In response to the Dispatches A&E’s missing millions programme on Channel 4 (17 February 2014) NHS Vale of York Clinical Commissioning Group (CCG) wishes to reflect the local position.

The programme discussed the marginal rate tariff. This government policy gives healthcare systems an incentive to prevent admissions.  The CCG can confirm that if it was able to ring fence funds under the marginal rate policy, it would primarily be invested in out-of-hospital care projects to prevent hospital admissions, leading to funds being channelled to other areas of healthcare. 

The CCG acknowledges that to date it has not yet been able to invest in this way but is sees its work to deliver services closer to where patients live is a positive step forward in helping to alleviate pressures on the hospital.

The CCG notes the Chief Executive’s comment regarding the re-admission payment policy (which is not a penalty). The CCG has adhered to the national policy and has made adjustments in line with the rate agreed with the Trust. The CCG would like to point out that in the spirit of partnership working, and recognising the need for the hospital to improve some of it pathways and processes, the CCG has not imposed some significant penalties.

The CCG is working closely with the hospital trust on approaches to improving patient flow, reducing pre- A&E activity and with other partners to facilitate the discharge of patients.

It is also playing a key role in working with other CCG’s in North Yorkshire and the Humber region and hospital trusts to establish an urgent care network. 

Locally this has given York Hospital some extra time to set up efficient working practices before it is decided to impose any national penalties. This is not the approach that is taken nationally, but NHS Vale of York CCG has taken this innovative approach to allow the hospital to address its spending and the establishment of a collaborative new Urgent Care Working Group.

The significant improvement facilitated by the new Urgent Care Working Group have realised an enhanced performance and reduced the national penalties that are due to be imposed in quarter’s 3 and 4 (September 2013- March 2014).

To date a wide range of projects have been successfully rolled out – some of which have contributed projects to reduce the pressures that come with the winter season. These include:

• 19 bedded resilience escalation ward to open in December
• Pilot frailty service to commence in February 
• Additional staff in the Emergency Department in the evenings, weekends and at nights.
• Strengthened community services
• Extension of the Rapid Assessment Teams
• Innovative use of Emergency Care Practitioners
• Step up step down beds including beds for the elderly medically infirm
• Access to newly commissioned Section136 suite (Place of Safety)
• Additional mental health practitioner in the Emergency Department at weekends
• Extra support for the Intermediate Care Team
• Project liaison to support local homeless people

As the plans are being implemented it is expected that the Trust will achieve the four hour A&E target. The agreed partnership arrangements to achieve a whole systems approach have improved this figure month on month. In January the hospital performance was at 95.2%.

The CCG can confirm that it has inherited a financial deficit of millions of pounds, and it is dealing with it by creating innovative schemes in health and social care. Despite the deficit, the CCG continues to pay for the delivery of quality services at the hospital.

The CCG recognises the opportunities that will be made available through the Better Care Fund and the integration of health and social care, and through close working with the Trust, partners and other stakeholders, it will continue to commission innovative services that can help to achieve the best in health and wellbeing for the Vale of York community.

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