Agenda item

To consider the 2015-2016 performance of the Blackpool Clinical Commissioning Group (CCG).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group (BCCG) and Mr Roy Fisher, Chairman, BCCG presented the BCCG’s performance report for March 2016 and for the full year, 2015-2016. Mr Bonson explained that the BCCG had to follow national reporting requirements and key target measures. The BCCG commissioned a range of services provided by other organisations and so shared performance responsibility. The key measures covered a range of access to service areas. 

He highlighted areas where performance was below target and needed improving. The target for accident and emergency waiting times from arrival to being discharged after treatment was for 95% of patient visits to be achieved within four hours. The end of year outcome was under 93% and for March 2016 only around 86%. Mr Bonson explained that accident and emergency waiting times were nationally challenging and that winter months had a knock-on impact for the rest of the year with ongoing efforts to regain performance.  Members enquired about the two measures for types of accident and emergency attendance and requested more detailed information on the ‘all types’ of attendance measure. Mr Bonson explained that the walk-in health centre in Whitegate Drive, Blackpool offered a Tier 3 GP-led primary care service and this level of accident and emergency service had to be recorded separately and agreed to provide more detailed information following the meeting. Mr Fisher explained that the Tier 3 service at the walk-in centre on Whitegate Drive provided an important part of the care pathway including pointing patients in the right direction of care.

He added that urgent care systems were generally under pressure, e.g. ambulance emergency call-outs had increased. This had resulted in ambulance response times falling short on all targets for March 2016 and the full year 2015-2016 across Lancashire. Pressures were also seasonal with the greatest number of call-outs during the winter period. However, more recently figures were back on track for the Lancashire area.

Mr Bonson explained that although the performance report measures were for Blackpool, the BCCG was responsible for regional commissioning of the North West Ambulance Service (NWAS) and therefore the figures presented were for the wider area. It was noted that more localised performance figures demonstrated that the NWAS met targets within Blackpool and it was agreed that a more detailed discussion on  the ambulance response rates in Blackpool would be brought to a future meeting.

Members sought clarification on the difference between two of the Category A red indicators which both required 75% of response times to be within eight minutes but were below target. Mr Bonson explained that the first red indicator was for life-threatening emergencies and the second red indicator for other extremely serious call-outs such as road traffic accidents. Members added that the public wanted reassurance that a good ambulance service was being provided and good work should be publicised.

Members enquired how Accident and Emergency services and ambulance services would cope with increased pressures particularly during the winter period and what planning was taking place. Mr Bonson explained that a multi-agency resilience group of key health and social care operational partners forecast pressures and reviewed resources and plans to manage pressures during winter and all year round. Specific winter planning started around September each year. Ms Pat Oliver, Director of Operations, Blackpool Teaching Hospitals added that summer months were often the busiest period for accident and emergency with the increase in visitors, events and festivals. Delays discharging patients also had a knock-on impact.

Mr Bonson referred to the provision of mental services with particular reference to improving access to psychological therapies (IAPT) and recovery rates for psychological therapies. The Chairman asked for clarification on the meaning of the various terms.

Mr Bonson explained that the therapies focused on counselling and other forms of ‘talking’ therapies. The first measure, upon which the others were developed, was complex and was a national estimate on the percentage of the local population expected to need to access mental health services and the local access target. The recovery rate was an important and challenging measure. Services were performing poorly  at just over 35% recovery, which was well short of the 50% target. He explained that recovery could only be deemed successful if a patient had made significant progress although this might not mean a full recovery. The Committee requested that full definitions of measures be circulated following the meeting.

Members noted that early intervention with young people could reduce longer-term mental health problems and asked how young people were supported. Mr Bonson explained that mental health provision for young people and adults was provided by different services. He agreed to provide information on the provision of mental health services including progress with recovery rates to a future meeting.

Mr Bonson added that a backlog of IAPT work had arisen but more recently progress had been made and performance was now above target. A new system had been developed whereby patients could self-refer to the right pathway, rather than through their GP, for less complex services such as counselling which meant bottlenecks were reduced by ensuring patients were in the right pathway queue.

The Chairman noted that the report covered a wide range of performance data but nothing on quality. In response, Mr Bonson confirmed that quality of care data was collected including complaints data and use of the ‘Friends and Family’ test for whether people would recommend a hospital service. Mr Fisher added that GPs had Patient Participation Groups which fed into collated datasets. Quality of care data was considered through the BCCG’s Quality and Engagement Committee and quality assurance could be reported back to Members.

The Chairman queried the performance of waiting times for cancer treatment and why the ultimate target was not set at achieving 100% performance success. Mr Bonson explained that monitoring against the target commenced as soon as a GP referral was made for assessment by a hospital consultant. However, the monitoring of performance did not take into account individual delays. There were various reasons for delays including patient choice, assessments identifying unexpected health problems and 14 cancer groups with different pathways. Some forms of cancer could be tested for and identified relatively quickly whilst others were extremely complex. He added that the national targets had been developed based on robust evidence.

Ms Oliver explained that the Hospital Trust considered approximately 1,000 patients each day for cancer related issues and gave assurance that the progress of each patient was carefully tracked. 

Members queried the impact of financial penalties referred to in the performance report. In response, Mr Bonson explained that there was a national requirement to impose penalties on providers missing performance targets, in particular waiting list targets. However, rather than just imposing punitive penalties on struggling providers the best use of funds for a more patient-focused approach was pursued. Mr Fisher explained that fines imposed on Blackpool service providers were reinvested in those services to promote improvement.

Mr Bonson and Mr Fisher were thanked for their report.

The Committee agreed:

1.      To receive detailed information on attendance types of patients at Accident and

Emergency. 

2.      To receive a full performance report on the ambulance service including response rates from Blackpool Clinical Commissioning Group and the North

West Ambulance Service.

3.      To receive definitions on the various terms and measures used concerning

improving access to psychological therapies (IAPT) following the meeting from BCCG.

4.      To receive information from BCCG on the provision of mental health services including progress with recovery rates at a future meeting.

5.      To receive a quality of care performance report from BCCG at a future meeting.