|Quality and performance indicators||Actual (YTD)||Target|
|A&E waiting times||% Patients admitted, transferred, or discharged within four hours of arrival at A&E||
|Referral to treatment (RTT) times for non-urgent consultant-led treatment||% Patients on incomplete pathway waiting less than 18 weeks||
|Diagnostic waiting times||% Patients waiting less than six weeks for diagnostic test||
|Cancer two-week wait||% Patients with maximum two-week wait for first outpatient appointment when referred urgently with suspected cancer by a GP||87.61%||93.00%|
|% Patients with maximum two-week wait for first outpatient appointment when referred urgently with breast symptoms (cancer not initially suspected) by a GP||72.77%||93.00%|
|Cancer 31-day wait||% Patients with maximum 31-day wait from diagnosis to first definitive treatment for all cancers||92.95%||96.00%|
|% Patients with maximum 31-day wait for subsequent treatment (surgery)||78.78%||94.00%|
|% Patients with maximum 31-day wait for subsequent treatment (anti-cancer drug regime)||99.29%||98.00%|
|% Patients with maximum 31-day wait for subsequent treatment (radiotherapy)||97.73%||94.00%|
|Cancer 62-day waits||% Patients with a maximum 62-day wait from urgent GP referral to first definitive treatment for cancer.||70.76%||85.00%|
|% Patients with a maximum 62-day wait from referral from an NHS screening service to first definitive treatment for cancer.||53.01%||90.00%|
|Maximum 62-day wait for first definitive treatment following a consultant’s decision to upgrade the priority of a patient (all cancers)||82.14%||No target|
|Mental health: Care Programme Approach (CPA)||The proportion of people under adult mental health specialties on CPA who were followed up within seven days of discharge from psychiatric in-patient care during the period||96.15%||95.00%|
|Referral to treatment waiting times||Number of more than 52-week waiters (incomplete pathways)||995||0|
|Incidence of healthcare associated infection||CDI (C Difficile Infections): Number of infections||85||89|
|MRSA: Number of infections||4||0|
|Never events||Number of events||2||0|
|Serious incidents||New incidents||50||0|
|Dementia||Estimated diagnosis rate for people with dementia||59.87%||66.70%|
|Improving Access to Psychological Therapies (IAPT)||The recovery rate of people using IAPT services||51.83%||50.00%|
|The proportion of people that wait 18 weeks or fewer from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period||98.30%||95.00%|
|The proportion of people that wait six weeks or fewer from referral to entering a course of IAPT treatment against the number of people who finish a course of treatment in the reporting period||85.53%||75.00%|
 Less than 1% of patients waiting no more than six weeks for a diagnostic test
 Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. An example could be an operation on wrong limb.
 Serious incidents are events where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant, that they warrant using additional resources to mount a comprehensive investigation.
There are performance concerns in respect of the following areas:
A&E waiting times
A&E performance for patients to be seen within 4 hours has not achieved the target of 95% between April and February 2022 with performance at 80.63%.
The infection prevention and control (IPC) guidelines, which were adapted to ensure safety during the COVID-19 pandemic are closely followed by the Trust for patients entering A&E. This clearly does impact upon the time taken between patients and consequently upon waiting times for patients.
The CCG is working collaboratively with the Trust and all Fylde Coast providers and partners to ease these pressures by ensuring patients are signposted to the most appropriate clinical setting for their conditions to be treated appropriately and efficiently.
18 week referral to treatment target
Fylde and Wyre CCG did not achieve the 92% RTT open pathway standard between April and February 2022 with performance at 65.38%. Work continues to be focused at specialty level to reduce the number of long waiting patients. A continuous programme of audit and validation is supporting the Trust Patient Tracking List (PTL) management. This focuses across outpatient, diagnostic and waiting list elements of the pathway. Full Trust validation of the waiting lists continues to take place on a weekly basis together with ongoing clinical triage at Consultant level to ensure that all patients are treated in order of clinical priority.
The Fylde Coast CCGs have also continued to engage with independent sector providers across Lancashire throughout 2021/22 to increase capacity and reduce waiting times for patients. This has focussed on equity of access with clinical priorities taking first place, followed by long waiting patients being treated in turn. There has also been a concerted focus on the timely discharge of patients to maximise all available bed stock and improve patient flow within Blackpool Teaching Hospitals.
Cancer waiting times
The CCG is not meeting some of its cancer waiting times targets and action plans; led by the Lancashire and South Cumbria Cancer Alliance, are in place to support improvement.
The diagnostics standard of less than 1% of patients waiting no longer than six weeks has not been achieved by Fylde and Wyre CCG predominantly due to constraints within the endoscopy service exacerbated by the COVID-19 pandemic. Blackpool Teaching Hospitals has an action plan in place which has improved performance; however, it is important to note that there are performance issues within the endoscopy services across Lancashire.
We are required to report our progress in delivering against sustainable development indicators.
We are developing plans to assess risks, enhance our performance and reduce our impact, including against carbon reduction and climate change adaptation objectives. This includes establishing mechanisms to embed social and environmental sustainability across policy development, business planning and in commissioning.
We will ensure we comply with our obligations under the Climate Change Act 2008, including the Adaptation Reporting Power, and the Public Services (Social Value) Act 2012.
We have a sustainable development management plan which sets out our commitments as a socially responsible employer. This features:
- compliance with environmental legislation.
- organisational and workforce development.
- partnerships and networks.
- energy and carbon management.
- commissioning and procurement.
- low carbon travel transport and access.
- water and waste.
- designing building environment.
Key to delivery is working with other stakeholders such as NHS Property Services in areas where joint understanding and working is necessary.
The COVID pandemic has meant that we have endorsed an ‘agile working’ approach across our organisation. This means that our employees have adopted a mix of work arrangements, spending most of their working hours away from a formal office and flexibility about where people can work if they do need to attend a CCG office for a specific reason or work activity. Our workforce has embraced the opportunities that agile working brings to support our sustainable development work, for example, reduction in travel time by using virtual meeting options such as Microsoft Teams, reduction in paper usage, more effective use of technology, reduced travel impact (for example cost and fuel usage) and lower energy consumption in offices.
We recognise our responsibility towards sustainability and the many benefits it brings. Working closely with our partners and providers, we continue to support new ways of working and development that embrace the concept of sustainability.
Any new projects, either new build or refurbishment, will include a sustainable package of measures that for example will include low energy lighting (LEDs) sustainable drainage solutions, heating controls and procurement of locally sourced materials and labour as standard and much more.
Working closely with health partners, encouragement will be given to the feasibility of ‘one-stop health provision’ and the reduction in the need to make multiple trips to several locations in the same town. Travel plans will be explored to reduce car journeys and shared with stakeholders.
Such an approach will be undertaken with new developments to co-locate health services under one roof. The CCG will be investigating further opportunities for other services at all its sites. Continuing dialogue will be held with staff and providers.
The CCG’s estates strategy sets out the vision for the next few years ahead where sustainability will play a key role in all developments.
The NHS Constitution sets out a clear set of rights our patients can expect, and we intend, as an organisation, for these to be met and for our patients to experience the best possible care and effective outcomes.
The CCG is committed to commissioning local services that deliver safe, effective, high-quality healthcare that meets nationally set guidance, policy, and procedures. Continual improvement in the quality of services that our patients receive is paramount and incorporates improvements in both patient experience and patient outcomes as well general quality measures. Our work is underpinned by the principles of good engagement and involvement of patients, carers, and the community to support our aspirations and the expectations of the NHS Long Term Plan.
Over the past year NHS Fylde and Wyre CCG has worked hard to make sure quality continues to be an integral strand to the services it commissions. One way in which the CCG checks the impact of services on quality is by reviewing quality impact risk assessments. A sample of the assessments that have been reviewed in the last year is below.
Table 2: Quality Impact Assessments (QIAs) / Equality Impact Risk Assessments (EIRAs)
|Service||Outline of Service||Approved|
|Long COVID Service||The service is available for patients with signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.||Approved 11 May 2021|
|Fylde Coast COVID vaccine hotline||A COVID-19 Vaccine Hotline to support people living on the Fylde Coast who require access to information regarding the Fylde Coast COVID-19 Vaccination Programme.||Approved 11 May 2021|
|Review of uptake of Severe Mental Illness (SMI) annual physical health checks (PHC) in Primary Care and Secondary Care||The purpose of the SMI Physical Health Check Task & Finish Group is to review the uptake of the annual
health checks both in Primary Care and Secondary Care.
|Approved 11 May 2021|
|Diabetes Community Clinic Pilot Scope
|The Community Diabetes Clinic pilot has ended, and community clinics have been paused. The pilot was intended to test out an alternative model of service providing multi-disciplinary support to unstable diabetic patients. The CCGs worked with Blackpool Teaching Hospitals to produce an evaluation.||Approved 13 July 2021|
|Mental Health Support Teams for Children and Young People in Education
|To commit to establish a Mental Health Support Team (MHST) in Blackpool and a team in Wyre.||Submitted in August 2021 (not approved)
Resubmitted in September with amends to the risk score and additional justification of the areas and schools selected.
The Committee approved the QIA/EIRA on 14 September 2021
|Parent Infant Relationship Service||A mapping exercise across the Fylde Coast ascertained that there was a notable gap for teams that provide specialist clinical interventions for under 2s, with a need identified across Blackpool for the provision of a Specialised Parent-Infant Relationship Team.
|Submitted in August 2021 (not approved)
Resubmitted with assurance that discussions were being held with the CCGs Director of Finance with work around processes and criteria being undertaken for the scheme to be considered a priority for use of funding.
The Committee approved the QIA/EIRA on 14 September 2021
|Blackpool Children and Young People with Learning Disabilities Service
|The aim of the service is to provide a local accessible, responsive, early intervention community based, specialist service to children and young people aged 0-18 with a moderate to severe Learning Disability who present with behaviours that challenge and/or mental health issues, whose needs cannot be met by existing services.||Approved 14 September 2021|
|Quality Impact Assessment (QIA) update
|As an aide memoire the Head of Quality provided
background information on the procedure for
submitting QIAs to the QI & EC and reminded the
Committee of the importance of why QIAs were
|Received and noted 12 October 2021|
|Funding request to support community access (EIRA only)||Specific funding request for an additional 25 hours per week 2:1 to support community
|Stage 1 EIRA was received and noted
14 December 2021
|Fylde Coast Homeless Cancer screening pilot Nov 2021
|To reduce the health inequality seen in cancer screening services to better include patients who have no fixed abode or are homeless.
Planned on-site quality assurance visits have largely not been undertaken during the pandemic to reduce the risk of transmission. Nevertheless, the CCG’s quality and safeguarding teams and commissioning managers have continued to be in contact with providers and have responded promptly to information, concerns, or queries in relation to patient safety and/or patient experience. As far as possible, the CCG’s teams have sought to understand and address the challenges experienced by providers to delivering high quality care; to offer support wherever practicably possible and where necessary, have put additional challenge and monitoring arrangements in place.
On site visits have been made to the Blackpool Teaching Hospitals Trust during periods of high demand on services, particularly the emergency department, to ensure patients and staff are safe and supported. The Care Home sector and primary care have also received a range of additional advice, support and monitoring to ensure patient safety, working collaboratively with other local commissioners and regulators.
Services supporting people with learning disabilities or autism in an in-patient setting have continued to be subject to regular quality assurance checks and Care and Treatment Reviews. Additional safe and well checks, in line with a national approach, have also taken place with overall assurance being received and agreed by the Lancashire and South Cumbria integrated care system team.
All contracted services have continued to be subject to a level of routine quality monitoring and reporting, with contract meetings taking place on a risk-based approach and reporting of quality has continued through the CCG’s Quality and Engagement Committee, meeting monthly. Where CQC inspections have required action plans, the CCG has continued to monitor and support providers as required, in the delivery against identified actions, to be compliant with the standards and to improve patient safety and patient experience.
Engaging people and communities
All Clinical Commissioning Groups (CCG) have a legal duty to involve the public (individuals and communities) in their commissioning activities. Whether this be in keeping them informed of changes, seeking feedback on plans, listening to suggestions for changes to inform our decisions or allowing the public to actively contribute to the decision-making process engagement is embedded into our constitution.
A snapshot of some of the engagement opportunities on the Fylde Coast throughout the year is below.
Our Lay Member for Patient and Public Engagement, Helen Williams ensures our commitment to excellent engagement is championed at all levels within the CCG. Her role is to make sure the voice of the local population is heard and that opportunities are created and protected for patient and public empowerment. Helen sits on the Governing Body and so supports the CCG’s efforts at the highest level.
The CCGs rely on public feedback and checking our engagement activity is robust. To do this we call three different meetings of groups as outlines in the following sections.
As a CCG, we have contributed to several campaigns and initiatives across Lancashire and South Cumbria. The objectives of these campaigns have been to inform people about local services, and genuinely involve and co-produce new ways of working with our population and partners. Campaign materials and toolkits have been produced by the Communications teams supporting each of the initiatives and shared across the system.
The system-wide programmes that CCGs have been part of are detailed in the ‘Working with our partners – Lancashire and South Cumbria Health and Care Partnership’ section above, but include COVID-19 vaccinations, Healthy Hearts, ‘Thank You’ Care Workers, Keep Well This Winter, and Lung Health Checks. Mental health campaigns include Cards for Kindness, Healthy Young Minds, and the Resilience Hub, plus suicide prevention campaigns (Let’s Keep Talking and the Orange Button community scheme).
Patient and Public Engagement and Involvement Forum (PPEI):
Our engagement activity is scrutinised by our Fylde Coast Patient and Public Engagement and Involvement (PPEI) Forum. Vice-Chaired by the Lay Member for Patient and Public Involvement, the forum is part of our formal governance process, directly reporting to the CCG’s quality improvement, governance and engagement committee and Governing Body.
The PPEI Forum advises on appropriate levels of engagement with the wider public and acts as a critical friend to make sure we are engaging with the right people at the right time during any form of service redesign.
It includes representation from Healthwatch, disadvantaged groups, the voluntary sector, disability representatives, carers, and older people.
The forum has met intermittently and online over the last year with some meetings being cancelled but they have gone ahead when possible.
They have discussed several topics including:
- Improving access to primary care
- The primary care surveys
- The Health Equity Commission
- Self-care week
- Winter pressures
- The community pharmacy consultation service pilot for emergency care
- Commissioning reform
They have also been fundamental in disseminating information across their wider networks to support COVID-19 messaging.
The Influence Panel, made up of members of the public from all walks of life who help the CCGs shape local decision-making, was suspended for the majority of 2021/22 due to the COVID-19 pandemic. It did meet once, in June, to support the rollout of the Community Pharmacy Consultation Scheme. Panel members were largely supportive of such a service being launched on the Fylde Coast but were keen to ensure it included a mechanism to collect patient feedback and offered pharmacists the opportunity to prescribe some non-over-the-counter medicines to further streamline the process. This was fed back to the NHS programme leads and feedback mechanisms have been put in place that will be analysed at the end of the pilot.
We also make use of a newsletter system that residents of the Fylde Coast can sign up to and receive information and opportunities to provide complete surveys and provide feedback on projects. The newsletter is sent to 1,194 people and over the last year 15 issues have been sent.
Every GP practice on the Fylde Coast has a PPG of some sort. Many meets in person or have used virtual platforms during the pandemic. Others are emailed by their practices. Some PPGs are more active than others, but all are fundamental to the work of their practices. The most active PPGs have worked as volunteers to help with the vaccination programme in their practices and helped keep in touch with the more vulnerable patients.
The CCG brings together the chairs of PPGs to a meeting to share ideas with others and to act as an engagement channel for CCG projects. The PPG network meeting has met consistently each month throughout 2021-22 discussing a range of topics including:
- Commissioning reform.
- Vaccination programme.
- Third party prescription ordering.
- General Practice Data for Planning and Research Directions 2021.
- Delivering integrated care and system reform
- Medical equipment recycling
- Pharmacy services
- Abuse of primary care staff
The minutes of the PPG network meeting are fed back to the PPEI Forum and are included in the forum’s reports to the Quality and improvement and engagement committee, and the patient and public engagement update submitted to the Governing Body. Two PPG representative attend the CCGs Primary Care Commissioning Committees in common meetings and provide valuable contributions to the meetings.
Keeping our population informed
Due to the pandemic restrictions digital based platforms have been invaluable on reaching a wide audience and ensuring that people are equipped with the most up to date information.
Across all social media and all workstreams there have been 3,171 posts over the year resulting in 14,866719 people seeing the information shared and 13,452 clicks to our website for more information. This is roughly the same number of posts but much fewer interactions however this may be down to the nature of the information being shared. In 2020-21 the information was around the then developing situation around the pandemic and therefore there was more interest. In the last year there have been fewer changes to restrictions and advice has stayed roughly the same and has not generated the same level of interest.
Where possible we strive to reply to questions and comments to our social media within 24 hours although the comments from over the weekend are often picked up on a Monday. In the last year we have had 697 comments to our posts however it should be noted that only around 20 per cent of these require a response.
We have relied heavily on community groups, friends, and families to spread information to those who do not have access to online information resources. For this we have used our links with the local media, local authorities, and voluntary sector.
Reducing health inequality
Avoidable health inequalities are, by definition, unfair, and socially unjust. A person’s chance of enjoying good health and a longer life is determined by the social and economic conditions in which they are born, grow, work, live and age. These conditions also affect the way in which people look after their own health and use services throughout their life. Addressing such avoidable inequalities and moving towards a fairer distribution of good health requires a life course approach and action to be taken across the whole of society.
The NHS Long Term Plan, published in January 2019, sets out the need to address the health and wellbeing gap, preventing any further widening of health inequalities. To do so requires a move towards greater investment in health and healthcare where the level of deprivation is higher. Public Health England define health inequalities as: Health inequalities are the preventable, unfair, and unjust differences in health status between groups, populations or individuals that arise from the unequal distribution of social, environmental, and economic conditions within societies, which determine the risk of people getting ill, their ability to prevent sickness, or opportunities to act and access treatment when ill health occurs.
The World Health Organisation (WHO) defines health inequalities as ‘differences in health status or in the distribution of health determinants between different population groups’ . There is clear evidence that reducing health inequalities improves life expectancy and reduces disability across the social gradient. Tackling this is therefore core to improving access to services, health outcomes, improving the quality of services and the experiences of people. It is also core to the NHS Constitution and the values and purpose of the NHS.
The NHS Constitution states that the NHS has a duty to ‘…pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population’. This is reflected in the National Health Service Act 2006 (as amended by the Health and Social Care Act 2012), which introduced for the first-time legal duties to reduce health inequalities, with specific duties on CCGs and NHS England.
The Health and Social Care Act 2012 introduced the first legal duties on health inequalities, with specific duties on NHS England and CCGs, as well as duties on the Secretary of State for Health (covering the Department of Health and executive agencies Annex A) and NHS Improvement. These duties, which took effect from 1 April 2013, were:
- Have regard to the need to reduce inequalities between patients in access to health services and the outcomes achieved (s.14T).
- Exercise their functions with a view to securing that health services are provided in an integrated way and are integrated with health-related and social care services, where they consider that this would improve quality, reduce inequalities in access to those services or reduce inequalities in the outcomes achieved (s.14Z1).
- Include in an annual commissioning plan an explanation of how they propose to discharge their duty to have regard to the need to reduce inequalities (s. 14Z11).
- Include in an annual report an assessment of how effectively they discharged their duty to have regard to the need to reduce inequalities (s. 14Z15).
Our Equality, Diversity and Inclusion Strategy 2021-2022 sets out the CCG’s objectives on reducing health inequalities in Blackpool. Our strategy is based on the requirements of the NHS Equality Delivery System (EDS), which supports the aims to embed equality into all policies and practices while moving forward with performance and going beyond the legislation.
The EDS provides a robust framework against which we can assess and grade the Fylde Coast CCGs’ performance against a range of nationally determined indicators grouped under the four goals:
- Better health outcomes.
- Improved patient access and experience.
- A representative and supported workforce.
- Inclusive leadership.
The EDS grading event for 2021-22 assessed the Fylde Coast CCGs’ performance in relation to Goal 3 – a representative and supportive workforce. The CCG scored ‘Achieving’ in each of the following outcomes:
3.1: Fair NHS recruitment and selection processes lead to a more representative workforce at all levels
3.2: The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations
3.3: Training and development opportunities are taken up and positively evaluated by all staff
3.4: When at work, staff are free from abuse, harassment, bullying and violence from any source
3.5: Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives
3.6: Staff report positive experiences of their membership of the workforce
Good equality practice has been reflected in a range of case studies that are published on the CCG’s website.
The CCG also conducts equality impact risk assessments for each of its commissioning projects to ensure plans have taken in to account the needs of the population and services are accessible to all people whatever their characteristics.
|ICS Special School Nursing Review
|Community Diabetes Clinic Pilot Pause and Review|
|Mental Health Support Teams in Schools
|Fylde Coast SMI Physical Health Check Task and Finish Group
|Housing Options Hospital Link Worker
|Blood Glucose Meter Formulary
|COPDOL Assessment – Backlog
|Board level staff Management of Change consultation
|Funding Request 2:1 to Support Community Access
|Fylde Coast cervical / breast screening pilot for people experiencing homelessness
|LeDeR Annual Report|
|Adult Integrated Respiratory Service (AIRS)
|TUPE of CCG staff to ICB|
|Parent Infant Relationship Service
|Figure 1: Some of the equality impact risk assessments carried out in 2021-22.|
In January 2020 the Fylde Coast CCGs approved the Fylde Coast Prevention and Health Inequalities Strategy, developed by the local Public Health team. The strategy outlines key priorities for tackling health inequalities on the Fylde Coast including initial developments for Fylde Coast partners to implement. The key priorities are:
- Healthy Weight
- Maternity and Early Years
- Mental Health
- Community-centred Approaches for Health and Wellbeing
- Drug Related Deaths
- Aging and Dementia
During 2021/22 the Fylde Coast CCGs undertook the following developments aligned to these priorities:
- Development of an inpatient smoking cessation service, aligned to the CURE tobacco dependency treatment model. An interim service soft-launched in January 2022 with the full service launching in April 2022. This includes integration with local authority commissioned community-based tobacco dependency treatment services to ensure support for people beyond their hospital admission.
- Development of a nurse-led homeless health service. This was initially planned for delivery in 2020 however the COVID-19 pandemic resulted the service becoming a COVID-19 response, to support people who are homeless when they had COVID-19, and targeting reducing the risks associated with contracting the virus (e.g. ensuring underlying health conditions were identified and addressed). Learning from the COVID-19 response, including the importance of a holistic partnership approach to supporting people who are homeless with their health, shaped the service that has been implemented.
- Working with Blackpool Better Start to set up a specialised ‘parent-infant relationship team’ in Blackpool. Parent-infant relationship teams are multi-disciplinary teams with expertise in supporting and strengthening the important relationships between babies and their parents or carers. The team will work predominantly with children aged 0-2 and their families but will also provide therapeutic interventions to the 3-5 cohort working in partnership with CAMHS and universal health to ensure that children and their families are able to access support where there are difficulties in the nurturing relationship.
Health and wellbeing strategy
Blackpool CCG is an active member of the Blackpool Health and Wellbeing Board. The chair of the Health and Wellbeing Board and the director of public health attend CCG Governing Body meetings held in public. Minutes of the Health and Wellbeing Board meetings are included on Governing Body agendas.
The focus of the Blackpool Health and Wellbeing Board is on improving outcomes and reducing inequalities through every stage in people’s lives. due to the pandemic the refresh of the health and wellbeing strategy has been delayed although more recently the CCG in conjunction with Blackpool council public health have produced a Fylde coast place-based health inequalities strategy which we are working to implement. However, the CCG continues to implement the health and wellbeing strategy building on the principles within it. The strategy has been used as a basis for recommendations to the health equality commission across Lancashire and South Cumbria.
The current Blackpool Health and Wellbeing Strategy can be found at: https://www.blackpool.gov.uk/Residents/Health-and-social-care/Documents/HWB-Strategy-2016-19-final.pdf.