Agenda item

To receive presentations on commissioning intentions for 2015/16 from the following:-

a)         Leicester City Clinical Commissioning Group – Attached at Appendix B

b)         NHS England Area Team – Attached at Appendix B1

Leicester City Clinical Commissioning Group

The Board received presentation on commissioning intentions of the Leicester City Clinical Commission Group for 2015/16 from Sue Lock, Managing Director.   A copy of the presentation was previously circulated with the agenda.

In addition to the comments included in the printed presentation, the following comments were noted:-

a)         The CCG had only recently received its allocation and were still in discussion with the providers and the other CCGs about the detail of what can be purchased within the overall allocation.

b)         The commissioning intentions were formed by National Planning Guidance, The Better Care Together Programme and the CCG’s priorities based upon local health needs and Equality Impact Assessments analysis.  The local priorities were drawn from both the Closing the Gap Strategy and the CCG’s own priorities, which are informed by the EIA analysis, and also from feedback on the provision of existing services to test that they are appropriately designed and delivered.  For example, the NHS Health checks where work had been carried out to ensure that there was suitable geographical coverage as well as suitable population coverage and to ensure that all those that required the checks received them.

c)         High level EIA’s are produced once the high level commissioning intentions are identified.  The specific detailed EIAs are then produced when the implementation of individual services are designed and introduced.  The EIA’s and the Quality Impact Assessments go through an internal executive committee and then onto the governing body.  They are published on the website and are tested at each stage of the governance structure.

d)         The changes to the national planning guidance were outlined in the presentation notes.  There were now access targets for mental health services which meant that services such as IAPT and psychosis would need to be assessed to evaluate the amount of activity that was commissioned and that they were appropriately designed to meet the level of demand.  The Joint Integrated Commissioning Board were looking at the development and roll out of personal health budgets and integrated personal commissioning.  There was now a greater focus on prevention services which was welcomed in order to achieve sustained improvements in patient health. 

e)         The commissioning intentions for the Better Care Together and the CCG’s priorities were listed in the presentation.  These presented an opportunity for closer working with Adult Social Care Services and for the CCG to provide more health care services in care homes to prevent hospital admissions.  It was important to support people to access the various services available to them through the personal health budget process, which could be complex and daunting.  Further work was also required to improve the access of older members of the Asian community and young black British men to mental health services.

f)          Research and analysis was being conducted into access rates across different parts of the city and by different groups to determine if services such as dementia had the right tools to test people’s understanding and memory, as one tool used by GPs for screening purposes is not suitable for older Asian people or people who do not have English as their first language or have recently moved to England; as some of the tests are reliant on responses in English and a knowledge of English culture and recent historical events.  These were being assessed to see if the screening process can be improved.

Members of the Board commented that:-

a)         The Chair felt that it would be good practice to have a common model for undertaking EIA’s both in local authorities and the health structure, and this should be considered.

b)         Community and anecdotal evidence suggested that the LGBT community had poor consumer experiences of health services.  Approximately 80% of gay and homosexually active men had not ‘come out’ to their GP and this led to significant problems with a lack of information about how they present their health issues to their health care professionals.  These issues may not be readily identified by the usual methods of on-going monitoring or reviewing service needs, which may be inhibiting the significant changes that are required to address the health inequalities that are being experienced by the LGBT community. 

c)         Greater involvement of key communities, of which LGBT was one, in participating in the EIA’s may be a way to improving trust and confidence that the right health priorities were being commissioned.

d)         There were cultural obstacles in BME communities to taking part in screening for breast, cervical and prostate cancers and this needed to be recognised in the screening process and addressed.  Dedicated outreach reach workers for these groups could be considered as a way to improve the take up rates of the various screening methods.  In response, it was stated that the CCG would look at individual GP take up rates of screening and would take steps to work with practices which experience lower rates in order to improve them.

The Chair recognised that there were a number of issues in considering items and topics such as this as it was difficult to articulate what would ultimately be different or better at the end of the process.  Data and data gaps were a theme across a number of strategies and commissioning plans. Gaps in data were important but also there were challenges in drawing upon vast arrays of data sources and articulating that in how decisions were made and commissioning intentions and priorities were formed.

He suggested that there should be a sub-group of the Board to look at data gaps, and the data gaps in relation to the LGBT community, for example, was not just exclusive in relation to health but also in the wider importance to the public sector generally.  The work should also look at the direct references from the Joint Specific Needs Assessments and the data that was available and the data that was needed to support issues which were considered at a higher strategic level.  It was important to demonstrate that decision making made the best use of the resources and data that underpinned them.

NHS England

Trish Thompson, Director of Operations and Delivery, NHS England Local Team, stated that the report submitted by NHS England was being withdrawn as further work was required on the consultation process for the specialised services being commissioned and the proposals were not, therefore, completed.

The direct commissioning of primary care by the CCG would be picked up later in the item on the CCG Primary Care Co-Commissioning.

The Chair expressed disappointment that the report was not available before the commissioning intentions were put into operation.  In response, it was stated that this situation was being experienced in other NHS England areas in relation to specialised commissioning services, and NHS England had fed their concerns back to the NHS Central Team.

RESOLVED:

1          That the CCG’s commissioning intentions be endorsed.

2.         That the NHS England’s commissioning intentions be circulated as soon as they are available.