…………PRIMARY CARE TRUST
SERVICE LEVEL AGREEMENT
Between …………. and ………………….Hospice
for
The Provision of Specialist Palliative Care Services
The Provision of Specialist Palliative Care Services
Service Level Agreement
Final July 2008
Page 1 of 11
The ……………………………………….will implement this agreement and abide by its conditions herein.
COMMENCEMENT DATE OF AGREEMENT
EXPIRY DATE OF AGREEMENT
1.
Signed for and on behalf of the ……………………………………
Signed: Name: Position: Date:
............................................................ ............................................................ ............................................................ ............................................................
2.
Signed for and on behalf of the Service Provider:
Signed: Name: Position: Date:
............................................................ ............................................................ ............................................................ ............................................................
Final July 2008
Page 2 of 11
1.
BACKGROUND This agreement is the first formal Service Level Agreement between the ……………………………………………………………………..for the provision of specialist palliative care services. This agreement will identify the core healthcare services and the process by which NHS funding will contribute to overall expenditure in accordance with the recommendations set out in the Department of Health’s Cancer Plan (2000) NICE Supportive and Palliative Care Improving Outcomes Guidance (2004) MCCN Strategy for Palliative Care 2007-10 and adhere to Health Care Commission Standards and standards within the operational framework
2.
SERVICE AIMS The primary activity will be the provision of specialist palliative care, offering treatment, advice and support to those who are suffering from a range of illnesses. This is designed to be an accessible and equitable service, provided at a place and time, which is acceptable, non-stigmatising and supported by a specialist multi-professional team. Specialist Palliative Care is the active total care of patients with progressive far advanced disease and limited prognosis, and their families, by a multiprofessional team who have undergone recognised specialist palliative care training. It provides physical, psychological, social and spiritual support, and will involve practitioners with a broad mix of skills.
3.
SERVICE OBJECTIVES The PCT and Provider are committed to enhance the health and well-being of residents of the area covered by the Service Level Agreement by high quality service, innovation and development and to meet identified needs within the resources available to both the PCT and the Provider and by joint initiatives with the Provider. The provision of services should: Provide complex symptom control, which mainly includes care through the assessment, rehabilitation and dying phase. Be appropriate to the needs of the individual. Aim to ensure that the wishes of patients/advocates are taken into account Be provided regardless of sex, ethnicity, disability or age (adults aged over 18 only) Represent a percentage mix of patient origin and activity which broadly reflects the local population profile for the agreed catchment areas within those PCTs providing funding for the hospice.
Final July 2008
Page 3 of 11
Ensure that patients receive information relating to their diagnosis, disease progression, care options and support services enabling them to make an informed choice. Include psychological, emotional, spiritual, social or practical support, which is responsive to their perceptions and needs. The Provider will to communicate within local networks and with other professional/agencies, providing continuity of care and support for patients and families/carers and will collaborate with other agencies to ensure effectiveness, continuity of patient care and to support and develop best practice.
4.
SERVICE DESCRIPTION AND RESPONSIBILITIES
In patient services Function: To provide care for those patients with complex, physical, psychological and social needs, not readily relieved in the home or other care setting. The focus is on short term intervention following assessment by the specialist team, but may also include end of life care where this is the most appropriate place. Key components: Patients admitted for specialist palliative care intervention and support will be admitted under the care of a Consultant in Palliative Medicine who is on the specialist register for palliative medicine and who is an active member of the specialist palliative care MDT. In addition to the named principal clinical management by a Consultant in Palliative Medicine patients will have access to specialist palliative care support through the specialist multi professional team The in-patient environment in which SPC is delivered has appropriate access, and conforms to the standards for care and environment amenities as defined by the Health Care Commission Specialist Palliative Care Day Therapy Function: The role of specialist palliative care day therapy is to enhance the independence and quality of life for the patient through a holistic assessment process involving rehabilitation, physiotherapy, occupational therapy, the management and monitoring of symptoms and the provision of psychosocial support. Service Component: The service will be clinically led by a Consultant in Palliative Medicine. who is on the specialist register for palliative medicine and who is an active member of the specialist palliative care MDT. Patients will have access to principal clinical management by a Consultant in Palliative Medicine and specialist palliative care support through the specialist multi professional team. The period of time a patient is allocated to a SPC day therapy place will be agreed locally, determined by individual need and conveyed to the patient.
Final July 2008
Page 4 of 11
Access to a SPC day therapy place will be of within 2 weeks referral as recommended within the MCCN Strategy for Palliative Care. The environment in which SPC day therapy is delivered will conform to the standards for care and environment amenities as defined with the DH standards for better health and the MCCN Strategy for Palliative Care . Access to written information for patients and their carers will be available within the SPC day therapy setting. Out patient services Function : Specialist Advice and care in support of primary, secondary and tertiary care should include the facility for SPC outpatient review Service Component: Outpatient services will be clinically led by a Consultant in Palliative Medicine who is on the specialist register for palliative medicine and who is an active member of the specialist palliative care MDT. Patients will have access to principal clinical management by a Consultant in Palliative Medicine and specialist palliative care support through the specialist multi professional team. A more detailed service specification will be provided using the template supplied by the PCT, this will give details of the services provided. The Provider should inform the PCT of any substantive changes to the services shown above and whilst the provider may change levels of services any PCT funding required to support such service development should be agreed in advance.
5.
REFERRAL PROCESS & ELIGIBILITY For all the services listed above Patients can be referred from medical staff, healthcare professionals from the community or hospital. Subject to availability of places, the provider will endeavour to accept patients whose assessed needs can be suitably met at the Hospice in accordance with the service specification and, when they feel unable to do so will, upon request of the PCT put those reasons in writing. Details of the relevant referral and admission criteria along with assessment procedures shall be available for inspection if required.
6.
INFORMATION AND REPORTING REQUIREMENTS The Provider shall ensure that information, records and documentation necessary to monitor the contract are maintained and are available at all times to the authorised representative. The provider shall at all times cooperate with the reasonable processes of the PCT for the monitoring, evaluation and carrying out of a quality audit in whatever way is reasonably requested by the PCT. Certain formal monitoring requirements relating to client activity detailed will be required.:
Final July 2008
Page 5 of 11
A full copy of the Minimum data set (MDS) return as specified by the National Council for Palliative Care (NCPC) In addition the Provider will supply the below information on a quarterly basis for ……………… residents Inpatients The total number admitted in that quarter shown by; Cancer/non-cancer diagnosis New and total patients Occupancy rates Average length of stay Day Care The total number of patients shown by Cancer/non-cancer diagnosis New and total patients Total day care attendances Total day care places Outpatients The total number of patients shown by; Cancer/non-cancer diagnosis New and total patients Medical and non-medical cases
A template, with specified definitions of the above, will be supplied by the Primary Care Trust for completion and data returned to the authorised representative of the Trust in electronic form within 6 weeks of the end of the relevant quarter. The details of such activity volumes will be monitored and discussed with Commissioners. The Provider will agree to any reasonable request for further information and will not refuse any reasonable request to allow the PCT to inspect any records or client data relating to the service covered by this Agreement. Any information acquired by the PCT as a result of any such inspection shall be confidential and its access will be regulated under the Data Protection Act. 7. PERFORMANCE An annual review meeting will be held and attended by appropriate PCT and Provider managers to consider the performance, the anticipated outcome of the agreement and future service developments and changes. In addition a mid-year review will be scheduled to discuss in year progress. Further meetings may be arranged at any time to consider significant variation in the terms or conduct of the agreement and where corrective action on either part is indicated. A service statement, as determined by the requirements of the Healthcare Regulations, will be agreed between the PCT and the provider and
Final July 2008
Page 6 of 11
updated on an annual basis giving further details of the activities of the Provider. Within the operational review the PCT may require information or evidence of multi-professional meetings and care planning, that patient wishes were taken into account, use of audit tools and their findings and support and counselling of relatives and carers. The PCT and Provider will agree a rolling development plan, in line with Government Strategy, which complies with Hospice Business Plans and collaborate on the Hospice Strategy. The PCT and the Hospice will plan and discuss all future developments. Any new services that the Provider wishes to introduce, and are considered to be a core service that require NHS funding will be discussed with the PCT, and presented to the local commissioner for approval before the service is implemented. Relevant timetable Activity May Quarterly data set return for January-March period Full year Minimum data set return as submitted to the National Council for Palliative Care. Annual Performance and Development meeting August Minimum data set return for April-June period October Minimum data set return for July-September period In year progress meeting February Minimum data set return for October-December period Returns/meetings being no earlier than the last 2 weeks of the above months Details of external inspection/assessments of the provider should be forwarded to the authorised representative of the Primary Care Trust upon receipt and the PCT will be at liberty, if required, to investigate any matters of concern. The procedure will also be adhered to if complaints/concerns are received by the Primary Care Trust In addition, the Provider will allow the PCT at all times to view at first hand any of its activities directly related to those services covered by the terms of this Agreement. The representatives of the PCT must demonstrate their authority to visit the premises of the Provider and to observe the quality procedures in place. Visits will be arranged at a mutually convenient time between the PCT and the Provider. The PCT will provide a report of each visit to the Provider. 8. HEALTH AND SAFETY The Service Provider’s attention is drawn to the Health and Safety at Work Act 1974. The Service Provider shall adequately train, instruct and supervise staff to ensure as is reasonably practicable, the health and safety of all persons who may be affected by the services provided under the agreement. The Service Provider should have a written policy on health and safety and all staff employed in connection with the service being provided should be aware and understand the policy.
Final July 2008
Page 7 of 11
9.
EQUAL OPPORTUNITIES The Service Provider shall comply with the below legislation and shall use its best endeavours to ensure that in their employment policies and in the delivery of the services required of the Service Provider under this agreement there shall be no unjustifiable inequality of treatment of staff or patients in terms of race, gender, sexuality, disability, age or religion. Race Relations Act 1976 - Amendment Act 2000 Sex Discrimination Act 1975 - Amendment Regulations 2003 Disability Discrimination Act 1995 DATA PROTECTION, CONFIDENTIALITY AND RECORD KEEPING All Service Users have a right to privacy and therefore all information and knowledge relating to them and their circumstances must be treated as confidential. The Service Provider must advise all staff on the importance of maintaining confidentiality and implement procedures which ensure that Service User’s affairs are only discussed with relevant people and agencies. The Service Provider should have a code of practice on confidentiality which contains the key provisions of the Data Protection Act 1998 and the requirements of the Caldicott principles and have mechanisms to ensure compliance with these requirements. The Service Provider shall comply with all legislation, including guidance issued by the Charity Commission and required by the Companies Act where the retention and destruction of records is concerned. The Provider shall also comply with guidance issued by the Healthcare Commission. including: The DH Circular – HSC 1999.053 “For the Record” STAFFING The provider will ensure that, at all times, it has sufficient suitably trained staff to ensure that services comply with all the statutory requirements and meet patient needs. A record of qualifications and training programmes shall be maintained by the provider and available for inspection. The provider shall have in place a training programme demonstrating the commitment to training and staff development and the maintenance of professional knowledge and competence. 12. FINANCE ARRANGEMENTS To be detailed and recorded as per local agreement including schedule of payments.
10.
11.
Final July 2008
Page 8 of 11
Yearly management accounts will be supplied. Such accounts will show actual expenditure against planned expenditure any variance from plan and expenditure and reasons for significant variance. Service developments or expansions which would be developed through monies provided by the Commissioner should not take place without the consent and agreement of the Commissioners and be in their operating plan as a priority.
13.
VARIATION This Service Level Agreement may not be varied unless a variation is agreed in writing and signed by all parties.
14.
DISPUTES ………… PCT and the Contractor shall use their best endeavours to resolve, by agreement, any dispute between them.In order to resolve any disputes, either party must initially use the following procedure. a) A meeting will be requested between the Contract Manager for the Contractor and the Authorised Representative of the PCT; this meeting will take place within 7 days. If the dispute remains unresolved, then a further meeting will take place at which local representatives from both parties will attempt to resolve the dispute. Senior Managers from either or both parties may be asked to act as mediators at meetings called under (b) above. Where a resolution cannot be reached, informal mediation will be sought from the Strategic Health Authority. If the dispute remains unresolved then the matter will be referred for arbitration under Clause 47
b)
c) d) e)
Use of the dispute procedure will not delay or take precedence over the use of the default procedure and shall not in any way prejudice the Service provided to the Service User. ARBITRATION All disputes, differences or questions between the parties to the Contract with respect to any matter arising out of or relating to the Contract, other than a matter of things as to which the decision of …………..PCT is under the Contract to be final and conclusive, shall after written notice by either party to the Contract to the other be referred to the DoH Regional Directors of Health and Social Care for that purpose or in default of such agreement within twenty-one (21) days, be referred to an arbitrator appointed by the Chartered Institute of Arbitrators. The decision of such arbiter shall be final and binding on the parties of the Contract.
Final July 2008
Page 9 of 11
The provision of the Arbitration Act 1996 shall apply to any arbitration under this contract and such arbitration shall be conducted solely within England. 15. TERMINATION Either party may terminate this agreement by giving not less than 3 months notice in writing to the other. This notice shall include reasons as to why the agreement has been terminated. The Department may terminate the agreement, or terminate the provision of any part of the Services, by written notice to the Service Provider with immediate effect if the Service Provider is in default of any obligation under the agreement and: a. where the default is capable of remedy the Service Provider has not remedied the default to the satisfaction of the Department within 30 days, or such other period as may be specified by the Department, after service of written notice specifying the default and requiring it to be remedied; or b. the default is not capable of remedy; or c. the default is a fundamental breach of the agreement If the Department terminates the agreement and then makes other arrangements for the provision of the Services, the Department shall be entitled to recover from the Service Provider any funds already allocated by the Department to the Service Provider for the provision of such services but not used for this purpose. 16. PERIOD OF AGREEMENT This Service Level Agreement shall take effect on ……..until ……….. At the end of the first 6 months, the agreement will be subject to a formal review and continuation is subject to satisfactory performance by the Service Provider, of the obligations hereunder. The period may be extended with the agreement of both parties. 17. AUTHORISED REPRESENTATIVES The Authorised Representative(s) of the Lead PCT for the purposes of the agreement is/are; ___________________________________________________________ The Authorised Representative of the Service Provider for the purpose of the agreement is: ____________________________________________________________ Any changes to the above should be notified to the appropriate party in writing.
Final July 2008
Page 10 of 11
Final July 2008
Page 11 of 11