NHS South Tees Clinical Commissioning Group. Governing Body. Agenda Item:

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1 NHS South Tees Clinical Commissioning Group Governing Body Agenda Item: Wednesday, 18 th September 2013 Title Quarter 1 Assurance Report Responsible Officer Amanda Hume Author of the Report Craig Blair Head of Commissioning and Delivery Recommendation(s) For the governing body to note the outcome of the CCG quarter 1 assurance process Summary The attached paper provides a brief overview of the CCG assurance process implemented by NHS England and the outcome of the CCG quarter 1 assessment. The paper details the position against the 5 domains of the assurance framework and provides further context to the Amber Red rating afforded to domain 3 Are health outcomes improving for local people? Financial Implications Legal/Regulatory Implications Assurance Framework/Risk Register Implications Details of relationship to the NHS Constitution Details of Patient and Public Involvement and/or Implications Has an Equality Analysis been d? Attachments The final balanced score card for the CCG is also attached in appendix 1. There are no financial implications at this time. None The attached paper directly relates to the CCGs ability to deliver the requirements of the assurance framework. Domain 2 of the assurance framework directly relates to the delivery of patient rights in terms of upholding the NHS Constitution. The balanced score card will be published following ratification of the process and associated documentation by NHS England N/A Quarter 1 CCG Assurance Framework.doc

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3 Quarter 1 CCG Assurance Framework Introduction NHS England has three key roles in working with CCGs: a development role to work with and support CCGs to become the best they can be; an assurance role to ensure as a statutory organisation, CCGs deliver the best possible services and outcomes for patients within their financial allocation; and a co-commissioning role to ensure the direct commissioning undertaken by NHS England works across the care pathway for patients and supports the delivery of local outcomes. The CCG assurance process is a key part of this and identifies how well CCGs are performing against their plans to improve services and deliver better outcomes for patients. The NHS England CCG assurance framework is designed to give assurance that CCGs are delivering quality outcomes for patients, as well as being the basis for assessing that they are continuously improving from the start point of authorisation. CCGs are expected to publish their progress against their locally agreed plans and ultimately their performance in delivering the key national standards and outcomes to their local population. The performance aspect of assurance is based on this published information. The assurance framework that has been implemented by NHS England is built on the following set of clear principles: quality for patients is at the heart of the process the approach will promote the accountability of CCGs to their local populations CCGs are supported to develop ambitious plans for improvement the process will identify CCG support needs the process will be applied consistently the approach will focus heavily on the role of CCGs in securing engagement the approach should utilise existing information flows that allow CCGs to manage their own business and to demonstrate accountability to their local populations the process will continually evolve in collaboration with NHS England, CCGs, Health and Well Being Boards, patients and the public the output of CCG assurance should be proportionate and transparent. Assurance Process NHS England has worked to minimise the data reporting requirements on CCGs and to this end a template has been developed to inform the quarterly assurance meeting. To ensure that each CCG is treated equally, the scorecard is populated with published data, which is consistent across CCGs, with a pre-published cut-off date. Where performance concerns are identified via the balanced scorecard, the national support framework provides a guide to ensure consistency in approach and to ensure that the correct level of support is agreed to deliver the necessary improvements at a CCG level. The outcome of any support conversation should also be published alongside the scorecard. Each balanced scorecard domain represents a separate element of assurance which gives a framework for the monitoring of the quality of services on an in year basis. Each domain is reviewed in detail as part of the quarterly checkpoint assurance meeting between the CCG and the Area Team.

4 Process for identifying support needs In certain circumstances, the assurance framework will identify concerns where CCGs are experiencing difficulty in delivering or maintaining delivery of agreed plans. In these exceptional circumstances, NHS England (via the Area Team) will consider the use of a more formal process to support organisations to improve or to take direct action. Where challenges are identified NHS England will as a minimum seek information, explanations or documents from the CCG to gain assurance about its approach to problem resolution and to discuss the support that NHS England (via the Area Team) can provide. Where concerns are more serious, NHS England has the ability to exercise formal powers of intervention where it believes that a CCG is failing or is at risk of failing to discharge its functions. Quarter 1 balanced score card (BSC) and checkpoint assurance meeting On the 14 th August the CCG Exec Team met with colleagues from the NHS Durham, Darlington and Tees Area Team to review CCG progress to-date against key plans and national requirements. This was in line with the process outlined above and discussion was informed via the completion and analysis of the BSC and the five domains identified within. The Outcome of this process was that the CCG received a Green, or Amber Green rating for all domains with the exception of Domain 3 are health outcomes improving for local people which received an Amber Red rating. The causal factor of the Amber Red rating for domain 3 focused on a breach of the C- difficile target. As part of the 2013/14 annual planning round, the CCG submitted a trajectory outlining that within quarter 1 of 2013/14 there would be no more than 14 instances of C-difficile, both acute and community acquired. As at the end of the quarter the CCG reported 14 cases, this was in line with the locally agreed trajectory however NHS England assessed the CCGs performance against 3/12ths of the annual target resulting in a revised quarter 1 target of 13.5 instances. Both the CCG and the NHS England Area Team have appealed this decision in light of the requirement to set a local trajectory, NHS England have subsequently agreed to apply the trajectory on an on-going basis but will not reissue the quarter 1 BSC and therefore the Amber Red received for domain 3 stands. Next steps In line with the assurance process the CCG has provided a detailed action plan to NHS England (via the Area Team) outlining the key actions being taken in response to the Amber-Red rating allocated to domain 3, this has been accepted by the Area Team and no further support or intervention required has been recommended to NHS England. Following ratification of this outcome at a national level the CCG will be required to publish the BSC and any supporting information in response to domains rated Amber- Red or Red. Craig Blair Head of Commissioning and Delivery South Tees Clinical Commissioning Group 9 th September 2013

5 Appendix 1 Region North CCG: Last Refresh Date 05 September /06/ :06 Print Out Reporting Escalation Framework Support CCG Assurance Framework Balance Scorecard Summary Domain Buttons Domain Titles Domain RAG Status Domain RAG Summary Status Domain 1 Domain 1 Domain 2 Domain 3 Domain 3 Domain 4 Domain 4 Domain 5 Domain 5 Are local people getting good quality care? Are patient rights under the NHS Constitution being promoted? Are health outcomes improving for local people? Are CCGs delivering services within their financial plans? Are conditions of CCG authorisation being addressed and removed (where relevant)? AMBER-GREEN The number of indicators triggering a AMBER-GREEN 6 GREEN All indicators met 0 No self-certification data AMBER-RED The number of indicators triggering a AMBER-RED 1 GREEN All indicators met 0 No RAG Total number of outstanding conditions 0 Fully Authorised