Governing Bodies in Common – In Public 16 March 2021, 14:40-17:00
1 Opening Actions Title Lead Purpose Time B L MK 1.1 Welcome, Introductions and Chair 14:40 Apologies 1.2 Declarations of Interest Chair Requirement • Registers of Interests for the three Governing Bodies Discussion • Governing Body Members to confirm whether they have received any offers of Gifts, Hospitality or Sponsorship this financial year
1.3 Minutes of the previous Chair Approval Governing Bodies in Common dated 19 January 2021
1.4 Action Log Chair Discussion
1.5 Matters Arising All Discussion 14:45
1.6 Patient Story (Verbal) Assurance 14:55
2 Operational Title Lead Purpose Time B L MK 2.1 Chair’s Report Chair Assurance 15:05 (Verbal)
2.2 Accountable Officer’s Report Accountable Assurance 15:15 Officer 2.3 Update on Covid Position and Incident Assurance 15:25 vaccinations Commander (Verbal) (Director of Performance and Governance) 3 Finance, Quality and Performance Title Lead Purpose Time B L MK 3.1 BLMK Performance and Chief Nurse / Assurance 15:35 Quality Report 2020/21 M6 Director of Performance and Governance 3.2 Finance Report BLMK CCGs Chief Finance Discussion 15:45 Officer 4 Projects and Programmes: Title Lead Purpose Time B L MK 4.1 The CCG Merger – Updated Director of Approval 15:55 Equality Impact Assessments Performance and Appendix A: Equality analysis of the Governance / formation of a single Programme commissioning organisation for the Director, One Bedfordshire, Luton and Milton BLMK CCG Keynes CCGs’ area – population Programme impact
Appendix B – Population summaries for Luton and Milton Keynes, Bedford Borough Council, Central Bedfordshire Council – January 2021
Appendix C – Workforce EIA Equality analysis of the formation of a single commissioning organisation for the Bedfordshire, Luton and Milton Keynes CCGs’ area – workforce impact 4.2 One BLMK CCG Programme Programme Assurance 16:05 Update Director, One BLMK CCG Programme
5 Governance Items for Decision Title Lead Purpose Time B L MK 5.1 Policy for Sponsorship and Associate Approval 16:15 Joint Working between BLMK CCG Director and the Pharmaceutical Industry Medicines and other non-NHS organisations Optimisation 6 Governance Items for Information Title Lead Purpose Time B L MK 6.1 Risk Report Director of Assurance 16:20 Performance • Board Assurance Framework and Governance • Corporate Risk Register 6.2 Chair’s Action at Q&PJC Independent Assurance 16:30 Nurse 6.3 Committee Minutes for Committee Assurance 16:35 assurance Chairs
6.3.1 BLMK Audit Committees in BCCG Audit Common: Minutes to follow Committee • 29 September 2020 Chair (Redacted) • 24 November 2020
• Verbal Update from the Chair
2 Please send an queries or comments to: [email protected] 6.3.2 BLMK Patient and Public Committee Engagement Joint Committee Chairs (PPEJC) • 20 October 2020 6.3.3 Equality, Diversity and Committee Inclusion Committee (EDI) Chairs • 1 October 2020
6.3.4 Quality and Performance Joint Committee Committee Chairs • 11 November 2020 • 1 December 2020 • 5 January 2021
6.3.5 BLMK Primary Care Committee Commissioning Committees in Chairs Common in Public • 20 November 2020
7 Closing Actions Title Lead Purpose Time B L MK 7.1 Any Other Business Discussion 16:40
7.2 Questions from the public Discussion 17:50
7.3 Date of next meeting Chair Information 17:00 6 April 2021 – BLMK CCG Governing Body
3 Please send an queries or comments to: [email protected]
Governing Bodies in Common in Public
16 March 2021
1.2 Registers of Interest
Author: Maryla Hart, Governance and Committee Officer Contact Information: [email protected] Lead Executive: Director of Performance and Governance / Head of Governance Which CCGs does this paper apply to?
Bedfordshire Y Luton Y Milton Keynes Y
Information
Which activity does this paper Declarations of Interest relate to? Declarations of Gifts, Hospitality and Sponsorship
How?
What is the Committee/ 1. To declare any interests with regards to Conflicts with the Governing Body being asked to meeting agenda. do? 2. To review the Conflicts of Interest Registers provided, which list Conflicts of Interest declared by members of the three BLMK CCGs. Members are asked to confirm whether their declaration is up to date. If it is not, members are asked to complete a new Declaration of Interest Form within 5 working days. This form should relate to their current role within their CCG(s) in March 2021. 3. All Members are asked to confirm that they have not received any offers of gifts, hospitality or sponsorship this financial year. Members who have received offers are asked to declare these and complete the appropriate declaration form within five working days. What are the financial N/A implications?
Set out the key risks and risk None compliance could be recorded as a breach, which the CCG ratings would have to report on its website.
Date to which the information 10/03/2021 this paper is based on was accurate
Executive Summary
Conflicts of Interest Registers for the Governing Body Members of the three CCGs are included in the meeting pack.
2
BEDFORDSHIRE CLINICAL COMMISSIONING GROUP - CONFLICTS OF INTERESTS REGISTER OF THE GOVERNING BODY 10 March 2021 Database owner Corporate Governance [email protected]
Non- Financial Indirect Interest Date of Interest Date of Interest Non- Financial Financial Interest Professional Personal Interests Interests From To Actions to be taken Title/Initials/First Current position (s) Surname Status company/practice to mitigate risk Anything to Declare Date signed Name held in the CCG Ali Saqhib Lay/Governing Body Lay Member for Audit BCCG Staff No 15/10/2019 Member Borrett Alison Lay/Governing Body Lay Member BCCG Staff My family member is Yes 22/10/2019 Member Representative PPE Director of Retail, Marketing & Operations for the Sue Ryder Charity. Relative sports events manager of JDRF Charity
Cox Felicity Accountable Officer Accountable Officer BLMK Staff I am also the 01/02/2021 Ongoing Agendas are Yes 09/03/2021 and ICS Executive Executive Lead for converging. I will Lead the BLMK ICS declare any conflicts but do not expect any to arise.
Cox Felicity Accountable Officer Accountable Officer BLMK Staff I am a registered 17/08/1987 Ongoing I will excuse myself and ICS Executive pharmacist with the should an interest Lead GPhC (Gerneal arise. Pharmaceutical Council) and a member of the Royal Pharmaceutical Society
England Sally Lay/Governing Body Lay Member BCCG Staff Director of Sale Yes 29/10/2019 Member Consulting Limited – provision of consultancy support to Central and North West London Foundation Trust in April/ May 2019
Jayalath Roshan GP/Governing Body Governing Body GP King Street Surgery, GP Partner King Yes 21/10/2019 Member Member / Clinical Kempston Street Surgery Lead Mental Health - Locality Chair Elect Bedford Borough
Longstaff Chris GP/Governing Body Governing Body GP Bassett Road Profit sharing GP GP Training Program Yes 14/09/2019 Member Member Surgery Partner at Bassett Direction, Milton Road Surgery Keyes.
MRCGP Panel member (CSA Examiner) Non- Financial Indirect Interest Date of Interest Date of Interest Non- Financial Financial Interest Professional Personal Interests Interests From To Actions to be taken Title/Initials/First Current position (s) Surname Status company/practice to mitigate risk Anything to Declare Date signed Name held in the CCG Makin Stephen Acting Chief Finance Acting Chief Finance 08/03/2021 No 08/03/2021 Officer Officer (Substantive role is Director of System Finance/Deputy Chief Finance Office)
Murray Anne Executive/Governing Chief Nurse BCCG No 27/09/2019 Body Member Onah Linus GP/ Governing Body GP Governing Body Ivel Medical Centre Partner at Ivel 01/04/2020 Ongoing Yes 26/01/2020 Member Member Medical Centre, Biggleswade
Onah Linus GP/ Governing Body GP Governing Body Ivel Medical Centre Ad hoc Locum Work 02/08/2017 Ongoing Yes 26/01/2020 Member Member at Herts Urgent Care (HUC) Onah Linus GP/ Governing Body GP Governing Body Ivel Medical Centre Wife works in a GP 2019 Ongoing Yes 26/01/2020 Member Member practice in Bedfordshire Sharma Dr Sanjay GP/Governing Body GP Governing Body Wheatfield Surgery Partner, Director and Yes 30/09/2019 Member Member 25% shareholder in Wheatfield Pharmacy, 60 Wheatfield Road, Luton, LU4 0TR
Smith Nicola Chair Chair GP Partner Parkside Yes 1993 Ongoing Declare at relevant Yes Form submitted to Medical Centre, meetings MK CCG Milton Keynes
Whiteman Sarah Executive/Governing Medical Director BLMK Staff Civil partner, 2010 Ongoing To be addressed as Yes 08/03/2020 Body Member Advanced nurse required practitioner (Walnut Tree Health Centre, Milton Keynes) Whiteman Sarah Executive/Governing Medical Director BLMK Staff Stonedean Practice, 2007 Ongoing To be addressed as Yes 08/03/2020 Body Member Member Practice of required Milton Keynes CCG, Former GP Partner and current sessional GP
Whiteman Sarah Executive/Governing Medical Director BLMK Staff Willen Hospice - 2001 2016 To be addressed as Yes 08/03/2020 Body Member (Provider) . Former required Trustee Whiteman Sarah Executive/Governing Medical Director BLMK Staff Hulcote & Salford 01/01/2019 Ongoing To be addressed as Yes 08/03/2020 Body Member Parish Council - required Parish Councillor (Local Authority Body)
Whiteman Sarah Executive/Governing Medical Director BLMK Staff MKUCS (Milton 2012 2013 No Longer applicable Yes 08/03/2020 Body Member Keynes Urgent Care Services) - Community Interest Company - Former director
and nominal share holder (x1) 2012 1.12.2020 relinquished Non- Financial Indirect Interest Date of Interest Date of Interest Non- Financial Financial Interest Professional Personal Interests Interests From To Actions to be taken Title/Initials/First Current position (s) Surname Status company/practice to mitigate risk Anything to Declare Date signed Name held in the CCG Whiteman Sarah Executive/Governing Medical Director BLMK Staff GMC (General 2012 Ongoing To be addressed as Yes 08/03/2020 Body Member Medical Council) - required Associate Whiteman Sarah Executive/Governing Medical Director BLMK Staff AKESO - (Coaching 01/08/2020 Ongoing To be addressed as Yes 08/03/2020 Body Member Network) - Coach - required Executive and Performance Coach
Whiteman Sarah Executive/Governing Medical Director BLMK Staff NHSE - Appriaser 2010 Ongoing To be addressed as Yes 08/03/2020 Body Member (Summative & required Formative discussions)
Whiteman Sarah Executive/Governing Medical Director BLMK Staff City Fiction - Advisor - 01/08/2020 Ongoing To be addressed as Yes 08/03/2020 Body Member Provide medical input required to publications Luton CCG Declarations of Interest Register. Governing Body. 10/03/2021
Name Current position (s) held- i.e. Declared Interest- (Name of the Type of Interest Is the Interest Governing Body, Member organisation and nature of Direct or practice, Employee or other business) Indirect? Interests Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial InterestsFinancial
Alsop, Richard Director of Commissioning I am a non-shareholding director of x Direct and and Contracting FACT Solutions UK Ltd, which Indirect provides professional services, including PR, communications and marketing services to public and private sector clients.
The company has a contract in Northamptonshire to provide mental health awareness programmes for children and young people.
My partner is the 100% shareholding director of FACT Solutions UK Ltd
Page 1 of 4 Name Current position (s) held- i.e. Declared Interest- (Name of the Type of Interest Is the Interest Governing Body, Member organisation and nature of Direct or practice, Employee or other business) Indirect? Interests Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial InterestsFinancial
Prescribing Clinical Pharmacist at Castle Street Medical Practice
Nova Clinical Services Limited Lay Member Finance & Aziz, Mahmood X Indirect/Direct Procurement No longer a director of Mind Consulting Limited, ceased trading
Employment with Blue Prism Limited
Bakhai, Chirag Deputy Clinical Chair, Luton None CCG
Cox, Felicity Accountable Officer and ICS I am also the Executive Lead for the x Direct Executive Lead BLMK ICS
Page 2 of 4 Name Current position (s) held- i.e. Declared Interest- (Name of the Type of Interest Is the Interest Governing Body, Member organisation and nature of Direct or practice, Employee or other business) Indirect? Interests Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial InterestsFinancial Cox, Felicity Accountable Officer and ICS I am a registered pharmacist with x Direct Executive Lead the GPhC (General Pharmaceutical Council) and a member of the None Denny, Lloyd ember, Public and Patient Engag
French, Kathleen Independent Nurse Daughter is a social worker at Luton x Direct Borough Council Previously director and owner of Kempson Day Associates Ltd, but Lay Member for Audit and Kempson, David the company has ceased trading x Direct Governance with effect from 31/12/19 and is applying for dissolution Acting Chief Finance Officer None (Substantive role is Director of Makin, Stephen System Finance/Deputy Chief Finance Office)"
Murray, Anne Chief Nurse None
Page 3 of 4 Name Current position (s) held- i.e. Declared Interest- (Name of the Type of Interest Is the Interest Governing Body, Member organisation and nature of Direct or practice, Employee or other business) Indirect? Interests Professional Non-Financial Non-Financial Non-Financial Non-Financial Personal Interests Personal Financial InterestsFinancial Singh, Dr Kirti Clinical director for mental Malzeard road medical X Direct health Luton CCG centre partner Governing body member Care taking contract Luton CCG Ans shadow board Medina medical centre BLMK Kirtisingh pvt ltd
GP Partner Parkside Medical Centre, y Direct Smith, Nicola Chair Milton Keynes
Talati, Hetal GP Member
None Turner, Helen Secondary Care Representative
Virji, Safiya GP Member
Page 4 of 4 MILTON KEYNES CCG GOVERNING BODY CONFLICTS of INTERESTS REGISTER
Date of Publication: March 2021
Name Current Type of Declared Interest Is the Date of Interest Action taken to mitigate position held in Interest interest risk the CCG direct or indirect Alsop Richard Director of Financial I am a non-shareholding director of FACT Solutions UK Ltd, Direct 2014 To Commissioning and which provides professional services, including PR, present and Contracting Personal communications and marketing services to public and private sector clients.
The company has a contract in Northamptonshire to provide mental health awareness programmes for children and young people.
My partner is the 100% shareholding director of FACT Solutions UK Ltd Carson Nessan GP Board Personal Wife GP Partner at Stonedean Practice Indirect Ongoing Will declare when Member appropriate Carson Nessan “ Non- Nominal Shareholder in MKUCS. Not involved in shareholder Ongoing Will declare when financial meetings but appraisal of local GPs appropriate profession al Cox Felicity Accountable Financial I am also the Executive Lead for the BLMK ICS Direct 01/02/2 Ongoing Agendas are converging I Officer Personal 1 will declare any conflicts but do not expect any to arise. Cox Felicity Accountable Non- I am a registered pharmacist with the GPhC (General Direct 17/08/1 Ongoing I will excuse myself should Officer financial Pharmaceutical Council) and a member of the Royal 987 an interest arise. profession Pharmaceutical Society al Ginn Roland Lay Member for Financial Joint owner & Director (Spring Breeze Advisory Services Ltd Direct May Date SBASL no longer trading. No Governance Interest 2019 work ever for MKCCG. Goyal Amit GP Board Member Holme Tom Secondary Care None Doctor Makin Stephen Acting Chief None Finance Officer (Substantive role is Director of System Finance/Deputy Chief Finance Office)" Murray Anne Chief Nurse, None BLMK Commissioning Collaborative Patel Krishna GP Board None Father is GP in the local area Indirect May Ongoing Leave meetings when Member financial 2019 conflict of interest arise. profession Declare conflicts of interest al Interest at the start of meetings. Rowland Mike Lay Board Personal Trustee of Carers Milton Keynes and Bucks Direct 2008 Ongoing Member Interest Chair of Governors at The Redway School Direct 1983 Ongoing Governor Priory Rise School Direct 2009 Ongoing Parent of a profoundly disabled daughter who is in receipt of Direct 1972 Ongoing Continuing Health care and attends a Milton Keynes Council Day Centre. Financial Associate MH Act Manager. CNWL. I receive a fix sum of £50 Direct 1996 Ongoing for each hearing I attend, usually 6 or 7 hearings annually. Sivills Edward GP Board Financial Wife is a GP Partner at MKV practice Indirect Ongoing I will declare if relevant to Member any decision Smith Darren Lay Board None Member Smith Nicola GP Chair Financial GP Partner Parkside Medical Centre Direct 1993 Ongoing Declare at relevant meetings
Governing Bodies in Common in Public
16 March 2021
1.3: Draft Minutes of Previous Meetings and the use of Emergency
Author: Various secretariat Contact Information: [email protected] Lead Executive: Nicola Smith, Chair Which CCGs does this paper apply to?
Bedfordshire Luton Milton Keynes
Information
Which activity does this paper Governing Body Minutes for Approval relate to? Emergency Powers for Milton Keynes CCC Governing Body
How? N/A
What is the Committee/ To review and approve the minutes of the following meeting: Governing Body being asked to do? Governing Bodies in Common in Public – 19 January 2021
To ratify the use of Emergency Powers for Milton Keynes CCG Governing Body in Private on 15 December 2020.
What are the financial N/A implications?
Set out the key risks and risk N/A ratings
Date to which the information 10/03/2021 this paper is based on was accurate
Executive Summary
The following minutes are presented to the Governing Bodies in Common for approval: • Governing Bodies in Common in Public – 19 January 2021
The Governing Bodies in Common in Private meeting on 15 December 2020 was not quorate for Milton Keynes Governing Body. It was decided at the meeting that emergency power as set out in the constitution would be used to make the three decisions on behalf of MK CCG. The emergency powers involved the Chair and the Chief Finance Officer approving the decisions. The 15 December minutes have been sent to the 16 March 2021 Governing Bodies in Common in private meeting for approval. These decisions related to the following items in the minutes: 3. Accountable Officer Appointment Process 4. Proposed BLMK CCG Financial Risk Sharing 2020/21
5. Clinical Policy Alignment Engagement On 18 January abridged draft minutes of the 15 December meeting showing decisions made were circulated to the Milton Keynes CCG Governing Body for information and assurance, along with an email explaining about the use of the emergency powers. The Governing Bodies are asked to ratify the use of Emergency Powers for MK CCG Governing Body in Private on 15 December 2020.
2
Minutes of the Governing Bodies in Common Meeting in PUBLIC Held on 19 January 2021 Held over Microsoft Teams Members Present:
Saqhib Ali Lay Member Bedfordshire SA Richard Alsop Director of Commissioning and Contracting BLMK RA Mahmood Aziz Lay Member Luton MA Chirag Bakhai GP Member Luton CB Alison Borrett Lay Member Bedfordshire AB Dr Nessan Carson GP Member Milton Keynes NC Patricia Davies Accountable Officer BLMK PD Sally England Lay Member Bedfordshire SE Kathy French Independent Nurse Luton KF Roland Ginn Lay Member Milton Keynes RG Tom Holme Secondary Care Doctor Milton Keynes TH Dr Roshan Jayalath GP Member Bedfordshire RJ David Kempson Lay Member Luton DK Stephen Makin Acting Chief Finance Officer BLMK SM Anne Murray Chief Nurse BLMK AM Linus Onah GP Member Bedfordshire LO Krishna Patel GP Member Milton Keynes KP Mike Rowlands Lay Member Milton Keynes MR Sanjay Sharma GP Member Bedfordshire SS Kirti Singh GP Member Luton KS Nicola Smith Chair BLMK NS Darren Smith Lay Member Milton Keynes DS Hetal Talati GP Member Luton HTa
Helen Turner Secondary Care Doctor Luton HTu Safiya Virji GP Member Luton SV Sarah Whiteman Medical Director BLMK SW
Others in attendance: Ruth Adams Geraint Davies Director of Performance and Governance BLMK GD Sarah Feal Head of Governance BLMK SF Fiona Garnett Associate Director Medicines Optimisation BLMK SF Maryla Hart Governance and Committee Officer (Minutes) Bedfordshire MH Vicky Head Interim Director of Public Health Bedfordshire VH Milton Keynes
Page 1 of 7 Ola Hill Risk and Governance Manager BLMK OH Tracy Keech Interim Chief Executive Officer, Healthwatch Milton Keynes TK Ashok Khandelwal Bedford Borough Healthwatch Representative Bedfordshire AK Jane Meggitt Director of Communications and Engagement BLMK JM Lucy Nicholson Chief Executive, Healthwatch Luton Luton LN
Apologies from Members: Lloyd Denny Lay Member Luton LD Christopher GP Member Bedfordshire CL Longstaff Ed Sivills GP Member Milton Keynes ES
Apologies from Attendees: Laura Church Public Health Representative Luton LC Nicky Poulain Director of Primary Care BLMK NP
1.1 Welcome, Apologies for absence and Introductions Action The Chair welcomed all members and attendees to the meeting.
Apologies were received and noted as above. The Chair advised that the meeting was quorate.
The Chair welcomed Sarah Feal, the new Head of Governance.
The Chair extended a vote of thanks to Chris Ford, Chief Finance Officer, who had retired in December. CF Is being deputised by Stephen Makin who is continuing in the role. The Chair thanked SM.
The Chair advised that due to the Covid pandemic response being prioritised, the CCGs are focusing on the most important issues in this meeting which we plan to get through as efficiently as possible.
NS advised the Public that the draft Clinical Commissioning Strategy and a survey relating to this have been published on the BLMK CCGs’ website.
1.2 Declarations of Interest The Chair invited members to declare any interests relating to matters on the Agenda. There were none declared. 1.3 Minutes of the previous meeting The minutes of the Governing Body in Public meeting held on 17 November 2020 were approved as an accurate record subject to the following change being made:
Page 8. 3.1: BLMK Performance and Quality Report 2020/21 M5 - August 2020. Penultimate paragraph. “KF advised that Bedford Hospital…”
Page 2 of 7
To be amended to
“AM advised that Bedford Hospital…”
ACTION: Action Log to be circulated to the Governing Body for information.
4. Matters Arising There were no matters arising.
5. Update on Covid 19 Position
PD and Governing Body colleagues gave a verbal update and touched on the following:
• Positive news around the Covid vaccine • Covid transmission and hospital admission rates. • PD stressed the importance of members of the public continuing to adhere to government guidelines. Covid is putting a huge strain on BLMK clinicians and health and social care staff. • The BLMK area has made huge strides in stepping up the vaccine effort. BLMK CCGs’ executive members AM, SW, NP and NS have been out delivering the vaccine. • BLMK has used almost every single vaccine delivered to us. • The enthusiasm of the over 80s for the vaccine was noted. • Primary care front line staff have been vaccinated. • BLMK CCG is promoting the message that the vaccine is safe. • The CCGs are working with our health and social care partners collegiately. • Housebound people are also receiving the vaccine. • Local Primary Care Networks (PCNs) have a plan to roll out vaccine provision across all of BLMK by the end of next week, to have coverage throughout. Residents will then be called up to receive the vaccine according to priority criteria. • PD thanked everyone involved.
AK raised concern around misinformation about the vaccine, especially amongst Black and Minority Ethnic (BAME) communities. AK asked about plans for education and messaging to the public, including in other languages. JM clarified that the CCGs are working closely with local Healthwatch and faith leaders in diverse communities to promote the message that the vaccine is safe and to encourage people to take up the vaccine when called. This campaign has already started, working with GPs and targeting the over 80s. The CCGs are also working with Local
Page 3 of 7
Authority (LA) partners and the voluntary sector to get the message out in as many languages as possible and to seize all opportunities for conversations about the vaccine. The CCGs appreciate working with Healthwatch.
The Governing Bodies noted the update.
6. BLMK Performance and Quality Report 2020/21 M7 October 2020
GD and AM presented the paper.
It was noted that the information presented in the paper was out of date. The purpose of the update was to give the Governing Bodies assurance on how the CCGs were reviewing the clinical impact of Covid and how this affected patients.
The CCGs have focused on key areas. One key area of concern is cancer patients. AM gave an update on cancer, including waiting times. In relation to cancer rates nationally we have been performing well on recovery from a regional perspective.
There are big challenges around Mental Health and the CCGs are working closely with the mental health trusts and other providers. Wellbeing and psychological support is available to all BLMK CCG staff from the two mental health trusts in our area. The CCGs are keeping a close eye on vulnerable groups including vulnerable children with regards to mental health.
The following was discussed:
• From a commissioner’s perspective of supporting the system, partners are working extremely well together across Bedfordshire and Milton Keynes. There are improved discharge processes across this area. • Staffing and physical space in hospitals are constrained. The CCGs can help with length of stay in hospital by moving patients into alternative settings. An update was given on the commissioning of beds elsewhere as well as support such as rehabilitation and therapy. • The Governing Bodies were given assurance that the CCGs were working on flow and appropriate discharge. • Additional support has been purchased into nursing homes for dementia patients including additional dementia support beds. • Achieving dementia diagnosis targets was always a challenge in Bedfordshire, including pre-Covid. Bedfordshire CCG had been
Page 4 of 7
part of a recovery programme to increase diagnosis. The current low diagnostic rates are not a new trend. • An update was given on endoscopy. • There have been challenges around calculating data on Milton Keynes University Hospital mortality rates, due to a new IT system. An update has been received from the Hospital and further assurance will be required in relation to the data position. AM is assured about the clinical oversight of mortality reviews by the Medical Director. • The effects of referral to treatment (RTT) waiting times on primary care provision were discussed. • Quality risks are listed on the directorate risk register, but will be escalated to the Corporate Risk Register if the need arises. • Consequences to the primary care workforce and to the patients themselves of patients presenting late to primary care with symptoms of illness were discussed.
ACTION: More information around the Milton Keynes University Hospital Mortality review to be added to the report.
ACTION: TK asked for assurance around hospital acquired infections (including Covid), infection control work and the high level of mortality in Milton Keynes Hospital at the moment. AM to put TK in touch with Jenny Brooks, Quality Manager from Milton Keynes CCG.
NS advised that the CCGs are carrying out infection control better than ever before.
The Governing Bodies noted the update.
7. M8 Finance Report BLMK CCGs
SM introduced the report and gave an update.
The Governing Bodies noted the update.
8. Maternity Services: Ockenden Report
AM introduced the report which provided a summary of the Ockenden Report which had been published in December 2020. The paper set out the key findings of the independent review of maternity services at Shrewsbury and Telford NHS Trust (SaTH) and the Immediate and Essential Actions (IEAs) that had been identified for implementation within all maternity units across England.
Page 5 of 7
AM gave an update on Maternity at Bedford Hospital, whose Care Quality Commission (CQC) report had been published last week. The BLMK CCGs’ Quality and Performance Joint Committee have regular updates on Bedford Hospital Maternity and had been sighted on the report.
ACTION: HT asked whether in the name of transparency and scrutiny it would be prudent to have lay members who were independent and did not have a vested interest in maternity as members of the Local Maternity and Neonatal System (LMNS) Strategic Board for Bedfordshire, Luton and Milton Keynes (BLMK)? AM welcomed the suggestion. AM to get a view on this proposal and come back through NS.
The Governing Bodies:
• Noted the work set out in the report and agreed this as a priority programme of activity during this period and ongoing. • Noted the revised Terms of Reference (ToR) for the Local Maternity and Neonatal System (LMNS) Strategic Board for Bedfordshire, Luton and Milton Keynes (BLMK) which will be approved at the next Strategic Board in February 2021. • Noted the current risks in BLMK system and work in place to address.
9. BLMK CCG - Merger Update
GD presented the report and advised that work was on track to be signed off by the region to schedule.
The Governing Bodies noted the report and progress made.
10 Controlled Drug Responsible Officer
FG gave an update.
The Governing Bodies noted and agreed that the Controlled Drugs Responsible Officer for BLMK CCGs was the Associate Director and Head of Medicines Optimisation, Fiona Garnett.
The Governing Bodies noted the content of the ‘Memorandum of Understanding between NHS England & NHS Improvement East of England and Clinical Commissioning Groups on the Safe Use of Controlled Drugs’ and the responsibilities with in this agreement, specifically the requirement set out on page 6, table 2.4.2 point one, Page 6 of 7
‘Responsibilities of each organisation to appoint individuals to represent the organisation. The Controlled Drugs (Supervision of Management and Use) Regulations 2013) Regs.8 and 10’.
11. Corporate Risk Highlight Report
OH introduced the report and gave an update.
ACTION: AM and OH to work on capturing Quality Risks on the Corporate Risk Register
GD thanked OH for working on risk as well as mass vaccination programme. NS and the Governing Bodies thanked OH.
The Governing Bodies noted the update and received assurance that there is effective risk management at the three CCGs, and work to develop aligned risk management systems is progressing.
12. Any Other Business There was no other business.
13 Questions from the Public No questions were received from the public.
14. Date of next Meeting: 16 March 2021.
The meeting closed at 16:55
Page 7 of 7
Governing Bodies in Common in Public 16 March 2021
1.4: Action Log
Author: Secretariat Contact Information: [email protected] Lead Executive: Committee Chair Which CCGs does this paper apply to?
Bedfordshire Y Luton Y Milton Keynes Y
Information
Which activity does this paper The tracker shows the outstanding actions of the Governing relate to? Bodies
How?
What is the Committee/ To discuss and provide updates for the trackers including new Governing Body being asked to action deadlines/reassigning action owners where appropriate. do? Action owners should be Executive or Senior Manager level. What are the financial N/A implications?
Set out the key risks and risk N/A ratings
Date to which the information N/A this paper is based on was accurate
Executive Summary
N/A
10/03/2021 Governing Bodies in Common Action Log
Governing Bodies in Common Action Log RAG KEY Escalated Escalated - items flagged RED for 3 subsequent meetings - BLACK Outstanding Outstanding - no actions made to progress OR actions made but not on track to deliver In Progress In Progress. Outstanding - actions made to progress & on track to deliver due date - Not Yet Due Not Yet Due COMPLETE: COMPLETE - GREEN Propose closure at next meeting CLOSED CLOSED (dd/mm/yyyy)
Action Meeting Date CCG Item Title Action Responsible Manager Past deadlines Current Deadline Current Position RAG No. (Enter full name) (Since Revised) (Add date action is agreed closed)
41 17/11/2020 BLMK in Public Corporate Risk Registers OH to organise 121s with Lay Members with regards to risk Ola Hill 31/03/2021 04/03/2021: 1 to 1s now being arranged following In Progress (CRR) and Governing registers before Christmas. confirmation of new BLMK Governing Body Body Assurance 18/01/2021 : 1 to 1s will be arranged for all confirmed lay Framework (GBAF) members in February
44 17/11/2020 BLMK in Public Health Inequalities: NS asked the team to come back to the Governing Bodies in Geraint Davies / Mar-21 Apr-21 04/03/2021: Update planned for 6 April meting. Not Yet Due Health Inequality Review Common with regular updates on the Health Inequality Review Lloyd Denny and let the GBiC know when they are ready to do so.
58 17/01/2021 BLMK in Public BLMK Performance and More information around the Milton Keynes University Anne Murray 16/03/2021 10/03/2021: Update to be given at meeting. In Progress Quality Report 2020/21 Hospital Mortality review to be added to the report. 26/02/2021: In progress M7 October 2020 28/01/2021: MKUH contacted. Work is underway with external consultants CHKS to plan changes and a review to the data. This will have a time lag of 3 months. Hospital happy to have explanatory conversation. We will follow up on this offer.
Page 1 of 4 10/03/2021 Governing Bodies in Common Action Log
Action Meeting Date CCG Item Title Action Responsible Manager Past deadlines Current Deadline Current Position RAG No. (Enter full name) (Since Revised) (Add date action is agreed closed)
30/19a 16/07/2019 Luton Part 1 Board to Board To schedule a Board to Board meeting with the L&D Felicity Cox 16/07/2019 Apr-21 22/09/2020: MWG has been in contact with the Luton and Not Yet Due Patricia Davies Dunstable NHS Trust. A Board to Board will be arranged for the future. A date cannot be given due to Covid. This will be revisited in April 2021. 16/07/2019 - To hold the meeting including BCCG by September 2019 11/09/2019 - This is being reviewed in light of the merger between BHT & L&D and changes within the CCGs. This may be better done with BCCG & BHT/L&D collectively and will be discussed with Chairs of BCCG & LCCG re the best approach to take. 19/11/2019 - Steps are being taken to hold a Board to Board with the Shadow merged L&D/BHT board and LCCG/BCCG in the new year. 21/01/2020 - The proposed Board to Board meeting with the Luton and Dunstable Hospital (L&D) is due to take place April 2020 18/02/2020 - update received - The proposed Board to Board meeting, which will include Bedfordshire CCG, is planned for the beginning of May 2020. 09/05/2020: Given that all public and board meetings have been suspended in terms of COVID, this has also been put on hold on in terms of any Board to Board Meetings. 21/07/2020: To be revisited.
38 17/11/2020 BLMK in Public Minutes of the previous MH to liaise with TK to ensure the amendment of the Maryla Hart COMPLETE: meeting amendment is correctly amended. Propose closure at next meeting
39 17/11/2020 BLMK in Public Corporate Risk Registers OH asked for any feedback or learning to be passed onto her All 31/12/2020 15/01/2021: Colleagues have feedback comments. This action COMPLETE: (CRR) and Governing as this is the first iteration of the CRR. will also be incorporated to business as usual regarding the Propose closure at Body Assurance management of the CRR. next meeting Framework (GBAF)
40 17/11/2020 BLMK in Public Corporate Risk Registers NS asked for a table of contents to be provided on future cover Ola Hill 19/01/2021 15/0/2021: Incorporated into the CRR and GBAF reports COMPLETE: (CRR) and Governing sheets listing all the documents included under this item. moving forward. Propose closure at Body Assurance next meeting Framework (GBAF)
Page 2 of 4 10/03/2021 Governing Bodies in Common Action Log
Action Meeting Date CCG Item Title Action Responsible Manager Past deadlines Current Deadline Current Position RAG No. (Enter full name) (Since Revised) (Add date action is agreed closed)
42 17/11/2020 BLMK in Public Corporate Risk Registers NC commented that it would be useful to have a list of the top Ola Hill 19/01/2021 18/01/2021: This format will be used in future reports COMPLETE: (CRR) and Governing 5-10 risks as they used to have in MKCCG. Propose closure at Body Assurance next meeting Framework (GBAF)
43 17/11/2020 BLMK in Public Health Inequalities: Everyone’s support and ownership of the Health Inequality All 15/01/2021: Colleagues have endorsed the approach. COMPLETE: Health Inequality Review Review would be very much appreciated. Including GB Propose closure at members, staff and partners. next meeting
46 17/11/2020 BLMK in Public Patient Story The Governance and Communications Teams to work with Maryla Hart / Anona Mar-21 10/03/2021: Patient story on March agenda kindly provided by COMPLETE: Lucy Nicholson from Healthwatch Luton to obtain patient Hoyle Healthwatch Luton. Propose closure at stories for future meetings. 14/01/2021: Due to Covid Pressures and the need to keep next meeting agendas short, there is not a patient story on the agenda for January.
57 17/01/2021 BLMK in Public Minutes of the previous Action Log to be circulated to the Governing Body for Maryla Hart COMPLETE: meeting information. Propose closure at next meeting
59 17/01/2021 BLMK in Public BLMK Performance and Tracy Keech (TK) asked for assurance around hospital acquired Anne Murray 16/03/2021 28/01/2021: Hospital contacted to liaise directly with TK to COMPLETE: Quality Report 2020/21 infections (including Covid), infection control work and the ensure assurance around Infection Control . Propose closure at M7 October 2020 high level of mortality in Milton Keynes Hospital at the next meeting moment. Anne Murray to put TK in touch with Jenny Brooks, quality manager from Milton Keynes CCG.
Page 3 of 4 10/03/2021 Governing Bodies in Common Action Log
Action Meeting Date CCG Item Title Action Responsible Manager Past deadlines Current Deadline Current Position RAG No. (Enter full name) (Since Revised) (Add date action is agreed closed)
60 17/01/2021 BLMK in Public Maternity Services: Helen Turner asked whether in the name of transparency and Anne Murray 16/03/2021 26/02/2021: 28/01/2021 Lay member identified (Alison COMPLETE: Ockenden Report scrutiny it would be prudent to have lay members who were Borrett) and has attended first Board. Propose closure at independent and did not have a vested interest in maternity as 28/01/2021: Lay member role currently being explored. next meeting members of the Local Maternity and Neonatal System (LMNS) Strategic Board for Bedfordshire, Luton and Milton Keynes (BLMK)? AM welcomed the suggestion. AM to get a view on this proposal and come back through NS.
61 17/01/2021 BLMK in Public Corporate Risk Highlight Anne Murray and Ola Hill to work on capturing Quality Risks Anne Murray / 16/03/2021 26/02/2021: In progress COMPLETE: Report on the Corporate Risk Register. Ola Hill 28/01/2021: Meeting held with Ola Hill. Quality Directorate Propose closure at risk register contains details at a service level, work is ongoing next meeting to collate the 3 registers. In order to capture the strategic risk in the context of the pandemic a risk statement has been produced and included for the corporate Risk Register.
Page 4 of 4
Governing Bodies in Common in Public 16 March 2021
2.2: Accountable Officer’s Report
Author: Felicity Cox Contact Information: [email protected] Lead Executive: Accountable Officer Which CCGs does this paper apply to?
Bedfordshire Yes Luton Yes Milton Keynes Yes
Information
Which activity does this paper This paper provides an update on the work being undertaken by relate to? the CCGs in the intervening period between January and March 2021. How? An update by the Accountable Officer, Felicity Cox
What is the Committee/ To note the paper. Governing Body being asked to do? What are the financial N/A implications?
Set out the key risks and risk N/A ratings
Date to which the information 16 March 2021 this paper is based on was accurate
Executive Summary
The purpose of this paper provides is to provide Governing Body with an update on the work that has been undertaken by Bedfordshire, Luton and Milton Keynes Clinical Commissioning Groups since it was last convened in January 2021.
New year, new role This is my first Governing Body as Accountable Officer for Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group. I was delighted in December to take up the role of Executive Lead for the BLMK Integrated Care System in December 2020 and take the reins as Accountable Officer from 1 February. While this is a new role for me, I am no stranger to the BLMK system, having spent alot of my professional NHS career working on the patch but most recently seven years ago, as Primary Care Trusts were evolved into Clinical Commissioning Groups. I am encouraged to meet some farmiliar faces and am looking forward to getting to know colleagues from across the health and social care environment, as we embark on a period of challenge and transition – moving from managing the pandemic into a period of reset and recovery. Covid-19 Since the Governing Body last met in January this year, the NHS in Bedfordshire, Luton and Milton Keynes and indeed nationally has been in the grip of a second, devastating wave of Covid-19 infections. While our area was placed into intervention before Christmas, with Tier 4 restrictions coming into force, this did not stop the escalating number of Covid positive infections in our community at the beginning of the year, which subsequently led to a winter like no other. As with the first wave of Covid-19, the number of people requiring primary care and acute hospital care increased significantly, along with the acuity of our patients, putting incredible pressure on NHS services, and in particular our workforce. Tragically, 2,191 people have now died from Covid-19 across Bedfordshire, Luton and Milton Keynes since the start of the pandemic last year, among them many of our own colleagues. As we approach the first anniversary of the Prime Minister’s ‘stay at home’ order on 23 March, I would like to formally register my personal thanks and gratitude to our NHS people, our local authorities, emergency services colleagues, care workers, key workers and volunteers, who have all rallied and worked tirelessly to care for our residents, feed them, protect them – and when all else has failed, to provide dignity in their final days. While the end of the pandemic is not yet in sight, the Covid-19 Vaccination programme, which was rolled out at the end of last year and gained momentum in recent weeks brings hope for brighter days ahead. Covid Impact Assessment
During the last month, we have undertaken a Covid Impact Assessment with input from our health and care partners to provide our system with a comprehensive assessment of the impact of the Covid-19 pandemic on our population and our health and care services.
This assessment has identified positive and negative impacts that will inform our reset and restoration plans. The report was reviewed at the Quality and Performance Committee on 2 March and committee members welcomed the detailed assessment that had been made and noted the mitigating actions that had been taken in respect of negative impacts.
2
An historic vaccination programme As a registered Pharmacist, working with licensed medicines and understanding the detail of routes to market, efficacy and dosing is part of the day job. In the last few months however, our residents have all become experts by experience in talking about the new vaccines which have been licensed to provide protection against Covid-19. This is the largest vaccination programme in the history of the NHS and in just a few months, we have established 20 Local Vaccination Sites (LVS) in our area, which includes:
o 17 Primary Care Network (GP) sites; o 3 pharmacy sites; o 3 Hospital Hubs; o 6 regional Vaccination Centres (VCs)
This infrastructure has allowed us to provide first doses to almost 200,000 people, with vaccine supply increasing significantly and our dedicated teams vaccinating throughout the Easter Bank Holiday weekend, we expect this number to continue it’s impressive trajectory.
In recent weeks, I have attended a number of our vaccination centres and been proud of our NHS and the tremendous work that is being done. I am also humbled by our volunteers, who have been at our centres in some of the harshest weather conditions, working of their own accord to support our residents and our NHS in delivering this programme.
The optimism at our centres is a tonic after the dark days of the pandemic, and it has been uplifting to hear the stories of hope from our residents who are keen to have the vaccine so they can be with their families again. We have also been moved by the many letters of thanks from residents who have sent in their praise for our staff, volunteers and the centres and I would like to thank everyone who has been involved in this programme for their exceptional work in helping to deliver it here in Bedfordshire, Luton and Milton Keynes.
The programme will continue for some time yet and I would like to encourage everyone to book an appointment as soon as they receive their letter inviting them for their vaccination.
NHS Bedfordshire, Luton and Milton Keynes Clinicial Commissioning Group
On 1 April this year, after 18 months of engagement and planning, the three Clinicial Commissioning Groups for Bedfordshire, Luton and Milton Keynes will come together to form one single Clinical Commissioning Group, NHS Bedfordshire Luton and Milton Keynes.
This will allow us to deliver economies of scale, while also continuing to operate at place, to make sure we deliver the right services for our residents.
As part of this, we have formed a new Governing Body for the single CCG, which will be Chaired by Dr Sarah Whiteman, who was formerly Medical Director for the Bedfordshire, Luton and Milton Keynes Commissioning Collaborative.
I would like to thank colleagues and stakeholders, who have worked with us through this process to ensure that we can provide assurance for to our residents. I would particularly like to thank everyone who has served on the governing body for their leadership and support to the process.
3
Integrating Health and Social Care Systems – a white paper for the future
The official formation of the single CCG in April is the next step on a journey that we have been on in the NHS since 2016, bringing together health and care organisations to improve outcomes for our residents.
On 8 February, the next step in this journey was released by Government in the shape of a White Paper, which sets out proposals to bring together CCGs and the ICS to create one single statutory body, which operates across the ICS footprint. It is envisaged that on 1 April 2022, the CCG will merge with the ICS to create one single organisation, which will allow for greater integration across health and social care, through a focus on place and devolving tactical commissioning as close to service delivery as possible.
This is will help us to deliver the Long Term Plan, published in 2019. which we are currently working together with stakeholders and residents on. , This will help us to take the learning from the pandemic and co-create the priorities for the ICS for the next two, five and ten years to achieve the improved outcomes the Long Term Plan requires.
We will continue to provide updates to Governing Body, stakeholders and residents about this work, as it develops.
4
Governing Bodies in Common in Public
16 March 2021
3.1: BLMK Performance and Quality Report 2020/21 M9 - December
Author: BLMK Performance Team Contact Information: [email protected] Lead Executive: Geraint Davies, Director of Performance and Governance and Anne Murray, Chief Nurse Which CCGs does this paper apply to?
Bedfordshire Luton Milton Keynes
Information
Which activity does this paper Provides the latest performance data and shows the impact on relate to? the delivery of statutory performance targets.
How? By providing information around the latest position for key performance and quality indicators together with commentary around recovery actions. What is the Committee/ To receive assurance around mitigation for areas of Governing Body being asked to underperformance. do? What are the financial N/A implications?
Set out the key risks and risk Introduction and key messages are included at the front of the ratings report.
Date to which the information Report is predominantly Month 9 2020/21 (December 2020) – this paper is based on was data for month 9 published nationally on 11th February 2021. accurate
Executive Summary
The report provides an overview of progress against key performance indicators across Bedfordshire, Luton and Milton Keynes together with a consolidated view of BLMK. This is based on the latest available data which is primarily M9 unless stated within the report. The report highlights the current impact of the Covid-19 pandemic across BLMK and the effect at Month 9. There continues to be a number of provider returns that have been suspended. As these returns come back on line they will be included within the report
Highlights Covid-19 - At 3rd March there were 66,497 cases, which is a rise of 637 over a 7-day period. Cumulative Covid-19 deaths across all settings stood at 2,149 at 19th February (latest available data). There were 23 deaths in hospitals in the 7 days to 1st March, bringing the total to 1,739.
Community- Cambridgeshire Community Services continue to implement restoration plans in light of reduced clinics and increased waiting items; quality impact assessments are carried out for all services. Plans include maintaining effective virtual solutions where these meet the needs of the service users. Where this is not possible, routine face-to-face appointments have been restored.
Planned Care Cancer - BLMK is continuing to implement the recovery plan in terms of treatment pathways and reducing the numbers of patients breaching 62 and 104 days. The recovery plan is monitored by the BLMK Cancer Board. The Cancer Transformation Programme continues with new funding streams to support innovation, cancer workforce and recovery plan in endoscopy. Diagnostic services are managing demand although capacity challenges have slowed down some of the high volume pathways.
Elective Services – The second Covid-19 wave has negatively impacted on elective performance in month 9. After an upward trend in referrals from M1-M7, a downward trend has been noted in M8 and M9. Whilst the CCG has written to Primary Care and Optometrists asking them to consider alternatives to referrals (such as advice and guidance) to ease secondary care pressures, it is likely some of this decreasing demand is due to the current national lockdown and a reluctance to engage with health services.
Waiting Lists - Waiting lists increased slightly in December as anticipated. This is largely due to non-elective pressures and capacity constraints in ITU where anaesthetists are prioritising ventilated patients. Recovery will be limited in the coming months and dependent on a sustained reduction in Covid pressures. The 52+ week position continues to deteriorate as Trusts focus on those that are clinically urgent rather than wait times. This position is likely to deteriorate further in the coming months and will need to form part of any Covid-19 recovery plans. The independent sector continues to support the NHS across BLMK.
Diagnostics - Performance has deteriorated slightly and any further recovery in M10 and M11 is likely to be hampered by the increased Covid-19 pressures. Endoscopy (flexi-sigmoidoscopy, gastroscopy and cystoscopy) capacity continues to be the main concern although all units are now undertaking tests albeit with reduced throughput. The Independent Sector are being used to support diagnostics.
Mental Health Dementia - In Bedfordshire the diagnosis rate has been deteriorating since April and has been below 60% since June. This is due to the limited number of assessments which took place during the first wave of the Covid-19 pandemic. Milton Keynes fell below target for the first time in May. This is due to the closure of the service during lockdown and staff being redeployed to support front line MH services. There has been an improvement in October. Luton continues to achieve the dementia diagnosis rate.
IAPT - Local data suggests that internal waits increased in December, mitigated to some degree by additional step 3 capacity. Recovery rates for BLMK are on target with Luton and Bedfordshire balancing the under- performance in Milton Keynes.Providers are working collaboratively to deliver a joint Public Access Workshop (PAW) series, which will deliver 2,000 patients able to access treatment in Q4.
Serious Mental Illness (SMI) and Learning Disabilities health checks - Single specification across BLMK produced and disseminated to GP practice. Task and finish subgroup set up to develop communications plan to raise awareness of importance of checks. An action plan is in place for both LD and SMI. An outreach SMI project is being delivered in Luton via the GP Federation and plans are in place to deliver a home visiting service in MK and a voluntary sector-led outreach project in Bedfordshire. LD Health Check One-Stop Clinics have now gone live to provide an additional resource for supporting practices with reviewing registers, data cleansing and coding. Local data set now standardised across all 3 areas.
2
CYP Eating Disorders - Referrals have increased over the year resulting in a growth of 47% and BLMK Caseload has seen a growth of 91% from Jan 20 to Jan 21. A proposal has been submitted to NHSE/I for additional funding, including day care provision to support this increased demand and acuity of presentation.
Perinatal Mental Health access - Teams are working together across the ICS to develop the new Maternal Mental Health service for BLMK with a launch date of April 2021. This service is targeted at women who have emotional and mental health needs directly related to pregnancy and birth. Referral rates to perinatal mental health specialist community teams are increasing; teams are working to recruit to support the increases demand.
Out of Area Placements - Acute inpatient units are at capacity, with high acuity patients. Some patients have had to be placed out of area (mainly in London-based units of the Trusts) and Trusts are working to repatriate them as a priority. Crisis teams are working at capacity to avoid admissions, with risk rating and additional support in place.
Infection Prevention & Control During December Covid-19 positive cases across BLMK rose significantly following the end of the November national lockdown. Many care homes and other organisations began to experience increased cases and outbreaks in acute service, Primary care and social care escalated particularly towards the end of the month following the Christmas/New Near period There were a large number of outbreaks in December linked to a significant local rise of cases throughout the general population. Weekly PCR testing of staff in acute trusts and care homes continued.
Quality & Safety Infection Control - There were 6 cases of C-Diff across BLMK in December giving a total year to date of 83 cases. 3 were community acquired and 3 were hospital acquired.All cases are reviewed by the relevant providers to identify any lapses in care that may have directly contributed to the infection. There were no new cases of MRSA bacteraemia in December across Beds, Luton and Milton Keynes giving 3 year to date.
Serious Incidents & Never Events Across Bedfordshire Luton and Milton Keynes, 24 serious incidents were reported in December 2020, none of which met the criteria for a never event. This gives a year to date position of 181 serious incidents, 3 of which have met the criteria for a never event (1 Luton never event was downgraded following investigation).
3
BLMK Performance and Quality Report
Month 9 December 2020 Contents
Pages Summary by Exception 3-5 Key Performance and Quality Indicators 6-10 Planned Care 11-21 Primary and Community Care 22-25 Mental Health, Learning Disabilities and Autism 26-31 Winter 32-34 Covid-19 Update 35-37 Quality and Safety including Children & Young People and 38-42 Maternity
2 Summary by Exception - Upward green arrow shows improving position and downward red is a deteriorating position. Sideways arrow show minimal change
Workstream Trend
Planned Care Cancer - 2 week wait standard has been below the national threshold since June, referrals decreased in December in line with seasonal trends Cancer - 31 day subsequent treatment for surgery improved but remained below the standard with 91% against the 94% national threshold. Cancer - 62 day standard improved slightly in December to 77.83% however it remains below the 85% standard. BLMK is continuing to implement the recovery plan in terms of treatment pathways. Cancer – Long Waits - there were seven 104+ days waiters which is an improvement on the 14 reported in November. GP referrals decreased in December, and were at 79% of the same month last year. It is likely some of the decrease in demand is due to the current national lockdown and a reluctance to engage with health services. Public messages reiterating that the NHS remains firmly open continue. Waiting lists increased slightly in December as anticipated. This is largely due to non-elective pressures and capacity constraints in ITU where anaesthetists are prioritising ventilated patients.
Diagnostic performance has deteriorated slightly and any further recovery in M10 and M11 is likely to be hampered by the increased Covid-19 pressures. Endoscopy capacity continues to be the main concern although all units are now undertaking tests albeit with reduced throughput.
3 Summary by Exception - Upward green arrow shows improving position and downward red is a deteriorating position. Sideways arrow show minimal change
Workstream Trend
Community Community Services continue to run at a reduced volume and the majority of appointments have been Care transferred to video/telephone appointments where clinically safe to do so. All referrals and follow up appointments are clinically prioritised in the context of Covid-19 restrictions. Mental Dementia Diagnosis rate deteriorated slightly in December and remains below the national threshold. This Health, is primarily due to the underperformance in Bedfordshire where the rate has fallen under 60% (June Learning onwards) due to the limited number of assessments which took place during lockdown. Disabilities IAPT Access remains below target. BLMK providers are working collaboratively to deliver a joint Public and Autism Access Workshop series, which will deliver 2,000 patients able to access treatment in Q4 to help meet the access target. Perinatal Mental Health Access achieved plan with 6.55% against the phase 3 plan of 6.23%. Teams are working together across the ICS to develop the new Maternal Mental Health service for BLMK with a launch date of April 2021. SMI/LD healthchecks have now recommenced however there are challenges in primary care around physical contact for blood pressure, blood test and weight tests. Q3 for SMI is under plan at 18.42% against the 35% phase 3 plan, a deterioration from Q2. Children & Young People Eating Disorders – Referrals have increased over the year resulting in a growth of 47% and BLMK Caseload has seen a growth of 91% from Jan 20 to Jan 21. A proposal has been submitted to NHSE/I for additional funding, including day care provision to support this increased demand and acuity of presentation. Acute inpatient units are at capacity, with high acuity patients. Some patients have had to be placed out of area (mainly in London-based units of the Trusts) and Trusts are working to repatriate them as a priority. Crisis teams are working at capacity to avoid admissions, with risk rating and additional support in place.
4 Summary by Exception - Upward green arrow shows improving position and downward red is a deteriorating position. Sideways arrow show minimal change.
Workstream Trend
Winter A&E attendances in December increased to 25,146 attendances compared to 24,980 in November, however is still lower than the 37,018 in the same period last year. Category 2 ambulance response times across BLMK remains deteriorated to 21 minutes and 31 seconds against the standard of less than 18 minutes. Covid-19 Cumulative cases to 15th February stood at 64,048 which is an increase of 1,277 over the previous 7 days. Update Cumulative Covid-19 deaths across all settings to 5th February 2021 (1,955) stood at 3.14% of confirmed cases. Quality and 6 cases of C-diff across BLMK (3 community and 3 hospital acquired) giving 83 year to date. Safety 24 serious incidents across BLMK none of which met the criteria for a Never Event. Year to date there have been 181 serious incidents of which 3 were Never Events. Summary hospital-level mortality indicator at Milton Keynes Hospital has improved but remains outside of the upper limit. It is believed this is due to changes in counting and the Trust have been asked to provide a narrative action plan. Bedford Hospital Maternity Unit – Trust has been meeting with the CQC weekly to review plans and progress has been evident. CCG Chief Nurse and AD for children and maternity commissioning are working with the new Director of Midwifery for Bedford Hospitals to align assurance processes.
5 Key Performance & Quality Indicators - Notes for data
Key Performance & Quality Indicators The following key performance & quality indicator dashboards and acute provider dashboard have been ragged against national thresholds. Green if an indicator has been achieved or over-achieved, Amber if it has under-achieved within the agreed tolerance threshold and Red if it has under-achieved below the tolerance threshold.
The arrows show whether performance has improved or deteriorated compared to the previous month/quarter. Due to constraints within the national reporting timetable the Cancer monthly activity reflects validated data up to September 2020; October onwards shows the latest un-validated position.
Where no patients have been seen/treated during the reporting month, this is shown by “NP”
Data is sourced from national statistics published by NHS England, NHS Improvement and NHS Digital, unless otherwise specified as local data.
Due to the Covid-19 pandemic and the need to release capacity across the NHS to support the response, NHS England has suspended the collection and publication of some official statistics for data due to be submitted in 2020/21. These indicators are greyed out in the dashboards and the report shows the last known position.
Phase 3 Recovery Plans As part of the phase 3 recovery planning a series of plans were agreed with providers which were profiled from September 2020 to March 2021. The Phase 3 Recovery Plan dashboard is ragged against the BLMK phase 3 plans and is ragged green if an indicator has achieved or over-achieved, Amber if it has under-achieved with a 5% tolerance threshold and Red if it has under-achieved below the tolerance threshold.
6 Key Performance and Quality Indicators
Bedfordshire 2020/21 2020/21 Milton 2020/21 2020/21 Measure Threshold Latest Data Trend Luton CCG Trend Trend BLMK Trend CCG YTD YTD Keynes CCG YTD YTD
Cancer Waiting Times - 2 Week Wait 93.00% Dec-20 83.10% 90.33% 82.41% 84.00%
Cancer Waiting Times - 2 Week Wait (Breast Symptoms) 93.00% Dec-20 55.00% 86.84% 98.41% 76.80%
Cancer Waiting Times - 28 Days Faster Diagnosis Standard Dec-20 69.25% 63.49% 78.61% 71.40%
Cancer Waiting Times - 31 Day First Treatment 96.00% Dec-20 98.94% 98.25% 92.91% 96.78%
Cancer Waiting Times - 31 Day Surgery 94.00% Dec-20 97.06% 94.74% 75.00% 91.30%
Cancer Waiting Times - 31 Day Drugs 98.00% Dec-20 100.00% 87.50% 100.00% 98.78%
Cancer Waiting Times - 31 Day Radiotherapy 94.00% Dec-20 100.00% 94.44% 92.00% 97.30%
Cancer Waiting Times - 62 Day GP Referral 85.00% Dec-20 74.07% 88.24% 78.69% 77.83%
Cancer Waiting Times - 62 Day Screening 90.00% Dec-20 100.00% 100.00% 80.00% 93.33%
Cancer Waiting Times - 62 Day Upgrade 90.00% Dec-20 100.00% 100.00% 91.67% 94.74% CCG RTT Incomplete Pathway - Waiting Lists Dec-20 Specific 32,272 14,651 24,595 71,518 RTT Incomplete Pathway - 18 Weeks 92.00% Dec-20 71.72% 72.82% 57.45% 67.04%
RTT Incomplete Pathway - 52 Week Waits 0 Dec-20 1277 346 397 2020
Diagnostic Test Waiting Times 1.00% Dec-20 24.81% 24.07% 17.33% 21.90%
Mixed Sex Accommodation Breaches 0 Feb-20 15 0 7 22
C-difficile Infections N/A Dec-20 2 3 1 6
MRSA Infections 0 Dec-20 0 0 0 0
Ambulance Response Times - Category 1 - Mean 7:00 Dec-20 14:36 7:08 6:29
Ambulance Response Times - Category 1T - 90th Centile 30:00 Dec-20 19:31 19:31 18:31
Ambulance Response Times - Category 2 - Mean 18:00 Dec-20 22:25 22:25 17:06
**Ambulance response times are taken from national data which is published at provider level only. For Bedfordshire CCG and Luton CCG the figures shown refer to the East of England Ambulance Service (EEAST) as a whole. For Milton Keynes CCG the figures shown refer to the South Central Ambulance Service (SCAS) as a whole. 7 Key Performance and Quality Indicators
Bedfordshire 2020/21 2020/21 Milton 2020/21 2020/21 Measure Threshold Latest Data Trend Luton CCG Trend Trend BLMK Trend CCG YTD YTD Keynes CCG YTD YTD
Estimated Diagnosis rate for people with dementia 66.70% Dec-20 59.30% 70.12% 63.94% 62.40%
IAPT Access (Year to date) 16.67% Nov-20 12.33% 7.83% 11.79% 10.93%
IAPT Recovery Rate 50.00% Nov-20 51.67% 56.00% 46.67% 51.30%
IAPT Waiting Times - 6 weeks 75.00% Nov-20 100.00% 100.00% 103.23% 100.81%
IAPT Waiting Times - 18 weeks 95.00% Nov-20 100.00% 100.00% 96.77% 99.19% CCG IAPT in-treatment pathway waits Nov-20 Specific 15.91% 2.33% 17.50% 12.87% Early Intervention in Pyschosis - 1st Treatment within 2 56.00% Nov-20 79.00% 78.00% 100.00% 85.67% weeks (Rolling 3 months) CPA 72-Hour Follow Ups 80.00% Nov-20 84.00% 80.00% 83.00% 82.33%
Out of Area Placements N/A Q2 2020/2021 20 20 0 0 315 10 335 345
SMI Physical Health Checks (Rolling 12 months) 60.00% Q3 2020/21 12.75% 20.58% 27.40% 18.42%
Learning Disabilities Health Checks 22.50% Q2 2020/2021 9.03% 8.00% 2.90% 7.34% Children and Young People's Mental Health Services Access 35.00% Nov-20 69.61% 49.42% 57.26% 60.61% (Rolling 12 months) Perinatal mental health services - Access (Rolling 12 months) 7.10% Nov-20 6.07% 1.80% 11.88% 6.55%
CYP Eating Disorders - Urgent (Rolling 12 months) 95.00% Q3 2020/21 84.21% 50.00% 66.67% 77.78%
CYP Eating Disorders - Routine (Rolling 12 months) 95.00% Q3 2020/21 80.29% 68.42% 78.72% 77.93%
Children's Wheelchairs 92.00% Q3 2019/2020 96.67% 96.15% 84.00% 92.59%
8 Acute Providers Dashboard All patients Trust-wide
Luton & Milton Bedfordshire 2020/21 Bedford 2020/21 2020/21 2020/21 Measure Threshold Latest Data Trend Trend Dunstable Trend Keynes Trend Hospitals YTD Hospital YTD YTD YTD Hospital Hospital
Cancer Waiting Times - 2 Week Wait 93.00% Dec-20 83.77% 81.21% 89.86% 82.09% Cancer Waiting Times - 2 Week Wait (Breast 93.00% Dec-20 58.59% 30.77% 80.82% 97.85% Symptoms) Cancer Waiting Times - 31 Day First Treatment 96.00% Dec-20 97.38% 99.08% 94.83% 94.53%
Cancer Waiting Times - 31 Day Surgery 94.00% Dec-20 94.44% 93.75% 95.83% 75.00%
Cancer Waiting Times - 31 Day Drugs 98.00% Dec-20 96.67% 93.33% 100.00% 100.00%
Cancer Waiting Times - 31 Day Radiotherapy 94.00% Dec-20 100.00% NP NP NP
Cancer Waiting Times - 62 Day GP Referral 85.00% Dec-20 77.78% 62.42% 85.71% 82.12%
Cancer Waiting Times - 62 Day Screening 90.00% Dec-20 100.00% NP 100.00% 81.82%
Cancer Waiting Times - 62 Day Upgrade 90.00% Dec-20 87.50% 100.00% NP 96.49%
RTT Incomplete Pathway - 18 Weeks 92.00% Dec-20 72.09% 71.53% 75.53% 56.14%
RTT Incomplete Pathway - 52 Week Waits 0 Dec-20 1472 792 680 311
Diagnostic Test Waiting Times 1.00% Dec-20 20.11% 19.08% 21.25% 18.51%
A&E 4hr Waits 95.00% Dec-20 Not Reporting Not Reporting Not Reporting 84.45%
12hr Trolley Waits 0 Dec-20 0 0 0 0
Mixed Sex Accommodation Breaches 0 Feb-20 17 17 17 0
Cancelled Ops not rebooked within 28 Days 0 Q3 2019/2020 12 12 12 8
Urgent Operations cancelled for a second time 0 Feb-20 0 0 0 0
C-difficile Infections N/A Dec-20 6 6 6 0
VTE Risk Assessment 95.00% Dec-19 97.85% 97.85% 97.85% 96.86%
Data for Bedfordshire Hospitals reflects national data, with local site-level data for Bedford Hospital and Luton & Dunstable Hospital, source via Provider contract reporting. Cancer data for Bedford Hospital and Luton & Dunstable Hospital shows October performance as this is the latest reported position available. 9 Phase 3 Recovery Plans – BLMK
Nov-20 Dec-20 National National Measure Plan Published Variance Plan Amber Published Variance Trend Position Position Waiting Lists 71,704 70,927 -1.08% 71,441 75,013 71,518 0.11%
52 Week Waits 2,126 1,723 -18.96% 2,488 2,612 2,020 -18.81%
Cancer - 2 Week Waits - Patients Seen 3,060 3,226 5.42% 2,966 2,818 3,150 6.20%
Cancer - 31 Day First Treatment 367 372 1.36% 355 337 373 5.07%
Measure Q1 - 2020/21 Q2 2020/21
Children & Young People Mental Health - Access 3,815 7,403 7032.85 11,905 60.81%
Perinatal Mental Health Access 2,665 668 634.6 2,545 280.99%
Learning Disability Health Checks 194 342 324.9 359 4.97%
IAPT - Access 2,980 5,742 5454.9 4,735 -17.54%
SMI Physical Health Checks 1,547 1,460 1387 1,535 5.14%
10 Source data: Activity data is from NCDR. 18 Weeks RTT and Diagnostic Test dates is from NHS Statistics. Planned Care - Cancer Overview
BLMK is continuing to implement the recovery plan in terms of treatment pathways and reducing the numbers of patients breaching 62 and 104 days. The recovery plan is monitored by the BLMK Cancer Board. The Cancer Transformation Programme continues with new funding streams to support innovation, cancer workforce and recovery plan in endoscopy.
2 week wait referrals are monitored on a weekly basis to identify opportunities to refine pathways and monitor the recovery position. In December referrals declined but this is usual at this time of year - latest data shows referrals have returned to normal levels. 2ww performance has been affected by some patients rescheduling appointments outside of 14 days from referral, due to anxieties around coming into a hospital setting – in order to minimise the impact of this Cancer nurse specialists are contacting patients to discuss symptoms and to provide reassurance.
NHS England have confirmed that the National Screening programmes should continue regardless of Covid-19. Whilst all screening programmes have continued across BLMK, cervical screening numbers dropped during December and into January coinciding with the initial roll out of the mass vaccination programme and the current Covid-19 restrictions, however this has started to pick up again.
Diagnostic services are managing demand although capacity challenges have slowed down some of the high volume pathways.
Over the last few weeks the impact of increased hospital admissions across the country has affected trusts being able to manage the most urgent P2 cancer surgery patients dues to lack of HDU/ITU beds. Across BLMK we have not seen the same levels of impact as other areas have and both trusts continue to maintain surgical capacity.
The EoE Cancer Alliances have developed a regional framework in recognition that appropriate timeliness of surgical treatment for clinically prioritised patients can be the difference between curative and palliative prognoses for cancer patients. BLMK have agreed to participate in this regional mutual aid model which seeks to adopt the principles of a system first approach; meaning that the regional mutual aid model will be deployed by NHSE to broker mutual aid only in the event that systems are unable to manage patients within their footprint. Commissioners are working with providers to develop a local BLMK process which has been supported by both Trusts
The work on Radiotherapy provision continues. The Cancer Board has given approval to proceed with a particular piece of work around outcomes for patients living in Luton and surrounding areas who have had radiotherapy at Mount Vernon Cancer Centre. The scope of this work will be completed by April 2021.
11 Planned Care – Cancer – 2 Week Wait Pathways
The tables and charts below show performance against the 2 week wait pathway standards for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 93%. Cancer Two Week Wait Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 93% 93% NHS Bedfordshire CCG 94.79% 93.69% 95.30% 93.14% 87.32% 97.29% 95.09% 91.74% 91.97% 89.91% 88.90% 84.76% 83.10% 89.51% NHS Luton CCG 94.23% 91.86% 94.84% 94.65% 93.85% 92.95% 95.24% 95.92% 95.37% 88.70% 86.99% 89.36% 90.33% 91.54% NHS Milton Keynes CCG 90.85% 88.06% 91.33% 82.99% 88.13% 93.32% 80.85% 79.04% 86.19% 79.90% 82.71% 84.16% 82.41% 83.30% BLMK STP 93.59% 91.84% 94.10% 90.29% 88.82% 95.54% 91.16% 88.77% 90.82% 87.05% 86.77% 85.37% 84.00% 88.05% Cancer Two Week Wait - Breast Symptomatic Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 93% 93% NHS Bedfordshire CCG 98.80% 91.25% 94.05% 90.57% 64.29% 100.00% 94.59% 92.98% 88.89% 80.77% 66.67% 65.85% 55.00% 75.52% NHS Luton CCG 97.73% 90.00% 97.22% 100.00% 66.67% 100.00% 95.83% 96.67% 95.45% 86.67% 68.75% 78.26% 86.84% 85.78% NHS Milton Keynes CCG 97.56% 91.53% 98.72% 93.10% 80.00% 95.45% 39.29% 62.50% 98.00% 93.55% 94.59% 91.76% 98.41% 88.60% BLMK STP 98.09% 91.12% 96.46% 93.66% 68.18% 97.92% 77.53% 85.71% 93.33% 87.60% 78.45% 78.87% 76.80% 82.45%
Following the impact of the first wave of the Covid-19 The number of people seen on a breast symptomatic pathway pandemic the number of people seen on a 2 week wait fell considerably during the first wave of the Covid-19 pathway has been increasing since June. In December there pandemic, but has steadily increased from month 3 onwards. were 3,150 people seen compared to 3,226 in November and In December there were 181 people seen compared to 213 in 2,935 in the same month last year. November and 209 in the same month last year.
Source data: NHS Statistics – Cancer Waiting Times Collection 12 Planned Care – Cancer – 31 Day Pathways
The tables and charts below show performance against the 31-day First Treatment and 31-day Subsequent Treatment – Surgery standards for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 96% for First Treatment and 94% for Subsequent Treatment - Surgery. Cancer 31 Day First Treatment Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 96% 96% NHS Bedfordshire CCG 97.70% 98.50% 97.67% 98.48% 98.21% 96.26% 96.62% 94.61% 94.23% 95.45% 95.31% 97.33% 98.94% 96.37% NHS Luton CCG 100.00% 100.00% 100.00% 97.14% 100.00% 100.00% 97.14% 96.97% 97.22% 96.36% 98.36% 95.83% 98.25% 97.82% NHS Milton Keynes CCG 95.83% 95.15% 91.46% 94.74% 94.51% 88.46% 96.12% 95.92% 94.05% 94.07% 95.69% 91.92% 92.91% 93.87% BLMK STP 97.43% 97.77% 96.45% 97.25% 97.39% 94.22% 96.50% 95.30% 94.57% 95.15% 95.90% 95.70% 96.78% 95.79% Cancer 31 Day Subsequent Treatment - Surgery Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 94% 94% NHS Bedfordshire CCG 91.67% 93.48% 97.30% 100.00% 90.24% 84.62% 85.42% 80.95% 80.00% 89.13% 94.74% 95.24% 97.06% 88.47% NHS Luton CCG 100.00% 100.00% 91.67% 100.00% 92.86% 100.00% 80.00% 94.74% 100.00% 100.00% 100.00% 90.00% 94.74% 93.75% NHS Milton Keynes CCG 100.00% 72.73% 88.24% 86.67% 95.65% 92.86% 86.67% 66.67% 93.75% 83.33% 100.00% 61.54% 75.00% 83.44% BLMK STP 95.00% 91.18% 93.94% 96.61% 92.31% 86.96% 84.93% 79.55% 87.50% 88.89% 96.61% 88.00% 91.30% 88.12%
Following the impact of the first wave of the Covid-19 The number of people having surgical treatment for cancer pandemic the number of people receiving a first treatment decreased in December to 69 compared to 75 in November within 31 days has increased. In December there were 373 and 60 in the same month last year. people treated compared to 372 in November and 350 in the same month last year. Source data: NHS Statistics – Cancer Waiting Times Collection 13 Planned Care – Cancer – 62 Day Pathways
The tables and charts below show performance against the 62-day GP Referral and Screening standards for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 85% for GP Referral and 90% for Screening. Note: NP denotes no patients seen during the month. Screening programmes were paused nationally in May and June 2020. Cancer 62 Day - GP Referral Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 85% 85% NHS Bedfordshire CCG 77.39% 73.39% 80.00% 77.37% 67.78% 74.55% 81.61% 77.67% 73.68% 69.49% 76.64% 75.00% 74.07% 74.49% NHS Luton CCG 93.55% 89.29% 83.33% 80.95% 88.00% 75.00% 80.95% 87.50% 87.50% 58.33% 83.33% 87.10% 88.24% 81.12% NHS Milton Keynes CCG 88.89% 80.77% 67.74% 76.36% 80.43% 62.86% 78.00% 80.00% 88.64% 81.16% 68.25% 80.00% 78.69% 77.78% BLMK STP 83.25% 77.45% 78.36% 77.78% 74.53% 70.91% 80.38% 79.66% 79.35% 71.30% 75.62% 77.78% 77.83% 76.42% Cancer 62 Day First Treatment - Screening Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 90% 90% NHS Bedfordshire CCG 75.00% 40.00% 60.00% 92.31% 92.86% NP 80.00% 100.00% 87.50% 100.00% 100.00% 91.67% NHS Luton CCG 100.00% 100.00% 100.00% 90.91% 100.00% NP 100.00% 100.00% NP 0.00% 100.00% 87.50% NHS Milton Keynes CCG 91.67% 63.64% 80.00% 60.00% 61.54% 0.00% 100.00% 100.00% 83.33% 100.00% 80.00% 63.27% BLMK STP 86.96% 72.00% 83.33% 82.35% 79.31% 0.00% 87.50% 100.00% 85.71% 92.86% 93.33% 78.10%
Following the impact of the first wave of the Covid-19 pandemic Since screening programmes were resumed in July 2020 the the number of people seen on a 62-day pathway had been numbers of people seen on a 62-day screening pathway has increasing since June however there was a decrease in increased but has yet to recover back to pre-pandemic levels. December when 203 people seen compared with 225 in In December 15 people were seen compared with 14 in November and 209 in the same month last year. November and 23 in the same month last year. Source data: NHS Statistics – Cancer Waiting Times Collection 14 Planned Care – Cancer – 28 Day Faster Diagnosis
The tables and charts below show performance against the 28-Day Faster diagnosis standard in 2020/2021 to December 2020. Introduction of the 28-day faster diagnosis standard was intended for April 2020 however the impact of Covid-19 has meant this has been delayed. Providers are submitting monthly returns and these are being monitored.
Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 70% 70% NHS Bedfordshire CCG 56.16% 60.04% 73.19% 73.29% 66.41% 65.92% 67.55% 71.93% 69.25% 68.10% NHS Luton CCG 46.77% 64.92% 71.92% 71.09% 68.55% 55.05% 59.30% 65.70% 63.49% 63.04% NHS Milton Keynes CCG 78.71% 84.86% 79.43% 81.91% 82.26% 76.51% 78.70% 83.39% 78.61% 80.20% BLMK STP 60.50% 70.00% 75.13% 75.36% 71.29% 67.41% 69.50% 73.98% 71.40% 70.93%
The 28-day faster diagnosis standard aims to ensure that all patients who are referred for investigation of suspected cancer find out within 28 days if they have or do not have a cancer diagnosis.
In December 3,290 people were referred for investigation compared to 3,105 in November with 2,349 notified of the result within 28 days compared to 2,297 in November.
Source data: NHS Digital Cancer Waiting Times Reports 15 Planned Care – Cancer – Long Waiters
There were a total of seven 104+ day breaches in December 104+ day breaches for confirmed cancer which are deemed across Bedfordshire, Luton and Milton Keynes. Year to date avoidable are discussed in detail and key learning points identified there have been a total of 165 breaches. These breaches were on a case by case basis. Bedfordshire Hospitals Trust is trialling a across a number of cancer pathways as shown on the table new breach review panel, which will reinforce clinical oversight below. and psychological harm consideration. Standard 31 Day First 31 Day Subs Screening 2 Week Wait Upgrade APR 17 0 1 0 1 1 Main issues: MAY 7 1 0 0 0 1 • Patient confidence – Trusts are still working to reassure JUN 14 1 2 3 1 0 patients that services are safe and Covid-free but there are still JUL 22 7 3 3 2 1 a cohort of patients who want to delay diagnostics because of AUG 18 5 2 1 0 0 fear of contracting Covid-19 in hospital setting SEP 17 1 0 0 1 0 • Compliance with tests – whilst Faecal Immunochemical Test OCT 10 1 0 1 1 0 (FIT) testing and repeat Prostate Specific Antigen (PSA) NOV 13 0 0 1 0 0 monitoring in secondary care was introduced to support clinical DEC 6 0 0 0 0 1 prioritisation, some patients are not compliant with the tests TOTAL 124 16 8 9 6 4 therefore impacting on the timeliness of pathways • Complexity of patients requiring multiple diagnostics prior to Historically, all BLMK Trusts undertook an RCA for any 62 day treatment pathway breaches with additional clinical harm review for 104+ • Capacity in some diagnostic modalities day breaches. The impact of Covid-19 has meant that there • There continues to be regular monitoring of harm reviews and are now long waiters on other cancer pathways and agreement Trusts are working on reviewing harm policies to take into has been reached with the 3 local trusts that from August to account protocols introduced during phase 2. share RCAs and harm reviews for all confirmed cancer patients breaching 104 days, irrespective of pathway. The trusts have a trajectory to get long waits back to pre-Covid levels by March 2021 and are showing signs of achievement against their trajectory.
Source data: NHS Digital Cancer Waiting Times Reports 16 Planned Care – Elective Services Overview
The second Covid-19 wave has negatively impacted on elective performance in month 9. After an upward trend in referrals from M1-M7, a downward trend has been noted in M8 and M9. Whilst the CCG has written to Primary Care and Optometrists asking them to consider alternatives to referrals (such as advice and guidance) to ease secondary care pressures, it is likely some of this decreasing demand is due to the current national lockdown and a reluctance to engage with health services. Public messages reiterating that the NHS remains firmly open continue.
Waiting lists increased slightly in December as anticipated. This is largely due to non-elective pressures and capacity constraints in ITU where anaesthetists are prioritising ventilated patients. Recovery will be limited in the coming months and dependent on a sustained reduction in Covid pressures. The 52+ week position continues to deteriorate as Trusts focus on those that are clinically urgent rather than wait times. This position is likely to deteriorate further in the coming months and will need to form part of any Covid-19 recovery plans. The independent sector continues to support the NHS across BLMK with Q1 planning in progress. Independent Sector activity does however remain focused on procedures with less complexity leaving a large volume which cannot be transferred.
Diagnostic performance has also deteriorated slightly and any further recovery in M10 and M11 is likely to be hampered by the increased Covid-19 pressures. Endoscopy (flexi-sigmoidoscopy, gastroscopy and cystoscopy) capacity continues to be the main concern although all units are now undertaking tests albeit with reduced throughput. The Independent Sector is being used to support diagnostics and will continue to do so under the framework agreement.
The most recent SSNAP data (July-September 2020) shows a consistent number of patients admitted to the stroke unit at Milton Keynes Hospital. No data is shown for Luton & Dunstable Hospital due to paused reporting during the Covid-19 response. At Milton Keynes, the percentage of patients directly admitted to a stroke unit within 4 hours in July-September is above the national target of 80% and above the national average of 59.3%. The percentage of patients who spent at least 90% of their stay on a stroke unit deteriorated from 95% in January-March to 91% in July-September, above the national average of 85%. The percentage of patients discharged to Early Supported Discharge (ESD) teams improved from 65% in January-March to 68% in July-September, which is above the 2020/21 threshold of 55% and above the national average of 46%.
17 Planned Care – GP Referrals and Waiting Lists
The tables and charts below show performance for GP Referrals and CCG waiting lists for a rolling 13-month period to December 2020. Performance is ragged against the Phase 3 plans from September 2020 onwards. GP Referrals Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 BLMK Phase 3 Plan 16109 16003 15404 14690 NHS Bedfordshire CCG 7340 8895 8121 6682 2501 3997 5121 6068 6266 6417 7121 6912 6271 NHS Luton CCG 3207 3592 3447 2790 1007 1460 2186 2207 2496 2584 2555 2434 2247 NHS Milton Keynes CCG 3444 4369 4319 2586 1026 1364 1999 2547 2375 2583 2760 2843 2534 BLMK STP 13991 16856 15887 12058 4534 6821 9306 10822 11137 11584 12436 12189 11052
Waiting Lists Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 BLMK Phase 3 Plan 72808 72359 71704 71441 NHS Bedfordshire CCG 31,380 31,384 31,282 31,510 31,220 31,078 30,248 31,094 31,741 32,468 32,227 31,897 32,272 NHS Luton CCG 16,517 16,293 15,649 15,950 14,750 13,991 12,995 13,643 13,785 14,166 14,476 14,357 14,651 NHS Milton Keynes CCG 14,938 18,250 20,522 21,771 21,209 22,441 22,164 23,622 24,341 23,215 24,679 24,673 24,595 BLMK STP 62,835 65,927 67,453 69,231 67,179 67,510 65,407 68,359 69,867 69,849 71,382 70,927 71,518
Source data: GP Referrals is sourced from the national published MRR dataset to December 20. RTT is sourced from the national published Consultant-led Referral To Treatment dataset to December 20. 18 Planned Care - 18 Week Referral To Treatment
The table and chart below show performance against the 18 Week Referral to Treatment standard for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 92%. Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold - 92% 92% NHS Bedfordshire CCG 86.85% 86.49% 86.44% 83.95% 76.51% 67.32% 56.87% 51.97% 59.07% 64.72% 69.46% 72.92% 71.72% 65.69% NHS Luton CCG 91.18% 90.58% 90.36% 87.92% 80.51% 73.74% 65.56% 60.26% 67.01% 71.87% 76.18% 76.20% 72.82% 71.75% NHS Milton Keynes CCG 80.04% 80.19% 79.44% 75.90% 66.17% 58.99% 50.26% 44.74% 50.74% 54.60% 57.21% 59.25% 57.45% 55.41% BLMK STP 86.37% 85.76% 85.22% 82.34% 74.12% 65.88% 56.35% 51.13% 57.73% 62.81% 66.59% 68.83% 67.04% 63.44%
At the end of December there were 71,518 people waiting for treatment across BLMK of which 23,573 patients have waited more than 18 weeks and 2,020 have waited more than 52+ weeks. The table below shows the total waiting list for the 4 specialties with the greatest number of extended waits, with a breakdown to show the number of patients still waiting at 26+ weeks, 39+ weeks and 52+ weeks.
Total Treatment Function 18+ Weeks 26+ Weeks 39+ Weeks 52+ Weeks Waiting List Ophthalmology 12424 5528 3912 3134 360 Other 14466 3782 2391 1263 212 Ear, Nose & Throat (ENT) 6680 3416 2427 1624 156 Trauma & Orthopaedics 6317 3083 2301 1749 821
Source data: NHS Statistics – Consultant Led Referral To Treatment Waiting Times collection 19 Planned Care - 52+ Week Waits
The table and chart below show 52+ week waits across BLMK. September onwards is ragged against the BLMK Phase 3 Recovery Plan.
Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 BLMK Phase 3 Plan 1104 1568 2126 2488 NHS Bedfordshire CCG 43 129 258 459 633 784 933 1085 1277 NHS Luton CCG 6 21 45 70 91 132 180 208 346 NHS Milton Keynes CCG 16 65 103 194 267 406 446 430 397 BLMK STP 65 215 406 723 991 1322 1559 1723 2020
At the end of December there were 2,020 people waiting longer than 52 weeks across BLMK. The chart on the right shows the position against the Phase 3 plan. The table below shows Providers with the greatest amount of long waiters for each of the top 5 specialties.
52+ Week Waits - T&O Ophthalmology Other Urology ENT December 2020 Bedfordshire Hopsitals 609 246 96 109 22 Milton Keynes Hospital 79 31 4 33 67 Bucks Healthcare 19 46 7 4 23 Cambridge University Hospital 33 18 44 4 16 East and North Herts 22 4 19 8 1 Other Providers 59 15 42 10 27 Grand Total 821 360 212 168 156
Source data: NHS Statistics – Consultant Led Referral To Treatment Waiting Times collection 20 Planned Care - Diagnostics Waiting Times
The table and chart below show performance against the Diagnostic test 6 week wait standard for a rolling 13-month period to December 2020. Performance is ragged against the national standard of <1%. The bottom table shows the number of people waiting more than 6 weeks with a breakdown of those still waiting at 10+ and 13+ weeks.
Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold < 1% NHS Bedfordshire CCG 1.88% 1.39% 0.82% 5.19% 53.65% 55.29% 37.60% 35.37% 32.34% 27.38% 24.61% 21.50% 24.81% 34.79% NHS Luton CCG 1.37% 3.03% 1.32% 8.01% 55.73% 59.59% 41.33% 37.96% 38.99% 33.93% 30.62% 24.73% 24.07% 39.40% NHS Milton Keynes CCG 1.15% 1.49% 1.22% 4.60% 41.77% 30.03% 19.23% 17.24% 18.18% 18.58% 18.46% 16.16% 17.33% 19.42% BLMK STP 1.55% 1.79% 1.05% 5.88% 52.86% 51.74% 34.08% 31.07% 29.46% 25.72% 23.50% 20.11% 21.90% 31.31%
In December, there were 18,931 patients on a diagnostics test pathway compared to 20,435 in November and 17,260 in the same period last year. There were 4,145 patients who waited more than 6 weeks compared to 4,109 in November. This was 21.90% compared to 29.2% for England as a whole and 33.5% against the East of England region.
The number of people still waiting at 10 weeks was 2,108 compared to 2,256 in November and the number of people waiting for more than 13 weeks reduced to 1,336 in December compared to 1,539 in November. 6+ Weeks 10+ Weeks 13+ Weeks Bedfordshire Hospitals 1771 970 521 Milton Keynes Hospital 1145 428 291 Cambridgeshire Community Services 396 287 237 Cambridge University Hospitals 233 171 123 East & North Herts 198 47 11 Other Providers 402 205 153 Total 4145 2108 1336
Source data: NHS Statistics – Diagnostics Waiting Times and Activity collection 21 Community Services and Primary Care - Appointments In General Practice
Bedfordshire 2020/21 2020/21 Milton 2020/21 2020/21 Measure England Latest Data Trend Luton CCG Trend Trend BLMK Trend CCG YTD YTD Keynes CCG YTD YTD
Appointments per 1,000 GP Registered Practice Populations 392 Dec-20 404 3442 348 2949 359 3086 378 3224
DNA - Proportion of Appointments with a known attendance status 4.62% Dec-20 3.42% 2.78% 4.60% 4.23% 4.27% 3.39% 3.90% 3.26%
Proportion of appointments with a GP 51.54% Dec-20 51.82% 52.54% 53.02% 56.03% 44.47% 46.52% 50.04% 51.60%
Proportion of appointments delivered Face to Face 58.43% Dec-20 71.45% 69.85% 66.17% 63.32% 71.87% 67.65% 70.44% 67.86%
Proportion of appointments delivered via Telephone 40.50% Dec-20 27.50% 29.00% 33.80% 36.63% 28.03% 32.21% 28.99% 31.50%
Proportion of appointments delivered via Video/Online 0.47% Dec-20 0.97% 0.88% 0.01% 0.01% 0.08% 0.10% 0.52% 0.48%
Proportion of Same Day Appointments 45.17% Dec-20 43.34% 49.36% 48.80% 54.78% 39.98% 44.49% 43.57% 49.15%
Source data: NHS Digital – Appointments In General Practice 22 Community Services and Primary Care – Bedfordshire CCG Community Services
Threshold CCG Operational Standards Apr May Jun Q1 July August September Q2 October NovemberDecember Q3 YTD 2020/21 Bedford 92% 84.8% 81.9% 77.3% 81.5% 66.2% 67.8% 72.9% 68.8% 75.3% 77.1% 77.5% 76.6% 75.9% BCCG Incomplete RTT 18 week pathways - only Community Paediatrics
92% 91.4% 90.3% 82.7% 87.9% 75.9% 78.7% 82.2% 79.2% 82.9% 82.9% 81.2% 82.4% 82.7% BCCG Incomplete RTT 18 week pathways - non-consultant Percentage of letters sent to the GP following children and young people Speech and Language first (new) clinic attendance within 7 100% 100.0% 94.4% 97.9% 97.5% 95.1% 100.0% 94.4% 96.0% 94.5% 92.3% 86.8% 92.1% 94.6% BCCG ordinary days. Percentage of discharge letters sent to the GP following children and young people Speech and Language final clinic attendance within 7 100% 90.9% 97.5% 98.8% 96.3% 100.0% 95.0% 93.8% 96.3% 100.0% 89.8% 98.1% 95.9% 96.2% BCCG ordinary days. Percentage of patients whose treatment programme started within 1 95% 100.0% 100.0% 100.0% 100.0% 100.0% 88.9% 83.3% 91.9% 100.0% 87.5% 100.0% 96.8% 96.6% BCCG working day of discharge from hospital Percentage of young carers identified and offered a referral for a Zero Zero Zero Zero Zero Zero Zero Zero Zero Zero Zero Zero Zero 90% BCCG carers assessment Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence Incidence % of children in and out of area receiving an initial health review 95% 70.0% 91.7% 100.0% 84.8% 94.7% 87.5% 75.0% 85.5% 78.9% 85.7% 71.4% 80.9% 83.8% BCCG within 20 working days of becoming a LAC % of children placed in and out of area receiving a review health 95% 88.1% 91.1% 98.0% 92.6% 95.5% 100.0% 87.5% 94.8% 82.9% 92.0% 100.0% 91.8% 93.0% BCCG assessment within 40 days from receipt of referral. Evidence that all young people leaving care receive a relevant 100% 100.0% 100.0% 100.0% 100.0% 100.0% 83.3% 100.0% 93.8% 100.0% 100.0% 100.0% 100.0% 97.7% BCCG health passport
100% 83.3% 100.0% 77.8% 85.7% 50.0% 66.7% 75.0% 70.0% 42.9% 40.0% 100.0% 61.1% 72.9% BCCG % of children receiving a children's wheelchair within 18 weeks % of children and young people on the caseload receiving a 95% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% BCCG respiratory management plan in the community Incomplete RTT 18 weeks: Non-Consultant pathway – service continues to run at a reduced volume and the majority of appointments have been transferred to video/telephone appointments where clinically safe to do so. All referrals and follow up appointments are clinically prioritised in the context of Covid-19 restrictions. A balance between new and follow up consultations is required to prevent disproportionate waits. Staff availability has fluctuated during the COVID-19 pandemic. This has been due to staff with COVID-19 symptoms, non COVID-19 sickness and Locum Consultant availability LAC Health Reviews: Two patients out of five did not receive an initial health review within 20 working days in December. Breaches were due to one referral coming in on D29 due to child in hospital and one unable to make contact due to house move. This child has been re- referred with new placement details and to an OOA LAC team. 23 Community Services and Primary Care – Luton CCG Community Services
Threshold CCG Operational Standards Apr May Jun Q1 July August September Q2 October NovemberDecember Q3 YTD 2020/21 Luton CCG Community Measures Dashboard Service Users on incomplete RTT pathways (yet to start treatment) 92% 67.07% 51.92% 39.00% 52.47% 33.00% 35.18% 41.43% 37.11% 46.53% 47.85% 56.28% 50.64% 47.48% LCCG waiting no more than 18 weeks from referral (Consultant led)
0% 75.40% 73.89% 75.60% 74.96% 75.00% 67.70% 56.04% 67.41% 50.00% 48.96% 53.59% 50.94% 64.98% LCCG Paediatric Audiology 90 19/20 1 0 1 2 6 17 21 44 50 39 19 108 154 LCCG Number of Personalised Care Plans (PCPs) completed baseline 827 Number of patients who have had an in-depth medication review 19/20 4 0 1 5 1 5 10 16 7 10 17 34 55 LCCG completed baseline 2036 Number of rapid intervention referrals that required: Single service 19/20 139 180 152 471 205 170 158 533 150 150 197 497 1,501 LCCG response baseline All Looked After Children coming into care and placed in Luton or the agreed geographical area, will have an Initial Health Assessment completed by a Paediatrician within 15 working days of the LAC 100% 100.00% 91.67% 88.89% 93.33% 100.00% 100.00% 87.50% 94.12% 50.00% 68.42% 100.00% 65.38% 83.56% Health Team receiving a fully completed referral and signed consent LCCG from LBC Where the Looked After Children Health Team have received a fully completed referral and signed consent from LBC, all Looked After Children placed in Luton or the agreed geographical area, will 100% 56.52% 75.00% 88.89% 74.24% 83.33% 100.00% 58.82% 80.36% 54.55% 66.67% 71.43% 62.50% 74.66% receive their Review Health Assessment within timescale (6 monthly LCCG for 0-4 years and annually for 5-17 years) LCCG LTC Patients at discharge who can successfully self manage 68% 59.52% 88.68% 80.00% 77.42% 76.47% 66.67% 64.86% 68.12% 56.92% 56.82% 39.39% 52.82% 66.12% LCCG All Care Leavers are offered a copy of their health history / passport 100% 100.00% 100.00% 100.00% 100.00% 100.00% 66.67% 100.00% 88.89% 50.00% NA NA 50.00% 92.59% Incomplete RTT 18 Weeks: Cambridgeshire Community Services continue to implement restoration plans in light of reduced clinics and increased waiting items; quality impact assessments are carried out for all services. Plans include maintaining effective virtual solutions where these meet the needs of the service users. Where this is not possible, routine face-to-face appointments have been restored. Workforce capacity is also being increased via service re-design and recruitment. The current RTT wait is 32 weeks. Paediatric Audiology: service has reduced clinics due to Covid-19, causing diagnostic delays and breaches. Throughout the pandemic the service has continued to offer essential/urgent services, including diagnostic tests following new-born hearing screening. Routine assessments resumed from August 2020. All new referrals and current caseloads have been reviewed and prioritised. Appointments are being offered according to clinical priority, rather than length of time waiting, however the service is unable to offer the same volume of appointments as per pre-covid-19 due to implemented safety restrictions. The service has recruited both a service and clinical lead to manage pathways, with weekend clinics resuming as of October 2020. LAC Initial Health Assessments: Review assessments - December saw a breach of two out of seven patients; 1 due to delayed consent and 1 cancelled by patient. 24 Community Services and Primary Care – Milton Keynes CCG Community Services
Threshold CCG Operational Standards Apr May Jun Q1 July August September Q2 October NovemberDecember Q3 YTD 2020/21 Milton Keynes CCG Community Measures Dashboard Service Users on incomplete RTT pathways (yet to start treatment) waiting no more than 18 weeks from referral (Consultant led - 92% 90.18% 93.59% 94.77% 92.80% 97.24% 93.87% 98.46% 96.35% 99.34% 99.39% 100.00% 99.61% 96.34% MKCCG Community Paediatrics) All Looked After Children (LAC) in and out of area receiving a health 90% 0.00% 100.00% 100.00% 83.87% 100.00% 88.00% 66.67% 90.24% 100.00% 70.00% TBC 85.71% 87.10% MKCCG review due in month completed within timescale
All Looked After Children (LAC) receiving a health review due in 90% 100.00% 89.47% 84.00% 91.67% 94.44% 97.14% 96.15% 95.88% 97.22% 90.32% TBC 94.03% 93.85% MKCCG month, completed within timescale
95% 97.13% 82.09% 86.59% 88.31% 95.00% 96.49% 96.58% 95.96% 98.13% 100.00% 98.67% 98.93% 93.98% MKCCG District Nursing All Referrals Seen Within timescale
90% 100.00% 93.33% 91.43% 93.51% 92.68% 100.00% 95.60% 95.73% 89.61% 97.67% 97.87% 95.54% 95.41% MKCCG Rapid Response Urgent Priority referral seen within 2 hours of triage
Incomplete Pathways, Percentage waiting 18 weeks or less 92% 96.83% 96.67% 60.26% 82.59% 71.72% 89.33% 98.18% 86.62% 96.59% 89.31% 86.75% 91.15% 88.05% (Children and Young Peoples Speech and Language Therapy MKCCG (SALT)) MKCCG Audiology Diagnostic: 6wk Wait Target 90% 12.50% 7.69% 68.00% 34.86% 71.43% 100.00% 100.00% 93.28% 100.00% 100.00% 100.00% 100.00% 72.71%
LAC data for December is not available due to undergoing validation. Exception reporting is not available for the SALT measure due to Covid-19 pressures.
CNWL continue to prioritise patients on clinical need, vulnerability and risk and the need for F2F contacts. Services have a range of contact solutions including telephone and video consultation where appropriate
25 Introduction – Mental Health, Learning Disabilities and Autism
Dementia Diagnosis Rate – BLMK saw a slight decrease in the diagnosis rate in Dec which is now at 62.4%. In Bedfordshire the diagnosis rate has been below 60% since June. This is due to the limited number of assessments which took place during the first wave of the Covid-19 pandemic. Milton Keynes fell below target for the first time in May. This is due to the closure of the service during lockdown and staff being redeployed to support front line MH services. Luton continues to achieve the standard. Memory Assessment Services are now able to offer a combination of face to face and digital assessments where appropriate. Bedfordshire and Luton are currently only able to see urgent patients due to staff sickness and redeployment to front line mental health services during the second wave. The impact of the ongoing Covid situation is monitored at the weekly MH Delivery group. Improving Access to Psychological Therapies (IAPT) – All three providers (CNWL: MK; ELFT: Beds: Total Wellbeing: Luton) are working collaboratively to deliver a joint Public Access Workshop (PAW) series, which will deliver 2,000 patients able to access treatment in Q4 to help meet the access target, alongside business as usual delivery of IAPT. Local data suggests that internal waits increased in December, mitigated to some degree by additional step 3 capacity. Recovery rates for BLMK are on target with Luton and Bedfordshire balancing the under-performance in Milton Keynes. Additional meetings have taken place with Turning Point to seek senior assurance that the service is on track to achieve the access target. January figures look positive and are being monitored closely in February. Perinatal Mental Health access - Teams are working together across the ICS to develop the new Maternal Mental Health service for BLMK with a launch date of April 2021. This service is targeted at women who have emotional and mental health needs directly related to pregnancy and birth. Referral rates to perinatal mental health specialist community teams are increasing; teams are working to recruit to support the increases demand Serious Mental Illness (SMI) and Learning Disabilities (LD) health checks - A BLMK commissioning sub-group has been set up to focus on improving targets, working with clinical leads to do this at place. A single specification across BLMK has been produced and disseminated to GP practices. An action plan is in place for both LD and SMI. An outreach SMI project is being delivered in Luton via the GP Federation and plans are in place to deliver a home visiting service in MK and a voluntary sector-led outreach project in Bedfordshire. LD Health Check One-Stop Clinics have now gone live to provide an additional resource for supporting practices with reviewing registers, data cleansing and coding. Local data set now standardised across all 3 areas. Children & Young People Eating Disorders – Referrals have increased over the year resulting in a growth of 47% and BLMK Caseload has seen a growth of 91% from Jan 20 to Jan 21. A proposal has been submitted to NHSE/I for additional funding, including day care provision to support this increased demand and acuity of presentation Out of Area Placements - Acute inpatient units are at capacity, with high acuity patients. Some patients have had to be placed out of area (mainly in London-based units of the Trusts) and Trusts are working to repatriate them as a priority. Crisis teams are working at capacity to avoid admissions, with risk rating and additional support in place. 26 Dementia Diagnosis
The table and chart below show performance against the Dementia Diagnosis Rate standard for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 66.7%. Dementia Diagnosis Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold 66.7% NHS Bedfordshire CCG 63.83% 63.47% 63.65% 63.41% 62.19% 60.26% 59.80% 59.58% 59.47% 59.37% 59.42% 59.61% 59.30% 59.30% NHS Luton CCG 70.60% 71.51% 71.45% 71.06% 69.70% 68.44% 68.71% 68.63% 69.07% 68.07% 68.84% 69.90% 70.12% 70.12% NHS Milton Keynes CCG 70.88% 70.42% 70.03% 70.14% 66.85% 65.18% 64.99% 64.35% 64.49% 64.07% 64.98% 64.73% 63.94% 63.94% BLMK STP 66.80% 66.65% 66.64% 66.46% 64.71% 62.96% 62.69% 62.40% 62.45% 62.10% 62.50% 62.73% 62.40% 62.40%
At the end of December 2020 there were 5,942 people aged 65+ with a diagnosis of dementia across Bedfordshire, Luton and Milton Keynes giving a position of 62.40%.
Source data: NHS Digital – Dementia Diagnosis Rates 27 Improving Access to Psychological Therapies
The table below shows performance against the IAPT Access target and IAPT in treatment pathway waits target for a rolling 13-month period to November 2020. The Access target is ragged against the national end of year standard and the In treatment pathways is ragged against the BLMK plan. The plan for In treatment pathways plan is on a reducing trajectory to achieve <10% by the end of 2020/21. The chart on the left shows performance against the Access target for 20/21 and the Phase 3 plan for the BLMK STP IAPT Access Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 2020-21 YTD Threshold End of year Run rate 19.75% End of year Run rate 25% NHS Bedfordshire CCG 13.72% 15.04% 17.05% 18.79% 20.47% 0.71% 1.66% 3.26% 5.20% 6.55% 8.33% 10.32% 12.33% 12.33% NHS Luton CCG 9.89% 10.85% 12.25% 13.58% 14.76% 0.46% 1.05% 1.79% 2.85% 3.75% 5.01% 6.31% 7.83% 7.83% NHS Milton Keynes CCG 12.33% 13.86% 15.69% 17.45% 19.32% 0.85% 1.85% 3.20% 5.03% 6.30% 8.04% 9.82% 11.79% 11.79% BLMK STP 12.28% 13.56% 15.35% 16.98% 18.57% 0.67% 1.54% 2.83% 4.49% 5.70% 7.32% 9.06% 10.93% 10.93% IAPT - In Treatment Pathway Waits Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 2020-21 YTD BLMK 2020/21 Trajectory 34.59% 31.62% 28.66% 25.69% 22.81% 19.85% 16.88% NHS Bedfordshire CCG 37.66% 34.00% 34.88% 34.38% 32.10% 24.41% 26.83% 30.95% 17.78% 9.86% 15.48% 14.49% 15.91% 20.59% NHS Luton CCG 4.17% 4.35% 11.54% 15.79% 14.29% 9.52% 2.94% 6.06% 8.33% 0.00% 3.45% 0.00% 2.33% 4.15% NHS Milton Keynes CCG 73.81% 68.97% 55.36% 51.28% 45.45% 51.11% 50.00% 47.92% 41.86% 30.23% 19.05% 30.43% 17.50% 39.32% BLMK STP 37.13% 37.25% 34.54% 34.04% 32.02% 27.10% 29.65% 30.91% 22.93% 13.25% 14.19% 15.29% 12.87% 22.37%
The Covid-19 pandemic impacted the IAPT Access at the start of 2020/21. In November, 1,965 people entered treatment across Bedfordshire, Luton and Milton Keynes, a 7.38% increase on the previous month and 13.26% higher than the same time last year
Source data: NHS Digital – Psychological Therapies, Report on the use of IAPT Services 28 Care Programme Approach (CPA) and Perinatal Mental Health
The table and chart below show performance against the CPA 72-hour follow up standard ragged against the 80% national standard
Care Programme Approach - 72 Hour Follow Ups Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 2020-21 YTD Threshold National Threshold 80% 80% NHS Bedfordshire CCG 68.00% 80.00% 72.00% 65.00% #N/A #N/A 75.00% 84.00% 74.00% NHS Luton CCG 78.00% 74.00% 67.00% 0.00% #N/A #N/A 83.00% 80.00% 63.67% NHS Milton Keynes CCG 88.00% 97.00% 94.00% 90.00% #N/A #N/A 84.00% 83.00% 89.33% BLMK STP 78.00% 83.67% 77.67% 51.67% #N/A #N/A 80.67% 82.33% 75.67% The system has changed to national reporting against the 72 hour follow up standard. The increase in discharges (linked to the increase in admissions) could be a factor in preventing timely follow up.
The table and chart below show performance against the Perinatal Mental Health Access standard for a rolling 13 months to November 2020. Performance is ragged against the national standard of 7.1% to June 2020. July 2020 onwards is ragged against the BLMK Phase 3 Plan Perinatal Mental Health Services Nov-19 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 2020/21 YTD BLMK Phase 3 Plan 5.21% 5.21% 5.21% 6.23% 6.23% NHS Bedfordshire CCG 4.44% 3.26% 4.62% 3.72% 4.08% 4.44% 4.89% 6.43% 6.25% 4.35% 5.98% 5.44% 6.07% 6.07% NHS Luton CCG 1.66% 1.25% 2.22% 1.66% 1.39% 1.11% 2.36% 3.05% 2.77% 2.22% 2.49% 1.80% 1.80% 1.80% NHS Milton Keynes CCG 0.00% 0.00% 10.66% 8.77% 10.66% 14.98% 12.55% 14.57% 13.77% 12.01% 10.93% 9.04% 11.88% 11.88% BLMK STP 2.38% 1.75% 5.69% 4.60% 5.22% 6.55% 6.39% 7.83% 7.44% 5.96% 6.43% 5.46% 6.55% 6.55%
In the 12 month period to November 2020, 840 women across BLMK accessed specialist perinatal mental health services compared to 700 in October.
Source data: NHS Digital – Mental Health Services Monthly Statistics 29 Physical Health Checks for people with Severe Mental Illness and Learning Disabilities/Autism
The tables and charts below show performance against the SMI Physical Health Checks standard for the 5 quarters to Q3 20/21, and the LDA Health Checks standard for the 5 quarters to Q2 20/21. SMI performance is ragged against the national standard of 60% up to Q1 20/21, Q2 20/21 onwards is ragged against the BLMK Phase 3 Plan. For LDA performance is ragged against the national standard of 67% up to Q1 20/21 then against Phase 3 Plan for Q2 20/21.
Physical Health Checks for People with Serious Mental Illness Physical Health Checks for People with Learning Difficulties Q3 2019/2020 Q4 2019/2020 Q1 2020/2021 Q2 2020/2021 Q3 2020/21 Q2 2019/2020 Q3 2019/2020 Q4 2019/2020 Q1 2020/2021 Q2 2020/2021 BLMK Phase 3 Plan 21.58% 35.00% 7.00% NHS Bedfordshire CCG 25.46% 25.34% 19.86% 15.53% 12.75% 10.33% 15.50% 23.30% 5.69% 9.03% NHS Luton CCG 21.72% 34.89% 22.68% 21.19% 20.58% 13.33% 13.89% 21.48% 4.03% 8.00% NHS Milton Keynes CCG 23.42% 28.27% 22.29% 31.27% 27.40% 8.98% 7.82% 9.70% 0.27% 2.90% BLMK STP 23.79% 28.95% 21.30% 20.82% 18.42% 10.75% 13.05% 19.23% 3.96% 7.34%
The national ambition is for 60% of people with a serious mental The national ambition is for 67% of people over the age of 14 on illness to receive an annual health check consisting of 6 separate a GP learning disability register to have an annual health check. physical checks. During the 12 months to the end of Q3 2020/21 In Q2 2020/21 (latest data available), 359 people with learning (latest data available), 1,371 people on the SMI register received the disabilities had an annual health check, of which 208 were in full 6 checks, of which 436 were in Bedfordshire, 507 in Luton and Bedfordshire, 119 in Luton and 32 in Milton Keynes. 428 in Milton Keynes.
Source data: NHS Statistics – Physical Health Checks for people with Severe Mental Illness and NHS Digital – Learning Disabilities Health 30 Check Scheme Children & Young People Eating Disorders
The tables and charts below show performance against the CYP Eating Disorders standards for the 5 quarters to Q3 20/21. Performance is ragged against the national standard of 95%. Children & Young People Eating Disorders - Urgent 2020/2021 Q3 2019/2020 Q4 2019/2020 1 2020/2021 Q2 2020/21 Q3 2020/21 YTD National Threshold 95% 95% NHS Bedfordshire CCG 100.00% 100.00% 100.00% 93.33% 84.21% 84.21% NHS Luton CCG 75.00% 66.67% 100.00% 100.00% 50.00% 50.00% NHS Milton Keynes CCG 75.00% 66.67% 60.00% 60.00% 66.67% 66.67% BLMK STP 90.48% 84.21% 91.30% 85.71% 77.78% 90.48% Children & Young People Eating Disorders - Routine 2020/2021 Q3 2019/2020 Q4 2019/2020 1 2020/2021 Q2 2020/21 Q3 2020/21 YTD National Threshold 95% 95% NHS Bedfordshire CCG 89.06% 87.34% 85.88% 83.02% 80.29% 80.29% NHS Luton CCG 80.95% 75.86% 72.73% 70.73% 68.42% 68.42% NHS Milton Keynes CCG 66.67% 66.67% 61.36% 66.67% 78.72% 78.72% BLMK STP 81.74% 79.59% 76.54% 76.56% 77.93% 77.93%
In Q3 2020/21, there were 27 urgent patients treated across There were 222 routine patients treated with 49 breaches of the Bedfordshire, Luton and Milton Keynes, with 6 breaches of the standard – 27 in Bedfordshire, 12 in Luton and 10 in Milton standard, 3 in Bedfordshire, 1 in Luton and 2 in Milton Keynes. Keynes. Performance across BLMK was worse than the England Performance across BLMK was higher than the England average average of 82.7% and also worse than the East of England of 72.7% and also higher than the East of England average of average of 83.8%. 73.7%. Source data: NHS Statistics – Children and Young People With An Eating Disorder Waiting Times collection. 31 Winter Demand/Pressures - A&E 4 Hour Waits
The table and chart below show performance against the A&E 4 Hour Wait standard for a rolling 13-month period to December 2020. Performance is ragged against the national standard of 95%. A&E 4 hour waits - Trust Wide Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold 95% Bedfordshire Hospitals Not reporting against the 4 hour wait standard Milton Keynes Hospital 82.52% 85.71% 88.45% 86.91% 95.46% 99.12% 98.81% 97.59% 97.64% 96.04% 94.26% 92.20% 84.45% 94.99% England 81.81% 83.51% 84.50% 85.78% 91.39% 94.23% 93.57% 93.00% 90.41% 88.65% 86.18% 85.67% 82.52% 89.33%
Attendances at A&E departments across Bedfordshire Hospitals and Milton Keynes Hospital trust wide fell sharply during the initial phase of the emergency response to Covid-19. Attendances had been increasing however since October have been falling again. December saw an increase to 25,146 attendances compared to 24,980 in November and 37,018 in the same period last year.
On 22nd May 2019, 14 trusts, including Luton and Dunstable Hospital, began field testing new emergency care performance standards and as a result these providers are not required to report against the four hour wait target. Since June last year the four hour wait performance at the Luton and Dunstable Hospital has not been reported. The merger of the Luton and Dunstable Hospital and Bedford Hospital in April 2020 to form Bedfordshire Hospitals NHS Foundation Trust resulted in performance against this standard not being reported for Bedford Hospital.
Source data: NHS Statistics – A&E Attendances and Emergency Admissions 32 Winter Demand/Pressures - Ambulance Response Times/Arrivals
The tables and charts below show performance by Provider against Category 2 ambulance response times standards for a rolling 13-month period to December 2020 – Category 1 standards have been achieved throughout 2020/21 across BLMK. East of England Ambulance Service (EEAST) covers Bedfordshire and Luton, South Central Ambulance Service (SCAS) covers Milton Keynes. Performance is ragged against the national standards. The two bar charts show the numbers of Hear & Treat and See & Treat ambulance responses, which aim to reduce the need for conveyance to an emergency department, across BLMK during 2020/21 to date. Ambulance Response Times - Category 2 Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020-21 YTD National Threshold ≤ 18 mins Bedfordshire (EEAST) 28:37 22:13 23:36 29:01 19:13 13:12 14:18 16:38 18:45 20:37 20:32 20:08 22:44 18:39 Luton (EEAST) 25:42 20:19 20:18 28:35 19:14 11:04 12:42 14:22 16:46 19:01 18:32 17:59 19:57 16:51 Milton Keynes (SCAS) 19:21 13:42 15:32 18:20 11:07 10:22 11:17 12:27 14:48 14:17 14:46 15:08 20:58 14:11 BLMK STP 25:01 19:09 20:21 25:52 16:54 11:52 13:04 14:52 17:11 18:25 18:28 18:10 21:31 16:56
Need to remove H&T and S&T charts for GB Report (local data)
Source data: Ambulance Response times are taken from NHS Statistics – Ambulance Quality Indicators ; Hear & Treat and See & Treat are taken from provider contract reports 33 Winter Demand/Pressures – NHS 111 Calls and Dispositions
Source data: NHS 111 data is taken from the national published NHS 111 dataset to December 2020. 34 Covid-19 Dashboard
The dashboard below shows the cumulative number of Covid-19 cases across the four BLMK local authorities up to 3rd March and the number of deaths from all causes and from Covid-19 in all settings up to 19th February 2021 (latest available data). The five year average all cause mortality figures have been included as a comparator.
Measure Period Bedford Central Bedfordshire Luton Milton Keynes BLMK
5-year 5-year 5-year 5-year 5-year 2021 Average % Variance 2021 Average % Variance 2021 Average % Variance 2021 Average % Variance 2021 Average % Variance 2015-2019 2015-2019 2015-2019 2015-2019 2015-2019 Covid-19 Cases 03-Mar 13,082 15,194 19,016 19,205 66,497
Hospital Deaths (All Causes) 19-Feb 266 128 107.5% 320 170 87.8% 257 121 111.7% 260 148 75.2% 1,103 568 94.1%
Hospital Deaths (Covid-19) 19-Feb 191 206 177 179 753
Care Home Deaths (All Causes) 19-Feb 63 56 13.3% 96 68 40.4% 39 56 -29.9% 62 55 13.1% 260 234 10.9%
Care Home Deaths (Covid-19) 19-Feb 22 30 9 20 81
Other Place of Death (All Causes) 19-Feb 116 69 67.6% 132 102 29.4% 116 71 62.9% 137 79 74.3% 501 321 56.1%
Other Place of Death (Covid-19) 19-Feb 11 16 18 30 75
Source data: Cases data is from the Public Health England Coronavirus (Covid-19) in the UK dashboard published by Gov.UK. Deaths data is sourced from the Office for National Statistics. 35 COVID-19 Cases across Bedfordshire, Luton and Milton Keynes
Key messages: Cumulative cases to 1st March stood at 66,497 (pillar 1 and 2). Cumulative case counts include patients who are currently unwell, those that have recovered and those that have died. Total UTLA counts shown can occasionally go down from one day to the next as data is revised.
Source data: Coronavirus (COVID-19) in the UK Dashboard https://coronavirus.data.gov.uk/#local-authorities
36 Covid-19 Deaths across Bedfordshire, Luton and Milton Keynes
All COVID 19 Deaths by Local Authority to 19th February 2021 Care home Home Hospice Hospital Other Bedford 59 17 5 405 0 Key messages: Cumulative Covid-19 deaths across all settings to th Central Bedfordshire 89 30 6 492 2 19 February 2021 (2,149) stood at 3.30% of confirmed cases, which is higher than the England average of 2.96%. Luton 26 41 5 455 1 Milton Keynes 100 36 8 372 0 Source data: ONS Weekly Deaths by Local Authority
Hospital Deaths
Source data: Charts: Table: Office For National Statistics (Deaths (numbers) by local authority and cause of death, registered up to the 19th February 2021, England and Wales) https://www.ons.gov.uk/ NHS Statistics https://www.england.nhs.uk/statistics/statistical-work-areas/Covid-19-daily-deaths/ – data is subject to the following caveat: The most recent 5-7 days are likely to change and an accurate picture may not be available at the date of this report. 37 Quality & Safety - Infection Prevention and Control (IPC)
During December Covid-19 positive cases across BLMK rose significantly following the end of the November national lockdown. Many care homes and other organisations began to experience increased cases and outbreaks in acute service, Primary care and social care escalated particularly towards the end of the month following the Christmas/New Near period There were a large number of outbreaks in December linked to a significant local rise of cases throughout the general population. Weekly PCR testing of staff in acute trusts and care homes continued. LFD testing is being rolled out in Acute, Primary and Community services and has been fully rolled out to care homes over December 2020. PPE supply issues are now minimal and all care homes have registered with the Clipper service to source PPE via the national portal. Knowledge of the correct use of PPE continues to improve with the main focus on safe mask use and this issue is mentioned at all appropriate meetings. Changes to national guidance, updates and reminders are shared across the system as required. IPC update training for care homes continues across the system and IPC training continues to be offered to Domiciliary care providers throughout December 2020. Training for the latest IPC guidance for Primary care continues and dates have been set for the next few months.
Covid-19 (Coronavirus) IPC focus in December 2020 was predominantly around: • Promotion of safe mask and PPE use. This issue was also discussed at all provider forums and IMTs including acute and community provider forums as appropriate. • Promotion of updated guidance and ensuring this was communicated quickly and effectively while maintaining a consistent message to all providers • Continued promotion of correct use of all PPE for each setting as per the national guidance • Working with the local authority to advise and support care homes and other social care providers including refresher training, outbreak IMTs with IPC review • Continuing the IPC training to social care providers • Providing advice, support and training to primary care • Supporting outbreaks in care homes and other social care providers, gaining assurance on adherence to national guidance and safe practice and attending outbreak multidisciplinary meetings for those with significant numbers of Covid-19 cases • Where necessary carrying out care home reviews and quality visits • Participating in national webinars and teleconferences to ensure we were consistently up to date • Supporting outbreak and incidents management reviews in all health care settings to gain assurance on adherence to national guidance and capturing lessons learnt • Ensuring lessons learnt in all incidents and outbreaks were shared across the health system • Identifying risks and escalating as appropriate via the clinical cell • Participation in regional incident management team meetings for acute and primary care • Supporting the mass vaccination project team and carrying out potential site visits to assess suitability • Supporting the planning of Flu Immunisation programme as required 38 Quality & Safety – Infection Control
C-difficile Infections Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020/21 YTD NHS Bedfordshire CCG 4 7 7 3 4 8 3 6 5 1 6 3 2 38 NHS Luton CCG 3 3 2 2 4 3 1 3 3 2 4 2 3 25 NHS Milton Keynes CCG 3 1 2 0 2 1 4 4 0 3 2 3 1 20 BLMK STP 10 11 11 5 10 12 8 13 8 6 12 8 6 83 CCGs agree a ceiling for C-difficile cases each year and the ragging in the above table is based on these numbers. The ceiling for 2020/21 is yet to be agreed and therefore April and May 2020 are ragged against the same period last year. MRSA Infections Dec-19 Jan-20 Feb-20 Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 2020/21 YTD National Threshold 0 0 NHS Bedfordshire CCG 0 1 1 0 0 0 1 0 0 1 0 0 0 2 NHS Luton CCG 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NHS Milton Keynes CCG 0 1 0 0 0 0 0 0 0 0 0 1 0 1 BLMK STP 0 2 1 0 0 0 1 0 0 1 0 1 0 3
The national ambition is for 0 MRSA infections.
C-diff – There were 6 cases across BLMK in December giving a total year to date of 83 cases. 3 were community acquired and 3 were hospital acquired.
All cases are reviewed by the relevant providers to identify any lapses in care that may have directly contributed to the infection.
MRSA – there were no new cases of MRSA bacteraemia in December across Beds, Luton and Milton Keynes giving 3 year to date.
Source data: Public Health England via Gov.uk. The nature of the data collection means that NHS acute trusts are able to request updates to their data at any time. This process means that there are frequently minor changes/additions to the most recent three data months in future publications. 39 Serious Incidents and Never Events
Bedfordshire 2020/21 2020/21 Milton 2020/21 2020/21 Measure Threshold Latest Data Trend Luton CCG Trend Trend BLMK Trend CCG YTD YTD Keynes CCG YTD YTD
Serious Incidents 0 Dec-20 11 53 1 30 12 98 24 181
Never Events 0 Dec-20 0 1 0 1 0 1 0 3
Across Bedfordshire Luton and Milton Keynes, 24 serious In Milton Keynes there were 12 serious incidents reported, none incidents were reported in December 2020, none of which met of which met the criteria for a never event. 7 pressure ulcers, 2 the criteria for a never event. This gives a year to date position slip/trip/falls, 2 apparent/actual/suspected self-inflicted harm of 181 serious incidents, 3 of which have met the criteria for a and 1 disruptive/aggressive/violent behaviour incident. Year to never event (1 Luton never event was downgraded following date there have been 98 serious incidents, with one never investigation). event.
In Bedfordshire there were 11 serious incidents reported, none The most recurrent year to date themes are for Bedfordshire of which met the criteria for a never event. 6 Nosocomial CCG - self-Harm, treatment delays, maternity and delayed (hospital acquired) Covid-19 infections, 1 medication incident, 1 diagnosis; for Luton CCG - maternity, patient falls and treatment treatment delay, 1 surgical incident, 1 self harm and 1 delays; and for Milton Keynes CCG - pressure ulcers, delayed substance abuse. Year to date there have been 53 serious diagnosis and maternity. incidents, one of which was a never event. All SIs are accompanied with detailed learning/action plans In Luton there was 1 serious incident reported which was a which the CCGs monitor on a regular basis. maternity incident. Year to date there have been 30 serious incidents, one of which was a never event.
Source data: Local Data 40 Children & Young People (CYP)
December and January Update Children’s mental health has remained a priority; the CAMHS teams have been responding to a surge of crisis presentations and eating disorders caseloads are 91% higher than in the previous year. The proposal is to progress 3 work streams for BLMK to address the increased demand: • Strengthen non CAMHS offer, be clear about what’s available, increase capacity, communicate clearly to primary care, schools and families • Adapt the CAMHS models to focus on higher risk young people and to provide more intensive community support- this will mean raising thresholds • Rapidly explore the potential for step up and step down beds/ intensive day care (potential solution for the increased number of CYP needing intensive support for eating disorders) Opportunities have arisen to bid for medium term funding to support this plan. BLMK have submitted 3 bids for Eating disorders, Bed Management and a Crisis house and to develop a Tier 4 CAMHS unit for BLMK. There is also the opportunity to bid for transforming Care funds to extend the Intensive Support Team (IST) Pilot. Other children and young peoples work has included; continued focus on MMR, exploring how we respond to Long Covid in CYP, development of an Asthma services improvement plan. Paediatrics have continued to review the list of CYP who are considered Clinically Extremely Vulnerable (CEV) to ensure that those remaining meet the new criteria and all other CYP are taken off the lists.
Priorities for February and March • Respond to national and regional enquiries on the mental health bids to maximise funding available to the system • Continue to work up the plan articulated above and start to deliver • Bid for Transforming Care Funds to extend the IST pilot for CYP with LD and A • Bid for 3 years funding for Mental Health Support Teams in Schools (MHST) • Work with Paediatrics and CAMHS to develop shared care clinical protocol for children with eating disorders who are admitted to children’s wards • Continue to review and maintain dynamic risk registers for the most vulnerable children and families so that fewer children and young people become very unwell and as a result are separated from their family either in a residential placement or hospital out of the area. • Maintain arrangements for effective virtual Care, Education and Treatment Reviews (CETR) and deliver the new in patient CETR arrangements • Continue to progress appointment to Key worker posts for learning disability and autism and develop operational policies. • Work with Digital colleagues to improve GP access to CYP templates and guidelines for childhood illnesses • Work with primary care colleagues to improve uptake of MMR 2 vaccine 41 Maternity
The focus on Bedford Hospital Maternity Unit has continued through December and January in response to the CQC report, the Ockenden review and in the context of strengthening quality and safety surveillance across the Local Maternity and Neonatal System (LMNS). The trust have been meeting with the CQC weekly to review plans and progress against these. Progress has been evident as the CQC have now stepped this down to monthly meetings. CCG Chief Nurse and AD for children and maternity commissioning are working with the new Director of Midwifery for Bedford Hospitals and the Regional Chief Midwife to align assurance processes moving forward Other focused area’s of work have been: • Responding to Covid - trusts have experienced much higher numbers of Covid positive women than in the first wave. Learning has been shared across the LMNS through the clinical reference group including the development of clinical protocol. • Personalised Care and Choice: Personalised Care Plans have been translated into 5 different languages. And an easy read version and have been distributed to the maternity units. • Safety and Quality has been a focus across the LMNS, the CCG Maternity Quality Lead has continued to support Bedford Maternity Unit. The LMNS has been working though our response to the Ockenden review, and how we evidence our position as a system ready for the submission on the 15th February. The transfers of care project group has been coordinating current state process mapping meetings for each place. This aim of this work is to develop Standard Operating Procedures for transfers of care between primary care and or health visiting and maternity services. Critical to success will be a case for change demonstrating the requirement for interoperability between clinical IT systems. • For BAME mothers we have been working on clinical pathways and communication about increased risk. The Maternity Voices Partnerships have created an amination video and posters to be shared on social media for pregnant women who identify as Black, Asian and Minority Ethnic as well as a leaflet that will form part of the booking pack. The Clinical Reference Group have developed an overarching BLMK LMNS policy . This document is currently going through the approval process. • Continuous Glucose Monitoring for all type 1 diabetic mums has now been successfully implemented across BLMK
Priorities for the next month include: • We have now developed an aligned dashboard for the whole LMNS which we are planning to have in place for April. This will be reviewed at the LMNS safety and quality meetings and exceptions reported to LMNS Strategic Board. • Establishing a Task and Finish Group specifically to strengthen current LMNS processes for, reviewing SI’s and ensuring external clinical specialist opinion from outside the Trust for cases of intrapartum foetal death, maternal death, neonatal brain injury and neonatal death. Also to strengthen action plans to ensure actions are SMART and Strong and responsive to thematic review. • Bedford Hospitals are reviewing their workforce- birth rate plus • Deploy posts funded through the LMNS transformation funding, including Neonatal Lead Nurse, Cultural Support Workers, Quality and Safety Leads, Mental Health Midwife. 42 Definitions
Ambulance - Cat 1 - Immediately life threatening conditions emergency response Cancer 62 day first treatment following referral from an NHS cancer within an average time of 7 minutes counted at time of first responder screening service – Patients who receive first definitive treatment for all cancers Ambulance – Cat 1T – As above however this is counted at time of emergency within 62 days following referral from an NHS cancer screening service. transfer vehicle arrival 52+ Week RTT waits - The number of incomplete Referral to Treatment (RTT) Ambulance – IFT – Inter Facility Transfer - Emergency transfers prioritised on pathways (patients yet to start treatment) of 52 weeks or more. the basis of the treatment or intervention the patient requires or is highly likely to A&E waiting times – total time in the A&E department - Percentage of patients require when they arrive at their destination, not the patient’s diagnosis. who spent 4 hours or less in A&E. Ambulance - Cat 2 – Emergency calls average response time of 18 minutes. Mixed-sex accommodation breaches - The total occurrences of unjustified CPA follow up within 7 days of discharge from psychiatric in-patient care - mixing in relation to sleeping accommodation. people under adult mental illness specialties on CPA followed up (face to face Cancelled operations on or after day of admission and not offered another contact or by phone discussion) within 7 days of discharge from psychiatric in- date within 28 days - Number of patients not treated within 28 days of last minute patient care. elective cancellation. Dementia Diagnosis – Diagnosis rate for people aged 65 and over, with a Trolley waits in A&E over 12 hours - Total number of patients who have waited diagnosis of dementia recorded in primary care, expressed as a percentage of the over 12 hours in A&E from decision to admit to admission estimated prevalence based on GP registered populations. Urgent Operations cancelled for a second time – The number of Urgent 18 Weeks Referral to Treatment – Incomplete pathway - Patients on a non- Operations Cancelled for the 2nd or more time urgent consultant led pathway setting a maximum time of 18 weeks from the point Psychosis treated with a NICE approved care package within two weeks of of referral up to the start of any treatment necessary where it is clinically referral - People experiencing first episode psychosis or ARMS (at risk mental appropriate. Incomplete pathways are those where patients are still waiting for state) that wait 2 weeks or less to start a NICE recommended package of care. treatment. IAPT Access Rate - Proportion of people that enter treatment against the level of Diagnostics – Access to 15 key diagnostic tests within 6 weeks. need in the general population Cancer 2 Week Wait Following Urgent GP Referral For Suspected Cancer – IAPT - people who completed treatment and are moving to recovery – Patients seen within two weeks of an urgent GP referral for suspected cancer Proportion of people who complete treatment who are moving to recovery. Cancer 2 Week Wait for Breast Symptoms where cancer was not initially IAPT waiting times - People that wait 6 weeks or less from referral to entering a suspected – Patients seen within two weeks of an urgent referral for breast course of IAPT treatment and people that wait 18 weeks or less from referral to symptoms where cancer was not initially suspected entering a course of IAPT treatment. Cancer 31 day first treatment following a cancer diagnosis – Patients that Improve access rate to Children and Young People’s (CYM) Mental Health receive first definitive treatment within 31 days of receiving a diagnosis for all Services (CYPMH) - Number of individual CYM under 18 receiving treatment by cancers. NHS funded community services as a proportion of those with a diagnosable Cancer 31 subsequent cancer treatments – Surgery – Patients that receive mental health condition. subsequent treatment of surgery within a maximum waiting time of 31 days. Waiting times for Urgent and Routine Referrals to Children and Young Cancer 31 subsequent cancer treatments – Anti cancer drug regimens – People Eating Disorder Services - Proportion of CYP with an Eating Disorder Patients that receive subsequent/adjuvant treatment of anti-cancer drug regimen (urgent cases) that wait one week or less from referral to start of NICE-approved within a maximum waiting time of 31 days. treatment and proportion of CYP with an Eating Disorder (routine cases) that wait Cancer 31 subsequent cancer treatments – radiotherapy – Patients that 4 weeks or less from referral to start of NICE-approved treatment. receive subsequent/adjuvant radiotherapy treatment within a maximum waiting time of 31 days including patients with recurrent cancer. Cancer 62 day first treatment following an urgent GP referral – Patients who receive first definitive treatment for all cancers within 62 days following an urgent GP referral. 43
Governing Bodies in Common in Public
16 March 2021
3.2: M10 Finance Update - BLMK CCGs
Author: CCG Finance Teams Contact Information: Director of System Finance, BLMK CCGs Lead Executive: Acting Chief Finance Officer Which CCGs does this paper apply to?
Bedfordshire X Luton X Milton Keynes X
Information
Which activity does this paper The report summarises the financial performance of the three relate to? BLMK CCGs at Month 10 2020/21 (January 2021)
How?
What is the Committee/ For Assurance/Discussion/Information Governing Body being asked to do? The Governing Body is asked to NOTE the contents of the Finance Report and the operation of the temporary financial regime for the NHS in 2020/21. What are the financial As set out in paper. implications?
Set out the key risks and risk Failure to meet statutory financial duties. ratings As per Finance Risk Register
Date to which the information 20 February 2021 this paper is based on was accurate
Executive Summary
The three BLMK CCGs report a combined year-to-date adverse variance to plan of £0.3m. This is mainly attributed to the Covid Hospital Discharge Programme (HDP) incurred in Month 7-10 but currently unfunded. It is assumed that Month 7-12 HDP costs incurred will be funded following NHS England & Improvement (NHSE/I) validation.
As a result, once this is accounted for, the combined BLMK CCG position is a £1.5m YTD favourable variance to plan.
The three CCGs are forecasting an £0.5m improvement to the position to the plans submitted to NHSE/I in late October for Months 7-12. The combined forecast position for the three CCGs is currently forecast I&E break-even.
The key risks to the current financial forecasts, relate to the impact of: . Penalties that may arise from under performance against the NHSE/I Elective Incentive Scheme. . Unexpected costs associated with the Covid mass vaccination programme These risks have reduced in Quarter 4 and not expected to impact on the current forecast position.
Plans for the delivery of the Mental Health Investment Standard in 2020/21, including the carry forward under delivery from the 2018/19 financial year for Bedfordshire & Milton Keynes CCGs, have been agreed with lead Mental Health providers.
2
Month 10 Finance Update - BLMK CCGs Governing Bodies in Common
16 March 2021 Headlines
NHS Financial Regime in 2020-21 Summary of BLMK CCGs Financial Performance at Month 9
In response to COVID-19, a temporary The three BLMK CCGs report a combined year-to-date adverse variance to plan of financial regime was put in the place to £0.3m. This is mainly attributed to the Covid Hospital Discharge Programme (HDP) cover the period April to September incurred in Month 7-10 but currently unfunded. It is assumed that Month 7-12 HDP 2020. The principle of this approach is costs incurred will be funded following NHS England & Improvement (NHSE/I) that during this period CCGs are validation. expected to breakeven on an in-year As a result, once this is accounted for, the combined BLMK CCG position is a basis. To achieve this, CCG allocations £1.5m YTD favourable variance to plan. were non-recurrently adjusted for Months 1-6 to reimburse commissioners The three CCGs are forecasting an £0.5m improvement to the position to the plans for unfunded costs – mainly direct Covid submitted to NHSE/I in late October for Months 7-12. The combined forecast related expenditure. position for the three CCGs is currently forecast I&E break-even.
For the second half of the year (H2) The key risks to the current financial forecasts, relate to the impact of: ICS/STP systems have been given fixed . Penalties that may arise from under performance against the NHSE/I Elective funding envelopes with the expectation Incentive Scheme. that these are sufficient to fund local . Unexpected costs associated with the Covid mass vaccination programme elective and non-elective activity to the These risks have reduced in Quarter 4 and not expected to impact on the current levels set out in the NHSE/I guidance on forecast position. the third phase response to the pandemic and to fund (with some Plans for the delivery of the Mental Health Investment Standard in 2020/21, exceptions) direct Covid related costs. including the carry forward under delivery from the 2018/19 financial year for Bedfordshire & Milton Keynes CCGs, have been agreed with lead Mental Health Systems will be expected to break-even providers. within these allocations. Individual organisations within a system can deliver surpluses or deficits by mutual NHS Planning & Contracting in 21/22 agreement with other NHS organisations NHSE/I has announced that planning for 2021/22 will be delayed and the current in the system, but overall the system block contract arrangements will be rolled over into the first quarter of next year. should seek to achieve financial balance. 2 Year to Date Financial Performance (1)
BEDFORDSHIRE LUTON MILTON KEYNES BLMK COMBINED
Year to Date Net Expenditure Year to Date Net Expenditure Year to Date Net Expenditure Year to Date Net Expenditure
CCG EXPENDITURE ANALYSIS Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance
£m £m £m % £m £m £m % £m £m £m % £m £m £m %
REVENUE RESOURCE LIMIT (IN YEAR) 663.0 300.1 351.7 1,314.8
Acute Services 362.1 361.0 1.1 0.3% 146.4 146.4 - 0.0% 186.5 186.0 0.5 0.3% 695.0 693.3 1.7 0.2% Mental Health Services 59.9 59.0 0.9 1.4% 38.0 38.4 (0.4) (1.1%) 30.8 31.1 (0.3) (0.9%) 128.7 128.5 0.2 0.1% Community Health Services 37.4 35.9 1.6 4.2% 30.9 31.5 (0.6) (1.9%) 23.6 22.9 0.7 3.0% 91.9 90.2 1.7 1.8% Continuing Care Services 26.9 27.4 (0.5) (1.8%) 7.2 7.0 0.2 2.8% 21.0 20.7 0.4 1.7% 55.1 55.0 0.1 0.2% Primary Care Services 70.4 70.1 0.3 0.5% 33.2 32.8 0.4 1.2% 39.1 39.9 (0.8) (2.0%) 142.7 142.8 (0.0) (0.0%) Of Which: Prescribing 55.9 55.9 (0.0) (0.0%) 26.1 25.7 0.4 1.5% 30.6 31.4 (0.8) (2.7%) 112.6 113.0 (0.4) (0.4%) Primary Care Co-Commissioning 56.0 55.2 0.8 1.4% 29.3 29.1 0.2 0.7% 32.0 31.8 0.2 0.8% 117.3 116.1 1.2 1.0% Other Programme Services 34.1 37.5 (3.4) (9.9%) 14.6 15.3 (0.7) (4.8%) 19.6 20.4 (0.8) (4.1%) 68.3 73.2 (4.9) (7.1%) TOTAL COMMISSIONING SERVICES 646.8 646.0 0.8 0.1% 299.6 300.5 (0.9) (0.3%) 352.6 352.6 0.0 0.0% 1,299.0 1,299.1 (0.1) (0.0%) Running Costs 7.7 7.9 (0.2) (2.9%) 3.7 3.8 (0.1) (2.7%) 4.7 4.6 0.0 0.9% 16.1 16.4 (0.3) (1.8%) TOTAL CCG NET EXPENDITURE 654.5 653.9 0.6 0.1% 303.3 304.3 (1.0) (0.3%) 357.3 357.2 0.1 0.0% 1,315.1 1,315.4 (0.3) (0.0%)
IN YEAR UNDERSPEND / (DEFICIT) 8.5 9.1 0.6 7.1% (3.2) (4.2) (1.0) (31.3%) (5.6) (5.5) 0.1 1.1% (0.3) (0.6) (0.3) (121.6%)
RETROSPECTIVE ALLOCATIONS - 0.2 0.2 100.0% - 1.3 1.3 100.0% - 0.3 0.3 100.0% - 1.8 1.8 100.0%
ADJUSTED SURPLUS / (DEFICIT) 8.5 9.3 0.8 9.4% (3.2) (2.9) 0.3 9.4% (5.6) (5.2) 0.4 7.2% (0.3) 1.2 1.5 547.5%
For all three BLMK CCGs, plan reflects allocation issued by NHSE/I, top-up allocation received for unfunded expenditure in Month1-6, plus expenditure as per CCG Month 7-12 plans.
The three CCGs report a combined Income & Expenditure (I&E) deficit of £0.6m, this is £0.3m worse than plan. However, once expectations re: prospective allocations for expenditure incurred has been accounted for (£1.8m), the combined position will be a £1.5m favourable variance to plan (£1.2m I&E surplus). Year to Date Financial Performance (2)
Year-to-Date (YTD) variances by CCG are set out below:
Bedfordshire Reports a £0.6m YTD surplus. Once adjusted for an expected allocation for Hospital Discharge Programme costs this becomes a £0.8m underspend. The main drivers for the £0.8m underspend arise from lower than expected costs of community beds and slippage on Phase 3 planned investments.
Luton Reports a £4.2m YTD deficit, which is £1m adverse to plan. The main points to note are as follows: . The YTD position includes costs relating to Months 7 - 10 acute IS costs and for Months 9 - 10 Hospital Discharge Programme costs, which is reimbursable subject to approval by NHSE/I. Once these retrospective allocations are applied it will improve the position by £1.3m resulting in a revised deficit of £2.9m, which is £0.3m better than plan.
Milton Keynes Reports a £5.5m YTD deficit, which is £0.1m better than plan. The main points to note are as follows: . The top up allocation for Months 7 - 10 acute Independent Sector costs and for Months 9 - 10 Hospital Discharge Programme costs are expected before the year end. Once these retrospective allocations are applied it will improve the position by £0.3m resulting in an adjusted deficit of £5.2m, £0.4m better than plan.
4 Forecast Financial Performance
BEDFORDSHIRE LUTON MILTON KEYNES BLMK COMBINED
Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure Forecast Net Expenditure
CCG EXPENDITURE ANALYSIS Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance Plan Actual Variance Variance
£m £m £m % £m £m £m % £m £m £m % £m £m £m %
REVENUE RESOURCE LIMIT (IN YEAR) 808.4 363.2 429.7 1,601.2
Acute Services 440.3 440.4 (0.1) (0.0%) 175.5 175.6 (0.1) (0.1%) 229.2 228.4 0.8 0.3% 845.0 844.4 0.6 0.1% Mental Health Services 72.5 72.9 (0.4) (0.5%) 46.6 47.1 (0.5) (1.1%) 38.6 38.1 0.5 1.3% 157.7 158.0 (0.4) (0.2%) Community Health Services 45.1 43.9 1.1 2.5% 37.0 38.2 (1.2) (3.2%) 28.2 27.5 0.7 2.6% 110.3 109.6 0.7 0.6% Continuing Care Services 32.5 32.4 0.0 0.1% 8.5 8.3 0.2 2.4% 24.9 25.2 (0.3) (1.4%) 65.8 65.9 (0.1) (0.2%) Primary Care Services 84.8 82.8 2.0 2.3% 39.7 39.6 0.1 0.3% 47.8 48.6 (0.9) (1.8%) 172.2 171.0 1.2 0.7% Of Which: Prescribing 67.0 66.9 0.2 0.3% 31.2 31.1 0.1 0.3% 37.0 37.9 (0.9) (2.4%) 135.3 135.9 (0.6) (0.4%) Primary Care Co-Commissioning 67.7 66.5 1.2 1.7% 35.5 35.3 0.2 0.6% 38.7 38.5 0.1 0.4% 141.8 140.3 1.5 1.1% Other Programme Services 43.7 48.9 (5.2) (11.9%) 20.8 21.7 (0.9) (4.3%) 25.2 26.6 (1.4) (5.6%) 89.7 97.2 (7.5) (8.4%) TOTAL COMMISSIONING SERVICES 786.5 787.8 (1.4) (0.2%) 363.6 365.8 (2.2) (0.6%) 432.5 432.9 (0.4) (0.1%) 1,582.5 1,586.5 (4.0) (0.3%) Running Costs 9.2 8.6 0.6 6.3% 4.4 4.5 (0.1) (2.3%) 5.6 5.6 0.0 0.1% 19.1 18.7 0.5 2.5% TOTAL CCG NET EXPENDITURE 795.6 796.4 (0.8) (0.1%) 368.0 370.3 (2.3) (0.6%) 438.0 438.5 (0.4) (0.1%) 1,601.7 1,605.2 (3.5) (0.2%)
IN YEAR UNDERSPEND / (DEFICIT) 12.8 12.0 (0.8) (6.3%) (4.8) (7.1) (2.3) (47.9%) (8.4) (8.8) (0.4) (5.2%) (0.4) (3.9) (3.5) (857.2%)
RETROSPECTIVE ALLOCATIONS - 0.8 0.8 100.0% - 2.3 2.3 100.0% - 0.8 0.8 100.0% - 3.9 3.9 100.0%
ADJUSTED SURPLUS / (DEFICIT) 12.8 12.8 (0.0) (0.0%) (4.8) (4.8) (0.0) (0.0%) (8.4) (8.0) 0.4 4.8% (0.4) (0.0) 0.4 97.2%
The three CCGs report a combined forecast deficit of £3.9m that is £3.5m worse than plan, however, once all retrospective allocations for M7 - 10 have been made the combined position will be breakeven, £0.4m better than plan.
CCGs are updating forecasts throughout February. CCGs are continuing to identify options to improve the financial positions where possible. Discussions are on-going with ICS partners and NHSE/I. Covid 19 YTD Expenditure – BLMK CCGs
NHS NHS NHS Bedfordshire Luton Milton Keynes Totals CCG CCG CCG £'000 £'000 £'000 £'000 DIRECT COVID EXPENDITURE 16,159 7,420 9,206 32,785
The total YTD costs of Covid for 20-21 across the three CCGs is £32.8m, this includes the cost of the Hospital Discharge Programme. Some cost are hosted by a specific CCG on behalf of all three BLMK CCGs.
Bedfordshire The CCG has incurred £16.2m of extra costs YTD relating to Covid-19, of this, £11.1m relates to the Hospital Discharge Programme.
Luton The CCG has incurred £7.4m extra costs YTD relating to Covid-19, of this, £5.2m relates to the Hospital Discharge Programme.
Milton Keynes The CCG has incurred £9.2m extra costs YTD relating to Covid-19, of this, £6.1m relates to the Hospital Discharge Programme.
6 NHS Planning & Contracting in 2021/22 Approach & Timeline
Planning Guidance
NHSE/I have announced that planning for 2021/22 will be delayed and the current block contract arrangements will be rolled over into the first quarter of next year. However, at this point funding for Q1 has not been confirmed, as it is subject to discussion with the government.
NHSE/I Planning Approach
. Minimise burden during Q4 2020/21 as the NHS responds to the pandemic . Financial rollover into Q1 2021/22 . Requirement for central returns minimised . Planning round deferred to Q1 2021/22 with focus on Q2-Q4 . Mental Health planning is expected to be completed earlier (TBC)
Indicative Timeline
. March – Further guidance on Q1 rollover and associated requirements . March: Final Q1 financial envelopes confirmed (following confirmation of funding settlement with government) . Early April: Q2-Q4 operational planning guidance issued . End of June: Q2-Q4 final operational plans submitted
Rollover arrangement for Q1 2021/22
The current financial framework will rollover into Q1 21/22. The detail of the rollover are subject to agreement with Government which may affect the total quantum available. The terms are likely to comprise: . Organisational plans for M1-3 based on 2020/21 H2 information and generated by NHSE/I . Additional funding for continued investment in mental health service and contractual commitment in primary care
7
Governing Bodies in Common in Public
16 March 2021
4.1: The CCG Merger – Updated Equality Impact Assessments
Author: Maria Wogan Contact Information: [email protected] Lead Executive: Geraint Davies, Director of Performance and Governance Which CCGs does this paper apply to? Information
Bedfordshire Luton Milton Keynes
Which activity does this paper Provides updated Equality Impact Assessments (EIA) on the relate to? BLMK CCG merger in respect of the BLMK population and the CCG’s workforce How? AGEM has updated the EIA that was initially presented in to the Governing Body in September 2020
What is the Committee/ The Governing Bodies are asked to review the EIA and endorse the Governing Body being asked to proposed recommendations as follows: do? Appendix A – recommendations on pages 26-27 Appendix C – recommendations on pages 16-20
And note that progress on the action plans will be reported to the Equality, Diversity and Inclusion Committee of the BLMK CCG.
What are the financial Addressed within the BLMK One CCG Programme budget implications?
Set out the key risks and risk The EIAs and associated action plans are risk mitigations in ratings relation to the CCGs’ public sector equality duty
Date to which the information 5 March 2021 this paper is based on was accurate
Executive Summary The CCGs are required to undertake an Equality Impact Assessment (EIA) in respect of the proposed merger of the CCGs and the establishment of the BLMK CCG. An initial EIA was presented to the Governing Bodies in September 2020 as part of the papers requesting Governing Bodies’ approval of the merger application. One of the recommendations in the initial EIA was that more detailed population and workforce summaries
were produced to inform an updated EIA. That work has now been completed and the population summaries are attached as Appendx B. In addition, separate EIAs have now been produced for the population impacts (Appendix A) and the workforce impacts (Appendix C) so that the reports can be used more effectively going forwards. The population EIA was reviewed by the Quality and Performance Committee on 2 March 2021 and the Committee endorsed the proposed actions. The workforce EIA was reviewed by the Executive Team on 3 March 2021 and the proposed actions were agreed. The Executive Team also agreed that these reports should be presented to the Equality, Diversity and Inclusion Committee for review and to support the development of effective action plans. The Governing Bodies are asked to review the EIA and endorse the proposed recommendations as follows: Appendix A – recommendations on pages 26-27 Appendix C – recommendations on pages 16-20 And note that progress on the action plans will be reported to the Equality, Diversity and Inclusion Committee of the BLMK CCG. Attachments: Appendix A – Equality analysis of the formation of a single commissioning organisation for the Bedfordshire, Luton and Milton Keynes CCGs’ area – population impact Appendix B – Population summaries for Luton and Milton Keynes, Bedford Borough Council, Central Bedfordshire Council – January 2021 Appendix C – Workforce EIA Equality analysis of the formation of a single commissioning organisation for the Bedfordshire, Luton and Milton Keynes CCGs’ area – workforce impact
2
Appendix A
Equality analysis of the formation of a single commissioning organisation for the Bedfordshire, Luton and Milton Keynes CCGs’ area – population impact
Page | 1
Contents Introduction ...... 4 BLMK CCG Mission [draft] ...... 4 Our mission is to optimise health and wellbeing for our population, advance health equality in our communities and make the best use of NHS resources...... 4 BLMK CCG Vision [draft] ...... 4 Evidence used ...... 5 Overview of the CCGs involved ...... 7 NHS BLMK ...... 7 Bedfordshire ...... 7 Bedford Borough...... 7 Central Bedfordshire ...... 8 Health in Bedfordshire ...... 8 Luton ...... 8 Milton Keynes ...... 8 2. Anticipated impact summary section ...... 10 2.1 Age ...... 10 2.2 Disability ...... 12 2.3 Gender reassignment (including transgender) ...... 15 2.4 Marriage and civil partnership ...... 15 2.5 Pregnancy and maternity ...... 15 2.6 Race ...... 16 2.7 Religion or belief ...... 18 2.8 Sex ...... 18 2.9 Sexual orientation ...... 19 2.10 Carers ...... 20 2.11 Other disadvantaged groups ...... 20 Human Rights considerations ...... 22 Health inequality ...... 23 Stakeholders ...... 24 Key concerns around health inequalities ...... 26 Recommendations: ...... 26
Page | 2
1. Deprivation and Geographical Isolation ...... 27 2. A review of the impact of travel on access to services ...... 28 3. Patient focus group involvement ...... 28 Future work ...... 29 Appendices ...... 29 Appendix I - Age profiles of the four places ...... 30 Luton: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate) ...... 32 Milton Keynes: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate) ...... 33 Bedford Borough: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate) ...... 34 Central Bedfordshire: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate) ...... 35 Appendix II Population disability profile based on the 2011 Census ...... 36 % ...... 36 Appendix III Ethnicity profile of the CCGs and places ...... 40
Page | 3
Introduction
The following Equality Analysis has been produced as part of NHS Bedfordshire, Luton, and Milton Keynes CCGs’ (BLMK) proposal of the formation of a single commissioning organisation. In keeping with the principles of robust Equality Analysis and to demonstrate the CCGs’ commitment to the principles of the Public Sector Equality Duty (PSED) this work has been undertaken to support the merger process.
As part of the process, population demographic reports have been produced which provide a baseline for any future harmonisation of approach and policies. This data shows a comparison of populations, which enables decision makers to identify differences in the demographic and any key considerations that will be required to ensure consideration for vulnerable groups. The EIA should be seen in company with the population summaries, workforce data and initial EIA previously undertaken. The population summaries have made use of published data and thus refer to 2017 ONS mid year estimates. Newer data is available in the raw format. The 2021 Census will provide more up to date once the information is available.
The three Clinical Commissioning Groups (CCGs) in Bedfordshire, Luton, and Milton Keynes (BLMK) are applying to NHS England and Improvement to come together as one organisation (one CCG) by April 2021. Over the last 18 months we have been working closely together to improve the health and wellbeing of the population we serve. The new CCG’s mission and vision is to:
BLMK CCG Mission [draft]
Our mission is to optimise health and wellbeing for our population, advance health equality in our communities and make the best use of NHS resources.
BLMK CCG Vision [draft]
Our vision that:
As a strategic commissioner, we will optimise health and wellbeing for our population by:
• Enabling effective collaborations of providers and primary care networks, supporting an evidence-based approach to the design of health and care services
• Enabling local place-based partnerships to support more people to manage and improve their own physical and mental health and wellbeing, and tackle the wider factors that impact people’s health
Page | 4
• Promoting clinical best practice and quality improvement across the system
The new CCG is committed to reducing inequalities and unwarranted variation and will be taking action to deliver on this agenda which will benefit the BLMK population and CCG staff. Therefore, the merger of the three CCGs provides the opportunity to address health inequalities and deliver improvements in BLMK. The new BLMK CCG will be coterminous with the Integrated Care System (ICS), and therefore able to support the development of strategic commissioning through the local Integrated Care Partnerships (ICPs) in Bedfordshire and Milton Keynes and the Primary Care Networks (PCNs). We believe that having a single CCG, instead of three separate organisations will allow us to make better use of our resources, reduce duplication and spread good practice. Our proposal will enable us to maximise investment and transformation opportunities ultimately improving the health and care of people living in Bedfordshire, Luton and Milton Keynes. Details of our proposal are described in our case for change.
This EIA has been produced to provide an assessment of the impact of the proposed merger on the CCG’s staff, patients and service users. This EIA looks at the impact of proposed changes with regard to the nine protected characteristics of the Equality Act 2010 and other key concerns such as carers, other vulnerable groups and health inequalities. This is to support the CCG in meeting its duties under the Public Sector Equality Duty, evidence equality considerations and demonstrate due regard is being taken to the findings. (These specific duties are set out on the next page)
Evidence used • Population demographic data for the three CCG areas
Bedfordshire CCG local population data (this data is no longer published) www.localhealth.org.uk https://www.milton-keynes.gov.uk/your-council-and- elections/statistics/population-statistics https://www.luton.gov.uk/Community_and_living/Luton%20observatory%20c ensus%20statistics%20and%20mapping/Pages/default.aspx https://www.lutonccg.nhs.uk/page/?id=3405 JSNA for each Local Authority area 2011 Census data https://www.nomisweb.co.uk/reports/lmp/la/contents.aspx Office of National Statistics Mid-Year estimates for the relevant areas / localities / places) https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrat ion/populationestimates/datasets/clinicalcommissioninggroupmidyearpopulat ionestimates
Page | 5
• Living longer in good health Bedfordshire, Luton and Milton Keynes Longer Term Plan (2019 – 2024) for improving health and care
• Health and Wellbeing in Milton Keynes, July 2019 What makes our population healthy? How good are our population health outcomes?
• CCG workforce data o NHS Workforce Race Equality Standard data o Staff Profiles from ESR
• CCG complaints data – (it should be noted that actions will already have been taken in response to these as they are historic)
• Examples of CCG’s who have successfully completed a merger
Page | 6
Overview of the CCGs involved
NHS BLMK
Over one million people live in the Bedford Borough, Central Bedfordshire, Luton and Milton Keynes – the BLMK area, and BLMK is one of the fastest growing areas in the country.
The number of people aged 85 and over is projected to double by 2035 and it is predicted that there will be higher than average growth in the number of adults aged 65 and over and the number of children and young people aged 10-19 years old. Across BLMK, women in the healthiest areas enjoy 22 more years in good health than those in the least healthy areas. For men the gap is 15 years.
As more people in these older age groups tend to have long-term, and sometimes multiple, health conditions, this presents a significant challenge for both health and social care. We are also expecting a higher than average growth in the number of children and young people aged 10-19 years old. Bedford Borough and Central Bedfordshire, Luton and Milton Keynes are all very different places that are also diverse within themselves.
Bedfordshire
The area currently covered by Bedfordshire CCG runs from the north of Bedford to the Luton boundary in the south.
It is covered by two local authorities, Bedford Borough Council (supporting a population of 184,097) and Central Bedfordshire Council (supporting a population of 258,461).
Bedford Borough
Bedford Borough is mostly urban, containing the towns of Bedford, Kempston and the Wixams new town development, surrounded by a rural area with many villages. There are significant ethnic minority communities and you’ll hear more than 100 languages being spoken in Bedford. The borough has seen large scale migration over recent years, particularly from Eastern Europe, as well as Africa, Asia and the Middle East.
Life expectancy in Bedford Borough is increasing and, when last recorded in 2015, was 80.2 years for men and 83.9 years for women.
Page | 7
However, there are some areas of deprivation and the life expectancy gap between Bedford’s most and least deprived areas is 10 years for women and 4.2 years for men. In the most deprived areas, two thirds of children are living in poverty.
Central Bedfordshire
Central Bedfordshire is a mix of rural villages and small market towns and is the least ethnically diverse of the BLMK areas. Life expectancy is better than the national average, at 81.4 years for males and 84.4 years for females, but there are some pockets of deprivation, mainly around Sandy, Houghton Regis and Dunstable.
Comparing the most and least deprived areas of Central Bedfordshire, there is a life expectancy gap of 6.7 years for men and 5.8 years for women.
Health in Bedfordshire
In deprived areas of Bedfordshire, early death is mainly due to cancer, circulatory and respiratory diseases.
Compared to similar areas, more people die early from heart disease in Bedford Borough and from breast cancer in Central Bedfordshire. In Bedford Borough, preventable deaths from cardiovascular disease are particularly high.
Hospital admissions for cardio-pulmonary disease, and admissions for asthma in under 19s, are both high in Bedfordshire.
Luton
Luton, covered by Luton Borough Council, is home to 237,690 people and has a higher than average number of young people. Luton is the most urban BLMK area and also the most culturally diverse. More than half the people living in Luton are of Black, Asian and Minority Ethnic (BAME) origin and there are an increasing number of BAME communities in Luton, each with its own needs and cultures.
Milton Keynes
The borough of Milton Keynes, covered by Milton Keynes Council, has a population of 300,000.
Page | 8
Around 90% of the population live in Milton Keynes itself, although the town only covers 20% of the land area. The remaining 10% of the population live in the borough’s rural areas that includes a number of rural villages and the small town of Olney.
The population is ethnically diverse with over a quarter coming from a Black, Asian and Minority Ethnic (BAME) group.
(full details of each area are provided in the supporting Population summary)
Page | 9
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.1 Age Describe age-related impact and evidence. This can include safeguarding, consent and welfare issues. For patients, the impact of any merger may not be seen immediately (except where policy harmonisation has already begun) however, based on the experience of other CCGs, as older patients are more likely to use NHS services, they may feel the effects of any changes most. In addition, nationally driven programmes such as a review of procedures of limited clinical value (especially elective surgeries) tend to affect older patients. The age profile for the four places CCGs is shown in the appendix 1.2 and with additional detail in the population summary.
The CCGs are aware of the potential of vulnerability in older and younger age groups in relation to safeguarding. In the BLMK CCG all safeguarding policies and processes will be assessed for relevance at place (Local Authority). Wider policy-making and team expertise across a single CCG will enhance CCG work in this area.
The intersectionality between age and disability should be noted particularly around dementia. A key priority for the CCG is to enhance and improve the diagnosis process which links to current work in the local Primary Care Networks. With an ageing population services must give due regard to meeting the needs of older people with mild dementia who are not in care homes.
It can be seen that considerable variation occurs in the CCGs populations. With this in mind the population has been split into Bedford Borough and Central Bedfordshire. Bedford Borough is much closer in profile to Luton and Milton Keynes, being more diverse than the rest of the more rural Central Bedfordshire.
What is clear however is that the population of Luton is younger in the urban areas. This will have to be taken into account in service decisions as all service models will need to be adapted to take account of local population characteristics, needs and contexts. For the more rural Central Bedfordshire area additional consideration will be needed for older patients and travel concerns in service delivery. It should be noted that while engagement has raised this concern the intention is for more service to be offered locally through Primary Care Networks (PCN) with the aim of reducing the need to travel to hospital sites. For some patients however, they may need to travel to one hub within
Page | 10
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices. their PCN. In Milton Keynes the impact of travel within the town, especially for those on low incomes and without access to a vehicle has been highlighted as a concern.
If any future changes are made requiring patients to travel further to access services, this could impact older patients significantly since they may find travel more difficult and concerning (it should be noted that these are not planned so far). Travel concerns are shown by data to be a proportionately greater issue in Central Bedfordshire as opposed to the other areas, an issue exacerbated by the greater distances and less public transport options. In the current COVID-19 pandemic the cost of travel may be a significant issue due to economic downturn and where people have been on furlough and or made redundant. As the impacts of this are emerging and developing this issue must be monitored to identify what action may be required at a future date. It is hoped that the current work with PCN will have a beneficial impact on this area and group by reducing the need visit hospital settings.
The current programme of elective surgery review may impact this group since several the policies on the list tend to be required by older patients. (It should be noted that this is not a decommissioning programme.) The application of any digital first solutions must also be considered for their impacts on older patients who are less likely to have access and experience in using the internet. In applying any digital first model the CCG must be mindful that not all patients will be equipped to use this model and must ensure that alternative routes are available as required. Access to a reliable internet connection is also linked to socio economic position so will be less likely in deprived areas. Evidence of online access amongst older patients is mixed but anecdotal evidence has shown a particular concern amongst this group if this is the only option. Some disabled patients may find internet-based services a challenge as will care home residents who may not have access to the required equipment. As rural areas often do not have access to a reliable 4G signal which can impact on internet access.
Consideration should be given in planning service changes that come out of the merger, to engaging with both rural and urban areas and both older and younger patients. This will help ensure their key concerns are understood and addressed where possible.
Page | 11
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.2 Disability Describe disability-related impact and evidence. This can include attitudinal, physical, communication and social barriers as well as mental health/learning disabilities, cognitive impairments. While there is a small variation between the totals for disabled patients for each of the four areas (as shown in the tables at the end of this section, the percentage of disabled patients in each area are roughly similar and below the England average. It should be noted that despite Central Bedfordshire showing an older population than the other three areas the number of people with limiting conditions is not higher showing as would be expected from national comparators. From this data it is clear that the population of Luton has the highest instances of poor health, potentially linked to deprivation, followed by Milton Keynes which although it has areas of significant deprivation is closer to the England average overall1. Thus, service planning must consider these issues in designing services.
These limiting conditions will cover a wide range of conditions such as COPD, physical disability and mental health conditions. Recent ONS data also showed that 6 out of 10 Covid deaths were people with a disability. In planning changes to services, the CCGs will need to consider the impact of potential additional travel if there are any future proposals to change the location of services (none are currently planned). Disabled patients will find travel more difficult than other patients and, in many cases, find public transport impractical to use. This should be seen as an urban issue as well as rural since those without a car may limit travel even within a town. Disability issues are not limited just to physical / mobility disabilities but also affects those with learning disabilities and mental health conditions as well, who may find travelling very stressful. The CCG has an opportunity in reviewing services to mitigate this issue. The proposed work to deliver more services locally through PCNs will be of advantage here, reducing the need to visit hospital settings.
The CCG is also a key partner in work on the SEND agenda for children and young people – the CCGs have been working together with Local Authority partners on the SEND agenda for the past 2 years and the merger will further support this integrated work. The Designated Clinical Officers for SEND and Children’s Commissioners support work across the 4 Local Authorities to ensure that Health, Care and Education is aligned around the needs of our children and young people so that they can learn and achieve.
1 Deprivation data Milton Keynes LA area
Page | 12
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
The BLMK ICS demonstrated their commitment to SEND from the onset and hosted a SEND conference in April 2019. Since that time, working groups have established their memberships and the DCO role is part of the CYP Leads meetings to ensure oversight of all quality improvement work driven by agreed priorities. There have been many advantages of this integrated approach:
• Shared identification of place-based strengths and expertise to support quality improvement across all 4 areas reducing duplication of work and enabling more rapid transformation where needed. • Local peer support for the DCO role and a clear recognition of its value. • Joint project work across the 3 system areas that is far reaching and supports economies of scale e.g. SEND e-learning modules with shared costs (CCGs, LAs and provider services) • Peer challenge to drive quality improvement • Funding opportunities are rapidly acted upon and have a pool of expertise to support applications.
It should be noted that there are also potential benefits from the merger since a single CCG would be able to respond to disability across the whole STP footprint, with increased access to national transformation funding. This would be complemented by local delivery teams who will be more focussed on the particular issues of each place.
Depending on the model applied will depend the impact on each and all groups. It is recommended that the EIAs undertaken around service change consider this a priority and make relevant mitigations where possible. Work across primary care networks – prioritising health checks for people with LD and serious MH. Impacts of length of years/life.
In addition, due regard must be given to meeting the communication needs of patients with a learning disability in communicating any changes. Public involvement related to the merger proposal and any consultation on future service change must be conducted in an inclusive way to ensure that disabled people have the opportunity to give their views, and co-production with local councillors, including attendance at placed based overview and scrutiny committees must be undertaken prior to decisions being made and implemented.
Page | 13
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
A review of each of the three CCG’s recent received complaints has shown the following examples:
• A specific complaint was received by that the “Desmond” Diabetes course did not have sufficient reasonable adjustments in place for LD / autism. • In addition, concerns were raised that the CCG is not meeting the needs of patients with autism in its commissioning.
• A provider (private) who failed to make reasonable adjustments for patients with physical disabilities.
• Changes to repeat prescribing that negatively impacted deaf patient
These cases highlight the importance of ensuring the needs of those with disabilities are considered in service design. This is particularly important when carrying out a review / harmonisation of services post-merger.
In planning changes to services, the CCGs will need to consider the impact of potential additional travel if services are collocated and locations change. Disabled patients will find travel more difficult than other patients and, in many cases, find public transport impractical to use. This is more about positive action in reviewing services however since the CCG is not currently planning changes that will extend travel.
In addition, due regard must be given to meeting the communication needs of patients with a learning disability in communicating any changes.
Consideration must also be given to the impacts of digital first services on those with communication differences. It is recommended that where a service will be primarily digital access only that alternative routes are maintained for whom this option is more challenging / not suitable. Examples include those with a learning disability who require face / face meetings. The experience during Covid has highlighted the impact of digital exclusion.
Page | 14
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.3 Gender reassignment (including transgender) Describe any impact and evidence in relation to transgender people. This can include issues such as privacy of data and harassment.
Data is not collected against this protected group at a local level, no evidence of impact can be identified and clinical services for this group are commissioned by NHS England rather than the CCGs. Though some Independent Funding Requests may be made to the CCG around different clinical interventions which are not covered by the national service.
With any service change this group of patients may feel particularly concerned if they have to use new services since they may have to provide details of their circumstances again to medical staff. Where permitted legally and when appropriate, sharing of information and contact preferences should be done as part of referral/transfer to mitigate this issue.
2.4 Marriage and civil partnership Describe any impact and evidence in relation to marriage and civil partnership. This can include working arrangements, part time working and caring responsibilities. No evidence of impact for this group since protections apply primary to employment not service delivery. Services are reminded to ensure inclusive language is used on forms and letters.
2.5 Pregnancy and maternity Describe any impact and evidence in relation to Pregnancy and Maternity. This can include working arrangements, part time working and caring responsibilities.
The CCG merger plans do not envisage any changes to maternity provision that will require people to travel longer distances. If at any point in the future, there are any service changes that propose people need to travel further, consideration will need to be given to the impact on patients of additional travel. This will have an impact in terms of cost and time and general difficulty of managing longer travel times while looking after children. This would apply to any potential service change.
Page | 15
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
Maternity services have been working together across BLMK as part of the national maternity transformation programme since 2016. The Local Maternity and Neonatal System Transformation Programme (LMNS) balances the benefits of working on a larger footprint with understanding and responding to local needs. Working across BLMK we have benefited from shared learning, stronger clinical leadership and have funded several specialist posts for example a BLMK Public Health Midwife. Co- production is central to the programme and we have Maternity Voices Partnerships based in each area, linked into local communities and groups.
Several the LMS workstreams are directly targeted as reducing inequality including: • Rolling out continuity of carer teams in geographical areas with a high BAME population • Developing local services and information for women and families with perinatal mental health concerns • Linking with primary care and health visiting to ensure vulnerable families are supported when there is a transfer of care between services • There is also a specific task and finish group looking at how we improve outcomes for BAME women, with a view to reducing the known health inequalities for this group.
2.6 Race Describe race-related impact and evidence. This can include information on different ethnic groups, Roma gypsies, Irish travellers, nationalities, cultures and language barriers.
The ethnicity profile varies across the footprint of the three CCGs, the census data shows that Luton (45.3% of residents are BAME) has a significantly more diverse population than any other area. Milton Keynes (19.6%) and Bedford Borough (19.5%) are more diverse than Central Bedfordshire (6.2%) as shown on the table on the next page.
Ensuring that patients whose first language is not English are appropriately informed of changes will be key. This represents 5.4% of the population in Luton, 3.1% in Bedford Borough and 0.5% - 1.5% in the other areas.2 Historically those whose first language
2 Full details in the population summary
Page | 16
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices. isn’t English have experienced difficulties in accessing services or even being aware that they exist and thus experience health inequalities.
It is also vital to ensure that the CCG’s commissioning decisions give due regard to cultural differences. An example of such concerns was around wig provision. A complainant previously raised the issue that the wig criteria did not include consideration for cultural requirements.
The experiences of COVID-19 has shown the impacts are not felt equally by the population and that vulnerable diverse groups see a disproportionate impact. This has been linked to challenges in accessing services and health inequalities.
The CCG will need to ensure that in its programme of harmonising policies and new commissioning, action is taken to reduce these inequalities.
The table below shows a population snapshot with further information included in the appendices
Ethnicity and language indicators, based on the 2011 census are shown in the appendix 2.6.
The relative proportion of BAME residents in each CCG area / place and its local population can be seen below.3
CCG Percentage of BAME residents in local population4 Luton 45.3% Bedfordshire 11.2% Bedford Borough 19.5% Central Beds 6.2% Milton Keynes 19.6%
3 2011 Census 4 2011 Census
Page | 17
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
Since the ethnicity mix in the three CCGs is not the same (especially with the further variation in the four places in mind), the CCG will need to ensure its workforce is reflective of the population served.
2.7 Religion or belief Describe any impact and evidence in relation to religion, belief or no belief on service delivery or patient experience. This can include dietary needs, consent and end of life issues. Due regard must be given to faith and cultural needs of patients in the review and redesign of services. It is recommended that the CCG engage with local faith leaders to understand key concerns and how they can be addressed to ensure inclusive services.
No particular issues have been identified at this stage but engagement with local faith leaders is recommended to ensure suitable considerations are made in services.
2.8 Sex Describe any impact and evidence in relation to men and women. This could include access to services and employment. The impact on patients and gender can be difficult to determine without making a full study of individual service’s activity data. As men have a lower life expectancy than women this tends to impact on service uptake. No evidence has emerged that services are not meeting the PSED with regard to these groups specifically.
It is recommended that consideration is given to this group in commissioning to address the drivers behind the life expectancy gap.
There are high levels of health inequalities between the least and most deprived areas in BLMK. A baby girl born in Central Bedfordshire can expect to live for 84.4 years, more than six years longer than a baby boy born in Luton at 78.3 years. There is a life expectancy gap of 10 years for men in Bedford Borough, compared to six years for women in Luton.
With variation in life expectancy across the BLMK area, which is linked to health inequalities the CCG will need to ensure that future service change is included in the Health Inequality action plan.
Page | 18
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
In addition it has been highlighted that the impact of the pandemic has affected women significantly, primarily as they are often the primary carer for children. Consideration of this will need to be made during the current Covid period and going forward.
2.9 Sexual orientation Describe any impact and evidence in relation to heterosexual people as well as lesbian, gay and bisexual people. This could include access to services and employment, attitudinal and social barriers. It is not anticipated that patients from the LGBTQ+ community will be impacted by service changes associated with the merger, but providers will be reminded of their obligations to ensure they deliver services inclusively and staff are adequately trained.
It has however been noted that Bedfordshire CCG has received complaints regarding perceived inequality around the requirements for artificial insemination in relation to its IVF policy. This issue will need to be considered by the single CCG in developing its new policy for this to ensure that policy is fair, proportionate and fully considers NICE guidelines
No national data exists around sexual orientation and this was not included in the census. We do know however that this group represents a substantial part of the local population (around 7-10% based on national data), so potentially 50,000-100,000 people within the whole CCG footprint.
We will continue to engage with people of all sexual orientations throughout any change/co-production process.
Page | 19
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.10 Carers Describe any impact and evidence in relation to part-time working, shift-patterns, general caring responsibilities. (Not a legal requirement but a CCG priority and best practice)
With regard to the impact on patients, a key concern for this group will be continuity of care for their patients and any increase in travel times which if increased would add further pressure for carers in terms of time and cost. Noting the demographics these concerns are likely to be greatest for residents in the Central Bedfordshire area, where the proportion of older patients is highest and public transport limited. This represents an area where the CCG can positively impact this group through the delivery of local services via PCN.
As many people have taken on new caring responsibilities during the pandemic it is recommended that all GP practices are encouraged to register as carers with their GP practice.
As part of the engagement around the merger and future service change the engagement should seek to include carers specifically.
In relation to CCG staff, our flexible working policies will support staff to maintain their caring responsibilities.
2.11 Other disadvantaged groups Describe any impact and evidence in relation to groups experiencing disadvantage and barriers to access and outcomes. This can include socio-economic status, resident status (migrants, asylum seekers), homeless people, looked after children, single parent households, victims of domestic abuse, victims of drug/alcohol abuse. This list is not finite. This supports the CCG in meeting its legal duties to identify and reduce health inequalities. The impact of deprivation on health outcomes has been identified as a key factor in several wards within the CCGs areas although the type of deprivation varies.
The four places are primarily urban but Central Bedfordshire is rural. Because of the urban focus, many services are focussed to the three urban centres. Access to public transport outside the urban areas is patchy meaning patient access to services is a key concern with the cost of travel being an issue for low income patients. This is
Page | 20
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices. exacerbated by limited public transport outside the main corridors. Rural bus services have declined with reduction in local authority funding. Consequently, any changes to services and their location would impact patients in all areas (rural areas the most) in terms of travel challenges for those without access to a vehicle. As with other aspects it should be noted that the changes are not expected to increase travel and indeed PCN delivery of services should reduce it. However, the CCG should look to address existing travel concerns in future service design.
In common with other CCG areas, those who are homeless or of no fixed abode remain vulnerable since they are more likely to not be registered with a GP practice, as a result they can be semi invisible in any change at least in the patient data. Consideration will need to be given as to how this group will be kept informed of any changes as well since traditional channels may be less/totally ineffective. We will work closely with Local Authorities and local third sector organisations to engage with homeless people.
Consideration should also be given to digital poverty and the impact that this has on members of the population who can not access on-line support and appointments. There has been an increase in digital provision in response to the Covid-19 pandemic and the CCG will need to consider how it ensures people without digital access will have access to these services.
A further consideration is geographical isolation. This is primarily an issue in rural areas where patients, who may be perceived to be more affluent with access to a vehicle, may see extended travel times to any “central” location. This primarily affects Central Bedfordshire but also affects the periphery of Milton Keynes also.
Where patients are older, driving may cease to be a practical option and unlike urban areas public transport may not be a practical option, only leaving taxis and community transport and support from relatives. This also means that early and late appointments may not be practical for patients in some postcodes to attend.
It is recommended that a review of community / patient transport options is undertaken to ensure that patients can be signposted to suitable transport options to access NHS services.
Page | 21
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
Consideration is needed for a range of vulnerable groups in service design. For those who are homeless access to care is difficult. Many are not registered with a GP, have no fixed abode or phone credit and live in potentially unsafe environments. Services must look to manage an access route for these people since they experience some of the worst health outcomes and high instances of severe mental health problems.
In Milton Keynes, the CCG has established a Vulnerable Peoples Partnership Board in response to Covid which is supporting comms & engagement and could support health inequalities beyond Covid if funded to do so. The CCG will need to consider how to implement the learning from Covid on future services.
Other vulnerable groups are those working in cash in hand roles and or sex work who maybe be reticent to come forward for primary care and preventative care.
There is some evidence that job losses in CCG mergers can fall disproportionately at bands 2-6, which impacts on those less affluent. This is something that decision makers will have to consider in planning the final structure since it will otherwise impact on the population.
Human Rights considerations
The promotion and protection of Human Rights is a core principle for the NHS. No changes proposed around the merger are intended to negatively impact those rights and a range of protections are in place. We must recognise however that there is a risk that as service are reviewed and changes that there could be impacts. There is considerable intersectionality with the protected characteristics, especially disability.
The Human Rights principles are:
• Fairness • Respect • Equality
Page | 22
• Dignity • Autonomy Protection of these rights is reliant on the contracts agreed with those who provide the services on the CCG’s behalf. Requirements on Human Rights are placed in the contracts and compliance with them is monitored as part of the contract management process. A review of complaints, feedback and engagement is key to identify areas where action is required. In addition, work around health inequalities may identify areas where there is a risk of impact around Human Rights.
Health inequality
The population summary in the first section highlights examples of the inequalities that exist within the 3 CCG’s area. A potential risk to inequalities is in redundancies in bands 2-6 which impact the local communities both through the redundancies and also the loss of stable employment opportunities.
With regard to patients the wider policy harmonisation programme needs to take into account local issues and work to reduce them. This is beyond the scope of this EIA, but an EIA is being undertaken on each policy/service change and will include specific consideration to health inequalities – examples being given of these in the earlier sections.
People with a learning disability (LD) die earlier and have poorer physical health than the general population in BLMK. The creation of a single CCG gives us the opportunity to do the following:
1. Share, disseminate and implement change from learning achieved through LeDeR (Learning from Death Reviews). 2. Dramatically improve our Learning Disability Registers in Primary Care to ensure a greater proportion with an LD are captured and offered the support and regular health checks to improve their health and outcomes (we currently do not have anywhere near the level of people with an LD on our registers than exist in our population. 3. Dramatically improve the rate of people with an LD having an Annual Health Check and development of an action plan arising from these checks. 4. Improve the rate of uptake of national screening programmes for people with an LD to ensure early identification of cancers to lead to better and quicker outcomes.
BLMK is both an urban and rural area, rich in social difference – with residents from Black, Asian, and other minority ethnic communities including Eastern European and Gypsy and
Page | 23
Traveller communities residing in the area. It is also a rural catchment, with an older population and is affected by high levels of depravation in other areas.
This means that engagement needs to be socially inclusive and bespoke – reaching out to people for whom English is a second language, those who have disabilities and those who are digitally excluded for economic, language and cultural reasons.
Through the Covid crisis, we have worked with Local Authorities and Police cohesion teams to develop a deeper, richer and shared understanding of our population and have enhanced our engagement, as a result. Furthermore, the pandemic, together with the Black Lives Matter movement has mobilised communities, which has led to the development of community relationships, which had hitherto been difficult to achieve.
As the single CCG is established and we return to business as usual, it is essential that these links are cultivated to ensure that we continue to engage with local communities in a meaningful and timely way, and provide opportunities for services to be shaped by lived realities and experiences.
This enables us to:
• Target the 20% seldom heard from community who are responsible for using 80% of our services; • Engage trusted voices from the community to understand the perspectives and challenges of different communities; • Undertake targeted communications with specific groups around issues with which they have lived experiences, or are adversely affected or impacted; • To collaborate at place with partners and trusted advocates to ensure that local voices are involved in shaping services for their communities.
Stakeholders
Collaboration with stakeholders is central to our Communications and Engagement Strategy and our success going forward. The merger process successfully brought legacy issues to the fore for resolution and the Covid-19 Crisis has allowed for the blurring of organisational lines with stakeholders, allowing for a more integrated way of working to achieve one single aim – to improve outcomes of our population.
As the new CCG is established, our approach to engagement with stakeholders will be retained, with processes being developed to ensure that we continue to work together across a number of strategically important areas to underpin the commissioning process and ensure that our communities are at the centre of all decisions on local services.
The processes that have been developed and will be retained and nurtured include:
Page | 24
• Engagement with GP members, who not only provide clinical leadership to the CCG, but are trusted voices within our communities are advocates for local health and care services; • Collaborating with Elected Members (MPs and Councillors), who are democratically elected to represent the voices of local communities, and play and important role supporting community outreach and cohesion. An honest and transparent relationship with elected members is essential and they have an important role to play as trusted members of the community and advocates of the health and social care strategy locally; • Engagement with Statutory bodies including the Health and Wellbeing Board and Overview and Scrutiny Committees to ensure that plans will continue to meet the needs of our local communities and provide opportunities for more collaborative and inclusive engagement; • Community and cultural groups including Faith and Cultural Leaders and Covid Champions, which provide an opportunity to listen to the views of local residents, understand the issues in each community and enable the Communications and Engagement team to provide richer and evidence based advice to commissioners in developing local services. • Voluntary sector is central to our new strategy to ensure that we can undertake meaningful engagement with organisations that act for significantly underrepresented groups within our communities; • Increased collaboration with Healthwatch, as the group responsible for providing patient insights to health and social care.
A process of continuous engagement is essential to the success of the communications and engagement strategy, especially as we emerge from the Covid crisis into a period of reset and restoration.
Continued Engagement should be planned must and focussed to those groups who are primarily impacted by a change in service in a meaningful and timely manner.
Our engagement work for the merger of the single CCG to date across our key audiences has been captured in the document: Communications and Engagement Plan: January 2020 to March 2021 (including You Said, We did)
Our future communications and engagement strategy has been developed to take into consideration the learning from the Covid crisis and a deeper understanding of the health inequalities that face our population.
Page | 25
Our people Employees from the three CCGs are central to our work. Many of them are local residents who have been severely impacted by the pandemic, whether in terms of loss of loved ones, colleagues or by being part of a period of significant change and adversity within the health service. The NHS People Plan has set out an approach to manage staff and the Communications and Engagement strategy has been developed, with a focus on employee engagement and wellbeing as a key priority. We are currently in the process of engaging across the system to take in best practice examples of employee engagement and organisational culture and development, to bolster our approach going forward, as the new CCG is established.
Key concerns around health inequalities
This analysis takes into account the nine Protected Characteristics of the Equality Act 2010 and the Public Sector Equality Duty.
• Age • Disability • Gender • Ethnicity • Religion and Belief • Pregnancy and Maternity • Gender Reassignment • Marriage and Civil Partnership • Sexual Orientation In addition, consideration has been made for the following other items:
• Caring responsibility • Other Disadvantaged Groups • Geographical Isolation Recommendations:
Page | 26
The programme of review and harmonisation of services which has commenced will need to have an identified workplan with EIAs undertaken on each area and engagement with relevant patients on the service design.
Such service redesign must also take account of local health inequalities. It is anticipated that additional work will be required to gain an understanding of these.
To support this, place-based population profiles have been produced for each area. (Bedford Borough, Central Bedfordshire, Luton and Milton Keynes)
Taking a population health management approach will also support the new CCG in identifying and addressing health inequalities. Coterminosity with the BLMK ICS footprint means that the BLMK CCG will have the ability to access more funding to address health inequalities.
The process will be done with the aim of being fair and inclusive and give due regard to the relevant NHS standard and the Equality Act, Public Sector Equality Duty and Human Rights Act.
1. Deprivation and Geographical Isolation It is recommended that while consideration for deprivation is not part of the Equality Act 2010, consideration should be made in any future changes of the impact of service change on access to services. Such considerations must consider rural deprivation as well and geographical isolation as well. Information and reports illustrating the deprivation of the CCG’s area can be found here
Geographical isolation is a particular concern for rural parts of Bedfordshire as opposed to the other areas and illustrates the need to ensure that the places give due regard to population types. Mosaic data is available for consideration on service design that illustrates the type of housing, access to vehicles and should be considered.
Even within urban areas the CCG should be mindful in future service planning that the cost of travel can have a significant impact on those on low incomes and also that travel corridors are focussed to commuting and north south travel.
The impact of COVID-19 in particular has been significant, for patients in terms of impact on income and on transport providers. Bus services in particular have seen a sustained reduction in use, which has impacted on their viability. While COVID-19 remains (January 2021) a key issue we must recognise that the post COVID-19 travel landscape will have changed.
Page | 27
2. A review of the impact of travel on access to services While the merger is not expected to result in any worse travel and indeed the rollout of local services via PCN is expected to reduce the need to travel to hospitals, patients have indicated travel as a concern.
It is recommended that this be considered in future health inequality studies and that service planning seeks to reduce travel for patients.
Noting that patients may have to travel to other practices, provision of information on community transport options / signposting will be helpful for patients.
3. Patient focus group involvement With the likelihood of a programme of service change and improvement to follow the merger, it is recommended that the CCG identify patient focus groups to be involved in the new service design. We are currently in the process of developing a Team BLMK community of residents, who will be drawn upon, depending on their lived experiences, to provide insights into all service changes. These groups will be reflective of the population and the key impacts identified in the EIA to ensure decisions are subject to check and challenge and are as inclusive as possible.
Page | 28
Future work
Engagement will need be undertaken as part of the review of services for patients which will need to include a follow up review and feedback once changes have been made. This will help to ensure due regard to the Public Sector Equality Duty in the CCGs approach.
The NHS Equality Delivery system will also provide an opportunity to review and gauge the success of the process, further areas of work, staff and patient views.
A review and update of the population profiles and information using the data from the 2021 Census once available is recommended to ensure the most up to date information is available to support Commissioning decisions.
Appendices
Showing an overview of the equality profile of the four places in chart and table format.
Drawn from 2011 Census and ONS midyear updates. (sourced via Nomis)
Page | 29
Appendix I - Age profiles of the four places
Age profiles of the populations served with Bedfordshire, Bedford Borough and Central Bedfordshire. 5
Age NHS Luton CCG Percentage Under 16 years 51,854 24.2 16 – 24 23,853 11.1 25 – 64 112,532 52.4 65 – 84 22,766 10.6 85 and over 3,653 1.7
Total 214,658 Age NHS Milton Keynes Percentage Under 16 years 62,488 22.8 16 – 24 25,065 9.2 25 – 64 148,985 54.4 65 – 84 32,950 12 85 and over 4,341 1.6
Total 273,829 Age Central Bedfordshire Percentage Under 16 years 55,271 19.7 16 – 24 24,686 8.8 25 – 64 150,498 53.7 65 – 84 43,695 15.6 85 and over 5,880 2.1
5 Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates (2017) Most recent data has been used where possible
Page | 30
Age Bedford Percentage Under 16 years 35,130 20.7 16 – 24 16,855 9.9 25 – 64 88,172 51.9 65 – 84 25,490 15 85 and over 4,265 2.5
Total 169,912 Total 273,829
Age NHS Bedfordshire CCG (for Percentage comparison) Under 16 years 90,401 20.1 16 – 24 41,541 9.2 25 – 64 238,670 53 65 – 84 69,185 15.4 85 and over 10,145 2.3
Total 449,942
Page | 31
Luton: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate)
Page | 32
Milton Keynes: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate)
Page | 33
Bedford Borough: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate)
Page | 34
Central Bedfordshire: population by single year of age and gender, compared against the England benchmark (ONS 2019 mid-year estimate)
Page | 35
Appendix II Population disability profile based on the 2011 Census6
CCG Indicator % England %
Luton Limiting long term illness or disability, 15.1% 2011 MK Limiting long term illness or disability, 13.9% 2011 Bedford Limiting long term illness or disability, 16% 17.6% Borough 2011 Central Limiting long term illness or disability, 14.4% Bedfordshire 2011 Bedfordshire Limiting long term illness or disability, 13.9 2011
Pie charts showing disability profiles:
6 2011 Census
Page | 36
Page | 37
Page | 38
Page | 39
Appendix III Ethnicity profile of the CCGs and places7 Indicators NHS Luton Percentage CCG NHS Luton England CCG Black and minority ethnic population 92,122 45.3 14.6 Population whose ethnicity is not 'White UK' 112,671 55.4 20.2 Population who cannot speak English well or 10,476 5.4 1.7 at all Indicators Central Percentage Bedfordshire Central England Bedfordshire Black and minority ethnic population 15,659 6.2 14.6
Population whose ethnicity is not 'White UK' 26,328 10.3 20.2 Population who cannot speak English well or 1,259 0.5 1.7 at all Black and minority ethnic population 15,659 6.2 14.6 Indicators Bedford Percentage Borough Bedford England Black and minority ethnic population 30,633 19.5 14.6 Population whose ethnicity is not 'White UK' 44,891 28.5 20.2 Population who cannot speak English well or 4,710 3.1 1.7 at all Indicators NHS Milton Percentage Keynes CCG NHS Milton England Keynes CCG Black and minority ethnic population 49,906 19.6 14.6 Population whose ethnicity is not 'White UK' 65,250 25.7 20.2 Population who cannot speak English well or 3,714 1.5 1.7 at all Indicators NHS Percentage Bedfordshire NHS England CCG Bedfordshire CCG’s Black and minority ethnic population 46,292 11.2 14.6 Population whose ethnicity is not 'White UK' 71,219 17.3 20.2 Population who cannot speak English well or 5,969 1.5 1.7 at all
7 ONS 2017 Mid-Year estimates
Page | 40
Pie charts showing ethnicity profiles:
Page | 41
Page | 42
Appendix B
Population summaries for Luton and Milton Keynes, Bedford Borough Council, Central Bedfordshire Council – January 2021
Page 1
Population summaries for Luton and Milton Keynes, Bedford Borough Council, Central Bedfordshire Council Contents Luton ...... 3 Luton population snapshot ...... 3 Health inequalities profile...... 4 Milton Keynes ...... 10 Milton Keynes population snapshot ...... 10 Health inequalities profile...... 12 Bedford Borough Council ...... 16 Bedford Borough Council population snapshot ...... 16 Health inequalities profile...... 17 Central Bedfordshire Council ...... 21 Central Bedfordshire Council population snapshot ...... 21 Health inequalities profile...... 22
This report has been produced to support Bedford, Luton and Milton Keynes CCGs in their merger and in commissioning services for their patients. The areas covered match the CCG and Local Authority areas. In recognition of the variation between the 2 areas the Bedford CCG area this has been subdivided into the 2 areas. The data in this report is taken from the 2011 Census, JSNAs, local public health reports, published ONS data1 and published Public Health data. The population summaries will be updated once data from the 2021 census becomes available.
1 Published reports use the 2017 Mid Year estimates and these have been used for consistency and to match with data in published local health population summaries for each area. Newer mid year estimates are available from 2019 but are only published in the raw data format.
Page 2
Luton
Luton population snapshot2 According to the Office for National Statistics (ONS) 2017 Mid-year Population Estimates, Luton’s population is 214,658. The statistics show that the population fell by 1,256 between 2016 and 2017; a fall driven by an increase of internal migration out of Luton to other parts of the UK and a slowing of international migration. The table below shows that Luton has a younger population.
Population by age group, 2017
Age NHS Luton CCG Percentage
Under 16 years 51,854 24.2
16 – 24 23,853 11.1
25 – 64 112,532 52.4
65 – 84 22,766 10.6
85 and over 3,653 1.7
Total 214,658 Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates
The 2011 census estimated that the Luton’s population was 55% White, while Black and Minority Ethnic (BME) residents was estimated at 45%. 5.4% of the population cannot speak English well or at all, which is much higher than the England average at 1.7%. Ethnicity and language indicators, 2011, numbers and percentage
Indicators NHS Luton CCG Percentage
NHS Luton CCG England
Black and minority 92,122 45.3 14.6 ethnic population
Population whose 112,671 55.4 20.2 ethnicity is not 'White UK'
Population who cannot 10,476 5.4 1.7 speak English well or at all
2 Analysis of population estimates tool - Office for National Statistics (ons.gov.uk)
Page 3
Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates The ethnic composition of Luton fits a model known as ‘super-diversity’ with approximately 55 per cent of the population coming from Black, Asian and Minority Ethnic (BAME) origin. There is an increasing number of BAME communities within the population each with its own needs and cultures. Luton has a long history of migration into the area both from elsewhere in the UK and overseas.3 There have been long-standing African-Caribbean, Bangladeshi, Indian, Irish and Pakistani communities in Luton as a result of international migration. More recently, the migration patterns have become more complex. In the mid-1990s, the opening of the University of Bedfordshire caused a rapid growth in the student population of the town. This growth has been sustained with an increase in numbers of overseas students. In the mid-2000s, the expansion of the European Union led to a significant increase in migration from eastern European countries, particularly Poland and Lithuania. There has also been migration from African countries such as the Congo, Ghana, Nigeria, Somalia and Zimbabwe. There is also a Turkish population in Luton. More recently, National Insurance Registration data has demonstrated further increases in international migration with Romanians moving to the town after the change in law allowing them the right to work in the UK at the beginning of 2014. Analyses of translation service data also highlighted the levels of diversity in the town by identifying over 120 languages or dialects being spoken by residents. This provides corroborating evidence of Luton being a super-diverse place. Additionally, statistics show that about 30,587 of people, 15% of the population, lived with a limiting long term illness or disability in 2011. This is significantly better compared to the England average of 17.6%4.
Long-term health conditions and morbidity Indicator NHS Luton CCG England
Limiting long-term illness or disability, 2011 15.1% 17.6%
Source: ONS Census
Health inequalities profile The health profile in Luton is varied compared with the England average. Luton is one of the 20% most deprived districts/unitary authorities in England and about 19% (9,960) children live in low-income families. Life expectancy for both men and women is lower than the
3https://www.luton.gov.uk/Health_and_social_care/Lists/LutonDocuments/PDF/Annual%20public%20 health%20reports/luton-annual-public-health-report-2018.pdf 4https://www.luton.gov.uk/Community_and_living/Lists/LutonDocuments/PDF/JSNA/2%20Healthy%20 People.pdf
Page 4
England average. Life expectancy is 9.7 years lower for men and 4.1 years lower for women in the most deprived areas of Luton than in the least deprived areas. The table below shows that the average life expectancy at birth for a child born in Luton according to information on inequalities in 2015-2017 was 78.3 years for males and 82.3 years for females, which is slightly below the England average for females at 83.1 years, and males at 79.6 years. The next table below also shows the gap in life expectancy between the most deprived and least deprived quintile of Luton in 2015-17. It shows that life expectancy in the most deprived area is at 74.6 years for males and 80.2 years for females. In the least deprived areas, life expectancy is 81.5 years for males and 83.6. Information on inequalities between Luton as a whole and England as a whole in 2015-17 Male Female
Life expectancy in Luton (years) 78.3 82.3 Life expectancy in England (years) 79.6 83.1 Absolute gap in life expectancy between Luton and England (years) -1.3 -0.9
Source: ONS
Information on inequalities between the most deprived and least deprived quintile of Luton in 2015-17 Male Female
Life expectancy in most deprived quintile of Luton (years) 74.6 80.2 Life expectancy in least deprived quintile of Luton (years) 81.5 83.6 Absolute gap in life expectancy between most and least deprived -6.9 -3.4 quintile (years)
Source: Public Health England
With regard to the broad causes of death for both sexes, as the chart below shows, cancer, circulatory diseases and respiratory diseases are the biggest causes of death for both sexes.
Page 5
Chart showing the breakdown of the life expectancy gap between the most deprived quintile and least deprived quintile of Luton, by broad cause of death, 2015-17
Source: Public Health England based on ONS death registration data and mid year population estimates, and Index of Multiple Deprivation, 2015 Note: Circulatory includes heart disease and stroke. Respiratory includes flu, pneumonia, and chronic lower respiratory disease. Digestive includes alcohol-related conditions such as chronic liver disease and cirrhosis. External includes deaths from injury, poisoning and suicide. Mental and behavioural includes dementia and Alzheimer's disease.
With regard to child health, Public Health England Local Authority Health Profile 2019 reveals that in Luton in Year 6, 25.9 per cent (811) of children are classified as obese, which is worse than the average for England. The rate for alcohol-specific hospital admissions among those under 18 is 12 per 100,000, which is better than the average for England. This represents 7 admissions per year. Additionally, the levels of GCSE attainment (average attainment 8 score) are worse than the England average; while the levels of breastfeeding and smoking in pregnancy are better than the England average.
Page 6
As for adult health, Public Health England indicates in its Luton Local Authority Health Profile 2019 that:
• The rate for alcohol-related harm hospital admissions is 772 per 100,000. This represents 1,392 admissions per year which is considered worse than the average for England. • The rate for self-harm hospital admissions is 188 per 100,000. This represents 420 admissions per year. • Estimated levels of physically active adults (aged 19+) are worse than the England average. • The rate of new cases of tuberculosis is worse than the England average • The rates of statutory homelessness, violent crime (hospital admissions for violence), under 75 mortality rate from cardiovascular diseases, under 75 mortality rate from cancer and employment (aged 16-64) are worse than the England average.5
Amongst the health issues to consider is diabetes. In Luton in 2018/19, there were 14,725 people, aged 17 years or older, who had been diagnosed with diabetes and included on GP registers in NHS Luton CCG, which equals 8.2 per cent of the population. However, the total prevalence of people with diabetes, diagnosed and undiagnosed, is estimated to be 10.3 per cent. The percentage of people with type 1 diabetes who achieved the blood glucose target of ≤58 mmol/ml (7.5 per cent) in the NHS Luton CCG was 29.3 per cent compared to 31.1 percent in England. The percentage of people with type 2 diabetes who achieved the blood glucose target of ≤58 mmol/ml (7.5 per cent) in the NHS Luton CCG was 60.5 per cent compared to 66.5 per cent in England. People with diabetes are at a higher risk of having a heart attack or stroke. In this area, people with diabetes were 140.8 per cent more likely than people without diabetes to have a heart attack. This was higher than the figure for England which was 86.9%. People with diabetes were also 70.2 per cent more likely to have a stroke. This was higher than the figure for England where there was a 58.5 per cent greater risk. Public Health England statistics show that, in NHS Luton CCG, type 1 diabetes is more common in males than females at 59.0 per cent, and 49.1 per cent of people with type 1 diabetes, are under the age of 40. Type 2 diabetes is also more common in males than females at 54.8 per cent, and people with type 2 diabetes are on average older than people with type 1. For instance, 40.3 per cent of people with type 2 diabetes in NHS Luton CCG are aged over 65. With regard to ethnicity, statistics show that, in NHS Luton CCG, 62.1 per cent of people with type 1 diabetes are White and 34 per cent are from BAME, the remaining ethnicities are unknown. For people with type 2 diabetes, 36.3 per cent are White and 55.5 per cent from BAME backgrounds, the remaining ethnicities are unknown. As for the risk of mortality, people with diabetes rarely die as a direct result of diabetes. Most die from complications such as heart disease, stroke and kidney failure. People with diabetes are more likely to die than their peers of the same age and sex in the general population. For instance, the additional risk of mortality for people with diabetes was 18.0 per cent in NHS Luton CCG; compared to the England additional risk at 21.8 per cent.6
5 https://fingertips.phe.org.uk/static-reports/health-profiles/2019/E06000032.html?area-name=Luton 6 Diabetes - PHE
Page 7
As for heart disease, statistics show that in NHS Luton CCG the early mortality rates (under 75 years) from coronary heart disease (CHD) are not significantly different from the England rate. The NHS Luton CCG area mortality rate has decreased by 44.4 per cent since 2004- 2006. In the three-year period 2016-2018, the early mortality rate for CHD in NHS Luton CCG area was 43.5 per 100,000 people. In 2018/19 the admission rate for CHD in NHS Luton CCG was 763.6 for every 100,000 people in the population (1,155 admissions). This is significantly higher than the England rate (488 per 100,000). Getting treatment quickly is important for a serious heart attack, where the coronary artery is blocked. In 2018/19, the East of England Ambulance Service Trust recorded 1,275 patients with a serious heart attack in 2018/19, who received appropriate primary PCI (pPCI) treatment (a procedure used to treat the narrowed or obstructed coronary arteries of the heart). The mean time to pPCI for these patients was 134 minutes, from the first call for help. In England this was 129.0 minutes. Additionally, in 2018/19 there were 4,467 people aged 18 years and over who had been diagnosed with chronic kidney disease (CKD) in the NHS Luton CCG area. This represents 2.5 per cent of the registered population aged 18 or over. This information is still being collected from some GP practices. The acceptance rate onto Renal Replacement Therapy (RRT) in 2012 to 2017 for NHS Luton CCG was 142.1 per million population compared to the England rate of 113.8. There were 233 NHS Luton CCG residents receiving RRT in 2017. The change in the number of residents receiving RRT between 2012 and 2017 was 18.3 per cent. In NHS Luton CCG during 2017, the percentage of people receiving RRT who had a renal transplant was 55.4 per cent, a further 2.6 per cent received home dialysis and 42.1 per cent received hospital dialysis. Statistics also show that in 2018/19 there were 2,991 people who had previously been diagnosed with a stroke in NHS Luton CCG. In the same period there were 226 admissions recorded on the Sentinel Stroke National Audit Programme (SSNAP). The diagnosed prevalence of atrial fibrillation (AF) in the NHS Luton CCG area is 1.1 per cent and the estimated prevalence is 1.8 per cent. There could be an additional 1,700 people with undiagnosed atrial fibrillation in the CCG. In NHS Luton CCG, 28.6 per cent of stroke patients admitted who had a history of atrial fibrillation were not prescribed anticoagulation; this is lower than the England rate (38.9 per cent). In the SSNAP audit data for NHS Luton CCG, 10 per cent of people who had AF diagnosed prior to their stroke admission and were not on anticoagulation at admission were either completely independent or had no significant disability after their stroke: 40 per cent of people died as a result of their stroke. Early mortality rates (under 75 years of age) for stroke in NHS Luton CCG were 18.2 per 100,000 people. This was significantly higher than the England rate (12.8). Later mortality rates (over 75 years of age) from stroke in NHS Luton CCG were 503.8 per 100,000 people. This was not significantly different from the England rate (506.3)7. With regard to cancer in NHS Luton CCG8:
• At the end of 2015, around 4,997 people were living up to 21 years after a cancer diagnosis. This is projected to rise to 8,060 by 2030.
7 Cardiovascular Disease - PHE 8 https://lci.macmillan.org.uk/England/06p/prevalence
Page 8
• Between 2011 and 2015 there was an average of 597 new cancer diagnoses per 100,000 people each year, which is similar to the England average of 614. • Between 2011 and 2015 there was an average of 294 cancer deaths for every 100,000 people per year, which is similar to the England average of 285. • One-year cancer survival rate was 68.9% in NHS Luton CCG for people diagnosed during 2015, which is lower than the England average of 72.3%.
Cancer prevalence by ethnicity shown as Ten year total cases for the years 2006-2015 9
Cancer types Asian Black White
Breast cancer 120 57 633 Colorectal 37 26 331 Non-Hodgkin lymphoma 34 23 110 Prostate 45 110 523 Head and neck 20 - 105 Kidney, renal pelvis and ureter 12 6 75 Lung, trachea and bronchus 8 - 151 Ovary 20 - 65 Stomach - 6 20 Uterus 21 - 107
9 http://www.ncin.org.uk/view?rid=3579
Page 9
Milton Keynes
Milton Keynes population snapshot In 2016, the population of Milton Keynes was estimated to be 264,480; between 2001 and 2016 the population increased by 51,780 people, over 24%, and this is expected to continue into the future as outlined in the Population Bulletin 2016/17. Although the Milton Keynes population age profile is slightly younger than England as a whole, the older age groups are forecast to have high growth rates. For instance, in 2016, 23% of the Milton Keynes population were under 16 compared with 19.1% in England. Additionally, 63.9% of the Milton Keynes population were aged 16-64 compared with 63.1% in England and 13.1% of the Milton Keynes population are aged 65+ compared with 17.9% in England. The largest population proportion of Milton Keynes in 2016 is within the age of 30-39 years old, whilst the largest population proportion in England is 45-54 years old. In 2016, the Milton Keynes’ highest proportion in both the genders was 0-9 and 30-39 years old, approximately 16% for each, both were higher than England’s proportion in the same age groups. The number of people aged 85 and over in Milton Keynes is expected to increase by 86% from 4,300 in 2017 to 8,000 by 2030.
Population by age group, 2017
Age NHS Milton Keynes CCG Percentage
Under 16 years 62,488 22.8
16 – 24 25,065 9.2
25 – 64 148,985 54.4
65 – 84 32,950 12
85 and over 4,341 1.6
Total 273,829 Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates The 2011 Census estimated that 25.7% of the population in Milton Keynes were from an ethnic group other than ‘White UK’ compared with 20.2% in England. Additionally, 19.6% of the population were from the BAME community compared to 14.6% in England. Between 2001 and 2011 the ethnic diversity of the Milton Keynes population increased more than that for England as a whole. In 2001, 13.2% of Milton Keynes residents were from an ethnic group other than ‘White UK’. By 2011, this number increased to 25.7% of Milton Keynes residents being from an ethnic group other than ‘White UK’.
Page 10
The breakdown of the population shows that between 2001 and 2011 the Black African ethnic section of the population grew from 1.3% to 5.2%. In 2011, this was then the largest single ethnic group. This was followed by the ‘Other White’ group which also grew considerably, from 2.5% of the population to 5.1%. This group included migrants from the countries that became members of the EU from 2004-2007. The Indian population accounts for 3.3% of the Milton Keynes population, plus 1.5% of the Milton Keynes population being Pakistani. In 2011, it was also estimated that 18.5% of the population in Milton Keynes were born outside of the UK, which is significantly higher than England at 13.8%. The 2011 Census outlined that the number of Milton Keynes residents born outside of the UK more than doubled from 20,500 at 9.9% in 2001 to 46,100 at 18.5% in 2011. According to ONS, the rate of turnover amongst international migrants in 2013 in Milton Keynes was 13.3 per 1,000 population similar to the England figure of 13.4 per 1,000. However, the internal migration turnover was 81.3 per 1,000 population. Further, in 2016, 6.4% of households in Milton Keynes have no adult who has English as their main language. 88.7% of households in Milton Keynes have all adults in the households with English as their first language and 93.6% have at least one adult with English as their first language. As the table below shows, the 2011 census estimated that the black and minority ethnic population in NHS Milton Keynes CCG area were 19.6% with 1.5% of the population cannot speak English well or at all.
Ethnicity and language indicators, 2011, numbers and percentage
Indicators NHS Milton Keynes Percentage CCG
NHS Milton Keynes CCG England
Black and minority 49,906 19.6 14.6 ethnic population
Population whose 65,250 25.7 20.2 ethnicity is not 'White UK'
Population who 3,714 1.5 1.7 cannot speak English well or at all Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates In relation to disability, statistics show that, in 2011, 35,341 people, about 13.9% of the population, lived with some long-term limiting illness in Milton Keynes. This is significantly better than the England average at 17.6%. Long-term health conditions and morbidity
Page 11
Indicator NHS Milton England Keynes CCG Limiting long term illness or disability, 2011 13.9% 17.6%
Source: ONS Census
Health inequalities profile This section summarises the health and inequalities profiles in NHS Milton Keynes CCG. The table below shows that the average life expectancy at birth for a child born in Milton Keynes according to information on inequalities in 2015-2017 was 79.2 years for males and 83.2 years for females, which is similar to the England average for females at 83.1 years, and males at 79.6 years. The next table below also shows the gap in life expectancy between the most deprived and least deprived quintile of Milton Keynes in 2015-17. It shows that life expectancy in most deprived area is at 75 years for males and 80.5 years for females. In the least deprived areas, life expectancy is 81.6 years for males and 85.8. Information on inequalities between Milton Keynes as a whole and England as a whole in 2015-17 Male Female
Life expectancy in Milton Keynes (years) 79.1 83.1 Life expectancy in England (years) 79.6 83.1 Absolute gap in life expectancy between Milton Keynes and England -0.4 0.1 (years) Source: ONS
Information on inequalities between the most deprived and least deprived quintile of Milton Keynes in 2015-17 Male Female
Life expectancy in most deprived quintile of Milton Keynes (years) 74.9 80.5 Life expectancy in least deprived quintile of Milton Keynes (years) 81.6 85.8 Absolute gap in life expectancy between most and least deprived -6.6 -5.4 quintile (years)
Source: Public Health England
Page 12
Chart showing the breakdown of the life expectancy gap between the most deprived quintile and least deprived quintile of Milton Keynes, by broad cause of death, 2015-17
Source: Public Health England based on ONS death registration data and mid year population estimates, and Index of Multiple Deprivation, 2015 Note: Circulatory includes heart disease and stroke. Respiratory includes flu, pneumonia, and chronic lower respiratory disease. Digestive includes alcohol-related conditions such as chronic liver disease and cirrhosis. External includes deaths from injury, poisoning and suicide. Mental and behavioural includes dementia and Alzheimer's disease
In its Local Authority Health Profile 2019, Public Health England gives a picture of people’s health in Milton Keynes. The health of people in Milton Keynes is generally similar to the England average. About 15.1 per cent (8,680) children live in low income families. Life expectancy for both men and women is similar to the England average. Life expectancy is 7.3 years lower for men and 6.9 years lower for women in the most deprived areas of Milton Keynes than in the least deprived areas.
Page 13
In Year 6, 20.3 per cent (711) of children are classified as obese. The rate for alcohol- specific hospital admissions among those under 18 is 22 per 100,000 people, which represents 15 admissions per year. The levels of smoking in pregnancy are worse than the England average, while the levels of breastfeeding are better than the England average.
For adult health, the rate for alcohol-related harm hospital admissions is 621 per 100,000 people, representing 1,489 admissions per year. The rate for self-harm hospital admissions is 131 per 100,000 population, better than the average for England. This represents 345 admissions per year. The rates of new sexually transmitted infections and killed and seriously injured on roads are better than the England average. In 2018/19 there were 14,724 people, aged 17 years or older, who had been diagnosed with diabetes and included on GP registers in NHS Milton Keynes CCG. This is equal to 6.4 per cent of the population. However, the total prevalence of people with diabetes, diagnosed and undiagnosed, is estimated to be 7.5 per cent. People with diabetes are at a higher risk of having a heart attack or stroke. In this area, people with diabetes were 111.8 per cent more likely than people without diabetes to have a heart attack. This was higher than the figure for England which was 86.9 per cent. NHS Milton Keynes CCG, people with diabetes were also 85.3 per cent more likely to have a stroke. This was higher than the figure for England where there was a 58.5 per cent greater risk. In NHS Milton Keynes CCG, early mortality (under 75 years) rates from coronary heart disease (CHD) are significantly lower than the England rate. This has decreased by 57.4% since 2004- 2006. For instance, in the three year period 2017-2019, the early mortality rate for CHD in NHS Milton Keynes CCG was 31.8 per 100,000 people compared to England rate at 37.5 per 100,000. In 2019/20 the admission rate for CHD in NHS Milton Keynes CCG was 615.2 for every 100,000 people in the population (1,370 admissions), which is significantly higher than the England rate at 470 per 100,000. In 2019/20, the South Central Ambulance Service Trust recorded 739 patients with a serious heart attack in 2019/20, who received appropriate primary PCI (pPCI) treatment, a procedure used to treat the narrowed or obstructed coronary arteries of the heart. The mean time to pPCI for these patients was 122 minutes, from the first call for help. In England this was 134.0 minutes. In 2019/20 there were 3,302 people who have previously been diagnosed with a stroke in NHS Milton Keynes CCG. In 2018/19 there were 224 admissions recorded on the Sentinel Stroke National Audit Programme (SSNAP). Although the diagnosed prevalence of atrial fibrillation (AF) in this CCG area is 1.5 per cent and the estimated prevalence is 1.9 per cent, there could be an additional 1275 people with undiagnosed atrial fibrillation in the area. In the SSNAP audit data for NHS Milton Keynes CCG, 26.4 per cent of people who had AF diagnosed prior to their stroke admission and were not on anticoagulation at admission were either completely independent or had no significant disability after their stroke. However, 21.1 per cent of people died as a result of their stroke. Early mortality rates (under 75 years of age) for stroke in NHS Milton Keynes CCG were 13.1 per 100,000 people, which was not significantly different from the England rate at 12.5 per 100,000. Later mortality rates (over 75 years of age) from stroke in NHS Milton Keynes CCG were 502.9 per 100,000 people. This was not significantly different from the England rate at 479.4 per 100,000.
Page 14
In 2019/20 there were 5,212 people aged 18 years and over who had been diagnosed with chronic kidney disease (CKD) in NHS Milton Keynes CCG. This represents 2.3 per cent of the registered population aged 18 or over.
The acceptance rate onto Renal Replacement Therapy (RRT) in 2013 to 2018 for NHS Milton Keynes CCG is 114.4 per million population compared to the England rate of 116.2. There were 262 patients receiving RRT in 2018. The change in the number of residents receiving RRT between 2013 and 2018 was 37.2 per cent. During 2018, the percentage of people receiving RRT who had a renal transplant was 65.3 per cent, a further 6.1 per cent received home dialysis and 28.6 per cent received hospital dialysis. Additionally, at the end of 2015, around 7,632 people in NHS Milton Keynes CCG were living up to 21 years after a cancer diagnosis. This could rise to an estimated 12,310 by 2030. In the NHS Milton Keynes CCG area between 2011 and 2015 there was an average of 627 new cancer diagnoses per 100,000 of the population each year compare to the England average of 614. The cancer mortality in the NHS Milton Keynes CCG area at the same period was an average of 298 cancer deaths for every 100,000 people per year, which is higher than the England average of 285. As for the survival rate, one-year cancer survival rate was 71.8 per cent in NHS Milton Keynes CCG for people diagnosed during 2015, which is close to the England average of 72.3 per cent10.
Ten year total case numbers (2006-2015) of cancer cases by ethnicity11
Cancer types Asian Black Chinese White
Breast cancer 43 33 12 1,185 Colorectal - - - 556 Non-Hodgkin lymphoma 9 - - 219 Prostate 22 40 - 897 Kidney, renal pelvis and ureter - - - 154 Leukaemia - - - 146 Testis - - - 80 Uterus - - - 152
10 Local Cancer Intelligence England | Local Cancer Intelligence | Macmillan Cancer Support 11 http://www.ncin.org.uk/view?rid=3579
Page 15
Bedford Borough Council
Bedford Borough Council population snapshot According to the Office for National Statistics (ONS) 2017 Mid-year Population Estimates, Bedford population is 169,912. It is estimated that the population will increase to around 193,200 by 2030, with the fastest rise being 65 years old and over. Around two thirds live in the urban areas of Bedford, and around one third live in the surrounding rural areas.
An estimated 65,100 people in Bedford are over the age of 50, of whom 31,200 are over 65 and 4,500 are over 85 (ONS 2017). Most notably, the 85+ population is forecast to increase by around 20% by 2025. This will have major implications for health and social care services in the area. The table below shows the population by age group.
Population by age group, 2017
Age Bedford Percentage
Under 16 years 35,130 20.7
16 – 24 16,855 9.9
25 – 64 88,172 51.9
65 – 84 25,490 15
85 and over 4,265 2.5
Total 169,912
Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates
As the table below shows, the 2011 census estimated that the Black, Asian and Minority ethnic (BAME) population in Bedford were 19.5% with 3.1% of the population who cannot speak English well or at all.
Up to 100 different ethnic groups live in Bedford Borough. More than 1 in 3 people in Bedford and Kempston are from BAME groups, compared to less than 1 in 8 in rural areas. Bedford Borough’s BME population has increased substantially in recent years; from 19% in the 2001 Census to 29% in 201112.
12 http://www.bedford.gov.uk/jsna
Page 16
Ethnicity and language indicators, 2011, numbers and percentage
Indicators Bedford Percentage
Bedford England
Black and minority 30,633 19.5 14.6 ethnic population
Population whose 44,891 28.5 20.2 ethnicity is not 'White UK'
Population who 4,710 3.1 1.7 cannot speak English well or at all
Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates In relation to disability, statistics show that, in 2011, 25,201 people, about 16% of the Bedford population, reported having some long-term health problem or condition limiting their daily activities in Bedford. This is slightly better than the England average at 17.6%. However, according to the statistics the prevalence of limiting conditions increases with age, with 50% of the population with a long term condition being over 65 in 201113.
Long-term health conditions and morbidity
Indicator Bedford England
Limiting long term illness or disability, 2011 16.0% 17.6%
Source: ONS Census
Health inequalities profile This section summarises the health and inequalities profiles in Bedford. The health of people in Bedford varies compared with the England average. The table below shows that the average life expectancy at birth for a child born in Bedford according to information on inequalities in 2015-2017 was 79.9 years for males and 83.2 years for females, which is similar to the England average for females at 83.1 years, and males at 79.6 years. The next table below also shows the gap in life expectancy between the most deprived and least deprived quintile of Bedford in 2015-17. It shows that life expectancy in most deprived
13 Vulnerable_Groups_-_Physical_Disability___Sensory_Impairment.pdf (windows.net)
Page 17
area is at 75.3 years for males and 80.3 years for females. In the least deprived areas, life expectancy is 83.5 years for males and 86.1 for females14.
Information on inequalities between Bedford as a whole and England as a whole in 2015-17 Male Female
Life expectancy in Bedford (years) 79.9 83.2 Life expectancy in England (years) 79.6 83.1 Absolute gap in life expectancy between Bedford and England (years) 0.3 0.1
Information on inequalities between the most deprived and least deprived quintile of Bedford in 2015-17
Male Female
Life expectancy in most deprived quintile of Bedford (years) 75.3 80.3 Life expectancy in least deprived quintile of Bedford (years) 83.5 86.1 Absolute gap in life expectancy between most and least deprived -8.3 -5.9 quintile (years)
Source: Public Health England
With regard to the broad causes of death in Bedford, as the chart below shows, cancer, circulatory diseases and respiratory diseases are the biggest causes of death for both sexes.
For instance, between 2015 and 2017, 1,372 people died prematurely in Bedford. The main causes were cancer, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD) and diabetes15.
14 Segment Tool (phe.gov.uk) 15 JSNA-Annual-Summary-2019.pdf (windows.net)
Page 18
Chart showing the breakdown of the life expectancy gap between the most deprived quintile and least deprived quintile of Bedford, by broad cause of death, 2015-17
Source: Public Health England based on ONS death registration data and mid year population estimates, and Index of Multiple Deprivation, 2015 Note: Circulatory includes heart disease and stroke. Respiratory includes flu, pneumonia, and chronic lower respiratory disease. Digestive includes alcohol-related conditions such as chronic liver disease and cirrhosis. External includes deaths from injury, poisoning and suicide. Mental and behavioural includes dementia and Alzheimer's disease
In its Local Authority Health Profile 2019, Public Health England gives a picture of people’s health in Bedford. About 14.9% (4,960) children live in low income families. Life expectancy for both men and women is similar to the England average.
In Year 6, as the Public Health England Local Authority Health Profile 2019 for Bedford points out, 21.1% (431) of children are classified as obese. The rate for alcohol-specific hospital admissions among those under 18 is 21 per 100,000 population, which represents 8
Page 19
admissions per year. Levels of GCSE attainment (average attainment 8 score) are worse than the England average. The levels of breastfeeding and smoking in pregnancy are better than the England average.
For adult health, the rate for alcohol-related harm hospital admissions is 593 per 100,000 people, representing 973 admissions per year. The rate for self-harm hospital admissions is 217 per 100,000 population, which is worse than the average for England. This represents 345 admissions per year. The rates of new sexually transmitted infections and killed and seriously injured on roads are better than the England average. Other health issues in Bedford, include:
• 61% of adults are classified as overweight or obese. • Unhealthy alcohol use is estimated to be common in Bedford with 35% of adults drinking above the recommended guidelines of no more than 14 units of alcohol each week, which increases the risk of damaging their health. • 749 people in Bedford were receiving treatment for drug addiction in March 2019. • In 2017 the prevalence of HIV was 2.6 per 1,000, which means that Bedford Borough is considered by Public Health England to be a high prevalence area. • Coverage of seasonal influenza vaccination uptake for at risk and under 65 years patients has consistently remained below the national ambition of 55%. Provisional data for 2018/19 shows that uptake in this group was 45.6%, down from 48.3% the previous year. • NHS Health Check uptake is low with only 48.3% of invited people attending their NHS Health Check compared to 50.3% across areas with a similar level of deprivation. In 2016-17, approximately 812 people were diagnosed with cancer in Bedford. Cancer was the largest cause of premature deaths, with the most common types being prostate and colorectal in men and breast and colorectal cancers in women. Between 2015 and 2017, the under 75 mortality rate was 261 per 100,000 for women, and 389 per 100,000 for men.
In 2017/18, 5,326 (2.9%) residents were known to have coronary heart disease (CHD) in Bedford. One of the main risk factors for cardiovascular disease is high blood pressure. Over 25,400 people (14%) in the Borough have a recorded diagnosis of hypertension. Another important risk factor is diabetes; 10,208 adults are known to be living with diabetes and an estimated 2,400 people are undiagnosed.
Mental health is also another issue16. In Bedford, it is projected that, at least one in four people, about 40,000 people, will experience a mental health problem at some point in their life and around half of people with lifetime mental health problems experience their first symptoms by the age of 1417.
16 This will also be an issue in other areas but is highlighted particularly in this JSNA 17 JSNA-Annual-Summary-2019.pdf (windows.net)
Page 20
Central Bedfordshire Council Central Bedfordshire Council population snapshot According to the Office for National Statistics (ONS) 2017 Mid-year Population Estimates, Central Bedfordshire Council population is 280,030. The largest portion of the population, 150,498 people (53.7%), in Central Bedfordshire Council, is aged between 25 to 64 years old. The table below shows the population by age group.
Population by age group, 2017
Age Central Bedfordshire Percentage
Under 16 years 55,271 19.7
16 – 24 24,686 8.8
25 – 64 150,498 53.7
65 – 84 43,695 15.6
85 and over 5,880 2.1
Total 280,030 Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates
Ethnicity and language indicators, 2011, numbers and percentage
Indicators Central Bedfordshire Percentage
Central Bedfordshire England
Black and minority 15,659 6.2 14.6 ethnic population
Population whose 26,328 10.3 20.2 ethnicity is not 'White UK'
Population who 1,259 0.5 1.7 cannot speak English well or at all Source: Office for National Statistics (ONS) Small Area Mid-Year Population Estimates + Office for National Statistics (ONS) Mid-year Population Estimates
In relation to disability, statistics show that, in 2011, 36,607 people, about 14.4% of the Central Bedfordshire population, reported having some long-term health problem or condition limiting their daily activities in Central Bedfordshire. This is slightly better than the England average at 17.6%.
Page 21
Long-term health conditions and morbidity
Indicator Central England Bedfordshire Limiting long term illness or disability, 2011 14.4% 17.6%
Source: ONS Census
Health inequalities profile This section summarises the health and inequalities profiles in Central Bedfordshire. The health of people in Central Bedfordshire varies compared with the England average. The table below shows that the average life expectancy at birth for a child born in Central Bedfordshire according to information on inequalities in 2015-2017 was 81.4 years for males and 84.4 years for females, which is slightly better than the England average for females at 83.1 years, and males at 79.6 years. The next table below also shows the gap in life expectancy between the most deprived and least deprived quintile of Central Bedfordshire in 2015-17. It shows that life expectancy in most deprived area is at 77.4 years for males and 81.3 years for females. In the least deprived areas, life expectancy is 83.6 years for males and 86.9 for females18.
Information on inequalities between Central Bedfordshire as a whole and England as a whole in 2015-17 Male Female
Life expectancy in Central Bedfordshire (years) 81.4 84.4 Life expectancy in England (years) 79.6 83.1 Absolute gap in life expectancy between Central Bedfordshire and 1.9 1.3 England (years)
Information on inequalities between the most deprived and least deprived quintile of Central Bedfordshire in 2015-17
Male Female
Life expectancy in most deprived quintile of Central Bedfordshire 77.4 81.3 (years) Life expectancy in least deprived quintile of Central Bedfordshire 83.6 86.9 (years) Absolute gap in life expectancy between most and least deprived -6.2 -5.6 quintile (years)
Source: Public Health England
18 Segment Tool (phe.gov.uk)
Page 22
With regard to the broad causes of death in Central Bedfordshire, as the chart below shows, cancer, circulatory diseases and respiratory diseases are the biggest causes of death for both sexes.
Chart showing the breakdown of the life expectancy gap between the most deprived quintile and least deprived quintile of Central Bedfordshire, by broad cause of death, 2015-17
In its Local Authority Health Profile 2019, Public Health England gives a picture of people’s health in Central Bedfordshire. About 11.3% (5,765) children live in low income families. Life expectancy for both men and women is higher than the England average.
The Public Health England Local Authority Health Profile 2019 for Central Bedford gives a picture of people’s health in Central Bedfordshire. It is designed to act as a ‘conversation starter’, to help local government and health services understand their community’s needs, so that they can work together to improve people’s health and reduce health inequalities. In Year 6, 14.9% (482) of children are classified as obese, better than the average for England. The rate for alcohol-specific hospital admissions among those under 18 is 24 per 100,000. This represents 15 admissions per year. Levels of GCSE attainment (average
Page 23
attainment 8 score) are worse than the England average.19 Levels of breastfeeding and smoking in pregnancy are better than the England average.
With regard to adult health, the rate for alcohol-related harm hospital admissions is 587 per 100,000, better than the average for England. This represents 1,613 admissions per year. The rate for self-harm hospital admissions is 163 per 100,000, better than the average for England. This represents 440 admissions per year. Estimated levels of smoking prevalence (in routine and manual occupations) are better than the England average. The rates of new sexually transmitted infections and new cases of tuberculosis are better than the England average. The rate of killed and seriously injured on roads is worse than the England average. The rates of statutory homelessness, violent crime (hospital admissions for violence), under 75 mortality rate from cardiovascular diseases and employment (aged 16- 64) are better than the England average.
19 While published reports compare with the England average a comparison against other local authorities in its deprivation decile is recommended for a complete picture. Measures for deprivation can fail to provide a full picture since they may not identify the specifics of each area.
Page 24
Appendix C
Equality analysis of the formation of a single commissioning organisation for the Bedfordshire, Luton and Milton Keynes CCGs’ area – workforce impact
Page | 1
Contents Introduction ...... 3 BLMK CCG Mission [draft] ...... 3 Our mission is to optimise health and wellbeing for our population, advance health equality in our communities and make the best use of NHS resources...... 3 BLMK CCG Vision [draft] ...... 4 Evidence used ...... 4 Overview of the CCGs involved ...... 6 NHS BLMK ...... 6 Bedfordshire ...... 6 Bedford Borough...... 6 Central Bedfordshire ...... 7 Health in Bedfordshire ...... 7 Luton ...... 7 Milton Keynes ...... 7 2. Anticipated impact summary section ...... 10 2.1 Age ...... 10 2.2 Disability ...... 10 2.3 Gender reassignment (including transgender) ...... 11 2.4 Marriage and civil partnership ...... 12 2.5 Pregnancy and maternity ...... 12 2.6 Race ...... 12 2.7 Religion or belief ...... 14 2.8 Sex ...... 14 2.9 Sexual orientation ...... 14 2.10 Carers ...... 15 2.11 Other disadvantaged groups ...... 15 Appendices ...... 20
Page | 2
Introduction
The following Equality Analysis has been produced as part of NHS Bedfordshire, Luton, and Milton Keynes CCGs’ (BLMK) proposal of the formation of a single commissioning organisation. In keeping with the principles of robust Equality Analysis and to demonstrate the CCGs’ commitment to the principles of the Public Sector Equality Duty (PSED) this work has been undertaken to support the merger process.
It is recognised that the initial impact of any such change will be felt first by the workforces of each CCG. Based on previous such changes, it is anticipated that some redundancies will be necessary, with considerable staff redeployment and changes to roles taking place. To this end the CCGs have commissioned Arden & GEM Commissioning Support Unit to carry out a workforce analysis of each of the 3 CCG’s staff base. Recommendations have also been set out for key considerations to be made during the management of change process and other arrangements subject to the approval of the proposed change.
An EIA has also been undertaken regarding the impacts on the current population demographic of the 3 CCGs with a view to providing a baseline for any future harmonisation of approach and policies. This data allows a comparison of populations and allows decision makers to identify any differences in the demographic and key considerations that will be required to ensure consideration for vulnerable groups.
As part of the process, population demographic reports have been produced which provide a baseline for any future harmonisation of approach and policies. This data shows a comparison of populations, which enables decision makers to identify differences in the demographic and any key considerations that will be required to ensure consideration for vulnerable groups. In depth workforce profiles reports for the 3 CCGs have also been produced. The EIA should be seen in company with the population summaries, workforce data and initial EIA previously undertaken.
The three Clinical Commissioning Groups (CCGs) in Bedfordshire, Luton, and Milton Keynes (BLMK) are applying to NHS England and Improvement to come together as one organisation (one CCG) by April 2021. Over the last 18 months we have been working closely together to improve the health and wellbeing of the population we serve. The new CCG’s mission and vision is to:
BLMK CCG Mission [draft]
Our mission is to optimise health and wellbeing for our population, advance health equality in our communities and make the best use of NHS resources.
Page | 3
BLMK CCG Vision [draft]
Our vision that:
As a strategic commissioner, we will optimise health and wellbeing for our population by:
• Enabling effective collaborations of providers and primary care networks, supporting an evidence-based approach to the design of health and care services
• Enabling local place-based partnerships to support more people to manage and improve their own physical and mental health and wellbeing, and tackle the wider factors that impact people’s health
• Promoting clinical best practice and quality improvement across the system
The new CCG is committed to reducing inequalities and unwarranted variation and will be taking action to deliver on this agenda which will benefit the BLMK population and CCG staff. Therefore, the merger of the three CCGs provides the opportunity to address health inequalities and deliver improvements in BLMK. The new BLMK CCG will be coterminous with the Integrated Care System (ICS), and therefore able to support the development of strategic commissioning through the local Integrated Care Partnerships (ICPs) in Bedfordshire and Milton Keynes and the Primary Care Networks (PCNs). We believe that having a single CCG, instead of three separate organisations will allow us to make better use of our resources, reduce duplication and share good practice. Our proposal will enable us to maximise investment and transformation opportunities ultimately improving the health and care of people living in Bedfordshire, Luton and Milton Keynes. Details of our proposal are described in our case for change.
This EIA has been produced to provide an assessment of the impact of the proposed merger on the CCG’s staff. This EIA looks at the impact of proposed changes with regard to the nine protected characteristics of the Equality Act 2010 and other key concerns such as carers, other vulnerable groups and health inequalities. This is to support the CCG in meeting its duties under the Public Sector Equality Duty, evidence equality considerations and demonstrate due regard is being taken to the findings. (These specific duties are set out on the next page)
Evidence used • Population demographic data for the three CCG areas
Bedfordshire CCG local population data (this data is no longer published) www.localhealth.org.uk
Page | 4
https://www.milton-keynes.gov.uk/your-council-and- elections/statistics/population-statistics https://www.luton.gov.uk/Community_and_living/Luton%20observatory%20c ensus%20statistics%20and%20mapping/Pages/default.aspx https://www.lutonccg.nhs.uk/page/?id=3405 JSNA for each Local Authority area 2011 Census data https://www.nomisweb.co.uk/reports/lmp/la/contents.aspx Office of National Statistics Mid-Year estimates for the relevant areas / localities / places) https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigrat ion/populationestimates/datasets/clinicalcommissioninggroupmidyearpopulat ionestimates
• Living longer in good health Bedfordshire, Luton and Milton Keynes Longer Term Plan (2019 – 2024) for improving health and care
• Health and Wellbeing in Milton Keynes, July 2019 What makes our population healthy? How good are our population health outcomes?
• CCG workforce data o NHS Workforce Race Equality Standard data o Staff Profiles from ESR
• CCG complaints data – (it should be noted that actions will already have been taken in response to these as they are historic)
• Examples of CCG’s who have successfully completed a merger
Page | 5
Overview of the CCGs involved
NHS BLMK
Over one million people live in the Bedford Borough, Central Bedfordshire, Luton and Milton Keynes – the BLMK area, and BLMK is one of the fastest growing areas in the country.
The number of people aged 85 and over is projected to double by 2035 and it is predicted that there will be higher than average growth in the number of adults aged 65 and over and the number of children and young people aged 10-19 years old. Across BLMK, women in the healthiest areas enjoy 22 more years in good health than those in the least healthy areas. For men the gap is 15 years.
As more people in these older age groups tend to have long-term, and sometimes multiple, health conditions, this presents a significant challenge for both health and social care. We are also expecting a higher than average growth in the number of children and young people aged 10-19 years old. Bedford Borough and Central Bedfordshire, Luton and Milton Keynes are all very different places that are also diverse within themselves.
Bedfordshire
The area currently covered by Bedfordshire CCG runs from the north of Bedford to the Luton boundary in the south.
It is covered by two local authorities, Bedford Borough Council (supporting a population of 184,097) and Central Bedfordshire Council (supporting a population of 258,461).
Bedford Borough
Bedford Borough is mostly urban, containing the towns of Bedford, Kempston and the Wixams new town development, surrounded by a rural area with many villages. There are significant ethnic minority communities and you’ll hear more than 100 languages being spoken in Bedford. The borough has seen large scale migration over recent years, particularly from Eastern Europe, as well as Africa, Asia and the Middle East.
Life expectancy in Bedford Borough is increasing and, when last recorded in 2015, was 80.2 years for men and 83.9 years for women.
Page | 6
However, there are some areas of deprivation and the life expectancy gap between Bedford’s most and least deprived areas is 10 years for women and 4.2 years for men.
Central Bedfordshire
Central Bedfordshire is a mix of rural villages and small market towns and is the least ethnically diverse of the BLMK areas. Life expectancy is better than the national average, at 81.4 years for males and 84.4 years for females, but there are some pockets of deprivation, mainly around Sandy, Houghton Regis and Dunstable.
Comparing the most and least deprived areas of Central Bedfordshire, there is a life expectancy gap of 6.7 years for men and 5.8 years for women.
Health in Bedfordshire
In deprived areas of Bedfordshire, early death is mainly due to cancer, circulatory and respiratory diseases.
Compared to similar areas, more people die early from heart disease in Bedford Borough and from breast cancer in Central Bedfordshire. In Bedford Borough, preventable deaths from cardiovascular disease are particularly high.
Hospital admissions for cardio-pulmonary disease, and admissions for asthma in under 19s, are both high in Bedfordshire.
Luton
Luton, covered by Luton Borough Council, is home to 237,690 people and has a higher than average number of young people. Luton is the most urban BLMK area and also the most culturally diverse. More than half the people living in Luton are of Black, Asian and Minority Ethnic (BAME) origin and there are an increasing number of BAME communities in Luton, each with its own needs and cultures.
Milton Keynes
The borough of Milton Keynes, covered by Milton Keynes Council, has a population of 300,000.
Page | 7
Around 90% of the population live in Milton Keynes itself, although the town only covers 20% of the land area. The remaining 10% of the population live in the borough’s rural areas that includes a number of rural villages and the small town of Olney.
The population is ethnically diverse with over a quarter coming from a Black, Asian and Minority Ethnic (BAME) group.
(full details of each area are provided in the supporting Population summary)
The CCG workforce are recruited from across the area and beyond, a full breakdown of the staff profile of each CCG can be found in the accompanying workforce reports.
Equality Issue Context / Details For Bedford CCG there was incomplete data on the It is recommended that staff across the CCGs be Electronic Staff Record regarding the protected encouraged to update ESR data to ensure that the characteristics Religion or Belief, and Sexual records are complete. Orientation. Information about the representation of these protected characteristics should be considered unreliable.
For Luton CCG disability, religion or belief, and sexual orientation in this report may be unreliable due to the proportion of the workforce for whom information on these protected characteristics was not held.
For Milton Keynes CCG, data was incomplete on disability, ethnicity, religion or belief, and sexual orientation in this report may be unreliable due to the proportion of the workforce for whom information on these protected characteristics was not held.
It is often regarded as a relevant factor in how inclusive an organisation is, as to how willing staff are to declare their equality information via ESR. The percentage of staff who have chosen to declare their disability is lower than NHS averages for Bedford CCG (5%) and even lower for the other 2. This leaves an uncertain picture when taken with the missing / withheld data.
With planned / proposed changes is particularly important for the CCGs need to have a clear understanding of which staff have a disability and require reasonable adjustments. A new organisation is however recommended to encourage staff to update their information and declare any disabilities they have. The events during Covid – 19 has highlighted the importance still further and it is important that staff risk assessments undertaken are taken into account.
It is not anticipated that the absence of full data with regard to Religion and Belief and marital status will be an issue since in previous CCG changes no evidence of significant impact was found for this group.
Page | 8
The percentage of staff who have not declared their sexual orientation is in line with NHS averages and while the CCG / CCGs would wish to raise declaration levels, it will bear this in mind during the process to ensure that due regard is given to staff from this group.
The proportion of BAME staff within each CCG o Bedford CCG workforce varies considerably; a factor in this maybe • BAME people were nearly proportionately the differing ethnicity profiles of the working age represented in the workforce 14% populations of the respective areas served by each o Luton CCG CCG but this • BAME people were proportionately represented in the workforce 43% o Milton Keynes CCG • BAME people were proportionately represented in the workforce 21%
It is pleasing to see that each CCG is generally reflective of the population it serves. The single CCG will need to consider the need to ensure that it remains reflective of the 4 places it will serve. It should be noted that the CCG will draw staff from across the region with other towns within commuting distance.
The NHS recognises that nationally BAME staff are not consistently represented at a senior level, in line with the NHS Workforce Race Equality standard the CCG will need to give regard to this issue in recruitment for future roles and in appointing to any new organisation.
Staff were predominantly female at all 3 CCGs. There • Bedford CCG 86% was less evidence for a higher proportion of men at • Luton CCG 82% higher pay bands in across 2 of the CCGs than in • Milton Keynes CCG 76% some other CCGs nationally. The above profile is fairly standard in the NHS as a whole but with some variation between the CCGs consideration will need to be given in forming a new organisation to ensure that male and female staff are treated equitably.
A significant proportion of staff across the 3 CCGs o Bedford CCG 40.6% part time work part time and this should be considered as part of o Luton CCG 30% the merger. Feedback during the engagement o Milton Keynes CCG 26% suggests staff who work part time are more likely to have caring responsibilities and will be concerned about increased travel across a wider footprint.
Page | 9
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.1 Age Describe age-related impact and evidence. This can include safeguarding, consent and welfare issues.
The age profile of each CCG’s staff is in line with that of other NHS organisations.
Concerns have been raised in previous CCG change programmes that older staff feel more vulnerable to redundancy, but this is also true for younger staff who are likely to have fewer years’ service and experience on average compared to longer serving staff. Consequently, these staff will then be more fearful about any change where the potential of redundancy could occur. It is acknowledged that all staff undergoing a change programme will feel the impacts and stress during this change as roles alter, the need to apply for and interview for roles. It may also see staff unsettled as they see themselves and their colleagues displaced. Staff support processes seek to mitigate this, but the impact cannot be fully mitigated.
It is recommended when communicating to staff that the CCG is mindful of such concerns. As has been organised for Executive Directors and Associate Directors as part of the organisational re-structure pension advice and guidance sessions are being arranged to support staff at this time since those staff close to retirement may be particularly concerned with planning.
As will be noted from the charts in the appendix, the age profile of the 3 CCGs is fairly similar, indicating that there is less likely to be a differential impact on different age groups from the merger.
2.2 Disability Describe disability-related impact and evidence. This can include attitudinal, physical, communication and social barriers as well as mental health/learning disabilities, cognitive impairments.
Staff who have a disability are, based on experience, likely to be more concerned by any such changes since many rely on the support of the organisation and any reasonable adjustments they have in place. In addition, disabled staff often have an experienced based viewpoint that finding another suitable role will be an additional
Page | 10
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices. challenge due to the inequality of opportunity experienced by this group in the wider job market and environment.
It is recommended that in managing change and any potential office relocations that consideration is made to mitigate potential impacts for this group. This might require for example placing a team with a wheelchair user in a particular office space which has more space for turning for example. Employees with a number of conditions may be unable to drive / or find longer journey more difficult this should be considered and reasonable adjustments made.
If a member of staff has a mental health condition or learning disability, they may be more sensitive to changes of line management as these can be traumatic. While this cannot always be avoided consideration should be given to supporting such staff and if possible, minimising the number of changes if possible. Pie charts showing the CCGs’ profile is shown in appendix 2.1.
It should be noted that the percentages (see the appendix) represent fairly small numbers so the overall percentage should be considered statistically similar.
2.3 Gender reassignment (including transgender) Describe any impact and evidence in relation to transgender people. This can include issues such as privacy of data and harassment.
There is no evidence that this group will be specifically affected by the proposed change. However, it should be noted that this group will be particularly sensitive of working with new colleagues due to their awareness of the staff member’s personal circumstances and the security of personal data when transmitted to a new organisation. All staff should be aware of the need to be sensitive to this.
Additional considerations should be given with regard to changes of line management since this may increase the number of people who have to be aware of an individual’s personal circumstances and how they chose to identify.
Page | 11
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.4 Marriage and civil partnership Describe any impact and evidence in relation to marriage and civil partnership. This can include working arrangements, part time working and caring responsibilities.
No evidence of impact.
2.5 Pregnancy and maternity Describe any impact and evidence in relation to Pregnancy and Maternity. This can include working arrangements, part time working and caring responsibilities.
Members of staff who are due to go on maternity leave, shared parental leave or paternity leave, are currently on such leave or have just returned may feel especially vulnerable. As with those with caring responsibilities changes in role, base and travel will be a particular concern for this group.
The CCGs must also ensure that staff absent from the workplace are involved in any consultations and kept fully informed while not at work.
2.6 Race Describe race-related impact and evidence. This can include information on different ethnic groups, Roma gypsies, Irish travellers, nationalities, cultures and language barriers.
The ethnicity profile varies across the footprint of the three CCGs, the census data shows that Luton (45.3% of residents are BAME) has a significantly more diverse population than any other area. Milton Keynes (19.6%) and Bedford Borough (19.5%) are more diverse than Central Bedfordshire (6.2%) as shown on the table on the next page.
Since the ethnicity mix in the three CCGs is not the same (especially with the further variation in the four places in mind), the CCG will need to ensure its workforce is reflective of the population served.
Page | 12
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
Historically it has been identified that BAME staff are more likely to be negatively impacted in a merger situation, especially where the percentage of BAME staff varies between the CCGs merging. With this in mind, the CCG has set out a plan to mitigate this as much as possible through a robust management of change policy, recruitment training and the availability of support for staff.
The relative proportion of BAME staff in each CCG and its local population can be seen below.1
CCG Staff Profile (BAME) CCG local population2 Luton 45.6% 45.3% Bedfordshire 23.2% 11.2% Milton Keynes 13.8% 19.6%
Since the BAME total in the 3 CCGs is not the same, it will be vital to ensure that any redundancies are proportionate, and that the CCG’s final total is reflective of the whole population served and the staff base. This will require further work and action around policies approaches and staff training. (It should be noted that the percentage of BAME people is higher in Bedford town which is not reflected here). A visual representation of the ethnicity of CCG staff is included in the appendix 2.6.
1 2011 Census 2 2011 Census
Page | 13
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.7 Religion or belief Describe any impact and evidence in relation to religion, belief or no belief on service delivery or patient experience. This can include dietary needs, consent and end of life issues.
No evidence of impact
2.8 Sex Describe any impact and evidence in relation to men and women. This could include access to services and employment.
There is some variation within the CCGs on the balance of men and women as a whole and in each band, particularly at a senior level. In line with the NHS average the CCGs have a much higher proportion of women than men employed. (Milton Keynes has a higher number of male staff than is average for a CCG – 29% of all staff) Any future redundancies are likely to impact more on women than men but are expected to be in line with the proportion of such in the workforce. A representation of the CCGs’ gender split in the workforce is shown in appendix 2.8.
2.9 Sexual orientation Describe any impact and evidence in relation to heterosexual people as well as lesbian, gay and bisexual people. This could include access to services and employment, attitudinal and social barriers.
With regard to workforce, a member of the LGBT community may have been in a position where they were happy in their team to be out / have disclosed their sexual orientation and with a change of manager and teams this could be a cause of concern and leave the staff member feeling vulnerable. There is no clear solution to this, but it must be recognised as something line managers must be sensitive to.
Page | 14
2. Anticipated impact summary section
This section sets out the expected impacts of the merger on residents within the CCGs’ area. Additional supporting data is included in the appendices.
2.10 Carers Describe any impact and evidence in relation to part-time working, shift-patterns, general caring responsibilities. (Not a legal requirement but a CCG priority and best practice)
As part of the process around the merger and future service change the engagement should seek to include carers specifically.
A key concern for staff with caring responsibilities will be around working hours, travel time, working pattern and job security. This must be considered by the CCG and where possible reasonable adjustments made to support such staff. This can be addressed through the CCG’s agile working policy. It should be noted that as the charts in appendix 2.10 show each CCG has 32% (aggregated to 36%) or more staff working some form of part time hours. Therefore, any new structure must take this into account and not assume whole time posts only.
With this in mind our flexible working policies will support staff to maintain their caring responsibilities.
2.11 Other disadvantaged groups Describe any impact and evidence in relation to groups experiencing disadvantage and barriers to access and outcomes. This can include socio-economic status, resident status (migrants, asylum seekers), homeless people, looked after children, single parent households, victims of domestic abuse, victims of drug/alcohol abuse. This list is not finite. This supports the CCG in meeting its legal duties to identify and reduce health inequalities.
There is some evidence that job losses in CCG mergers can fall disproportionately at bands 2-6, which impacts on those less affluent. This is something that decision makers will have to consider in planning the final structure since it will otherwise impact on the population.
A further potential impact is for those staff who work on projects for the CCGs but are employed by other organisations such as CSUs. It is not anticipated that the formation of
Page | 15
a single Commissioning Organisation itself will change their roles, but it is possible future planning may. At such point considerations such as TUPE would potentially apply. With this in mind, CSU staff for whom TUPE is deemed to apply, should be considered in the planning of teams. With many items the impact here is hypothetical and depends on future decisions on contracts and in housing. This analysis takes into account the 9 Protected Characteristics of the Equality Act 2010 and the Public Sector Equality Duty.
• Age • Disability • Gender • Ethnicity • Religion and Belief • Pregnancy and Maternity • Gender Reassignment • Marriage and Civil Partnership • Sexual Orientation In addition, consideration has been made for the following other items:
• Caring responsibility • Other Disadvantaged Groups • Distance of travel • Staff under employ by other organisations such as a CSU who may be affected by TUPE The primary source for information on the CCG’s workforce has been data held on Electronic Staff record.
Key recommendations to ensure Due regard and compliance to the Public Sector Equality Duty in organisational change. It is intended that these actions will ensure mitigations are in place to the potential impacts identified. As a key priority the CCG should develop a management of change policy that gives specific regard to the following aspects:
• Recommendations around Disabled Staff
Page | 16
o Some staff may not have declared a disability but have been working in a way that amounts to a reasonable adjustment, but this has not been formalised. If roles change this position may need to change. o All managers are responsible for ensuring that they are aware of the particular needs of their staff, for example if office moves are proposed, the manager must ensure these take account of individual needs such as access and personal evacuation plans. o To avoid singling out disabled staff, managers should have a general discussion with each member of their team to see if there are particular aspects of their circumstances that they feel should be taken into account. o Due regard to be given in redeployment to maintaining any reasonable adjustments in place. o Consideration given to how any additional travel requirements in a role covering a larger area are managed with regard to their impact on any disabled member of staff, with the intention of managing the impact fairly.
• Part Time Staff o It is recognised that during such a process the work patterns of staff may change. Due regard must be given to treating part time staff, many of whom have caring responsibilities fairly.
The data shows that a significant number of staff work part time in both CCGs but due to the difference in Male / Female staff balance the figures appear slightly different. (full details can be found in the workforce reports for each CCG – taken October 2020).
• In the planning of teams, roles and workforce these numbers must be taken into account though there is no absolute link between band and work pattern shown. • Further detail of the profile of part time workers by band in each CCG is shown in the workforce report
• Caring responsibilities
o This aspect can be hard to quantify and is a hidden impact on worker’s lives. o The CCG is recommended to provide specific reassurance to all staff in support of those who are carers. o Due regard must given in the creating of roles and structures to the impact of working hour changes, travel and base on such staff over and above the general impact of these changes on other staff. o Examples of reasonable adjustments which can be made are: . Compressed hours
Page | 17
. Remote working . Job shares In addition to any management of change it is recognised that the CCG is likely to review the current estate usage and seek to make savings overall. No firm decision has been made yet with regard to the approach to be taken, e.g. place based commissioning so further impact is difficult to ascertain with any certainty. The considerations that will need to be made with regard to property / base change are:
• In any relocation / estate rationalisation any member of staff with a disability must be supported appropriately. It is important to avoid disruptions to the staff members agreed adjustments during this time. For example, this may mean that the move of individual teams (with such a member of staff) are delayed until the relevant power doors are fitted, evacuation chair training or office furniture is in place, or an alternative suitable arrangement is made. (It is anticipated that the member of staff would be consulted on these considerations.) • With a larger geographical area of operation, the need for staff to travel further seems likely o In previous such formations of a single Commissioning Organisations, staff have had travel time and mileage protected for a set period. o Again with regard to disability some staff may find travel more difficult and this must be taken into account and reasonable adjustments made.
Further recommended support actions to support staff It is recognised that such a period of change will be one of concern for all staff and with this in mind, the CCG will introduce a range of support measures to mitigate this issue where possible for staff. It is recommended that the CCG maintain effective support mechanisms enabling staff to raise any workforce / equality issues appropriately. It is noted that in previous formations of a single Commissioning Organisation such an approach has been key to a successful outcome. The emerging staff networks will also be a useful route for staff to raise themes and gain peer support. It is also recommended that the CCG plan proactive activities that support staff mental health and wellbeing, throughout the organisational change process. Practically this means that:
Page | 18
o HR support is available to staff who wish to seek it, from the start of the process. o Union drop in / contact arrangements are published across the CCGs footprint o Details of how to access the CCG’s staff support service are advertised internally by poster and via internal facing internet / intranet pages. . The staff support service allows staff to access an independent advice line for a range of issues at a time convenient to them. It is hoped that this will provide an additional independent support mechanism. It also important that workforce activities resulting from the formation of a single Commissioning Organisation such as the development of a new structure and job roles are created with regard to and assessed for their impact on vulnerable staff groups, with reasonable adjustments identified and put in place.
It is noted that an Organisational Development programme is currently being delivered and this has already given due regard to such concerns. It is recommended based on other such changes that specific training is provided to responsible managers on recruitment and Equality and Diversity before undertaking their roles in this process. Human Rights It is not anticipated that the merger will impact on the Human Rights of staff. Staff would transfer between 2 NHS organisations with the same terms and conditions and protections. Future work
Once the merger has taken place and the management of change has seen staff in post a review is recommended to identify whether any groups have been disproportionality impacted. This should take place at between 6 – 12 months post merger.
Feedback could be planned as part of the next staff survey and feedback sought from the staff networks.
A further workforce report detailing the single CCG is recommended to ensure effective comparison. Where the workforce has more development to be representative of the population served this should see a recruitment plan produced to address this. This will link effectively with the CCG’s commitments and obligations under the NHS Workforce
Page | 19
Race Equality Standard, Equality Objectives and Public Sector Equality Duty commitments.
The NHS Equality Delivery system will also provide an opportunity to review and gauge the success of the process, further areas of work and staff views.
Appendices
Showing an overview of the CCG’s workforce against the equality profile of the four places in chart format. The full data set is available in the workforce reports which show the workforce profile in October 2020.
Drawn from 2011 Census and ONS midyear updates. (sourced via Nomis), workforce data drawn from ESR.
Page | 20
NHS Bedford CCG
Local Working Age Population* NHS Bedfordshire CCG Workforce
50 to 64 Age 16 to 29 Age 29 and 32.0% 23.9% under 50 and 6.3% over 49.5% 30 to 49 44.3% 30 to 49 44.1%
Disability** Disabled Disability Disabled 4.0% 5.9%
Not Not Disabled Disabled 96.0% 94.1%
BME Ethnicity BME Ethnicity 11.2% 13.5%
White White 88.8% 86.5%
Male Male Gender Gender 13.5% 49.5%
Female 50.5% Female 86.5% Divorced‡ Marital Status Single Divorced‡ Marital Status Single 13.8% 36.6% 9.1% 21.9%
Married† Married† 49.6% 69.0%
Religion Religion Atheist Christian Atheist Christian 31.1% 62.6% 19.7% 63.7%
Other Other 6.3% 16.6%
Page | 21
LGBO Sexual Orientation LGBO Sexual Orientation 2.6% 0.6%
Hetero- Hetero- sexual sexual 97.4% 99.4% * NHS Bedfordshire CCG area population aged 16 to 64 years old, 2019 ONS mid-year estimate (age, gender), 2011 UK Census (disability, ethnicity, marital status, religion or belief), 2018 Annual Population Survey - East of England region (sexual orientation - adults) ** Disabled local population estimate: Those who described their day-to-day activities as “limited a lot” in the 2011 UK Census † Married includes Civil Partnership, ‡ Divorced includes legally separated and widowed
NHS Luton CCG
Local Working Age Population* NHS Luton CCG Workforce
50 to 64 Age Age 29 and 16 to 29 25.2% under 28.3% 50 and over 2.2% 47.2% 30 to 49 50.6% 30 to 49 46.6%
Disability** Disabled Disability Disabled 4.9% 3.8%
Not Not Disabled Disabled 95.1% 96.2%
Ethnicity Ethnicity
BME BME 44.2% White 42.9% White 55.8% 57.1%
Gender Male Gender Male 18.0% 51.6%
Female 48.4% Female 82.0%
Page | 22
Divorced‡ Marital Status Divorced‡ Marital Status Single 12.0% Single 11.0% 20.7% 42.7%
Married† 45.3% Married† 68.3%
Religion Christian Religion Christian 49.7% 67.1% Atheist Atheist 19.4% 5.7%
Other Other 27.1% 30.9% LGBO Sexual Orientation LGBO Sexual Orientation 2.6% 0.0%
Hetero- Hetero- sexual sexual 97.4% 100.0% * NHS Luton CCG area population aged 16 to 64 years old, 2019 ONS mid-year estimate (age, gender), 2011 UK Census (disability, ethnicity, marital status, religion or belief), 2018 Annual Population Survey - East of England region (sexual orientation - adults) ** Disabled local population estimate: Those who described their day-to-day activities as “limited a lot” in the 2011 UK Census † Married includes Civil Partnership, ‡ Divorced includes legally separated and widowed
NHS Milton Keynes CCG
Local Working Age Population* NHS Milton Keynes CCG Workforce
50 to 64 Age 16 to 29 Age 29 and 28.5% 23.5% 50 and under over 1.1% 46.3% 30 to 49 52.6% 30 to 49 47.9%
Disability** Disabled Disability Disabled 4.4% 4.8%
Not Not Disabled Disabled 95.6% 95.2%
Page | 23
BME Ethnicity BME Ethnicity 18.6% 20.7%
White White 81.4% 79.3%
Male Male Gender Gender 24.2% 49.9%
Female 50.1% Female 75.8% Single Divorced‡ Marital Status Single Divorced‡ Marital Status 19.4% 14.6% 38.1% 10.8%
Married† Married† 47.3% 69.9%
Atheist Religion Atheist Religion 34.9% Christian 25.4% 55.5% Christian 68.3% Other Other 6.3% 9.6% LGBO Sexual Orientation LGBO Sexual Orientation 2.8% 2.9%
Hetero- Hetero- sexual sexual 97.2% 97.1% * NHS Milton Keynes CCG area population aged 16 to 64 years old, 2019 ONS mid-year estimate (age, gender), 2011 UK Census (disability, ethnicity, marital status, religion or belief), 2018 Annual Population Survey - South East region of England (sexual orientation - adults) ** Disabled local population estimate: Those who described their day-to-day activities as “limited a lot” in the 2011 UK Census † Married includes Civil Partnership, ‡ Divorced includes legally separated and widowed
Page | 24
Governing Bodies in Common in Public 16 March 2021
4.2 One BLMK CCG Programme Update
Author: Maria Wogan, Programme Director
Contact Information: 07837 892711 - [email protected]
Lead Executive: Geraint Davies
Which CCGs does this paper apply to?
Bedfordshire Luton Milton Keynes
Information
Which activity does this paper One BLMK CCG Programme – progress relate to?
How? Provides a report on progress with delivery of the programme
What is the Committee/ Note the report Governing Body being asked to do? What are the financial None implications?
Set out the key risks and risk Provided in the programme risk log ratings
Date to which the information 05/03/21 this paper is based on was accurate
Executive Summary
This paper describes progress with delivery of the One BLMK CCG Programme during February 2021.
Summary of BLMK One CCG Programme Progress
Good progress is being made against all of the milestones and tasks in the merger programme plan and a detailed report was provided to the One BLMK CCG Programme Board on 9 March 2021.
The formal Director to Director led Checkpoint Review Meeting scheduled for the 8 February was stepped down as progress was on track to meet NHSEI assurance requirements.
Key milestones achieved during February have been:
• Submission of assurance letter from AO of the CCGs to the NHSEI Regional Director on 26/02/21 - confirming that all conditions of merger have been met and the CCG are on track to transfer all staff, assets and liabilities of the existing CCGs to the new BLMK CCG on 1 April 2021 • Confirmation of appointments to all of the Governing Body roles • NHSEI agreement of the draft constitution • Stakeholder engagement update report submitted to NHSEI on 26/02 (condition for merger) • CFO recruitment and appointment completed on 19 February 2021 • Approval of the due diligence management action plan by Executive Team and Audit Committee. Progress against the due diligence actions are on track and was reported to the Programme Board.
Tier 3 Process
The implementation of the Tier 3 process for staff is ongoing. We have commenced phase 2 of ring-fenced interviews and expect this to complete mid/late March. There has been ongoing support for staff throughout this process and we have commissioned some additional support that will provide additional one to one support for staff as required.
Clinical Leadership roles
Interviews for the following BLMK CCG strategic clinical leadership roles are taking place on 8 March 2021:
• Cancer • Chief Clinical Information Officer and digital strategic lead • Long Term Conditions • Mental Health and Learning Disabilities
Governance Matters
First BLMK CCG Governing Body Meeting – 6 April 2021
The first Governing Body meeting of the BLMK CCG will be held on 6 April 2021. It is proposed that the start of this meeting is used to provide an opportunity to introduce the members of the new Governing Body to the public. The agenda items for the first meeting will include approval of the key corporate documents for the new CCG as follows:
• Governance Handbook • Clinical Commissioning Strategy • People Strategy • Communications and Engagement Strategy • Financial Strategy • Quality Strategy • Primary Care Strategy • Confirmation of: o Appointed Internal Audit and Counter Fraud Services o Appointed Caldicott, Wellbeing and Freedom To Speak Up Guardians o Registered with NHS Resolution (awaiting new Bank details) o Finalised Governing Body appointments (no vacancies) o GB Remuneration Framework
The BLMK CCG will be responsible for the following governance matters following the dissolution of the three current CCGs:
Annual Reports and Accounts 2020/21
The Governing Bodies are asked to note that the BLMK CCG will be responsible for signing off the annual reports and accounts for the current CCGs.
CCGs’ Seals
Governing Bodies are asked to note that following the establishment of the BLMK CCG, the Head of Governance will be responsible for the destruction of the seals held by the current 3 CCGs.
One BLMK CCG Programme Board
The One BLMK CCG Programme Board will be considering how frequently it needs to meet post merger at its meeting on 9 March. It is being recommended that the Programme Board meet every other month up to September 2021 to ensure all remaining elements of the merger programme are completed correctly and to track the realisation of merger benefits. The membership of the Programme Board will need to be amended to include members of the new Governing Body and a proposal will be reported at the GB on 6 April 2021, based on the outcome of the programme board meeting.
Governing Bodies in Common in Public
16 March 2021
5.1 Policy for Sponsorship and Joint Working between BLMK CCG and the Pharmaceutical Industry and other non-NHS organisations
Author: Fiona Garnett and Janet Corbett Contact Information: Janet Corbett Lead Executive: Nicky Poulain Which CCGs does this paper apply to?
Bedfordshire Luton Milton Keynes
Information
Which activity does this paper The paper relates to potential activites which the CCG may enter relate to? into with Pharmaceutical and other health related companies.
How? The Policy provides a framework within which the CCG can develop sponsorship arrangements or joint working with Pharmaceutical and other Health related companies such that assurance is provided to the CCG Governing Body, to clinicians, and to the public, that any agreements made do not adversely influence prescribing advice or choice of products.
What is the Committee/ The Governing Body is asked to approve the policy. Governing Body being asked to do? What are the financial There are no explicit financial implications (but please see below) implications?
Set out the key risks and risk Failure to adopt a policy and failure by staff to adhere to it could ratings give rise to reputational risks and possible financial consequences relating to these. Date to which the information March 2021 this paper is based on was accurate
Executive Summary
The Policy provides a framework within which the CCG can develop sponsorship arrangements or joint working with Pharmaceutical and other Health related companies such that assurance is
provided to the CCG Governing Body, to clinicians, and to the public, that any agreements made do not adversely influence prescribing advice or choice of products.
It sets out a number of important principles in line with Nolan and defines organisational accountability and responsibilities along with detailed guidance on how staff should interact with companies offering sponsorship, joint working, training opportunities etc.
2
Policy for Sponsorship and Joint Working between BLMK CCG and the Pharmaceutical Industry and other non-NHS organisations
Introduction Pharmaceutical companies, and other companies that provide products to the NHS, wish to work with CCGs through offering sponsorship or joint working initiatives, in line with their company objectives.
The purpose of this Policy is to provide a framework within which the CCG can develop sponsorship arrangements or joint working with Pharmaceutical and other Health related companies such that assurance is provided to the CCG Governing Body, to clinicians, and to the public, that any agreements made do not adversely influence prescribing advice or choice of products. These decisions should always be based on evidence of value for money, safety and efficacy, and it should be demonstrable that the governance surrounding such decisions is independent from sponsorship and joint working arrangements with industry.
Good governance within the public sector is based upon the seven ‘Nolan principles’ (See Appendix 1). It is important that all employees of Bedfordshire, Luton and Milton Keynes Clinical Commissioning Group (BLMK CCG) understand these principles and embed them in their working practices and behaviours, so that the public and patients we serve have confidence and trust in the organisation. Joint working with industry and receiving hospitality from industry are key areas where CCG employees should apply the ‘man in the street’ test as perception of an action can be as significant as the factors involved.
This Policy translates the Nolan principles into a protocol to support staff working with industry, particularly the pharmaceutical industry, and incorporates updated statutory guidance to CCGs on Managing Conflicts of Interest.
Aims
• Provide BLMK CCG staff with a set of principles and guidelines to follow when entering into a sponsorship or joint working agreement with pharmaceutical companies or other non-NHS organisations who supply medicines, medical devices, diagnostic agents, dressings, appliances or reagents (all referred to as pharmaceutical companies throughout this document). It does not aim to inhibit sponsorship or joint working as it is recognised that such arrangements can be mutually beneficial.
• Provide the BLMK CCG Board and clinicians with assurances that decisions on prescribing and sponsorship or joint working which give mutual advantage are made within a framework of probity.
• Provide pharmaceutical companies with an understanding of the limits of BLMK CCG jurisdiction and to state positively that BLMK CCG, regardless of the prescribing practice of individual practitioners, does not endorse specific products as a result of sponsorship or joint working agreements.
BLMK CCG Pharmaceutical Industry Policy March 2021 1
2. Context There is an obligation on NHS bodies to work together, and in collaboration with other agencies, to improve the health of the population they serve and the health services provided for that population.
Pharmaceutical companies, and other companies that provide products to the NHS, wish to work with CCGs through offering sponsorship or joint working initiatives, in line with their company objectives. There is a national imperative for NHS organisations to work with industry as this can be mutually beneficial and may introduce innovation into practice. The CCG acknowledges and recognises the interdependent relationship between the NHS and industry, and their need to promote medicines and other products to maintain their profitability.
There is a national remit for CCGs to develop mature working relationships with pharmaceutical companies. Collaborative partnerships with industry can have a number of benefits in the context of this obligation. However, BLMK CCG acknowledges the interdependent relationship between the pharmaceutical industry and the NHS and their need to maintain profitability and promote specific drugs. It is important to have a transparent approach to any sponsorship/joint working proposed to the CCG and for the CCG to consider fully the implications of a proposed sponsorship/joint working deal before entering into any arrangement so that the Board and clinicians are assured that such sponsorship agreements or joint working initiatives do not adversely influence prescribing advice which should be based on evidence, value for money, safety and equity.
If any such partnership is to work, there must be trust and reasonable contact between the sponsoring company and the NHS. Such relationships, if properly managed, can be of mutual benefit to the organisations concerned. However it is essential that pharmaceutical companies or other suppliers cannot influence, or be perceived to influence, CCG decision making. Whatever type of agreement is entered into, a clinician’s judgement must always be based upon clinical evidence that the product is the best for their patients.
The House of Commons Health Committee Report on the Influence of the Pharmaceutical Industry acknowledges that the UK pharmaceutical industry conducts much excellent research, produces products that contribute to health, and is of great economic importance, but its influence is such that it dominates clinical practice. This is in line with available literature which shows that the more doctors rely on commercial sources of information, the less appropriate and less cost-effective are their prescribing decisions.
Pharmaceutical companies also promote their products or therapeutic area to BLMK CCG staff, many of whom will be supplementary or independent prescribers or have the ability to influence prescribing decisions. BLMK CCG staff should be aware that pharmaceutical companies see promotion of their products as important in influencing prescribing behaviour and continue to spend much of their revenue on this activity.
The Association of the British Pharmaceutical Industry (ABPI) Code of Practice 2016 sets out the principles which pharmaceutical companies should follow when promoting their medicines. This includes sponsorship and hospitality. The ABPI is a voluntary organisation, but most pharmaceutical companies are members. BLMK CCG staff should seek assurances that the company follows good practice principles in relation to the promotion of medicines, medical devices, diagnostic agents, dressings, appliances or reagents if they are not members of the ABPI.
Definitions For the purposes of the Policy the term commercial sponsorship is defined as including any funding to the NHS from an external source, including funding all or part of the costs of a member of staff, NHS research, staff training, pharmaceuticals, equipment, meeting rooms, costs associated with meetings, meals, gifts, hospitality, hotel and transport costs, provision of free services including guest speakers, buildings or premises. In sponsorship
BLMK CCG Pharmaceutical Industry Policy March 2021 2 arrangements, pharmaceutical companies simply provide funds for a specific event or work programme.
Where hospitality is involved, reference should also be made to the CCG’s ‘Conflict of Interest Policy’ for further guidance and for details of how to declare a Conflict of Interest or to declare Hospitality.
Joint working is defined as including ‘situations where, for the benefit of patients, the NHS and Industry organisations pool skills, experience and resources for the joint development and implementation of patient centred projects, and share a commitment to successful delivery’.
Joint working is a more complex arrangement and CCG staff should refer to the Department of Health document on Best practice guidance for joint working between the NHS and the pharmaceutical industry, published in February 2008 and the toolkit, Moving beyond sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical industry for further background information. Sponsorship for these more complex initiatives may also be handled through a third party who provide resources such as staff to undertake audits or perform review clinics. The third party would obtain the funds from the pharmaceutical companies directly without involving the CCG. This is often referred to as a Medical and Educational Goods and Services (MEGS) agreement and is a preferred model for more involved complex initiatives.
Where collaborative partnerships involve a pharmaceutical company the proposed arrangements must comply fully with the Medicines (Advertising) Regulations 1994 (regulation 21 ‘inducements and hospitality’).
Secondary employment is a term used to describe any employment additional to the work with the CCG. The CCG takes all reasonable steps to ensure that employees, committee members, contractors and others engaged under contract with them are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engaged in, any employment or consultancy work in addition to their work with the CCG. The purpose of this is to ensure that the CCG is aware of any potential conflict of interest. Examples of work which may conflict with the business of the CCG, including part-time, temporary and fixed term contract work, include: • Employment with another NHS body • Employment or carrying out duties with another organisation which might be in a position to supply goods/services to the CCG • Directorship for GP federation; and • Self-employment, including private practice, in a capacity which might conflict with the work of the CCG or might be in a position to supply goods/services to the CCG
The CCG requires that all individuals obtain prior written permission to engage in secondary employment and reserves the right to refuse permission where it believes a conflict will arise which cannot be effectively managed. Consideration of the implications of secondary employment may be relevant when sponsorship or joint working agreements are proposed. In particular it is unacceptable for pharmacy advisers or other advisers, employees or consultants to the CCG on matters of procurement for themselves to be in receipt of payments from pharmaceutical or other industry suppliers.
BLMK CCG welcomes appropriate sponsorship and joint working with pharmaceutical companies when these initiatives are aligned with the National Institute for Health and Care Excellence (NICE) guidance, BLMK CCG formulary (including OptimiseRx® and ScriptSwitch®) or prescribing recommendations made by the BLMK Area Prescribing Committee (APC). However, NHS funding sources should have been investigated first and found not to be available or practical before entering into an agreement. Where possible and practical and particularly for large projects, this should be across the industry as a whole rather than with single companies.
BLMK CCG Pharmaceutical Industry Policy March 2021 3
Pharmaceutical rebate schemes are not within the scope of this policy; however, due to the potential for overlap and for clarity, the CCG follows the good practice principles in relation to the assessment and uptake of rebates schemes as set out in the BLMK CCG Pharmaceutical Industry Rebate Policy.
This policy should be used by BLMK CCG staff when offered meetings, sponsorship or joint working initiatives with pharmaceutical companies. It should be read alongside the BLMK CCG Standards of Business Conduct Policy which outlines the principles that staff should follow when offered gifts, sponsorship or hospitality from non-NHS organisations.
In all cases, the CCG and its employees must publicly declare sponsorship/joint working or any commercial relationship linked to the supply of goods or services and be held to account for it, even if a sponsored activity occurred in an employee’s own time.
Scope The Policy applies to: • The Governing Body and its committees. • Employees of the CCG, including seconded and sessional staff, and temporary staff such as agency staff and interims. • Member practices and their employees when undertaking duties on behalf of the CCG. This includes clinicians undertaking roles with the CCG, e.g. Clinical Directors and Clinical Leads, and any other roles where a clinician from a member practice undertakes duties on behalf of the CCG. • Third parties acting on behalf of the CCG and services contracted by the CCG, e.g. Commissioning Support Services.
Accountability and responsibilities Responsible Director; Director of Finance or Medical Director TBC Responsible Senior Manager – AD and Head of Medicines Optimisation Responsible Committee – BLMK Prescribing Committee
Compliance with the Policy and Protocol All staff and individuals identified in the scope of the Policy must comply with the flow diagram and templates set out in the Appendices. All those within the scope must be conversant with the details of the Policy and ensure it is followed and enacted by themselves and any staff they manage, including any third parties or contracted staff.
A. Pharmaceutical Sponsorship from non-NHS Organisations Pharmaceutical companies may approach BLMK CCG staff with offers of sponsorship or joint working. Similarly, BLMK CCG staff may wish to approach pharmaceutical companies to sponsor or work with them on projects. This policy covers both of these scenarios and outlines general principles and guidelines for BLMK CCG staff to work within.
A1. General Principles Before entering into any sponsorship agreement the CCG will: • Satisfy itself, with reference to information available, that there are no potential irregularities that may affect a company’s ability to meet the conditions of the agreement or impact on it in any way, for example checking financial standing by referring to company accounts.
• Assess the costs and benefits in relation to alternative options where applicable, and to ensure that the decision-making process is transparent and defensible.
• Ensure that legal and ethical restrictions on the disclosure of confidential patient information, or data derived from such information, are complied with; no information should be supplied to a company for their commercial gain. As a general rule, information which is not in the public domain should not normally be supplied.
BLMK CCG Pharmaceutical Industry Policy March 2021 4
• Determine how clinical and financial outcomes will be monitored.
• Ensure that the sponsorship/joint working agreement has break clauses built in to enable the CCG to terminate the agreement if it becomes clear that it is not providing expected value for money and/or clinical outcomes.
• Make clear that acceptance of commercial sponsorship will not in any way compromise commissioning decisions of the CCG or be dependent on the purchase or supply of goods and services. Sponsors should not have any influence over the content of an event, meeting, seminar, publication or training event. Sponsorship arrangements do not imply that the CCG endorse individual companies or their products.
A2. The CCG will apply the following principles: • Purchasing decisions, including those concerning pharmaceutical and appliances, will always be taken on the basis of best clinical practice and value for money. Such decisions will take into account their impact on other parts of the health care system, for example, products dispensed in hospital which are likely to be required by patients regularly at home.
• When making purchasing decisions on products which originate from NHS intellectual property, ethical standards will ensure that the standard is based on best clinical practice and not on whether royalties will accrue to an NHS body.
• Arrangements whereby sponsorship/joint working is linked to the purchase of particular products, or to supply from particular source, will not be allowed, unless as a result of a transparent tender for a defined package of goods and services.
• Patient information attracts a legal duty of confidentiality and is treated as particularly sensitive under Data Protection legislation. Professional codes of conduct also include clear confidentiality requirements. The CCG will assure itself taking advice when necessary, that sponsorship/joint working arrangements are both lawful and meet appropriate standards.
• Where a sponsorship/joint working arrangement permitting access to patient information appears to be legally and ethically sound (for example, where the pharmaceutical company is to carry out or support NHS functions, where patients have explicitly consented), a contract will be drawn up which draws attention to obligations of confidentiality, specifies security standards that should be applied, limits use of the information to purposes specified in the contract and makes it clear that the contract will be terminated if the conditions are not met. This must comply with the current legal position concerning sharing of Patient Identifiable Data (PID). Guidance must be sought from the CCG’s Senior Information Risk Officer.
• Where the major incentive to entering into a sponsorship/joint working arrangement is the generation of income rather than other benefits, then the scheme should be properly governed by income generation principles rather than sponsorship arrangements. Such schemes should be managed in accordance with income generation requirements, i.e. they must not interfere with the duties or obligations of the CCG. A memorandum trading account should be kept for all income generation schemes and the Finance Department must be involved in making and conducting the agreement.
BLMK CCG Pharmaceutical Industry Policy March 2021 5
• Sponsorship/joint working arrangements involving the CCG will be at a corporate, rather than individual level, even if the activities concerned are to take place in an employee’s own time.
• If publications are sponsored by a commercial organisation, that organisation should have no influence over the content of the publication. The company logo can be displayed on the publication, but no further advertising or promotional information should be displayed. The publication should contain a disclaimer which states that sponsorship of the publication does not imply that the CCG endorses any of the company’s products or services.
• All CCG employees should discuss the implications, with their manager, before accepting an invitation to speak at a meeting organised by a pharmaceutical or other company. The company should have no influence over the content of any presentation made by the CCG employee. It should be made clear that the employee’s presence does not imply that the CCG endorses any of the company’s products or services. This also applies to interviews with CCG employees given live or published.
• The CCG will ensure that all sponsorship/joint working deals are documented through the use of a corporate register, which can be audited as appropriate. In order to demonstrate openness, the Register will be available on request to the public.
• In order to provide a robust framework to support successful implementation of this policy any proposals for sponsorship/joint working by the Pharmaceutical Industry, whether direct or indirect through an intermediary, should be reviewed and commented on by the BLMK CCG Primary Care Prescribing Committee. This process is encapsulated in the Pharmaceutical Industry Sponsorship/Joint Working Proposal Process Flow Diagram (Appendix A).
• Checklists 1&2 (Appendices C & D) should be populated by the appropriate lead usually the strategic implementation lead or work stream lead and submitted to the Medicines Optimisation Coordinator. The proposal is then considered at the CCG Prescribing Committee. The Prescribing Committee issue a recommendation on the proposal. The recommendation and the populated checklists are then considered by the BLMK CCG’s Clinical Commissioning Committee (CCC) for final approval.
• Point of contact for Pharmaceutical industry to BLMK CCG: [email protected]
B. Meeting with Pharmaceutical Company or other non-NHS Representatives
B1. Principles for The principles that staff should follow when offered gifts, sponsorship or hospitality from non-NHS organisations are set out in the BLMK CCG Standards of Business Conduct Policy and these should be referred to in conjunction with this policy.
• BLMK CCG welcomes appropriate sponsorship and joint working with pharmaceutical companies when these initiatives are aligned with the NICE guidance, BLMK CCG formulary (including OptimiseRx® and ScriptSwitch®) or prescribing recommendations made by the BLMK Area Prescribing Committee (APC).
• BLMK CCG will not endorse specific products as a direct result of sponsorship or joint working agreements with pharmaceutical companies.
• Any sponsorship or joint working initiative should demonstrate clear benefits to patients. Clinical decisions must always be made in the best interest of patients. No agreements are acceptable which compromise clinical judgement.
BLMK CCG Pharmaceutical Industry Policy March 2021 6
• Pharmaceutical companies that offer sponsorship or joint working with BLMK CCG should agree to abide by the principles set out in the ABPI Code of Practice. If the company is not a member of the ABPI, BLMK CCG staff should seek assurances that the company follows good practice principles in relation to the promotion of medicines, medical devices, diagnostic agents, dressings, appliances or reagents.
• Any sponsorship or joint working initiatives should be transparent, open to scrutiny and be a matter of public record.
• BLMK CCG NHS funding or resources should be sought first and found not to be available or ruled out before considering sponsorship or joint working with pharmaceutical companies.
• All BLMK CCG staff should be aware of the influence of pharmaceutical promotion on prescribing decisions and seek advice from the Medicines Optimisation Team.
B2. Guidelines for BLMK CCG staff when meeting with pharmaceutical company representatives
Pharmaceutical company representatives may legitimately approach BLMK CCG staff to request meetings to discuss sponsorship or joint working initiatives. BLMK CCG staff may also proactively seek meetings with pharmaceutical company representatives. In both cases, staff should be aware of their line manager or directorate / PCN position on meeting with pharmaceutical company representatives.
Pharmaceutical companies promote their products or therapeutic area to CCG staff, many of whom will be supplementary or independent prescribers or have the ability to influence prescribing decisions. BLMK CCG staff should be aware that pharmaceutical companies see promotion of their products as important in influencing prescribing behaviour and continue to spend much of their revenue on this activity. And so, only products either currently on local formularies or having positive guidance from NICE or the BLMK Area Prescribing Committee may be promoted. Requests to discuss new products or products not currently on BLMK CCG or hospital formulary should be directed to the nominated representative of the Medicines Optimisation Team. Representatives must not approach members of BLMK CCG Prescribing Groups in order to ‘lobby’ for decisions to be made in favour of their products.
Staff should only meet with representatives by prior appointment, to reduce unnecessary interruptions, to clarify who will be attending the meeting and that the objectives of the meeting are mutually beneficial. Ad hoc meetings with other staff whilst representatives are in the office should be discouraged. The Medicines Optimisation team will use the form in Appendix 7 to agree meetings with representative. For the purpose of this policy, “meet” applies to face to face meetings, virtual meetings and also phone calls, web chats etc
During meetings, staff should not provide BLMK CCG prescribing data or medicine usage information that is not already in the public domain unless permission to do so has been given by their line manager or the BLMK CCG Prescribing Committee.
Samples of products or supplies may be offered during meetings, but these should not be accepted by BLMK CCG staff unless prior approval has been given by their line manager or BLMK CCG Prescribing Committee. Placebo or dummy devices may be accepted for educational or training purposes.
Sponsorship of educational meetings held under CCG auspices by pharmaceutical companies should not be accepted if the products concerned are not in line with the CCG's approach to rational prescribing. CCG run Protected Learning Events will be funded by the CCG.
BLMK CCG Pharmaceutical Industry Policy March 2021 7
Sponsorship of nurse or other health professional staff training by pharmaceutical or other companies should only be accepted if such training is demonstrated to be impartial and broadly in line with the prescribing advice strategy or other guidance on clinical and cost effectiveness, and with the training needs assessment.
Hospitality provided in relation to any meeting must be secondary to the purpose of the meeting. The level of hospitality must be appropriate and not out of proportion to the occasion, and the costs must not exceed that which could be reciprocated by the CCG or which the recipients would normally adopt if paying for themselves. Hospitality in association with formal public meetings of boards is not appropriate. Where meetings are sponsored by external sources, this must be disclosed in the papers relating to the meeting and in any published proceedings.
Promotional messages should not be included in any patient information or health promotion material supplied by the CCG.
BLMK CCG staff should follow the Standards of Business Conduct Policy and also be aware that the Association of the British Pharmaceutical Industry (ABPI) Code of Practice 2016 sets out the principles which pharmaceutical companies should follow when promoting their medicines including sponsorship and hospitality (http://www.abpi.org.uk). The ABPI is a voluntary organisation, but most pharmaceutical companies are members. Staff are encouraged to report any potential breach of the ABPI Code of Practice to a member of the Medicines Management Team, locality manager or BLMK CCG clinical governance lead.
B3. Guidelines for considering pharmaceutical sponsorship for meetings, educational events and hospitality The principles that staff should follow when offered gifts, sponsorship or hospitality from non- NHS organisations are set out in the BLMK CCG Standards of Business Conduct Policy. These guidelines apply equally to funding received to support place based meetings, such as Board meetings, Protected Learning Zone meetings, or “in-house” educational meetings as well as BLMK CCG staff being funded to attend external educational meetings.
Should NHS funding be ruled out or not available and pharmaceutical sponsorship sought, BLMK CCG staff should contact the Medicine Management Team for advice on potential pharmaceutical company sponsors. The Medicine Management Team will keep a list of pharmaceutical companies who have expressed an interest in sponsoring and whose products are already approved for use within BLMK CCG. When BLMK CCG staff are offered pharmaceutical sponsorship, they should contact the Medicines Optimisation Team for advice before accepting this to ensure that the company would not be promoting a product that is not recommended within BLMK CCG.
A Summary of Pharmaceutical Sponsorship Form (Appendix B) should be completed for the proposed sponsorship and sent to the Head of Medicines Optimisation. The Head of Medicines Optimisation or nominated Deputy may approve sponsorship forms without referral to the BLMK CCG Prescribing Committee if the sponsorship value is £300 or less. However these should be declared retrospectively to the Committee. Values over £300 will be referred to the next BLMK CCG Prescribing Committee meeting for approval or otherwise. If approved, the Head of Medicines Optimisation will forward the approved form to the Corporate Services Manager for recording in the central register of gifts, sponsorship or hospitality and return a signed copy to the applicant for their records. If there is an issue with the proposed products to be promoted at the meeting or method of promotion, the Head of Medicines Optimisation will liaise with the applicant.
When completing the sponsorship form, it should be borne in mind that the method of promotion should be agreed prior to the meeting taking place and that representatives are not allowed to give presentations on their company’s products at the meeting. When promotional stands are used, these should normally be placed outside of the rooms where the event takes place, for example in a foyer, and then removed once the event has
BLMK CCG Pharmaceutical Industry Policy March 2021 8 commenced. If the area outside the meeting room is open to the public and hence promotional stands cannot be displayed, then the stand may go in the meeting room as long as the material is removed prior to the start of the meeting.
Pharmaceutical company representatives are not allowed to be delegates at sponsored events unless this has been declared and approved on the sponsorship form.
If a pharmaceutical company sponsors a speaker at the event, they may not insist on a particular speaker who may favour their products, but should instead allow BLMK CCG to choose the speaker.
The form in Appendix E should be used to confirm arrangements with the company.
C. Guidelines for projects involving joint working with pharmaceutical companies
Joint working is a more complex arrangement than simple sponsorship of an event or programme. As such, a fuller written agreement is required which clearly specifies the benefits to the NHS, BLMK CCG and its’ patients arising from any project involving joint working. The benefits to the pharmaceutical company must also be explicit.
The forms in Appendix C and D BLMK CCG Agreement for Joint Working and Checklist should be completed and forwarded to the Head of Medicines Optimisation. If approved by the BLMK CCG Prescribing Committee, the Head of Medicines Optimisation will forward the approved form to the Corporate Services Manager for recording in the central register of gifts, sponsorship or hospitality and return a signed copy to the applicant for their records. If there is an issue with the proposed products to be promoted at the meeting, method of promotion or joint working arrangement, the Head of Medicines Optimisation will liaise with the applicant. Joint working projects should not commence until approval from the BLMK CCG Prescribing Committee has been given.
Staff should note that all agreements must include: • A ‘break’ clause, enabling the termination of the agreement at short notice. This should outline the repercussions of a non-NHS organisation breaking the terms of the signed agreement. • That the identity of any patient or other confidential information will not be made available to the pharmaceutical company except as listed in the signed written agreement • That reports or information cannot be used elsewhere without the permission of BLMK CCG
Review
This policy will be reviewed in the light of new guidance from the Department of Health or by December 2023
BLMK CCG Pharmaceutical Industry Policy March 2021 9
Appendix A
Process Flow diagram
• Sponsorship proposal made • Applicant to discuss with relevant clinical groups eg LTC, Diabetes 1 Group etc to gain wider agreement in support of proposal
• Complete relevant checklists and forms 2 • Send completed checklists to Head of Medicines Optimisation
• Proposal considered by BLMK Prescribing Committee 3 • Applicant informed of outcome
BLMK CCG Pharmaceutical Industry Policy March 2021 10
Appendix B
Declaration of gifts and hospitality form in accordance with the BLMK Sponsorship and Joint Working with Pharmaceutical Industry and other non-NHS Organisations
Please complete all parts and then forward to the Head of Medicines Optimisation, by e- mail: [email protected]
(For declaring other Gifts, Hospitality and sponsorship, please contact the Governance team for the appropriate form)
For guidance, please refer to the Standards of Business Conduct Policy for gifts, hospitality and sponsorship and the Pharmaceutical Sponsorship Policy for working with non-NHS Organisations for sponsorship. Both policies are available on the staff intranet.
To be completed by All Staff Name:
Position within CCG:
Date of Offer:
Date of Receipt (if applicable) eg. date of event:
Details of Gift / Hospitality / Sponsorship (including clinical area and products to be promoted if applicable) Estimated Value:
Supplier / Offeror: Name and Nature of Business:
Details of Previous Offers or Acceptance by this Offeror/ Supplier: Details of the officer reviewing and approving the declaration made (Name, Job title and date): Declined or Accepted?
Reason for accepting or declining and actions taken to mitigate against a conflict:
Other Comments:
PTO
BLMK CCG Pharmaceutical Industry Policy March 2021 11
To be completed if sponsorship is from the pharmaceutical industry or bodies acting on their behalf: Are the products on the CCG Formulary and / or endorsed by NICE? Method of promotion: eg Leaflets, stand and products on display, expert speaker Will the Pharmaceutical Company be presenting at the event? Is the company a member of the ABPI? If no, what assurances have you been given that the (List available company follows good practice principles in relation to at: https://www.abpi.org.uk/member- promotion of medicines, dressings, and diagnostics? representation/abpi-members-list/
Decision making staff should be aware that the information provided in this form will be added to the CCG’s registers which are held in hardcopy for inspection by the public and published on the CCG’s website. Decision making staff must make any third party whose personal data they are providing in this form aware that the personal data will held in hardcopy for inspection by the public and published on the CCG’s website and must inform the third party that the CCG’s privacy policy is available on the CCG’s website. If you are not sure whether you are a ‘decision making’ member of staff, please speak to your line manager before completing this form.
Signed: Date:
Now forward the form to the Head of Medicines Optimisation. To be completed by Head of Medicines Optimisation on behalf of the BLMK CCG Prescribing Committee Approved by Medicine Management Lead / BLMK CCG Prescribing Committee (delete Yes / No as appropriate) If NO reason for rejection:
Signed...... Date...... Date form sent to applicant (if not approved) or Governance Team (if approved):
Signed: Position:
(Senior CCG Manager or Executive Director if required) Date:
BLMK CCG Pharmaceutical Industry Policy March 2021 12
Appendix C
BLMK Initial Checklist for Assessment of Collaborative Working with the Pharmaceutical Industry or their Agents or Affiliated Companies
If any responses to the following are No, the agreement will contravene the policy. Further advice must be sought from the Head of Medicines Optimisation before proceeding.
GENERAL Has CCG funding or other NHS resources been considered first and found not to be available or ruled out? Y/N Is the agreement in the best interests of patients Y/N Is the offer independent of purchasing or prescribing decisions? Y/N Is professional judgement unaffected Y/N Is patient and NHS data confidentiality maintained Y/N Is the company a member of the ABPI or do they follow good practice in promoting pharmaceuticals? Or are you satisfied with your knowledge of the sponsoring organisation(s) (i.e. is there evidence of audited accounts, is the organisation and its ownership known, is it capable of being independently audited?) Y/N Is the agreement upright and honest and free from conflict of interest? Y/N
CONTRACTUAL Does a contractual agreement or service agreement exist (to include the aims and objectives of the collaborative working; an outline of the accountability framework within which the provider will operate; the protocols to be used on the programme, including a full description of the service(s) to be provided and the names and details of personnel to be involved; the procedure to be followed in the event of adverse incidents; any professional indemnity and liability arrangements that the service provider has in place; the option to modify or suspend the programme in the light of any assessments, evaluations or adverse events; the option for either party to withdraw, with agreed and clearly defined notice periods on both sides Y/N Are the skills, competencies, professional status and qualifications of the named individuals who will be directly involved with the programme of a sufficient level to provide the aims and objectives effectively, efficiently and reliably? Y/N Is the agreement lawful Y/N Is there no reason to suspect the company will be unable to fulfil obligations Y/N Have all appropriate parties discussed the proposed offer? Y/N Are lines of accountability clear – clinical, professional, managerial? Y/N
CLINICAL EVIDENCE Is the agreement evidence based (The Medicines Optimisation team is available to give assessments of available evidence) Y/N Does the agreement represent best clinical practice Y/N Is the agreement compatible with national and local arrangements for prescribing Y/N
FINANCIAL Does the agreement represent value for money Y/N If the agreement is linked to the purchase of a particular product, has there been a competitive tender process in line with CCG SFIs? Y/N Have costs and benefits been assessed in relation to alternative options Y/N Is there provision within the agreement for financial audit Y/N Have the future potential implications of the agreement been considered Y/N (e.g. continuing cost of treatment initiated during a trial) and are on-going and future purchasing decisions are unaffected by the agreement
AUDIT Is there provision within the agreement for financial audit Y/N
BLMK CCG Pharmaceutical Industry Policy March 2021 13
OUTCOME MEASURES Does the agreement include monitoring of clinical/ financial measures Y/N Is there provision for break clauses for the CCG to terminate the agreement if outcomes are not satisfactory Y/N
The answers to the following MUST be NO otherwise the agreement may contravene the policy
EXCLUSIONS
Is there any reason to suspect the company will be unable to fulfil obligations? Y/N Are there any purchasing decisions affected by the agreement? Y/N Is the NHS expected to pick up recurrent costs of the scheme? Y/N If the answer is yes than it needs to be considered as a Business Development.
Assessment undertaken by
Signature
Designation
Date of assessment
BLMK CCG Pharmaceutical Industry Policy March 2021 14
Appendix D
BLMK CCG Agreement for Joint Working.
Please complete all parts of this form plus the initial checklist and then forward to the Head of Medicines Optimisation, by email to [email protected]
FUNDING OF: Please enter brief details eg funding for an asthma course for practice nurses
BY: Enter name of company
TYPE OF COMPANY: (Usually but not exclusively a pharmaceutical company)
Application for funding of: £ State amount agreed
Please complete on a separate sheet:
Basis for the Work: Justification for the work, brief background, purpose and objectives of the work to be funded. To include the contribution from BLMK CCG, if any, defining the work and audit / training / meetings to be held.
Description of the Work and Personnel involved: Overall and detailed objectives, personnel / organisations involved, expected benefits and outcomes.
Project Action Plan: Detailed description of the project to show how funding will be used and timescales.
Joint working is accepted on the basis that:
1) The Sponsor agrees to abide by the BLMK Clinical Commissioning Group sponsorship policy for working with Non-NHS organisations. The Sponsor may only be involved to the extent defined in this agreement, consistent with the policy.
3) Any reports resulting from the work may acknowledge The Sponsor’s contribution.The Sponsor cannot use any reports or information from this work without explicit permission from BLMK CCG.
The Sponsor knows of no potential embarrassment that would accrue to BLMK CCG as a result of this agreement. The Sponsor shall not use the name of the CCG including logos or its employees or services to infer endorsements of products or activities without explicit agreement.
BLMK CCG should hold copies of all Service Agreements.
Name of BLMK Manager requesting Signature, designation, date and contact number sponsorship
Name of non-NHS organisation Signature, designation, organisation name, date representative and contact number
BLMK CCG Pharmaceutical Industry Policy March 2021 15
The following will be considered by the BLMK Prescribing Committee:
1. Does the proposal on offer align with current views on evidence-based clinical practice? 2. Is the proposal on offer consistent with CCG priorities? 3. Have all offers of sponsorship including gifts or hospitality accepted (greater than £25) been registered in the CCG’s gifts, sponsorship and hospitality register?
Approved by BLMK Prescribing Committee (yes or no) Date:
BLMK CCG Pharmaceutical Industry Policy March 2021 16
Appendix E
BLMK CCG SPONSORSHIP FOR PROFESSIONAL OR SCIENTIFIC MEETINGS
To
Of (State Company)
Thank you for agreeing to sponsor the meeting on
Venue:
Title of Meeting
Sponsorship is accepted on the understanding that:-
. The Sponsor agrees to abide by the BLMK CCG sponsorship policy for working with the Pharmaceutical industry and other Non-NHS organisations . The meeting organiser retains overall control of the event and the content of the event . The sponsor does not have the automatic right to present teaching or promotional material . Where the organiser considers additional value may be gained from a presentation by the sponsor, that the content of the material is agreed in advance. . The sponsor does not use the CCG contact to promote products outside the meeting. . Any stand the sponsor uses to promote products is to be outside the main meeting room, where this is possible. . Attendance at the meeting by the sponsor is at the discretion of the course organiser. . Where course material is provided by a pharmaceutical company there is no promotion of specific products (the name of the company supporting the meeting is acceptable) . Any reports resulting from the work may acknowledge The Sponsor’s contribution. . The Sponsor cannot use any reports or information from this work without explicit permission from BLMK. . The Sponsor knows of no potential embarrassment that would accrue to BLMK CCG as a result of this agreement. The Sponsor shall not use the name of the CCG including logos or its employees or services to infer endorsements of products or activities without explicit agreement.
Please confirm that you accept the terms detailed above:
Signed: Date:
Print Name: Position/Company:
Signed on behalf of the CCG
Signed: Date:
Print Name: Position
BLMK CCG Pharmaceutical Industry Policy March 2021 17
Appendix F
Process for Pharmaceutical Representatives If you wish to discuss a product with the Medicines Management Team please complete this form and email it back to the Medicines Management Team at [email protected]
**Please note no appointments will be considered until we have received this information** This form can also be filled out online at https://medicines.blmkccg.nhs.uk/categories/formulary/pharmaceutical-reps/
Your name:
Job title
Company name:
Email address:
Telephone number:
What products does the pharmaceutical sales representative wish to discuss? (Please be specific)
Is this product in our local formulary? Yes No (please circle/delete) Bedfordshire and Luton Formulary Wound Care Formulary (Beds & Luton) Milton Keynes formulary
How is this product more effective than the current product in use? Include the clinical and quality benefits to the patients of Bedfordshire, Luton and Milton Keynes.
How does the price compare with similar products?
What addition information do you have to enable the team to make an informed decision?
You may attach further information.
BLMK CCG Pharmaceutical Industry Policy March 2021 18
Appendix G
The 7 Principles of Public Life (The Nolan Principles) The Seven Principles of Public Life, known as the Nolan Principles, were defined by the Committee for Standards in Public Life . They are:
Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.
Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.
Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.
Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.
Openness Holders of public office should be as open as possible about all the decisions and actions that they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands it.
Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.
Leadership Holders of public office should promote and support these principles by leadership and example
Appendix H
References and Associated Documentation
• Standards of Business Conduct Policy October 2020. BLMK Clinical Commissioning Group. • NHSE guidance on Managing conflicts of Interest in the NHS 2017 https://www.england.nhs.uk/wp-content/uploads/2017/02/guidance-managing- conflicts-of-interest-nhs.pdf • Code of Practice for the Pharmaceutical Industry. Prescription Medicines Code of Practice Authority and the ABPI. 2016. • The House of Commons Health Committee - Report on the Influence of the Pharmaceutical Industry. March 2005. • Moving beyond sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical industry. Available from the National Archive website: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/pro d_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_11 9052.pdf
• ABPI list of companies https://www.abpi.org.uk/member-representation/abpi- members-list/
BLMK CCG Pharmaceutical Industry Policy March 2021 19
Governing Bodies in Common in Public
16 March 2021
6.1: Risk Report
Author: Ola Hill, Risk and Governance Manager Contact Information: [email protected] Lead Executive: Geraint Davies, Director of Performance and Governance Which CCGs does this paper apply to?
Bedfordshire X Luton X Milton Keynes X
Information
Which activity does this paper Assurance of effective corporate level risk mangement at the relate to? three CCGs
How? The CCGs now have a combined risk register, and legacy risks from the three local risk registers are being reviewed, updated and archived as necessary. What is the Governing Body To receive assurance that there is effective risk management at being asked to do? the three CCGs, and work to develop aligned risk management systems is progressing. What are the financial As set out in the individual risks. implications?
Set out the key risks and risk N/A ratings
Date to which the information 9 March 2021 this paper is based on was accurate
Executive Summary
This report provides assurance to the Governing Body in relation to the management of high level strategic and operational risk within the CCGs. Information regarding strategic risk is provided through the Board Assurance Framework (BAF), and information regarding the operational risks is provided through the Corporate Risk Register. Both of these are now being reviewed on an ongoing basis. Each CCG maintains a corporate risk register that includes risks escalated from different workstreams and activities, which was combined in November 2020 into a congruent document on the 4Risk online risk management system. This report gives an overview of the top risks on the Corporate Risk Register and changes to the Board Assurance Frameworks since the last meeting of the Governing Bodies in Common. At the time of writing, the roll out of the common online risk management system, 4Risk had progressed significantly, which all risks migrated from the online MKCCG and LCCG systems and the remaining unified excel spreadsheets being migrated. One on One training for Directrorate Super Users has been taking place since January 2021 and training and demos have been taking place with Directorate teams. The Risk Management Awareness ESR training programme will be rolling out in Q1 2021/22 and the BLMK Risk Management Framework will be presented for approval in Q1 for new CCG. The Governing Body should be assured that Risk Management functions continue to operate and support the achievement of the CCGs’ strategic objectives and have set a solid foundation for risk management in the new single CCG.
Board Assurance Framework
The three CCGs’ BAFs have been pulled into one congruent document, with each CCG maintaining its own current set of strategic objectives. This new BLMK format is proposed as part of rollout of the single risk management system across the three CCGs and for the new organisation. The BAFs will retain the strategic objectives for the respective CCGs until the new set of strategic objectives are incorporated for the single CCG on 1st April 2021. As part of the review and realignment, a number of risks have been closed and archived since the last meeting. The updated version of the BAF has been reviewed with members of the Executive Team. The BAF is undergoing a full review and refresh in advance of the 2021/22 financial year. The number of strategic risks on the combined BAF, by CCG is summarised below and the full BAF is attached at Appendix A. The new format for the BLMK BAF has been amended following feedback from the Audit Committee in Common on 23rd February.
Bedfordshire CCG 9 Luton CCG 6 Milton Keynes CCG 10 Total 25
2
The following risks have been closed and archived since the last meeting of the Governing Body.
Risk Ref Risk Title Residual Risk Comment Score BAF 5 LCCG (BAF 5) – The CCG may fail to Closed. Relates to meet its statutory duty to deliver the I = 5 L = 4 previous financial year agreed end of year financial position and 20 system control total BAF 12 BCCG (Risk 2.1b) – Failure to fully deliver Closed. Relates to £35.3m of QIPP savings in 2019/20, which previous financial year could result in failure to achieve our I = 4 L = 4 £11.1m control total (£35.3m is inclusive of 16 £5m ICS pressure, and £4.1m BHT/ L&D Affordability Gap) BAF 18 BCCG (Risk 5.4) As Bedfordshire, Luton Closed. Shadow and Milton Keynes move toward becoming Working Group a single strategic commissioner there is a commenced in 2020 as risk that they may not achieve the did the Committees in milestones necessary to do so by April I = 4 L = 3 Common and Joint 2021, resulting in disruption to the wider 12 Committees where appropriate. The Constitution has also been approved by NHS England BAF 24 MKCCG (ST61) CHC overspend against Closed. Actions have budget I = 3 L = 4 been implemented and 12 CHC is no longer at risk of overspend BAF 30 MKCCG (ST63) Insufficient capacity & Closed. Superseded by capability as a result of increased I = 3 L= 4 new risk to be drafted re partnership & matrix working requirements 12 system transformation, ICS white paper etc
Corporate Risk Register
The Corporate Risk Register was combined in November 2020 and shows high level operational risks from across the three CCGs. At the time of writing, there are currently 16 open risks on the Corporate Risk Register. HIGH MEDIUM LOW BLMK 1 1 - Bedfordshire CCG 3 - - Luton CCG 2 3 - Milton Keynes CCG 3 3 - Total 9 7
3
There are three top risks currently on the Corporate Risk Register (rated 16). Below is a summary of the top risks on the BLMK Corporate Risk Register at the time of writing. The full Corporate Risk Register is attached at Appendix B.
Risk Ref Risk Title Risk Description Risk Control Current Direction Risk of Travel Priority CRR 56 BLMK Covid As a result of the Covid-19 incident For Hospital Discharge Service there will be I = 4 L = 4 Costs the NHS is operating with amended new S75 agreement that needs to be agreed 16 contract and payment arrangements with Local Councils. LA/CCG Finance Cell - there is a risk that the CCG is has been convened. Reimbursement for incurring additional and unfunded hospital discharge costs expected based costs that could.. upon data submitted by CCGs. For Hospital Discharge Service there will be new S75 agreement that needs to be agreed with Local Councils. LA/CCG Finance Cell has been convened. Reimbursement for hospital discharge costs expected based upon data submitted by CCGs. CRR 58 BCCG - Learning Escalated from the CHC Risk 1) All complex cases have a CHC assessor I = 4 L = 4 Disability Local Register and Mental Health Risk case managing, where risks escalate 16 Provision Register involvement from the local authority/CCG Learning Disability Local Provision As a result of only a small amount of 2) Intensive Support Team intervention when local provision for individuals with required to support complex cases within more complex and.. area
CRR 60 MKCCG - Failure As a result of the long waits for Attendance at the Patient List Tracking I = 4 L = 4 to achieve 18 & elective care, there is a risk that meeting to gain assurance on the Trust's 16 52 week health needs will deteriorate actions on long waiters, especially those who performance. resulting in poorer outcomes for have waited 40 weeks + to avoid further 52 patients. This risk has increased due week breaches. to the Covid-19 pandemic.. Maximise the use of the NHSE funded Independent Sector to delivery some elective care. This will create additional capacity, reducing the wait list and treatment timeframes. Monthly Commissioner, Contracts and Performance meetings with provider teams RMS referral triage to deflect unnecessary activity away from secondary care into community services. This will increase treatment times for those not needing consultant led care. The IMSK service will assess & triage all IMSK related referrals from Primary Care to ensure all alternative clinical pathways are explored and fully utilise conservative treatments where surgical options are expected to deliver poor outcomes. Trust led review of operating procedures in light of the Covid-19 pandemic. To only operate when it is safe to do so and supported by national guidelines. Embed virtual clinics which reducing the need for unnecessary face to face appointments moving to a phase of watchful waiting
4
Risk Movement The following risk movement has been noted on the CRR since the last meeting of the Governing Body.
Ref Risk Title Residual Target Status Comment Risk Score Risk Score CRR MKCCG – Lack of provider 6 4 Due to Covid 10 engagement in pathway refocussing of the transformation CCG and partners, this risk is no longer pertinent CRR MKCCG – Retained 8 6 Current payment 12 behaviours leading to methods are now opportunities in GIC not being in line with national optimised guidance. MKUHFT are keen to work with the CCG to agree a GIC for 21/22. CRR MKCCG - Covid-19 16 Superseded by 16 BLMK workstream CRR LCCG - CCG NO deal Brexit 9 Superseded by 36 Implications EPRR 1 (now CRR 61) CRR BCCG - Learning Disability 16 1 Escalated from 58 Local Provision CHC Risk Register and Mental Health
Risk Register CRR BCCG - factors impacting on 12 4 Escalated from the 59 Bedford Borough general Primary Care practices Commissioning
Risk Register. CRR MKCCG - Failure to achieve 16 12 Escalated from 60 18 & 52 week performance. Clinical Quality / Patient Safety Risk
Register CRR NO Deal Brexit Implications - 9 4 Escalated from 61 Continuity of supply of EPRR Risk medicines and medical Register
devices
Status Key Closed
Escalated
De-escalated
5
Oversight and Assurance
In order to ensure that the oversight of risk management processes within the new CCG remain robust and effective, it is proposed that the reporting mechanisms for the Corporate Risk Register and Board Assurance Framework are reprioritised. The proposed reporting schedule is as follows: • Monthly reporting to the Executive Team Business Meeting • Bi-monthly reporting to the Audit Committee • Quarterly reporting to the Governing Body,
The proposed reporting schedule will ensure effective Executive oversight of management actions and ensure that the Audit Committee and Governing Body can be fully assured regarding Risk Management processes and functions when the Corporate Risk Register and Board Assurance Framework are presented. The reporting schedule will be formally codified in the BLMK Risk Management Framework for the new CCG.
Recommendation
It is recommended that the Governing Body: • Note and approve the updates to the BAF (Appendix A) • Note and approve the updates to the Corporate Risk Register (Appendix B) • Approve the proposed amendments to the reporting schedule for the Coporate Risk Register and Board Assurance Framework.
6
Board Assurance Framework
Report Date 09 Mar 2021
Page 1 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 4.1) Breach of Cause of risk I = 4 L = 2 A new Leadership and cultural Media training to be provided for Jane Meggitt 31 Mar I = 3 L = 2 14 Improv statutory duty to consult and Failure to establish and 8 values training course has Chair of Governing Body, Chief 2020 6 e engage on CCG priorities and maintain effective been developed embedding Operating Officer and other govern service developments. relationships with internal and collaboration and relevant staff around reputational ance Risk Owner: Jane Meggitt external stakeholders engagement. issues. and An internal engagement plan Update Communications and Jane Meggitt 30 Jun inform Risk Lead: Sarah Frisby Effect of risk realising to change culture in the Engagement Plan for BLMK to 2020 decisio Adverse impact on CCG’s Last Updated: 16 Feb 2021 organisation has been reflect new approaches to ns reputation, and ability to developed engagement. New BLMK Latest Review Date: influence the local and Communications and national agenda. Engagement taken place with Latest Review By: Engagement Strategy will be Inappropriate use of services ICS and LA to agree drafted. Last Review Comments: due to lack of information and approaches to engagement understanding. for BLMK/ Worked closely together when engaging on LTP – developing links that can be used in future engagement opportunities Healthwatch in attendance at Governing Body meetings IAF Assessment by NHSE completed at end of March to determine compliance. Results due in June Internal Audit of Patient Involvement completed and reasonable assurance given as rating. Recruitment campaign to strengthen public member involvement took place in 17/18
Page 2 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Regular attendance at Overview & Scrutiny Committees and Health and Wellbeing Boards which provide established channels to consult the public and involve local politicians to seek scrutiny of service development decisions Robust governance arrangement in place for Patient & Public Engagement Committee. (ToR reviewed recently, signed off by PPEC members in April and ratified by Governing Body in May) Statement of principles for implementing arrangements to meet statutory duty on patient involvement reflected in CCG Constitution. The Communications and Engagement team engages with the wider CCG to set standards of conduct to ensure all engagement and consultation is best practice. The Communications and Engagement team has refreshed its Induction presentation to reinforce the importance of engagement and collaboration with our communities. This will be delivered to all new starters.
Page 3 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 5.1) Risk of Cause of risk I = 4 L = 4 Commitment made that new Continued engagement with Micahael 30 Jun I = 4 L = 3 15 Improv member practices disengaging Insufficient interest from GPs 16 Clinical Chair will be in post Member Practices as we move Wuestefeld- 2020 12 e with the CCG in undertaking leadership Spring 2020. towards becoming a single Gray govern roles strategic commissioner. Risk Owner: Mike Thompson Frequency of Members’ ance Forums increased on request Primary Care Strategy to be Micahael 31 Jul and Risk Lead: Micahael Effect of risk realising of membership and key developed which will include Wuestefeld- 2020 inform Wuestefeld-Gray Governing Body function not national speakers attending. leadership development Gray decisio supported, unable to Last Updated: 16 Feb 2021 objectives ns demonstrate to our public that GPs engaged with CCG to Latest Review Date: we are clinically led, and do join recruitment panels for Survey carried out with all Micahael 31 Jul Latest Review By: not deliver the recruitment of GP governing member practices to gain their Wuestefeld- 2020 transformational changes in body members views on the CCG’s approach to Gray Last Review Comments: clinical pathways we aim for clinical leadership; clinical Invite extended to GPs to join leadership skills; effective workshop to build JD for communication and engagement; clinical Chair and recruitment relationships between clinical material. leaders and membership. Action Local primary care leaders plan being developed following undertaking national primary presentation of results at care leadership programme Members’ Forum and local programme of coaching and mentoring via NAPC has been put in place. Medical Director appointed to JET working closely with allied medical professionals across BLMK, focusing on primary care at scale, clinical leadership, workforce and delivery across the three CCGs
Page 4 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by New Constitution in place which supports four Practice representatives on Governing Body (3 of which must be a GP) Constitution and Standing Orders changed to reflect the priorities of the membership for targeted use of clinical leadership resources. Primary Care Clinical Directors in post and CCG supporting development and network maturity Regular GP Governing Body Member meetings arranged with the Chair. Two GPs elected by Members to join CCG Governing Body
Page 5 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 5.3) Inability to Cause of risk I = 4 L = 4 Bedfordshire Care Alliance Three Local Care Collaboratives Geraint 30 Sep I = 4 L = 3 17 Improv work effectively with partners to BCCG having insufficient 16 established with long term (LCCs) being formed under Davies 2020 12 e improve service delivery and influence within the BLMK ambition to work together to Bedfordshire Care Alliance to govern reconfigure health and social partnership deliver more integrated care deliver elements of integrated ance care services within Failure to establish a across Bedfordshire. Some care locally. and Bedfordshire governance structure that care will be overseen at a Some CCG functions and roles Geraint 30 Sep inform provides clarity around each bigger scale with Milton Risk Owner: Geraint Davies will be transferring to ICPs as they Davies 2020 decisio part of the system. Keynes where it is economic mature. Work to commence on ns Risk Lead: Differential financial positions to do so. ways in which these roles and between the collaborative Last Updated: 16 Feb 2021 Collaborative Commissioning functions can be distinguished CCGs Latest Review Date: Executive Meeting on behalf from strategic commissioning of NHS partners in place roles. Latest Review By: Effect of risk realising Impact on any existing Core Strategic Commissioner As Strategic Commissioner it is Geraint 30 Sep Last Review Comments: collaborative arrangements functions approved at the aim to work with four BLMK Davies 2020 Failure to deliver single Governing Body Meeting local authorities on JSNA, Heath system operating plan and 21.11.19 & Wellbeing strategies, public objectives of the Integrated health commissioning, Better Director of Integration in place Care System Care funds and Section 75 - a joint post between Milton All partners not working commissioning arrangement in Keynes CCG and the Local together in the same way the 4 boroughs. Authority. Different objectives and Working towards becoming a Geraint 31 Mar decision making criteria single strategic commissioner for Davies 2021 (elected members within BLMK Local Authorities; CCGs being membership organisations) Support future development of Geraint 31 Mar Integrated Care Partnerships Davies 2021 Support the future development of Nicky Poulain 31 Mar primary care networks 2021 Appointment of Lay Chair across Geraint 30 Sep ICS System Davies 2020 Establishment of an ICS wide Geraint 30 Sep Partnership Board Davies 2020 Establishment of One Team Geraint 30 Sep Programme Board to oversee Davies 2020 delivery of establishment of one single CCG.
Page 6 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Governing Body members from across the three CCGs met. The session was aimed at strengthening relationships across the patch and an opportunity for commissioning leaders to consider the approach, timeline and process we will undertake, as we move towards operating as a single CCG by April 2021. Early thinking plotted an outline roadmap through to April 2021 around key areas such as the role of strategic commissioner within an ICS, clinical leadership, governance and benefits Joint Accountable Officer now in post holding a responsibility for shaping an integration agenda with partners based on delivery of key commissioning objectives. ‘pan-CCG’ staff briefings taking place. Long Term Plan ratified and submitted to NHSE One single executive team in place working as part of the Governing Bodies across all three CCGs, helping to strengthen the commissioning voice as it continues to lead on developing plans for BLMK with its system partners.
Page 7 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by SROs established within the BLMK Commissioning Collaborative. This will help us create capacity and focus at strategic and operational level, to keep the show on the road and ensure we deliver against our statutory duties, while making plans for the future that will enable us to operate as a single CCG by April 2021. STP Memorandum of Understanding in place Substantive COO now in place at BCCG and has worked across Bedfordshire organisations System Sustainability & Transformation Boards reporting to Health & Wellbeing Boards x 2
Page 8 of 31 Board Assurance Framework
BCCG - Improve governance and inform decisions
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 5.2) The CCG fails Cause of risk I = 4 L = 4 Annual internal audit to IG workplan in place Lynda Harris 31 Jul I = 4 L = 3 16 Improv to comply with legal and best Weaknesses in the CCG’s 16 provide assurance on the 2020 12 e practice requirements regarding information governance integrity of the self- Information Asset Owners to Lynda Harris 30 Oct govern the information it holds. controls and training, meaning assessment against the toolkit undertake annual IAO training 2020 ance staff are unaware of criteria, the overall Risk Owner: Geraint Davies (audit recommendation) and requirements effectiveness of information inform Risk Lead: Lynda Harris governance processes, and Regular adhoc IG spot checks Lynda Harris 31 Mar decisio Last Updated: 03 Mar 2021 Effect of risk realising wider risk exposures. undertaken within CCG 2021 ns Sensitive information, Directorates Annual Mandatory IG Training Latest Review Date: 03 Mar including patient identifiable 2021 information, held by the CCG Latest Review By: Lynda could be shared COVID-19 Data Protection Harris inappropriately Impact Assessments (DPIAs) in place to assess new Last Review Comments: SIRO Reputational and potentially projects/processes reminding all staff to undertake legal implications for the CCG their annual online IG training Data Security Protection Toolkit completed in March 2019 GDPR Data Protection Officer in place
Page 9 of 31 Board Assurance Framework
BCCG - Improve integration of services
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 3.1) As a result of Cause of risk I = 4 L = 4 Digital transformation work Final drafts of Strategic Outline Nicky Wadely 30 Sep I = 4 L = 4 13 Improv multiple factors (i.e. workforce, Difficulties in recruiting to 16 around Primary Care Home, Cases completed for West Mid 2019 16 e increasing and aging practices vacancies/resilience patient access underway. This Beds, Leighton Buzzard and Ivel integrat population, premises issues stemming from staff includes increasing the Valley ion of constraints) practices do not absences sharing of clinical information Work being commissioned to Mike 31 Oct service have the capacity, capability or Lack of capacity to expand across a wider range of support development of BLMK Thompson 2019 s resilience for transformation within current premises professionals. wide Estates Strategy, to which will result in reduced Lack of resource to enable Extended access to primary complement strategic estates access to services and inc transformation care across CCG area priorities established for Risk Owner: Mike Thompson Bedfordshire Effect of risk realising Multidisciplinary Team Risk Lead: Nicky Wadely Increased locum cost to approach developed and Outline Business Cases with Nicky Wadely 30 Apr Last Updated: 16 Feb 2021 providers which is not a implemented at cluster level designs for Dunstable Hub and 2020 sustainable model and with community, mental health Gilbert Hitchcock House Hub to Latest Review Date: practices hand back contract and social care teams in both be completed Practices will close their list to places Latest Review By: Primary Care Network contracts Mike 31 Jul new patients causing Primary Care Home (PCH) to be signed with further Thompson 2020 Last Review Comments: pressure and possible domino programme and developments in collaborative effect on other practices implementation of Primary working throughout the year Practices will not have the Care Network (PCN) DES internal capacity to support Development of caretaker step in Mike 30 Sep contracts to develop introduction of new ways of provider framework. Provider Thompson 2020 integrated working and working. It is anticipated that procurement training to take improve population health further implementation of place. Primary Care Networks and Support programme for Time Population health analytics Mike 31 Mar associated support will enable for Care and High Impact capability development Thompson 2021 development of Actions transformation capacity within Practice resilience programme Mike 31 Mar Workforce development primary care. Thompson 2021 strategy in place and into delivery phase. Strategy to be Transformation funding to be used Mike 31 Mar revised for 2019/20 linked to to help enable transformation at Thompson 2021 ICS Primary Care Strategy PCN/Place level Continued development of Nicky Wadely 31 Mar Primary Care Network leadership 2021
Page 10 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 1.3) Risk that Cause of risk I = 5 L = 4 A new HR&ODL Strategy Further discussions at the Jane Meggitt 10 Oct I = 2 L = 4 10 Improv workforce issues prevent us Unclear approach and 20 developed with four strands: overarching STP workforce group 2019 8 ed from transforming the delivery of absence of strategy; Limited Leadership Culture; as to how it will be implemented. Access care across the local health and system workforce capacity Workforce Planning, Setting out requirements for Jane Meggitt 10 Oct & social care system. and capability; Workforce Recruitment & Retention; workforce plan within submissions 2019 Quality culture not congruent with Learning & Development; Risk Owner: Jane Meggitt for new pathways and re- required changes; Poor Policies, Procedures & procurements of existing services Risk Lead: communication with health Systems working with partners to identify and social care partners; Last Updated: 15 Feb 2021 A new Service Level workforce capacity and capability Limited BCCG workforce Agreement has been signed requirements involved in multiple Latest Review Date: capacity and capability to by the AOs of HVCCG, procurements and flag key risks manage multiple Latest Review By: BCCG, ENH, LCCG and West to the Executive and Board procurements alongside Essex, that sets out the Last Review Comments: business as usual HR&ODL services, which is implemented via the approved Effect of risk realising HR&ODL Strategy. Unstable and demotivated workforce; Lack of ability for Bidders for new pathways are succession planning; staff being asked to describe shortages and skill gaps; workforce solutions in detail. pressure on financial Current new ways of working planning. locally, regionally and nationally were identified. STP work streams have been identified with HR&OD leads. Apprenticeship levies - Workforce recruitment and attraction. Workforce strategy reviewed
Page 11 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BBCG (Risk 1.4) The CCG’s Cause of risk I = 4 L = 4 A comprehensive winter plan It is recognised that whilst there Emma Hunt- 05 Mar I = 3 L = 4 11 Improv winter resilience plan does not Activity surges 16 is in place which sets out are robust plans in place, there is Smith 2020 12 ed result in the achievement of High Acuity of patients actions being implemented still a risk of demand exceeding Access expected targets Out of hospital capacity across the Bedfordshire capacity during the winter period, & Risk Owner: Mike Thompson Workforce shortages in Health and Social Care which could cause issues with Quality groups critical to supporting system to ensure that flow in and out of the acute Risk Lead: Emma Hunt-Smith the urgent care system. appropriate arrangements are hospital and community services. Last Updated: 15 Feb 2021 Funding pressures. in place to provide high quality and responsive Therefore, in addition to the Latest Review Date: Effect of risk realising services not just for the aforementioned whole system Latest Review By: Increasing Length of Stay 2019/20 winter period but for commitment, whole system surge Deterioration of Medically future years in line with the planning will be led by BCCG as Last Review Comments: Optimised (MO) and Delayed Long Term Plan. appropriate in line with OPEL Transfers of Care (DToC) These programmes of work escalation triggers and actions. performance collectively aim to meet the Deterioration of A&E national requirements of: performance •delivery of the delayed Overcrowding in A&E transfers of care <3.5% Patients in outlying escalation expectation wards with skeletal staff •reducing length of stay for coverage patients across the system Risk to patient safety and •increase primary care experience. streaming •implementation of Same Day Emergency Care (SDEC) •delivery of seven day services / weekend discharges
Members of the System Resilience Group review the data against these key deliverables each month, reporting slippage and concerns to the A&E Delivery Board
Page 12 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by A detailed Demand and Capacity Plan commenced September 2019 which managed through a fortnightly system meeting. An average ‘bed equivalent’ capacity gap of 33 was identified. Partner organisations including BCCG committed to the provision of additional capacity through efficiencies, transformation and the purchase of additional winter beds in order to bridge this gap. Executive member representatives across Health and Social Care form the Demand and Capacity Steering Group which initially met throughout winter to ensure progression against key milestones for scheme implementation and to review the progression of each scheme and its impact on reducing bed occupancy in the acute trust to 92%. However, in February 2020 it was agreed these fortnightly meetings will continue indefinitely to oversee and manage demand and capacity issues across the system. Members of the Steering Group scrutinise and challenge progress of identified schemes for deliverability. Milestones and KPIs are monitored to ensure delivery against plan.
Page 13 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 1.1) Risk to Cause of risk I = 3 L = 4 Assurance visits undertaken 2019 review of yellow inform and Maria Laffan 31 Mar I = 2 L = 2 8 Improv quality , patient care and Poor assurance from 12 by all members of the quality purpose commencing in August 2020 4 ed experience providers through contract team, both announced and Monthly team meetings in place to Maria Laffan 09 Jun Access monitoring and not listening to unannounced as determined Risk Owner: Anne Murray review combined analysis of 2020 & patients in relation to their by risk level. Update: quality service provision and quality Quality Risk Lead: Maria Laffan experiences assurances re visiting clinical delivery. escalation from this areas has paused due to Last Updated: 15 Feb 2021 meeting as appropriate to ICQC Effect of risk realising Covid impact. and risk register Latest Review Date: Patients not receiving safe, Clear processes established effective care and there being Strong relationship with local Maria Laffan 09 Jun Latest Review By: and in place with partner an ineffective costly service Health watch being established 2020 organisations to report Last Review Comments: delivery. information (e.g. safeguarding Local Quality team monthly Maria Laffan 09 Jun boards, Transforming Care operational meeting to flag and 2020 Learning Disabilities board) concerns or increase focus on service delivery Ensure robust Quality Impact Assessment of all QIPP programmes are in place before programmes go live by developing a programme of work for 18/19 19/20 Ensure safer staffing measurements are in place across all provision Escalation to face to face senior level meetings in relation to risks identified from Serious Incidents and Safeguarding alerts. Escalation to Regional Quality Surveillance Group together with details of quality visits to enable system wide sharing and intervention as required from NHS England.
Page 14 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Increased clinical involvement and sharing of quality impact assessments in relation to service changes at the newly formed clinical reference group. Internal Audit of CHC processes Learning from Serious Incidents monitored and work on-going with providers on resulting action plans Monitoring of learning from complaints to identify key themes and learning points to improve quality of care, treatment and patient experience New CQUIN data means all data will now be reviewed on final end of year submission. Ongoing discussions with providers on general performance will continue Provider/Commissioner deep dives undertaken aligned to contract performance notice process. Quality contractual requirements specified with clear reporting lines and timescales in place.
Page 15 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Quality Team are active participants in both Local Authorities Safeguarding boards for Children and Adults Regular quality contractual meetings held with providers to review data and intelligence Reporting on themes identified from Route Cause Analysis undertaken on constitutional breaches at pathway and patient level is on place. Reports to Integrated Commissioning and Quality Committee to provide assurance and enable Independent challenge from Lay members. Triangulation of contractual data and intelligence with information received via public and Patient forums including Health watch. Quality teams working specifically with Healthwatch on community services quality visits Yellow Inform button (reporting system of safety and quality issues by GPs and providers) in place. Feedback being monitored.
Page 16 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF BCCG - BCCG (Risk 1.2:) Risk of Cause of risk I = 3 L = 4 Attendance at National patient Monthly SI panels in place for Maria Laffan 09 Jun I = 3 L = 3 9 Improv increased patient safety Culture in providers where 12 safety events to share Acute. Mental health, Ambulance, 2020 9 ed incidents learning from SIs and patient learning community and other providers. Access safety challenge is not Clinical engagement on all SI Risk Owner: Anne Murray Deep dives requested into & embedded. panels any themed areas of concern Quality Risk Lead: Maria Laffan Last Updated: 15 Feb 2021 Effect of risk realising Escalation to face to face Increased patient safety senior level meetings in Latest Review Date: incidents with similar causes relation to risks identified from Latest Review By: and lack of learning Serious Incidents and Safeguarding alerts. Last Review Comments: Escalation to Regional Quality Surveillance Group together with details of quality visits to enable system wide sharing and intervention such as risk summit as required from NHS England Extraordinary meetings with providers and clinical leaders of organisations who report higher numbers of SI Monthly Serious Incident panel at CCG to include quality and Commissioner leads. Quality review meetings with all providers Quality visit reviewing if learning is embedded Review of all provider 60 day reports on SIs and associated action plans
Page 17 of 31 Board Assurance Framework
BCCG - Improved Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Shared discussion at Herts & South Midlands Quality surveillance
LCCG - 001 Commissioning Differently
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF LCCG - LCCG (BAF 2) - There is a risk Weaknesses: I = 4 L = 3 Bespoke clinical leadership I = 4 L = 2 2 001 of insufficient engagement and Primary Care and Patients 12 for priority areas and 8 Commi ownership in the system vision may not believe in the vision programmes throughout the ssionin leading to resistence to change GPs feel overburdened CCG g which may delay or prevent the Acute sector do not own the Executive and Clinical Board Differen progress of transformation. issue Directors alignment to PCNs tly Risk Owner: Nicky Poulain Focused agenda at PLT and Risk Lead: Consequence: Member's Forum Poor outcomes for the Last Updated: 15 Feb 2021 Luton engagement in the STP population to provide the shared vision Latest Review Date: Pace and scale not achieved Latest Review By: Acute sector overperformance - eating into scarce resources Last Review Comments: Commissioning plans not achieved
Page 18 of 31 Board Assurance Framework
LCCG - 001 Commissioning Differently
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF LCCG - LCCG (BAF 3) - Individuals and Weaknesses: I = 4 L = 3 Commissioned Cambridge I = 4 L = 2 3 001 organisations resist integration, Primary, Community and 12 Community Services to be 8 Commi continuing to work to internal Social Care do not have coordinating provider for 'At ssionin strategies rather than the effective relationships Home First' g system-wide vision. Poor commitment to Luton Primary, Community Differen integration Risk Owner: Nicky Poulain and Social Care tly Acute sector continues to Transformation Board to Risk Lead: work to own strategy ensure system working Last Updated: 15 Feb 2021 Utilise the agreed outcomes Latest Review Date: Consequence: of the ICS CEO's group and Latest Review By: Unnecessary admissions to Individual Workstreams acute for some patients Last Review Comments: High number of short stay admissions CCG finances strained due to acute sector over performance Voluntary sector resources not fully utilised
Page 19 of 31 Board Assurance Framework
LCCG - 003 Transforming our organisation
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF LCCG - LCCG (BAF 4) The CCG may Weaknesses: I = 4 L = 3 Communications and I = 4 L = 2 4 003 not be effective in engaging and Lack of public engagement, 12 Engagement Strategy in place 8 Transfo involving the public, clinicians insufficient co-production and monitored through the rming and organisations in the Difficulties reaching diverse Communications and our transformation of the NHS in population Engagement Steering Group organis Luton. Provider engagement Health and Social Care ation Primary Care engagement Risk Owner: Jane Meggitt Reference Group to support Voluntary Sector engagement Risk Lead: engagement with public. Last Updated: 15 Feb 2021 Consequence: Communication of CCG's Latest Review Date: intentions not effective Latest Review By: Patients not engaged in commissioning of services Last Review Comments: Behaviours slow to change Providers working in silos
BAF LCCG - LCCG (BAF 32) - There is a risk I = 4 L = 3 Engagement with local I = 4 L = 3 7 003 that providers’ provision may of 12 Healthwatch 12 Transfo poor quality due to workforce, or Ongoing contract and rming capacity problems which could performance reviews our lead to poorer outcomes. The review and learning from organis Risk Owner: Anne Murray ation serious incidents Risk Lead: Jennie Russell Visits to providers to gain Last Updated: 15 Feb 2021 assurance of quality and Latest Review Date: safety Latest Review By: Last Review Comments:
Page 20 of 31 Board Assurance Framework
LCCG - 003 Transforming our organisation
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF LCCG - LCCG (BAF1) - There is a risk There is a risk that there will I = 5 L = 4 Bedfordshire, Luton and I = 5 L = 2 1 003 that there will be insufficient be insufficient workforce 20 Milton Keynes Commissioning 10 Transfo workforce capacity across the capacity across the Luton Collaborative established with rming Luton System to deliver the System to deliver the priorities Executive Team working our priorities of the both the of the both the Integrated across the three CCGs. organis Integrated Care System and the Care System and the Collaborative working though ation Integration with Luton Borough Integration with Luton the STP Priority 2 Council Borough Council Transformation Boards to Risk Owner: Nicky Poulain improve capacity across the Risk Lead: system. Last Updated: 15 Feb 2021 Luton CCG and Luton Borough Council co-located Latest Review Date: and integrated working to Latest Review By: avoid duplication. Last Review Comments: NEL CSU appointed for the functions of Contract Management, Performance and Business Intelligence New Medical Director working across three CCGs and Executive Lead for Primary Care Workforce, strengthening links with Health Education England (Local Action Workforce Board (LWAB for BLMK). OD plan, staff meetings, PDP's for all staff in place. Training, development, appraisal process in place along with talent mapping matched to the objectives of the organisation.
Page 21 of 31 Board Assurance Framework
LCCG - 003 Transforming our organisation
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Permanent appointments to the Board, Executive and within teams in the CCG to ensure the required longer term capacity and capability to deliver the CCG business professionally and consistently.
BAF LCCG - LCCG (BAF 7) - The CCG may Weaknesses: I = 4 L = 3 BLMK Commissioning I = 4 L = 2 6 003 be unable to recruit and retain Succession planning across 12 Collaborative provides 8 Transfo staff and clinical leaders with the the system resilience at individual CCG rming right skills and abilities to deliver Competing with larger CCG's level, with a shared our the system-wide strategy. with better benefits recruitment review process in organis Risk Owner: Nicky Poulain Integration programme place. ation demanding capacity Engagement with staff Risk Lead: Small pool of clinicians through staff meetings and Last Updated: 15 Feb 2021 annual staff survey Consequence: Latest Review Date: High turnover of staff slows Robust system of Latest Review By: down progress performance management Small teams so cannot and development in place to Last Review Comments: achieve the pace and scale identify talent and map gaps Knowledge management in knowledge across the organisation Staff Involvement Group (SIG) is in place to ensure engagement will staff Workforce strategy developed with shared service provider
Page 22 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (ST76) Cyber security As a result of outdated I = 4 L = 3 A plan is in place to replace AGEM to install new servers and Wendy 30 Jun I = 4 L = 3 23 G - S2 - risks unsupported systems or 12 Windows 7 with Windows 10 turn off old servers in GP Rowlands 2020 12 Access delays in patching systems, Practices. 8 out of 11 completed. Risk Owner: Wendy Rowlands Fire wall in place at each GP & there is a risk that the CCG IT Deadline extended again due to site Quality Risk Lead: Wendy Rowlands infrastructure is unprotected, Covid-19. New servers are being resulting in the CCG being Last Updated: 16 Feb 2021 installed to replace Windows HBL to undertake a cyber security Wendy 31 Jul prone to Cyber attacks. This 2012 servers risk assessment when they take Rowlands 2020 Latest Review Date: could impact on other over services Latest Review By: partners joined to the Microsoft have agreed to network. continue to support Windows Last Review Comments: 7 for an additional 12 months. Upgrade will offer additional security therefore the CCG will still push forward with the upgrade plan.
Windows 10 installation completed in the CCG site.
Page 23 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (ST55) Patients have Complexity of cases, wait I = 4 L = 4 Cancer lead is now assigned Conduct a Peer review of urology Maria Brown 28 Feb I = 4 L = 3 20 G - S2 - poor cancer outcomes times (particularly in Urology) 16 to cancer transformation pathways with NHSE ensuring 2020 12 Access Risk Owner: Maria Laffan hand off between secondary along with Programme lessons learnt and to drive & care and tertiary centres, and Support and a an allocated improvements Quality Risk Lead: capacity in secondary care person from the Cancer Continue attendance at meetings Maria Laffan 31 Mar resulting in delays in Alliance. The Trust are also Last Updated: 16 Feb 2021 and monitor mitigations through 2020 accessing cancer treatment out to advert for a project CQRMs. Latest Review Date: and subsequent risks to lead. patient recovery, outcomes Latest Review By: CCG and MKUH colleagues and mortality rates. Last Review Comments: are working together and have reviewed the cancer pathways. There is now a Clinical triage of patients and this process priorities those patients who need to be seen sooner following blood results etc. CCG and MKUH colleagues are working together on the reporting. CCG colleagues attend MKUH the cancer meetings. Collaborative work between MKH, MKCCG and the Cancer Alliance to improve cancer pathways - utilising the available national funding to support transformation. Contract levers in place to manage underperformance Increased CCG and provider board focus Oversight and scrutiny of performance at MKH PTL and Contract meeting.
Page 24 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by QSG oversight and escalation to Regional QSG as required RCA reviews of all 62 day breaches Recruited a Urology Nurse within the Trust to increase capacity and release Consultant work. The provider utilises a cancer PTL tool . Scheduled PTL meetings and speciality meetings re division capacity and demand. Through regular CQRMs, the CCG and MKUH have worked together to provide assurance on cancer pathways, diagnosis and the workforce. The waiting lists for patients has reduced and patients are being diagnosed sooner and this improves the patient's prognosis.
Page 25 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (ST 53) Failure to As a result of the long waits I = 4 L = 5 Attendance at the Patient List Work with Acute Trusts to perform MIchael 30 Sep I = 4 L = 4 22 G - S2 - achieve 18 & 52 week for elective care, there is a 20 Tracking meeting to gain a Demand and Capacity review in Ramsden 2020 16 Access performance risk that health needs will assurance on the Trust's the context of the Covid 19 & Risk Owner: Richard Alsop deteriorate resulting in poorer actions on long waiters, pandemic. Outputs will determine Quality outcomes for patients. This especially those who have the implications for elective care Risk Lead: MIchael Ramsden risk has increased due to the waited 40 weeks + to avoid in the short and medium term. Covid-19 pandemic further 52 week breaches. Last Updated: 09 Mar 2021 Use contractual measures to MIchael 31 Mar implications on surgery Latest Review Date: Maximise the use of the understand issues and apply Ramsden 2021 NHSE funded Independent mitigation. This is an ongoing Latest Review By: Sector to delivery some action . Last Review Comments: elective care. This will create additional capacity, reducing the wait list and treatment timeframes.
Monthly Commissioner, Contracts and Performance meetings with provider teams RMS referral triage to deflect unnecessary activity away from secondary care into community services. This will increase treatment times for those not needing consultant led care. The IMSK service will assess & triage all IMSK related referrals from Primary Care to ensure all alternative clinical pathways are explored and fully utilise conservative treatments where surgical options are expected to deliver poor outcomes.
Page 26 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by Trust led review of operating procedures in light of the Covid-19 pandemic. To only operate when it is safe to do so and supported by national guidelines. Embed virtual clinics which reducing the need for unnecessary face to face appointments moving to a phase of watchful waiting
BAF MKCC MKCCG (ST82) Cessation of Extra Care have given notice I = 3 L = 4 Action plan created by CNWL Replacement premises to be Jan Wood 30 Jun I = 3 L = 4 19 G - S2 - the CNWL TOPAS service if to CNWL to vacate premises 12 monitored through contract found & approved 2020 12 Access new accommodation cannot occupied by TOPAS service meetings Location of new premises; Jan Wood 01 Jul & found which could result in no business case to support estates 2020 Quality premises for clients leading to Risk Owner: Jan Wood Weekly project meetings changes to be approved: weekly excess cost & anxiety for project meetings to maintain Risk Lead: patient & families due to momentum: MKC to be kept placements out of area. Last Updated: 16 Feb 2021 informed Latest Review Date: Latest Review By: Last Review Comments:
Page 27 of 31 Board Assurance Framework
MKCCG - S2 - Access & Quality
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (ST52) Insufficient National, regional and local I = 4 L = 5 "Monitoring and investigation Quality Committee review regular Jenny Brooks 12 Nov I = 3 L = 4 21 G - S2 - Health and Social Care staff shortages in key areas, 20 of serious incidents in workforce reports from providers. 2019 12 Access Workforce Capacity and there are significant provider services will flag This work will link into LWAB for a & Capability to deliver challenges in recruiting and staffing related incidents." wider picture, this will then be Quality transformation plans (ST28) retaining substantive staff into present to the Quality Committee. Development of staff into new new and existing roles within Risk Owner: Anne Murray roles in secondary and Providers working with education Maria Laffan 31 Mar the health and social care primary care institutions to make training more 2020 Risk Lead: Maria Laffan workforce to deliver service accessible, improve workforce transformation. Resulting in LWAB local Workforce Action Last Updated: 16 Feb 2021 supply, develop new roles and inability to implement Board working through grow the medical workforce. Latest Review Date: transformation plans leadership & organisational Ongoing until the end of the year Latest Review By: impacting on quality of patient sub-groups with providers to care and delivery of new ways secure recruitment and Health and social workforce risks Maria Laffan 31 Mar Last Review Comments: of working. retention initiatives and discussed at integration board to 2020 development of attractive identify opportunities for offers and portfolio careers workforce integration to improve efficiency. This work is ongoing LWAB scoped workforce completed in line BLMK and hotspots across BLMK Integration work. Transformation teams raising and monitoring risk in Programme Boards. Workforce planning across STP through Local Workforce Advisory Boards.
Page 28 of 31 Board Assurance Framework
MKCCG - S3 - Financial Sustainability
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (F21) Failure to deliver As a result of the carried fwd I = 5 L = 4 Financial Plan Developed for Scoping opportunities with BLMK Wendy 30 Jun I = 5 L = 4 29 G - S3 - 20/21 Financial Plan underlying financial position of 20 20/21 with QIPP schemes system partners via CEO/CFO Rowlands 2020 20 Financi Risk Owner: Wendy Rowlands the CCG, and the new 20/21 identified for 63% of target fora. Put on Hold due to Covid-19 al cost pressures leading to a Joint Savings Programme in Re-assess the position as part of Wendy 30 Jun Sustain Risk Lead: consequential significant Place with Providers with joint the recovery workstream actions Rowlands 2020 ability QIPP required to deliver the Last Updated: 16 Feb 2021 review meetings & CCG Lead for Covid-19 20/21 Financial Plan target - co-ordinator. CCG Latest Review Date: there is a risk that the CCG is BLMK CCG QIPP Programme Paul Burridge 30 Jun Commissioners have unable to fully identify and Board to be established chaired 2020 Latest Review By: honorary contracts with deliver the required by Director of Performance. Put providers to support joint Last Review Comments: QIPP/Transformation savings on hold due to Covid-19 transformation programmes plan and by consequence the Identification of schemes - a Paul Burridge 30 Jun 20-21 Financial Plan target. Monitoring Process in place workshops took place on 11th and 2020 through Finance Committee & 12th March 2020 conducted at a Board BLMK level with attendance from Directors and Assistant/Associate Directors from all 3 CCGs. Aim to agree a small number of large financial opportunities that can be scoped and built up quickly to mitigate the financial gap. A number of areas were identified and action for leads to build opportunities into programmes, with measurable outcomes and plans, which can then be tracked and managed via the PMO. - Put on hold due to Covid-19 Seek support and capacity from Wendy 30 Jun NHSE/I East Region. Rowlands 2020
Page 29 of 31 Board Assurance Framework
MKCCG - S3 - Financial Sustainability
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (F22) Failure to Deliver As a result of financial I = 4 L = 3 Acting CFO has written to Ensure that recommendations of Wendy 30 Jun I = 4 L = 3 27 G - S3 - MHIS pressures the CCG is unable 12 NHSE/I East Region setting the MHIS audit undertaken by Rowlands 2020 12 Financi Risk Owner: Wendy Rowlands to deliver the requirements of out position re: MHIS delivery GTUK are implemented. al the Mental Health Investment in 2019/20 and cumulative Work with NHSE/I to set out Wendy 30 Jun Sustain Risk Lead: Wendy Rowlands Standard (MHIS); including under delivery relating to prior financial and consequential Rowlands 2020 ability cumulative recovery of under year attainment (as pe MHIS Last Updated: 16 Feb 2021 implications of recovering delivery against the target for audit, yet to be issued). cumulative MHIS under Latest Review Date: the 18/19 financial year (as performance. identified through the 18/19 Latest Review By: all appropriate spend is MHIS audit). Last Review Comments: captured and reported against the standard
Enhanced reporting of delivery against the MHIS to Finance Committee and Governing Body. MH provider has signed-off 20 -21 MHIS plans.
BAF MKCC MCCG (F26) Covid-19 impact As a result of the Covid-19 I = 3 L = 4 Targeted guidance has been Agree with the CFO Counter Wendy 30 Jun I = 3 L = 4 26 G - S3 - leading to increased risk of incident there is potential 12 sent staff to ensure that staff Fraud specific work items to be Rowlands 2020 12 Financi fraud increased risk of fraud, this remain astute to fraud risks pursued locally. al includes: cyber fraud, and the changing nature of Risk Owner: Wendy Rowlands Regular staff communications to Wendy 31 Jul Sustain misappropriation, invoice fraud during the crisis. be issued. Rowlands 2020 ability Risk Lead: fraud, procurement fraud The CCG has a Local etc… Last Updated: 16 Feb 2021 Counter Fraud Service Latest Review Date: (LCFS). Latest Review By: Last Review Comments:
Page 30 of 31 Board Assurance Framework
MKCCG - S3 - Financial Sustainability
Risk CCG Risk Title Risk Description Initial Risk Control Action Required Person To be Current Ref Obj. Score Responsible implemen Score ted by BAF MKCC MKCCG (F24) Delegated As a result of the nationally I = 4 L = 4 Financial monitoring through Review calculations of impact of Wendy 30 Jun I = 4 L = 4 25 G - S3 - Primary Care Spend to Exceed agreed Primary Care Contract 16 Primary Care Committee, new GP contract deal and Rowlands 2020 16 Financi 20/21 Allocation settlement and the increase in Finance Committee and anticipated allocation top up to al Risk Owner: Wendy Rowlands GP practices in MK to meet Board assess potential to offset financial Sustain population growth there is a pressure. Reconsider this in light Financial plan developed ability Risk Lead: Wendy Rowlands risk that expenditure on of new budget regime for Covid- based on assessment of new delegated primary care will 19 Last Updated: 16 Feb 2021 contract deal and practice exceed the allocation growth in MK Latest Review Date: resulting in failure to deliver Assess opportunities for slippage Wendy 30 Jun the financial control total Latest Review By: in plans to mitigate financial Rowlands 2020 Last Review Comments: pressure
BAF MKCC MKCCG (F25) Covid-19 Impact As a result of the Covid-19 I = 4 L = 4 LA/CCG Finance Cell has Develop financial plan beyond Wendy 17 Jun I = 4 L = 3 28 G - S3 - on delivery of 20-21 Financial incident the NHS is operating 16 been convened. July once NHSE guidance Rowlands 2020 12 Financi Plan with amended contract and Reimbursement for hospital released al Risk Owner: Wendy Rowlands payment arrangements - discharge costs expected Sustain there is a risk that the CCG is based upon data submitted by CCGs to review SFIs in light of Wendy 30 Jun ability Risk Lead: incurring additional and CCGs. response. Rowlands 2020 unfunded costs that could Last Updated: 16 Feb 2021 Revised budget plan jeopardise the delivery of the S75 agreement to be agreed with Wendy 30 Jun implemented for Covid-19 and Latest Review Date: 20-21 financial targets. Local Authorities. Rowlands 2020 new NHSE financial regime to Latest Review By: top up additional costs each Last Review Comments: month
The CCG has created an incident cell structure which includes finance representation. Revenue and capital commitments agreed by the Cell are being captured to support financial reporting locally and nationally.
Page 31 of 31 Corporate Risk Register
Report Date 09 Mar 2021
Page 1 of 11 Corporate Risk Register
Medium
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 8 MKCCG - Lack of Lack of alignment between I = 4 L = 3 BLMK CCG shadow working now in place I = 3 L = 3 alignment accountability and contracting 12 9 Person Responsible: between existing mechanisms for commissioners and CCG led comms & engagement programme To be implemented by: structures and providers across the ICS may lead to in place for staff to understand move towards new system-wide transformational delay becoming a single CCG from April 2021. ways of work One CCG Approach in place across BLMK CCGs at Exec Level with defined functions/responsibilities from 1st April Regular Collaborative level CCG briefings for staff on One CCG approach to change/transformation of functions. Tier 2.. Executive Team established to enable a joined up commissioner view STP DoF Group established
CRR 14 MKCCG - Failure Failure of a successful and productive I = 3 L = 4 Development of ICP is a central area of I = 3 L = 3 of successful ICP being developed and agreed 12 established BLMK One Team Programme 9 Person Responsible: Integrated Care across Milton Keynes partners, there Plan, with specific actions identified. To be implemented by: Partnership (ICP) is a risk that progress with achieving Development of Target Operating Model for to be developed further service integration and/or wider cross CCG changes will support across Milton system.. determination of the local ICP scope for Keynes discussion with partners. Partnership working to help establish parameters of emerging ICP being provided by external support (Carnell Farrar)
Page 2 of 11 Corporate Risk Register
Medium
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 21 LCCG - BCF may "Weaknesses: I = 3 L = 3 "Allocation of core funding is robustly I = 3 L = 3 "CCG BI & LBC Finance to provide core I = 3 L = 2 not meet the Difficulties gaining adequate 9 considered, approved & managed. 9 funding quarterly report & bi-monthly highlight 6 defined outputs outcomes from core funding Change scheme Business Cases presented report for the EHCH change scheme to BCF operations that meet BCF criteria. to JSCG for approval, to ensure the proposals Project Support for Programme Manager Measuring outcomes & benefits of meet the criteria and are able to clearly monitoring. This action has been impacted by core funding cannot be directly evidence the expected benefits. Covid-19. Following conversations with the applied to the BCF.. Programme reporting & management is in BCF Locality Lead Core funding will not be place." reported until guidance has been received from the BCF Board. The Bi-monthly reporting Assurance and Governance embedded into for EHCHs is.. the programme Person Responsible: Yasmin Martin-Leggitt BCF report, risk register, quarterly core funding highlight report and bi-monthly report To be implemented by: 20 Nov 2020 from EHCH's presented to JSCG Monthly Joint Financial Reporting to FSG and JSCG Programme Manager, FSG and JSCG have a full understanding of the BCF Framework and criteria Quarterly reports to the Better Care Fund Board as part of the NHS England programme governance
CRR 24 LCCG - Risk that "Weaknesses: I = 2 L = 2 Engaging stakeholders, VCS & members of I = 2 L = 2 "Following Business case approval & outlined I = 1 L = 2 VCS groups & the Poor communication. 4 the public in co-production at each planning 4 comms approach, bi-monthly highlights reports 2 public may not Benefits may not be adequately stage of scheme will be monitored to identify risks & issues on engage and explained. engagement of this cohort Strong communication plan assigned to the understand the change scheme Person Responsible: Yasmin Martin-Leggitt transformation Consequence: Public & VCS buy-in to plans and To be implemented by: 27 Nov 2020 local confidence will be reduced. Public VCS need, will not be fully..
Page 3 of 11 Corporate Risk Register
Medium
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 35 LCCG - System "Weaknesses: I = 4 L = 3 BCCG BIAs audited and no substansive risk I = 4 L = 2 "To review structure and capacity of EPRR I = 3 L = 2 Wide Business There is not currently the capacity in 12 identified, focus to turn to Luton primary care 8 across the STP footprint to increase business 6 Continuity Plans the system to review and test the BIAs for review continuity capacity. may not be robust business continuity plans in primary Person Responsible: Mark Meekins care and provider organisations . Business Continuity Plans requested as part To be implemented by: 31 May 2019 of procurement process. This may lead to a failure in the.. Commissioning Support Unit closely monitor contractual obligations with Providers in the Luton system.
The need for Business Continuity Plans highlighted in contracts.
CRR 61 NO Deal Brexit As a result of a lack of trade deal at I = 3 L = 3 Comprehensive risk assessment carried out I = 3 L = 3 Refresh risk assessment with provider I = 3 L = 2 Implications - the end of the EU transition period, 9 with all partners 9 partners in light of Radiometer incident and 6 Continuity of there is a risk that the supply chain of LRF RWCS planning DHSC has taken actions to protect supplies supply of medications, consumables and - alternative routes Person Responsible: Abimbola Hill medicines and medical devices with touch points in - Supporting trader readiness for the new medical devices Europe will be.. To be implemented by: 31 Mar 2021 customs and border processes - Buffer stocks of medical supplies where possible (6 weeks buffer stocks available) - Regulation - Shortage management response in place
Page 4 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 3 MKCCG - As a result of national, regional and I = 4 L = 5 Transformation teams raising and monitoring I = 3 L = 4 Quality Committee review regular workforce I = 3 L = 2 Insufficient Health local staff shortages in key areas, 20 risk in Programme Boards. 12 reports from providers. This work will link into 6 and Social Care there are significant challenges in LWAB for a wider picture, this will then be Development of staff into new roles in Workforce recruiting and retaining substantive present to the Quality Committee. secondary and primary care Capacity and staff into new and existing roles within Person Responsible: Jenny Brooks Capability to the health.. LWAB local Workforce Action Board working deliver through leadership & organisational sub- To be implemented by: 12 Nov 2019 transformation groups with providers to secure recruitment Providers working with education institutions to plans and retention initiatives and development of make training more accessible, improve attractive offers and portfolio careers workforce supply, develop new roles and grow LWAB scoped workforce hotspots across the medical workforce. Ongoing until the end BLMK of the year Monitoring and investigation of serious Person Responsible: Linda Chibuzor incidents in provider services will flag staffing To be implemented by: 31 Mar 2020 related incidents. Health and social workforce risks discussed at Workforce planning across STP through Local integration board to identify opportunities for Workforce Advisory workforce integration to improve efficiency. This work is ongoing completed in line BLMK and Integration work. Person Responsible: Linda Chibuzor To be implemented by: 31 Mar 2020
Page 5 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 7 MKCCG - The alignment of the CCGs; the I = 4 L = 4 CCGs Transition Team & Transition plan I = 3 L = 4 On going monitoring I = 3 L = 3 Insufficient development of the ICS and reduction 16 established to manage practical aspects of 12 Person Responsible: Richard Alsop 9 capacity & in running costs required by 2020 commissioning alignment. capability as a there is a risk that the CCG has To be implemented by: 27 Mar 2020 Do, Buy, Share Project underway across result of insufficient capacity to deliver its CCGs to review CCG support functions to increased statutory business. ensure that they are both robust and aligned partnership & and have sufficient capacity for the future. matrix working requirements Ensure Director lead for key priorities and cross organisational workstreams Limited use of interim capacity being used to support high priority areas One Team approached established Nov 19 - additional resources to support this transition
Page 6 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 22 LCCG - "Weaknesses: I = 3 L = 4 "1) Backing data - invoicing, reporting & I = 3 L = 4 "Mental Health LCCG funded clients - to agree I = 3 L = 2 Effectively Failure to manage partnership 12 budgetting 12 Person Responsible: Andrew Bland 6 Manage S75 relation – expectations, performance, 2) Open transparent reporting Partnership capacity 3) Shared evidenced activity data and spend To be implemented by: 30 Oct 2020 for joint planning "An across Bedfordshire D2A meeting is in Health versus Social Care - who pays 4) Agreeing S75 schedules line by line" train with the local finace leads reviewing Lack of statutory backing to S75 Monthly JSCG meetings have been reinstated schedules 3 & 4 for approval at JSCG pooled budget following the suspension in March due to the November. S75 Hospital Discharge Template Capacity diverted.. Covid pandemic to be finalised & due process to be followed with legal.
Person Responsible: Mike Chow To be implemented by: 06 Nov 2020" Person Responsible: Andrew Bland To be implemented by: 06 Nov 2020 "Integration Programme Manager to chase LBC legal for the finalisation of the refreshed S75 Deed of Variation 2019-2020 Person Responsible: Kate Sutherland To be implemented by: 20 Nov 2020 "S75 2020-2021 Agreement underway. Schedules are being reviewed & first draft presented at November JSCG. Person Responsible: Kate Sutherland To be implemented by: 30 Nov 2020 "Physical Disabilities new clients - to agree following review of the LD 50:50 agreement. Finance to present to JSCG January 2021 - delayed due to Finance pressures from Covid. Person Responsible: Liz Cox To be implemented by: 14 Jan 2021
Page 7 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 52 LCCG - "Weaknesses: I = 4 L = 3 BLMK SRO identified to give Executive I = 4 L = 3 "Review functions to establish resource I = 4 L = 2 Insufficient Transfer of resources from NHSE 12 oversight and ownership 12 requirements for a BLMK wide Primary Care 8 resource and insufficient across BLMK Contracting Team. Ongoing progress update capacity to deliver reports provided to Executive Team. Joint working across ICS taking place to allow NHS England Lack of senior capability/ capacity for greater collaboration across BLMK Person Responsible: Paul Lindars delegated within the contracting team. responsibilities NHS E consultation and subsequent To be implemented by: 01 Apr 2021 recruitment to Primary Care contracts role Consequence: including senior team member. Direct resource implication on the..
CRR 56 Covid Costs As a result of the Covid-19 incident I = 4 L = 4 For Hospital Discharge Service there will be I = 4 L = 4 S75 agreement to be agreed with Local I = 4 L = 2 the NHS is operating with amended 16 new S75 agreement that needs to be agreed 16 Authorities. 8 contract and payment arrangements - with Local Councils. LA/CCG Finance Cell Person Responsible: Stephen Makin there is a risk that the CCG is has been convened. Reimbursement for incurring additional and unfunded hospital discharge costs expected based To be implemented by: 30 Nov 2020 costs that could.. upon data submitted by CCGs. CCGs to review SFIs in light of response. For Hospital Discharge Service there will be Person Responsible: Stephen Makin new S75 agreement that needs to be agreed with Local Councils. LA/CCG Finance Cell To be implemented by: 30 Jun 2020 has been convened. Reimbursement for Model impact of interim contract and payment hospital discharge costs expected based arrangements to assess financial impact upon data submitted by CCGs. outturn scenarios. Engagement with Regional NHSE/I Team to set out key financial and contractual risks, this includes payments under the revised contractual arrangements that are greater than would otherwise be expected Person Responsible: Stephen Makin To be implemented by: 31 Jul 2020
Page 8 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 57 BCCG - Factors Escalated from the Primary Care I = 4 L = 4 "Workforce Development Programme I = 4 L = 3 "Despite improvement there are still concerns I = 1 L = 1 impacting on Commissioning Risk Register 16 Releasing Time for Care 12 around a number of practices. 1 Central As a result of the multiple factors Estates and Technology Development Bedfordshire impacting on Central Bedfordshire Primary Care Network development Continued support from place based teams. general practices general practices, there is a risk that GP resilience Programme practices will become.. PMS Reinvestment Scheme Initiatives in place to build resilience in the Place-based team longer term continue to deliver. MK chambers/support offers from MKGP Plus RCGP support Discussions around support from other ELFT primary care solutions providers (e.g. ELFT) are taking place where Digital development appropriate. Bedoc support offer Merger support PCNs delivering extended hours, many are Pre/post-CQC support" advertising for thier reimbursable roles (Clinical.. Person Responsible: Nicky Wadely To be implemented by: 30 Nov 2020
CRR 58 BCCG - Escalated from the CHC Risk I = 4 L = 4 1) All complex cases have a CHC assessor I = 4 L = 4 "During the covid period there has been I = 1 L = 1 Escalated from Register and Mental Health Risk 16 case managing, where risks escalate 16 escalation for some individuals unable to 1 the CHC Risk Register involvement from the local authority/CCG access day services. There is increased risk Register and Learning Disability Local Provision that these individuals will not wish to leave the 2) Intensive Support Team intervention when Mental Health As a result of only a small amount of family home once services are restablished required to support complex cases within area Risk Register local provision for individuals with and increased risk that behaviours may Learning more complex and.. require police support. Disability Local The CHC department have supported by Provision As a purchasing equipment for the home to reduce result of only a behaviours and tried to be.. small amount of Person Responsible: Diana Butterworth local provision for individuals with To be implemented by: 29 Nov 2019 more complex and challenging needs there is a risk that care provisi
Page 9 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 59 BCCG - factors "Escalated from the Primary Care I = 4 L = 4 "Workforce Development Programme I = 4 L = 3 "Despite improvement there are still concerns I = 2 L = 2 impacting on Commissioning risk register. 16 Releasing Time for Care 12 around a number of practices. 4 Bedford Borough As a result of the multiple factors Estates and Technology Development general practices impacting on Bedford Borough Primary Care Network development Continued support from place based teams. general practices, there is a risk that GP resilience Programme practices will become.. PMS Reinvestment Scheme Initiatives in place to build resilience in the Place-based team longer term continue to deliver. MK chambers/support offers from MKGP Plus RCGP support Discussions around support from other ELFT primary care solutions providers (e.g. ELFT) are taking place where Digital development appropriate. Bedoc support offer Merger support PCNs delivering extended hours, many are Pre/post-CQC support" advertising for thier reimbursable roles (Clinical.. Person Responsible: Nicky Wadely To be implemented by: 26 Feb 2021
Page 10 of 11 Corporate Risk Register
High
Risk Ref Risk Title Risk Description Initial Risk Control Current Action Required Target Score Score Score
CRR 60 MKCCG - Failure As a result of the long waits for I = 4 L = 5 Attendance at the Patient List Tracking I = 4 L = 4 Work with Acute Trusts to perform a Demand I = 4 L = 3 to achieve 18 & elective care, there is a risk that 20 meeting to gain assurance on the Trust's 16 and Capacity review in the context of the 12 52 week health needs will deteriorate resulting actions on long waiters, especially those who Covid 19 pandemic. Outputs will determine the performance. in poorer outcomes for patients. This have waited 40 weeks + to avoid further 52 implications for elective care in the short and risk has increased due to the Covid- week breaches. medium term. 19 pandemic.. Maximise the use of the NHSE funded Person Responsible: MIchael Ramsden Independent Sector to delivery some elective To be implemented by: 30 Sep 2020 care. This will create additional capacity, reducing the wait list and treatment Use contractual measures to understand timeframes. issues and apply mitigation.
Monthly Commissioner, Contracts and This is an ongoing action . Performance meetings with provider teams Person Responsible: MIchael Ramsden RMS referral triage to deflect unnecessary activity away from secondary care into To be implemented by: 31 Mar 2021 community services. This will increase treatment times for those not needing consultant led care. The IMSK service will assess & triage all IMSK related referrals from Primary Care to ensure all alternative clinical pathways are explored and fully utilise conservative treatments where surgical options are expected to deliver poor outcomes. Trust led review of operating procedures in light of the Covid-19 pandemic. To only operate when it is safe to do so and supported by national guidelines. Embed virtual clinics which reducing the need for unnecessary face to face appointments moving to a phase of watchful waiting
Page 11 of 11
Governing Bodies in Common in Public
16 March 2021
6.2: Note of Chair’s Action at Quality and Performance Joint Committee (Q&PJC)
Author: Maryla Hart, Governance and Committee Officer Contact Information: Lead Executive: Kathy French, Chair of Quality and Performance Joint Committee and Independent Nurse, Luton CCG Governing Body Which CCGs does this paper apply to?
Bedfordshire Y Luton Milton Keynes
Information
Which activity does this paper The following Quality and Performance Joint Committee relate to? Functions: xiv. Approve all CCG policies relating to quality, clinical effectiveness and safety. xv. Contribute to the delivery of reporting requirements including, but not limited to, the CCGs’ annual reports and accounts. How? The Governing Body is being asked to note the Chair’s action taken at Quality and Performance Joint Committee in relation to the approval of policies. What is the Committee/ To note the Chair’s Action taken at Quality and Performance Governing Body being asked to Joint Committee on 5 January 2021 do? What are the financial N/A implications?
Set out the key risks and risk If the Chair’s Action if not reported to the Governing Bodies in ratings Common, this will go against Governance processes as outlined in the Schemes of Reservation and Delegation and the Q&PJC Terms of Reference. Date to which the information 09/03/2021 this paper is based on was accurate
Executive Summary
The 5 January 2021 Q&PJC meeting was not quorate. It was decided to proceed with the meeting and take a Chair’s Action for the item that required approval on behalf of Bedfordshire CCG: 6.3: Updated HBLICT policies. No other items on the agenda were to be presented to the Joint Committee for decision on this occasion. The minutes of item 6.3 are as follows:
Updated HBLICT Policies: a. Acceptable Use Policy b. Telecoms Policy c. Network Security Policy d. Information Security Policy e. Mobile Device Security Policy
The Committee was asked to approve the policies on behalf of Bedfordshire CCG. All members present were happy to support the policies. However, the committee was not quorate.
ACTION: A Chair’s Action to be taken to approve the policies. KF to liaise with the Governance Team. By presenting this paper to the Governing Bodies in Common, the Q&PJC is making a report on the Chair’s Action to the Governing Body to which the business relates, as per the Q&PJC Terms of Reference. The Governing Bodies in Common are asked to note the Chair’s Action.
2
Governing Bodies in Common in Public
16 March 2021
5.3: Committee Minutes
Author: Various Contact Information: [email protected] Lead Executive: Various Which CCGs does this paper apply to?
Bedfordshire Luton Milton Kenyes
Information
Which activity does this paper To provide an update on the most recent activities of each of the relate to? sub-committees of the Governing Bodies, by presenting final versions of meeting minutes. How? The paper serves to provide assurance that the committees are carrying out their functions effectively.
What is the Committee/ To receive the updates and to be assured. Governing Body being asked to do? What are the financial N/A implications?
Set out the key risks and risk N/A ratings
Date to to which the information The dates on the minutes this paper is based on was accurate
Executive Summary
The most recent approved committee minutes are provided for information for the Governing Body
Minutes of the PPEJC Meeting Held on Tuesday 20th October 2020 Held over Microsoft teams
Patient and Organisational Representatives Effie Assan Patient and public representative BLMK EA Steve Black Patient and public representative BLMK SB Diana Blackmun Healthwatch Central Bedfordshire Bedfordshire DB Cheryl Green Patient and Public Representative BLMK CGr Alan Hancock Patient and Public Representative BLMK AHa Tracy Keech Healthwatch Milton Keynes Milton Keynes TK Lucy Nicholson Healthwatch Luton Luton LN Josan Race Community Action Milton Keynes BLMK JR Martin Trinder Community Voluntary Services (CVS) BLMK MTr Bedfordshire Phil Turner Patient and public representative BLMK PT John Wright Healthwatch Bedford Borough Bedfordshire JW
Members Present: Richard Alsop Director of Commissioning and Contracting BLMK RA Alison Borrett Chair of PPEJC / Lay Member Bedfordshire AB Dr Nessan Carson GP Member Milton Keynes NC Lloyd Denny Lay Member Luton LD Dr Christopher GP Member Bedfordshire CL Longstaff Jane Meggitt Director of Communications and Engagement BLMK JM Nicky Poulain Director of Primary Care BLMK NP Mike Rowlands Lay Member Milton Keynes MR
CCG Staff and Presenters Present Jackie Bowry Communications and Engagement Manager BLMK JB Jennis Cain Secretariat for PPEJC and Mental Health PA BLMK JC Sanhita Chakrabarti Assistant Director of Public Health BLMK SC Mark Cox Head of Commissioning Transformation BLMK MC Sarah Frisby Senior Communications and Engagement BLMK SF Manager Christina Gleeson Public Health across Bedford Borough, BLMK CGl Central Beds and Milton Keynes Council Anona Hoyle Senior Communications and Engagement BLMK AHo Officer Michelle Summers Head of Communications and Engagement BLMK MS
Apologies: Lisa Wright Advocate for Children and Young People BLMK LW (CYP) across BLMK
1. Welcome, Housekeeping and Introductions Action The Chair welcomed all members and attendees to the meeting. The Chair advised that the meeting was quorate.
Page 1 of 7 Apologies for absence Apologies were received and noted as above. 2. Declarations of Interest The Chair asked for any declarations of interest with regards to items on the agenda.
There were no declarations of interest. 3. Chair’s Update The Chair gave an introduction and verbal update. The application for one BLMK CCG was submitted to NHSE at the end of September; the next stage is for NHSE to review the application.
System working and Covid-19 The Communications and Engagement Team will be looking to work with Communications and Engagement partners across the ICS system, helping to develop system-side communications over the next 6 months. This will form part of the communications and engagement strategy. 4. Minutes of last meeting
The minutes of the meeting held on 18 August 2020 were approved as an accurate record subject to the following amendment:
• Amend initials ‘CG’ to either CGr or CGl as appropriate
5. ACTION Log The following were outstanding: Action 22: NHS 111 collateral available in different languages Update: In progress as still awaiting for the national team to respond - once received it will be localised.
Action 23: Nicky to catch up with Tracy re comments made on Facebook. Update: Mix messages are now fixed. This action can be closed.
All other actions were closed. 6 & 7. Communications and Engagement pipeline – our approach, and Communications and Engagement Strategy 2021.
To enable a fuller dialogue, the two agenda items were discussed at the same time.
JM gave an overview of the strategy document and explained as part of the application to become one organisation the communications team has been asked to review the Communications and Engagement Strategy. The document is high level which will set out principles e.g. what does co- design, engagement and consultation look like. JM explained that people use the same terminology but have a different level of understandings of what it means. The document will include the patient voice and have a clear plan and clarification on ‘what good looks like, which should help manage expectations.
CGr stated it was quite ‘wordy’, high level and did not include much actual content. The paragraph ‘everyone should have a voice’ should be changed to ‘everyone should have an opportunity’. CGr said she has
Page 2 of 7 listened to the Bedford Borough Overview and Scrutiny Committee and felt that the strategy needed to be more prescriptive. The phrase ‘The CCG is required by law to involve the public and decision-making’ should include an explanation as to why there is a need to consult as well as an explanation on the difference between engagement and consultation. CGr asked how are we going to hear patients voices actively and suggested having new channels of how to do things virtually and online such as ‘talking heads’ with patients, clinicians and the local authority.
PT mentioned that collectively it is a 2-way process of us listening to the public feedback, and listening to the public on what they would like to know about the CCG and the work taking place to improve local health services. He suggested that information about what is happening and what has been done is publicly available. He said he would like the information to be easily accessible, for example around Luton Town.
CL felt that the line ‘how do we measure our success’ in the strategy was measuring the success on the relationship with practice members. He suggested that the paragraph be amended to reflect that the patient is central and that success is measured by the level of public understanding.
AHa stated the document is very general and mentioned a stakeholder map state which was not included in the document.
SB responded to CL point on ‘how do we measure success of a communications and engagement plan’ he stated it is about measuring the activity but felt there was little included about whether the communication was effective, and suggested that this be incorporated.
NC mentioned that he found the ‘bottom-up’ approach, involving both patients and professionals at the start of the pathway design process was an effective way of designing a service to meet the needs of patients.
MT commented on timing, he said he cannot see any reference regarding timeframes for engagement or consultation. He said it was important to be asking questions at the right time.
DB noticed on page 12 ‘You asked we did‘, (patients stories), felt that the way to share their experiences and to feedback on changes to services is to show them stories of people who has had success and has enabled change. DB asked is there a way of widening the coverage of publications/communications as not everyone has access to the internet or attends governing meetings etc. This may encourage people to come forward.
JR suggested having pop-up banners in colleges, secondary schools, pharmacies and food banks as part of external communication, which would include the digitally disadvantaged.
CGr asked how the CCG will measure engagement conducted by providers and whether the need to engage is included in the contract.
RA commented on NC comment about extending engagement to local people at Integrated Care Partnership (ICP) level in the patch, and the importance of engaging and delivering at place.
Page 3 of 7
JW suggested reducing inequalities under the mission was over ambitious, suggesting it be changed to reducing health inequality. He also pointed that Central Bedfordshire is not the only area to have rural communities as Bedford Borough has a large rural community area too.
CGr commented on page 20 - Commission and Engage with services users and asked how is this measured?
On p.26 Re: The Complaints team: CG asked who analyses the complaints to determine common themes. What is done with the data and how do the public know what has changed as a result?
JM responded to CGr comment about engagement and consultation; the engagement is about listening and ensuring patients voices are taken on board.
JM responded to AHa point on measuring success as part of the Covid work, advising that the CCG has accepted offer from a psychologist to develop messaging so that the messages land better.
MS responded to AHa comment re: stakeholder map, MS explained that it is an organic document and the feedback will be incorporated into the document and then shared with the public for further comment. The CCG will work with partners on what co-production means and agree some principles.
TK stated that similar conversations about the aspirations had taken place previously and little had changed as a result. She suggested that the organisation had been working in silos and that a review takes place on what has been said and done in response, what is working and what further actions need to be taken.
PT advised that some programmes and projects that he had been involved with had stopped such as the ICS Priority 1-5 work streams. He would like to know where we are with this work and what the progress has been made.
RA advised that Mark Cox from his directorate is working closely with both commissioners and the Communications Team to help streamline work.
MS responding to the ICS query – Emma Richards is now the lead for the ‘Priority 1-5 work streams following Peter Hewitt’s departure in March. We will add this to a future PPEJC agenda.
CL wanted to respond to the viewpoint PT made about priority 1-5; he stated that from a GP and practice perspective the CCG does a good job at resolving problems, issues and prioritising work, however he feels the CCG is not good at keep sharing its successes and progress with stakeholders.
Suggestion was made that there needed to be more support for PPGs ay network level PT agreed the CCG needs to articulate the successes stories and communicate it to the public so they know what’s happening.
Page 4 of 7
JM stated it’s about getting the balance right and will add in the strategy the cycle of review on a six month basis.
The committee assured feedback mechanisms are in place and pointed out the right questions are being asked like the what, who and why, for our patients to understand what we doing then that should deliver the why.
ACTION:
To include ICS Priority 1-5 work streams as future agenda item.
MS to update the Communications and Engagement Strategy to include feedback from committee
Members to send any additional feedback to [email protected] or [email protected]
8. BLMK Flu Campaign update
Sanhita Chakrabarti (CCG), Jackie Bowry (CCG) and Christina Gleeson from the Public Health Team introduced this item.
SC updated the committee that is has been a good collaborative project across BLMK, professionals and communities have helped shape and deliver the communication around the programme and provided a targeted approach in low take-up areas.
The programme has commenced with collaboration including practices, primary care networks, community pharmacists, care homes and local authorities to ensure vulnerable patients are vaccinated.
The majority of front line staff and social care workers are to be vaccinated. Organisations are working collaboratively e.g. a Shefford GP practice is collaborating with the fire service and local authority.
CGl explained that the ‘Trusted Voice’ campaign photo session with local clinicians and community leaders is taking place Thursday 22nd October 2020. She also mentioned that there has been feedback from the Covid champions that there needs to be a focus on carers as the campaign progresses.
JB informed the committee that there is a flu page on the BLMK website which includes videos, posters and leaflets in various languages such as Bengali, Gujarati, Hindi, Polish, Punjabi, Romanian and Urdu. The Flu steering group works with colleagues from Public Health, Healthwatch and other organisations to help share the key messages. The Local authorities are promoting via Facebook advertising to key groups’ i.e. pregnant ladies, women with children 2-3 years and people with long term health conditions.
Clinicians have agreed to talk on various local radio shows such as Romanian radio, Luton Urban Radio, hospital radio, community and on- going slots with Inspire FM to promote the flu campaign.
Page 5 of 7 Also engaged at the older people’s festival which was organised by Healthwatch Central Bedfordshire, and will be attending the Carers, Older person and Dementia Partnership Boards which are facilitated by Healthwatch Milton Keynes.
LD requested that the CCG capture race and ward, age to help understand which wards or communities where take-up is low and to review messaging.
MR commented that there are different types of carers - unpaid family carers and paid for professional carers. 9. Updates and Reports
• NHS 111 First - MS advised that the paper provided an update following the presentation and discussion around Communications and Engagement in August 2020.
• Report - BLMK One Team Public Engagement
JM advised that findings from the One BLMK public survey formed part of the final submission to NHS England and Improvement to become one CCG by April 2021.
10. Regular reports and papers relating to action log • BLMK Recovery plan Paper has been updated to reflect contributions made in June 2020
• Glossary of Terms This was produced following requests in June 2020 meeting.
• Social Media Log Report for period 10 August to 4th October 2020
11. Any Other Business
PT suggested having a section at the start of meetings to update the committee on what’s happened since the previous meeting.
AB suggested that ideas are ‘deposited’ in an ‘idea’s bank’ to reduce the risk of ideas being forgotten.
EA complimented the glossary of terms.
CGr gave reference to a local press report they have indicated there could be an issue with regular blood tests, but had not seen an official response from the hospital or CCG regarding this.
NP responded to CGr stating there has been a national supply chain issue that has impacted both Bedford and the Luton and Dunstable Hospital but not Milton Keynes.
Page 6 of 7 MS advised that the CCG had been liaising with the Head of Communications at the local hospitals. The hospitals have been working with the national team to develop messaging for sharing with patients. CG said she is part of the Covid champions group so will bring up the blood tests comment in that meeting.
CL commented (via message box) that the CCG and partners can learn from the blood test situation to ensure that information is shared and cascaded appropriately in the future.
EA expressed that she enjoyed reading the engagement strategy document and it was clear that we wanted to listen to what patients and public had to say, this does not however come across in day to day life. The CCG should publicise how people can get involved; communicating to the members of the public, ways to make their voices heard such as groups they can join or ways they can comment
ACTIONS: Include an ‘update element’ on the agenda for future meetings Develop an ‘PPEJC Idea Bank’ 12. Date of next meeting Tuesday 15th December 2020 at 10:00 a.m. Via Microsoft Teams The Meeting Closed at 11.58
Page 7 of 7
Equality, Diversity and Inclusion Committee Meeting Held on Thursday 1st October at 10:00 – 11:30 (Via Microsoft Teams)
MINUTES
Present:
Dr Roshan Jayalath (Chair) RJ GP Governing Body Member Geraint Davies (Deputy Chair) GD Director of Performance and Governance Dr Sarah Whiteman SW Medical Director Emma Richards ER Corporate Services and Workforce Lead Jennie Russell JR Safeguarding Representative Kulwinder Bola KB Joint SEND Development Manager Kamini Patel KP Commissioning Project Manager Elaine Baugh EB Governance and Risk Support Officer Eugena Marshall-Lewis EML Commissioning and Operations Manager Fahad Matin FM Diabetes Project Lead/Commissioning Support Lead Bharti Quinn BQ Programme Manager Edna Muraya EM Senior Finance Manager Hardik Bhagat HB Interim HR Business Partner David King DK Equality & Human Rights Manager, Ardengem Michelle Summers MS Associate Director Comms and Engagement Lorraine Belam LB Minute Taker
Apologies: Rev Lloyd Denny, Kathy Nelson, Tess Dawoud, Mike Thompson, Linda Chibuzor
1 Opening Actions 1.1 Welcome, Introductions and Apologies
The Chair welcomed everyone to the meeting. Apologies were noted as above.
1.2 Conflicts of Interest
There were no declarations of conflict of interest.
1.3 Minutes of Last Meeting
The minutes of the last meeting on 17th August were approved.
1.4 Additional Member to EDI Committee
The Deputy Chair proposed that the Director role (role currently occupied by Mike Thompson) covering the portfolio of population health should be invited as an additional member of the EDI committee. The committee approved this addition.
1.5 The action log was updated.
EDI Committee Minutes 01/10/20
2 Operational 2.1 WRES Data Report
DK presented the report templates and confirmed that the data had been submitted on time and the supporting reporting template will be put on website.
SV asked whether there was a reason for the report referring to both BME and BAME. DK confirmed that there is ongoing national discussion as to which term is the most appropriate, however for this WRES report he followed the technical team’s guidance. The Committee agreed to change to BAME within this report. Action: DK to update report. DK
DK highlighted a number of questions (Equal Opportunities, Discrimination, Experiencing Harassment) where the data had been supressed Nationally or could not be considered significant due to the very low response from BAME staff. IT was agreed that encouragement to all staff to complete survey and update their ESR details are to continue. It was suggested that a separate targeted survey to BAME staff may be undertaken.
In setting values for the new organisation the CCGs need to consider diversity and inclusivity and to be aware that staff may feel particularly vulnerable coming into a merger situation and this should be closely monitored.
2.2 Draft WRES Action Plan 2020/21 – BLMK (draft plan circulated prior to meeting)
DK led the discussion around the Draft Action Plan, which needs to be completed by end of October.
The Committee discussed and commented:
• Reverse mentoring. Senior leaders paired with more junior staff encouraging empathy in senior leaders. Agreed the need to build TOR around this so both parties were comfortable with the arrangements. Staff to be able to choose mentor. Mentor to have a good degree of competence. Action: DK to DK investigate whether specific training available for this. • Refresher Training around recruitment/selection – to challenge unconscious bias, values based recruitment, mixing up recruitment panels with someone outside the team can be valuable. • Recognise that data findings point to an issue at Luton but unclear as to exact problem. SV advised that things may change with move to one CCG. Is there mileage in a quick survey to get a sense of where issues are? Have we got the resources to do this? JR advised that the results are not reflective of the treatment record in Luton – perhaps the way the question is being asked is providing the negative answers? KP offered assistance, as a Mental Health Champion, has conducted surveys in Luton and could provide further information if requested. DK emphasised that the people plan needs to be about wider diversity not just BAME, e.g. disability standard, LBGT etc, these areas under represented across the NHS. • Recognised that there needs to be a piece of work to triangulate WRES Action Plan for other areas.
The Chair thanked DK for his contribution and the Committee agreed to submit the data and Action Plan. EDI Committee Minutes 01/10/20
2.3 Equality Analysis Form Proposal for BLMK (circulated prior to meeting)
This EIA has been produced to provide an assessment of the impact of the proposed merger on the CCG’s staff, patients and service users. This EIA looks at the impact of proposed changes with regard to the 9 Protected Characteristics of the Equality Act 2010 and other key concerns such as carers, other vulnerable groups and Health Inequalities and mitigation of any potential negative impact. It forms part of the CCGs Merger application.
The Committee Agreed to approve the EIA.
2.4 Inequalities Review of Terms of Reference
Noted that this document was unavailable for circulation prior to this meeting.
Summary: The review will be led by Rev. Lloyd Denny, lay member for patient and public involvement at Luton Clinical Commissioning Group (LCCG). The review will seek to address and come up with recommendations, the following questions: - 1. Why were members of BAME communities disproportionately infected and subsequently die from COVID -19? 2. Since reporting, what steps have been taken across the UK to respond to the findings of the Public Health England report? 3. Since reporting, has the health system in the BLMK area done anything to mitigate the health inequalities, for example, health providers what have they done since the report was published, given its national profile and seriousness? 4. There is understandable scepticism from BAME communities that this review is a delaying tactic or at the least will delay action. Therefore, this review will be based on the "lived experience" and will seek evidence from a wide section of our population; paying particular attention to the often-overlooked sections of our population. The review will seek to report by April 2021 so that its findings, recommendations and action plan can inform the priorities of the anticipated newly established single BLMK CCG.
JR expressed a keenness to be involved in this review given her current involvement with the Joint ‘Health Inequalities‘ sub group in Luton and co-author of ‘Inclusive Growth Commission’ Report’ in Luton.
Committee agreed the TOR in principle. Action: Document to be circulated to Committee Members with any feedback to be sent direct to MS/GD.
3. Any Other Business
It was agreed that a further Committee Meeting would be held in November, LB to arrange.
9. Date of Next Meeting Monday 30th November 2020 from 13:30 – 15:00 Future meetings are scheduled for: 15th January 2021 at 11:30; 7th April 2021 at 12:00; 14th July 2021 at 12:00 The Chair thanked all attendees and the meeting was closed
EDI Committee Minutes 01/10/20
Quality and Performance Joint Committee
Minutes of the Quality and Performance Joint Committee Held on 3 November 2020, 10:00-12:00 The Meeting was held virtually via Microsoft Teams Members Present: Richard Alsop Director of Commissioning and Contracting BLMK RA Mahmood Aziz Lay Member Luton MA Alison Borrett Lay Member Bedfordshire AB Sally England Lay Member Bedfordshire SE Kathy French Independent Nurse - Chair Luton KF Director of Communications and JM Jane Meggitt Engagement BLMK Dr Linus Onah GP Member Bedfordshire LO Dr Ed Sivills GP Member Milton Keynes ES
Others in attendance: Elaine Baugh Governance and Risk Support Officer Luton EB Linda Chibuzor Deputy Director of Nursing Milton Keynes LC Carol Davies Head of Performance Reporting and Bedfordshire CD Analysis Clare Flower Quality Manager (Luton) and Quality Lead BLMK CFl for Children, Young People & Maternity (BLMK) Ola Hill Governance and Risk Manager Bedfordshire OH Alison Joyner Associate Director of Performance BLMK AJ Management Maria Laffan Deputy Chief Nurse Bedfordshire ML Jennie Russell Deputy Director of Quality and Clinical Luton JR Governance Gillian Turrell Senior Quality Manager - Acute and Bedfordshire GT Ambulance Services Claira Ferraira Complaints and Patient Experience Lead Milton Keynes CFe Gill Humberstone Complaints and FOI Manager Bedfordshire GH
Apologies: Geraint Davies Director of Performance and Governance BLMK GD Anne Murray Chief Nurse BLMK AM Maryla Hart Governance and Committee Officer Bedfordshire MH David Foord Associate Director, Quality Programmes BLML DF
1.1 Welcome and Apologies for absence Action
Page 1 of 8 The Chair welcomed all members and attendees to the meeting. Apologies were received and noted as above. The Chair advised that the meeting was quorate. 1.2 Declarations of Interest The Chair invited members to declare any conflicts relating to matters on the agenda. There were none declared. 1.3 Matters Arising There were no matters arising.
1.4 Minutes of the Extraordinary Meeting held 29 September 2020 The minutes were approved as an accurate record subject to the following amendment: • ML advised that the Quality Accounts were signed off by the Accountable Officer and the Chief Nurse.
ACTION: The final minutes of the Extraordinary Meeting held on 29 MH September 2020 to be updated to reflect amendments.
Minutes of Meeting held 6 October 2020 The minutes were approved as an accurate record.
1.5 Action Tracker The Action Tracker was not reviewed at the meeting due to time constraints.
ACTION: To circulate the Action Tracker for attendees to review and EB/MH update.
2.1 BLMK Performance and Quality Report 2020/21 M5 CD presented the BLMK Performance and Quality Report for M5 (August 2020).
The Covid cases on the 1st November 2020 were: • Bedford Borough Council – 2413 • Central Bedfordshire Council – 2470 • Luton Borough Council – 3472 • Milton Keynes Council – 2170
There were 51 beds occupied by Covid patients at the two Acute Trusts, with some patients on ventilation. Weekly reports are going to the Cells and a Recovery Pack is produced monthly.
ML added that the CCGs meet weekly with the Local Authorities and Public Health Teams. Currently there are 67 inpatients in the Bedfordshire Hospitals Trust sites, with 2 patients in ICU. The increase in cases is impacting on the wider system; work is taking place to ring-fence some community beds.
Deep Dives is being conducted on the priority areas to identify the real challenges.
SE queried the following sentence on page 17 of the report “BLMK is the highest performing within the East of England region and significantly higher than the national average.” ML explained that this was in relation to access to
Page 2 of 8
Mental Health Services for children. It was acknowledged that a piece of work may need to be considered around referrals and access for children.
AB queried whether the deadline of 23rd October 2020 was met in relation to the requirement for all patients on the admitted waiting list to have had a Shared Decision Making conversation.
ACTION: To obtain an update on whether the October priorities for CYP CD were met.
ML advised that at present for East London Foundation Trust (ELFT) there is no Mental Health patients in an out of county placements. Activity is returning to normal levels however the acuity of the patients is higher. There is a challenge with inpatient care for young people.
ML has met with the provider of Manton Heights Manton Heights ABI Unit and Care Home and assured the Joint Committee that there was a robust action plan in place. The Quality Teams will continue to work closely with the Care/Nursing Homes and the Care Quality Commission (CQC) to support and gain assurance on the quality of care being provided.
LO queried the difference in data as outline on page 5 between Bedfordshire CCG and Luton CCG now that the Acute Trust has merged. CD explained that the data on page 5 is national validated data at CCG level. The information on page 7 is at the Acute Provider level. Local data is available for the Luton & Dunstable site and the Bedford Hospital site but this data is un-validated. ML advised that any discrepancy in the level of service provided at the different sites would be picked by the Cancer Board.
ACTION: To investigate if the tables of pages 5-7 can be presented at site CD level ie Bedford Hospital, Luton & Dunstable Hospital.
ML assured that Joint Committee that visits to Nursing/Care Homes will continue with priority based on risk, based on an internal rag rating. The Victoriana Care Homes would have received a visit from an infection control and training perspective. The Team is working closely with the Local Authority Teams and virtual training is delivery twice weekly.
The Joint Committee noted the BLMK Performance and Quality Report 2020/21 M5.
2.2 Use of Dynamic Risk Registers for people with an LD and/or Autism and complex case management processes
The report was presented for information. DF will be presented the paper at the next meeting.
2.3 BLMK Safeguarding Adults Q2 Report
JR presented the report. All the organisations in Milton Keynes have completed their framework for assurance. The Team is working with the organisations in Bedfordshire and Luton.
There are ongoing concerns with East London Foundation Trust (ELFT) in relation to the number of Serious Incidents (SI), Serious Case Reviews (SCR) Page 3 of 8
and Safeguarding referrals raised within the last three months. The Safeguarding and Quality Teams are working with ELFT. The Local Authority Safeguarding Team is leading on a review of SIs and Safeguarding with ELFT. There is also a concern around ‘risky’ discharges from inpatient settings and a lack of follow up.
In Milton Keynes there are three ongoing SCRs and 2 in Luton. A rapid review has been conducted into 17 Covid related deaths in Care Homes in Luton; the lessons learned will help with the second wave. NHS England has requested that there are designated Care Home beds for Covid+ patients who are discharged from hospital.
There has been one Domestic Homicide Review in Luton.
The Teams are continuing to support Rough Sleepers during the Second Wave and the winter period. Where these patients were house in Hotels this as resulted in increased engagement, self-care and health education.
Lessons have been learned from the decision by the Home Office to accommodate Asylum Seekers in Hotel without notifying the local health and social care organisations.
Healthwatch have raised concerns around the quality of care at ELFT inpatient sites across Bedfordshire and Luton. The Teams are working with ELFT regarding the quality improvement concerns raised.
AB queried whether there were any contractual levers which could be used against ELFT for endangering patients. ML explained that there are regular meeting with ELFT and Healthwatch regarding the concerns, although there are often complex issues with patients not just health related e.g. housing, financial. RA advised that a contractual approach would be the last resort. There needs to be a system response to the care of mental health patients.
SE queried whether ELFT has been asked to produce an action plan to address concerns which would be monitored at a CCG level and raised the issue of the level of investment going to ELFT from the Mental Health Investment Standards. ML advised that they are gaining more benefit by taking the current approach to work with ELFT.
LO suggested from his experience the problem with ELFT was the culture. JR advised that steps are being taken to address the culture.
The Chair felt that the Joint Committee needs to continue to monitor on a regular basis.
The Joint Committee noted the BLMK Safeguarding Adult Q2 Report.
2.4 BLMK Provider Serious Incidents & Never Events report Quarter 2
ML explained that there has been an increase in mental health SIs. There have been some very extreme responses from patients.
MA suggested reviewing the picture from a year ago as part of the planning for the second wave.
Page 4 of 8
ACTION: To compare the data from 2019/20 with the current data ML
ML gave assurances regarding the Maternity Service at Milton Keynes.
The Joint Committee noted the BLMK Provider Serious Incidents & Never Events report Quarter 2.
2.5 Draft Phase 3 Recovery Monitoring Report
CD presented a joint piece of work by the Programme Management Office (PMO) Team and the Performance Team. The aim of the report is to provide assurance on the Phase Three Recovery Plan, as per the Simon Stevens letter of 31st July 2020.
The Teams are working with Commissioners to identify an appropriate metrics, there needs to be one set of measures which all partners recognise however it is not the intention for this report to replace business as usual reporting.
The intention is for this report to be produced monthly to go to the Recovery Cell and Health Cell for discussion. It could also go to the Finance and Performance (F&P) Committee and the Quality and Performance Committee, if deemed useful.
SE advised that a long discussion took place at the F&P Committee last week regarding the report. A key piece of feedback was how to balance counting with the quality measures associated with the recovery.
ML advised that there is a quality and equality impact assessment process around the plans.
MA added that the system needs to be agile in order to respond to and manage the recovery systemwide. The Chair agreed that the plans need to be agile to respond to a fluid situation particularly around staffing.
RA advised that the Cells would co-ordinate the plans, working as a system to respond to the triggers in the Winter Plan.
LO suggested caution with how the plans are implemented to avoid unintended consequences within other parts of the system.
CD advised that a weekly report will go to the Health Cell outlining all the ongoing issues across the system.
The Joint Committee noted the Draft Phase 3 Recovery Monitoring Report.
3.1 Maternity Services (Verbal)
CFl advised that she is working at the Bedford Hospital Maternity Unit two days per week and advised that the service is transparent and open to receive help.
The biggest risk is around midwifery staffing, a workforce plan has been submitted to CQC. A Consultant Midwife has been appointed and an interim Director of Midwifery.
Page 5 of 8
Historical issues around the culture on the unit have been identified and there is an increase in whistleblowing to CQC.
In the year 2019/20 there were six stillbirths reported, as at August 2020 there has been 11 stillbirths. Nationally the number of stillbirths has increased from April – June 2020.
ML advised that there are short, mid and long term plans with regular meetings with the Leadership, there is also support from the Regional Team. The risk is on the CCG’s Corporate Risk Register.
CFl has been focusing on the safety aspects during her visits to the unit and assured the Joint Committee that staff are being listened to. There is additional assurance from the Health Care Investigation Branch, who are conducting independent investigations.
The Joint Committee thanked CFl for her verbal update.
3.2 Summary of East of England Ambulance Services NHS Trust (EEAST) Well Led focused CQC Report
GT gave an update on the current position at EEAST. The Team have been sighted on a letter from NHSE/I regarding the Special Measures Support Package. An Improvement Director will be appointed, facilitation, external buddying with other Ambulance Services and access to Special Measures funding. An Oversight and Assurance Group has been established.
Seven Safeguarding polices are being reviewed by the end of November 2020. A Management Cascade Programme will be implemented and a Safeguarding Lead has been appointed.
There has been an increase in bullying and harassment reporting, which the Trust is investigating.
The Joint Committee noted the of East of England Ambulance Services NHS Trust (EEAST) Well Led focused CQC Report.
3.3 QSG Workshop Feedback (Verbal)
ML advised that a meeting took place last week with the Regional Team to discuss how to transition from a Regional QSG to a local QSG.
A process will be developed for the transition to an ICS QSG, which will be Chief Nurse led.
The Joint Committee thanked ML for the update on the QSG Workshop.
4.1 GPs Charges for Safeguarding Reports
ML presented the report for information only; the report has been approved by the Executive Committee.
There is some discussion around a sliding scale approach to payments for reports.
Page 6 of 8
The Joint Committee thanked ML for the update on the GPs Charges for Safeguarding Reports.
5.1 Provider Quality Accounts & BLMK Commissioner Statements
ML presented the report for information only. The Statement of Response has been developed.
The suggested timeframe for Providers to publish their accounts is the 15th December 2020. The letters have been signed off by the Accountable Officer and Chief Nurse.
The Joint Committee thanked ML for presenting the Provider Quality Accounts & BLMK Commissioner Statements.
6.1 Complaints, Concerns & Enquiries Reports – Quarter 2
CFe presented the report for Milton Keynes CCG. Activity is returning to normal. No complaints were received for Q2.
CFe highlighted a concern under Section 9 – Managing Risks. An enquiry was received from NHSE regarding transferring a patient to a different practice which has resulted in 78 tasks during Q2.
The telephone lines at Sherwood Place are currently down, this has been reported.
There has been some good learning during the quarter particularly around making a Safeguarding referral using the MASH Form which has been feedback to Milton Keynes Council.
The Joint Committee noted the Complaints, Concerns & Enquiries Reports.
6.2 Complaints, Concerns & Enquiries Reports – Quarter 2 and 6.3 GH presented the reports for Bedfordshire CCG (BCCG) and Luton CCG (LCCG). There have been more that 700 enquiries and Freedom of Information (FoI) requests in Q2. This could be due to the Team responding to calls from the BCCG prime number.
A complaint was received by BCCG around the Fertility Service for a same sex couple as the policy is not clear. It is anticipate that the complaint will go to the Ombudsman although the complaint has been handled appropriately.
Nothing to note for LCCG.
The Joint Committee noted the Complaints, Concerns & Enquiries Reports
6.4, FOI Reports - Q2 6.5 and GH presented the FOI Reports for BCCG, LCCG and MKCCG. There have 6.6 some breaches • MKCCG – 3
Page 7 of 8
• BCCG – 5 • LCCG – 2 The Information Commissioners Office (ICO) is taking Covid into consideration; however the CCGs do have a statutory duty to respond.
There were six Public Interest Tests undertaken.
The Joint Committee noted the FOI Reports.
7. Any Other Business
NHS 111 Business Case SE advised that the 111 Business Case was reviewed at F&P and will come to the Q&P Joint Committee next month, due to the potential clinical implications.
ML added that the Think 111 First will have a full Quality Impact Assessment with the Business Case.
The meeting ended at 11:57
Page 8 of 8
Quality and Performance Joint Committee Minutes of the Quality Committees in Common Meeting Held on 1 December 2020, 10:00-12:00 The Meeting was held virtually via Microsoft Teams Members Present: Richard Alsop Director of Commissioning and Contracting BLMK RA Mahmood Aziz Lay Member Luton MA Alison Borrett Lay Member Bedfordshire AB Geraint Davies Director of Performance and Governance BLMK GD Sally England Lay Member Bedfordshire SE Kathy French Independent Nurse - Chair Luton KF Jane Meggitt Director of Communications and JM Engagement BLMK Dr Linus Onah GP Member Bedfordshire LO
Others in attendance: Carol Davies Head of Performance Reporting and Bedfordshire CD Analysis David Foord Associate Director, Quality Programmes BLML DF Maryla Hart Governance and Committee Officer BLMK MH Wendy Kuriyan Designated Doctor for Safeguarding Bedfordshire WK Children & Young People Hannah Pugliese Associate Director for Children, Young BLMK HP People and Maternity Commissioning Jo Wilson Primary Care Safeguarding Nurse Bedfordshire JW Luton
Apologies: Anne Murray Chief Nurse BLMK AM Dr Ed Sivills GP Member Milton Keynes ES
1.1 Welcome and Apologies for absence Action The Chair welcomed all members and attendees to the meeting. Apologies were received and noted as above. David Foord was Deputising for Anne Murray. The Chair advised that the meeting may not be quorate as a non- Clinician for Milton Keynes was not present. However, no decisions were due to be made, so it was agreed to progress with the meeting. 1.2 Declarations of Interest The Chair invited members to declare any conflicts of interest relating to matters on the agenda. There were none declared.
1.3 Matters Arising
Page 1 of 6 NHS 111 Business Case SE sought assurance about whether the NHS 111 Business Case needs to be discussed from a quality perspective. DF stated that the Chief Nurse had advised that the case does not need to come to Q&PJC. The case had undergone a thorough Equality Impact Assessment (EQIA) and a Quality Impact Assessment (QIA). The business case is going back to Finance and Performance Joint Committee (F&PJC) in February. If any Quality issues arise at the F&PJC meeting they can be escalated to this committee at that point.
1.4 Minutes of the Meeting held on 3 November 2020
The minutes were approved as an accurate record subject to the following amendment being made:
• The initials SB to be corrected to SE.
1.5 Action Tracker The Action tracker was discussed and the following actions were agreed as closed:
23. Performance and Quality Report – Month 2: MH, LD and Autism 31. Cancer 32. Cancer 33. Maternity Services at Bedfordshire Hospitals NHS Trust – Bedford Site 34. Maternity Services at Bedfordshire Hospitals NHS Trust – Bedford Site 36. Risk Registers 37. Provider Accounts 39. Next steps: outstanding responses 40. BLMK Performance and Quality Report 2020/21 M5 41. BLMK Performance and Quality Report 2020/21 M6 42. BLMK Provider Serious Incidents & Never Events report Quarter2. To compare the data from 2019/20 with the current data. Update: This has been done and taken through the clinical cell structure. DF gave a verbal update. 43. Action Tracker: To circulate the Action Tracker for review
The following updates were given:
29. IAPT Quality Report: Information about what marketing has been used to promote IAPT to be sent to MH to circulate to the Committee. Update: DF asked for an update to be provided for the January meeting. 38. Next steps: outstanding responses: Quality Accounts. Update: MK Hospital is the only one outstanding but is being chased up by the Quality Team. There is no date as yet.
2.1 BLMK Performance and Quality Report 2020/21 M6
CD presented the report and ran through the highlights.
There was an unannounced CQC inspection of Bedford Hospital’s Maternity Services on 5 November. Further information on this to be provided in Item 3 DF on the agenda.
Page 2 of 6
KF advised that Acute Trusts are undertaking Lateral Flow Testing, which twice-weekly COVID is testing for staff. ACTION: DF to establish whether Lateral Flow testing is being used in BLMK care/nursing homes.
The following were discussed:
• How the CCGs work closely with the rest of the system to monitor and report on Key Performance Indicators (KPIs) and RAG Ratings throughout winter. • Managing the Level 4 incident we are in is the current priority. • The use of the private sector to manage waiting lists. • The Clinical Cell deep-dive • Escalation of challenging behaviours for patients with mental health problems and Autism Spectrum Disorder (ASD) • LO’s GP surgery is seeing increased demand, although this is not unusual at this time of year. • Staff sickness rates and the as yet unknown impact of staff being diverted to deliver mass vaccinations. • It was clarified that the greyed out columns on page 7 in the report
represent suspended data collections. The latest data was from February 2020.
• Even at this current pressurised time the CCGs still need to look at
things that will improve our quality and performance, embed successful
ways of working and not get lost in firefighting. We must also ensure
the new contracting system will help facilitate effective pathway redesign.
ACTION: To provide assurance that there is nothing the CCGs are overlooking, given the figures and RAG ratings on page 6 of the Performance Report. RA to follow up with Loraine Rossati about these figures and recovery rates.
The Committee noted the report. 2.2 Dynamic Risk Registers for people with a Learning Disability (LD) and/or Autism and complex case management processes.
DF ran through the slides presented in the pack.
The following was discussed:
• A question was asked about the qualifications needed to conduct a Care and Treatment Review. People conducting a Care and Treatment Reviews (CTRs) do not need to have a LD or mental health background. Their role is more like that of a chair and they need a good understanding of commissioning. The CCGs may at times fund an independent chair to come in to help avert conflicts. Local knowledge does help. There is specific training provided by NHSE/I • Issues around beds and a lack of purpose built facilities in our region. • The escalating numbers being referred to the service consist almost entirely of children with ASD only and not with a LD. They are seeing a lot of children who weren’t previously known to the services before.
Page 3 of 6
• There is money coming down from the system for winter resilience to support working with the community and voluntary sectors. There is a need for this rather than pathologising all problems. • Around Tier 4 there is work going on with the East of England Provider Collaborative looking at changing bed management so providers have more control and looking to create tier 4 beds for children in BLMK.
The Committee noted the report. 3.1 Bedfordshire Hospitals NHS Trust (BHT) Maternity Update
HP presented this item and gave an update on the situation.
ACTION: LO has raised concerns with the maternity service on behalf of the patients of a GP colleague of his. The service did not seem particularly interested. HP advised that this had been picked up by the Clinical Lead Sanhita Chakrabarti. HP to provide assurance around acknowledgement of this and time lines for resolution.
ACTION: HP to bring back a report to the January committee. To include: • The outputs and whether actions are being followed through • Measures of assurance regarding progress • Update about communications around the CQC visit, including for the public.
ACTION: JM and HP to work together on communications briefings around the CQC visit.
The following points were raised:
• The Luton and Dunstable Hospital can take shared learning from this situation. • For local clinicians Bedford Hospital Maternity is the biggest risk in local system for patients and reputational risk.
The Committee noted the update.
3.2 Long Term Conditions
The paper was provided to the committee for information. None of the authors were available to present.
KF apologised for this rare occurrence but today’s meeting has clashed with other meetings. The committee’s secretariat and teams presenting will seek to ensure that all papers have a presenter in future.
4.1 Risk Register, (Verbal Update)
DF gave an update. The risk registers of the three CCGs are currently being consolidated.
The top five Quality risks noted across the BLMK CCGs at the moment are:
1. Maternity (predominantly Bedford Hospital)
Page 4 of 6
2. Inability to do Safeguarding visits to services due to Covid 3. Increase in challenging behaviours and increased mental ill health of people with LD and ASD due to Covid 4. Stroke improvement programme not progressing due to Covid 5. Homelessness and increased risks to people who are street homeless around Covid and their lack of access to services
ACTION: Risk Registers to be added to the February agenda.
4.2 Primary Care Safeguarding Training JW ran through the report and gave an update on the current provision of Safeguarding Children & Adult Training available to GPs in response to COVID across BLMK CCGs.
The following was raised:
• GPs do not have to provide the CCG with data on training compliance and they can source the training elsewhere. They can do different modules with different providers. Unless the CCG puts in the contract that GPs must share training compliance information, we cannot access it. In Hertfordshire they are are starting to look at contracts to address this. • LO advised that in terms of GPs, we can say with reasonable assurance that they will be are compliant. The General Medical Council says GPs must be appropriately trained, annual appraisals will check if training and the CQC also asks for mandatory training. Therefore it would be hard for GPs to stay in the system and not be compliant with their training. • There is huge recruitment across board by PCNs for people with various training requirements. It was advised that JW could work with training hubs. • A primary care webinar at Bedfordshire hospital held at a weekend was well attended, so weekends could be a good time to provide training to clinicians.
ACTION: A conversation to be had with primary care leads, primarily Nicky Poulain, to ascertain how the CCGs can get assurances of Safeguarding Training compliance from our contractors across the board JW / JR / including but not limited to GPs and dentists. NHSE may delegate this NP responsibility to us in the future. Primary Care to confirm how we will address this moving forward.
The committee thanked JW and noted the update.
5.1 CDOP Annual Report
This item was deferred until January as not all annual reports were completed and available to present from external partners.
6. Any Other Business
Performance and Quality Updates
Page 5 of 6
Integrated Performance and Quality Report (IPQR) updates to committee are by their nature retrospective and the information contained therein can be out of date by the time the Committee receives the reports. A more current position would be helpful. It was agreed that the weekly SitRep reports from Carol Davies would be helpful to the Committee as they contain a more contemporaneous position. These are usually produced late on a Tuesday. In addition, by exception, RA, GD and AM can brief on the day of the meeting of any critical quality and/or performance issues at that time.
ACTION: The Quality Team to circulate to the committee the weekly Performance and Quality updates written by Carol Davies.
Date of next meeting: 5 January 2020
Page 6 of 6
CONFIDENTIAL Quality and Performance Joint Committee
Minutes of the Quality and Performance Joint Committee Held on 5 January 2021, 10:00-12:00 The Meeting was held virtually via Microsoft Teams Members Present: Richard Alsop Director of Commissioning and Contracting BLMK RA Mahmood Aziz Lay Member Luton MA Alison Borrett Lay Member Bedfordshire AB Sally England Lay Member Bedfordshire SE Kathy French Independent Nurse - Chair Luton KF Jane Meggitt Director of Communications and BLMK JM Engagement Anne Murray Chief Nurse BLMK AM Dr Linus Onah GP Member Bedfordshire LO
Others in attendance: Carol Davies Head of Performance Reporting and Bedfordshire CD Analysis Maryla Hart Governance and Committee Officer BLMK MH (Minutes) Ola Hill Governance and Risk Manager BLMK OH Claira Ferreira Complaints and Patient Experience Lead Milton Keynes CFe Clare Flower Quality Manager (Luton) and Quality Lead BLMK CFl for Children, Young People & Maternity (BLMK) Lynda Harris Head of Information Governance/DPO BLMK LH Helena Hughes Designated Nurse for Safeguarding Bedfordshire HH Children & Young People Catherine Kearney Designated Doctor for Child deaths Luton, Luton CK Cambridgeshire Community Services NHS Trust Maria Laffan Deputy Chief Nurse Bedfordshire ML Mandy Park Designated Nurse Safeguarding Children BLMK MP and Looked After Children Hannah Pugliese Associate Director for Children, Young BLMK HP People and Maternity Commissioning Sandra Watts Child Death Overview Panel (CDOP) Bedfordshire SW Manager
Apologies: Geraint Davies Director of Performance and Governance BLMK GD Dr Ed Sivills GP Member Milton Keynes ES
CONFIDENTIAL Page 1 of 7
1.1 Welcome and Apologies for absence Action The Chair welcomed all members and attendees to the meeting.
Apologies were received and noted as above.
The meeting was not quorate. It was decided to proceed with the meeting and take a Chair’s Action for the item that required approval on behalf of Bedfordshire CCG: 6.3: Updated HBLICT policies. No other items on the agenda were to be presented to the Joint Committee for decision on this occasion.
1.2 Declarations of Interest
The Chair invited members to declare any conflicts of interest relating to matters on the Agenda. No declarations were made.
1.3 Matters Arising
There were no matters arising.
1.4. Minutes from Part 2 meeting held on 1 December 2020
The minutes of the meeting held on 1 December 2020 were approved as an accurate record.
1.5. Action Tracker
The action tracker was discussed and the following actions were agreed as closed:
29: IAPT Quality Report 30: IAPT Quality Report 44: BLMK Performance and Quality Report 2020/21 M6 45: BLMK Performance and Quality Report 2020/21 M6 46: BHT Maternity Update 47: BHT Maternity Update 48: BHT Maternity Update 50: Primary Care Safeguarding Training 51: AOB: Performance and Quality Updates
The Following Updates were given:
38: Next steps: outstanding responses. Update: Outstanding quality accounts have been received from East London Foundation Trust (ELFT) and Milton Keynes Hospital. The latter were submitted late but the accounts have been shared with KF and AM and a draft statement on the accounts has been prepared. All other quality accounts are in
Page 2 of 7 CONFIDENTIAL and complete. ML has not yet seen the accounts published on the NHS choices website.
2.1 Child Death Overview Process (CDOP) Annual Report
Bedford Borough, Central Bedfordshire and Luton
SW introduced the paper and KC gave an overview.
The following was flagged:
• AM confirmed that next financial year, Bedfordshire and Luton figures for the numbers of deaths reviewed will be combined with Milton Keynes figures, which will help the CCGs meet their statutory regulations around numbers of deaths analysed. • The length of time taken to review deaths must be difficult for families.
The following was mentioned:
• Chromosomal deficiency • Modifiable factors and service modifiable factors • Births JM left the meeting • The need to work on consanguinity and high maternal Body Mass Index (BMI) (classed as modifiable factors) and on service modifiable factors. • The need to work more closely with partners. • Infant mortality. The team plan on working with the local Maternity Services work stream much more closely. • Purchase of the eCDOP software package has sped up and improved information sharing.
ACTION: AM is Chair of Local Maternity and Neonatal System (LMNS) Maternity and Neonatal Transformation Board. AM and Catherine Kearney to discuss working with the Board outside of the meeting.
LO advised he would like to see the denominator of live births in a given year being used, as the rates of births fluctuate. The current denominators used were explained.
LO asked whether there is or should be a checklist for identifying modifiable risk factors. CK advised that there is not standardisation across the country with regards to modifiable factors listed.
Page 3 of 7 CONFIDENTIAL Milton Keynes MP ran through the Milton Keynes Report.
Milton Keynes shares learning with Bedfordshire and Luton. Recommendations for next year include the Public Health Chair for Milton Keynes working more closely with Bedfordshire and Luton, and monitoring paediatric care. Milton Keynes have increased recording of ethnicity around CDOP, have embedded new CDOP guidance and are using eCDOP.
The Committee noted the reports. 2.2 Section 11 Self-Assessment Framework
AM introduced the report.
ACTION: The CCGs to share their work more with the Safeguarding AM/MH Partnership. This is to be added to the Committee’s forward planner. AM to advise MH of details.
The Committee noted the Section 11 Self-Assessment Framework
3.1 BLMK Performance and Quality Report 2020/21 M7
AM and CD gave some brief highlights which included the following:
• Cancer • Referral to Treatment • Waiting times • Breeches • Covid rates
It was noted that this report was already out of date. A discussion was had about performance and quality reporting to the committee going forward. The following was raised:
• There is a bit of a time lag due to timings of meetings. This report has already been to Finance and Performance Committee. Meeting timings should be reflected on before April. • An exception snap shot would be useful. • The results of the pandemic on rates of Serious Incidents (SIs) was discussed. Hidden harm from late diagnosis may emerge later down the line. Currently the CCGs are not seeing higher rates of SIs. • It makes sense to produce one pack around Performance and Quality • The importance of teasing out salient elements in the report
Page 4 of 7 CONFIDENTIAL ACTION: The performance team to take on board the feedback given regarding the Performance and Quality report going forward.
The Committee noted the BLMK Performance and Quality Report 2020/21 M7 - October 2020 and the BLMK Weekly System Reports.
3.2 Mass Vaccination update AM gave a verbal update.
The Committee noted the update. 9. Maternity Services at Bedfordshire Hospitals NHS Trust – Bedford Site: Update and Ockendon Report Overview
CF presented the report. MA joined the meeting
AM advised that the CQC had accepted some of the challenges that Bedford hospital pushed back on; the CQC had not spotted that the hospital was performing alright on these issues.
HP joined the meeting.
Freedom to speak up was discussed.
ACTION: A monthly maternity update to be provided to Q&PJC, to include the assurance framework once complete. Maternity Report HP / CF to go to Governing Body.
The Committee noted the report.
4.2 East of England Ambulance Service Trust (EEAST ) Overview and Assurance update AM introduced the report. Updates will continue to be provided to the Committee.
The Committee noted the report. 4.3 Safeguarding Children Quarterly Report This item was deferred to the February meeting.
4.4 Top Risks
ML gave a verbal update.
The team is still working on bringing the Quality Risk Register onto the 4 Risk system. Quality Risk Registers include registers around the clinical cell and specific risks around local areas.
Page 5 of 7 CONFIDENTIAL
The top risks in both of the above two categories are:
• Outcomes for patients, particularly cancer outcomes. • Surge is a risk around all key areas including mental health and acute. • Wider impact around performance of 18 and 52 week waits • Locally, to Central Beds and Luton is Special Educational Needs and Disability (SEND) and to locally to Bedford, Maternity at Bedford Hospital NHS Trust (BHT) are risks.
The Quality Team and the Governance and Risk Manager were confident that risks were being captured. Risk Registers will be on the single 4 Risk System by March.
The Committee noted the update.
5. CQC Inpatient Survey During the COVID-19 Pandemic, Summary Report AM introduced the report, which was shared with the committee for information.
The Committee noted the report.
6.1 Bedfordshire and Luton Joint Prescribing Committee Minutes: 23 September 2020
The minutes were presented to the committee for information.
ACTION: Medicines Management to present a 6-montly report to AM/ KF Quality and Performance Committee. AM and KF to advise when they would like this report for.
The Committee noted the Bedfordshire and Luton Joint Prescribing Committee Minutes:, 23 September 2020
6.3 Updated HBLICT Policies: a. Acceptable Use Policy b. Telecoms Policy c. Network Security Policy d. Information Security Policy e. Mobile Device Security Policy
The Committee was asked to approve the policies on behalf of Bedfordshire CCG. All members present were happy to support the policies. However, the committee was not quorate.
KF / MH
Page 6 of 7 CONFIDENTIAL ACTION: A Chair’s Action to be taken to approve the policies. KF to liaise with the Governance Team.
7. Any Other Business There was no other business
The meeting Closed at 11.08
Page 7 of 7 CONFIDENTIAL
Minutes of the Primary Care Commissioning Committees in Common Meeting Held in Public on 17th November 2020 at 1045-1245 Held over Microsoft teams
Members Present: Alison Borrett Lay Member PCCiC Chair (BCCG Chair PCCC) Bedfordshire AB Darren Smith Lay Member (MKCCG Chair PCCC) Milton Keynes DS Lloyd Denny Lay Member (LCCG Chair PCCC) Luton LD Dr Amit Goyal GP Board Member Milton Keynes AG Dr Christopher Longstaff GP Board Member Bedfordshire CL Dr Linus Onah GP Board Member Bedfordshire LO Mahmood Aziz Lay Board Member Luton MA Maria Laffan* Deputy Chief Nurse (Left at 1200 Item 7) BLMK ML Mike Rowlands Lay Board Member Milton Keynes MR Dr Nessan Carson GP Board Member Milton Keynes NC Nicky Poulain Director of Primary Care BLMK NP Paul Lindars Associate Director Primary Care Development BLMK PL Dr Roshan Jayalath GP Board Member Bedfordshire RJ Sally England Lay Board Member Bedfordshire SE Dr Sanjay Sharma GP Board Member Bedfordshire SS Dr Sarah Whiteman Medical Director BLMK SW Stephen Makin** Deputy CFO/Director of System Finance BLMK SM
Apologies from Members: Anne Murray Chief Nurse * Deputy ML BLMK AM Chris Ford CFO/Deputy AO ** Deputy SM BLMK CF David Kempson Lay Member Luton DK Dr Ed Sivills GP Member Milton Keynes ES Dr Helen Turner Secondary Care Doctor Luton HT Dr Krishna Patel GP Member Milton Keynes KP Patricia Davies Accountable Officer BLMK PD Richard Alsop Director of Commissioning & Contracting BLMK RA
Others in attendance: Alexia Stenning Associate Director Primary Care Commissioning & BLMK AS Transformation Amanda Flower Associate Director Primary Care Commissioning & BLMK AF Transformation Carla Barbato Programme Manager Primary Care Milton Keynes CB Edna Muraya Senior Finance Manager Milton Keynes EM Dr Hetal Talati GP Board Member/PCN Clinical Director (Eden) Luton HT Janine Welham Primary Care Manager Milton Keynes JW John Wright Chair of Healthwatch Bedford Borough Bedford Borough JW Kayley O’Sullivan Primary Care Support Officer Milton Keynes KO Lauren Sibbons Senior Contract Manager – General Practice (Joined NHSE/I (BLMK LS
Page 1 of 9 1130 for Item 6.3) System) Lisann Blower EA Primary Care – Minute Taker LCCG LB Lucy Nicholson Chief Executive Healthwatch (Left 1218 Item 10) Luton LN Lynda Linbourne Deputy Head – Primary Care Commissioning and Bedfordshire LL Contracting Mark Peedle Head of Digital (Joined at 1045 for Item 4) BLMK MP Mike Harrison Co-Chief Executive, Beds and Herts LMCs Bedfordshire & MH Luton Nikki Barnes Associate Director Transformation & Integration& ICS Bedfordshire NB Estates Programme Lead BLMK ICS Nina Hannagan Contract Support Manager NHSE/I (BLMK NH System) Patricia Coker Head of Service Lead for Integration Central Central PC Bedfordshire Council (Joined 1120 Item 6.1) Bedfordshire Phil Turner Chair Healthwatch Luton PT Dr Raj Grewal Service Co-ordinator Healthwatch Milton Keynes RG Raj Hira Public Health Principal for Primary Care, Milton Milton Keynes RHi Keynes Council Richard Noble GPFV Transformation Manager (Joined at 1118 Item Bedfordshire RN 6.1) Roger Hammond Associate Director Finance – Primary Care & OOH BLMK RH Sarah Watts Senior Quality Manager for Primary Care & Out of BLMK SWa Hospital Simon White Chief Officer Health Integration Bedford Borough Bedford Borough SWh Council Susi Clarke Primary Care Workforce Programme Lead BLMK ICS SC Tony Medwell Head of Primary Care Contracts and Commissioning Bedfordshire TM Dr Una Duffy GP from a Member Practice Luton UD
Apologies from Attendees Andrew Harrington CEO MKGP Federation (MKGP Ltd and MKGP Plus Ltd) Milton Keynes AH David Barter Head of Commissioning NHSE/I DB Diane Blackmun Chief Executive Officer of Healthwatch Central Central DB Bedfordshire Bedfordshire Jennie Russell Deputy Director of Quality and Clinical Governance Luton JR Liz Cox Associate Director of Finance – Luton / Strategy, BLMK LC Planning & Performance Lucy Hubber Interim Director of Public Health, Luton Council Luton LH Dr Matt Mayer CEO BBO LMC Milton Keynes MM Nicky Wadely Associate Director of Population Health BLMK NW Dr Nicky Williams Co-Chief Executive, Beds and Herts, LMCs Bedfordshire & NWi Luton Oliver Mytton Deputy Director of Public Health, Milton Keynes Milton Keynes OM Council Pam Lewin Primary Care Contract Manager – GP BLMK NHSE/I PLe Rachel Webb Director of Primary Care and Public Health NHSE/I RW Dr Richard Wood CEO BBO LMC Milton Keynes RWo Tracy Keech Interim Chief Executive Officer Healthwatch Milton Keynes TK
Page 2 of 9 1. Welcome and Apologies for absence Action The Chair for Bedfordshire and for Committees in Common (Alison Borrett): - welcomed all members, attendees, the Public to the first PCCiC meeting held in Public - apologies were received and noted as above - advised that the meeting was quorate - informed the Committee that the meeting would be recorded for the purpose of the minutes and published on line and therefore members of the public were advised to keep their cameras turned off and for microphones to be muted - for future meetings the public can request questions related to agenda items prior to the meeting but for the purpose of today’s meeting they should use the chat feature. 2. Declarations of interest (DoI) (Chair) (i) No members declared any additional/new interests to their current DoI on the CCG Interests Register. (ii) No declarations of interests were made by members or attendees in relation to items on the agenda. 3. Clarify purpose of the Primary Care Commissioning Committees in Common (Chair) The Primary Care Commissioning Committee (PCCC) is a committee between NHS England and Bedfordshire, Luton and Milton Keynes CCGs, with the primary purpose of jointly commissioning primary medical services for the local populations. As the CCGs are currently three statutory bodies, each area retains its own Committee terms of reference.
It was established to enable the members to make collective decisions on the review, planning and procurement of primary care services under delegated authority from NHS England. The Committee has representatives from NHSE, GP members, Primary Care Networks (PCNs), Local Authorities, Local Medical Committees, Healthwatch, Public Health and the CCGs.
4. BLMK Primary Care Digital Strategy update (Mark Peedle) The impact of Covid 19 has seen a rapid acceleration in the take up of digital technology with constructive developments within primary care including online consultation tools now widely used in 90% of Practices and being embedded in Care Homes. - 111 first & same day primary care: working with BLMK partners on a digital waiting room for easy access for urgent and emergency department access (non-emergency); exploring / piloting a Hub model for PCNs to use for online video consultations; - Integrated Urgent Care: video consultations in Out of Hours Services (OOHS) and Clinical Assessment Services (CAS) and access to diagnostics by OOHS clinicians on behalf of GP - Primary Care - Secondary care interface, working across care systems : tools to improve advice and guidance prior to referrals; focusing on a multi-disciplinary team approach - Mental Health link with primary care: looking at effective access to multi-disciplinary team meetings and rehabilitation services - Next steps: BLMK Digital Assembly established and attended by all Primary Care Networks (PCNs) and Clinical Directors; continued engagement with BLMK Integrated Care System (ICS) Digital leads and fully engaged with the East Region Digital Transformation group. Realistic roadmap for the next two to three years to be developed (clinically led and agreed).
The Caldicott Guardian is kept fully appraised of the work of the Digital Team to ensure it was clinically safe. RG requested that the Digital team consider the difficulty within triage pathways for carers or family to access NHS services where the patient is unable to provide clinical consent.
MP assured the Committee that BLMK CCGs recognised that digital technology was not a single solution and they will continue to ensure that it is considered part of the system approach but not ‘the’ system and that solutions and access were available to digitally excluded patients.
Page 3 of 9 The Committee received assurance from the update on the BLMK Primary Care Digital Strategy.
ACTION 001: MP to share the BLMK Primary Care Digital Strategy with the BLMK Patient & MP Public Engagement Committee for support/endorsement. 5. BLMK Estates Working Group Report (Nikki Barnes) The Estates Working Group (01.11.20.) made the following recommendations in relation to primary care estates schemes. Members of the Primary Care Commissioning Committees are asked to approve the final costings to relocate Conway Medical Centre and to note both the application to utilise Section 106 funding for an options appraisal for Cobbs Garden Surgery and the bid submitted as part of the Bedfordshire One Public Estate programme.
5.1 Relocation of Conway Medical Centre The Committee discussed the Business case proposal to relocate to nearby Kingsway Health Centre. The scheme was previously approved by LCCG PCCC and scrutinised by the BLMK Estates Working Group. The main driver for the scheme is the relocation of one of the most constrained practices in BLMK into new premises with ample capacity to serve patients well. The relocation with another practice in their PCN bolsters long term resilience in the area. The updated version of the Project Initiation Document will be shared with the Committee.
Proposal received from the Landlord and formal report from the District Valuer confirming an increase in cost against the primary care delegated budget, but rated as value for money. Due diligence to finalise leasing arrangements will be completed.
LCCG PCCC approved the final costings for the scheme to relocate Conway Medical Centre. 5.2 Cobbs Garden Surgery: application to utilise Section 106 funding for an options appraisal BLMK Director of Primary Care (NP) has approved support for the Practice to apply to Milton Keynes Council to access Section 106 funding for professionals advisors to carry out an options appraisal. They are a constrained Practice in an area of significant housing growth and have Section 106 funding already secured to support improvements in capacity. The outputs of the study will be shared with the Committee. The Practice are aware that this will be an early exploratory stage, and does not commit MKCCG to funding any recommendations from the options appraisal.
The Committee noted the approval granted by the BLMK Director of Primary Care for an application to utilise Section106 to commission an options approval and business case development for improving the surgery. 5.3 Bid submitted as part of the Bedfordshire One Public Estate Programme BCCG PCCC previously signed off the strategic outline case document for a range of Hubs across Bedfordshire. It approved progression to outline business cases, subject to availability of funding and supported the concept of trying to secure funding externally as opportunities arose.
Bid submitted on behalf of the Bedford Borough and Central Bedfordshire Hub Programmes with BLMK Executive Team approval to start the detailed planning for proposed Hubs in West Mid Bedfordshire, Houghton Regis, Kempston and Leighton Buzzard. Planning would include healthcare plan, working up detailed service model and schedule of accommodation to understand size required and test against initial assumption. Confirmation of the outcome of the bid will be received early in 2021.
The Committee noted the bids submitted on behalf of the Bedford Borough and Central Bedfordshire Hub Programmes. 6. Primary Care Workforce (Susi Clarke)
Page 4 of 9 6.1 Primary Care Workforce/Training Hub highlight report Report provided a high level summary of key workstream areas. SC highlighted pieces of work and initiatives for information and to note: - additional funding received to increase GP numbers across BLMK; in addition to schemes already running SC is working with GP Leads to refresh GP recruitment and retention strategy based on meeting local needs - support packages for assistance with new roles being recruited into primary care - PCN workforce plans enable active targeting to make sure wrap around support provided - Practice Nurse Leads and Clinical Pharmacist Leads increasing student placement capacity and training existing and more experienced staff to supervise students - running a national pilot looking at how to support students virtually - funding training to develop a multi-disciplinary coaching and mentoring faculty for new roles and student placements, but also providing career / portfolio option for experienced staff - programme of funded continual development for the training and education of staff (over 418 staff based on PCNs requirements).
SC confirmed to RG that a focus of the Training Hub was around a cultural shift for both patients and practice workforce with support through different ways and levels of approach.
The Committees noted the work outlined in the Highlight Report. 6.2 Workforce plans and Additional Roles Reimbursement Scheme (ARRS) Primary Care Networks were given an additional opportunity to amend Workforce Plans for 2020-21 enabling them to include numbers to recruit to the Nursing Associate and Training Nurse Associate roles. The planned number of whole time equivalent posts to be recruited within this financial year is 240. The Training Hub to support staff to be embedded in the networks and to support the networks to understand how those roles would work. Training Hub and CCG to provide process whereby each PCN has the opportunity to bid against the indicative underspend. There is a strict criteria and PCNs can only bid against the underspend in their CCG area. Those PCNs further advanced in the process to work with CCGs to support the rest of the system to progress. If required Workforce Plans would be amended and resubmitted to NHSE at an aggregate level. SC assured NC of the career pathway in place across BLMK for the role of Practice Nurse and confirmed that there was a Team of Nurse Leads supporting those in post and provided examples of career progression across BLMK. PL explained to SE the multiple factors contributing to the Bedfordshire underspend including recruitment to lower banded roles, variations of infrastructure in place and ability to recruit. The Chair requested that the Committee were kept updated on Items 6.1 and 6.2. The Committee noted the current position in terms of planned recruitment 2020-21, the indicative underspend and the next steps for PCNs to bid against the underspend. 6.3 BCCG Primary Care PCN Development Funding 19/20 (Paul Lindars and Richard Noble) PCNs were asked to confirm their development funding submissions made earlier in year or resubmit with new priorities or ideas. Update confirmed the PCNS that have engaged either in situ or been approved and provided assurance to the Committee that the place teams continued to work closely with PCNs to ensure that funding was utilised within the current financial year.
PL and RN confirmed to SE that PCNs who were adopting a different online consultation model were operating within NHSE approved options, and that this enabled the system to test and understand different solutions through digital workstreams. AG explained how his practice/PCN had chosen the system they use and how every surgery had different ways of working so should not be limited to current providers and should be considered as part of the funding NHSE/CCCG provide for these systems.
Page 5 of 9 Continuation of the PCN Development Contract agreed in 2019/20 with the Bedfordshire, Luton and Milton Keynes (BLMK) ICS (Paul Lindars)
National Association of Primary Care (NAPC) contract was paused due to Covid 19 and to make best use of the remaining legacy contract it was agreed by the Primary Care Cell to repurpose the approach to establish a tailored online project based and evaluated learning approach of the General Practice Nursing CARE programme. This will be consolidated through four exemplar PCN sites and shared across BLMK. It has received positive feedback and the plan is to echo that model to provide PCN support using legacy funding.
The Committee noted the update on BCCG PCN Development Funds (2019-20) and on the BLMK NAPC Legacy Agreement (2019-20). 6.4 Funding for Primary Care Workforce Development, beyond Additional Roles Reimbursement Scheme (ARRS) (Paul Lindars) PL outlined the BLMK CCG / ICS primary care funding allocations to be received from NHSE/I, noting the different allocations for different projects in the programme and an overview of the governance structure in place to manage the funding. There is an expectation that these funds are invested this year.
The Committee noted the funding allocations to be received from NHSE/I and the proposed governance framework to oversee the programme of work.
The NHSE/I Memorandum of Understanding states ICSs are empowered to shift funds between designated workstreams. The Committee discussed the recommendation to use ‘spare’ funding allocated for online consultations to support the GP resilience programme.
The Committee approved the recommendation to divert spare online consultation funds to support the GP resilience programme.
2020/21 PCN Development Funding Proposal The Committee reviewed the recommendation that utilisation of the BLMK PCN Development Funding for 2020/21 is based on the recommended principles outlined in the paper. The CCG to share these principles with PCN Clinical Directors allowing further feedback and possible refinement in relation to the menu of proposed PCN initiatives. Once the menu has been finalised in agreement with PCN Clinical Directors, the CCG will release the PCN allocations.
The Committee agreed the recommended approach, including the principles set out to deploy the PCN development funds. 7. BLMK Primary Care Strategy (Summary) April 2021-2021 (Amanda Flower, Alexia Stenning & Paul Lindars) The Associate Directors for Primary Care presented a summary of the strategy produced as part of the BLMK CCGs merger application for NHSE England which outlined the definition and vision for primary care from now to delivery in 2023-24: - primary care covers wider scope than general practices and the strategy covers the services that support and work around practices and PCNs to provide care to the population - inspiration drawn from the Primary Care Home Model on how to integrate services around PCNs (community health, mental health and social care services), with services co-designed with GPs and communities - aim to deliver improvements in the health and wellbeing of the population and create a strong, safe and sustainable health and care system through six key areas develop Primary Care Networks to boost out of hospital care reduce pressure on emergency hospital services give people more control and personalised services digitally-enabled primary Page 6 of 9 care focus on population health (how to reduce inequalities and improve health outcomes for the population) - outlined impact of Covid and the challenges for the population and healthcare professionals to move from traditional ways of working to new digital solutions; 0800-2000 opening across the system; weekend access and multi-disciplinary team working - Phase 3 recovery includes: major response around expanded flu vaccination programme; mass vaccination planning; focus on early diagnosis of cancer for people with a learning disability, maintenance of disease registers, new patient reviews, routine medication reviews, frailty reviews, screening programmes, childhood immunisations - demonstrated the benefits of working together as one clinically led BLMK CCG with aligned clinical and management leadership. NP assured MH that the strategy did not disregard individual practices not in PCNs (three) and that the CCGs recognised and worked with all 98 practices ACTION 002: NP invited RG and other Healthwatch members to advise how they would like to RG, JW, work with BLMK CCGs and partners to receive assurance on patient confidence and feedback LN, PT, on the strategic approach. DB The Committee received assurance on the BLMK Primary Care Strategy. 8. Quality and Outcome Framework (QoF) Changes – supporting Primary Care 2020-2021 (Tony Medwell) QoF is a system of quality management and payment to general practice with built in quality incentives around screening, monitoring, ill health prevention and addressing inequalities. It is a national scheme but with a local approach based on local population needs. Recent interim guidance aims to support practices to reprioritise and focus on care not related to Covid 19 and to do that GPs require guaranteed income support. The changes are intended to release capacity within general practice to focus efforts upon the identification and prioritisation of people at risk of poor health, and those who experience health inequalities for proactive review. All practices across BLMK are currently working on three local Population Stratification Plans. The Committee noted the QoF changes and were assured that BLMK Practices have commenced working on QoF Population Stratification plans which will be agreed with the BLMK PCCiC. The Committee will be updated on progress on 19.01.21. 9. Pilot to adequately resource Practices to produce Child Protection Safeguarding Reports (Tony Medwell) The Committee discussed the request to ratify an operational decision made by the BLMK Executive to commence a six month pilot Safeguarding Report process. All CCGs tasked by NHS England to establish a process to fund GPs and improve the quality of reports undertaken within primary care to ensure children and vulnerable adults were effectively safeguarded. The pilot will establish a baseline of activity, time taken for each report, quality of reports and that the reports requested are appropriate. TM confirmed to NC and CL that their requests to consider digital (integration rights) and how to streamline the process particularly around duplicate requests would be included within the pilot. The Committee will be informed of the outcome and recommendations of the pilot. The Committee ratified the decision made by the BLMK Executive to commence a pilot Safeguarding Report process which includes remuneration and quality support to GPs. 10. BLMK Finance Report (Roger Hammond) RH reported financial expenditure to Month 6 and forecast against NHSE advised 2020-21 budget (Months 1-6). He explained the temporary financial regime put in place in response to Covid for April-September 2020 where CCGs received budgets from NHSE, which for primary care was based on 2019/20 expenditure. This did not reflect additional investments that had been Page 7 of 9 notified into primary care. CCGs report monthly expenditure which NHSE review and a retrospective non-recurrent adjustment is reimbursed for reasonable variances. CCG has received Months 1-5 adjustments resulting in break even position. The overspend in Month 6 reflects the net position. From Month 7 CCGs received an allocation for the rest of the year enabling the setting of more realistic budgets. Outside of normal delegated approach, practices have been financially supported through their response to Covid. BLMK have received ring-fenced allocation to support primary care covid related costs for the remainder of the year and completing process for practice claims. Covid expenditure and non delegated areas of spend shared, with confirmation that variants seen were primarily driven by the Month 6 position in terms of actual budget versus spend. The Committee received assurance on the BLMK financial report as at Month 6. 11. Bedfordshire PMS Reinvestment Funds 2020-2021 (Tony Medwell) PMS Reinvestment Schemes specifications for Bedfordshire were paused due to Covid 19 response and changes to the GP contract under the pandemic regulations. National guidance supported practices with interim income protection and it is proposed that the current payments arrangements for Q1 and Q2 continue for Q3 and Q4, except where notice had already been given on service provision. Practices have started to reinstate services provided by PMS reinvestment funds in line with national and local priorities including Multi-Disciplinary Team working to support patients with more complex conditions. Work has commenced to agree the reinvestment criteria for released funding of PMS premium monies for the 2021-22 Scheme.
The Committee discussed the proposed scheme from December 2020 recommended by Dr Roshan Jayalath (Mental Health Commissioning Clinical Lead BCCG & BLMK ICS), for Health Checks for patients with a serious mental illness (SMI) with includes additional support and clinical reviews. To fund this scheme, it is proposed to cease current dementia payments to practices from October 2020. The Committee were assured that practices and wider mental health partners had systems and processes in place to identify dementia patients; payments had continued to practices during 2020-21 although the one year scheme had ceased.
BCCG PCCC approved the proposal for PMS reinvestment reinstatement of scheme for Health Checks for patients with a serious mental illness. 12. Current impact of Covid on Primary Care Services (Nicky Poulain) NP concentrated on recognising the challenges for primary care services, the 98 practices, PCNs and staff and commending how adaptive they have proved to be to support patients and ensure both patient and staff safety. She described the impact for practices of working differently with community providers to ensure personalised services to patients in care homes and housebound patients; new ways of working (including digital) for both staff and patient experience; the ongoing process to ensure a sufficient supply of PPE; regular testing for practice staff and the challenges of covid vaccinations.
The Committee noted the update and endorsed the credit due to GPs and primary care staff. 13. Memorandum of Understanding & Delegated Functions of Responsibilities Agreement (LS) NHSEI have developed a core offer of support for CCGs. The Memorandum of Understanding sets out their role as a regulator for the CCGs and provides the CCGs and the public with assurance on the ways in which both NHSEI and the CCGs are working collaboratively to deliver benefits for patients. The appendices circulated outline the level of support available and the level of co-production and integrated work that is taking place. LS confirmed that the arrangement was working effectively, particularly with the Heads of Primary Care and three CCGs and thanked the CCGs for working collaboratively with NHSEI.
The Committee noted the integrated support offer available to CCGs from NHSEI.
Page 8 of 9 14. Any other business No other business was raised. 15. Date of Next Meeting: 19.01.21. at 1030-1230. 16. Meeting Closed 12:32
Page 9 of 9