NHS Castle Point & Rochford and Southend Clinical Commissioning Groups Board Meeting
Part I Agenda
Thursday 29 July 2021 from 3pm to 5.45pm
Microsoft TEAMS
Action Papers Lead Time Page No. GENERAL BUSINESS Welcome and apologies for 1. To note Verbal Chair - absence 3.00pm Declarations of interest and review 2. To note Attached Chair 3-5 of Register of Interest Minutes of the meeting held 3. To approve Attached Chair 6-13 27 May 2021 3.05pm Action Log and Matters Arising 4. To note Attached Chair 14 from last meeting (not on Agenda) 5. Questions from the Public To note Verbal Chair 3.10pm - SYSTEM REPORTS Nicola Adams, 6. Board Assurance Framework To note Attached Governance Lead 3.15pm 15-21 Nicola Adams, 7. Strategic Objectives 2021/22 To approve Attached Governance Lead Rachel Hearn, Director 8. Patient Story To note Presentation 3.30pm - of Nursing 9. Joint Committee Update To note Verbal Chair 3.45pm - Tricia D’Orsi, NHS 10. Performance Report To note Attached 3.50pm 22-37 Alliance Director PLACE REPORTS Tricia D’Orsi, NHS 11. Alliance Director Report To note Attached 4.00pm 38-47 Alliance Director Simon Williams, 12. South East Essex Place Plan To note Attached Deputy NHS Alliance 4.10pm 48-50 Director Rachel Hearn, Director 13. Patient Safety & Quality Report To note Attached 4.20pm 51-55 of Nursing Finance reports Mark Barker, Joint 14. a) Month 3 Report To note Attached 4.30pm 56-86 Chief Finance Officer b) Financial Plans Policies a) On Call Director Policy Nicola Adams, 15. b) Business Continuity To approve Attached 4.40pm 88-141 Governance Lead Strategy c) EPRR Strategy Tricia D’Orsi, NHS 16. SEND Update Report To note Attached 4.45pm 142-154 Alliance Director Extension of Southend CCG Tricia D’Orsi, NHS 17. To note Attached 4.55pm 155-157 Governing Body Member Tenure Alliance Director Claire Routh, Head of 18. Comms & Engagement Report To note Attached Communications & 5.05pm 158-180 Engagement Revised Committee Terms of Reference: To approve Attached Nicola Adams, 19. 5.15pm 181-193 19.1 Finance & Performance Governance Lead Committee To approve Attached Action Papers Lead Time Page No. 19.2 Patient Safety & Quality Committee Committee Updates
20.1 Patient Safety & Quality To note Attached Committees in Common
20.2 Finance & Performance To note Attached Committees in Common 20. Chair 5.25pm 194-207 20.3 Audit Committees in To note Attached Common
20.4 Primary Care To note Attached Commissioning Committees in Common
Ratifying virtual decision Nicola Adams, 21. To note Attached 5.35pm 208-210 - Approval of IG policies Governance Lead 22. Any Other Business To note Verbal Chair 5.40pm - FOR INFORMATION Minutes from: a) Joint Clinical Executive Committee – 20/05/21, 03/06/21, 17/06/21, 01/07/21 Included in b) CP&R Patient and For 23. Attached Chair - appendices Community Reference Info mation r paper pack Group – 18/05/2021 c) Southend Patient and Community Reference Group – 20/04/21
Date/time of next Part I Board Meeting: 24. To note Verbal Chair - - Thursday, 30 September 2021 at 3pm CONFLICT OF INTEREST REGISTER - June 2021 Direct or Last Name First Name Current Position(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest
From To Financial InterestFinancial Non-Financial Professional Interest Non-Financial Personal Interest Consent to Publish Andole Dr Sreeman Secondary Care Consultant Asst Medical Director NHSE All on- CQC Specialist Advisor going Clinical Reference Group, Neurosciences, NHSE/I Stroke Consultant, Kings College Hospital. MBRACE-UK, confidential enquiry into Maternal Deaths and Morbidity - Committee Member. Medical Director East of England Ambulance Trust
Barker Mark Joint Chief Finance Officer N/A N/A N/A N/A N/A N/A N/A N/A Barusya Dr Kate Governing Body Member GP Partner North Avenue Surgery Direct April 2019 Present Clinical Lead for Maternity and CYP & Sessional GP IC24 OOH Direct May 2018 Present DMO Appraiser, NHS England Direct Oct 2013 present Clinical Supervisor, ARU Medical School Direct Nov 2018 Present Director, Barusya Company Ltd Direct Aug 2008 Present Chaturvedi Dr Krishna Governing Body Member Sessional GP N/A N/A N/A N/A N/A N/A N/A Clinical Executive Committee Chair
Doherty Steve Board Member - Practice Manager Practice Business Manager, Audley Mills Direct Current Representative Surgery Secretary, Audley Mills Eye Services Ltd Direct Current Secretary, Audley Mills Medical Education Centre Ltd D'Orsi Patricia NHS Alliance Director N/A N/A N/A N/A N/A N/A N/A N/A
Freeman Tracey Lay Member Governance Interim Finance Specialist, Maldon District Direct May 20 Oct-20 Council Garcia-Lobera Dr José Chair GP Partner, Pall Mall Surgery Direct Present not be part of the Commissioning process/ Trustee, Southend United Community and Direct Present decision where conflict may Education Trust occur Gibson Janis Lay member Public & Patient Castle Point Association of Voluntary Direct 2015 Present Engagement Services, Chief Executive Officer Estuary House Association, Non-Executive Director Direct 2017 Present Brother in law director of KPMG Social Prescribing Indirect Meeting room hire to the CCG Indirect Oct 19 Present Gupta Sunil Governing Body Member GP at Rushbottom Lane Surgery Direct 1995 Present
Non Executive Director of Essex Equip Ltd Direct Nov 2017 Present
GP Trainer Direct 2004 Present Examiner for the Royal College of General Practitioners (RCGP) Direct 2004 Present
Member of the Board of the Essex Faculty of the RCGP Direct Jun 2013 Present
Member of the East of England Clinical Senate Council Direct Oct 2013 Present
GP Advisor for Care Quality Commission inspections of General Practices Direct Sept 2014 Present
GP Advisor as part of the RCGP Special Measures Support Team Direct Oct 2014 Present Member of the Conservative Party Representative of the Essex Faculty at the Direct 2016 Present United Kingdom Council of the Royal College of General Practitioners Direct Nov 2015 Present
Gupta Sunil Member of CCG Improvement and Assessment Framework Panel for Dementia Direct Apr 2016 Present
Member of the NICE Quality Standards Advisory Committee Direct May 2016 Present
Chair of South East Essex Dementia Steering Group Direct 2018 Present
Representative of the Royal College of General Practitioners on the National Direct May 2018 Present Patient Safety Response Advisory Panel
Vice Chair of East of England Clinical Senate Council Direct Jan 2017 Present Member of the General Practice Curriculum working group for Anglia Ruskin University Direct May 2017 Present Member of the Advisory Committee on Resource Allocation
Direct Aug 2017 Present
Page 3 of 211 Direct or Last Name First Name Current Position(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest
From To Financial InterestFinancial Non-Financial Professional Interest Non-Financial Personal Interest Consent to Publish Gupta Sunil Associate Postgraduate GP Dean in Health Direct Feb 2018 Present Education East of England Direct Mar 2018 Present Member of Essex Health and Wellbeing Board
Wife is Consultant Community Paediatrician Indirect 2016 Present for PROVIDE in Mid Essex
Member of the Essex Primary Care Inter- Direct Oct 2015 Present Professional Centre for Workforce Development Steering Group
Representative of the Essex Faculty at the United Kingdom Council of the Royal Direct Nov 2015 Present College of General Practitioners
Member of the Essex Primary Care Workstream Group Direct May 2016 Present
Member of the Expert Reference Group on the Achieving Better Access to mental Health Services by 2020: Dementia Care Direct July 2016 Present Services
Gupta Sunil Representative of the Royal College of General Practitioners on the National Direct Nov 2016 Present Patient Safety Response Advisory Panel
Member of the Midlands and East GP Forward View Stakeholder Group Direct Mar 2018 Present
Houston Dr Brian GP Governing Body member & Clinical Partner at Highlands Direct Present Lead Wife works for EPUT Care coordination Indirect Daughter is a registrar doctor A&E Basildon Indirect
Kamdar Dr Mahesh GP Governing Body member Locum GP in Member GP Practice 2018 Present Khan Dr. M GP Governing Board member Member of practice which is a shareholder Financial 2014 Ongoing Rizwan in GP Healthcare Alliance Ongoing Partner of member practice of CCG - Dr Financial 2003 Khan and partners, Rushbottom Lane surgery, Benfleet 2019 Ongoing Member of practice that is part of Benfleet Financial Primary Care Network Ongoing Clinical Director of Benfleet PCN Financial July 21 Partners and employee’s at Dr Khan and partners are board members of GP Indirect 2014 Ongoing Healthcare Alliance GP Educator lead for EU doctor recruitment for the STP – employ EU GPs via the scheme Indirect 2017 Ongoing Kuriakose Dr Biju Governing Body Member GP Partner, GP Trainer, GP Tutor, GP Direct Current Research Champion
Share Holder GP Healthcare Alliance Direct Current Wife works as Psychiatrist (Old Age) for Direct Current EPUT at Crystal Centre Chelmsford Liebmann Dr Rachael Secondary Care Clinician Trustee Royal College of Pathologists - Direct 2009 Present Charity Consultant Histopathologist Queen Victoria Direct 2015 Present Hospital NHS Foundation Trust - NHS Provider Specialist Trust Group Medical Director The Doctors Laboratory and Health Services Direct 2017 Present Laboratories Indirect 2014 Present Husband - Chief Executive Young Epilepsy - Charity Husband - Trustee Royal College of Indirect 2016 Present Paediatrics and Child Health
McKeever Anthony Joint Accountable Officer/Executive Lead Director Macs et al Ltd, through which for Mid & South Essex ICS contract with NHS as interim Sep-00 present Metcalfe Mark Governing Body Member GP Partner in member practice of CCG Direct 2011 Ongoing GP practice part of GP healthcare Alliance and Crouch Valley Federations Direct 2014 Ongoing Director of Onyx Medical Limited (Medical Education Company) Direct 2017 Ongoing
Ng Dr Kelvin Governing Body Member N/A N/A N/A N/A N/A N/A N/A N/A Clinical Lead for Prescribing Ozturk Dr Sami Governing Body Member N/A N/A N/A N/A N/A N/A N/A N/A Saville Dr Lucy Governing Body Member GP Partner Audley Mills 2005 Present Medical Advisor for Foster Agency 2014 Present Husband Consultant Anaesthetist /Critical 2019 Present Care Showell Dr Daniel Public Health Consultant Employed by ECC who is a partner with the Direct 2013 Present CCG on multiple issues. Siddiqui Dr Kashif Governing Body Member GP Partner, St George's Medical Practice, Direct September Present Benfleet. Practice is a Member of GP 2012 Healthcare Alliance, Benfleet PCN, accepts Medical Students from ARU, member of clinical research network. GP Trainer Health Education East of In-Direct August 2016 Present England
Page 4 of 211 Direct or Last Name First Name Current Position(s) held in the CCG Declared Interest Type of Interest Indirect Date of Interest Action taken to mitigate risk COMMENTS Interest
From To Financial InterestFinancial Non-Financial Professional Interest Non-Financial Personal Interest Consent to Publish Stratford Pauline Lay Member James Currell, Associate Director of Operations is my cousins son in law. Syed Dr Taz Governing Body Member Wife Louise is a health visitor for Virgin in Indirect 2016 Present Declare interest in any Williams Simon Deputy Alliance Director N/A N/A N/A N/A N/A N/A N/A N/A
Page 5 of 211 NHS Castle Point and Rochford CCG/ NHS Southend CCG Part I Governing Body Meeting in Common 27th May 2021, 3pm – 5.00pm MINUTES Agenda Item 3
Attendees from Southend CCG: Dr Kate Barusya (KB) GP Governing Body NHS Southend CCG Dr Brian Houston (BH) GP Governing Body NHS Southend CCG Dr Krishna Chaturvedi (KC) GP Governing Body NHS Southend CCG Dr Kelvin Ng (KN) GP Governing Body NHS Southend CCG Dr Taz Syed (TS) GP Governing Body NHS Southend CCG Dr Irfan Akram (IA) GP Governing Body NHS Southend CCG Attendees from CP&R CCG: Dr Sunil Gupta (SG) GP Governing Body Chair NHS CP&R CCG Dr Sami Ozturk (SO) GP Governing Body NHS CP&R CCG Dr Biju Kuriakose (BK) GP Governing Body NHS CP&R CCG Dr Kashif Siddiqui (KS) GP Governing Body NHS CP&R CCG Dr Mahesh Kamdar (MK) GP Governing Body NHS CP&R CCG Dr Riz Khan (RK) GP Governing Body NHS CP&R CCG Dr Mark Metcalfe (MM) GP Governing Body NHS CP&R CCG Attendees that sit across both Southend and CP&R CCGs: Anthony McKeever (AM) Joint Accountable Officer Mid & South Essex CCGs Janis Gibson (JG) Lay Member, Patient Engagement NHS CP&R and Southend CCGs Pauline Stratford (PS) Lay Member, Primary Care NHS CP&R and Southend CCGs Tricia D’Orsi (TD) NHS Alliance Director NHS CP&R and Southend CCGs Simon Williams (SW) Director of Integration & Partnerships NHS CP&R and Southend CCGs Dr Rachael Liebmann (RL) GP Governing Body NHS CP&R and Southend CCGs Lorraine Coyle (LC) Deputy Chief Nurse NHS CP&R and Southend CCGs In Attendance Mark Barker (MB) Chief Finance Officer Mid & South Essex CCGs Rachel Hearn (RH) Executive Director of Nursing & Quality Mid & South Essex CCGs Nicola Adams (NA) Associate Director of Corporate Governance NHS Thurrock CCG Kaltrina Bajrami (KB) Communication & Engagement Officer NHS CP&R and Southend CCGs Interim Alliance Business Support Manager Hayley Waggon (HW) NHS CP&R and Southend CCGs (Minutes) Apologies Dr Lucy Saville Krishna Ramkhelawon Becky Pollard` Dr Jose Garcia-Lobera Members of the public in attendance Rosina Worf Veronica Sadowsky
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Sar Tindall
1. Welcome and Apologies 1.1 SG welcomed everyone to the meeting in common of the Southend and CP&R CCG Governing Body.
SG welcomed IA to his first meeting and introduced IA as the newly elected GP Governing Body Member for Southend CCG.
1.2 Apologies were noted as above.
2. Declarations of Interest 2.1 Members of the Committee were reminded of their obligation to declare any interest they may have on any issue arising at committee meetings which might conflict with the business of CP&R/Southend CCG and that declarations declared by members of the Committee are listed in the CCG’s Register of Interests. The Register is available either via the Committee Secretary to the governing body or the CCG website at the following link: https://castlepointandrochfordccg.nhs.uk/about-us/key-documents/2508- declarations-of-interest-governing-body/file or https://southendccg.nhs.uk/about- us/key-documents/320-nhs-southend-ccg-governing-body-declarations-of-interests- register/file
SG confirmed that the Declarations of Interest will be reviewed and updated prior to the next meeting.
3. Minutes from 25.03.2021 3.1 The minutes from the Governing Body held in March 2021 were agreed as an accurate reflection of the meeting.
4. Action Log 4.1 The action log was updated as below:
Action 022 – Letter of thanks – this letter has been sent to Cathy Cunningham. Closed.
5. Questions from the Public 5.1 No questions from members of the public were received.
6. Board Assurance Framework (BAF) 6.1 NA presented to Governing Body the first BAF for 21/22. NA noted that during the Covid waves the BAF and risk management process was stood down and risks were managed through the CIMT Risk Register. Work has been undertaken to work with risk leads to update the register which will now be reported bi-monthly. Relevant sections for assurance and scrutiny will be taken to relevant Committee in Commons and the risk register will also be reviewed by the Audit Committee in Common. NA noted that the BAF is being reviewed and recent risks will be added, risk leads are working on actions to address the risks included on the BAF.
TF noted that the BAF went to last week’s Audit Committee in Common and the Committee requested more detail on 2 risk areas to ensure progress is being made. NA confirmed these were the Medicines Optimisation risk and Digital risk. The digital risks were previously detailed for each project and these have now been grouped together and local project registers created to ensure risks are managed. NA confirmed the further information requested by the Committee will be brought back to the July Committee meeting.
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6.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the BAF.
7. Patient Story 7.1 RH presented the new patient story which focused on Leigh’s experience of Cancer care for herself and care received by her late husband Paul.
It was noted how powerful this patient story was and highlighted good practice seen by the couple but also identified areas for improvement. RH noted that areas of improvement are being looked at and the Cancer Board are ensuring learning from patient experience is being incorporated. RH noted that she wants to ensure Committees and Board meetings are updated on what is happening following the patient stories so the experience is turned into action on how services are commissioned moving forward.
IA thanked RH for sharing the powerful story and noted that GPs play a vital role for cancer patients who often contact Primary Care for support during this time. IA felt GPs should have regular contact with cancer patients throughout their treatment.
TD was struck by the term Leigh used on the ‘violence’ of being told the news about the diagnosis. TD felt that there is such a high importance of psychological support being available to patients during this time and felt this could be a focus for Alliances moving forward. JG agreed and noted the need to think holistically and about the whole family who would be impacted in these situations.
RH noted that moving forward the Patient Safety & Quality Committee in Common will have a standing item on the agenda which looks at the outcomes following the patient story. This will also be fed back to Governing Body meetings.
7.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Patient Story
8. Joint Committee Update – 20 May 2021 8.1 SG updated Governing Body members on the Joint Committee meeting which took place on 20 May. SG noted there were three main discussion items: - Additional operation theatre capacity – the Joint Committee approved capacity of 3 operating theatres which will be situated across the 3 acute sites. This will enable 3000 extra operations to take place and held reduce the waiting lists for routine operations. - Legal undertakings of the acute trust – SG noted that this focused on 5 main areas and noted progress is being made across all 5 areas; Governance, Maternity, Harm Reviews, Diagnosis & Treatment of cancer patients and addressing the waiting list for routine operations. - Adult Mental Health – the Joint Committee discussed the investment into improving the crisis response in relation to mental health and the need for closer integration with Primary and Community mental health services.
8.2 KS questioned if there are plans to discuss Primary Care demand at future meetings. AMK felt this discussion should be had at the Primary Care Co-Commissioning Committee due to the delegated function of Primary Care. Discussion around Primary Care demand is being had with the CCG Chairs at system level and AMK felt the system could help to ensure communication to the public details the pressure being seen by practices. Discussion was had around the demand being seen, especially in relation to the number of calls practices are getting. KS noted that there has been an increase in
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phone calls by 40% which is significant. AMK highlighted that solutions need to be tackled at place level and would support place to make decisions to assist with supporting primary care.
KB noted that there is additional work being added to Primary Care by patients being unable to access appointments at the hospital once referred and are being advised to go back to their GPs. AMK highlighted that there is also pressure being seen at the acute trust.
KN also flagged that patients have been empowered to make decisions and regularly attend Primary Care detailing the tests they want to be conducted. This makes it more challenging for the GP. It is also challenging to recruit into Primary Care which adds to the pressure. AMK wanted to thank his Primary Care colleagues for all the work they are doing and recognises the intense pressure and demand they are currently under.
PS wanted to flag the performance standard by the hospital in providing advice and guidance to GPs. This process is set up to avoid unnecessary referrals and to support GPs. Currently response rates are over 23 days instead of the 2 days where it should be. AMK noted that uptake and value of advice and guidance varies across Mid & South Essex but agreed the interface between Primary and Secondary care impacts on how well this works. TD noted that advice and guidance has been embraced in SEE and this TD method should not be lost and TD agreed to raise these concerns with the performance team.
BK also flagged that the expectation on Primary Care from patients is a lot higher. Patients can now contact practices by email and expect a more urgent response which impacts on how staffing is used. AMK agreed and felt it is necessary to use Primary Care leadership and experience to try and find solutions/support to meet the current demand.
8.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Joint Committee Update.
9. Alliance Director Update 9.1 TD presented the Alliance Director update which she took as read. TD noted the length of the report and felt this was testimony to the hard work taking place across the system and the CCGs.
TD drew the attention of the Governing Body to the work being undertaken with PCNs around the accelerator sites. Work is ongoing with Clinical Directors on looking at how they provide services for their local populations.
TD highlighted that the Covid vaccination programme has been successfully rolled out in SEE through PCN and mass vaccination sites. A good uptake across practices has been seen but TD confirmed that further work needs to be had to ensure uptake and access in certain areas. TD was pleased to confirm the roll out of the Covid vaccination van which will help to deploy vaccinations in areas with lower uptake.
TD was pleased to note that SEE is the wave 3 pilot site for population health management. Currently a development plan, to ensure effective roll out, is being worked through. To support this practices have signed a data sharing agreement to ensure primary care data can be used as part of this project.
Following the development of the SEE Place Plan further work with Alliance stakeholders will take place to ensure the plan is developed to ensure a collaborative
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plan is created.
TD was pleased to note the successful appointments to the interim posts within SEE which will be in place for the next 6 months. These posts will help to drive forward the place plan within SEE. 9.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Alliance Director Update.
10. Mid & South Essex System Financial Planning Update 10.1 MB presented the Mid & South Essex System Financial Planning update which is being brought to the Governing Body for approval. MB noted that initial plans were developed in advance of the publication of system financial envelope to ensure that commissioning could continue. The budgets have been reviewed, adjusted and submitted in line with NHSE guidance timelines. The plans report a balance position for the CCGs but MB noted risks still remain and are included within the report.
MB noted three main investment areas which are; investment in community beds to ensure acute services are resilient and therefore frail and elderly care will look to be moved into a community setting. A further £1m has been set aside to assist with establishing the ICS. Further investment will see the movement away from warfarin prescribing to NOAC medication which is NICE approved and better for patient care but will require further investment.
MB noted that previously only 2 CCG had delegated commissioning, a further £98.7m has been received for the first 6 months of the year which covers the delegated budget for the other 3 CCG areas as well as further acute IS funding, adjustment for CNST high growth and MHIS corrections. Further funding for the first 6 months has been provided to the CCGs to support the Covid pressures being faced and this links to the work being undertaken to recover the backlog built up over the last 16 months. The elective recovery programme supports this framework and MB noted this is quite ambitious and there will need to be a focus on the vanguard programme, the implementation of the 3 additional theatre sites and also additional capacity being provided for the independent sector to help manage the less complex activity.
This does bring a number of risks which need to be managed as a system. The achievement of the additional financial support from the ERF is a significant risk. MB is working closely with Dawn Scrafield to ensure access to activity data to enable monitoring of the activity to ensure no further pressure is added to the system. MB also highlighted the pressure around workforce and the difficulty in recruiting to specialist areas to enable targets to be met. MB noted that the efficiencies and stretch targets detailed are ambitious to be delivered and embedded over the next 6 months.
10.2 KS asked MB how confident he was that the Primary Care budget would be spent this year. MB was more confident that this would be spent this year compared to previous years. Last year the impact of Covid created small underspends for Primary Care but MB was confident this would not be the case this year.
10.3 The Castle Point & Rochford and Southend CCG Governing Body members APPROVED the MSE System Financial Planning Update.
11. Policies across MSE 11.1 NA presented the paper which updated Governing Body members of the governance around the CCG policies. A review of the policies has been undertaken and it was felt that due to the upcoming ICS transition harmonising the policies across the 5 CCGs would not be appropriate. However, the CCGs felt it was important to ensure the policies
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were in date and fit for purpose.
Following the review recommendations were taken to Remuneration Committee in relation to HR policies and recommendations for other policies was taken to the Audit Committee in Common. It was recommended and supported that policies were rolled over until March 2022. CCGs are currently working to update the version control of the rolled over policies and these will also be updated on the website within the next few weeks.
11.2 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Policies across MSE report.
12. Patient Safety & Quality Report 12.1 LC took the report as read and highlighted the following key points
- Domestic Abuse Bill – Safeguarding Leads have been working with partners and the safeguarding boards to ensure robust processes are in place and potential new legislative requirements can be implemented. - LC noted that due to sickness and vacancies within the SEE Quality Team there has been some workforce pressures experienced. Mitigation plans have been put in place and LC wanted to thank system partners in other CCGs for supporting SEE during this time. - LC was pleased to report no outbreaks or exposure of Covid within the SEE care homes for this reporting period. - There are no serious incidents outstanding for CP&R CCG. Southend CCG have 2 serious incidents outstanding, one if currently under independent review and it is expected that the other full report will be received soon.
LC noted that alongside the report is a number of appendices which detail the deep dive elements discussed during the Patient Safety & Quality Committee in Common.
12.2 PS wanted assurance that never event learning is embedded, and changes are made to processes moving forward. RH noted that several discussions at Committees have been had around this and a thematic review was undertaken on the MSEFT never events which found similar themes. Work is underway with MSEFT which also focus on culture, especially in theatres, to ensure people feel they can speak up if they are concerned, this also includes the patient. This is also being picked up during the Quality Improvement Board next week and RH agreed to ensure Governing Body members received an update on this at the next meeting.
12.3 TD wanted to thank LC and the team on the work they have been doing around LD Health checks which have seen improved uptake across Mid & South Essex. TD also thanked TS who has delivered training to PCNs and practices across the system on the importance of these checks. TD was also pleased to note that the backlog for LeDeR reviews have been addressed.
12.4 SA questioned how learning from LeDeR reviews are used. LC noted a review of this has been completed and identified areas of good work but also areas for improvement. At the next Governing Body meeting a detailed update will be provided to Governing LC Body members around this.
12.5 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Patient Safety & Quality report.
13. Performance Report
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13.1 TD took both papers as read and noted that any questions or concerns raised around performance would be fed back to the team and TD would assure an update on these would be provided to Governing Body Members. PS had previously noted her concerns around Advice & Guidance performance and TD agreed to follow this up with the team.
13.2 TF was disappointed that the performance team could not attend today’s meeting as she felt this would enable rich discussion around areas of concern.
13.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Performance Report.
14. Summary of discussions held at Committees in Commons 14.1 Finance & Performance Committee in Common MB provided an update of the last Finance & Performance Committee in Common. MB noted a focus on efficiencies and effectiveness across the system to ensure a balanced position. It was agreed regular updates would be provided to the Committee to ensure progress around efficiencies is reviewed and decisions made, around performance and contracts, can take place quickly if required. Discussion was also had around the elective recovery funding and the required targets that need to be achieved to ensure reimbursement of costs.
SA wanted to ensure that Governing Body Members were also aware of any concerns around financial elements across the CCGs. SA noted the importance that finance focus/progress is made by everyone. MB noted that efficiencies are taken to the System Efficiencies Programme Board (SEPB) which is attended by key individuals across providers. MB would welcome Governing Body representation at this meeting as well. SA was happy to attend these meetings. TD agreed and felt the work being undertaken by the SEPB could also highlight areas which Place could focus on to support the system position. AMK agreed and noted that the use of block contracts will help the understanding of system positions further and noted that MB is working closely with Dawn Scrafield within MSEFT to ensure good communication around funding is there.
TF noted that the Lay members attend all the subcommittee and committee in commons and finance is a regular topic for discussion. TF felt that the BAF will also identify risks and that the Governing Body need to be assured that risks are progressing.
14.2 Patient Safety & Quality Committee in Common LC noted that the Committee met this month and also reviewed the patient story shown at today’s meeting. discussion was also had around patient safety and how this is overseen and implemented across services. LC highlighted strong discussion around the quality strategy being developed and updates were given following the strategy workshops undertaken.
RH noted that the Committee has matured over the last few months and there is a movement to holding deep dive sessions for each committee meeting which links to a patient story. These deep dives will be brought to Governing Body’s as appendices within the patient Safety & Quality report.
14.3 The Castle Point & Rochford and Southend CCG Governing Body members NOTED the Summaries from the Committees in Commons.
15. AOB 15.1 The minutes from other Committees were NOTED by the Governing Body members.
15.2 There being no further business, the meeting was adjourned at 17.15pm
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Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group
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Agenda Item: GOVERNING BODY in Common
Log Action Date Due Lead RAG Status Date No: Added By closed Details of action required Mtg Date Return Exec Lead Details if completed or reason for delay/deferral - if date completed move to 'Closed' tab 023 TD to raise concerns with the performance team 27.05.2021 29.07.2021 TD Update: this was discussed at the Clinical Interface Group on the response times for Advice & Guidance meeting and discussions have also taken place at the CCG Chairs call. 024 LC to provide detailed report around learning 27.05.2021 29.07.2021 LC Update: this is included in the LD appendix of the Patient identified from LeDeR deaths Saftey & Quality report. This was a detailed discussion at the last PSQ CiC. A further report will be provided in August as part of the Patient Safety & Quality report.
Page 14 of 211 ITEM 06/07 BOARD ASSURANCE FRAMEWORK/ STRATEGIC OBJECTIVES 2021/22
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Agenda Item 6
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
BOARD ASSURANCE FRAMEWORK UPDATE
Purpose of Report: To provide the Board with an update on those risks on the Board Assurance Framework (BAF) currently rated red (risk score between 15 and 25) or rated red in terms of project delivery and to seek approval of revised CCG Strategic Objectives.
Recommendations and The Board is asked to: decision/actions: • Note the BAF update report below and at Appendix A and seek any further assurances required. • Approve the revised Strategic Objectives set out at Appendix B.
Executive Summary The majority of risks on the BAF are within the remit of the Joint (including financial impact): Committee which will meet bi-monthly (June, August, October, December, February). From now on, the BAF will be updated in the intervening months, commencing July 2021.
The 12 risks currently rated red are shown at Appendix A and summarised below:
Ref Risk Area CANC01 Cancer services performance PLAC01 Diagnostic performance PLAC02 Referral to treatment times AGEW07 Palliative and end-of-life care MATS02 Acute Trust maternity performance CYP03 Compliance with the Children and Families Act 2014 in relation to Special Education Needs and Disability (SEND) UNPC07 Compliance with the Children and Families Act 2014 in relation to Tier 4 Services GOSD11 Infection Prevention and Control GOSD12 Acute / Provider Quality Assurance GOSD15 Mental Health Acute / Provider Quality Assurance GOSD13 Management of Serious Incidents (SIs) GOSD15 Integrated Care System
Since the Joint Committee meeting held in June, the Chief Finance Officer has confirmed that 6 finance related risks should be de- escalated (see table below). The Finance and Performance Committee will receive a more detailed report on risks within its remit on 21 July 2021.
In addition, risk reference PRCC10, relating to the Ageing Well Beds Programme, has been re-rated to Amber due to tactical measures for winter pressures and potential future COVID waves now being in place and agreement to progress a longer term approach to reconfiguration.
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Red risks de-escalated since last Joint Committee meeting (June) Ref Risk Area FIN01 Achievement of financial envelope across the system FIN02 Achievement of system savings, including corporate overheads FIN06 Financial impact of elective recovery FIN07 Independent Sector Provider contract affordability (to be closed as now included with risk ref FIN06 (elective care recovery). FIN10 Transformation / Re-organisation Costs FIN11 Capital Resource Limit PRCC10 Ageing Well Beds Programme
The Board is also asked to note that the content and format of the BAF and associated processes are being reviewed. This will include:
• Remapping all risks against revised Strategic Objectives once agreed (please see below). • Reviewing lead officer responsibility for risks. • Reviewing responsibility for risks to ensure that risks are reported to the appropriate committees and to Board/Joint Committee. This work is ongoing and will be completed prior to the August Joint Committee meeting. • Clarifying the process for updating / adding / closing risks • Developing Place / CCG specific risks. • Consistent risk rating/scoring (impact x likelihood). • Reviewing BAFs maintained by the CCGs’ main providers to identify any gaps. The first review has been completed and the results shared with JET members. • Embedding the BAF throughout the organisation by ensuring that risks are regularly reviewed by workstreams / at team meetings to ensure that controls/assurances/mitigating actions are regularly monitored and updated. • Revised BAF reporting arrangements to Joint Committee and CCG Boards. • Development of a revised Risk Management Policy.
Proposals are also being drafted for the development of a Risk Register/BAF for use by the System Oversight and Assurance Group.
The existing Strategic Objectives for the MSE CCGs have been reviewed and amended to ensure that they remain relevant and up-to- date. The changes proposed to the strategic objectives are set out in Appendix B. The proposed objectives have been shared with CCG Chairs, Audit Chairs and other Board members and feedback was received following local place based discussions. The draft objectives have been amended to reflect this feedback where appropriate..
The Board is now asked to formally adopt the revised Strategic Objectives as set out on Appendix B.
Presented by: Nicola Admas, Interim Associate Director of Corporate Governance Written by: Sara O’Connor, Head of Corporate Governance, MECCG
Executive Director Anthony McKeever, Joint Accountable Officer Sponsor:
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Fit with CCG Strategic Risks are mapped against all relevant strategic objectives Objectives
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Finance & Performance Committees meeting in common Monthly document). Patient Safety & Quality Committees meeting in common Bi-monthly Joint Committee Bi-monthly
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ✓ ) X
Has an Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF:
Conflicts of Interest: None identified
Escalation: The BAF will be reviewed by the Joint Committee at its meeting on To CCG Boards, other 26 August 2021. Committee or BAF
Page 18 of 211 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups
BOARD ASSURANCE FRAMEWORK - RED RATED RISKS Updated: 20 July 2021
Overall Rating Target Red if Risk Owner / Risk Residua Description (Actions Planned to support delivery) Current Strategic Residual Milestone Risk Project 'current Work-stream BAF ID Workstream Area Responsible Risks to delivery of objective (Blockers) Impact l Risk (Controls) Enablers Risk Objectives Likelihood Deadline Score / Delivery risk Officer Rating Score (Assurance - 1st line of defence) Rating Appetite rating' or 'project July 2021 Update: Pathway plans for MSEFT are being finalised and will be shared and signed off by Cancer Alliance and Specialised Commissioning.
31, 62 and 104 day: Capacity and flow across system including use of Independent Sector (IS) and TIer 2 services is being used (Tier Patient Safety & Harm 1. NHS 2 supporting diagnostic pathway). To achieve cancer performance Patient Experience Cancer and Constitutional Karen 30/09/2021 Partnership Working CANC01 in accordance with Inequality 5 3 15 5 End of Life Standards and Wesson Backlog recovery plan for 62 day: People Resources Constitutional Standards. Acute Hospital Demand priorities in place to return to 163 by end of September (H1 as per Planning Guidance). Service Delivery Backlog recovery plan for 104 day: In place to return to zero by end of September (H1 as per Planning Guidance).
Patient Safety & Harm 1. NHS July 2021 Update: To achieve diagnostic (DM01) Patient Experience Constitutional Karen Plan to recover the standard and meet the planning guidance was developed for submission at end of May 2021. Planned Care PLAC01 performance in accordance Acute Hospital Demand 5 3 15 30/09/2021 People Resources 5 Standards and Wesson Additional capacity being scoped to help recover. Plan being developed as per national ask re Community with Constitutional Standards Inequality priorities Diagnostic Hubs - this is a national request that systems are required to respond to. Service Delivery 1. NHS Patient Safety & Harm July 2021 Update: To achieve the Constitutional Partnership Working Constitutional Karen Service Delivery Planning submission requirement is to reduce all long waiting patients so that by end of Half 1 (first 6 months of Planned Care PLAC02 Standard for referral to 5 5 25 30/09/2021 People Resources 5 Standards and Wesson Patient Experience financial year) no patients are waiting over 98 weeks. The current plan achieves this. This includes all urgent treatment (RTT). Comms & Engagement priorities Acute Hospital Demand (Priority 1 and Priority 2) being treated, then others in chronological order. 1. NHS Constitutional Standards and priorities 2. Address Patient Experience Cancer and Karen July 2021 Update: AGEW07 Palliative and End of Life Care health Inequality 4 4 16 30/09/2021 IT Infrastructure Partnership WorkingHuman Resources4 End of Life Wesson Work programme continues to address variation across the HCP footprint. Dashboard in development. inequalities Service Delivery 6. Transform and strengthen primary and community care 1. NHS Constitutional Standards and Patient Safety & Harm priorities Patient Experience July 2021 Update: - Acute Trust Maternity Maternity 2. Address Regulator Penalties Maternity Improvement plan has been updated on a monthly basis, this includes delivery against action for the MATS02 performance - Section 31 CQC Rachel Hearn 4 4 16 30/06/2021 Partnership Working 0 Services health Reputational Damage section 31 and Maternity Support Programme. All key milestones met. Quality assurance visits continue. Warning notice published inequalities Claims & Complaints Maternity Improvement Officer has been aligned to support the group following the outcome of the diagnostic. 4. Diverse and Inequality highly skilled workforce
* Re-inspections due July 2021 Update: 18mths following Neurodevelopmental pathway: initial inspection. * Paper and Business cases being presented to the Joint Committee in June 2021 including ASD backlog Thurrock - due now. Essex - 2022. * Provider reset group have agreed to develop a resource pack and a universal referral approach across MSE. Southend inspected in * QB test implementation plans now in place with NELFT and PROVIDE, work is continuing with the Lighthouse. May The CCG will continue to work 1. NHS Event in May for QB Test hosted for all partners, well recieved. * Transforming Care in partnership with education Constitutional Reputational Damage * Bosa Autism Assessment is now being delivered by NELFT and PROVIDE. trajectories (monthly) Tricia D'Orsi * Care Education and and care to become fully Standards and Patient Safety & Harm * Neuro paper has been presented to the Growing Well Programme Board which highlights the programmes Children and Treatment Reviews Partnership Working CYP03 compliant with the Children and priorities Patient Experience 4 4 16 currently in place and the need to co-ordinate strategic plans going forward (CETRs) - in place 4 Young People SEND SRO People Resources Families Act 2014 in relation to 2. Address Inequality General Special Educational Needs montored monthly at place 90% CETR before Special Education Needs and health Regulator Penalties * LD Healthcheck implemention plans in place and being progressed. admission target. Disability (SEND). inequalities * Progress continues through the Children's Partnership Boards on the deliver of the Written Statement of Action * LD Register metrics (WSOA) for Essex County Council & Thurrock who are still awaiting their revisit. < 25yrs quarterly * Southend have completed their revisit and awaiting formal notification of outcome. monitoring * Autism waiting times (WT) - backlog Risk rating reviewed but remains red due to to the pressures on service provision due to the impact of the to be addressed by pandemic. April 2022. Current WT list circa 1300.
Page 19 of 211 Mid and South Essex Board Assurance Framework NHS Mid and South Essex Health and Care Partnership October 2020 Clinical Commissioning Groups
1. NHS Constitutional Standards and Patient Safety & Harm The CCG will continue to work priorities Service Delivery July 2021 Update: in partnership with education 2. Address Acute Hospital Demand Discussions remain ongoing. The plan in terms of the "launchpad" wrap around model due to some temporary Unplanned and care to become fully health UNPC07 Tricia D'Orsi Patient Experience 4 4 16 changes and restrictions with provision is being reassessed and alternatives considered. Staffing has been 01/11/2021 Partnership Working 4 Care compliant with the Children and inequalities Inequality potentially identified and a service level agreement with the provider is being worked up. Individual escalations Families Act 2014. (Tier 4 6. Transform Safeguarding continue to be managed on a case by care basis. Services). and strengthen Reputational Damage primary and community care services
June 2021 Update: Work continues to be undertaken regarding thematics and learning through post infection review process.
MRSA bacteraemia MSE system: 1. NHS 28 at year end which is a 10% reduction on 2019-20. Constitutional 12 cases have been considered as hospital acquired. Standards and priorities C difficile MSE system: 4. Diverse and Patient Safety & Harm Governance 265 year end against ceiling of 296 which is 28% reduction on 2019-20. highly skilled Safeguarding Partnership Working and Statutory GOSD11 Infection Prevention and Control Rachel Hearn 5 3 15 MSEFT ceiling for C difficile 2020-2021 is 185. 139 cases reported at year end. 30/06/2021 5 workforce Patient Experience Comms & Engagement Duties 6. Transform Reputational Damage Revised ceilings for C difficile and E coli nosocomial infections are due by end of June 2021. and strengthen primary and Invasive Group A Streptococcus (iGAS): community care The iGAS Action Plan has been closed, with any remaining open actions and ongoing monitoring transferred services onto IP&C Plan. This includes the System Outbreak Management Policy which is awaiting the national review of PHE Policy. Such work has been delayed due to pandemic.
More detailed information can be viewed in the annual IP&C report.
1. NHS Constitutional Standards and June 2021 Update: Patient Safety & Harm priorities MSEFT Undertakings update - Harm reviews required for RTT 2020/21 have been completed. Governance Patient Experience Acute / Provider Quality 2. Address 04/2019 - 2952 reviews have been completed with 19 cases of harm identifited with 7 outstanding cases still Partnership Working and Statutory GOSD12 Rachel Hearn Inequality 4 4 16 30/06/2021 4 Assurance health going through the review process. IT Infrastructure Duties Claims & Complaints inequalities Futher work currently being undertaken to determine the harm review process going forward and will be Reputational Damage 4. Diverse and presented at System Oversight Assurance Group (SOAG). highly skilled workforce 1. NHS Constitutional Standards and Patient Safety & Harm Sept 2021 priorities Patient Experience June 2021 Update: Governance Mental Health Acute / Provider 2. Address Inequality Four areas have been completed to date, namely perinatal mental health, eating discorders, discharge planning People Resources and Statutory GOSD15 Rachel Hearn 4 4 16 ongoing 4 Quality Assurance health Claims & Complaints and personality disorders. Learning identified in fragmented commissioning with an options appraisal being Partnership Working Duties TBC inequalities Reputational Damage developed. Two further areas identified for July and August - patient care and partnership working. ongoing 4. Diverse and Staffing, HR, OD highly skilled workforce June 2021 Update: SIs continue to managed as per the national framework. EPUT are an early adopter of the Patient Safety Incident Response Framework (PSIRF) and their plan has now been agreed and will be implemented from 1. NHS 01.05.2021. A presentation on progress will be provided at the September Patient Safety and Quality Constitutional Patient Safety & Harm Committees in Common meeting. Governance Standards and Management of Serious Patient Experience People Resources and Statutory GOSD13 priorities Rachel Hearn 3 4 12 30/06/2021 3 Incidents (SIs) Claims & Complaints For all other, CCGs SIs are managed through a central SINE panel with administrative support. Work is Partnership Working Duties 4. Diverse and Reputational Damage underway to amalgamate the mailboxes. highly skilled workforce The Quality Team is awaiting the trajectory to clear the backlog of ‘Stop the clocks’ that occurred during the pandemic.
June 2021 Update ICS Transition Programme Board established with seven work streams (quality and safety; finance; governance and accountability; digital and data; comms & engagement; people and organisational development; and strategic alignment). Governance 3. Establish Workstreams established and developing project plans for the technical close down and safe transition of CCG Reputational Damage People Resources and Statutory GOSD15 Integrated Care System Integrated Care Jo Cripps 5 3 15 functions into the new statutory ICS. At time of writing, national guidance and HR framework has not been 30/06/2021 5 Staffing, HR, OD Partnership Working Duties System published. The Secretary of State (SoS) will take a decision on possible boundary change to the ICS at the end of June. This could create a new ICS covering Southend, Essex and Thurrock. The delay to receipt of guidance and impending SoS decision creates some risk to the programme, however mitigations are in place.
Page 20 of 211 AGENDA ITEM 6 - APPENDIX B
PROPOSED NEW STRATEGIC OBJECTIVES FOR MID AND SOUTH ESSEX CCGS - 2021/22
CURRENT STRATEGIC OBJECTIVES PROPOSED CCG OBJECTIVES 2021/22 (Numbers in brackets indicate previous objective number) Strategic (1) Ensure services are organised to respond to and Restore access to services to achieve performance against NHS Objective 1 meet COVID-19 requirements. Constitutional standards, quality improvement priorities and deliver (2) Improve access to services for patients in line with ongoing COVID-19 requirements. NHS Plan requirements. Strategic (3) Make a step change in addressing inequalities and Work with partner organisations and our population to address health Objective 2 quality priorities to deliver outcomes in accordance with inequalities, including those derived from Covid-19, and achieve Constitutional Standards. social value
Strategic (9) Achieve system and organisational transformation to Support system transformation and organisational change to ensure Objective 3 streamline decision making, improve VFM and better the ICS is successfully established and can fulfil its aims and duties. support new commissioning models. Strategic (8). Address workforce challenges within the system and Develop and support the creation and wellbeing of a diverse and Objective 4 support our staff to deliver the vision across the health highly skilled workforce and ensure the safe transition of staff to the and care partnership for M&SE. new organisation. Strategic (4) Achieve key statutory financial duties including Achieve key statutory financial duties including delivery of the system Objective 5 delivery of the system financial control total. financial control total, value for money and reduction of the underlying system deficit. Strategic (5) Transform and strengthen Community and Primary Build effective Alliances at place to transform and strengthen the Objective 6 Care Services, developing and strengthening Primary ability of Primary and Community Care Services to focus upon Care Networks to bring care closer to home and avoid prevention and early intervention and improve outcomes in the most hospital admissions. appropriate settings (6) Strengthen partnership working across Mid and South Essex (M&SE) and within localities to deliver a broad range of value for money (VFM), integrated services, strengthening prevention and early intervention. Strategic (7) Expand and embed an increased range of digitally Promote digitally delivered services whilst considering the Objective 7 delivered services to support better access, efficient requirements of those who need to access services in other ways. services and self-care.
Page 21 of 211 ITEM 10 PERFORMANCE REPORT
Page 22 of 211
Agenda Item 10
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
CONSTITUTIONAL PERFORMANCE: ACUTE
Purpose of Report: Provide the Committee with an overview of the:
• Planning process for recovery of capacity, activity, and the significantly increased waiting list backlog sizes and any submissions made.
• Groups where actions, escalation and system working exists ensuring challenge, progress and assurance of recovery for Cancer and Elective Care (RTT and Diagnostics).
• Update on the performance and position of the acute Constitutional Standards.
Recommendations and Members of the Board are asked to note the report and seek decision/actions: additional assurance if required.
Executive Summary This paper includes updates, where applicable, on the following (including financial areas: impact): • Planning process, planning round and submissions for performance. • Demand on services. • Constitutional Standards (to include but not exclusive to): o Referral to Treatment (RTT) o Diagnostics o Cancer Standards • Integrated Urgent Care • Stroke - as a quarterly standard this will be updated in Julys committee paper. • Integrated Urgent Care (NHS111) • Advice and Guidance • East of England Ambulance Services standards
Written by/ James Buschor – Head of Performance and Planning Karen Wesson – Director Commissioning and Performance Presented by: Tricia D’Orsi – NHS Alliance Director
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Page 23 of 211 Executive Director Rachel Hearn – Chief Nurse Sponsor:
Non-Officer/Board Dr Jose Garcia – Elective/Planned Care Clinical Lead, Southend CCG Sponsor: Chair Dr Donald McGeachy – Clinical Lead, Acute Commissioning Team, Mid and South Essex CCGs
Approval Route: Group/Committee Date The paper hasn’t been to these groups, these group Cancer Programme Delivery Group Fortnightly Wednesdays have had the information and opportunity to check, challenge and ensure the System Planning and Delivery - Planned Weekly Wednesdays questions assurance that is Care summarised in this document. System Restoration, Planning and Weekly Wednesdays Performance Meeting
Have any financial implications been signed off by Yes No N/A the Chief Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact x Assessment been carried out and issues addressed?
Details of Stakeholder, NHS England and Improvement Patient & Public Cancer Alliance Engagement: Patient Representatives Clinical Leads from MSEFT, Primary Care, Macmillan GPs Operational Leads MSEFT Commissioning/Performance Leads Acute Team and Place representatives Communication Lead for Cancer Communication Team supporting RTT Independent Sector Providers Tier 2 Service Providers
Conflicts of Interest: Nil
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Page 24 of 211 CONSTITUTIONAL PERFORMANCE: ACUTE
Cancer Standards
National Standard/ Local Objective
Planning Guidance Ask: Cancer: • Recovery of demand\referral rates • Restart screening programmes • Reduce number of patients waiting over 104days and 62 days for treatment. • Thurrock Lung Health Checks (TLHC) and Rapid Diagnostic Centre (RDC) implementation Palliative and End of Life Care: Increased number of patients on EOL register
Key Issue 1 Non-compliance with Cancer Constitutional Standards
Key Issue 2 Number of patients waiting over 62 days (backlog) on a 62-day pathway is greater than the 118 sustainable size.
Key Issue 3 There are a number of patients waiting over 104+ days on a cancer 62-day pathway.
Key Issue 4 Ongoing completion of harm reviews.
Time scale Backlog recovery trajectory for patients waiting 104+ days is being developed. for benefits to be Trajectory towards backlog recovery for patients waiting 62+ days has been realised submitted as part of the planning round.
Compliance with the 62-day cancer constitutional standard is reliant on the cancer backlog recovery.
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Page 25 of 211 Risk – BAF • MSE2020:0005, MSE2020:0009
1. Purpose
To provide the Committee with an update on cancer waiting times, performance against Constitutional Standards and plan. To advise the committee of the progress and mitigations. 2. Background
The assurance and actions taken to support delivery is overseen by the Cancer Delivery Group (Clinical Pathway Leads and Macmillan GPs) and Cancer Board (Chair David Walker and Donald McGeachy), with some components at the Elective Care Programme Board (Clinical Lead Jose Garcia). This is supplemented by a number of other sub-groups e.g. outpatients, Tier2, Independent Sector providers etc.
Each programme of work has clinical support from the pathway leads within MSEFT, Macmillan GPs and patient representation to ensure feedback.
There is system engagement with NHSE/I EOE Cancer Alliance South to ensure robust response and recovery progress. 3. Performance
• Cancer 2 week wait referrals The following table summarises the monthly performance against the 93% standard, for patients being seen by a specialist within two weeks following an urgent GP referral, during 2021/22 to date (May-21).
The following graph shows referral volume from March being greater than pre-COVID-19 average and same periods in 2019.
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MSEFT have raised that significantly high referrals volumes being received for skin and breast. A separate working group with wider system colleagues (feeding back into the Cancer Programme Board) has been set up to further analyse and ensure all pathways are being maximised and standard continues to be met.
• Cancer 62 days The following table summarises the performance against the 85% standard, for patients to start treatment from an urgent referral for suspected cancer within 62 days, during 2021/22 to date (May-21).
The cancer 62-day standard is measured on treatment and thus a key metrics required to recover this standard is to reduce the backlog (number of patients waiting over 62 days) to a sustainable size of 118 and eliminate the backlog of patients waiting 104+ days.
The following graph shows performance in terms of the 62-day backlog size. The submitted plan is to reduce the backlog to 163 by the end of H1. As at week ending 04/07 the backlog is 236 patients (month end plan for July 2021 = 198).
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Page 27 of 211
The following graph shows performance in terms of the 104+ day backlog size for patients waiting on a 62-day pathway. As at week ending 04/07 the backlog is 47 patients. A recovery trajectory to ensure no patients wait above 104+ days on a 62-day pathway is required.
Referral to Treatment (RTT)
National Standard/ The RTT standard is a key performance standard indicating how Local Objective trusts are delivering on a patient's right to receive treatment within 18 weeks of being referred to a consultant-led service.
Key Issue 1 High number of patients with an RTT pathway greater than 52 weeks within MSEFT.
Key Issue 2 Planned care activity not meeting plan.
Key Issue 3 Number of patients waiting over 98+ and 104+ weeks on an RTT pathway.
Key Issue 4 Completion of harm reviews in line with agreement with Regulators.
Time scale for benefits MSEFT working to submitted planned care capacity, activity levels to be realised and subsequent RTT 52+ week wait recovery trajectories.
MSEFT working to meet the regional commitment to have zero patients waiting 98+ weeks on an RTT pathway by end of H1.
Risk – BAF MSE2020:0011, MSE2020:12
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Page 28 of 211 1. Purpose
To provide the Committee with an update on RTT waiting times, performance against Constitutional Standards and plan. To advise the committee of the progress and mitigations. 2. Background
The operational oversight of the RTT recovery is led and coordinated via the weekly System Planning and Delivery Planned Care Group. This is a system group that meets with the operational leads to understand the challenges and actions required to deliver the recovery trajectory and expectations. Reporting and progress of plans is via this group whilst oversight is via the System Oversight and Assurance Group (SOAG).
3. Key points to note
The system has identified five key priority specialties that will make an impact on the recovery of the RTT performance these are: Orthopaedics; Ophthalmology; Dermatology; Urology & Paediatrics. The CCGs have identified clinical leads for each specialty to support this work.
4. Performance
The following table summarises the performance against the RTT standard, of 92% of patients to be seen and treated within 18 weeks when referred into a consultant led elective service, 2021/22 to date (May-21).
As at week ending 04/07, the RTT backlogs at MSEFT are as follows: • Patients waiting 52+ weeks: 5,131 • Patients waiting 98+ weeks: 369 • Patients waiting 104+ weeks: 229
As part of the weekly System Planning and Delivery - Planned Care Group work programme, an RTT recovery model has been developed by specialty the details of which were outlined in the May 2021 committee paper.
For 98+ weeks, the following three graphs show the requirements to meet the commitment of ensuring no one waits 98+ weeks. The first graph shows the trend to the position of 369 patients and the required trend to reduce to zero by end of H1. The second graph shows the number of clock stops which would need to increase to 100 per week based on a ‘tip in’ rate of 69 patients per week shown against the actual ‘tip in’ rate in the third graph. The second graph shows planned number of clock stops split between BAU and those resulting from mitigation recovery actions.
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Page 29 of 211 Page | 8
Page 30 of 211 In terms of 52+ week trajectory the number of patients are reducing since week ending 21/03/2021 as per the following graph.
As described in detail in last month’s committee paper the decrease has been due to the decrease in referrals during the height of the Covid-19 pandemic. As outlined in previous committee papers as a risk to the 52+ week recovery position the tip in rate is now increasing as referrals recovered this time last year as per graph below.
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Page 31 of 211
The trust on average treat/stop circa 4,000 patients/clocks per week so without any prioritisation of clinical need and just treating patients chronologically both the backlogs described above could be cleared relatively quickly. The complexity of recovery lies in triaging patients based on clinical need and a priority on waiting time.
The following actions are being undertaken and reported against at the weekly System Planning and Delivery - Planned Care Group.
• Very long wait PTL meetings at patient level to ensure patient specific plans in place to book patients in and to ensure no patient waiting over 98 weeks from end of H1.
• Priority patients (whose intended procedure is categorised as priority 1 and priority 2) to be identified and scheduled first.
• Service leads validating all patients with an RTT wait in a backlog above (whose procedure are categorised as priority 3 or 4 by specialty) against the Service Restriction Policy.
• Indicate for these specialties, if patients listed meet the clinically evidence criteria for the procedure, then an alternative more appropriate pathway to be sought or removal of patient from the list needs to occur in order to release capacity for patients meeting clinical need.
• Operational leads and service managers to review their theatre capacity to understand how quickly the patients waiting can be slotted in.
• Operational leads and service managers to identify efficiencies to increase proportion/number of treatments for patients with an RTT wait in a backlog above through: • Optimise capacity for chronological booking after prioritisation. • Ensure Inter-provider transfers to identified additional capacity at Independent Sector Providers are strictly transferred in chronological order for priority 3 and 4 procedures. • Identify any opportunities for Tier II provider capacity.
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Page 32 of 211 Diagnostics:
National Standard/ The Diagnostic operational standard that less than 1% of patients Local Objective should wait 6 weeks or more from referral for a diagnostic test
Key Issue 1 Not achieving the diagnostic standard (DM01); this has impact not only on patient experience having to wait a long time and will impact on the 52-week performance
Key Issue 2 Expectation for zero patients waiting 13+ weeks.
Time scale for benefits Planning Round Ask: to be realised Community Diagnostic Hubs planning round requirement for submission of requirement template.
Diagnostic activity plan being developed to be submitted in planning round submission.
Risk – BAF MSE2020:0010
1. Purpose
To provide the Committee with an update on Diagnostic Standard, performance against Constitutional Standards and plan. To advise the committee of the progress and mitigations. 2. Background
The operational oversight of diagnostic recovery is led and coordinated via the weekly System Planning and Delivery Planned Care Group. This is a system group that meets with the operational leads to understand the challenges and actions required to deliver the recovery trajectory and expectations. Reporting and progress of plans is via this group whilst oversight is via the System Oversight and Assurance Group (SOAG).
3. Performance
The following table summarises the performance against the diagnostic standard, that 99% of patients should have their diagnostic test within 6 weeks of referral, during 2021/22 to date (May- 21).
The COVID-19 pandemic has significantly impacted diagnostic services.
As at May-2021 there were 8,373 patients waiting six weeks and 4,092 patients waiting 13+ weeks.
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Page 33 of 211 Diagnostics impacts on both cancer and Referral to Treatment performance. The system has worked to maximise capacity where possible through the use of Tier 2 services and additional scanners being brought to the local sites to help support recovery of the standard.
Diagnostic activity recovery plans have been submitted in the planning round submission. Additional capacity also being sought to aid recovery.
New prioritisation guidance has been released and being worked through feeding into the weekly System Planning and Delivery Planned Care Group.
Advice and Guidance:
National Standard/ Increased use of Advice and Guidance to support demand Local Objective management expectation is for turnaround time for response is 2 working days
Key Issue 1 Variation across CCGs in using Advice and Guidance
Key Issue 2 Response times greater than expected 2 working days
Time scale for benefits Ongoing to be realised
Risk – BAF MSE2020:0013
1. Purpose
To provide the Committee with an update on Advice and Guidance, performance and usage. To advise the committee of the progress and mitigations. 2. Key points to note
System capacity to support recovery has been through collaborative working with MSEFT to ensure turnaround times improve to meet the standard, improve primary care confidence in using service as know will get a response.
3. Performance The following graph shows the monthly number of requests made from MSE CCG practices showing an average of 1,702 requests a month made since step increase from September 2020.
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Page 34 of 211
The 95th centile response time performance for MSEFT is circa 17 days (note May-21 data is incomplete as response times not calculated for open requests).
Ambulance Standards:
National Standard/ Arrival to handover times should be below 30 Local Objective
Key Issue 1 Flow within the MSEFT sites has a direct impact on ambulance
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Page 35 of 211 handover times which in turn means that the ability for ambulances to get back “on the road” is impacted
Time scale for benefits Ongoing to be realised
Risk – BAF MSE2020:0024
1. Purpose
To provide the Committee with an update on Ambulance arrival to handover times.
2. Key points to note
This is for information only and overseen at CCG Finance and Performance committees and MSE Urgent and Emergency Care Board as this was not a delegated function to the acute team.
3. Performance
Integrated Urgent Care (NHS 111) Standards:
National Standard/ 95% of calls should be answered within 60 seconds. Local Objective
Phase 3 plan asked for: Implementation of Think NHS111 as per national ask
Key Issue 1 COVID-19 has had a direct impact on the performance and call response times
Time scale for benefits Ongoing to be realised
Risk – BAF MSE2020:0019, 0020
1. Purpose
To provide the Committee with an update on NHS111 performance. To advise the committee of the progress and mitigations. 2. Background
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Page 36 of 211 Governance: In addition to formal contractual performance. Due to the changing asks for NHS111; Mid & South Essex Think 111 Programme Board. This has two subgroups: Think 111: Acute Subgroup/Think 111: IUC sub group, both have been established to ensure implementation of the initiatives to reduce the demand, congestion and overcrowding of Emergency Departments.
3. Key points to note
This programme went live as planned on 1 December 2020. A briefing was given via the Partnership Brief across the Health and Care Partnership, GP Bulletin and will continue to be monitored and reviewed as the new model is live.
4. Performance
The following table shows the monthly performance for calls answered in 60 seconds.
Emergency Department Standard:
National Standard/ 95% of people should be managed within 4 hours of arrival at the Local Objective department.
Key Issue 1 Performance is currently not meeting the standard and this will be reviewed via the UEC Board for MSE Health and Care Partnership
Time scale for benefits Ongoing to be realised
1. Purpose
To provide the Committee with an update on emergency department performance against Constitutional Standards. 2. Background
This is for information only and overseen at CCG Finance and Performance committees and MSE Urgent and Emergency Care Board as this was not a delegated function to the acute team.
3. Performance
MSEFT ED 4hour performance is 86.2% at the latest reported position (June 2021):
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Page 37 of 211 ITEM 11 ALLIANCE DIRECTOR REPORT
Page 38 of 211 Agenda Item 11
NHS Alliance Director Update
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Purpose of Report: To update the Governing Body on matters arising in south east Essex.
Recommendations and The Governing Body members are asked to note the work taking decision/actions: place in south east Essex.
Executive Summary As detailed within the main body of this report a considerable (including financial amount of progress has been made in addition to the Covid-19 impact): incident response. There has been a number of initiatives put in place to support our population during these unprecedented times and support for frontline staff to manage the increasing demand on services.
Written by/Presented Various South East Essex Leads by:
Executive Director Tricia D’Orsi, NHS Alliance Director, South East Essex Sponsor:
Non-Officer/Board N/A Sponsor:
Fit with CCG Strategic Compliance with CCG Constitution Objectives?
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). N/A
Reports Submitted to Board only: Date signed-off by Executive Team. 20/07/2021 (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Yes No N/A
Page 39 of 211 Have any financial implications been signed off by x the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact x Assessment highlighted any issues?
If yes, describe how they are resolved:
Details of Stakeholder, N/A Patient & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: N/A
Page 40 of 211 1. Introduction This report is being brought to the Governing Bodies as a standing item to allow for Place updates to be shared with members. This report provides a summary of areas of work being undertaken by the CCG.
2. Primary Care Networks (PCNs) Development work with the PCNs continues at pace, taking into account current practice/PCN workload pressures and the impact of covid vaccination programme delivery.
• NHSE Population Health Management (PHM) programme started on 6th July. Initial session well-attended and SEE Clinical Auditors invited to the Data and Analytics training sessions.
• CCG facilitated PCN Development sessions were held in May for the following PCNs. Southend East Southend Victoria West Central SS9
• PCN facilitated development sessions were held in May & July for the following PCNs Benfleet Canvey Rayleigh Rochford
• CCG facilitated session also held in July for Southend Victoria and PCN facilitated session for West Central. Southend East was postponed due to local circumstance and SS9 postponed due to Staff College event.
• All practices have completed the PCN DES IIF requirement to map GP appointments to national slot categories.
• PCN Estate Planning session has been held with PCN Operational Managers.
• Key deliverables due by September 2021 Establish integrated locality leadership team in at least one PCN Undertake initial evaluation of Accelerator, Demand Manager and Collaborative working schemes. Further development of Clinical Leadership Development Programme with HCP Partners. Review of PCN Development Programme in line with local position and national requirements for 2021/22 Workforce plans to be submitted by PCNs and approved by Commissioners
3. Population Health Management – SEE July has seen the start of our South East Essex Population Health Management (PHM) project. This is being delivered in conjunction with NHSE, where we are lucky to be one of the first PLACE focused pilots in the country. For those unaware, PHM is a methodology of utilising joint up data sets, contracting and financial models, and organisational focus to address complex problems impacting on our population. Many of these issues involve elements from the care and support offered by all organisations within our Alliance; making this joint up and collaborative approach vitally important when looking to improve the quality of life for people living in South East Essex. A number of events have been held, each with high levels of representation from our Alliance members, and all with a fantastic demonstration of engagement, focus, and desire to make a real difference. The data has highlighted those individuals with long-term health conditions, who are suffering from mental health issues, as our target group, with further analysis underway to identify a sub-cohort of that population for our focused pilot. Over the next 22 weeks we will work together as
Page 41 of 211 an Alliance to design the intervention that will make the difference to that cohort, and in doing so grow the understanding and use of PHM within our workforce.
4. Mental Health
Adult Mental Health: System Transformation Update In MSE the service models have been coproduced by local partners and stakeholders including service users and their families and carers. The developments have been done under the leadership of the Mental Health Partnership Board (MHPB) where all plans are signed off and any escalations are managed. There is acknowledgement that disparities in service offers and delivery exist across the system resulting in an Amber rating. Work is underway to review governance, clinical leadership, CCG structures and processes to enable navigate the System/Place responsibilities and arrangements, with support from the Regional NHS England-Improvement team to ensure MSE performance delivers Green Rating as routinely as possible.
MSE has centralised its MH commissioning function under the Thurrock CCG Alliance Director, to facilitate and progress at pace the implementation of the LTP mandate for MH to ensure consistency of offer, remove duplication of effort promoting efficiency for a do once approach but with significant focus on Place delivery and ownership.
Recruitment and Retention continue to be a challenge and whilst it is possible to recruit into the posts within the new models of care, there is a risk of adverse impact on existing services. This approach will flexibly adapt requirement as recruitment commences and track against implementing the Transformation Plan at Place into the System. Various innovative options that include training to develop local capacity resilience are being explored and implemented as recruitment always presents with challenge. The workforce plans are being monitored by a MH workforce group that reports to the People Board.
A governance structure has been developed and will be rolled out from this month to ensure that progress is tracked, and the system is agile enough to respond appropriately and in a timely fashion as the implementation of the transformation plan progresses. This will be a collaborative commissioner-provider agreement that in partnership owns both the risks and benefits and jointly holds accountability.
Our workforce plans demonstrate more investment has gone to the Voluntary, Community and Social Enterprise Sector (VCSE) organisations which often support people in more flexible ways that Statutory organisations. Through Health Education England MSE has also been able to access training places to develop Peer Support Workers roles further, with a few VCSE providers taking up these opportunities. This is in recognition of VCSEs as valued partners in meeting the diverse needs of our population but also contributing skills to mitigate some of the workforce gaps.
Adult Mental Health: South-East Essex Place
Mental health transformation The Rethink led workshops have captured 98 pages of stakeholder feedback and apirations for informing community mental health transformation. We are now establishing a South East Essex mental health transformation project group which will develop a detailed plan for reorganising existing community mental health provision. This reorganisation will be in line with local priorities and the mandate set out by the NHS Long Term Plan such as developing an integrated workforce within Primary Care Networks and delivering services driven by need rather than diagnosis.
Trauma alliance The Trauma Alliance is now in operation, supporting providers across South East Essex to better support individuals impacted by trauma. Over the last month they have held:
• Professional consultations: 13 (10x PCNs; 2x Social Prescribers; 1x TFY). • Community of practice: 2x interactive sessions; 2x input forms. • The first three-way intervention is occurring this month.
Page 42 of 211 Ethnically Diverse Communities Support When it Matters (SWIM) have been commissioned to do focused engagement with ‘failed to reach’ communities in the South East. In July 2021, they have commenced a series of meetings with local service providers and community groups. This is phase one of a programme of work that will incorporate 1) finding out what mental health means to all communities; 2) evaluating how inclusive and relevant existing mental health services are to all community groups and 3) using their findings to inform mental health service transformation and developments.
Dual diagnosis A new Dual Diagnosis Integrated Practice Lead is being implemented for the Southend area. We are working closely with EPUT and the local substance misuse provider, CGL, to create a post that brings together both sectors to remove the gaps in provision and to ensure a better quality of service for those with a Dual Diagnosis needs.
IAPT IAPT demand steadily increasing, in line with wider system. Direct patient access (via website) to IAPT digital offer has recently been implemented to improve speed of access and help manage wait times.
Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- CPR 20 20 20 20 20 20 20 21 21 21 21 21
Referrals 388 459 429 480 501 465 361 463 417 501 485 567
Access Rate 1.17% 1.73% 1.54% 1.78% 1.87% 1.66% 1.36% 1.62% 1.44% 1.70% 1.34% 2.05%
Target 1.83% 1.83% 1.83% 1.83% 1.83% 1.83% 1.83% 2.08% 2.08% 2.08% 2.08% 2.08%
Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Southend 20 20 20 20 20 20 20 21 21 21 21 21
Referrals 377 543 497 569 550 591 427 578 607 729 599 614
Access Rate 1.42% 1.67% 1.90% 2.11% 2.20% 2.10% 1.59% 1.93% 1.97% 2.36% 1.90% 2.19%
Target 1.83% 1.83% 1.83% 1.83% 1.83% 1.83% 1.83% 2.08% 2.08% 2.08% 2.08% 2.08%
Mental Health support for Rough sleeping Southend was successful in an NHSE bid for £150K to progress plans for high need rough sleeping mental health programme from 21/22. Although we do not have full recruitment of the NHSE/MSE funded team as yet, our winter pressures funded OT is still delivering interventions focusing on those with an SMI need. 24 people have been supported in the last quarter with: assessment and advice; equipment provision; budgeting; brain injury coping strategies; pre-trauma related work; referral to secondary MH services; graded exposure and supporting with housing first project. Outcomes planning workshop has been held for new Rough Sleeper MH team: we plan to separate outcomes for individuals; services and the system.
SMI health checks There is a national target of supporting 60% of people with SMI to receive a comprehensive physical health-check and appropriate follow-up interventions annually. Current performance is outlined below. As of 13th June 2021, Castle Point and Rochford CCG achieved 60%, and Southend 57%. This has been supported by the work of the SMI Outreach team, who are working across GP Practices under honorary contract arrangements to proactively engage and complete health checks and arrange physical health interventions.
Page 43 of 211 Despite significant improvements in uptake in the South East, the SMI Physical health Steering Group are keen to do more to understand the barriers that SMI patients experience to having both the health check and accessing interventions to improve their health. Commissioners are currently exploring options for a co-production activity with patients with serious mental illness (SMI) in South East Essex, with an aim of gathering insight and recommendations on how to improve the uptake of physical health screening; and interventions to improve their physical health.
For context, as of June 2021, the SMI health check position for MSE is as follows:
5.Children & Young People (CYP)
Mental health • Tier 2 Children and Young people counselling services have been in place in South East Essex since August 2020, and are continuing to see increased levels of demand on their services. Additional funding has been awarded to increase their capacity, and allow them to continue to provide our children and young people with much needed mental health support. • Children and Young People’s Emotional Wellbeing and Mental Health Services (EWMHS) contract is due to expire, and a procurement process is currently underway to appoint a provider for the new contract. This is the culmination of many months of work to understand what is required in the new contract. • Scoping work is currently being undertaken with the adult’s mental health team to explore options for increasing support within primary care for adolescent mental health and transition processes. Discussions are currently ongoing with a number of primary care networks, based on prevalence, to consider what options would potentially work.
Community • Childhood Asthma – the South East Essex Childhood Asthma steering group has been re- established and will be re-launching their workstream to develop and implement an integrated childhood asthma pathway. A standards framework and organisational pledges have been agreed, and a joint clinic between community and acute is currently being piloted
Page 44 of 211 in SEE. Further work will include education, training, standardisation of documents and digital apps (MySpira and MyAsthma). • E-redbook has now been successfully rolled out in Southend area, and plans are now being drawn up to roll this out to Castle Point and Rochford. • SEE are currently trialling a small pilot of feeding and swallowing services for a small number of children and young people who are most of risk. EPUT are currently trialling this focus on both feeding and swallowing, and feeding aversions to prevent issues in the future. This is currently going well, with the expectation that a small evaluation of the pilot will take place to consider a longer-term model. • Work is ongoing with Little Havens to look at their offer for end of life care and respite care for our most vulnerable children and their families. The pandemic has placed considerable pressure on their workforce numbers, which has impacted their ability to deliver services from their bespoke building. They continue to deliver respite care and activities which are positively received by families.
Community Paediatrics – Southend Hospital (Lighthouse Centre) The community paediatric service based at The Lighthouse Child Development Centre in Southend provides services to support the care and development of children and young people.
This includes support for children and young people with a range of clinical needs affecting their development including cerebral palsy, genetic disorders, neuromuscular conditions and neuro- disabilities including ADHD and Autism. Services include community paediatricians, physiotherapy and occupational therapy. These services are currently provided by Mid and South Essex NHS Foundation Trust.
Demand for these services is growing and families have told us about their concerns and dissatisfaction, especially in regard to long waiting times. We have been working closely together to try and resolve some of the challenges but have not been able to deliver the improvements needed despite best efforts of all concerned.
The COVID-19 pandemic, and increased demand for hospital emergency services, has meant that the Trust and its staff have had to focus care on those with life threatening illnesses.
As the health system begins to recover and reset from the pandemic the Trust has reviewed its strategic plans and, as a result, informed Southend and Castle Point and Rochford Clinical Commissioning Groups that it is no longer in a position to provide community paediatric services and has formally given notice.
Working together across the Mid and South Essex system we have begun to explore how moving to a different provider will deliver a high-quality service for children, young people and their families.
Under NHS contract rules, the CCG is allowed to transfer the current contract to another NHS provider. The procedure, known as ‘contract novation’, will ensure that services can continue to be delivered. Work will now begin to identify a suitable alternative provider who will be responsible for delivering services for the next two and a half years covering the remaining contractual period.
This change will provide the opportunity all partners to work with staff, children and parents to redesign and transform the model of care so that it meets the current demand but also ensures services are fit for the future.
Designated Medical Officer (DMO) The DMO has been continuing to support providers and Local Authority teams to deliver services for our SEND children. In particular, the DMO has recently established a Health Assurance Group which took the opportunity to look at the EHCP process for health providers. This group, led by the DMO, created a EHCP Health Handbook for use by professionals to take them through the process. The DMO is doing further work on the quality of EHCPs. This role continues to play a vital role in the strategic director of services for SEND children and young people.
In June 2021, there was a formal agreement to recruit to a Designated Clinical Officer role to support the DMO. This is now out for advert, and if successful this role should be in place by September/October.
Page 45 of 211
Surge planning Following modelling from Public Health England, there is going to be a report upsurge in RVS and respiratory conditions for children and young people. There is the potential that this increases by 30- 50%. Primary care, acute care and community care are currently in the midst of planning a response for this in SEE and across MSE.
6. Diabetes
• NDPP referrals across MSE are the highest in UK. • SEE is developing a local plan to increase Primary Care compliance against the 8 care processes. • NHSE transformation plans are on track – recruitment to begin imminently around this.
7. Medicines Management
. GP practice visits have been successful so far with majority completed. Feedback received has been very positive. . Community pharmacy COVID vaccination site now receiving and administering AZ vaccines and Pfizer vaccines and filling appointment slots well.
8. South East Essex Alliance
Following contribution from the SEE Alliance members, the SEE Place Plan has been refreshed and priorities of focus for the next year identified. The Place Plan is now a collaborative plan and has support from all Alliance members. The Place Plan was taken to a meeting with Mac McKeeveer and Mike Thorne on 16 July and feedback on the plan was positive. Work is now ongoing to develop an implementation and financial plan to support the Place Plan and this will be in place by the end of September 21.
Theory of change workshops for the SEE Alliance members continue to improve relationships between Alliance members.
9. Digital
BP@Home The BP@Home initiative has now been rolled out across mid and south Essex, with 97 of the 148 practices currently enrolled in the programme. Evaluation is underway and there continues to be positive feedback from both practices and patients.
10. South East Essex Finance
NHS financial arrangements for 2021/22 continue to operate outside of the normal allocation process for 2021/22, as part of the ongoing national response to the Covid emergency.
For CCGs, the M1-M6 (H1) funding is based broadly upon the allocations received in the second half of the 2020/21 financial year.
Additional funding was added to baseline allocations to cover payment to the main Independent Sector acute provider organisations (who were funded directly via NHS England in 2020/21).
Mandated national block arrangements continue to operate with NHS organisations.
Top-up funding remains available for the Elective Recovery Fund (ERF) with the independent Sector and the Hospital Discharge Programme (HDP).
All organisations retain their responsibility to ensure sound financial governance and to ensure value for money and appropriate use of public funds.
Page 46 of 211 Allocations for M7-12 (H2) are expected to be released, via NHS England, in September 2021, followed by a further planning round for H2 of the 2021/22 financial year.
At M3, both CCGs in South East Essex are reporting a breakeven position, assuming the receipt of retrospective Hospital Discharge and IS reimbursements of £1.3m.
The forecast position to M6 is also a breakeven position, assuming receipt of retrospective Hospital Discharge and IS reimbursements of £2.1m
Managing Covid, Prescribing, CHC and Independent Sector cost (over and above that reimbursed via the ERF) are likely to continue to represent a significant challenge for the remainder of the financial year, mostly due to the uncertainties that the Covid pandemic continues to present.
Whilst current run rates suggest that these are manageable, in totality, close monitoring and corrective action, may prove necessary as the year progresses. Opportunities for reducing planned expenditure and for managing expected cost pressures, where apparent, are being explored.
CCGs are forecasting full delivery of the Mental Health Investment Standard (MHIS). Reconciling payments/benefits derived in the first half year and accurately forecasting expenditure for the remainder of the financial year is extremely complex. Delays in implementing transformation plans and the shortage of MH staff could adversely affect delivery of the MHIS. This remains a national must-do.
Table 1 below reflects the position for both Castle Point & Rochford and Southend CCGs, both year- to-date and forecast, for the period to the end of June 2021.
Table 1 : South East Essex CCGs Financial Performance as at 30th June 2021
Page 47 of 211 ITEM 12 SOUTH EAST ESSEX PLACE PLAN
Page 48 of 211 Agenda Item 12
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
South East Essex Alliance Place Plan
Purpose of Report: For noting
Recommendations and For the committee to recognise the direction of travel in South East Essex decision/actions: through Alliance working and to endorse the aims and objectives detailed in the plan.
Executive Summary The SEE Place plan was developed through significant discussion and (including financial engagement with Alliance members to reflect the breadth of coordinated impact): partnership working required across south east Essex to deliver the strategic intentions of the MSE Health and Care Partnership five year strategy.
Written by/Presented Simon Williams, Deputy Alliance Director by:
Executive Director Tricia D’Orsi, NHS Alliance Director Sponsor:
Non-Officer/Board Jose Garcia and Sunil Gupta, Chairs Sponsor:
Fit with CCG Strategic Proposed strategic objectives: Objectives? 1: Restore access to services to achieve performance against NHS Constitutional standards, quality improvement priorities and deliver ongoing COVID-19 requirements. 2: Work with partner organisations and our population to address health inequalities, including those derived from Covid-19, and achieve social value 3: Support system transformation and organisational change to ensure the ICS is successfully established and can fulfil its aims and duties. 6: Build effective Alliances at place to transform and strengthen the ability of Primary and Community Care Services to focus upon prevention and early intervention and improve outcomes in the most appropriate settings
Approval Route: Group/Committee Date
NHS Castle Point and Rochford CCG NHS Southend CCG
Page 49 of 211 (List Groups/Committees that South East Essex Alliance Board 12 August have reviewed this document). 2021
Joint SEE Clinical Executive Committee 15 July 2021
Reports Submitted to Board only: Date signed-off by Executive Team. n/a (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Have any financial implications been signed off by Yes No N/A the Chief Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact X Assessment highlighted any issues?
If yes, describe how they are resolved:
Details of Stakeholder, n/a Patient & Public Engagement:
Risks / Link to BAF: BAF Distilled Strategic Objectives and related risks: BAF Ref: Strategic objectives 3, 5, 6, 9 Risks relate to: SEND, Tier 4 services, Community CYP03; bed management and reconfiguration, control of UNPC07; income and expenditure, independent sector FIN02; FIN 07; provider costs, transformation/reorganisationcosts FIN10; FIN11 and the capital resource limit
Conflicts of Interest: none
NHS Castle Point and Rochford CCG NHS Southend CCG
Page 50 of 211 ITEM 13 PATIENT SAFETY & QUALITY REPORT
Page 52 of 211 Agenda Item 13
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
PLACE Patient Safety & Quality Report July 2021
Purpose of To provide the Governing Body members with a local patient safety and quality Report: update and to provide assurance that any significant risks or issues are being appropriately managed in relation to commissioned services by the CCGs.
Recommendations Members of the Governing Body are asked to note the report. and decision/actions:
Executive The members are to consider the following highlights of the report: Summary (including financial Serious Incidents- There have been no new serious incidents reported impact): for this reporting period for either CCGs. There are two ongoing Serious incidents which are media/ Information Governance related.
Continuing Health Care – The CHC teams continue to work towards achieving the agreed trajectory for the outstanding reviews to be completed. The reason for the backlog is due to staff sickness and vacancy.
Learning Disabilities- The first data relating to achieved completed Learning Disabilities Annual Health checks (AHC) recorded by GP Practices are showing that practices are actively working towards the 75% trajectory for completed AHC. The data release indicates that both CCGs are currently 9% in month cumulative performance which is 1% less that the 10% in month trajectory.
Written Lorraine Coyle Deputy Chief Nurse NHS CPR and NHS Southend CCGs by/Presented by:
Executive Director Rachel Hearn, Executive Director of Nursing Mid and South Essex CCGs. Sponsor:
Non-Officer/Board N/A Sponsor:
Approval Route: Group/Committee Date (List Groups/Committees N/A that have reviewed this document).
Page 53 of 211 Yes No N/A
Have any financial implications been signed off by the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact Assessment been carried out and issues addressed?
Details of Stakeholder, Patient & Public Engagement:
Conflicts of Interest: Conflicts of Interest for any agenda item must be declared at start of the meeting in order that the Chair may determine any required management of the conflict.
National Standard
Key Issue 1
Key Issue 2
Time scale for benefits to be realised
Risk – BAF
Page 54 of 211 NHS CASTLE POINT AND ROCHFORD CCG AND SOUTHEND CCG PLACE PATIENT SAFETY & QUALITY REPORT
1. Purpose
1.1 This report provides a brief overview of exceptional patient safety and quality issues for all services over which NHS Castle Point and Rochford CCG and Southend CCG has direct oversight. Summary of papers presented and reviewed in more detail at the Patient Safety and Quality Committee in Common which was held on 13 July are appendices at the end of this report. Members of the Governing Body are also attending and represent the CCG at the Patient Safety and Quality Committee in common.
2.0 Learning Disabilities Annual Health Checks
2.1 The first data relating to achieved completed Learning Disabilities Annual Health checks (AHC) recorded by GP Practices are showing that practices are actively working towards the 75% trajectory for completed AHC.
Table 1. Learning Disability Health Checks – NHS CPR st and NHS Southend CCG – Cumulative – From 1 April Data Source: SystmOne: Basildon and Brentwood, Castle Point and Rochford, Mid Essex, Southend and Thurrock Reporting Units – run on 05/07/2021 Note: The data is run cumulatively each month to avoid double-counting patients. Last month’s cumulative total is then taken away from this month to give the current month position.
By CCG MSE Trajectory 2 5 10 14 19 25 31 38 46 54 64 75 % % % % % % % % % % % % % Patients Cumulative Number of Checks Completed Register Size on LD Monthly (From Phase 3 Register A M Ju Au Se Oc No De Ja Fe M CCG Plans) -Current pr ay n Jul g p t v c n b ar NHS 10 16 22 24 30 47 Castle LD Checks – 20/21 0 6 31 53 61 71 6 7 7 8 8 5 Point 2 and LD Checks 21/22 722 701 2 43 64 Rochf ord 21/22 Checks as a % of 3 6 9 0 0 0 0 0 0 0 0 0 CCG Register % % % % % % % % % % % % NHS 17 26 37 47 60 75 South LD Checks – 20/21 0 5 8 32 49 96 9 0 1 6 1 7 end 3 16 1,100 1,100 CCG LD Checks 21/22 5 91 6 21/22 Checks as a % of 3 8 15 0 0 0 0 0 0 0 0 0 Register % % % % % % % % % % % %
2.2 The data indicates that both CCGs are currently 9% in month cumulative performance which is 1% less that the 10% in month trajectory. The performance data will now be shared with PCN Directors for dissemination within their primary care networks. This approach is to proactively encourage completion throughout the year rather than starting them in Quarter 4.
3.0 Serious Incidents
Page 55 of 211 3.1 There have been no new serious incidents reported for this reporting period for either CCGs. There are two ongoing Serious incidents which are media/ Information Governance restated. One is still being investigated. The second Si is currently being independently reviewed.
4.0 Continuing Health Care
4.1 The CHC teams continue to work towards achieving the agreed trajectory for the outstanding reviews to be completed. The reason for the backlog is due to staff sickness and vacancy.
5.0 Recommendation
5.1 The Governing Body is requested to note the contents of the report.
6.0 Appendices
6.1 The following update reports are also appended for information:
Appendix A – Joint Committee Appendix B – Mental Health Appendix C – Learning Disability Appendix D – Medicines Management Appendix E – Safeguarding Appendix F – Primary Care Quality Appendix G – Care Sector The above topics were reported to and considered by the Patient Safety and Quality Committees meeting in common on 13 July 2021.
Page 56 of 211 ITEM 14 FINANCE REPORTS
Page 57 of 211
Agenda Item 14a
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Finance Report as at 30th June 2021 (Month 3)
Purpose of Report: To update the Governing Body members on the financial position within both CCGs for the period ending 30th June 2021.
Recommendations and The Governing Body is asked to: decision/actions: Note the financial positions reported, for both CCGs, as at 30th June 2021.
Executive Summary The key headlines within this report are as follows; (including financial impact): CCG Financial Plans for Half 1 (H1), months 1 to 6 of this financial year: System-wide financial plans for Half 1 (H1) of the 2021/22 financial year have been agreed by NHS England, both by CCG and across the system, with both CCGs having setting break-even positions against their available allocations. CCGs must operate within these financial envelopes for H1 of this financial year. Financial envelopes for Half 2 (H2 – months 7-12) of 2021/22 have yet to be released by NHS England. Financial Results for the period to 30th June 2021/22 : Both CCGs are reporting no variances to plan, for both the year- to-date and forecast outturn positions.
Lee Bushell, Deputy CFO
Executive Director Mark Barker, CFO Sponsor:
Non-Officer/Board Sponsor:
Fit with CCG Strategic Objectives?
Approval Route: Group/Committee Date 1 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 58 of 211 (List Groups/Committees that have reviewed this document).
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Have any financial implications been signed off by the Chief Yes No N/A Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact Assessment X highlighted any issues?
If yes, describe how they are resolved:
Details of Stakeholder, Patient & Public Engagement:
Risks / Link to BAF: BAF Ref:
Conflicts of Interest:
2 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 59 of 211 Introduction 1. Contrary to the start of the previous (2020/21) financial year, CCG’s have now returned to a financial regime within which they are obliged to operate within NHS England issued allocations for months 1 to 6 (Half [H] 1) of 2021/22.
It is worthy of note that there remain two funding sources, which at present, are recoverable via NHS England and which remain outside of the published allocations, namely : • Hospital Discharge Programme (HDP) • Elective Recovery Fund (ERF)
Pending receipt of anticipated reimbursement from NHS England, both CCG’s are reporting no variances from plan within their financial results, both year-to-date and forecast outturn (Half 1) of this financial year.
Members will be aware that the CCG is now operating as part of the wider system and, as such, financial positions are being monitored both at organizational and system level.
Key headlines for the period April to June 2021 (Months 1-3) for the 2021/22 Financial Year 2. Members will recall that, at the start of the 2020/21 financial year, there was a significant shift in the financial reporting landscape, via NHS England intervention as a result of the COVID-19 pandemic. To this end, the formal contracting round remains “paused” and CCGs continue to be instructed to pay NHS Providers based on an NHS England provided payment schedule. The values within these schedules broadly reflects Provider’s prior year income, with adjustments for growth and inflation made for both financial years. It is worthy of note that, until the Agenda for Change pay settlement is agreed, there have been no uplifts for pay increases in 2021/22, and once agreed, block payments and CCG allocations are expected to be increased accordingly. NHS England also issued guidance allowing block values to be adjusted by way of contract variation, and this process continues into the 2021/22 financial year.
3. Further guidance has yet to be issued in relation to M7-12 (H2) planning but NHSE has indicated that the regime will be much more challenging in the second half of the year.
4. The CCGs have worked together to be consistent in their use of planning assumptions on inflation etc. Local CCG plans are based upon ongoing commitments. Some mandated cost pressures/investments and transformation
3 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 60 of 211 plans are being prioritised at System level, with Mid Essex CCG currently holding the resource for these system investments. As costs are agreed and incurred, resource adjustments will be made between CCGs accordingly.
5. Some additional transformation funding has been made available to CCGs on an individual basis or as System host.
6. There are some significant risks in the System planning assumptions, particularly in relation to: • £6.7m of cash releasing savings required across the System - currently held by Mid Essex CCG. Delivery of the target is being overseen by the Savings & Efficiencies Programme Board. The intention is that this will be allocated to individual organisations over coming months, thus presenting an additional challenge.
• Further £2.5m System stretch target currently held by MSEFT and £5.4m EPUT stretch target
• Additional expenditure being incurred in relation to the recovery of waiting list activity although which are assumed to be funded via the Elective Recovery Fund.
• Both CCGs (and indeed all CCGs in the MSE footprint) have planned significant investment in Mental Health Services in order to meet the Mental Health Investment Standard. Delivery against this target is dependent upon our Mental Health Provider partners recruiting significant numbers of new staff, the plan for which is extremely ambitious. This will require ongoing monitoring throughout the financial year.
7. Key points to note from the financial position to date : • Current overspends of - CP&R CCG; £0.3m year to date and £0.6m forecast overspend (H1). - Southend CCG; £1.1m year to date and £1.6m forecast overspend (H1). - Both of these positions reflect the fact that neither CCG has yet to received reimbursement for costs incurred in relation to both the Hospital Discharge Programme (HDP) or the Elective Recovery Fund (ERF) – after receipt, the net positions will be in line with the planned position of breakeven, both year to date and forecast outturn. - Within the Appendices to this report, these anticipated reimbursements are shown under the heading; “Anticipated Resource Adjustments”.
• Running costs for both CCGs are currently on plan
• We are currently unaware of H2 allocations and the financial challenge that this will present to the CCG, and system, though it is anticipated that this will present a significant challenge. Early indications suggest the following : 4 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 61 of 211
- Half 2 (H2) allocations will likely be a roll-over of Half 1 (H1) - HDP reimbursements are likely to continue at existing levels for Half (H2) - ERF is expected to continue, using the same rules as being utilized in Quarter 2 - Efficiency targets will be required to deliver at 3.5%, however, should there be any reductions within our system in relation to income support that would count towards the 3.5% target. - Fuller detail to follow later in Autumn.
Recommendations
The Governing Body is asked to note the reported financial position and the risks faced in delivering against this year’s financial targets.
5 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 62 of 211 APPENDICES
1. CASTLE POINT & ROCHFORD CCG a) INCOME & EXPENDITURE STATEMENT AS AT 30TH JUNE 2021
Year to Date Forecast Variance Variance 2020/21 Year to Date Year to Date (Over )/ Forecast (Over) /
CATEGORY Budget Budget Actual Under Outturn Spend Programme of %age Under £m £m £m £m £m
PROGRAMME COSTS NHS Block Contracts Acute Services 67.9 33.9 33.9 (0.0) 67.9 47% 0.0 Mental Health/Learning Disabilities 8.8 4.4 4.4 (0.1) 8.9 6% (0.1) Community Services 6.8 3.4 3.4 (0.0) 6.8 5% (0.0) Ambulance Services 4.6 2.3 2.3 0.0 4.6 3% (0.0) Sub Total 88.0 44.0 44.1 (0.1) 88.1 (0.1)
Non-NHS Services Non-NHS Acute Services 3.8 1.9 2.2 (0.3) 5.1 4% (1.3) Non-NHS Mental Health Services 3.6 1.8 2.0 (0.2) 3.8 3% (0.2) Primary Care Co-Commissioning 13.5 6.0 6.0 (0.0) 13.5 9% 0.0 Prescribing & Medicines Management 16.4 8.2 8.1 0.1 16.2 11% 0.2 Other Primary Care 3.4 1.7 1.9 (0.3) 3.7 3% (0.3) Non-NHS Community Services (inc BCF) 6.3 3.2 3.2 (0.0) 6.3 4% (0.0) Continuing Health Care 7.4 3.7 4.1 (0.4) 7.8 5% (0.4) Other Programme Costs 1.4 0.7 (0.1) 0.8 (0) 0% 1.6 Contingency 0.0 0.0 0.0 0.0 0.0 0% 0.0 COVID-19 Costs 0.0 0.0 0.0 0.0 0.0 0% 0.0 TOTAL CCG PROGRAMME COSTS 143.9 71.2 71.4 (0.3) 144.5 100% (0.6)
TOTAL CCG RUNNING COSTS 1.7 0.9 0.9 0.0 1.7 0.0
TOTAL CCG EXPENDITURE 145.6 72.0 72.3 (0.3) 146.2 (0.6)
RESOURCE LIMIT FUNDING Programme Resource Limit - Confirmed - In-Year 143.9 71.2 71.2 0.0 143.9 0.0 Programme Resource Limit - Anticipated Resource Adjustments 0.0 0.0 0.3 0.3 0.6 0.6 Running Cost Resource Limit - Confirmed 1.7 0.9 0.9 0.0 1.7 0.0 TOTAL RESOURCE LIMIT FUNDING 145.6 72.0 72.3 0.3 146.2 0.6
IN-YEAR SURPLUS/(DEFICIT) 0.0 0.0 (0.0) (0.0) 0.0 0.0
6 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 63 of 211 b) STATEMENT OF FINANCIAL POSITION AS AT 30TH JUNE 2021
NHS Castle Point & Rochford CCG Statement of Financial Position as at 30th June 2021
2020/21 YTD As at 31/3/21
£000 £000 Non-Current Assets Property, plant and equipment 156 156 Total Non-Current Assets 156 156
Current Assets Trade and Other Receivables 3,888 4,219 Cash and Cash Equivalents 1,000 (1,638) Total Current Assets 4,888 2,581
Total Assets 5,044 2,737
Current Liabilities Trade and Other Payables (27,215) (45,344) Total Current Liabilities (27,215) (45,344)
Non-Current Assets plus/less Net Current Assets/Liabilities (22,171) (42,607)
Assets less Liabilities (22,171) (42,607)
Financed by Taxpayers' Equity General Fund 22,171 42,607 Total Taxpayers' Equity 22,171 42,607
7 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 64 of 211 c) CASHFLOW POSITIION AS AT 30TH JUNE 2021
NHS Castle Point & Rochford CCG Cash Analysis April May June July August Sept October Nov Dec January February March 2021/22 £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s ACTUAL FORECAST H2 PLAN TO BE CONFIRMED
Receipts CCG cash drawdown 33,000 26,400 25,700 18,300 22,800 22,300 ------148,500 Receipts from debtors 1,578 467 233 3,746 346 786 ------7,155 VAT 132 95 39 30 30 30 ------355 Other receipts ------
Total receipts 34,710 26,962 25,971 22,076 23,176 23,116 ------156,010
Payments NHS creditors 25,813 16,032 15,842 15,788 18,817 16,178 ------108,469 Non-NHS trade creditors 6,433 8,264 5,509 3,892 3,892 4,558 ------32,549 Delegated Co-Commissioning 1,939 2,099 2,472 1,936 1,771 1,757 ------11,974 Salary 244 259 244 250 250 250 ------1,497 Tax & NI 118 128 141 130 130 130 ------777 Pension 78 80 77 80 80 80 ------476 Other payments 7 6 3 2 2 2 ------23
Total payments 34,633 26,868 24,286 22,078 24,943 22,957 ------155,765
Net cash movements in the period 77 94 1,685 (3) (1,767) 159 ------245
Opening Bank & Cash balance 48 126 220 1,905 1,902 135 48
Add receipts 34,710 26,962 25,971 22,076 23,176 23,116 ------156,010 Less payments (34,633) (26,868) (24,286) (22,078) (24,943) (22,957) ------(155,765) - Closing Bank & Cash balance 126 220 1,905 1,902 135 294 ------294
8 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 65 of 211 d) BETTER PAYMENT PRACTICE CODE ADHERANCE AS AT 30TH JUNE 2021
Better Payment Practice Code (BPPC) - Year to Date Performance Number Value of invoices £000s Non-NHS Suppliers Total non-NHS trade invoices paid in the year 2,360 26,748 Total non-NHS trade invoices paid within target 2,219 23,376 Percentage of non-NHS trade invoices paid within target 94.03% 87.39%
NHS Suppliers Total NHS invoices paid in the year 136 57,672 Total NHS invoices paid within target 118 57,023 Percentage of NHS invoices paid within target 86.76% 98.87%
Total Total invoices paid in the year 2,496 84,420 Total invoices paid within target 2,337 80,399 93.63% 95.24%
9 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 66 of 211 e) AGED DEBTORS AND CREDITORS POSITION AS AT 30TH JUNE 2021
Total Aged Debtors and Creditors June 21 Amount Current 1-30 days 31-60 days 61-90 days over 90 days £s £s £s £s £s £s Aged Debtors NHS Trusts (15,342) 0 0 0 0 (15,342) 8 Note 8 NHS CCGs 2,685,422 53,781 2,390,731 1 (52,087) 4 297,031 6 (4,034) 9 Note 1,4,6,9 NHS England 712,557 112,352 (2,663) 2 62,576 5 263,197 7 277,095 10 Note 2,5,7,10 Non-NHS 239,400 230,116 (3,433) 3 10,716 0 2,000 Other 72,219 53,146 2,389 16,735 0 (50)
Total Debtors 3,694,256 449,396 2,387,024 37,940 560,227 259,669
Aged Creditors NHS Trust 9,600 0 9,838 0 0 (238) NHS CSUs 66,898 1,611 65,288 11 0 0 0 Note 11 NHS CCGs 197,145 179,341 0 17,804 0 0 NHS England 0 0 0 0 0 0 Non NHS (146,812) 206,287 (369,814) 12 46 (5,738) 14 22,408 15 Note 12,14,15 Other 102,184 60,900 40,922 13 362 0 0 Note 13 Total Creditors 229,016 448,138 (253,766) 18,211 (5,738) 22,170
Note 1 NHS SOUTHEND CCG: £2.4m, approved to be paid on 15/7/21 Note 2 NHS ENGLAND: £3k Credit balance cleared 5/7/21 Note 3 MACMILLAN CANCER SUPPORT: £3k Credit balance cleared 2/7/21 NHS SOUTHEND CCG: £25k, (paid 1/7/21) NHS MID ESSEX CCG: £78k Credit for invoice raised incorrectly - awaiting confirmation Note 4 to refund. Note 5 NHS ENGLAND: £63k: STP Business as usual Capital GPIT Note 6 NHS SOUTHEND CCG: £297k, paid 1/7/21 Note 7 NHS ENGLAND: £263k: COVID Laptop deployment costs & 20/21 Flu Costs November/December MID AND SOUTH ESSEX NHS FOUNDATION TRUST: £9k Credit for incorrect recharge, to be refunded. ESSEX PARTNERSHIP Note 8 UNIVERSITY NHS FOUNDATION TRUST: £7k Credit for incorrect value invoice - awaiting confirmation to refund. Note 9 NHS SOUTHEND CCG: £4k Cr., Remaining balance for Pay recharge for Q1-Q3 Note 10 NHS ENGLAND: £278k (20/21 Flu Costs September/October)
Note 11 NHS ARDEN AND GEM CSU: £65k, ARDENS HEALTH INFORMATICS LTD: £422k Credit for invoice paid in May, LEWIS C P & PARTNERS: £41k (paid in July), Note 12 PLAYFORDS: £10k (installation of power/data points at surgeries) Note 13 RUNWOOD HOMES: £41k (paid in July) Note 14 LEARNA LTD: £8k Cr. (to off-set against invoices - see also note 15) HAVENS HOSPICES: £5k. (awaiting confirmation of new Purchase Order), LEARNA LTD: £5k (see note 15). Note 15 Outstanding balances on partially paid invoices: WAKERING MEDICAL CENTRE: £2k, OAKLANDS SURGERY: £2k, PRACTICE SURGERIES LTD: £1k, RAHMAN H U & PARTNER:£1k
10 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 67 of 211 2. SOUTHEND CCG a) INCOME & EXPENDITURE STATEMENT AS AT 30TH JUNE 2021
Year to Date Forecast Variance Variance 2019/20 Year to Date Year to Date (Over )/ Forecast (Over) /
CATEGORY Budget Budget Actual Under Outturn Spend Programme of %age Under £m £m £m £m £m
PROGRAMME COSTS Joint Committee Acute Services SLAs 69.3 34.7 35.0 (0.3) 70.2 46% (0.9) Acute NCAs 0.0 0.0 0.0 (0.0) 0.1 0% (0.1) Emergency Transport Services SLAs 4.8 2.4 2.4 0.0 4.8 3% 0.0 Mental Health/Learning Disabilities 13.4 6.7 6.7 0.0 13.4 9% 0.0 Urgent Care & Out of Hours 1.6 0.8 0.8 0.0 1.6 1% 0.0 Non-Emergency Patient Transport 0.6 0.3 0.3 0.0 0.6 0% (0.0) 89.8 44.9 45.2 (0.3) 90.7 (0.9)
CCG Acute Services - non Joint Committee 1.0 0.5 0.5 (0.0) 1.1 1% (0.1) Mental Health - non Joint Committee 3.4 1.7 1.7 (0.0) 3.4 2% (0.0) Primary Care Co-Commissioning 14.4 6.3 6.3 0.0 14.4 9% 0.0 Prescribing & Medicines Management 15.6 7.8 7.7 0.1 15.4 10% 0.3 Other Primary Care 1.2 0.6 0.6 (0.0) 1.2 1% (0.0) Community Services 5.7 2.8 2.8 (0.0) 5.7 4% (0.0) Continuing Health Care 12.5 6.3 7.6 (1.4) 14.5 9% (2.0) Better Care Fund 7.1 3.6 3.6 0.0 7.1 5% 0.0 Other Programme Costs 1.7 0.9 0.3 0.6 0.5 0% 1.2 Contingency 0.0 0.0 0.0 0.0 0.0 0% 0.0
TOTAL CCG PROGRAMME COSTS 152.4 75.3 76.4 (1.1) 154.0 100% (1.6)
TOTAL CCG RUNNING COSTS 1.7 0.9 0.9 0.0 1.7 0.0
TOTAL CCG EXPENDITURE 154.1 76.2 77.2 (1.1) 155.7 (1.6)
RESOURCE LIMIT FUNDING Programme Resource Limit - Confirmed 152.4 75.3 75.3 0.0 152.4 0.0 Programme Resource Limit - Anticipated Resource Adjustments 0.0 1.1 1.1 1.6 1.6 Running Cost Resource Limit - Confirmed 1.7 0.9 0.9 1.7 0.0 TOTAL RESOURCE LIMIT FUNDING 154.1 76.2 77.2 1.1 155.7 1.6
IN-YEAR SURPLUS/(DEFICIT) (0.0) (0.0) (0.0) 0.0 (0.0) 0.0
11 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 68 of 211 b) STATEMENT OF FINANCIAL POSITION AS AT 30TH JUNE 2021 NHS Southend CCG Statement of Financial Position as at 30th June 2021
2020/21 YTD As at 31/3/21
£000 £000 Non-Current Assets Property, plant and equipment 0 0 Total Non-Current Assets 0 0
Current Assets Trade and Other Receivables 995 2,286 Cash and Cash Equivalents (992) (1,031) Total Current Assets 3 1,255
Total Assets 3 1,255
Current Liabilities Trade and Other Payables (30,398) (36,374) Total Current Liabilities (30,398) (36,374)
Non-Current Assets plus/less Net Current Assets/Liabilities (30,395) (35,119)
Assets less Liabilities (30,395) (35,119)
Financed by Taxpayers' Equity General Fund 30,395 35,119 Total Taxpayers' Equity 30,395 35,119
12 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 69 of 211 c) CASHFLOW POSITIION AS AT 30TH JUNE 2021
NHS Southend CCG Cash Analysis April May June July August Sept October Nov Dec January February March 2021/22 £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s ACTUAL FORECAST H2 PLAN TO BE CONFIRMED
Receipts CCG cash drawdown 27,500 22,000 25,000 25,100 22,900 22,600 ------145,100 Receipts from debtors 1,484 436 2,005 1,026 820 820 ------6,591 VAT 41 55 21 20 20 20 ------177 Other receipts ------
Total receipts 29,025 22,491 27,025 26,146 23,740 23,440 ------151,867
Payments NHS creditors 16,107 16,978 16,577 19,270 16,269 16,269 ------101,470 Non-NHS trade creditors 10,529 3,181 7,606 4,708 5,508 4,908 ------36,438 Delegated Co-Commissioning 1,794 2,083 2,610 1,861 1,849 1,927 ------12,124 Salary 113 130 117 120 120 120 ------720 Tax & NI 62 58 69 62 62 62 ------375 Pension 36 35 34 36 36 36 ------213 Other payments 376 0 1 2 2 2 ------383
Total payments 29,016 22,464 27,014 26,059 23,846 23,324 ------151,724
Net cash movements in the period 9 27 11 87 (106) 116 ------144
Opening Bank & Cash balance 44 53 80 91 178 72 44
Add receipts 29,025 22,491 27,025 26,146 23,740 23,440 ------151,867 Less payments (29,016) (22,464) (27,014) (26,059) (23,846) (23,324) ------(151,724) - Closing Bank & Cash balance 53 80 91 178 72 188 ------188
13 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 70 of 211 d) BETTER PAYMENT PRACTICE CODE ADHERANCE AS AT 30TH JUNE 2021
Better Payment Practice Code (BPPC) - Year to Date Performance Number Value of invoices £000s Non-NHS Suppliers Total non-NHS trade invoices paid in the year 2,945 28,075 Total non-NHS trade invoices paid within target 2,802 24,790 Percentage of non-NHS trade invoices paid within target 95.14% 88.30%
NHS Suppliers Total NHS invoices paid in the year 111 49,660 Total NHS invoices paid within target 95 48,982 Percentage of NHS invoices paid within target 85.59% 98.63%
Total Total invoices paid in the year 3,056 77,735 Total invoices paid within target 2,897 73,772 94.80% 94.90%
14 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 71 of 211 e) AGED DEBTORS AND CREDITORS POSITION AS AT 30TH JUNE 2021
Aged Debtors and Creditors June 21 Total Amount Current 1-30 days 31-60 days 61-90 days over 90 days £s £s £s £s £s £s Aged Debtors NHS Trusts 103 0 0 0 0 103 NHS CSU 0 0 0 0 0 0 NHS CCGs 275,776 275,776 0 0 0 0 NHS England 267,145 8,015 (2,905) 1 0 142,225 3 119,810 4 Note 1,3,4 Non-NHS 35,225 25,842 0 (1) 0 9,385 5 Note 5 Other 99,662 3,582 88,497 2 0 7,583 0 Note 2
Total Debtors 677,911 313,214 85,592 (1) 149,808 129,298
Aged Creditors NHS Trusts (922) 0 0 0 0 (922) 12 Note 12 NHS CSU 46,035 1,181 2,206 41,782 8 866 0 Note 8 NHS CCGs 398,462 14,294 35,731 6 30,831 9 317,606 10 0 Note 6,9,10 NHS - NHS ENGLAND 0 0 0 0 0 0 Non-NHS 1,302,772 1,227,578 52,748 7 12,683 (8,986) 11 18,750 13 Note 7,11,13 Other 14,856 0 13,168 1,688 0 0
Total Creditors 1,761,203 1,243,053 103,853 86,984 309,485 17,828
Note 1 NHS ENGLAND: £3k Credit (invoice raise 2/7/21 to cancel) Note 2 SOUTHEND-ON-SEA BOROUGH COUNCIL: £91k - with SoSBC to pay as at 1/7/2, 1FEERING PHARMACEUTICALS LTD: £3k Credit (raising invoice to clear) Note 3 NHS ENGLAND: £142k - statement provided to NHS England to clarify invoicing and encourage payment Note 4 NHS ENGLAND: £120k - statement provided to NHS England to clarify invoicing and encourage payment Note 5 NON NHS INDIVIDUAL: £9k (Debt recovery agency, CCI, engaged to pursue debt. Preoceeding to legal action as no response revceived)
Note 6 NHS CASTLE POINT AND ROCHFORD CCG: £36k (paid in July) THE CHILDRENS TRUST: £33k (paid in July), WARDOUR GROUP LTD: £7k, (awaiting new bank details from vendor), HAVENS HOSPICES: £6k (awaiting revised Note 7 Purchase Order) Note 8 NHS ARDEN AND GEM CSU: £42k (£22k paid in July). Note 9 NHS CASTLE POINT AND ROCHFORD CCG: £26k (paid in July) Note 10 NHS CASTLE POINT AND ROCHFORD CCG: £297k (paid in July) Note 11 LARCHWOOD CARE HOMES (SOUTH) LTD: £14k Cr. (awaiting invoices to off-set credit), WARDOUR GROUP LTD: £5k (awaiting new bank details from vendor). Note 12 ST GEORGES UNIVERSITY HOSPITALS NHS FOUNDATION TRUST: £1k Cr (a refund has been requested) Note 13 SUMMERCARE LTD: £10k (paid in July), PRACTICE NORTHUMBERLAND AVENUE: £8k (Originally £16k invoice, partially paid)
15 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 72 of 211
Agenda Item 14b
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Financial Plans 2021/22
Purpose of Report: To provide the Governing Body with the approved financial plans within both CCGs for Half 1 (H1; months 1 to 6) of the 2021/22 financial year
Recommendations and The Governing Body is asked to: decision/actions: Note the financial plans reported, for both CCGs, as submitted to NHS England, and ratified at the Mid & South Essex Finance & Performance Committee in Common.
Executive Summary The key headlines within this report are as follows; (including financial impact): CCG Financial Plans for Half 1 (H1), months 1 to 6 of this financial year: System-wide financial plans for Half 1 (H1) of the 2021/22 financial year have been agreed by NHS England, both by CCG and across the system, with both CCGs having set break-even positions against their available allocations.
CCGs must operate within these financial envelopes for H1 of this financial year.
Financial envelopes for Half 2 (H2 – months 7-12) of 2021/22 have yet to be released by NHS England.
Two funding sources remain outside of the published allocations, and are recoverable via NHS England, namely : • Hospital Discharge Programme (HDP) • Elective Recovery Fund (ERF)
Lee Bushell, Deputy CFO
Executive Director Mark Barker, CFO Sponsor:
1 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 73 of 211 Non-Officer/Board Sponsor:
Fit with CCG Strategic Objectives?
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document).
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Have any financial implications been signed off by the Chief Yes No N/A Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact Assessment X highlighted any issues?
If yes, describe how they are resolved:
Details of Stakeholder, Patient & Public Engagement:
Risks / Link to BAF: BAF Ref:
Conflicts of Interest:
2 Castle Point and Rochford Clinical Commissioning Group Southend Clinical Commissioning Group Page 74 of 211 Financial Plan 1st Half 2021/22
Page 75 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 1 Key points M1-6
• M1-6 total allocation of £146m
• Initial allocation growth at 4.05%
• Includes MHIS allocation which achieves 4.05% growth in investment
• Includes Block Cash payments to NHS providers of £97.79m (0.5% growth)
• Delegated co-commissioning Primary Care allocation of £13.5m
• Running costs allocation of £1.7m
• CCG submitting breakeven plan – overall position balanced via a transfer of £1,434k to support the system position.
Page 76 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 2 Assumptions Total Growth assumptions by Area Assumption • Growth rates including inflation and demand for each NHS Providers 0.50% portfolio as per the table. Non-NHS & Ind Sector 0.20% • No contingency or QIPP requirement for 1H 21/22. Mental Health 4.05% • £1,434k transferred out to support remainder of the CHC 1.60% system. • HDP will be funded outside the envelope based on Funded nursing care 3.40% CPR CCG’s weighted population share from the Community 0.67% STP’s finite pot of £11.910m. BCF 5.30% Prescribing 0.68% Primary Care 4.50% Core Primary Care 0 Other 1.09% Running costs 0
Page 77 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 3 Allocation summary
Allocation £'000's
Baseline allocation (Based on H2 2020-21) 138,490 NR Adjustments (881) Baseline allocation 137,609
Additional funding Acute Independent Sector 4,561 Primary Care Co-commissioning 846 MHIS 407 Programme Growth 1,125
Total core allocation 144,547
SDF 1,644
Total allocation 146,191 Page 78 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 4 Financial plan summary
H1 21/22 Investments Portfolio Growth SDF H1 21/22 opening / transfers Acute 73,506 369 3,191 191 77,257 Mental Health 10,406 422 0 895 11,723 Continuing Care 7,272 122 0 0 7,394 Community Health Services 6,124 0 2,793 0 8,917 Primary Care Prescribing 15,655 106 571 0 16,332 Primary Care Co-Commissioning 12,659 0 846 0 13,505 Primary Care Other 2,256 102 (458) 558 2,458 Other Programme 8,519 21 (2,105) 0 6,435 Running costs 1,712 0 458 0 2,170 TOTAL 138,109 1,142 5,296 1,644 146,191 Page 79 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 5 Risks and Mitigations
• CCG will receive income relating to Elective Recovery Fund (ERF) however there is risk the income may not be sufficient to cover the unavoidable ERF costs. - There is an expectation NHSE will reimburse CCGs for additional costs • Covid costs above those amounts funded, impact of possible future Covid waves not currently included in plans. - There is an expectation NHSE will reimburse CCGs for additional costs • Unforeseen CCG cost pressures pose a a risk due to no contingency included in plans across system. Risky portfolios include CHC and Prescribing. - There is expectation that local flexibilities and underspends should be sufficient to close any gaps in H1. • Delivery of in-year system efficiencies. - There is a system efficiency programme which is focussing on long term system delivery and efficiencies.
Page 80 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 6 Page 81 of 211 @CPRCCG www.castlepointandrochfordccg.nhs.uk 7
Financial Plan 1st Half 2021/22
22/07/2021 Page 82 of 211 1
Key points M1-6 M1-6 total allocation of £153m
Initial allocation growth at 4.32%
Includes MHIS planned expenditure achieving 4.32% growth in investment
Includes Block Cash payments to NHS providers of £96.5m (0.5% growth)
Delegated co-commissioning Primary Care allocation of £14.4m
Running costs allocation of £1.7m
CCG submitting breakeven plan – overall position balanced by system growth funding of £1,201k.
Page 83 of 211 2
Assumptions
Total Growth assumptions by Area • Growth rates including inflation and demand for each Assumption portfolio as per the table. NHS Providers 0.50% • No contingency or QIPP requirement for 1H 21/22. Non-NHS & Ind Sector 0.20% • £1,201k system growth funding to deliver breakeven position. Mental Health 4.32% • HDP will be funded outside the envelope based on CPR CHC 1.60% CCG’s weighted population share from the STP’s finite pot Funded nursing care 3.40% of £11.910m. Community 0.67% BCF 5.30% Prescribing 0.68% Primary Care 4.50% Core Primary Care 0 Other 1.09% Running costs 0
22/07/2021 Page 3 Page 84 of 211
Allocation summary
Allocation £'000's
Baseline allocation (Based on H2 2020-21) 143,097 NR Adjustments (1,199) Baseline allocation 141,898
Additional funding Acute Independent Sector 1,495 Primary Care Co-commissioning 1,008 MHIS 803 Programme Growth 1,128 Additional allocation1 5,245
Total core allocation 151,577
SDF 1,305
Total allocation 152,882
1 Additional allocation received to corrected error in 2020/21 funding.
22/07/2021 Page 4 Page 85 of 211
Financial plan summary
H1 Investments / Portfolio 21/22 Growth SDF H1 21/22 transfers opening Acute 73,495 367 2,387 16 76,265 Mental Health 15,584 632 (157) 661 16,720 Continuing Care 12,314 197 0 0 12,511 Community Health Services 8,980 1 92 0 9,073 Primary Care Prescribing 14,955 102 429 0 15,486 Primary Care Co-Commissioning 13,373 0 1,008 0 14,381 Primary Care Other 1,901 85 (53) 604 2,537 Other Programme 5,572 (170) (1,228) 0 4,174 Running costs 1,730 0 5 0 1,735 TOTAL 147,903 1,215 2,483 1,281 152,882
22/07/2021 Page 5 Page 86 of 211
Risks and mitigations CCG will receive income relating to Elective Recovery Fund (ERF) however there is risk the income may not be sufficient to cover the unavoidable ERF costs.
- There is an expectation NHSE will reimburse CCGs for additional costs
Covid costs above those amounts funded, impact of possible future Covid waves not currently included in plans.
- There is an expectation NHSE will reimburse CCGs for additional costs
Unforeseen CCG cost pressures pose a a risk due to no contingency included in plans across system. Risky portfolios include CHC and Prescribing.
- There is expectation that local flexibilities and underspends should be sufficient to close any gaps in H1.
Delivery of in-year system efficiencies.
- There is a system efficiency programme which is focussing on long term system delivery and efficiencies.
22/07/2021 Page 6 Page 87 of 211 ITEM 15 POLICIES FOR APPROVAL
Page 88 of 211 Agenda Item 15
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
MID AND SOUTH ESSEX POLICY AND STRATEGY APPROVAL
Purpose of Report: To seek approval for the adoption of the revised mid and south Essex Clinical Commissioning Groups policies: • On Call Director policy • Business Continuity Strategy • EPRR Strategy
These documents are a key requirement to enable CCG compliance with the NHS England Core Standards.
Recommendations and The Board/Committee are asked to discuss and approve the adoption of decision/actions: the policies and strategies presented.
Executive Summary The attached policies and strategies are updated versions due as part of (including financial impact): the planned review of the documents.
In discussion with NHS England Emergency Preparedness, Resilience and Response (EPRR) the policies has been streamlined and to guide the reader to other policies rather than incorporating sections of national policies into local ones.
Written by: Jo Martindale - Business Continuity and EPRR Officer, Emergency Planning Team (EPT) Karen Wesson – Director of Commissioning, Performance & EPRR
Presented by: Nicola Adams – Interim Associate Director of Corporate Governance
Executive Director Karen Wesson – Director of Commissioning, Performance & EPRR Sponsor:
Non-Officer/Board Anthony McKeever, Executive Lead Mid and South Essex Health and Sponsor: Care Partnership & Joint Accountable Officer CCGs
Fit with CCG Strategic Ensure services are organised to respond to and meet COVID-19 Objectives? requirements.
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Audit Committee in Common 25 May 2021 document).
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Yes No N/A
Page 89 of 211
Have any financial implications been signed off by the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact Assessment been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
N/A
Conflicts of Interest: N/A
Escalation: N/A To the Board To another Committee To the BAF/CRR
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Mid and South Essex Clinical Commissioning Groups
On Call Director/Manager Policy
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Policy Author: Jackie King Head of EPRR
Version: 11.1 3 June 2021
Date ratified: see CCG Table
Ratifying Body: Mid and South Essex CCG Governing Bodies
Review date: February 2023
Board / Governing Body Approval
CCG Approval Date V11.1 Basildon & Brentwood CCG Castle Point & Rochford CCG Mid Essex CCG Southend CCG Thurrock CCG
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Contents
1.0 Mid and South Essex Emergency Preparedness, Resilience and Response (EPRR) Statement...... 4
2.0 Responding to an Incident ...... 4
3.0 Scope ...... 4
4.0 On Call Information and Arrangements ...... 5
4.1 Administration ...... 5
4.2 Operational Arrangements ...... 5
4.3 Resilience Direct and On Call Documentation ...... 5
4.4 PageOne Connect ...... 6
5.0 Training ...... 6
6.0 Role of the CCG On Call Director/Manager ...... 7
6.1 On-Call Director/Manager in a Business Continuity Incident ...... 7
7.0 On call Payment ...... 7
8.0 Reference Documentation ...... 7
9.0 Distribution ...... 7
10.0 Version Control Sheet ...... 8
Appendix 1 - CCG On Call Director Initial Incident Notification Record ...... 10
Appendix 2 - Record of Work Undertaken Form ...... 12
Appendix 3 – Essex CCG Training Needs Analysis (2019) ...... 13
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1.0 Mid and South Essex Emergency Preparedness, Resilience and Response (EPRR) Statement
An integrated approach for Emergency Preparedness Resilience and Response (EPRR) across the CCGs requires a single generic plan to be used. The CCGs accept their statutory duties as Category 2 Responders under the Civil Contingencies Act 2004 (CCA) and as such will cooperate with Category 1 Responders in order to enhance co-ordination, efficiency and to share information as required, prior to, during and following an incident.
The CCGs will have in place business continuity plans that allow them to continue to provide their core functions during a major incident, as far as practicable and to recover from the additional pressure that an incident may place on an organisation.
In addition to its duties contained within the Civil Contingency Act, the CCGs recognise their EPRR responsibilities as detailed within Section 46 of the Health & Social Care Act 2012 (H&SCA) and will, in partnership with its commissioned services meet this responsibility through: • Building upon the existing strengths of current multi-agency coordination and cooperation which includes local NHS Trusts and other Category 1 Responders; • Ensuring that responsibilities of the Resilience Forums and Local Health Resilience Partnership enhance any response to emergency arrangements, both during the response and recovery phase; • Fully integrating with partner agencies’ emergency arrangements, in supporting the local health economy; • Reviewing the state of readiness and operability to extend further, with the assistance of new and improved partnerships, the capability to handle a new kind and potential magnitude of threat; • Ensuring that plans for business continuity are in place; • Cultivating a culture within the CCGs to make emergency preparedness an intrinsic element of management and operations.
2.0 Responding to an Incident
To be able to respond to an incident the CCGs operate a twenty-four hour a day, seven day a week (24/7) on-call Senior Manager rota. This is via the PageOne system.
The on-call will manage: • Major Incident Notifications; • Surge Management/Capacity Issues.
To respond to a notification of a major incident or a surge/capacity incident they have in place On Call arrangements 365 days a year, 24hours a day, 7 days a week (24/7)
3.0 Scope
This policy applies to anyone undertaking on-call from the Mid and South Essex Clinical Commissioning Groups (CCGs), comprising NHS Basildon and Brentwood CCG, NHS Mid Essex CCG, NHS Castlepoint and Rochford CCG, NHS Southend CCG and NHS Thurrock CCG (referred to as the CCGs).
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4.0 On Call Information and Arrangements
4.1 Administration
The Resilience team or equivalent as nominated by the CCG’s Emergency Accountable Officer (EAO) will coordinate the on call rota and upload it on Resilience Direct, this includes the Easter and Christmas/New Year rota.
4.2 Operational Arrangements
The CCG On Call Director/Manager will respond to all requests from the NHS England and Improvement East of England Incident Director, but will effectively manage and liaise with providers of both commissioned services, and primary care, regarding their response to the incident, and that they are able to provide ‘Business as Usual’ services; in addition to managing surge at the Acute Trusts.
Each On-call director/manager has a pager to enable them to be contacted in an incident. The CCGs have in place handover arrangements for those on call.
The On-call director/manager is on call 24 hours a day during their on call period. During hours their on-call requirements can be supported “in hours” by their resilience teams.
The On-call director/manager may request the assistance of other CCG directors and senior managers when responding to an incident.
All calls and records of action taken must be logged and sent to the Emergency Planning Team within 72 hours of an incident to ensure that this is logged and reported on to NHS England EPRR team as required.
There is no restriction about how far away from base the on call Director/Manager should be when on call, but they must be aware of the need to possibly attend the local CCG Incident Coordination Centre.
On call Directors/Managers should refrain from alcohol and other intoxicating substances while on call as they will have to operationally lead and respond to an incident which could include travel / drive and speak coherently on the telephone.
4.3 Resilience Direct and On Call Documentation
Resilience Direct (https://www.resilience.gov.uk) contain a number of documents that may be needed by the on call managers/directors.
These include but not limited to: • CCG Incident Response Plan this includes the Incident Coordination Centre • CCG On Call Director Policy • Incident Log Sheet • Emergency Planning Contact Directory • List of trained Loggists • System Resilience/Surge and Public Holiday Plans • NHS England guidance including: o 12-hour Breach protocol Reporting Protocol: Ambulance Divert Requests o East of England Guidance Delayed Handover Protocol: Patient Safety in the Community PSitC
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• CCGs Business Continuity Plans • CCGs Mass Casualty Plans • National and Regional Plans and any current relevant information • Local event information
4.4 PageOne Connect
PageOne Connect is a Cabinet Office approved service which allows mass messaging and users to send messages to multiple devices and landlines across multiple organisations to pre-determined ‘smart groups’
CCG smart groups vary but may include:- • All staff • Primary care GP/Practice Managers • Resilience
PageOne Connect will be used by the Director/Manager on call in emergency situations, or when no other means of communication is available, to send an important message aimed at members of one or more of the CCGs smart groups.
The message sent will be as clear and concise as possible and include instructions of what is immediately required of members of the smart group.
5.0 Training
Those individuals undertaking roles and responsibilities within a major incident or business continuity incident must undertake appropriate training for their function.
Training needs will be identified through the Training Needs Analysis process and co- ordinated by the mid and south Essex CCGs Head of Emergency Planning. The EPRR and Business Continuity training schedule will be agreed by the CCG EAOs.
The mid and south Essex CCGs Emergency Planning Team will ensure systems are in place to ensure that staff are made aware of their CCGs Emergency and Business Continuity Plans and are trained as appropriate for roles that it is are anticipated they may be required to undertake. This will include:
• Mandatory Training for all staff (2 yearly) • On Call Training (All on call staff - tactical level) • Strategic Training (on call directors and senior managers) • Strategic Refresher training (on call directors and senior managers 2 yearly following full strategic training day) • Familiarisation training (Incident room and plans) • Loggist training • Business continuity training
All CCG training will be aligned to the standards for NHS incident training contained within the Skills for Justice National Occupational Standards (NOS) framework. http://www.ukstandards.org.uk
The Emergency planning team will keep records for all training undertaken by staff, with the exception of the mandatory training where the records will be kept by the individual CCGs and human resource departments.
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All staff undertaking the “Gold” or strategic training will be provided with a portfolio which they are expected to maintain.
Training Needs analysis can be found in Appendix 3.
6.0 Role of the CCG On Call Director/Manager
The On-call director/manager is responsible for handling the calls they receive, either a critical, major or business continuity incident, surge requirement and responding as necessary.
In the event of a major incident or business continuity incident the director/manager On-call will be responsible for activating the incident response arrangements and if required, activating the Coordination Centre.
The CCGs on-call manager/director should read this policy in conjunction with the Incident Response Plan, EPRR Strategy, Business Continuity Guide.
6.1 On-Call Director/Manager in a Business Continuity Incident
The most common business continuity disruptions are loss of premises, staff, IT or utilities due to external or internal incidents. All staff have a responsibility to report incidents that have or may potentially have an impact on business continuity.
The action card and information on action required is detailed within the Strategy and Incident Response Plan.
7.0 On call Payment
The CCGs reimburse staff as agreed contractually.
8.0 Reference Documentation
These documents can be found on Resilience Direct which all on call managers should have access to and their own log in.
• Methane reporting template (Appendix 1) • Record of Work Undertaken Form (Appendix 2) • Mid and South Essex CCGs Incident Response Plan • Mid and South Essex CCGs Business Continuity Management System suite of documents • NHS England Reporting Protocol; Ambulance Divert Requests • East of England Ambulance NHS Trust - Delayed Handover Protocol: Patient Safety in the Community (PSitC) October 2018 • NHS England Midlands and East 12 Hour Breach Reporting Protocol • COPE – Combined Operational Procedures for Essex (ERF)
9.0 Distribution
The policy will be on the Essex CCG’s Resilience Direct Account and on call staff advised.
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10.0 Version Control Sheet
Policy Title: DIRECTOR ON CALL POLICY
Version Date Author Comment issue/review Name and title Draft V1 Brian Dobinson – New Document Emergency Planning Support Officer Version 2 14/08/2013 Brian Dobinson – Amendment to section 3 in relation to West Essex CCG Emergency Planning Support Officer Version 3 16/09/2013 Dan Hale - Head of Clarification of ‘On Call Director’ to account for Senior Managers Emergency Planning Version 4 23/04/2014 Brian Dobinson - Amendments brought about by CCGs having their own Incident Emergency Planning Response Plan, and Incident Coordination Centres. Support Officer Version 5 29//09/2014 Brian Dobinson - Small amendment about development and maintenance of rotas. Emergency Planning Support Officer Version 6 01/07/2015 Brian Dobinson - Annual review of policy. Minor amendments around the move Emergency Planning from Dropbox to Resilience Direct Support Officer Version 7 08/09/2015 Jackie King Amendments to all sections and action card updates from NHS England included Head of resilience Version 7.1 12/11/2016 Jackie King Annual review of policy .SE have moved to a 2 tier rota so Head of Emergency director/manager has been added. Surge section reviewed to outline clearer the role of urgent care/ resilience teams in surge Planning management Inclusion of the role of NHS England Central Midlands team in relation to West Essex CCG Version 7.2 27/02/2017 Jackie King Change to property services contact in action card Head of Emergency Planning Version 7.3 21/04/2017 Jackie King Amendment to section 5 page 10 Head of Emergency Notes added following discussion with NHS England Midlands Planning and East (East) Head of EPRR Version 8 Jackie King Role of the CCG in a Major Incident Response – to mirror Head of Emergency amendments to the CCG IRP Pages 6-8 Planning Training updated - Page 11 Appendix additions 14 onwards: - • New MI alerting record • New quick start guides for MI, BC and surge Version 9 20/12/2018 Jackie King Head of Minor update changes throughout as part of annual review, final Emergency Planning following consultation on the 20th December 2018 Version 9.1 5/3/2019 Jackie King Typos corrected following Mid Essex Audit committee meeting Head of Emergency page 10/11/16 Planning Version 10 17th January Jackie King Annual review of policy 2020 Head of Emergency NHS England to NHS England and NHS Improvement – East of Planning England Rota and pager responsibility changes Page 8 update to the role of the CCG in a major incident in line with Incident response plan and COPE Updated TNA appendix 3 Other minor word changes and clarification Consultation 11- 31st December further amendments as follows 3.2 Operational Arrangements: additional pager and on call folder information page 26 5.0 Surge information brief updated page 10 Addition weekend reporting section 7 page 11
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CCG specific information to be kept alongside this policy Version 11 April 2021 Karen Wesson Annual Review Director EPRR Policy streamlined and reference other policies reducing duplication in line with discussion with NHS England Remove North East Essex and West Essex CCGs following notice of MOU Removal of CCG Incident Log Sheet Addition of Record of Work Undertaken Form Version 11.1 June 2021 Jo Martindale Updated all references to Essex CCGs to mid and south Essex Business Continuity & CCGs. EPRR Officer
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Appendix 1 - CCG On Call Director Initial Incident Notification Record Time of call: Date: Organisation:
Name of caller and position: Contact Details Landline Mobile Email
Major Incident Declared or Standby:
Date and Time:
Command and control structure established /being established
Initial response strategy set, if so what is it
SCG activated Y/N
Exact Location Exact location /geographical area of incident
Type of Incident Flooding/Fire/Utility failure / Chemical / Disease outbreak etc.
Scale - How significant and widespread is the incident or might it become
Impact – How bad is it and how bad could it become
Duration – indication of how long it is likely to continue
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Hazards Present and Potential
Access Effective routes for access
Any road closures, inaccessible routes Routes safe to use
Number of Numbers and Types/severity Casualties / Fatalities Fatalities
Emergency Services Emergency services in attendance
Hospitals/ other health services involved
Receiving Hospitals
Partner agencies required Any other comments Any request for Action?
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Appendix 2 - Record of Work Undertaken Form
Name of person completing the form: Banding of person completing the form: Sheet number:
Date Time Work undertaken include detail for example: Action Taken this should include Time taken in Please tick if include contacted • Completed required routine submission if initiated incident response, set minutes claimed for day of (use 24- (OPEL, return, SITREP) up calls or meetings. payment week hour clock) • Attended scheduled meeting – detail contacted name of meeting e.g. GOLD call
• Pager or on call response – responded to pager/phone call from XXX, about XXX, point of contact
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Appendix 3 – Essex CCG Training Needs Analysis (2019)
Diploma in Strategic Health leadership in a Crisis Health Tactical Media Emergency Loggist (Integrated (Silver) Leadership Loggist refresher (Nominated Planning Training DipHep Strategic (Gold) in a crisis Spokesperson) Management For Health )
Director on Call NA E E N/A N/A E Senior Manager on D /E if one tier Call NA on call rota E N/A N/A D
Communications Lead NA N/A N/A N/A N/A E Emergency Planning Officers /leads E E E E E N/A
Loggists NA N/A N/A E E N/A All staff in the organisation NA N/A N/A N/A N/A N/A CCG Emergency Accountable Officer NA E D N/A N/A D
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Working Annual On Call Communication Live EPRR ICC Business With table Training cascade exercise introduction familiarisation Continuity Your top group/1:1 exercise 3 yearly Loggist exercise
Director on Call E E E E E E E E
Senior Manager on Call E E E E E E E E
Communications Lead E N/A E E NA N/A E E Emergency Planning Officers /leads E E E E N/A E E E
Loggists E N/A E E D N/A D D All staff in the organisation E N/A D E N/A N/A N/A D CCG Emergency Accountable Officer E E E E E E E E
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Mid and South Essex Clinical Commissioning Groups
Business Continuity Policy and Programme
June 2021 Version 3.2
1 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 105 of 211 Board / Governing Body Approval CCG Approval Date Basildon and Brentwood CCG Castle Point and Rochford CCG Mid Essex CCG Southend CCG Thurrock CCG
Version Date Author/Reviewer Comment issue/review Name and title Version 1.1 December Maxine Hazle A section added on succession 2016 planning for Essex CCGs Version 1.2 December Maxine Hazle Annual Review 2017 Version 1.3 January 2018 Maxine Hazle Mid and South Essex Sustainability and Transformation Partnership (STP) added to the policy Version 2.0 March 2019 Maxine Hazle Annual review Version 2.1 September Maxine Hazle Re worded Audit section 9.6.4 2019 Version 3.0 July 2020 Maxine Hazle Annual review Version 3.1 April 2021 Jo Martindale, Removal of WECCG and Business Continuity NEECCG & EPRR Officer Removal of section 6.2 Mid and South Essex Sustainability and Transformation Partnership Joint Committee Amendment of 7.1 Risk Management Strategy – figure 1 Amendment to section 10 Document Approval and Control Version 3.2 June 2021 Jo Martindale, Amendments to reflect feedback Business Continuity from CCG Audit Committee in & EPRR Officer Common: Updated all references to Essex CCGs to mid and south Essex CCGs. Amendment of the document approval route, removal of Mid and South Essex CCG Joint Committee.
2 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 106 of 211 Contents
Table of Contents Board / Governing Body Approval ...... 2 Contents ...... 3 1 Introduction ...... 5 2 Purpose ...... 5 3 Definitions ...... 5 Business Continuity Management System ...... 5 Business Impact Analysis ...... 6 Prioritised Activities ...... 6 Key Products/Services ...... 6 Maximum Tolerable Period of Disruption (MTPOD) ...... 6 Recovery Time Objective (RTO) ...... 6 Recovery Point Objective (RPO) ...... 6 Business Continuity Plans (BCP) ...... 6 4 Policy Statement ...... 6 5 Benefits of Effective BCMS ...... 7 6 CCG Roles and Responsibilities ...... 7 6.1 CCG Executive Board/Governing Body ...... 7 6.2 Accountable Officer ...... 7 6.3 Emergency Accountable Officer (EAO) ...... 7 6.4 Business Continuity Professional ...... 7 6.5 Heads of Service / Function Leads ...... 8 6.6 Business Continuity Plan Owner ...... 8 6.7 CCG Executive Lead for Procurement/Contracting ...... 8 7 Risk Management Strategy ...... 8 7.1 Risk Management Strategy – Figure 1 – sent to Governance leads for reviewing .... 9 7.2 Risk Identification and Assessment ...... 10 7.3 External Risks ...... 10 7.4 Internal Risks ...... 10 7.5 Risk Mitigation ...... 10 7.6 Risk Escalation ...... 10 8 Succession Planning ...... 11 9 BCM Lifecycle Model ...... 11 3 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 107 of 211 9.1 Policy and Programme Management ...... 12 9.2 Embedding Business Continuity ...... 12 9.3 Analysis ...... 13 9.4 Design ...... 13 9.5 Implementation ...... 14 9.6 Validation ...... 14 9.6.1 Training ...... 14 9.6.2 Testing and Exercising ...... 14 9.6.3 Review ...... 15 9.6.4 Audit ...... 15 10 Document Approval and Control ...... 16 10.1 Document Approval ...... 16 10.2 Document Control ...... 16 10.3 Document Publication ...... 17 10.4 Document Retention ...... 17 10.5 Freedom of Information ...... 17 Annex 1 – Business Continuity Self-Assessment Tool ...... 18
4 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 108 of 211 1 Introduction Business Continuity Management (BCM) is a statutory requirement for all the mid and south Essex Clinical Commissioning Groups (CCG’s) to undertake. The Civil Contingencies Act 2004 and the NHS England Emergency Planning Framework 2015 requires the CCG to have` a Business Continuity Management System and Policy to ensure that, in the event of a significant service interruption, critical day-to-day functions can be maintained whilst timely recovery and restoration of key services, systems and processes is also achieved.
It is the policy of the mid and south Essex CCGs to take all reasonable steps to ensure that in the event of a service interruption, the organisation will be able to maintain essential services and restore normal services as soon as reasonably practicable. The Business Continuity Management System (BCMS) and Policy aims to introduce the concept of BCM to the CCG.
2 Purpose This policy sets out the general principles and framework for the creation and revision of a Business Continuity Management System and Business Continuity Plans relevant to the business activities of the CCG.
The mid and south Essex CCG’s Business Continuity Management System and Policy provides a structure through which:
• A comprehensive BCMS is established and maintained; • Business Impact Analysis and Risk Assessment will be applied to key services and their supporting prioritised activities, processes and resources; • Key services, together with their supporting prioritised activities, process and resources will be identified • Plans will be developed to ensure restoration of key services to a minimum acceptable standard following disruption; • Invocation of business continuity plans can be managed • Accountable Officers, Chief Operating Officers, Emergency Accountable Officers, and CCG Executive Boards/Governing Body can be assured that the BCMS remains up to date and relevant.
3 Definitions The following definitions apply to the terms used in this document in accordance with ISO22301 the international standard for Business Continuity.
Business Continuity Management System ‘A holistic management process that identifies potential threats to an organisation and the impacts to business operations that those threats, if realised, might cause, and which builds a framework for building organisation resilience with the capability for an effective response that safeguards the interests of its key stakeholders, reputation, brand and value-creating assets.
5 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 109 of 211 Business Impact Analysis ‘The process of analysing activities and the effect that a business disruption may have upon them’
Prioritised Activities ‘Those activities to which priority must be given following an incident in order to mitigate impacts’
Key Products/Services ‘Beneficial outcomes provided by an organization to its customers, recipients and interested parties’
Maximum Tolerable Period of Disruption (MTPOD) ‘The time it would take for adverse impacts, which might arise as a result of not providing a product/service or performing an activity, to become unacceptable’
Recovery Time Objective (RTO) ‘The period of time following an incident within which a product or an activity must be resumed, or resources must be recovered’
Recovery Point Objective (RPO) ‘The point to which information used by an activity must be restored to enable the activity to operate on resumption, also referred to as Maximum Data Loss’ (Detailed on the AGEMCSU Disaster Recovery Plan)
Business Continuity Plans (BCP) ‘Documented procedures that guide organizations to respond, recover, resume and restore to a predefined level of operation following disruption’
4 Policy Statement It is the Policy of the mid and south Essex Clinical Commissioning Groups to ensure, so far as reasonable practicable, that the key services and prioritised activities, which contribute to the achievement of effective healthcare commissioning and management are protected against potential threats, such as:
• Loss of People (skills and knowledge) • Loss of Premises (buildings and facilities) • Loss of Resources (IT, information, equipment, materials) • Loss of Suppliers (products and services supplied by a third supplier)
This will be achieved by the implementation of an effective BCMS whereby:
• Responsibility for ensuring plans are capable of restoring a minimum acceptable standard of service delivery rests with the Accountable Officer and the Emergency Accountable Officer; • Supporting departments will provide professional support to improve resilience of prioritised activities and resources that support key services;
6 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 110 of 211 • Annual review of CCG business continuity process will be undertaken by the Emergency Planning Team, providing support and plan development as necessary; • Business Continuity Plans (BCP) will be exercised in line with the organisations exercise timetable, Department of Health requirements and any applicable service level agreements. Where necessary, modifications will be made to take account of exercise results; • Contracts with suppliers of critical goods and services will include a requirement for the supplier’s business continuity processes to be approved and exercised; and • All staff will be aware of the plans that affect their service area and role following invocation of business continuity plans.
5 Benefits of Effective BCMS The policy provides a clear commitment to establish a BCMS that will enable CCG’s to:
• Continue to provide key services in times of disruption; • Make best use of personnel and other resources in times when both may be scarce; • Reduce the period of disruption to CCG and their users, partners and stakeholders; • Resume normal working more efficiently and effectively after a period of disruption; • Comply with standards of corporate governance; • Improve the resilience of the CCG infrastructure to reduce the likelihood of disruption; and • Reduce the operational, financial and reputational impact of any disruption.
6 CCG Roles and Responsibilities
6.1 CCG Executive Board/Governing Body The CCG Executive Board/Governing Body are accountable to the public and NHS England for ensuring that a BCM framework is in place to safeguard that in the event of a disruption to services the public continue to receive the best quality and range of services it is reasonably practicable to deliver and that key services are maintained.
6.2 Accountable Officer The Accountable Officer holds the board/governing body level responsibility for ensuring the CCG meets its statutory duties through the implementation of an effective BCMS. They have the ultimate responsibility for the CCG, and for business delivery in all situations, including responsibility for approving all Business Continuity Priorities and Objectives.
6.3 Emergency Accountable Officer (EAO) Each of the mid and south Essex CCGs will have an EAO, this will be the Joint Accountable Officer for the 5 CCGs. The Emergency Accountable Officer has delegated authority for the strategic implementation of major incident and service/business continuity planning.
6.4 Business Continuity Professional The CCGs Business Continuity Officer is the professional lead for business continuity across mid and south Essex CCGs and will;
7 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 111 of 211 • Review and develop the BCMS (strategy, policies and documents) in line with statutory requirements, standards, best practice and the needs of CCGs; • Monitor standards and compliance with the policy, through review and audit; • Provide support and guidance to Emergency Accountable Officers and Heads of Service.
6.5 Heads of Service / Function Leads The CCG Head of Service/ Function leads will ensure:
• Communicate the implications of departmental changes that may impact the Business Continuity programme. • Collect information for the BIA • Develop, implement, and maintain departmental plans on behalf of the plan owner • Conduct and participate in exercises
6.6 Business Continuity Plan Owner Ensure that the Business Continuity Plan adequately reflects the organisations business continuity capability. Within the mid and south Essex CCGs this will be the Director of the service and they will ensure the plan is fit for purpose and need to sign the plan off before it can become final.
6.7 CCG Executive Lead for Procurement/Contracting The CCG lead for procurement/contracting is responsible for ensuring that suppliers and contractors have robust Business Continuity Plans in place to ensure they can meet their contractual obligations. For any significant contracts the CCG lead for procurement/contracting will forward the contractors and suppliers Business Continuity Plans to the mid and south Essex CCGs Emergency Planning Team, who will review the plans against the below standards and provide feedback and sign post the contractors and suppliers to the NHS England and NHS Improvement Business Continuity Toolkit.
• Emergency Preparedness, Chapter 6 Business Continuity Management • Business Continuity Institute Good Practice Guidelines 2018 • NHS England Core Standards for EPRR • NHS England Business Continuity Toolkit
7 Risk Management Strategy In implementing an effective BCMS mid and south Essex CCGs will ensure that business continuity processes are integrated within the Risk Management Strategy allowing consistent risk identification, assessment, mitigation and escalation to CCG Executive Boards/Governing Body as follows (Figure 1)
8 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 112 of 211 7.1 Risk Management Strategy – Figure 1
External Internal Risks Risks
BIA (Directors/Head of Departments)
Emergency Planning Team – identify risks and inform Heads of Service/ Department CCG
Risks to be agreed by Emergency
Accountable Officer
All high and extremes risks – escalate to the risk management corporate governance lead in each CCG/STP
Appropriate CCG/STP Risk Register
Governance approval:
Basildon and Brentwood Audit Committee Castle Point and Rochford Audit Committee
Mid Essex Audit Committee
Southend Audit Committee
Thurrock Audit Committee
And to CCG Boards as required
Mid and South Essex CCG Joint Committee
9 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 113 of 211 7.2 Risk Identification and Assessment The CCGs Emergency Planning Team will be responsible for identifying the Emergency and Business Continuity Planning Risks, these risks will be agreed by the Emergency Accountable officers.
The purpose of completing risk assessments and defining choices by allocating mitigating factors is to;
• Reduce the likelihood of a disruption to prioritised activities; • Shorten the period of disruption to prioritised activities; • Limit the impact of a disruption to the organisations key services.
Risk identification and assessment will focus on two main areas;
7.3 External Risks External risks which may impact prioritised activities will be identified by the Head of Emergency Planning using the Home Office and Council held;
• National Risk Register; • Regional Risk Register; and • Community Risk Registers
Risks identified from National and Community Risk Registers will be assessed using the worst credible case scenario. In addition, the BIA process may identify external risks.
7.4 Internal Risks Internal risks which may impact prioritised activities should be included within the BIA to establish;
• The impact using the descriptors of the Corporate Risk Register; • Mitigating factors; and • Residual risk score
7.5 Risk Mitigation The Emergency Planning Team and Head of Service/Department will be responsible for implementing risk mitigation to reduce the likelihood and/or impact of risks identified, with further assessment of any residual risk. Risk mitigation will be agreed by the CCG Emergency Accountable Officer.
7.6 Risk Escalation The Emergency Accountable Officer will escalate all high and extreme risks to the risk management corporate governance lead in each CCG to ensure inclusion on the CCGs Risk Register as deemed necessary.
7.7 Review of Risks
The Emergency and Business Continuity Planning Risks will be reviewed quarterly by the Emergency Planning Team or when required to record newly identified risks, unless a risk requires more frequent review.
10 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 114 of 211 The Emergency Planning Team will review high or extreme risks on a six monthly basis with the risk management Corporate Governance lead in each CCG to ensure that appropriate links are made to the CCGs own risk management processes as necessary.
8 Succession Planning Succession Planning is a process to help the CCG to be prepared to fill openings created by retirements or unexpected departures and also to be prepared to meet the demands for additional corporate leaders resulting from growth. With no strong succession plan in place there is an increased risk that the CCG is not prepared with the best-suited replacement in the event of unexpected departures of a top executive, this could hamper the decision- making ability of the CCG and may disrupt operations.
Each of the mid and south Essex CCGs has a different approach to Succession Planning. The approach for each CCG is detailed in their individual Business Continuity Plan. If the CCG has no Succession Plan in place and no action plan in place to develop a Succession Plan this will be identified as a risk in section 4 of their Business Continuity Plan.
9 BCM Lifecycle Model The process being used within the CCG’s is based on the Business Continuity Model outlined in The BCI Good Practice Guidelines 2018. The BCM Lifecycle shows the stages of activity that an organisation moves through and repeats with the overall aim of improving organisation resilience.
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9.1 Policy and Programme Management
Is at the start of the Business Continuity Management (BCM) lifecycle. It is the Professional Practice that defines the organisational policy relating to Business Continuity (BC) and how that policy will be implemented, controlled and validated through a BCM programme.
This includes:
• Agreeing the definition and objectives for Business Continuity within the CCGs • Agreeing the scope of the Business Continuity Programme • Identifying and agreeing the on the standards or guidelines that will be used as a benchmark for the CCGs Business Continuity Programme • Roles and Responsibilities for the Business Continuity Programme including response capacity • References to relevant policies, standards, and legal and regulatory requirements • Identification of interested parties • Agreeing methods and frequency for measurement and review of all stages of the Business Continuity Life Cycle • Agreeing methods for sign off and communication of the policy and all programme activities
9.2 Embedding Business Continuity
Is the Professional Practice that continually seeks to integrate Business Continuity into day to day business activities and organisational culture.
This will be achieved through:
• Raising awareness about Business Continuity through communications • Encouraging buy in from interested parties • Ensuring required competencies and skills are in place through the Emergency Planning teams training schedule • Ensuring appropriate training opportunities and learning opportunities are provided
12 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 116 of 211 9.3 Analysis
Is the Professional Practice within the BCM Lifecycle that reviews and assesses an organisation in terms of what its objectives are, how it functions and the constraints of the environment in which it operates. The main technique used for the analysis of the CCGs for Business Continuity purposes is the Business Impact Analysis (BIA). The CCGs Business Continuity Officer uses the BIA to determine the CCGs Business Continuity requirements.
The BIA process is summarised below and will be carried out with Heads of Services
• Prioritise the CCGs services by determining the Maximum Tolerable Period of Disruption (MTPOD) for each • Prioritise the process or processes required to deliver the CCGs most urgent services, including identification of the activities that make up those processes, if required • Priorities the activities that deliver the most urgent services and determine the resources required for the continuity of these activities following and incident, as well as their interdependencies • Perform a final analysis which should lead to the determination of Business Continuity requirements • Seek top management approval of BIA results • Risks – the internal risks will be identified in the CCGs overarching BCP and any specific risks to departments will be identified in the BC service level plans
9.4 Design
Design is the Professional Practice within the BCM lifecycle that identifies and selects appropriate strategies and tactics to determine how continuity and recovery from disruption will be achieved.
The CCG’s approach to determining BCM strategies will involve:
• Implementing appropriate measures to reduce the likelihood of incidents occurring and /or reduce the potential effects of those incidents • Taking account of mitigation measures in place • Providing continuity for critical services during and following an incident 13 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 117 of 211 • Taking account of services that have not been identified as critical
9.5 Implementation
Is the Professional Practice within the BCM Lifecycle that executes the agreed strategies and tactics through the process of developing the Business Continuity Plan (BCP).
The Business Continuity Plan ensures that actions are considered for:
• The immediate response to the incident • Interim solutions or maintaining an emergency level of service, leading on to reinstating full services
9.6 Validation
Is the Professional Practice within the BCM Lifecycle that confirms that the BCM Programme meets the objectives set in the BC Policy and that the organisations BCP is fit for purpose.
This will be achieved through:
9.6.1 Training Those individuals undertaking roles and responsibilities within business continuity or an incident must undertake appropriate training for their function in line with the ‘National Occupational Standards’.
Training will be undertaken in line with the annual training and exercise schedule agreed by CCG Executive Boards/Governing Body; this should occur regularly to familiarise staff with command and control procedures and to ensure there is no erosion of skills. Training records will be used as documented evidence of the completion of relevant and suitable training as per the Business Continuity Training programme document.
9.6.2 Testing and Exercising Plans developed to allow organisations to respond efficiently and effectively, must be tested regularly using recognised and agreed processes such as table top, command post or live exercises.
14 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 118 of 211 Roles within the plan (not individuals) are exercised to ensure any specific role is fit for purpose and encapsulates all necessary functions and actions to be carried out during an incident.
Through the exercising process, individuals have the opportunity to practice their skills and increase their confidence, knowledge and skill base in preparation for responding at the time of a real incident. Exercising will be undertaken in line with the annual Training and Exercise Schedule agreed by CCG Executive Boards/Governing Body and in line with NHS England ‘Emergency Planning Framework (2015)’ which defines the process and timescales for exercising. This includes a minimum expectation of a communications exercise every six months, a table top exercise ever year, and a live exercise every three years, in addition to any activation.
A post exercise report will be written to summarise the test/exercise and to highlight areas of best practice and for improvement, with lessons identified. Post exercise reports will follow the Document Approval Process (Section 14.1) before being submitted to the Local Health Resilience Partnership (LHRP), NHS England Midlands and East Local Team and shared with any external agencies as required.
9.6.3 Review The business continuity management review programme is the process by which mid and south Essex CCGs will undertake annual review of and continual improvement to the BCMS.
Annually in quarter 2 the Head of Emergency Planning will undertake a full EPRR and Business Continuity Management review including a full review against the EPRR national standards in conjunction with NHS England. The Head of Emergency Planning will produce an annual report which will be approved via the process set out in 9.1.
The purpose of the review is to ensure the effectiveness and management of BCMS and to set the Emergency Planning Work Plan for the coming financial year.
The annual report, summarising the findings of the review will be shared with NHS England and the Local Health Resilience Partnership as evidence of continual improvement.
The Head of Emergency Planning will also produce and submit as per 9.1 an additional update reports in quarter 1, 3 & 4. In addition the Head of Emergency Planning will meet as a minimum 6 monthly (Q1 and 3) with the CCGs Emergency Accountable Planning Officers to discuss BCM.
The Emergency Planning Team will provide information to internal/external audit in relation to the Business Continuity functions as required.
9.6.4 Audit The Business Continuity Management system will be audited in line with the CCG’s Audit Plan, the period between audits should not exceed two years and this timescale should be factored into the CCGs Audit Plan. The Audit process will include:
• Defining the audit scope 15 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 119 of 211 • Defining the audit approach • Reviewing the information gathered by the BCM activities • Identifying gaps in the content and level of information gathered • Obtaining and comparing relevant documentation, such as, BIA’s • Reference secondary sources such as, guidance, standards and legislation • Providing a draft audit report for discussion • Providing an agreed audit report incorporating recommendations • Providing an agreed remedial action plan, including timescales • Providing a monitoring process to ensure the action plan is implemented
The Emergency Planning Team will undertake a self-assessment of the BCMS annually with each mid and south Essex CCGs utilising the NHS England Core Standards and ISO22301 Business Continuity Self-Assessment Tool (Appendix one). The outcomes from the self- assessment will produced in a report and submitted as per the governance process in section 9.1.
10 Document Approval and Control
10.1 Document Approval All documents within the BCMS will be subject to the following formal approval, ratification and review process. All documents relating to Business Continuity will be circulated for comment to the CCGs EAO before subsequent approval by the CCG Board/Governing Body via the following Committees:
Basildon and Brentwood Audit Committee
Castle Point and Rochford Audit Committee CCG Board / Mid Essex Audit Committee AEO review Governing Body Southend Audit Committee
Thurrock Audit Committee
Approval of documents within Committee, Board and Governing Body Meetings must be reflected within the minutes taken.
Documents will be required to be reviewed annually from the date of ratification, unless otherwise stated, or sooner should there be a change to business process or services which affects the arrangements outlined within the document.
10.2 Document Control All documents will be subject to document control to ensure the most up to date version is in use as follows:
16 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 120 of 211 Sequence Explanation Example DRAFT First draft version of the document (should be DRAFT 4 May 13 followed by the date last updated) 1.0 First published version of the document. Version 1.0 X.X DRAFT Subsequent version of the document in draft format Version 1.1 DRAFT (should be followed by the date last updated) 4 May 13 X.X Subsequent version of the document published with Version 1.1 minor amendments X.0 Subsequent version of the document published after Version 2.0 annual review or major amendment
10.3 Document Publication Documents will be made available to all staff via the internal CCG website.
It is the policy of mid and south Essex CCGs to make Emergency Planning, Resilience and Response documents publically available via the public CCG website with information redacted as per Section 15.0 Freedom of Information.
Those individuals with business continuity responsibilities such as named roles within the plan and on call directors will receive an electronic copy of all newly published documents or versions via email from the Emergency Planning Team.
Stakeholders and partner agencies requiring copies of the EPRR documents will receive them electronically via email from the Emergency Planning Team.
10.4 Document Retention Electronic copies of all previous versions of documents will be retained for 7 years. All documentation will be reviewed before destruction to ensure it may not be required for any forth-coming/subsequent enquiry.
10.5 Freedom of Information The Freedom of Information Act 2000 gives the public a wide-ranging right to see all kinds of information held by the government and public authorities. Authorities will only be able to withhold information if an exemption in the Act allows them to. As such a publically available version of this document will be made available. In line with Government and NHS Document Protection Markings some information (confidential and sensitive) will be redacted from publically available versions.
17 Business Continuity Management System and Policy Version 3.2 June 2021 Next Review Date: April 2023 Page 121 of 211 Annex 1 – Business Continuity Self-Assessment Tool
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Mid and South Essex Clinical Commissioning Groups
Emergency Preparedness, Resilience and Response (EPRR) and Business Continuity Strategy
Strategy
Policy Author: Jackie King and Karen Wesson
Version: Version 6.1
Date ratified: Date (by virtual approval)
Ratifying Body: CCG Board/Governing Bodies
Review date: June 2021
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 127 of 211 Board / Governing Body Approval
CCG Approval Date V6.1 Basildon and Brentwood CCG Castle Point and Rochford CCG Mid Essex CCG Southend CCG Thurrock CCG
Version Date Author/Reviewer Comment issue/revie Name and title w Draft Version 1st July Jackie King, CCG This document has been developed utilising 0.1 Head of Resilience emerging national information/, local policy development and utilising the previous Emergency Preparedness, Resilience and Response (EPRR) Scope and Policy V2 (Brian Dobinson) 02/07/2014 Draft Version 3rd July Jackie King, CCG Incorporates the BC scope and policy 0.2 Head of Resilience Draft Version 6th July Jackie King, CCG Incorporates the Management review 0.3 Head of Resilience process sent for consultation to CCG EPRR leads and AO/AEOs July 2015 Draft Version 6th August Jackie King, CCG Amendments following consultation, 0.4 Head of Resilience comments from Mid CCG and B&B sent for final consultation Version 1 1st Jackie King, CCG No further amendments following final September Head of Resilience consultation with CCGs Version 2 12th Jackie King, CCG Version 1 reviewed against the New NHS November Head of Resilience England Emergency Preparedness 2015 Resilience and Response Framework 2015 Version 2.1 12th Jackie King, CCG Annual strategy review, slight amendments November Head of Emergency to reflect West Essex reporting to NHS 2016 Planning England and SE Essex new on call arrangements Version 2.2 18th April Jackie King, CCG amendment to 6.8 CCG Emergency 2017 Head of Emergency Planning Team – request mid Essex CCG Planning Version 3.0 September Jackie King, CCG Annual strategy review 2017 Head of Emergency Amendments Planning Command and control to reflect incident response plan review Hazard Analysis and Risk Management – section made clearer Assurance, Audit and Review – reporting increased to quarterly Training - updated Version 4.0 October Jackie King, CCG Annual strategy review , Reviewed by Head 2018 Head of Emergency of Emergency Planning and CCGs EPRR Planning lead / AEO, Changes made reflect any structure changes and improvement has been made to the flow of the document
Version 5.0 November Jackie King, CCG Annual Review. Reviewed by Head of 2019 Head of Emergency Emergency Planning and CCGs EPRR lead Planning / AEO, NHS England to NHS England and Improvement Rota management . Strategic refresher training added. And reference to
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 128 of 211 Suffolk LRF Version 5.1 May 2020 Jackie King, CCG Update requested from Mid Essex to make Head of Emergency it clear CCGs are informally aligned to Planning ISO22301 as do not have formal certification see page 5 paragraph 8 Version 6 February Jackie King, CCG Amended to reflect discussion with NHS 2021 Head of Emergency England EPRR colleagues that links can be Planning added where relevant to ensure national Karen Wesson references remain up to date. Director of EPRR North East Essex and West Essex CCGs removed as MOU ended 31 March 2021 Other minor amendments to titles and documents. Plan will need to be reviewed again when the NHS England and NHS Improvement Framework update is released Plan will need to be updated as Mid and South Essex CCGs reconfigure
Version 6.1 3rd June Jo Martindale, CCG Amendments to reflect feedback from CCG 2021 Business Continuity Audit Committee in Common: & EPRR Officer Updated all references to Essex CCGs to mid and south Essex CCGs.
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 129 of 211
Contents
1.0 Introduction ...... 5 2.0 Purpose ...... 6 3.0 Scope ...... 7 3.1 In Scope of this strategy ...... 7 4.0 Strategy Statement ...... Error! Bookmark not defined. 5.0 Command and Control (including On Call) ...... 7 5.1 Command and Control ...... 7 5.2 On Call ...... 8 5.3 Administration of On Call ...... 8 5.4 On Call Documentation ...... 8 6.0 Roles and Responsibilities ...... 8 6.2 CCG Executive Board/Governing Body ...... 8 6.3 Accountable Officer ...... 9 6.4 Accountable Emergency Officer (AEO) ...... 9 6.5 On Call Director ...... 9 6.6 Lay Board/Governing Body Member with EPRR Responsibility ...... 9 6.7 CCG Head of Emergency Planning ...... 9 6.8 CCG Emergency Planning Team ...... Error! Bookmark not defined. 6.9 Staff with Specific Resilience Roles ...... 10 6.10 BCMS Specific Roles ...... 10 7.0 Partnership Working ...... 10 7.1 Local Health Resilience Partnership (LHRP) ...... 10 7.2 Essex Resilience Forum (ERF) ...... 11 8.0 Communication and Information Sharing ...... 11 9.0 Record Keeping ...... 11 10.0 Hazard Analysis and Risk Management ...... Error! Bookmark not defined. 11.0 Development of Plans ...... 11 12.0 Business Continuity Management ...... 12 12.1 Business Continuity Management System Statement ...... 12 12.2 Benefits of Effective BCMS ...... 12 13.0 Assurance, Audit and Review ...... 13 13.1 CCG Assurance and Audit and Annual Review ...... 13 13.2 National Assurance 2017-18 Emergency Preparedness, Resilience and Response. .... 13 14.0 Training ...... 14 15.0 Testing/Monitoring/Exercising of Plans ...... 15 16.0 Review ...... 15 17.0 Document Approval and Control ...... 15 17.1 Document Approval ...... 15 17.2 Document Control ...... 16 17.3 Document Publication ...... 16 17.4 Document Retention ...... 16 18.0 Freedom of Information ...... 16 19. References ...... 16
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 130 of 211 1.0 Introduction
The NHS needs to plan for, and respond to, a wide range of incidents and emergencies that could affect health or patient care. These could be anything from extreme weather conditions to an outbreak of an infectious disease or a major transport accident or a terrorist act.
The Civil Contingencies Act (2004) requires NHS organisations, and providers of NHS-funded care, to show that they can deal with such incidents while maintaining services to patients. This work is referred to in the health service as ‘emergency preparedness, resilience and response’ (EPRR). (NHS England Core standards for emergency preparedness, resilience and response (EPRR) Jan 2013 amended 2020)
The Civil Contingencies Act 2004 (CCA) delivers a single, framework for the provision of civil protection in the UK. The principle objectives of the Act are to ensure consistency of planning across all government departments and its agencies, whilst setting clear responsibilities for frontline responders. CCGs can find the specific Cabinet Office content on the CCA at www.gov.uk/government/policies/emergency-planning
The Cabinet Office defines a Major Incident as:
An event or situation, with a range of serious consequences, which requires special arrangements to be implemented by one or more emergency responder agencies.
Notes:
a) ‘emergency responder agencies’ describes all Category one and two responders as defined in the Civil Contingencies Act (2004) and associated guidance; b) a major incident is beyond the scope of business-as-usual operations, and is likely to involve serious harm, damage, disruption or risk to human life or welfare, essential services, the environment or national security; c) a major incident may involve a single-agency response, although it is more likely to require a multi-agency response, which may be in the form of multi-agency support to a lead responder; d) the severity of consequences associated with a major incident are likely to constrain or complicate the ability of responders to resource and manage the incident, although a major incident is unlikely to affect all responders equally; e) the decision to declare a major incident will always be a judgement made in a specific local and operational context, and there are no precise and universal thresholds or triggers. Where LRFs and responders have explored these criteria in the local context and ahead of time, decision makers will be better informed and more confident in making that judgement.
Through risk assessment, planning, training and exercising mid & South Essex CCGs will ensure that they are capable of responding to incidents of any scale in a way that delivers optimum care and assistance to those affected, and minimises the consequential disruption to healthcare services and help brings about a speedy return to normal levels of functioning. mid & South Essex CCGs will have in place contingency plans that allow them to continue to provide services (or provision through its providers) during an incident, so far as is practicable and to recover from the additional pressure that an incident may place on an organisation.
The mid and south Essex CCG’s are committed to implementing an integrated and robust Business Continuity Management System (BCMS), via informal alignment to ISO22301 (Societal security- Business Continuity management systems) and the meeting of a number of statutory duties in relation to Emergency and Business Continuity Planning, to ensure the continuation of safe and effective healthcare commissioning and management.
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 131 of 211 The CCGs are required to comply with guidance and framework documents, including but not limited to;
• NHS England Emergency Planning Framework1 • NHS England Core Standards for Emergency Preparedness, Resilience and Response2; • NHS England Business Continuity Management Framework (January 2013). Guidance available at https://www.england.nhs.uk/ourwork/eprr/bc • NHS Standard Contract (General condition 30) • NHS England Operating Framework – Response to Pandemic Influenza3 • NHS England Concept of Operations for mass casualty events 2017 • NHS Constitution4 • National Occupational Standards for Civil Contingencies (NOS)5
This is achieved through the publication, testing and exercising of plans for key services as agreed by the CCGs Executive Boards/Governing Bodies.
2.0 Policy Statement An integrated approach for Emergency Preparedness Resilience and Response (EPRR) across the CCGs requires a single generic plan to be used. The CCGs accept their statutory duties as Category 2 Responders under the Civil Contingencies Act 2004 (CCA) and as such will cooperate with Category 1 Responders in order to enhance co-ordination, efficiency and to share information as required, prior to, during and following an incident.
The CCGs will have in place business continuity plans that allow them to continue to provide their core functions during a major incident, as far as practicable and to recover from the additional pressure that an incident may place on an organisation.
In addition to its duties contained within the Civil Contingency Act, the CCGs recognise their EPRR responsibilities as detailed within Section 46 of the Health & Social Care Act 2012 (H&SCA) and will, in partnership with its commissioned services meet this responsibility through: • Building upon the existing strengths of current multi-agency coordination and cooperation which includes local NHS Trusts and other Category 1 Responders; • Ensuring that responsibilities of the Resilience Forums and Local Health Resilience Partnership enhance any response to emergency arrangements, both during the response and recovery phase; • Fully integrating with partner agencies’ emergency arrangements, in supporting the local health economy; • Reviewing the state of readiness and operability to extend further, with the assistance of new and improved partnerships, the capability to handle a new kind and potential magnitude of threat; • Ensuring that plans for business continuity are in place; • Cultivating a culture within the CCGs to make emergency preparedness an intrinsic element of management and operations.
To achieve this the CCGs operate a 24/7 on-call Senior Manager rota. This is via the PageOne system.
The on-call will manage: • Major Incident Notifications; • Surge Management/Capacity Issues.
1 https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf 2 https://www.england.nhs.uk/publication/nhs-england-core-standards-for-eprr/ 3 https://www.england.nhs.uk/publication/operating-framework-for-managing-the-response-to-pandemic- influenza/ 4 https://www.gov.uk/government/publications/the-nhs-constitution-for-england 5https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/913502/ NRS_for_LRFs_V3.0__Aug2020.pdf
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 132 of 211 The purpose of this strategy is to provide the CCGs with an EPRR policy statement as required to comply with the core standards, ensuring that the organisations are aware of its responsibilities
3.0 Purpose
The purpose of this document is to ensure that the CCGs act in accordance with the Civil Contingencies Act 2014 (CCA), The Health and Social Care Act 2012 (H&SCA) and the NHS England national policy and guidance, by undertaking the following duties:
• To ensure that major incident and continuity plans have been established and are well communicated; • To ensure that the plans address the consequences of all situations that might feasibly occur; • To ensure that plans involve robust arrangements for the operational recovery from all such incidents; • To ensure that all key stakeholders are consulted and collaborated with concerning their role in the plan and that they understand those responsibilities; • To ensure that the plans are tested and are regularly reviewed; • To ensure that funding and resources are available to respond effectively to major incidents; • To ensure that all CCGs have access to up to date guidance relating to EPRR; • To ensure that staff receive emergency preparedness training that is commensurate with their role and responsibilities; • To ensure that indicators demonstrating emergency preparedness and/or early warning of risk are used within contracts and service specifications; • To ensure that the whole system is monitored and audited regularly. 4.0 Scope 4.1 The mid & south Essex CCGs covered in this strategy are:- • Brentwood and Basildon CCG - Phoenix Court, Christopher Martin Road, Basildon, SS14 3HG. • Castle Point and Rochford CCG –Pearle House, 12 Castle Road, Rayleigh • Mid Essex CCG including the Joint Commissioning Team - Wren House, Hedgerows Business Park, Colchester Road, Chelmsford, CM2 5PF • Southend CCG – Victoria Avenue, Southend-On-Sea SS2 6ER • Thurrock CCG - Civic Offices, New Road, Grays, Essex RM17 6SL 5.0 Command and Control (including On Call) 5.1 Command and Control For major incident standby or major incident declared affecting the CCGs area, bordering areas or the NHS England and Improvement Region the CCGs will be alerted via Director/Manager On Call Pager system usually by one of the following:
• NHS England and Improvement East of England • East of England Ambulance Service • NHS providers
It is possible that notification of an incident may originate from other sources/services e.g. Public Health England, NHS Digital, Essex Resilience Forum (ERF)
Each CCG is responsible for their local CCG incident response. Mid and south Essex CCGs have agreed a joint approach to incident management, with the lead coordinated via the EPRR team.
If the Director/Manager on Call receives major incident notification from another agency other than NHS England and Improvement East of England, the on-call manager will advise NHS England and Improvement East of England to discuss and agree the incident levels, the response required from the CCG and to agree support required from NHS England and NHS Improvement – East of England.
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As part of their collaborative EPRR function the CCGs have a generic Incident Response Plan which incorporates the Incident Coordination Centre (ICC).This plan defines the role of the CCGs in an incident. If and when required, in the event of an incident, the Incident Response Plan will be activated.
Each of the CCGs have their own CCG Business Continuity Plan which in the event of a business continuity disruptive incident details the CCG response and recovery arrangements to facilitate the restoration of activities and to mitigate the impacts of the business disruption to the CCGs operations and reputation
5.2 Operational Arrangements: The CCG On Call Director/Manager will respond to all requests from the NHS England and Improvement East of England Incident Director, but will effectively manage and liaise with providers of both commissioned services, and primary care, regarding their response to the incident, and that they are able to provide ‘Business as Usual’ services; in addition to managing surge at the Acute Trusts.
Each On-call director/manager has a pager to enable them to be contacted in an incident. The CCGs have in place handover arrangements for those on call.
The On-call director/manager is on call 24 hours a day during their on call period. During hours their on-call requirements can be supported “in hours” by their resilience teams.
The On-call director/manager may request the assistance of other CCG directors and senior managers when responding to an incident.
All calls and records of action taken must be logged and sent to the Emergency Planning Team within 72 hours of an incident to ensure that this is logged and reported on to NHS England EPRR team as required. 5.3 Administration of On Call The Resilience team or equivalent as nominated by the CCG’s Emergency Accountable Officer (EAO) will coordinate the on call rota and upload it on Resilience Direct, this includes the Easter and Christmas/New Year rota. 5.4 On Call Documentation Resilience Direct (https://www.resilience.gov.uk) contain a number of documents that may be needed by the on call managers/directors.
These include but not limited to: • CCG Incident Response Plan this includes the Incident Coordination Centre • CCG On Call Director Policy • Incident Log Sheet • Emergency Planning Contact Directory • List of trained Loggists • System Resilience/Surge and Public Holiday Plans • NHS England guidance including: o 12 hour Breach protocol Reporting Protocol: Ambulance Divert Requests o East of England Guidance Delayed Handover Protocol: Patient Safety in the Community PSitC • CCGs Business Continuity Plans • CCGs Mass Casualty Plans • National and Regional Plans and any current relevant information • Local event information 6.0 Roles and Responsibilities 6.1 CCG Executive Board/Governing Body
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 134 of 211 Each of the CCGs Executive Board/Governing Body are accountable to the public and NHS England and Improvement for ensuring that the EPRR framework including BCMS framework is in place to ensure effective responses to incidents and to safeguard that in the event of a disruption to services the public continue to receive the best quality and range of services it is reasonable practical to deliver and that key services are maintained 6.2 Joint Accountable Officer The mid and south Essex CCGs Joint Accountable Officer has overall responsibility for ensuring there are effective CCG arrangements for emergency preparedness, resilience and response and business continuity management in place to meet statutory requirements and guidance 6.3 Accountable Emergency Officer (AEO) The Emergency Accountable Officer (EAO), as required under the Health and Social Care Act 2012, is responsible for the strategic implementation of major incident and business continuity planning. The EAO or a nominated deputy has a duty to attend the Local Health Resilience Partnership (LHRP) Group. NHS England EPRR Framework6 defines the AEO responsibilities as:
• Ensuring that the organisation, and any sub-contractors, is compliant with the EPRR requirements as set out in the CCA 2004, the NHS Act 2006 (as amended) and the NHS Standard Contract, including the NHS England Emergency Preparedness, Resilience and Response Framework and the NHS England Core Standards for EPRR • Ensuring that the organisation is properly prepared and resourced for dealing with an incident • Ensuring that their organisation, any providers they commission and any subcontractors have robust business continuity planning arrangements in place which are aligned to ISO 22301 or subsequent guidance which may supersede this • Ensuring that the organisation has a robust surge capacity plan that provides an integrated organisational response and that it has been tested with other providers and partner organisations in the local area served • Ensuring that the organisation complies with any requirements of NHS England, or agents of NHS England, in respect of monitoring compliance • Providing NHS England with such information as it may require for the purpose of discharging its functions • Ensuring that the organisation is appropriately represented by director level engagement with, and effectively contributes to any governance meetings, subgroups or working groups of the LHRP and/or ERF, as appropriate 6.4 On Call Director (refer to section 5) The On-call director/manager is responsible for handling the calls they receive, either a critical, major or business continuity incident, surge requirement and responding as necessary.
In the event of a major incident or business continuity incident the director/manager On-call will be responsible for activating the incident response arrangements and if required, activating the Coordination Centre. 6.5 Lay Board/Governing Body Member with EPRR Responsibility The Lay Board/Governing Body Member has oversight at Board/Governing Body level for EPRR arrangements. 6.7 Emergency Planning Team The CCGs Emergency Planning Team has operational responsibility for ensuring that the organisations comply with EPRR legislation and policy requirements this includes ensuring the CCGs meet their responsibilities as per the NHS England Framework7.
These are: • Ensure contracts with all commissioned provider organisations (including independent and third sector) contain relevant EPRR elements, including business continuity
6 https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf 7 https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 135 of 211 • Monitor compliance by each commissioned provider organisation with their contractual obligations in respect of EPRR and with applicable Core Standards • Ensure robust escalation procedures are in place so that if a commissioned provider has an incident the provider can inform the CCG 24/7 • Ensure effective processes are in place for the CCG to properly prepare for and rehearse incident response arrangements with local partners and providers • Be represented at the LHRP, either on their own behalf or through a nominated lead CCG representative • Provide a route of escalation for the LHRP in respect of commissioned provider EPRR preparedness • Support NHS England in discharging its EPRR functions and duties locally, including supporting health economy tactical coordination during incidents (Alert Level 2-4) • Fulfil the duties of a Category 2 responder under the CCA 2004 and the requirements in respect of emergencies within the NHS Act 2006 (as amended). 6.8 Resilience Teams These individuals will be responsible for attending training as outlined in the LHRP training needs analysis and are responsible for responding to any incidents as detailed within the CCGs plans. AEOs must ensure there are sufficient staff trained in key roles. 6.9 Providers The NHS England Framework defines the requirements of providers including ambulance services, mental health services and primary care
7.0 Partnership Working 7.1 Local Health Resilience Partnership (LHRP)8 LHRPs provide strategic forums for joint EPRR planning across a geographic area and support the health sector’s contribution to multi-agency planning through the LRF. These forums will be co- chaired by NHS England and local lead director of public health (DPH).
• LRFs lead the multi-agency planning for any incident. LHRPs coordinate EPRR across their operational area and provide health input into LRFs. • LHRPs will ensure coordinated strategic planning for incidents impacting on health or continuity of patient services and effective engagement across LHRP and local health economies. • The DPH co-chair will have a specific responsibility to provide public health expertise and coordinate public health input. • The NHS England co-chair will provide local leadership on EPRR matters to all providers of NHS funded services and maintain engagement with CCGs to ensure resilience is commissioned effectively, reflecting local risks. The LHRP should consider, and contribute to, the Community Risk Register (CRR) developed by the ERF. These assessments should inform the planning and strategy set by the LHRP
The LHRP will coordinate health input to NHS England, PHE and local government in ensuring that member organisations develop and maintain effective health planning arrangements for incidents.
Specifically, the LHRP must ensure: • That the arrangements reflect strategic leadership roles, ensuring robust service and local health economy response at the tactical level to incidents • Coordination and leadership across health organisations within local health economies is in place • That there is opportunity for coordinated training & exercising • That the health sector is integrated into appropriate wider EPRR plans and structures of civil resilience partner organisations with in the LRF area(s) covered by the LHRP
8 https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 136 of 211 7.2 Essex Resilience Forum (ERF) The ERF is the strategic forum where system partners plan and address the multi-agency response to EPRR. The ERF is responsible for setting and determining the work programme and risks for the local system (Essex) and ensuring that plans are in place to address these.
NHS England and Improvement represents Health at a strategic level at the ERF.
The Emergency Planning Team or AEO delegated person will attend the ERF Risk Intelligence Group as required
8.0 Communication and Information Sharing Under the CCA 2004 responders have a duty to share information with partner organisations. This is seen as a crucial element of civil protection work, underpinning all forms of cooperation.
As Category Two responders, during a major incident, the mid & south Essex CCGs have a duty to share relevant information and cooperate with Category One and other responders. In practice this may mean cascading messages from other responders to warn and inform the public.
The mid & South Essex CCGs will formally consider the information that will be required to plan for, and respond to, an emergency. The mid & South Essex CCGs Information Governance policies and procedures should cover the requirements of EPRR. Further information can be found at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/60970/datapr otection.pdf.
9.0 Record Keeping All staff involved in the response to a declared incident must keep records of actions/decisions taken and submit these records to the mid & South Essex CCG Head of Emergency within 72 hours. A trained loggist and log book should be used in the event of a major incident.
10.0 Development of Plans Specific CCG plans to mitigate or manage identified risks/incidents and EPRR include: • CCG Incident Response Plan (In Place) • CCG Business Continuity Policy and Plans (In Place) • CCG Incident Coordination Centre Plan (In Place) • CCG Mass Casualty Non Acute System Response Plan • CCG Cyber Plan
Multi-agency plans will be developed through the Essex Local Resilience Forum (ERF) and health related plans co-ordinated on behalf of the ERF through the Local Health Resilience Partnership. Key Multi agency documents available include:-
These plans will be activated via the LRF/SCG if required. These include:- • ERF - Pandemic Influenza • ERF Combined Operational Procedures for Essex COPE • Multi agency Evacuation Plan • Media response plan for major incidents • ERF Fuel Plan • EFR Vulnerable Persons and Premises Identification Protocol • ERF Infectious Disease Plan • ERF Death Strategy • ERF Emergency Mortuary Plan • ERF Strategic Multi agency flood plan • ERF Adverse weather plan
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 137 of 211 12.0 Business Continuity Management The mid & South Essex CCGs Business Continuity Management System provides a structure through which: • A comprehensive BCMS (Business Continuity Management System) is established and maintained; • Business impact analysis and risk assessment is applied to key services and their supporting prioritised activities, processes and resources; • Key services, together with their supporting prioritised activities, process and resources are identified; • Risk mitigation strategies are applied to reduce the impact of disruption to key services in line with the Risk Management Strategy; • Plans are developed to ensure restoration of key services to a minimum acceptable standard following disruption; • Invocation of business continuity plans can be managed; • Plans are subject to ongoing exercising and revision; • Accountable Emergency Officers and CCG Executive Boards/governing body can be assured that the BCMS remains up to date and relevant. 12.1 Business Continuity Management System Statement Mid & South Essex CCGs will implement a robust BCMS whereby; • Responsibility for ensuring that plans are capable of restoring a minimum acceptable standard of service delivery rests with the Accountable Emergency Officer; • Supporting departments provide professional support to improve resilience of prioritised activities and resources that support key services; • Annual review of each of the mid & South Essex CCGs business continuity processes are undertaken by the mid & South Essex CCGs Business Continuity and EPRR Officer and the Head of Emergency Planning, providing support and plan development as necessary; • Business continuity plans are exercised in line with the CCGs/ organisations exercise timetable, Department of Health and NHS England requirements and any applicable service level agreements. Where necessary, modifications will be made to take account of the exercise results; • Contracts with suppliers of critical goods and services include a requirement for the supplier’s business continuity processes to be approved, and exercised. • All staff are aware of the plans that affect their service area and role following invocation of business continuity plans. 12.2 Benefits of Effective BCMS Effective BCMS will enable CCGs to; • Continue to provide key services in times of disruption; • Make best use of personnel and other resources in times when both may be scarce; • Reduce the period of disruption to CCGs and their users, partners and stakeholders; • Resume normal working more efficiently and effectively after a period of disruption; • Comply with standards of corporate governance; • Improve the resilience of the CCGs infrastructure to reduce the likelihood of disruption; and • Reduce the operational, financial and reputational impact of any disruption.
The mid & south Essex CCGs Business Continuity and EPRR Officer with the Head of Emergency Planning are responsible for undertaking an annual review of the business continuity management system and seeking Accountable Emergency Officers approval.
The mid & south Essex CCGs Business Continuity and EPRR Officer with the CCG Head of Emergency Planning will ensure that each CCG has the following in place: • Up to date Business Impact Analyses (BIAs) • CCG Corporate and Service Level Business Continuity Plans • CCG Business Continuity Policy
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 138 of 211 • CCG Operational Fuel Shortage response procedure • Information to support response and recovery e.g. staffing lists, suppliers, contact lists
Detailed information on business continuity management is available in the NHS England Business Continuity Management Framework http://www.england.nhs.uk/ourwork/eprr/ 13.0 Assurance, Audit and Review 13.1 CCG Assurance and Audit and Annual Review Assurance in respect of EPRR and Business Continuity arrangements will be provided to the CCG Board/Governing Body as outlined in section 17.1
Each financial year, in quarter two, the mid & South Essex CCGs Head of Emergency Planning will undertake a full EPRR and Business continuity management review against the NHS England EPRR national core standards. The Head of Emergency Planning will produce a report which will be approved via the process outlined in section 17.1
Each quarter 4, the Head of Emergency Planning will undertake an annual review against the Emergency Planning Team EPRR work plan. The Head of Emergency Planning will produce a report which will be approved via the process set out in section17.1
The Head of Emergency Planning will produce and submit as per 17.1 additional update reports in quarter 1 and 3
The mid & south Essex CCGs Head of Emergency Planning will ensure they meet with each CCG AEO, in person, at least annually and will otherwise communicate, as required, via email or phone on any key EPRR information, decisions and issues as required.
The mid & south Essex CCGs Emergency Planning Team will provide information to internal/external CCG audit in relation to the EPRR/business continuity functions in this strategy as required.
Aims and Objectives of EPRR/BCMS Review:- The aim of undertaking the EPRR and BCMS review is to ensure: • Performance of the EPRR and BCMS including incident/BC response is reviewed; • CCG Compliance with EPRR and BCMS Training, • CCG Compliance with Testing and Exercise and Audit Programmes; • Continued review of risks, including new and residual • Areas of improvement are identified and implemented;
Objectives The mid & south Essex CCGs main objective for undertaking the EPRR and BSCMS review are to: • Ensure approval of the EPRR and BCMS and its performance from Senior Management and CCG Boards/Governing Body; • Provide opportunities to assess the EPRR and BCMS for improvements and to provide assurance that it remains fit for purpose; • Ensure agreement and allocations of appropriate resource for the forthcoming year; • Ensure CCGs meet the national requirements • Increase assurance of mid & South Essex CCGs resilience to respond to and recover from all Incidents. 13.2 National Assurance - Emergency Preparedness, Resilience and Response. The annual EPRR National Assurance Process developed in 2013 is intended to ensure that NHS organisations are delivering and/or working towards meeting the requirements for EPRR.
The minimum requirements which commissioners and providers of NHS funded services must meet are set out in the current NHS England Core Standards for EPRR (Core Standards). These standards are in accordance with the CCA 2004 and the NHS Act 2006 (as amended).
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 139 of 211 The NHS Standard Contract Service Conditions require providers to comply with EPRR Guidance. mid & south Essex CCGs commissioners must ensure providers are compliant with the requirements of the EPRR Core Standards as part of the annual national assurance process.
NHS England and NHS Improvement seeks assurance from CCGs that they are compliant with the EPRR Core Standards. For the mid & South Essex CCGs, this assurance is supported by the mid & south Essex CCGs EPRR team. The mid & south Essex CCGs EPRR team ensure that the CCGs are compliant with the requirements of the Core Standards as part of the annual CCG assurance framework
The mid & South Essex CCGs Emergency Planning team will ensure that the CCGs meet the timescales outlined in the EPRR assurance process year on year. This process will ensure: • CCG self-assessment against the NHS England Core Standards for EPRR. • CCG Boards (or equivalent) are sighted on the level of compliance achieved, the results of the self-assessment and the action/work plan for the forthcoming period • that any additional assurance, e.g. ‘Deep dive’, is undertaken as required.
The mid & south Essex CCGs Emergency planning team will ensure oversight of the CCGs action plan and monitor progress with the CCG AEO
The mid & south Essex CCGs will seek assurance via the mid & South Essex CCGs Emergency Planning Team that for providers where they are the led commissioner, that the provider is compliant with the requirements of the Core Standards as part of the annual national assurance process.
The mid & south Essex CCGs Emergency Planning Team will assist NHS England and NHS Improvement East of England in the coordination of all mid and south health care provider responses and actively monitor on going progress against any resulting action plan
14.0 Training Those individuals undertaking roles and responsibilities within a major incident or business continuity incident must undertake appropriate training for their function.
Training needs will be identified through the Training Needs Analysis process and co-ordinated by the mid & south Essex CCGs Head of Emergency Planning. The EPRR and Business Continuity training schedule will be agreed by the CCG AEOs.
The mid & south Essex CCGs Emergency Planning Team will ensure systems are in place to ensure that staff are made aware of their CCGs Emergency and Business Continuity Plans and are trained as appropriate for roles that it is are anticipated they may be required to undertake. This will include:
• Mandatory Training for all staff (2 yearly) • On Call Training (All on call staff - tactical level) • Strategic Training (on call directors and senior managers) • Strategic Refresher training (on call directors and senior managers 2 yearly following full strategic training day) • Familiarisation training (Incident room and plans) • Loggist training • Business continuity training
All CCG training will be aligned to the standards for NHS incident training contained within the Skills for Justice National Occupational Standards (NOS) framework. http://www.ukstandards.org.uk
The Emergency planning team will keep records for all training undertaken by staff, with the exception of the mandatory training where the records will be kept by the individual CCGs and human resource departments
All staff undertaking the “Gold” or strategic training will be provided with a portfolio which they are expected to maintain.
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 140 of 211 15.0 Testing/Monitoring/Exercising of Plans Plans developed to allow organisations to respond efficiently and effectively to an incident must be tested using recognised and agreed processes including workshops, table top and live exercises.
Roles within the plan (not individuals) are exercised to ensure that specific roles are fit for purpose and that all necessary functions and actions anticipated to be undertaken by a role during an incident are reflected in the role requirements.
The CCGs undertake testing as defined by NHS England EPRR Framework9. EPRR exercises are part of the continuous improvement, lessons learnt from the exercises will inform reviews and updates to the plans, any resulting actions identified will be addressed.
The requirements for these tests are outlined within the Framework and requirement includes: • Six-monthly communications test, • Annual table-top exercise • Live exercise at least once every three years • Command post exercise every three years.
CCGs should consider exercising with partner agencies and contracted services where the identified risks and the involvement of partner organisations is appropriate. Learning from exercises must be cultivated into developing a method that supports personal and organisational goals and is part of an annual plan validation and maintenance programme.
The CCGs exercise schedule will be agreed via the document approval process in section 17.1.
16.0 Review This strategy will be reviewed annually or sooner if needed to reflect national policy change, or local guidance change or following an incident.
17.0 Document Approval and Control 17.1 Document Approval Prior to document approval, any documentation development, review or update will be shared with the CCGs for comment. For documents where collective agreement is required, following consultation/review, the CCGs EPRR team will coordinate a call to ensure that any feedback or change is agreed. It is essential that this resolved prior to CCG sign off, as such, it is the AEO responsibility to ensure that the changes reflect the opinion of the CCGs.
The review and approval of documents by the CCG Board/Governing Body or relevant sub-committee must be reflected within the meetings minutes.
All documents will be required to be reviewed on a two-yearly cycle from the date of ratification, unless otherwise stated. All documents will be reviewed if there is a national or local guidance change, a business process or service change that has a direct impact on a particular document.
The table below shows the respective governance approval route for any EPRR documentation.
Basildon and Brentwood Audit Committee Castle Point and Rochford Audit Committee CCG Board / AEO review Mid Essex Audit Committee Governing Body Southend Audit Committee Thurrock Audit Committee
9 https://www.england.nhs.uk/wp-content/uploads/2015/11/eprr-framework.pdf
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 141 of 211 17.2 Document Control All documents will be subject to Document Control to ensure the most up to date version is in use as follows:
Sequence Explanation Example DRAFT First draft version of the document (should be followed by DRAFT 21 June 13 the date last updated) 1.0 First published version of the document. Version 1.0 X.X DRAFT Subsequent version of the document in draft format (should Version 1.1 DRAFT be followed by the date last updated) 20 June 13 X.X Subsequent version of the document published with minor Version 1.1 amendments X.0 Subsequent version of the document published after annual Version 2.0 review or major amendment 17.3 Document Publication Once approved, each CCG must ensure that the document is available to all staff via the intranet
It is the policy of the CCGs to make Emergency Planning, Resilience and Response documents publically available via the CCG website with information redacted as per Section 13.0 of the Freedom of Information Act 2000.
Those individuals with specific emergency planning responsibilities such as named roles within the plan and On Call Directors will receive an electronic copy of all newly published documents or versions via email from the mid & south Essex CCGs Emergency Planning Team. All EPRR documentation will be published and available on Resilience Direct. 17.4 Document Retention The CCGs are responsible for retaining a copy of any documentation in line with their record/archiving policy requirements. All incident documentation must be kept for a minimum of 25 years.
18.0 Freedom of Information The Freedom of Information Act 2000 gives the public a wide-ranging right to see all kinds of information held by the government and public authorities. Authorities will only be able to withhold information if an exemption in the Act allows them to. As such a publically available version of this document will be made available. In line with Government and NHS Document Protection Markings some information (confidential and sensitive) will be redacted from publically available versions.
19. References • Cabinet Office (2012) Health and Social Care Act 2012 (Sections 46) • Cabinet Office Civil Contingencies Act (2004) 2010 No. 657 PUBLIC HEALTH, ENGLAND Cabinet office Legislation.gov.UK (2004The Civil Contingencies act) • NHS England Emergency Planning Framework 2015: • NHS England Core Standards for Emergency Preparedness, Resilience and Response 2018; • NHS England Business Continuity Management Framework (January 2013) • NHS England Operating Framework – Response to Pandemic Influenza (NHS England Guidance available at http://www.england.nhs.uk/ourwork/eprr/ ) • NHS England (2014/15) NHS Standard Contract Service Conditions Gateway No 00821 Dec 2013 (Service Condition 30), page 28.
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Emergency Preparedness, Response and Recovery (EPRR) and Business Continuity Strategy Version 6.1 June 2021 Next Review Date: February 2023 Page 142 of 211 ITEM 16 SEND UPDATE REPORT
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Agenda Item 16
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Special Educational Needs and Disabilities Bi-Monthly Update
Purpose of Report: To update on progress, achievements and challenges in respect of the Special Educational Needs and Disabilities (SEND) programme of work across South East Essex.
Recommendations and • Note the positive progress made to date decision/actions: • Acknowledge the need for further work to continuously improve services, procedures and protocols to ensure optimised outcomes for all children, young people and families with SEND in South East Essex.
Executive Summary (including This report provides Governing Body members with an overview of financial impact): progress and achievements made to date in relation to special educational needs and disabilities work programme across south east Essex. It also outlines current challenges and key opportunities as part of the wider system and local place plans for SEND to enable the CCGs to meet their statutory responsibilities for children and young people with SEND.
Written by/Presented by: Ross Gerrie, Children, Young People & Maternity Commissioning Manager Marie McEntee, Children and Young People Commissioning Manager Caroline McCarron, Interim Deputy Alliance Director, South East Essex
Executive Director Sponsor: Tricia D’Orsi, Alliance Director
Non-Officer/Board Sponsor: Dr Jose Garcia-Lobera, Chair, Southend CCG Dr Sunil Gupta, Chair Castle Point & Rochford CCG
Fit with CCG Strategic Delivering national and local priorities Objectives? Seamless, joined up services
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document).
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
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Have any financial implications been signed off by the Chief Yes No N/A Finance Officer? (Please Tick ) x
Has the Equality/Quality/Privacy Impact Assessment x highlighted any issues?
If yes, describe how they are resolved:
Details of Stakeholder, Patient & Essex Family Forum and newly formed Southend Independent Public Engagement: SEND Forum are involved with all key areas of development for SEND provision. Wider involvement includes Local Authority and Provider stakeholders as well as other voluntary sector groups.
Risks / Link to BAF: • Failure to comply with the SEND statutory BAF Ref: duties. • Unable to demonstrate robust health ICPS1b commissioning procedures to facilitate compliance. • Unable to demonstrate robust Joint Commissioning procedures with partners to facilitate compliance • Inability of CCG to ensure timely, input from health to panel assessments. • Failure to comply with written statement of action (WSOA) recommendations
Conflicts of Interest: None
1. Introduction:
1.1. The Special Educational Needs & Disability (SEND) Code of Practice provides statutory guidance on duties, policies and procedures relating to Part 3 of the Children and Families Act 2014 and associated regulations. It relates to children and young people with special educational needs (SEN) and disabled children and young people. A ‘young person’ in this context is a person over compulsory school age and under 25.
1.2. This regular report to the Governing Bodies provides members with an overview of progress and achievements made to date in relation to the SEND work programme across south east Essex. It also outlines current challenges and key opportunities as part of the wider system and local place plans for SEND to enable the CCGs to meet their statutory responsibilities for children and young people with SEND.
2. Background:
2.1. In October 2018 and September 2019 respectively, Southend and Essex were subject to separate Local Area SEND inspections, jointly carried out by the Department for Education and NHS England, to judge the effectiveness of the area in implementing the SEND reforms as set out in the Children and Families Act 2014. The outcome reports noted clear strengths within the respective local areas however, areas of significant weakness were also noted resulting in a requirement for both areas to have a Written Statement of Action (WSOA) and re-inspection within two years.
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2.2. As reported in previous papers, the WSOAs clearly outline the respective actions for each local area to undertake to address the significant areas of weakness and ultimately improve the experience and outcomes for children and young people (CYP). The re-inspection programme was suspended due to Covid but re-instated in April 2021. Both local areas receive regular progress visits from the Department for Education and NHS England in lieu of formal reinspection’s.
2.3 In late April 2021, Southend was formally advised of an upcoming re-visit from inspectors. The re-visit took place in early May 2021. This re-visit focused solely on the four areas of weakness outlined in the Written Statement of Action. CQC and Ofsted have now published the final letter. The letter is attached in Appendix 1. The report highlights improvements to the Local Offer, the multi-agency approach to education health and care (EHC) plans and better evaluation of education needs, as well as commenting on the ‘palpable’ change in culture and greater commitment to joint working for the best outcomes for children and young people with SEND in Southend. 2.4 However, inspectors found more progress needs to be made in joint commissioning but recognised that since March 2020 the pace of change had been ‘accelerated’ in this area. Inspectors also acknowledged that systems have now been established to ‘give clearer oversight of joint working and better accountability, but because of these necessary changes, some important elements of the WSOA are only recently established or not yet fully implemented.’ A follow-up meeting has taken place with Department for Education and NHS England to develop an Accelerated Action Plan by 20th August 2021.
2.3. Full Inspection Letters and Written Statement of Action Responses can be found within Appendix 1.
3. Progress:
3.1 Governance & Strategy
MSE Health and Care Partnership Priorities
3.1.1. The children and young people’s commissioning team under the leadership of Tricia D’Orsi in her role as SRO for Children & Young People, commissioners for MSE HCP have developed clearly defined health priorities for children and young people. SEND is unfailingly in the top three priorities for transformational change and improvement across the partnership.
3.1.2. In addition, a new Children and Young People’s Director role has been created to drive forward the CYP agenda across Mid and South Essex. This is an interim role, and is currently being filled by Helen Farmer (former Associate Director for CYP and maternity in Thurrock). This is an exciting addition to the children and young people’s team.
3.1.3. The MSE priorities are outlined below:
• SEND, including Covid 19 response, early identification of need, EHC Plans, Joint Commissioning, WSOA, Neurodevelopmental pathways, Learning Disability Health Checks and Transforming Care. • Mental Health – Transformation Plan, EWMHS re-procurement, MHSTs, Crisis support
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• Community & Acute Reset – CYP End of Life Care, Childrens Community Nursing, PCN delivered GP clinics, long-term conditions, outpatient activity and A&E/PAU activity
3.1.4. In South East Essex, our place priorities directly align to the MSE overarching priorities and include the following:
• SEND – Lighthouse Reset & Transformation Plan, Leadership & Partnership Working, Early Identification & Joint Commissioning • Mental Health – Covid 19 response, Local Transformation Plan, CYP mental health support in primary care, CYP counselling service, EWMHS • Community & Acute – CYP End of Life Care and Little Havens, Asthma workstream, feeding and swallowing service • Alignment and joint development of strategy for SEND for Southend and Essex Local Areas.
Designated Clinical Officer
3.1.5. Recruitment has begun for the Designated Clinical Officer (DCO) to work alongside the DMO in both Southend and Castle Point and Rochford.
3.2 Joint Commissioning
3.2.1 Commissioning Groups have been established to progress identified priorities for each Local Area. Terms of reference for the Joint Commissioning groups and subsequent task & finish groups have been formerly approved. Executive representation at the SEND improvement board is in place alongside commissioner and Designated Medical/Clinical Officer functions. The boards monitor the progress of the workstreams in accordance with WSoA and inspection revisit timeframes.
3.2.2 The Southend Local Area Joint Commissioning Group reports up to the SEND Strategic Board. The Group is focused on three key projects currently in progress:
Priority Area 1 The newly established Health Assurance Group continues to meet, and is (P1) – chaired by Dr Kate Barusya as the Designated Medical Officer. The Terms of Education, Reference are in draft form at the moment, but will be included in a future report Health and Care for information. Plans (EHCPs) – Quality This group has been driving forward the development of the EHCP Health Assurance Handbook – to be utilised by frontline staff to ensure they are familiar with the EHCP processes in Southend. This is currently on the agenda for the Southend Operational Group for feedback and approval.
A joint Audit Review has been established – this group will be responsible for auditing the completed EHCPs to ensure they have been delivered on time and the content is appropriate. Health will be represented on this group through the DMO and providers. Any issues found will be reported back to providers for them to action.
Further work is being started on the process for children moving into the area, to ensure that they do not have to start from the beginning of the process. We are working with providers on this. 4
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Priority Area 2 The Balance System project takes a whole system approach to delivery of (P2)– Joint effective, high quality therapies. Utilising all available resources i.e. early years Commissioning settings, schools, community health providers, voluntary sector etc., the of Therapies – balance system aims to embed universal, targeted and specialist approaches The Balanced to ensure early identification of need and the right support at the right time and System in the right place.
The balance system work incorporates both Southend and Essex therapy services, a dedicated project group with full terms of reference and a workplan is in place to lead and deliver this workstream.
Phase 1 is continuing to map all therapy resources and interventions across the Southend and Essex footprint. Better Communication (consultancy lead) are continuing to work closely with all therapy providers in Essex and Southend including A Better Start Southend. The early sharing of the SLT process has been scheduled for early July 2021. The Essex SEND Joint Commissioning Group (JCG) has agreed to extend the deadline for provider completion of the physio and occupational therapy mapping stage for Occupational Therapy and Physiotherapy to 31st August 2021. Mapping will be complete across all therapies with analysis complete and recommendations for next steps by September 2021. The Multi-school’s council are involved to lead on young people’s engagement. The Southend SEND Independent Forum (SSIF) and SEN Team Leader have been actively attending regular meetings for this work. A communications plan underpins the workstream. Engagement sessions and a survey have been advertised with core sessions developed for school, Early Years and other education settings to provide feedback. Uptake at the sessions has been limited to date therefore the project team are looking at additional ways to maximise meaningful engagement. This work is overseen by a multi- agency project team and key milestones are monitored through respective Joint Commissioning Boards and fed up to Strategic Boards for SEND in Essex and Southend. Priority Area 3 Neurodevelopment and particularly Autistic Spectrum Disorder (ASD) (P3) Multi- pathways have been an ongoing challenge in SEE. Through the Southend agency 0-19 Joint Commissioning Group, a multi-agency proposal has been developed and neuro- approved to pilot a new support pathway for children and families who are developmental potentially embarking on the diagnostic pathway. pathway. The proposal is to embed a multi-agency triage of all referrals for neurodevelopmental concerns. Through a combination of subject specialists (Consultants, therapists, School Nurses, Social Workers & Family Support Workers) all referrals will be triaged to identify the appropriate pathway to meet the needs of the child and family. This may be directly to an Early Help support pathway, directly to therapy support, directly to a consultant pathway, or a combination of the above. Through the referral process and with the help of the Family Support workers all the relevant information will be collated from the family, school and relevant health services at the outset. This will allow informed opinions at the triage stage and critically considerably speed up the pathway/journey.
A Task and Finish Group is in place to develop this single approach to co- ordination and support for children aged 5+. The service model has been coproduced with health, education and care colleagues together with SSIF, the Southend parent/carer forum. The group are focussing on the development of jointly agreed outcomes together with clear communications and support literature. 5
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Joint funding for this initiative has been developed and signed off through a formalised Section 75 agreement. A full action plan has been developed to capture all of the implementation and planning work prior to delivery stage. Implementation go live for the service is due in September 2021 following staff recruitment. This work is overseen by a multi-agency project team and key milestones are monitored through Joint Commissioning Board and fed up to Strategic Boards for SEND in Southend. Other areas of A next stage of developing a virtual SEND spend review has commenced to work currently identify opportunities from funding streams to optimise joint commissioning and taking place outcomes.
The Outcomes and Performance Framework has been finalised with a view to embedding a robust and detailed evidence base to effectively demonstrate the impact on children, families and services.
A commissioning roadmap for Southend has been finalised and was shared at the SEND Summit for review. Through the SEND Summit future priorities were developed which will help inform future iterations of the road map and in addition a forward plan has also been developed for the Joint Commissioning Group. The forward plan focuses priorities for the Joint Commissioning Group and will help inform the forthcoming strategy which is currently being developed. Strategy consultation is currently taking place and will be developed by September 2021.
A Communications Group has been established to develop a joint approach as to how SEND priorities and developments are communicated to wider partnership, families of children with SEND and to the young people themselves. Developing the voice of the child is integral to the work of this group.
A self-evaluation tool was developed, reviewed through the SEND summit and finalised prior to the inspection. This was developed to enable the partnership to measure the extent to which the Southend local area is effectively identifying, assessing and meeting the needs of children and young people with SEND and improving outcomes. The self-evaluation tool will be refreshed on a regular basis to help track and monitor progress for the local area.
A ‘Voice of the Child’ programme is continuing to be developed through a communications and engagement workstream to ensure that CYP with SEND have an opportunity to influence and share the development of services. Actively listening to the views of CYP, hearing their wishes and ideas and understanding their lived experience will greatly enhance how we scope, plan
and develop services in the future.
3.2.3. The Essex Local Area Joint Commissioning Group reports up to the SEND Improvement Board. The Joint Commissioning Group is focused on five projects currently in progress. Priority Area 1 As noted above within the Southend update, neurodevelopment and Neuro disability particularly Autistic Spectrum Disorder (ASD) pathways have been an pathway (inc ongoing challenge in SEE. recovery pathway for waiting lists) Through the Essex Joint Commissioning Neurodevelopment work stream a deep dive of services available in all CCGs within the Essex footprint has been completed, supporting the scoping of new models. 6
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Principles for a robust and effective pathway model have been agreed between all partners. These have also been circulated through to the Mid and South Essex Growing Well Board. Place based business cases are in development to ensure pathways/model reflect place based infrastructure and resources.
A CPR facing referral pathway is currently being scoped. The pathway takes account of the aims and objectives and key principles agreed across Mid and South Essex for neurodevelopmental need. Further coproduction has taken place alongside engagement with Essex County Council Universal commissioned services and commissioners of targeted service provision. Priority Area 2 See above detail outlined for Southend Priority 2 as this work is across Therapies (The Southend and Essex Local Areas. Balanced System) Priority Area 3 Peer review and mapping has been completed to understand the current SENDIASS and delivery model for the Special Educational Needs and Disabilities Essex family forum. Independent Advice and Support Service for Essex (SENDIASS).
Gaps in the current provision have been identified and a proposal for a short term solution has been submitted to the Joint Commissioning Board and agreed. The proposal outlines the need for the extension of a fixed term resource. Plans are in place to develop a longer term proposal for presentation in September 2021. Workshops will be being held in July to scope and design future delivery options. Priority Area 4 Mapping of health, education and social care equipment pathways is Equipment almost complete and the next steps will be to look at any alignment opportunities for consistent practice and standardisation.
An initial find from the mapping exercise was that the Lighthouse Centre were not ordering equipment via the Equipment Community Service in Essex – agreement has now been reached that all equipment orders will now come through ECL and the joint funding panel is required.
Essex Family Forum have carried out a survey with families on equipment, and this was presented to the Equipment Sub-group on 20th July. Findings from this will be included in actions from the sub-group as it moves forward. Data analysis is continuing to be undertaken to show spend and trends on ordering of equipment for children and young people, as well as waiting times. There is a particular focus on waiting time from assessment date to delivery date.
Work has begun on creating a public facing document/leaflet to ensure that families are fully informed of the process for their children and young people to get equipment, should they need it. This is being done in conjunction with Essex Family Forum and our providers. Priority Area 5 - An internal provider to ECC has been contracted to review the content and The Local offer. presentation of the Local Offer. A scoping document has been developed including web design, detailing a delivery plan with clear timelines. The current website content is being reviewed and re-written to comply with GDPR and accessibility (reading age) in anticipation of the new website going live in June 2021.
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Other areas of work Review, redesign and implementation of an innovative Education, Health currently taking and Care plan process is underway, aiming for individualised high-quality place plans that supports the child’s current needs and their aspirations. ISOS consultancy has been commissioned (jointly) to facilitate and support in the redesign of the Essex system (health representation throughout).
Commissioning representatives from Mid and South Essex CCGs are members of each workstream, alongside the parent/carer forum.
A draft Outcomes and Evidence Framework has been created with a view to embedding a robust and detailed evidence base to effectively demonstrate the impact on children, families and services alongside a joint performance dashboard across the 5 CCGs and local authority.
3.3 Autistic Spectrum Disorder (ASD) – Diagnostic Pathway
3.3.1 The CCGs currently commission autism assessment diagnostic provision from a range of providers. For CYP over the age of 5 years services are commissioned from; London Early Autism Diagnosis (LEAD) Service, Provide Wellbeing and Healios. Diagnostic provision for children up to the age of 5 years is provided by the Lighthouse through a multi-disciplinary team.
3.3.2 Diagnostic assessments across all providers were paused during the first lock down, slowly over the summer months services began to come back on line, the delay predominately centered on safety concerns of resuming face to face assessments. The Healios contract is a new venture for the CCGs and provides a fully digital diagnostic offer, all assessments are undertaken in a virtual but fully interactive way. This method of assessment is not suitable for all CYP but it has proven to be hugely successful in other areas across the county with very positive feedback from CYP and families.
3.3.3 There are a small number of cases the team have been unable to contact despite repeated attempts and a mechanism in place with the CRS for follow-up notification back to parent by letter and notification to the GP. The CRS are continuing to support with new referrals which is most appropriate at this time and we will achieve good lead in times for new appointments for new referrals requiring assessment.
3.3.4 At 31st January 2021 241 children over the age of 5 years were awaiting an ASD diagnostic assessment. At 15th March 2021, the number of children remaining on the waiting list is 88. By 10th June all CYP over 5 years of age from backlog caseloads were allocated to providers, and have been assessed or have an imminent appointment. This takes account of a small number of historically ‘hard to appoint’ cases. We have very good trajectories in place to undertake any remaining backlog cases in full by the end of July and cases now going through this process are new referrals. Commissioning arrangements remain in place to continue to maintain the current ASD assessment arrangements will be maintained to prevent increased waiting times in South East Essex for children over 5. These assessments have been commissioned from three separate Providers (LEAD, Provide Wellbeing and Healios), using this opportunity to do a test and learn of different models and evaluate how they integrate within the wider service pathways.
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3.3.5 The current arrangements for deploying the Central Referral Service (CRS) resource provision to administer referrals will be maintained at present for new cases identified as requiring assessment. For Children under 5 a reduction of waiting list initiative has been developed as part of a wider piece of work across Mid and South Essex providing significant investment which will further reduce waiting times for children under 5.
3.3.6 The Pan-Essex Triple P Online initiative was successfully implemented and integrated within the majority of local service provider organisations. There has been high levels of uptake in the programme/s from parents across the area, albeit with variances across the different referring service sectors. The pandemic disrupted the Stepping Stones additional support; however, this is being phased back into practice. The project has now been extended to March 2022.
3.4 Transforming Care
3.4.1 Work is underway through the pan-Essex Learning Disabilities Equalities programme (formerly Transforming Care programme) to develop transformation plans for children at risk of admission to assessment and treatment units (ATUs) with behaviour that challenges and/or autism/learning disability. Options have been defined to enhance an extended outreach/intensive home treatment services to prevent ATU admission and A&E attendance wherever possible which will be presented at the relevant boards in coming weeks for discussion.
3.4.2. The programme has developed a proposal to pilot an Intensive ‘Outreach Support Team’ with expertise in autism, this Essex wide team will have two main functions: • To provide therapeutic intensive support to the cohort of 30-40 C&YP with autism identified as being at risk of admission, with the aim of avoiding admission where possible. Or if the young person is admitted, to support the discharge planning process. • To support mainstream services (schools, EWMHS, social care etc.) to enable individuals to step down from the enhanced service when risks have reduced. The team will provide specialist risk assessment and management which is critical in holding risk safely without defaulting to an in-patient admission as well as specialism in sensory processing, a common complaint from families this is lacking from existing services and provision of psychological therapies that are adapted for people with autism.
3.4.3. Funding for the pilot has been secured through national grant funding and a provider has been identified to pilot the service. Initial governance arrangements for this service have now been complete and a project implementation group is being set up to develop the service.
3.5 Mental Health
3.5.3 A dedicated children and young people’s counselling service for Southend, Castle Point and Rochford and Mid Essex has been commissioned via mental health Local Transformation Plan monies. The negative impact of the covid pandemic has led to the development of this service, providing a much-needed service to support children and young people who are experiencing increased levels of anxiety and low mood. The service launched in August for a 6-month pilot. This service has gone from strength to strength, and is currently experiencing continued high demand for their interventions. In December 2020, additional funding was approved to extend the pilot for a further 6 months, in addition the capacity of the services was increased to meet rising and significant demand. Feedback to date has been very positive. Commissioners continue to monitor the service in line with demand. 9
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3.5.4 In February 2021, NHS England invited areas to submit further recommendations on locations for additional Mental Health Support Teams (MHSTs) in schools. Mid and South Essex submitted a detailed bid, one additional team has been proposed for Southend, in addition to the one team already in place. Two new teams have been proposed for Castle Point and Rochford as they do not currently have any MHSTs. Mid and South Essex HCP have now had confirmation of additional wave funding and implementation plans for the two new proposed teams have now been developed and an expression of interest notification has been sent to schools within Castle Point and Rochford. The response to the expression of interest has been overwhelming and an engagement and site selection event will take place at the end of September 2021 in order to finalise school selections.
3.6 The Lighthouse Development Centre
Community Paediatrics – Southend Hospital (Lighthouse Centre)
3.6.1 The community paediatric service based at The Lighthouse Child Development Centre in Southend provides services to support the care and development of children and young people.
This includes support for children and young people with a range of clinical needs affecting their development including cerebral palsy, genetic disorders, neuromuscular conditions and neuro-disabilities including ADHD and Autism. Services include community paediatricians, physiotherapy and occupational therapy. These services are currently provided by Mid and South Essex NHS Foundation Trust.
Demand for these services is growing and families have told us about their concerns and dissatisfaction, especially in regard to long waiting times. We have been working closely together to try and resolve some of the challenges but have not been able to deliver the improvements needed despite best efforts of all concerned.
The COVID-19 pandemic, and increased demand for hospital emergency services, has meant that the Trust and its staff have had to focus care on those with life threatening illnesses.
As the health system begins to recover and reset from the pandemic the Trust has reviewed its strategic plans and, as a result, informed Southend and Castle Point and Rochford Clinical Commissioning Groups that it is no longer in a position to provide community paediatric services and has formally given notice.
3.6.2 Working together across the Mid and South Essex system we have begun to explore how moving to a different provider will deliver a high-quality service for children, young people and their families.
3.6.3 Under NHS contract rules, the CCG is allowed to transfer the current contract to another NHS provider. The procedure, known as ‘contract novation’, will ensure that services can continue to be delivered. Work will now begin to identify a suitable alternative provider who will be responsible for delivering services for the next two and a half years covering the remaining contractual period.
3.6.4 This change will provide the opportunity all partners to work with staff, children and parents to redesign and transform the model of care so that it meets the current demand but also ensures services are fit for the future.
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3.7 General Provision
3.7.3 Positive Pathways, funded via a one-off ‘Covid’ grant from Essex County Council, which provides additional wellbeing Support for 11-16-year olds has now launched and has already demonstrated significant support take up from schools and wider partners to offer young people wellbeing support struggling to engage with school due to emotional wellbeing and mental health needs. The project will now move to an oversight and evaluation phase.
3.8 Parent Carer Forums
3.8.3 Since 2008 parent carer forums have been established in most local authority areas in England. Parent carer forums are endorsed and supported by the Department for Education via both a small financial grant and the provision of a dedicated advice and guidance provision, namely ‘Contact a Family’.
3.8.4 The new Southend SEND parent/carer forum, Southend SEND Independent Forum (SSIF), is going from strength to strength. Although still very new, the forum has quickly established a structured approach to involvement in the planning of local services and ensuring both the voice of the child and parent/carer is heard.
3.8.5 The Essex Family Forum is well established in Essex and has good links with health, education and care services. Both parent carer forums are currently working on resource pack guides for parents of children with neurodiversity needs.
4 Forward Plan
4.3.3 Continue to support delivery plans for the joint commissioning priorities for each Local Area, leading and contributing where required. 4.3.4 Finalise and agree EHCP Health Handbook for future publication. 4.3.5 Drive forward the actions from the Lighthouse development workshop, and update on progress at future meetings. 4.3.6 Continue the recruitment campaign for the Designated Clinical Officer. 4.3.7 Work with key providers and partner agencies to improve performance and waiting times with a view to enhancing the child/family journey and optimising outcomes. 4.3.8 Implement the QB Test model. 4.3.9 Commence delivery of the Mid and South Essex ASD waiting list initiative for backlog cases, including for children under 5 in South East Essex.
5 Recommendation:
5.1 Governing Body is asked to;
5.1.2 Note the positive progress made to date.
5.1.3 Acknowledge the need for further work to continuously improve services, procedures and protocols to ensure optimised outcomes for all children, young people and families with SEND in south east Essex.
Appendicies – SEND Inspection Reports Local Areas –
• Southend Local Area Revisit Report • Southend local area SEND Inspection Report • Southend local area SEND Written Statement of Action submission
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• Essex local area SEND Inspection Report • Essex local area SEND Written Statement of Action submission
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Page 155 of 211 ITEM 17 EXTENSION OF SOUTHEND CCG GOVERNING BODY MEMBER TENURE
Page 156 of 211 Agenda Item 17
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Extension of Southend CCG Governing Body Member Tenure
Purpose of Report: This report is brought to the Governing Body to update them following the request to extend Southend Governing Body Member tenure until 31 March 2022.
Recommendations and The Governing Body are asked to note the extension of Southend decision/actions: Governing Body member tenure until 31 March 2022.
Executive Summary A proposal was brought to the Joint Governing Body meeting in February (including financial 2021, which looked to extend the Southend CCG Governing Body impact): Members tenure up until 31 March 2022. Following this meeting, each Member Practice in Southend was written to asking for their support to extend the current Governing Body Members tenure until 31 March 2022. An alternative option was also provided to Member Practices if they felt this proposal was not acceptable and a full election process would be undertaken.
Following responses from the Member Practices, the Governing Body are asked to note the decision made by Member Practices who supported the extension of tenure until 31 March 2022. Following this meeting the required HR paperwork will be completed to ensure the process is completed.
Written by: Hayley Waggon, Interim Alliance Business Support Manager
Executive Director Sponsor: Tricia D’Orsi, NHS Alliance Director
Non-Officer/Board Dr Jose Garcia Sponsor:
Fit with CCG Strategic n/a Objectives?
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). n/a n/a
NHS Castle Point and Rochford CCG NHS Southend CCG
Page 157 of 211 Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Have any financial implications been signed off by Yes No N/A the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact Assessment highlighted any issues?
If yes, describe how they are resolved: N/A
Details of Stakeholder, N/A Patient & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: The extension of the tenure relates to Board Members, who are therefore have a conflict of interest. However, the decision to extend was made by the Membership and consequently the decision is to be noted by the Board.
NHS Castle Point and Rochford CCG NHS Southend CCG
Page 158 of 211 ITEM 18 COMMS & ENGAGEMENT REPORT
Page 159 of 211
Agenda Item 11 Comms & Engagement Report
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Purpose of Report: To update the Governing Body on how both Castle Point and Rochford and Southend Clinical Commissioning Group (CCG) has been informing and engaging local residents and stakeholders during the period from 19 March –18 July 2021 and plans for the next reporting period.
Recommendations and The Governing Body members are asked to note the report. decision/actions:
Written by/Presented Claire Routh, Head of Communications and Engagement by:
Executive Director Tricia D’Orsi, NHS Alliance Director, South East Essex Sponsor:
Non-Officer/Board N/A Sponsor:
Fit with CCG Strategic Objectives?
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this document). N/A
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Have any financial implications been signed off by Yes No N/A the Chief Finance Officer? (Please Tick ) x
Has the Equality/Quality/Privacy Impact x Assessment highlighted any issues?
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If yes, describe how they are resolved:
Details of Stakeholder, N/A Patient & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: N/A
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COMMUNICATIONS AND ENGAGEMENT REPORT 19 March – 18 July 2021 Submitted by: Claire Routh, Head of Communications and Engagement Status: For noting
1. Introduction
This report aims to demonstrate how both Castle Point and Rochford and Southend Clinical Commissioning Group (CCG) has been informing and engaging local residents and stakeholders during the period from 19 March –18 July 2021 and plans for the next reporting period.
If you would like to know more about this work or have feedback on the report, please get in touch with us by emailing [email protected]
2. Summary
This report includes:
• A review of communications and engagement activity supporting the ongoing COVID-19 incident response in mid and south Essex • Delivery against communications and engagement strategic priorities • Communications and engagement plans for the next reporting period • An insight dashboard reflecting the impact and outcomes of our communications work during the above reporting period
3. Ongoing COVID-19 response
The CCG communications team continues to work as part of a COVID-19 incident communications and engagement workstream for mid and south Essex. This workstream supports the central COVID-19 incident team as required.
The Mid and South Essex Health and Care Partnership communications team are members of the Essex Resilience Forum (ERF) communications group. This group brings together NHS organisations, local government and emergency services to coordinate the communications response to the pandemic across Essex. This forum meets at least one a week.
4. Delivery against communications and engagement strategic priorities
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This section includes information about activities which took place during this reporting period linked to strategic objectives for communications and engagement incident team.
❖ Objective 1 – Continue to embed a clear and consistent communications and engagement approach to support mid and south Essex CCGs to achieve their collective corporate objectives both in response to COVID-19 and as part of both the internal and wider reset plans
The Insight dashboard below offers information about how the communications and engagement team has supported the incident response and reset of services during the current reporting period.
❖ Objective 2 – Ensure that staff, patients, stakeholders and the local community receive timely, relevant and accurate information about the COVID-19 response and work around reset and recovery, with assurance we are listening and responding to their views
Virtual patient and community representative/reference group meetings
During this reporting period the CCGs have held three virtual patient and community reference group meetings, bringing together key community stakeholders and patient representatives to hear about ongoing pandemic response and service updates, the development of our integrated care system and engage with the CCG around service plans as well as bring their own questions and concerns to the forum.
All meetings were well attended, with comparable numbers to meetings in previous reporting periods and diversity of delegates including patient participation groups.
Minutes, presentations and actions logs for all these meetings can be found on each CCGs website page.
Resident surveys. Mid and South Essex Health and Care Partnership launched two resident surveys seeking views from receiving invitations, booking appointments, the venue and receiving the vaccination. This survey is applicable to anyone who has received the vaccination at any of sites. Feedback helps us to continually make improvements to the COVID-19 vaccination programme. Healthwatch Essex provided assistant to anyone who needed help completing the survey. An infographic of responses to the first survey can be found here
COVID-19 Outreach: reaching diverse communities
The below diagram summarises further example of co-produced outreach activities that have occurred during this time period.
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COVID-19 Outreach: “Essex Vax Van”
The launch of a visiting vaccination service has been a large project for the communications and engagement team during this reporting period. The idea of bringing vaccination sessions to seldom asked and vulnerable communities where they live and work came from an GP in south east Essex and was made real through a strategic partnership with Ford UK. More information about the service and images from the press launch are available on the Health and Care Partnership website.
Engagement with underserved groups in partnership with local voluntary groups and local authorities
We have been working closely with colleagues in partners organizations, particularly at Southend-on-Sea Borough Council (SBC) where we have the greatest diversity in population.
We are exploring links with a multi-cultural drop-in clinic held at the North Road Chapel located in the Milton Ward to offer VaxVan and/or community grants.
Southend Residents Federation have confirmed they are interested in exploring ways to work collaboratively to support and engage with people in the Kursal and Westborough Wards.
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Special thanks to Dr Taz Syed and CAST who are supporting ‘Covid Conversations’ to explore barriers with the group with the view to co-producing a clinic.
Conversations are also progressing with with South Essex Homes, Estuary housing, Children’s centres, Storehouse, South Essex Homes and St Lukes Community Hub to reach out to the Woodgrange Est, Queensway, Kursall, Westborough & St Lukes Ward.
Community Grants & CVS activity With pockets of low COVID-19 vaccination uptake, data showed certain areas/communities in Essex were not engaging in the national vaccination programme, we wanted to shift the power.
As part of a wider movement from top down, paternalistic service delivery to working with people to solve problems– we wanted to harness the ideas, knowledge and talents of local communities in new ways.
In line with the wide mid and south Essex Engagement framework we are therefore providing a share of their vaccination equalities funding to work with Centres Supporting Voluntary groups (CVS’s) to develop place-based projects that respond to local barriers. Working with grassroots groups and trusted communicators is vital to addressing low uptake and mitigate health inequalities. Working with CVS’s we will create community solutions that support and increase uptake at a local level through:
• Providing small grants to community groups to develop ‘covid conversations’ within their community (administered via SAVS) And working with CVS’s to; • develop projects and volunteering initiatives that tackle barriers to access • enable the distribution of trusted sources of information relating to the COVID-19 vaccine • promote and organise dates for outreach sessions and co-produced clinics
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Next Steps • Community Grants launched at the end of June. We will work with communities to develop solutions e.g. targeted comms that is co-designed with the community, or co- produce an outreach clinic using the VaxVan or EPUT bus/MTU (mobile treatment unit). SAVS, SBC & CCG will actively reach out to groups and areas where there is low uptake to promote the opportunity.
• Each CVS across mid and south Essex has been allocated grant funding to enable them to work alongside vaccination centres to help promote the vaccine in communities. The CVS will work directly with health colleagues to identify how they can best utilise their volunteers and community networks to help in areas with low uptake. E.g. may include localised leafleting/door knocking in postcodes with low uptake, pop up stands to promote the vaccine at food banks and community centres.
• Working with the Red Cross and ClearSprings to reach asylum seekers accommodated within Southend. Ongoing work that will involve translated survey to reach people to identify if they have been vaccinated, if not vaccinated support with translation services if required to help them access appointment. Project led by need to subject to responses outreach or hosted clinics with a translator will be supported.
• Continued efforts on developing clinics with the black African & Caribbean communities
Resident magazine
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The communications and engagement team continues to create the content for a quarterly residents’ magazine, localised to each CCG footprint but also containing essential information relevant to the entire 1.2m population of the Mid and South Essex Health and Care Partnership’s footprint. These magazines are currently published electronically to avoid the infection control and distribution issues that print editions would have and allow for easier sharing across social networks. The edition released during the current reporting period, which features key guidance on the COVID vaccination programme and the development of the local integrated care system, has been shared widely on social media and through partner networks and is available from each CCGs website page.
❖ Objective 3 – Support efforts to maintain public confidence in our services so that people access health and care support when they need it, promoting collaborative and new working arrangements across the system to maintain a positive perception of local health and care services
Statutory and additional annual reporting
All clinical commissioning groups in England were required by national regulations to compile, have audited and publish their Annual Report and Accounts for the 2020/21 financial year during this reporting period. In recognition of the additional pressure on CCGs during the previous financial year, NHS England removed the requirement for the annual report to contain a “Performance Analysis” section, where details of the previous year’s communications and engagement activity normally appears.
However, to offer assurance on their continued commitment to the principle of patient engagement in the design and development of healthcare as enshrined in the NHS Constitution, the team undertook to produce a separate report on their joint engagement activity during 2020/21. This was referenced by and published alongside the Annual Report and Accounts. Both documents can be downloaded from each CCGs website page.
Development of the integrated care system (ICS) for mid and south Essex
Community representatives and other key CCG stakeholders have been kept updated on the progress of the Mid and South Essex Health and Care Partnership towards statutory ICS status through various virtual meetings including the patient meetings referenced above and the regular Alliance meetings held with partners in each of the partnership’s “places” (Basildon and Brentwood; mid Essex; Southend; and Thurrock).
❖ Objective 4 – Continue to provide robust arrangements for maintaining relations with the media both proactively and reactively
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The Insight dashboard offers information about how the team has proactively and reactively worked with the media during this reporting period.
The launch of the Essex Vax Van mentioned earlier on in this report was also important to build relations with local, regional and national media by arranging an opportunity to interview and broadcast about the project at its first public session.
❖ Objective 5 – Continue to develop effective structures and mechanisms for meaningful and sustainable communication and engagement with key stakeholders, members, partners, patients, the public and local community groups, GP practices and CCG staff
Bespoke websites for our Primary Care Networks, maintaining a common look and feel
The communications and engagement team has been continuing to work with Primary Care Networks on development of a public facing website for each network.
Work is progressing well with the first wave of sites to be launched in mid-August, for the following PCNs: • Benfleet • SS9 (Leigh on sea) • Braintree • Colne Valley (pictured right) • Chelmsford City • Chelmsford West • Dengie and South Woodham Ferrers • Phoenix
The prototype website recently underwent independent user testing carried out by our web developer. Testers included two local healthcare professionals working in local PCNs as well as members of the general public. These included a youth representative and a person who relies on a screen reader for website access.
Testers were recruited via our partners at Essex Is United, Healthwatch Essex and Southend Youth Council.
Overall, the website was perceived positively and mostly rated as “very good”. Common concerns from user testing will be addressed before the launch date, which is expected to meet the following timeline:
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Wave One Wave Two Wave Three Wave Four (August 2021) (October 2021) (December 2021) (February 2022) • Braintree • Aegros • Canvey • Southend • Colne Valley • Chelmer • Rayleigh Victoria • Chelmsford City • Witham and • Rochford • Billericay • Chelmsford West Maldon • Stanford-le-Hope • Brentwood • Dengie and SWF • Southend East and Corringham • Wickford • Phoenix • Southend West • Tilbury and • East Basildon • Benfleet Central Chadwell (TBC) • SS9 • Grays • Central Basildon • Aveley, South (TBC) Ockendon and • West Basildon Purfleet (ASOP) (TBC)
Developing a single intranet for Mid and South Essex Health and Care Partnership staff
The creation of a single central resource for all partnership workers, clinical and non-clinical alike, including policies, news and opportunities for professional development is a new project to support our workforce as part of the ICS transition programme.
The communications and engagement team is leading the project and began by holding an engagement session which 36 members of staff attended to give their views on what such a resource should look like. This intelligence was supplemented by further comments in an online survey.
Having created a ‘wireframe’ plan for the intranet from that engagement, the team is now working with the CCGs’ IT provider, Arden and GEM CSU, to build and deliver the intranet in two key phases. Phase one is a soft launch scheduled for August 2021 to support the initial transition programme from CCGs to a single ICS organisation. The phase two launch for the completed Intranet should happen by early 2022.
The team will be working on a full internal comms marketing plan to coincide with the launch to ensure staff know a) it exists and b) how to use it and find what they are looking for.
Further information
The Insight dashboard below offers further examples information about how the communications and engagement team has proactively communicated and engaged with key stakeholders through regular newsletters, surveys and forums.
5. Plans for the next reporting period against communications and engagement objectives
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Key areas of activity over the next reporting period include:
• Engage with our communities, stakeholders and staff around the expected transition of the five mid and south Essex CCGs to a single ICS organisation along with other parts of the local NHS • Continue to support system priorities developing working relations with partners to support more joint projects • Exploring further opportunities to engage and work alongside children and young people/parent of those with SEN • Continue outreach to younger people and seldom-heard groups to maximise local take-up of COVID vaccination and reduce pressure on the health and care system from an increase in cases • Support and enhance public health messaging around the ongoing pandemic • Prepare for the formalisation of the joint communications team’s structure under the new ICS organisation • Ensure that ‘business as usual’ engagement on service development is not overlooked
6. Insight dashboard
The communications and engagement team has produced a dashboard which is based on the Government Communications Service Framework Evaluation Model. Because a dashboard was not produced for May Boards due to the production of the annual reports discussed above, this single Insight edition is for a longer reporting period than usual, 19 March to 18 July 2021.
This dashboard shows the output, outcomes and impact of our communications and engagement activities in response to the COVID-19 pandemic and wider corporate objectives.
Page 170 of 211 11 insi ht 1 MARCH TO 30 JUNE 2021 A look at COVID-19 communication and engagement across mid and south Essex CCGs
Digital Engagement As we start to transition into an ICS, we have adopted a new social media strategy to focus our efforts on pushing all our information out primarily to the Mid and South Essex Health and Care Partnership social media platforms. The analytics below therefore only reflect the results from these platforms.
TWITTER FACEBOOK INSTAGRAM LINKEDIN
681 Posts 354 Posts 166 Posts 34 Posts Reach 3.2M Reach 6.047K Reach 2.265K 158.1K Reach 6.362K 9.899K 317.5K Impressions Impressions 165.2K Impressions Impressions 1,489 206 373 961 Engagements Engagements Engagements Engagements Clicks Clicks 806 Clicks 3 Clicks 14 1,560
2,487 404 Total followers 1,016 219 Total followers Total followers Total followers
Top post Top post Top post Top post
14.386K Impressions 18.753K Impressions 13.971K Reach 158.815K Reach 80 Engagements 35 Reach 78 Engagements 2.070K Impressions 3 Clicks 39 Impressions 76 Engagements
Page 171 of 211 ESSEX COVID VACCINATION WEBSITE
AUDIENCE Users: ...... 32K TOP 10 PAGES Sessions: ...... 31K (all content)
USER ACQUISITION Homepage ...... 21,754 Search engine...... 15,788 Vaccination centres ...... 18,724 Referred from another website ...... 9,459 Social media ...... 1,823 Getting your vaccine ...... 8,140 Email ...... 448 Vaccine eligibility ...... 7,312 DEVICE News story: Plenty of vaccinations available Mobile ...... 23,115 in Essex: bookable and walk-in ...... 2,566 Desktop ...... 7,005 Tablet ...... 1,432
KEY TO DIGITAL METRICS
Social media Web analytics Email analytics
analytics Pageviews: the total number of Open rate: the percentage of pages viewed by all of your users. the total number of subscribers Impression: the number of times who opened an email campaign. your content is displayed, no In order to register an open rate, the total number of new matter if it was clicked or not. Users: the recipient needs to make an and returning visitors to your site. action of either downloading the images within the email or Reach: the total number of the period of time a clicking on a link. Therefore, unique people who see your Sessions: user is actively engaged with there could be people who read social media content. your website. emails who do not take one of these actions. The average open Engagement: the number of rate for the healthcare industry is the percentage of public shares, likes, retweets, Bounce rate: around 30%. visitors who navigate away from comments and mentions on the site after viewing only one your posts. page. A rising bounce rate is an Click-through rate: the indicator that your homepage is percentage of people who click Link clicks: the number of not doing its job. on a link or image within an email. clicks on links contained within your posts. Engagement rate: calculates the number of clicks and opens in Video views: the total number bulletins. This is the most relevant of views on video posts. email analytic as it shows how many subscribers are interacting with content and/or responding to communications over time. Page 172 of 211 Internal Communications STAFF VIRTUAL BRIEFINGS
Staff fed back through Feedback from staff Comments from engagement sessions has been positive: staff included: led by a staff taskforce “I think the honesty Mac has is team that they would 76% of staff strongly agreed appreciated, the ability to anonymise like to hear more from (19%) or agreed (57%) that questions allows people the the Joint Executive they felt more informed about opportunity to ask questions with the latest on key updates confidence, but also allows keyboard Team and be able to warriors to hide behind it.” ask them questions and current priorities as a result of attending the staff “It is good that these briefs are on a regular basis. It is also good to gain about key issues. briefing. 15% neither agreed or different information about the other disagreed and 10% disagreed or In response to this all staff CCG’s. It was also good to see other strongly disagreed. briefings across mid and south members of staff on the panel.” Essex CCGs were established “Really useful - allows consistency in March at the start of each 72% of staff strongly of message across the month and place-based agreed (16%) or agreed organisation.” briefings were then organised (56%) that it helped them to with alliance directors two understand the challenges weeks later to talk about facing the CCGs/system at the Constructive issues on a more local basis. moment. 16% neither agreed or feedback has included the On average almost half of our disagreed and 10% disagreed or below areas and changes have staff (around 230 people) staff strongly disagreed. been made as a result at each briefing to reflect these comments: have joined each briefing live • More time for question and and then a written FAQ and recording to watch later is sent answers out to staff after each session. • Having different execs or staff presenting • Varying the time of the monthly brief so more staff can attend
Connect: guidance COVID -19 fraud newsletter, Readership statistics accessing services over the May Staff Newsletter Bank Holiday and appointment of the Average of seven bulletins sent A bulletin to keep staff up-to-date Chief Finance Officer. between 19 May and 30 June: with news from across mid and south • Mandatory training and 21% of staff opened the bulletins Essex CCGs is sent to all CCG staff appraisals guidance (149 clicks) each week. • NHS Mail and support for staff 32% of staff clicked a link Due to changing the staff newsletter across mid and south Essex within the bulletin delivery software to using gov.delivery (139 clicks) in April 2021, the data in this report is 91% engagement rate* • Update on COVID-19 from May until July 2021. vaccination programme across mid and south Essex (135 clicks) Popular content *This engagement rate also takes into • COVID -19 Fraud Newsletter account the 12 all staff HR/comms Based on the top 25 articles the (133 clicks) topics staff were most interested in emails which have been sent to staff • Accessing health services over this reporting period were COVID-19 between 6 May and 30 June. Moving the May Bank Holiday (131 clicks) vaccination programme updates, forward we have separated the a NHS mail and advice article, • Appointment of the Chief bulletin list from the HR list so we can mandatory training and appraisals Finance Officer (58 clicks) more accurately report how Connect is performing. Page 173 of 211 LIVE LIFE CONNECTED
The communications The programme provides One participant said: team supported the a self-development online “I can already report launch of a new self- app where staff can work through zones to support positive changes. development platform their wellbeing. This is also I work nights and I have for staff across the complimented by weekly increased the quality of Mid and South Essex body works classes including my sleep and the food Health and Care yoga and zumba and an I eat at night. This has Partnership in online community for already made me feel early May. participants to share their progress and support each much better, at work other. To date [665] staff have and at home”. signed up and are benefiting from the programme. Average email engagement rate: 77%
STAFF ENGAGEMENT TASKFORCE
In March a staff Staff fed back on various parts taskforce was set up 113 engagement sessions of our organisation including were offered. to enable small staff our vision and strategy, organisational health and focus group sessions. HR support. As a result of They enabled staff to 253 colleagues across this feedback an action plan feedback on what it’s MSE CCGs attended - around has been put in place and like to work for the half our workforce. a number of changes made CCGs and what they as a result including the new staff briefings, informal coffee would like to see from staff also responded 180 mornings with execs in each a future organisation to a staff survey asking similar place, introducing 50 minutes questions to the workshops. as we move become meetings as standard to give and NHS ICS Body by staff breaks between meetings April 2022. and beginning to co-design with staff what our future structures will look like.
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Primary Care
During this period, the primary 28% of recipients opened the bulletin care bulletin transitioned to a new email provider, therefore the usual 10% of recipients clicked a link within information on analytics was only the bulletin partially available for the March period (2 March – 23 March) in the click to open rate usual format 37%
New look 30 April 2021 to 30 June analytics primary care (new email provider) bulletin Please note, at this stage (early May 2021) In early May, a new look primary care we had transitioned to a new email system, so bulletin was introduced to support health analytics may reflect this change in provider. and care staff working across mid and The results below show the average for the south Essex. We are testing out a new 8 editions that were sent during 30 April – 30 format that cuts down a lot of content and June: makes information easier to navigate.
The new bulletin will be published once 21% of recipients opened the bulletin per week on Wednesdays to cut email traffic. This is as a result of feedback from practices who prefer less bulletins per week 19% of recipients clicked a link within with more targeted and local content. the bulletin
60% engagement rate
Page 175 of 211 Media
The highlights of these three This was followed up by the launch Coverage 1160 pieces months were around the launch of of the Essex Vax Van, which again - many directly created the Robot Cats into care homes. made it on to national television – During March and April, the ‘cats’ with ITV News, The Guardian and by our own content and the care home using them BBC in May. made it on to BBC Radio Essex, BBC 5 Live, the Global Radio group Media Enquiries - 122 and on TV with BBC Look East and related mainly to hospital BBC Breakfast. waiting times and COVID vaccinations and a request for interviews with Ray Winstone on the skin campaign.
CARE MARKET E-BULLETIN
We have continued to Nine bulletins have provide bulletins to the been created with an care sector across mid average unique and south Essex every Engagement rate of two weeks. 113% in the new Gov Delivery format – suggesting that the bulletin is being shared beyond the distribution list.
Media releases relating to good news stories have be sent out – including the use of technology to improve people’s lives – happiness tables and robot pets.
Page 176 of 211 CHILDREN AND YOUNG PEOPLE
A successful We have continued to produce communications weekly bulletins for staff working within services for children and campaign was rolled out young people across Mid and South in Spring to launch the Essex. Top stories from 1 March to new digital eRedbook. 30 June have included videos to raise awareness of Self Help – Self Until now parents were given Harm and the Essex Youth Service a paper red book when their Essex County Lines campaign. We baby was born but with the are looking to make the Children and introduction of eRedbook, Young People’s Health and Care mums and dads can use their System Bulletin even more appealing and attractive over the next couple of smart phone or go online to months by including videos from CYP digitally track, manage and system leaders and partners talking record every aspect of their about their projects. baby’s health – including The average engagement rate for the vaccinations, growth and CYP system bulletin is . development - from birth 43% to early years. The project, launched in Southend, is being rolled out across Essex.
Page 177 of 211 Campaigns
COVID VACCINATION
Over the recent • Leafleting – promoting walk-in clinics months we have Results continued to work with • Banners and posters – promoting walk-in clinics our colleagues and Social media partners across Essex • Heart Essex radio campaign – to drive awareness of targeting 18 – 39-year olds Total posts...... 682 the vaccines among • DAX on demand digital streaming Total clicks...... 3451 the eligible cohorts, (e.g. podcasts) campaign – targeting 18 – 39 year olds as well as encourage Total reach...... 854741 uptake among some Total impressions. 369999 of the harder to reach communities and those Outreach activity to Total retweets/shares. . .837 who are hesitant or wish vaccinate hard to Total likes...... 747 to know more about the reach and diverse vaccines. communities Total comments...... 98 • Muslim community – Chelmsford, Braintree and Regular communication Southend (done by VaxVan has been maintained and GP) using a range of • Chinese community – channels: Chelmsford (VaxVan) • Social media posts - to engage • Traveller sites – Thurrock and new cohorts, information about others in MSE 2nd doses • Homeless Community – across • The Essex Covid Vaccination MSE, including visits to hostels, website soup kitchens, B&B’s
• Video – using community • Aveley Community Centre spokespeople, NHS colleagues • Girls Empowerment Initiative to instil confidence in the vaccines Tilbury (African Women’s Group) • Travel screens in high footfall • Southend campus for students areas, bus stops and train stations followed by pop up on the high – supporting Phase 2 of the street vaccination programme • Outreach to Welcome to the • Bus back advertising in popular UK – a migrant community group bus routes – encouraging people in Southend to have the vaccine as we head back to ‘normal’ • Outreach to the homeless community and to the mosques • – Newspaper print advertising in Southend promoting walk-in clinics Page 178 of 211 DAX
DAX (digital audio Campaign date exchange) is a means Start Date: of digital advertising 20th May - 16th June 2021 which allows us to reach the audience at scale as well as Impressions booked targeting specific 600,701 demographics across (Delivered 612,937. Over delivered by 12,236) their favourite music, radio and podcasts. Geo-Targeting Essex - 450,000 impressions (Delivered 459,130)
Thurrock - 66,621 Impressions (Delivered 67,992)
Southend - 84,080 Impressions(Delivered 85,815)
Target Demo
All Adults 18-24 and 25-44
HEART ESSEX RADIO CAMPAIGN
Essex - Phase 2 Campaign Dates Vaccine - Radio 19th May - 15th June 2021 Campaign Heard by 350,000 Order: 8305015 listeners accross Essex
286 x 30” commercials in total 4.3 Opportunities to hear
Page 179 of 211 ESSEX VAX VAN LAUNCHES
With pockets of low Mid and south Essex has COVID-19 vaccination since become the first uptake, data showed system in the region to certain areas/ achieve over 75% uptake communities in Essex on all ethnicities. were not engaging in the national vaccination programme, we wanted Initial evaluation to shift the power. findings* show: A unique partnership between the The model enables people to shape NHS in Essex and Ford to develop services that they need, and promote 98.2% of those who have world’s first ever custom-built COVID-19 opportunities to contribute as creative been vaccinated on the van rated vaccination vehicle. The initiative citizens to solve COVID-19 vaccine the service 10/10 enabled a new model of outreach uptake challenges. facilitating shared ownership ensuring culturally sensitive approach for Through engaging community Nearly half of those communities not engaging in the leaders, trusted voices are taking vaccinated (46%) stated that national COVID-19 vaccination control, ensuring slots are filled the model of vaccination service programme. sharing key information in a way offered affected their decision to others will respect and understand. receive the COVID-19 vaccination. 5 May saw the Since the launch of the van, bespoke co-designed vaccination clinics have 100% confirmed they press launch of the taken place in multiple locations would recommend it to others in across the ICS footprint including their community, reinforcing the #EssexVaxVan mosques, traveller sites and a subjective norm around COVID-19 Led by ICS communications team clinic specifically for our Chinese vaccinations. delivering: community.
3 Increased uptake of The flexibility *based on 40 surveys completed since May 2021. vaccination. of the model meant that 3 A mechanism for diverse split gender communities to co-design The NHS both in Essex and nationally clinics have a mobile solution and a voice has also benefitted from international, taken place in how to improve uptake. regional and local coverage detailing simultaneously innovative approaches to maximising 3 Stronger relationships with with sufficient uptake of the COVID-19 vaccine community leaders/trust. areas for privacy and dignity and reducing health inequalities – this choice of gender for who administers 3 Catalogue of international, included, BBC News, Asian Voice, the vaccine. Families have been national, regional, local The One Show and ITV news. able to be vaccinated together. media coverage. Information has been offered in While the power of this initiative different languages with trusted was through alternative community information about vaccinations during channels to reach people outside Ramadan cascaded at the time. of our corporate channels - reach Simple briefings were also supplied on social media has also ensured to onsite vaccine teams on equality positive corporate communications issues, actions to be taken and reaching over 379,000, high potential sources of support. engagement including over 7,000 views of the hero video.
Page 180 of 211 MY HEALTH MATTERS CAMPAIGN
We have launched a new campaign known as ‘My Health Matters’ which aims to bring together tools, tips and resources that can help people across mid and south Essex to take care of themselves and their families and support their health and wellbeing. The roll-out of the campaign is linked The campaign initially had a soft to a number of strategic priorities, launch on 20 April 2021 – however, including PCNs, our Primary Care creative agency support is now being Strategy as well as wider system explored to roll-out the campaign in ambitions. phases over the next 12 months
SKIN ANALYTICS
We launched a skin The campaign consists of: cancer campaign in • Interactive graphics –where you’ll June to support the see a mole or mark and the ABCD new technology now of skin cancer available in GP practices • Know the Symptoms campaign in mid and south Essex - Video about recognising the signs of skin cancer to support appropriate referral for skin cancer. • Concepts tested with building contractors – a prevention and early intervention message.
• 1000s of builders reached. National building contractors - including Neilcott Construction, Countryside Properties and Travis Perkins merchants all on board with the campaign.
Page 181 of 211 ITEM 19 REVISED COMMITTEE TERMS OF REFERENCE
Page 182 of 211
Agenda Item 19
Committee Terms of Reference
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting of 29 July 2021
Purpose of Report: To receive and approve harmonised Terms of Reference for the Finance & Performance Committee and Patient Safety & Quality Committee
1. Recommendations The CCG Board is asked to approve the Terms of Reference of the and following CCG committees: decision/actions: • Finance & Performance Committee (Appendix 1) • Patient Safety & Quality Committee (Appendix 2)
Executive Summary CCG commmittees began meeting in common as part of the CCGs’ (including financial impact): business continuity arrangements at the outset of the Covid pandemic. Committee Terms of Reference were not harmonised at this time as it was not clear how long these arrangements would continue, as a result of which there were variations in the remit and membership of these committees between different CCGs.
Since Business as Usual arrangements were re-commenced, a review of the way that CCGs receive assurance on finance, performance and quality issues has been undertaken with relevant committee members. The consensus was that the committees in common model was working well and should be continued. To this end, harmonised Terms of Reference have been developed so that each CCG’s committee has the same remit and broadly similar membership. The Terms of Reference have been approved by both committees in common who now recommend them for adoption by CCG Boards.
For South East Essex CCGs, these Terms of Reference replace the previous Terms of Reference of the Joint Quality, Finance & Performance Committee.
Written by/Presented by: Viv Barnes, Director of Governance & Performance Nicola Adams, Interim Associate Director of Corporate Governance
Executive Director Mark Barker / Rachel Hearn Sponsor:
Non-Officer/Board Sponsor:
Fit with CCG Strategic 9 - Achieve system and organisational transformation to streamline Objectives? decision making, improve VFM and better support new commissioning models
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Finance & Performance Committees in Common 16 June 2021 document). Patient Safety & Quality Committees in Common 13 July 2021
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Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: None identified
Escalation: None To the Board To another Committee To the BAF/CRR
Page 184 of 211 Appendix 1
NHS Castle Point & Rochford / Basildon & Brentwood / Mid Essex / Southend / Thurrock CCG Finance & Performance Committee Terms of Reference 1. Status 1.1. The Finance & Performance Committee (the Committee) is a committee of, and accountable to, the CCG Governing Body.
1.2. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the CCG's Constitution and Standing Orders.
2. Purpose 2.1 The Finance & Performance Committee will provide objective oversight and scrutiny of the CCG’s financial plans and decisions, including recommendations from the System Finance Leads Group, and will approve investment decisions within its remit according to the detailed financial limits set out in the CCG constitution. The Committee shall regularly review the CCG’s financial performance and identify the key issues and risks requiring discussion or decision by the Governing Body. The Committee will also review the performance of the main services commissioned by the CCG.
3. Authority 3.1. The Finance & Performance Committee is accountable to the Governing Body.
3.2. The Finance & Performance Committee is authorised by the Governing Body to: 3.2.1. investigate any activity within its terms of reference. It is authorised to seek any information it requires within its remit, from any employee, member of the CCG or member of the Governing Body who are directed to co-operate with any request made by the committee within its remit as outlined in these terms of reference; 3.2.2. commission any reports it deems necessary to help fulfil its obligations; 3.2.3. obtain legal or other independent professional advice and secure the attendance of advisors with relevant expertise if it considers this is necessary to fulfil its functions. In doing so the committee must follow any procedures put in place by the CCG and Governing Body for obtaining legal or professional advice; and 3.2.4. create task and finish sub-groups in order to take forward specific programmes of work as considered necessary by the Committee’s membership. The Committee shall determine the membership and
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terms of reference of any such task and finish sub-groups in accordance with the CCG’s constitution, standing orders and Scheme of Reservation and Delegation (SoRD).
3.3. For the avoidance of doubt, in the event of any conflict, the CCG’s Standing Orders, Standing Financial Instructions and the SoRD will prevail over these terms of reference.
4. Duties
4.1. The responsibilities and duties of the Finance & Performance Committee can be categorised as follows:
Financial Performance
4.1.1 To oversee the development of the CCG’s Financial Strategy and Revenue and Capital Plan and assure the robustness of any underlying assumptions made in drawing up these plans, ensuring that the CCGs act in accordance with their financial duties whilst supporting achievement of the system control total
4.1.2 To receive and advise on medium term financial and savings planning, including the refresh of the Financial Recovery Plan.
4.1.3 To review annual budgets/short-term financial plans prior to approval by the Governing Body.
4.1.4 To monitor in-year financial performance, reviewing and challenging the delivery of savings plans, seeking explanations for significant deviations from budgets and recommending corrective action should forecasts suggest that financial balance will not be achieved.
4.1.5 To consider and advise on the management of the capital programme.
Commissioning Performance 4.1.6 To maintain an overview of the performance of the main services commissioned by the CCG
4.1.7 To provide assurance and advise the Governing Body on performance against key contractual and national performance indicators, ensuring that action plans are implemented to address areas of significant underperformance.
Other Duties
4.1.8 To receive best value reports/benchmarking identifying outliers/issues and make recommendations regarding necessary action, as appropriate.
4.1.9 To seek assurance that effective management of risk is in place to manage and address finance and performance issues. This includes scrutiny of the relevant sections of the Board Assurance Framework and Corporate Risk Register.
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Investment (including Procurement)
4.1.10 To consider business cases / service proposals and recommend appropriate action, e.g. procurement route, ensuring compliance with appropriate legislation and guidance. The committee will approve investments and procurements within its delegated limits.
4.1.11 To review procurement outcomes and approve the award of contracts and/or make recommendations to the Governing Body, in accordance with the Scheme of Delegation.
4.1.12 To review and monitor the procurement programme and the contestability plan for key programmed procurements.
4.1.13 To review lessons learned from procurements and recommend changes to practice and procedures where necessary.
5. Membership
5.1. The Committee shall be appointed by the Governing Body.
5.2. The Committee’s membership will comprise:
1.1.1 Up to 2 Elected GP members of the Governing Body
1.1.2 Up to 2 Lay members of the Governing Body
1.1.3 Chief Finance Officer or nominated deputy
1.1.4 One other Executive Director or nominated deputy
6. Attendees
6.1. Only members of the Committee have the right to attend meetings.
6.2. The Chair of the Committee may invite other individuals (e.g. Performance Lead, Governance Lead) to attend all or part of a meeting as and when appropriate. Such attendees will not be eligible to vote.
7. Chair
7.1. The Committee will be chaired by a non-executive member of the Governing Body.
7.2. If an elected GP member of the Governing Body is the Chair, a Lay member will be the deputy Chair. If a Lay member of the Governing Body is the Chair, an elected GP member will be the deputy Chair.
7.3. In exceptional circumstances, where urgent action is required, the Chair is authorised to take urgent action with prior discussion with one other committee
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member. A report should be made to the full committee at the earliest next opportunity.
8. Quoracy
8.1. The quorum necessary for the transaction of business shall be three members including the CFO or nominated deputy and a non-executive member.
8.2. A meeting is established when members attend face-to-face, by telephone, video- call, any other electronic means or a combination of the above.
8.3. A meeting of the Committee at which a quorum is present, or are available by electronic means, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
9. Decision making and voting
9.1. The Committee will ordinarily reach conclusions by consensus. When this is not possible the Chair may call a vote.
9.2. Only members of the Committee may vote. Each member is allowed one vote and a majority will be conclusive on any matter.
9.3. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
9.4. If a decision is needed which cannot wait until the next scheduled meeting, the chair may conduct business on a ‘virtual’ basis through the use of telephone, email or other electronic communication.
10. Administration
10.1. The Committee does not meet in public but it may meet in common with other CCG committees.
10.2. Meetings will be held when required, with a minimum of 4 meetings per year.
10.3. Secretariat support will be provided to the Committee to ensure the committee can discharge its function effectively and efficiently.
10.4. The Chair will agree the agenda prior to the meeting and the agenda and supporting papers will be circulated in accordance with the time specified in the CCG Standing Orders.
10.5. Any items to be placed on the agenda are to be sent to the secretary no later than seven calendar days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair.
10.6. Minutes will be taken at all meetings including telephone and electronically facilitated meetings.
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10.7. The minutes and/or a report of the Committee’s proceedings will be ratified by agreement of the Committee or Committee Chair prior to presentation to the Governing Body and CCG Joint Committee.
11. Conflicts of Interest Management
11.1. No member of the Committee, or attendee, shall be present, take part in or be party to discussions about any matter relating to their own role.
11.2. The Committee will operate in accordance with Managing Conflicts of Interest: Statutory Guidance for CCGs and the CCG policy and procedure for managing conflicts of interest at all times.
11.3. Where a member of the Committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
11.4. Any declarations of interests, conflicts and potential conflicts, and arrangements to manage those agreed in any meeting of the Committee, will be recorded in the minutes.
11.5. Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the CCG policy and may result in suspension from the Committee.
12. Reporting Responsibilities and Review of Committee Effectiveness
12.1. The Committee will submit copies of its minutes and/or a report of its proceedings to the Governing Body and the CCG Joint Committee following each of its meetings. Where minutes and reports identify individuals, or otherwise fulfil the requirements, they will not be made public and will be presented at part II of the Governing Body meeting. Public reports will be made to satisfy the requirements of the 2012 NHS Regulations (CCG) 16(2-5).
12.2. The Committee will provide an annual report to the Governing Body to provide assurance that it is effectively discharging its delegated responsibilities, as set out in these terms of reference.
12.3. The Committee will conduct an annual review of its effectiveness to inform this report.
13. Review of Terms of Reference
13.1. These terms of reference will be formally reviewed by the Committee on an annual basis, but may be amended at any time.
13.2. Any proposed amendments to the terms of reference will be submitted to the Governing Body for approval.
13.3. A record of the date and outcome of reviews is kept in the CCG governance handbook.
Page 189 of 211 Appendix 2
NHS Castle Point & Rochford / Basildon & Brentwood / Mid Essex / Southend / Thurrock CCG Patient Safety & Quality Committee Terms of Reference 1. Status 1.1. The Patient Safety & Quality Committee (the Committee) is a committee of, and accountable to, the CCG Governing Body.
1.2. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the CCG's Constitution and Standing Orders.
2. Purpose 2.1 The purpose of the Patient Safety & Quality Committee is to provide oversight and give assurance to the CCG Governing Body of the quality of services commissioned directly by the CCG and/or those that serve the population of the CCG and to promote continuous improvement, learning and innovation with respect to safety of services, clinical effectiveness and patient experience.
3. Authority 3.1. The Patient Safety & Quality Committee is accountable to the Governing Body.
3.2. The Patient Safety & Quality Committee is authorised by the Governing Body to: 3.2.1. investigate any activity within its terms of reference. It is authorised to seek any information it requires within its remit, from any employee, member of the CCG or member of the Governing Body who are directed to co-operate with any request made by the committee within its remit as outlined in these terms of reference; 3.2.2. commission any reports it deems necessary to help fulfil its obligations; 3.2.3. obtain legal or other independent professional advice and secure the attendance of advisors with relevant expertise if it considers this is necessary to fulfil its functions. In doing so the committee must follow any procedures put in place by the CCG and Governing Body for obtaining legal or professional advice; and 3.2.4. create task and finish sub-groups in order to take forward specific programmes of work as considered necessary by the Committee’s membership. The Committee shall determine the membership and terms of reference of any such task and finish sub-groups in accordance with the CCG’s constitution, standing orders and
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Scheme of Reservation and Delegation (SoRD).
3.3. For the avoidance of doubt, in the event of any conflict, the CCG’s Standing Orders, Standing Financial Instructions and the SoRD will prevail over these terms of reference.
4. Duties
4.1. The responsibilities and duties of the Patient Safety & Quality Committee can be categorised as follows:
4.1.1 To develop and oversee implementation of the Quality Strategy for the CCG.
4.1.2 To seek assurance that the commissioning strategy and policies of the CCG fully reflect all elements of quality (patient experience, effectiveness and patient safety).
4.1.3 To provide assurance to the CCG Governing Body that commissioned services are being delivered in a high quality and safe manner.
4.1.4 To provide scrutiny, assurance and oversight of the performance of providers of NHS care against relevant targets and standards, e.g. NHS Constitution standards, Care Quality Commission Essential Standards.
4.1.5 To seek assurance that action plans to address areas of significant under- performance are being fully implemented in a timely fashion, including regulatory compliance and enforcement actions.
4.1.6 To ensure a clear escalation process, including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern and to keep the Governing Body informed of any escalations or sensitive issues in good time.
4.1.7 To have oversight of the process and compliance issues concerning serious incidents requiring investigation (SIRIs), including Never Events
4.1.8 To provide assurance and to advise the CCG Governing Body on performance and compliance with relevant CCG statutory duties, e.g. safeguarding children and adults.
4.1.9 To maintain an overview and scrutiny of the Continuing Health Care Service for adults, Individual Placements Team and children’s continuing health care
4.1.10 To receive and scrutinise internal reports, local/national reviews and enquiries and other data relating to patient safety and quality to ensure that ‘lessons are learnt’ and recommendations are incorporated in CCG processes (and those of providers) to strengthen clinical practice.
4.1.11 To oversee and be assured that effective management of risk is in place to manage and address clinical governance issues. This includes scrutiny of the relevant sections of the Board Assurance Framework and Corporate Risk Register.
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5. Membership
5.1. The Committee shall be appointed by the Governing Body.
5.2. The Committee’s membership will comprise:
1.1.1 Up to 2 Elected GP members of the Governing Body
1.1.2 Up to 2 Lay members of the Governing Body
1.1.3 Executive Director of Nursing and Quality or nominated deputy
1.1.4 One other Executive Director or nominated deputy
6. Attendees
6.1. Only members of the Committee have the right to attend meetings.
6.2. The Chair of the Committee may invite other individuals (e.g. Safeguarding Leads, CHC Team Leaders, Governance Lead) to attend all or part of a meeting as and when appropriate. Such attendees will not be eligible to vote.
7. Chair
7.1. The Committee will be chaired by a non-executive member of the Governing Body.
7.2. If an elected GP member of the Governing Body is the Chair, a Lay member will be the deputy Chair. If a Lay member of the Governing Body is the Chair, an elected GP member will be the deputy Chair.
7.3. In exceptional circumstances, where urgent action is required, the Chair is authorised to take urgent action with prior discussion with one other committee member. A report should be made to the full committee at the earliest next opportunity.
8. Quoracy
8.1. The quorum necessary for the transaction of business shall be three members.
8.2. A meeting is established when members attend face-to-face, by telephone, video- call, any other electronic means or a combination of the above.
8.3. A meeting of the Committee at which a quorum is present, or are available by electronic means, is competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.
9. Decision making and voting
9.1. The Committee will ordinarily reach conclusions by consensus. When this is not possible the Chair may call a vote.
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9.2. Only members of the Committee may vote. Each member is allowed one vote and a majority will be conclusive on any matter.
9.3. Where there is a split vote, with no clear majority, the Chair of the Committee will hold the casting vote.
9.4. If a decision is needed which cannot wait until the next scheduled meeting, the chair may conduct business on a ‘virtual’ basis through the use of telephone, email or other electronic communication.
10. Administration
10.1. The Committee does not meet in public but may meet in common with other CCG committees.
10.2. Meetings will be held when required, with a minimum of 4 meetings per year.
10.3. Secretariat support will be provided to the Committee to ensure the committee can discharge its function effectively and efficiently.
10.4. The Chair will agree the agenda prior to the meeting and the agenda and supporting papers will be circulated in accordance with the time specified in the CCG Standing Orders.
10.5. Any items to be placed on the agenda are to be sent to the secretary no later than seven calendar days in advance of the meeting. Items which miss the deadline for inclusion on the agenda may be added on receipt of permission from the Chair.
10.6. Minutes will be taken at all meetings including telephone and electronically facilitated meetings.
10.7. The minutes and/or a report of the Committee’s proceedings will be ratified by agreement of the Committee or Committee Chair prior to presentation to the Governing Body and CCG Joint Committee.
11. Conflicts of Interest Management
11.1. No member of the committee, or attendee, shall be present, take part in or be party to discussions about any matter relating to their own role.
11.2. The committee will operate in accordance with Managing Conflicts of Interest: Statutory Guidance for CCGs and the CCG policy and procedure for managing conflicts of interest at all times.
11.3. Where a member of the committee is aware of an interest, conflict or potential conflict of interest in relation to the scheduled or likely business of the meeting, they will bring this to the attention of the Chair of the meeting as soon as possible, and before the meeting where possible.
11.4. Any declarations of interests, conflicts and potential conflicts, and arrangements to
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manage those agreed in any meeting of the Committee, will be recorded in the minutes.
11.5. Failure to disclose an interest, whether intentional or otherwise, will be treated in line with the CCG policy and may result in suspension from the Committee.
12. Reporting Responsibilities and Review of Committee Effectiveness
12.1. The Committee will submit copies of its minutes and/or a report of its proceedings to the Governing Body and CCG Joint Committee following each of its meetings. Where minutes and reports identify individuals, or otherwise fulfil the requirements, they will not be made public and will be presented at part II of the Governing Body meeting. Public reports will be made to satisfy the requirements of the 2012 NHS Regulations (CCG) 16(2-5).
12.2. The Committee will provide an annual report to the Governing Body to provide assurance that it is effectively discharging its delegated responsibilities, as set out in these terms of reference.
12.3. The Committee will conduct an annual review of its effectiveness to inform this report.
13. Review of Terms of Reference
13.1. These terms of reference will be formally reviewed by the Committee on an annual basis, but may be amended at any time.
13.2. Any proposed amendments to the terms of reference will be submitted to the Governing Body for approval.
13.3. A record of the date and outcome of reviews is kept in the CCG governance handbook.
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Agenda Item 20.1
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
SUMMARY OF THE MEETINGS OF THE M&SE CCG PATIENT SAFETY AND QUALITY COMMITTEES MEETINGS HELD IN COMMON ON 11 MAY 2021 AND 13 JULY 2021
Purpose of Report: To provide the Board with a summary of discussions held at the M&SE CCG Patient Safety & Quality Committees meetings held in common on 11 May 2021 and 13 July 2021.
Recommendations and The Board is asked to note the content of the report. decision/actions:
Executive Summary The five M&SE CCG Patient Safety and Quality committees meet in (including financial impact): common on a bi-monthly basis. The report below provides a summary of discussions held on 11 May and 13 July 2021.
Written by: Sara O’Connor, Head of Corporate Governance, MECCG
Executive Director Rachel Hearn, Executive Director of Nursing and Quality Sponsor:
Non-Officer/Board Janis Gibson, Lay Member (Patient and Public Engagement) Sponsor:
Fit with CCG Strategic Strategic Objective 3: Make a step change in addressing inequalities and Objectives? quality priorities to deliver outcomes in accordance with Constitutional Standards.
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this The minutes of the PSQ CiC meeting held on 11 May 13 July 2021 document). 2021 were approved at the meeting on 13 July 2021.
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ) X
Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: PSQ risks are reported to each PSQ committees in BAF Ref: common meeting.
Conflicts of Interest: None identified.
Escalation: N/A To the Board
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To another Committee To the BAF/CRR
SUMMARY OF THE MEETINGS OF THE M&SE CCG PATIENT SAFETY AND QUALITY COMMITTEES HELD IN COMMON ON 11 MAY 2021 AND 13 JULY 2021
This report sets out the key discussions held at the Patient Safety & Quality (PSQ) Committee meetings held in common on 11 May 2021 and 13 July 2021.
11 May 2021
• The minutes of the previous meeting held on 9 March 2021 were approved, subject to a minor amendment. • The committees reviewed the PSQ risks and noted there were currently 6 red rated risks relating to medicines management, special educational needs and disability (SEND), Tier 4 children’s beds, Care Quality Commission (CQC) quality oversight, mental health quality and Serious Incidents (SIs). • NHS Patient Safety updates dated 30 March and 27 April 2021 were received and noted. • The Joint Committee / Acute Commissioning update reported noted that There was a rise in Meticillin Resistant Staphylococcus Aureus Bacteraemia (MRSAB) and Clostridioides difficile infections (CDI) against Zero tolerance/set objective ceiling expectations for 2020/21. 257 Serious Incidents, including 8 Never Events, were reported in 2020/21 across MSEFT. All ophthalmology, dermatology and colorectal RTT harm reviews had been completed for the year 2019/20 and up to January 2021. MSEFT had complied with their undertakings in relation to cancer harm reviews and all harm reviews had been completed with some areas of harm identified. A learning plan would now be developed • The EPUT Mental Health report noted that the Trust had commenced their new Patient Safety Incident Response Framework (PSIRF) process and the MSE CCGs were working in shadow form with them. Fortnightly meetings were taking place to review old SIs using the former process. EPUT had reduced their OPEL status from 3 to 2 following some quality visits and dialogue with the CCG mental health team. The Mental Health Taskforce had completed 4 reviews and some recurring themes had been identified. • The Learning Disability reported noted that Learning Disability Annual Health Check (LD AHC) performance was between 72% and 50% at the end of March 2021, with work ongoing to improve performance. The Essex Learning Disability Partnership (ELDP) meetings had been re-instated as part of contractual arrangements. The Learning Disabilities Mortality Review (LeDer) target for 2020-2021 was successfully achieved with all reviews completed within the agreed timeframe. • The Basildon and Brentwood Escalations report noted the closure of Ghyll Grove Care Home had been progressing well. Some concerns had been raised around capacity for specialist school nurses which had been escalated to the MSE Children and Young Peoples (CYP) forum and the SEND improvement board. • The Thurrock Escalations reported noted that 29 care homes in Thurrock had been rated as ‘Good’ and 7 as ‘Requires Improvement’. The newly appointed care home
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lead had been working closely to provide support. Funding had been secured to support some IP&C audits and support in care homes and an enhanced discharge to assess care pathway. An informal SEND inspection had been carried out prior to the formal follow-up SEND inspection, which was expected imminently. No additional concerns had been highlighted around health. 1 Thurrock GP surgery had been rated ‘Inadequate’ by the Care Quality Commission (CQC) and 1 as ‘Requires Improvement’. A lead primary care nurse had been working closely with the practices to support them. • The Castle Point and Rochford and Southend Escalations report provided an update on progress with reviews being undertaken regarding children and young people. An update on the shortage of Tier 4 beds mental health beds for children was also provided, noting that this was a national problem. An update on support provided to care homes within this area was also provided. • The Mid Essex Escalations report noted that Invasive Group A Streptococcus (IGAS) action plan had been completed at the end of April 2021. • The committees received a Safeguarding System Report outlining progress with reviews. The report also highlighted that the Domestic Abuse Bill had gained royal assent and was now the Domestic Abuse Act, which would provide increased protection for victims and strengthened measures to tackle perpetrators. In addition, the Liberty Protection Safeguards (LPS) Code of Practice was due in early Summer 2021 with implementation due in April 2022. The committees were asked to note the financial implications of implementation. It was also noted that the Care Sector Hubs had assumed an evolving role post C-19 in terms of safeguarding, quality and preparing for a third wave of C-19. • The M&SE CCGs Annual Quality Report 2020/21 was approved. • The Medicines Management/Controlled Drugs reported noted the differences identified in the delivery of Disease-modifying antirheumatic drugs (DMARDs) and anticoagulation drugs across MSE and action being taken to address this. Updated NICE guidance on the treatment of Atrial Fibrillation and anticoagulation had been received which was expected to change the way these diseases were treated. The committee endorsed the refreshed Memorandum of Understanding between NHS England/Improvement East of England and CCGs on the safe use of Controlled Drugs and supported the proposal for Rachel Hearn, Executive Director of Nursing and Quality, to be recognised as the Controlled Drugs Responsible Officer for the CCGs • The latest draft of the revised Infection Prevention and Control Strategy was supported by members. • The committees were shown a Patient Story relating to cancer services and were advised of action being taken to address issues identified. • A presentation on cancer harm reviews was provided by Dr Catherine O’Doherty, from MSEFT. • The committees were provided with an overview of transitional governance arrangements, which included the MSE CCGs Joint Committee being reconvened. Following discussion, it was the majority view of members that the PSQ Committees should continue to meet in common.
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13 July 2021
• The minutes of the previous meeting held on 11 May 2021 were approved with no amendments. • The committees were shown a patient story in which a patient shared her experience with the Specialist High Intensity Focus Team (SHIFT) in south east Essex. The story is included on the agenda of CCG Board meetings. • A report on the Serenity Integrated Mentory Service and SHIFT service was provided to the committees. A review is being carried out by Essex Partnership University Trust (EPUT) of these services following a national media campaign and the results will be shared at a future meeting. • A report on patient safety and quality risks was provided, 5 of which were rated red. It was noted that a review of the Board Assurance Framework was being undertaken. • The committees received and reviewed NHS Patient Safety Updates dated 25 May and 29 June 2021. It was agreed that a focussed discussion on the role of the CCGs’ Patient Safety Specialist would take place at a future committee meeting. • The committees received an update on infection prevention and control, serious incidents, Invasive Group A Streptococcal Disease Investigation report recommendations and harm reviews, Pathology First and Maternity services. The appendices to the patient safety and quality (PSQ) reports submitted to Board provide more detailed information. • Update reports were also received in relation to Mental Health, Learning Disability and Primary Care. Further information on these can be found in the appendices to the Board PSQ report. • The Basildon and Brentwood escalations report highlighted that the Continuing Health Care team had been commended by the regional NHSE/I lead for their timely and accurate Independent Review Panel (IRP) submissions. Discussions are ongoing regarding provision of additional capacity to support the specialist school nursing team requirements. Brentwood Community Hospital had received a positive response to a recent quality visit. • The Thurrock escalations report highlighted that a recruitment process was being undertaken to recruit to two Head of Nursing roles within Thurrock and Mid Esesx. • The Castle Point and Rochford and Southend escalations report advised that the CCGs had failed to meet the 80% target for CHC assessments for May 2021, reporting achievement of 70% and 66% respectively. As a result, the CCGs would be working with NHSE/I to agree a trajectory to get back to the reqiored 80% threshold. • The Mid Essex escalations report highlighted four historic active serious incident investigations, one of which would be considered further to understand the reasons for the delay in closing the incident. • The Adult and Children Safeguarding report provided an overview of active case reviews. The report also highlighted national, regional and local themes identified, safeguarding concerns and emerging risks. • The Medicines Management report noted that across the MSE CCGs the total volume of antibiotics prescribed had decreased dramatically throughout the past year, largely due to a marked decrease in amoxicillin prescriptions for children. An Antibiotic Forum had been established across primary care which would help to ensure consistency in practice and guidelines. A Medicines Management update is appended to the Board PSQ report.
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• The committees received a summary of complaints reported to the CCGs. • The committees received and noted the content of the MRSA Bacteraemia year- end report and Infection, Prevention and Control Annual Report 2020/21. • The committee received a care sector report, a summary of which is appended to the PSQ report. • The committees noted virtual decisions taken since the date of the last meeting relating to approval of provider quality accounts for 2020/21. • Revised Terms of Reference for the committees were approved and are included on the Board agenda for approval.
Recommendation:
The Board is asked to note the content of the report and seek any further assurance required.
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Agenda Item 20.2
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE
Purpose of Report: To provide the Joint Committee with a summary of the issues discussed at the Finance & Performance Committees in Common meeting on 19 May 2021.
Recommendations and The Joint Committee is asked to note the contents of this report. decision/actions:
Executive Summary Routine finance and performance monitoring reports were received with (including financial impact): no issues identified as requiring escalation to the Joint Committee and/or CCG Boards. No commissioning or contracting reports were reviewed that require Joint Committee approval.
Written by: David Triggs, Joint Committee Secretary Presented by:
Executive Director Mark Barker, Joint Chief Finance Officer Sponsor:
Fit with CCG Strategic Objective 2: Improve access to services for patients in line with NHS Objectives Plan requirements. Objective 4: Achieve key statutory financial duties including delivery of the system financial control total.
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ) X
Has an Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: Relevant F&P risks from the BAF are reviewed at each meeting
Conflicts of Interest: None identified
Escalation: N/A To CCG Boards, another Committee or BAF Page 201 of 211
FINANCE & PERFORMANCE COMMITTEES IN COMMON UPDATE
Purpose
To provide the Joint Committee with a summary of the issues discussed at the Finance & Performance Committees in Common meeting on 19 May 2021.
Key Points
The following issues were discussed:
• Financial and Performance Risks – the Committees in Common agreed the proposed 2021/22 financial risks for inclusion in the Board Assurance Framework. • Financial Sustainability – Dawn Scrafield CFO at Mid and South Essex Foundation Trust (MSEFT) gave a presentation on the MSE System financial sustainability including the scale of the ask (a current year forecast deficit of £205m) and the work being conducted with support from PWC to identify the drivers of high costs and interventions that would help the health system to address the financial challenges that exist. • Joint Commissioning Team (JCT) Finance Report – the Committees in Common received a report on the Month 12 JCT financial position. • Performance report (Acute and Non-Acute) – the Committees in Common received a summary of performance against constitutional standards including Referral to Treatment, Diagnostics, Cancer, Integrated Urgent Care, Stroke, NHS111, Advice and Guidance and ambulance standards. The Committees noted Non-Acute targets delivered at a local level included IAPT (Psychological Therapies, Learning Disability Health Checks, Severe Mental Illness Health checks. All areas had put in place recovery plans and achieving the recovery would be very challenging. • 2021/22 Business Plan and CCG Budgets. The Committees noted the business plan arrangements for the second half of the financial year which would be presented to the CCG Boards for approval in May 2021. • Children and Young Persons with ASD. The Committees approved the award of a 12-month contract to pilot an Assertive Outreach Community service for Children and Young People with autism and at risk of admission. This was part of a national standard set out within the NHS Long Term Plan.
Recommendation
The Joint Committee is asked to note the contents of the report.
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Agenda Item 20.3
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
Audit Committees update report
Purpose of Report: To provide assurance to the Board in relation to the conduct of audit committee business.
Recommendations and The CCG Board is asked to NOTE the update from the Audit Committee. decision/actions:
Executive Summary The Audit Committees of the five CCGs across mid and south Essex (including financial impact): have been holding meetings in common from May 2021. This report provides an update to the CCG Boards regarding the business conducted by the Audit Committees highlighting any risks or issues that should be noted by or escalated to the Board.
Two meetings of the Audit Committees have been held to date on 25th May 2021 and 16th July 2021. Decisions taken at the meetings held were quorate with good attendance from members.
The following items were approved by the Audit Committees: • Extension / roll over of policies that did not require significant change to ensure that policies were current. This decision was previously noted at CCG Board Meetings • Information Governance policies. • Emergency Planning Resilience and Response Policies, which were recommended for Board approval. • Internal Audit, Counter Fraud, Security Management and External Audit Plans.
The following items were received and noted by the Audit Committees, providing assurance that robust processes and systems of internal control were in place and operating as expected: • Internal Audit, Counter Fraud and Security Management Reports – no significant issues were raised. • External Audit Reports – no significant issues were raised, but CCGs confirmed that the annual report and accounts were prepared on a going concern basis. • 37 waivers, to the value of £1.073k, approved by the Chief Finance Officer were noted at Castle Point and Rochford, Southend, Mid Essex CCGs in May 2021. 4 waivers, to the value of £2,858k, approved by the Chief Finance Officer were noted in Mid Essex and Basildon & Brentwood CCGs in July 2021. • Information Governance Report, highlighted poor performance in complying with the Freedom of Information Act as a result of delays due to the COVID pandemic. The July meeting noted that all CCGs had submitted their Data Protection and Security Toolkit as ‘compliant’.
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Items escalated by the Audit Committees: • Risks relating to the Trust undertakings and workforce were escalated to the Board Assurance Framework.
In addition to meetings being held in common each of the CCGs held individual meetings in June for the approval of the CCGs Annual Report and Accounts. Each Committee either approved (where delegated to) or recommended to the Board the approval of the Annual Report and Accounts, noting the contributions of the CCG staff to ensure the statutory requirements were achieved.
Written by: Nicola Adams, Associate Director of Corporate Governance (Company Secretary), Thurrock CCG, Castle Point & Rochford CCG and Southend CCG.
Executive Director Mark Barker, Chief Finance Officer Sponsor:
Non-Officer/Board Audit Committee Chairs Sponsor:
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).
Reports Submitted to Board only: Date signed-off by Executive Team. N/A (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact Assessment been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: N/A
Escalation: N/A To the Board To another Committee To the BAF/CRR
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Agenda Item 20.4
NHS Castle Point & Rochford CCG and NHS Southend CCG Part I Board Meeting 29 July 2021 via Microsoft Teams
SUMMARY OF DISCUSSIONS HELD AT THE M&SE CCG PRIMARY CARE COMMISSIONNG COMMITTEES MEETING IN COMMON ON 9 JUNE 2021
Purpose of Report: To provide the Board with a summary of discussions held at the M&SE CCG Primary Care Commissioning Committees meeting held in common on 9 June 2021.
Recommendations and The Board is asked to note the content of the report. decision/actions:
Executive Summary With effect from 1 April 2021 all five M&SE CCGs are now (including financial impact): responsible for fully delegated Primary Care commissioning. The committees of each CCG held their first meeting in common on 9 June 2021 and the report below summarises the items that were discussed.
Written by: Viv Barnes, Director of Governance & Performance, MECCG
Executive Director William Guy, NHS Alliance Director for Basildon & Brentwood and Sponsor: SRO for Primary Care for MSE CCGs
Non-Officer/Board Pauline Stratford (Primary Care) Sponsor:
Fit with CCG Strategic 2 - Improve access to services for patients in line with NHS Plan Objectives? requirements; 5 - Transform and strengthen community and primary care services; developing and strengthening PCNs to bring care closer to home and avoid hospital admissions; 7 - Expand and embed an increased range of digitally delivered services to support better access, efficient services and self-care; 8 - Address workforce challenges within the system and support our staff to deliver the vision across the health and care partnership for mid and south Essex.
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this N/A document).
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick ) X
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Has the Equality/Quality/Privacy Impact Assessment X been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
Conflicts of Interest: None identified.
Escalation: N/A To the Board To another Committee To the BAF/CRR
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SUMMARY OF DISCUSSIONS HELD AT THE M&SE CCG PRIMARY CARE COMMISSIONING COMMITTEES MEETING IN COMMON ON 9 JUNE 2021
This report sets out the key discussions held at the Primary Care Commissioning (PCC) Committees meeting held in common on 9 June 2021 as follows:
• The minutes of previous meetings were approved, and the action log reviewed.
• The Committees received a Primary Care contracts report, which included the following updates: A number of applications for partnership variations had been received and approved. A 12 month extension had been agreed to the Purfleet Care Centre APMS contract until June 2022. The Kingsway Surgery and Brickfields Surgery in South Woodham Ferrers were due to merge on 30 June 2021 and the practice would be known thereafter as the Kingsway Surgery. The deadline for practices to submit their annual e-declarations had now passed and any declarations of non-compliance would be reported back to the committee. The Quality and Outcomes Framework 2020/21 submissions had been reviewed with 149 of 150 practices having agreed to the payments as calculated. All GP practices bar one remained signed up to the Primary Care Network Designated Enhanced Service (PCN DES). Discussions were continuing with the surgery that had not signed up to the annual DES. There had been some changes to the configuration of PCNs with the total number now standing at 27 PCNs across MSE PCN recruitment was below trajectory and a recovery action plan was being established to support increased performance against the recruitment plans. The COVID-19 vaccination programme was still ongoing with some practices starting to withdraw from Phase 2 of the programme. A large number of practices had indicated they would be interested in Phase 3 of the programme and preparatory work for this was underway. Central funding had been made available to support primary care with increased demand in the form of the Covid Capacity Expansion Fund. A first tranche of funding had been distributed to practices and a second tranche had recently been received. The MSE Special Allocation Service (SAS) procurement had concluded and a contract had been awarded to Commisceo PCS Ltd with effect from 1 April 2021. The Translation and Interpreting Service was out for procurement with a proposed start date of 1 November 2021 and the existing contract had been extended to 31 October 2021 in the meantime.
• The Committees received an overview of the processes that were being put in place to ensure that primary medical services were providing safe and effective quality care to all patients across MSE.
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• The Committees received a Primary Care finance report, which included the following updates: An allocation of circa £85 million had been received by the MSE CCGs for 2021/22 delegated commissioning, which was only for the first 6 months of the year in line with other financial allocations. This allocation did not include full funding for the PCN Additional Roles Reimbursement Scheme as 45% of this allocation had been retained by NHSE/I which could be accessed if PCN claims collectively exceeded the 55% included in the baselines. Budgets had been set in accordance with the contractual entitlements of practices and PCN and historic spend levels for other financial entitlements, including locally utilised transformation funding. Adjustments had been made where contractual changes had come into force from 1 April 2021. Any surplus between the assumed full year allocation and budgets had been placed in a general reserve. For Mid Essex CCG, where budgets exceeded anticipated allocations, this was represented as a negative reserve that would need to be addressed as a system.
• The Committees received a report on the establishment of a single IT and Digital team for MSE and the creation of a unified digital strategy for the next 12 months to stabilise, maximise and transform. The report also provided updates on the Corporate and GP IT and Primary Care Enabling Services contracts with the Arden and GEM Commissioning Support Unit.
• The Committee received a report on decisions made virtually or in Part II meetings where this information could now be made public. The Committee noted that the Mid Essex CCG Joint Primary Care Commissioning Committee had approved a request on 24 March 2021 for the Brickfields and Kingsway Surgeries to defer their contractual merger until the end of June 2021.
Recommendation:
The Board is asked to note the content of the report and seek any further assurance required.
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Castle Point & Rochford and Southend CCGs Board Virtual Circulation 23rd June 2021
MID AND SOUTH ESSEX POLICY AND STRATEGY APPROVAL
Purpose of Report: To ensure that IG Policies across the mid and south Essex CCGs are up to date and fit for purpose.
Recommendations and The CCG Board are asked to CONSIDER and APPROVE the following: decision/actions: • Information Governance Framework Policy v2.1 • Rolling over of the Information Sharing Policy v3.0
as recommended by the Information Governance Team and MSE Audit Committes.
Executive Summary On 25th May 2021, the MSE Audit Committees in Common approved the (including financial impact): Information Governance Framework Policy v2.1 and the rolling over of the Information Sharing Policy v3.0 for each of the mid and south Essex CCGs, subject to minor amendments suggested by the Audit Committees and Internal Auditors, and recommended to Board for approval.
Both the Information Governance Policy and Information Sharing Policy require Board approval prior to the deadline for submission of the Data Security and Protection Toolkit at the end of June 2021. As the June 2021 Board has been cancelled, it is necessary to circulate these policies for your virtual approval.
The minor changes that have been made since the last version of the Information Governance Framework Policy v.2.1 are as follows:
• Addition of new Caldicott principle • Addition of Head of Corporate ICT Technology and IT Cyber Security & Director of Corporate Operations as per 19/20 IG Audit o It was agreed at the short steering group that the responsibilities under the Director of Corporate Operation, a role we do not have, would be split and included in the SIRO role & IT Director role • IGSG ToRs – it was agreed these remain as is, as that has been the case for the majority of the year
The minor changes that have been made since the last version of the Information Sharing Policy v3.0 are as follows:
• Data Protection Officer role added. • References to IG toolkit updated to DSPT.
Written by/Presented by: IG Team (hosted by Basildon & Brentwood CCG) Nicola Adams, Associate Director of Corporate Governance
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Executive Director Tricia D’Orsi, NHS Alliance Director Sponsor:
Non-Officer/Board Audit Committee Chairs Sponsor:
Fit with CCG Strategic Achieve system and organisational transformation to streamline decision Objectives? making, improve CFM and beter support new commissioning models.
Approval Route: Group/Committee Date (List Groups/Committees that have reviewed this Audit Committee in Common 25 May 2021 document).
Reports Submitted to Board only: Date signed-off by Executive Team. (NB: With the exception of standing agenda items, all reports submitted to the Board must be signed-off by the Executive Team)
Yes No N/A Have any financial implications been signed off by the Chief Finance Officer? (Please Tick )
Has the Equality/Quality/Privacy Impact Assessment been carried out and issues addressed?
Details of Stakeholder, Patient N/A & Public Engagement:
Risks / Link to BAF: N/A BAF Ref:
N/A
Conflicts of Interest: N/A
Escalation: N/A To the Board To another Committee To the BAF/CRR
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