October 2021

Request received

Within your authority or trust, provide the number of:

1. Low secure children and adolescent mental health service (CAMHS) and medium secure CAMHS beds. How many of those are currently available for new admissions?
2. Low secure CAMHS beds. How many of those are currently available for new admissions?
3. Medium secure CAMHS beds. How many of those are currently available for new admissions?
4. Welfare social care secure beds. How many of those are currently available for new admissions?
5. Forensic secure beds. How many of those are currently available for new admissions?
6. Young people who have been assessed as requiring a CAMHS tier 4 mental health bed but have not been admitted due to a shortage in resource. We do not require personal details or reasons for the conclusion reached, just numbers.
7. Young people who have been assessed as requiring a CAMHS low secure mental health bed but have not been admitted due to a shortage in resource.
8. Children accommodated in unapproved, unregulated settings.

Our response

1. The general adolescent mental health unit has 12 low secure bed spaces and 2 high dependency unit bed spaces. At this time, it is open to new admissions.
2. The general adolescent unit has 5 bed spaces but is subject to change on a daily basis.
3. There are no medium secure units in Cornwall and the Isles of Scilly.
4. NHS Kernow does not hold this information. Contact Cornwall Council.
5. There are no forensic secure bed spaces for under 18s in Cornwall and the Isles of Scilly.
6. NHS Kernow holds the information but where the numbers are less than 5 the information cannot be disclosed. As it could potentially identify the individuals involved, especially if combined with other data. This would constitute a breach of the Data Protection Act 2018. Therefore, this information is exempt from disclosure under section 40(2) of the Freedom of Information Act 2000 on the grounds that it is personal information.
7. As answer 6.
8. As answer 4.

Request received

1. What allergy services do you commission for your population? Differentiate between children and adults.
2. Describe current pathways for children and adults who have presented with suspected and/or confirmed anaphylaxis? Both at the emergency department and within primary care settings.
3. Who in the organisation has responsibility for the commissioning and monitoring of performance for allergy services? Provide job title and salary band.
4. Provide details of how performance monitoring is undertaken for allergy services. List key performance indicators (KPIs) used to monitor performance of the services?
5. Have you taken any steps to improve allergy services you commission during the last 5 years? If yes, describe them.
6. What is the referral criteria into local allergy services?
7. How are allergy referrals prioritised?
8. Covering the most recent 12-month period (up to when data is available). What was the average wait time from referral to the patient receiving an appointment with an allergy service?
9. What patient feedback and experiences do you routinely collect relating to allergy services provision?

Our response

1. There is no specific service specification for adults and children in Cornwall and the Isles of Scilly.
2. Primary care referral guidelines can be accessed on our Referral Management Service website.
3. NHS Kernow does not hold emergency department referral guidelines. Contact Royal Cornwall Hospitals NHS Trust for this information.
4. Senior commissioning manager for planned care medicine, band 8a.
5. There is no specific KPI requirements within our acute hospital contracts specific to allergy services. The planned care team use a variety of other methods to monitor our immunology teams. Including meetings with services and receive speciality level reporting at national and local level on a monthly basis. However, these do not specifically include reporting at a subspecialty (allergy) level.
6. The planned care team undertook a review of our referral guidelines for allergy in 2019. Subsequently they made adjustments following the discussions with the clinicians held at that time.
7. Referral guidelines for allergy can be accessed on our Referral Management Service website.
8. Referrals will be prioritised at speciality level, in order of clinical priority.
9. As per question 4, reporting for allergy service is not provided at a sub-speciality level.
10. NHS Kernow do not actively collect routine information from patients on allergy services. We utilise learning from any complaints, plaudits and compliments when notified to us.

Request received

1. During 2018 to 2019 and 2019 to 2020, provide the number of episodes of care you have processed for your commissioned services with NHS trusts for the following Sacroiliac joint:
   • steroid injections
   • radiofrequency ablations (RFA)
   • surgical procedure
2. Confirm if your commissioned NHS trusts require individual funding requests (IFRs) for steroid injection procedures? Also the number of IFRs your CCG have received from NHS trusts if their policy requires this?
3. Did your commissioned NHS trusts require IFRs for joint RFA procedures? Also the number of IFRs your CCG have received from NHS trusts if their policy requires this?
4. Confirm if your commissioned NHS trusts require IFRs for surgical procedures? Also the number of IFRs your CCG have received from NHS trusts if their policy requires this?
5. Can you confirm how many injections a single IFR covers for a patient per year and ongoing if applicable?
6. Confirm how many RFA procedures a single IFR covers and the interval between procedures if applicable?
7. Provide a copy of the latest service specification that you have with your NHS Trust, which shows the care pathway that you provide?

Our response

Details below for question 1:

• Sacroiliac joint steroid injections: 2018 to 2019 = 79. 2019 to 2020 = 64.
• Sacroiliac joint RFA: 2018 to 2019 = 29. 2019 to 2020 = 23.
• NHS Kernow does not hold information on Sacroiliac joint surgical procedures. This is a specialised service commissioned by NHS England. Contact NHS England.

The answer to question 2 is no.

For questions 3 to 6, the answer is not applicable.

In response to question 7, there is no service specification for this.

Request received

1. Blood glucose test strip formulary review date.
2. Email and contact details for the medicines optimisation team.
3. Wound dressing formulary review date.

Our response

1. Blood glucose test strip information is available on the Cornwall Joint Formulary website.
2. Email the prescribing team or call 01726 627800.
3. Wound dressing information is available on the Cornwall Joint Formulary website. Note it is currently under review.

Request received

1. Do you currently procure clinical decision or primary care support tools, software or services?
2. What was the value for this procurement?
3. Was this part of a funding exercise? If so, confirm details of the fund and its allocation.
4. What was the date of the contract inception?
5. What other companies were reviewed as part of the tender process? Provide any evidence of the review and scoring against your nominated criteria.
6. Where was this tender presented to allow companies to apply?
7. What is the current renewal date of the contract?
8. Provide any copies of business cases that outline the requirement for this company. Also include subsequent benefits realisation documentation post implementation detailing requirements were met.

Our response

NHS Kernow does not currently procure any clinical decision support or primary care support tools.

Request received

1. Who is the current community musculoskeletal services provider?
2. How long was the last contract award for?
3. When is the contract due for renewal?
4. What is the annual expenditure with that provider for the service in question?
5. What premises the provider delivers the services from?
6. Who is the service manager or head of service in charge of this area?
7. Who is the clinical lead responsible for this area of work?

Our response

For questions 1 to 4, see table below:

For question 5, a list of providers is available on the Referral Management service website.

John Groom is our director of planned care. The musculoskeletal clinical lead is Dr Rebecca Hopkins.

Request received

This request relates to low and mid-technology communication aid devices for people with speech difficulties. I am requesting data for 2021, 2020 and 2019. Communication aid devices examples:

• iPads and tablets
• text to speech apps
• keyboard based communication aids

1. Do you have a recurring budget? If yes, how much was the budget?
2. If yes, how many people with speech difficulties were provided with aids that were funded by you? What devices were provided?
3. How many people with a diagnosis of motor neurone disease were provided with an aid funded by your CCG? What devices were provided?
4. If you do not have a budget, how should a local, community or acute based speech and language therapist working make available assessment and provision of these devices?

Our response

NHS Kernow does not hold such a budget. This would be included within block contracts for adults. For more information about how this budget is managed, contact Cornwall Partnership NHS Foundation Trust.

There is a children and young person augmentative and alternative communication team which is run by the local authority. They may be able to provide the information relating to under 18-year-olds. Email the alternative communications team.

Request received

This is a request concerning the provision of accommodation and facilities for mental health patients in cases of special urgency.

1. Could you provide a list of the hospitals specified under the Section 140 (Mental Health Act 1983) arrangements in your area? How many beds are available?
2. Can you tell me what arrangements are in place for the reception of patients in cases of special urgency?
3. Can you provide information about, or a copy of, the local joint policy between the local authorities, services, and NHS commissioners?
4. Who are the senior leads for each party in this joint policy?

Our response

1. NHS Kernow commissions Cornwall Partnership NHS Foundation Trust to provide a bed in response to a Section 140 request and to ensure availability of a bed in the case of a special urgency. We do not commission a specified number of beds but ask for availability of a bed at 1 of 2 hospital sites in the county:
   • Longreach House in Redruth
   • Bodmin Hospital in Bodmin
2. The current policy is under review and we are unable to share this until it has been formally ratified by all stakeholder boards. Contact Cornwall Partnership NHS Foundation Trust and Cornwall Council’s adult social care team for the interim arrangements.
3. The current policy is under review and therefore we are unable to share this until it has been formally ratified by all stakeholder boards. Senior lead roles:
   • chief social worker, adult social care, Cornwall Council
   • director of mental health, Cornwall Partnership Foundation Trust
   • director of planned care, NHS Kernow
4. See answer 1.

Request received

1. Name of clinical commissioning group (CCG) or integrated care system (ICS).
2. Does the CCG or ICS commission staff from community services to provide in-reach into acute hospitals?
3. Describe how the in-reach service supports patient care?
4. Commissioned whole time equivalent (WTE) of the in-reach service offer?
5. Commissioned hours of operation and working pattern of the service?
6. What is the skill set of the in-reach support staff?
7. What key performance indicators (KPI) metrics are used to measure impact and performance of the in-reach service?
8. Share any relevant KPI metrics from the last 12 months for the service, or the most recent full financial year?
9. What is the annual cost of the in-reach service?
10. What is the current CCG or ICS population size that the service covers?

Our response

Our name is NHS Kernow Clinical Commissioning Group. We do not commission staff from community services to provide in-reach into acute hospitals.

For questions 3 to 10, our response is not applicable.

Request received

1. Does your organisation currently use or plan to use or endorse a remote patient monitoring (RPM) solution to allow communication directly with the patient whilst they are at home? To capture vitals and clinical information to be captured back into the primary health record (for example using EMIS, Vision, SystmOne)?
2. If no,
   • is telemedicine or RPM, something that you would consider (within the next 2 years)
   • reducing hospital re-admissions
   • reducing GP appointments
   • saving administration time
   • for patient convenience
   • identify pre-diagnosed clinical conditions
   • recognising and acting upon patient deterioration sooner
   • If the organisation is not considering RPM for suitable patients, is there a reason why this is not being considered?
3. If yes, and a RPM is currently being used within primary care, confirm the following:
   • Name of system type, name, supplier and clinical area?
   • Does this system integrate directly with any clinical systems?
   • When did this system come into use, and when is the current contract up for renewal?
   • Was the implementation as part of a funded initiative and if so, what fund, when, cost?
   • How much does the system currently cost the organisation (per patient per year)?
   • What information and measurements are currently captured?
   • What information would you like to capture but currently are unable to?
   • Has there been any analysis of this data to demonstrate that remote patient monitoring from home or community residence? Has it reduced patient admissions into hospital and/or improved patient care or medication needs?
   • Who is the main person, decision maker or team responsible for the decision to use RPM?
4. If yes, an RPM is being scoped or considered but isn’t currently in place, confirm:
   • Conditional or clinical area you are looking to?
   • What are your objectives around considering a RPM?
   • Who is the main person, decision maker or team responsible for the decision to use RPM?

Our response

1. Yes, some current use.
2. Not applicable.
3. Yes.
4. Responses below:
   • Various telemedicine devices from various suppliers being trialled with specific patient cohorts. For example blood pressure monitors, ECGs and pulse oximeters.
   • No direct integration at present though data can be downloaded and brought into the medical record by clinicians or via website template where available.
   • Current pilots have been set up through nationally funded initiatives at different times and the CCG is not committed to a contract.
   • Yes, funded via NHS England mainly as part of COVID response activities.
   • Not applicable.
   • Blood pressure, ECG and oxygen saturation.
   • Direct integration of captured data into clinical system.
   • This is being monitored as part of ongoing pilot schemes.
   • NHS Kernow does not release the names of employees below director level. Andrew Abbott is director of primary care.
5. Not applicable.

Request received

Please provide me with the following data, broken down by year (2017, 2018, 2019, 2020 and 2021 to date). For the total number of complaints about an NHS staff member at secondary care services commissioned by your CCG of:

1. Sexual harassment
2. Sexual misconduct
3. Rape
4. Sexual assault

Please break down by types of service and details of any actions taken in response to such complaints.

Our response

NHS Kernow does not hold this information. Commissioners do not request this type of information from the providers. Contact the providers for this information:

• Royal Cornwall Hospitals NHS Trust
• Cornwall Partnership NHS Foundation Trust
• University Hospitals Plymouth NHS Trust

Request received

1. Supply all head offices area GP offices including primary care network (PCN) agreements and contracts from 2019 onwards. This includes IT agreements and contracts.
2. Is 1 of the contracts a CCG practice agreement terms governing the provision and receipt of digital services in general practice? As it also says the CCG shall complete and maintain an up-to-date summary description of the services for the practice. Can you provide a summary of services of all doctors’ offices in CCG area from 2015 to 2019 and PCNs from 2019 to 2021?
3. When did CCG communicate GP IT estate requiring system design changes by either communicating this to itself or to third party IT contractors, NHS digital and NHS England? As doctors’ offices were required to become federated and PCNs and so requiring their computer systems merger or sharing.
4. Referencing the securing excellence in primary care (GP) digital services operating model 2019 to 2021:
   • 4.2.1: When did CCG do this doctor’s office and primary care network work? If it did not when did CCG inform NHS England and NHS digital?
   • 4.2.2: When did CCG do this doctor’s office and primary care network work? If it did not when did CCG inform NHS England and NHS digital?
   • 4.2.3: When did CCG do this doctor’s office and primary care network work? If it did not when did CCG inform NHS England and NHS digital?
   • 4.2.4: When did CCG do this doctor’s office and primary care network work? If it did not when did CCG inform NHS England and NHS digital?
   • When did CCG do this doctor’s office and PCN work? If it did not when did CCG inform NHS England and NHS digital?
   • Regarding opting-out: When did CCG do this doctors office and PCN work? If it did not when did CCG inform NHS England and NHS digital?
5. When did the CCG communicate about GP Connect system design instructions to itself or third party IT contractors? For example NHS Digital and NHS England for federated GP offices, PCNs requiring their computer systems merger or sharing?
6. As you know from NHS England has delegated to CCGs the responsibility for delivering most GP IT services:
   • When did CCG allow PCN’s to receive its HSCN ODS code (organisational code)?
   • Who applied CCG or PCNs for PCN HSCN ODS codes and did CCG give permission if it was PCNs applying?
   • Who signed the PCN’s HSCN connection agreement and did CCG give permission if it was PCNs?
   • Which type of PCN HSCN connection agreement was signed?
   • Did CCG give the initial PCNs HSCN signing on credentials to PCNs?
   • Are there and if there are who are the IT service providers for organisations which provide IT services to CCG HSCN users?
   • When did CCG order doctors offices to form PCNs?
   • How many log-ins by doctors offices have been into PCNs?

Our response

1. No. NHS Kernow exempts release of the information under section 14.1 of the FOI Act. NHS Kernow considers that the request as vexatious. This exemption is engaged because it would cause a disproportionate or unjustified level of disruption by:
   • impose a burden by obliging us to sift through a substantial volume of information to isolate and extract the relevant details
   • create a burden by requiring us to spend a considerable amount of time considering any exemptions and redactions
2. Yes.
   • GPSoC and GPIT Futures Foundation clinical system (EMIS/SystmOne and also Microtest until March 2021)
   • GPSoC and GP IT Futures systems (Docman, Frontdesk, Eclipse)
   • HSCN connectivity server
   • network infrastructure and desktop support services
   • additional
3. NHS Kernow has not communicated that doctors’ offices are required to become federated or primary care networks requiring their computer systems merger or sharing.
4. The reference to enhanced capabilities within the primary care (GP) digital services operating model means capabilities that are over and above the core and mandated requirements or that are not related to the provision of the GMS or PMS contract. As such NHS Kernow is not required to provide any such services. Nor is it obliged to inform NHS England and NHS Digital of any provision of or decision not to provide any such services. All practices in Cornwall have access to a suitable online consultation tool, the implementation of which was accelerated as part of the COVID-19 response. All practices in Cornwall have access to online patient services tools through their foundation clinical system. It is not clear that national negotiations, existing safeguards for vulnerable groups and third party confidentiality and system functionality have been satisfactorily resolved to enable access to full record, including the ability to add their own information for all patients.
5. Implementation started in 2018.
6. Responses below:
   • Codes were assigned to primary care networks in July 2019 by NHS Digital’s ODS team.
   • NHS Kernow applied for the codes on behalf of primary care networks.
   • Not applicable, primary care networks do not have their own organisation specific HSCN connection agreement.
   • As answer c.
   • As answer c.
   • Cornwall IT Services, BT, Crowbytes, Egton, TPP, Emis, Egton, Advanced, OneAdvanced.
   • Formation of primary care networks was not mandated by the CCG.
   • Not applicable. A primary care network is not a network that can be logged in to, whether by a primary care network or doctor’s office.

Request received

1. Does your trust currently use robotic process automation?
2. Which departments within your trust currently use robotic process automation?
3. Which commercial partner is your trust currently using?
4. Is the trust intending to expand the use of robotic process automation?
5. Total budget spent on robotic process automation?
6. Forecasted investment in robotic process automation?
7. Which departments have been identified for robotic process automation projects?
8. The name of the Trusts current TIE?

Our response

NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. NHS Kernow does not hold the information requested, email Royal Cornwall Hospitals NHS Trust.

Request received

1. Which electronic patient record technologies do you use? State the vendor from the Health systems support framework or major vendors.
2. Do you use any local shared or detailed care record technologies?
3. Which (if any) clinical communication technologies do you use?
4. What is the name and contact details (email, phone, office address) of your digital transformation lead, chief information officer, or director of IM&T? If this doesn’t exist in your organisation, provide details for the leadership in the organisations that support or make-up your organisation.
5. What is the name and contact details (email, phone, office address) of the rehabilitation services lead? If this doesn’t exist in your organisation, provide details for the leadership in the organisations that support or make-up your organisation.

Our response

1. NHS Kernow is a clinical commissioning group responsible for the planning and commissioning of health care services. NHS Kernow does not use any of the systems listed. More information may be available from Royal Cornwall Hospitals NHS Trust and Cornwall Partnership NHS Foundation Trust
2. Bray Leino BroadCare is used to manage individual care packages commissioned by NHS Kernow. Blueteq provides information and an authorisation route for high-cost drugs and devices that sit outside the national tariff.
3. As answer 1.
4. NHS Kernow does not have any of the roles listed. Clare Bryan is our chief finance officer and senior information risk officer. Email Clare Bryan, write to Room 210, Cornwall Council offices, 39 Penwinnick Road, St Austell PL25 5DR or call 01726 627800.
5. Details of the Governing Body membership can be found on our website.
6. As above.

Request received

Between August and September 2021, integrated care systems were asked to submit to NHS England the planned dates for all trusts and all 3 pathways of the tobacco dependency treatment aspects of the NHS long term plan to begin delivery and for services to be fully established. I would like to request those trajectories, as well as any related plans.

Pathways:

1. acute inpatient
2. maternity
3. mental health inpatient

Our response

Our response to this request included an attachment. Email our FOI team for a copy of the document.

NHS Kernow submitted the trajectories and plans on behalf of the system as the ICS is in development. Names of staff below director level were redacted in line with NHS Kernow’s information governance policy. The financial information has been redacted as this is a planning document which has not been through the relevant committees for approval. Note that the timeframes outlined in the trajectory document have now moved from being indicative to live timeframes. Whilst the project timeframes in the strategy are only indicative dates of when particular tasks are expected to be completed.

Request received

This information relates to information from January 2016 to date regarding the prescribing of:

• Liothyronine
• Armour Thyroid
• Erfa

1. All letters, emails, newsletters or other instructions to consultants, doctors, GPs or hospital trust’s.
2. Correspondence, either letters, newsletters, emails or other communication.
3. policies, procedures or guidance on prescribing.
4. Documents, policies, processes and any other communication, including letters, emails or otherwise, relating to all audits performed by, or on behalf of, the CCG.
5. Policies, processes, privacy impact assessments, public interest tests, instructions and guidance for pharmacists employed by the CCG to review patient medication.
6. Data processes, privacy impact assessments, policies and risk assessment relating to the access, use of, reuse of and sharing of patient’s personal confidential data.
7. All information, minutes of meetings, documents and correspondence, including emails, letters and any other communication, relating to NICE guidelines for the prescribing of Liothyronine.

Our response

Our response to this request included an attachment. Email our FOI team for a copy of the document. This contained a suggested template letter to be used by the practice. The 2016 protocol is not currently active, it would need to be reviewed and updated by the medicines optimisation team if it was to be run again.

Details of letters and audit work conducted in 2016 are not held by NHS Kernow.

Request received

1. Can you share your local pricing schedule in relation to fertility treatment?
2. Do you have a copy of your fertility policy you could share? If this is available online send a link.
3. Can you advise your approach to the overseas visitors charging guidance for fertility treatment?
4. Provide a name and contact email for person responsible for commissioning issues around fertility.

Our response

1. No CQUIN included in contract. Prices are for 2021 to 2022:
   • IVF cycle 37 years and under: £3,100
   • IVF cycle 38 years and over: £3,500
   • ICSI cycle 37 years and under: £3,500
   • ICSI cycle 38 years and over: £4,000
2. Information on treatment policies is available on our website.
3. NHS funding granted to couple therefore both partners must be eligible.
4. Planned care team