Bulletin for CCGs: Issue 32, 12 April 2013


Download the CCG Bulletin: Issue 32, 11 April 2013


Welcome from Barbara Hakin

Dame Barbara Hakin, National Director: Commissioning Development

Dame Barbara Hakin, National Director: Commissioning Development

Welcome to the first CCG bulletin of the new financial year and the first in the new clinically-led commissioning system. I do hope you all had a great Easter and are ready for the new world we have been planning for and working towards for so long. You will have already heard there is a name change too. NHS England (formerly the NHS Commissioning Board) officially launched on 1 April 2013 along with CCGs and all our new partner organisations within the health and care system in England – taking on their new statutory duties and responsibilities.

This is a real landmark for the NHS in England. It’s been just over two and half years since the NHS White Paper was published and we now have the opportunity to transform health and healthcare for everyone so that we have high quality care for all, now and for future generations. Together, every aspect of the new commissioning system – whether CCGs, commissioning support units (CSUs), or NHS England’s national, regional and area teams – can strive to create the culture and conditions for health and care services to be the best they can be.

Although many of us have had an Easter break, things did not slow down – this issue of the bulletin is full of news, events, consultations and actions for CCGs. We have also delivered it in a new format making it easier to navigate the stories as well as giving you the flexibility to manage your subscription. I hope you find the changes helpful, and I’m always happy to hear your feedback.

I hope you will also be aware of the revised NHS Constitution which was updated and published at the end of last month by the Department of Health. NHS England has now launched a number of workshops to discuss how NHS England, CCGs and Health Education England can help promote the NHS Constitution. Please do sign up for one or more of these events so that you can input into this.

I also want to highlight the complaints process. Following the Francis Report, we are committed to ensure that the NHS, patients and the public are fully aware of the process, so please do take some time to familiarise yourself with the current legislation.

I have heard that there may be some uncertainty as to how CCGs’ performance on 18 weeks, cancer waits, A&E waits and ambulance response times will be calculated for the purposes of the quality premium.  The position is set out in the final version of the quality premium guidance (see pages 13-16).  Broadly the position is that, for 18 weeks and cancer waits, providers will report data on the basis of the CCG that is responsible for the individual patient in question;  for A&E performance, data will be mapped from providers to CCGs based on the proportion of each provider’s activity that is attributed to each CCG (unless the activity is less than 1% of the total);  and, for ambulance response times, each CCG will be judged on the basis of the overall performance of the ambulance trust that serves its geographic area (rather than performance in relation to the CCG’s specific area which it is not possible to measure).

You will remember that we included details in the last issue of the bulletin about the first NHS Clinical Commissioners conference which is being held on 23 April in London. I’ll be there, along with a number of colleagues, so I do hope to see many of you at the event.

Finally, although I am shortly moving to the role of Chief Operating Officer and Deputy Chief Executive for NHS England on an interim basis, I will continue to stay in touch with you via this bulletin. We’ve been on a long – and sometimes challenging – journey to set up and develop the new NHS commissioning system, yet there is still so much more we can do to really transform outcomes and experience for our patients. Therefore I’m really pleased to be able to carry on working with you while we continue that journey.

Dame Barbara Hakin
National Director: Commissioning Development


Complaints handling by CSUs on behalf of CCGs

Complaints received by clinical commissioning groups (CCGs) may be delegated to a commissioning support unit (CSU) to investigate which raises a number of information governance considerations.

CSUs are not legal entities in their own right. They are hosted by NHS England with staff employed by the Business Services Authority and as such they cannot therefore be Data Controllers as defined by the Data Protection Act. NHS England would be the Data Controller.

NHS England has to ensure that adequate and suitable arrangements are in place for CSUs to be able to handle patient-identifiable data, to meet compliance with the Data Protection Act and other legal obligations such as the common law duty of confidentiality.

In order to comply with fair processing requirements, CCGs need to inform complainants that:

  • their complaints will be passed to a named CSU so that their complaint can be investigated;
  • this will involve the CSU accessing their records and disclosing relevant information to the CCG;
  • their information may be used for other purposes and providing a list of these other purposes e.g. monitoring the complaints process or improving service quality, but that wherever possible only anonymous information will be used for these other purposes. If identifiable data is needed for other purposes then their consent will need to be obtained unless there is another legal basis;
  • they know who to contact should they have any concerns about how their information is to be used and that if they do not want their information to be disclosed to the CSU how to dissent from this, how quickly they would need to respond if they wanted to prevent their information being shared (for example five working days) and what the implications would be if they were to withhold their consent i.e. that this may prevent the CCG from investigating their complaint adequately.

In future, if the information above is contained within the complaints form that the patient uses and on the CCG’s website, then CCGs and CSUs can imply consent. If, however, the patient simply submits a letter without the complaints form, and with no way of knowing whether they have accessed the website, then the two weeks’ notice in order for them to refuse the transfer of their information to the CSU should be signalled to the complainant.

These arrangements should be backed up by a clear information-sharing protocol between the CCG and CSU, defining how information will be shared and for what purposes, the process and contractual arrangements in place, what each will to do ensure compliance with the protocol and legal obligations, and the penalties for non-compliance by either or both parties.

It is only reasonable to imply consent for the use of personal and confidential information to investigate and resolve the complaint, provided the individual concerned has been informed about who will have access to it and how their information will be used. Article 2(h) of the European Data Protection Directive defines consent as “any freely given specific and informed indication of his wishes by which the data subject signifies his agreement to personal data relating to him being processed”.

In exceptional circumstances, a complaint may raise serious patient safety issues. Where this is the case, there may be justification on public interest grounds for using the individual’s personal confidential data even where they wish to withhold their consent for its use. Such decisions should be taken by a senior clinician, with advice from the Caldicott Guardian where appropriate.


Consultation on EU Directive 2011/24/EU on the application of patients’ rights in cross-border healthcare

The Department of Health has launched a consultation setting out the Government’s approach to implement a newly adopted EU Directive on the application of patients’ rights in cross-border healthcare. The consultation seeks views on the detail of the implementation, and the effects the proposed approach may have on the UK and NHS.

The Directive clarifies patients’ rights and aims to facilitate patient choice in accessing healthcare in other Member States of the European Economic Area (EEA), ensuring that services are safe and of high quality when citizens decide to do so. It sets out the grounds on which patients can request reimbursement of the eligible costs of treatment from their home health system and helps patients benefit from improved information and greater clarity on the rules that apply.

The Directive also sets out a number of areas for EU-wide cooperation in healthcare, including recognition of prescriptions, e-health, European reference networks, health technology assessment, and sharing data.

It is for each Member State to decide how to implement the Directive at national level. This consultation sets out the Government’s overall approach, including how it is proposed to meet the individual obligations contained within the Directive.

The closing date for responses is 24 May 2013.

Link for more information about the consultation and how to take part


Promoting the NHS Constitution – consultative workshops

The Constitution is fundamental to the NHS. It sets out the principles and values of the NHS and the rights and responsibilities of patients, staff, and the public. The Department of Health has recently published the refreshed NHS Constitution and accompanying Handbook which can be viewed here.

Last year, the NHS Future Forum looked at the impact of the NHS Constitution and concluded that awareness of it remains low, there is little evidence it is widely used as a means of helping patients and staff to uphold their rights and the pledges made, and that for the NHS Constitution to have real effect it is vital to raise awareness and embed it at every level in the NHS.

CCGs, NHS England and Health Education England (HEE) have a statutory duty to ‘promote’ the Constitution. We believe that a sustained improvement across the NHS is only possible through a coordinated, system-wide approach – even more crucial following the Francis Report. We are proposing working together with CCGs and HEE to co-develop and implement a joint strategy for promoting and embedding the Constitution in everything that the NHS does, including appropriate means of monitoring progress and impact.

We have been holding workshops across England over the last month or so, and we are seeking to get more CCG representation in the South of England region and the North of England region. If you are in a CCG in either of these regions, we would be grateful if you could let us know your availability on the proposed date(s) below. If you are able to attend more than one slot, please indicate this in your email back and we will go with the date(s) that have the most attendees.

The North

Date and Time:  7 May (09:30-13:30)

Venue:  Quarry House, Leeds, LS2 7UE

The South

Date:  18 April (12:30-16:30), 19 April (09:30-13:30)

Venue:  NHS South of England, Rivergate House, Newbury, Berkshire RG14 2PZ

If you would like to attend one of the above workshops, please reply to with the following information:

  • Name
  • CCG and region
  • Role
  • Availability


Final quality premium guidance published

Final guidance has now been published which confirms that the maximum amount payable to CCGs in 2014/15 for improving outcomes against the national and local measures will be £5 per head of population.

The guidance also confirms that CCGs will have flexibility to decide how best to use money earned from the quality premium – provided that it is spent in ways that improve patient care or health outcomes.

The guidance also clarifies that NHS England is committed to include a national measure on mental health in the 2014/15 quality premium.

The final guidance can be found here.


Revised Serious Incident Framework

Making sure that the NHS responds effectively and compassionately to serious incidents that occur during health care is vital, both to protect patients from further harm as well as to ensure that patients’ families and carers and NHS staff are fully supported to deal with the aftermath of a serious incident.

NHS England has developed and published a revised framework for serious incident management in the NHS. This revised framework explains CCGs’, providers’ and other organisations’ responsibilities when managing serious incidents and also provides links to and further information about the tools available to help the new commissioning system from April 2013. It does not fundamentally alter the principles set out in the National Patient Safety Agency’s 2010 National Framework for Reporting and Learning from Serious Incidents Requiring Investigation and elsewhere, but does update them to reflect the new commissioning arrangements.

CCGs play a key role in holding their provider organisations to account for management of and responses to serious incidents. CCGs will therefore want to be familiar with the expectations around serious incident management and to ensure their provider organisations are equally aware of the framework.

Arrangements for serious incident management also need to be fit for purpose. If there is any feedback on the principles contained in the framework, or any questions, please send to


Care Homes – Never Events

An Alert was published on 28 March 2013 for the attention of commissioners of Care Homes. Action is required to ensure that new and varied commissioning contracts include the Never Events applicable to Care Homes. Commissioners should read the Alert and take the appropriate action in respect of their Care Homes contracts as soon as possible.


Community and mental health services – operational standards, national quality requirements and reporting requirements

An Alert was published on 28 March 2013 for the attention of commissioners of Community and Mental Health services. Action is required to ensure that new and varied commissioning contracts include the appropriate Operational Standards, National Quality Requirements and Reporting Requirements. Commissioners should read the Alert and take the appropriate action in respect of their Community and Mental Health contracts as soon as possible.


Helping the public identify their CCG

NHS England is currently exploring how to make it easier for a member of the public to find out which CCG they belong to. It is proposed that this information will be available in a more accessible form via the NHS Choices website and will allow someone to search for their CCG by entering their GP practice, or their postcode if they are not registered with a GP. If you have an interest in this area or would like to know more, please contact by Friday 19 April.


NHS England publishes clinical access policies for specialised services

NHS England has published an agreed set of clinical access policies for specialised commissioning. For the first time ever, specialised services will be commissioned using a nationally consistent approach, meaning that patients will have equal access to high quality services, regardless of where they live.

Find out more


NHS England publishes generic commissioning policies

NHS England has published a number of interim generic policies, ensuring fair and consistent decision-making across its direct commissioning function.

The 14 policies cover all aspects of NHS England’s direct commissioning responsibilities including specialised services, primary care, screening, military and offender health.

Find out more


NHS Clinical Commissioners conference – 23 April 2013, London

CCG leaders are being invited to the first national event from NHS Clinical Commissioners.

Building our future together takes place on Tuesday 23 April in London and keynote speakers include Rt Hon Jeremy Hunt, Secretary of State for Health.

The day will focus on discussing common issues, providing an opportunity to share what is working well, and giving CCG leaders an opportunity to network with peers.

The draft programme and more information about booking a place are available on the NHS Clinical Commissioners website.


Managing the Challenges of Developing Integrated Care Services – 5 July 2013, London

This in-depth masterclass will explore the policy context of integrated care services and identify solutions to the challenges enabling the development of an effective integrated care strategy.

Integrated Care Services has been put at the centre of NHS reform, delivering on this agenda raises significant challenges for commissioners and clinicians. Health care personnel involved in delivering integrated services need to work together in order to meet the needs of patients.

For further information and to book your place visit or email

We would be pleased to offer registrants via the bulletin a 20% discount.

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One comment

  1. Pearl Baker says:

    Having attended a Personal Budgets Forum organised by an Independent Living Network, with the presentation given by a Service Manager from a Local Authority, it was agreed that the Mentally Ill were missing out. Conflict of Interest, no Independent Advocates was partly to blame.

    I was the only person there representing the Mentally Ill.

    The Presentation.

    Why Personal Budgets?

    It gives you the chance to Decide what support will be best for you.

    Buy your own support.

    ‘Are you eligible for a Personal Budget’

    Life is or will be threatened.

    Significant health problems have developed or will develop.

    Abuse or neglect has occurred or will occur.

    There is or will be little or no choice & control over vital aspects of the immediate environment.

    There is or will be an inability to carry out vital personal care or domestic routines.

    Vital involvement in work, education or learning cannot or will not be sustained.

    Vital family & Social roles & Responsibilities cannot or will not be undertaken.

    Eligibility Established.

    How does a personal Budget contribute to your support?


    I have supported those suffering from a severe and enduring mental illness for many years I.e Schizophrenia and Bipolar disorder.

    The above form a significant group with one in a hundred of the population suffering a Schizophrenic breakdown in their lifetime. One third recover, another third suffer intermittent breakdowns, and the last third do not resound to treatment.

    The same is for Bipolar accept the number is one in two hundred.

    Until we start supporting these people as per the legislation and the law, they will continue to be the forgotten people.

    The 1983 Mental Health Act section 117 (free aftercare) is being ignored and abused.

    GPs should play a more Proactive role in identifying their patients who would benefit from Personal Budgets.

    Independent Advocates would be contacted to represent their patients views and their right to a life of their choice.

    Pear Baker