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Formal Q&A - 25th September 2013

Questions to the Governing Body raised by members of the public

Below you will find the questions received by the Governing Body as part of the main meeting. You can also download this document via the menu on the right hand side.


Question: When will the governance process for the Urgent Care initatives be announced, and, in particulat the details on what is to be reported and to whome, adn what reports and details are to be in the public domain?

Answer from the CCG: NHS England required each health economy to form Urgent Care Boards made up of CCGs, acute hospitals, GPs, mental health providers working together to manage the urgent care system in their area.  The Urgent Care Board in this area is in place and reports into all the partners represented on the group.  In the CCG reports are received by the Leadership Team, which manages the operational, performance and quality aspects.  Any issues would be reported, through the Leadership Team, to the Governing Body.  The urgent care system is seen as being what happens in an Accident and Emergency Department.  A ‘dashboard’, a summary of how hospitals and the healthcare system is performing, will be brought to the Governing Body and will be published on the CCG’s website to help people understand how the system is working and how pressures in the system are being addressed.


Question: Given the increasing importance and size of the centrally dictated commissioning programme, how are individual items determined, and what part in the process comes from individual CCGs, and what from the local and regional tiers of NHS England? What input and influence is made by individual CCGs into the centrally dictated commissioning decisions and the subsequent monitoring of performance?

Answer from the CCG:

Each year the CCG produces a Prospectus describing its plans for next year.This is produced by 3 processes:

1 - Each year the Secretary of State publishes the NHS Mandate to NHS England. NHS England sets out its plans, including centrally determined requirements of CCGs on finance and performance, and also national initatives

2 - Cheshire East Health and Wellbeing Board, which has responsibility for the overall health and social care needs of the Cheshire East population. The CCG reviews this strategy and takes the actions forward in its own plans.

3 - As a CCG we like to listen to the views of the public through various meetings, we look at the health needs assessment indicating the mixture of health needs, and base plans on the local need. Any reccommendations which come from HealthVoice are fed through into the plans.



Question:The Chief Officer in his report advises that Stockport NHS Foundation Trust is the only one in our area that will receive a contribution from the £200 million to be released to aid A&E departments.  This is no doubt because this hospital received a governance failure warning  from Monitor in April 2013 because they had breached the A&E  4 hour  waiting time rule in Q1 & Q2 2011/12 and Q1,Q2,Q3,Q4 in 2012/13.

 In the light of this situation, which appears to be still an issue, and the fact that East Cheshire NHS Trust is now achieving the 4 hour requirement, should the CCG be advising / guiding the population to avoid Stockport and use Macclesfield for A & E?   Can the CCG take any action to encourage people to use Macclesfield Hospital, which is currently meeting it’s A&E Target.

Answer from the CCG: As a public body, the CCG cannot be seen to promote, recommend or advertise one NHS body over another.  The CCG has a duty to make sure the population of Eastern Cheshire understands how each of the local acute hospital trusts are performing and we are proposing to  put a simple summary on our website so that people can see the A&E and 18 week refer-to-treat performance figures.

Eastern Cheshire covers Poynton and Disley, and it must be recognised that a number of people living in those areas will access South Manchester and Stockport hospitals.  The CCG has a duty to ensure they receive the same standard of care whatever the provider.


Question: One remains concerned about the attitude of East Cheshire NHS Trust seeping through from the record of this committee:

  1. a.  Not achieving the 18 week target  in specialty areas
  2. b.  They will not use a private sector provider for orthopaedic patients. Can a provider sub-contract work, or refuse to sub-contract it, without reference to the commissioner?
  3. c.  Still  behind in training

There is no update on the issues from the last Board meeting - increased absence and use of agency staff; In–Patient survey placed the Trust in the bottom 25% of Trusts nationally; the management of the waiting list is suspect.

While the committee is sending letters to encourage an improvement in performance, is there a need for a performance review at the highest possible level?

One notes, from the Locality Report, that the CCG is involved in the Greater Manchester  “Healthier Together” programme. This will no doubt result in the re-allocation / rationalisation of resources in the southern area, with the less efficient losing out. The Locality Management report indicates that this is North Derbyshire, Stockport, North Derbyshire, Tameside and Glossop. Other sources say the south region is UHSM, Tameside, Stepping Hill and Macclesfield. (Could this be clarified?)

It is possible then that ECT will become involved with Stepping Hill, a Foundation Trust, in some form and ECT appears to need a lift in performance?

Answer from the CCG: The minutes of the Quality and Performance Committee are written to be transparent and reflect the discussions which take place in the meetings.  The focus tends to be on East Cheshire Trust, as the CCG’s main provider, and the CCG is particularly challenging with them on their performance on quality issues.  However the relationship between the CCG and East Cheshire Trust is very good, strong, and healthy challenging, driving improvements.  If the reports seem unduly critical, this is a positive indication that the CCG will not relent in its ambition to encourage improvement in its biggest service provider. 

The reports of other CCGs for whom South Manchester or Stockport hospitals are the main providers will have similar themes reflected for those providers.


Comment and Questions: We are still on target, with a lot of teeming and ladling of under and overspends to achieve the end result. In its first CCG budget the expectation must be of some error, believing that a fair bit of guesstimation will have taken place in its setting.

On the provider spend front there are a number of substantial differences in the year end forecast against budget. We are warned in the report of various weaknesses in achieving the budget. The major service area overspent is Acute, which may be the factor in the analysis by provider

However what action can be taken where we are substantially adrift from the budgeted provider spend?

If one assumes that above a ten per cent difference needs looking at the providers are:
No Budget

                                                            Forecast Spend £

Liverpool Women’s Hospital F1             96,716

Manchester Surgical Services                65,673

Over Budget


Forecast % over budget

Countess of Chester



University Hospital of North Staff’s


North Staffs Combined Healthcare


Eye Care Medical


Alder Hay


Staffs and SOT Partners


Robert Jones and Agnes Hunt


Salford Royal


Derby County Health Service


Spa Medical


Ultrasound Service Care


BMI Royal Alexandra



Can any actions be taken to reduce the rate of spend with these providers and improve the forecast?

Response from the CCG: The answer is in the finance report, but as to the question on the substantial overspend on elective planned care and whether steps can be taken to encourage patients not to have their treatment outside our area, this is patient choice and the CCG cannot promote any NHS organisation over any other.  The spend is reflective of where people choose to go for their operations, and the geography of where they live and where the hospital is may be a factor.  Choose and Book gives a list of options and patients can decide which is most appropriate for them, their decision may be based on whether the procedure is available on a Saturday, or the wait times.

In terms of percentage changes, sometimes large percentage changes can be on small activity:  it may be that 100% change could be from 1 to 2.  The CCG became a new organisation on 1st April 2013 and most ‘variation’ in the planning is due to the fact that this is planning for a different population. Some of the planning assumptions have been refined and improved as the year has progressed, and the variances do not always reflect historical changes.