senior Information Risk Owner
• Nominated Security Management Director
• Accountable Emergency Officer
• Member of Live Well, Primary Care
Commissioning and Quality and Governance
Committees
• Chair of Equality and Diversity Sub-
committee
Dr James Booth
Elected GP and Vice Chair (Clinical)
James is a GP and partner at Melbourne House
Surgery in Chelmsford.
He qualified from University College London in
2002 and qualified as a Member of the Royal
College General Practitioners in 2006. James
has lived in Chelmsford all his life and has also
worked at Broomfield and St John’s Hospitals.
• Vice Clinical Chair and Clinical Board
member
• Clinical Lead for Safeguarding
• Clinical Lead for Children and Adolescent
Mental Health Services
• Special Educational Needs or Disability
(SEND) Champion
• Quality and Governance Committee Chair
• Live Well Committee member
• Member of Medicines Management Sub-
Committee and Primary Care Forum
45
Annual Report 2016/17 Mid Essex CCG
Melanie Crass
Director of Primary Care and Immediate Care
Melanie was appointed as Director of Primary Well, Primary Care Commissioning and
Care and Immediate Care in February 2016. Quality and Governance Committees
Melanie has a 25-year history of operating in • Member of Primary Care Forum
large, complex health organisations in both
England and for a short time Canada earlier in
her career. Melanie has extensive experience
of commissioning and contracting in addition
to the full spectrum of healthcare provision
including primary, community, secondary and
mental health services.
• Board member
• Member of Finance and Performance, Live
Dee Davey
Chief Finance Officer
Dee is responsible for financial systems,
strategy and reporting, and for business
information and intelligence. Dee worked in
Local Government for 20 years before joining
the NHS.
• Board member
• Member of Finance and Performance and
Live Well Committees
Dan Doherty
Director of Clinical Commissioning, and
since 25 March 2016 seconded to Mid and
South Essex Success Regime (Locality
Health nd Care)
Dan is a practising physiotherapist who
previously worked at St. Peter’s Hospital.
For the past year Dan has been on secondment
with the Mid and South Essex Success Regime,
working on system transformation with a
particular focus on innovation in health and
care.
• Clinical Board member
46
Annual Report 2016/17 Mid Essex CCG
Dr Caroline Dollery
Chair
Caroline has been a GP at Danbury Medical
Centre (now Beacon Health Group) for 18
years. Her clinical interests include mental
health, learning disability, cardiology and
paediatrics. Caroline was previously the GP
Board Member for Governance.
• Chair of CCG Board and Clinical Board
member
• Chair of Live Well Committee
• Chair of Primary Care Forum
• Member of Primary Care Commissioning
and Remuneration and Terms of Service
Committees
Anne-Marie Garrigan
Lay Board Member (Patient and Public
Engagement Lead)
Anne-Marie started her working life with
National Westminster Bank in 1980, moving
into early years and childcare in the 1990s, and
then working for Essex County Council from
2000 until 2011 where she had a number of
leadership roles within the Schools, Children
and Families Directorate, with her last role as
an Extended Services Commissioner.
• Lay Board member
• Chair of Primary Care Commissioning
Committee
• Chair of the Patient Reference Group
• Deputy Chair of Quality and Governance
Committee
• Equality and Diversity Sub-committee
member
47
Annual Report 2016/17 Mid Essex CCG
Rachel Hearn
Acting Director of Nursing and Quality
(since 25 March 2016)
Rachel is a Registered Nurse and the acting
Director of Nursing and Quality. Rachel has
over 16 years’ clinical experience as a nurse
within the NHS. Having worked predominantly
in emergency and general medicine, Rachel
has led work streams on the changing face of
emergency care.
• Clinical Board member
• Member of Quality and Governance,
Live Well, Finance and Performance and
Maternity Liaison Committees
• NICE Guidance Restrictions Group member
Alan Hubbard
Lay Board Member (Commercial)
Alan is a former Senior Executive with the
Lloyds Banking Group. He has over 30 years’
management experience across a range of
functions in the UK and abroad.
Alan has served for over 10 years as a public
sector non-executive director with the local NHS
in various roles, including Vice-Chair. He was
previously Chair of Essex Probation Trust and
has worked as a part-time consultant supporting
Essex businesses. He is also an Independent
Member of the Joint Audit Committee for
the Essex Police Commissioner and Chief
Constable.
• Lay Board Member
• Audit Committee Member
• Chair of Finance and Performance
Committee
• Chair of Exceptional Cases Panel
• Remuneration and Terms of Service
Committee Member
• Freedom to Speak Up Guardian
48
Annual Report 2016/17 Mid Essex CCG
Dr Donald McGeachy
Medical Director (and since 25 March 2016
seconded to Mid and South Essex Success
Regime as Interim Medical Director for Out-
of-Hospital Care)
Donald has been a GP for more than 30 years,
working in Derbyshire, Cumbria, Tonga, New
Zealand and Essex. For the past 10 years he
has taken an increasing interest in healthcare
management and was part of the Board of Mid
Essex Primary Care Trust (PCT) then North
Essex PCT Cluster.
Donald was elected as a GP Board member reconfiguration culminating in an options
in April 2012 before being appointed as CCG appraisal prior to public consultation.
Medical Director on 1 June 2014.
• Clinical Board member
For the past year Donald has been seconded • Primary Care Forum member
to work in the Mid and South Essex Success • Clinical Lead North Essex 111
Regime. Much of this has been liaising
with the Acute hospital group and providing
commissioning input to plans for hospital
Maggie Pacini
Consultant in Public Health at Essex County
Council
Maggie became mid Essex’s designated
Consultant in Public Health in September
2015. Maggie splits her time between County
Hall and local CCGs. She focuses on the
planning of services based upon the health
needs assessment, evidence-based practice
and prioritisation. She also acts as a link back
to the rest of the Public Health team at the
county council, the other CCG Public Health
consultants and the health improvement and
health protection teams.
• Co-opted Board member (non-voting)
• Live Well Committee member
• Exceptional Cases Panel member
• Equality and Diversity sub-committee
member
49
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