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Patient experiences improving across Staffordshire and Stoke-on-Trent although finances still strained

Improvements are being made to patient care across Staffordshire and Stoke-on-Trent, despite this year’s annual assessment ratings for clinical commissioning groups (CCGs).

Five of the six CCGs have been rated ‘inadequate’ in the assessment for 2018/19, although NHS England has recognised the work being done to address key areas of concern and the significant achievements that have been made in other areas.

The CCGs have continued to prioritise patient safety and made improvements in areas that directly impact on the care patients receive such as improving the urgent and emergency care system, with performance at the University Hospitals of North Midlands (UHNM) recognised as one of the most improved in the country.

All six CCGs have also been rated as ‘Green’ in the Patient and Community Engagement Indicator, after achieving either ‘Good’ or ‘Outstanding’ in the five assessment domains and evidencing compliance in fulfilling their statutory duties.  

Marcus Warnes, Accountable Officer for the six CCGs in Staffordshire and Stoke-on-Trent, said: “Throughout the last 12 months we have prioritised patient safety, and this is and always will be our main concern. I will not compromise patient safety at the expense of financial challenges; however, this is clearly something that we still need to address, not just as individual CCGs but by working together across the local healthy economy.”

The key area of concern for the CCGs rated as inadequate relate to the continued financial challenges they have faced during 2018/19. Although NHS England noted that Stafford and Surrounds CCG and Cannock Chase CCG met their deficit control total this year, there has been a significant deterioration in the financial position for North Staffordshire CCG and Stoke-on-Trent CCG and the underlying deficit across Staffordshire and Stoke-on-Trent has exceeded £100million. East Staffordshire CCG retained their ‘Good’ rating after hitting this year’s financial control total.

NHS England were encouraged that the system has embarked on a new contracting approach for 2019-20, working collaboratively across the system to identify and implement opportunities for transformational savings with a risk sharing agreement across provider and commissioner organisations.

Through the IFP, the distribution of the CCGs’ allocation between partners has been agreed at the start of the year after considering baseline spend, investments and cost pressures, and saving trajectories. The distribution has been based on baseline spending levels in 2019/20 and the principle that each organisation bears the same proportion of the overall deficit in the system.

In addition, a system programme savings target has been agreed, which focuses on schemes that rely on partners working together across the health economy. Delivery of the programme savings will be risk managed across the system with progress and delivery being monitored on a monthly basis.

Marcus added: “As commissioners, we have a clear understanding of how we need to address our financial issues and we are working closely with our providers to do that with things like an Intelligent Fixed Payment system that has been introduced. The Intelligent Fixed Payment System is a new contracting approach that moves the focus from cost shifting between partners to collaboration and system cost reduction.

“Despite the financial challenges however, during this period there have been some very significant achievements that we are rightly proud of, and the ratings do not reflect the services our patients receive or the hard work and commitment of our staff.”

Despite the annual assessment ratings for 2018/19, NHS England has recognised that the CCGs in Staffordshire and Stoke-on-Trent have made significant achievements in the last 12 months.

They have prioritised patient safety and experience and have gained recognition for the way they involved patients with changes to local NHS services.

The results of the Patient and Community Engagement Indicator, which is a formal requirement of IAF, has rated all six CCGs as ‘Green’ after achieving either ‘Good’ or ‘Outstanding’ in the five assessment domains, which include Governance, Annual Reporting, Day-to-Day Practice, Feedback and Evaluation and Equalities and Health Inequalities. 

 Other achievements recognised by NHS England in this year’s assessment include:

  • Good progress in improving our urgent and emergency care system, especially at the University Hospitals of North Midlands (UHNM), which is now one of the most improved in the country. Performance at the Royal Wolverhampton Trust (RWT) and the University Hospitals of Derby and Burton (UHDB) is also consistently good, which is helping to improve outcomes of patients
  • Delayed Transfers of Care (DTOCs) have dramatically reduced. DTOCs relate to patients who don’t need to be in hospital but are in a bed because the support they need to live at home is not available. Month-on-month they have declined by over 40 per cent across Staffordshire and Stoke-on-Trent
  • UHNM is now one of the highest achieving trusts for cancer targets, which has resulted in Staffordshire receiving additional funding through the West Midlands Cancer Alliance and significant improvements have been made and maintained at UHDB
  • Investment in mental health services has been increased and now meets the national standard across Staffordshire and Stoke-on-Trent
  • All Staffordshire and Stoke-on-Trent GP practices are now members of a Primary Care Network which means they will collaboratively work at scale and are looking to offer more and better services to patients.