To receive a report on the progress of the Herefordshire Clinical Commissioning Group.

The Committee received a report from the Herefordshire Clinical Commissioning Group (HCCG) from Mr Jon Wicks, Interim Chief Officer and Mr David Farnsworth, Executive Nurse Quality Safety.  During his report, Mr Wicks highlighted the following areas:

·         The CCG had been authorised, and the process had identified that it would benefit from support in developing its Integrated plan, oversight and management of Quality, Innovation, Productivity and Prevention (QIPP) and strategic planning and development. A programme of support has been agreed with NHS England, and it was expected that this would continue over a period of approximately 6 months.

·         That the Herefordshire Clinical Commissioning had held its first public Board meeting.  There were four GP’s elected onto the Board to form the Governing Body, with two lay members.

·         That a review of the costs of urgent care systems was underway.

·         That the introduction of a Map of Medicine for GPs would set out the steps for treatment for the most common clinical conditions.  This would be available to all GPs and would improve their ability to make appropriate referrals.

·         That savings required in the QIPP programme would be required by the commissioners, and half of these had already been identified.  The CCG was confident that the target could be delivered.  In reply to a question from a Member, he went on to say that these savings would be achieved through transitional changes in the system.  National changes in pricing methodology for patients had also worked in the HCCG’s favour.  There had been changes in how the costs of maternity care were calculated, and it had been possible to make savings with the Wye Valley Trust as a result.

In reply to a question, Mr Wicks said that the CCG was financially stable with a balanced financial plan that included built in contingencies.

In reply to a question, Mr Farnsworth said that there had been a soft launch of the 111 service in the County on 19^th March, for which there had been a great deal of preparation.  There had been significant performance issues at this stage, and the service had been returned to Primecare after 10 days. The service had been stabilised and issues had been addressed by the provider.  It was agreed that regular performance data from the 111 service should be provided to the Scrutiny Officer.

Mr Farnsworth went on to report that information sharing between all health agencies had led to heightened concerns over quality performance at the Wye Valley NHS Trust (WVT), and in response some high level assurances were being sought. The report before the Committee was intended to provide detail of concerns to Members, whilst keeping them informed of assurances being sought and how this work was being monitored.

In February 2013, the Francis report (part 2) had been published, and triggered a detailed scrutiny of mortality at all NHS Trusts. Initially 5 Trusts had been identified as significant outliers, with a further 9 trusts then being added to a national programme of scrutiny by Sir Bruce Keogh. During the previous year, WVT had previously seen a worsening mortality index, but as with other areas of care, this had been improving. The Trust was not included in the national programme. Concerns had been raised as the Hospital Standardised Mortality rate for the Trust had increased in February to over 134, which would have placed them under the aegis of programme of scrutiny chaired by Sir Bruce Keogh

The Trust had worked with the national mortality leads to review these figure, which had been reduced to 117 in March. It was anticipated that on-going work by both the Trust and the CCG would be sufficient to address this area of concern. Continued updates on the work in place to improve quality have been received by the CCG, and these were monitored internally through the designated CCG board committee (Quality & Patient Safety).  The overall programme of assurance would be led by NHS England and would report to a Risk Summit, where the actions would be monitored through the governance structures of each agency, and collectively through the Quality Surveillance Group. The CCG would provide continued updates to the Health Overview & Scrutiny Committee as required. The CCG had been satisfied that wider assurances were available to counter concerns that there was immediate risk to patient safety.

In reply to a question from a Member, he said that these figures were standardised to take into consideration factors such as elderly patient groups and periods of bad weather.  Where specific spikes appeared in the data, issues could be quickly identified and addressed.

The Chairman welcomed the report from the CCCG, and said that it demonstrated the speed with which an issue was recognised and then actioned upon.  The issues in the report had been discussed with the Chief Executive of the Wye Valley NHS Trust and consideration was being given as to how such issues could be dealt with in the future.  The Trust had undertaken to provide a report on the matter to the next meeting of the Committee.

RESOLVED: That the report be noted.