Q_A by decree


									Key questions from the SHAs

#    Theme        Question                                                Answer

                                                                      PCT Boards are expected to consider at a minimum provider performance reports, assurance
                                                                      framework and corporate risk registers. Within the provider performance report, it is
                                                                      suggested that there is a synthesis of the critical items that the board must know as well as a
                                                                      level of detail where appropriate (the balance of which is an issue of judgement). The PCT's
                                                                      risk management report should include (a) the key risks that the PCT faces across all its
                                                                      commissioned activities, including where relevant the risks of their providers, (b) how they are
                  How can PCTs demonstrate that they are managing managing these risks (e.g., mitigating actions and milestones), and (c) how they are working
    1 Board       risks related to their providers?                   with providers, partners and other stakeholders to minimise risks
                                                                      The board should be involved in and debate provider performance based on proportionality
                  How should boards manage their time and focus - for and potential risk. In their main, the PCT boards' role is to assess the PCT's own
                  example, is WCC encouraging PCTs boards to look at organisational capabilities in monitoring and assuring provider performance, providing
                  the PCT's own performance of managing providers or governance, guidance and intervention in this sphere where required. However, in some key
                  should boards themselves be directly looking at the cases, the board will need to be aware of the major risks/issues facing their main providers
    2 Board       provider's performance?                             and be actively involved in managing these risks/issues.
                                                                      All PCT boards should consider recommendations from the Mid-staffs report and demonstrate
                  Is there any guidance nationally on when a board    that they make active judgements as to when to intervene and how. Some good practice
                  should intervene in provider issues, e.g. workforce guidelines, e.g. on provider workforce issues are to be made available within the next few
    3 Board       issues, identified risks etc.?                      weeks

                                                                          The board risk governance document is the corporate risk register provided to the board
                  What is the board risk governance document? How         which is provided to the board to manage the key risks/issues facing the PCT (including major
                  can a PCT demonstrate that the board is effectively     risks/issues at their key providers). This document is not a register of all the risks facing the
    4 Board       managing risks?                                         organisation. Board minutes can also be used to demonstrate effective management of risks
                  Should the DH invest centrally and develop best
                  practice pathways and data to assess the                The DH is starting to work with partners on corordinating and developing this data.. SHAs and
      Central     effectiveness of interventions along pathways for key   PCTs are also encouraged to develop their own shared respository for work being done locally
    5 support     diseases / conditions?                                  that can be shared with PCTs both within region and more broadly.
      Central     What are the resources and tools that could be made     The WCC development website http://wcc.networks.nhs.uk outlines some of the tools and
    6 support     available to PCTs?                                      best practice case examples that are available to PCTs
                                                                          The WCC strategic planning guidance and also materials from the PCT teach-ins outline
                                                                          some of the tools and techniques that some PCTs are using in these areas. Some specific
                                                                          materials will be put onto the website which provides support for commissioners (as above).
                                                                          And DH will facilitate some national work to support PCTs in requirements of competency 6
                 How can the PCTs demonstrate competency with             and 11, working primarily with the NHS but also with NICE and other DH colleagues such as
    7 Competency regard to C6 and C11?                                    the quality team

                                                                                   Page 1 of 15
#        Theme         Question                                               Answer

                                                                              A PCT that has defined criteria for evaluating and prioritising investments and disinvestments
                                                                              (and met the other criteria) is at level 2 for competency 6b. A PCT that has a robust process to
                  Can you explain what you mean when you refer to             use its criteria and conducts a full annual impact review of all investments and disinvestments
     8 Competency prioritisation in competency 6?                             (and meets the other criteria) is at level 3 for competency 6b
                  Could the specialised commissioning development
                  tool be applied to other joint commissioning                The specialised commissioning development tool as it currently stands applies specifically to
     9 Definition arrangements (e.g., a cancer network)?                      specialised commissioning groups.
    10 Definition What is disinvestment (vs. programme efficiency)?           Disinvestment includes the cessation of a service or reduction of a service.

                   Will the PCTs get refreshed data for programme             The latest programme budgeting data is due in November. In addition, PCTs can access
    11 DH guidance budgeting?                                                 much of the datasets via the NHS comparators website - https://nww.nhscomparators.nhs.uk
                   Will PCTs have clarity on the performance framework        The DH has said that it will be working with the NHS on the development of the performance
    12 DH guidance regime by November?                                        framework over the Autumn.
                                                                              Strategic and financial plans submitted under WCC should remain confidential to the PCT.
                     Can PCTs say in the worst case scenario they would       PCTs are encouraged to share as much information as they are able to to enable an informed
                     be closing down "X" service which could create a         and constructive debate with the panel. Specific decisions on investment and disinvestments
    13   DH guidance significant political risk?                              (e.g., cessation of services) should be taken locally by the PCT
                     Would it be possible to give a clear definition of
                     Programmes; Projects; Goals; Initiatives; and Actions
                     within WCC and how they compare with MSP and            Page 5 of WCC assurance strategy guidance describes the following elements and the
    14   DH guidance Prince2                                                 relationship between them - mission, vision, goals, outcomes, and initiatives.
                                                                             The SHA will be asked to provide minutes of 6 board meetings on behalf of their PCTs. It
                     What time frame will be used to look at Board           would be useful to provide the minutes of the board meetings when the Strategic plan was
    15   DH guidance minutes?                                                discussed.(This is a correction to the previous answer)
                     Where a PCT does not lead on the Acute Contract
                     negotiation, how should they fill out the template? For If the collaberative (acute)commissioning arrangements are being separately assured (e.g in
                     example, if one PCT negotiates on behalf of 4, how      London) then that body will complete the template on behalf of the PCT. If not the lead and
                     will it work and how will individual PCTs be able to    associate commissioners should work together on the template so that associate PCTs can
    16   DH guidance demonstrate their ability to negotiate?                 demonstrate their commissioning input into contract negotiation and management.
                                                                             No - the World Class Commissioning programme is seen as being a critical enabler to
                                                                             ensuring and enabling PCT development, and therefore delivery of priority health outcomes
                                                                             and reduction in health inequalities. However, the intention remains to streamline the process
                                                                             as much as possible over the coming years while maintaining its rigour so that the effort
                                                                             required of PCTs is significantly reduced as improved commissioning skills become
    17   DH guidance Will World Class Commissioning go away?                 embedded

                                                                              The DH does not centrally hold best practice pathways currently. However, we would
                                                                              encourage SHAs who will be closer to local practice on the ground to share best practices,
                   Are there any examples of existing pathways that tick      both within their region and nationally. Where relevant, the DH would discuss with the PCT
    18 DH guidance all the boxes?                                             and if agreed would share materials nationally on the support and development website.

                                                                                       Page 2 of 15
#      Theme         Question                                                Answer
                                                                             Programme budgetting is one tool the PCT can use to demonstrate progress on competencies
                   How much weight would be put on programme                 6 and 11. It is referred to in some of the criteria but in the context of 'programme budgeting or
    19 DH guidance budgetting?                                               equivalent'
                   How to demonstrate on micro and macro level the           Pages presented during "Teach-ins" by the SHA provide some guidance on how effectiveness
    20 DH guidance effectiveness on the clinical pathway?                    along the care pathway could be approached by the PCTs

                                                                             The strategic plan should cover the 5 year period up to 2013/14. It should balance being
                                                                             strategic and high level but also providing sufficient information to demonstrate that there is an
                                                                             underpinning base of detailed operational planning particularly for the short term.
                                                                             Greater detail should be provided in the strategic plan on actions being taken against the
                                                                             strategic initiatives in the shorter term, but it should not go into the same level of depth that the
                                                                             PCT's AOP would.
                   What is the relationship of Strategic plan and            The absolute level of detail is a matter of discussion between the PCTs and the SHAs and the
    21 DH guidance operational plan?                                         PCTs would be assessed against the criteria detailed in the assurance handbook.
                   What is the balance of level of effort spent on           A key message for Year 2 is ensuring that the majority of the work undertaken for WCC
                   assurance vs. in-year work required to deliver the        assurance is embedded in business-as-usual in the PCT - for example, strategic planning,
    22 DH guidance impact                                                    financial planning, organisational development
                   Will you review the timings for Year 3 so that they
    23 DH guidance don‟t coincide with the financial year end?              This will be reviewed as part of the evaluation of Year 2 with the NHS
                                                                            PCTs are encouraged to evidence their focus on transforming community services as part of
                     What part does the commissioning of community          their overall commissioning strategy. In addition, they may choose to include their TCS plan
    24 DH guidance   services play in WCC?                                  as one of their 3 additional documents provided
                                                                            WCC in Year 2 reflects the need for PCTs to ensure that whatever collaborative
                                                                            commissioning processes are in place have robust governance arrangements in place. For
                     What are the roles and responsibilities around         Year 2 even where there are extensive collaboration arrangements, each PCT will continue to
    25 DH guidance   collaborative commissioning in WCC?                    be assured individually.
                                                                            At the time of writing this is yet to be confirmed - we are already working with the NHS to
                     What criteria will be used to identify relative        describe how relative performance on WCC will be assessed. This will be shared by the end
    26 DH guidance   performance of PCTs?                                   of October.
                                                                            PCTs will not be formally assessed this year against outcomes - either on their historic rate of
                     Could setting ambitious aspirations lead to PCTs       improvement or their aspirations. In the future, PCTs will be assessed against their relative
                     being performance managed against these                rate of improvement versus peers. The PCT's aspirations will remain a tool to encourage and
                     aspirations (in a similar fashion to being performance stimulate improvement rather than being something against which PCTs are directly
    27 DH guidance   managed against targets)?                              assessed.
                                                                            SCGs have their own separate development tool developed nationally but implemented
                     How should PCTs evidence Specialised                   locally. PCTs should demonstrate how they work with their SCG through their self-
    28 DH guidance   Commissioning?                                         assessment and their schemes of delegation for their SCG group.

                   How is the DH and other SHAs tackling the political       The DH recognize that this is an issue and will work with SHAs to ensure the implications are
    29 DH guidance implications associated with disinvestments etc?          managed

                                                                                     Page 3 of 15
#      Theme       Question                                                 Answer
                   Please clarify the performance sub-domain in the
                   Board component of Governance (p93 of the
                   Handbook). Under Green, the wording used is:
                   "The PCT is: delivering on all existing “Vital Signs”
                   commitments; on trajectory or meeting all of “Vital      The wording should be revisited to state "all existing commitments and Vital Signs Tier 1
    30 DH guidance Signs” Tier 1 indicators."                               indicators".
                   All PCT management costs appear to be shown under
                   „other PCT spend‟, what therefore is the expectation
                   for other PCT commissioning spend, is it simply Public   PH management cost should go into "Other PCT spend" alongside all other management
    31 DH guidance Health Departments?                                      costs

                   The JSNA that we use is not simply a document – it is
                   a web-based information service. There is a limited
                   summary document, but this doesn‟t really do justice
                   to the JSNA. Is this a common thing nationally and do
                   you have any thoughts on how best to approach this?
                   For future development of the assurance process, it
                   would be good if the team putting the toolkit together
                   could give some thought to how multi-media evidence      The PCT should discuss with their SHA but options include providing the summary document
                   (not just documents) are submitted as this is/will be    (and/or any other form of document that is reviewed by the local authority or Board) for its
    32 DH guidance more and more commonplace                                JSNA.
                   Could you confirm whether Part II minutes for Boards
                   could be considered (many commercial conversations
                   happen here) and if so, that we are assured of their     The board minutes will be provided by the SHA on behalf of their PCTs and will be the board
    33 DH guidance confidentiality                                          minutes that SHAs themselves have direct access to.
                   Is the national calibration process going to be made     The DH is currently working on detailing out the process for national calibration which will be
    34 DH guidance transparent?                                             shared later in the year/early next year.
                                                                            The panel report from last year will be made available to the panelists for this year. In
                                                                            addition, in the "pitch on the patch" the CE is encouraged to briefly refer to what was
                                                                            discussed last year and the key comments/feedback that they received from the panelists last
    35 DH guidance Do panelists review the panel report from last year?     year.
                   If the PCT has redeveloped its strategic plan a few
                   months ago, does it need to redevelop a plan for Year The PCT, with guidance from its SHA, should take a local view of the level of refresh needed
    36 DH guidance 2?                                                    to their strategic plan
                                                                         The 3 specific scenario details will be provided by SHAs to their PCTs. SHAs are currently
                   What are the 3 specific scenarios? Will the scenarios working together to develop these scenarios to ensure alignment where possible, however,
    37 Finance     vary across the SHAs?                                 there may be some regional variation in scenarios
                                                                         PCTs are encouraged to understand the financial position (including level of debt) of their
                                                                         providers. In addition, they should be aware of the implications and the extent of financial
                   How might PCTs demonstrate that they are managing impact of their initiatives (e.g., disinvestments, shifting provision of care) on their existing and
    38 Finance     provider economics?                                   potential providers given fixed and variable cost structure.

                                                                                     Page 4 of 15
#        Theme        Question                                                  Answer
                      Finance and Governance Assessments should feed
                      through to Use of Resources as should all the             This is detailed on page 17 of the handbook. In addition a joint letter will be sent to all SHAs
                      competencies. Will there be something clarifying this     and PCTs providing narrative on how WCC assurance and the Audit Commission systems
    39 Finance        in writing?                                               will align.

                                                                                Strategic initiatives are the activities being taken to deliver against the PCT's strategic goals
                      What exactly are the 'initiatives' that need to be        while cost savings initaitives are those that broadly 'free-up' resources for investment
                      included in the template as specific items? Classic       elsewhere. For the example mentioned depending on the exact scope of the activities, it might
                      example is where a PCT has demand management              be inferred that demand management schemes might qualify as cost saving initiatives (if their
                      schemes to reduce secondary care spend so it can          primary objective is to release resources for other investment) and prevention schemes as
                      invest in prevention schemes to reduce smoking- are       strategic initiatives (if they directly address the PCT's strategic goals and deliver against
                      both the DMS and prevention schemes 'initiatives' or      particular outcomes). Initiatives should be described at a relatively high level within the
    40 Finance        just the latter?                                          financial template and align to those in the strategic plan.
                      Is the balance sheet on the financial template under
                      UKGAAP or IFRS?. NHS orgs have been asked to
                      resubmit their accounts under IFRS which will give
                      different surpluses than if they are reviewed under old
    41 Finance        UKGAAP.                                                   PCTs should consult with finance colleagues from their SHA.
                                                                                The same level of rigour should be applied in planning and consideration. However in terms of
                    Do you need to demonstrate the same level of rigour         what is described in the overall strategy, there would be an expectation of greater level of
    42 Finance      in all the 3 financial scenarios?                           detail for the base case.
                    In the financial statements worksheet what is the
                    difference between non-elective spells and
    43   Finance    unscheduled care?                                           They are the same, please fill in one or the other.
                    In the financial statements worksheet where should
                    mental health continuing care be shown? (under
    44   Finance    Mental Health or under Continuing Care)                     Please seek guidance from your SHA to ensure consistency within your region.
                    What is the expected treatment for hosted services
    45   Finance    e.g. NPFIT, Healthy Futures?                                Please include under "Other"
    46   Finance    Where should LIFT costs be included?                        These should be in the capex and in balance sheet
                    On Governance/Board/Performance - how exactly will          The 12 month rolling average of performance for the PCT against Existing Commitments and
                    this be interpreted i.e., what exactly is meant by          Vital Signs Tier 1 indicators will be used. This will be provided by the SHA on their PCTs'
                    'delivering' and 'on trajectory' and what timeframe is      behalf and will cover the latest 12 month period before the start of the panel preparation
    47   Governance being looked at?                                            (analytical) period.

                                                                                         Page 5 of 15
#      Theme         Question                                                   Answer

                                                                                Strategic initiatives are broad and distinct programmes of activities/actions that in aggregate
                                                                                will deliver one or more of the PCT's strategic priorities. PCTs are encouraged to have a small
                                                                                number of major prioritised initiatives around which the organisation can align. The guidance
                                                                                suggests the PCT may wish to describe between 10-20 such initiatives and as such these
                                                                                would be expected to be at a relatively high level. Investment / disinvestment in strategic
                                                                                initiatives and cost saving initiatives should account for the majority of the PCT's changes in
                     What is the granularity of strategic initiatives? Do the   spend (as detailed in the Resource & Apps sheet of the finance template). PCTs will be asked
                     initiatives have to add up to the majority of the          to highlight variances between investment/disinvestment outlined in their strategic
    48 Initiatives   budget?                                                    initiatives/cost savings initiatives and the shifts in spend in the Resource & Apps sheet.

                                                                                This is referred to on pg 21 of the handbook. Any changes to outcomes selected in year one
                                                                                will require PCTs to provide a rationale and justification for the change. In general the DH is
                                                                                not anticipating a significant number of changes to last year‟s outcomes. However, in some
                                                                                cases, some changes may be appropriate – for example, (a) where there is a „better‟ metric
                                                                                this year than was available last year and which is more appropriate to the local needs of the
                                                                                population of the PCT; or (b) where the panel provided feedback / suggestions for other
                                                                                metrics to be considered which the PCT has responded to. In all cases of change, it would be
                     What do PCTs need to do in order to change their           helpful if PCTs could pre-discuss changes to outcomes with their SHA and for the PCT to note
                     outcomes from last year? (some individuals were            that the SHA has provided input into the change of outcome.
                     under the impression there would need to be a lot of
                     justification or „hoop jumping‟ to change an outcome –     In addition, panels and analysts will also review performance against all of last year‟s selected
                     I am not sure if this is the case, but it seems to need    outcomes (whether they have remained priorities that have been chosen again for this year, or
    49 Outcomes      some clarification)                                        deselected for this year).
                     Is there a standard response for PCTs to give to           The DH will not be providing standard lines on this. PCTs should state if an outcome change
                     indicate where their outcomes changed during last          has been agreed with their SHA since the publication of the final panel reports from last year,
    50 Outcomes      year‟s process?                                            and the rationale for the change (see above).
                                                                                Having worked with the APHO,there is a revised inequalities indicator. This is the slope index
                                                                                of inequality (SII). This is a single score which represents the gap in years of life expectency
                                                                                between the best and the worst off areas within the PCT. Additional information is available
                     Please can you explain how the IMD will be used to         on the IC website, where there is a link to the APHO website which provides a more detailed
    51 Outcomes      calculate health inequalities for the 2010 round?          explanation of the metric.
                     How will the health inequalities slope index be
                     interpreted - for example, between a PCT with higher
                     life expectancy but also high range of health
                     inequalities (i.e., high slope index), versus a PCT with
                     lower life expectancy but also a lower range (i.e.,        The health inequalities metric and the life expectancy metric should be viewed as
    52 Outcomes      smaller slope index) in health inequalities?               complementary metrics to ensure a full understanding of the PCT's performance in both areas
                     Is there a minimum number of outcomes that PCTs
    53 Outcomes      need to select?                                            There is no minimum number of outcomes.
                     What is the process if a metric has changed since last     If a metric definition has changed on the nationally defined set of metrics, all data for this year
    54 Outcomes      year (e.g., the breastfeeding metric)?                     on will be displayed using the new metric

                                                                                         Page 6 of 15
#     Theme       Question                                               Answer
                                                                         Rolling averages are used to ensure that a statistically significant, representative picture of the
                  Why are rolling averages used for some metrics either PCT is provided and to avoid issues with anomolies in data in some periods where small
                  across a calendar year (e.g., where data is collected numbers of cases can cause significant skews in data. Where metrics are provided in-year
                  monthly/quarterly) or across multiple years (e.g., for (e.g., quarterly or monthly) these are averaged across the calendar or financial year to provide
    55 Outcomes   life expectancy, the new health inequalities metric)?  a full picture of the PCT for the past year.

                                                                            The locally defined outcomes criteria clearly states that a national data set is available. Where
                  What should a PCT do if there is not a national data-     one is not available, the PCT is encouraged to maintain this as an area of focus within their
    56 Outcomes   set for a locally defined outcome?                        strategic plan and monitor their performance and delivery against this area locally.
                  What is the role of the SHA in agreeing aspirations       The SHA provides a critical role in supporting and challenging the PCT in setting its
    57 Outcomes   versus the panel?                                         aspirations. However, the panel will maintain the final view on the PCT's aspirations.
                                                                            PCTs should use the more detailed data available on the APHO website (noted above) to
                  How should PCTs go about setting their trajectories       benchmark their performance relative to peers and set aspirations in a similar fashion to other
    58 Outcomes   for the new health inequalities slope index?              aspirations.
                  What should a PCT do if a metric on the national list
                  last year has now been dropped but they would like to     PCTs can move this metric to being one of their locally defined metrics so long as the criteria
    59 Outcomes   maintain that outcome?                                    for locally defined metrics is met.
                  Why do locally defined outcomes need to have a
                  national dataset while some of the outcome metrics
                  on the national list themselves do not have a full        The outcomes on the national list all either have a national dataset or there is a clear rollout
    60 Outcomes   dataset that covers 152 PCTs?                             plan in place under a national programme (e.g., for IAPT services).
                  What approach will be taken to assessing outcome          As data is only available for one year, the PCT‟s current position versus peers will be reviewed
                  aspirations where only 1 full year of data is available   and as per other aspirations, PCTs will be asked the rationale for the extent, scale and
                  (e.g., Health inequalities, Chlamydia prevalence          challenge of their aspiration, including how they have themselves determined an appropriate
    61 Outcomes   (screening))?                                             rate of improvement.
                  What approach will be taken to assessing outcome
                  aspirations where the national data-set exists but not    A marker will be provided for PCTs where data is not available because of validation issues.
                  all PCTs have data on system (e.g., infants               If a PCT has unvalidated data and this is an outcome that they have chosen, they will be
    62 Outcomes   breastfed)?                                               asked to provide assurance that the aspiration is valid given that the data is unvalidated.
                                                                            If the PCT is part of the set where data is available, this data will be used which will provide the
                                                                            PCT‟s current position versus peers whose data is also available.
                  What approach will be taken to assessing outcome          Where data is not yet available for that PCT, but they have chosen it as an outcome, they
                  aspirations where the national data-set is currently      should provide assurance as part of their rationale for their aspiration on how they have set
    63 Outcomes   being rolled out (e.g., IAPT services)?                   the aspiration and have ensured that it is ambitious and credible.

                                                                         Given the limitations of data collection in these areas, the assurance system can only use
                                                                         what is available
                                                                         In year 3+ as PCTs are increasingly reviewed on their ongoing performance, guidance will be
                                                                         provided to the analysts and panellists on the extent to which the PCT will have been able to
                   What approach will be taken to assessing outcome      influence the metrics during the WCC period (from 2008/9 onwards)
                  aspirations where the most recent data is 2+ years old PCTs are additionally encouraged to demonstrate local improvement through their strategic
    64 Outcomes   (e.g., life expectancy)?                               plan (either through local data that they have access to or by use of leading indicators)

                                                                                    Page 7 of 15
#     Theme       Question                                                 Answer

                  Metric Outcome 57 – “Diabetes controlled blood           The diabetes metric is moving to standards of „7 or less‟, „8 or less‟, „9 or less‟ from this year.
                  sugar” is stated as a national metric of 7.5 or less.    For this year of WCC assurance, the assessment will look at historic rates of improvement
                  However, from this year, the QOF measurement has         based on the previous diabetes metric of 7.5 or less
                  been changed to 3 indictors with standards of “7 or      However, from next year, the new metric using „7 or less‟ will be used and PCTs should set
                  less”, “8 or less” and “9 or less”. How will this be     their aspirations against this „7 or less‟ standard
    65 Outcomes   handled this year and next year?
                                                                           WCC outcome aspirations might be set at a higher level than Vital Signs. This is subject to
                                                                           local discretion. Vital Signs are based on agreed targets and resource allocations and,
                                                                           although challenging, PCTs are generally expected to achieve them under all of the most likely
                                                                           financial scenarios. WCC outcomes aspirations are ambitious improvement rates set by the
                                                                           PCT which are designed to encourage and stimulate improvement rather than being absolute
                  Might WCC outcome projections be higher than Vital       targets to be met (i.e., PCTs are encouraged to 'aim high and slightly miss' rather than 'play
    66 Outcomes   Signs?                                                   safe and meet')

                                                                           PCTs will not be formally assessed against outcomes this year. However, the outcomes
                                                                           scorecard showing their historic relative rate of improvement versus peers and their
                  What results will be published for PCTs against the      aspirations levels will be published alongside commentary from the panel on (a) the fit of
                  outcomes section of WCC assurance? Will PCTs be          outcomes chosen to the PCT's strategic plan/local population needs (where there has been a
                  ranked on the basis of outcomes performance this         change in outcomes, (b) the level of ambition, challenge and robustness of the health
    67 Outcomes   year?                                                    outcomes, (c) initial improvements seen against the PCT's chosen outcome priorities

                                                                          The outcomes discussion forms an important element of the day as an indication of whether
                                                                          the PCT is successfully planning and delivering against its strategic priorities. As such
                  Is the balance of time between outcomes,                outcomes will typically be discussed during the specific outcomes session and where relevant
                  competencies and governance interviews on the           often in the strategy discussion later in the interviews. However, panels will determine their
                  panel day fixed and is there sufficient time / focus on specific areas of focus (using the outputs of the analysis of the evidence during the panel
    68 Outcomes   the outcomes?                                           preparation period as a guide) during the panel day and hence specific timings may adjust.
                                                                          All metrics, their source and definition will be clarified soon as part of the additional guidance
                                                                          specifically against the outcome metrics. The guidance will describe what the baseline data
                  Outcome 36: % of stroke admissions given a brain        set will be for each outcome metric and the exact time period (given that indicators are
                  scan within 24hours, please would you clarify the       constructed differently with some as rolling averages etc) that PCTs should be setting their
    69 Outcomes   source, definition and how it is adjusted to PCT level? first year's aspiration figure for.

                                                                           The first column in the aspiration form is the PCTs position that it can observe now. In practice
                                                                           this means that this will be the dataset that is currently available beginning end of Nov '09. The
                                                                           second column will be where the PCT aspires to be and observe in each subsequent year. An
                                                                           example would be life expectancy. This outcome measures the 3 year rolling average of life
                                                                           expectancy for a PCT. The most recent data available for this outcome is for years 2004/07.
                                                                           The PCT should use this information to set their aspiration for the first column in aspirations
                  How should the PCTs set aspirations for the first        (which is for 2009/10). For the second column of their aspiration they should be basing it on
    70 Outcomes   year?                                                    the data that would come out next year (e.g. data for years 2005/08)

                                                                                    Page 8 of 15
#     Theme      Question                                                 Answer
                                                                          To streamline the framework and ensure it is as effective as possible, it would be better to
                                                                          provide fewer and more specific examples describing the larger scale initiatives. WCC
                                                                          assurance encourages PCTs to be able to evidence consistency in their strategy in all aspects
                 Should the PCTs provide a number of examples or          - outcomes, competencies and governance- all evidence submitted should directly reflect the
    71 Process   few key examples for evidencing each competency?         aims and priorities of the overall strategy.
                 Can you provide guidance on how evidence is to be
                 signposted (E.g., is it alright to provide section not
                 page numbers because these may change with             This will be fine so long as the sections are short, and the signposting to them is very specific
    72 Process   formatting)?                                           (e.g., paragraph numbers within a section)
                                                                        The self-assessment form provides space for up to six documents to be cross-referenced to
                                                                        for sign-posting. These six documents can be from the nationally defined list of documents or
                 Are there limits on the number of documents the        from the three documents that PCTs can upload in addition to the national list. PCTs are
                 PCTs can provide to support their self assessments of asked to be specific in their sign-posting referring to specific pages, paragraphs or sub-
    73 Process   the competencies?                                      sections rather than ranges of the document.
                                                                        The PCT should provide detail on three contracts that they have with providers (one acute,
                                                                        one primary care and a third of their choice). Within these three forms and their self-
                 Should the PCTs be providing evidence for contract     assessment for competency 10, the PCT should outline how they manage contract
    74 Process   compliance for all providers?                          compliance for providers within all sectors
                 Do outcome aspirations need to be set for all the      Outcome aspirations should be outlined for the base case scenario only in the outcomes form.
                 financial scenarios? If not, for which scenario should However, in their strategic plan, the PCT should demonstrate the implications of different
    75 Process   the projections be made?                               financial scenarios on their outcomes aspirations.
                                                                        Yes. PCTs will be asked to provide rationale and justification for any changes in their priority
                 Will the outcomes be compared to the ones chosen       outcomes. In addition, performance against the outcomes selected last year will also be
    76 Process   last year?                                             reviewed.
                 Can the PCTs save draft forms on the website? Can
                 the PCTs submit the forms and then re-edit them        Draft / partly completed forms can be saved or submitted on the website to be updated later.
    77 Process   before the end date?                                   Partly completed forms can also be printed for getting wider syndication.
                                                                        PCTs are able to access a status report that shows how many organisations have completed
                 Will PCTs know how many organisations have             the survey (in total by category, rather than at individual response level) and can nominate
                 completed their feedback survey? Can PCTs add          additional stakeholders to participate if it looks likely that the PCT will not reach the minimum
    78 Process   additional stakeholders to the survey?                 of 20 responses.
                                                                        PCTs have to identify up to 10 outcomes, of which 2 are mandatory (life expectancy and
    79 Process   How many outcomes do PCTs have to select?              health inequalities)
                                                                        No. PCTs are asked to submit the documents that are outlined in the national list of
                                                                        documents plus up to three documents of their choosing. If PCTs do submit a document of
                                                                        their own choice they are asked to provide detail on the document and how it fits into the
                 Do PCTs need to submit 6 documents per                 assurance process. Against each of the competencies and governance areas, PCTs are then
    80 Process   competency?                                            able to cross-reference to up to 6 of these documents to sign-post evidence.
    81 Process   Can the online data pack be printed?                   Yes. However, pages currently have to be printed one by one.

                                                                                  Page 9 of 15
#     Theme      Question                                                Answer

                                                                        For the purposes of the strategic plan and financial plan, WCC uses the financial periods
                                                                        between 2009/10 (end of this financial year) to 2013/14. The Outcomes aspirations set should
                                                                        align to these same periods. We are cogniscent that outcomes data will come from different
                                                                        time periods. PCTs should take as a baseline the data available for each outcome as of early
                                                                        November 2009. The first period that they are then asked to set an aspiration against will be
                                                                        for the end of the financial year 2009/10. The second period will then be the end of 2010/11
                                                                        flowing through to the fifth period at the end of 2013/14. We will be issuing more guidance
                 What does a year mean? Financial / accounting /        specifically against the outcome metrics describing what the baseline data set will be for each
                 WCC? (This is specifically in reference to the         outcome metric and the exact time period (given that indicators are constructed differently with
    82 Process   aspirations and Y3 being 2010/11)                      some as rolling averages etc) that PCTs should be setting their first year's aspiration figure for.
                  Is there any way of preventing the rigging of email   If PCTs try to repeat the email addresses the system only releases one form. The system
                 addresses to be included within the stakeholder        admin role in the department and the SHA superuser can view all of the stakeholders
    83 Process   survey?                                                selected.
                                                                        These are documents of the PCT's choosing. There is no expectation that additional „other‟
                                                                        documents will or should be submitted and they should only be submitted in the event that the
                                                                        nationally defined list of documents does not provide evidence in a specific area. Where this
                                                                        is the case, PCTs should provide a clear rationale for the upload of the „other‟ additional
                                                                        documents (including a description of the document) and should signpost specific pieces of
                 What 'other' documents are required - are they totally evidence as part of their self-assessments within the document as per the nationally defined
    84 Process   optional, or there things DH are expecting to see?     set of documents.

                                                                       The maximum expected number of document references in any given competency or
                                                                       governance area is six (e.g., competencies 6, 7, and Board ). Of these six, in some situations,
                                                                       one set are the pathway descriptions (e.g., for competency 7). Where the PCT would like to
                 Given the small number of options for referencing     refer to evidence in multiple care pathway descriptions (in addition to five other document
                 documents (6 options) can PCTs:                       types), it is suggested that the PCT refers to one of their three care pathways in the drop-down
                 o      Refer to multiple care pathways in one         box but signpost specific pieces of evidence within the other two care pathway descriptions as
                 document (e.g make care pathway 1 contain all 3?)     required. Given that these documents are each less than 5 pages long (as highlighted in the
                 o      Highlight one care pathway as a reference      guidance for care pathway descriptions), it is anticipated that with careful signposting the
    85 Process   document, but refer to all three in the box?          PCTs will be able to flag evidence easily to the analysts and panels.
                                                                       Document signposting is a new feature for Year 2. As above, the maximum number of
                                                                       document references in any given competency or governance area is six (see handbook
                 Can the number of evidence slots for documents        appendix IV). Hence, the number of evidence slots is deemed appropriate for the purpose
    86 Process   being reference be increased?                         required.
                                                                       The contracting process form will be used alongside the PCT‟s self-assessment in the relevant
                                                                       competencies. PCTs have a limited number of characters to provide commentary within the
                                                                       contract process form so the need for sign-posting of evidence is therefore limited. However,
                 Can the Contracting Processing Form be included       it should be noted that PCTs should not provide commentary on how they approach their
                 within the drop down list for the document reference  contracting process within the areas of the form that are designed to append excerpts etc from
                 section (evidence for self assessment) as this may be contracts. These areas will only be assessed to support the narrative provided within the
    87 Process   a valuable reference                                  contracting process form.

                                                                                 Page 10 of 15
#     Theme      Question                                              Answer
                 Can last year's handbook please be put back on the
                 website - as this year's handbook does not repeat all
                 the details of last year's handbook where content has Last year‟s handbook is still available on the DH website and will be uploaded onto the WCC
    88 Process   stayed the same!                                      assurance toolkit

    89 Process   Can the opening hours of the helpdesk be put online       These will be displayed on the assurance toolkit

                                                                           PCTs can print out their competency and governance self-assessment forms, their outcomes
                 Can materials from the toolkit be downloaded eg           form and their contracting process forms. The specific details of the competency and
    90 Process   competency pages?                                         governance criteria, the outcomes metrics etc are all available within the handbook.
                 On the data pack , because the two mandatory are
                 split male and female, and so take up 4 boxes, there
    91 Process   is only room for 6 more outcomes?                         We believe this has been resolved
                 Could the outcome "blob" slide (part of the panel         The 'blob' slide will also be available as part of the information packs used by the analysts in
    92 Process   pack) be made available?                                  the panel preparation phase
                 How should outcomes trajectories be shown e.g.
    93 Process   percentages; actual numbers; level of increase        The outcome trajectories should be shown as actual forecasted numbers for the years
                                                                       The initiatives on the financial template have been divided into 2 categories - strategic
                                                                       initiatives and cost saving initiatives. The primary goal of the strategic initiatives is to deliver on
                 Clarification of WCC Initiatives as on Financial      the PCT's health outcomes and overall strategic goals. The primary goal of the cost saving
    94 Process   Template compared to Strategic Initiative?            initiatives is for the PCT to save money so it can invest elsewhere.
                                                                       PCTs will be able to track response rates - but not individual responses. The PCTs can
                 What happens if there are not enough respondents for nominate additional stakeholders (as part of their second list of stakeholder nominations) to
    95 Process   the stakeholder survey?                               participate if it looks likely that the PCT will not reach the minimum of 20 responses.
                 Are the number of respondents accepted capped?
                 E.g. first wave nominees slow to respond; second
                 wave nominees provided (same number); all
                 nominees respond towards the final deadline. Will all
                 respondents be used or will there be a capping        There is no capping of the number of respondents and all the survey responses will be
    96 Process   procedure                                             considered.

                                                                           The questions are still being finalised nationally but are still likely to focus on the following
                                                                           - How, if at all, do you engage with your local population for PBC purposes?
                                                                           - How would you rate the following aspects of the information provided for PBC by the PCT?
                                                                           - Have you agreed a commissioning plan with your PCT for 2008/09?
                                                                           - How many, if any, of the business cases for service redesign have been accepted by your
                 What questions from the PBC survey will be used as        PCT?
    97 Process   evidence?                                                 - To what extent do you agree or disagree that PBC has improved patient care?

                                                                                   Page 11 of 15
#     Theme      Question                                                   Answer

                 Please can there be more clarity about what is             A primary care contract in this instance is the contract a PCT has with its GPs. The contract
                 expected as an example of primary care contract for        forms are meant to illustrate how a PCT is managing the majority of its GP practices. It would
                 the contracts form? What is meant by delegation as         help to highlight whether the PCT is using PMS or APMS contracts with most of its GPs. It
    98 Process   part of this? Can this include community contract?         would be helpful to use the contract forms that are used with the majority of the GP practices.
                                                                            A detailed list of the outcomes, their definitions, the time periods that PCTs should use as their
                                                                            baseline for setting aspirations against at the cut off point (early November) and the expected
                 Please can we have a spreadsheet with the final set        first year that the aspiration should be set against specific to each outcome will be distributed
    99 Process   of outcome metric definitions                              as soon as possible.
                                                                            The maximum number of characters is shown on the toolkit. PCTs are encouraged to be
                                                                            focused in their narrative and in the evidence submitted. It is more important to have a smaller
                                                                            amount of robust evidence than long, detailed narrative.
                                                                            PCTs should not try to summarise all of their evidence base into the narrative sections but
                 What is the maximum number of characters in                instead use the area to highlight other critical evidence that is not covered within one of their
                 rationale boxes; what is best way to demonstrate the       submitted documents.
                 rationale e.g. reference a document - must this            PCTs will only be able to signpost against the documents that they have actually submitted
                 document be included as one of the three of PCTs           (either a document from the national list of documents or one of the three documents of their
100 Process      choosing?                                                  choosing)
                                                                            The media survey is conducted using nationally consistent methodology and is provided by the
                                                                            SHA on behalf of the PCT. The PCT does not need to submit anything against this piece of
101 Process      Media survey; what form will this take?                    evidence.
                 On page 64 of the WCC handbook it is written that
                 there will be guidance on interview groups for the         There will be further guidance which will be circulated soon but it is unlikely to change
102 Process      panel day. When will this guidance be issued?              significantly from last year
                 What is the expected time for response and resolution      Emails sent to the WCC support desk will be responded to within one working day, with every
103 Process      of email queries to WCC Support desk                       effort made to resolve issues as soon as possible
                 How do we extract electronically the outcomes; self
                 assessment of competencies; self assessment of
                 board / finance / strategy governance (rather than as
104 Process      a screen dump or printing)?                                This functionality is not available in Year 2
                 How do we extract stakeholder survey results               Anonymised results (both quantitative and the qualitative responses) will be part of the PCT's
105 Process      information electronically?                                information pack
                 Would the scoring for last year and this year be           Scores for last year and this year will be the arthmetic mean of the sub-competencies to 1
106 Process      provided to 1 decimal point?                               decimal point.
                 In the metrics for Yr 2, the handbook includes „Trends
                 in % of complaints concluded within 25 days‟. Is this
                 still being collected? If not, what measure will be used   We are currently working with the IC to determine what metric to use instead and will confirm
107 Process      for WCC assurance?                                         when agreed

                                                                                   Page 12 of 15
#   Theme     Question                                               Answer
                                                                     PCTs should base their aspirations off an understanding and analysis of their historic rate of
                                                                     improvement, the rate of improvement of their peers, and the level of initiatives/investment
                                                                     that will be put against each outcome area. Aspirations should be logged into the toolkit as an
              For the improvement aspiration, are we supposed to     absolute number rather than as a % improvement or a relative rate of improvement versus the
108 Process   be using our national ranking amongst PCTs?            national group
              Are there plans for publication of the stakeholder
              survey in large print/other languages? some of the
              voluntary groups may need such
              materials and I understand that we have a legal duty   The stakeholder survey is designed to be completed electronically. Where particular
              to provide. Also, is there a hard copy for those       stakeholders have issues in completing the survey, they should contact the PCT who will ask
109 Process   stakeholders without web access.                       the SHA 'super-user' to complete electronically on their behalf - e.g., via telephone interview
                                                                     The pathway guidance is an addition for Year 2 of WCC assurance and provides the key
                                                                     points of evidence that might be expected from the pathways given the competencies and
                                                                     governance criteria, while providing local flexibility for PCTs to complete as relevant for their
              Is any further guidance planned other than the 4       local area. PCTs are reminded that the pathway descriptions should be short and concise
110 Process   points in the guidance on the pathways document?       (max 5 pages for each pathway description)
              Do PCTs need to submit their annual operating plan     The AOP is not one of the national set of documents this year. However, PCTs may decide to
111 Process   as evidence                                            submit as one of their 3 additional documents
              With regards to the Primary Care Contract Process
              Form – should this include Community Services not      The primary care contract process form is targeted at primary care only (e.g., contracts with
112 Process   just GP/Dental Contracts?                              GPs).
              Within document submission, do PCTs need to submit     The LAA should be submitted along with a cover sheet briefly highlighting the process for
113 Process   the LAA or not?                                        reconfirming the LAA and the changes to the LAA in the last year where relevant

              In the self assessment commentary, should PCTs         Given the changes to the criteria over the past year, PCTs are encouraged to ensure that their
              refer back/reference what they put in the self         full-base of evidence (across submitted documentation, self-assessments, online contracting
114 Process   assessment in year 1?                                  forms etc) cover the full range of criteria for each competency/governance area
                                                                     PCTs will not be judged on the response rate that they receive from the stakeholder survey as
                                                                     a direct input to any of the competencies or governance areas. However, if their response
              Are PCTs judged on the response rate that they         rate was substantially lower or higher than their peers, the analysts and panelists may take
115 Process   receive to the stakeholder survey?                     this into consideration in their overall perspectives on the PCT.
                                                                     Locally chosen outcomes are the outcomes metrics (up to 8) that the PCT can choose in
                                                                     addition to life expectancy and health inequalities (which are nationally set for all PCTs).
                                                                     These locally chosen outcomes can either come off the national list of metrics (as set out in
                                                                     Appendix 1 of the handbook) or be locally defined (i.e., outcome metrics that are not on the
                                                                     national list of metrics in Appendix 1 but do meet the criteria for locally defined outcomes -
              What is the difference between locally chosen          e.g., have a full set of data across all PCTs etc). PCTs may choose up to 3 outcomes that are
              outcomes and locally defined outcomes in the           locally defined (i.e., not on the national list of metrics) out of their up to 8 local outcome
116 Process   handbook?                                              choices.

                                                                            Page 13 of 15
#   Theme     Question                                               Answer
                                                                     As part of the national timetable: (a) each region has been set their final WCC submission
                                                                     deadline - this is the final date for which all documents, forms (e.g., contracting process form)
                                                                     and self-assessments should be completed; and (b) SHAs have also specified which dates
                                                                     PCTs must complete the stakeholder survey nominations forms by (first and second lists).
                                                                     Regionally, some SHAs have also provided interim deadlines to their PCTs for draft
              How does the local SAH timetable sit with the national documentation and pre-uploads. PCTs should contact their SHAs on specific timings for their
117 Process   timetable?                                             region.
              When the toolkit refers to 1,000 characters for the
              commentary sections, does this 1,000 characters
118 Process   include spaces or not?                                 Yes, the 1,000 character limit includes spaces

              Are PCTs responsible for submitting the excerpt from
              accounts re public sector payment policy compliance?
              It‟s listed in the Appendix of the handbook as a
119 Process   document for submission but not on page 43 and 44. Yes, PCTs should submit these through the toolkit document submission process

                                                                       We are currently working with the IC to source the most recent data available at the end of
                                                                       October for each of the metrics/surveys that are used to populate the PCTs' information packs
              Could you confirm that the staff survey metrics will     (automated reports). For the staff survey specifically we will use data currently available which
              consider responses from commissioning staff only         provides a split between provider arm and commissioning staff and is publicly available on the
120 Process   and which year the data will be taken from               Staff Survey website (the splits are voluntarily provided by PCTs)

                                                              PCTs will need to have uploaded a specific document before they are able to signpost to
              Is it possible to put in the evidence for a competency
121 Process   before the PCT has uploaded the document first? them.
                                                              Analysts will read the whole SCP. However, for the purposes of the competencies, PCTs
              Will the analysts read the whole SCP and therefore
                                                              must signpost where specific evidence can be found within the SCP on a competency-by-
              does the PCT need to signpost evidence in the SCP
122 Process   for a competency?                               competency basis.
                                                              The strategic plan guidance is only a guidance and the PCTs are able to modify the structure
              Does the strategy document structure need to be of the document to fit their own local needs. PCTs will be assessed as per the criteria outlined
123 Process   exactly like the one presented in the guidance? in the assurance handbook.
                                                              PCTs are advised to not embed documents within documents as there is a high likelihood that
                                                              they will not be reviewed. The analysts will review documentation submitted that has been
                                                              printed by the SHA and hence there is a chance that embedded information / documentation
124 Process   Can a PCT embed a document within a document?   provided could get missed
              How should the PCT demonstrate board engagement The PCT should primarily include this within their self-assessment narrative in the Governance-
125 Process   in the SCP?                                     Strategy section, and also briefly within their strategic plan.

                                                                              Page 14 of 15
#   Theme      Question                                                   Answer
                                                                          PCTs can add different organisations to the list for the 2nd tranche of nominations. We'd
                                                                          probably not encourage them to add extra people from the same organisations in their 2nd
                                                                          tranche (unless they realise there is a genuine issue such as someone leaving) as if the 1st
                                                                          set then do answer it's not really broadening the breadth of respondents as there's likely to be
               Can PCTs add different organisations in the second         similar responses from people within the same organisation. On that note we would
               round for the stakeholder survey? Can the PCT only         encourage the SHA super-user to check who the PCT has nominated to ensure that there is
               add different people and not different organisations if    (a) sufficient breadth in organisations and (b) that the organisations that you would expect to
126 Process    the responses are not sufficient?                          be nominated have been (eg their main provider).
               Can the PCTs create a 'fake' document with inputs
               from multiple sources and upload this document as          The PCTs should not submit a mega document with inputs from multiple sources. The 3
               one of the three locally selected documents for            additional documents are meant to highlight any key piece of work done by the PCT which
127 Process    submission?                                                would be helpful for the panel to know in understanding the overall strategy.

                                                                          Competency 11 tests whether the PCT has a clear understanding of the effectiveness and
               Taking out funding from some areas might make a            efficiency of specific interventions. This analysis is likely to form one, but not the only, input
               provider‟s financial position unviable and hence PCTs      into prioritisation of initiatives and interventions. In determing the allocation of their spending,
               might have to invest in potentially sub-optimal            PCTs should form a holistic view based on objective analysis, local market conditions, local
128 Strategy   interventions?                                             data and the performance (e.g., quality, economics etc) of the local health economy
               If despite significant investment the PCT is not           PCTs are encouraged to analyse the impact of past interventions, variances in their
               observing any change in their outcomes should the          performance vs. benchmarks on these interventions and based on these to have an informed
               PCT stop funding the interventions (e.g. teenage           internal debate (where relevant, with partners/stakeholders as appropriate) and form a local
129 Strategy   pregnancy)?                                                view
                                                                          PCTs should detail disinvestments to the extent that they are able, and within the overall
                                                                          portfolio be developing greater detail around the key programmes that will be most critical.
                                                                          The panel will want to understand the extent to which plans are fomulated and agreed with
                                                                          stakeholders (e.g., providers) but will recognise that there will be (a) variance in the extent to
               How far is it expected that the PCT would have             which different programmes have detailed plans, and (b) that plans will evolve potentially
130 Strategy   developed a detailed disinvestment plan?                   between when the PCT submits and when the panel days are held
                                                                          PCTs will need to take an informed local decision on this, in partnership with local
                                                                          stakeholders including their SHA. Patient needs should remain the paramount objective, but
                                                                          PCTs will need to understand the risks associated with their providers and any potential
               Should activity be moved away from the acute sector        failure. A good understanding of providers' fixed and variable costs are likely to help in taking
131 Strategy   if this impacts the financial stability of the provider?   an informed decision.
               At what level should the PCT prioritise and how            The PCT should outline their overall initiatives but with enough granularity for the panel to
               should it demonstrate this (e.g., is an action a part of   have sufficient confidence in the robustness of the initiatives. 10-20 key initiatives should be
132 Strategy   an initiative)?                                            described in the Strategic plan

               Do the goals in the strategic plan only relate to health The goals should include the main areas of significant strategic importance to the PCT. These
               specific health outcomes or can they include other       may be specific to particular health outcomes areas but may also include other key goals
133 Strategy   areas (e.g. improving access, reconfiguring services)? around reconfiguring services, improving access etc.

                                                                                  Page 15 of 15

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