2014-15_AnnRept_ELRCCG-2

1East Leicestershire and Rutland CCG Annual Report | 2014-15
Annual Report and Accounts | 2014-15
NHS EAST LEICESTERSHIRE AND RUTLAND
CLINICAL COMMISSIONING GROUP

High quality care for all, now
and for future generations
“It is there to improve our health and wellbeing,
supporting us to keep mentally and physically
well, to get better when we are ill and, when
we cannot fully recover, to stay as well as we can
to the end of our lives. It works at the limits of
science - bringing the highest levels of human
knowledge and skill to save lives and improve
health.
It touches our lives at times of basic human need,
when care and compassion are what matter most.
The NHS is founded on a common set of
principles and values that bind together the
communities and people it serves - patients and
public - and the staff who work for it.”
The NHS Constitution
The NHS belongs
to the people

Contents
Foreword from our Chair and Managing Director . . . . . . . 4
New services in a year of challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Clinically led . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Informing, involving, innovating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Thinking like a patient, acting like a taxpayer . . . . . . . . . . . . . . . . . . . . . . . . . 7
Transforming how we do things . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Supporting our Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Member Practices’ Introduction . . . . . . . . . . . . . . . . . . . . . . 9
Our reflection on Progress and Performance . . . . . . . . . . . . . . . . . . . . . . . . . . 9
The power of clinical leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Patient advocates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Evaluation of our effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Strategic Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Who we are and what we do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Our Vision and Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Our strategic aims and commissioning priorities . . . . . . . . . . . . . . . . . . . . . . 17
Working in partnerships across Leicester, Leicestershire and Rutland . . . . . . . 17
Our population, the communities we serve and their health needs . . . . . . . . 17
Our priorities for new investment in 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . 21
Quality and patient safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Patient Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
The Berwick Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
The Francis Inquiry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Winterbourne View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Compassion in practice nursing, midwifery and care staff -
our vision and strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Staff satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Safeguarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Our commissioning activities and who we commission from . . . . . . . . . . . . . 39
Operating and Financial Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Development and performance in year and in the future . . . . . . . . . . . . . . . . 30
The Resources, Principal Risks and Relationships that may
affect long-term performance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Better payments practice code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Prompt payments code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Cost Allocation & Setting of Charges for information . . . . . . . . . . . . . . . . . . 44
Governing Body’s policy for managing risk . . . . . . . . . . . . . . . . . . . . . . . . . . 45
The CCG’s priorities for the next two years (2014-16) . . . . . . . . . . . . . . . . . . 45
Position of the organisation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Sustainability Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Equality and Diversity Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Equality Objectives 2013 – 2015 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Publication of Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Workforce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Information relating to activities of the CCG . . . . . . . . . . . . . . . . . . . . . . . . . 50
Members’ Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Governing Body members’ profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Members of committees of the Governing Body . . . . . . . . . . . . . . . . . . . . . . 61
Sickness absence data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Pension liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
External audit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Disclosure of serious untoward incidents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Principles for Remedy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Employee Consultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Disabled Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Emergency preparedness, resilience and response . . . . . . . . . . . . . . . . . . . . . 69
Statement as to Disclosure to Auditors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Remuneration Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Salary & Pension Disclosure Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Pension Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Cash Equivalent Transfer Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Statements by the Accountable Officer . . . . . . . . . . . . . . . 81
Statement of the Managing Director’s responsibilities as the
Accountable Officer of NHS East Leicestershire and Rutland
Clinical Commissioning Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Governance Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Appendix 1: Annual Accounts 2014-15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Foreword from our Chair and Managing Director
On behalf of East Leicestershire and Rutland
CCG and the people who work in and with
it, we’re delighted to present our second
Annual Report.
We’re still a relatively new organisation, having become a statutory body just
over two years ago. Our aim is quite simple: to improve health by meeting
our patients’ needs with high quality and efficient services, led by
clinicians and delivered closer to home.
We don’t do that on our own, but by working with our partners and
stakeholders in the local NHS, local government, the voluntary sector and user
and patient groups. Having had the chance to read this Report, we hope you’ll
agree that whilst there is plenty we still need to do, there is already plenty of
which we can be proud.
As an NHS organisation, established under the Health and Social Care Act 2012,
we have a number of legal and constitutional duties.
These can be accessed at:
www.eastleicestershireandrutlandccg.nhs.uk/our-strategies-and-plans
The publication of this Annual Report is amongst one of our most important
duties. It ensures we are publicly accountable to the communities and people
we serve. It sets out our aims and strategies and how we performed against
them. It explains who we are, how we work and the partnerships in which we
are involved.
NEW SERVICES IN A YEAR OF CHALLENGE
There is no doubt that 2014-15 has been a challenging year for everyone
involved in organising and delivering health and social care to the people of
East Leicestershire and Rutland. This Report sets out how we’ve risen to this
challenge.
In the midst of what Simon Stevens, NHS Chief Executive, has called “the
longest period of austerity our health and social care services have faced since
the Second World War”, we are pleased that we have been able to implement
a number of changes to enhance local services. You can read about many of
them in this Report, including:
• New Urgent Care Centres – used by over 4,000 people in their first few
weeks of existence;
• New integrated health and care teams - delivered through the Better
Care Fund - helping hundreds of people get support and treatment in
their own home rather than having to go to hospital or be able to get
home from hospital earlier after treatment;
• Advanced care planning – supporting GPs to develop care plans for
people living in care homes, and those with terminal illnesses, so that
we can understand their wishes, communicate between different
services and better meet their needs;
• Introducing Personal Health Budgets so that people can take control of
their care provision in a way that suits them; and
• Training GPs in managing heart failure and treatment of atrial
fibrillation, thereby preventing some high risk people from suffering a
stroke.

Melton Mowbray
Oakham
Lutterworth
Enderby Market
Harborough
LEICESTER
RUTLAND
Uppingham
Scraptoft
Oadby
Wigston
OOOO
Enderby
LEICESTER
OaOa
Wigston
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Urgent Care Centres
Accident & Emergency
GPs in ELRCCG practices
Loughborough
NOTTINGHAMSHIRE
Nottingham
Derby
Grantham
Peterborough
Kettering
Corby
Rugby
Coventry
Nuneaton
Hinckley
NORTHAMPTONSHIRE
WARWICKSHIRE
CCCCCCCC
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Where our care is delivered
Figure 1: Map of East Leicestershire and Rutland

CLINICALLY LED
As an organisation, we are proud to say we are “clinically led” and praised by
our local NHS England colleagues for visibly being so.
That’s not simply a phrase we use. It’s central to what we’re about and how
we do things. It means that our aims and priorities are driven by local family
doctors and other clinicians, rooted in their own local communities across East
Leicestershire and Rutland. Clinicians are in the majority in our decision makers.
These people are trusted by local people and their families to have their best
interests at heart and deeply committed to helping them get healthy and stay
healthy. Or when they fall ill, to make sure they get the very best treatment and
care possible, in the right place at the right time, and delivered with compassion
and respect.
We were particularly pleased in February 2015 to be selected by NHS England
to be one of the first wave of CCGs to take on responsibility for commissioning
GP services from April 2015. This will give patients, communities and clinicians
more scope in deciding how local services are developed.
Our Clinical Vice Chairs and Locality Leads explain more about what Clinical
Leadership means in the Member Practices Introduction of this Report.
INFORMING, INVOLVING, INNOVATING
The timeless values of the NHS drive everything we do. As the NHS Constitution
says “The NHS belongs to the people”.
That’s why we’re constantly looking for ways, new and old, to listen to people’s
concerns and views, then do something about what they tell us and – crucially -
be seen to do so.
That’s not just good in principle, it’s good in practice. It means we’re much
more likely to get things right first time or be able to put things right if they’re
not working as they should.
As this Report hopefully shows, we’ve had some real successes over the past
year in this regard, including:
• taking a ‘Listening Booth’ to over
25 locations across East Leicestershire
and Rutland to enable our patients,
the public and carers to tell us in
their own words how they feel about
local healthcare;
• collating Patient Stories, captured
direct on film from individual patients
and discussed as a standing item
at Governing Body meetings –
including experiences with infection
control, care in acute hospital wards,
support for patients at risk of self-
harm, bowel cancer diagnosis and
end of life care; and
• conducting detailed engagement
exercises around Urgent Care and
Community Services.
Going forward in 2014-15, we intend
to build on these foundations by
designing and implementing an
integrated web, social media and
mobile engagement strategy – to put
us right at the forefront of the NHS
digital revolution.
Figure 2: Our Listening Booth visited over 25 locations

THINKING LIKE A PATIENT, ACTING LIKE A TAXPAYER
We are constantly looking at ways in which we can work with our partners
across health and social care, as well as with the voluntary sector, to continue
to deliver the best possible outcomes for local people whilst being conscious of
the need to deliver value for money. This Report shows how we’ve done during
2014-15, delivering successfully against all our financial targets, as follows:
• Achieving our planned expenditure against budget;
• Producing a planned surplus of £3.3m; and
• Achievement of in year financial savings plan of £9m.
TRANSFORMING HOW WE DO THINGS
Everybody knows money is tight - exceptionally so - and the financial challenge
is not going to go away any time soon. Our local health economy in Leicester,
Leicestershire and Rutland faces a deficit of almost £400 million by 2018-19 if
we do not fundamentally redesign and transform the way we do things. That
gives us an opportunity to design services that are more convenient for patients,
whilst making the best use of every penny of taxpayers’ money we receive. So
our plans concentrate on transforming from a system that over relies on people
having to stay in hospital beds to one that supports and manages people within
their local communities and in their own homes.
Building on these foundations, our Two Year Operational Plan focuses on
transforming services to enhance the quality of life for people with long-term
health conditions, improve quality of care, reduce inequalities in access to
healthcare and improve joint working and integration with social care.
In particular, in 2015-16, we plan to:
• Lay strong foundations for delivery of new and integrated models of care
in line with the Better Care Together programme and our Better Care Funds
to drive transformational change and improve outcomes for our patients and
population;
• Prioritise programmes of work which offer the best patient outcomes
delivering qualitative change at pace across our health and social care
economy; and
• Focus on developments that deliver financial balance and value for money
redesign which maximises modernisation and transformation of our providers.
In practical terms, this will include:
• Improved performance in waiting at Accident and Emergency;
• Introduction of 7-day working in primary care and improved integration with
community services;
• Improved access to psychological services, through more investment and joint
working with colleagues in West Leicestershire CCG;
• Improved patient choice and delivery of national standards in the time taken
between referral to treatment, cancer and diagnostic standards;
• Increased investment in dementia care management;
• Better outreach for people with complex or multiple needs;
• Rapid access to diagnostics for our frail older people;
• Reduction in avoidable admissions to hospital;
• Improved end of life care, with more people dying in their place of choice;
and
• Implementation of a unified prevention plan, including weight management,
physical activity and sexual health.
Figure 3: Public feedback

SUPPORTING OUR STAFF
Nothing we do or achieve happens by accident. It is the result of an awful lot of hard work, dedication and imagination by our own staff and thousands of people
in the organisations with whom we work and engage.
We take seriously our responsibilities to support and develop our staff and those with whom we work. For example, during the past year, we have provided large
scale educational events (protected learning time) for GPs and practice staff and undertaken a detailed staff survey to help us listen to our staff about the things
that matter to them.
We’d like to take this opportunity to thank them all for all they do.
Karen English Graham Martin
Managing Director Chair
(Accountable Officer)

Member Practices’ Introduction
East Leicestershire and Rutland Clinical
Commissioning Group (ELR CCG) is a NHS
organisation set up by the Health and Social Care
Act 2012 to commission and organise the delivery of
NHS.
During 2014-15, ELR CCG served 321,580 patients registered with 32 GP
practices in Blaby, Lutterworth, Market Harborough, Rutland, Melton Mowbray,
Oadby and Wigston and the surrounding areas.
OUR REFLECTION ON PROGRESS AND PERFORMANCE
Overall, we believe the CCG has made good progress during the 2 years since
it moved from shadow form. In particular, our clinical leaders highlight the
following achievements/new services that have particularly benefited local
patients and clinicians:
• The introduction of new Urgent Care Centres in Oadby, Market Harborough,
Oakham and Melton Mowbray – offering increased access to care for patients
at weekends, evenings and bank holidays;
• Improving services for patients with mental health needs, through redesign
of the acute mental health pathway (how we treat patients), plus a new crisis
house for those finding themselves in immediate need of support;
• Advanced care planning, with everyone proactively planning and working
together to meet the needs of people in care homes and on the palliative care
list;
• Expansion of Increasing Access to Psychological Treatment (IAPT) services,
delivering patient-initiated contact that has resulted in improved take-up;
• Strengthening the crisis pathway for patients with mental health needs,
particularly for those with urgent needs, but not in crisis, so they are now
seen within 5 days;
• Major improvements in mental health out of area placements, working with
our colleagues in Leicestershire Partnership Trust to reduce out of area places
from 37 down to single figures;
• Introducing a training programme for GPs in all practices in atrial fibrillation,
reducing the chance of patients suffering from blood clots or stroke;
• Developing the first Allliance agreement in the country to bring together out-
patient, day case and diagnostic services to be delivered in the community,
closer to patients and their homes, and freeing up bed capacity in the acute
sector hospitals for patients who need them;
• Extending patient choice, reducing waiting times and backlogs through
delivering national standards on Referral to Treatment Times (RTT);
• Ensuring the voice of children and young people is heard in decisions over
local health and care strategies and delivery, recognising that the children of
today are the adults of the future;
• Improving services for children and young people with eating disorders;
• Coming below the national average for antibiotic prescribing, helping avoid
unnecessary use of antibiotics; and
• Development of the intensive community support (ICS) service, provided by
Leicestershire Partnership Trust (LPT), comprising 48 at home places (virtual
beds) across ELR for utilisation for both step up and step down. The service is
able to respond promptly to unscheduled care requests and is integrated
into the Intensive Community Response Service and night assessment services.

THE POWER OF CLINICAL LEADERSHIP
We estimate that during a typical year, well over 2 million individual
consultations take place in doctors’ surgeries in our area. That’s an average of
around 5,500 every day.
The insight gleaned from family doctors and other health professionals carrying
out these consultations gives them a powerful and unique insight into the real
health needs of local people and their families, as well as how the healthcare
system works in day-to-day reality. Together with their clinical colleagues
working in hospitals and other health settings, they hold unique knowledge that
simply cannot be obtained elsewhere.
Clinical leadership is all about harnessing that knowledge and placing it at
the heart of NHS decision-making and local strategies. Our Governing Body
membership includes GP clinical leads, a board nurse and a secondary care
clinician. It means our decisions are informed by direct recent experience of real
work at the NHS coalface, addressing real problems and challenges, looking
after the needs of real patients, their families and carers.
Family doctors are natural problem solvers and good at making practical
decisions. They have a strong tendency to focus on the quality of care their
patients receive from local NHS providers, helping us to hold them to account
and provide practical, constructive challenge to our own organisation. They are
also natural communicators, trusted by patients to tell them the truth. GPs and
local clinicians have an awareness of the needs not just of the patient in front of
them, but all patients in their local area. They are good at prioritising what best
meets local needs and, as natural pragmatists, tend to concentrate on what is
necessary to ‘get the job done’.
PATIENT ADVOCATES
GPs are the CCG’s patient advocates. In our role as clinical leads, we act as the
voice for over 300,000 people registered with our surgeries. In fulfilling that
role, we continually ask:
• What’s the real work needed, the real problems and challenges, the real
needs of our patients?
• Is what the CCG proposing going to work for my patients?
• Is it going to work in Primary Care?
• Is it practical? Is it necessary? Will it work?
Will it deliver
for patients?
Will it
work?
What are the
real needs?
What are the
real challenges?

By concentrating as patient
advocates on the quality of
what we are commissioning
and the outcomes it delivers,
we play a crucial role in
holding local providers to
account.
In our working lives in
surgeries and treatment
rooms, in primary care as
well as the secondary sector,
we constantly provide
constructive challenge to
ourselves and our colleagues.
In our role with the CCG,
we bring that constructive
challenge to those who are
commissioning services.
Clinical Leadership

EVALUATION OF OUR EFFECTIVENESS
During 2014-15 the Governing Body evaluated its own performance through
facilitation by an external consultant which led to the review of the Board
Development programme for the members of the Governing Body, both
individually and collectively. Governing Body development sessions have taken
place at agreed intervals during 2014-15 which involved sessions focusing on
roles, responsibilities, enhancing leadership skills and focusing on collective and
individual responsibility. These sessions are aimed to support members of the
Governing Body to function more effectively as a Governing Body.
Information sessions have also taken place for members of the Governing Body
providing them with an opportunity to review national guidance / initiatives
in greater depth and its implications on the clinical commissioning group’s
business; develop further insight into performance issues with key providers;
enhance their knowledge on a specific topics; and receive detailed information
on key national requirements.
Our Governing Body GP members have played a full and active part in all its
activities, with excellent attendance rates including development/information
sessions as well as public meetings.
ENGAGING AND EMBARKING ON CHANGE
We are embarking upon significant change to commissioning future community
and primary care services which has been clearly articulated in a number
of strategic documents including the CCG’s Integrated Community Services
Strategy, Primary Care Operating Framework: A GP Guide November 2014 and
health economy wide Better Care Together Programme.
The emergence of GP Federated models is also underway and offers the
opportunity for partnership working to strengthen any new community services
model that is commissioned.
To achieve our proposed model for the future of community services we have
spent time engaging with local stakeholders including providers, Local Authority,
voluntary sector and GP locality groups.
Our engagement process has enabled us to understand current issues and the
breadth of potential for bringing together community and primary care services
We have identified a number of areas which need to be addressed through the
proposed model to ensure a solid foundation for community services. We will be
embarking on a further round of engagement in the Autumn to ensure we get
things absolutely right.
These areas are not exhaustive and include:
• Changing the current model of community services commissioning to give the
CCG and its GPs more accountability to influence how services are delivered;
• Creation of joint GP/provider posts to enhance accountability;
• Delivery of a rehabilitation and re-ablement model that moves services from a
hospital to a home environment;
• Improving access to community services that are currently considered sub
optimal including physiotherapy;
• Expanding the times when care is available both at home and in health
facilities;
• Establishing clinical support networks and services in acute and primary care
to identify, enable and manage both complex care, frail elderly and sub-acute
care locally;
• Making the most of the land and estate available to deliver local services
avoiding unnecessary travel to acute hospitals;
• Minimising service barriers through simplified specifications and joint
commissioning of primary, social and community services; and
• Changing the model of community services commissioning to focus on
outcomes rather than inputs.

WHAT FEEDBACK TELLS US
During 2014-15 we carried out detailed Practice Member engagement - visiting our practices and hearing their views, ideas and concerns. A review of this
engagement has clarified many of the problems encountered by patients, carers and GPs when accessing health services. Our programme of change and
improvement during 2015-16 is designed to address these challenges.
These include:
• Home First as a prominent principle of service delivery;
• Demographic pressures – more people in the CCG area will be
over 70 years of age by 2030 and many of those people will be
living with a range of complex health issues requiring rehabilitation
and reablement;
• Patients find accessing care confusing and setting up a care
package for a patient is confusing and time consuming for
primary care;
• Recruitment of GPs is becoming more difficult and it is likely that
recruitment locally will not be able to keep pace with demand;
• GPs will be managing a higher acuity patient in the home;
• GPs and commissioners have little influence over the community
services provided for their population and good response times
are not consistently achieved;
• Community service communication is often poor;
• Significant recruitment and retention issues in community
nursing workforce with a high vacancy rate;
• Community services set up to deliver care aimed at avoiding
hospital admissions is impacted by inability to recruit staff and
the pace of Better Care Together changes;
• Current estate condition in ELR is in variable condition and is - in
parts - poorly utilised;
• Small numbers of physical beds are spread across four sites which
risks compromising clinical quality (limited peer review, isolation
of staff) and is not cost effective; and
• Under-utilisation of current Intensive Community Support (ICS)
beds.
Figure 4: A Word Cloud of what our GP Practices told us via our Practice Engagement Feedback

Dr Andy Ker
Clinical Vice Chair
Dr Richard Hurwood
GP Locality Lead, Melton,
Rutland and Harborough
Dr Richard Palin
Clinical Vice Chair
Dr Hilary Fox
GP Locality Lead Melton,
Dr Girish Purohit
GP Locality Lead, Melton,
Dr Nick Glover
GP Locality Lead,
Blaby and Lutterworth
Dr Graham Johnson
GP Locality Lead, Blaby and
Lutterworth
Dr Vivek Varakantam
GP Locality Lead,
Oadby and Wigston
Representing our Practices

Strategic Report
WHO WE ARE AND WHAT WE DO
East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) is a NHS
organisation created by the Health and Social Care Act 2012.
We operate from offices at Thurmaston in Leicester and employed 84 staff as at
end March 2015.
We organise the delivery of NHS services for patients covered by 32 GP member
practices across three localities:
• Melton Mowbray, Rutland and Market Harborough;
• Oadby and Wigston; and
• Blaby and Lutterworth.
We do this by ‘commissioning’ or
buying health and care services
including:
• Primary Care;
• Planned hospital care;
• Urgent Care;
• Rehabilitation care;
• Community health services; and
• Non-urgent patient transport.
Our area of operations contains:
• 5 community hospitals;
• 1 large acute provider;
• 1 large non-acute provider;
• 2 local authorities; and
• 4 district/borough councils.
We commission acute services from out-of-county Trusts and a range of
independent sector providers such as Spire Leicester and Nuffield Leicester and
Circle Healthcare based at the Nottingham Treatment Centre.
Furthermore, ELR CCG provides grants for some voluntary sector providers
including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s
support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-
of-life care, and The Laura Centre (support for adults and children affected by the
death of a child).
We act as the co-ordinating commissioning body to manage the following
contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:
• NHS111 - Non Emergency Urgent Care number providing call handling and
triage, the Provider is Derbyshire Health United (DHU);
• Out of Hours - GP clinical assessment service during the Out of Hours
period, the Provider is Central Nottinghamshire Clinical Service (CNCS);
• out-of-county contracts (acute);
• out-of-county community health services;
• East Midlands Ambulance Service;
• non-emergency patient transport services – Arriva Transport Solutions;
• any qualified provider contracts;
• Leicester, Leicestershire and Rutland voluntary sector arrangements;
• community based elective care alliance arrangement;
• home oxygen service contract;
• ELR CCG also works with our LLR CCG partners to support the management
of contracts across the three CCGs in line with the NHS Standard Contract
Management Framework.
On 1 February 2015, NHS England announced that from 1 April, we would take
on the management of primary care medical for all the practices in our area.
Planned care Urgent care
Communitycare
Primary care
Mental healthMaternityand neonates/
Childrenand young people
Long term
conditions
Rehabilitation care Non-urgent
patient transfer

OUR VISION AND VALUES
Our vision and values guide what we are trying to achieve and how we wish go
about it.
Our vision is “to improve health by meeting our patients’ needs with high
quality and efficient services, led by clinicians and delivered closer to home.”
In pursuing this vision, we are guided by nine values:
• Quality - ensuring quality underpins everything we do;
• Involvement - involving our patients, practices, staff, partners and the public
in all aspects of our work, with a strong commitment to listen, learn and act
on their views;
• Innovation - embracing new ideas, seeking creative solutions to deliver the
best results;
• Progression - looking ahead to identify and seize opportunities;
• Inspiration - striving for excellence, inspiring confidence and trust in others;
• Respect - championing equality, treating our patients and each other with
respect, dignity and professionalism;
• Education - improving services and quality through effective training and
development for staff and clinicians;
• Economy - spending wisely and preventing waste; and
• People - developing a team people want to work with, where staff are valued
and involved.
To improve health by meeting
our patients’ needs with high
quality and efﬁcient services led
by clinicians and delivered closer
to home
Quality
Involvement
Innovation
Progression
InspirationRespect
Education
Economy
People

OUR STRATEGIC AIMS AND COMMISSIONING PRIORITIES
Our values and strategic aims are based on the views of our member
practices, clinicians, our patients and carers, our staff and partner
organisations. We have spent time talking and listening to people
about the changes they would like to see in local healthcare and
where we should be focusing our efforts.
The broad themes that stood out in what people told us are:
• care delivered closer to home including access to services in patients’ own
homes and other alternatives to hospital admissions;
• closer working with social care to improve care pathways;
• more work on prevention (reducing diseases through screening, advice and
health checks); and
• better quality and more effective services.
Taking into account these themes, we developed the following strategic aims:
• Transform Services and enhance quality of life for people with long-
term conditions - with a particular focus on COPD, diabetes, dementia,
mental health and learning disabilities;
• Improve the quality of care - focusing on clinical effectiveness, safety and
patient experience, with specific goals to deliver excellent community health
services, acute care, mental health care and improve the quality of primary
care;
• Reduce inequalities in access to healthcare - targeting areas and
population groups with the greatest need;
• Improve integration of local services - between health and social care and
between acute and primary/community care;
• Listening to our patients and public - our commitment is to listen, and to
act on, what our patients and public tell us; and
• Living within our means - the effective use of public money.
The CCG’s vision and values are based on ethical, open and transparent
behaviour and all business practices follow this approach. These visions and
values are communicated to staff on commencement in post and office holders
receive contract / terms of office from HR which detail staff code of conduct and
behaviour expected and the consequences of non-compliance.

WORKING IN PARTNERSHIPS ACROSS LEICESTER,
LEICESTERSHIRE AND RUTLAND
Partnership working is vital to East Leicestershire and Rutland Clinical
Commissioning Group and it is the best way to bring about many of the
changes we wish to see implemented. Over the last year ELR CCG has actively
engaged with partner organisations to build on existing relationships, and
develop new and improved relations with clinicians, patients and carers, public
members, staff, partner organisations, including local authorities, and other
commissioning agencies.
We have many partners, and have established key working relationships with
the following:
• Leicester City and West Leicestershire CCGs;
• Leicestershire County Council and Rutland County Council (particularly with
social service commissioners and through Health and Wellbeing Boards) as
well as the borough and district councils within our CCG boundaries;
• Our providers including University Hospitals of Leicester, Leicestershire
Partnership NHS Trust, East Midlands Ambulance Service, voluntary sector
providers and charities;
• Healthwatch Leicestershire, Healthwatch Rutland, and other patient and carer
representative bodies;
• Leicestershire Police and Leicestershire Fire and Rescue Services;
• De Montfort University and the University of Leicester;
• Arden and Greater East Midlands Commissioning Support Unit (AGEM CSU);
and
• Health Education East Midlands (HEEM).
In order to achieve our vision and values we will be work closely with our
local authority, CCG and provider partners to develop our five-year Leicester,
Leicestershire and Rutland strategy. Furthermore, we are working with our local
authority partners to develop our two-year plans, now known as the Better Care
Fund, to ensure health and social care work more closely together.
The CCG is committed to making care more integrated in order to improve
health for its population.
We are working with our local authority partners to ensure that resources are
used effectively. We will do this through the Better Care Fund, strengthening
our joint commissioning and working arrangements to deliver integrated care
for older people and supporting people with long-term conditions (LTCs). This
is particularly crucial if our CCG is to meet its financial challenges through the
transformation of care systems, and improve the quality of healthcare across all
our providers.
Public health input into the development and implementation of the CCG’s
strategic priorities is vital, and we base our priorities and initiatives upon
the Joint Strategic Needs Assessment (JSNA) and the Health and Wellbeing
Strategy of the county council. Public health staff continue to help the CCG to
understand local needs and issues of our diverse population. This contribution
is critical to both inform and develop our strategies, as well as in delivering our
priorities.
We are an active partner key in the Better Care Together (BCT) programme. This
is a significant programme of work which will transform the health and social
care system in Leicester, Leicestershire and Rutland (LLR) by 2019. BCT brings
together partners, including local NHS organisations and councils, to ensure that
services change to meet the needs of local people. We are also working closely
with public and patient involvement (PPI) representatives to develop plans for
change.

A quarter of the population (23.6%)
of East Leicestershire and Rutland is
under the age of 20, and around
25% are aged 60 and over (26.2%).
50.6% of our population is female, which
is similar to the England average of 50.2%.
The average life expectancy within East
Leicestershire and Rutland is 80.5 years for men,
and 83.9 years for women, both of which are
higher than the England average.
The number of people aged 60 and over is higher
than the England average (22.6%), and our older
population is predicted to increase over the next 10
years, with an estimated 19,000 additional people
aged 60 years and over.
In NHS East Leicestershire and Rutland CCG, only a small
proportion of people live in deprived areas. Nevertheless, there
are significent pockets of disadvantage in areas on the edges of
Leicester City and within the market towns. We have to ensure this
deprivation is not overlooked.
OUR POPULATION, THE COMMUNITIES WE SERVE AND THEIR HEALTH NEEDS
The population of ELR CCG as a whole has relatively low levels of material
deprivation, compared to other parts of England. In comparing the various areas
where our population live against the rest of England, we rank overall as 200 out
of 211 CCGs for deprivation (where 1 is the most deprived).
Within the CCG, there are areas that have poorer health outcomes. The main
areas affected are in Oadby and Wigston. These inequalities in health need to be
addressed. In one area of Wigston, residents have a significantly higher rate of
mortality from all causes and mortality from respiratory diseases than the England
average. Although not significantly higher, rates of mortality from circulatory
disease and mortality from stroke are higher than the England average .
Although not as significant as in Wigston, other pockets of greater need exist in
other parts of East Leicestershire and Rutland, including Melton, Harborough and
Blaby.
These inequalities in health need to be addressed. Significant health inequalities
exist for other minority and seldom heard ps, e.g., Black and Minority Ethnic
(BME), and travelling families within specific areas. Hence our plans address issues
relating to diabetes, cardiovascular disease, COPD, dementia, access to primary
care services and mental health.Figure 5: Our CCG population

Evidence suggests that the most effective way to reduce the gap in life
expectancy in the short term is to improve the management of diseases
(including CVD and COPD) and their risk factors (including smoking, alcohol,
hypertension and diabetes) that predominately affect the socially excluded. .
Accounting for 69% of all deaths, the major killers for East Leicestershire and
Rutland CCG are:
• cancer (29%)
• cardiovascular disease – CVD - (27%)
• respiratory disease (13%).
The health of our local population is generally better than the overall population
of England. However, there is a significant number of people affected by
ill health, including GP -diagnosed coronary heart disease (10,739 people),
hypertension (47,770 people), and diabetes (16,625 people).
The CCG currently has high levels of non- elective activity when benchmarked
against similar health economies. Without a focused approach and active
intervention, the ageing population will increase the gap between expected and
actual activity. Elective activity is consistent with the national average.
Figure 6: The major killers

OUR PRIORITIES FOR NEW INVESTMENT IN 2014-15
Our priorities for new investment in 2014-15, and our spending and investment
therein, were:
• Transforming Primary Care;
• Redesigning Community Services;
• Delivering an effective Urgent Care System;
• Improving Mental Health and delivering parity of esteem;
• Developing services for people with long term conditions; and
• Delivering maternity, children and young people’s services.
Transforming Primary care
Evidence shows that there are significant pressures in primary care. There is an
increased patient expectation, attendances have gone up 75% since 1998, and
there has been a slow drift of work from secondary care and community care,
which has put added pressure on staff time and resources.
2014-15 has seen significant developments in Primary Care. A full programme
of engagement with all of our member practices supported the design of the
GP operating framework, which sets out the plan for practices working together
in federation to support improved patient outcomes and alleviate some of the
pressure on general practice from increased demand of an ageing population.
In 2015-16 we expect all of our practices to have formally joined into 8/9
federations to deliver services for a greater population size.
This development of federations has taken place in parallel to the CCG’s
successful bid for delegated responsibility for primary care contracts in 2015-
16. This management of the whole primary care commissioning process will
give the CCG a fantastic opportunity to improve patient care and access whilst
addressing the capacity and workforce gaps in both general practice and
community services.
There will be a continued commitment to annual clinical visits to practices
to inform our future commissioning intentions and to assure the CCG that
practices are following best practice guidelines.
Redesigning Community Services
During 2014-15 we developed a Community Services Strategy, setting out our
vision for a fully integrated, co-ordinated model for health and social care,
delivering seven day services that put people’s care needs at the centre and
reduce the need for bed based provision.
Our vision is supported by a ‘home first’ philosophy. The Strategy aligns with the
Better Care Together five year strategic plan and our Better Care Fund plans and
outlines a model of care with the following key components:
• co-ordinated services with the patient at the centre of care;
• multi-disciplinary teams (primary, community and social care) wrapped round
the patient/citizen offering 24/7 services;
• focus on early intervention along with reablement and promoting
independence;
• specialist medical input as required;
• services that offer an alternative to hospital stay;
• community hospital beds where ‘home first’ is not possible;
• harness the power of the wider community;
• patients will receive education and support to understand and manage their
condition;
• increasing use of Personal Health Budgets;
• carers will receive ‘carer assessments’ and have their needs recognised;
• harnessing the voluntary and independent sectors in the delivery of services
that are co-ordinated with statutory services;
• an innovative environment that embraces the use of new technology; and
• a workforce delivering caring and compassionate care and with the training
and education to take on new roles that support the integration of health and
social care.

The proposed structure for service delivery outlined in our Community Services
Strategy combines wrapping services around primary care, with seamless
delivery of care that is integrated across organisations. The platform for delivery
of services will be the Primary Care localities and GP hubs (GP groups within
the localities, each with a registered population of 30-35,000). Services will be
delivered through co-ordinated pathways of care with integrated working within
healthcare and across health and social care where possible.
The Community Services Strategy has been developed alongside the CCG’s
Primary Care Operating Framework to ensure a fully integrated approach.
End-of-life Care
The CCG’s overall emphasis on delivering end-of-life care between 2014-2016
is to support patients to die in their place of choice and to work with our GP
practices to improve the quality of care for patients who are at the end of their
life.
In 2014/2015, the focus for the CCG has centred on identifying patients within
primary medical care that are approaching the end of their life and ensuring
that an effective care plan is developed with the patient and/or their carer. There
has been continued working with care homes to ensure that care plans are
developed appropriately within the care home environment and communicated
effectively with care home staff.
Delivering an effective Urgent Care System
In line with the national vision Leicester, Leicestershire and Rutland (LLR) has
identified priorities for emergency and urgent care for the next two to five years.
There has been significant emphasis over the last year on operational delivery
and the flow of patients through A&E. While this still remains an imperative, the
wider health and social care strategy for urgent and emergency care must be
in line with the local priorities, national policies and the needs of the people in
Leicester, Leicestershire and Rutland.
Work was undertaken early in 2014-15 to build on the initiatives undertaken in
primary care and community services, including the existing actions to improve
patient flow at the emergency care front door.
To determine the scale of the urgent and emergency care network required, we
used a detailed understanding for our area of:
• patient flows;
• the number and location of emergency and urgent care facilities;
• the service they provide; and
• the most pressing needs for our population.
We worked with social care partners to review and model care for those leaving
hospital care and requiring support for their continuing health and social care
needs.
We recognise the contribution of independent sector providers to support step-
down and support for discharge, and how we can work with these partners to
effectively and appropriately transfer care. Appropriate and effective services
available seven day a week underpinned all the initiatives in order to improve
timely access, continuity of care, and continuing care close to home. This system
based approach was critical to ensure that we were better prepared for winter
2014-15.

Good mental health is fundamental to our well-being,
yet mental health conditions are commonplace and living
with the burden of a mental illness can exact a heavy
price on individuals and those who care for them. It is
well recognised that good mental health is linked to good
physical health and more work is needed to achieve parity
of esteem in mental health support when compared with
the emphasis placed on physical health conditions. Mental
health has been identified as a key priority for joint action
within our five-year Better Care Together Strategic Plan.
During 2014-15 ELR CCG worked with their partners
and stakeholders to sign the Leicester, Leicestershire and
Rutland Crisis Care Concordat which outlines how police,
mental health services, ambulance professionals and health
professionals will work together to help and support
individuals going through a mental health crisis. Plans to
deliver this joined up approach have been developed.
Improving mental health and
delivering parity of esteem

Developing services for people with long term conditions
Respiratory disease
Respiratory disease is a major cause of morbidity
and mortality being the third leading cause of
death in England after circulatory disease and
cancer. It is also one of the principal reasons
for emergency admissions to hospital and, as a
result, it accounts for a substantial proportion of
NHS expenditure.
In England, around 23,000 people die from
chronic obstructive pulmonary disease (COPD)
each year, equivalent to one death every 20
minutes.
Acute exacerbation of COPD is itself a high-mortality condition: 15% of those
admitted to hospital with COPD die within three months which is higher than
the rate for acute myocardial infarction at 13%.
In 2013-2014 and 2014-15, the CCG developed a programme of delivery within
primary medical care linked to secondary and community care regarding the
management of COPD and asthma.
The key components of the improvement programme are:
• case finding patients to increase accurate diagnosis;
• spirometric competency assessed through specialist respiratory clinicians to
confirm the diagnosis of COPD; and
• inhaler technique training with primary healthcare professionals.
Average prevalence rates have increased from 1.2% (2010-2011) to an overall
average of 1.48% (2011-2012) and 1.57% (2012-2013) for all ages of our
registered patient population.
Spirometric competency assessment is a rolling programme across our 32
general medical practices working with our practice nurses. For 2013, just over
two thirds of our practices had achieved an up-to-date spirometry competency
assessment with the remainder of the practices planning to update their
competency training in line with the rolling programme of assessment.

Dementia
Dementia is a term used to describe various different brain disorders where a
loss of brain function is progressive and eventually severe. The most common
form of dementia is Alzheimer’s disease followed by vascular dementia.
Symptoms include loss of memory, mood changes and problems with
communication and reasoning.
Dementia is a long-term condition and people may live with dementia 7-12
years after their diagnosis. Nationally one in four females and one in five males
over the age of 85 have dementia. The higher prevalence in females is to some
degree due to longer life expectancy. In terms of mortality, 10% of deaths
in men over 65 years and 15% of deaths in women have been found to be
attributable to dementia in a UK study (this equates to 59,685 deaths annually).
In 2014 there were 130,400 people over the age of 65 years within
Leicestershire County and Rutland. This is predicted to rise to 186,900 by
2030, an increase of 43.3%. The following information details the number of
estimated people diagnosed with dementia in 2014 and the numbers predicted
for the future.
Area 2014 2030 Increase
Numbers
% Increase
Leicestershire 8,881 15,411 6,530 73.5%
Rutland 611 1,164 553 90.5%
Table 1: Number of estimated people diagnosed with dementia in 2014 and future predictions
Although the dementia registers and the figures show an increase in the
prevalence of dementia over time, 60% of people living with dementia in
Leicestershire and Rutland remain undiagnosed.
The 2013-14 prevalence figures for dementia within Leicestershire and Rutland
indicate similar figures to the England average:
Detail East Leicestershire and Rutland
Clinical Commissioning Group
List size 321,461
Register Count 2,080
Prevalence (unadjusted) 0.647%
Similar to England average
Table 2: 2013/14 prevalence figures for dementia
Work continued during 2014/2015 to develop services that can meet the needs
of an ageing population. This included work to develop the care of dementia
within general medical practice as well as working closely with community and
secondary care to ensure dementia has a key focus on care delivery.
For example, the Alzheimer’s Society began delivery of their Hospital Liaison
Dementia Support Service within University Hospitals of Leicester during 2014-
15 to support carers and people with dementia within a hospital setting,
providing information, and guidance on coping strategies, diagnosis and
support to access community services post hospital stay.

During 2014-15, we worked
with our local authority
partners, supporting the
development of local
authority services for people
with dementia and their
carers. These services provide
advice, information and
support to help people with
dementia and their carers to
maintain their independence
and to continue to live at
home.
Supporting people with dementia

Over the last few years we have seen an
increase in the number of births and an
increase in complexity. Although we have
better than or average rates in relation to,
perinatal / infant mortality, teenage pregnancy
and breastfeeding rates, it is widely accepted
that we have pockets of deprivation where
these rates are significantly higher. This high
level of need results in a greater demand on
maternity and neonatal services.
We provide high quality safe maternity and
neonatal services based on best practice and
which are easily accessible. These services will
be supported by the appropriate infrastructure
across both primary and secondary care.
During 2014-15 the following developments
took place:
• Primary Mental Health Professional Advice
Telephone service was expanded to
be available throughout office hours;
• introductory courses in child mental health
were delivered to over 600 staff
across a range of partner agencies;
• an independent review of CAMHS
community service was commissioned and
completed ; and
• expansion of family therapy service to
support educational psychology and
social care practitioners.
Delivering maternity, children
and young people services

QUALITY AND PATIENT SAFETY
Quality, patient safety, clinical effectiveness
and the experience of patients underpins the
delivery of health and social care services.
A number of recent high profile cases
(Winterbourne View [DH, 2012], the Report
of the Mid Staffordshire NHS Public Enquiry
by Robert Francis QC [2013], and the Saville
Inquiry [2013] have identified that vulnerable
people were not afforded basic standards of
care and their fundamental rights to dignity
were not respected. We must not allow this
scale of poor quality care and abuse to occur
in the services we commission.
We recognise the need for service
improvements to deliver better quality of
patient care and experience in the long-term,
whilst reducing clinical variation, eliminating waste and delivering better value
for money.
We will achieve this through the development of short, medium and long-
term investment in delivering the work that supports our strategic priorities.
This will include accompanying QIPP programmes. Alongside this, through
CCG contractual arrangements with providers we will ensure effective quality
indicators are in place which allow for a greater understanding of the impact of
health interventions on patients and the standard of services commissioned.
During 2014 we have made considerable progress in ensuring that we have
embedded effective systems to ensure that the CCG is able to monitor,
challenge and scrutinise provider performance to ensure improvements in the
quality of care commissioned.
Some examples of this are:
• The continued assessment of ‘patient experience dashboards’ for all of our
out-of-county acute contracts;
• Regular contacts through Quality Contracting Teams with our neighbouring
CCGs to monitor the quality of care being provided by our out of county
providers;
• Continued work with our local Healthwatch organisations to act on
intelligence received about provider performance;
• Understanding and scoping quality assurance systems within primary care;
• Development of quality schedules for Optometry, Pharmacy and General
Practice Community Based Services contracts. This will allow the CCG to
assure itself of the quality of care being provided by these services, and work
with providers to improve where necessary;
• Agreeing systems with NHS England to establish closer links and share
intelligence of primary care quality risks including establishing systems of
escalation where necessary;
• Development of a Care Home Strategy group to ensure all teams within
the CCG whose work involves care homes is executed in a streamlined
manner, to ensure quality care is delivered and compliance is monitored
effectively by maintaining an overview of work streams to deliver a care home
plan setting out aims, objectives, metrics, leads and time scales; and
• Systematic scrutiny and oversight of settings of care for people within
inpatient settings in learning disability services to ensure that safe and
effective discharge arrangements are in place.
However, the CCG is not complacent. We continue to review and refresh the
data sets used against the domains of the NHS Outcomes Framework and
ensure consistency and validation of data sources.
Alongside this we have embedded systems which allow for feedback from
service users using Healthwatch members and stakeholder events as well as via
our Listening Booths.

PATIENT EXPERIENCE
The CCG is committed to ensuring that the patient and service user voice is at
the heart of what we do. Improving patient experience has been a key area of
focus for East Leicestershire and Rutland Clinical Commissioning Group. During
2014-15 the CCG baselined the various elements of patient experience data
routinely collected. We have used this to identify key themes, trends and identify
any information gaps and take action as required.
‘Patient experience dashboards’ have been developed for our main acute
providers as well as the local out of county providers where our residents may
choose to access hospital services, that is:
• University Hospitals of Leicester NHS Trust;
• Kettering General Hospital NHS Foundation Trust;
• United Lincolnshire Hospitals NHS Trust;
• Northampton General Hospital NHS Trust;
• Nottingham University Hospital NHS Trust;
• Oxford University Hospitals NHS Trust;
• Peterborough and Stamford NHS Foundation Trust; and
• University Hospitals Coventry and Warwickshire.
Nine indicators have been developed, incorporating publicly available data and
data sourced by contracting teams. Indicators include a selection of patient
safety and patient experience indicators to provide a high level overview of the
quality of care being provided at each Trust. The dashboards are reported to the
ELR CCG Quality and Performance Committee on a quarterly basis.
Patient Participation Groups (PPGs) are in place at the majority of ELR CCG GP
practices. The CCG engages regularly with Patient Participation and Reference
Group (PPRG) to strengthen the voice of the patient within the work of the
CCG.
Our Chair convenes a quarterly Patient and Public Engagement Groups group.
The group comprises attendees from local third sector organisations, PPG/PRG
Chairs, and members of local Healthwatch. The group provides a sense check
on CCG plans and supports two way communication.
WE ARE LISTENING PROJECT
The “We are Listening” project has continued throughout the year. We have
travelled to over 25 locations, speaking to almost 200 people with the ELR
CCG branded listening booth. The listening booth allows ELR CCG to speak to
the public, patients and carers outside of health locations; approaching people
when they are feeling relaxed and have the time to talk about their experiences
of healthcare. The idea is to focus on how people feel and their attitudes and
opinions. The booth is designed to complement the data already available
through patient surveys and other large scale feedback mechanisms.
During the exercise, we collected positive and negative feedback from patients.
We went out to visit diverse groups including Sure Start centres, Learning
Disability groups,
market stalls and
lunch clubs across
all localities of the
CCG area. The
Listening Booth
formed an integral
part of the Urgent
Care Consultation,
and by accessing
a wide range of
locations with the
listening booth,
representatives
of seldom heard
groups were able
to participate in
the consultation.
Figure 7:Listening Booth Word Cloud

The feedback received via the listening booth has been broken down into
themes and trends, with feedback also provided to providers of services. This
information has been used to influence changes in the way we commission
services, and also to influence improvements in the quality of care being
provided, where patients have highlighted issues.
Patient stories have become an integral part of our public Governing Body
meetings. We use patient stories to drive changes and influence commissioning
decisions through clinical discussions in these meetings. In the last year, we have
been able to demonstrate meaningful changes arising out of the use of patient
stories at Governing Body meetings. Our Patient Stories allow real patients to tell
us their real-life experiences in their own words.
Some highlights include:
• Improvements to managing the risk of clostridium difficle infection;
• Input into the acute mental health pathway redesign;
• Focus on complex children’s care system;
• the impact of fragmentation of pathways for patients who live on borders;
and
• continuing challenges around the cancer diagnosis/treatment pathway.
WEB AND DIGITAL COMMUNICATIONS AND ENGAGEMENT
STRATEGY
We are proud of some of the innovations we have trialled during 2014-15 to
inform and involve local people and stakeholders in what we do and how we do
it. Moving forward, we intend to introduce further major innovations, including:
• a groundbreaking responsive web and digital communications and
engagement strategy, built on a ‘digital first’ integrated approach to our
website and other channels;
• a significant expansion of social media, based around a ‘communitarian’
approach that values and engages our stakeholders and communities as
equals and partners in our social space, rather than simply seeing them as
passive recipients of ‘just another set of broadcast channels’;
• trialling mobile capabilities,
harnessing the power of a true
understanding of
the unique opportunities that
mobile brings, recognising the
opportunities for
engagement afforded by
individualisation, location and
context awarenesss
and user-selected push
notifications;
• combining traditional methods
with the power of web, mobile
and social media to reach out
to hard to reach groups
and those beyond the ‘usual
suspects’ who traditionally have
been involved in health and
care discussion
and debate; and being
recognised as true innovators
in NHS digital and mobile
engagement.
This will enable us to
communicate with more people
in new and additional ways, at
times and through ways that offer
greater choice, convenience and
reach.
Figure 8: Blipfoto - one of our new social media channels being trialled

QUALITY AND EXCELLENCE
We continue to be committed to improving the quality of patient care, by a
focus on clinical effectiveness, patient safety and patient experience with specific
goals to deliver excellent health services and improve the quality of patient care.
This will be achieved by:
• continuously improving the quality of care within providers, including acute,
mental health and community services using contractual processes as a lever;
• combining commissioning and provider data with patient safety data and
carer feedback, including complaints, reference groups and engagement
events, to inform areas requiring improvement and attention and to ensure
on-going improvement;
• reducing variations in primary care for example access to primary care services,
appropriate prescribing, equitable access to health checks for all patients
including hard to reach groups;
• extending patient choice of provider for a range of community and mental
health services through the use of local and national AQP processes;
• delivering efficiency by maximising use of community services through an
integrated care approach with health and social care, to provide a seamless
service for patients; and
• assuring delivery through collaboration with main providers ensuring ‘value
for money’ for all partners.
Our plans for 2015-16 include a review of all quality schedules and local
Commissioning for Quality and Innovation (CQUIN) schemes to ensure
improvements areas have a greater focus.
We routinely review data published by the Care Quality Commission (CQC) to
inform our quality monitoring arrangements. Where providers have received
action plans following inspection visits we monitor progress against these
through our quality contracting processes. During 2015-16 we will be extending
this to include CQC intelligence within our quality data sets for Care Homes and
primary GP practices.
We have built positive relationships with our local CQC inspectors and have
developed joint meetings with Local Authority colleagues to ensure intelligence
sharing around providers; this supports our responsibility following the Francis
Publication in 2013.
Improving quality of
patient care
Excellent Community Health
Services
Improving quality of acute
services
Improving quality of Mental
Health Services
High Quality Responsive
Patient Care
Patient Safety Clinical
Effectiveness
Patient
Experience

PATIENT SAFETY
During 2014-15 we continued to focus our efforts on ensuring providers
actively reduce healthcare acquired infections such as Methicillin Resistant
Staphylococcus Aureus (MRSA) bacteraemia, Clostridium Difficile infection
(CDiff) MSSA and E Coli. This is achieved through monitoring compliance with
and achievement of nationally set trajectories for MRSA, Blood Stream Infections
(BSI) and CDiff and MRSA.
In the last year the CCG has:
• undertaken infection control review of patients in the community with a stool
sample reported as positive for CDiff that was sent from a GP surgery or
within 3 days of admission to UHL;
• addressing antimicrobial prescribing identified as not being in line with LLR
antibiotic guidance for primary care and audit of Proton Pump Inhibitator
prescribing; and
• continuing to support the combination of infection control data with the
data held by the CCG Medicines Management Team in relation to QIPP and
prescribing targets.
This has identified key learning themes, which have been shared via locality
meetings with our membership.
We have continued to review existing programmes associated with patient
safety themes, including:
• reviewing the findings of the Berwick review to reflect how commissioners
can support behavioural change with regard to patient safety;
• ensuring robust investigations of all serious incidents from all providers are
undertaken and submitted in a timely manner;
• continuing with systematic reviews of all serious incidents to identify areas for
targeted work – across providers;
• implementation of the intelligence reporting system across primary care for
GPs to raise issues and concerns to establish themes and trends that may be
developing;
• working with providers to eliminate avoidable pressure ulcers and working in
partnership with the local authorities to eliminate avoidable pressure ulcers in
care homes by including a pressure ulcer CQUINs into Care Home contracts;
• reviewing the outcomes of the Leicester, Leicestershire and Rutland learning
lessons review across primary and secondary care and identify key work-
streams which will improve pathways and outcomes for patients; and
• reviewing locally set infection control indicators in line with Department of
Health set objectives to improve infection control outcomes for patients;
THE BERWICK REVIEW
The publication of “A promise to learn - a commitment to act: Improving the
Safety of Patients in England” Berwick (2013) set out a number of commitments
for clinicians, managers and all staff of the NHS and for organisations leaders
and Boards. These commitments being:
• Listen to and involve patients and carers in every organisational
process and at
every step in their care;
• Monitor the quality and safety
of care constantly, including
variation within
the organisation;
• Respond directly, openly
faithfully and rapidly to
safety alerts, early warning
systems and complain from
staff. Welcome all of these.
• Embrace complete transparency;
• Train and support all staff
all of the time to improve
processes of care;
• Join multi-organisational
collaborative – networks in
which team can learn
from and teach each other; and
• use evidence based tools to
ensure adequate staffing levels.

During 2014-15 we ensured that mechanisms were in place via our contractual
arrangements with providers to respond to the Berwick recommendations. This
has included:
• reviewing and monitoring provider mechanisms to ensure that there are early
warning systems embedded in practice, evidenced by reviewing of nursing
and ward based safety metrics and actions in place where risks are identified;
• publication of staffing levels in line with “Hard Truths” and NICE staffing
guidance;
• ensuring triangulation of patient experience data such as surveys, friends and
family test, feedback from enquires and learning from complaints;
• identification of areas focus through learning from patient safety incidents
and serious incidents; and
• triangulation of provider data with data from GP concerns to improve quality
of discharge summaries to GPs following and inpatient stay.
Our contractual processes are only one way of ensuring the cultural change
needed to ensure a reduction in harm and improve safety across health
services. In August 2014 across Leicester, Leicestershire and Rutland the health
community published the “Learning Lessons to Improve Care”, a case note audit
review of care for people who died in 2012-13. ELR CCG is represented on the
Clinical Task Force convened to oversee the implementation of actions arising
from the review.
During quarter 3 of 2014-15 the East Midlands Patient Safety Collaborative
was convened. Early priorities are being agreed to shape the work plans for the
coming year and ELR CCG are supporting the development of this work plan
through attendance and positive contribution to the collaborative.
Alongside this the Leicester Improvement Innovation and Patient Safety Unit
(LIPS) collaboration between University Hospitals of Leicester and Leicester
University has been set up during 2014. ELR CCG has been invited to join
this collaboration to develop local patient safety initiatives. Both of these
collaboratives have been convened to address the cultural changes required
following publication of the Berwick and Francis reports.
The key safety priorities for 2015-16 will be:
• a commitment to work with the East Midlands Patient Safety Collaborative;
• a commitment to work collaboratively with the Leicester Improvement
Innovation and Patient Safety Unit; and
• Join the Sign up to Safety campaign.
THE FRANCIS INQUIRY
We welcomed the publication of the of the Francis Inquiry in February 2013
and actively engaged across the CCG including Governing Body members, staff,
member practices and the practice nursing community.
We developed a comprehensive plan in response to the recommendations
relevant to the CCG, including those relating to organisational culture which
were built into the CCG’s visions and values.
One of the key outcomes associated with the Francis response has been the
development and implementation of an automated GP intelligence reporting
system. This enables real time reporting of GP concerns relating to patient safety
and experience in any provider organisation.

Contractual mechanisms continue with the strengthening of our approach to
the monitoring of quality in providers. This has included the revision of quality
schedules to ensure they reflect the Francis recommendations and a proactive
approach to unannounced quality visits. The new approach to quality visits
continues to incorporate a multi professional desk top review of various data
sources to inform areas to visit, providers continue to welcome the increased
level of scrutiny and respond positively to this approach.
The thematic analysis of GP concerns has identified two specific work streams
that have commenced in 2014-15 these being: addressing quality of discharge
letters from University Hospitals of Leicester; and scoping of quality and capacity
within the district nursing services provided by Leicestershire Partnership Trust
across LLR.
During 2014-15 the Managing Director and Chief Nurse and Quality Officer
have been active contributors to the Leicestershire Area Team Quality
Surveillance Group. This group brings together a range of organisations
including: Public Health England, Local Authorities, Healthwatch Leicestershire
and Healthwatch Rutland, Health Education England, Trust Development
Agency, Care Quality Commission and partner CCGs. This is to ensure
intelligence sharing about providers in order to prevent a replication of the care
failings that occurred within Mid Staffordshire NHS Foundation Trust
The recent publication of “Freedom to Speak Up” in February 2015, sets out
20 principles for organisations within the NHS to adopt and embed to foster a
change of culture which ensures patients are placed at the heart of everything
we do.
Through 2015-16 we will:
• Use intelligence gathered from the variety of data streams to focus on
continuing quality and safety improvements;
• Continue to work collaboratively across LLR to ensure the cultural changes
required to improve care for our population are embedded; through active
participation within the Clinical Task Group, EM Patient Safety Collaborative
and LIPS; and
• Further develop and embed systems to ensure that staff who raise concerns
regarding poor quality care are listened to and supported in a non blame
culture.
WINTERBOURNE VIEW
The CCG is committed to delivering against the Winterbourne View Concordat.
This is to transform the way services are commissioned and delivered to:
• stop people being placed in hospital inappropriately;
• provide the right model of care and drive up the quality of care; and
• that by 1 June 2014 there is a rapid reduction in hospital placements for this
group of people.
More recently a joint Learning Disabilities Programme Board with clear terms
of reference, governance structure and stakeholder reference group has been
established. It includes representation from ELR CCG, local authority, Local
Area Team children’s and adults’ commissioners. This Programme Board will
oversee the development and delivery of the Winterbourne View action plan.
The Programme Board links back to the Health and Wellbeing Board via an
Integrated Commissioning Board that includes district council representation.

A stakeholder reference group has been established to support this work. This
includes families of children, young people and adults, commissioners and
NHS providers. It is planned to use this group as a longer term stakeholder/
advisory group for the Winterbourne View delivery plan. Additional members
will be brought in as required. There will be a degree of overlap with other
local authorities and CCGs in the Leicester, Leicestershire and Rutland area, and
particularly in relation to work with providers.
During 2014-15 we are systematically reviewing placements for patients within
inpatient settings commissioned by ELR CCG. In December 2014 the Chief Nurse
and Quality Officer chaired Care and Treatment Review panels for commissioned
placements to ensure appropriate arrangements were in place for ensuring
effective discharge when service users are deemed medically fit to transfer to
other settings.
During 2015-16 ELR CCG will:
• as members of the Better Care Together ensure proactive contribution to the
Learning Disability work plans; and
• ensure strengthened mechanisms are in place to review discharge
arrangements for those service users in hospital inpatient settings to ensure
safe and effective transfers to out of hospital care.
COMPASSION IN PRACTICE NURSING, MIDWIFERY AND CARE
STAFF - OUR VISION AND STRATEGY
We have used the publication of Compassion in Practice: Nursing, Midwifery
and Care Staff Our Vision and Strategy (DH 2012) as a key enabler to the
delivery of a long-term sustainable high quality nursing and care staff workforce
which support dignity in care provision.
The Chief Nursing Officer for England has developed the ‘6Cs Live!’ website,
which aims to build an online community of nurses and care givers across health
and social care. We have been actively participating in a range of ‘6Cs Live!’
webinars that support delivery of the six action areas:
• Helping people to stay independent, maximising well-being and improving
health outcomes;
• Working with people to provide a positive experience of care;
• Delivering high quality care and measuring impact;
• Building and strengthening leadership;
• Ensuring we have the right staff, with the right skills, in the right place; and
• Supporting positive staff experience.
The Chief Nurse and Quality Officer has contributed to the work across the
Leicestershire and Lincolnshire Area Team to support implementation of the 6Cs
action areas.
Our Protected Learning Time sessions across the CCG have supported the
development of a nursing forum for primary care nurses. The Practice Nurse
Facilitator has supported inductions programmes for new primary care nurses,
commenced reviewing competencies for clinical training programmes provided
by the LLR GP Training Function (hosted by ELR CCG) and has developed a
primary care nursing forum.
During 2014-15 we have demonstrated that through inclusion within quality
schedules, there has been a strong focus on staffing and skills mix within our
acute and non acute providers.
Through the use of “Safer staffing nursing” and “Birth right plus” staffing tools
our acute providers have assured their Trust Boards that they have reviewed
staffing establishments and published in line
with “Hard Truths” monthly staffing data.
In 2015-16 we will:
• continue to work with our providers to
ensure effective recruitment; and
retention practices of and reduction in
the use of agency staff continues; and
• Review and refresh our local plans to
further develop the action areas within
Compassion in Practice.

STAFF SATISFACTION
Staff satisfaction is an important workforce measure of how content or satisfied
employees are with their jobs and is typically measured using a staff opinion
survey which asks staff for their views about topics such as: remuneration,
workload and perceptions of management, flexibility, resources and teamwork.
The NHS National Staff Survey measures a range of aspects of working life and
enables organisations to monitor how well they are doing against the pledges
made to staff in the NHS Constitution. It has been, and will continue to be, an
enabler for NHS organisations to listen to and act on the views of their staff.
Perhaps more important is that evidence shows there to be a clear relationship
between staff and patient experience so improving the working lives of staff also
helps NHS organisations to provide better care for patients.
During 2014 the CCG implemented a number of actions in response to the
previous year’s survey findings and to further build the level of staff satisfaction.
Some examples include: continuing to improve internal communication
by holding regular staff briefings; the fortnightly publication of an internal
newsletter; and holding regular charity events and celebrations, e.g. the biggest
coffee morning for Macmillan and a Diwali lunch.
For the second year, it was not compulsory for CCGs to undertake the National
Survey, however, given its importance and the information it provides, the CCG
commissioned Picker Institute Europe to provide the online survey and achieved
an impressive 94% response rate which was a 2% improvement on the previous
year. The results of the survey are shared with staff to produce departmental
level action plans to address any areas of concern.
Jan’s Joggers are a new lunchtime group - aiming to get out for a walk every day at lunchtime for a 30 minute
walk

Some highlights from the results of the staff survey are:
• The majority of staff have had an annual appraisal which helped themimprove
how they do their job and agree clear objectives;
• Communication with senior management is effective;
• Team members have a set of shared objectives;
• The majority of staff enjoy coming to work and are enthusiastic about their job;
• Staff believe there are frequent opportunities for them to show initiative in
their roles;
• Three quarters of staff would recommend the CCG as a place to work; and
• The number of alleged incidents of bullying and harassment from managers/
colleagues has significantly reduced and will remain an area of focus.
Listening to staff

SAFEGUARDING
The CCG continues to have a strong focus on safeguarding vulnerable people.
We have developed and adopted a range of policies which underpin how
we approach safeguarding arrangements. The Quality and Performance
Committee of the Governing Body has oversight and scrutiny of safeguarding
arrangements for the CCG. The Chief Nurse and Quality Officer is the Executive
Lead for safeguarding and is a member of the Leicestershire and Rutland Local
Safeguarding Children Board (LSCB) and Safeguarding Adult Board (SAB). The
CCG is supported in its statutory duties by Designated Nurses and a Designated
Doctor for safeguarding.
The CCG uses the Markers of Good Practice for Children and Safeguarding
Adults Framework which meets the requirements set out in Safeguarding
Vulnerable people in the reformed NHS - accountability and assurance
framework published in March 2013 to assess provider compliance against
statutory safeguarding duties.
During 2014-15 the CCG along with NHS England Local Area Team and
the two other Leicester and Leicestershire CCGs, commissioned a review of
the designated function to ensure capacity and capability of this function in
supporting the CCG with delivering statutory duties.
This review has confirmed that the CCG has commissioned the appropriate level
of Designated Doctor and Nurse time and we are reviewing local service levels
agreements to ensure that quality of the service provision for 2015-16.
There have been no serious case reviews commissioned by the Leicestershire
and Rutland Safeguarding Board for people within East Leicestershire and
Rutland CCG area during 2014-15. However the GP Locality forums have
adopted a standardised approach to bringing any issues relating to safeguarding
issues on a monthly basis. In the last year we have supported the partnership
arrangements by contributing to the Child Sexual Exploitation campaign and we
have a local Practice Nurse supporting the work of the multiagency subgroup
within the LSCB.
The CCG has completed and submitted to the LSCB and SAB a self assessment
against Section 11 audit and the Safeguarding Adults Assurance Framework .

OUR COMMISSIONING ACTIVITIES AND WHO WE
COMMISSION FROM
East Leicestershire and Rutland CCG (ELR CCG) commissioned health services
totalling £328 million for people registered with our practices. We hold
contracts ranging from small grants to the voluntary sector, to a £126 million
contract with the main acute provider, University Hospitals of Leicester NHS
Trust.
Although the picture of healthcare providers is becoming more complex with
the roll out of initiatives such as ‘any qualified provider’ (AQP), offering patients
a wider choice of organisations to provide their care, the local services we
commission remain dominated by:
• UHL which provides acute hospital services at three sites in Leicester and in
local community hospitals. UHL provides secondary care to a catchment area
of approximately one million people and specialised services for up to three
million people. It is one of the largest acute trusts in the country;
• Leicestershire Partnership NHS Trust, the main provider of community health
and mental health services. LPT manages most of the community-based teams
serving ELR CCG and is a key provider at the six community hospitals; and
• East Midlands Ambulance Service NHS Trust provides emergency 999 and
urgent care crews across Derbyshire, Leicestershire, Rutland, Lincolnshire
(including North and North East Lincolnshire), Northamptonshire and
Nottinghamshire.
We commission acute services from out-of-county NHS trusts and a range of
independent sector providers such as Spire Leicester, Nuffield Leicester and
Circle, based at the Nottingham Treatment Centre.
Furthermore, ELR CCG provides grants for some voluntary sector providers
including the Alzheimer’s Society (carer’s support service), Carer’s Action (carer’s
support), Leicestershire Organisation for the Relief of Suffering (LOROS) for end-
of-life care, and The Laura Centre (support for adults and children affected by
the death of a child).
We act as the co-ordinating commissioning body to manage the following
contracts on behalf of all three Leicester, Leicestershire and Rutland CCGs:
• out-of-county contracts (acute);
• out-of-county community health services;
• East Midlands Ambulance Service;
• non-emergency patient transport services – Arriva Transport Solutions;
• any qualified provider contracts;
• Leicester, Leicestershire and Rutland voluntary sector arrangements;
• community based elective care alliance arrangement; and
• home oxygen service contract.
ELR CCG also works with our Leicester, Leicestershire and Rutland CCG partners
to support the management of contracts across the three CCGs in line with the
NHS Standard Contract Management Framework.

OPERATING AND FINANCIAL REVIEW
I certify that the Clinical Commissioning Group has complied with the statutory
duties laid down in the National Health Service Act 2006 (as amended by the
Health & Social Care Act 2012) and prepared the accounts under the Directions
issued by NHS Commissioning Board under the National Health Service Act 2006
(as amended). Appendix 1 provides the Annual Accounts for 2014-15.
DEVELOPMENT AND PERFORMANCE IN YEAR AND IN THE FUTURE
During 2014-15 the CCG’s Finance and Performance Committee (and towards
the end of the year by the Finance and Activity Committee) monitored all
performance indicators on a monthly basis, and is responsible for assuring the
Governing Body of compliance. This in turn was assured by the NHS England’s
Area Team at their checkpoint meetings with the CCG.
The CCG had a total allocation of £338,493,000 in the 2014-15 financial year.
NHS England had set a target for the CCG to achieve a surplus of £3,308,000.
Table 3 sets out the 2014-15 summary financial performance for the CCG. The
CCG over-achieved its target by delivering a surplus of £3,310,011.
East Leicestershire
and Rutland Clinical
Commissioning Group
Summary Financial
Performance
Budget
£
Actual
£
Variance
- Under/
Overspend)
£
Total allocation 338,493,000 338,493,000 0
Total Acute Commissioning 154,290,935 160,217,997 5,927,062
Total Non-acute Commissioning 105,584,715 109,084,218 3,499,504
Total Practice Prescribing 46,063,205 46,494,454 431,249
Total Primary Care Services 6,173,187 5,830,086 -343,101
Miscellaneous (inc reserves) 16,134,753 6,394,161 -9,740,592
Total Commissioned Healthcare
Expenditure
328,246,795 328,020,917 -225,878
Total Running Costs 6,938,205 7,162,073 223,868
Total Expenditure 335,185,000 335,182,989 -2,011
Surplus £ £ £
Programme control total 2,308,000 2,512,083 204,083
Running Costs control total 1,000,000 797,927 -202,073
Total control total 3,308,000 3,310,011 2,011
Table 3: ELR CCG 2014-15 Summary Financial Performance

The financial performance of the whole of the health economy in 2014-15 has
been difficult with the main provider of acute services (University Hospitals of
Leicester NHS Trust) reporting a sizeable deficit.
The LLR CCGs have continued to work closely with the trust to ensure that
services to patients have not suffered as a result of the financial problems. The
Commissioning Plans of the CCGs are supportive of the trust in achieving a
financial balance in the next two years. This will result in changes to the way
services are currently provided and the location in which they are provided.
To this end the CCG has significant new investments in community and social
care services with the aim of relieving the reliance and pressure on acute
services. The CCG has also worked alongside Leicestershire Partnership NHS
Trust to develop and improve inpatient services for people who have a mental
health issue.
Also during this year the CCG monitored the NHS Outcomes Framework, the
NHS Constitution and the new Quality Premium. The former is to drive local
improvements in quality and outcomes for patients and the Constitution to
ensure that patients’ rights and pledges were maintained through contracts with
service providers. The Quality Premium brings together a composite of indicators
from the outcomes framework and constitution, and incentivises the CCGs to
improve performance.
One of the ways we measure performance is setting and monitoring Key
Performance Indicators which include descriptions and measures (please see
Table 4).
Whilst we are pleased with performance in many areas of activity (e.g. progress
on time taken from referral to treatment) in several areas over the last year we
and our partners have not managed to hit national performance targets, with
highly publicised challenges at several of our providers including accident and
emergency services at Leicester Royal Infirmary, the Bradgate mental health unit
(Leicestershire Partnership NHS Trust) and East Midlands Ambulance Service.
During 2014-15 the CCG worked closely with all service providers and partners
across health and social care to support the implementation of plans to drive up
quality of care and performance.

The following tables set out East Leicestershire and Rutland CCG’s position on the expected rights and pledges from the NHS Constitution 2014-15
and includes thresholds that the NHS Commissioning Board will use when assessing organisational delivery.
EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved
2014-15
Standard
2014-15
Referral to Treatment (non-admitted) 95% 95.6%
(All Providers)
Referral to Treatment (incomplete) 92% 95%
(All Providers)
Cancer waits - two weeks from urgent referral with breast symptoms 93% 92.99%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (drug) 98% 94.29%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (radiotherapy) 94% 92.4%
(All Providers)
Care Programme Approach: The proportion of people under adult mental illness specialties on CPA who were
followed up within 7 days of discharge from psychiatric in-patient care during the period
95% 96.1%
(LPT)
Table 4: Key Performance Indicators

EAST LEICESTERSHIRE & RUTLAND CCG. NHS CONSTITUTION KEY PERFORMANCE INDICATORS. Performance achieved
2014-15
Standard
2014-15
Referral to Treatment (admitted) 90% 86.4%
(All Providers)
Cancer waits - two weeks from urgent GP referral 93% 92.9%
(All Providers)
Cancer waits - 31 days to first
definitive treatment
96% 94.2%
(All Providers)
Cancer waits - 31 days for subsequent cancer treatment (surgery) 94% 92.4%
(All Providers)
Cancer waits – 62 days from urgent GP referral to treatment 85% 82.8%
(All Providers)
Cancer waits - 62 days from NHS screening service to treatment 90% 80.8%
(All Providers)
Cancer waits - 62 days for treatment following a consultant’s decision to upgrade the priority of
the patient
100% 92.3%
(All Providers)
Diagnostic waiting times 99% 98.5%
(All Providers)
Patients should be admitted, transferred or discharged within 4 hours of their arrival at an A&E
department
95% 92%
(UHL only)
Category A Red 1 incidents response within 8 minutes - (conditions that may be immediately life
threatening and the most time critical)
75% 73.2%
EMAS
Category A Red 2 incidents, response within 8 minutes - (conditions which may be life threatening
but less time critical than Red 1)
75% 70.09%
EMAS
Category A calls resulting in an ambulance arriving at the scene within 19 minutes 95% 93.2%
EMAS
Cancelled ops - All patients who have operations cancelled, for non-clinical reasons, to be offered
date within 28 days, or funded at the time and hospital of the patient’s choice.
100% 95.6%
(UHL Only)
Mixed Sex Accommodation Breaches 0 breaches 5
(All Providers)
NB: Indicators rated as ‘amber’ meet the lower threshold, but do not meet the nationally set target. For example: Referral to treatment (admitted) has a target of
90%, the lower threshold is 85%, therefore a position of 88.7% is between the target and the lower threshold, giving an amber indicator.
Table 5: Key Performance Indicators

2014-15_AnnRept_ELRCCG-2

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