The Director of Quality NHS Bradford City Clinical Commissioning Group (CCG) and Bradford Districts CCG and the Deputy Chief Officer and Chief Finance Officer, NHS Bradford City and Bradford Districts CCG will present a report (Document “G”) that presents performance against the NHS England Clinical Commissioning Group Improvement and Assessment Framework for 2016/17 for Bradford City (BCCCG), Bradford Districts (BDCCG) and Airedale, Wharfedale and Craven (AWCCCG) Clinical Commissioning Groups.

Members are invited to comment on the report.

(Michelle Turner/Julie Lawreniuk – 01274 237796/237642)

The Director of Quality, NHS Bradford City Clinical Commissioning Group (CCG) and Bradford Districts CCG presented a report (Document “G”) which provided an update on the CCGs’ performance for 2016/17.  Members were informed that the role of the three CCGs was to buy care services and improve outcomes for patients, whereas NHS England was responsible for purchasing specialist care.  The CCGs were held to account and it had been a difficult year in relation to budgets.

The Deputy Chief Officer and Chief Finance Officer, NHS Bradford City and Bradford Districts CCG reported that NHS England had to monitor performance and had introduced a new framework for 2016/17.  Overall the three CCGs received a ‘Good’ rating and this was an improvement for Airedale, Wharfedale and Craven CCG, which had ‘Required Improvement’ in 2015/16.  There were a number of constitutional targets that had to be met, e.g. that patients had to be seen within 18 weeks of referral and the workforce along with funding was a key challenge.  Issues in relation to Accident and Emergency performance were being progressed and the Quality, Innovation, Productivity and Prevention (QIPP) programme would ensure that the money spent brought maximum benefit and quality of care to the public.

The Director of Quality explained that work had been undertaken to improve performance in relation to cancer in Bradford City CCGs, however, not all patients attended appointments and screening was a constant battle.  Further engagement with Bradford City CCG patients was required to ensure that they attended.  Some good work was ongoing with Accident and Emergency Departments and Mental Health provision was a good news story. 

The Clinical Chair of the NHS Bradford Districts CCG stated that the report had been driven by what the CCGs were accountable for and various clinical outcomes would need to be improved in order to increase people’s lifespans.  In relation to cancer, people needed to attend screening appointments and more information on awareness should be provided.  The CCG was under pressure with regard to Accident and Emergency targets and it needed to ensure that people were dealt with correctly.

Members then raised the following questions and comments:

·         What was the impact on GP surgeries in relation to waiting times and had they been reduced?

·         How had the non-elective admissions in relation to Bradford’s Healthy Hearts programme been reduced by 10%?

·         How was the gap between annual budgets and the increasing cost of providing healthcare being managed?

·         Choices would have to be made about what services would go.

·         Airedale, Wharfedale and Craven CCG was in a worse financial situation than the two Bradford CCGs.

·         The Mental Health section within the report seemed light in content and confusing.

·         A two month wait following a cancer referral was too long.

·         What was meant by ‘increased demand’?

·         Could ‘workforce issues’ be considered for inclusion in the next report?

·         What work had been undertaken in relation to cultural sensitivity?

·         What message could be fed back to constituents?

·         The neo natal mortality and still birth figures had previously improved. 

In response it was clarified that:

·         GP streaming had not been fully rolled out and it was hoped that it would reduce waiting times and improve performance by 10%.

·         The amount had not reduced within Airedale, Wharfedale and Craven CCG, however, there was indirect evidence that there had been an impact within 12 months.

·         What would happen to the demand for the next four years could be projected and calculations could be done to work out the costs and the available funds.  Action was being undertaken, however, there were not enough solutions to close the gap.

·         Difficult choices would not have to be made yet, as the CCGs were managing with the funds available.  Staff had been consulted and many had ideas.  No services would be stopped without consultation and there were many inefficiencies that could be looked at in the first instance.

·         The programmes of work were all clinically led and in 2015/16 Airedale, Wharfedale and Craven CCG had not delivered the surplus it should have and was placed in financial recovery.  In 2016/17 it had recovered and it was hoped that in 2017/18 it would have 1% surplus.

·         The report looked at performance and information could be provided as to the current situation.  Mental Health issues had been presented in other reports.  The CCGs had worked hard to establish a Mental Health Strategy and more detail could be circulated.

·         Cancer targets were complicated and the 62 day target was to start treatment.  Often the delay was due to a referral to Leeds and the issue related to treatment, not diagnosis.  The reason as to why some communities did not attend appointments needed to be understood and clinicians were encouraging patients to look after themselves with support.  Early diagnosis and treatment was key for cancer care.

·         People were living longer and developing cancer.

·         The report focussed on the CCGs performance and they were not held to account on staffing issues.  There were many staffing problems and it was agreed that the right workforce meant a better service.  Healthcare professionals could not be attracted in a timely manner, therefore a workforce strategy had been implemented and ways forward agreed.  The Health and Wellbeing Board was held to account in respect of the Bradford picture.  A slightly different staffing model was now required, as there would be fewer healthcare professionals who would have to work in a different way.

·         Bradford City CCG was making sure patients were seen by a psychologist that was sensitive to their culture.  It needed to be ensured that assistance was specific to each community and this information could be shared with the Committee.

·         If people felt that they ‘owned’ the NHS service, it would help.  The issue was about how the NHS could make people manage their health well. 

·         The details had been reported against National figures and there had been a slight decline in the improvement.       

Resolved –

That a further report be submitted in 12 months.

ACTION: Director of Quality NHS Bradford City and Bradford Districts Clinical Commissioning Group (CCG)/Deputy Chief Officer and Finance Officer, NHS Bradford City and Bradford Districts CCG