SC16 Places of Safety SC17 Complaints SC18 Service Development and Improvement Plan SC19 HCAI Reduction Plan SC20 Venous Thromboembolism SC21 Not used SC22 Not used SC23 Service User Health Records SC24 NHS Counter-Fraud and Security Management SC25 Procedures and Protocols SC26 Clinical Networks, National Programmes and Approved Research Studies SC27 Formulary SC28 Information Requirements SC29 Managing Activity and Referrals SC30 Emergency Preparedness and Resilience Including Incidents SC31 Force Majeure: Service-specific provisions SC32 Safeguarding SC33 Incidents Requiring Reporting SC34 Death of a Service User SC35 Duty of Candour SC36 Payment SC37 Local Quality Requirements and Quality Incentive Schemes SC38 Commissioning for Quality and Innovation GENERAL CONDITIONS GC1 Definitions and Interpretation GC2 Effective Date and Duration GC3 Service Commencement GC4 Transition Period GC5 Staff GC6 Not used GC7 Partnership Arrangements GC8 Review GC9 Contract Management GC10 Co-ordinating Commissioner and Representatives GC11 Liability and Indemnity GC12 Assignment and Sub-Contracting GC13 Variations GC14 Dispute Resolution GC15 Governance, Transaction Records and Audit GC16 Suspension GC17 Termination
SCHEDULE 4 – QUALITY REQUIREMENTS Operational Standards Ref Operational Standards Threshold (2014/15) Method of Measurement (2014/15) Consequence of breach Timing of application of consequence Applicable Service Category RTT waiting times for non-urgent treatment CB_B1 Percentage of admitted Service Users starting treatment within a maximum of 18 weeks from Referral Operating standard of 90% at specialty level (as reported on Unify) Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £400 in respect of each excess breach above that threshold Monthly Services to which 18 Weeks applies CB_B2 Percentage of Service Users starting treatment within a maximum of 18 weeks from Referral Operating standard of 95% at specialty level (as reported on Unify) Review of monthly Service Quality Performance Report the number of breaches in the month exceeds the tolerance permitted by the threshold, £100 in respect of each excess breach above that threshold Monthly Services to which 18 Weeks applies CB_B3 Percentage of Service Users on incomplete RTT pathways (yet to start treatment) waiting no more than 18 weeks from Referral Operating standard of 92% at specialty level (as reported on Unify) Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £100 in respect Monthly Services to 18 Weeks applies non-
than two weeks for first outpatient appointment threshold, £200 in respect of each excess breach above that threshold CB_B7 Percentage of Service referred urgently with breast symptoms (where cancer was not initially suspected) waiting no more than two weeks for first outpatient appointment Operating standard of 93% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Quarterly A CR R Cancer waits – 31 days CB_B8 Percentage of Service Users waiting no more than one month (31 days) from diagnosis to first definitive treatment for all cancers Operating standard of 96% Review of monthly Service Quality Performance Report the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R CB_B9 Percentage of Service Users waiting no more than 31 days for subsequent treatment where that treatment is surgery Operating standard of 94% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £1,000 in respect of each excess breach above that threshold Quarterly A CR R CB_B10 Percentage of Service Users waiting no more than 31 days for subsequent treatment Operating standard of 98% Review of monthly Service Quality Performance Report Where the number of breaches in the Quarter exceeds the tolerance permitted by the Quarterly A CR R
CB_B16 Percentage of Category A calls resulting in an ambulance arriving at the scene within 19 minutes Operating standard of 95% Performance measured monthly with annual reconciliation Monthly withholding of 2% of Actual Monthly Value with an end of year reconciliation with 2% of the Actual Annual Value retained if annual performance is not met, or the withheld sums returned (with no interest) if annual performance is met Monthly withholding, annual reconciliation AM Mixed sex accommodation breaches CB_B17 Sleeping Accommodation Breach >0 Verification of the monthly data provided pursuant to Schedule 6 Part C in accordance with the Professional Letter £250 per day per Service User affected Monthly A CR MH Cancelled operations CB_B18 All Service who have operations cancelled, on or after the day of admission (including the day of surgery), for reasons to be offered another binding date within 28 days, or the Service User’s treatment to be funded at the time and hospital of the Service User’s choice Number of Service Users who are not offered another binding date within 28 days >0 Review of monthly Service Quality Performance Report Non-payment of associated with cancellation and payment or reimbursement (as applicable) of episode of care Monthly A CR S
Mental health CB_B19 Care Programme Approach (CPA): The percentage of Service Users under adult mental illness specialties on CPA who were followed up within 7 days of discharge from psychiatric in-patient care Operating standard of 95% Review of monthly Service Quality Performance Reports the number of breaches in the Quarter exceeds the tolerance permitted by the threshold, £200 in respect of each excess breach above that threshold Quarterly MH MHSS National Quality Requirements National Quality Requirement Threshold (2014/15) Method of Measurement (2014/15) Consequence of breach Monthly or annual application of consequence Applicable Service Category CB_A15 Zero tolerance MRSA >0 Review of monthly Service Quality Performance Report £10,000 in respect of each incidence in the relevant month Monthly A
CB_A16 Minimise rates of Clostridium difficile [Insert Baseline Threshold identified for Provider] Review of monthly Service Quality Performance Report As set out in Schedule 4 Part G, in accordance with applicable Guidance Annual A CB_S6 Zero tolerance RTT waits over 52 weeks for incomplete pathways >0 Review of monthly Service Quality Performance Report £5,000 per Service User with an incomplete RTT pathway waiting over 52 weeks at the end of the relevant month Monthly Services to which 18 Weeks applies CB_S7a All handovers between ambulance and A & E must take within 15 minutes with none waiting more than 30 minutes >0 Review of monthly Service Quality Performance Report £200 per Service User waiting over 30 minutes in the relevant month Monthly A+E CB_S7b All handovers between ambulance and A & E must take within 15 minutes with none waiting more than 60 minutes >0 Review of monthly Service Quality Performance Report £1,000 per Service User waiting over 60 minutes (in total, not aggregated with CB_S7a consequence) in the relevant month Monthly A+E CB_S8a Following handover between ambulance and A & E, ambulance crew should be ready to accept new calls within 15 minutes >0 Review of monthly Service Quality Performance Report £20 per event where > 30 minutes in the relevant month Monthly AM CB_S8b Following handover between ambulance and A & E, ambulance crew should be ready to accept >0 Review of monthly Service Quality Performance Report £100 per event where > 60 minutes (in total, not aggregated with CB_S8a Monthly AM
Completion of a valid NHS Number field in mental health and acute commissioning data sets submitted via SUS, as defined in Contract Technical Guidance 99% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly A MH MHHS Completion of a NHS Number field in A&E commissioning data sets submitted via SUS, as defined in Contract Technical Guidance 95% Review of monthly Service Quality Performance Report Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly A&E Completion of Mental Health Minimum Data Set ethnicity coding for all detained and informal Service Users, as defined in Contract Technical Guidance Operating standard of 90% Review of monthly Service Quality Performance Reports the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly MH MHSS Completion of IAPT Minimum Data Set outcome data for all appropriate Service as defined in Contract Technical Guidance Operating standard of 90% Review of monthly Service Quality Performance Reports Where the number of breaches in the month exceeds the tolerance permitted by the threshold, £10 in respect of each excess breach above that threshold Monthly MH MHSS
or necessary care in consequence of the Never Event Intravenous administration of epidural medication >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All Healthcare Premises All except PT, Ph Maladministration of insulin >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All Healthcare Settings All except PT Overdose of midazolam during conscious sedation >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All Healthcare Premises A S Opioid overdose of an opioid-naïve Service User >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure All Healthcare Settings All except PT
reports and monthly Service Quality Performance Report where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event Severe scalding of Service Users >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All Healthcare Premises All MATERNITY Maternal death due to post-partum haemorrhage after elective caesarean section >0 Review of reports submitted to NRLS/Serious Incidents reports and monthly Service Quality Performance Report In accordance with Never Events Guidance, recovery by the Responsible Commissioner of the costs to that Commissioner of the procedure or episode (or, where these cannot be accurately established, £2,000) plus any additional charges incurred by that Commissioner (whether under this Contract or otherwise) for any corrective procedure or necessary care in consequence of the Never Event All Healthcare Premises A
Documents supplied by Commissioners Date Document Insert text locally or Not Applicable B1. Provider’s Mandatory Material Sub-Contractors Mandatory Material Sub-Contractor [Name] [Registered Office] [Company number] Service Description Start date/expiry date Processing data – Yes/No Insert text locally or state Not Applicable B2. Provider’s Permitted Material Sub-Contractors Permitted Material Sub-Contractor [Name] [Registered Office] [Company number] Service Description date/expiry date Processing data – Yes/No Insert text locally or state Not Applicable
Reporting Requirements Reporting Period Format of Report Timing and Method for delivery of Report Application National Requirements Reported Centrally As specified in the list of assessed mandated collections published on the HSCIC website to be found at as applicable to the Provider and the Services As set out in relevant Guidance As set out in relevant Guidance As set out in relevant Guidance All PROMS As set out in relevant Guidance As set out in relevant Guidance As set out in relevant Guidance All NDTMS As set out in NTA Guidance As set out in NTA Guidance As set out in NTA Guidance SM National Requirements Reported Locally Monthly Activity Report Monthly Using SUS data, where applicable All Service Quality Performance Report, detailing performance against Operational Standards, National Quality Requirements, Local Quality Requirements, Never Events, including, without limitation: details of any Monthly Submit to Co-ordinating Commissioner within 10 Operational Days of the end of the month to which it relates. All
themes in content of complaints Report against performance of Service Development and Improvement Plan (SDIP) In accordance with relevant SDIP In accordance with relevant SDIP In accordance with relevant SDIP All Cancer Registration dataset reporting (ISN): report on staging data in accordance with Guidance As set out in relevant Guidance As set out in relevant Guidance As set out in relevant Guidance CR R Monthly summary report of all incidents requiring reporting Monthly All Data Quality Improvement Plan: report of progress against milestones In accordance with relevant DQIP In accordance with relevant DQIP In accordance with relevant DQIP All Report and provide monthly data and detailed information relating to violence-related injury resulting in treatment being sought from Staff in A&E departments, urgent care and walk-in centres, and from ambulance services paramedics (where the casualties do not require A&E department, urgent care and walk-in centre attendance), to the local community safety partnership and the relevant police force, in accordance with applicable Guidance (College of Emergency Monthly As set out in relevant Guidance As set out in relevant Guidance A A+E AM U
Medicine Clinical Guidance Information Sharing to Reduce Community Violence (July 2009)) Report on outcome of reviews and evaluations in relation to Staff numbers and skill mix in accordance with General Condition 5.2 (Staff) 6 monthly (or more frequently if and as required by the Commissioner from time to time) All Requirements Reported Locally Insert as agreed locally
Data Quality Improvement Plan Data Quality Indicator Data Quality Threshold Method of Measurement Milestone Date Consequence Insert text locally Incidents Requiring Reporting Procedure Procedure(s) for reporting, investigating, and implementing and sharing lessons learned from: (1) Serious Incidents (2) Reportable Patient Safety Incidents (3) Other Patient Safety Incidents Insert text locally Service Development and Improvement Plan Milestones Timescales Expected Benefit Consequence of Achievement/ Breach Insert text locally [Subject to General Condition 9 (Contract Management)] or [locally agreed] Surveys