Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
Subject
Summary
Actions
Quality and Safety
Quality is a key governance priority for Calderdale, recognising the role of CCGs in creating a culture which supports continuous improvement. As a subcommittee of the Cluster Board the CCE has the responsibility for scrutinising and gaining assurance in relation to the three domains of quality; safety, effectiveness and experience and the role of the Quality Group is to provide this assurance to the CCE. The group receives regular reports which collate information about quality, safety and experience from various sources. The CCE Quality Group met on 19 July 2012 and 16 August 2012 where information on the following key quality metrics were reported:EMSA CHFT reported 2 clinically unjustified breaches in the Surgical Assessment Unit on 10th May 2012. These breaches were toilet/wash facilities breaches, therefore will not show on Unify report, and were due to capacity issues. These were rectified first thing in the morning rather than move patients during the night. CHFT have now put in place a process where the Head of Quality is informed as soon as breaches occur. At the June 2012 Quality Group it was reported that CHFT had recorded one clinically unjustified breach in April 2012. This occurred on the Calderdale Royal site on the Acute Stroke Unit (ASU) and involved toilet and washing facilities. Following discussion with CHFT’s EMSA lead the April data will be revised to remove this breach as the breach was clinically justified. The patient had been admitted to the acute stroke unit, with suspected stroke, but a diagnosis of non-stroke was made on the second day of admission and the patient was moved from the ASU. As ASUs are exempt from MSA requirements, a breach should not have been recorded. CHFT will be applying breach revisions policy and it is anticipated that in future reports these breaches will be removed
EMSA No actions required
VTE Risk Assessment VTE risk assessment at CHFT continues to be in line with the national average.
VTE Risk Assessment No actions required
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
National Patient Safety alerts CHFT have one alert open past the closure date of 2 April 2012 – Safer spinal (intrathecal), epidural and regional devices (NPSA/2011/PSA001). The Royal College of Anaesthetists, Association of Anaesthetists and the Obstetric Anaesthetic Association produced a joint statement last year saying that they felt there were risks associated with individual Trusts doing their own small trials and felt that there should a national trial of the new devices and then a decision made and the device chosen to be implemented nationally. The NPSA responded by saying that they didn’t agree and urged Trusts to continue trialling and then implement their chosen device. The Clinical Director for anasthetics is leading on this and has identified the risks to CHFT of trialling new devices with differing connectors with doctors who work across many sites. CHFT believe their risks of wrong spinal injection are extremely low as they are generally caused by wrong injection of chemotherapy agents into CSF, which they do not undertake as patients are referred to Leeds for intrathecal chemotherapy). Further advice is awaited from the College and there are other Trusts who have made the same decision on the back of the joint statement. CQC Compliance In March 2012 the Secretary of State asked the CQC, as the regulatory agency, to conduct an inspection of Termination of Pregnancy Services as a priority. Verbal feedback, given to CHFT on the day of inspection, indicated that they were compliant with the standards they were inspected against. The report has now been published and the following table provides an overview of the outcome: Provider Date of review Outcome 21 - Records Link to report
Calderdale Royal Hospital 22 March 2012 Compliant Calderdale Royal Hospital Termination of Pregnancies
The follow up reports for SWYPFT Chantry View and Fox View in May 2012 have found the service to be fully compliant against the standards inspected against. A routine inspection has also been undertaken at The Poplars which was found to be compliant against the standards inspected against.
NPSA – outstanding alert to be discussed at Clinical Quality Board and considered for inclusion on CHFT and NHS Calderdale Corporate risk registers.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
MRSA There have been 4 cases of MRSA attributed to NHS Calderdale to date. Case 1 & 2 relate to the same patient. Initially this was following acute abdominal surgery in CHFT and the second episode was 2 weeks following discharge home and it was possibly associated with the hip prosthesis. Both episodes count towards the NHSC objective as the blood cultures were more than 14 days apart. Cases 3 & 4 both occurred at LTHT (one at LGI paediatric oncology and the other at St James). One report has been received and reports the bacteraemia as being line associated. The second report is awaited. Risk included on Calderdale risk register The risk that avoidable Health Care Acquired Infections are not prevented and future reductions in rates for Methicillin-resistant Staphylococcus aureus (MRSA) are not met is scored 20 on the Corporate Risk Register (Risk No 290
C-Difficle The year to date has demonstrated an overall increase in incidence of Clostridium difficile. At the current rate, both NHSC and CHFT could be expected to breach the respective objectives. Following the increase in numbers in June, the cases have had further scrutiny. A cluster of cases at CHFT have been investigated and typed and found to be unconnected, microbiologically. A Clostridium difficile management plan has been agreed across the wider health economy to address Clostridium difficile issues, supported by NHS North of England. Clostridium difficile is a major part of the health economy work plan for 12/13 and the Clostridium difficile management plan will be monitored through this forum.
MRSA – Clinical Quality Board received CHFT Infection, prevention and control action plan. HCAI Group Meeting frequency has been increased to bimonthly to acknowledge the risk affecting all health economy partners and reports to Calderdale CCG Quality Group. A Root Cause Analysis is undertaken for all acute and community acquired bacteraemias and reported to Infection Prevention and Control Operational group, Director of Public Health, Calderdale CCG and HCAI Health Economy Group with lessons learnt being shared across the Health Economy. C-Diff – Included within the HCAI Health Economy Group work. A health economy CDI management plan has been developed and agreed and is monitored by the HCAI Health Economy Group, this plan has also received SHA scrutiny. Root Cause Analysis
Clinical Commissioning Executive: Calderdale Designate Chief Officer: Matt Walsh Safeguarding The CCG has identified Dr Steven Cleasby as its lead for safeguarding, Dr Cleasby is a member of the Calderdale LSCB and LSAB. As part of the Quality Group work plan, Quarterly updates are presented, this includes, current issues, risk and developments, including open serious Case reviews. The annual report (11/12) for Safeguarding children was presented to CCE in July 2012 and the Adults will be presented in October 2012 As part of the OD plan for the CCG, board members have participated in development sessions focusing on their statutory duties in relation to All age safeguarding and safeguarding has been included in the schedule of mandatory training for the governing body. Calderdale currently has 2 risks on the risk register relating to safeguarding: The first risk relates to capacity issues to deliver the Serious Case Review in Adults to the timescales required. Additional mitigation actions have been agreed to source external support to ensure we are able to deliver to agreed time frames. The second risk relates to the improvement notice issued to Calderdale in relation to Children’s Social Care. The Quality Group and CCE have received updates in relation to the delivery of the single improvement plan and NHS Calderdale’s contribution to that plan. Single Integrated Improvement Plan – NHS Calderdale Action Plan Following the Inspection the Local Authority area Judgements in January 2010 published on the OFSTED website on 26th February 2010 reflecting an inadequate judgement for Safeguarding and an adequate judgement for Looked after Children Services, the Children’s Improvement Board was established in January 2010 and continues to oversee the implementation of the improvement of Children’s Social Care Services. The Single Improvement Interagency Plan (SIIP). The Notice to Improve cannot be lifted until there is a further formal inspection. A Peer Review by the local Government Development and Innovation Group was commissioned upon recommendation from the Improvement Board to review progress and took place in Calderdale in September 2011. A second peer review is to be undertaken commencing 26th November 2012. An initial meeting has been held to discuss the process that will be undertaken and all co-ordination
CKWCB/ September 2012 undertaken for all Care Home CDI cases, CDI outbreaks and CDI associated deaths. Outcomes are reported to the IP & C Operational Group as per MRSA reports. Antibiotic campaign planned for winter 2012 Continual work across the health economy and region on viral gastroenteritis outbreak management.
SIIP – the SIIP – NHS Calderdale Action Plan is being monitored by the Quality Group and lead officers for actions will be attending the September 2012 meeting to provide an update on progress.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
for this will be formulated by Stuart Smith Interim Director of Children’s Social Care to be shared at the next Improvement Board on the 10th September 2012. The first draft of the Single Integrated Improvement Plan for NHS Calderdale has been developed and received at the August Quality Group meeting. The lead officers for the actions will be invited to the September Quality Group meeting to provide an update on progress. All actions have either been completed or within timescales to complete. Patient Experience Calderdale and Huddersfield NHS Foundation Trust (CHFT) National In-Patients Survey The Quality Group and CCE have received and reviewed the ninth national survey of inpatients, which involved 161 acute and specialist NHS trusts. Patients were eligible for the survey if they were aged 16 years or older and had at least one overnight stay during June, July or August 2011 and were not admitted to maternity units. The number of respondents taking part in the CHFT survey totalled 475 patients. CHFT have identified Patient Experience in their Quality Improvement Strategy 2009 - 2012 and their goal for 2012 is to be in the top 20% of acute trusts in the NHS and for 90% of our patients to recommend their care to others. The Trust have committed to complete full Inpatient Surveys on a twice-yearly basis and a full Out-patient Survey annually, together with localised monthly surveys, which will be conducted in all wards and departments. Overall, CHFT have demonstrated little real improvements compared to the 2010 survey. Building closer relationships and safe high quality and co-ordinated care have shown some improvement from the 2010 survey. Access and waiting domain has shown low improvements and better information, more choice is in the low improvement, low score quadrant. The following actions and next steps have been agreed and will be overseen by the Quality Group: i.
The 2012/13 CQuINs Scheme for CHFT Acute services includes two indicators for patient experience. The nationally set indicator and a local indicator which involves Real Time Patient Monitoring to: Maintain of good practice
Patient Experience – Inpatient and Out-patient surveys for CHFT The response to these surveys will be discussed with CHFT at the next Clinical Quality Board on 9 October 2012. Patient experience is a standing agenda item on the Clinical Quality Board. The Quality Group will monitor performance of the Patient Experience CQUINS indicators. How to: maintain quality during the transition: preparing for handover Updates on progress are received at the Quality Group. Calderdale’s initial handover meeting will take place on 28 September 2012.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
ii.
Improve performance in discharge questions Improve performance in medication questions Improve performance in hospital food question the national indicator the local Expected achievements for the local CQuINs indicators will be agreed following a quarter 1 baseline and taking into account the national survey results. The national CQuINs goal has been agreed. Patient experience is a standing item at CHFT Quality Board where actions and improvement work is agreed and monitored. Calderdale CCG has identified improving Patient Experience as a priority area in their Commissioning Plan with Quality Group leading this work. A Quality Group development session took place on 28 June 2012, where priorities for patient experience were considered, along with how we use patient experience information and sources to inform and improve the services we commission.
CQUINs The overview of the development of local CQUIN schemes including implementation, trajectories setting, improvement plans and recommending these to the relevant Contract Management Boards continues to be managed through the Clinical Quality Board arrangements. All providers submitted Quarter 1 returns by the specified deadline (31st July 2012). For Quarter 1, our main providers achieved the following performance in the indicators that required data submission in Q1
Provider Calderdale and Huddersfield Foundation Trust (CHFT) - acute
Q1 100%
Q2
Q3
Q4
Q1 comments Achieved VTE indicator All other indicators for 12/13 scheme required data submission for benchmarking and then agree trajectories
Risks All reports received at the Quality Group include details regarding the risks. There is an ongoing cycle of reviewing and considering risks.
CQUINS – All Q1 submissions are to be reviewed at the relevant Clinical Quality Board and agreement of Q1 performance. We are currently agreeing year end trajectories for indicators that relied on Q1 data submission for baseline.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
Performance
South West Yorkshire Partnership Foundation Trust (SWYPFT)
87.5%
Spire Elland Hospital
100%
Yorkshire Ambulance Service (YAS)
94%
Did not achieve assessment for psychological therapies and partially achieved in patient survey.
To be agreed at the Clinical Quality Review Group on 4th September 2012. Partially achieved improving response rates for rural areas & raising public awareness indicators
Headline Indicators: Calderdale has achieved the required thresholds for the following headline indicators from the Operating Framework : • Planned Care - referral to treatment times for admitted patients • Cancer – patient receiving their first definitive treatment with 62 days • Urgent Care – time spent in A&E (< 4 hours) and ambulance response times Areas that will require continued focus: Dignity and Respect - Mixed Sex Accommodation – discussed above Safety – minimising the incidence of C.Difficile – discussed above Public Health - NHS Healthchecks The NHS Health Check programme is a systematic prevention programme that assesses an individual’s risk of heart disease, stroke, diabetes and kidney disease. It targets people aged 40-74 who have not been previously diagnosed with one of these conditions and
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
consists of face to face individual assessment followed by risk management advice. The NHS Calderdale scheme is organised through a locally enhanced scheme (LES) which all practices have agreed to deliver and contains specific levels of performance to be achieved. Data for Q1 2012/13 shows a marked improvement on the previous year’s achievement. This has been the result of an increase in the number of practices delivering the Health Checks and an increase in their performance. Next Steps Although there has been a notable improvement overall, 5 practices delivered no activity during Q1 2012/13. Each of the practices has been contacted who have highlighted staff changes as the main reason for no activity taking place. However it should be noted that no activity was undertaken by these practices in 2011/12. Each practice will be contacted again during August to discuss their progress, although achievement of the 10% invite threshold by Q2 will be a challenge for these practices. It is proposed that if no improvement activity is undertaken during Q2, then those practices that deliver <4% and do not have a credible plan to support the remainder of the year, then NHS Calderdale will seek to offer the NHS Health Checks through other providers. This issue will be discussed at the next meeting of the LMC Executive.
Finance and QIPP
Financial position Month 4 2012/13 • We are forecasting to deliver our control total of £3.6m. The current allocation for the year is £363.8m, which is just above the financial plan. We are currently in line with budget and have a £1.2m surplus at month 4. • The CCE has approved the funding of the West Yorkshire CSU set up costs. Risks There continue to be a number of risks for the Group to be aware of for 2012/13: • QIPPS plans don’t deliver the required level of recurrent savings, this will not pose a financial risk in 12/13 (fixed income contracts in place with CHFT and Leeds) but
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
•
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could impact on 13/14 negotiations if the required secondary care savings are not delivered. The ability to fully utilise contingent and investment reserves. A business planning process is in place to assess and approve applications for non recurrent funding. Current levels of expenditure are low and behind plan. Work is on going to mitigate this risk and a separate action plan is being monitored. Risks will continue to be monitored and we are confident that we will mitigate our financial risks and achieve all our duties this year
QIPP Plan 2012/13 • The PCT requires £5.6m of savings to be realised from budgets this year in order to achieve our financial targets. Our current forecast is that we will achieve £4.6m this year, an overall shortfall of £1m. • We currently have a shortfall of £1.5m in confirmed plans relating to elective and non elective schemes. The shortfall does not pose any financial risk this year as we have a fixed price contract with our main acute provider. These two schemes are currently rated as red. • Additional savings are being forecast for two of our schemes, mental health and procurement and latest activity data suggests that the low secure contract will ensure savings of approximately £500k over plan. These additional savings will offset our underperforming areas. We also expect continuing care to deliver further savings and this should be confirmed in next month’s report. Items escalated from F&P group • To note the risks detailed above. Governance and Risk
Calderdale has a well-embedded system of risk management which has been adopted by the CCG. Risks are identified at all levels within the organisation and are reviewed by the Senior Management Team. Critical risks are reported to both CCE and Cluster Governance Committee. Currently there is one critical risk. Avoidable Health Care Acquired Infections are not prevented and future reductions in rates for Methicillin-resistant Staphylococcus aureus (MRSA) are not met. Rates for 2012/13 set at 3 cases of MRSA bacteraemia in Calderdale GP registered patients irrespective of where the infection was acquired.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
As part of transition, the local Audit and Governance Group will be undertaking a detailed review of all of the risks in each directorate through a rolling programme over the next 12 months. At its meeting on 26 July 2012, the Audit and Governance Group considered the High Level Risk Log (HLRL) and recommend it to the CCE as a true reflection of the current risk position. Work is underway by the senior management team to develop the local Assurance Framework, this work will be overseen by the Audit and Governance group and approved at the CCE, this work is expected to be complete by October 2012. The Audit & Governance Group has been meeting bi-monthly since November. The main items of discussion at the 26th July 2012 last meeting were: • • • Our Risks
Serious incident, serious case reviews and complaints Internal audit progress report Annual audit letter
What are our key risks? New HLRL risks this period • Thornhill Rd Nursing Home concerns • Summerfield house nursing home concerns • There are a number of workforce related risks associated with the close-down of PCTs and transition of staff to new organisations. Continuing HLRL risks • Avoidable Health Care Acquired Infections – MRSA annual target exceeded (CRITICAL RISK –risk score 20) • The quality improvement requirements associated with reduction in pressure ulcers may not be achieved • Calderdale MBC is not yet ready for re-inspection by OFSTED/CQC. • SNHS Calderdale may not have the appropriate systems and processes in place to ensure the system model is affordable going forward • Commissioning Support (CS): 1) Not developed in timely manner
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
2) Fails to offer what the CCG is looking for 3) Offer is too costly 4) The requirement to develop and resource a CSS may prevent development and retention of local capacity at a key time, leading to greater insecurity for PCT staff. How do we manage risk? There is a clear focus upon risk and risk management within the Audit and Governance sub – group. The senior management team have an established and well-functioning risk management process operating in support of the identification, management and governance of risk. The CCE has adopted the tool developed for the CCG which presents all the known risks to the organisation. The risks are scored according to likelihood and impact by an “owner” lead manager and signed off by a director (in future one of the “heads of”), producing a hierarchy of severity. These risks are then presented to first Audit & Governance subgroup and then to CCE. The Dashboard is accessed by authorised users through a simple web browser and unlike other systems can be easily interrogated to improve awareness of risks. Managing the transition and workforce
Our CCG has applied for authorisation as part of the first wave. The process of authorisation consists of three main phases: • Submission of the application with supporting evidence (2nd July). • Desk top review undertaken by the NHS Commissioning Board (NHS CB) (July) • Site visit by the NHS CB assessor team on 25th September 2012 • Notification of conclusion by 31st October 2012. We have received the draft desk top review report and submitted our response on any factual errors in the report. Overall the CCG was seen to have submitted a well written and comprehensive set of documents providing good evidence for a number of the required criteria. It was noted that the documentation provided assurance of strong clinical focus and member practice engagement as well as a strong clinical rationale for the commissioning plan which was underpinned by a robust prioritisation process. In addition, relationships with Calderdale Council were seen as being well established.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
The desk top review concluded that 48 (40%) of the criteria required greater clarification or additional supporting evidence (i.e. ‘red buttons’ where the evidence appeared to be weak or missing) and 71 were classed as ‘green’ i.e. where sufficient evidence had been submitted. . 14 Key Lines of Enquiry were identified in the desk top review. A number of these are common to other wave one CCGs: • Governance arrangements - the extent to which the CCG is functioning on a day to day basis at arms-length from the PCT Cluster and whether the Governing Body is functioning. • Collaborative arrangements – with other CCGs and Calderdale Council • Commissioning strategy for 2014/15 and longer term financial plan including QIPP; multi-professional input into the commissioning cycle. • Capacity and capability – In-house and Commissioning Support • Quality – patient feedback and insight • CCG role in the refresh of Joint Strategic Needs Assessment, development of the Health and Wellbeing Strategy, proactive and sustained involvement Health and Wellbeing Board (HWB) and collaboration in terms of joint commissioning plans. • Safeguarding systems and processes. Site visit Preparation is continuing apace for the site visit which is due to take place on the 25th September. The purpose of the site visit is to: • To provide formal opportunity for the NHS CB to meet and assess the CCG leadership team within their local context and; • Enable the CCG to further demonstrate compliance with the 119 authorisation criteria and resolve any remaining queries identified during the desk top review. • Confirm that the picture of the CCG that emerged from the desk top review is an accurate representation • Gain a more comprehensive understanding of the local context and challenges faced by the CCG and corporate ownership of these. • Opportunity for CCG team to demonstrate capability, insight and preparedness to take on commissioning, leadership of local health community and challenges. • Identify any areas requiring conditions and how the NHS CB can support the
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
development of the CCG moving forwards. Site visit will also explore: • Where the CCG is now, immediate plans (next 12 months) and identification of short term development needs • Early thinking on approach to developing the vision and new ambitions of the CCG longer term (3-5 years’ time) Whilst there will be immediate feedback from the assessor team on the day, the final report with their conclusions is expected by the end October. The process of appointing to the Governing Body in line with the national guidance on Governing Body roles and responsibilities is continuing: • Three of the clinical leaders (GP Board members) will be stepping down from the end of September. • Dr Steven Cleasby who has fulfilled the role of Vice Chair of the Clinical Commissioning Executive will take on the role of Assistant Clinical Chair. • The assessment interview for the lay member - Deputy Chair and Chair of Audit and Governance was held in August and the position has been offered to the successful candidate. • The interviews for the secondary care specialist were also held in August and the position was offered to the successful candidate subject to references. • The interviews for the lay member – focussing on patient and public involvement and for the Registered Nurse are due to take place on the 19th and 20th September respectively. The Governing Body membership will be fully in place once the interviews have taken place in September. Workforce The sickness absence in Calderdale has continued to rise in July to a peak of 2.2%. This is still within the 2.5% threshold. Of NHS Calderdale’s sickness absence 1.3% relates to long term sickness. This is due to 2 members of staff on long term sick – one has now returned to work. It has been identified in NHS Calderdale that some staff sickness absence has not been reported via the correct route. The HR team is picking this issue up via the managers
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
in the cases concerned, and by working with Calderdale’s Designate Chief Officer to reiterate the correct reporting procedures to staff and managers. Formal consultation has now commenced across the CKW Cluster with staff whose functions are destined to transfer to either a CCG or the West Yorkshire Commissioning Support Unit. As part of the formal consultation, CCG structures were released for consultation on Monday 30 July 2012, with a deadline of 31 August 2012 for feedback to be received. The CSS structure was released for staff for consultation on Wednesday 22 August 2012 with a deadline of 7 September 2012 for feedback. The Department of Health’s pooling & matching policy was finally released on 1 August 2012. The joint local interpretation of the policy by CKW and Airedale, Bradford & Leeds Clusters was released to staff week commencing 13 August 2012. Pooling and matching in both the CKW and ABL Clusters is now scheduled to commence in September 2012, following the conclusion of the consultation on organisational structures. NHS Calderdale CCG has appointed Julie Lawreniuk as its designate Joint Chief Finance Officer (shared with NHS Greater Huddersfield CCG). Appointments have also been made to the Secondary Care Specialist and Lay Member (Audit & Governance). The interviews for the Lay Member PPI takes place on the 19 August 2012 and the Registered Nurse post on the 20 August 2012.
Transformation
Calderdale and Kirklees Health and Social Care Strategic Review The Strategic Review Board continues to lead the large scale strategic review of health and social care services across the CHFT footprint. At its last meeting the Board considered and agreed: •
The Board’s revised Terms of Reference – which are to be shared with CCEs, along with minutes of all future meetings
The Board also considered: • An update from the Programme Steering Group, which represents the Programme partnership, and meets weekly – led by Dr Paul Wilding from GHCCG.
Clinical Commissioning Executive: Calderdale
CKWCB/
Designate Chief Officer: Matt Walsh
September 2012
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The Programme Risk Register An update on the Communications and Engagement Strategy and Action Plan
CAMHS Services Earlier this year, and following considerable discussion with partners, Calderdale CCE approved a proposal to tender the tier 3 CAMHS service currently provided by CHFT. Both North Kirklees and Greater Huddersfield CCEs also approved this proposal and a procurement programme board for this exercise is now underway. This group is made up of representatives from across the 3 CCGs, and is chaired by Carol McKenna. The advert for Expressions of Interest was placed on the Supply to Health website on 10 August, with pre-qualification questionnaires to be submitted by 10 September. It is anticipated that a recommendation on contract award will be brought to the Cluster procurement sub-committee in late December/January.