Insert heading depending. Insert Insert heading depending on on NHS line length; please delete cover options once

Transcription

1 Insert heading depending Insert Insert heading depending on line on on NHS line length; please delete on line length; line Standard length; please Contract please delete delete other other 2013/14 cover cover options once once other cover options once you have chosen one. 20pt you you have have chosen one. one. 20pt 20pt 1

2 NHS Standard Contract 2013/14 First published: 4 February 2013 Updated: 18 February 2013 Prepared by the NHS Standard Contracts Team on behalf of the NHS Commissioning Board 2

3 Contract Reference Conditions will apply to all or only some Service categories, as indicated in the right column using the following abbreviations: Services Accident and Emergency Acute Ambulance Cancer Services Care Home Community Services Mental Health and Learning Disability Services Mental Health Secure Services Patient Transport Primary Care Services (not commissioned under primary care contracts) Radiotherapy Substance Misuse Surgical Services Termination of Pregnancy A+E A AM CR CH C MH MHSS PT PC R SM S TP 3

4 PROVISION OF SERVICES SC1 Compliance with the Law 1.1 The Provider must provide the Services and perform all of its obligations under this Contract in accordance with: the terms of this Contract; and the Law; and Good Practice. 1.2 The Commissioners must perform all of their obligations under this Contract in accordance with: the terms of this Contract; and the Law; and Good Practice. 1.3 The Parties must have regard to and promote awareness of the NHS Constitution. SC2 Regulatory Requirements 2.1 The Provider must: comply, where applicable, with the registration and regulatory compliance guidance of any relevant Regulatory or Supervisory Body; respond to all applicable requirements and enforcement actions issued from time to time by any relevant Regulatory or Supervisory Body; comply, where applicable, with the standards and recommendations issued from time to time by any relevant Regulatory or Supervisory Body; consider and respond to the recommendations arising from any audit, Serious Incident report or Patient Safety Incident report; comply with the standards and recommendations issued from time to time by any relevant professional body and agreed in writing between the Co-ordinating Commissioner and the Provider; 4

5 2.1.6 comply with the recommendations from time to time contained in guidance and appraisals issued by NICE; respond to any reports and recommendations made by Local Healthwatch; and meet its obligations under Law in relation to the production and publication of Quality Accounts. SC3 Service Standards 3.1 The Provider must: meet the Local Quality Requirements and the National Quality Requirements; meet the Operational Standards; ensure that Never Events do not occur; and meet the applicable national standards and outcomes measures from time to time set out in Guidance. 3.2A A failure by the Provider to comply with Service Condition 3.1 will be excused if it is directly attributable to or caused by an act or omission of a Commissioner, but will not be excused if the failure was caused primarily by an increase in Referrals. 3.2B A failure by the Provider to comply with Service Condition 3.1 will be excused if it is directly attributable to or caused by an act or omission of a Commissioner, but will not be excused if the failure was caused primarily by an increase in Referrals, which will include activity due to an increased use of 999 or any other emergency telephone numbers. 3.3 If the Provider does not comply with Service Condition 3.1, the Coordinating Commissioner may, without affecting any other rights that it or any Commissioner may have under this Contract: except AM AM issue a Contract Query under General Condition 9.4 (Contract Management) in relation to the breach, failure or Never Event occurrence; and/or take action to remove any Service User affected from the Provider s care; and/or if it reasonably considers that there may be further noncompliance of that nature in relation to other Service Users, take action to remove those Service Users from the Provider s care. 3.4 The Provider must co-operate fully with the Responsible Commissioner and the original Referrer in any re-referral of the Service User to another provider (including providing Service User Health Records, other information relating to the Service User s Package of Care and clinical opinion if reasonably requested). Any failure to do so will constitute a material breach of this Contract. 5

6 3.5 If a Service User is admitted for acute Elective Care services and the Provider cancels that Service User s operation after admission for nonclinical reasons, the terms of the NHS Constitution Handbook cancelled operations pledge will apply. A SC4 Co-operation 4.1 The Parties must at all times act in good faith towards each other. 4.2 The Parties must co-operate in accordance with the Law and Good Practice to facilitate the delivery of the Services in accordance with this Contract, having regard at all times to the welfare and rights of Service Users. 4.3 The Provider must co-operate fully and liaise appropriately with: the Commissioners; any third party provider from whose care a Service User may be transferred to the Provider; any third party provider to whose care the Provider may transfer or discharge the Service User; any third party provider providing care to the Service User at the same time as the Provider s provision of the Services to the Service User; and primary and social care services, in order to: ensure that a consistently high standard of care for the Service User is maintained at all times; ensure that a co-ordinated approach is taken to promoting the quality of care for the Service User across all Pathways spanning more than one provider; achieve a continuation of the Services that avoids inconvenience to, or risk to the health and safety of, the Service User, employees of the Commissioners or members of the public. 4.4 The Provider must ensure that its provision of any activity to any third party does not hinder or adversely affect its delivery of the Services or its performance of this Contract. SC5 Commissioner Requested Services/Essential Services 5.1 The Provider must maintain its ability to provide, and must ensure that it is able to offer to the Commissioners, the Commissioner Requested Services or the Essential Services. Yes/No 6

7 5.2 The Provider must have and at all times maintain an up-to-date CRS Continuity Plan or Essential Services Continuity Plan. The Provider must provide a copy of any updated CRS Continuity Plan or Essential Services Continuity Plan to the Co-ordinating Commissioner within 5 Operational Days following any update. 5.3 The Provider must, in consultation with the Co-ordinating Commissioner, implement the CRS Continuity Plan or the Essential Services Continuity Plan as required: Yes/No Yes/No if there is any interruption to the Provider s ability to provide the Commissioner Requested Services or the Essential Services as appropriate; if there is any partial or entire suspension of the Commissioner Requested Services or Essential Services as appropriate; or on expiry or early termination of this Contract or of any Service for any reason (and this obligation will apply both before and after expiry or termination). SC6 Service User Booking and Choice and Referrals 6.1 The Parties must comply with Patient Choice Guidance, Choice Guidance and Choose and Book Guidance. The Provider must take any necessary actions reasonably required by the Co-ordinating Commissioner relating to Patient Choice Guidance, Choice Guidance and Choose and Book Guidance. 6.2 The Provider must describe and publish all relevant Services (as set out in Choose and Book Guidance) in Choose and Book, through a Directory of Service. In relation to those Services: except MHSS A, MH, C the Provider must ensure that all Services are Directly Bookable as set out in Choose and Book Guidance; the Provider must make specified information available to prospective Service Users through the NHS Choices Website, and must in particular use NHS Choices to promote awareness of the Services among the communities it serves, ensuring the information provided is accurate, up-to-date, and complies with the provider profile policy set out at (or any replacement website as is made available from time to time); the Commissioners must use their best endeavours to ensure that all Referrals are made through the Choose and Book system; and the Provider must offer clinical advice and guidance to GPs on potential Referrals through Choose and Book, whether this leads to a Referral being made or not. 7

8 SC7 Withholding and/or Discontinuation of Service Rejection of Referral 7.1 The Provider must accept any Referral of a Service User however it is made, unless permitted to reject the Referral under this Service Condition The Provider may reject a Referral on the grounds: of any service limitations in the Service Specifications set out in Schedule 2 Part A (Service Specifications); or of the location of the Referrer; or that a Prior Approval request made by the Provider under the Prior Approval Scheme has been rejected by the Commissioner, unless prohibited from doing so under Patient Choice Guidance or Choice Guidance. 7.3 The Provider may not reject a Referral in relation to emergency response ambulance services on the grounds of the location of the Referrer. AM Withholding and/or Discontinuation of Service 7.4 Nothing in this Service Condition 7 allows the Provider not to provide or to stop providing a Service if that would be contrary to the Law. 7.5 The Provider will not be required to provide or to continue to provide Service to a Service User: who in the Provider s reasonable professional opinion is unsuitable to receive the relevant Service, for as long as they remain unsuitable; in respect of whom no valid consent (where required) has been given in accordance with the Service User Consent Policy; who displays abusive, violent or threatening behavior unacceptable to the Provider acting reasonably and taking into account the mental health of that Service User; in that Service User s domiciliary care setting or circumstances (as applicable) where that environment poses a level of risk to the Staff engaged in the delivery of the relevant Service that the Provider reasonably considers to be unacceptable; or where expressly instructed not to do so by an emergency service provider who has authority to give that instruction, for as long as that instruction applies. 7.6 If the Provider proposes not to provide or to stop providing a Service to any Service User under Service Condition 7.5: 8

9 7.6.1 where reasonably possible, the Provider must explain to the Service User, Carer or Legal Guardian (as appropriate), taking into account any communication or language needs, the action that it is taking, when that action takes effect, and the reasons for it (confirming that explanation in writing within 2 Operational Days); the Provider must tell the Service User, Carer or Legal Guardian (as appropriate) that he has the right to challenge the Provider s decision through the Provider s complaints procedure and how to do so; wherever possible, the Provider must inform the relevant Referrer (and if the Service User s GP is not the relevant Referrer, subject to obtaining consent in accordance with Law and Guidance, the Service User s GP) in writing without delay before taking the relevant action; and the Provider must liaise with the Responsible Commissioner and the relevant Referrer to seek to maintain or restore the provision of the relevant care to the Service User in a way that minimises any disruption to the Service User s care and risk to the Service User. 7.7A If the Provider, the Responsible Commissioner and the Referrer cannot agree on the continued provision of the relevant Service to a Service User, the Provider must (subject to any requirements under Service Condition 11 (Transfer of and Discharge from Care Obligations)) notify the Responsible Commissioner (and where applicable the Referrer) that it will not provide or will stop providing the Service to that Service User. The Responsible Commissioner must then liaise with the Referrer to procure alternative services for that Service User. 7.7B If the Provider, the Responsible Commissioner and the emergency incident coordinator having primacy of the relevant incident cannot agree on the continued provision of the relevant Service to a Service User, the Provider must (subject to any requirements under Service Condition 11 (Transfer of and Discharge from Care Obligations)) notify the Responsible Commissioner (and where applicable the Referrer) that it will not provide or will stop providing the Service to that Service User. The Responsible Commissioner must then liaise with the Referrer as soon as reasonably practicable to procure alternative services for that Service User. 7.7C If the Provider, the Responsible Commissioner and the Referrer cannot agree on the continued provision of the relevant Service to a Service User, the Provider must (subject to any requirements under Service Condition 11 (Transfer of and Discharge from Care Obligations)) give the Responsible Commissioner (and where applicable the Referrer) not less than 28 days notice that will stop providing the Service to that Service User. The Responsible Commissioner must then liaise with the Referrer to procure alternative services for that Service User. 7.8 If the Provider stops providing a Service to a Service User under Service Condition 7.5 and the Provider has complied with Service Condition 7.6, the Responsible Commissioner must pay the Provider in accordance with Service Condition 36 (Payment Terms) for the Service provided to that Service User before the discontinuance. except AM, MHHS AM MHSS 9

10 7.9 Unless a relevant Prior Approval Scheme applies, the Provider must not carry out, nor refer to another provider to carry out, any non-urgent or routine physical treatment and/or care that is unrelated to a Service User s original Referral or presentation without first consulting the Service User s GP. SC8 Unmet Needs 8.1 Each Party has a responsibility to ensure that the health (including primary and specialised health) and/or social care needs of each Service User are met. 8.2 If the Provider believes that a Service User or a group of Service Users may have an unmet health or social care need, it must notify the Responsible Commissioner accordingly. The Responsible Commissioner will be responsible for making an assessment to determine any steps required to be taken to meet those needs. 8.3 If the Provider considers that a Service User has an urgent need for care which is outside the scope of the Services, it must notify the Referrer without delay and must co-operate with the Referrer to secure the provision to the Service User of the relevant care, acting at all times in the best interests of the Service User. 8.4 The provisions of Schedule 2 Part J (Social Care Provisions) will apply in relation to social care services to be provided under this Contract. CH SC9 Consent 9.1 The Provider must publish, maintain and operate a Service User consent policy which complies with Good Practice and the Law. SC10 Care Planning 10.1 The Provider must share decision-making in the development of each Care Plan with the relevant Service User, Carer and Legal Guardian (as appropriate to the Service User). The Provider must provide the Service User with a copy of their Care Plan The Provider must prepare, evaluate, review and audit each Care Plan on an on-going basis. Any review must involve the Service User, Carer and Legal Guardian (as appropriate to the Service User) The Provider must deliver the relevant Services to each Service User in accordance with their Care Plan Where appropriate the Provider must comply with the Care Programme Approach in providing the Services. CH, MH, MHHS 10

11 SC11 Transfer of and Discharge from Care Obligations 11.1 The Provider must comply with: the Transfer of and Discharge from Care Protocols; the 1983 Act; the 1983 Act Code (including, following all procedures specified by or established as a result of the 1983 Act Code); and Transfer and Discharge Guidance The Provider must not transfer and/or discharge a Service User if transfer and/or discharge would not be in accordance with: MH, MHSS, CH MH, MHSS, CH Good Practice; and the Law The Provider must use its best efforts to avoid circumstances and transfers and/or discharges likely to lead to emergency readmissions or recommencement of care Before the transfer of a Service User to another Service under this Contract and/or before the transfer and/or discharge of a Service User to the care of a third party provider, the Provider must liaise as appropriate with any third party provider, and with the Service User and any Legal Guardian and/or Carer, to prepare and agree a Care Transfer Plan. The Provider must implement the Care Transfer Plan when delivering the further Service, or transferring and/or discharging the Service User to the care of the third party provider, unless (in exceptional circumstances) to do so would not be in accordance with Good Practice If a Transfer of Care involves the transfer of part of the Service User s Package of Care, the Provider must comply with (and the relevant Commissioner must use all reasonable endeavours to ensure that other relevant providers of care within the Pathway comply with) any relevant Shared Care Protocols and Inter-agency Agreements If required by the relevant Transfer of and Discharge from Care Protocol, the Provider must at the time of the Service User s transfer and/or discharge give a Discharge Summary to the Service User (and if appropriate to the Legal Guardian of the Service User) Within 24 hours after the transfer and/or discharge of the Service User from the Provider s care, the Provider must issue the Discharge Summary to the Service User s GP and/or Referrer and to any third party provider, using the Delivery Method Whenever the Provider sends to a Service User s GP and/or Referrer or any third party provider an item of correspondence relating to the Provider s provision of care which differs from the Discharge Summary given to the Service User under Service Condition 11.7, the Provider must 11

12 send a copy of that item of correspondence to the Service User (and if appropriate to the Legal Guardian of the Service User). SC12 Service User Involvement 12.1 The Provider must engage, liaise and communicate with Service Users, their Carers and Legal Guardians in an open and clear manner in accordance with the Law and Good Practice As soon as reasonably practicable following any reasonable request by the Co-ordinating Commissioner, the Provider must provide evidence to the Co-ordinating Commissioner of the involvement of Service Users, Carers and Staff in the development of Services The Provider must carry out the Surveys. The Provider must co-operate with any surveys that the Commissioners may, acting reasonably, carry out. The form, frequency and reporting of the Surveys will be as set out in Schedule 6 Part G (Surveys) or as otherwise agreed between the Coordinating Commissioner and the Provider in writing from time to time The Provider must review and provide a written report to the Co-ordinating Commissioner on the results of each Survey. The report must also identify any actions reasonably required to be taken by the Provider in response to the Survey. The Provider must implement those actions as soon as practicable. The Provider must publish the outcomes of and actions taken in relation to all Surveys. SC13 Equity of Access, Equality and Non-Discrimination 13.1 The Parties must not discriminate between or against Service Users, Carers or Legal Guardians on the grounds of age, disability, gender reassignment, marriage or civil partnership, pregnancy or maternity, race, religion or belief, sex, sexual orientation or any other non-medical characteristics, except as permitted by the Law The Provider must provide appropriate assistance and make reasonable adjustments for Service Users, Carers and Legal Guardians who do not speak, read or write English or who have communication difficulties (including hearing, oral or learning impairments) In performing this Contract the Provider must have due regard to the obligations contemplated by section 149 of the Equality Act 2010 to: eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by that Act; advance equality of opportunity between persons who share a relevant protected characteristic (as defined in that Act) and persons who do not; and foster good relations between persons who share a relevant protected characteristic (as defined in that Act) and persons who do not, 12

13 and for the avoidance of doubt this obligation will apply whether or not the Provider is a public authority for the purposes of section In consultation with the Co-ordinating Commissioner, and on reasonable request, the Provider must provide a plan or plans setting out how it will comply with its obligations under Service Condition If the Provider has already produced such a plan in order to comply with the Law, the Provider may submit that plan to the Co-ordinating Commissioner in order to comply with this Service Condition The Provider must provide to the Commissioners any information, in addition to that required under Service Condition 28 (Information Requirements) and Schedule 6 (Contract Management, Reporting and Information Requirements), that the Commissioners may reasonably require to: monitor the equity of access to the Services; and fulfil their obligations under the Law. SC14 Pastoral, Spiritual and Cultural Care 14.1 The Provider must take account of the spiritual, religious, pastoral and cultural needs of Service Users and must liaise with the relevant spiritual and pastoral authorities as appropriate in each case. SC15 Services Environment and Equipment 15.1 The Provider must at all times comply with the Law, Guidance and any applicable Operational Standards, National Quality Requirements and Local Quality Requirements in relation to the Services Environment and the Equipment. The Provider must ensure that the Services Environment is fit for the purpose of providing the Services and is clean, safe, suitable, sufficient, adequate, functional, accessible (making reasonable adjustments where required in order to ensure accessibility) and effective Unless provided otherwise in this Contract, the Provider must at all times and at its own cost provide all Equipment necessary to provide the Services in accordance with the Law and any necessary Consents The Provider must ensure that all Staff using Equipment, and all Service Users and Carers using Equipment independently as part of the Service User s care or treatment, have received appropriate and adequate training and have been assessed as competent in the use of that Equipment. SC16 Places Of Safety 16.1 The Parties must ensure that the requirements of Law and Guidance regarding places of safety are met, and that they reach agreement on the identification of Places of Safety in accordance with Good Practice. A, MH, MHSS 13

14 SC17 Complaints 17.1 The Commissioners and the Provider must each: publish, maintain and operate a Complaints Procedure which complies with the Law; and ensure that Service Users are made aware of that Complaints Procedure and how to use it effectively The Provider must implement Lessons Learned from complaints and demonstrate at Review Meetings the extent to which Service improvements have been made as a result. RECORDS AND REPORTING SC18 Service Development and Improvement Plan 18.1 The Commissioners and Provider must comply with their respective obligations under the SDIP. The Provider must report performance against the SDIP in accordance with Schedule 6 Part C (Reporting Requirements). The SDIP may be varied by a Service Variation in accordance with General Condition 13 (Variations). Yes/No SC19 HCAI Reduction Plan 19.1 The Provider must have an HCAI Reduction Plan for each Contract Year and must comply with its obligations under that plan. The HCAI Reduction Plan must reflect local and national priorities relating to HCAI including antimicrobial resistance. SC20 Venous Thromboembolism 20.1 The Provider must: A comply with Guidance (including NICE Guidance) in relation to venous thromboembolism; perform root cause analysis of all confirmed cases of pulmonary embolism and deep vein thrombosis acquired by Service Users while in hospital (both arising during a current hospital stay and where there is a history of hospital admission within the last 3 months, but not in respect of Service Users admitted to hospital with a confirmed venous thromboembolism but no history of an admission to hospital within the previous 3 months); and if required by the Co-ordinating Commissioner, perform local audits of Service Users risk of venous thromboembolism, and the Provider must report the results of those root cause analyses and audits in accordance with Schedule 6 Part C (Reporting Requirements). 14

15 SC21 18 Weeks Referral-To-Treatment Standard 21.1 This Service Condition 21 will only apply in respect of Consultant-led Services to which the 18 Weeks Referral-to-Treatment Standard applies The Provider must manage the provision of any relevant Service so as to meet the 18 Weeks Referral-to-Treatment Standard. The Provider will monitor performance against the 18 Weeks Referral-to-Treatment Standard The relevant Pathways will be agreed by Commissioners based on the level of risk to delivery of the 18 Weeks Referral-to-Treatment Standard If in any month the Provider does not meet the 18 Weeks Referral-to- Treatment Standard threshold set out in Schedule 4 Part A (Operational Standards) for any specialty, the Commissioners will deduct from any payments to be made to the Provider under this Contract for that specialty an amount calculated in accordance with Schedule 4 Part G (18 Weeks) The Provider must ensure that the letter to a Service User confirming that Service user s first outpatient appointment includes the 18 Weeks Information. Yes/No Yes/No Yes/No Yes/No Yes/No SC22 Financial Adjustments for Performance in Reducing Clostridium Difficile 22.1 The Provider must not exceed the Baseline Threshold for the number of cases of Clostridium difficile At the end of each Contract Year the Parties will review the number of cases of Clostridium difficile for that Contract Year. If the Provider has exceeded the Baseline Threshold the Co-ordinating Commissioner will recommend the relevant Commissioners to make financial deductions (or require the Provider to pay sums) calculated in accordance with Schedule 4 Part H (Clostridium difficile). A A SC23 Service User Health Records 23.1 The Provider must create, maintain, store and retain Service User Health Records for all Service Users. The Provider must retain those records for the periods of time required by Law and/or by national retention schedules published by the Department of Health or NHS CB or HSCIC, and then securely destroy them At a Commissioner s request, the Provider must promptly transfer the Service User Health Record held by the Provider for any Service User for whom that Commissioner is responsible (or deliver a copy of it) to a third party provider of healthcare or social care services nominated by that Commissioner On termination or expiry of this Contract or any Service the Provider must promptly transfer, or deliver a copy of, any relevant Service User Health 15

16 Record held by the Provider for any Service User to the Responsible Commissioner or to a third party nominated by that Commissioner The Provider must: use Service User Health Records solely in connection with the performance of the Provider s obligations under this Contract; and give each Service User full and accurate information regarding their treatment and must evidence that in writing in the relevant Service User Health Record. NHS Number 23.5 Subject to Guidance and any relevant standards published by the Department of Health and/or NHS CB and/or HSCIC, the Service User Health Record must include the Service User s verified NHS number. SC24 Caldicott Guardian and Senior Information Risk Owner 24.1 If the Provider replaces its Caldicott Guardian or Senior Information Risk Owner it must promptly notify the Co-ordinating Commissioner of the identity and contact details of the replacement. SC25 Procedures and Protocols 25.1 If requested by the Co-ordinating Commissioner or the Provider, the Coordinating Commissioner or the Provider (as the case may be) must within 5 Operational Days following receipt of the request send or make available to the other copies of any Services guide or other written policy, procedure or protocol implemented by any Commissioner or the Provider (as applicable) The Co-ordinating Commissioner must notify the Provider and the Provider must notify the Co-ordinating Commissioner of any material changes to any items it has disclosed under Service Condition The Parties must comply with their respective obligations under any Other Locally Agreed Policies and Procedures. SC26 Clinical Networks, Screening Programmes and National Clinical Audit and Patient Outcomes Programme 26.1 The Provider must: participate in the Clinical Networks and Screening Programmes listed in Schedule 2 Part F (Clinical Networks, Screening Programmes and National Clinical Audit and Patient Outcomes Programme); 16

17 participate in the national clinical audits within the National Clinical Audit and Patient Outcomes Programme (NCAPOP) relevant to the Services; and if it deems it to be appropriate given its obligations under Service Condition 4 (Co-operation), participate in other partnership arrangements in place in the local health economy The Provider must adhere to all protocols and procedures operated or recommended under the programmes and arrangements referred to in Service Condition 26.1, unless in conflict with existing protocols and procedures agreed between the Parties, in which case the Parties must review and try to resolve that conflict. SC27 Formulary 27.1 The Provider must: ensure that its Formulary is published and readily available on the Provider s website; ensure that its Formulary reflects all relevant positive NICE Technology Appraisals; and make available to Service Users all relevant treatments recommended in positive NICE Technology Appraisals. SC28 Information Requirements 28.1 The Parties agree and acknowledge that the submission of complete and accurate data in accordance with this Service Condition 28 is necessary to support the commissioning of all health and social care services in England The Provider must: provide the information specified in this Service Condition 28 and in Schedule 6 Part C (Reporting Requirements): with the frequency, in the format, by the method and within the time period set out or referred to in Schedule 6 Part C (Reporting Requirements); and as detailed in relevant Guidance; and if there is no applicable time period identified, in a timely manner; if and to the extent applicable: comply with all relevant published NHS information and data standards, including mandatory returns assessed and published by HSCIC; and 17

18 implement any other datasets and information requirements agreed from time to time between it and the Co-ordinating Commissioner; comply with Guidance issued by NHS CB and HSCIC, and with the Law, in relation to protection of patient identifiable data; and use the Service User s verified NHS number on all patient datasets, subject to and in accordance with Guidance and any relevant standards issued by the Department of Health and/or NHS CB and/or HSCIC The Co-ordinating Commissioner may request from the Provider any information in addition to that to be provided under Service Condition 28.2 which any Commissioner reasonably requires in relation to this Contract. The Provider must supply that information in a timely manner The Co-ordinating Commissioner must act reasonably in requesting the Provider to provide any information under Service Condition 28.3, and may not, without good reason, require the Provider to supply any information: to any Commissioner locally where that information is required to be submitted centrally under Service Condition 28.2; or where that information is required to be submitted in a particular format under Service Condition 28.2, to supply that information in a different or additional format (but this will not prevent the Coordinating Commissioner from requesting disaggregation of data previously submitted in aggregated form) The Provider and Co-ordinating Commissioner must each ensure that any information provided to the other in relation to this Contract is accurate and complete The Provider must ensure that each dataset that it provides under this Contract contains the Organisation Data Service code and/or other appropriate identifier for the relevant Commissioner The Parties must comply with Guidance relating to clinical coding published by the NHS Classifications Service and with the definitions of activity maintained under the NHS Data Model and Dictionary The Provider may implement any change of practice in the counting and coding of activity compliant with national information and data standards as may be agreed from time to time with the Co-ordinating Commissioner. The Provider must give the Co-ordinating Commissioner at least 6 months notice of any proposed change. Any change agreed must be implemented on 1 April of the following Contract Year, unless: the Co-ordinating Commissioner agrees a different date for its implementation; or the change is mandated by HSCIC, in which case the change will come into effect on the date(s) (or in any phased sequence) specified by HSCIC; or 18

19 the change is required by the PbR Rules, in which case the change will come into effect on the date(s) (or in any phased sequence) specified in the PbR Rules Information to be provided by the Provider under this Service Condition 28 and Schedule 6 Part C (Reporting Requirements) and which is necessary for the purposes of Service Condition 36 (Payment Terms) must be provided: to the Co-ordinating Commissioner in aggregate form; and/or directly to each Commissioner in disaggregated form relating to its own use of the Services, as the Co-ordinating Commissioner may direct Where SUS is applicable, if: there is a failure of SUS; or there is an interruption in the availability of SUS to the Provider or to any Commissioner, the Provider must submit the national datasets collected in accordance with this Service Condition 28 both directly to the Co-ordinating Commissioner within the timescales required under SUS Guidance and to SUS as soon as reasonably practicable If the Co-ordinating Commissioner becomes aware of an Information Breach it must notify the Provider accordingly. The notice must specify the Information Breach and the Co-ordinating Commissioner s intention to instruct the Commissioners to withhold the sums specified in Service Condition unless the Information Breach is rectified within 5 Operational Days following service of that notice If the Information Breach is not rectified within 5 Operational Days of the date of the notice served in accordance with Service Condition (unless due to any act or omission of any Commissioner), the Coordinating Commissioner must instruct the Commissioners to withhold up to 1% of all the monthly sums payable by them under Service Condition 36 (Payment Terms) in respect of the current month and thereafter for each and every month that Information Breach continues The Commissioners must withhold the sums withheld under Service Condition unless and until the Provider rectifies the relevant Information Breach to the reasonable satisfaction of the Co-ordinating Commissioner. The Commissioners must then pay the Provider the withheld sums within 10 Operational Days. Subject to Service Condition no Interest will be payable by the Commissioners to the Provider on any sum withheld under Service Condition If the Provider produces evidence satisfactory to the Co-ordinating Commissioner that any sums withheld under Service Condition were withheld without justification, the Commissioners must pay Interest to the Provider on the sums they each withheld for the period for which those sums were withheld. If the Co-ordinating Commissioner disputes 19

20 the Provider s evidence the Provider may refer the matter to Dispute Resolution The Commissioners will not be required to release to the Provider (and may retain permanently) any sum withheld under Service Condition if the Provider fails to rectify the relevant Information Breach to the reasonable satisfaction of the Co-ordinating Commissioner by the earliest of: the date 6 months after the date of the notice served in accordance with Service Condition 28.11; the termination of this Agreement; and the Expiry Date. Data Quality Improvement Plan The Co-ordinating Commissioner and the Provider may at any time agree a Data Quality Improvement Plan (which must be appended to this Contract at Schedule 6 Part D (Data Quality Improvement Plan)). Any Data Quality Improvement Plan must set out milestones to be met and may set out financial sanctions for failing to meet those milestones. Any financial sanctions must not exceed the sums which the Commissioners would otherwise be entitled to withhold in respect of an Information Breach under Service Condition If the Provider fails to meet a milestone by the agreed date, the Co-ordinating Commissioner may exercise the relevant agreed consequence If a Data Quality Improvement Plan with financial sanctions is agreed in relation to any Information Breach the Commissioners may not withhold sums under Service Condition in respect of the same Information Breach If an Information Breach relates to the National Requirements Reported Centrally the Parties must not by means of a Data Quality Improvement Plan agree the waiver or delay or foregoing of any withholding under Service Condition to which the Commissioners would otherwise be entitled. MANAGING ACTIVITY AND REFERRALS SC29 Managing Activity and Referrals 29.1 The Commissioners and the Provider must each monitor and manage Activity and Referrals for the Services in accordance with this Service Condition 29 and the PbR Rules The Parties must not agree or implement any action that would operate contrary to Patient Choice Guidance or so as to restrict or impede the exercise of Patient Choice The Commissioners must: 20

21 manage Activity for the Services via Referrers and use their reasonable endeavours to notify the Provider promptly of any anticipated changes in Referral numbers; and procure that their agents and practitioners adhere to any referral and treatment protocols as may be agreed between the Parties The Provider must manage Activity in accordance with any caseloads, occupancy levels and clinical thresholds set out in the Service Specifications and any Activity Planning Assumptions and/or published in Choose and Book. The Provider must: comply with the reasonable requests of the Commissioners to assist the Commissioners in understanding and managing Referrals; and require its agents, sub-contractors and employees to adhere to any Referral and treatment protocols that may be agreed between the Parties. Indicative Activity Plan 29.5 Before the start of each Contract Year, the Parties must agree an Indicative Activity Plan specifying the threshold for each activity (and those agreed thresholds may be zero). If the Parties do not agree an Indicative Activity Plan before the start of any Contract Year an Indicative Activity Plan with an indicative activity of zero will be deemed to apply for that Contract Year The Indicative Activity Plan will comprise the aggregated Indicative Activity Plans of all of the Commissioners. IAP IAP Activity Planning Assumptions 29.7 Before the start of each Contract Year, the Co-ordinating Commissioner must notify the Provider of any Activity Planning Assumptions for that Contract Year, specifying a threshold for each assumption. The Provider must comply with those Activity Planning Assumptions. APA Early Warning 29.8 The Co-ordinating Commissioner must notify the Provider within 3 Operational Days after becoming aware of any unexpected or unusual patterns of Referrals and/or Activity in relation to any Commissioner, specifying the nature of the unexpected pattern and the Commissioner s initial opinion as to its likely cause The Provider must notify the Co-ordinating Commissioner and the relevant Commissioner within 3 Operational Days after becoming aware of any unexpected or unusual patterns of Referrals and/or Activity in relation to any Commissioner, specifying the nature of the unexpected pattern and the Provider s initial opinion as to its likely cause. Reporting and Monitoring Activity The Provider must submit an Activity Report at the intervals and in the 21

22 format agreed and specified in Schedule 6 Part C (Reporting Requirements) A The Co-ordinating Commissioner and the Provider will monitor actual activity reported in each Activity Report in respect of each Commissioner against: IAP and APA thresholds set out in the Indicative Activity Plan; and thresholds set out in the Activity Planning Assumptions B The Co-ordinating Commissioner and the Provider will monitor actual activity reported in each Activity Report in respect of each Commissioner against the thresholds set out in the Activity Planning Assumptions and any previous Activity Reports C The Co-ordinating Commissioner and the Provider will monitor actual activity reported in each Activity Report in respect of each Commissioner against any previous Activity reports and generally. APA No IAP No APA Activity Management Following: notification by the Co-ordinating Commissioner of any unexpected or unusual patterns of Referrals and/or of Activity in accordance with Service Condition 29.8; or notification by the Provider of any unexpected or unusual patterns of Referrals and/or of Activity in accordance with Service Condition 29.9; or A the submission of any Activity Report in accordance with General Condition indicating variances against the thresholds set out in the Indicative Activity Plan and/or any breaches of the thresholds set out in the Activity Planning Assumptions, B the submission of any Activity Report in accordance with Service Condition indicating breaches of the thresholds set out in the Activity Planning Assumptions, C the submission of any Activity Report in accordance with General Condition indicating any unexpected or unusual patterns of Referrals and/or Activity, in relation to any Commissioner, either the Co-ordinating Commissioner or the Provider may issue to the other an Activity Query Notice The Co-ordinating Commissioner and the Provider must meet to discuss any Activity Query Notice within 10 Operational Days following its issue At the Activity Management Meeting the Co-ordinating Commissioner and the Provider must: IAP and APA APA No IAP No APA consider patterns of Referrals, of Activity and of the exercise by Service Users of their rights under Patient Choice; and 22

23 agree either: Utilisation Meeting that the Activity Query Notice is withdrawn; or to hold a Utilisation Meeting, in which case the provisions of Service Condition will apply; or to conduct a Joint Activity Review, in which case the provisions of to will apply; Within 10 Operational Days following agreement to hold a Utilisation Review Meeting under Service Condition 29.14, the Co-ordinating Commissioner and the Provider must meet: to agree a Utilisation Improvement Plan and/or update any previously agreed Utilisation Plan; and to discuss any matter that either considers necessary in relation to Utilisation. Joint Activity Review Within 10 Operational Days following agreement to conduct a Joint Activity Review under Service Condition 29.14, the Co-ordinating Commissioner and the Provider must meet: to consider in further detail the matters referred to in Service Condition and the causes of the unexpected or unusual pattern of Referrals and/or Activity; and (if they consider it necessary or appropriate) to agree an Activity Management Plan The Co-ordinating Commissioner and the Provider should not agree an Activity Management Plan in respect of any unexpected or unusual pattern of Referrals and/or Activity which they agree was caused wholly or mainly by the exercise by Service Users of their rights under Patient Choice If the Co-ordinating Commissioner and the Provider fail to agree an Activity Management Plan at or within 10 Operational Days following the Joint Activity Review they must issue a joint notice to that effect to the Governing Body of the Provider and of each Commissioner. If the Coordinating Commissioner and the Provider have still not agreed an Activity Management Plan within 10 Operational Days following the date of the joint notice, either may refer the matter to Dispute Resolution The Parties must implement any Activity Management Plan agreed or determined in accordance with to inclusive in accordance with its terms. 23

24 29.20 If any Party breaches the terms of an Activity Management Plan, the Commissioners or the Provider (as appropriate) may exercise any consequences set out in it. Prior Approval Scheme Before the start of each Contract Year, the Co-ordinating Commissioner must notify the Provider of the terms of any Prior Approval Scheme for that Contract Year The Provider must manage Referrals in accordance with the terms of any Prior Approval Scheme. If the Provider does not comply with the terms of any Prior Approval Scheme in providing a Service, the Commissioners will not be liable to pay for that Service If a Prior Approval Scheme imposes any obligation on a Provider that would operate contrary to Patient Choice Guidance or Choice Guidance: that obligation will have no contractual force or effect; and the Prior Approval Scheme must be amended accordingly; and if the Provider provides any Service in accordance with the Prior Approval Scheme as amended in accordance with Service Condition the relevant Commissioner will be liable to pay for that Service in accordance with Service Condition 36 (Payment Terms) If the Co-ordinating Commissioner requires any amendments to be made to a Prior Approval Scheme during a Contract Year, the Co-ordinating Commissioner must give the Provider not less than one month s notice in writing of those amendments. Those amendments must be implemented by the Provider on the date set out in the notice, and will only be applicable to Referrals made after that date If the 18 Weeks Referral-to-Treatment Standard is at risk for any activity covered by a Prior Approval Scheme, the Co-ordinating Commissioner may require the Provider to specify a revised pathway to mitigate that risk If the Provider requests Prior Approval in accordance with a Prior Approval Scheme the relevant Commissioner must respond within the time period specified in the Prior Approval Scheme. If the Commissioner fails to do so it will be deemed to have given Prior Approval At the Provider s request in case of urgent clinical need or a risk to patient safety, and if approved by the Commissioner s Medical Director (that approval not be unreasonably withheld or delayed), the relevant Commissioner must grant retrospective Prior Approval for a Service provided to a Service User. Risk Share Agreement The Provider and the Commissioners will follow the activity reporting and monitoring arrangements set out in the Risk Share Agreement which is included in this Contract at Schedule 3 Part C (Risk Share Agreement). Yes/No 24

25 EMERGENCIES AND INCIDENTS SC30 Emergency Preparedness and Resilience Including Major Incidents 30.1 Each Party must identify and have in place an Accountable Emergency Officer Each Party must have and maintain an up-to-date Business Continuity Plan Each Party must have and maintain an Incident Response Plan The Provider must have in place evacuation plans which provide for relocation of Service Users to alternative secure premises in the event of any Significant Incident or Emergency and how that relocation is to be effected in such a way as to maintain public safety and confidence The Provider must: MHSS assist in the development of and participate in joint planning and training exercises connected with its Incident Response Plan, including by conducting as required: a communications exercise every 6 months; a desktop exercise annually; and a major live or simulated exercise if such an exercise has not been conducted within the previous 3 years; have in place and maintain Staff who are suitably trained and competent in emergency preparedness, resilience and response; have in place and maintain adequate facilities (including an Incident Co-ordination Centre) from which an Significant Incident or Emergency can be effectively managed, in accordance with the NHS CB Emergency Planning Framework For ambulance services the training requirement referred to in Service Condition will be in addition to the enhanced training for Hazardous Area Response Team (HART) support staff The Provider must comply with: AM national and local civil contingency plans; the Civil Contingencies Act 2004; any other Law and/or Guidance, including the EPRR Guidance, 25