NHS Commissioning Board CCG Authorisation Site Visit Report CCG name: Greater Huddersfield CCG Wave: 2
Greater Huddersfield CCG:Site Visit Report
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Panel Chair Date report generated:
Brenda Howard 26/10/2012
Summary assessment overview The CCG has inherited strong partnership working and has demonstrated a sound working relationship with the local authority and other partners. The CCG has well developed collaborative arrangements, particularly with the CSS. It has a thoughtful approach to safeguarding, which balances resilience through collaboration with recognition of the need to ensure that systems are locally embedded. The CCG demonstrated a great people focus. During the site visit the mutual respect between clinicians and managers was evident. There has been universal local endorsement of the GP leaders. The CCG has a good starting foundation and a stable financial inheritance. Areas of strength The level of Organisational Development is high. The CCG demonstrated its commitment to training and developing its staff and leadership. The QIPP dashboard which shows information down to practice level demonstrates a good way of monitoring the progress of the workstreams and how/ what they are achieving. The CCG showed a commitment to continuous improvement, which was demonstrated through its involvement with Manchester University and being prepared to undertake a Gateway review so early in its development. The extent of partnership working, evidenced through the seven partner programme and strategic review is commendable.There is clearly wide engagement across the CCG in the strategic programme. Remaining evidence gaps (overview) and related risks identified The two areas where assurance is still needed relate to understanding the health needs and inequalities of the CCGs population, to a much greater extent than is evident at present. This will be key in influencing future commissioning plans, and will require the help and support of public health colleagues to achieve this. Areas for development beyond authorisation requirements The CCG could usefully broaden its patient engagement approaches to obtaining patient feedback, beyond GP surgeries. Where the CCG procures from or commissions support from third parties, it needs to consider how it gets assurance on delivery. Once the CCG has a better understanding of its health needs and the impact of the operating framework on its financial plan, the CCG might consider faster implementation of its commissioning ambitions, given the relative financial stability it is inheriting. Ownership and understanding of risk management should be embedded in the culture of the organisation across all staff.
Greater Huddersfield CCG:Site Visit Report
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Dashboard summary assessment
Summary Domain Dashboard 1. A strong clinical and multi-professional focus which brings real added value 2. Meaningful engagement with patients, carers and their communities 3. Clear and credible plans which continue to deliver the QIPP (quality, innovation, productivity and prevention) challenge within financial resources, in line with national requirements (including excellent outcomes) and local joint health and wellbeing strategies 4. Proper constitutional and governance arrangements, with the capacity and capability to deliver all their duties and responsibilities including financial control, as well as effectively commissioning all the services for which they are responsible 5. Collaborative arrangements for commissioning with other CCGs, local authorities and the NHSCB as well as the appropriate commissioning support 6. Great leaders who individually and collectively can make a real difference Total 119 authorisation sub-criteria
Assessment threshold outcomes No. of reds No. of greens 0 17 1
14
0
22
1
31
0
17
0
16
2
117
The following criteria were changed from red to green as a result of evidence seen at the site visit: 1.3 - B, 2.1.1 - A, 2.1.1 - C, 2.1.2 - C, 2.2 - A, 2.2 - B, 2.4.1 - B, 2.4.2 - A, 2.4.2 - B, 2.4.2 - C, 3.1.1 - B, 3.1.1 - C, 3.1.1 - E, 4.1 - C, 4.2.1 - A, 4.2.1 - H, 4.2.3 - A, 4.2.3 - D, 4.3.1 - C, 4.3.1 - D, 4.3.3 - A, 5.1 - A, 5.1 - B, 5.2 - B, 5.3 - B, 5.3 - C, 5.3 - D, 6.4 - B, 6.4 - G, 6.4 - H
Greater Huddersfield CCG:Site Visit Report
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Domain 1 Summary
Summary assessment overview The evidence submitted was strong, clear and easy to triangulate. It was evidenced that the key to the CCG vision is that it is supported by all member practices and that this enables shared working and distributed leadership. There is a strong sense of clinical leadership and clinical ownership. Areas of strength Good collaborative arrangements have been demonstrated with the local authority and Commissioning Support Service. The council leader and the Managing Director of the CSS both attended the panel day in support of the CCG. There was a strong clinical focus with evidence of engagement with patients, carers and communities. Good strategic clinical view, with strong enthusiastic working. Remaining evidence gaps (overview) and related risks identified None remaining after site visit. Areas for development beyond authorisation requirements None noted.
Greater Huddersfield CCG:Site Visit Report
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Domain 2 Summary
Summary assessment overview The CCG has demonstrated systems by which the patient voice is an integral part of the decisionmaking process and gave examples at the site visit. Strong evidence was given at the site visit of stakeholder engagement and involvement. It is encouraging to see the CCG has systems under development for securing patient feedback and to share learning from complaints and SIs. The CCG can give examples of how this has helped to inform commissioning decisions. The remaining issue to be resolved relates to gaining a deeper understanding of local health needs in the population. Areas of strength - The stakeholder analysis in respect of strategic partners contained in the communication and engagement strategy is comprehensive. -The CCG has produced a geographical map showing the diversity of its community. -The CCG is engaged in a research project on health inequalities with Manchester University -The CCG is a partner in a 7-partner strategic programme, including local government and the voluntary sector, which is leading a system-wide strategic review Remaining evidence gaps (overview) and related risks identified The CCG needs to demonstrate that it has analysed the specific health needs and inequalities within its population beyond the general health priorities, and that these insights have influenced its commissioning plan. Areas for development beyond authorisation requirements The CCG needs to develop a more granular understanding of the distribution of health needs across Huddersfield, with support from public health. This needs to reflect the diversity of the population and specify the particular health challenges faced in different areas across the commmunity. With the transfer of public health resource to the local authority, the CCG needs to ensure adequate support to meet its requirements in a format that will assist them in commissioning to meet the health needs of the population.
Greater Huddersfield CCG:Site Visit Report
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Domain 3 Summary
Summary assessment overview The CCG has a credible integrated plan which has been aligned with the Kirkless JHWS and its timelines for delivery of system changes. The CCG demonstrated that they have a detailed financial plan to deliver QIPP and the Operating Plan, with some contingencies. The CCG has a finance team and a commissioning team in place to help with the whole contract management and monitoring process. Areas of strength The CCG has credible QIPP plans with a track record of delivery and effective performance management. Good evidence of clinical leadership and engagement in QIPP delivery. Case studies reflect a pragmatic approach to change. Remaining evidence gaps (overview) and related risks identified None remaining following the site visit. Areas for development beyond authorisation requirements The CCG needs to continue to communicate with patient groups, so that they are aware of what the CCG is trying to develop and change for the benefit of the commnunity. The CCG needs to maintain its good relationship with the CSS and ensure that the CSS continues to provide a comprehensive commissioning service for the CCG.
Greater Huddersfield CCG:Site Visit Report
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Domain 4 Summary
Summary assessment overview The CCG has adopted a thoughtful approach to the balance between in house and shared resource. This is particularly notable for safeguarding and CSS arrangements where the CCG has sought to balance the need for local appropriateness with the added resilience of collaborative arrangements The good signposting and clarity at evidence submission stage indicates sound governance and organisational capacity is in place at the CCG. There are good examples of established local arrangements to be used and taken forward. There are clear processes followed to identify the support arrangements required at the CCG. Areas of strength The CCG has inherited strong safeguarding arrangements, following significant past investment in this area. The CCG demonstrated its arrangements to embed these within the new organisation whilst retaining the benefit of expertise and resilience from having a shared resource with other CCGs. Training arrangements are strong. The CCG has strong working arrangements with CSS. It has adopted a clear process to identify, clarify and progress buy/build/share resource to enable the CCG to deliver its duties in a cost effective manner. The contractual relationship is well documented and is further enhanced by a strong, on-the-ground relationship. The Joint Strategic Review Programme demonstrates wider health economy approach to effective working/QIPP challenges. Remaining evidence gaps (overview) and related risks identified The CCG needs to develop a more granular understanding of the distribution of health needs across Huddersfield, with support from public health. Once this is understood, the CCG needs to develop its commissioning plans to address these health needs. Areas for development beyond authorisation requirements The CCG should embed further its risk management arrangements across all management disciplines to ensure widespread understanding and ownership of risk issues.
Greater Huddersfield CCG:Site Visit Report
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Domain 5 Summary
Summary assessment overview The CCG has a sound foundation in place for commissioning support, and links with local authorities and the HWB are strong. Their safeguarding arrangements appear to be comprehensive at all levels, right down to the frontline at GP practices. The CCG has good collaborative arrangements in place with their neighbouring CCGs and have written agreements to evidence this. Areas of strength The CCG has established thorough arrangements for securing commissioning support services, and the links with local authorities and the H&WB are strong. Their safeguarding arrangements are sufficiently strong, which includes designated doctor and nurse roles and lead for the MCA. There is also a lead for safeguarding. The CCG has good arrangements for collaboration with other CCGs in place. Remaining evidence gaps (overview) and related risks identified None remaining after site visit. Areas for development beyond authorisation requirements The CCG needs to further develop its relationship with public health, following the move to the local authority. The CCG could consider agreeing an SLA with public health, with associated KPIs, so that it is clear what is expected from both parties.
Greater Huddersfield CCG:Site Visit Report
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Domain 6 Summary
Summary assessment overview Strong GP engagement was clearly evident and the CCG confirmed that this had been universally endorsed by the GP community in Huddersfield. It was clear that the GP leadership in the CCG is bringing fresh thinking to the commissioning role. The strong OD approach, which has been taken down to practice level is particularly noteworthy. The status of the evidence submitted was strong, clear and easy to triangulate. It was evidenced that the key to the CCG vision is that it is supported by all member practices and that this enables shared working and distributed leadership. Individual clinical leaders can demonstrate commitment to partnership working, leading commissioning and the drive for transformational change. Areas of strength Areas of good constitutional and governance arrangements with the capacity and capability to deliver all CCG duties and responsibilities. This also includes a legacy of strong financial control and delegated financial responsibilities being given to the CCG in 2012-13. Evidence of distributed leadership throughout the CCG organisation which will lead to extensive and on-going communication and engagement across practices. The Organisational Structure distinguishes between CCG in-house roles and shared roles. There is evidence of senior in-house roles such as Chief Officer, Head of Contracting & Commercial Strategy, Head of Practice Support & Development and Head of Strategic Planning & Service Redesign. This demonstrates that the CCG has the resources in order to provide maintain strategic oversight. Examples of CCG leadership development were evidenced throughout the case studies. Good examples were demonstrated of where the CCG has enhanced clinical involvement in service redesign and improvement. Remaining evidence gaps (overview) and related risks identified None remaining after site visit. Areas for development beyond authorisation requirements The CCG should consider how to further develop engagement beyond GPs within member practices.
Greater Huddersfield CCG:Site Visit Report
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Outstanding issues
Threshold for Site Visit Authorisation Threshold
Rationale for red rating and distance from threshold
2.1.1 - B
A high level overview of the population for Huddersfield has been provided on page 88 onwards of the JSNA: (http://www.kirklees.gov.uk/com munity/statistics/jsna/pdf/Kirklee sJSNAReport2010_6_Hudds.pdf ).
Outstanding Issues (including CCG’s proposed plan and timescale to meet requirements, if applicable and discussed at site visit) The CCG should further demonstrate that the analysis of health needs have been reflected in its integrated plans.
Page 96 onwards gives details about the Valley's health needs of the constituent communities (http://www.kirklees.gov.uk/com munity/statistics/jsna/pdf/Kirklee sJSNAReport2010_6_Val.pdf). Page 80 onwards provides the same for Mirfield (http://www.kirklees.gov.uk/com munity/statistics/jsna/pdf/Kirklee sJSNAReport2010_6_MDDK.pd f). This has been triangulated with information in pages 13 to 14 of Integrated Plan. Health needs are not clearly identified in the CCG's integrated plan. At site visit the panel were not reassured that the CCG has a sufficiently granular understanding of the health needs of the population of Huddersfield. Beyond a general description of health needs, the CCG did not demonstrate a detailed understanding of health inequalities, reflecting the diversity of its population. Specific health challenges were not described. With the transfer of public health resource to the local authority, the CCG needs to ensure adequate support to meet its requirements in a format that will assist commissioning for the population.
Greater Huddersfield CCG:Site Visit Report
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Threshold for Site Visit Authorisation Threshold
4.2.3 - C
Rationale for red rating and distance from threshold
Outstanding Issues (including CCG’s proposed plan and timescale to meet requirements, if applicable and discussed at site visit) Section 1.3 of the Integrated The CCG has identified health Plan identifies some of the inequalities in its integrated plan. health inequalities existing in the However, further evidence is CCG's covered population. The required on the specific means diagram on p. 6 also refers to by which the inequalities will be the CCG's ambition of 'Leading addressed. through enthusiasm and cohesiveness to reduce health inequalities in Greater Huddersfield'. However, further evidence is required on the specific means by which the inequalities will be addressed. At site visit there was not enough detail on the health needs of the population provided to meet this criterion.
Greater Huddersfield CCG:Site Visit Report
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