Appendix 2

Report to:Tees Valley Chief Executives

Subject:Tees Valley Public Health Shared Service

Date:June 2014

  1. Purpose of the Report

1.1To update the Tees Valley Local Authority Chief Executives on the Tees Valley Public Health Shared Service, and key progress / achievements since the last report in March 2014.

  1. Background

2.1Tees Valley Public Health Shared Service (TVPHSS) formally commenced in April 2013. The service provides a cost effective Public Health Function across the Tees Valley and makes best use of scarce specialist public health specialist resources, knowledge and skills. The arrangement enables the five Tees Valley Directors of Public Health (DsPH) and their teams, Clinical Commissioning Groups (CCGs), Public Health England and NHS England to work collaboratively to improve health and wellbeing and reduce health inequalities in the area.

  1. Key Progress / Achievements

3.1Outcome 1 - Clinical Public Health Leadership

Finding the Missing Thousands

  • NHS Health Check Programme – at the end of year, 1st April 2013 - 31st March 2014, all localities substantially exceeded national targets for invitations. Local data for this period also revealed that combined ‘Tees’ totals for assessments performed in primary care and community settings realised 51.22% of targets set nationally. The national target at present is 50% uptake of the invitation target with an aspirational target of 75% over the coming years.
  • At the beginning of May, the Directors of Public Health in our local authorities were presented with the Tees Healthy Heart Check (NHS Health Check) and Lung Health Check (LHC) combined report. This includes data from Quarter 4 (1st January – 31st March 2014) and total activity for 2013 / 2014. It also provides information of activity by ward of residence, statin uptake for patients with a CVD risk score ≥20%, percentage of eligible patients screened (LHC) and subsequently diagnosed with COPD and invaluable information about quintile of residence for all patients screened. The report was very well received.
  • Coatham Project - This is a six-month pilot project in Redcar & Cleveland, being led by TVPHSS, toreduce inequalities in uptake of healthy heart checks (HHC) in Coatham ward.The project willraise awareness of the availability of a free HHC and provide eligible residents with an alternative setting to access a HHC, other than GP practice.An asset based approach will be adopted working with community organisations and groups affiliated to the Coatham ward. A mobile setting, using a trailer positioned on the High Street every Friday (market day) and libraries will be offered as alternative settings for the HHC. The project will have ongoing evaluation to monitor its impact.
  • Lung Health Check programme - interim evaluation of this programme reveals that:
  • Since January 2013 more than 4,000 local smokers have been screened for COPD by their local GP practice.
  • Overall 15% (or 1 in 7) of people who have had a lung health check have subsequently been diagnosed with COPD.
  • Of all COPD diagnoses made during the first year of the programme 27% of people had had a lung health check.
  • Older smokers (aged 65 and over) are ten times more likely to be diagnosed with COPD following a lung health check than younger smokers (aged less than 40 years).

Full evaluation of the programme will be available later this year.

  • From April 1st 2014 the Lung Cancer Awareness check was incorporated into the Lung Health Check. The rationale behind this is that the eligible population for LHC are at higher risk of developing lung cancer.
  • TVPHSS look forward to welcoming Jamie Waterall (National Lead for NHS Health Checks) on 25th July during his visit to the North East. This will provide an opportunity to discuss support required from Public Health England (PHE) and areas of innovation and good practice within our localities.

Sexual Health

TVPHSS leads on the commissioning of a Teeswide integrated sexual health serviceand supports the delivery of sexual health promotion and prevention in local authorities.

TVPHSS now advises and supports the commissioning and procurement process of sexual health services in Darlington.

A Teeswide sexual health needs assessment highlighting sexual health needs, current services provision and gaps in services provision has been completed and is in the process of being presented at local authority Health and Wellbeing Boards and subgroups. An action plan based on the recommendations made in the sexual health needs assessment is being implemented and overseen by the Tees Valley sexual health commissioners group.

Public Health Core Offer

  • The Public Health Core Offer steering groups for Hartlepool and Stockton CCG and South Tees CCG, chaired by the TVPHSS, are currently agreeing a work programme for 2014 / 2015 for the mandated public health core offer to NHS commissioners.

Immunisation and Screening

  • TVPHSS continues to represent the Tees Valley Directors of Public Health at the NHS England Durham, Darlington and Tees Area Team (DDT AT) Screening and Immunisation Oversight Board, Screening Board and Immunisation Board as well as other immunisation groups andwork with the DDT AT/ PHE Immunisation and Screening team to improve the uptake of immunisations and NHS cancer screening programmes.
  • Agreement with DDT AT team to provide quarterly information on childhood immunisations at ward, children’s centre and GP practice level for all our local authorities.

Tees Valley Public Health Clinical Quality Advisory Forum

  • The clinical quality advisory forum meets regularly with representation from all local authority public health teams in Tees Valley. The forum has developed a clinical governance framework, serious incident policy and PGD policy which are in the process of being localised and adopted by local authorities. The forum further provides a structured format to share relevant clinical incidents, safeguarding concerns and complaints and to inform on relevant issues raised at CCG, AT and TEWV quality meetings.

Pharmaceutical service

  • Supporting on-going mobilisation of:
  • drug / and or alcoholmisuse services in Hartlepool and Stockton.
  • Smokingcessation services in RCBC and MBC including implementation of Quit Manager in pharmacy setting and development of new pathways for use of the drug - Varenicline.
  • Developed and supporting implementation of a plan to ensure the formal review of existing Pharmaceutical Needs Assessments for eachof five Health and Well-being Boards by 1st April 2015.Publication of a revised Pharmaceutical Needs Assessment is a statutory requirement for each local authority.
  • Supported the introduction of Pharmoutcomes, a database for recording and managing data related to community pharmacy services.
  • Developed template policy for Patient Group Directions and working with existing providers to ensure Patient Group Directions are authorised in line with legislation.
  • Supported mobilisation from 1st April 2014 of new service for supply of Healthy Start Vitamins through community pharmacies in MBC, RCBC, HBC and SBC.
  • Supporting mobilisation of weight management project in community pharmacy (SBC)
  • Providing input into a project to improve the uptake of cervical screening (MBC).
  • Inputting into the review and development of guidance for management of medicines in schools.

3.2Outcome 2 – Public Health Intelligence

  • Joint Strategic Needs Assessment (JSNA) – the process to support Topic Leads to maintain and develop the JSNA electronic content for all Tees localities is in place. A list of unmet needs and commissioning intentions for 2012-15 has been distributed for each locality. JSNA theme summaries for each locality are now available on the JSNA. Work continues with Darlington to support the development and maintenance of their JSNA using their Local Information System.
  • Better Care Fund (South Tees) – work has begun to develop a common understanding of joint intelligence among the five principal organisations involved in the integration of health and social care (two local authorities, South Tees CCG, South Tees Acute Trust and TEWV Trust). Appropriate data is being identified, assessed and will be shared in a summarised format.
  • Children’s Centres – work continues to maintain and develop routinely available data to support frontline staff and service managers.
  • Sexual health – work continues to support needs assessment and contract management.
  • Obesity – provided a contribution to an event in Stockton-on-Tees (Northern Locality Forum) with the purpose of raising awareness of the risk of obesity and the burden on local health and healthcare.
  • Benchmarking health risks and outcomes – an analysis of Tees Valley districts and their ‘nearest neighbours’ was published in March 2014. This shows how each local authority is better (or worse) than peer authorities as a spur to more effective health improvement.
  • Premature mortality – an analysis of the numbers of premature deaths (age under 75 years) for the common causes of death was published in March 2014.
  • Top Leaders Impact Group – a contribution to learning on inequalities in health in South Tees was provided for a recent visit of senior leaders to Teesside. This involved a journey through Middlesbrough including a site visit to a community-based residential initiative for vulnerable adults.
  • Continuing support for local authority Public Health Improvement Specialists with data analysis, presentation and interpretation.
  • Ad hoc support to individuals and organisations including such things as:
  • Support with access to cancer data and interpretation
  • Geographical mapping of pharmacy services
  • Analysis of data to support both child and adult mental health strategies

3.3Outcome 3 - Public Health Commissioning

Sexual Health Service

  • End of year reconciliation is currently being completed taking into consideration actual activity, penalties and incentivised activity.
  • Exceptions reporting on walk-in times at North Ormesby Health Village and chlamydia targets are still being closely monitored. Sexual Health Teesside (SHT) are to commission a marketing company to provide a dedicated Teeswide team to oversee all aspects of chlamydia testing such as marketing and promotion.
  • New 2014/15 CQUIN schemes are expected to be finalised by 13th June 2014.
  • Following a CQC children looked after and safeguarding inspection (CLAS) in Stockton in January 2014 a number of recommendation were made. TVPHSS are closely monitoring Sexual Health Teesside’s (SHT) remedial action plan. Actions include training all clinical staff to level 3 safeguarding (due to complete by 30th June 2014) and the provision of evidence that all SHT employees have received Safeguarding Children Training in accordance with contract specifications (due to complete by 30th July 2014).
  • TVPHSS is still awaiting provider sign off of contractual documentation which effectively disaggregates the contract amongst the 7 responsible commissioners (LAs, CCG, Area Team). However, advice on this issue is being sought from the Tees Valley District Lawyers Group.
  • A project proposal was presented to the TVPHSS Governance Board (3June 2014) for consideration and approval to proceed with a review of the Tees Commissioning Model for Sexual Health Services as the current contractual arrangements will end in January 2016. The proposal details the steps required for a full review of the existing Sexual Health Services’ commissioning model across Hartlepool, Stockton, Redcar & Cleveland and Middlesbrough. The project will also look at the cost and quality of the current delivery model and make recommendations to the Authorities on future model(s) of delivery and commissioning options. TVPHSS will lead the review with local authority sexual health leads actively supporting that
  • In addition, a rationale was also presented to the Governance Board recommending that sexual health services remain as integrated tees-wide services. It was proposed that a lead authority will be identified to act on behalf all four tees’ authorities and that a single procurement process will be undertaken that allows local determination of services to reflect need.
  • TVPHSS are supporting the review of sexual health services and procurement planning in Darlington who will be undertaking a separate process to the Tees Local Authorities.
  • TVPHSS are validating and monitoring payments for non-contracted GUM activity for out of area attendances on behalf of the authorities.

GP & Pharmacy Contracting for PH Services:

  • Discussions with Local Pharmacy Committee and Local Medical Committee have been completed and PH contracts have been prepared and issued to all providers. The TVPHSS are monitoring take up amongst providers.
  • TVPHSS are continuing to manage the process for validating monthly and quarterly GP and Pharmacy payments with end of year reconciliation taking place in June 2014 for those services which have annual incentivised targets.
  • An IT solution (Pharmaoutcomes) has been procured and gone live to support improvements in the administration and validation of Pharmacy claims.
  • Mobilisation of an IT solution to support the electronic transfer of patient records from community providers of NHS Health Checks to GPs has begun. It is anticipated that this will be live in July 2014.
  • Development and review work on the commissioning model for primary care services and NHS Health Checks continues to be led by the TVPHSS.
  • TVPHSS are continuing to review provider performance on a quarterly basis to develop service improvement strategies.

NHS Trust Provider Contracts for PH Services:

  • Service reviews continue to be led by LA leads with support from the TVPHSS contracting team.
  • LA commissioning intentions and contract values for 2014/15 have been negotiated with providers North and South. Preparation of contract documentation relating to 14/15 is being completed.
  • The provision of immunisations and vaccinations has been varied from NTHFT and STHFT contracts. The responsibility for which transfers to the Area Team.
  • The TVPHSS are continuing to facilitate LA discussions with the CCG and Area Team in relation to the realignment and transfer of commissioning responsibilities, service reviews and future procurements.
  • TVPHSS are supporting exit and procurement planning processes.
  • TVPHSS continue to review provider performance and manage contract review meetings with providers on a monthly and quarterly basis.

3.4Outcome 4 - Public Health Business Support

  • Work completed with Finance to ensure the efficient closure of accounts for 2013/2014. The Shared Service has achieved an underspend position which will be carried forward and utilised in order to reduce the LA contributions for the 2014/2015 budget.
  • Work is ongoing to ensure robust systems are in place for provider payments.

3.5Outcome 5 - Training and Workforce Development

  • Public health taster sessions have been arranged with a junior doctor, who is considering public health as a career but has no experience or understanding of how the job works day to day.
  • Consultant in TVPHSS has qualified as an educational supervisor for the public health specialist training scheme.
  • Middlesbrough will host the second in a series of Tees Valley locality CPD session on 19th June entitled “Public Health in Local Government - are we maximising on the opportunities?”
  1. Continuous Quality Improvement

The Public Health Governance Board received feedback from the semi-structured interviews, conducted in August 2013, with all five DsPH and the Clinical DPH for TVPHSS. An overview of emerging themes/issues include:

  • Common understanding of the potential of TVPHSS
  • Differing perceptions based on previous relationships
  • Differing interpretation and expectation around Governance and Hosting arrangements
  • Visibility in the Councils
  • Linkages with other Stakeholders
  • Responsiveness and Customer Focus
  • Opportunities and Benefits of TVPHSS

The board agreed it was a useful reflection of thoughts on the service in August 2013 but would need updating to highlight progress/issues that need resolving, and the broad themes would need constant reflection and updates at future Board meetings.

  1. Recommendations

It is recommended that the Chief Executives note the content of the report and key achievements to date.

Report Authors:Edward Kunonga

Chair, Tees Valley Public Health Shared Service Governance Board

Dr Toks Sangowawa

Clinical Director of Public Health, Tees Valley Public Health Shared Service

Date:June 2014

1